A qualitative study of assistant nurses' experiences of palliative care in residential care

Nurse assistants' experiences of encountering patients in grief due to the death of a loved one - a qualitative study in municipal health and social care

PURPOSE

The aim was to explore nurse assistants´ experiences of paying attention to and encountering patients receiving municipal health and social care, who are in grief due to the death of a loved one.

METHODS

A qualitative study with focus group interviews (n = 6) was conducted with nurse assistants (NAs) (n = 28) in municipal health and social care (n = 5) in southern Sweden. The data were analysed inductively using qualitative content analysis.

RESULTS

Three categories (1) Noticing changes in the patient, (2) Using different strategies to create a dialogue with the patient, (3) Experiencing challenges when encountering patients in grief, included eight sub-categories were identified. The result is captured in the theme of Having to be attentive to signs of grief after patients´ loss of loved ones, sensing the right time to approach and comfort, while having to cope with emotional challenges.

CONCLUSIONS

The NAs encountered expressions of strong emotions from patients in grief, and even expressions of a desire to end their lives. Additionally, the NAs had to deal with their own emotions that were evoked when meeting patients in grief. These challenges indicate the need for enhanced conditions in the work culture, and improved training and supervision in health and social care.

Nurse assistants' perception of caring for older persons who are dying in their own home : An interview study

BACKGROUND

As the proportion of older persons in society increases, there is a growing trend towards providing end-of-life care in their homes. Palliative care is a complex and knowledge-demanding form of care, and nurse assistants are those who work closest to the older person at the end-of-life in their own homes. However, nurse assistants sometimes have low educational and insufficient levels of knowledge in palliative care, which can affect the quality of care they provide. Moreover, nurse assistants' experiences are relatively unexplored in this context. The purpose of the study was to illuminate nurse assistants' experiences in caring for dying older persons at home.

METHOD

An empirical, qualitative interview study was conducted with 14 nurse assistants with experience of palliative care in homecare. The material was analyzed using thematic content analysis.

RESULTS

From the nurse assistant's experiences, one main theme emerged: doing everything possible for the dying older person despite challenges. Moreover, three sub-themes emerged: making a difference at a crucial time, death awakens emotions, and balancing personal and professional relationships. The nurse assistants' saw their role primarily as relieving symptoms but also focusing on next of kin. The following are described as essential parts of their role: carrying out practical nursing tasks, focusing on the physical environment, working alone and seeking help from colleagues due to a physical distance to the other members of the multidisciplinary team. The nurse assistants experienced a lack of support as there was no structured guidance or debriefing available in difficult emotional situations. Furthermore, they disclosed that they were left alone to deal with their feelings.

CONCLUSION

This study demonstrates that nurse assistants strive to provide comprehensive care for dying older persons despite facing obstacles from their working conditions and work organization. They lack supervision and education in palliative care, but they rely on their experience-based knowledge to a large extent and provide care according to the four cornerstones of palliative care.

Perceptions of Healthcare Workers Regarding Palliative Care Services in a Tertiary Care Teaching Hospital in North India – A Mixed Methods Observational Study

Background:

Cancers and various terminal illnesses need integrated palliative care with curative management, but, unfortunately, our health care system mainly focuses on the treatment of disease. Lack of awareness, difficulty in pain management and untrained staff are some of the challenges in palliative care services.

Objectives:

The study was done to explore the perception of healthcare workers regarding availability, utilisation and challenges in the delivery of palliative care services.

Material and Methods:

A mixed method study was conducted at tertiary care teaching hospital in North India. Qualitative approach using interviews and focus group discussions (FGDs) among healthcare workers was done to understand their knowledge, perception, barriers and challenges in implementing palliative care services. One hundred and thirteen healthcare workers were interviewed using a semi-structured questionnaire and FGD was conducted to gain more insight into the issues of palliative care. The data obtained was analysed with the help of computer software Microsoft Excel and SPSS version 23 for windows. The data was presented as proportion and mean (S.D.) as deemed appropriate for qualitative and quantitative variables respectively. Thematic analysis was done with the data of FGD.

