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Puente-Fernández D, Soto Felipe C, Mota-Romero E, Esteban-Burgos AA, Montoya-Juárez R, Roldan-Lopez de Hierro CB. Cultural adaptation and validation of the Quality of Dying in Long-term Care (QoD-LTC and QoD-LTC-C) scales by caregivers in nursing homes. Psychogeriatrics 2023; 23:1061-1070. [PMID: 37781959 DOI: 10.1111/psyg.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND There is a lack of tools that can evaluate quality of dying in nursing homes from the perspective of deceased patients' caregivers. The aim of this study was to adapt and validate the caregivers' versions of the Quality of Dying in Long-Term Care (QoD-LTC) and Quality of Dying in Long-Term Care Complete (QoD-LTC-C) scales in the Spanish context. METHODS This was a cultural adaptation and validation study. The scales were translated from English to Spanish and vice versa, and 13 experts in end-of-life care participated in a two-round Delphi panel. Caregivers of 69 deceased residents from seven nursing homes in southern Spain completed both scales. Reliability, feasibility, and concurrent validity with global quality of dying perception and symptom burden (Edmonton Symptom Assessment Scale), were evaluated. RESULTS Spanish caregivers' version of the QoD-LTC scale showed good internal consistency for the total scale (α = 0.74) and each of its three factors, and good inter-rater reliability (ICC = 0.50) and test-retest reliability (ICC = 0.81). The Spanish QoD-LTC-C scale for caregivers showed good internal consistency for the total scale (α = 0.81) and for its component factors, and good test-retest reliability (ICC = 0.89) and inter-rater reliability (ICC = 0.66). Both scales correlated with family caregivers' global perception of deceased residents' quality of dying (r = 0.39; r = 0.32), but not with the ESAS score. CONCLUSIONS Both scales presented an adequate factorial structure, internal consistency, and reliability to assess caregivers' perception of the quality of dying in Spanish nursing homes.
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Affiliation(s)
- Daniel Puente-Fernández
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
| | | | - Emilio Mota-Romero
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
- Salvador Caballero Health Care Centre, Granada-Metropolitan Primary Care District, Andalusia Health Service, Granada, Spain
| | | | - Rafael Montoya-Juárez
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain
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Cabañas Cob A, Apellaniz Aparicio B, Santa Palao G, Pardo Chacón C, Larena Grijalba P, Fabado Martínez P. [Health and social care in an urban nursing home providing healthcare services and primary care's role: A qualitative study with residents, relatives and professionals]. Aten Primaria 2023; 55:102529. [PMID: 36565598 PMCID: PMC9798115 DOI: 10.1016/j.aprim.2022.102529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
AIM To identify the elements involved in adequate health and social care for old people living in nursing homes, determine their possible barriers and enablers and define primary care's role in it. DESIGN Qualitative study with phenomenological approach. SETTING State funded private nursing home and its corresponding primary care center in the southeastern urban area of Madrid. PARTICIPANTS Elderly residents, their relatives, and professionals from the nursing home and the primary care center. METHOD Five focus groups were conducted between November 2019 and January 2020, with semi-structured interviews based on the variables of analysis and themes related to the objectives. The sessions were recorded and transcribed. An open and axial coding was performed to identify categories after a triangulation of the data. RESULTS The elements of adequate care identified are individualized care, promotion of autonomy, adequate information to residents and relatives, quality of services, coordination between professionals, and a continuous end of life care. The main barriers are the deficit of professionals, the differences in expectations between users and workers, and the organizational gap between the healthcare system and nursing homes providing healthcare services. The role identified for primary care is mostly bureaucratic. CONCLUSIONS It is necessary to continue exploring these elements and to outline the role of primary care in nursing homes with different characteristics.
