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Kim J, Gray JA. Rasch analysis of a palliative care self-efficacy instrument for nursing assistants. Geriatr Nurs 2024; 60:316-325. [PMID: 39368451 DOI: 10.1016/j.gerinurse.2024.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/24/2024] [Accepted: 09/24/2024] [Indexed: 10/07/2024]
Abstract
This study used Rasch models to evaluate the psychometric properties of a self-efficacy instrument focused on psychosocial aspects of palliative care developed for nursing assistants (NAs). NAs from 6 skilled nursing facilities in Illinois, U.S. (n=102) were divided into intervention and control groups and answered 16 questions at baseline and 1-month follow-up. A total of 84 NAs completed assessments at both times. The rating scale structure improved when 3 instead of 5 response categories were used. After removing 4 items, the instrument demonstrated unidimensionality and local independence. A person-item threshold map indicated a ceiling effect. For the intervention group, 2 items and 1 item became easier and more difficult respectively post-training. With adjustments, the 12-item instrument became an adequate measure of palliative care self-efficacy. By using PCSE-NA as a tool to assess palliative care self-efficacy of NAs, geriatric nurses can identify weaknesses of and ways to improve training for NAs.
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Affiliation(s)
- Jinsook Kim
- School of Health Studies, Northern Illinois University, DeKalb, IL, 60115, USA.
| | - Jennifer A Gray
- School of Health Studies, Northern Illinois University, DeKalb, IL, 60115, USA
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Kim J, Gray JA. Measuring palliative care self-efficacy of intellectual and developmental disability staff using Rasch models. Palliat Support Care 2024; 22:146-154. [PMID: 36683394 DOI: 10.1017/s1478951522001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The objectives of this study were to evaluate the psychometric properties of a palliative care self-efficacy instrument developed for intellectual and developmental disability (IDD) staff using Rasch analysis and assess the change in palliative care self-efficacy between 2 time points using Rasch analysis of stacked data. METHODS Staff from 4 nonprofit IDD services organizations in a US Midwestern state (n = 98) answered 11 questions with Likert-style responses at baseline and 1-month follow-up post training. Rasch analysis was performed to examine rating scale structure, unidimensionality, local independence, overall model fit, person and item reliability and separation, targeting, individual item and personal fit, differential item functioning (DIF), and change in palliative care self-efficacy between 2 time points. RESULTS The rating scale structure improved when 5 response categories were collapsed to 3. With the revised 3 response categories, the instrument demonstrated good psychometric properties. Principal components analysis of Rasch residuals supported the assumption of unidimensionality. Model fit statistics indicated an excellent fit of the data to the Rasch model. The instrument demonstrated good person and item reliability and separation. Gender-related DIF was found in 1 item, and work tenure-related DIF in 3 items. Overall palliative care self-efficacy improved between 2 time points. SIGNIFICANCE OF RESULTS Rasch analysis allowed for a more thorough examination of this palliative care self-efficacy instrument than classical test theory and provided information on rating scale structure, targeting, DIF, and individual persons and items. These recommendations can improve this instrument for research and practical contexts.
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Affiliation(s)
- Jinsook Kim
- School of Health Studies, Northern Illinois University, DeKalb, IL, USA
| | - Jennifer A Gray
- School of Health Studies, Northern Illinois University, DeKalb, IL, USA
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Kim ES, Kim S, Kim K, Lee H. Psychometric properties of the Korean version of the Palliative Care Nursing Self-Competence scale for infant use. Aust Crit Care 2023; 36:1019-1024. [PMID: 36759272 DOI: 10.1016/j.aucc.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/21/2022] [Accepted: 12/20/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Despite the significant advances in neonatal treatment and care over the past 30 years, palliative care in the neonatal intensive care unit has not been fully provided in South Korea. Neonatal nurses are essential professionals in palliative care as they are directly involved in the care, but there is little information on their palliative care competency because no assessment instrument is available in Korea. OBJECTIVES The aim of this study was to develop and test the validity and reliability of the Korean version of the Palliative Care Nursing Self-Competence scale for neonatal palliative care. METHODS This scale for infant care was developed through parallel translation techniques and revised based on cognitive interviews. Survey data were then collected from 220 neonatal nurses who worked in 13 neonatal intensive care units in Korea. Internal consistency reliability, construct validity based on exploratory factor analysis, and criterion-related validity were tested. RESULTS The final version of the scale included 40 items in five domains that explained 53.4% of the variance. Criterion-related validity was confirmed based on a positive correlation with the Korean version of the attitudes towards neonatal palliative care measurement tool. The Cronbach's alpha for the scale was 0.95. CONCLUSIONS The Korean version of the Palliative Care Nursing Self-Competence scale for infant care has satisfactory construct validity and reliability to measure palliative care self-competence of neonatal nurses in Korea and evaluate an education program in future studies.
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Affiliation(s)
- Eun Sook Kim
- Neonatal Intensive Care Unit, Samsung Medical Center, 06351, South Korea.
| | - Sujeong Kim
- Department of Family Health Nursing, College of Nursing, The Catholic University of Korea, 06591, South Korea; Research Institute for Hospice/Palliative Care, The Catholic University of Korea, 06591, South Korea.
| | - Kyua Kim
- Pediatric Intensive Care Unit, Severance Hospital Health Care System, 03722, South Korea.
| | - Hyejung Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University Seoul, 03722, South Korea; College of Nursing, Yonsei University Seoul, 03722, South Korea.
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Ko E, Lowie S, Ni P. Confidence in carrying out palliative care among intensive care nurses. Nurs Crit Care 2023; 28:13-20. [PMID: 34889484 DOI: 10.1111/nicc.12735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nurses in intensive care units (ICUs) play a crucial role in providing palliative care. Effective provision of palliative care in the ICU requires nurses' active engagement, yet little is known about the confidence for palliative care that ICU nurses hold in China. AIM To explore confidence in performing palliative care among ICU nurses in China and factors related to nurses' level of confidence. STUDY DESIGN A cross-sectional design was implemented. METHODS This study utilized convenience sampling to recruit ICU nurses from nine hospitals in Wuhan, China. Data were collected via an online survey. Multiple regression was conducted to identify the predictors of the ICU nurses' confidence in performing palliative care. RESULTS A total of 231 ICU nurses participated in the study, resulting in a response rate of 78% (231/296). Participants reported a relatively low level of confidence for carrying out palliative care (mean score = 2.60 ± 0.53; range = 1-4). Nurses who had more positive attitudes toward palliative care communication (P < .001), higher levels of formal training on palliative care (P < .001), more years of working as an ICU nurse (P < .05) and those working in integrated ICU (P < .001) showed a higher level of confidence in carrying out palliative care. CONCLUSION Participants' lack of confidence in performing palliative care makes for increased challenges, particularly in uncertainty about family assessments, palliative care discussions and lack of palliative care training. Strengthening palliative care curricula in nursing education and professional training is imperative to enhance ICU nurses' confidence. RELEVANCE TO CLINICAL PRACTICE Strengthening palliative care education and training, particularly in relation to palliative care communication, is critical. Implementing and tailoring culturally relevant palliative care call for attention to practice and for policy changes in palliative care delivery in China.
