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Barriers in the Decision Making About and Performance of Continuous Sedation Until Death in Nursing Homes
- Source :
- The Gerontologist, 60(5), 916-925. Oxford University Press
- Publication Year :
- 2020
- Publisher :
- Oxford University Press, 2020.
-
Abstract
- Background and Objectives While decision making about and performance of continuous sedation involve many challenges, they appear to be particularly pervasive in nursing homes. This study aims to identify barriers to the decision making and performance of continuous sedation until death in Flemish nursing homes as experienced by the health care professionals involved. Research Design and Methods Ten focus groups were held with 71 health care professionals including 16 palliative care physicians, 42 general practitioners, and 13 nursing home staff. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Results Perceived barriers concerned factors prior to and during sedation and were classified according to three types: (a) personal barriers related to knowledge and skills including the lack of clarity on what continuous sedation should be used for (linguistic ambiguity) and when and how it should be used (practical ambiguity); (b) relational barriers concerning communication and collaboration both between health care professionals and with family; (c) organizational barriers related to the organization of care in nursing homes where, for example, there is no on-site physician, or where the recommended medication is not always available. Discussion and Implications The findings suggest there are considerable challenges for sound decision making about and performance of continuous sedation until death in nursing homes. There is a need for multicomponent initiatives that provide guidance in the context of the complexity of a resident’s medical situation, the family, and the specific organization of care, which would have the potential to facilitate and improve the decision-making process and performance of continuous sedation in nursing homes.
- Subjects :
- Adult
Male
Research design
Palliative care
Health Personnel
media_common.quotation_subject
Sedation
Decision Making
Context (language use)
law.invention
Belgium
Nursing
law
Surveys and Questionnaires
Health care
medicine
Humans
Qualitative Research
Aged
media_common
Terminal Care
business.industry
Communication Barriers
Palliative Care
General Medicine
Ambiguity
Focus Groups
Middle Aged
Focus group
Nursing Homes
CLARITY
Female
Deep Sedation
Geriatrics and Gerontology
medicine.symptom
business
Psychology
Gerontology
Subjects
Details
- Language :
- English
- ISSN :
- 17585341 and 00169013
- Volume :
- 60
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- The Gerontologist
- Accession number :
- edsair.doi.dedup.....7a77110cf9c171b60af2b61674a5bc65