养老护理院临终关怀计划（NUHELP）：开发一种复杂干预措施。
NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention.
机构信息
Salvador Caballero Primary Care Centre, Andalusian Health Service, Granada, Spain.
Department of Nursing, Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain.
出版信息
BMC Palliat Care. 2021 Jun 26;20(1):98. doi: 10.1186/s12904-021-00788-1.
BACKGROUND
Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country.
METHODS
A descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals.
RESULTS
As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program.
CONCLUSIONS
The objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.
背景
养老院作为临终关怀设施，其重要性可能会日益增加。以往的研究表明，居住在这些设施中的人临终症状的发生率很高，对姑息治疗的需求也很大。本研究旨在根据以往的模式，为西班牙的养老院制定临终关怀方案，但要适应该国养老院的具体情况和工作人员的需求。
方法
本研究是一项复杂干预措施的描述性研究。该研究包括三个阶段。第一阶段是一项前瞻性研究，评估养老院工作人员在完成基本姑息治疗培训计划前后的姑息治疗自我效能（使用 SEPC 量表）和临终关怀态度（使用 FATCOD-B 量表）。在第二阶段，采用德尔菲共识技术选择目标，由养老院和初级保健专业人员评估 42 项质量标准的相关性、可行性和达标程度。在第三阶段，通过涉及养老院、初级保健和姑息治疗专业人员的两次焦点小组会议，为这些目标选择干预措施。
结果
培训后，观察到自我效能和临终关怀态度有所改善。在第二阶段，选择了 14 项标准，并将其分为 5 个目标：进行全面评估并制定个性化的护理计划，以适应所发现的姑息需求；以清晰易懂的方式提供信息；要求并记录预先护理指令；在适当的情况下，尽早提供针对损失和悲伤的护理；根据所需姑息治疗的复杂性，将患者转介至专门的姑息治疗单位。基于这些目标，焦点小组会议的参与者设计了构成该方案的 22 项干预措施。
结论
NUHELP 方案的目标和干预措施构成了一个临终关怀方案，可以在养老院实施，通过改变其临床实践、组织以及与卫生系统的关系，提高这些设施的临终关怀质量，并为有效的卫生干预方案提供范例。
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