Professionals’ Expectations and Preparedness to Implement Knowledge-Based Palliative Care at Nursing Homes before an Educational Intervention: A Focus Group Interview Study (original) (raw)
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BMC Palliative Care, 2018
Background: The demography of the world is changing as the population is ageing. Because of this change to a higher proportion of older people, the WHO has called for improved palliative care for older persons. A large number of all deaths in the industrialised world occur while older people are living in nursing homes and therefore a key question becomes how the principles of palliative care can be implemented in that context. The aims of this study are: a) to describe a model of an educational intervention with the goal of implementing knowledge-based palliative care in nursing homes, and b) to describe the design of the evaluation of the effectiveness regarding the implementation of knowledge-based palliative care. Methods/design: A complex intervention is evaluated by means of a cross-over design. An educational intervention concerning palliative care consisting of five seminars during 6 months for staff and managers has been developed and conducted in 20 nursing homes in two counties. Before the intervention started, the feasibility was tested in a pilot study conducted in nursing homes not included in the main study. The intervention is evaluated through a nonrandomized experimental design with intervention and control groups and pre-and post-assessments. The evaluation includes older persons living in nursing homes, next-of-kin, staff and managers. Data collection consists of quantitative methods such as questionnaires and register data and qualitative methods in the form of individual interviews, focusgroup interviews and participant observations. Discussion: The research will contribute to new knowledge about how to implement knowledge-based palliative care in a nursing home setting. A strength of this project is that the Medical Research Council framework of complex intervention is applied. The four recommended stages, Development, Feasibility and piloting, Evaluation and Implementation, are combined for the educational intervention, which functions as a strategy to achieve knowledgebased palliative care in the nursing homes. Implementation is always a question of change and a good theoretical understanding is needed for drawing valid conclusions about the causal mechanisms of change. The topic is highly relevant considering the world's ageing population. The data collection is completed and the analysis is ongoing. Trial registration: NCT02708498.
Kōtuitui: New Zealand Journal of Social Sciences Online
In industrialised countries, a large number of older adults with increasingly complex end of life care needs will die while in longterm care. It is essential that processes be in place to facilitate quality end of life care in these settings. In collaboration with two local hospices over the course of one year, we developed a new model of palliative care within long-term care-Supportive Hospice Aged Residential Exchange (SHARE). SHARE fostered knowledge exchange between hospice nurses and long-term care staff to improve palliative care delivery within 20 long-term care facilities (LTCF's). An in-depth qualitative investigation of the views of 59 healthcare professionals and 12 bereaved family members of residents, regarding SHARE implementation, was undertaken through semi-structured interviews. Transcripts were analysed thematically and mapped to the theoretical domains framework (TDF) in order to identify facilitators and challenges to SHARE implementation. Domains facilitating SHARE implementation provided benefits in terms of 'knowledge', 'skills development', and supported the mentoring and role modelling provided by the hospice. Challenges highlighted the resource constraints of the long-term care context. The use of the TDF has enabled the identification of essential components such as skills development, which facilitate the implementation of SHARE in LTCF's.
Palliative care in nursing homes: exploring care assistants' knowledge
International journal of older people nursing, 2007
Aim. To explore the level of palliative care knowledge and to identify educational needs of care assistants (CAs) working within a nursing home context. Background. In the United Kingdom (UK) many patients at the end-of-life are admitted to (or reside in) nursing homes, where they receive care from unqualified CAs who have little formal training. Mandatory training in specific skills to meet palliative care needs are absent. Method. Questionnaire to CAs in 48 of 91 private nursing homes in one UK region. Findings. A population of 1135 CAs were targeted with a response rate of 45% (n = 508). A high proportion of CAs in this sample required information about the philosophy and principles of palliative care. Results support the need for an educational initiative to improve palliative care in nursing homes. Conclusion. Although recognized as a common place of death for older people, CAs are often unprepared to provide end-of-life care to nursing home residents. It is recommended th...
2019
Background: Older people in long-term care facilities are at a greater risk of receiving care at the end of life that does not adequately meet their needs, yet staff in long-term care are often unprepared to provide palliative care. The objective of the study was to explore palliative care nurse specialists’ experiences regarding the benefits of and barriers to the implementation of a palliative care educational intervention, Supportive Hospice Aged Residential Exchange (SHARE) in 20 long-term care facilities. Methods: Reflective logs (465), recorded over the course of the yearlong SHARE intervention by the three palliative care nurse specialists from two local hospices, who were the on-site mentors, were qualitatively analyzed by two researchers utilizing inductive content analysis. Results: Categories emerging from the logs include the importance of relationships, knowledge exchange, communication, and the challenges of providing palliative care in a long-term care setting. Conclu...
