Implementing a quality improvement programme in palliative care in care homes: a qualitative study.
Implementing a quality improvement programme in palliative care in care homes: a qualitative study.
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DOI：
10.1186/1471-2318-11-31
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发表时间：
2011-06-09
期刊：
影响因子：
4.1
通讯作者：
Higginson IJ
中科院分区：
文献类型：
--
作者：
Hall S;Goddard C;Stewart F;Higginson IJ
越来越多的老年人在养老院度过了生命的最后一刻。本研究的目的是探讨实施疗养院黄金标准框架（GSFCH）的好处和障碍，这是一项姑息治疗的质量改进计划。参与GSFCH的九家护理院参加了此次活动。我们对9位护理院经理、8位护士、9位护理员、11位住客和7位住客的家庭成员进行了半结构化访谈。我们使用框架方法进行定性分析。分析基于GSFCH的关键任务，即7Cs：沟通、协调、症状控制、连续性、持续学习、护理者支持和临终者护理。这使我们能够考虑方案各个组成部分以及整个方案的好处和障碍。GSFCH的感知益处包括：改善症状控制和团队沟通；寻找有用的外部支持和专业知识；增加员工信心；促进居民的选择；也提升了这个家的声誉。感知到的障碍包括：文书工作增多；缺乏对临终关怀的知识和理解；成本;并获得全科医生的合作。GSFCH中的许多工具和任务都侧重于改善通信。参与者描述了家庭内部以及与外部提供者（如全科医生和姑息治疗专家）的有效沟通。然而，许多人在全科医生那里遇到了问题。虽然工作人员描述了支持性护理登记的好处，编码预测疾病阶段和预先护理计划，其中包括改善沟通，但一些人认为需要更多的使用经验，并且对讨论死亡表示担忧。参与者描述的大多数障碍与其他干预措施有关，以改善养老院的临终关怀。有必要调查护理院（如GSFCH）的质量改善计划对居民及其家庭的更广泛结果的影响，并监测任何由此产生的改善的可持续性。探索这些复杂干预措施的不同组成部分的影响也很重要。
An increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care. Nine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their family members. We used the Framework approach to qualitative analysis. The analysis was deductive based on the key tasks of the GSFCH, the 7Cs: communication, coordination, control of symptoms, continuity, continued learning, carer support, and care of the dying. This enabled us to consider benefits of, and barriers to, individual components of the programme, as well as of the programme as a whole. Perceived benefits of the GSFCH included: improved symptom control and team communication; finding helpful external support and expertise; increasing staff confidence; fostering residents' choice; and boosting the reputation of the home. Perceived barriers included: increased paperwork; lack of knowledge and understanding of end of life care; costs; and gaining the cooperation of GPs. Many of the tools and tasks in the GSFCH focus on improving communication. Participants described effective communication within the homes, and with external providers such as general practitioners and specialists in palliative care. However, many had experienced problems with general practitioners. Although staff described the benefits of supportive care registers, coding predicted stage of illness and advance care planning, which included improved communication, some felt the need for more experience of using these, and there were concerns about discussing death. Most of the barriers described by participants are relevant to other interventions to improve end of life care in care homes. There is a need to investigate the impact of quality improvement programmes in care homes, such as the GSFCH, on a wider range of outcomes for residents and their families, and to monitor the sustainability of any resulting improvements. It is also important to explore the impact of the different components of these complex interventions.
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影响因子：
1.7
作者：
Sims-Gould, Joanie;Wiersma, Elaine;MacLean, Michael
通讯作者：
MacLean, Michael
DOI：
10.1016/j.jamda.2006.12.007
发表时间：
2007-03-01
影响因子：
7.6
作者：
Furman, Christian Davis;Pirkle, Rebecca;Miles, Toni
通讯作者：
Miles, Toni
DOI：
10.1097/01.jam.0000123063.79715.8e
发表时间：
2004-05-01
影响因子：
7.6
作者：
Oliver, Debra Parker;Porock, Davina;Zweig, Steven
通讯作者：
Zweig, Steven
DOI：
10.1016/j.atc.2005.12.003
发表时间：
2006-03-01
期刊：
ANESTHESIOLOGY CLINICS OF NORTH AMERICA
影响因子：
--
作者：
Gruenewald, DA;White, EJ
通讯作者：
White, EJ
制定和评估复杂的干预措施：新的医学研究委员会指南。
DOI：
10.1136/bmj.a1655
发表时间：
2008-09-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Craig P;Dieppe P;Macintyre S;Michie S;Nazareth I;Petticrew M;Medical Research Council Guidance
通讯作者：
Medical Research Council Guidance