阻碍提供者关系和药物输送的感知障碍：养老院和私人住宅中临终关怀提供者的经验。
Perceived barriers that impede provider relations and medication delivery: hospice providers' experiences in nursing homes and private homes.
机构信息
Buehler Center on Aging, Health, & Society, Northwestern University, Chicago, Illinois 60611, USA.
出版信息
J Palliat Med. 2010 Mar;13(3):305-10. doi: 10.1089/jpm.2009.0283.
OBJECTIVES
Hospice providers often work with nursing home providers or with family caregivers to deliver medication services aimed at alleviating suffering in patients with life-limiting illnesses. From the perspective of hospice providers, this study explores barriers that may impede provider relations and medication delivery in nursing homes and private homes.
METHODS
Semistructured, open-ended interviews were conducted in-person with a purposive sample of 22 hospice providers (14 registered nurses, 4 physicians, and 4 social workers) from 4 hospice programs in the greater Chicago metropolitan area.
RESULTS
In general, registered nurses, doctors, and social workers discussed similar barriers in nursing homes and in private homes. According to hospice providers, nursing home providers and family caregivers exhibited comparable attitudinal barriers ("owning" their settings; "knowing what's best for the patient"; distrust toward hospice; and emotional state), and encountered similar site-readiness barriers (ill-defined hierarchy, poor communication, disagreements among care providers, and responsibility overload). Additionally, comparable alignment barriers (differences in care priority and in education/training) existed between hospice providers and care providers in nursing homes and private homes. Together, these barriers impeded care providers' communication with hospice providers and their readiness to accept hospice guidance. Overall, poor provider relations compromised the efficiency and quality of medication management, as well as potentially undermined the role of hospice providers.
CONCLUSION
From the perspectives of hospice providers, this study provides preliminary insight into barriers that multilevel interventions may need to address to improve provider relations and medication delivery in nursing homes and private homes.
目的
临终关怀提供者通常与疗养院提供者或家庭护理人员合作，提供旨在减轻绝症患者痛苦的药物服务。从临终关怀提供者的角度来看，本研究探讨了可能阻碍疗养院和私人住宅中提供者关系和药物输送的障碍。
方法
在芝加哥大都市区的 4 个临终关怀计划中，采用目的抽样法，对 22 名临终关怀提供者（14 名注册护士、4 名医生和 4 名社会工作者）进行了半结构式、开放式访谈。
结果
一般来说，注册护士、医生和社会工作者在疗养院和私人住宅中讨论了类似的障碍。根据临终关怀提供者的说法，疗养院提供者和家庭护理人员表现出类似的态度障碍（“拥有”他们的环境；“了解对患者最好的”；对临终关怀的不信任；和情绪状态），并遇到类似的现场准备障碍（定义不明确的层次结构、沟通不畅、护理提供者之间的分歧以及责任过载）。此外，疗养院和私人住宅中的临终关怀提供者和护理提供者之间也存在类似的调整障碍（护理优先级和教育/培训方面的差异）。这些障碍共同阻碍了护理提供者与临终关怀提供者的沟通，以及他们接受临终关怀指导的准备。总体而言，较差的提供者关系降低了药物管理的效率和质量，并可能破坏临终关怀提供者的角色。
结论
从临终关怀提供者的角度来看，本研究初步探讨了多层次干预措施可能需要解决的障碍，以改善疗养院和私人住宅中的提供者关系和药物输送。
Zotero 插件