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Affiliation(s)
- Eunjeong Ko
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Samantha Lowie
- Outpatient Behavioral Health, Vista Hill Foundation, San Diego, California, USA
| | - Ping Ni
- Nursing School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Robinson J, Goodwin H, Williams L, Anderson N, Parr J, Irwin R, Gott M. A task service and a talking service: A qualitative exploration of bereaved family perceptions of community nursing care at the end of life. Palliat Med 2022; 36:1522-1531. [PMID: 36267044 PMCID: PMC9749007 DOI: 10.1177/02692163221127168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Greater emphasis on community-based care at the end of life is supported by the premise that most people want to be cared for and die at home. As such, it is important to understand the current state of palliative care nursing within an integrated generalist-specialist model of care in the community. AIM To explore bereaved family perceptions and experiences of community nursing at the end of life, with a particular focus on service integration. DESIGN A qualitative study design using semi-structured telephone interviews with bereaved family. A critical realist framework was used to inform the analysis of interview data and thematic analysis of data was used to identify key themes. SETTING/PARTICIPANTS Participants were the family carers of patients who had died within the catchment area of two large District Health Boards in Auckland, New Zealand. RESULTS Twenty-three participants were interviewed. Participants described their experiences of community nursing in terms of the service they provided. Hospice nursing roles were described in terms of a "talking service" and District Nursing as a "task service." There was minimal expectation of the general practice nurse in terms of palliative care support and little evidence of service integration. CONCLUSION Findings from this study support the need for a new integrated model of palliative care nursing which utilizes the unique skill set of nurses working across all community care settings including general practice, hospice and district nursing services. Accommodating different models of nursing care which can be responsive to patient need rather than limited to a defined service delivery model.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Natalie Anderson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Rebekah Irwin
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Eche IJ, Eche I, Aronowitz T. Psychological Distress and Work-Related Quality of Life Among Oncology Nurses During the COVID-19 Pandemic: A Cross-Sectional Study. Clin J Oncol Nurs 2022; 26:268-274. [PMID: 35604733 DOI: 10.1188/22.cjon.268-274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Oncology nurses are at disproportionate risk for psychological distress because they often encounter ethical challenges and deaths while providing care. Exposures to emergent suffering during the COVID-19 pandemic compound their chronic distress, which likely increased their vulnerability to psychological distress and may increase their risk for reduced work-related quality of life (WRQOL). OBJECTIVES This study examined the association between psychological distress and WRQOL among oncology nurses during the COVID-19 pandemic. METHODS A cross-sectional analysis of psychological distress and WRQOL among oncology nurses (N = 63) was conducted. FINDINGS The mean Depression, Anxiety and Stress Scale score was 33.4, showing low depression levels, mild anxiety, and mild stress. The mean PTSD score was 29.3, and the mean WRQOL Scale score was 78.8. Depression, anxiety, and stress were strongly correlated to PTSD, and WRQOL was negatively correlated to PTSD, depression, anxiety, and stress.
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Rusli KDB, Tan AJQ, Ong SF, Speed S, Lau Y, Liaw SY. Home-based nursing care competencies: A scoping review. J Clin Nurs 2021; 32:1723-1737. [PMID: 34897853 DOI: 10.1111/jocn.16169] [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: 09/11/2021] [Revised: 11/03/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
AIMS AND OBJECTIVES To identify and consolidate the available evidence about nursing-related competencies for home-based care. BACKGROUND Over recent years, the demand for home-based nursing care has increased because of the need to meet the increasing need for chronic disease care to be delivered in patients' homes. However, knowledge is lacking about the expected competencies for home-based care nurses. DESIGN A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. The review identified literature using five electronic databases (CINAHL, PubMed, Embase, Cochrane and Scopus) and a hand search for grey literature in relevant home-based care journals and online searches. Key search terms and inclusion and exclusion criteria were used as strategies to identify relevant articles. RESULTS Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified the following 10 competencies: (1) care assessments; (2) performance of nursing procedures; (3) management of health conditions; (4) critical thinking and problem-solving skills; (5) interpersonal relationships and communication; (6) interdisciplinary collaboration; (7) leadership and resource management; (8) professional development; (9) technological literacy; (10) quality and safety. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses' competence level for home-based care or for development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardisation of home-based nursing care expectations across various stakeholders.
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Affiliation(s)
- Khairul Dzakirin Bin Rusli
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shu Fen Ong
- APN & Speciality Nurse Department, Khoo Teck Puat Hospital, Yishun Health, Singapore, Singapore
| | - Shaun Speed
- Faculty of Health and Social Care, University of Chester, Wirral, UK
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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SARIÇAM G, KAHVECİ K, AKDOĞAN D. Palyatif Bakımda Nörolojik Hastalıklarda Hemşirelerin Bilgisi Yeterlimi? KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.834227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Palliative Care Nursing Competence of Chinese Oncology Nurses and Its Related Factors. J Hosp Palliat Nurs 2020; 21:404-411. [PMID: 31166301 DOI: 10.1097/njh.0000000000000581] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In China, the development of palliative care is challenging because of limited available resources and rapidly increasing demands. The nurses' competence is a significant element in providing high-quality palliative care. This cross-sectional study aimed to describe the palliative care competence among oncology nurses and to examine the relationships between it and palliative care knowledge, attitudes, and workplace learning conditions. A total of 220 nurses with more than 6 months of experience and who worked in inpatient wards were invited to participate in this study. Four questionnaires were administered to collect data-the Palliative Care Quiz for Nurses, the Attitudes Toward Palliative Care Scale, the Workplace Learning Conditions scale, and the Palliative Care Nursing Self-competence Scale. The data were analyzed using descriptive statistics and Pearson correlations. The moderate level of competence was reported by 212 participants (response rate, 96.36%). The scores were lower in the aspects of competence such as spiritual care and ethical and legal issues. Competence was positively related to workplace learning conditions and knowledge but not attitudes. The results highlighted the necessity of improving the palliative care competence among oncology nurses. The optimization of learning conditions in the hospital is recommended to be a vital force in strengthening competence.
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Thavaraj A, Gillett K. Does post-registration palliative care education for nurses improve practice? A systematic review. Int J Palliat Nurs 2020; 25:552-564. [PMID: 31755829 DOI: 10.12968/ijpn.2019.25.11.552] [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] [Indexed: 11/11/2022]
Abstract
AIMS We aimed to answer the question: what is the evidence that post-registration palliative care education for nurses improves practice? BACKGROUND The 2008 End of Life Care Strategy emphasised the need for a workforce equipped to provide high-quality end-of-life care for patients and their families. As registered nurses are the healthcare professionals spending most time with patients and families at the end of life, associated policy documents stress the importance of educating nurses to equip them with the necessary knowledge and skills to provide effective care. Despite education being a consistent recommendation, the ability of education to influence nursing practice is uncertain. METHODS We undertook a systematic review of literature using Joanna Briggs Institute Methodology for Mixed Methods by searching the Medline, Embase and CINAHL databases between January 2006 and December 2018. FINDINGS Ten studies met the inclusion criteria, seven contained quantitative data. Six demonstrated improvements in outcome measures, but not all results were statistically significant. Most quantitative data related to self-reported measures of confidence. Six studies contained qualitative findings that were categorised into themes: confidence, practice change, skills and proactivity. CONCLUSION Little research exists exploring the impact of post-registration palliative care education for nurses. Existing outcome measures do not clearly demonstrate changes to end-of-life practice. Research is suggested to establish links between self-reported confidence and improvements to practice. Evaluation of the impact on practice should be an integral component of end-of-life education initiatives.
