Communication of the death of a patient in hospices and nursing homes: A qualitative study

Purpose of the researchAnnouncing the death of a patient to another in hospices and nursing homes (NH) requires special skills, especially when the recipient is another resident. The aim of this study is to describe how hospice and NH staff deal with the communication regarding a patient's death, if this communication is perceived as a problem, and strategies implemented.Methods and sampleThe 55 health care workers (HCWs, 26 nurses and 29 auxiliary nurses) of two NHs and two hospices in Turin (Italy) were interviewed with a semi-structured interview exploring the residents' perception of need to receiving information on another patient's death, the experiences of having given this information in the last 6 months, and the strategies implemented. The interviews were analyzed using Colaizzi's method and researchers looked for the main themes and related subthemes.Key resultsSix themes were identified and grouped into 2 main themes: a. the choice to tell the truth or not, which may be influenced by: the patients' request for confirmation of the fate of the other resident, by patients' fear of death (“I will be next”), the relationships among the guests, and personal and group experiences; b. the need to share own feelings and the burden of deciding whether or not to inform the other residents and how to go about this.ConclusionsIf a structured discussion of experiences and reflection on cases is not implemented, HCWs may limit communication to bare information, lies, and adopt behaviors of avoidance and concealment.     

Dignity and its related factors among older adults in long-term care facilities: A cross-sectional study

ObjectivesThis study aimed to explore the dignity and related factors among older adults in long-term care facilities.MethodsCross-sectional data were obtained from a sample of 253 Chinese older adults dwelling in long-term care facilities. Dignity among older adults was measured using the Dignity Scale, and its potential correlates were explored using multiple linear regressions.ResultsResults showed that the total score of the Dignity Scale is 151.95 ± 11.75. From high to low, the different factors of dignity among older adults in long-term care facilities were as follows: caring factors (4.83 ± 0.33), social factors (4.73 ± 0.41), psychological factors (4.66 ± 0.71), value factors (4.56 ± 0.53), autonomous factors (4.50 ± 0.57), and physical factors (4.38 ± 0.55). A higher score of the Dignity Scale was associated with higher economic status, fewer chronic diseases, less medication, better daily living ability and long-time lived in cities.ConclusionOlder adults with low economic status, more chronic diseases, and poor daily living ability, taking more medications, or the previous residence in rural areas seem to be most at low-level dignity in long-term care facilities and thus require more attention than their peers.     

老年护理院护士职业吸引力影响因素的质性研究

目的：探讨影响老年护理院护士职业吸引力的因素。方法：采用半结构质性访谈的方法对苏州市3家老年护理院的16名护士进行访谈。结果：通过Colaizzi分析法提炼出3个主题。主题1,护士选择老年护理院工作的因素是亲戚或同学介绍、老年护理院就业门槛低;主题2,影响老年护理院护士职业吸引力的积极因素是认识和接受老年护理、工作相对大医院轻松、快速自我成长;主题3,影响老年护理院护士职业吸引力的消极因素是护士职业认可度低、生活婚恋压力大、外出培训机会少。结论：苏州市老年护理院护士职业吸引力低,建议政府相关部门通过开展护理专业学生的老年护理教育、提高老年护理人员薪酬待遇、提升老年护理人员职业发展空间等策略来提高老年护理院护士的职业吸引力。     

护理本科生对社区护理学混合式教学体验的质性研究

目的 了解护理本科生对社区护理学混合式教学的看法,为进一步完善混合式教学在护理教育中的应用提供参考。 方法 采用焦点小组访谈的形式对15名参与社区护理学混合式教学的护理本科生进行半结构化访谈,并运用Colaizzi 7步分析法分析访谈资料。 结果 提炼出6个关于护理本科生对社区护理学混合式教学体验的主题:激发学习兴趣,提高学习自主性;扩大视野,拓展思维;高效利用课堂时间,改善学习策略;多元互动,提高综合能力;学习任务增加,心理压力大;网络学习不深入。 结论 混合式教学有助于护理本科生综合能力的培养,提高教学效果,但仍需护理教育者在实践中进一步完善。     

慢阻肺患者基于“互联网+护理服务”体验的质性研究

：目的 了解COPD患者基于“互联网+护理服务”体验,探讨影响“互联网+护理服务”管理的因素。方法 采用目的性抽样策略从江苏省某三级医院参与“互联网+护理服务”的COPD患者中选取16例为研究对象,通过半结构访谈进行资料收集,运用主题分析法确定主题与亚主题。结果 共提取4个主题：①安全感 （熟悉感、便利感、获得自我掌控感）;②未被满足感 （获得针对性信息、服务途径不足、费用可报销）;③顾虑感（对护理认可度、隐私安全、增加焦虑）;④使用顺畅感（互联网技术素养、平台智能性）。结论 互联网+护理服务”的应用可以提升COPD患者安全感,减少医疗服务成本,在新冠病毒感染流行期间可以减少患者入院次数,提高生活质量,值得推广;同时管理者应优化微信平台服务内容及形式,提高患者平台使用体验感;规范护理人员准入制度,提高患者对护理认可度;加强患者出院指导,提高其平台使用能力。     

