Herbst Franziska A, Heckel Maria, Tiedtke Johanna M, Adelhardt Thomas, Sturm Alexander, Stiel Stephanie, Ostgathe Christoph
Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Z Gerontol Geriatr. 2019 May;52(3):264-271. doi: 10.1007/s00391-018-1378-8. Epub 2018 Mar 16.
There is a lack of research into how hospital staff and institutional stakeholders (i. e. institutional representatives from public health authorities, hospital hygiene, and the departments of microbiology, palliative care, and geriatrics) engage with patients who are carriers of multidrug-resistant organisms and receiving end-of-life care. Knowledge of their experiences, workload, and needs should be considered in dealing with hospitalized carriers of multidrug-resistant organisms as well as staff education.
This study explored and compared staff members' and stakeholders' perspectives on multidrug-resistant organisms and on provision of end-of-life care to carrier patients.
In this study four focus groups consisting of hospital staff members and institutional stakeholders were formed within a mixed-methods parent study in a palliative care unit at a university clinic and a geriatric ward of a Catholic and academic teaching hospital. Participants discussed results from staff and stakeholder interviews from a former study phase. Data were analyzed according to Grounded Theory and perspectives of staff members and institutional stakeholders were compared and contrasted.
Key issues debated by staff members (N = 19) and institutional stakeholders (N = 10) were 1) the additional workload, 2) reasons for uncertainty about handling carrier patients, 3) the format of continuing education, and 4) the preferred management approach for dealing with multidrug-resistant organism carrier patients. Although similar barriers (e. g. colleagues' ambiguous opinions) were identified, both groups drew different conclusions concerning the management of these barriers. While institutional stakeholders recommended making decisions on hygiene measures under consideration of the specific patient situation, staff members preferred the use of standardized hygiene measures which should be applied uniformly to all patients.
Staff members and institutional stakeholders perceived similar barriers to practice caused by multidrug-resistant organisms and similar needs for continuing education. The staff members' preferred management approach might originate from an uncertainty about the multidrug-resistant organism infection risk. Experiences and visions of both groups should be included in a specific recommendation for end-of-life care to ensure behavioral confidence.
对于医院工作人员和机构利益相关者（即来自公共卫生当局、医院感染控制部门以及微生物学、姑息治疗和老年医学部门的机构代表）如何与耐多药生物的携带者且正在接受临终关怀的患者打交道，目前缺乏相关研究。在处理住院的耐多药生物携带者以及开展工作人员教育时，应考虑他们的经验、工作量和需求。
本研究探讨并比较了工作人员和利益相关者对耐多药生物以及为携带者患者提供临终关怀的看法。
在一项混合方法的母研究中，在一所大学诊所的姑息治疗病房和一家天主教教学医院的老年病房，组建了四个由医院工作人员和机构利益相关者组成的焦点小组。参与者讨论了前一研究阶段工作人员和利益相关者访谈的结果。根据扎根理论对数据进行分析，并对工作人员和机构利益相关者的观点进行比较和对比。
工作人员（N = 19）和机构利益相关者（N = 10）讨论的关键问题包括：1）额外的工作量；2）处理携带者患者时存在不确定性的原因；3）继续教育的形式；4）处理耐多药生物携带者患者的首选管理方法。虽然识别出了类似的障碍（例如同事的模糊意见），但两组在这些障碍的管理方面得出了不同的结论。机构利益相关者建议根据具体患者情况对卫生措施做出决策，而工作人员则更喜欢使用应统一应用于所有患者的标准化卫生措施。
工作人员和机构利益相关者认为耐多药生物给实践带来了类似的障碍，并且对继续教育有类似的需求。工作人员首选的管理方法可能源于对耐多药生物感染风险的不确定性。两组的经验和观点都应纳入针对临终关怀的具体建议中，以确保行为上的信心。