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Affiliation(s)
| | - Karen Gillett
- Lecturer, King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London
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Schwill S, Reith D, Walter T, Engeser P, Wensing M, Flum E, Szecsenyi J, Krug K. How to ensure basic competencies in end of life care - a mixed methods study with post-graduate trainees in primary care in Germany. BMC Palliat Care 2020; 19:36. [PMID: 32209073 PMCID: PMC7093985 DOI: 10.1186/s12904-020-00540-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background Providing end of life care (EoLC) is an important aspect of primary care, which reduces the risk of hospital admission for most patients. However, general practitioners (GPs) seem to have low confidence in their ability to provide EoLC. Little is known about an adequate volume and kind of training in EoLC among GP trainees. Methods We performed a before-after comparison in all post-graduate GP trainees who were registered in the vocational training program (KWBW VerbundweiterbildungPLUS). They were offered participation within a two-day seminar focussing on palliative care in 2017. Those who attended the seminar (intervention group I) completed a paper-based questionnaire directly before the intervention (T1) and 6 months after (T2). None-attendees (group C) were also asked to fill out the questionnaire once. The questionnaire covered previous experiences in palliative care, self-assessment of competencies in EoLC in the organisation of patient care as well as in control of symptoms, attitudes towards death and caring for dying patients and questions about GPs’ role in EoLC. Results In total, 294 GP trainees (I: n = 219; C: n = 75) participated in the study. Of those, more than 90% had previously gained experience in EoLC mainly during vocational training in the hospital rotation. Around a third had previously gained competencies in EoLC in medical school. Between groups I (T1) and C no significant differences were observed in socio-demographic characteristics, pre-existing experience or overall expertise. At T2, 75% of participants of group I declared they have extended their competencies in EoLC after the intervention and 70% classified the intervention as helpful or very helpful. Overall, they rated their competencies significantly higher than at T1 (p < 0.01). In detail, competencies in organisation of EoLC and competencies in handling of symptoms significantly improved (p < 0.01). Due to the intervention, 66% could reflect their attitudes towards dying, death and grief and 18% changed their attitudes. Group I highlighted palliative care as one of GPs tasks (Likert 4.47/5, SD 0.75). Conclusions The intervention fostered personal competencies, understanding and self-confidence in EoLC among GP trainees. This is crucial for the aim to broadly provide EoLC.
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Affiliation(s)
- Simon Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany.
| | - Dorothee Reith
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Tobias Walter
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Peter Engeser
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Elisabeth Flum
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
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Khalil H, Byrne A, Ristevski E. The development and implementation of a clinical skills matrix to plan and monitor palliative care nurses' skills. Collegian 2019. [DOI: 10.1016/j.colegn.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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ADISA R, ANIFOWOSE AT. Pharmacists' knowledge, attitude and involvement in palliative care in selected tertiary hospitals in southwestern Nigeria. BMC Palliat Care 2019; 18:107. [PMID: 31783834 PMCID: PMC6884848 DOI: 10.1186/s12904-019-0492-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/20/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The growing number of people living with life-limiting illness is a global health concern. This study therefore aimed to explore the involvement of pharmacists in selected tertiary hospitals in Nigeria in palliative care (PC). It also sought to evaluate their knowledge and attitude to PC as well as factors that hinder pharmacists' participation in PC. METHOD Questionnaire-guided survey among pharmacists working in three-tertiary hospitals in southwestern Nigeria. The self-administered questionnaire comprised 18-item general knowledge questions related to PC, attitude statements with 5-point Likert-scale options and question-items that clarify extent of involvement in PC and barriers to participation. Overall score by pharmacists in the knowledge and attitude domains developed for the purpose of this study was assigned into binary categories of "adequate" and "inadequate" knowledge (score > 75% versus≤75%), as well as "positive" and "negative" attitude (ranked score > 75% versus≤75%), respectively. Descriptive statistics, Mann-Whitney-U and Kruskal-Wallis tests were used for analysis at p < 0.05. RESULTS All the 110 pharmacists enrolled responded to the questionnaire, given a response rate of 100%. Overall, our study showed that 23(21.1%) had adequate general knowledge in PC, while 14(12.8%) demonstrated positive attitude, with 45(41.3%) who enjoyed working in PC. Counselling on therapy adherence (100;90.9%) was the most frequently engaged activity by pharmacists; attending clinical meetings to advise health team members (45;40.9%) and giving educational sessions (47;42.7%) were largely cited as occasionally performed duties, while patient home visit was mostly cited (60;54.5%) as a duty not done at all. Pharmacists' unawareness of their need in PC (86;79.6%) was a major factor hindering participation, while pharmacists with PC training significantly felt more relaxed around people receiving PC compared to those without training (p = 0.003). CONCLUSION Hospital pharmacists in selected tertiary care institutions demonstrate inadequate knowledge, as well as negative attitude towards PC. Also, extent of involvement in core PC service is generally low, with pharmacists' unawareness of their need in PC constituting a major barrier. Thus, a need for inclusion of PC concept into pharmacy education curriculum, while mandatory professional development programme for pharmacists should also incorporate aspects detailing fundamental principles of PC, in order to bridge the knowledge and practice gaps.
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Affiliation(s)
- Rasaq ADISA
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Lau ST, Lopez V, Liaw SY, Lau Y. Development and psychometric evaluation of the community care competency scale in multi-ethnic undergraduate nursing students. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e802-e813. [PMID: 31286634 DOI: 10.1111/hsc.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/23/2019] [Accepted: 06/17/2019] [Indexed: 06/09/2023]
Abstract
Preparing healthcare students for community care has been emphasised due to the global ageing population. An instrument to measure students' community care competency is lacking. This study aimed to develop and evaluate the psychometric properties of a new scale known as Community Care Competency Scale (CCCS) for measuring nursing students' community care competency. CCCS consists of 21 items derived from literature review and community care standards. Content validity was established through a panel of seven experts in the areas of knowledge with a content validity index of 0.96. A cross-sectional study was undertaken in a university in Singapore by using an anonymous self-administered questionnaire to nursing students, and obtained a response rate of 87% (n = 283). Psychometric properties were explored using convergent and known-group validity testing, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and Cronbach's alpha test. The results showed good convergent and known-group validity. EFA and CFA showed a coherent construct of the 21 items of CCCS in a one-factor model. The Cronbach's alpha of 0.94 indicated excellent internal consistency. The CCCS is a valid, reliable and easy-to-administer instrument that measures community care competency. This instrument will contribute to the empirical body of knowledge on evaluating the effectiveness of community care educational programmes for nursing students to prepare future healthcare professionals.
