School of Health and Population Sciences, College of Medical and Dental Sciences, 52 Pritchatts Road, University of Birmingham, Birmingham B15 2TT, United Kingdom.
Int J Nurs Stud. 2012 May;49(5):586-95. doi: 10.1016/j.ijnurstu.2011.10.021. Epub 2011 Nov 29.
In the United Kingdom approaching 20% of people aged 85 years and over live in care homes and most will die there. Improving end-of-life care is a government health priority and homes may work with primary care staff and specialist palliative practitioners to provide comprehensive end-of-life care. Consequently effective collaboration between care home and health service practitioners is vital to ensure high quality end-of-life care.
To evaluate the impact of a training programme to improve end-of-life care in nursing homes, on collaboration between nursing home staff and other health practitioners.
Evaluation using survey methods and qualitative case studies.
All 95 nursing homes in the first national 'Gold Standards Framework in Care Homes' programme in England were invited to participate in the evaluation.
A survey of homes' characteristics, the approaches to end-of-life care, and liaison with other services, was completed pre and post programme implementation. Case studies were conducted in a sub-sample of 10 homes to provide important context and depth to the evaluation.
Pre and post surveys were returned by 49 (52%) homes. Improved collaborations as a result of the programme were anticipated by 31% of managers. Challenges to collaboration included working with large numbers of general practitioners, out-of-hours services and access to specialist practitioners. Improved collaborations between home staff and health service practitioners were identified by 33% of managers as one of the main programme outcomes. Staff reported increased knowledge of end-of-life care, and enhanced confidence, which in turn resulted in improved communication and collaboration. Post-programme, staff felt more confident initiating contact and discussing residents' end-of-life care with general practitioners and those working in specialist palliative care services.
The Gold Standards Framework in Care Homes programme can contribute towards end-of-life care by helping to improve the quality and quantity of communication and collaboration between nursing home staff and primary care and specialist practitioners. Further research is needed to determine why this was not consistent across all homes.
在英国，近 20%的 85 岁及以上的老年人居住在养老院，其中大多数人将在那里去世。改善临终关怀是英国政府的一项卫生重点，养老院可能会与初级保健人员和专科姑息治疗从业者合作，提供全面的临终关怀。因此，养老院和卫生服务从业者之间的有效合作对于确保高质量的临终关怀至关重要。
评估一项培训计划对改善养老院临终关怀的效果，以及该计划对养老院工作人员与其他卫生从业者之间合作的影响。
使用调查方法和定性案例研究进行评估。
英格兰首个全国性的“金标准框架在养老院”计划中的所有 95 家养老院都被邀请参与评估。
在计划实施前后，对养老院的特点、临终关怀方法以及与其他服务的联络情况进行了调查。在一个亚样本的 10 个养老院进行了案例研究，为评估提供了重要的背景和深度。
有 49 家（52%）养老院完成了预调查和后调查。31%的管理人员预计该计划会改善合作。合作面临的挑战包括与大量全科医生、非工作时间服务和获得专科医生的机会有关。33%的管理人员将养老院工作人员与卫生服务从业者之间的更好合作确定为该计划的主要成果之一。工作人员报告说，他们对临终关怀的了解有所增加，信心也有所增强，这反过来又促进了沟通和合作。在计划实施后，工作人员感到更有信心与全科医生以及从事专科姑息治疗服务的人员就居民的临终关怀问题主动联系并进行讨论。
“金标准框架在养老院”计划可以通过帮助改善养老院工作人员与初级保健和专科从业者之间的沟通和合作的质量和数量，为临终关怀做出贡献。需要进一步的研究来确定为什么并非所有养老院都能从中受益。
