Sánchez-García María Remedios, Moreno-Rodríguez Marina, Hueso-Montoro César, Campos-Calderón Concepción, Varella-Safont Ana, Montoya-Juárez Rafael
Centro de Salud Cúllar Vega, Distrito de Atención Primaria Granada-Metropolitano, Servicio Andaluz de Salud, Junta de Andalucía, Cúllar Vega, Granada, Andalucía, España.
Servicio Andaluz de Salud, Junta de Andalucía, Granada, Andalucía, España.
Aten Primaria. 2017 May;49(5):278-285. doi: 10.1016/j.aprim.2016.09.004. Epub 2016 Nov 25.
To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes.
Descriptive qualitative research with phenomenological orientation, through content analysis.
Nursing Homes at Primary Care District in Granada (Spain).
Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care.
Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories.
Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams.
It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.
确定养老院中与临终关怀相关的专业人员所经历的促进因素和障碍。
采用现象学取向的描述性定性研究，通过内容分析进行。
西班牙格拉纳达初级保健区的养老院。
15名临床专业人员，在养老院至少有6个月的工作经验，无姑息治疗方面的特定背景。
与不同学科和养老院的专业人员进行了3次焦点小组讨论。访谈进行了录音并逐字转录。进行了开放式和轴心式编码以确定相关类别。
专业人员发现，在与家属沟通时存在困难，包括家属的内疚感、难以理解亲属病情恶化以及死亡问题处理过晚。在决策方面，专业人员认识到他们不鼓励患者参与。预先指示被视为一种必要工具，但他们没有考虑系统地实施。专业人员强调的其他困难包括与其他专业人员缺乏协调，这与对患者需求的误解有关，以及缺乏培训、物资和人力资源。促进因素包括与初级保健团队的关系。
有必要改善养老院专业人员、家属、患者和其他医护人员之间的沟通。
