School of Health and Society, University of Salford, Salford, UK.
Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.
J Adv Nurs. 2021 Jun;77(6):2774-2784. doi: 10.1111/jan.14822. Epub 2021 Mar 10.
To evaluate care planning in advance of end-of-life care in care homes.
A qualitative study.
Qualitative data were collected from January 2018-July 2019 (using focus groups and semi-structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation.
Participants comprised of registered nurses (N = 4), care assistants (N = 8), bereaved relatives (N = 7), and domiciliary staff (N = 3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non-registered care home staff and those with non-formal caring roles such as housekeeping.
There is a need for more focused education to support registered and non-registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change.
Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high-quality end-of-life care in care homes.
评估养老院临终关怀前的护理计划。
定性研究。
2018 年 1 月至 2019 年 7 月，从英格兰西南部的 3 家养老院收集定性数据（使用焦点小组和半结构化访谈）。使用主题分析和关键现实主义评估对数据进行分析。
参与者包括注册护士（N=4）、护理助理（N=8）、已故亲属（N=7）和家庭工作人员（N=3）。尽管预先进行护理计划的重要性得到了很好的认可，但一些养老院工作人员强调，频繁进行关于死亡的讨论是一项情感劳动。显然，在某些情况下，养老院工作人员未满足的情感需求导致他们匆忙避免与居民和亲属讨论死亡。在所有 3 家养老院中，都注意到支持养老院工作人员情感需求的机制很少。此外，缺乏培训和知识似乎抑制了养老院工作人员与特定群体居民（如患有痴呆症的居民）进行有意义的护理计划对话的能力。缺乏培训主要存在于非注册养老院工作人员和那些没有正式护理角色的人员中，例如家政服务人员。
需要更有针对性的教育来支持注册和非注册养老院工作人员与居民有效进行关于死亡的敏感讨论。此外，需要更多的情感支持来帮助建立劳动力的弹性并维持变革。
本研究产生的知识可用于为未来的预先护理计划干预措施的设计和开发提供信息，这些干预措施能够支持养老院提供高质量的临终关怀。