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Mota Romero E, Puente Fernández D, Rodríguez Pertíñez C, Árbol Fernández G, Moreno Guerrero S, Montoya Juárez R. Inadequate human resources, equipment and training: A qualitative assessment of the objectives of the NUHELP end-of-life care programme in the context of the COVID-19 pandemic. Palliat Med 2022; 36:1252-1262. [PMID: 35730120 DOI: 10.1177/02692163221103099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic had a particularly severe impact on nursing homes, exposing numerous pre-existing deficiencies in end-of-life care. AIM To describe how the COVID-19 pandemic affected nursing home and primary care professionals' attempts to achieve the objectives of a pre-existing end-of-life programme and to explore their personal experiences of end-of-life care in these facilities. DESIGN A qualitative descriptive study using thematic analysis. SETTING/PARTICIPANTS Twenty semi-structured interviews were conducted from March to November 2020 with professionals from nursing homes and primary care facilities who participated in the development of the NUHELP programme. RESULTS Six main themes were identified: (1) Comprehensive assessments of residents at the homes were not conducted due to excessive workload and high staff turnover. (2) New technologies and changes to professional roles were used to meet relatives' needs for information. Residents only received information when they requested it. (3) Advance care planning was not carried out and was limited to potential hospital transfer. (4) Arrangements were made to allow relatives to spend time with residents during their final moments, but complicated grief among relatives and professionals is anticipated. (5) Management of complexity varied depending on the degree of coordination with primary care facilities. (6) Nursing home professionals felt abandoned, with a lack of human resources, equipment and training. CONCLUSIONS The pandemic cast light on existing shortcomings in nursing homes in terms of comprehensive assessments, communication, decision making, grief management and palliative care complexity. Nursing homes need more human, material and training resources, as well as improved coordination with the public healthcare system.
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Affiliation(s)
- Emilio Mota Romero
- Andalusian Health Service District Metropolitano Granada, Salvador Caballero Primary Care Centre, Granada, Andalusia, Spain
| | | | | | - Gema Árbol Fernández
- Servicio Andaluz de salud Área de Gestión Granada Metropolitano, Unidad de Gestión Clínica Peligros, Granada, Spain
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Fernández-Rodríguez Á, Sarabia-Cobo C, Molina-Mula J. Knowledge and attitudes towards living wills among healthcare professionals, residents and relatives in nursing homes: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e245-e254. [PMID: 34028118 DOI: 10.1111/hsc.13434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 04/08/2021] [Accepted: 04/28/2021] [Indexed: 02/05/2023]
Abstract
Living wills are a tool to support the principle of autonomy in end-of-life situations, when the person does not have the capacity to make decisions. The aim was to explore the knowledge and attitudes of residents, relatives and healthcare professionals in nursing homes in Cantabria regarding living wills. A qualitative phenomenological design was conducted. Two focus groups were held with seven participants in each group. A sample of 14 people participated in this study: four residents, five relatives and five professionals. This study was approved by the Clinical Research Ethics Committee of Cantabria. Two main categories were found, with six subcategories each: death, with six subcategories-as a social taboo, as a natural process, facing death, accompanying uncertainties, unnecessary lengthening of life and guilt-and living wills, with six subcategories-knowledge, unknowingness or misconceptions, usefulness, strategies to promote dissemination, intention of granting a living will and the professional's role in restricting or promoting autonomy. Unknowingness or misconceptions and uncertainties in relation to death were the most represented subcategories of each category. Although the attitudes among the study participants were mostly positive, there is a lack of knowledge concerning living wills, which is enhanced by the social taboo related to death.