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Affiliation(s)
- Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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Rabbetts L, Harrington A, Breaden K. Nurses' experience of providing home-based palliative care in the country setting: An integrated literature review. Int J Nurs Pract 2019; 26:e12773. [PMID: 31423691 DOI: 10.1111/ijn.12773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/16/2019] [Accepted: 07/06/2019] [Indexed: 11/26/2022]
Abstract
AIMS The aim of the study is to explore the experiences of nurses providing home-based palliative care for patients who live in country settings. METHODS This study is an integrated literature review. Electronic databases, specific journals of interest, and reference lists were searched using key words and Boolean operators. Descriptive thematic analysis was undertaken to identify main themes and subthemes. Critical appraisal of the articles was conducted using the qualitative Critical Appraisal Skills Program guidelines. Primary research articles published in English, in peer-reviewed journals from 1990 to 2017, were included. RESULTS Twelve articles were included in this review. Two main themes emerged including the nature of nursing in country communities and nurses' emotional responses. The first main theme had the subthemes of community connections, geographical distance and isolation, organizational deficits, lack of education, and resources. The second main theme consisted on five subthemes including feeling rewarded, autonomy and professional isolation, hope and hopelessness, frustration, and fear. CONCLUSION Literature is sparse reporting the lived experience of nurses providing palliative care in country areas for patients wanting to die at home. An increase in demand for a home-based palliative nursing service will require additional funding globally to meet this increase in the future.
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Affiliation(s)
- Lyn Rabbetts
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Ann Harrington
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Katrina Breaden
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Krautheim V, Schmitz A, Benze G, Standl T, Schiessl C, Waldeyer W, Hapfelmeier A, Kochs EF, Schneider G, Wagner KJ, Schulz CM. Self-confidence and knowledge of German ICU physicians in palliative care - a multicentre prospective study. BMC Palliat Care 2017; 16:57. [PMID: 29166887 PMCID: PMC5700543 DOI: 10.1186/s12904-017-0244-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Little is known about ICU physicians’ self-confidence and knowledge related to palliative care. Our objective was to investigate self-confidence and knowledge of German ICU physicians related to palliative care, and to assess the impact of work experience, gender, specialty and additional certifications in pain or palliative medicine. Methods In a multicentre prospective observational study ICU physicians of ten hospitals were asked to rate their self-confidence and to complete a multiple choice questionnaire for the assessment of knowledge. Beyond descriptive statistics and non-parametric tests for group comparisons, linear regression analysis was used to assess the impact of independent variable on self-confidence and knowledge. Spearman‘s rank test was calculated. Results 55% of answers in the knowledge test were correct and more than half of the participants rated themselves as “rather confident” or “confident”. Linear regression analysis revealed that an additional certificate in either pain or palliative medicine significantly increased both knowledge and self-confidence, but only 15 out of 137 participants had at least one of those certificates. Relation between self-confidence and the results of the knowledge test was weak (r = 0.270 in female) and very weak (r = −0.007 in male). Conclusions Although the questionnaire needs improvement according to the item analysis, it appears that, with respect to palliative care, ICU Physicians’ self-confidence is not related to their knowledge. An additional certificate in either pain or palliative medicine was positively correlated to both self-confidence and knowledge. However, only a minority of the participants were qualified through such a certificate. Electronic supplementary material The online version of this article (10.1186/s12904-017-0244-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Veronika Krautheim
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Andrea Schmitz
- Interdisziplinäres Zentrum für Palliativmedizin, Medizinische Fakultät Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Gesine Benze
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Thomas Standl
- Klinik für Anaesthesiologie, Operative Intensiv- und Palliativmedizin, Städtisches Klinikum Solingen, Solingen, Germany
| | | | - Wolfgang Waldeyer
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Hapfelmeier
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Eberhard F Kochs
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Gerhard Schneider
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,Klinik für Anaesthesiologie, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Klaus J Wagner
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Christian M Schulz
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
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Berggren E, Ödlund Olin A, Orrevall Y, Strang P, Johansson SE, Törnkvist L. Early palliative home care: Evaluation of an interprofessional educational intervention for district nurses and general practitioners about nutritional care. SAGE Open Med 2017; 5:2050312117726465. [PMID: 28839942 PMCID: PMC5564855 DOI: 10.1177/2050312117726465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/17/2017] [Indexed: 01/06/2023] Open
Abstract
Background: Teamwork is important in early palliative home care, and interprofessional education is required to achieve teamwork. It is thus crucial to ensure that interprofessional education works well for the members of all participating professions because levels of knowledge and educational needs may vary. Aim: To evaluate, by profession, the effectiveness of an interprofessional educational intervention for district nurses and general practitioners on three areas of nutritional care for patients in a palliative phase. Design: A quasi-experimental study that used a computer-based, study-specific questionnaire to evaluate the effectiveness of the intervention. The continuing education in primary health care (ConPrim®) model was used to create the intervention. ConPrim includes a web-based program, a practical exercise and a case seminar, all with interprofessional training. Setting: Primary health care centers in Stockholm County, Sweden. Intervention group (n = 87; 48 district nurses, 39 general practitioners); control group (n = 53; 36 district nurses, 17 general practitioners). Results: The total intervention effect was significant in all three areas, p = 0.000–0.004. The intervention effects were similar and significant for both professions in areas 1 and 2. In area 3, the intervention effects were significant for general practitioners but not for district nurses. Conclusions: The intervention seems promising, as it may create better prerequisites for teamwork and caring for patients living at home. However, it needs to be optimized to better increase district nurses’ level of knowledge (area 3).
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Affiliation(s)
- Erika Berggren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm County Council, Sweden
| | - Ann Ödlund Olin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
| | - Ylva Orrevall
- Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden.,Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Sven-Erik Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm County Council, Sweden
| | - Lena Törnkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm County Council, Sweden
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Palliative care education in Latin America: A systematic review of training programs for healthcare professionals. Palliat Support Care 2017; 16:107-117. [DOI: 10.1017/s147895151700061x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:The integration of palliative care (PC) education into medical and nursing curricula has been identified as an international priority. PC education has undergone significant development in Latin America, but gaps in the integration of PC courses into undergraduate and postgraduate curricula remain. The aim of our review was to systematically examine the delivery of PC education in Latin America in order to explore the content and method of delivery of current PC programs, identify gaps in the availability of education opportunities, and document common barriers encountered in the course of their implementation.Method:We carried out a systematic review of peer-reviewed academic articles and grey literature. Peer-reviewed articles were obtained from the following databases: CINAHL Plus, Embase, the Web of Science, and Medline. Grey literature was obtained from the following directories: the International Association for Hospice and Palliative Care's Global Directory of Education in Palliative Care, the Worldwide Hospice Palliative Care Alliance's lists of palliative care resources, the Latin American Association for Palliative Care's training resources, and the Latin American Atlas of Palliative Care. The inclusion criteria were that the work: (1) focused on describing PC courses; (2) was aimed at healthcare professionals; and (3) was implemented in Latin America. The PRISMA checklist was employed to guide the reporting of methods and findings.Results:We found 36 programs that were delivered in 8 countries. Most of the programs were composed of interdisciplinary teams, taught at a postgraduate level, focused on pain and symptom management, and utilized classroom-based methods. The tools for evaluating the courses were rarely reported. The main barriers during implementation included: a lack of recognition of the importance of PC education, a lack of funding, and the unavailability of trained teaching staff.Significance of results:Considerable work needs to be done to improve the delivery of PC education programs in Latin American countries. Practice-based methods and exposure to clinical settings should be integrated into ongoing courses to facilitate learning. A regional platform needs to be created to share experiences of successful training programs and foster the development of PC education throughout Latin America.
