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Bagchus C, Zee MS, van der Steen JT, Klapwijk MS, Dekker NL, Onwuteaka-Philipsen BD, Pasman HRW. Challenges in recognizing and discussing changes in a resident's condition in the palliative phase: focus group discussions with nursing staff working in nursing homes about their experiences. BMC Palliat Care 2024; 23:144. [PMID: 38858719 PMCID: PMC11163817 DOI: 10.1186/s12904-024-01479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Most nursing home residents have complex care needs, require palliative care and eventually die in these facilities. Timely recognition of changes in a resident's condition is crucial for providing appropriate care. Observations by nursing staff play a significant role in identifying and interpreting these changes. METHODS Focus group discussions were conducted with nursing staff from ten nursing homes in the Netherlands to explore their experiences and challenges in recognizing and discussing changes in a resident's condition. These discussions were analysed following the principles of thematic analysis. RESULTS The analysis of the challenges nursing staff face in identifying and interpreting changes in a resident's condition, resulted in three themes. First, that recognizing changes is considered complex, because it requires specialized knowledge and skills that is generally not part of their education and must partly be learned in practice. This also depends on how familiar the nursing staff is with the resident. Furthermore, different people observe residents through different lenses, depending on their relation and experiences with residents. This could lead to disagreements about the resident's condition. Lastly, organizational structures such as the resources available to document and discuss a resident's condition and the hierarchy between nursing home professionals often hindered discussions and sharing observations. CONCLUSION Nursing staff's experiences highlight the complexity of recognizing and discussing changes in nursing home residents' conditions. While supporting the observational skills of nursing staff is important, it is not enough to improve the quality of care for nursing home residents with palliative care needs. As nursing staff experiences challenges at different, interrelated levels, improving the process of recognizing and discussing changes in nursing home residents requires an integrated approach in which the organization strengthens the position of nursing staff. It is important that their observations become a valued and integrated and part of nursing home care.
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Affiliation(s)
- C Bagchus
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
- Faculty of Health, University of Applied Sciences Leiden, Leiden, the Netherlands
| | - M S Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - J T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Primary and Community Care and Radboudumc Alzheimer center, Radboud university medical center, P.O. Box 9600, 6500 HB, Nijmegen, The Netherlands
| | - M S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - N Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, the Netherlands
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - H R W Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands.
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Pinto S, Lopes S, de Sousa AB, Delalibera M, Gomes B. Patient and Family Preferences About Place of End-of-Life Care and Death: An Umbrella Review. J Pain Symptom Manage 2024; 67:e439-e452. [PMID: 38237790 DOI: 10.1016/j.jpainsymman.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/05/2024]
Abstract
CONTEXT The place where people are cared towards the end of their life and die is a complex phenomenon, requiring a deeper understanding. Honoring preferences is critical for the delivery of high-quality care. OBJECTIVES In this umbrella review we examine and synthesize the evidence regarding preferences about place of end-of-life care and death of patients with life-threatening illnesses and their families. METHODS Following the Joanna Briggs Institute methodology, we conducted a comprehensive search for systematic reviews in PsycINFO, MEDLINE, EMBASE, CINAHL, Epistemonikos, and PROSPERO without language restrictions. RESULTS The search identified 15 reviews (10 high-quality, three with meta-analysis), covering 229 nonoverlapping primary studies. Home is the most preferred place of end-of-life care for both patients (11%-89%) and family members (23%-84%). It is also the most preferred place of death (patient estimates from two meta-analyses: 51%-55%). Hospitals and hospice/palliative care facilities are preferred by substantial minorities. Reasons and factors affecting preferences include illness-related, individual, and environmental. Differences between preferred places of care and death are underexplored and the evidence remains inconclusive about changes over time. Congruence between preferred and actual place of death ranges 21%-100%, is higher in studies since 2004 and a meta-analysis shows noncancer patients are at higher risk of incongruence than cancer patients (OR 1.23, 95% CI: 1.01-1.49, I2 = 62%). CONCLUSION These findings are a crucial starting point to address gaps and enhance strategies to align care with patient and family preferences. To accurately identify patient and family preferences is an important opportunity to change their lives positively.
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Affiliation(s)
- Sara Pinto
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; Nursing School of Porto (S.P.), Rua Dr. António Bernardino de Almeida, Porto, Portugal; Cintesis@RISE, NursID (S.P.), Rua Dr. Plácido da Costa, Porto, Portugal
| | - Sílvia Lopes
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; NOVA National School of Public Health, Public Health Research Center (S.L.), Universidade NOVA de Lisboa, Lisboa, Portugal; Comprehensive Health Research Center (S.L.), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Andrea Bruno de Sousa
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Mayra Delalibera
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Barbara Gomes
- Faculty of Medicine (S.P., S.L., A.B.S., M.D., B.G.), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation (B.G.), King's College London, London, United Kingdom, Bessemer Road, SE5 9PJ, London, United Kingdom.
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Gill A, Meadows L, Ashbourne J, Kaasalainen S, Shamon S, Pereira J. 'Confidence and fulfillment': a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses. Palliat Care Soc Pract 2024; 18:26323524241235180. [PMID: 38449569 PMCID: PMC10916492 DOI: 10.1177/26323524241235180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
Objective To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes. Methods A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively. Results Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings. Significance of results The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC.
