Stacpoole Min, Hockley Jo, Thompsell Amanda, Simard Joyce, Volicer Ladislav
St Christopher's Hospice, UK.
University of Edinburgh, Edinburgh, UK.
Ann Palliat Med. 2017 Oct;6(4):327-339. doi: 10.21037/apm.2017.06.26.
Increasing numbers of older people with advanced dementia are cared for in care homes. No cure is available, so research focused on improving quality of life and quality of care for people with dementia is needed to support them to live and die well. The Namaste Care programme is a multi-dimensional care program with sensory, psycho-social and spiritual components intended to enhance quality of life and quality of care for people with advanced dementia. The aim of the study was to establish whether the Namaste Care program can be implemented in UK care homes; and what effect Namaste Care has on the quality of life of residents with advanced dementia, their families and staff. This article explores the qualitative findings of the study, reporting the effect of the programme on the families of people with advanced dementia and care home staff, and presenting their perceptions of change in care.
An organisational action research methodology was used. Focus groups and interviews were undertaken pre/post implementation of the Namaste Care program. The researcher kept a reflective diary recording data on the process of change. A comments book was available to staff and relatives in each care home. Data was analysed thematically within each care home and then across all care homes.
Six care homes were recruited in south London: one withdrew before the study was underway. Of the five remaining care homes, four achieved a full Namaste Care program. One care home did not achieve the full program during the study, and another discontinued Namaste Care when the study ended. Every home experienced management disruption during the study. Namaste Care challenged normal routinised care for older people with advanced dementia. The characteristics of care uncovered before Namaste was implemented were: chaos and confusion, rushing around, lack of trust, and rewarding care. After the programme was implemented these perceptions were transformed, and themes of calmness, reaching out to each other, seeing the person, and, enhanced well-being, emerged.
Namaste Care can enrich the quality of life of older people with advanced dementia in care homes. The program was welcomed by care home staff and families, and was achieved with only modest expenditure and no change in staffing levels. The positive impact on residents quality of life influenced the well-being of family carers. Care staff found the changes in care enjoyable and rewarding. Namaste Care was valued for the benefits seen in residents; the improvement in relationships; and the shift towards a person-centred, relationship-based culture of care brought about by introducing the program. Namaste Care deserves further exploration and investigation including a randomised controlled trial.
越来越多患有晚期痴呆症的老年人在养老院接受照料。目前尚无治愈方法，因此需要开展聚焦于改善痴呆症患者生活质量和护理质量的研究，以帮助他们安度余生。“合十礼关怀计划”是一项多维度护理计划，包含感官、心理社会和精神层面的内容，旨在提高晚期痴呆症患者的生活质量和护理质量。本研究的目的是确定“合十礼关怀计划”能否在英国养老院实施；以及该计划对晚期痴呆症患者及其家人和工作人员的生活质量有何影响。本文探讨了该研究的定性结果，报告了该计划对晚期痴呆症患者家属和养老院工作人员的影响，并呈现了他们对护理变化的看法。
采用组织行动研究方法。在实施“合十礼关怀计划”之前和之后开展焦点小组讨论和访谈。研究人员记录反思日记，记录变革过程中的数据。每家养老院都设有意见簿供工作人员和亲属使用。在每家养老院内部，然后在所有养老院之间对数据进行主题分析。
在伦敦南部招募了六家养老院：一家在研究开始前退出。在剩下的五家养老院中，四家实施了完整的“合十礼关怀计划”。一家养老院在研究期间未完成全部计划，另一家在研究结束时停止了“合十礼关怀计划”。每家养老院在研究期间都经历了管理混乱。“合十礼关怀计划”对晚期痴呆症老年人的常规护理提出了挑战。在实施“合十礼关怀计划”之前发现的护理特点包括：混乱无序、匆忙忙碌、缺乏信任以及功利性护理。该计划实施后，这些看法发生了转变，出现了平静、相互关怀、关注个体以及幸福感增强等主题。
“合十礼关怀计划”可以丰富养老院中晚期痴呆症老年人的生活质量。该计划受到养老院工作人员和家属的欢迎，实施成本适度，且人员配置水平没有变化。对居民生活质量的积极影响也影响了家庭护理人员的幸福感。护理人员发现护理方式的改变令人愉悦且有意义。“合十礼关怀计划”因其给居民带来的益处、人际关系的改善以及引入该计划所带来的向以个人为中心、基于关系的护理文化的转变而受到重视。“合十礼关怀计划”值得进一步探索和研究，包括进行随机对照试验。
