With the aging of the population, dying with dementia will become one of the most common ways in which older adults will end their final years of life, particularly for those living in a nursing home. Though individuals living with dementia have complex care needs and would benefit from a palliative approach to care, they have traditionally not been recipients of such care. An important aspect of determining quality in end-of-life care is the identification of expert practices, processes or behaviors that may help achieve this care. However, for those living with dementia in nursing homes, we have a limited understanding of how to best support expert end of life care. To redress this gap in knowledge, the purpose of this study was to examine and describe expert care of the individual with dementia approaching death from the perspective of nurses and health care aides (HCAs) identified by their peers as having special expertise in caring for this population. A qualitative research design known as Interpretative Description was used to conduct the study. Expert nurses and HCAs were identified through a two-phase nomination process. Individual semi-structured interviews were conducted with consenting participants. Data were analyzed using constant comparative analysis to determine the key critical behaviors. Analysis of data collected from expert nurses (n = 8) and HCAs (n = 7) revealed six critical behaviors when caring for residents dying with dementia. All nurses and HCAs unanimously endorsed that the overarching goal of care is similar for all residents who are actively dying; to achieve comfort. The six critical behaviors in caring for residents dying with dementia included: 1) recognizing and responding to changes in a resident’s pattern of behavior; 2) attending to the person; 3) working with the family; 4) engaging with others; 5) responding after the death has occurred; and 6) having a positive attitude toward care of the dying. The critical behaviors described by nurses and HCAs in this study provides emerging evidence of best practices in care of those with dementia and their families, particularly near the end of life within the nursing home setting.

中文翻译：

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护理因痴呆症死亡的疗养院居民的关键护理和医疗保健助手行为

随着人口老龄化，死于痴呆症将成为老年人结束生命最后几年的最常见方式之一，尤其是对于那些住在疗养院的人。尽管患有痴呆症的人有复杂的护理需求，并且会从姑息性护理中受益，但他们传统上并不是这种护理的接受者。确定临终关怀质量的一个重要方面是确定可能有助于实现这种关怀的专家实践、流程或行为。然而，对于那些住在疗养院的痴呆症患者，我们对如何最好地支持专家临终关怀的理解有限。为了弥补这一知识差距，本研究的目的是从护士和医疗保健助手 (HCA) 的角度来检查和描述对濒临死亡的痴呆症患者的专家护理，他们的同行认为他们在护理该人群方面具有特殊专业知识。使用称为解释性描述的定性研究设计进行研究。通过两个阶段的提名过程确定了专家护士和 HCA。与同意的参与者进行了单独的半结构化访谈。使用持续比较分析对数据进行分析，以确定关键的关键行为。对从专家护士 (n = 8) 和 HCA (n = 7) 收集的数据进行的分析揭示了在照顾死于痴呆症的居民时的六种关键行为。所有护士和 HCA 一致同意，所有正在死亡的居民的总体护理目标是相似的；达到舒适。照顾因痴呆症死亡的居民的六种关键行为包括：1）识别和应对居民行为模式的变化；2) 照顾该人；3) 与家人一起工作；4) 与他人交往；5) 死亡发生后的反应；6) 对临终关怀抱有积极的态度。本研究中护士和 HCA 描述的关键行为为护理痴呆症患者及其家人的最佳实践提供了新的证据，特别是在疗养院环境中接近生命结束时。1) 识别和应对居民行为模式的变化；2) 照顾该人；3) 与家人一起工作；4) 与他人交往；5) 死亡发生后的反应；6) 对临终关怀抱有积极的态度。本研究中护士和 HCA 描述的关键行为为护理痴呆症患者及其家人的最佳实践提供了新的证据，特别是在疗养院环境中接近生命结束时。1) 识别和应对居民行为模式的变化；2) 照顾该人；3) 与家人一起工作；4) 与他人交往；5) 死亡发生后的反应；6) 对临终关怀抱有积极的态度。本研究中护士和 HCA 描述的关键行为为护理痴呆症患者及其家人的最佳实践提供了新的证据，特别是在疗养院环境中接近生命结束时。