End-of-Life Care in Long-Term Care Facilities: Managers' Perspectives

• Main Authors: Chia-Ying Hsieh, 謝佳穎
• Other Authors: Li-Chan Lin
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/3duemy

碩士 === 國立陽明大學 === 臨床護理研究所 === 106 === A qualitative study was conducted to explore long-term care facility managers’ opinions, experiences, and decision-making regarding end-of-life care. Purposive sampling was utilized to sample 20 long-term care facility managers for one-on-one semistructured interviews, and grounded theory was adopted for data analysis. The results were divided into four types comprising 18 categories. (a) challenges regarding favorable time, place, and people: (1) the idea of a good death changed from living as long as possible to dying when it is time; (2) the long-term care facility possessed advantages for end-of-life care, and (3) decision makers’ belief in hospice ; (b) end-of-life care strategies adopted by the long-term care facilities: (1) predicting the time of death and making early preparation for a good death, (2) communicating with residents and their families in a timely manner to avoid misunderstanding, (3) interacting with residents’ families carefully to reduce risks of medical disputes, (4) separating the space for dying from other spaces to reduce emotional impact, (5) facility staff being supported by their supervisors and their workload being adjusted adequately, (6) emphasizing on spiritual care and highlighting key points for funeral preparation, and (7) providing education close to practice that is favorable for end-of-life care; (c) current obstacles: (1) unpredictable period of hospital stay that may impose burden on the facility, (2) inadequate equipment and services to meet the needs of care, (3) difficulty to determine a person being at the end-of-life stage and thus resulting in ethical dilemma, (4) hospice home care being uncommon and with inconsistent service quality, (5) numerous but complex methods to determine death, and (6) unclear effectiveness of documents resulting in medical disputes; and (d) end-of-life care outcomes of the long-term care facilities: (1) internalization the concept of practicing hospice in the facilities, and (2) residents being hospitalized or referred to other facilities at the end of the end-of-life care. This study also obtained a core category of striving for the state of carefree. The results revealed the end-of-life care processes in the long-term care facilities in Taiwan. Clinical suggestions regarding “end-of-life care strategies” were proposed for long-term care facility managers to promote end-of-life care. On the basis of the “current obstacles” relevant suggestions were also proposed for policy planning.