Tim Luckett1, Lynnette Chenoweth2, Jane Phillips1, Deborah Brooks3, Janet Cook1, Geoffrey Mitchell4, Dimity Pond5, Patricia M Davidson1, Elizabeth Beattie3, Georgina Luscombe6, Stephen Goodall7, Thomas Fischer8, Meera Agar1. 1. Faculty of Health,University of Technology Sydney,Ultimo,New South Wales,Australia. 2. Centre for Healthy Brain Ageing,University of New South Wales,Randwick,New South Wales,Australia. 3. School of Nursing,Queensland University of Technology,Herston,Queensland,Australia. 4. School of Medicine and Public Health,The University of Newcastle,New South Wales,Australia. 5. Faculty of Medicine,The University of Queensland,St Lucia,Queensland,Australia. 6. Sydney Medical School,The University of Sydney,Camperdown,New South Wales,Australia. 7. Centre for Health Research and Evaluation (CHERE),Faculty of Business,Haymarket,New South Wales,Australia. 8. University of Applied Sciences,Pflegewissenschaft,Dresden,Germany.
Abstract
BACKGROUND: Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation. METHOD: Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach. RESULTS: Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback. CONCLUSION: The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.
BACKGROUND: Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation. METHOD: Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach. RESULTS: Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback. CONCLUSION: The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.
Entities:
Keywords:
aged care; dementia; inter-disciplinary; nursing homes; palliative care
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