End-of-life care bonus promoting end-of-life care in nursing homes: An 11-year retrospective longitudinal prefecture-wide study in Japan

Nishiguchi, Sho; Sugaya, Nagisa; Sakamaki, Kentaro; Mizushima, Shunsaku

doi:10.5582/bst.2016.01183

Cited by 12 publications

(16 citation statements)

References 29 publications

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“…In a previous small sample study, nurses' experience with EOL care had a positive effect on their tenure and professional efficacy (7). Moreover, in our previous study, we showed that employing nurses with more than 5 experiences with EOL care was associated with increased EOL care in nursing homes (2), which is consistent with the results of the present study involving facilities performing EOL care conferences. The association between the nurses' experiences and the increased EOL care in the nursing homes among facilities performing EOL care conferences may be associated with the nurses' leadership (9,10).…”

Section: Discussionsupporting

confidence: 91%

“…In our previous study, we reported that EOL care conferences were related to increased EOL care in nursing homes (2). The present study additionally investigated how EOL care conferences are performed to best achieve EOL care in nursing homes.…”

Section: Discussionmentioning

confidence: 82%

“…The association between the nurses' experiences and the increased EOL care in the nursing homes among facilities performing EOL care conferences may be associated with the nurses' leadership (9,10). The role of nurses is essential for the implementation of EOL care because nurses are the only medical providers in most nursing homes (2,5).…”

Section: Discussionmentioning

confidence: 99%

“…We analyzed cross-sectional data acquired in 2014 from our previous longitudinal survey (2). The survey was conducted using a questionnaire based on our pilot study, which included face-to-face interviews with nursing home staff.…”

Section: Design Setting and Participantsmentioning

confidence: 99%

“…In our previous study, we revealed that EOL care conferences are related to increased EOL care in nursing homes (2). However, the importance of EOL care conferences remains poorly understood worldwide.…”

mentioning

confidence: 95%

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End-of-life care conferences in Japanese nursing homes

Nishiguchi

Sugaya

Inamori

2019

DD&T

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In aging societies, nursing homes that provide 24-hour functional support to frail elderly residents (1), who require assistance due to diminished capacity, play an important role in end-of-life (EOL) care. In Japan, EOL care in nursing homes has gradually increased over the past decade (2-4). However, approximately 30% of facilities continue to transfer residents to hospitals for EOL care (2,4). In the remaining 70% of facilities, approximately 40% of the residents receive EOL care and ultimately die in hospitals rather than in nursing homes (2,4). Thus, residents may be transferred to hospitals against their wishes for EOL care. Multidisciplinary care is a requirement of EOL care in nursing homes. However, providing EOL care overnight is challenging. Nurses in nearly all nursing homes work on-call shifts during the evenings (5). Professional caregivers in nursing homes usually perform EOL care without assistance during the nighttime (6). Thus, the professional caregiver's role may be practically the most important. Professional caregivers who do not have sufficient experience with EOL care have fears about EOL care (7). Thus, multidisciplinary care is essential to prevent unnecessary anxiety in nighttime professional caregivers who are inexperienced with EOL care. EOL care conferences were introduced in the Japanese guidelines for EOL care in nursing homes (8), which state that such conferences promote Summary End-of-life (EOL) care conferences have an important role in promoting EOL care in nursing homes. However, the details of the conferences remain poorly understood. A Japanese prefecture-wide survey was conducted to investigate the factors involved in such conferences that contribute to an increase in the amount of EOL care. One hundred fiftythree nursing homes performed the conferences. The outcome was the amount of EOL care provided in nursing homes after adjusting for the facility beds in 2014. We investigated the factors of staff experience with EOL care, frequency of the conferences, years the conferences were conducted, review conferences after EOL care, and professional participants in the conferences. The multivariate analysis revealed significant associations between EOL care in nursing homes and nurses' experience with EOL care (adjusted β coefficient 2.9, 95% confidence interval (CI) 0.52 ~ 5.22, p = 0.017), more than 5 years of continuous conferences (adjusted β coefficient 3.8, 95% CI 0.46 ~ 7.05, p = 0.026), and family participation (adjusted β coefficient-4.0, 95% CI-7.5 ~-0.48, p = 0.026). In conclusion, the continuation of conferences and enrollment of the nurse with experience in EOL care may promote EOL care in nursing homes, while family enrollment in conferences may decrease EOL care in nursing homes. EOL care conferences in nursing homes should be continuously performed by staff, with an experienced nurse undertaking the task of information sharing before discussing EOL care with the patients' families.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Design Setting and Participantsmentioning

confidence: 99%

mentioning

confidence: 95%

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End-of-life care conferences in Japanese nursing homes

Nishiguchi

Sugaya

Inamori

2019

DD&T

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Notfallsituationen und Krankenhauszuweisungen in Pflegeeinrichtungen – ein Scoping-Review zu Begleitumständen und versorgungsrelevanten Maßnahmen

Bretschneider

Poeck

Freytag

et al. 2022

Bundesgesundheitsbl

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Zusammenfassung Hintergrund Pflegeheimbewohner:innen werden häufiger hospitalisiert als nicht institutionalisierte Gleichaltrige. Eine Vielzahl an Rettungsdiensteinsätzen und Krankenhauszuweisungen wird als potenziell vermeidbar eingeordnet. Ziele der Arbeit Zuweisungsbegünstigende Begleitumstände bei Notfallsituationen in Pflegeeinrichtungen sowie Ansätze zur Reduktion von Krankenhauszuweisungen sollen identifiziert werden, um die Komplexität der Versorgungsprozesse und Handlungsperspektiven aufzuzeigen. Material und Methoden Scoping-Review mit Analyse aktueller Original- und Übersichtsarbeiten (2015–2020) in den Datenbanken PubMed, CINAHL sowie per Handsuche. Ergebnisse Aus 2486 identifizierten Studien wurden 302 Studien eingeschlossen. Verletzungen, Frakturen, kardiovaskuläre und respiratorische Erkrankungen sowie Infektionskrankheiten sind die häufigsten retrospektiv erfassten Diagnosegruppen. Hinsichtlich der einweisungsbegünstigenden Umstände konnten verschiedene Aspekte identifiziert werden: bewohnerbezogene (z. B. Multimorbidität, fehlende Patientenverfügungen), einrichtungsbezogene (u. a. Personalfluktuation, Unsicherheiten), arztbezogene (z. B. mangelnde Erreichbarkeit, erschwerter Zugang zu Fachärzt:innen) und systembedingte (z. B. eingeschränkte Möglichkeiten zur Diagnostik und Behandlung in Einrichtungen). Verschiedene Ansätze zur Verminderung von Krankenhauszuweisungen sind in Erprobung. Diskussion Vielfältige Begleitumstände beeinflussen das Vorgehen in Notfallsituationen in Pflegeeinrichtungen. Interventionen zur Reduktion von Krankenhauszuweisungen adressieren daher u. a. die Stärkung der Kompetenz des Pflegepersonals, die interprofessionelle Kommunikation und systemische Ansätze. Ein umfassendes Verständnis der komplexen Versorgungsprozesse ist die wesentliche Grundlage für die Entwicklung und Implementierung effektiver Interventionen.

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