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Affiliation(s)
- Ashlinder Gill
- Division of Palliative Care, Department of Family Medicine, McMaster University, 5th Floor, 100 Main Street West, Hamilton, ON, Canada L8P 1H6
| | - Lynn Meadows
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jessica Ashbourne
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, Division of Palliative Care, Department of Family Medicine, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Sandy Shamon
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - José Pereira
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Pallium Canada, Ottawa, ON, Canada
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Simpson J, Remawi BN, Potts K, Blackmore T, French M, Haydock K, Peters R, Hill M, Tidball OJ, Parker G, Waddington M, Preston N. Improving paramedic responses for patients dying at home: a theory of change-based approach. BMC Emerg Med 2023; 23:81. [PMID: 37532997 PMCID: PMC10394789 DOI: 10.1186/s12873-023-00848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Paramedics are increasingly being called to attend patients dying from advanced incurable conditions. However, confidence to deal with such calls varies, with many feeling relatively unskilled in this aspect of their role. A number of interventions have been piloted to improve their skills in end-of-life care (EoLC) but without a fully specified theoretical model. Theory of Change models can provide theoretical and testable links from intervention activities to proposed long-term outcomes and indicate the areas for assessment of effectiveness. This study aimed to develop an intervention for improving paramedic EoLC for patients in the community. METHODS A Theory of Change approach was used as the overarching theoretical framework for developing an intervention to improve paramedic end-of-life skills. Nine stakeholders - including specialist community paramedics, ambulance call handlers and palliative care specialists - were recruited to five consecutive online workshops, ranging between 60 and 90 min. Each workshop had 2-3 facilitators. Over multiple workshops, stakeholders decided on the desired impact, short- and long-term outcomes, and possible interventions. During and between these workshops a Theory of Change model was created, with the components shared with stakeholders. RESULTS The stakeholders agreed the desired impact was to provide consistent, holistic, patient-centred, and effective EoLC. Four potential long-term outcomes were suggested: (1) increased use of anticipatory and regular end-of-life medications; (2) reduced end-of-life clinical and medication errors; (3) reduced unnecessary hospitalisations; (4) increased concordance between patient preferred and actual place of death. Key interventions focused on providing immediate information on what to do in such situations including: appraising the situation, developing an algorithm for a treatment plan (including whether or not to convey to hospital) and how to identify ongoing support in the community. CONCLUSIONS A Theory of Change approach was effective at identifying impact, outcomes, and the important features of an end-of-life intervention for paramedics. This study identified the need for paramedics to have immediate access to information and resources to support EoLC, which the workshop stakeholders are now seeking to develop as an intervention.
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Affiliation(s)
- Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK.
| | - Bader Nael Remawi
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YT, UK
| | - Kieran Potts
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Tania Blackmore
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
| | - Maddy French
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
| | - Karen Haydock
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Richard Peters
- North West Ambulance Service NHS Trust, Bolton, BL1 5DD, UK
| | - Michael Hill
- Heart of Kent Hospice, Preston Hall, Aylesford, Kent, ME20 7PU, UK
| | | | - Georgina Parker
- Heart of Kent Hospice, Preston Hall, Aylesford, Kent, ME20 7PU, UK
| | | | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, LA1 4YT, UK
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5
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Harding AJE, Gonella S. More investment in end-of-life care training of healthcare professionals is required to enhance care, evidence and outcomes. Evid Based Nurs 2023; 26:108. [PMID: 36627177 DOI: 10.1136/ebnurs-2022-103619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | - Silvia Gonella
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
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6
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Stiel S, Brütt AL, Stahmeyer JT, Bockelmann AWE, Schleef T, Völkel A, Hoffmann F. Implementation, barriers, and recommendations for further development of advance care planning for the last phase of life in nursing homes in Germany (Gut-Leben): protocol for a mixed-methods study. BMC Palliat Care 2023; 22:27. [PMID: 36964521 PMCID: PMC10036959 DOI: 10.1186/s12904-023-01147-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Nursing home entry often marks the transition into the end-of-life. In 2018, Germany legally introduced reimbursement for advance care planning (ACP according to § 132 g SGB V) in nursing homes that applied for ACP approval to improve end-of-life care. The Gut-Leben project aims to evaluate the implementation and barriers of ACP in nursing homes in Germany, with a special focus on the federal state of Lower Saxony, and provide practical recommendations for further development of end-of-life care. METHODS This mixed-methods study spreads across five work packages (WP) over a three-year period. WP 1 will explore the approval process, implementation, and barriers to ACP in nursing homes. Data will be collected through a national postal survey in a random sample of n = 600. WP 2 will explore whether documented ACP reports are applicable as a data source for research (expecting up to 500 available ACP reports). In WP 3a and 3b, data on the ACP process will be collected in n = 15 approved nursing homes in Lower Saxony over a 12-months period. For WP 3a and WP 3b, data on ACP conversations (n = 600) and on end-of-life care paths (n = 300) will be collected by facilitators and nurses of the respective nursing homes. In WP 4, residents' characteristics upon entry and changes in these characteristics over the length of stay are analyzed, utilizing claims data from the AOK Lower Saxony (expected sample of about 100,000 people entering nursing homes over a 10-years period). WP 5 connects, interprets, and reflects on the findings from WP 1-4 through focus groups and individual interviews with facilitators, nursing staff, residents, relatives, and care providers. Within a participatory approach, a practice advisory board will be set up existing of personal of nursing homes and will be closely involved in the whole research process. DISCUSSION In summary, the Gut-Leben project provides insight into the implementation and barriers of ACP in nursing homes according to German legislation for the first time, including practitioners' and residents' perspectives. Insights will help the further development of ACP in Germany through practical recommendations based on quantitative and qualitative data.
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Affiliation(s)
- Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Anna Levke Brütt
- Junior Research Group for Rehabilitation Sciences, Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jona T Stahmeyer
- Health Services Research Unit, AOK Niedersachsen, Hannover, Germany
| | - Anne W E Bockelmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Tanja Schleef
- Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Anna Völkel
- Junior Research Group for Rehabilitation Sciences, Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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7
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Åvik Persson H, Ahlström G, Årestedt K, Behm L, Drevenhorn E, Sandgren A. Palliative care delivery at nursing homes before and after an educational intervention from professionals' perspective: A pre-post design. Scand J Caring Sci 2023; 37:229-242. [PMID: 35524431 DOI: 10.1111/scs.13084] [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: 10/21/2021] [Revised: 03/09/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge-Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals' experience of palliative care delivery before and after the educational intervention. METHODS The educational intervention for nursing home professionals consisted of five 2-h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire 'Your experience of palliative care' was completed 1 month before (baseline) and after (follow-up) the intervention. Descriptive and inferential statistics were calculated. RESULTS The positive effects at follow-up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons' wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. CONCLUSIONS This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow-up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change.
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Affiliation(s)
- Helene Åvik Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Lina Behm
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Eva Drevenhorn
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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8
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Vellani S, Maradiaga Rivas V, Nicula M, Lucchese S, Kruizinga J, Sussman T, Kaasalainen S. Palliative Approach to Care Education for Multidisciplinary Staff of Long-Term Care Homes: A Pretest Post-Test Study. Gerontol Geriatr Med 2023; 9:23337214231158470. [PMID: 36845318 PMCID: PMC9947670 DOI: 10.1177/23337214231158470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
This study used a single-group pre-test and post-test design to evaluate an educational workshop for multidisciplinary staff working in long-term care homes on implementing a palliative approach to care and perceptions about advanced care planning conversations. Two outcomes were measured to assess the preliminary efficacy of the educational workshop at baseline and 1-month post-intervention. Knowledge regarding implementing a palliative approach to care was assessed using the End-of-Life Professional Caregivers Survey and changes in staff perception toward ACP conversations were assessed using the Staff Perceptions Survey. Findings suggest that staff experienced an improvement in self-reported knowledge regarding a palliative approach to care (p ≤ .001); and perceptions of knowledge, attitude, and comfort related to advance care planning discussions (p ≤ .027). The results indicate that educational workshops can assist in improving multidisciplinary staff's knowledge about a palliative approach to care and comfort in carrying out advance care planning discussions with residents, family care partners, and among long-term care staff.
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Affiliation(s)
- Shirin Vellani
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Maria Nicula
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Stephanie Lucchese
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Julia Kruizinga
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Tamara Sussman
- Faculty of Arts, School of Social Work,
McGill University, Montreal, QC, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada,Sharon Kaasalainen, Faculty of Health
Sciences, School of Nursing, McMaster University, 1280 Main Street West,
Hamilton, ON L8S 4L8, Canada.
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9
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Smith C, Gill P, Baillie J. The clinical decision-making process involved in end of life care for people with dementia in primary care: A protocol paper. J Adv Nurs 2023. [PMID: 36779442 DOI: 10.1111/jan.15587] [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: 06/20/2022] [Revised: 12/22/2022] [Accepted: 01/20/2023] [Indexed: 02/14/2023]
Abstract
AIM This article is a report of a study protocol designed to explore what factors inform healthcare professionals' clinical decision-making when providing end of life care for people with dementia in primary care. DESIGN The proposed study will adopt a qualitative study design, utilizing an ethnographic approach. METHODS A mixed sample group of registered healthcare professionals, including district nurses, specialist nurses and general practitioners, will be purposively sampled and recruited from one health board in Wales, which will cover three settings in primary care. A multi-method approach will be utilized to provide rich data, including non-participant observation, semi-structured interviews, and review of key documents. Data will be managed using NVivo 12 and analysed thematically. Ethics approval was gained in April 2022. DISCUSSION Little is known about the end of life care decision-making process of healthcare professionals caring for people with dementia in primary care settings. This study will therefore address this pertinent gap. The study findings may also be transferable to healthcare professionals working in similar clinical settings across the UK. IMPACT It is anticipated that this study will inform the subsequent development of an intervention that can be used by healthcare professionals to support decision making and subsequently the provision of quality end of life care in primary care for people with dementia.
