Covariance Structure Analysis of a Model for Use in Administrative Evaluation Regarding End-Of-Life Care in Nursing Homes – Promotion of the PDCA Cycle

The purpose of this study was to verify the relationships linking implementation of the PDCA cycle for end-of-life care in nursing homes, nursing ability and the results of end-of-life care based on a model for administrative evaluation of nursing care. A further aim was to identify factors toward the improvement of practical nursing skills. A total of 256 administrators of nursing homes registered as National Council for Elderly Welfare Facilities were invited to take part in the study's selfreported questionnaire survey, the evaluation model was verified using structural equation modeling. The factors identified for practical nursing skill improvement were 1) consideration of easily understandable explanations, guidelines and plans for end-of-life care in nursing homes, and securement of agreement from residents and their families, and 2) regularization of meetings with staff and families for reflection after a resident passes away. These factors are expected to promote the PDCA cycle for end-of-life care in nursing homes.