Shaulov Adir, Frankel Meir, Rubinow Alan, Maaravi Yoram, Brezis Mayer
Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
Center for Clinical Quality and Safety, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
J Am Geriatr Soc. 2015 Oct;63(10):2114-9. doi: 10.1111/jgs.13645.
To evaluate the quality of end-of-life (EOL) care in nursing homes.
Survey and semistructured interviews.
Jerusalem district nursing homes.
Staff members of 28 long-term care and skilled nursing facilities in the Jerusalem area in Israel of various ethnic, religious, and administrative affiliations (N = 207).
Qualitative analysis of semistructured interviews and statistical analysis of questionnaires.
Most staff members reported that EOL preferences were unknown for more than 90% of residents and that fewer than 10% had a healthcare proxy. Most staff members recalled conducting fewer than five EOL conversations over the past year with residents or family members and could recall fewer than five cases in which a resident was allowed to die in the nursing home. According to staff opinions the prevalence of tube feeding was estimated at greater than 10%, initiated because of aspiration, malnutrition, and understaffing, often against family's preferences. More than 25% of staff members believed that pain management was inadequate. Knowledge about management of chronic pain was poor in half of nurses and nearly one-third of physicians. Most staff would rather not receive the treatments they administered to residents.
Nursing homes in Jerusalem lack competency for quality EOL care, and there are multiple psychological, training, and policy challenges to improvement.
评估养老院临终关怀的质量。
调查与半结构化访谈。
耶路撒冷地区养老院。
以色列耶路撒冷地区28家长期护理和专业护理机构的工作人员，这些机构具有不同的种族、宗教和行政背景（N = 207）。
对半结构化访谈进行定性分析，对问卷进行统计分析。
大多数工作人员报告称，超过90%的居民的临终偏好未知，且拥有医疗代理人的居民不到10%。大多数工作人员回忆说，在过去一年里，他们与居民或家属进行的临终谈话少于五次，并且能回忆起不到五例居民在养老院自然死亡的情况。根据工作人员的意见，鼻饲的发生率估计超过10%，实施鼻饲的原因是误吸、营养不良和人员不足，这往往违背了家属的意愿。超过25%的工作人员认为疼痛管理不足。一半的护士和近三分之一的医生对慢性疼痛管理的知识匮乏。大多数工作人员宁愿不接受他们给居民使用的治疗。
耶路撒冷的养老院缺乏提供高质量临终关怀的能力，在改善方面存在多种心理、培训和政策挑战。
