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日本养老院的临终关怀会议。

End-of-life care conferences in Japanese nursing homes.

作者信息

Nishiguchi Sho, Sugaya Nagisa, Inamori Masahiko

机构信息

Department of General Internal Medicine, Shonan Kamakura General Hospital.

Unit of Public Health and Preventive Medicine, Yokohama City University.

出版信息

Drug Discov Ther. 2019;13(1):47-51. doi: 10.5582/ddt.2019.01002.

Abstract

End-of-life (EOL) care conferences have an important role in promoting EOL care in nursing homes. However, the details of the conferences remain poorly understood. A Japanese prefecture-wide survey was conducted to investigate the factors involved in such conferences that contribute to an increase in the amount of EOL care. One hundred fifty-three nursing homes performed the conferences. The outcome was the amount of EOL care provided in nursing homes after adjusting for the facility beds in 2014. We investigated the factors of staff experience with EOL care, frequency of the conferences, years the conferences were conducted, review conferences after EOL care, and professional participants in the conferences. The multivariate analysis revealed significant associations between EOL care in nursing homes and nurses' experience with EOL care (adjusted β coefficient 2.9, 95% confidence interval (CI) 0.52 ~ 5.22, p = 0.017), more than 5 years of continuous conferences (adjusted β coefficient 3.8, 95% CI 0.46 ~ 7.05, p = 0.026), and family participation (adjusted βcoefficient ‒4.0, 95% CI ‒7.5 ~ ‒0.48, p = 0.026). In conclusion, the continuation of conferences and enrollment of the nurse with experience in EOL care may promote EOL care in nursing homes, while family enrollment in conferences may decrease EOL care in nursing homes. EOL care conferences in nursing homes should be continuously performed by staff, with an experienced nurse undertaking the task of information sharing before discussing EOL care with the patients' families.

摘要

临终关怀(EOL)护理会议在促进养老院的临终关怀方面发挥着重要作用。然而,此类会议的具体细节仍鲜为人知。我们在日本一个县范围内进行了一项调查,以探究促成临终关怀护理量增加的此类会议所涉及的因素。153家养老院举办了这些会议。结果是2014年在对设施床位进行调整后养老院提供的临终关怀护理量。我们调查了员工临终关怀护理经验、会议频率、举办会议的年限、临终关怀护理后的回顾会议以及会议中的专业参与者等因素。多变量分析显示,养老院的临终关怀护理与护士的临终关怀护理经验之间存在显著关联(调整后的β系数为2.9,95%置信区间(CI)为0.52至5.22,p = 0.017)、连续举办会议超过5年(调整后的β系数为3.8,95% CI为0.46至7.05,p = 0.026)以及家属参与(调整后的β系数为 -4.0,95% CI为 -7.5至 -0.48,p = 0.026)。总之,会议的持续开展以及有临终关怀护理经验的护士参与可能会促进养老院的临终关怀护理,而家属参与会议可能会减少养老院的临终关怀护理。养老院的临终关怀护理会议应由工作人员持续进行,由经验丰富的护士在与患者家属讨论临终关怀护理之前承担信息共享的任务。

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