Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-27T15:52:40.909Z Has data issue: false hasContentIssue false
  • English
  • Français

A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: perceptions of palliative care planning coordinators and other health professionals in the IDEAL study

Published online by Cambridge University Press:  27 June 2017

Tim Luckett ,
Lynnette Chenoweth ,
Jane Phillips ,
Deborah Brooks ,
Janet Cook ,
Geoffrey Mitchell ,
Dimity Pond ,
Patricia M. Davidson ,
Elizabeth Beattie  and
Georgina Luscombe
...Show all authors
Tim Luckett*
Affiliation:
Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
Lynnette Chenoweth
Affiliation:
Centre for Healthy Brain Ageing, University of New South Wales, Randwick, New South Wales, Australia
Jane Phillips
Affiliation:
Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
Deborah Brooks
Affiliation:
School of Nursing, Queensland University of Technology, Herston, Queensland, Australia
Janet Cook
Affiliation:
Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
Geoffrey Mitchell
Affiliation:
School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia
Dimity Pond
Affiliation:
Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
Patricia M. Davidson
Affiliation:
Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
Elizabeth Beattie
Affiliation:
School of Nursing, Queensland University of Technology, Herston, Queensland, Australia
Georgina Luscombe
Affiliation:
Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
Stephen Goodall
Affiliation:
Centre for Health Research and Evaluation (CHERE), Faculty of Business, Haymarket, New South Wales, Australia
Thomas Fischer
Affiliation:
University of Applied Sciences, Pflegewissenschaft, Dresden, Germany
Meera Agar
Affiliation:
Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia South Western Sydney Clinical School, University of New South Wales, New South Wales, Australia Ingham Institute for Applied Medical Research, New South Wales, Australia Improving Palliative Care through Clinical Trials (ImPaCCT), New South Wales, Australia
*
Correspondence should be addressed to: Tim Luckett, PhD, Senior Lecturer, Faculty of Health, University of Technology Sydney, Level 7, 235 Jones St, Ultimo, NSW 2007 (PO Box 123), Sydney. Phone: +61 2 9514 4861. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation.

Method:

Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach.

Results:

Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback.

Conclusion:

The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.

