Klemmt Malte, Zehl Franziska, Neuderth Silke, Henking Tanja
Medizinische Hochschule Hannover, Institut für Allgemeinmedizin und Palliativmedizin, Hannover, Deutschland; Technische Hochschule Würzburg-Schweinfurt, Institut für Angewandte Sozialwissenschaften, Würzburg, Deutschland.
Technische Hochschule Würzburg-Schweinfurt, Institut für Angewandte Sozialwissenschaften, Würzburg, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2024 Dec;190-191:63-71. doi: 10.1016/j.zefq.2024.09.004. Epub 2024 Nov 8.
Autonomy at the end of life is associated with the ability to make self-determined decisions. The heterogeneous field of inpatient integration assistance poses particular challenges in this context. Advance care planning (ACP) is now available to people with disabilities. Nevertheless, little is known about the institution-related needs and the current status with regard to ACP in integration assistance homes.
A survey of all 850 inpatient homes providing integration assistance for adults in Bavaria was carried out. The survey was conducted online and addressed to home managers. In total, data of 96 homes (11.3% of all homes) was included in the descriptive and categorizing text analysis.
Residents die in 60% of the homes surveyed. 73.7% of the homes offer ACP for their residents, with 62.9% of these homes using standardized procedures. One of the reasons given by the participants for not offering ACP is a better qualification of employees. Barriers include the residents' lack of ability to participate in ACP meetings or relatives' reluctant attitude towards ACP.
End-of-life care is a relevant topic for inpatient homes providing integration assistance. Accordingly, ACP is already being addressed by a large proportion of homes. Here, special needs of residents due to existing impairments can pose challenges.
The study enables us to draw conclusions about the optimization of ACP from the perspective of care homes, which relate to structural (e.g., adaptation of existing concepts), personal (e.g., qualification) and emotional (e.g., de-tabooization) aspects.
临终时的自主权与做出自主决定的能力相关。在这种情况下，住院综合护理这一多样化领域带来了特殊挑战。现在，残疾人也可获得预先护理计划（ACP）。然而，对于综合护理机构中与机构相关的需求以及ACP的现状，我们知之甚少。
对巴伐利亚州为成年人提供综合护理的所有850家住院护理机构进行了一项调查。该调查通过在线方式进行，对象是护理机构的管理人员。在描述性和分类文本分析中，总共纳入了96家机构（占所有机构的11.3%）的数据。
在接受调查的机构中，60%有居民去世。73.7%的机构为其居民提供ACP，其中62.9%的机构采用标准化程序。参与者给出的不提供ACP的原因之一是员工资质有待提高。障碍包括居民缺乏参与ACP会议的能力或亲属对ACP态度不积极。
临终护理是提供综合护理的住院机构的一个重要话题。相应地，很大一部分机构已经在关注ACP。在此，现有损伤导致的居民特殊需求可能带来挑战。
该研究使我们能够从护理机构的角度得出关于优化ACP的结论，这些结论涉及结构（如调整现有概念）、人员（如资质）和情感（如消除禁忌）等方面。