新生儿科护士实施以家庭为中心护理体验的质性研究

目的 了解新生儿科护士实施以家庭为中心护理（family centered care,FCC）的真实体验,探讨实施过程中存在的困难与需求,为开展大范围FCC提供参考。 方法 采用半结构式访谈法,选取2019年1月—3月在上海市某三级甲等医院新生儿科工作的61名护士进行访谈,运用Colaizzi 7步分析法对资料进行整理分析,提炼主题。结果 提炼出新生儿科护士实施FCC体验的3个主题:护士在实施FCC过程中表现出多重情感体验;实施FCC对新生儿父母有众多帮助;现阶段实施FCC仍存在诸多障碍。 结论 实施FCC是新生儿护理模式的发展趋势,实施过程中要重视护士的压力与需求,保持与新生儿父母的有效沟通,但技能的掌握需要组织的指导与支持,并需提供学习的途径与平台。     

护理本科生基础护理学实验教学体验的质性研究

目的 深入了解护理本科生在基础护理学实验教学中的体验,发现教学过程中存在的不足,为进一步改进教学策略、提高教学质量提供借鉴。 方法 采用现象学研究方法,通过目的抽样抽取11名护理本科生进行半结构深入访谈,资料分析采用Colaizzi 7步分析法。 结果 经分析、归纳,提取出3个主题:护生自我评价、教学现状、改进意见。 结论 护生对操作技能学习热情高与自信心不足并存,基础护理学实验教学应紧跟临床需要,科学培养与评价护生,增进护生综合素质培养。     

养老院服务体验对护理人员人文关怀能力影响的质性研究

目的 深入了解养老院服务体验对护理人文关怀能力的影响.方法 采用现象学方法,深入访谈参与养老院服务的15名临床护士,并用Colaizzi的7步分析法分析资料.结果 提炼出3个主题:服务体验;对护理人文关怀的理解;服务体验对护理人文关怀能力的影响.结论 护士参与养老院服务促进了护理人文关怀能力的提升,是培养护理人文关怀能力的积极方式.     

Usefulness,feasibility and face validity of the interRAI Palliative Care instrument according to care professionals in nursing homes: A qualitative study

BackgroundNursing homes are important locations for palliative care. High quality palliative care requires an evaluation of the different care needs of the nursing home residents. The interRAI Palliative Care instrument is a comprehensive assessment that evaluates the needs and preferences of adults receiving palliative care.ObjectivesThis study aims to evaluate the usefulness, feasibility and face validity of the interRAI Palliative Care instrument.DesignA qualitative study was conducted, based on the abductive reasoning approach.SettingFifteen nursing homes in Flanders (Belgium).ParticipantsCalls for participation were sent out by four umbrella organizations of Flemish nursing homes (Belgium) and at a national conference for nursing home staff. Nineteen care professionals (nurses, certified nursing assistants, psychologists, physiotherapists, quality coordinators and directors) of 15 nursing homes voluntarily agreed to participate in the study.MethodsDuring one year, care professionals evaluated the needs and preferences of all nursing home residents receiving palliative care by means of the interRAI Palliative Care instrument. Data on the usefulness, feasibility and face validity of the interRAI Palliative Care instrument were derived from notes, semi-structured interviews and focus groups with participating care professionals and were thematically analyzed and synthesized. Data were gathered between December 2013 and March 2015.ResultsIn general, the interRAI Palliative Care (interRAI PC instrument) is a useful instrument according to care professionals in nursing homes. However, care professionals made a series of recommendations in order to optimize the usefulness of the instrument. The interRAI PC instrument is not always feasible to complete because of organizational reasons. Furthermore, the face validity of the instrument could be improved since certain items are incomplete, lacking, redundant or too complex.ConclusionsFindings highlight the importance of adapting the content of the interRAI Palliative Care instrument for use in nursing homes. Furthermore, the use of the instrument should be integrated in the organization of daily care routines in the nursing homes. Tackling the critical remarks of care professionals will help to optimize the interRAI Palliative Care instrument and hence support palliative care of high quality in nursing homes.     

