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Ye Z, Jing L, Zhang H, Qin Y, Chen H, Yang J, Zhu R, Wang J, Zhang H, Xu Y, Chu T. Attitudes and influencing factors of nursing assistants towards hospice and palliative care nursing in chinese nursing homes: a cross-sectional study. BMC Palliat Care 2023; 22:49. [PMID: 37098562 PMCID: PMC10127064 DOI: 10.1186/s12904-023-01175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/14/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Hospice and palliative care nursing (HPCN) in China is mainly available at public primary care institutions, where nursing homes (NHs) are rarely involved. Nursing assistants (NAs) play an essential role in HPCN multidisciplinary teams, but little is known about their attitudes towards HPCN and related factors. METHODS A cross-sectional study was designed to evaluate NAs' attitudes towards HPCN with an indigenised scale in Shanghai. A total of 165 formal NAs were recruited from 3 urban and 2 suburban NHs between October 2021 and January 2022. The questionnaire was composed of four parts: demographic characteristics, attitudes (20 items with four sub-concepts), knowledge (nine items), and training needs (nine items). Descriptive statistics, independent samples t-test, one-way ANOVA, Pearson's correlation, and multiple linear regression were performed to analyse NAs' attitudes, influencing factors, and their correlations. RESULTS A total of 156 questionnaires were valid. The mean score of attitudes was 72.44 ± 9.56 (range:55-99), with a mean item score of 3.6 ± 0.5 (range:1-5). The highest score rate was "perception of the benefits for the life quality promotion" (81.23%), and the lowest score rate was "perception of the threats from the worsening conditions of advanced patients" (59.92%). NAs' attitudes towards HPCN were positively correlated with their knowledge score (r = 0.46, P < 0.01) and training needs (r = 0.33, P < 0.01). Marital status (β = 0.185), previous training experience (β = 0.201), location of NHs (β = 0.193), knowledge (β = 0.294), and training needs (β = 0.157) for HPCN constituted significant predictors of attitudes (P < 0.05), which explained 30.8% of the overall variance. CONCLUSION NAs' attitudes towards HPCN were moderate, but their knowledge should be improved. Targeted training is highly recommended to improve the participation of positive and enabled NAs and to promote high-quality universal coverage of HPCN in NHs.
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Affiliation(s)
- Zhuojun Ye
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China.
| | - Haoyu Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Yongfa Qin
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Hangqi Chen
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Jiying Yang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Ruize Zhu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Jingrong Wang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Huiwen Zhang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Yifan Xu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
| | - Tianshu Chu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Cailun Rd#1200, Pudong New Area, Shanghai, 201203, China
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Karacsony S, Martyn J, Rosenberg J, Andrews S. Exploring the attitudes, beliefs, and values of the long-term care workforce towards palliative care: A qualitative evidence synthesis protocol. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.2000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sara Karacsony
- College of Health and Medicine , University of Tasmania, Lilyfield, Australia
| | - Julie Martyn
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Queensland, Australia
| | - John Rosenberg
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Queensland, Australia
| | - Sharon Andrews
- College of Health and Medicine , University of Tasmania, Lilyfield, Australia
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Engel M, van der Ark A, Tamerus R, van der Heide A. Quality of collaboration and information handovers in palliative care: a survey study on the perspectives of nurses in the Southwest Region of the Netherlands. Eur J Public Health 2021; 30:720-727. [PMID: 32221585 PMCID: PMC7445043 DOI: 10.1093/eurpub/ckaa046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background When patients receiving palliative care are transferred between care settings, adequate collaboration and information exchange between health care professionals is necessary to ensure continuity, efficiency and safety of care. Several studies identified deficits in communication and information exchange between care settings. Aim of this study was to get insight in the quality of collaboration and information exchange in palliative care from the perspectives of nurses. Methods We performed a cross-sectional regional survey study among nurses working in different care settings. Nurses were approached via professional networks and media. Respondents were asked questions about collaboration in palliative care in general and about their last deceased patient. Potential associations between quality scores for collaboration and information handovers and characteristics of respondents or patients were tested with Pearson’s chi-square test. Results A total of 933 nurses filled in the questionnaire. Nurses working in nursing homes were least positive about inter-organizational collaboration. Forty-six per cent of all nurses had actively searched for such collaboration in the last year. For their last deceased patient, 10% of all nurses had not received the information handover in time, 33% missed information they needed. An adequate information handover was positively associated with timeliness and completeness of the information and the patient being well-informed, not with procedural characteristics. Conclusion Nurses report that collaboration between care settings and information exchange in palliative care is suboptimal. This study suggests that health care organizations should give more attention to shared professionalization towards inter-organizational collaboration among nurses in order to facilitate high-quality palliative care.
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Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Andrée van der Ark
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rosanne Tamerus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
BACKGROUND The demand for hospice-at-home (HH) nurses is increasing due to an ageing global population and many people preferring to die at home. Therefore, the retention of existing HH nurses is vital. AIMS This paper explores HH nurses' experiences of caring for dying patients to discover the factors that enable them to maintain their enthusiasm for their work, and cope with the challenges of working in a patient's home. METHODS This qualitative study consisted of multiple unstructured interviews with 16 HH nurses conducted in England. FINDINGS The interviews show that HH nurses: use a broad range of coping mechanisms; encounter intense, complex, unpredictable and ethically unclear challenges; identify a need for more support; and love their job. CONCLUSION In order for nurses to continue to enjoy their job, extra support to incorporate protected time for debriefing at the end of an HH nurse's shift is needed. Nurses also need training to develop positive coping skills, external supervision on a one-to-one basis as needed, and have their value demonstrated, by their employers and managers recognising and acknowledging them. These factors are likely to facilitate in the retention of employment of HH nurses.
