NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention
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Mota Romero, Emilio; Esteban Burgos, Ana Alejandra; Puente Fernández, Daniel; García Caro, María Paz; Hueso Montoro, César; Montoya Juárez, RafaelEditorial
BMC
Materia
Nursing home care End of Life Holistic care Nurse-patient interaction Nurse-patient relationships Older people Palliative care
Date
2021-06-26Referencia bibliográfica
Mota-Romero, E... [et al.]. NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention. BMC Palliat Care 20, 98 (2021). [https://doi.org/10.1186/s12904-021-00788-1]
Sponsorship
Consejeria de Salud, Junta de Andalucia (Fundacion Publica Andaluza Progreso y Salud) AP-0105-2016Abstract
Background: Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous
studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a
significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing
homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing
homes in the country.
Methods: A descriptive study of a complex intervention procedure was developed. The study consisted of three
phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and
attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the
completion of a basic palliative care training program. In the second phase, objectives were selected using the
Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility,
and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through
two focus group sessions involving nursing home, primary care, and palliative care professionals.
Results: As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was
observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive
assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information
in a clear and accessible way; to request and record advance care directives; to provide early care with respect to
loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of
the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22
interventions that make up the program.
Conclusions: The objectives and interventions of the NUHELP program constitute an end-of-life care program
which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by
modifying their clinical practice, organization, and relationship with the health system as well as serving as an
example of an effective health intervention program.