Referral and timing of referral to hospice care in nursing homes: the significant role of staff members.
Referral and timing of referral to hospice care in nursing homes: the significant role of staff members.
复制标题
疗养院临终关怀的转诊和转诊时间：工作人员的重要作用。
DOI：
10.1093/geront/48.4.477
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Aman Nanda
中科院分区：
文献类型：
--
作者：
Lisa C. Welch;Susan C. Miller;E. Martin;Aman Nanda
目的
考虑到许多疗养院（NH）居民对临终关怀的担忧，本研究旨在了解影响临终关怀转诊或非转诊以及转诊时间的因素。
设计和方法
我们对来自七个参与的NHS和两个临终关怀医院的人员进行了半结构化采访。我们采访了NH护理主任关于设施转诊的做法，并进行了采访，34 NH护士，30 NH助手，17临终关怀护士了解的因素，导致临终关怀状态的32 NH死者。选定的死亡者因诊断和临终关怀状态而异（接受临终关怀>7天，<或=7天，或根本没有）。我们对采访进行了录音、转录和编码。
结果
NH工作人员的认识终端下降，对临终关怀的信念，和主动性显着影响临终关怀转诊和转诊的时间。工作人员认识到熟悉的衰退迹象有助于临终关怀转诊;相比之下，认为死亡是意外的想法阻碍了转诊，认为预后不确定的想法推迟了转诊。工作人员认为临终关怀不会增加NH护理的价值，或者只用于危机，这阻碍了转诊，并且认为临终关怀只用于“最后”延迟转诊。当工作人员认为临终关怀是对NH护理的补充，并且工作人员主动提出临终关怀的选择时，居民接受临终关怀的时间更长。
影响
加强培训，认识终端下降，临终关怀服务在国家卫生机构，和工作人员的主动性的作用将支持国家卫生机构的工作人员在适当的时候提高临终关怀的选择。
PURPOSE
Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral.
DESIGN AND METHODS
We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors of nursing regarding facility referral practices and conducted interviews with 34 NH nurses, 30 NH aides, and 17 hospice nurses knowledgeable about the factors that led to the hospice status of 32 NH decedents. Selected decedents varied by diagnosis and hospice status (received hospice for >7 days, <or=7 days, or not at all). We audiotaped, transcribed, and coded interviews for themes.
RESULTS
NH staff members' recognition of terminal decline, beliefs about hospice, and initiative significantly influenced hospice referral and timing of referral. Staff members' recognition of familiar signs of decline facilitated hospice referral; in contrast, a perception that death was unexpected impeded referral, and a perception of uncertain prognosis delayed referral. Staff members' beliefs that hospice does not add value to NH care or is for crises only impeded referral, and a belief that hospice is only for the "very end" delayed referral. Residents received hospice for longer periods when staff believed that hospice complemented NH care and when staff took the initiative in raising the option of hospice.
IMPLICATIONS
Enhanced training about recognizing terminal decline, hospice services in NHs, and the role of staff initiative would support NH staff in raising the option of hospice when appropriate.