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Affiliation(s)
- Cathryn Smith
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Paul Gill
- Department of Nursing, Midwifery and Health, Faculty of Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Jessica Baillie
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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10
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Gonella S, Di Giulio P, Berchialla P, Bo M, Cotogni P, Macchi G, Campagna S, Dimonte V. The Impact of Health and Social Care Professionals' Education on the Quality of Serious Illness Conversations in Nursing Homes: Study Protocol of a Quality Improvement Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:725. [PMID: 36613049 PMCID: PMC9819581 DOI: 10.3390/ijerph20010725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Health and social care professionals (HCPs) who work in nursing homes (NHs) are increasingly required to sustain serious illness conversations about care goals and preferences. Although these conversations may also be challenging for experienced HCPs and the literature recognizes high-quality communication as key to providing patient-centered care, so far, no specific educational program has been developed for the NH setting to improve HCPs' communication skills. Our study aims to test the feasibility and potential effectiveness of an innovative, blended communication skills training program (Teach-to-Communicate) targeting the HCPs who work in NHs. This program includes classroom-based theory, experiential learning, and e-learning, and relies on interdisciplinary contexts and several didactic methods. The study consists of two phases: phase I is the development of written resources that employ focus group discussion involving field experts and external feedback from key stakeholders. Phase II consists of a multicenter, pilot, pre-post study with nested qualitative study. The Teach-to-Communicate training program is expected to enhance the quality of communication in NH and HCPs' confidence in sustaining serious illness conversations, reduce family carers' psycho-emotional burden and improve their satisfaction with the care received, and increase advance care planning documentation. Our protocol will provide insight for future researchers, healthcare providers, and policymakers and pave the way for blended educational approaches in the field of communication skills training.
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Affiliation(s)
- Silvia Gonella
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Giorgia Macchi
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Valerio Dimonte
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
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11
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Bainbridge D, Bishop V, Myers J, Marshall D, Stajduhar K, Seow H. Effectiveness of Training Programs About a Palliative Care Approach: A Systematic Review of Intervention Trials for Health Care Professionals. J Palliat Med 2022; 26:564-581. [PMID: 36378898 DOI: 10.1089/jpm.2022.0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Palliative care (PC) training initiatives have proliferated to assist generalist health care providers (HCPs) develop skills for applying an early PC approach. To date, there is little synthesis of high-level evidence to review the content and effectiveness of these programs. To address this gap in knowledge, we conducted a systematic review of trials of training inventions to build PC competency in HCPs, according to PRISMA guidelines (PROSPERO registration no. 271741). Materials and Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, HealthSTAR, Web of Science, and the Cochrane Database of Systematic Reviews and Clinical Trials for studies published since 2000. Eligible studies were trials assessing PC training for HCPs. Interventions had to address at least two of six PC-related components, adapted from the National Consensus Project: identification or assessment; illness understanding; symptom management; decision making; coping; and referral. Two reviewers independently assessed articles for inclusion, using Rayyan, and extracted relevant data. Risk of bias was assessed using the Cochrane ROB2 or ROBINS-I tools. Results: Of 1209 articles reviewed, 22 studies met the inclusion criteria, with the majority being conducted in the United States (n = 9) or Europe (n = 8). Nearly all studies (n = 19) collected data through self-reported surveys; administrative (n = 4), clinical outcomes (n = 4), or interaction analysis (n = 6) data were also or solely used. Interventions featured didactic, skill-based training followed by role-play and/or individual coaching. Communication around illness understanding was the most taught PC component. Few interventions involved comprehensive PC training, with 12 studies representing 3 or less of the 6 framework components. Most studies (n = 16) reported a significant positive impact on at least one outcome, most often HCP self-reported outcomes. Conclusions: While many of these interventions demonstrated improved confidence among HCPs in the PC components taught, findings were mixed on more objective outcome measures. Further trial-based evidence is required on comprehensive PC training to help inform these interventions.
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Affiliation(s)
- Daryl Bainbridge
- Department of Oncology and McMaster University, Hamilton, Ontario, Canada
| | - Valerie Bishop
- Department of Oncology and McMaster University, Hamilton, Ontario, Canada
| | - Jeff Myers
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Denise Marshall
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Hsien Seow
- Department of Oncology and McMaster University, Hamilton, Ontario, Canada
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12
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Nguyen PT, Liaw SY, Tan AJQ, Rusli KDB, Tan LLC, Goh HS, Chua WL. “Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Cousins E, Preston N, Doherty J, Varey S, Harding A, McCann A, Harrison Dening K, Finucane A, Carter G, Mitchell G, Brazil K. Implementing and evaluating online advance care planning training in UK nursing homes during COVID-19: findings from the Necessary Discussions multi-site case study project. BMC Geriatr 2022; 22:419. [PMID: 35562712 PMCID: PMC9098790 DOI: 10.1186/s12877-022-03099-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advance care planning in nursing homes is important to ensure the wishes and preferences of residents are recorded, especially during the COVID-19 pandemic. However, care staff and family members frequently report feeling unprepared for these conversations. More resources are needed to support them with these necessary discussions. This research aimed to develop, implement and evaluate a website intervention for care staff and family members to provide training and information about advance care planning during COVID-19. METHODS The research was a primarily qualitative case study design, comprising multiple UK nursing home cases. Data collection included semi-structured interviews with care staff and family members which were coded and analysed thematically. A narrative synthesis was produced for each case, culminating in a thematic cross-case analysis of the total findings. Theoretical propositions were refined throughout the research. RESULTS Eight nursing homes took part in the study, involving 35 care staff and 19 family members. Findings were reported according to the RE-AIM framework which identified the reach, effectiveness, adoption, implementation and maintenance of the intervention. Themes included: website content that was well received; suggestions for improvement; implementation barriers and facilitators; examples of organisational and personal impact. CONCLUSIONS Four theoretical propositions relating to advance care planning in nursing homes are presented, relating to: training and information needs, accessibility, context, and encouraging conversations. Implications for practice and training include an awareness of diverse learning styles, re-enforcing the right to be involved in advance care planning and encouraging opportunities for facilitated discussion. TRIAL REGISTRATION ISRCTN registry (ID 18003630 ) on 19.05.21.
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Affiliation(s)
- Emily Cousins
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Sandra Varey
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Andrew Harding
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Adrienne McCann
- Innovation Value Institute, Maynooth University, Maynooth & Age Friendly Ireland, Ireland
| | - Karen Harrison Dening
- School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester & Dementia UK, London, UK
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh & Marie Curie Hospice Edinburgh, Edinburgh, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
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14
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Nursing Leadership and Palliative Care in Long-Term Care for Residents with Advanced Dementia. Nurs Clin North Am 2022; 57:259-271. [DOI: 10.1016/j.cnur.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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An exploration of the views of staff on cultural aspects of end-of-life care in Japanese long-term care facilities: a qualitative study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Long-term care facilities are increasingly important places for palliative and end-of-life care provision in Japan. While the importance of culture has been noted for palliative and end-of-life care, an exploration of its influence on care provision in long-term care settings has received little direct attention in Japan. Exploring staff views and beliefs in palliative and end-of-life care in these settings can potentially enhance our understanding of culturally oriented care and facilitate the development of tailored and more effective support practices. This study aimed to explore the cultural views and beliefs regarding palliative and end-of-life care among the staff in Japanese long-term care facilities. A qualitative exploratory study was conducted using focus groups with facility staff (N = 71) and semi-structured interviews with facility managers (N = 10) in the Kanto region of Japan. Thematic analysis was conducted according to Braun and Clarke's approach. The findings are presented in five key themes: ‘Changes in society's and family's end-of-life perspectives’, ‘Values and beliefs regarding death and dying’, ‘Anxiety and regret’, ‘Tensions in doing the right thing’ and ‘Ways of alleviating pressure’. The findings indicate that the provision of palliative and end-of-life care is underpinned by cultural nuances that influence care providers' approach and delivery. Recognising and understanding the cultural beliefs of staff around death, dying and end-of-life care are important in meeting the needs of residents. Palliative care education for staff in these settings should include cultural considerations that reflect changing societal views on death and dying.
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16
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Yildiz B, Korfage IJ, Witkamp EF, Goossensen A, van Lent LG, Pasman HR, Onwuteaka-Philipsen BD, Zee M, van der Heide A. Dying in times of COVID-19: Experiences in different care settings - An online questionnaire study among bereaved relatives (the CO-LIVE study). Palliat Med 2022; 36:751-761. [PMID: 35264024 PMCID: PMC9006387 DOI: 10.1177/02692163221079698] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic and restricting measures have affected end-of-life care across different settings. AIM To compare experiences of bereaved relatives with end-of-life care for a family member or friend who died at home, in a hospital, nursing home or hospice during the pandemic. DESIGN An open observational online survey was developed and disseminated via social media and public fora (March-July 2020). Data were analyzed using descriptive statistics and logistic regression analyses. PARTICIPANTS Individuals who lost a family member or friend in the Netherlands during the COVID-19 pandemic. RESULTS The questionnaire was filled out by 393 bereaved relatives who lost a family member or friend at home (n = 68), in a hospital (n = 114), nursing home (n = 176) or hospice (n = 35). Bereaved relatives of patients who died in a hospital most often evaluated medical care (79%) as sufficient, whereas medical care (54.5%) was least often evaluated as sufficient in nursing homes. Emotional support for relatives was most often evaluated as sufficient at home (67.7%) and least often in nursing homes (40.3%). Sufficient emotional support for relatives was associated with a higher likelihood to rate the place of death as appropriate. Bereaved relatives of patients who died at a place other than home and whose care was restricted due to COVID-19 were less likely to evaluate the place of death as appropriate. CONCLUSION End-of-life care during the COVID-19 pandemic was evaluated least favourably in nursing homes. The quality of emotional support for relatives and whether care was restricted or not were important for assessing the place of death as appropriate.
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Affiliation(s)
- Berivan Yildiz
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Fe Witkamp
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Research Centre Innovations in Care, University of Applied Sciences, Rotterdam, The Netherlands
| | | | - Liza Gg van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - H Roeline Pasman
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Masha Zee
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
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Challenges Experienced by Italian Nursing Home Staff in End-of-Life Conversations with Family Caregivers during COVID-19 Pandemic: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052504. [PMID: 35270195 PMCID: PMC8909457 DOI: 10.3390/ijerph19052504] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 12/29/2022]
Abstract
End-of-life conversations are among the most challenging of all communication scenarios and on the agenda of several healthcare settings, including nursing homes (NHs). They may be also difficult for experienced healthcare professionals (HCPs). This study explores the difficulties experienced by Italian NH staff in end-of-life conversations with family caregivers (FCs) during COVID-19 pandemic to uncover their educational needs. A qualitative descriptive study based on inductive thematic analysis was performed. Twenty-one HCPs across six Italian NHs were interviewed. Four themes described their experiences of end-of-life conversations: (1) communicating with FCs over the overall disease trajectory; (2) managing challenging emotions and situations; (3) establishing a partnership between HCPs and FCs; (4) addressing HCPs' communication skills needs. HCPs had to face multiple challenging situations that varied across the care period as well as complex emotions such as anxiety, guilt, uncertainty, fear, anger, or suffering, which required tailored answers. COVID-19 pandemic increased FCs' aggressive behaviors, their distrust, and uncertainty due to visitation restrictions. HCPs had to overcome this by developing a set of strategies, including adoption of an active-listening approach, supportive communication, and explicit acknowledgement of FCs' emotions. Since communication needs were mostly practical in nature, HCPs valued practical communication training.
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18
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Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020667. [PMID: 35055488 PMCID: PMC8775885 DOI: 10.3390/ijerph19020667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/04/2023]
Abstract
Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.
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19
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Iida K, Ryan A, Payne S, Iida K, Ryan A, Payne S, Hasson F, McIlfatrick S. Palliative care in Japanese long-term care facilities. Int J Palliat Nurs 2022; 28:28-37. [DOI: 10.12968/ijpn.2022.28.1.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Internationally, the demand for the provision of high-quality palliative care is increasing exponentially. Japan is a rapidly ageing society and it is therefore important to understand the current context to develop practice and inform future resource allocation in long-term care facilities (LTCFs). Aim: To describe the broad context of palliative care services, practice, education and policies in LTCFs in Japan. Methods: A process of expert elicitation and documentary review undertaken. The WHO palliative care model for public health was used as an analytical framework. Findings: Several deficits were identified regarding palliative care in Japanese LTCFs: a lack of palliative care strategy and standardised training for staff, and limited information on the use of palliative care medicines, quality improvement tools and frameworks. Conclusion: Such deficits need to be addressed to inform current nursing practice, future training needs for staff, quality care initiatives and decision making for advance care planning and resource allocation to respond to the ever-increasing demand for palliative care in these settings.
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Affiliation(s)
| | | | | | - Kieko Iida
- PhD Researcher, Institute of Nursing and Health Research, Ulster University, UK
| | - Assumpta Ryan
- Professor, Institute of Nursing and Health Research, Ulster University, UK
| | - Sheila Payne
- Emeritus Professor, International Observatory on End of Life Care, Division of Health Research, Lancaster University, UK
| | - Felicity Hasson
- Senior Lecturer, Institute of Nursing and Health Research, Ulster University, UK
| | - Sonja McIlfatrick
- Professor, Institute of Nursing and Health Research, Ulster University, UK
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20
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Cortés-Rodríguez AE, Roman P, López-Rodríguez MM, Fernández-Medina IM, Fernández-Sola C, Hernández-Padilla JM. Role-Play versus Standardised Patient Simulation for Teaching Interprofessional Communication in Care of the Elderly for Nursing Students. Healthcare (Basel) 2021; 10:healthcare10010046. [PMID: 35052210 PMCID: PMC8775804 DOI: 10.3390/healthcare10010046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency.
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Affiliation(s)
- Alda Elena Cortés-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Pablo Roman
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
- Correspondence: ; Tel.: +34-950214563
| | - María Mar López-Rodríguez
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Isabel María Fernández-Medina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Health Sciences Research Centre, University of Almería, 04120 Almería, Spain
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco 4810101, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (A.E.C.-R.); (M.M.L.-R.); (I.M.F.-M.); (C.F.-S.); (J.M.H.-P.)
- Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, The Burroughs, London NW4 4BT, UK
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21
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Ura C, Okamura T, Takase A, Shimmei M, Ogawa Y. We have fear of death in common: Factors associated with positive attitudes toward end-of-life care among care staff in long-term care facilities. Geriatr Gerontol Int 2021; 22:87-89. [PMID: 34859552 DOI: 10.1111/ggi.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Chiaki Ura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Akinori Takase
- Institute of Regional Development, Taisho University, Tokyo, Japan
| | - Masaya Shimmei
- Faculty of Human Welfare, Department of Psychology and Welfare, Den-en Chofu University, Kawasaki, Japan
| | - Yukan Ogawa
- Institute of Regional Development, Taisho University, Tokyo, Japan
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22
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Åvik Persson H, Ahlström G, Ekwall A. Professionals' Expectations and Preparedness to Implement Knowledge-Based Palliative Care at Nursing Homes before an Educational Intervention: A Focus Group Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178977. [PMID: 34501567 PMCID: PMC8431503 DOI: 10.3390/ijerph18178977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/10/2023]
Abstract
The provision of knowledge-based palliative care is rare in nursing homes. There are obstacles to practically performing this because it can be difficult to identify when the final stage of life begins for older persons. Educational interventions in palliative care in nursing homes are a challenge, and joint efforts are needed in an organisation, including preparedness. The aim was to explore professionals' expectations and preparedness to implement knowledge-based palliative care in nursing homes before an educational intervention. This study has a qualitative focus group design, and a total of 48 professionals working in nursing homes were interviewed with a semi-structured interview guide. Qualitative content analysis with an inductive approach was used for the analysis. One major theme was identified: professionals were hopeful yet doubtful about the organisation's readiness. The main categories of increased knowledge, consensus in the team, and a vision for the future illustrate the hopefulness, while insufficient resources and prioritisation illustrate the doubts about the organisation's readiness. This study contributes valuable knowledge about professionals' expectations and preparedness, which are essential for researchers to consider in the planning phase of an implementation study. The successful implementation of changes needs to involve strategies that circumvent the identified obstacles to organisations' readiness.
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23
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Lamppu PJ, Finne-Soveri H, Kautiainen H, Laakkonen ML, Laurila JV, Pitkälä KH. Effects of Staff Training on Nursing Home Residents' End-Of-Life Care: A Randomized Controlled Trial. J Am Med Dir Assoc 2021; 22:1699-1705.e1. [PMID: 34133971 DOI: 10.1016/j.jamda.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This trial examines the effects of end-of-life training on long-term care facility (LTCF) residents' health-related quality of life (HRQoL) and use and costs of hospital services. DESIGN A single-blind, cluster randomized (at facility level) controlled trial (RCT). Our training intervention included 4 small-group 4-hour educational sessions on the principles of palliative and end-of-life care (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff. Education was based on constructive learning methods and included resident cases, role-plays, and small-group discussions. SETTING AND PARTICIPANTS We recruited 324 residents with possible need for end-of-life care due to advanced illness from 20 LTCF wards in Helsinki. METHODS Primary outcome measures were HRQoL and hospital inpatient days per person-year during a 2-year follow-up. Secondary outcomes were number of emergency department visits and cost of all hospital services. RESULTS HRQoL according to the 15-Dimensional Health-Related Quality-of-Life Instrument declined in both groups, and no difference was present in the changes between the groups (P for group .75, adjusted for age, sex, do-not-resuscitate orders, need for help, and clustering). Neither the number of hospital inpatient days (1.87 vs 0.81 per person-year) nor the number of emergency department visits differed significantly between intervention and control groups (P for group .41). The total hospital costs were similar in the intervention and control groups. CONCLUSIONS AND IMPLICATIONS Our rigorous RCT on end-of-life care training intervention demonstrated no effects on residents' HRQoL or their use of hospitals. Unsupported training interventions alone might be insufficient to produce meaningful care quality improvements.
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Affiliation(s)
- Pauli J Lamppu
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Helsinki Hospital, Geriatric Clinic, Helsinki, Finland
| | | | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Marja-Liisa Laakkonen
- Department of Social Services and Health Care, Helsinki Hospital, Geriatric Clinic, Helsinki, Finland
| | - Jouko V Laurila
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland.
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Nagata C, Tsutsumi M, Kiyonaga A, Nogaki H. Evaluation of a training program for community-based end-of-life care of older people toward aging in place: A mixed methods study. Nurse Educ Pract 2021; 54:103091. [PMID: 34087577 DOI: 10.1016/j.nepr.2021.103091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/17/2022]
Abstract
AIMS To evaluate a training program that supports community-based service staff in implementing aging-in-place and end-of-life care programs. BACKGROUND Globally, as the population ages, the need for end-of-life care has never been greater. Since Japan is facing the issues of a super-aged population sooner than most countries, there is a particularly urgent need to enhance end-of-life care for older people. Most Japan's older people wish to spend their final days at home, however, only 11-13% end their lives at home, while 73% die in hospitals. As part of care system, small-scale community-based service for aging-in-place established across Japan in 2006 managed locally. These are flexible services using home or facility care or both for the individual to live long term at their preferred place. We developed the end-of-life care educational training program to encourage behavioral changes in community-based service staff of various readiness levels. DESIGN Mixed methods study design. METHODS A pre-post evaluation of knowledge, confidence and attitude toward end-of-life care, combining quantitative and qualitative data from 53 community-based service staff members who participated in the training program from September 2017 to September 2019. Participants were informed of the end-of-life care process using focus group discussions about end-of-life care and completed surveys evaluating the program before, immediately following and three months after the training. We used the four-level Kirkpatrick model as the evaluation indicator. RESULTS Quantitative analysis results indicated that participants were satisfied with the training program. Their knowledge scores regarding end-of-life care significantly improved; they also experienced confidence gains and changes in attitudes, becoming more approving of end-of-life care. Qualitative data revealed details of participants' satisfaction and what was learned. Through the focus group discussions, they created action plans for implementing end-of-life care programs, which some had accomplished in their local centers by the three-month follow-up. CONCLUSIONS These results suggest that the training program is effective for promoting end-of-life care through community-based services in Japan. Conducting follow-up training could effectively strengthen participants' commitment to end-of-life care at community-based services. Use of the training program is expected to promote services to support aging-in-place.
