Frey Rosemary, Foster Susan, Boyd Michal, Robinson Jackie, Gott Merryn
School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Int J Palliat Nurs. 2017 May 2;23(5):238-247. doi: 10.12968/ijpn.2017.23.5.238.
To address a gap in the literature by exploring bereaved families' perceptions of the transition to palliative care for their relative in long-term care.
In-depth interviews were conducted with a convenience sample of twenty-six family members who were most involved in the care of residents who had died within the last 12 months. Interviews explored care, perceptions of staff palliative care knowledge, communication with staff, care planning and decision-making. The range of responses fit the Donabedian (1966) health care model of structure/process/outcome. In the case of long-term care, structure includes staff training; process is the manner of care and outcome would be a 'good' (or bad) death.
There was little evidence that a well-managed transition to a palliative approach to care was being initiated. Key themes included: 1) unrecognised need for transition; 2) information gaps and 3) feeling 'out of the loop'. Ten subthemes were also identified.
Engaging family and relevant internal and external health providers in care planning not only promotes care in line with resident wishes but also assists family bereavement. Results indicate the need for the development of a new collaborative, multidisciplinary model to enhance the delivery of palliative care in long-term care.
通过探究丧亲家庭对其亲属在长期护理机构中向姑息治疗过渡的看法，填补文献中的空白。
对26名家庭成员进行了深入访谈，这些家庭成员是从过去12个月内去世的居民的护理人员中方便抽样选取的，他们参与护理的程度最高。访谈探讨了护理情况、对工作人员姑息治疗知识的看法、与工作人员的沟通、护理计划和决策。回答的范围符合多纳贝迪安（1966年）的结构/过程/结果医疗保健模式。就长期护理而言，结构包括工作人员培训；过程是护理方式，结果将是“善终”（或“非善终”）。
几乎没有证据表明正在启动向姑息治疗方式的妥善管理的过渡。关键主题包括：1）未被认识到的过渡需求；2）信息差距；3）感觉“被排除在外”。还确定了10个次主题。
让家庭以及相关的内部和外部医疗服务提供者参与护理计划，不仅能促进符合居民意愿的护理，还能帮助家庭度过丧亲之痛。结果表明需要开发一种新的协作性多学科模式，以加强长期护理机构中姑息治疗的提供。
