Nurse assistants’ experience of an intervention focused on a palliative care approach to frail older people in residential care (original) (raw)
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International Journal of Older People Nursing, 2012
Background. Nurse assistants working in residential care facilities need support to ensure that they provide high-quality care for the residents and support for relatives, from admission to bereavement. Aim. The aim was to describe the nurse assistants' experience of how an intervention with a palliative care approach, had influenced them in their work in residential care for older people. Participants. Fourteen nurse assistants working in three different municipal residential care facilities. Methods. Data were collected by means of semi-structured individual interviews following an intervention consisting of study circles combined with workshops. The data were analysed using content analysis. Result. The nurse assistants felt that, through the intervention, they had gained insight into their understanding of the importance of quality of care. This included an increased awareness of, and respect for, residents' and relatives' needs, and an increased understanding of the importance of the outcome of encounters with residents and their relatives. After the intervention, they also felt there was increased openness and understanding between colleagues. However, the nurse assistants also expressed frustration over obstacles to implementing a palliative care approach, such as lack of resources and supportive leadership. Conclusion. The nurse assistants felt that the intervention was positive and encouraged them to provide more person-centred care within the framework of a palliative care approach. Although the intervention was intended to involve and support the management, it was not sufficient. Nurse assistants described lack of resources and supportive leadership. There is, therefore, a need to place greater emphasis on leadership and their support of nurse assistants so that they can provide high-quality care.
Scandinavian Journal of Caring Sciences, 2014
Applying a palliative care approach in residential care: effects on nurse assistants' experiences of care provision and caring climate Background: A palliative care approach aims to integrate psychosocial and existential as well as relationship aspects in the care and is an approach that can be used in residential care. Nurse assistants are the ones who are closest to the residents but have limited prerequisites for working in accordance with the palliative care approach. We aimed to investigate the effects on nurse assistants' experiences of care provision and the caring climate of an intervention applying a palliative care approach in residential care. Methods: An intervention involving nurse assistants (n = 75) and their leaders (n = 9), in comparison with controls (n = 110), was evaluated using a questionnaire at three points in time. Results: In the intervention group, positive effects were seen concerning the nurse assistants' reports of the care provision in that they focused more on the residents' stories about their lives and on communicating with the residents about what gave meaning to their lives. Also, negative effects were seen when the nurse assistants rated that the residents' needs for medical and nursing care had not been met at the facility directly after the intervention. No effects were seen concerning the caring climate or the prerequisites of providing more personcentred care. Conclusion: The intervention seemed to have encouraged the nurse assistants to focus on relationship aspects with the residents. So as not to jeopardise the NAs' well-being and to support NAs in keeping themselves involved in existential issues, their support most certainly needs to be continuous and ongoing. However, in spite of the leaders' involvement, the intervention was not sufficient for changing the organisational prerequisites for more person-centred care.
International journal of nursing studies, 2012
Palliative care should be provided, irrespective of setting to all patients facing a life-threatening illness and to their families. The situation and needs of older people differ from those of younger people since they often have several co-existing diseases and health complaints. This implies an extensive need for care and for longer periods of palliative care. The main providers of palliative care for older people are nurse assistants, who are also those with the shortest education. The aim of this study was to illuminate nurse assistants' experience of palliative care for older people in residential care. The study had an explorative, descriptive design. Thirteen residential care units in three different districts in a large city in southern Sweden. Twenty-five nurse assistants selected to represent variations in age, gender workplace and work experience. Data were collected from six focus-group interviews and subjected to content analysis to gain an understanding of the phe...
Journal of advanced …, 2008
Title. Multi-faceted palliative care intervention: aged care nurses' and care assistants' perceptions and experiences. Aim. This paper is a report of a study to describe residential aged care nurses' and care assistants' perceptions of a multi-faceted palliative care intervention to identify potential areas to be addressed during subsequent action research phases. Background. Action research was used to enhance the delivery of a palliative approach in residential aged care. The chronic care model guided the development of a multi-faceted intervention. This involved the: (1) establishment of a 'link nurse' role; (2) learning and development strategies for nurses, care assistants and general practitioners; (3) use of multi-disciplinary team meetings; and (4) access to specialist consultation. Method. A purposive sample (n = 28) of aged care nurses and care assistants participated in a series of four focus groups conducted in July 2005. Thematic content analysis of the transcripts was performed. Findings. Four themes emerged: (1) targeted education can make a difference;
Residential aged care: The last frontier for palliative care
Journal of Advanced Nursing, 2006
Aim. This paper is a report of an explorative study describing the perceptions and beliefs about palliative care among nurses and care assistants working in residential aged care facilities in Australia.Background. Internationally, the number of people dying in residential aged care facilities is growing. In Australia, aged care providers are being encouraged and supported by a positive policy platform to deliver a palliative approach to care, which has generated significant interest from clinicians, academics and researchers. However, a little is known about the ability and capacity of residential aged care services to adopt and provide a palliative approach to care.Methods. Focus groups were used to investigate the collective perceptions and beliefs about palliative care in a convenience sample of nurses and care assistants working in residential aged care facilities in Australia. Thematic content analysis was used to analyse the data, which were collected during 2004.Results. Four major themes emerged: (1) being like family; (2) advocacy as a key role; (3) challenges in communicating with other healthcare providers; (4) battling and striving to succeed against the odds. Although participants described involvement and commitment to quality palliative care, they also expressed a need for additional education and support about symptom control, language and access to specialist services and resources.Conclusion. The residential aged care sector is in need of support for providing palliative care, yet there are significant professional and system barriers to care delivery. The provision of enhanced palliative care educational and networking opportunities for nurses and care assistants in residential aged care, augmented by a supportive organizational culture, would assist in the adoption of a palliative approach to service delivery and requires systematic investigation.