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Alsharif W, Davis M, McGee A, Rainford L. An investigation of Saudi Arabian MR radiographers' knowledge and confidence in relation to MR image-quality-related errors. Radiography (Lond) 2016; 23:e27-e33. [PMID: 28390556 DOI: 10.1016/j.radi.2016.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate MR radiographers' current knowledge base and confidence level in relation to quality-related errors within MR images. METHOD Thirty-five MR radiographers within 16 MRI departments in the Kingdom of Saudi Arabia (KSA) independently reviewed a prepared set of 25 MR images, naming the error, specifying the error-correction strategy, scoring how confident they were in recognising this error and suggesting a correction strategy by using a scale of 1-100. The datasets were obtained from MRI departments in the KSA to represent the range of images which depicted excellent, acceptable and poor image quality. RESULTS The findings demonstrated a low level of radiographer knowledge in identifying the type of quality errors and when suggesting an appropriate strategy to rectify those errors. The findings show that only (n = 7) 20% of the radiographers could correctly name what the quality errors were in 70% of the dataset, and none of the radiographers correctly specified the error-correction strategy in more than 68% of the MR datasets. The confidence level of radiography participants in their ability to state the type of image quality errors was significantly different (p < 0.001) for who work in different hospital types. CONCLUSION The findings of this study suggest there is a need to establish a national association for MR radiographers to monitor training and the development of postgraduate MRI education in Saudi Arabia to improve the current status of the MR radiographers' knowledge and direct high quality service delivery.
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Affiliation(s)
- W Alsharif
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland; Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia.
| | - M Davis
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
| | - A McGee
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
| | - L Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
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Erlich A, Posluns E, Stokes E, Di Prospero L. Food for Thought: Are Radiation Therapists Able to Recognize Patients Who Would Benefit from Dietary Counseling? J Med Imaging Radiat Sci 2015; 46:S13-S22. [DOI: 10.1016/j.jmir.2015.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 12/12/2022]
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Abstract
BACKGROUND Nurses play a major role all over the world in the palliative care team. AIM The aim of this study was to investigate the knowledge and attitude of nurses toward palliative care in a tertiary level hospital in Nigeria. SUBJECTS AND METHODS SETTING This cross-sectional questionnaire-based study was carried out among nurses at a tertiary health care facility in Ado-Ekiti, South-West Nigeria. A cross-sectional questionnaire-based study was carried out. The questionnaire sought information about the sociodemographic profile of respondents, their knowledge of definition and philosophy of palliative care among other things. Descriptive statistics was used to obtain the general characteristics of the study participants, while Chi-square was used to determine the association between categorical variables. A two-sided P < 0.05 was considered as significant. RESULTS A total of 100 questionnaires were returned with a female preponderance among the respondents with F: M ratio of 9:1. Regarding the definition of palliative care, 71.8% (48/66) of the respondents understood palliative care to be about pain medicine, 55% (33/60) thought it to be geriatric medicine, while 90.2% (83/92) felt palliative care is about the active care of the dying. Exactly 80.5% (66/82) respondents agreed that palliative care recognizes dying as a normal process while 84.1% (74/88) respondents were of the opinion that all dying patients would require palliative care. The use of morphine would improve the quality of life of patients according to 68.9% (42/61) of respondents. CONCLUSION There are gaps in the knowledge of healthcare workers in the area of palliative care and this call for a review of the current nursing curriculum and practice guidelines in Nigeria.
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Affiliation(s)
- Jo Fadare
- Department of Pharmacology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Am Obimakinde
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Do Olaogun
- Department of Obstetrics and Gynecology, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Jm Afolayan
- Department of Anesthesia, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - O Olatunya
- Department of Pediatrics, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Ko Ogundipe
- Department of Surgery, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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Chan WCH, Tin AF, Wong KLY. Coping With Existential and Emotional Challenges: Development and Validation of the Self-Competence in Death Work Scale. J Pain Symptom Manage 2015; 50:99-107. [PMID: 25701687 DOI: 10.1016/j.jpainsymman.2015.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 02/02/2015] [Accepted: 02/14/2015] [Indexed: 10/24/2022]
Abstract
CONTEXT Palliative care professionals often are confronted by death in their work. They may experience challenges to self, such as aroused emotions and queries about life's meaningfulness. Assessing their level of "self-competence" in coping with these challenges is crucial in understanding their needs in death work. OBJECTIVES This study aims to develop and validate the Self-Competence in Death Work Scale (SC-DWS). METHODS Development of this scale involved three steps: 1) items generated from a qualitative study with palliative care professionals, (2) expert panel review, and (3) pilot test. Analysis was conducted to explore the factor structure and examine the reliability and validity of the scale. Helping professionals involved in death work were recruited to complete questionnaires comprising the SC-DWS and other scales. RESULTS A total of 151 participants were recruited. Both one-factor and two-factor structures were found. Emotional and existential coping were identified as subscales in the two-factor structure. Correlations of the whole scale and subscales with measures of death attitudes, meaning in life, burnout and depression provided evidence for the construct validity. Discriminative validity was supported by showing participants with bereavement experience and longer experience in the profession and death work possessed a significantly higher level of self-competence. Reliability analyses showed that the entire scale and subscales were internally consistent. CONCLUSION The SC-DWS was found to be valid and reliable. This scale may facilitate helping professionals' understanding of their self-competence in death work, so appropriate professional support and training may be obtained.
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Affiliation(s)
- Wallace Chi Ho Chan
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Agnes Fong Tin
- Center on Behavioral Health, The University of Hong Kong, Hong Kong SAR, China
| | - Karen Lok Yi Wong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China
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Nurses' knowledge and comfort levels using the Physician Orders for Life-sustaining Treatment (POLST) form in the progressive care unit. Geriatr Nurs 2015; 36:21-4. [DOI: 10.1016/j.gerinurse.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/01/2014] [Accepted: 09/08/2014] [Indexed: 11/20/2022]
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Cavaye J, Watts JH. Student Nurses Learning about Death, Dying, and Loss: Too Little, Too Late? ACTA ACUST UNITED AC 2014. [DOI: 10.2190/il.22.4.c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Concerns about the care provided to people dying from life-threatening illness have prompted a number of international reforms to improve the quality of palliative and end-of-life (EOL) care. The majority of this care is provided by nurses. They spend more time with dying patients than any other health professionals and therefore, need specific clinical skills and knowledge. Palliative and EOL care education is increasingly being positioned as a specialism, available only to a small number of registered nurses as part of continuing professional development. However, increasing numbers of patients with life-threatening illness are being treated in non-specialist settings by nurses with a generalist education. Furthermore, undergraduate nurse education has traditionally had a limited focus on palliative and EOL care, hence claims that undergraduate nursing curricula are inadequate. Drawing on an international literature, this review explores the evidence about the adequacy of undergraduate curricula in this area. It considers the extent to which palliative and EOL curriculum is included in undergraduate nurse education and draws upon evidence from students and registered nurses, who as consumers of education, report feeling unprepared to care for and communicate with, dying patients.
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Reed FM, Fitzgerald L, Bish MR. District nurse advocacy for choice to live and die at home in rural Australia: a scoping study. Nurs Ethics 2014; 22:479-92. [PMID: 24981253 DOI: 10.1177/0969733014538889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. OBJECTIVES The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. METHOD Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. RESULTS 34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role. DISCUSSION Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. CONCLUSION It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.
