Datum	24 september 2010
Tijd	09.00 - 09.45 uur
Soort	Plenaire sessie
Zaal	EUROPA
Keynote spreker	mw. J. Hockley - St Christopher's Hospice
Voorzitter	mw. dr. S.C.C.M. Teunissen
Developing high quality end of life care for older people in nursing care homes – challenges and possible solutions More and more frail older people are dying in nursing homes. However, there are reports that there is concern over the lack of knowledge in end of life care. Two independent nursing homes (NH1, NH2a & NH2b) volunteered to take part in an action research study to develop high quality end of life care. In each nursing home, an exploratory phase was undertaken using focus groups, interviews, participant observation, and documentary analysis. This exploratory work confirmed specific contextual and clinical issues related to end-of-life care and highlighted that dying was peripheral to the nursing home culture where the emphasis was on functional rehabilitation. In each home, an initiative, inductively derived from discussion with staff and based on the exploratory phase, was devised and implemented. In the first nursing home, the initiative entailed development of ‘collaborative learning groups’ (CLGs) which took place following the death of a resident; in the second home, the adaptation and introduction of an ‘integrated care pathway (ICP) for the last days of life’ to be used prior to the death of a resident, provided a system around which high quality end-of-life care could be promoted. Both actions were evaluated. These initiatives enabled a greater openness towards death and dying in both nursing homes. A model for developing practice is presented combining these two inductively derived initiatives that acknowledge the importance of both the lifeworld of staff in their care of dying residents and their families and the nursing home system. This model, and the process of undertaking the action research, is discussed in relation to Habermas’s Theory of Communicative Action – a substantive theory of ‘system’ and ‘lifeworld’.
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