Correspondence to Chiho Shimada, Tokyo Metropolitan Institute of Gerontology E-mail: shimadac@tmig.or.jp

The Influences of Collaborative Reflection on Nursing Home Staff Members’ View of End of Life Care

Chiho Shimada, Ryo Hirayama, Mio Ito, Ryutaro Takahashi Tokyo Metropolitan Institute of Gerontology 　　　　　　　　　　　　　　　　　　　　　　　　　　　　　

【 Background】

【 Discussion 】

【 Results】

2) Second Phase: Collaborative ReflectionAfter individual reflection, participants met and discussed their experiences, and gave feedback to each other.

【 Methods】

【 Objectives】

【 Analysis】In Japan, nursing homes (NHs) have received increasing attention as an end of life (EOL) care setting. It is necessary for staff members to mutually share and learn from their care experiences.

Using preliminary data from Japanese NH staff members engaged in EOL care for older residents, we explored whether and how staff members’ view of EOL care might be influenced by participation in a program to reflect on care experiences individually and collaboratively.

Reflection Program for NH Staff Members on EOL CareSeven NHs introduced this program, and staff members from multiple disciplines (e.g., care workers, nurses, care managers) in each NH participated in the two-phased process described below.

1) First Phase: Individual ReflectionParticipants reflected on their care experiences individually by answering a questionnaire (as below, in Japanese) after the resident’s death.

We first generated codes such that they summarized the subjective influences of program participation (e.g., what participants learned, how their view of EOL care changed) indicated in descriptions. Then, these codes were categorized according to the similarity of the meaning.

Whereas the program is suggested to help participants to review their care experiences, what they have found and learned during the sessions varies. To clarify the process through which participating in the program affects NH staff members’ views, we seek to explore individual (e.g., participants’ characteristics) and situational/contextual (e.g., how the session proceeds) factors that make a difference in the influences of collaborative reflection.

DataAfter collaborative reflection, participants described what they felt and found throughout the program. Their descriptions were used for our content analysis. Total number of participants were 290. Of those, 200 participants provided descriptions.

The story about the resident that you think illustrates what s/he was

like

Whether and how you provided EOL care in considering the resident’s personality and

preference

Observed EOL symptoms

Whether and how symptoms were controlled

Adherence to the EOL care plan

Whether and how you tried to relieve the resident’s pain and

distress

Family members’ involvement with EOL care

How peaceful the resident looked when died

Evaluation of EOL care for the resident provided in your NH

Things (if any) that stick to your mind and/or you regret around

your EOL caregiving to the resident

Words that the resident’s family members gave you during and/or

after your EOL caregiving

Looking Back Across Time

<Building shared memory>

<Contextualizing experiences>

<Gaining confidence in my care performance >

Eliciting Lessons to Elevate the Quality of Care

“I was relieved after I found my colleague also felt anxiety.”“I found I’m not the only one who was not satisfied with the practice.”

“The program helped me to look the whole process of my caregiving, not only my feeding, which I couldn’t do well, and I now think, all in all, what we did was not so bad.

“I wasn’t sure that I did it right but I felt relieved when they gave me supportive comments on my practice in the discussion.” “I got confident in what I did for him.”

“I recognized how my colleagues felt in the process of this EOL care”“I didn’t know that they had such strong motivation to care for the resident until the very end of his life.”“It was nice to get additional information about the resident and to understand different idea of EOL care.”

<Finding diversity: Respecting difference>

<Sharing feelings about EOL care>

<Reminiscing>

“I was sorry to have been absent at the last, but I felt satisfied after hearing of the last condition from my colleagues. “

“The program gave us a good opportunity to remember together what she was like.”

<Identifying how to train myself as a professional care provider>

<Identifying organizational tasks to develop EOL care system>

Reviewing My Experiences in Relation to Others’

“We have to communicate with each other more often.”“I found that it’s important for staff members to work with family members closely”

“I would like to learn from the way my colleagues provided care in order to improve my practice.”