Integrating palliative care into nursing homes

Autor: Anna L. Romer, Pamela Parrish, Howard Tuch
Rok vydání: 2003
Předmět:
Zdroj: Journal of palliative medicine. 6(2)
ISSN: 1096-6218
Popis: Genesis ElderCare and the University of Pennsylvania School of Nursing embarked on a 3-year intervention study with six nursing homes in Maryland to explore and compare two interventions aiming to integrate palliative care expertise and practice into this setting. This effort was supported by a grant from Promoting Excellence in End-of-Life Care, a national program office of The Robert Wood Johnson Foundation. This project to create a model of palliative care in long-term care involved designing an intervention and then working with six matched nursing homes, three in the Baltimore area and three on the Eastern Shore of Maryland, a more rural part of that state. Each area had a control home, (i.e., no additional training or enrichment was offered); however, these two control homes did benefit from system-wide activities to promote improved palliative care that were initiated in all Genesis nursing homes during that time. One distinctive feature of this effort is that it represents a collaboration between academic and industry partners. Neville Strumpf, Ph.D., R.N.C., FAAN, Edith Clemmer Steinbright chair of Gerontology at the University of Pennsylvania School of Nursing, and Howard Tuch, M.D., director of Palliative Care Services at Genesis ElderCare, were the coinvestigators of this project. Diane Stillman, M.S.N, C.S., served as project manager, supervising the data collection and analysis on the University of Pennsylvania side, and Pam Parrish, R.N., B.A., C.H.P.N., served as the nurse palliative care expert consultant to the nursing homes. Nancy Morrison, M.B.A., served as the corporate liaison at Genesis. Her active support of the project facilitated the partnership between nursing home administrators and researchers. Drs. Tuch and Strumpf were seeking to graft palliative care knowledge, skills, and attitudes onto existing structures in long-term care. They focused on three specific areas: advance care planning, pain and symptom management, and attention to psychosocial and spiritual issues for patients and families. These researchers designed an intervention that could be implemented at two levels of involvement: education alone and education plus the creation of a palliative care team. All four intervention homes received an initial 2-day training of high-level personnel (administrators, directors of nursing, social workers, nurses, palliative care coordinators) at an outside facility. The palliative care coordinators then brought the tools and messages of the initial training back to their settings. Following a train-the-trainer model, these palliative care coordinators and Pam Parrish, the nurse consultant, then conducted additional training at the homes for all staff—social services, admissions, activities, dietary, housekeeping, aides, and staff nurses. As part of the intervention, they introduced a Palliative Care Delivery Process, as well as a variety of tools to improve pain and symptom management, advance care planning, and psychosocial/spiritual care. In addition, researchers sought to establish a clearer picture of dying in these nursing homes, so they collected a variety of information shortly after every death that took place in the six homes during the intervention. Data collectors were nurses working as part of the University of Pennsylvania team, not nursing home staff. Researchers initiated a “palliative care team” at two of the homes, one in the Baltimore area, one on the Eastern Shore—these sites are referred to as the “Team Homes.” Creating an interdisciplinary, medical director-led team gave a concrete focus to the training. This structural change (the advent of a palliative care team)
Databáze: OpenAIRE
Externí odkaz: