Staff Perceptions of End-of-Life Care following Implementation of the Liverpool Care Pathway for the Dying Patient in the Acute Care Setting: A New Zealand Perspective

Clark, Jean; Sheward, Karen; Marshall, Bridget M.; Allan, Simon

doi:10.1089/jpm.2011.0375

Cited by 32 publications

(49 citation statements)

References 28 publications

(43 reference statements)

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“…When a care pathway is introduced, staff feel an urge to collaborate within the hospital and with primary care, which lead to better organized care processes [19]. Other examples of better care organization are standardization of care process, better documentation and communication with the patients and the healthcare professional, better follow-up of the care process and tasks are performed more confidently [15, 17, 20, 21]. …”

Section: Introductionmentioning

confidence: 99%

Better organized care via care pathways: A multicenter study

et al. 2017

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An increased need for efficiency and effectiveness in today’s healthcare system urges professionals to improve the organization of care. Care pathways are an important tool to achieve this. The overall aim of this study was to analyze if care pathways lead to better organization of care processes. For this, the Care Process Self-Evaluation tool (CPSET) was used to evaluate how healthcare professionals perceive the organization of care processes. Based on information from 2692 health care professionals gathered between November 2007 and October 2011 we audited 261 care processes in 108 organizations. Multilevel analysis was used to compare care processes without and with care pathways and analyze if care pathways led to better organization of care processes. A significant difference between care processes with and without care pathways was found. A care pathway in use led to significant better scores on the overall CPSET scale (p<0.001) and its subscales, “coordination of care” (p<0.001) and “follow-up of care” (p<0.001). Physicians had the highest score on the overall CPSET scale and the five subscales. Care processes organized by care pathways had a 2.6 times higher probability that the care process was well-organized. In around 75% of the cases a care pathway led to better organized care processes. Care processes supported by care pathways were better organized, but not all care pathways were well-organized. Managers can use care pathways to make healthcare professionals more aware of their role in the organization of the care process.

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Section: Introductionmentioning

confidence: 99%

Better organized care via care pathways: A multicenter study

et al. 2017

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“…Det rapporteres blant annet om økt kunnskap knyttet til medikamentell symptomlindring og avslutning av livsforlengende behandling (Di Leo et al, 2011), større trygghet når en skal ta viktige avgjørelser (Clark, Sheward, Marshall, & Allan, 2012b) og økt forutsigbarhet i arbeidet (Skorpen & Haugen, 2015). Det er også vist at LCP medfører en bevisstgjøring hos personell, med endret fokus fra kurativ til lindrende behandling (Di Leo et al, 2011;Clark et al, 2012b;Sleeman et al, 2015). Venkatasalu, Whiting, & Cairnduff (2015) gjennomførte en intervjustudie blant leger ved akuttavdelinger i sykehus etter at LCP ble faset ut i Storbritannia.…”

Section: Litteraturgjennomgangunclassified

“…LCP synes også å ha positiv innvirkning på det tverrfaglige samarbeidet omkring pasienten (Di Leo et al, 2011;Clark et al, 2012b;Sleeman et al, 2015). Sleeman et al (2015) gjennomførte en intervjustudie med leger, sykepleiere og annet helsepersonell på sykehus i Storbritannia.…”

Section: Litteraturgjennomgangunclassified

“…Dette handler om at pasienten blir sett ut fra et helhetlig perspektiv, at de hele tiden er i forkant, at de tilbyr god lindring og ikke overbehandling, at pårørende blir ivaretatt -og at det er en bedre kontinuitet i pleien og omsorgen. Resultatene viser at det har skjedd en kunnskaps-og holdningsendring hos sykepleierne med innføringen av LCP -funn som støttes av andre kvalitative studier gjort internasjonalt (Di Leo et al, 2011;Clark et al, 2012b;Sleeman et al, 2015). Resultater fra kvalitative studier har imidlertid vaert lite vektlagt i evaluering av LCP (Neuberger et al, 2013;Chan et al, 2016;Meneses-Echáves et al, 2016), til tross for at det er allment kjent at det innenfor palliasjonsfeltet er store utfordringer med å gjennomføre såkalt «robuste», kvantitative studier både når det gjelder utforming, etikk, kunnskap og økonomi (Kaasa, 2007).…”

