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Professional caregivers' experiences with the Liverpool Care Pathway in dementia: An ethnographic study in a Dutch nursing home

Published online by Cambridge University Press:  11 July 2017

Natashe Lemos Dekker ,
Marjolein Gysels  and
Jenny T. van der Steen Open the ORCID record for Jenny T. van der Steen [Opens in a new window]
Natashe Lemos Dekker*
Affiliation:
Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
Marjolein Gysels
Affiliation:
Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
Jenny T. van der Steen
Affiliation:
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
*
Address correspondence and reprint requests to: Natashe Lemos Dekker, Amsterdam Institute for Social Science Research, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands. E-mail: N.lemosdekker@uva.nl.
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Abstract

Objective:

There are few studies on how professional caregivers apply the Liverpool Care Pathway (LCP) in nursing home care for people with dementia. Further, despite critiques in the United Kingdom, the LCP continues to be used in the Netherlands, while, to the best of our knowledge, no studies have been conducted since its implementation. The purpose of the present study was to analyze professional caregivers' experiences with the LCP in this context.

Method:

This article draws on an ethnographic study. Data collection was based on 4 months of ethnographic fieldwork in 2015 in 11 psychogeriatric units of a nursing home in a rural area of the Netherlands. Data collection included participant observation and 25 semistructured audiotaped interviews with specialist elderly care physicians, nursing staff, and a nurse practitioner.

Results:

We found that professional caregivers appreciate the LCP as a communication tool and as a reminder of care goals. However, the document was deemed too complicated and to cause duplication of work. It was also reported that the LCP did not cover the complexity of care needs that emerge in practice. Actual care needs were prioritized over the LCP, which calls its contribution into question.

Significance of Results:

Overall, the LCP does not match the context of dementia care in the nursing home. While it could be argued that the LCP does not intend to replace good care, its benefits as a reminder and a communication tool need continued consideration in relation to the amount of work it requires as a bureaucratic obligation.

Keywords

Liverpool Care PathwayDementiaNursing homeProfessional caregiversEthnography
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Special Issue 4: Topics in Bereavement , August 2018 , pp. 479 - 486
Copyright
Copyright © Cambridge University Press 2017 