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5
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Chiang SW, Wu SC, Peng TC. The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 15:15-22. [PMID: 33259952 DOI: 10.1016/j.anr.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to explore the experiences of caregivers in long-term care facilities as they implement palliative care. Although palliative care has been available in Taiwan for more than 30 years, it is often provided in hospitals, few models in the long-term care facilities. METHODS Semi-structured interviews using grounded theory methodology and purposive sampling. Two small long-term care facilities that had performed well in palliative care were selected from eastern Taiwan. A total of 12 caregivers participated in in-depth semi-structured face-to-face interviews. RESULTS Four major stages in the implementation of palliative care were identified: (1) feeling insecure, (2) clarifying challenges, (3) adapting to and overcoming the challenges, and (4) comprehending the meaning of palliative care. The core category of these caregivers as "the guardians at the end of life" reflects the spirit of palliative care. CONCLUSION This study demonstrates that successful palliative care implementation would benefit from three conditions. First, the institution requires a manager who is enthusiastic about nursing care and who sincerely promotes a palliative care model. Second, the institution should own caregivers who possess personality traits reflective of enthusiasm for excellence, unusual ambition, and a true sense of mission. Third, early in the implementation phase of the hospice program, the institution must have the consistent support of a high-quality hospice team.
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Affiliation(s)
- Shu-Wan Chiang
- Department of Nursing, Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
| | - Shu-Chen Wu
- Department of Nursing, Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
| | - Tai-Chu Peng
- Department of Nursing, Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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Shu Z, Wang Y, Li T, Jing L, Sun X. Instrument development of health providers' Knowledge, Attitude and Practice of Hospice Care Scale in China. Int J Health Plann Manage 2020; 36:364-380. [PMID: 33063349 DOI: 10.1002/hpm.3074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/25/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To match the reform of hospice development in China, this study aimed to construct an indigenized health providers' Knowledge, Attitude and Practice of Hospice Care (KAPHC) Scale in China with good validity and reliability. METHODS We used three steps to develop the scale, establishing items-pool firstly based on literature review and expert consultation, followed by forming a draft-scale design through synthetically consideration, and finally modifying the draft by conducting a self-administrative survey in sampled institution and testing the reliability and validity by statistical analysis. RESULTS The KAPHC Scale was comprised of 15 knowledge items, 24 attitude items and 22 practice items. In the part of knowledge, the Cronbach's α coefficient was 0.686, the average difficulty was 0.62 and average discrimination was 0.46. The attitude items were divided into four domains (KMO = 0.770), with Cronbach's α coefficient of 0.868. The practice items included confidence of practices and self-reported behaviors (KMO = 0.732), with Cronbach's α coefficient of 0.958. CONCLUSION The KAPHC Scale demonstrated good validity and reliability. As an effective tool, the scale may contribute to assessing health providers' KAP status of hospice care and exploring their future education needs in mainland China.
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Affiliation(s)
- Zhiqun Shu
- Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai Ninth People's Hospital, Shanghai, China
| | - Yiting Wang
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tiantian Li
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Clinic Medical College, Anhui Medical University, Anhui, China
| | - Limei Jing
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoming Sun
- Zhongshan Hospital, Fudan University, Shanghai, China.,School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Pudong Institution for Health Development, Shanghai, China
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Laporte P, Juvet T, Desbiens JF, Tapp D, Pasquier J, Bornet MA. Factors affecting attitudes towards caring for terminally ill patients among nursing students in Switzerland: a cross-sectional study. BMJ Open 2020; 10:e037553. [PMID: 32948561 PMCID: PMC7500309 DOI: 10.1136/bmjopen-2020-037553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Positive attitudes towards end-of-life care are essential among nursing students to adequately support terminally ill patients and enable students to feel confident about providing end-of-life care. This study aimed to determine nursing students' attitudes towards caring for terminally ill patients, as well as the associations between these attitudes and year of study, exposure to terminally ill people, self-perceived nursing skills and subjective impact of instruction. DESIGN Cross-sectional study. SETTING A health sciences school in Switzerland. PARTICIPANTS All preparatory students, first-year nursing students and third-year nursing students were invited to participate; 178 agreed to participate. PRIMARY OUTCOME MEASURE Attitudes towards terminally ill patients were assessed using the Frommelt Attitudes Toward Care of the Dying Scale, Form B (FATCOD, Form B), as the primary outcome. Secondary measures were gender, age, year of study, number of terminally ill persons encountered, self-perceived palliative care nursing skills and subjective impact of instruction. RESULTS Mean FATCOD, Form B score was 117.7 (SD: 9.8, median: 118.0). Better attitudes towards terminally ill patients were significantly associated with being aged 24-26 years (β=6.97, 95% CI 2.00 to 11.95, p=0.006), year of study (β=3.47, 95% CI 1.69 to 5.25, p<0.001), professional encounters with terminally ill patients (β=3.59, 95% CI 2.23 to 4.95, p<0.001) and self-perceived palliative care nursing competence (β=1.23, 95% CI 0.41 to 2.04; p=0.003). In the multivariate analysis, professionally encountering terminally ill patients remained significant (β=3.00; 95% CI 1.43 to 4.57; p<0.001). CONCLUSIONS Nursing students' attitudes towards caring for terminally ill patients were positive and improved as their year of study progressed. Professional exposure to terminally ill patients was the strongest factor, followed by private encounters, self-perceived palliative care nursing skills, year of study and age.
