Improving advance care planning in patients with dementia: The effect of training nurses to engage in acp-related conversations

M. Wils, J. Verbakel, J. Lisaerde
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引用次数: 11

Abstract

© 2017, Asia Pacific League of Clinical Gerontology & Geriatrics. Background: Advance care planning consists of an individual approach to anticipate the decisions on treatment during the course of illness and at the end of life. In a nursing home setting there is a pressing need for advance care planning, especially for residents with dementia. Timely discussion of the treatment goals may help to increases the resident’s autonomy and the quality of life and care. Objectives: The aim of the study is to assess the effect of an education program for nurses on the registration of care goals in a nursing home with a population of elderly residents suffering from dementia. Another objective was to explore the views of nursing home staff on advance care planning in patients with dementia. Methods: This quantitative study is a pre-and post-intervention evaluation in a nursing home in Flanders, Belgium, providing care for a population of 124 residents diagnosed with dementia. The intervention consisted of a 12-month program for nursing staff (n=13) including training in theoretical and communication skills. This group was asked to complete a structured 10-item-questionnaire (type Likert) at 0 and 12 months between January 2011 and January 2012 exploring their views on facilitating and obstructing factors concerning the implementation of ACP. At the same time a pre-and post-measurement of all ACP-related registrations, based on a novel care goals model in the electronic medical record was done. Results: The intervention included all 124 residents diagnosed with dementia. 13 members of the nursing staff participated in the training and completed the questionnaire at point 0 and 12 months. At 12 months we noticed a significant increase in the number of interviews regarding ACP held with the residents, and also a significant increase in the number of care goals documented. We identified several facilitating factors and barriers for the ACP process. Furthermore we saw significant changes in caregiver’s views on ACP at the end of the intervention period. Conclusions: Prior to the intervention the members of the nursing staff presented some resistance towards the implementation of ACP, supported the ACP process afterwards. ACP was said to help raise the dignity and autonomy of the residents, and was especially useful in improving clarity for medical decision making. The number of successfully recorded information on ACP was increased significantly. Special attention should be given to the barriers that obstruct the implementation of ACP in the nursing home setting.
改善痴呆患者的提前护理计划:培训护士参与acp相关对话的效果
©2017,亚太临床老年医学与老年病学联盟。背景:预先护理计划包括一种个人的方法来预测在疾病过程中和生命结束时的治疗决定。在养老院设置有一个迫切需要提前护理计划,特别是对老年痴呆症的居民。及时讨论治疗目标可能有助于提高居民的自主性和生活质量和护理。目的:本研究的目的是评估护士教育计划对养老院老年痴呆症患者护理目标登记的影响。另一个目的是探讨养老院工作人员对痴呆症患者预先护理计划的看法。方法:本定量研究是在比利时法兰德斯的一家养老院进行干预前和干预后的评估,该养老院为124名被诊断为痴呆症的居民提供护理。干预包括对护理人员(n=13)进行为期12个月的计划,包括理论和沟通技巧的培训。该小组被要求在2011年1月至2012年1月期间完成一份结构化的10项问卷调查(Likert类型),探讨他们对实施ACP的促进和阻碍因素的看法。同时,基于电子病历中的新型护理目标模型,对所有acp相关注册进行了前后测量。结果:干预包括所有124名被诊断为痴呆的居民。13名护理人员参加了培训,并在第0和第12个月完成了问卷调查。在12个月时,我们注意到与住院医生进行的关于ACP的访谈数量显著增加,记录的护理目标数量也显著增加。我们确定了ACP进程的几个促进因素和障碍。此外,在干预期结束时,我们看到护理人员对ACP的看法发生了重大变化。结论:干预前护理人员对ACP的实施存在一定阻力,干预后支持ACP进程。据说ACP有助于提高居民的尊严和自主权,尤其有助于提高医疗决策的明确性。成功记录ACP信息的数量显著增加。应特别注意在养老院环境中阻碍ACP实施的障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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