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References

REFERENCES

Brännström, M., Fürst, C.J., Tishelman, C., et al. (2016). Effectiveness of the Liverpool Care Pathway for the dying in residential care homes: An exploratory, controlled before-and-after study. Palliative Medicine, 30(1), 54–63.Google Scholar
Brown, M.A., Sampson, E.L., Jones, L., et al. (2013). Prognostic indicators of 6-month mortality in elderly people with advanced dementia: A systematic review. Palliative Medicine, 27(5), 389–400.Google Scholar
Chan, R.J. & Webster, J. (2016). End-of-life care pathways for improving outcomes in caring for the dying. The Cochrane Database of Systematic Reviews, 1, CD008006. doi: 10.1002/14651858.CD008006.pub2.Google Scholar
Clark, J.B., Sheward, K., Marshall, B., et al. (2012). Staff perceptions of end-of-life care following implementation of the Liverpool Care Pathway for the Dying Patient in the acute care setting: A New Zealand perspective. Journal of Palliative Medicine, 15(4), 468–473.Google Scholar
Davies, N., Manthorpe, J., Sampson, E.L., et al. (2015). After the Liverpool Care Pathway: Development of heuristics to guide end-of-life care for people with dementia. Protocol of the ALCP study. BMJ Open, 5(9), e008832. doi: 10.1136/bmjopen-2015-008832.Google Scholar
Di Leo, S., Romoli, V., Higginson, I.J., et al. (2015). “Less ticking the boxes, more providing support”: A qualitative study on health professionals' concerns towards the Liverpool Care of the Dying Pathway. Palliative Medicine, 29(6), 529–537.Google Scholar
Duffy, A., Payne, S. & Timmins, F. (2011). The Liverpool Care Pathway: Does it improve quality of dying? [corrected]. British Journal of Nursing, 20(15), 942–946.Google Scholar
Ellis-Smith, C., Evans, C.J., Bone, A.E., et al. (2016). Measures to assess commonly experienced symptoms for people with dementia in long-term care settings: A systematic review. BMC Medicine, 14, 38.Google Scholar
Erasmus Medical Center (2017). Zorgpad Stervensfase (Verbetertraject) [in Dutch]. Utretcht: KNL Integral Kankercentrum Nederland. Available from www.iknl.nl/palliatieve-zorg/verbetertrajecten/zorgpad-stervensfase.Google Scholar
Gambles, M., Stirzaker, S., Jack, B.A., et al. (2006). The Liverpool Care Pathway in hospices: An exploratory study of doctor and nurse perceptions. International Journal of Palliative Nursing, 12(9), 414–521.Google Scholar
Geijteman, E.C., Dekkers, A.G. & van Zuylen, L. (2013). 10 years after implementation of the Liverpool Care Pathway for the Dying Patient: Important improvements in end-of-life care [in Dutch]. Ned Tijdschr Geneeskd, 157(37), A6174.Google Scholar
George, R., Martin, J. & Robinson, V. (2014). The Liverpool Care Pathway for the Dying Patient (LCP): Lost in translation and a tale of elephants, men, myopia—and a horse. Palliative Medicine, 28(1), 3–7.Google Scholar
Glaser, B.G. & Strauss, A.L. (1967). The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine Publishing.Google Scholar
Hendriks, S.A., Smalbrugge, M., Galindo-Garre, F., et al. (2015). From admission to death: Prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia. Journal of the American Medical Directors Association, 16(6), 475–481.Google Scholar
Jack, B.A., Gambles, M., Murphy, D., et al. (2003). Nurses' perceptions of the Liverpool Care Pathway for the Dying Patient in the acute hospital setting. International Journal of Palliative Nursing, 9(9), 375–381.Google Scholar
Lichtner, V., Dowding, D., Esterhuizen, P., et al. (2014). Pain assessment for people with dementia: A systematic review of systematic reviews of pain assessment tools. BMC Geriatrics, 14, 138.Google Scholar
Mayland, C.R., Williams, E.M., Addington-Hall, J., et al. (2013). Does the “Liverpool Care Pathway” facilitate an improvement in quality of care for dying cancer patients? British Journal of Cancer, 108(10), 1942–1948.Google Scholar
Neuberger, J.B., Guthrie, C., Aaronovitch, D., et al. (2013). More Care, Less Pathway: A Review of the Liverpool Care Pathway. London: Department of Health. Available from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf.Google Scholar
Ramasamy Venkatasalu, M., Whiting, D. & Cairnduff, K. (2015). Life after the Liverpool Care Pathway (LCP): A qualitative study of critical care practitioners delivering end-of-life care. Journal of Advanced Nursing, 71(9), 2108–2118.Google Scholar
Robinson, A., Eccleston, C., Annear, M., et al. (2014). Who knows, who cares? Dementia knowledge among nurses, care workers, and family members of people living with dementia. Journal of Palliative Care, 30(3), 158–165.Google Scholar
Sleeman, K.E. & Collis, E. (2013). The Liverpool Care Pathway: A cautionary tale. BMJ (Clinical Research ed.), 347, f4779. doi: 10.1136/bmj.f4779.Google Scholar
Swart, S.J., van Veluw, H., Koningswoud, J., et al. (2003). Van “Liverpool Integrated Care Pathway” naar “Zorgpad voor de Stervensfase–Rotterdam” [in Dutch]. Nederlands Tijdschrift voor Palliatieve Zorg, 4(1), 12–161.Google Scholar
van der Steen, J.T. (2010). Dying with dementia: What we know after more than a decade of research. Journal of Alzheimer's Disease, 22(1), 37–55.Google Scholar
van der Steen, J.T., Heymans, M.W., Steyerberg, E.W., et al. (2011). The difficulty of predicting mortality in nursing home residents. European Geriatric Medicine, 2(2), 79–81.Google Scholar
Veerbeek, L., van Zuylen, L., Swart, S.J., et al. (2008). The effect of the Liverpool Care Pathway for the Dying: A multi-centre study. Palliative Medicine, 22(2), 145–151.Google Scholar
Waterman, L.Z., Denton, D. & Minton, O. (2016). End-of-life care in a psychiatric hospital. BJPsych Bulletin, 40(3), 149–152.Google Scholar
Watson, J., Hockley, J. & Dewar, B. (2006). Barriers to implementing an integrated care pathway for the last days of life in nursing homes. International Journal of Palliative Nursing, 12(5), 234–240.Google Scholar