飯田 貴映子

Abstract Long-term care facilities are increasingly important places for palliative and end-of-life care provision in Japan. While the importance of culture has been noted for palliative and end-of-life care, an exploration of its influence on care provision in long-term care settings has received little direct attention in Japan. Exploring staff views and beliefs in palliative and end-of-life care in these settings can potentially enhance our understanding of culturally oriented care and facilitate the development of tailored and more effective support practices. This study aimed to explore the cultural views and beliefs regarding palliative and end-of-life care among the staff in Japanese long-term care facilities. A qualitative exploratory study was conducted using focus groups with facility staff (N = 71) and semi-structured interviews with facility managers (N = 10) in the Kanto region of Japan. Thematic analysis was conducted according to Braun and Clarke's approach. The findings are presented in five key themes: ‘Changes in society's and family's end-of-life perspectives’, ‘Values and beliefs regarding death and dying’, ‘Anxiety and regret’, ‘Tensions in doing the right thing’ and ‘Ways of alleviating pressure’. The findings indicate that the provision of palliative and end-of-life care is underpinned by cultural nuances that influence care providers' approach and delivery. Recognising and understanding the cultural beliefs of staff around death, dying and end-of-life care are important in meeting the needs of residents. Palliative care education for staff in these settings should include cultural considerations that reflect changing societal views on death and dying.

BACKGROUND: Given the increase in the number of deaths within long-term care facilities (LTCFs), the need for palliative and end-of-life (EOL) care education among such facilities has been increasing. As such, a systematic synthesis of global palliative and EOL care educational approaches and evaluation can aid further educational development. OBJECTIVE: To synthesise the current literature on palliative and EOL care educational interventions for staff working in LTCFs and identify barriers to, and facilitators of, intervention implementation. METHODS: The study used an integrative review framework wherein indexed databases, namely, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library and Japan Medical Abstract Society, were systematically searched for studies published in English and Japanese between 2007 and 2019. Search terms that are related to palliative care, LTCF, and education were combined to increase search sensitivity. The quality of the papers was assessed using Joanna Briggs Institute Critical Appraisal Tools and the Mixed-Methods Appraisal Tool. RESULTS: A total of 52 studies were included in the review. Our results suggested that although studies in this area and setting have been evolving, suboptimal developmental research and educational practices, global variability and unstandardised approaches to education and lacking viewpoints from service users have remained. Barriers to intervention implementation were also reported due to the specific characteristics of LTCFs, which include high staff turnover and considerable variation in professional skills and experience. CONCLUSIONS: Given the different LTCF types, systems and policies across each country or region, further research on standardised educational interventions with contextual considerations using large-scale studies with robust methodology is needed to meet the increasing demand for palliative and EOL care among the global ageing population. IMPLICATIONS FOR PRACTICE: Palliative and EOL care educational intervention for LTCF staff need to include more consideration of context, organisational culture and the user involvement throughout the process of education and research to enhance the quality of care in this complex setting.

OBJECTIVE: The objective of this qualitative systematic review is to evaluate and synthesize the recent literature on advance care planning (ACP) experiences of community-dwelling older people in interaction with community healthcare professionals. INTRODUCTION: The importance of healthcare professionals initiating ACP with their patients and clients has been reported. However, older people who live in the community have fewer opportunities to have discussions regarding ACP with healthcare professionals compared with those who live in other settings. Timely initiation of ACP and sustainable discussion among older people, families, and community healthcare professionals is expected, which may lead to improved palliative and end-of-life care in the community. INCLUSION CRITERIA: This review will consider studies that include individuals older than 60 years living in their homes in the community. Studies published in English or Japanese that focus on qualitative data and are published from 1999 to present will be considered. METHODS: The key information sources to be searched are: MEDLINE, CINAHL, Embase, PsycINFO, JSTORE, Scopus, Japan Medical Abstract Society, CiNii for published papers, and Google Scholar, ProQuest Dissertations & Theses Global, and MedNar for unpublished papers and gray literature. Eligible studies will be critically appraised using the standardized JBI tool. Qualitative research findings will be pooled using the meta-aggregation approach. Then the final synthesized findings will be graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis and presented in a Summary of Findings.

高齢者長期ケア施設における外国人看護職・介護職の就労の現状などを明らかにすることを目的に、関東地方の介護保健施設を対象にアンケート調査を行い、383施設(老人保健施設166施設、介護老人福祉施設170施設、療養型病床47施設)より有効回答を得た。その結果、108施設(27.4%)が外国人職員の雇用経験があり、雇用した職種は、ヘルパー85名(35.0%)、無資格介護職75名(30.9%)、介護福祉士18名(7.4%)、看護助手42名(17.3%)、EPA(経済連携協定)による介護福祉士候補15名(6.2%)、准看護師3名(1.2%)、看護師1名(0.7%)で、フィリピン出身者を雇用した施設が最も多く、以下、中国、韓国、ブラジルなどであった。