Sveikatos priežiūros profesionalų ir administracijos darbuotojų požiūrio į gyvenimo pabaigos sprendimus Lietuvos sveikatos priežiūros įstaigose analizė ; Analysis of attitude of health professionals and administrative staff to the end of life decisions in Lithuanian health care institutions
In order to ensure the quality of life for the aging society, it is necessary to reconsider the end of life decision-making, service organization, continuous improvement thereof. Such decisions are ethnically complex and require a lot of human and financial resources. Aim of the work: To investigate the attitude of health care professionals and administrators to the end of life decision management in Lithuanian health care institutions. Research methodology. Anonymous questionnaire survey was performed. The group of respondents consisted of the employees of intensive care units of Vilnius, Kaunas, Klaipeda city hospitals (doctors, nurses), administration staff (unit selected according to the selection criteria) and politicians. The study was conducted in December 2016 . The number of fully completed questionnaires – 237. The response rate was 52.3%. Statistical analysis of data was performed using the statistical data analysis package IBM SPSS Statistics Subscription. Differences of variables were considered as statistically significant when p < 0.05. Relations between the attributes were assessed using the chi-square (χ²) criterion. Results. Statistically significantly, greater part of the "clinicians" respondents (27.9%) compared with non-clinicians (12.3%) stated that the decisions related to the patient's vital functions should be taken by the patient himself. The greater part of the "clinicians" respondents (52.9%) compared with non-clinicians (41.5%) believe that the number of qualified personnel in health care facilities is insufficient. The shortage is observed among psychologists, nurses, and nursing assistants. A statistically significantly greater proportion of those involved in the waiting of the life end outcome (57.5%) compared with non-participating (33.8%) respondents believe that the number of qualified personnel is insufficient in health care facilities and a statistically significantly higher proportion of those who did not participate (66.2%) compared to the participants (42.5%) respondents believe that the numbers of qualified personnel are sufficient (p <0.5). Statistically significantly greater part of the "clinicians" respondents (88.4%) compared with non-clinicians (75.4%) answered that it is necessary to apply additional motivation measures for staff working with palliative patients. Conclusions: Significant decision-making in the health care system, especially for the end of life decisions, is a hybrid of the general management knowledge and specialized medical (health care) knowledge. When assessing the results of research, we can state that significantly more "clinicians" respondents rated the availability and quality of service worse than the respondents' non-clinicians. Part of the "clinicians" (44.8%) would initiate the rearrangement and improvement of hospital services related with the end of life decisions however, they do not know where to start. In the opinion of the research participants, the crucial decisions concerning the end of life should be made by a clinical consultation, the patient himself or the God. The majority (29.5%) of nurses and doctors (16.5%) who took part in the research believe that the staff devotes sufficient attention to the patient. Practical recommendations. To create a personnel incentive system that encourages provide more attention to the patient, carefully carry out their duties, seek to promote the satisfaction of patients and is relatives with the performance of the physician. Reallocation of financial resources for employment of the missing qualified personnel (nurses, assistant nurses, psychologists for the staff, patients and their relatives).