Rawlings Deb, Devery Kim, Poole Naomi
Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
Palliative and Supportive Services, Flinders University Faculty of Medicine, Nursing and Health Sciences, Adelaide, South Australia, Australia.
BMJ Open Qual. 2019 May 31;8(2):e000669. doi: 10.1136/bmjoq-2019-000669. eCollection 2019.
With over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: 'Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…'.
The modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated.
Five themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice.
Learners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention-behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.
预计超过半数的死亡发生在急症医院，而工作人员并未接受过照料临终患者的培训，因此在这些环境中提供高质量的临终关怀很难实现。《[共识声明名称未给出]》已由“临终关怀要点”项目转化为电子学习模块，本研究旨在通过回答每个模块末尾的问题“明天，我可以做出的一项能更妥善提供临终关怀的改变是……”来展示临床医生在日常实践中如何解读该共识声明。
这些模块由一名姑息治疗教育工作者在一个同行评审小组的支持下开发，并在35名卫生专业人员中进行了试点。收集了模块前后的评估数据，在2016年至2017年的10个月期间，共有5181人注册该项目，访问了六个模块中的一个或多个。对3201份针对事后实践改变问题的自由文本回复数据进行了分析，并生成了主题。
从数据中得出了五个主题：沟通、情感洞察、专业思维模式、以患者为中心的护理和专业实践。
完成“临终关怀要点”课程的学习者分享了他们表示明天可以改变实践的方式，这很可能被视为对澳大利亚医疗安全与质量委员会在引领和协调澳大利亚医疗保健质量与安全全国性改进工作中所做努力的一种临床回应。虽然意图不能保证实践改变，但意图 - 行为关系理论表明意图与行为有很强的关联。这表明这些模块有能力影响急症医院的临终关怀。
