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Authors: Oftring, Zoe
Title: Einführung der Handlungsempfehlung Sterbephase (HES) auf jeweils zwei Akutstationen der I. und III. Medizinischen Klinik der Universitätsmedizin Mainz – eine Begleitstudie zur Ermittlung der Machbarkeit und von Veränderungen in der Betreuung Sterbender
Online publication date: 7-Jan-2022
Language: german
Abstract: Background: To our knowledge, this is the first study on the implementation of the “Handlungsempfehlung Sterbephase (HES)”. The HES is the successor document of the Liverpool Care Pathways (LCP) for the German-speaking countries. It is a multidimensional instrument that can support health care professionals in caring for terminally ill patients and their relatives. Aim: Our aim was to investigate the feasibility of implementing the HES in four acute care internal medicine wards at the University Hospital Mainz and to record changes in the quality of care from the perspective of nursing staff. Methods: A mixed methods pre-post design was chosen to collect data before and after the implementation process. In terms of quantitative data, records of patients who had died pre-implementation (Base Review) or who died during the study phase with HES inclusion (Post Review) were analysed. For patients who were not treated according to the HES, the reasons were recorded descriptively. Additionally, nurses were interviewed using a written questionnaire. In terms of qualitative data, nurses participated in focus group interviews. These were analysed using qualitative content analysis. Results: During the 27-month study phase (January 2016 – April 2018), 330 patients died on the 4 pilot wards, 71 (22%) of whom were included in the HES. For 7 other patients, the HES was discontinued as their condition improved. The evaluation of 80 Base and 78 Post Review documents revealed a significant improvement of the documentation in the patient record for both oncological and non-oncological patients, particularly in terms of symptom control, communication, and discontinuing of stressful procedures. According to the questionnaire, nurses saw improvements in 15 of 16 aspects. According to the focus group interviews, the HES resulted in more structure, more openness, and a changed attitude towards dying. Nurses described more satisfaction and security and 12 out of 14 nurses wanted to continue using the HES. However, divergences with physicians were burdensome and in some cases presented a barrier to starting treatment according to the pathway. Conclusion: The application of the HES care pathway for the dying phase in a university acute care setting is feasible. Although its implementation requires training, time, and staff, it can significantly improve the care for the dying and their relatives. It also results in more satisfaction, security and cooperation between nurses and physicians.
DDC: 610 Medizin
610 Medical sciences
Institution: Johannes Gutenberg-Universität Mainz
Department: FB 04 Medizin
Place: Mainz
Version: Original work
Publication type: Dissertation
License: in Copyright
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Extent: XVII, 325 Seiten, Illustrationen, Diagramme
Appears in collections:JGU-Publikationen

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