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Affiliation(s)
| | - Carmen Sarabia-Cobo
- Faculty of Nursing, University of Cantabria, IDIVAL Nursing Research Group, Santander, Spain
| | - Jesús Molina-Mula
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Mallorca, Spain
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Roach A, Rogers AH, Hendricksen M, McCarthy EP, Mitchell SL, Lopez RP. Guilt as an Influencer in End-of-Life Care Decisions for Nursing Home Residents With Advanced Dementia. J Gerontol Nurs 2022; 48:22-27. [PMID: 34978495 PMCID: PMC8938982 DOI: 10.3928/00989134-20211206-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The concept of guilt has been studied in the context of caregivers of older adults with advanced dementia, usually describing the feelings a person has of placing a loved one in a long-term care facility; however, little research has been done to understand how nursing home staff and proxies for older adults with dementia describe guilt as a decision-influencer in end-of-life care. For the current study, private, semi-structured interviews were conducted with 158 nursing home staff and 44 proxies in 13 nursing homes across four demographic regions in the United States. Interviews were reviewed and analyzed for how the concept of guilt was perceived as a decision-influencer. Nursing home staff described guilt as an important influencer in why proxies make decisions about end-of-life care. Staff noted that proxies who felt guilty about their relationship with their loved one or lack of time spent at end-of-life tended to be more aggressive in care decisions, whereas no proxies mentioned guilt as an influencer in care decisions. Rather, proxies used language of obligation and commitment to describe why they make decisions. Findings highlight the disconnect between nursing home staff and proxies in what motivates proxies to make end-of-life decisions for loved ones. Nursing home staff should be aware of misconceptions about proxies and work to understand proxies' true rationale and motivations for making care decisions. [Journal of Gerontological Nursing, 48(1), 22-27.].
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Martínez-Heredia N, Soriano Díaz A, Amaro Agudo A, González-Gijón G. Health Education as a Means of Addressing Death in the Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6652. [PMID: 34205630 PMCID: PMC8296413 DOI: 10.3390/ijerph18126652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 01/05/2023]
Abstract
Education for death is an emerging field of study in which health education research and proposals are increasingly being made with the aim of acquiring knowledge and skills to promote positive attitudes towards health and preparation for the end of life. The aim of this study is to find out what experience older people have had with death education and the importance they give to health education. A qualitative methodological design was selected using a semi-structured interview. The survey consisted of interviews with 28 participants from the city of Granada (Spain) aged 61 to 78. This qualitative-descriptive study is based on an analysis of older people's experience of education and preparation for death throughout their lives. The results show that, in most cases, the only information received was in childhood and always from a religious perspective. Death and health are closely related, so working on death education helps to improve the quality of life of elderly people. Health education offers ways of coping with the end of life through the transmission of values and practices that make it possible to anticipate and resolve situations of instability or anxiety. Facing death naturally and as just another part of life will help to make healthy ageing possible, through educational proposals related to the integral health of elderly people.
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Affiliation(s)
- Nazaret Martínez-Heredia
- Department of Pedagogy, University of Granada, 18011 Granada, Spain; (A.S.D.); (A.A.A.); (G.G.-G.)
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Puente-Fernández D, Jimeno-Ucles R, Mota-Romero E, Roldán C, Froggatt K, Montoya-Juárez R. Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5287. [PMID: 34065678 PMCID: PMC8156125 DOI: 10.3390/ijerph18105287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a need for instruments that can evaluate the psychosocial quality of dying in nursing homes. The aim of this study was to adapt and validate the Quality of Dying in Long-Term Care scale (QoD-LTC) to the Spanish context. METHODS Descriptive cross-sectional study. Fourteen nurses from 7 facilities in southern Spain assessed 153 residents who died in the centers; validity, reliability, and feasibility were evaluated. RESULTS The Spanish version consists of 11 items with acceptable reliability (α = 0.681). Three factors model was validated by principal components analysis. A mean of 180.62 (SD = 86.66) seconds is needed to fill it in. An inter-observer 0.753 (95% CI: 0.391-0.900, p< 0.001) and intra-observer 0.855 (95% CI: 0.568-0.951 p = 0.001) reliability were observed. Weak correlation was observed; positive with mono-item question (0.322) and negative with Eastern Cooperative Oncology Group (ECOG) with a value of (-0.321) and Integrated Palliative outcome scale (IPOS) with a value of (-0.252). CONCLUSIONS The QoD-LTC scale presents an adequate factorial structure, internal consistency, and feasibility to evaluate psychosocial quality of dying in nursing homes. It can be used as a quality indicator.
