Andrea Koppitz1, Georg Bosshard2, Stephanie Kipfer3, Lorenz Imhof4. 1. Deputy Head of Nursing Research and Development, Institute of Nursing, Zurich University of Applied Sciences, Switzerland. 2. Long Term Care Physician, University Hospital of Zurich, Clinic for Geriatric Medicine, and Centre on Ageing and Mobility, University of Zurich. 3. Research Associate, Haute École De Santé, Health Department, Fribourg, Switzerland. 4. Head of Nursing Research and Development, Institute of Nursing, Zurich University of Applied Sciences.
Abstract
BACKGROUND: Alleviating symptoms, fulfilling psychosocial needs, and the inclusion of family are among the criteria that determine care quality in palliative treatment. The care quality is especially inadequate for people with dementia (PwD) at the end of life. To improve this, it is necessary to understand the process of nurses' clinical decision-making in symptom management in the terminal phase of PwD. AIM: The aim of the study was to examine the decision-making process of symptom management for PwD in nursing homes in their terminal phase of life. DESIGN: A qualitative design was chosen with a constructivist approach. Individual interviews were conducted with nurses (n=32) in four Swiss nursing homes. RESULTS: 'Recount and reflect' plays a vital role in the care of PwD in terminal phase, enabling symptom recognition and facilitating symptom management. A process of thinking during the course of action enables nursing staff members to understand what, when, and how symptom changes have taken place. CONCLUSION: Highly-trained nurses need to support health care assistants through counselling, coaching, and leadership to help reduce the symptom burden experienced by PwD. Relatives are necessary to maintain an exchange of ideas regarding the appropriate treatment to reduce symptom burden.
BACKGROUND: Alleviating symptoms, fulfilling psychosocial needs, and the inclusion of family are among the criteria that determine care quality in palliative treatment. The care quality is especially inadequate for people with dementia (PwD) at the end of life. To improve this, it is necessary to understand the process of nurses' clinical decision-making in symptom management in the terminal phase of PwD. AIM: The aim of the study was to examine the decision-making process of symptom management for PwD in nursing homes in their terminal phase of life. DESIGN: A qualitative design was chosen with a constructivist approach. Individual interviews were conducted with nurses (n=32) in four Swiss nursing homes. RESULTS: 'Recount and reflect' plays a vital role in the care of PwD in terminal phase, enabling symptom recognition and facilitating symptom management. A process of thinking during the course of action enables nursing staff members to understand what, when, and how symptom changes have taken place. CONCLUSION: Highly-trained nurses need to support health care assistants through counselling, coaching, and leadership to help reduce the symptom burden experienced by PwD. Relatives are necessary to maintain an exchange of ideas regarding the appropriate treatment to reduce symptom burden.
Entities:
Keywords:
Decision-making; Dementia; Nursing homes; Palliative care; Terminal care
Authors: Susanne de Wolf-Linder; Margarete Reisinger; Elisabeth Gohles; Emma L Wolverson; Maria Schubert; Fliss E M Murtagh Journal: BMC Nurs Date: 2022-07-20