Bökberg Christina, Ahlström Gerd, Karlsson Staffan, Hallberg Ingalill Rahm, Janlöv Ann-Christin
BMC Health Serv Res. 2014 Nov 30;14:596. doi: 10.1186/s12913-014-0596-z.
Persons with dementia receive health care and social services from a wide range of professional care providers during the disease trajectory, presenting risks of miscommunication, duplication and/or missed nursing interventions. Accordingly, the aim of this study was to investigate professional care providers' views on conditions for best practice in terms of collaboration and improvement needs in the chain of care from early to end-of-life stage for persons with dementia in Sweden.
The study had a qualitative design based on three focus group interviews. A strategic sample of 23 professional care providers was included. Data were subjected to content analysis based on the three stages of dementia (early, moderate, end-of-life).
The results were divided into five categories: Diagnosis is a prerequisite for specialized dementia care, Creating routines in the chain of care, Competent staff a prerequisite for high-quality care, Day care facilitates transition in the chain of care and Next-of-kin participation is a prerequisite for continuity in the chain of care. It was clear that, according to the participants, best practice in dementia care in Sweden is not achieved in every respect. It appeared that transitions of care between different organizations are critical events which need to be improved. The further the disease progresses, the less collaboration there seems to be among professional care providers, which is when the next of kin are usually called upon to maintain continuity in the chain of care.
The results indicate that, according to the care providers, best practice in terms of collaboration is achieved to a higher degree during the early stage of dementia compared with the moderate and end-of-life stages. Lack of best practice strategies during these stages makes it difficult to meet the needs of persons with dementia and reduce the burden for next of kin. These are experiences to be taken into account to improve the quality of dementia care. Implementation research is needed to develop strategies for best practice on the basis of national knowledge-based guidelines and to apply these strategies in the moderate and end-of-life stages.
痴呆症患者在疾病发展过程中会从广泛的专业护理提供者那里接受医疗保健和社会服务，这存在沟通不畅、重复和/或护理干预遗漏的风险。因此，本研究的目的是调查专业护理提供者对瑞典痴呆症患者从疾病早期到生命末期护理链中最佳实践条件以及改进需求的看法。
本研究采用基于三次焦点小组访谈的定性设计。纳入了23名专业护理提供者的策略性样本。数据基于痴呆症的三个阶段（早期、中期、生命末期）进行内容分析。
结果分为五类：诊断是专门痴呆症护理的前提条件、在护理链中建立常规、称职的工作人员是高质量护理的前提条件、日托有助于护理链中的过渡以及亲属参与是护理链连续性的前提条件。很明显，根据参与者的说法，瑞典痴呆症护理的最佳实践在各个方面并未完全实现。不同组织之间的护理过渡似乎是需要改进的关键事件。疾病进展得越严重，专业护理提供者之间的协作似乎就越少，而此时通常会要求亲属来维持护理链的连续性。
结果表明，根据护理提供者的说法，与中期和生命末期阶段相比，痴呆症早期在协作方面的最佳实践实现程度更高。这些阶段缺乏最佳实践策略使得难以满足痴呆症患者的需求并减轻亲属的负担。这些经验在提高痴呆症护理质量时需要加以考虑。需要开展实施研究，以根据国家基于知识的指南制定最佳实践策略，并将这些策略应用于中期和生命末期阶段。