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Affiliation(s)
- Daniel Puente-Fernández
- Doctoral Program of Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain
| | | | - Emilio Mota-Romero
- Salvador Caballero Primary Care Centre, Andalusian Health Service, 18012 Granada, Spain;
| | - Concepción Roldán
- Department of Statistics and Operational Research, University of Granada, 18071 Granada, Spain;
| | - Katherine Froggatt
- Formerly International Observatory on End-of-Life Care, Lancaster University, Lancaster LA1 4YD, UK;
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Herreros B, Benito M, Gella P, Valenti E, Sánchez B, Velasco T. Why have Advance Directives failed in Spain? BMC Med Ethics 2020; 21:113. [PMID: 33198746 PMCID: PMC7667789 DOI: 10.1186/s12910-020-00557-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background In Spain, there has been great effort by lawmakers to put Advance Directives (ADs) into practice since 2002. At the same time, the field of bioethics has been on the rise, a discipline that has spurred debate on the right of patients to exercise their autonomy. Despite all this, the implementation of ADs can be said to have failed in Spain, because its prevalence is very low, there is a great lack of knowledge about them and they have very little impact on clinical decisions. The purpose of this article is to analyze and discuss the main reasons for the failure of ADs in Spain. Main body The main reasons why ADs have no impact on clinical practice in Spain have been fundamentally four: (1) the training of health professionals about the end of life and AD is lacking; (2) there has been no public process to increase awareness about AD, and therefore people (with the exception of specific highly sensitized groups) know little about them; (3) the bureaucratic procedure to document and implement ADs is excessively complex and cumbersome, creating a significant barrier to their application; (4) in Spain, the remnants of a paternalistic medical culture continue to exist, which causes shared decision-making to be difficult. Conclusion Due to the four reasons mentioned above, AD have not been a useful tool to help honor patients’ autonomous decisions about their future care and, therefore, they have not achieved their objective. However, despite the difficulties and problems identified, it has also been observed that health care professionals and the Spanish public have a very positive view of AD. Having identified the problems which have kept AD from being successful, strategies must be developed to help improve their implementation into the future.
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Affiliation(s)
- Benjamín Herreros
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid, Madrid, Spain. .,Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain.
| | - María Benito
- Legal Medicine, Psychiatry and Pathology Department, Universidad Complutense , Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
| | - Pablo Gella
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza de Francisco Morano, s/n, 28005, Madrid, Spain
| | - Emanuele Valenti
- Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Beatriz Sánchez
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Calle Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - Tayra Velasco
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Plaza de Ramón y Cajal, s/n, 28040, Madrid, Spain
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Sánchez-García MR, Gutiérrez-Romero JA, Fernández-Alcántara M, Hueso-Montoro C, Goodman C, Montoya-Juárez R. End of life care in nursing homes in Spain: Exploratory analysis and evidences of validity of a new scale. Appl Nurs Res 2017; 37:6-12. [PMID: 28985922 DOI: 10.1016/j.apnr.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/10/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
Quality end-of-life care is a central issue in nursing homes, requiring the assessment of individual and family needs by health professionals. Although previous instruments have been developed, they usually rely on family reports and have been adapted from other clinical contexts (hospital or primary care). It is important to consider how health care professionals working in nursing homes perceive what is necessary to achieve quality end-of-life care. In this study, the objective was to develop an instrument to assess quality of end-of-life care in the context of Spanish care homes. A 24 item scale Nursing Home End of Life Care Scale (NHEOLC) was developed through a systematic evaluation of existing tools combined with an iterative process of consultation with group experts in end of life care in long term care settings. A total of 307 health care professionals agreed to participate in the study and completed the scale. The scale was grouped in six dimensions: physical, psychological aspects and spiritual aspects of care, family care, bereavement, and patient/family preferences management. The results suggest an adequate factorial structure of the scale and good internal consistency for the total score and the subscales. In addition, the results showed significant differences depending on the size of the nursing home, the category of health professionals, and their own perceptions of his work regarding end-of-life care.
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Affiliation(s)
| | | | | | | | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, United Kingdom.
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