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Affiliation(s)
- Pauline Laporte
- Haute Ecole Arc Santé, University of Applied Sciences and Arts Western Switzerland (HES-SO), Neuchâtel & Delémont, Switzerland
| | - Typhaine Juvet
- Haute Ecole Arc Santé, University of Applied Sciences and Arts Western Switzerland (HES-SO), Neuchâtel & Delémont, Switzerland
| | | | - Diane Tapp
- Faculty of Nursing, Laval University, Québec City, Québec, Canada
| | - Jérôme Pasquier
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Marc-Antoine Bornet
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
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8
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Exploring a Nursing Home-Specific Interdisciplinary Approach: Toward Palliative Care for the Demented and Complex-Disabled Elderly. J Hosp Palliat Nurs 2020; 21:E9-E15. [PMID: 31162151 DOI: 10.1097/njh.0000000000000579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The number of elderly suffering from dementia and complex disabilities is gradually increasing in nursing homes, and they form a differentiated group that requires palliative care provided by practitioners in various disciplines from the time of their admission to improve the quality of their remaining lives. The purpose of this study was to explore an interdisciplinary care approach by nurses and related practitioners for the demented and complex-disabled elderly in nursing homes that focuses on palliative care based on an ethical point of view. A qualitative thematic analysis was conducted through in-depth interviews of 29 interdisciplinary practitioners working at 5 nursing homes. From them, 3 themes and 9 subthemes were extracted as the key results. First, practitioners set up cooperative care plans based on constantly tracking down clues to gradual functional deteriorations. Second, practitioners establish a cooperative committee to link residents and practitioners for responding to the subtle expressions of the elderly. Finally, practitioners maximize the opportunities for improving the quality of the elderly's remaining lives. These results can be the basis for the first prototype in developing interdisciplinary practical guidelines for nursing home-specific palliative care and can provide new insights for the practical care concept of palliative care.
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9
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Ndiok A, Ncama B. Barriers and benefits of model development for integration of palliative care for cancer patients in a developing country: A qualitative study. Int J Nurs Pract 2020; 27:e12884. [PMID: 32815240 DOI: 10.1111/ijn.12884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 11/27/2022]
Abstract
AIM The aim of the study was to identify barriers and benefits in establishing a model for integration of palliative care of cancer patients in daily clinical practice in tertiary health institutions. METHODS This was a qualitative design study using in-depth interviews with four stakeholders and focus group discussions with 19 nurse managers using purposive sampling to select the participants, utilizing interpretive paradigm method. Need was ascertained for a model that would guide nursing care for cancer patients. RESULTS Barriers identified in relation to integrating palliative care in daily clinical practice included lack of hospital policies about palliative care activities, cultural influences, denial or rejection of diagnosis by patients, inappropriate attitude of health care workers, patients failing to keep check-up appointments and financial implications of setting up a dedicated palliative care team. Benefits of the model were twofold: hospital outcomes and patients/family outcomes. CONCLUSIONS Quality care for cancer patients/families calls for the adoption of clearly set out principles of palliative care as an integral component of daily practice. Challenges to implementation of palliative care services in hospitals can be overcome by establishing workable policies and allocating adequate funds for palliative care activities.
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Affiliation(s)
- Akon Ndiok
- Department of Nursing Science, University of Calabar, Calabar, Nigeria.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Busisiwe Ncama
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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10
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Chang SO, Lee SJ, Park MS, Choi YL, Kim GM. Conceptualizations of function‐focused care used by practitioners in Korean nursing homes. Nurs Health Sci 2020. [DOI: 10.1111/nhs.12758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Su Jung Lee
- College of Nursing Korea University Seoul Korea
| | | | | | - Geun Myun Kim
- Department of Nursing Gangneung‐Wonju National University Wonju Korea
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11
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Abstract
OBJECTIVES Care transitions between hospitals and skilled nursing facilities (SNFs) are associated with disruptions in patient care and high risk for adverse events. Communication between hospital-based and SNF-based clinicians is often suboptimal; there have been calls to foster direct, real-time communication between sending and receiving clinicians to enhance patient safety. This article described the implementation of a warm handoff between hospital and SNF physicians and advanced practice providers at the time of hospital discharge. METHODS Before patient transfer, hospital clinicians called SNF clinicians to provide information relevant to the continuation of safe patient care and offer SNF clinicians the opportunity to ask clarifying questions. The calls were documented in the hospital discharge summary. RESULTS A total of 2417 patient discharges were eligible for inclusion. Warm handoffs were documented at an increasing rate throughout implementation of the intervention, beginning with 15.78% (n = 3) in stage 1, then 20.27% (n = 75) in stage 2, and finally 46.89% (n = 951) in stage 3. The overall average rate of documentation was 42.57%. Participant feedback indicated that clinicians were most concerned about understanding the purpose of the warm handoff, managing their workload, and improving the efficiency of the process. CONCLUSIONS Use of a warm handoff showed promise in improving communication during hospital-SNF patient transfers. However, the implementation also highlighted specific barriers to the handoff related to organizational structures and clinician workload. Addressing these underlying issues will be critical in ensuring continued participation and support for efforts that foster direct communication among clinicians from different healthcare institutions.
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12
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Sequential Two-Stage Network and Thematic Analysis for Exploring an Interdisciplinary Care Approach in Nursing Homes. Comput Inform Nurs 2019; 37:473-481. [PMID: 31518340 DOI: 10.1097/cin.0000000000000530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since various groups of older adults with different conditions and levels of function coexist in nursing homes, it is necessary to develop integrated care strategies through collaboration among experts across related fields. The purposes of this study are to identify the regularity of information sharing in managing daily function for older adults, with a special focus on interdisciplinary cooperation, and to explore a practical care strategy for nursing home residents. The collaborative methods of network and thematic analysis were done by conducting in-depth interviews with 33 interdisciplinary experts working at seven nursing homes. This study proposed three relationships and three themes as interrelated key factors for providing interdisciplinary care to the elderly at various levels of function based on the experiences accumulated by the practitioners. First, independent sharing is required to make professional judgments about how daily function in older adults changes from reported baselines. Second, practitioners accurately judge clinical situations and supplement experts' judgments through partial sharing. Finally, all interdisciplinary consensus through complete sharing achieves the ultimate goal of maintaining remaining function in older adults. These findings can be the first step in developing practical care guidelines for interdisciplinary use, and the results can be used to develop integrated assessment and intervention strategies.
