Hunter Paulette V, Kaasalainen Sharon, Froggatt Katherine A, Ploeg Jenny, Dolovich Lisa, Simard Joyce, Salsali Mahvash
Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, Canada.
School of Nursing, McMaster University, Hamilton, Ontario, Canada.
Ann Palliat Med. 2017 Oct;6(4):340-353. doi: 10.21037/apm.2017.06.14.
Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care.
Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach.
We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force.
We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.
入住长期护理机构（LTC）时更高的护理敏锐度导致死亡时间缩短，但加拿大大多数长期护理院没有正式的姑息治疗方法。合十礼护理是一种专门为居住在长期护理机构中的晚期认知障碍患者量身定制的姑息治疗方法。本研究的目的是运用生态框架来确定实施合十礼护理的障碍和促进因素。
对两家计划实施合十礼护理的加拿大长期护理院的家属、无执照工作人员和有执照工作人员进行了六次小组访谈。所有受访者此前均无实施合十礼护理的经验。使用模板组织法对所得定性数据进行分析。
我们发现，最强有力的实施促进因素是对该项目需求的积极认知、项目的益处以及与以居民为中心或姑息治疗方法的契合度。障碍包括长期护理机构总体资源基础薄弱、需要调整高度成熟的常规做法以适应该项目以及依赖临时劳动力。
我们得出结论，在加拿大长期护理系统中，对合十礼护理的积极认知因对支持新方案的组织能力的担忧而有所缓和。
