Care Home Project Team, St. Christopher's Hospice, Sydenham, London SE26 6DZ, United Kingdom.
International Observatory of End of Life Care, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, United Kingdom.
Int J Nurs Stud. 2018 Jun;82:1-10. doi: 10.1016/j.ijnurstu.2018.02.004. Epub 2018 Feb 24.
The predicted demographic changes internationally have implications for the nature of care that older people receive and place of care as they age. Healthcare policy now promotes the implementation of end-of-life care interventions to improve care delivery within different settings. The Gold Standards Framework in Care Homes (GSFCH) programme is one end-of-life care initiative recommended by the English Department of Health. Only a small number of care homes that start the programme complete it, which raises questions about the implementation process.
To identify the type, role, impact and cost of facilitation when implementing the GSFCH programme into nursing care home practice.
A mixed-methods study.
Nursing care homes in south-east England.
Staff from 38 nursing care homes undertaking the GSFCH programme. Staff in 24 nursing care homes received high facilitation. Of those, 12 also received action learning. The remaining 14 nursing care homes received usual local facilitation of the GSFCH programme.
Study data were collected from staff employed within nursing care homes (home managers and GSFCH coordinators) and external facilitators associated with the homes. Data collection included interviews, surveys and facilitator activity logs. Following separate quantitative (descriptive statistics) and qualitative (template) data analysis the data sets were integrated by 'following a thread'. This paper reports study data in relation to facilitation.
Three facilitation approaches were provided to nursing home staff when implementing the GSFCH programme: 'fitting it in' facilitation; 'as requested' facilitation; and 'being present' facilitation. 'Being present' facilitation most effectively enabled the completion of the programme, through to accreditation. However, it was not sufficient to just be present. Without mastery and commitment, from all participants, including the external facilitator, learning and initiation of change failed to occur. Implementation of the programme required an external facilitator who could mediate multi-layered learning at an individual, organisational and appreciative system level. The cost savings in the study outweighed the cost of providing a 'being present' approach to facilitation.
Different types of facilitation are offered to support the implementation of end-of-life care initiatives. However, in this study 'being present' facilitation, when supported by multi-layered learning, was the only approach that initiated the change required.
国际上预测的人口结构变化对老年人接受的护理性质和他们随着年龄增长的护理地点产生影响。医疗保健政策现在提倡实施临终关怀干预措施，以改善不同环境中的护理服务。养老院黄金标准框架（GSFCH）计划是英国卫生部推荐的临终关怀倡议之一。只有少数启动该计划的养老院完成了该计划，这引发了对实施过程的质疑。
确定在将 GSFCH 计划实施到护理院实践中时，促进的类型、角色、影响和成本。
混合方法研究。
英格兰东南部的护理养老院。
参与 GSFCH 计划的 38 家护理养老院的员工。24 家护理养老院的员工接受了高促进。其中 12 家还接受了行动学习。其余 14 家护理养老院接受了 GSFCH 计划的常规当地促进。
研究数据来自护理养老院（养老院经理和 GSFCH 协调员）内部员工和与养老院相关的外部促进者。数据收集包括访谈、调查和促进者活动日志。在对定量（描述性统计）和定性（模板）数据集进行单独分析后，通过“跟踪线索”将数据集整合在一起。本文报告了与促进相关的研究数据。
在实施 GSFCH 计划时，向护理院员工提供了三种促进方法：“适应”促进、“按需”促进和“在场”促进。“在场”促进最有效地完成了计划，直至获得认证。然而，仅仅在场是不够的。如果没有所有参与者（包括外部促进者）的掌握和承诺，学习和启动变革就无法实现。该计划的实施需要一名外部促进者，他能够在个人、组织和欣赏系统层面上调解多层次学习。研究中的成本节约超过了提供“在场”促进方法的成本。
提供了不同类型的促进措施来支持临终关怀倡议的实施。然而，在这项研究中，“在场”促进在得到多层次学习的支持下，是启动所需变革的唯一方法。
