Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members

Autor/inn/en	Welch, Lisa C.; Miller, Susan C.; Martin, Edward W.; Nanda, Aman
Titel	Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members
Quelle	In: Gerontologist, 48 (2008) 4, S.477-484 (8 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0016-9013
Schlagwörter	Nurses; Nursing Homes; Referral; Hospices (Terminal Care); Older Adults; Gerontology; Terminal Illness; Interviews; Allied Health Personnel; Administrators; Influences; Educational Needs; Employee Attitudes + Suchen Sie Ihr Suchwort? Sonderheim; Hospice; Hospiz; Älterer Erwachsener; Gerontologie; Interviewing; Interviewtechnik; Influence; Einfluss; Einflussfaktor; Educational need; Bildungsbedarf; Arbeitnehmerinteresse
Abstract	Purpose: Given concerns about end-of-life care for many nursing home (NH) residents, this study sought to understand factors influencing hospice referral or nonreferral as well as timing of referral. Design and Methods: We conducted semistructured interviews with personnel from seven participating NHs and two hospices. We interviewed NH directors of nursing regarding facility referral practices and conducted interviews with 34 NH nurses, 30 NH aides, and 17 hospice nurses knowledgeable about the factors that led to the hospice status of 32 NH decedents. Selected decedents varied by diagnosis and hospice status (received hospice for greater than 7 days, less than or equal to 7 days, or not at all). We audiotaped, transcribed, and coded interviews for themes. Results: NH staff members' recognition of terminal decline, beliefs about hospice, and initiative significantly influenced hospice referral and timing of referral. Staff members' recognition of familiar signs of decline facilitated hospice referral; in contrast, a perception that death was unexpected impeded referral, and a perception of uncertain prognosis delayed referral. Staff members' beliefs that hospice does not add value to NH care or is for crises only impeded referral, and a belief that hospice is only for the "very end" delayed referral. Residents received hospice for longer periods when staff believed that hospice complemented NH care and when staff took the initiative in raising the option of hospice. Implications: Enhanced training about recognizing terminal decline, hospice services in NHs, and the role of staff initiative would support NH staff in raising the option of hospice when appropriate. (As Provided).
Anmerkungen	Gerontological Society of America. 1030 15th Street NW Suite 250, Washington, DC 20005. Tel: 202-842-1275; Fax: 202-842-1150; e-mail: geron@geron.org; Web site: http://www.geron.org/journals/gsapub.htm
Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10