Aim: To better understand the participation of nursing staff in end-of-life nutrition and hydration decision-making in an American nursing home.
Design: A qualitative exploration with ethnographic focus.
Methods: In April 2017, in-person, semi-structured interviews were performed with 19 nursing staff members in a nursing home located in the south-eastern United States. Additional information was gathered through participant observation during interviews and review of organizational and regulatory policies. Transcripts were coded and analysed using qualitative methods described by Roper and Shapira (2000).
Results: Three primary themes relating to nursing staff participation in end-of-life nutrition and hydration decision-making were identified: (a) Formal decision-making: decisions made and implemented by persons with the authority to make legal and binding care decisions in the nursing home setting; (b) Informal decision-making: decisions not requiring medical orders; and (c) Influential factors: factors that influence actions of nursing staff.
Conclusion: A variety of factors have an impact on nursing staff participation in end-of-life nutrition and hydration decision-making. Participation is closely aligned with the type of decision, whether formal or informal, and role, whether Certified Nursing Assistant/Aide, Licensed Practical/Vocational Nurse, or Registered Nurse.
Impact: End-of-life nutrition and hydration decision-making in nursing homes differs from decision-making in other care settings and presents a challenge globally. Interventions that support the participation of nursing staff in end-of-life nutrition and hydration decision-making have the potential to positively impact the experiences of residents and family members faced with these issues in the nursing home setting.
目标: 为更好地了解美国疗养院护理人员参与养老院临终营养和水份补充决策的情况。 设计: 以人种学为重点的定性探索方法。 方法: 2017年4月,在位于美国东南部的一家疗养院,对19名护理人员进行半结构化访谈。通过访谈和审查组织和监管政策期间对受访者的观察,收集额外的信息。使用罗佩尔和沙皮拉描述的定性方法(2000年)对转录内容进行编译和分析。 结果: 确定与护理人员参与临终营养和水份补充决策相关的三个主要主题:(a) 正式决策:由有权在疗养院环境中做出合法且具有约束力的护理决策的人员做出并执行的决策;(b)非正式决策:不需要医嘱的决定;以及(c)影响因素:影响护理人员行为的因素。 结论: 多种因素对护理人员参与临终营养和水份补充决策均具有影响作用。参与性与决策类型(正式或非正式)和角色密切相关,无论是认证助理护士/助手、执业/职业护士还是注册护士。 影响: 养老院的临终营养和水份补充决策不同于其他护理机构的决策,在全球范围内都提出了挑战。支持护理人员参与临终营养和水份补充决策的干预措施有可能对养老院内人员及其家庭成员面临这些问题的体验产生积极的影响。.
Keywords: best practice; decision-making; end of life; hand feeding; hydration; nursing home; nursing staff; nutrition; tube feeding.
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