Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
Nurse Educ Pract. 2021 Jul;54:103091. doi: 10.1016/j.nepr.2021.103091. Epub 2021 May 19.
To evaluate a training program that supports community-based service staff in implementing aging-in-place and end-of-life care programs.
Globally, as the population ages, the need for end-of-life care has never been greater. Since Japan is facing the issues of a super-aged population sooner than most countries, there is a particularly urgent need to enhance end-of-life care for older people. Most Japan's older people wish to spend their final days at home, however, only 11-13% end their lives at home, while 73% die in hospitals. As part of care system, small-scale community-based service for aging-in-place established across Japan in 2006 managed locally. These are flexible services using home or facility care or both for the individual to live long term at their preferred place. We developed the end-of-life care educational training program to encourage behavioral changes in community-based service staff of various readiness levels.
Mixed methods study design.
A pre-post evaluation of knowledge, confidence and attitude toward end-of-life care, combining quantitative and qualitative data from 53 community-based service staff members who participated in the training program from September 2017 to September 2019. Participants were informed of the end-of-life care process using focus group discussions about end-of-life care and completed surveys evaluating the program before, immediately following and three months after the training. We used the four-level Kirkpatrick model as the evaluation indicator.
Quantitative analysis results indicated that participants were satisfied with the training program. Their knowledge scores regarding end-of-life care significantly improved; they also experienced confidence gains and changes in attitudes, becoming more approving of end-of-life care. Qualitative data revealed details of participants' satisfaction and what was learned. Through the focus group discussions, they created action plans for implementing end-of-life care programs, which some had accomplished in their local centers by the three-month follow-up.
These results suggest that the training program is effective for promoting end-of-life care through community-based services in Japan. Conducting follow-up training could effectively strengthen participants' commitment to end-of-life care at community-based services. Use of the training program is expected to promote services to support aging-in-place.
评估一项支持社区服务人员实施就地养老和临终关怀计划的培训计划。
在全球范围内，随着人口老龄化，对临终关怀的需求从未如此之大。由于日本面临人口老龄化问题的时间比大多数国家都要早，因此特别需要加强老年人的临终关怀。大多数日本老年人希望在自己家中度过最后的日子，然而，只有 11-13%的人在家中结束生命，而 73%的人在医院去世。作为护理系统的一部分，2006 年在日本各地建立了小规模的社区基础服务，以满足老年人的需求。这些服务灵活多样，使用家庭或设施护理，或两者结合，以确保个人在其首选的地方长期生活。我们开发了临终关怀教育培训计划，以鼓励不同准备程度的社区服务人员改变行为。
混合方法研究设计。
对参加 2017 年 9 月至 2019 年 9 月培训计划的 53 名社区服务人员的临终关怀知识、信心和态度进行了预-后评估，该评估结合了定量和定性数据。通过关于临终关怀的焦点小组讨论，向参与者告知临终关怀过程，并在培训前后和培训后三个月完成评估该计划的调查。我们使用四级柯克帕特里克模型作为评估指标。
定量分析结果表明，参与者对培训计划表示满意。他们对临终关怀的知识得分显著提高；他们还获得了信心提升，并对临终关怀的态度发生了变化，更加赞成临终关怀。定性数据揭示了参与者满意度和所学内容的细节。通过焦点小组讨论，他们为实施临终关怀计划制定了行动计划，其中一些人在三个月的随访中在当地中心完成了这些计划。
这些结果表明，培训计划通过日本的社区服务有效促进了临终关怀。进行后续培训可以有效地加强社区服务人员对临终关怀的承诺。该培训计划的使用有望促进支持就地养老的服务。
