Palliative Care in Nursing Homes: Advance Directives and Events at the End-of-Life

2.50
Hdl Handle:
http://hdl.handle.net/10755/156725
Type:
Presentation
Title:
Palliative Care in Nursing Homes: Advance Directives and Events at the End-of-Life
Abstract:
Palliative Care in Nursing Homes: Advance Directives and Events at the End-of-Life
Conference Sponsor:Sigma Theta Tau International
Conference Year:2004
Conference Date:July 22-24, 2004
Author:Strumpf, Neville E., PhD, RN, C, FAAN
P.I. Institution Name:University of Pennsylvania
Title:Edith Clemmer Steinbright Professor in Gerontology and Director for the Center for
Co-Authors:Cheryl Monturo, MSN, APRN, BC
In the US < 20-25% of all deaths (500,000) occur annually in nursing homes (NH) or shortly after transfer to a hospital. NH residents have limited access to palliative care (PC). Objective: The purpose of the parent study was to implement an integrated PC Program as part of routine activities in the NH, and to evaluate its impact on residents and staff. A secondary aim was to examine the occurrence of nutritional treatment decisions (tube feeding –TF) within advance directives (AD) compared to utilization of TF in the last month of life. Design: Quasi-experimental. Population: Data were collected from 6 for profit NH in Maryland from 1999-2001. Four homes served as the intervention homes and two functioned as controls. Intervention/Outcome: The intervention consisted of PC education, consultation and interdisciplinary team development. We analyzed the following outcomes: Assessment and treatment of physical and emotional symptoms, attitudes of NH staff, events/treatments at end-of-life, and process implementation and culture change. Methods: Data were collected at baseline, during and following the intervention, using a PC screen, events at end-of-life worksheet, and field notes. Findings: At time of death, intervention homes had more residents with AD than control (p 0.01). Of those residents in intervention homes with AD (30%), 83% requested no TF. In 90% of documented events in the last month of life, a resident’s wishes were honored to forego TF. No resident with a documented weight loss was treated with TF. Conclusions: Visible successes included capacity to implement PC and to achieve positive outcomes, especially in those settings with stable leadership and commitment to project goals. Implications: Long-term, successful integration of PC in NH requires: Health care policies encouraging PC; reimbursement incentives recognizing that PC requires skills and resources; and pubic demand for PC as a reasonable expectation in every NH.
Repository Posting Date:
26-Oct-2011
Date of Publication:
22-Jul-2004
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePalliative Care in Nursing Homes: Advance Directives and Events at the End-of-Lifeen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156725-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Palliative Care in Nursing Homes: Advance Directives and Events at the End-of-Life</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July 22-24, 2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Strumpf, Neville E., PhD, RN, C, FAAN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Pennsylvania</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Edith Clemmer Steinbright Professor in Gerontology and Director for the Center for</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">strumpf@nursing.upenn.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Cheryl Monturo, MSN, APRN, BC</td></tr><tr><td colspan="2" class="item-abstract">In the US &lt; 20-25% of all deaths (500,000) occur annually in nursing homes (NH) or shortly after transfer to a hospital. NH residents have limited access to palliative care (PC). Objective: The purpose of the parent study was to implement an integrated PC Program as part of routine activities in the NH, and to evaluate its impact on residents and staff. A secondary aim was to examine the occurrence of nutritional treatment decisions (tube feeding &ndash;TF) within advance directives (AD) compared to utilization of TF in the last month of life. Design: Quasi-experimental. Population: Data were collected from 6 for profit NH in Maryland from 1999-2001. Four homes served as the intervention homes and two functioned as controls. Intervention/Outcome: The intervention consisted of PC education, consultation and interdisciplinary team development. We analyzed the following outcomes: Assessment and treatment of physical and emotional symptoms, attitudes of NH staff, events/treatments at end-of-life, and process implementation and culture change. Methods: Data were collected at baseline, during and following the intervention, using a PC screen, events at end-of-life worksheet, and field notes. Findings: At time of death, intervention homes had more residents with AD than control (p 0.01). Of those residents in intervention homes with AD (30%), 83% requested no TF. In 90% of documented events in the last month of life, a resident&rsquo;s wishes were honored to forego TF. No resident with a documented weight loss was treated with TF. Conclusions: Visible successes included capacity to implement PC and to achieve positive outcomes, especially in those settings with stable leadership and commitment to project goals. Implications: Long-term, successful integration of PC in NH requires: Health care policies encouraging PC; reimbursement incentives recognizing that PC requires skills and resources; and pubic demand for PC as a reasonable expectation in every NH.</td></tr></table>en_GB
dc.date.available2011-10-26T15:04:20Z-
dc.date.issued2004-07-22en_GB
dc.date.accessioned2011-10-26T15:04:20Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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