背景:居住在长期护理院(LTCH)中的居民具有复杂的护理需求,多种慢性疾病,增加虚弱和认知障碍。包括预先护理计划(ACP)的姑息治疗方法应与慢性病管理相结合。然而,这在大多数LTCH中并不是一种规范。尽管它的需求越来越大,仍然缺乏工作人员参与非加太进程。
目的:本研究的目的是探索与LTCHs中的ACP实践相关的跨学科人员的看法和经验。
方法:这项研究是加拿大一个更大项目的一部分,ICANACP,旨在增加吸收,并为脆弱的老年人提供ACP。使用解释性描述性方法进行探索性定性设计,利用焦点小组和对安大略省四个LTCH的员工进行半结构化访谈,加拿大。
结果:有98名参与者,包括护士(n=36),医生(n=4),个人支持工作者(n=34),支持人员(n=23),和公共监护人(n=1)。得出了三个共同主题和九个子主题:a)ACP的持续性质;b)围绕ACP对话的复杂性;c)希望ACP成为LTCH的护理标准。
结论:这项研究的结果为我们理解ACP实施作为LTCH实践标准的复杂性提供了重要贡献。其中一个重要发现与在LTCHs入学之前缺乏ACP对话有关,到那时,许多居民可能已经失去了参与这些讨论的认知能力。LTCH人员的分层性质也阻碍了成功实施ACP计划所需的跨学科合作。我们研究中的参与者表示支持ACP交流,并需要开放正式和非正式的跨学科交流。有必要通过跨学科护理实践来振兴LTCH的护理,角色描述的澄清,优化人员配置,各类员工的能力建设以及LTCH领导层对此类护理的承诺。
结论:这些发现建立在越来越多的研究基础上,这些研究表明需要提高员工在LTCH中ACP沟通中的参与度。
BACKGROUND: Residents living in long-term care homes (LTCH) have complex care needs, multiple chronic conditions, increasing frailty and cognitive impairment. A palliative approach that incorporates advance care planning (ACP) should be integrated with chronic disease management, yet it is not a norm in most LTCHs. Despite its growing need, there remains a lack of staff engagement in the ACP process.
OBJECTIVE: The aim of this study was to explore the perceptions and experiences of interdisciplinary staff related to the practice of ACP in LTCHs.
METHODS: This study is part of a larger Canadian project, iCAN ACP, that aims to increase uptake, and access to ACP for older Canadians living with frailty. An exploratory qualitative design using an interpretive descriptive approach was employed utilizing focus groups and semi-structured interviews with staff from four LTCHs in Ontario, Canada.
RESULTS: There were 98 participants, including nurses (n = 36), physicians (n = 4), personal support workers (n = 34), support staff (n = 23), and a public guardian (n = 1). Three common themes and nine subthemes were derived: a) ongoing nature of ACP; b) complexities around ACP conversations; and c) aspirations for ACP becoming a standard of care in LTCHs.
CONCLUSIONS: The findings of this study provide important contributions to our understanding of the complexities surrounding ACP implementation as a standard of practice in LTCHs. One of the critical findings relates to a lack of ACP conversations prior to admission in the LTCHs, by which time many residents may have already lost cognitive abilities to engage in these discussions. The hierarchical nature of LTCH staffing also serves as a barrier to the interdisciplinary collaboration required for a successful implementation of ACP initiatives. Participants within our study expressed support for ACP communication and the need for open lines of formal and informal interdisciplinary communication. There is a need for revitalizing care in LTCHs through interdisciplinary care practices, clarification of role descriptions, optimized staffing, capacity building of each category of staff and commitment from the LTCH leadership for such care.
CONCLUSIONS: The findings build on a growing body of research illustrating the need to improve staff engagement in ACP communication in LTCHs.