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13
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Nasu K, Konno R, Fukahori H. End-of-life nursing care practice in long-term care settings for older adults: A qualitative systematic review. Int J Nurs Pract 2019; 26:e12771. [PMID: 31364244 DOI: 10.1111/ijn.12771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/03/2019] [Accepted: 06/15/2019] [Indexed: 12/19/2022]
Abstract
AIM To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults. BACKGROUND Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically. DESIGN Qualitative systematic review. DATA SOURCES Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. METHODS The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation. RESULTS Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. CONCLUSION Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.
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Affiliation(s)
- Katsumi Nasu
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rie Konno
- School of Nursing, Hyogo University of Health Sciences, Hyogo, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
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14
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Karacsony S, Good A, Chang E, Johnson A, Edenborough M. An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities. BMC Palliat Care 2019; 18:61. [PMID: 31337388 PMCID: PMC6647142 DOI: 10.1186/s12904-019-0447-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 07/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing quality palliative care in residential aged care facilities (RACFs) (aged care homes) is a high priority for ageing populations worldwide. Older people admitted to these facilities have palliative care needs. Nursing assistants (however termed) are the least qualified staff and provide most of the direct care. They have an important role at the frontline of care spending more time with residents than any other care provider but have been found to lack the necessary knowledge and skills to provide palliative care. The level of competence of this workforce to provide palliative care requires evaluation using a valid and reliable instrument designed for nursing assistants' level of education and the responsibilities and practices of their role. METHOD The overall study purpose was to develop and test an instrument capable of evaluating the knowledge, skills and attitudes of nursing assistants within a palliative approach in RACFs. Development consisted of a four-phase mixed-methods sequential design. In this paper, the results and key findings following psychometric testing of the instrument in Phase 4 is reported using data collected from a random sample of 17 RACFs and 348 nursing assistants in the Greater Sydney region. Study hypotheses were tested to confirm discriminative validity and establish the utility of the instrument in both research and training assessment. RESULTS Individual item properties were analysed for difficulty, discrimination and item-total correlations. Discriminative and structural validity, and internal consistency and test-retest reliability were demonstrated. Three separate questionnaires comprising 40 items were finalised: The Palliative Approach for Nursing Assistants (PANA)_Knowledge Questionnaire (17 items), the PANA_Skills Questionnaire (13 items) and the PANA_Attitudes Questionnaire (10 items). CONCLUSIONS This study provides preliminary evidence for the validity and reliability of three new questionnaires that demonstrate sensitivity for nursing assistants' level of education and required knowledge, skills and attitudes for providing a palliative approach. Implications for practice include the development of palliative care competencies through structured education and training across this workforce, and ongoing professional development opportunities for nursing assistants, especially for those with the longest tenure.
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Affiliation(s)
- Sara Karacsony
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,School of Nursing, College of Health and Medicine, University of Tasmania, UTAS Education Centre, 1 Leichhardt Street, Darlinghurst, NSW, 2010, Australia.
| | - Anthony Good
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amanda Johnson
- School of Nursing, Midwifery and Paramedicine NSW/ACT, Australian Catholic University, PO Box 968, North Sydney, NSW, 2059, Australia
| | - Michel Edenborough
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia
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15
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Karacsony S, Chang E, Johnson A, Good A, Edenborough M. Assessing nursing assistants' competency in palliative care: An evaluation tool. Nurse Educ Pract 2018; 33:70-76. [PMID: 30248577 DOI: 10.1016/j.nepr.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 11/30/2022]
Abstract
Nursing assistants are the largest aged care workforce providing direct care to older people in residential aged care facilities (RACF) in Australia and internationally. A palliative approach is a large component of this direct care that necessitates nursing assistants possess requisite knowledge, skills and attitudes. While training needs have been identified to enhance their practices, preservice education is variable, educational interventions have been adhoc and professional development found to be inadequate to the demands of the workplace. In addition, evaluation of nursing assistants' knowledge, skills and attitudes has lacked an instrument specifically tailored to nursing assistants' level of education and role responsibilities when providing a palliative approach. This paper reports on Phase 3 of a research study to develop such an instrument capable of assessing nursing assistants' knowledge of, skills in, and attitudes within a palliative approach. This phase assesses the usability and performance capabilities of the new instrument on a purposive sample of nursing assistants in two RACFs using the survey method. Results showed that the instrument was able to discriminate between groups of nursing assistants based on experience in role. Usability results indicated that the instrument is user friendly and time efficient.
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Affiliation(s)
- Sara Karacsony
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Amanda Johnson
- School of Nursing, Midwifery and Paramedicine NSW/ACT, Australian Catholic University, PO Box 968, North Sydney, NSW 2059, Australia.
| | - Anthony Good
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Michel Edenborough
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
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Thompson G, Shindruk C, Wickson-Griffiths A, Sussman T, Hunter P, McClement S, Chochinov H, McCleary L, Kaasalainen S, Venturato L. "Who would want to die like that?" Perspectives on dying alone in a long-term care setting. DEATH STUDIES 2018; 43:509-520. [PMID: 30207512 DOI: 10.1080/07481187.2018.1491484] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/09/2018] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
The discourse of dying alone is negatively weighted and models of a good death identify not dying alone as a key outcome. Understanding why dying alone is viewed negatively and its effects on care is a priority. In separate focus groups with long-term care residents, family caregivers, and staff, we identified evidence for four different perspectives on the importance of presence at the time of death. However, while each individual had their own unique perspective on dying alone, the predominant view expressed across respondent groups was that having human connection near the end of one's life was important.