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Wheeler C, Anstey S, Lewis M, Jeynes K, Way H. The effect of education on community nursing practice in improving the patient-carer experience at the end of life. Br J Community Nurs 2014; 19:284-290. [PMID: 24902056 DOI: 10.12968/bjcn.2014.19.6.284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Successfully completing the 'Foundations in End of Life/Palliative Care' distance-learning module has had a measurable effect on the knowledge, competence and confidence of community nurses in the principles and practice of palliative and end-of-life care. An appropriate practice-based education module can empower community nursing practice and have a direct impact on improving the patient-carer experience at the end of life. This article provides evidence from the quantitative and qualitative data from pre- and post-module self-assessment questionnaires along with the successful completion of an electronic multiple-choice questionnaire and short-answer classroom test to demonstrate this.
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Affiliation(s)
- Christine Wheeler
- Clinical Nurse Specialist, Palliative Care, Cardiff and Vale University Health Board and Associate Lecturer, Cardiff University
| | | | - Melanie Lewis
- Lead Nurse, Palliative Care, Cardiff and Vale University Health Board
| | - Kay Jeynes
- Locality Lead Nurse, Cardiff and Vale University Health Board
| | - Helen Way
- Clinical Nurse Specialist, Palliative Care, Velindre NHS Trust, Cardiff
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Abstract
Home health care faces challenges that could affect job satisfaction and quality of care. The aim of the study was to describe nurses’ experiences of competence in home health care. The study sample comprised of interviews with six nurses and was analyzed using manifest qualitative content analysis. The category “Being prepared” and subcategories “Importance of leadership strategies,” “Training promotes safety and independence,” and “Co-operation for professional development” were identified. Organizing and planning continuous learning activities at a managerial level, such as collaborations with a focus on supervision and sense of coherence (SOC) training, could develop patient safety within home health care. The results demonstrate that professionally competent nurses working in home health care environments contribute to safe working practices to meet quality care outcomes.
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The need for palliative care education, support, and reflection among rural nurses and other staff: A quantitative study. Palliat Support Care 2014; 13:265-74. [DOI: 10.1017/s1478951513001272] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Many people now die in community care, and, considering the aging population, all healthcare staff members must be prepared to provide palliative care. Our objectives were to describe the total staff working in different care organizations in a rural community in Sweden and to explore palliative care competence, to describe educational gaps and the need for support and reflection, and to determine whether there are differences in care organizations, professions, age, and gender.Method:A 4-section 20-item questionnaire was distributed to 1686 staff (65% response rate): in nursing homes (n = 395), home care (n = 240), and group residential settings (n = 365). Registered nurses (n = 70), assistant nurses (n = 916), managers (n = 43), and paramedics (n = 33) participated. Descriptive and correlational statistics were employed.Results:Significant differences were found, and 40% (53% among men) lacked palliative care education, Fewer than 50% lacked education in the spiritual/existential areas, and 75% of those aged 20–66 (75% women, 55% men) needed further education. More women than men and staff aged 50–59 had an increased need to reflect.Significance of Results:Our study may provide guidance for managers in rural communities when planning educational interventions in palliative care for healthcare staff and may support direct education with content for specific professions.
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Hirooka K, Miyashita M, Morita T, Ichikawa T, Yoshida S, Akizuki N, Akiyama M, Shirahige Y, Eguchi K. Regional Medical Professionals' Confidence in Providing Palliative Care, Associated Difficulties and Availability of Specialized Palliative Care Services in Japan. Jpn J Clin Oncol 2014; 44:249-56. [DOI: 10.1093/jjco/hyt204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bing-Jonsson PC, Bjørk IT, Hofoss D, Kirkevold M, Foss C. Instruments Measuring Nursing Staff Competence in Community Health Care. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2013. [DOI: 10.1177/1084822313494784] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is currently no review of instruments that measure nursing staff competence in community health care. This study aims to (a) identify competence measurement instruments developed for nursing staff in community health care, and (b) explore conceptual and methodological issues concerning these instruments. A systematic literature search was made for the period 2000-2012. Instruments were evaluated for target group, content, and methodological quality. Of 11 identified instruments, all self-report, only four provided sufficient evidence of instrument validity. Few instruments had conceptualized competence by defining and operationalizing the concept. The evidence of the quality of the instruments varied greatly and was generally not sufficient. This review may help researchers decide which existing competence measurement instrument to use or whether they have to develop a new instrument.
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Willis S, Sutton J. Managing complex palliative wounds: an interactive educational approach for district nurses. Int J Palliat Nurs 2013; 19:457-62. [DOI: 10.12968/ijpn.2013.19.9.457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shirley Willis
- Cardiff and Vale University Health Board, Vale Locality, Vale of Glamorgan, Wales
| | - Joanne Sutton
- Primary Care and Public Health, School of Health Care Sciences, College of Biomedical and Life Sciences, Cardiff University, Eastgate House, 35–43 Newport Road, Cardiff CF24 0AB, Wales
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Frey R, Gott M, Banfield R. What indicators are measured by tools designed to address palliative care competence among ‘generalist’ palliative care providers? A critical literature review. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x11y.0000000003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Moore PM, Rivera Mercado S, Grez Artigues M, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2013; 2013:CD003751. [PMID: 23543521 PMCID: PMC6457800 DOI: 10.1002/14651858.cd003751.pub3] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction. SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.
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Affiliation(s)
- Philippa M Moore
- Family Medicine, P. Universidad Catolica de Chile, Lira 44, Santiago, Chile.
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Pulsford D, Jackson G, O'Brien T, Yates S, Duxbury J. Classroom-based and distance learning education and training courses in end-of-life care for health and social care staff: a systematic review. Palliat Med 2013; 27:221-35. [PMID: 22126845 DOI: 10.1177/0269216311429496] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Staff from a range of health and social care professions report deficits in their knowledge and skills when providing end-of-life and palliative care, and education and training has been advocated at a range of levels. AIMS To review the literature related to classroom-based and distance learning education and training initiatives for health and social care staff in end-of-life and palliative care, in terms of their target audience, extent, modes of delivery, content and teaching and learning strategies, and to identify the most effective educational strategies for enhancing care. DESIGN A systematic review of the literature evaluating classroom-based and distance learning education and training courses for health and social care staff in end-of-life and palliative care. DATA SOURCES Online databases CINAHL, MEDLINE, EMBASE and PSYCHINFO between January 2000 and July 2010. Studies were selected that discussed specific education and training initiatives and included pre-and post-test evaluation of participants' learning. RESULTS 30 studies met eligibility criteria. The majority reported successful outcomes, though there were some exceptions. Level of prior experience and availability of practice reinforcement influenced learning. Participative and interactive learning strategies were predominantly used along with discussion of case scenarios. Multi-professional learning was infrequently reported and service user and carer input to curriculum development and delivery was reported in only one study. CONCLUSIONS Classroom-based education and training is useful for enhancing professionals' skills and perceived preparedness for delivering end-of-life care but should be reinforced by actual practice experience.
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Affiliation(s)
- David Pulsford
- School of Health, University of Central Lancashire, Preston, UK.