护生在临床安宁照护情境中的体验

目的探索护生在临床安宁照护情境中的现场体验,了解其真实感受,分析其中情况及成因,找寻规律和差异,总结经验,形成较有价值的理论,指导护理教育的课程改革与实践。方法采用质性研究的方法,通过分项目记录、观察及半结构访谈工具收集护生在疼痛、死亡等情境中的现场体验资料,同步分析、归纳、推理,最终形成理论。结果护生的情绪与病人 (家属)的信任关系有关；护生在安宁照护情境中受到死亡价值观的冲突和影响；护生进入安宁照护情境前需要培训和支持；综合医院安宁照护现状不甚理想。结论需高度关注护生的人文关怀精神和同理心的培育；综合医院安宁照护工作需要被关注和研究；安宁照护需要社会整体环境的支持。     

Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence

Background

Hospice care supports patients and their families physically and emotionally through the dying phase. In many countries a substantial portion of specialised end-of-life care is provided through hospices. Such care has developed outside of general healthcare and is commonly provided in a patient's home or in dedicated facilities. Hospice provision may need to increase in the future due to an ageing population with a greater need for access to end-of-life care.

Objectives

In this systematic review we sought to identify the current evidence on (1) the effectiveness, including cost-effectiveness, of hospices, and hospice care in a patient's home and in nursing homes and (2) the experiences of those who use and of those who provide such services.

Methods

We included quantitative and qualitative studies on hospice care that was provided in a patient's home, nursing home or hospice. We did not include studies on end-of-life care that was provided as part of general healthcare provision, such as by general practitioners in primary care, community nurses or within general hospitals. For quantitative evaluations we included only those that compared hospice care with usual generalist healthcare.The databases CINAHL, MEDLINE, EMBASE, and The Cochrane Library were searched from 2003 to 2009. Evidence was assessed for quality and data extractions double-checked. For quantitative studies we present the outcome data comparing hospice versus usual care. For qualitative evaluations we organise findings thematically.

Findings

Eighteen comparative evaluations and four thematic papers were identified. Quantitative evidence, mostly of limited quality in design, showed that hospice care at home reduced general health care use and increased family and patient satisfaction with care. Main themes in the qualitative literature revealed that home hospice services support families to sustain patient care at home and hospice day care services generate for the patient a renewed sense of meaning and purpose.

Conclusions

Although studies had methodological limitations, in this review we found much evidence to support the benefits of hospice care. There were limited evaluations found on the impact of hospice care on psychological well-being, such as symptoms of depression, and on inpatient hospice care and non-hospital related costs.     

Geriatrics training for nurses in a skilled nursing facility: a GWEP feasibility study

Geriatrics knowledge and expertise is critical to the care of older adults in skilled nursing facilities. However, opportunities for ongoing geriatrics training for nurses working in skilled nursing facilities are often scarce or nonexistent. This feasibility study describes a mixed-methods analysis of nurses' educational needs and barriers to continuing education in a for-profit skilled nursing facility in an underserved, urban environment. Potential mechanisms to overcome barriers are proposed.     

Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory

BackgroundAgeing societies and a rising prevalence of dementia are associated with increasing demand for care home places. Monitoring technologies (e.g. bed-monitoring systems; wearable location-tracking devices) are appealing to care homes as they may enhance safety, increase resident freedom, and reduce staff burden. However, there are ethical concerns about the use of such technologies, and it is unclear how they might be implemented to deliver their full range of potential benefits.ObjectiveThis study explored facilitators and barriers to the implementation of monitoring technologies in care homes.DesignEmbedded multiple-case study with qualitative methods.SettingThree dementia-specialist care homes in North-West England.ParticipantsPurposive sample of 24 staff (including registered nurses, clinical specialists, senior managers and care workers), 9 relatives and 9 residents.Methods36 semi-structured interviews with staff, relatives and residents; 175 h of observation; resident care record review. Data collection informed by Normalization Process Theory, which seeks to account for how novel interventions become routine practice. Data analysed using Framework Analysis.ResultsFindings are presented under three main themes: 1. Reasons for using technologies: The primary reason for using monitoring technologies was to enhance safety. This often seemed to override consideration of other potential benefits (e.g. increased resident freedom) or ethical concerns (e.g. resident privacy); 2. Ways in which technologies were implemented: Some staff, relatives and residents were not involved in discussions and decision-making, which seemed to limit understandings of the potential benefits and challenges from the technologies. Involvement of residents appeared particularly challenging. Staff highlighted the importance of training, but staff training appeared mainly informal which did not seem sufficient to ensure that staff fully understood the technologies; 3. Use of technologies in practice: Technologies generated frequent alarms that placed a burden upon staff, but staff were able to use their contextual knowledge to help to counter some of this burden. Some technologies offered a range of data-gathering capabilities, but were not always perceived as useful complements to practice.ConclusionImplementation of monitoring technologies may be facilitated by the extent to which the technologies are perceived to enhance safety. Implementation may be further facilitated through greater involvement of all stakeholders in discussions and decision-making in order to deepen understandings about the range of potential benefits and challenges from the use of monitoring technologies. Staff training might need to move beyond functional instruction to include deeper exploration of anticipated benefits and the underlying rationale for using monitoring technologies.