养老院临终患者利物浦护理路径的体验：一项评估医生和护士从业者看法的混合方法研究。
Experiences with the Liverpool care pathway for the dying patient in nursing home residents: a mixed-method study to assess physicians' and nurse practitioners' perceptions.
机构信息
Department of Public Health and Primary Care, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300 RC, the Netherlands.
Marente, Leiden, the Netherlands.
出版信息
BMC Palliat Care. 2020 Nov 30;19(1):183. doi: 10.1186/s12904-020-00686-y.
BACKGROUND
The Liverpool care pathway for the dying patient (LCP) is a multidisciplinary tool developed for the dying phase for use in palliative care settings. The literature reports divergent experiences with its application in a nursing home setting related to its implementation and staff competencies. The aim of this study is to understand how the LCP is being used in the context of the nursing home, including for residents with dementia, and experienced from the perspectives of those responsible for medical treatment in nursing homes.
METHODS
A mixed-methods approach was used, consisting of a survey followed by interviews. A link to a 9-item online survey with closed and open-ended questions was emailed to all physicians and nurse practitioners of 33 care organisations with nursing homes in three regions of the Netherlands (North, West and South). In addition, 10 respondents with particularly positive or negative experiences were selected for semi-structured interviews.
RESULTS
The survey was completed by 159 physicians and nurse practitioners. The respondents were very positive on the content and less positive on the use of the LCP, although they reported difficulties identifying the right time to start the LCP, especially in case of dementia. Also using the LCP was more complicated after the implementation of the electronic health record. The LCP was judged to be a marker of quality for the assessment of symptoms in the dying phase and communication with relatives.
CONCLUSION
An instrument that prompts regular assessment of a dying person was perceived by those responsible for (medical) care to contribute to good care. As such, the LCP was valued, but there was a clear need to start it earlier than in the last days or hours of life, a need for a shorter version, and for integration of the LCP in the electronic health record. Regular assessments with an instrument that focusses on quality of care and good symptom control can improve palliative care for nursing home residents with and without dementia.
背景
利物浦临终关怀路径（LCP）是一种多学科工具，专为临终阶段开发，用于姑息治疗环境。文献报告了在疗养院环境中应用该路径的不同经验，涉及实施和员工能力。本研究旨在了解 LCP 在疗养院背景下的使用情况，包括痴呆症患者，并从负责疗养院医疗的人员的角度了解经验。
方法
采用混合方法，包括调查后进行访谈。向荷兰三个地区（北部、西部和南部）的 33 个护理组织的所有医生和护士从业者发送了一份包含 9 个问题的在线调查的链接，该调查有封闭式和开放式问题。此外，选择了 10 名具有特别积极或消极经验的受访者进行半结构化访谈。
结果
共有 159 名医生和护士从业者完成了调查。受访者对 LCP 的内容非常肯定，但对其使用不太肯定，尽管他们报告在确定开始 LCP 的正确时间方面存在困难，尤其是在痴呆症的情况下。电子病历实施后，使用 LCP 也变得更加复杂。LCP 被认为是评估临终阶段症状和与家属沟通的质量评估的标志。
结论
负责（医疗）护理的人员认为，一种提示定期评估临终患者的工具有助于提供良好的护理。因此，LCP 很有价值，但显然需要更早开始，而不是在生命的最后几天或几小时，需要更短的版本，并将 LCP 整合到电子病历中。使用关注护理质量和良好症状控制的工具进行定期评估可以改善疗养院有和没有痴呆症的居民的姑息治疗。
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