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Luckett T, Davidson PM, Lam L, Phillips J, Currow DC, Agar M. Do community specialist palliative care services that provide home nursing increase rates of home death for people with life-limiting illnesses? A systematic review and meta-analysis of comparative studies. J Pain Symptom Manage 2013; 45:279-97. [PMID: 22917710 DOI: 10.1016/j.jpainsymman.2012.02.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 11/17/2022]
Abstract
CONTEXT Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly. OBJECTIVES To establish whether community SPCSs offering home nursing increase rates of home death compared with other models. METHODS We searched MEDLINE, AMED, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and CENTRAL on March 2 and 3, 2011. To be eligible, articles had to be published in English-language peer-reviewed journals and report original research comparing the effect on home deaths of SPCSs providing home nursing vs. any alternative. Study quality was independently rated using Cochrane grades. Maximum likelihood estimation of heterogeneity was used to establish the method for meta-analysis (fixed or random effects). Potential biases were assessed. RESULTS Of 1492 articles screened, 10 articles were found eligible, reporting nine studies that yielded data for 10 comparisons. Study quality was high in two cases, moderate in three and low in four. Meta-analysis indicated a significant effect for SPCSs with home nursing (odds ratio 4.45, 95% CI 3.24-6.11; P<0.001). However, the high-quality studies found no effect (odds ratio 1.40, 95% CI 0.97-2.02; P=0.071). Bias was minimal. CONCLUSION A meta-analysis found evidence to be inconclusive that community SPCSs that offer home nursing increase home deaths without compromising symptoms or increasing costs. But a compelling trend warrants further confirmatory studies. Future trials should compare the relative efficacy of different models and intensities of SPCSs.
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Affiliation(s)
- Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT), South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
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Raunkiaer M, Timm H. Interventions concerning competence building in community palliative care services--a literature review. Scand J Caring Sci 2013; 27:804-19. [PMID: 23289896 DOI: 10.1111/scs.12020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/07/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies establish that many incurably ill people would prefer to die at home, whether their final home is their own home or a nursing home. Experience shows that the professionals in palliative care at the basis level need to increase their competences. The purpose of this literature review is to examine experiences with interventions regarding the development of competencies within community palliative care services - in other words, at the individual work places. METHOD The study has been carried out as a literature review of international databases (PubMed/Medline, CHINAL, PsycInfo) with selected key words. RESULTS The review of the literature identified 15 publications which dealt with interventions regarding education and competence building. The publications represent individual studies, only two of which were controlled. All conclude that competence building has a positive effect according to the professionals. It is unknown whether or how patients and relatives feel a positive effect from the interventions just as it is unknown how the development of competencies has actually led to a more developed practice. The effect of local competence building in palliative care in the primary sector is lacking. Methods are needed to further examinations of how a competency has actually led to a more developed practice.
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Affiliation(s)
- Mette Raunkiaer
- Danish Knowlegde Center for Palliative Care, Copenhagen, Denmark
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Prem V, Karvannan H, Kumar SP, Karthikbabu S, Syed N, Sisodia V, Jaykumar S. Study of Nurses' Knowledge about Palliative Care: A Quantitative Cross-sectional Survey. Indian J Palliat Care 2012; 18:122-7. [PMID: 23093828 PMCID: PMC3477365 DOI: 10.4103/0973-1075.100832] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care. AIMS The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge test (PCKT). SETTINGS AND DESIGN Cross-sectional survey of 363 nurses in a multispecialty hospital. MATERIALS AND METHODS The study utilized a self-report questionnaire- PCKT developed by Nakazawa et al., which had 20 items (statements about palliative care) for each of which the person had to indicate 'correct', 'incorrect', or 'unsure.' The PCKT had 5 subscales (philosophy- 2 items, pain- 6 items, dyspnea- 4 items, psychiatric problems- 4 items, and gastro-intestinal problems- 4 items). STATISTICAL ANALYSIS USED Comparison across individual and professional variables for both dimensions were done using one-way ANOVA, and correlations were done using Karl-Pearson's co-efficient using SPSS version 16.0 for Windows. RESULTS The overall total score of PCKT was 7.16 ± 2.69 (35.8%). The philosophy score was 73 ± .65 (36.5%), pain score was 2.09 ± 1.19 (34.83%), dyspnea score was 1.13 ± .95 (28.25%), psychiatric problems score was 1.83 ± 1.02 (45.75%), and gastro-intestinal problems score was 1.36 ± .97 (34%). (P = .00). The female nurses scored higher than their male counterparts, but the difference was not significant (P > .05). CONCLUSIONS Overall level of knowledge about palliative care was poor, and nurses had a greater knowledge about psychiatric problems and philosophy than the other aspects indicated in PCKT.
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Affiliation(s)
- Venkatesan Prem
- Department of Physiotherapy, Manipal College of Allied Health Sciences (Manipal University), Manipal Hospital, Bangalore, India
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Boase S, Mason D, Sutton S, Cohn S. Tinkering and tailoring individual consultations: how practice nurses try to make cardiovascular risk communication meaningful. J Clin Nurs 2012; 21:2590-8. [PMID: 22788734 DOI: 10.1111/j.1365-2702.2012.04167.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES To explore the perspectives of practice nurses in their role of communicating cardiovascular risk to patients. BACKGROUND Nurses in primary care have for some time been engaged in cardiovascular risk discussions with patients. With the recent introduction of the NHS Health Checks, the focus on this work is set to increase. DESIGN Qualitative using a framework approach. METHODS Two focus groups and 16 semi-structured interviews were conducted with nurses purposively sampled from those working in primary care. RESULTS The nurses' accounts revealed the need to develop a relationship of trust and establish a level of relevance with each individual patient whilst discussing cardiovascular risk. Potential aspects of these discussions were as follows: working within a highly structured data-collecting task; time constraints and consideration of the individual's context. We used the idea of tailoring to describe how nurses navigate and constantly modify and pitch their approach for each patient they see in response to these constraints. CONCLUSION We suggest that in order for risk to be made meaningful to patients, practice nurses recognise the need for such information to be embedded in the more reciprocal dynamics of nurse-patient consultations. From their perspective, success is often as much about not saying something, or saying it in a particular way, as saying anything accurately or consistently. RELEVANCE TO CLINICAL PRACTICE For practice nurses to be instrumental in the successful delivery of health prevention policy initiatives such as the NHS Health Checks, it is important to acknowledge their views and perspectives in undertaking this work. This study suggests that the nurses recognised the need for further skills and a refinement of approach for those health professionals involved.
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Affiliation(s)
- Sue Boase
- General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK.
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Phillips JL, Piza M, Ingham J. Continuing professional development programmes for rural nurses involved in palliative care delivery: an integrative review. NURSE EDUCATION TODAY 2012; 32:385-392. [PMID: 21641095 DOI: 10.1016/j.nedt.2011.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 04/20/2011] [Accepted: 05/02/2011] [Indexed: 05/30/2023]
Abstract
PURPOSE To review published studies evaluating the impact of continuing professional development (CPD) programmes on rural nurses palliative care capabilities in order to inform the development of targeted learning activities for this population. DESIGN An integrative review. METHODS Searches of key electronic databases and the World Wide Web was undertaken using key words, followed by hand searching for relevant articles. All studies were reviewed by two authors using a critical appraisal tool and level of evidence hierarchy. RESULTS The search strategies generated 74 articles, with 10 studies meeting the inclusion criteria. All of these studies evaluated palliative care CPD programmes involving rural nurses which focused on increasing palliative care capabilities. The evidence generated by this review was limited by the absence of randomised controlled trials. A level III-1 study, with a small sample size provided the highest level of evidence, but the lack of control negated the investigators' capacity to confirm causality. Few studies measured the impact of CPD on the quality of care or utilised novel technology to address the tyranny of distance. Despite, these limitations valuable insights into the barriers and facilitators to engaging rural nurses in palliative care learning opportunities were identified. CONCLUSIONS Evidence that CPD impacts positively on patient and families outcomes is necessary to sustain an on-going investment in learning activities. In order to optimise the opportunities afforded by emerging web-based technology rural nurses' need to develop and maintain their computer competencies. Further investigation of the impact of specialist clinical placements on rural nurses' palliative care capabilities is also indicated.