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Affiliation(s)
- Genevieve Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Chloe Shindruk
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada
| | | | - Tamara Sussman
- Faculty of Arts, School of Social Work, McGill University , Montreal , Quebec , Canada
| | - Paulette Hunter
- St. Thomas More College, University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Susan McClement
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Harvey Chochinov
- Department of Psychiatry, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba , Winnipeg , Manitoba , Canada
| | - Lynn McCleary
- Department of Nursing, Faculty of Applied Health Sciences, Brock University , Saint Catharines , Ontario , Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University , Hamilton , Ontario , Canada
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Rodriquez J, Boerner K. Social and organizational practices that influence hospice utilization in nursing homes. J Aging Stud 2018; 46:76-81. [PMID: 30100120 DOI: 10.1016/j.jaging.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/07/2018] [Accepted: 06/23/2018] [Indexed: 11/18/2022]
Abstract
Hospice has grown considerably but the likelihood that someone gets hospice depends on social and organizational practices. This article shows how staff beliefs and work routines influenced hospice utilization in two nursing homes. In one, 76% of residents died on hospice and in the other 24% did. Staff identified barriers to hospice including families who saw hospice as giving up and gaps in the reimbursement system. At the high-hospice nursing home, staff said hospice care extended beyond what they provided on their own. At the low-hospice nursing home, an influential group said hospice was essentially the same as their own end-of-life care and therefore needlessly duplicative. Staff at the high-hospice nursing home proactively approached families about hospice, whereas staff at the low-hospice nursing home took a reactive approach, getting hospice when families asked for it. Findings demonstrate how staff beliefs and practices regarding hospice shape end-of-life care in nursing homes.
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Affiliation(s)
- Jason Rodriquez
- Department of Sociology, University of Massachusetts - Boston, Boston, MA, United States.
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts - Boston, Boston, MA, United States.
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Feder SL, Britton MC, Chaudhry SI. "They Need to Have an Understanding of Why They're Coming Here and What the Outcomes Might Be." Clinician Perspectives on Goals of Care for Patients Discharged From Hospitals to Skilled Nursing Facilities. J Pain Symptom Manage 2018; 55:930-937. [PMID: 29097273 DOI: 10.1016/j.jpainsymman.2017.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT The number of patients discharged from acute care hospitals to skilled nursing facilities (SNFs) is rising. These patients have increasingly complex needs and many experience poor outcomes while under SNF care, including hospital readmissions. Patients' goals of care (GoC) are viewed as a factor contributing to unplanned hospital readmissions from SNFs. However, clinicians' perspectives of GoC for hospitalized patients discharged to SNFs are not well-described. OBJECTIVES To explore how clinicians view GoC for hospitalized patients discharged to SNFs. METHODS Qualitative study using semi-structured interviews and thematic analysis. RESULTS Forty-one clinicians from one acute care hospital and two SNFs completed interviews ranging in length from 14 to 52 minutes (mean = 32 minutes). Of the sample, 22% were nurses, 20% physicians, 15% were from care management, and 15% were from social services. Respondents viewed patients' GoC for continuing treatment at the SNF as important, but acknowledged that they were infrequently discussed during hospitalization. Many respondents felt that patients and families had unrealistic GoC for SNF care. Factors that contributed to unrealistic GoC included patients' limited knowledge of disease processes, prognosis, and treatment options; and inconsistent or insufficient communication of GoC among hospital and SNF clinicians, the patient, and family members. Respondents associated a lack of GoC or unrealistic GoC with patients' dissatisfaction with SNF care, unplanned transitions to hospice, and hospital readmissions. CONCLUSIONS Respondents reported that GoC conversations infrequently occurred during hospitalization, contributing to unrealistic patient and family expectations for SNF care and poor patient outcomes. Interventions are needed that facilitate timely, accurate, and consistent GoC discussions across care continuums.
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Affiliation(s)
| | - Meredith Campbell Britton
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Nilsen P, Wallerstedt B, Behm L, Ahlström G. Towards evidence-based palliative care in nursing homes in Sweden: a qualitative study informed by the organizational readiness to change theory. Implement Sci 2018; 13:1. [PMID: 29301543 PMCID: PMC5753464 DOI: 10.1186/s13012-017-0699-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/13/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Sweden has a policy of supporting older people to live a normal life at home for as long as possible. Therefore, it is often the oldest, most frail people who move into nursing homes. Nursing home staff are expected to meet the existential needs of the residents, yet conversations about death and dying tend to cause emotional strain. This study explores organizational readiness to implement palliative care based on evidence-based guidelines in nursing homes in Sweden. The aim was to identify barriers and facilitators to implementing evidence-based palliative care in nursing homes. METHODS Interviews were carried out with 20 managers from 20 nursing homes in two municipalities who had participated along with staff members in seminars aimed at conveying knowledge and skills of relevance for providing evidence-based palliative care. Two managers responsible for all elderly care in each municipality were also interviewed. The questions were informed by the theory of Organizational Readiness for Change (ORC). ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care. RESULTS Analysis of the data yielded ten factors (i.e., sub-categories) acting as facilitators and/or barriers. Four factors constituted barriers: the staff's beliefs in their capabilities to face dying residents, their attitudes to changes at work as well as the resources and time required. Five factors functioned as either facilitators or barriers because there was considerable variation with regard to the staff's competence and confidence, motivation, and attitudes to work in general, as well as the managers' plans and decisional latitude concerning efforts to develop evidence-based palliative care. Leadership was a facilitator to implementing evidence-based palliative care. CONCLUSIONS There is a limited organizational readiness to develop evidence-based palliative care as a result of variation in the nursing home staff's change efficacy and change commitment as well as restrictions in many contextual conditions. There are considerable individual- and organizational-level challenges to achieving evidence-based palliative care in this setting. The educational intervention represents one of many steps towards developing a culture conducive to evidence-based nursing home palliative care.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden.