Results:

The knowledge, attitude and practices regarding palliative care were poor across the HCW. During FGD with faculty and residents, the participants showed great concern about the absence of palliative care across many specialties while expressing an acute need for the establishment of a separate interdisciplinary unit on palliative care to improve the quality of life in patients.

Conclusion:

The study shows that there are gaps that need to be addressed to make palliative services available in our hospital.

Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals

Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.

Expanding the Concept of End-of-life Care in Long-term Care: A Scoping Review Exploring the Role of Healthcare Assistants

BACKGROUND

The context of care provided in long-term care homes is changing, as an increasing number of older adults are entering long-term care with advance stages of illness and higher care needs. Long-term care homes are quickly becoming the place of death for an increasing number of older adults, despite recent literature identifying inadequate and suboptimal levels of end-of-life care. Within long-term care, healthcare assistants represent 60%-70% of the unregulated workforce and provide 70%-90% of the direct care to residents. Research indicates that a high level of uncertainty exists surrounding the role of healthcare assistants in end-of-life care, with numerous studies reporting the role of healthcare assistants to be 'unclear' with varying levels of responsibilities and autonomy.

OBJECTIVE

The purpose of this scoping review was to explore healthcare assistants' experiences and perspectives of their role in end-of-life care in long-term care.

METHODS

We applied Arksey and O'Malley's methodological framework, with recommendations from Levac and colleagues' guiding principles. Electronic databases and the grey literature were searched for relevant articles. Search concepts included end-of-life care and healthcare assistants. Articles were included in this review if they explored healthcare assistants' experiences or perspectives of providing end-of-life care in long-term care. The peaceful end of life theory by Ruland and Moore (1998) was used to organise data extraction and analysis.

RESULTS

A total of n = 15 articles met the inclusion criteria. The most predominant role-required behaviours reported by healthcare assistants were as follows: psychosocial support to significant others, knows the resident's care wishes and physical care with respect and dignity. The most predominant extra-role behaviours reported by healthcare assistants were as follows: becoming emotionally involved, acting as extended family and ensuring residents do not die alone.

CONCLUSIONS

Findings from this review expanded the concept of end-of-life care by illustrating the role-required and extra-role behaviours healthcare assistants perform when providing end-of-life care in long-term care.

IMPLICATIONS FOR PRACTICE

Findings from this scoping review highlight the numerous behaviours healthcare assistants perform outside their role description in order to provide end-of-life care to dying residents in long-term care. These findings could inform policymakers and managers of long-term care homes.

"The challenge of joining all the pieces together" - Nurses' experience of palliative care for older people with advanced dementia living in residential aged care units

AIMS AND OBJECTIVES

To describe nurses' experiences of palliative care for older people with advanced dementia living in residential aged care units.

BACKGROUND

Dementia is a global health problem and the number of older people with dementia who need palliative care is increasing. Previous research has revealed that care for older people with dementia in the final stage of life is usually complex. However, little is known about how nurses experience palliative care for older people with advanced dementia living in residential aged care units.

METHOD

Nine individual, semi-structured face-to-face interviews with nurses working in residential aged care units for older people with advanced dementia in palliative care in Western Sweden were analysed using qualitative inductive content analysis. The COREQ checklist was followed.

RESULTS

The nurses considered that palliative care for older people with advanced dementia is a complex and challenging form of care. In particular, they identified three challenges that must be met: developing specialised knowledge and skills, developing teamwork as a working method and creating a caring relationship.

CONCLUSIONS

The results of our analysis indicate that if nurses are aware of and understand that the challenges are essential for "joining all the pieces together," the palliative care for older people with advanced dementia may become a positive experience for nurses and may increase their sense of satisfaction and security in their professional role.

RELEVANCE TO CLINICAL PRACTICE

For the palliative care to be successful, the nurses need to "join all the pieces together," that is succeed in developing specialised knowledge and skills, developing teamwork as a working method and creating a caring relationship to establish a person-centred care with the older person with advanced dementia and with his or her relatives.