BACKGROUND In Switzerland as in many countries, steady trend is observed in nursing homes to promote writing of advanced directives (ADs). Implementation of ADs reflects the rise in public concern for the persons' right to self-determination and informed decision. The issue of end-of-life conditions is particularly acute in situations with dementia. This article investigates how ADs interventions in nursing homes strive simultaneously to behave in line with the principles of care ethics and with the intention to respond to legally binding instructions. Healthcare to dying residents with dementia in nursing homes is interpreted in light of the Regulation theory. METHODS Nursing home palliative care reference nurses were contacted through questionnaire. One hundred twenty-one addresses were reached, 69 responses were collected, giving a response rate of 57%. In order to deepen the understanding, 10 semi-directive interviews were conducted in 10 different nursing facilities with 12 palliative nurses. RESULTS Presently, Swiss nursing homes are lacking a model of AD suitable to people with dementia. The study sheds light on dissimilarities in the purpose assigned to ADs' procedure in the different facilities. Discrepancies in end-of-life care practices reveal more the influence of structural and organisational devices specific to each setting than conflicting views on end-of-life care principles. We analyse the interpretation of the Law and its implementation in the participating NHs as compromises that could be accounted for as a form of social regulation. CONCLUSION Dementia accentuates the uncertainty inherent to end-of-life trajectories. The implementation of standardised procedures aimed at collecting the wishes of the person deprived of his or her discernment is source of dissonances with regard to the multiple interests involved in these care situations. In this context, the drafting of ADs during end-of-life care in NH correspond to new normative constraints requiring new collective regulation actions.

中文翻译：

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报废的社会法规活动：对完成瑞士养老院的预先指令的定性研究。

背景技术在瑞士和许多国家一样，在养老院中观察到稳定的趋势以促进高级指令（AD）的编写。实施反倾销措施反映出公众日益关注人们的自决权和知情决定权。在痴呆症患者中，生命终止状况的问题尤为严重。本文调查了AD护理院中的干预措施如何同时努力遵循护理伦理原则并试图对具有法律约束力的指示做出回应。根据监管理论，对护理院中垂死的痴呆症居民的医疗保健进行了解释。方法通过问卷与护理院姑息治疗参考护士进行联系。到达了一百二十一个地址，收集了69个回复，回应率为57％。为了加深理解，我们在10个不同的护理机构与12位姑息护士进行了10次半指导性访谈。结果目前，瑞士的养老院缺乏适合痴呆症患者的AD模型。该研究揭示了在不同设施中分配给AD程序的目的的差异。与对报废医疗原则的观点不一致时相比，报废医疗实践的差异更多地揭示了针对每种环境的结构和组织机构的影响。我们将对法律的解释及其在参与的国家人权机构中的实施分析为折衷，可以作为一种社会监管形式来解释。结论痴呆症加剧了生命终结轨迹固有的不确定性。旨在收集被剥夺了自己的见识的人的意愿的标准化程序的实施，在涉及这些护理情况的多重利益方面引起了不和谐的根源。在这种情况下，新罕布什尔州临终关怀期间起草AD对应于新的规范约束，需要新的集体监管措施。