| | - Birgitta Wallerstedt
- Department of Health and Care Sciences, Linnaeus University, SE-392 81, Kalmar, Sweden
| | - Lina Behm
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, SE-221 00, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, SE-221 00, Lund, Sweden
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Sánchez-García MR, Moreno-Rodríguez M, Hueso-Montoro C, Campos-Calderón C, Varella-Safont A, Montoya-Juárez R. [Facilitators and barriers regarding end of life care at nursing homes: A focus group study]. Aten Primaria 2017; 49:278-285. [PMID: 27890302 PMCID: PMC6875926 DOI: 10.1016/j.aprim.2016.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/02/2016] [Accepted: 09/05/2016] [Indexed: 11/10/2022] Open
Abstract
AIM To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN Descriptive qualitative research with phenomenological orientation, through content analysis. PLACEMENT Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. METHODS Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. RESULTS Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. CONCLUSION It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.
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Affiliation(s)
- María Remedios Sánchez-García
- Centro de Salud Cúllar Vega, Distrito de Atención Primaria Granada-Metropolitano, Servicio Andaluz de Salud, Junta de Andalucía, Cúllar Vega, Granada, Andalucía, España.
| | | | - César Hueso-Montoro
- Departamento de Enfermería, Universidad de Granada, Granada, Andalucía, España
| | | | - Ana Varella-Safont
- Distrito de Atención Primaria Granada-Metropolitano, Servicio Andaluz de Salud, Junta de Andalucía, Granada, Andalucía, España
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Malik M, Chapman W. Education and Training in End-of-Life Care for Certified Nursing Assistants in Long-Term Care. J Contin Educ Nurs 2017; 48:81-85. [DOI: 10.3928/00220124-20170119-09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/27/2016] [Indexed: 11/20/2022]
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Bükki J, Neuhaus PM, Paal P. End of life care in nursing homes: Translating focus group findings into action. Geriatr Nurs 2016; 37:440-445. [DOI: 10.1016/j.gerinurse.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
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Castelli Dransart DA, Scozzari E, Voélin S. Stances on Assisted Suicide by Health and Social Care Professionals Working With Older Persons in Switzerland. ETHICS & BEHAVIOR 2016. [DOI: 10.1080/10508422.2016.1227259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Elena Scozzari
- School of Social Work Fribourg, University of Applied Sciences and Art Western Switzerland
| | - Sabine Voélin
- School of Social Work Geneva, University of Applied Sciences and Art Western Switzerland
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Kataoka-Yahiro MR, McFarlane S, Koijane J, Li D. Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities. Am J Hosp Palliat Care 2016; 34:335-346. [DOI: 10.1177/1049909116638347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.
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Affiliation(s)
- Merle R. Kataoka-Yahiro
- Department of Nursing, School of Nursing and Dental Hygiene, University of Hawai’i at Manoa, Honolulu, HI, USA
| | - Sandra McFarlane
- Corporate Human Resources, Hawaii Health Systems Corporation, Honolulu, HI, USA
| | - Jeannette Koijane
- Kokua Mau–Hawaii Hospice and Palliative Care Organization, Honolulu, HI, USA
| | - Dongmei Li
- University of Rochester, School of Medicine and Dentistry, Clinical and Translational Science Institute, Rochester, NY, USA
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Morley JE, Cao L, Shum CK. Improving the Quality of End-of-Life Care. J Am Med Dir Assoc 2016; 17:93-5. [DOI: 10.1016/j.jamda.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022]
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Karacsony S, Chang E, Johnson A, Good A, Edenborough M. Measuring nursing assistants' knowledge, skills and attitudes in a palliative approach: A literature review. NURSE EDUCATION TODAY 2015; 35:1232-1239. [PMID: 26043658 DOI: 10.1016/j.nedt.2015.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 05/03/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Nursing assistants are the largest aged care workforce providing care to older people in residential aged care facilities. Although studies have focused on their training and development needs when providing a palliative approach, a valid and reliable instrument to evaluate their knowledge, skills and attitudes is required. AIMS To examine what instruments have been used to evaluate nursing assistants' knowledge of, skills in and attitudes towards a palliative approach in residential aged care facilities, critically evaluate development processes, and discuss the strengths and limitations of existing instruments for this population. METHODS CINAHL, the Cochrane Library, ERIC, MEDLINE, PubMed, Scopus and Web of Science were searched using key words. Selected articles were published in English in the period 2004-2014 and included instruments which evaluated nursing assistants and a palliative approach. RESULTS Ten studies using seven instruments met the inclusion criteria. One of these instruments measured nursing assistants' level of comfort in providing end-of-life care. The six remaining instruments measured palliative care knowledge, palliative care practice, self-efficacy, knowledge and attitudes towards people with advanced dementia, beliefs and attitudes to death, dying, palliative and interdisciplinary care across the aged care workforce. CONCLUSION Seven instruments have been used to evaluate nursing assistants' knowledge, skills and attitudes in a palliative approach. Instrument design and recommended psychometric processes for development limit specificity and usefulness of these instruments for nursing assistants' scope of practice. Adhering to recommended psychometric processes will increase the validity and reliability of an instrument tailored to this population and a palliative approach.
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Affiliation(s)
- Sara Karacsony
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag, 1797, Penrith, NSW 2751, Australia.
| | - Esther Chang
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag, 1797, Penrith, NSW 2751, Australia.
| | - Amanda Johnson
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag, 1797, Penrith, NSW 2751, Australia.
| | - Anthony Good
- Centre for Complementary Medicine Research (CompleMED), University of Western Sydney, Locked Bag, 1797, Penrith, NSW 2751, Australia.
| | - Michel Edenborough
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag, 1797, Penrith NSW 2751, Australia.
