Faculty of Health,University of Technology Sydney,Ultimo,New South Wales,Australia.
Centre for Healthy Brain Ageing,University of New South Wales,Randwick,New South Wales,Australia.
Int Psychogeriatr. 2017 Oct;29(10):1713-1722. doi: 10.1017/S1041610217000977. Epub 2017 Jun 27.
Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation.
Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach.
Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback.
The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.
由于沟通不畅和护理计划有限，疗养院中晚期痴呆症患者的姑息治疗往往不尽如人意。在一项集群随机对照试验中，来自 10 家疗养院的注册护士（RN）接受了培训并获得资金支持，担任姑息治疗计划协调员（PCPC），以组织家庭病例会议并指导工作人员。这项定性子研究旨在探讨 PCPC 和卫生专业人员对促进病例会议的益处的看法，并确定影响实施的因素。
对担任 PCPC 角色的 RN 以及参与病例会议的其他疗养院工作人员和医生进行了半结构化访谈。两位研究人员使用主题框架方法进行了分析。
对 11 名 PCPC、18 名其他护士、8 名辅助卫生工作者和 3 名医生进行了访谈。促进病例会议的益处包括工作人员和家属之间的沟通更好，多学科更多地参与病例会议和护理计划，以及工作人员对痴呆症姑息治疗的态度和能力得到提高。影响实施的关键因素包括：人员配备水平和时间；来自管理层、工作人员和医生的支持；以及积极的家庭反馈。
本研究探索的促进方法解决了病例会议的已知障碍。然而，该行业当前的商业模式使得病例会议难以获得所需的护理资格、培训和时间水平。合作式疗养院文化和与卫生专业人员的持续关系也是成功的先决条件。应进一步研究记录居民和家庭的看法，以利用消费者的倡导。