Palliative medicine, 2018
The provision of high-quality palliative care in nursing homes (NHs) is a major challenge and places demands on the knowledge and skills of the staff. This study assesses the palliative care knowledge of staff in NHs in Europe. Cross-sectional study using structured survey Setting/participants: Nurses and care assistants working in 322 representative samples of NHs in Belgium, the Netherlands, England, Finland, Poland and Italy. Palliative care knowledge is measured with the Palliative Care Survey. Scores on the scales range between 0 and 1; higher scores indicate more knowledge. A total of 3392 NH-staff were given a questionnaire, and 2275 responded (67%). Knowledge of basic palliative care issues ranged between 0.20 in Poland (95% confidence interval (CI) 0.19; 0.24) and 0.61 in Belgium (95% CI 0.59; 0.63), knowledge of physical aspects that can contribute to pain ranged between 0.81 in Poland (95% CI 0.79; 0.84) and 0.91 in the Netherlands (95% CI 0.89; 0.93), and knowledge of ps...
Educational needs in palliative care of Primary Health Care nurses
Revista Brasileira de Enfermagem
Objectives: to understand the experience of Primary Health Care nurses with palliative care and their educational needs on the topic. Methods: an exploratory study, with a qualitative approach. The data was collected through 19 focus groups involving 181 nurses. In interpreting the results, the thematic analysis was used. Results: the knowledge presented by nurses in palliative care proved to be limited. Gaps were identified in the definition of palliative care and in the philosophical principles that guide it. The experiences described highlighted the need for continuing education regarding the definition and philosophy of palliative care, patient eligibility, integral care to the patient and the family, interpersonal communication and difficult news, performance in a multi-professional team, and end-of-life care. Final Considerations: the analysis of the perceptions of Primary Health Care nurses about palliative care can help identify the obstacles to improving the provision of th...
Journal of Contemporary Medicine
Background: Palliative care practice, aimed at improving psychosocial and physical quality of life without the aim of providing medical cure, is under development in our country. We aimed to reveal the implementation strategy and success of a short palliative care education program organized for health workers in our institution. Method: This descriptive and cross-sectional study was conducted at the Palliative Care Research and Application Centre of Gaziosmanpaşa University in Tokat. As part of implementation strategy, an educational program for all nurses, technicians and other hospital staff (office personnel and etc.) was organised. A test was applied to measure the knowledge levels of the participants in the education program about palliative care before and after the training. The same test was given to hospital personnel who did not participate in the education program after 4 weeks, and pre-and post-test results of attending staff and the test results of non-attending staff were compared and analysed via SPSS Statistic 20 program. Findings: There were 120 women (63.2%), 70 men (36.8%) participants in attending group and 42 women (45.2%), 51 men (54.8%) participants in non-attending group. Rate of correct response to 'Which of the following is not suitable for the definition of palliative care?' question, increased 14.7% and reached 55.8% in attending group. The non-attending group expressed that they have learned palliative care from attending group with 73.7%. Conclusions: This study showed that there is a high level of lack of knowledge about palliative care among healthcare workers and that a statistically significant level of awareness can be achieved via a brief education program.
Palliative Care: Improving Nursing Knowledge, Attitudes, and Behaviors
Clinical journal of oncology nursing, 2017
Oncology nurses affect patient care at every point along the cancer journey. This creates the perfect opportunity to educate patients and caregivers about palliative care early and often throughout treatment. However, healthcare providers frequently do not have the knowledge and confidence to engage in meaningful conversations about palliative care. . The specific aims were to improve oncology nurses' palliative care knowledge, attitudes, and behaviors by providing a palliative care nursing education program. An additional aim was to increase the number of conversations with patients and families about palliative care. . This project had a pre-/post-test design to assess knowledge, attitudes, and behaviors at baseline and one month after implementation of an established education curriculum. The teaching strategy included one four-hour class for oncology RNs with topics about the definition of palliative care, pain and symptom management, and how to have palliative care conversa...