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Condelius A, Andersson M. Exploring access to care among older people in the last phase of life using the behavioural model of health services use: a qualitative study from the perspective of the next of kin of older persons who had died in a nursing home. BMC Geriatr 2015; 15:138. [PMID: 26502955 PMCID: PMC4624384 DOI: 10.1186/s12877-015-0126-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is little investigation into what care older people access during the last phase of their life and what factors enable access to care in this group. Illuminating this from the perspective of the next of kin may provide valuable insights into how the health and social care system operates with reference to providing care for this vulnerable group. The behavioural model of health services use has a wide field of application but has not been tested conceptually regarding access to care from the perspective of the next of kin. The aim of this study was to explore the care accessed by older people during the last phase of their life from the perspective of the next of kin and to conceptually test the behavioural model of health services use. METHODS The data collection took place in 2011 by means of qualitative interviews with 14 next of kin of older people who had died in a nursing home. The interviews were analysed using directed content analysis. The behavioural model of health services use was used in deriving the initial coding scheme, including the categories: utilization of health services, consumer satisfaction and characteristics of the population at risk. RESULTS Utilization of health services in the last phase of life was described in five subcategories named after the type of care accessed i.e. admission to a nursing home, primary healthcare, hospital care, dental care and informal care. The needs were illuminated in the subcategories: general deterioration, medical conditions and acute illness and deterioration when death approaches. Factors that enabled access to care were described in three subcategories: the organisation of care, next of kin and the older person. These factors could also constitute barriers to accessing care. Next of kin's satisfaction with care was illuminated in the subcategories: satisfaction, dissatisfaction and factors influencing satisfaction. One new category was constructed inductively: the situation of the next of kin. CONCLUSIONS A bed in a nursing home was often accessed during what the next of kin regarded as the last phase of life. The needs among older people in the last phase of life can be regarded as complex and worsening over time. Most enabling factors lied within the organisation of care but the next of kin enabled access to care and contributed significantly to care quality. More research is needed regarding ageism and stigmatic attitudes among professionals and informal caregivers acting as a barrier to accessing care for older people in the last phase of their life. The behavioural model of health services use was extended with a new category showing that the situation of the next of kin must be taken into consideration when investigating access to care from their perspective. It may also be appropriate to include informal care as part of the concept of access when investigating access to care among older people in the last phase of their life. The results may not be transferable to older people who have not gained access to a bed in a nursing home or to countries where the healthcare system differs largely from the Swedish.
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Affiliation(s)
- Anna Condelius
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
| | - Magdalena Andersson
- City Office, Unit of Research and Development and Social Sustainability Development, Malmo, Sweden.
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Tornøe K, Danbolt LJ, Kvigne K, Sørlie V. A mobile hospice nurse teaching team's experience: training care workers in spiritual and existential care for the dying - a qualitative study. BMC Palliat Care 2015; 14:43. [PMID: 26385472 PMCID: PMC4574396 DOI: 10.1186/s12904-015-0042-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/28/2015] [Indexed: 12/28/2022] Open
Abstract
Background Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients’ spiritual and existential suffering is therefore important. The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team’s experience with teaching and training care workers in spiritual and existential care for the dying in nursing homes and home care settings. Methods The team of expert hospice nurses participated in a focus group interview. Data were analyzed using a phenomenological hermeneutical method. Results The mobile teaching team taught care workers to identify spiritual and existential suffering, initiate existential and spiritual conversations and convey consolation through active presencing and silence. The team members transferred their personal spiritual and existential care knowledge through situated “bedside teaching” and reflective dialogues. “The mobile teaching team perceived that the care workers benefitted from the situated teaching because they observed that care workers became more courageous in addressing dying patients’ spiritual and existential suffering. Discussion Educational research supports these results. Studies show that efficient workplace teaching schemes allowexpert practitioners to teach staff to integrate several different knowledge forms and skills, applying a holisticknowledge approach. One of the features of workplace learning is that expert nurses are able to guide novices through the complexities of practice. Situated learning is therefore central for becoming proficient. Conclusions Situated bedside teaching provided by expert mobile hospice nurses may be an efficient way to develop care workers’ courage and competency to provide spiritual and existential end-of-life-care. Further research is recommended on the use of mobile expert nurse teaching teams to improve nursing competency in the primary health care sector.
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Affiliation(s)
- Kirsten Tornøe
- Lovisenberg Diaconal University College, Lovisenberg gt.15B, 0456, Oslo, Norway. .,MF, Norwegian School of Theology, Gydas vei 4, Majorstuen, P.O. Box 5144, 0302, Oslo, Norway. .,Religionspsykologisk Senter (Center for the Psychology of Religion), Innlandet Hospital, P.O. Box 68, 2312, Ottestad, Norway.
| | - Lars Johan Danbolt
- MF, Norwegian School of Theology, Gydas vei 4, Majorstuen, P.O. Box 5144, 0302, Oslo, Norway. .,Religionspsykologisk Senter (Center for the Psychology of Religion), Innlandet Hospital, P.O. Box 68, 2312, Ottestad, Norway.
| | - Kari Kvigne
- Department of Nursing, Faculty of Public Health, Hedmark University College, P.O. Box 400, 2418, Elverum, Norway. .,Department of Nursing, Nesna University College, Nesna, Norway.
| | - Venke Sørlie
- Lovisenberg Diaconal University College, Lovisenberg gt.15B, 0456, Oslo, Norway.
