Perceptions of optimal end‐of‐life care in hospitals: A cross‐sectional study of nurses in three locations

Aim To examine whether nurses' location of employment, demographics, or training influences their perceptions of what constitutes optimal care for dying patients in hospital. Design Questionnaire‐based, cross‐sectional study. Methods Between December 2016–June 2018, 582 registered or enrolled nurses from Australia (N = 153), South Korea (N = 241), and Hong Kong (N = 188) employed in a variety of hospital care units rated the extent to which they agreed with 29 indicators of optimal end‐of‐life care across four domains: patient, family, healthcare team, and healthcare system. Latent class analysis identified classes of respondents with similar responses. Results Top five indicators rated by participants included: ‘physical symptoms managed well’; ‘private rooms and unlimited visiting hours’; ‘spend as much time with the patient as families wish’; 'end‐of‐life care documents stored well and easily accessed’ and ‘families know and follow patient's wishes’. Four latent classes were generated: ‘Whole system/holistic’ (Class 1); ‘Patient/provider‐dominated’ (Class 2); ‘Family‐dominated’ (Class 3) and ‘System‐dominated’ (Class 4). Class 1 had the highest proportion of nurses responding positively for all indicators. Location was an important correlate of perceptions, even after controlling for individual characteristics. Conclusion Nurses' perceptions of optimal end‐of‐life care are associated with location, but perhaps not in the direction that stereotypes would suggest. Findings highlight the importance of developing and implementing location‐specific approaches to optimize end‐of‐life care in hospitals. Impact The findings may be useful to guide education and policy initiatives in Asian and Western countries that stress that end‐of‐life care is more than symptom management. Indicators can be used to collect data that help quantify differences between optimal care and the care actually being delivered, thereby determining where improvements might be made. 摘要 目标 研究护士的工作地、人口统计或培训是否影响其对医院临终病人理想关怀的看法。 设计 基于问卷调查的横断面分析研究。 方法 2016年12月至 2018年6月,582名来自澳大利亚(N = 153)、韩国(N = 241)和香港(N = 188)各医院科室定额的登记或注册护士,他们对29个理想临终关怀指标表示认同,涵盖患者、家庭、医疗团队和医疗系统四大领域。潜在类别分析将给出相似回答的受访者归为一类。 结果 受访者评分最高的五个指标包括:“身体症状管理良好”,“私人病房和不限探视时间”,“家属尽情陪护患者”,“临终关怀文件保存良好且易于获取”,“家属了解并遵循患者意愿”。生成的四个潜在类别是:“全系统/整体”(1类)、“患者/提供者主导”(2类)、“家庭主导”(3类)和“系统主导”(4类)。第1类对所有指标给出积极回答的护士比例最高。即使在控制了个体特征之后,其工作地也是感知的重要关联。 结论 护士对理想临终关怀的看法与所在地有关,但可能与刻板印象暗示的方向无关。研究发现强调制定和实施特定工作地方法以优化医院临终关怀的重要性。 影响 研究发现可能有助于指导亚洲和西方国家的教育和政策举措,这些国家强调临终关怀不