RESUMO
This qualitative study elicits factors that influence decision-making by nurses about transferring a dying resident from the nursing home to the hospital. Focus groups with directors of nursing (DONs) from long-term care facilities revealed those decisions are influenced by knowledge (or lack thereof) of resident or family preferences, nurse interactions with physicians, nursing home technological and personnel resources, and nurse concerns about institutional liability. DONs can improve transfer decisions by communicating with all parties, clarifying nursing home processes for end-of-life care, and scheduling early and thorough conversations with residents and families about end-of-life care. DONs can implement improvements through staff education on communication issues, rigorous evaluation and performance outcome measures related to patient transfer, and conveyance to staff of the institution's mission and the nursing service's values.
Assuntos
Tomada de Decisões , Enfermeiros Administradores , Papel do Profissional de Enfermagem , Casas de Saúde/organização & administração , Transferência de Pacientes/organização & administração , Grupos Focais , Hospitalização , Humanos , Programas de Assistência Gerenciada , Relações Médico-Enfermeiro , Doente TerminalAssuntos
Diretivas Antecipadas/psicologia , Atitude Frente a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pacientes Internados/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Humanos , Renda , Pacientes Internados/educação , Descrição de Cargo , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Cidade de Nova Iorque , Cuidados de Enfermagem/organização & administração , Educação de Pacientes como Assunto , Grupos Raciais , Inquéritos e QuestionáriosRESUMO
The benefits and risks for older adults with dementia executing advance directives are discussed. Salient issues related to decision-specific capacity and models for advance planning and end-of-life decisions by cognitively impaired older adults are presented.
Assuntos
Diretivas Antecipadas/psicologia , Idoso/psicologia , Demência/psicologia , Competência Mental/psicologia , Tomada de Decisões , Demência/diagnóstico , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Pessoa de Meia-Idade , Modelos Psicológicos , Técnicas de Planejamento , Ordens quanto à Conduta (Ética Médica)/psicologiaRESUMO
BACKGROUND: Informed consent forms should document and reflect the goals of informed consent and shared decision making. We conducted this study to examine the extent to which informed consent for procedure forms meet accepted informed consent standards, how well state informed consent statutes correlate with these standards, and whether existing forms can enhance the interactions between patients and physicians or other health care providers. HYPOTHESIS: Informed consent forms do not meet accepted standards. A different format may be more useful for patient-physician interactions. DESIGN: A content analysis was conducted of hospital informed consent for procedure forms from a random selection of hospitals in the 1994 American Hospital Association membership directory. Forms were examined for evidence of the basic elements of informed consent (nature of the procedure, risks, benefits, and alternatives) and items that might enhance patient-physician interactions and encourage shared decision making. UNIT OF ANALYSIS: From 157 hospitals nationwide, 540 hospital informed consent for procedure forms were examined. MEASUREMENTS AND MAIN RESULTS: Ninety-six percent of forms indicated the nature of the procedure, but risks, benefits, and alternatives were found less often. Only 26% of forms included all 4 basic elements, 35% included 3 of 4 elements, 23% had 2 of 4 elements, 14% had only 1 element, and 2% had none of the elements. Forms appear to authorize treatment (75%) or protect hospitals and caregivers from liability (59%) rather than clarify information about procedures (40%) or aid patients in decision making (14%). Forms from states with statutes that require that all 4 elements be provided were no more likely than other states to include them (Fisher exact test = 1.000). Fewer than 40% of forms supported models of shared decision making. CONCLUSIONS: The content of most forms did not meet accepted standards of informed consent or patient-physician interactions. We propose a form that more fully supports the models of ideal informed consent and shared decision making to enhance the applicability of informed consent in the clinical setting.
Assuntos
Ética Médica , Consentimento Livre e Esclarecido/legislação & jurisprudência , Relações Médico-Paciente , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Humanos , Educação de Pacientes como Assunto/legislação & jurisprudência , Estados UnidosRESUMO
This article reports on a new instrument, the Geriatric Institutional Assessment Profile (GIAP), developed to assess (1) hospital workers' knowledge, attitudes, and perceptions regarding care of geriatric patients, and (2) the perceived adequacy of an institutional environment to serve geriatric patients' needs. Findings are reported from 303 questionnaires completed by health care employees from a 658-bed academic medical center. Internal consistency estimates were consistently high for the various components of the GIAP. Factor analysis was performed to examine underlying dimensions of knowledge and institutional environment. The GIAP has the potential to narrow the gap between actual and best practice in geriatric care by identifying staff information needs and concerns, as well as institutional barriers and facilitators to providing quality geriatric hospital care.
Assuntos
Benchmarking/normas , Enfermagem Geriátrica/normas , Serviços de Saúde para Idosos/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas , Estados UnidosRESUMO
Nurses can improve end-of-life decision making for patients by understanding the related legal, ethical and cultural issues involved and by encouraging the use of advance directives.
Assuntos
Diretivas Antecipadas , Enfermagem Geriátrica , Defesa do Paciente , Educação de Pacientes como Assunto , Idoso , Humanos , Guias de Prática Clínica como AssuntoRESUMO
Pain management for the elderly person is complex, challenging, but ultimately rewarding for the nurse who learns the core knowledge for assisting the older individual who is in pain.