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van Riesenbeck I, Boerner K, Barooah A, Burack OR. Coping With Client Death: How Prepared Are Home Health Aides and What Characterizes Preparedness? Home Health Care Serv Q 2015; 34:204-19. [PMID: 26496432 PMCID: PMC4734357 DOI: 10.1080/01621424.2015.1108890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study explored the experiences of 80 home health aides (HHAs) whose client died within the last 2 months. Data collection involved comprehensive semi-structured in-person interviews to try to better understand characteristics of HHAs and their clients associated with preparedness for death. Among those, personal end-of-life (EOL) care preferences of HHAs and having knowledge of preferences and decisions regarding client's EOL care showed significant links to preparedness. Findings suggest that HHAs' preparedness for client death could be enhanced both by addressing their personal views on EOL care and by providing more information about the client's EOL care plans.
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Affiliation(s)
| | - Kathrin Boerner
- b Jewish Home Lifecare, Research Institute on Aging , New York , New York , USA
- c Department of Gerontology , University of Massachusetts Boston , Boston , Massachusetts , USA
| | - Adrita Barooah
- b Jewish Home Lifecare, Research Institute on Aging , New York , New York , USA
| | - Orah R Burack
- b Jewish Home Lifecare, Research Institute on Aging , New York , New York , USA
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Barooah A, Boerner K, van Riesenbeck I, Burack OR. Nursing home practices following resident death: the experience of Certified Nursing Assistants. Geriatr Nurs 2014; 36:120-5. [PMID: 25554351 DOI: 10.1016/j.gerinurse.2014.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/15/2014] [Accepted: 11/24/2014] [Indexed: 11/26/2022]
Abstract
This study examined certified nursing assistants' (CNAs) experiences of nursing home practices following resident death. Participants were 140 CNAs who had experienced recent resident death. In semi-structured, in-person interviews, CNAs were asked about their experiences with the removal of the resident's body, filling the bed with a new resident, and how they were notified about the death. The facilities' practice of filling the bed quickly was most often experienced as negative. Responses to body removal and staff notification varied, but negative experiences were reported by a substantial minority. Being notified prior to returning to work was associated with a more positive experience. Learning about the death by walking into a room to find the bed empty or already filled was the most negative experience. Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience.
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Affiliation(s)
- Adrita Barooah
- Jewish Home Lifecare, Research Institute on Aging, 120 West 106th Street, New York, NY 10025, USA
| | - Kathrin Boerner
- University of Massachusetts Boston, Department of Gerontology, 100 Morrissey Boulevard, Boston, MA 02125, USA.
| | - Isabelle van Riesenbeck
- University of Osnabrück, FB 8/Institut für Psychologie Seminarstraße 20, 49074 Osnabrück, Germany
| | - Orah R Burack
- Jewish Home Lifecare, Research Institute on Aging, 120 West 106th Street, New York, NY 10025, USA
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Unroe KT, Cagle JG, Dennis ME, Lane KA, Callahan CM, Miller SC. Hospice in the nursing home: perspectives of front line nursing home staff. J Am Med Dir Assoc 2014; 15:881-4. [PMID: 25239013 PMCID: PMC4253535 DOI: 10.1016/j.jamda.2014.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Use of hospice has been associated with improved outcomes for nursing home residents and attitudes of nursing home staff toward hospice influences hospice referral. The objective of this study is to describe attitudes of certified nursing assistants (CNAs), nurses, and social workers toward hospice care in nursing homes. DESIGN, SETTING, AND PARTICIPANTS We conducted a survey of 1859 staff from 52 Indiana nursing homes. MEASUREMENTS Study data include responses to 6 scaled questions and 3 open-ended qualitative prompts. In addition, respondents who cared for a resident on hospice in the nursing home were asked how often hospice: (1) makes their job easier; (2) is responsive when a patient has symptoms or is actively dying; (3) makes care coordination smooth; (4) is needed; (5) taught them something; and (6) is appreciated by patients/families. Responses were dichotomized as always/often or sometimes/never. RESULTS A total of 1229 surveys met criteria for inclusion. Of the respondents, 48% were CNAs, 49% were nurses, and 3% were social workers; 83% reported caring for a nursing home patient on hospice. The statement with the highest proportion of always/often rating was 'patient/family appreciate added care' (84%); the lowest was 'hospice makes my job easier' (54%). More social workers responded favorably regarding hospice responsiveness and coordination of care compared with CNAs (P = .03 and P = .05, respectively). CONCLUSIONS A majority of staff responded favorably regarding hospice care in nursing homes. About one-third of nursing home staff rated coordination of care lower than other aspects, and many qualitative comments highlighted examples of when hospice was not responsive to patient needs, representing important opportunities for improvement.
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Affiliation(s)
- Kathleen T Unroe
- Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN.
| | - John G Cagle
- University of Maryland-Baltimore School of Social Work, Baltimore, MD
| | - M E Dennis
- Regenstrief Institute, Inc., Indianapolis, IN
| | | | - Christopher M Callahan
- Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN
| | - Susan C Miller
- Brown University School of Public Health, Providence, RI
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Swagerty D. Integrating palliative care in the nursing home: an interprofessional opportunity. J Am Med Dir Assoc 2014; 15:863-5. [PMID: 25441100 DOI: 10.1016/j.jamda.2014.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel Swagerty
- Department of Family Medicine and Landon Center on Aging, University of Kansas School of Medicine, Kansas City, KS.
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Park K, Yeom H. Factors influencing Korean nurses’ attitudes towards hospice care. Int Nurs Rev 2014; 61:563-9. [DOI: 10.1111/inr.12135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- K.S. Park
- Keumho Nursing Home; College of Nursing; The Catholic University of Korea; Seoul Korea
| | - H.A. Yeom
- Research Institute for Hospice/Palliative Care; College of Nursing; The Catholic University of Korea; Seoul Korea
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Morley JE, Sanford AM. The God Card: Spirituality in the Nursing Home. J Am Med Dir Assoc 2014; 15:533-5. [DOI: 10.1016/j.jamda.2014.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/02/2014] [Indexed: 12/31/2022]
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