An evaluation of the impact of the Gold Standards Framework on collaboration in end-of-life care in nursing homes. A qualitative and quantitative evaluation
Section snippets
Background
In England over a third of people aged 85 and over will die in a care home (Seymour et al., 2005), and admissions may occur specifically for end-of-life care. Similar profiles of care home deaths are evident in the United States and Australasia (Teno, 2003, Marshall et al., 2011). However, until relatively recently, homes had a low profile in terms of their contribution to care for frail older people (Hockley and Clark, 2002, Bowman, 2011). Clearly though, they have significant roles in
Literature review
Practitioners working with nursing homes include general practitioners, district nurses and nursing and medical specialists in palliative care (SPC). However there is little research into collaboration between homes and these services (Katz, 2003, Goodman et al., 2005). This requires investigation, because the various health care sectors have different cultures which may impact upon care (Avis et al., 1999, Miller, 2010). Additionally homes vary in terms of resident type, size, management style
Setting and participants
Research sites were the nursing homes participating in the GSFCH programme, and evaluation participants included managers, staff, residents and family. The four one-day GSFCH workshops for nurse managers and senior nurses were held between June 2005 and February 2006. The research evaluation team and the GSFCH development team were separate. However, indicative outcomes were reported to the development team, to inform programme review. Nursing homes were recruited to the programme by local
Homes’ relationships with health services at baseline
At baseline, variations were revealed in nursing homes’ relationships with other services. There were structural differences, such as the number of GP practices which had patients in the home, and operational issues such as staff perceptions of GP support and knowledge of palliative care.
On average, homes worked with four GP practices. However, one third (35%) liaised with just one or two practices while almost one in five (17%) worked with 10 or more. Given the size of some group practices,
Discussion
The evaluation of the Gold Standards Framework in Care Homes indicated that the programme has the potential to improve collaborative end-of-life care delivery between home staff and other health professionals. The longitudinal survey response rate of 52% was encouraging, given that nursing home response rates are typically lower than this (Marshall et al., 2011). Liaison between homes and GP practices reflected earlier findings: only a minority of homes had contact with one practice, while the
Conclusion
The GSFCH programme offered nursing homes a systematic approach to end-of-life care which included training, support and opportunities for networking. Together these elements provided a tangible acknowledgement of the key role of nursing homes in providing end-of-life care. They also contributed to improvements in knowledge among the participants, empowered managers, and improved communication and collaboration between homes and other health services. While some problems endured, many staff
Acknowledgements
We are grateful to all participants for their involvement and to The Gold Standards Framework team for their cooperation. Chris Wright provided statistical advice. The study was supported by a grant from Macmillan Research and Education group.
References (64)
- et al.
Strategies and innovative models for delivering palliative care in nursing homes
Journal of the American Medical Directors Association
(2011) - et al.
The impact of organisational and individual factors on team communication in surgery: a qualitative study
International Journal of Nursing Studies
(2010) - et al.
An analysis of calls to an out-of-hours palliative care advice line
Public Health
(2003) - et al.
The opportunity for collaborative care provision: the presence of nursing home/hospice collaborations in the U.S. states
Journal of Pain and Symptom Management
(2004) - et al.
Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia
Patient Education & Counseling
(2006) - et al.
What influences referrals within community palliative care services? A qualitative case study
Social Science & Medicine
(2008) - et al.
What fosters or prevents interprofessional teamworking in primary and community care? A literature review
International Journal of Nursing Studies
(2008) The concept of collaboration in primary care
- et al.
Evaluation of a project providing community palliative care support to nursing homes
Health and Social Care in the Community
(1999) - et al.
An evaluation of the implementation of a programme to improve end-of-life care in nursing homes
Palliative Medicine
(2009)