Challenges Recognized by Ward Managers Regarding End-of-Life Care Management for the Oldest-Old Patients Admitted to Acute Care Wards

Abstract

　Objective：The purpose of this study was to clarify the challenges that ward managers perceive in the management of end-of-life care （EOL care） for older patients aged 90 years or above （hereafter, “oldest-old”） admitted to acute care wards.

　Methods：This study targeted ward managers of acute care wards in 414 facilities in the Kanto region in which oldest-old patients were hospitalized. An anonymous self-administered questionnaire was distributed to two ward managers at each facility, and responses were collected individually via mail.

　Results：A total of 828 questionnaires were distributed, of which 196 indicating respondents’ consent were analyzed. Of the respondents, 59.4% reported experiencing the death of one or more oldest-old patient per month. Among the items that staff nurses were perceived to be aware of in EOL care for oldest-old patients, “what the oldest-old patient values” was the least frequently mentioned, while “advance care planning” was the most frequently cited item that departments wished to strengthen. The most frequently cited area for strengthening EOL care management skills was “building a team capable of providing nursing care tailored to the characteristics of the oldest-old patients.”

　Discussion：According to the respondents’ perceptions, staff nurses may not be able to provide EOL care that reflects a patient’s worldview and values, despite it being the core of EOL care. Ward managers must improve their management skills in team building tailored to the characteristics of their departments.