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Affiliation(s)
- Jane L Phillips
- The Cunningham Centre for Palliative Care and School of Nursing, The University of Notre Dame, Sydney, Australia.
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Farquhar MC, Ewing G, Booth S. Using mixed methods to develop and evaluate complex interventions in palliative care research. Palliat Med 2011; 25:748-57. [PMID: 21807749 DOI: 10.1177/0269216311417919] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND there is increasing interest in combining qualitative and quantitative research methods to provide comprehensiveness and greater knowledge yield. Mixed methods are valuable in the development and evaluation of complex interventions. They are therefore particularly valuable in palliative care research where the majority of interventions are complex, and the identification of outcomes particularly challenging. AIMS this paper aims to introduce the role of mixed methods in the development and evaluation of complex interventions in palliative care, and how they may be used in palliative care research. CONTENT the paper defines mixed methods and outlines why and how mixed methods are used to develop and evaluate complex interventions, with a pragmatic focus on design and data collection issues and data analysis. Useful texts are signposted and illustrative examples provided of mixed method studies in palliative care, including a detailed worked example of the development and evaluation of a complex intervention in palliative care for breathlessness. Key challenges to conducting mixed methods in palliative care research are identified in relation to data collection, data integration in analysis, costs and dissemination and how these might be addressed. CONCLUSIONS the development and evaluation of complex interventions in palliative care benefit from the application of mixed methods. Mixed methods enable better understanding of whether and how an intervention works (or does not work) and inform the design of subsequent studies. However, they can be challenging: mixed method studies in palliative care will benefit from working with agreed protocols, multidisciplinary teams and engaging staff with appropriate skill sets.
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Affiliation(s)
- Morag C Farquhar
- General Practice and Primary Care Research Unit, Department of Public Health & Primary Care, University of Cambridge, Institute of Public Health, UK.
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Östlund U, Kidd L, Wengström Y, Rowa-Dewar N. Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud 2011; 48:369-83. [PMID: 21084086 PMCID: PMC7094322 DOI: 10.1016/j.ijnurstu.2010.10.005] [Citation(s) in RCA: 252] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/30/2010] [Accepted: 10/22/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES It has been argued that mixed methods research can be useful in nursing and health science because of the complexity of the phenomena studied. However, the integration of qualitative and quantitative approaches continues to be one of much debate and there is a need for a rigorous framework for designing and interpreting mixed methods research. This paper explores the analytical approaches (i.e. parallel, concurrent or sequential) used in mixed methods studies within healthcare and exemplifies the use of triangulation as a methodological metaphor for drawing inferences from qualitative and quantitative findings originating from such analyses. DESIGN This review of the literature used systematic principles in searching CINAHL, Medline and PsycINFO for healthcare research studies which employed a mixed methods approach and were published in the English language between January 1999 and September 2009. RESULTS In total, 168 studies were included in the results. Most studies originated in the United States of America (USA), the United Kingdom (UK) and Canada. The analytic approach most widely used was parallel data analysis. A number of studies used sequential data analysis; far fewer studies employed concurrent data analysis. Very few of these studies clearly articulated the purpose for using a mixed methods design. The use of the methodological metaphor of triangulation on convergent, complementary, and divergent results from mixed methods studies is exemplified and an example of developing theory from such data is provided. CONCLUSION A trend for conducting parallel data analysis on quantitative and qualitative data in mixed methods healthcare research has been identified in the studies included in this review. Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings, help researchers to clarify their theoretical propositions and the basis of their results. This can offer a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and develop new theory.
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Affiliation(s)
- Ulrika Östlund
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Kelly C. Does specialist respiratory education make a difference to practice? Nurse Educ Pract 2010; 10:308-15. [PMID: 20233676 DOI: 10.1016/j.nepr.2010.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 01/14/2010] [Accepted: 02/07/2010] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) poses a huge burden to society. Continued professional development can be regarded as a requisite for implementing quality care. Within the literature the effectiveness of COPD care is evident, yet it is seldom attributed to the educational attainment of healthcare professionals. This study aimed to examine whether a nationally delivered COPD module is perceived to impact on clinical practice. METHODS As part of a mixed methods study (Cresswell et al., 2003), qualitative data were gathered post-intervention from 68 students utilising a semi-structured, self-completed questionnaire. Data were analysed using a themed content analysis and a quasi-statistical approach. RESULTS The major themes that emerged from the analysis were: changes in personal practice, evidence of changes implemented and changes in participants' personal views regarding disease management. These findings suggest that when students gain knowledge they use it to the benefit of patients. DISCUSSION Overall students reported an increase in knowledge and confidence regarding COPD management and an impact on practice was reported. The findings will add to a mounting body of evidence that supports the value of continuing professional learning and will aim to satisfy consumers of education of the efficacy of knowledge in terms of direct patient impact.
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Affiliation(s)
- Carol Kelly
- Faculty of Health, St. Helens Road, Ormskirk, Lancashire, L39 4QP, United Kingdom.
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Munday D, Petrova M, Dale J. Exploring preferences for place of death with terminally ill patients: qualitative study of experiences of general practitioners and community nurses in England. BMJ 2009; 339:b2391. [PMID: 19605422 PMCID: PMC2714676 DOI: 10.1136/bmj.b2391] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the experiences and perceptions of general practitioners and community nurses in discussing preferences for place of death with terminally ill patients. DESIGN Qualitative study using semistructured interviews and thematic analysis. PARTICIPANTS 17 general practitioners and 19 nurses (16 district nurses, three clinical nurse specialists). SETTING 15 general practices participating in the Gold Standards Framework for palliative care from three areas in central England with differing socio-geography. Practices were selected on the basis of size and level of adoption of the standards framework. RESULTS All interviewees bar one had experience of discussing preferred place of death with terminally ill patients. They reported that preferences for place of death frequently changed over time and were often ill defined or poorly formed in patients' minds. Preferences were often described as being co-created in discussion with the patient or, conversely, inferred by the health professional without direct questioning or receiving a definitive answer from the patient. This inherent uncertainty challenged the practicability, usefulness, and value of recording a definitive preference. The extent to which the assessment of enabling such preferences can be used as a proxy for the effectiveness of palliative care delivery is also limited by this uncertainty. Generally, interviewees did not find discussing preferred place of death an easy area of practice, unless the patient broached the subject or led the discussions. CONCLUSIONS Further research is needed to enable development of appropriate training and support for primary care professionals. Better understanding of the importance of place of death to patients and their carers is also needed.
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Affiliation(s)
- Daniel Munday
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL.
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Bibliography. PROGRESS IN PALLIATIVE CARE 2009. [DOI: 10.1179/096992609x392222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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