Section: Problematisk Dokumentasjonunclassified

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Omsorg ved livets slutt - En kvalitativ studie av sykepleieres erfaringer med bruk av Liverpool Care Pathway i sykehjem

Brattgjerd¹,

Olsen²

2016

TFO

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Results: Nurses experiences of using LCP can be summarized in two main themes with several subthemes: "LCP contributes to good care at the end of life" ("To see the whole patient", "To be ahead", "To relieve, not cure", "To see and involve relatives" and "To ensure continuity of care"), and "Challenges related to the use of LCP" ("Difficult to diagnose the patient as terminal", "Problematic documentation", "Rigid integrated care plan requires use of discretion", and "Hard to achieve continuity in collaboration with physician"). Conclusion:The study shows that nurses face several challenges related to the use of LCP in nursing homes. Yet, they experience that LCP contributes to a dignified and proper end-of-life care for the patient.

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“…8,11 Although nurses view symptom management as important, inadequate knowledge can be a barrier to appropriate medication use at the end of life. 12 Other factors that may hinder use of medications include fear of opioids, which includes fear of hastening death or causing negative effects such as depressed respirations. 2,13,14 The expectation is that nurses provide adequate medication for symptom control and advocate for changes when medications are not managing symptoms.…”

mentioning

confidence: 99%

Nurses’ Perceptions of Medication Use at the End of Life in an Acute Care Setting

Howes¹

2015

Journal of Hospice & Palliative Nursing

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Palliative care is frequently part of nursing practice in acute care settings. Research has evaluated nurses' general perceptions on end-of-life care in hospital and identified symptom management as a concern. The aim of this study was to explore nurses' perceptions regarding end-of-life medication use in an acute care setting to enable identification of variables that may impact symptom management and medication use at the end of life. Using a qualitative description methodology, 22 nurses from 8 medical and surgical units participated in 7 focus groups. Nurses were less likely to use medication when having difficulty identifying symptoms and when medications were not familiar. Other factors included conflicting perspectives and the emotional experience. Nurses felt that physicians were often reluctant to involve the palliative care team and experienced delays in obtaining orders or clarifying goals of care. Nurses felt uncomfortable with medication use when their feelings conflicted with family perspectives and found communication with families challenging overall. Nurses expressed a desire to achieve comfort but felt fears surrounding medication use. Fears included hastening death, adverse effects such as depressed respirations, and the possibility of pain pump errors or inappropriate use. Education and resources regarding symptom assessment and common end-of-life medications were identified as important. KEY WORDSacute care, medication administration, nursing, palliative care I t is well recognized that adequate symptom management is a critical component of end-of-life care. Despite this knowledge, it is still common to have unmet symptom needs at the end of life. 1 This problem is most severe in areas that do not specialize in palliative care, particularly in the acute care setting. 2,3 In the hospital setting, health care professionals often do not recognize that a patient is approaching end of life, as the focus has been on active interventions. This may result in missed opportunities to optimize symptom control. As acute care settings tend to focus on cure and active management, transitioning to a palliative care model can be unclear or seen as a failure. 4,5 In general, there is a lack of current research available that focuses on end of life in the acute care setting.The literature does show that families are often dissatisfied with hospital care at the end of life and feel that there is a need for improved symptom control and communication with health care professionals. 6 Both staff and families report that the hospital environment may not be appropriate for end-of-life care because of high levels of noise, busyness, and lack of privacy as well as resource restrictions (eg, staffing levels and time). 6,7 When attempting to address the hospital nurses' perspectives, there is also limited research. The literature has focused on the challenges nurses face with providing endof-life care. Hospital nurses report feeling unprepared and often experience difficulties in meeting the needs of patients and fami...

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Staff Perceptions of End-of-Life Care following Implementation of the Liverpool Care Pathway for the Dying Patient in the Acute Care Setting: A New Zealand Perspective

Cited by 32 publications

References 28 publications

Better organized care via care pathways: A multicenter study

Better organized care via care pathways: A multicenter study

Omsorg ved livets slutt - En kvalitativ studie av sykepleieres erfaringer med bruk av Liverpool Care Pathway i sykehjem

Nurses’ Perceptions of Medication Use at the End of Life in an Acute Care Setting

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