Journal of Clinical Nursing, 2011
Aims and objectives. To examine the role of trained health and personal care assistants in supporting district nurses and family carers in providing palliative and end of life care in the community. Background. In the UK, there is a policy directive to improve end of life care and to enable greater numbers of people to die at home. This places considerable demands on community nursing services and family carers. In response to this, the Complex and Palliative Continuing Care Service employing generic health and personal care assistants was developed as part of the Marie Curie Delivering Choice Programme in one city in the UK. This paper draws on findings from an independent evaluation of the scheme. Design. The wider evaluation used a formative evaluation methodology. Method. This paper draws on in-depth interviews with a range of stakeholders (n = 17), in-depth interviews with bereaved carers (n = 6) and an analysis of documentation. Results. Stakeholders and bereaved carers perceived that the health and personal care assistants made a vital contribution to community palliative care. Careful recruitment, specific training, case management by district nursing with allocation of specific tasks and close ongoing communication were key features which stakeholders indentified. Family carers welcomed the way assistants developed relationships and became familiar and able to meet the care needs of patients. There were some problems reported which related to capacity, work flow and the need for extensive written care plans. Conclusion. Employing health care assistants under the supervision of district nurses appears to support patients and family at home during end of life care and contribute to good quality nursing care. Relevance to clinical practice. The needs for community-based palliative and end of life care will increase rapidly over the course of the next 20 years, placing pressure on community nursing services and family carers.
Palliative care in the community – the role of the resource nurse, a qualitative study
BMC Palliative Care
Background Approaches involving resource nurses have been used in several fields of practice to enhance quality of care. A literature review reveals limited research on the role of the resource nurse in palliative care in the community. Aim To explore experiences related to the role of the resource nurse in palliative care in the setting of nursing homes in Norway. Design The study has an explorative design with a qualitative approach. Methods Two semi structured group interviews were conducted. Five resource nurses participated in the first interview, two resource nurses participated in the last interview. The group interviews were audiotaped, transcribed verbatim and analysed with systematic text condensation. Results The resource nurses wish to promote high-quality palliative care. They are skilled palliative nurses working clinically, and they use their experience and knowledge to talk about and demonstrate good practice. By conveying knowledge and being role models, they bolste...
Journal of Nursing Education and Practice, 2022
Background and objective: The neglect of older people at the end of life in residential care documented in the Australian Royal Commission into Aged Care and Quality and Safety mandates urgent solutions to improve care. This integrative literature review aimed to explore the potential role of the palliative care nurse practitioner (PC-NP) in promoting quality end of life in residential care. Methods: Databases Medline, Emcare, PsychINFO and CINAHL were searched from January 2010 to April 2022. Full text of primary articles meeting inclusion criteria encompassing residents living in residential care settings, the role of the PC-NP in supporting quality dying were obtained and independently screened to determine final studies for review. Findings were thematically analysed. Two reviewers independently extracted data and assessed level of evidence and quality ratings for both quantitative and qualitative studies. Results: Of 12 articles meeting eligibility criteria, four specifically focused on the PC-NP or the palliative care nurse in residential care, seven examined the generic nurse practitioner role, and one the aged care nurse role in supporting palliative care. Themes common to all roles including positive patient outcomes, advance care planning, hospital avoidance, staff education and enhanced communication with families. Themes specific to the PC-NP included meeting end-of-life needs, end-of-life prescribing, and enhancing the role of the General Practitioner. Conclusions: Although reflected in only a handful of studies, this integrative review has provided preliminary insights into potential contributions of the PC-NP to quality end-of-life care for residential care residents.
Journal of Holistic Nursing, 2021
Aim: To explore and develop understanding of nursing home staff's emotional experiences of being in a close relationship with a resident in long-term care who later died. Design: Ethnographic fieldwork. Methods: As part of fieldwork, narrative interviews were conducted with nursing home staff (n = 6) in two nursing homes in Norway and analyzed using interpretative phenomenological analysis. Findings: Through data analysis, we identified three superordinate themes: (1) wanting to be something good for the resident and their families, (2) striving to make sense of the resident's death, and (3) struggling to balance being personal and professional. Implications for holistic nursing and conclusion: Nursing home staff experience tensions between ideals of distanced professionalism and the emotional experience of proximity, evidenced by personal commitment and mutual recognition in relationships with "special residents" in long-term care. To support holistic practice, awareness is needed of the emotional impact of relationships on health professionals. Suppressing feelings puts staff at risk of moral distress, compassion fatigue, and burnout, as well as higher turnover and absenteeism. Managers should facilitate discussions on professionals' ideals of relationship-based practice, including processing of, and reflection on, emotional experiences in long-term care. Rituals to mark a resident's death can provide further emotional containment. Authors' Note: This PhD project is part of Work Package 4 in Multicultural workforce in nursing homes: Contemporary challenges, opportunities, and potentials for the future in the Norwegian municipal care sector, MULTICARE, financed by the Research Council of Norway (grant no. 256617). The authors would like to thank the nursing home staff who participated in this study and shared their experiences and time. They also would like to thank Emeritus