End of Life Care in Assisted Living Facilities

描述（由申请人提供）：本研究的目的是解决关于临终关怀（EOL）的描述性知识缺乏的问题，这些知识在发展最快的，但尚未得到充分研究的，为虚弱的老年人提供辅助生活设施（ALF）的聚集住宅环境中。据估计，在全国范围内，死亡人数占ALF居民年营业额的28%。越来越多垂死的ALF居民加入了临终关怀计划。尽管预计在几年内，养老院的入住率将超过养老院，并且预计到2020年，目前全国100万养老院居民的人口将翻一番，但关于养老院的EOL护理和临终关怀参与的信息有限。具体而言，本研究将探讨疗养院员工和安宁疗护护士的观点：1)如何为疗养院住客提供EOL疗护；2)疗养院中EOL疗护的促进因素和障碍。它回应了美国国立卫生研究院的倡议“临终关怀研究”（rfa - nr -99- 004,1999年1月20日）和医学研究所的呼吁，即研究临终关怀，告知人们如何死亡和在哪里死亡。将使用定性描述性设计。面对面的半结构化访谈将在俄勒冈州的农村和城市站点进行，有目的地抽样多达36名ALF和临终关怀护士。此外，还将分析在ALFs的EOL护理中使用的文件（例如，流程表，方案）。定性内容分析将包括以下组成部分：文本数据的开放编码、文本数据和文档的持续比较分析、负面案例分析、理论备忘录和文档跟踪。将确定护理活动的关键特征，活动执行方式的异同，以及相关的挑战和障碍。本研究的最终成果将从提供或监督这种护理的工作人员的角度，详细描述ALF住院患者的EOL护理是如何发生的。这些发现与pi早期对临终病人及其家属的调查结果相结合，将成为在随后的R01研究中开发和测试旨在改善ALFs EOL护理的模型干预的基础。

DESCRIPTION (provided by applicant): The purpose of this study is to address the absence of descriptive knowledge about end-of-life (EOL) care in the fastest growing, yet understudied, congregate residential setting for frail older adults, assisted living facilities (ALF). Nationally it is estimated that death accounts for 28% of the annual turnover in ALF residents. Increasingly, dying ALF residents are enrolled in hospice programs. Despite projections that ALFs will surpass nursing homes in occupancy within several years, and estimates that the current national population of 1 million ALF residents will double by 2020, there is limited information on EOL care and hospice involvement in ALFs. Specifically, this study will examine the perspectives of ALF staff and hospice nurses on: 1) how EOL care is provided for ALF residents and 2) facilitators and barriers to EOL care in ALFs. It addresses the National Institutes of Health initiative "Research on Care at the End-of-Life" (RFA-NR-99-004, 1/20/99) and the Institute of Medicine's call for research on EOL care that informs both how and where people die. A qualitative descriptive design will be used. Face-to-face semi-structured interviews will be conducted with a purposeful sampling of up to 36 ALF and hospice nurses in both rural and urban sites in Oregon. In addition, documents used in EOL care in ALFs will also be analyzed (e.g., flow sheets, protocols). Qualitative content analysis will include the following components: open coding of text data, constant comparative analysis of text data and documents, negative case analysis, theoretical memos, and document trails. Key characteristics of the care activities, similarities and differences in how the activities are performed, and related challenges and barriers will be identified. The end product of this study will be a detailed description of how EOL care happens for ALF residents, from the perspectives of the staffs that provide or supervise this care. The findings in combination with the PIs earlier findings from dying residents and their families will be the basis for developing and testing a model intervention aimed at improving EOL care in ALFs in a subsequent R01 study.