The Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, UK.
Palliat Med. 2011 Mar;25(2):125-38. doi: 10.1177/0269216310387964. Epub 2011 Jan 31.
Nursing homes are a common site of death, but older residents receive variable quality of end-of-life care. We used a mixed methods design to identify external influences on the quality of end-of-life care in nursing homes. Two qualitative case studies were conducted and a postal survey of 180 nursing homes surrounding the case study sites. In the case studies, qualitative interviews were held with seven members of nursing home staff and 10 external staff. Problems in accessing support for end-of-life care reported in the survey included variable support by general practitioners (GPs), reluctance among GPs to prescribe appropriate medication, lack of support from other agencies, lack of out of hours support, cost of syringe drivers and lack of access to training. Most care homes were implementing a care pathway. Those that were not rated their end-of-life care as in need of improvement or as average. The case studies suggest that critical factors in improving end-of-life care in nursing homes include developing clinical leadership, developing relationships with GPs, the support of 'key' external advocates and leverage of additional resources by adoption of care pathway tools.
养老院是死亡的常见场所，但老年居民得到的临终关怀质量参差不齐。我们采用混合方法设计，确定养老院临终关怀质量的外部影响因素。进行了两项定性案例研究，并对案例研究现场周边的 180 家养老院进行了邮寄调查。在案例研究中，与 7 名养老院工作人员和 10 名外部工作人员进行了定性访谈。调查中报告的临终关怀支持获取方面的问题包括全科医生（GP）的支持存在差异、GP 不愿意开适当的药物、其他机构支持不足、非工作时间支持不足、注射器驱动器的成本以及培训机会有限。大多数养老院正在实施护理途径。那些没有实施的养老院将其临终关怀服务评为需要改进或平均水平。案例研究表明，改善养老院临终关怀的关键因素包括发展临床领导力、与全科医生建立关系、得到“关键”外部倡导者的支持以及通过采用护理途径工具利用额外资源。