Keywords

dementiapalliative carenursing homesaged careinter-disciplinary
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 10 , October 2017 , pp. 1713 - 1722
Copyright
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abernethy, A. P. (2007). Individualised multi-disciplinary case conferences: can they be practically added to specialist palliative care? 8th Australian Palliative Care Conference. Sydney.Google Scholar
Agar, M. et al. (2015). Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol. BMC Palliative Care, 14, 63.Google Scholar
Australian Government Department of Health (2013). Multidisciplinary case conferences [Online]. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-caseconf-factsheet.htm; last accessed 29 August 2016.Google Scholar
Australian Medical Association and Royal Australian College of General Practitioners (2006). Proposal – GP Services to Residential Aged Care. Canberra: AMA and RACGP.Google Scholar
Birch, D. and Draper, J. (2008). A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia. Journal of Clinical Nursing, 17, 1144–1163.CrossRefGoogle ScholarPubMed
Blakeman, T. M., Harris, M. F., Comino, E. J. and Zwar, N. A. (2001). Evaluating general practitioners' views about the implementation of the enhanced primary care medicare items. Medical Journal of Australia, 175, 95–98.CrossRefGoogle ScholarPubMed
Bostick, J. E., Rantz, M. J., Flesner, M. K. and Riggs, C. J. (2006). Systematic review of studies of staffing and quality in nursing homes. Journal of the American Medical Directors Association, 7, 366–376.CrossRefGoogle ScholarPubMed
Clay-Williams, R., Nosrati, H., Cunningham, F. C., Hillman, K. and Braithwaite, J. (2014). Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review. BMC Health Services Research, 14, 369.CrossRefGoogle ScholarPubMed
Department of Health Social Services and Public Safety (2015). Care Standards for Nursing Homes. Belfast: Department of Health Social Services and Public Safety.Google Scholar
Dwyer, D. (2011). Experiences of registered nurses as managers and leaders in residential aged care facilities: a systematic review. International Journal of Evidence Based Healthcare, 9, 388–402.CrossRefGoogle ScholarPubMed
Engel, S. E., Kiely, D. K. and Mitchell, S. L. (2006). Satisfaction with end-of-life care for nursing home residents with advanced dementia. Journal of the American Geriatrics Society, 54, 1567–1572.Google Scholar
Givens, J. L., Jones, R. N., Shaffer, M. L., Kiely, D. K. and Mitchell, S. L. (2010). Survival and comfort after treatment of pneumonia in advanced dementia. Archives of Internal Medicine, 170, 1102–1107.CrossRefGoogle ScholarPubMed
Goodman, C. et al. (2016). Effective health care for older people living and dying in care homes: a realist review. BMC Health Services Research, 16, 269.Google Scholar
Hakanson, C., Cronfalk, B. S., Henriksen, E., Norberg, A., Ternestedt, B. M. and Sandberg, J. (2014). First-line nursing home managers in Sweden and their views on leadership and palliative care. The Open Nursing Journal, 8, 71–78.Google Scholar
Halcomb, E. J., Shepherd, B. M. and Griffiths, R. (2009a). Perceptions of multidisciplinary case conferencing in residential aged care facilities. Australian Health Review, 33, 566–571.Google Scholar
Halcomb, E. J., Shepherd, B. M., Griffiths, R., Halcomb, E. J., Shepherd, B. M. and Griffiths, R. (2009b). Perceptions of multidisciplinary case conferencing in residential aged care facilities. Australian Health Review, 33, 566–571.Google Scholar
Harrington, C. et al. (2012). Nursing home staffing standards and staffing levels in six countries. Journal of Nursing Scholarship, 44, 88–98.CrossRefGoogle ScholarPubMed
Health Information and Quality Authority (2016). National Standards for Residential Care Settings for Older People in Ireland. Dublin: Health Information and Quality Authority.Google Scholar
Holle, D., Kruger, C., Halek, M., Sirsch, E. and Bartholomeyczik, S. (2015). Experiences of nursing staff using dementia-specific case conferences in nursing homes. American Journal of Alzheimer's Disease & Other Dementias, 30, 228–237.CrossRefGoogle ScholarPubMed
Holle, D., Roes, M., Buscher, I., Reuther, S., Muller, R. and Halek, M. (2014). Process evaluation of the implementation of dementia-specific case conferences in nursing homes (FallDem): study protocol for a randomized controlled trial. Trials, 15, 485.Google Scholar
Kassenaerztliche Vereinigung Berlin, Aok Nordost, Ikk Brandenburg Und Berlin, Bahn Bkk and Siemens Bkk (2011). Berliner Projekt - Die Pflege mit dem Plus. Vertrag nach Paragraph 73 c SGB V. Berlin: Krankenkassen.Google Scholar
Mcauliffe, L., Nay, R., O'donnell, M. and Featherstonehaugh, D. (2009). Pain assessment in older people with dementia: literature review. Journal of Advanced Nursing, 65, 2–10.Google Scholar
Medical Research Council (2006). Developing and Evaluating Complex Interventions: New Guidance. London: MRC.Google Scholar
Mitchell, G. et al. (2005). General practitioner, specialist providers case conferences in palliative care–lessons learned from 56 case conferences. Australian Family Physician, 34, 389–392.Google Scholar
Mitchell, G. K., De Jong, I. C., Del Mar, C. B., Clavarino, A. M. and Kennedy, R. (2002). General practitioner attitudes to case conferences: how can we increase participation and effectiveness? Medical Journal of Australia, 177, 95–97.Google Scholar
Mitchell, S. L. (2015). Clinical practice: advanced dementia. New England Journal of Medicine, 372, 2533–2540.Google Scholar
Mitchell, S. L. et al. (2009). The clinical course of advanced dementia. New England Journal of Medicine, 361, 1529–38.CrossRefGoogle ScholarPubMed
Mitchell, S. L., Kiely, D. K. and Hamel, M. B. (2004). Dying with advanced dementia in the nursing home. Archives of Internal Medicine, 164, 321–326.Google Scholar
New South Wales Nurses and Midwives' Association (2016). Let's have RNs 24/7 in Aged Care Across Australia! [Online]. Available at: http://www.nswnma.asn.au/get-involved/aged-care-nurses/; last accessed 1 February 2017.Google Scholar
Phillips, J. L., West, P. A., Davidson, P. M. and Agar, M. (2013). Does case conferencing for people with advanced dementia living in nursing homes improve care outcomes: evidence from an integrative review. International Journal of Nursing Studies, 50, 1122–1135.Google Scholar
Reuther, S. et al. (2012). Case conferences as interventions dealing with the challenging behavior of people with dementia in nursing homes: a systematic review. International Psychogeriatrics, 24, 1891–1903.CrossRefGoogle ScholarPubMed
Ritchie, J. and Spencer, L. (1994). Qualitative data analysis for applied policy research. In A. Bryman and R. G. Burgess (eds.), Analyzing Qualitative Data. Abingdon: Routledge.Google Scholar
Strauss, A. and Corbin, J. (1998). Basics of Qualitative Research Techniques and Procedures for Developing Grounded Theory. London: Sage Publications.Google Scholar
Tong, A., Sainsbury, P. and Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19, 349–357.CrossRefGoogle ScholarPubMed
van der Steen, J. T. et al. (2014). White paper defining optimal palliative care in older people with dementia: a delphi study and recommendations from the European association for palliative care. Palliative Medicine, 28, 197–209.CrossRefGoogle ScholarPubMed
Verenso (2015). Handreiking Multidisciplinair Overleg (MDO). Utrecht: Verenso.Google Scholar