Do-Not-Hospitalize Orders in Assisted Living Facilities: Direct Care Workers’ Perspectives

Purpose: To gather sufficient qualitative data to create an intervention that would prevent direct care workers (DCWs) from sending residents with do-not-hospitalize (DNH) orders to the hospital.
Method: This was a qualitative study with eight participants that included a descriptive survey followed by semi-structured interviews.
Results: DCWs were unfamiliar with DNH orders and their thinking on end-of-life care was binary (hospice or hospital) and protocol driven. However, supportive leaders were able to help DCWs problem-solve these complicated scenarios. Results were mixed on whether having a RN on site was helpful.
Conclusion: DCWs may benefit from having access to a nurse with palliative care experience when making decisions about residents with DNH orders.