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Affiliation(s)
- Chizuru Nagata
- Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Masae Tsutsumi
- Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Asako Kiyonaga
- Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Hiroshi Nogaki
- Division of Community/Gerontological Nursing, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
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Liaw YQ, Goh ML. Reducing contamination of midstream urine samples through standardized collection processes: a best practice implementation project. JBI Evid Synth 2021; 18:256-271. [PMID: 31972684 DOI: 10.11124/jbisrir-d-19-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this project is to decrease the rates of midstream urine sample contamination through standardization of evidence-based techniques among nurses. INTRODUCTION Urinary tract infection is a prevalent health problem worldwide. The diagnosis and treatment of urinary tract infection depend on a thorough physical examination and the results of an uncontaminated midstream specimen of urine. However, improper techniques used in the collection often cause sample contamination, leading to delayed diagnosis and the use of inappropriate antibiotics for treatment. As nurses are at the forefront of care delivery, they are involved in reducing the rates of midstream urine sample contamination. Thus, the use of an evidence-based approach to standardize collection of midstream urine culture is crucial for the provision of higher-quality patient care. METHODS Education sessions were delivered to the nurses and an evidence-informed standardized patient education leaflet was crafted by the project team for implementation. With a sample size of 30 nurses and patients, the project took place in a 21-bed adult surgical ward in a hospital in Singapore. The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) programs were used to implement the evidence-based project. The project was implemented in three phases from October 2018 to January 2019. A standardized audit tool devised from JBI PACES was used for the audits in this project. The rates of midstream urine specimen contamination and the knowledge of nurses were also monitored. RESULTS The baseline audit revealed that the nursing staff required educational sessions to improve their knowledge of midstream urine sample collection. Aside from criteria 1,3 and 4, the remaining criteria achieved compliance of more than 80%. The criteria below 80% compliance became the main focus of the project interventions. At follow-up cycle 1, all criteria achieved at least 80% compliance except criteria 4 and 5, which achieved 73% and 69% compliance, respectively. At the three-month post implementation audit, all criteria achieved a compliance rate of at least 80%. Fisher's exact test was carried out, and statistical significance of the results was achieved (p < 0.001) when compared to baseline audit. The rates of midstream urine specimen contamination also significantly decreased from 40% at the baseline audit to 20% at the third-month post implementation audit. Nurses' knowledge markedly improved as measured by the three-question quiz. CONCLUSION This evidence-based implementation project highlights the effectiveness of the JBI PACES and GRiP processes for initiating best practice within a nursing environment. The use of JBI best-practice recommendations to standardize methods for midstream urine specimen collection effectively reduced the rates of midstream urine contamination.
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Affiliation(s)
- Yi Qi Liaw
- University of Surgical Cluster, National University Hospital, Singapore
| | - Mien Li Goh
- Evidence Based Nursing Unit, National University Hospital, Singapore.,Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence
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Ferri P, Di Lorenzo R, Stifani S, Morotti E, Vagnini M, Jiménez Herrera MF, Bonacaro A, Artioli G, Rubbi I, Palese A. Nursing student attitudes toward dying patient care: A European multicenter cross-sectional study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021018. [PMID: 33855982 PMCID: PMC8138802 DOI: 10.23750/abm.v92is2.11403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 12/02/2022]
Abstract
Background and aim of the work: Nursing education plays a key role in preparing future nurses to deal with dying patients, which represents one of the most emotionally involving aspect of nursing. The aims of the study were to explore nursing students’ attitudes towards care of dying patients in three different European contexts and to analyze the variables that can influence them. Methods: We conducted an international multicenter cross-sectional study. We administered the Frommelt Attitude Toward Care of the Dying Scale form B (FATCOD-B) and a demographic form to 569 students, enrolled in three Nursing Programmes in different countries (Italy, Spain and United Kingdom), who accepted to participate in the study. The data were analyzed using SPSS software version 26.0. Results: Median total FATCOD-B scores indicated intermediate levels of students’ attitudes towards care for dying patients, with a statistically significant difference among the three student groups. The median total FATCOD-B scores did not statistically significantly change in students with different age, gender, year of study, religious beliefs, nursing education on palliative care, previous experiences of dying patient care and personal grieving. Conclusions: In our study, nursing students feel partially prepared in caring for dying patients and their attitudes do not change as the course of study progresses. No selected variables had an impact on students’ attitudes towards palliative care. Since nurses play a vital role in ensuring the quality of care, education on end-of-life care should be offered as a core part of undergraduate nursing programs. (www.actabiomedica.it)
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Affiliation(s)
| | - Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Mental Health and Drug Abuse Department of AUSL-Modena.
| | - Serena Stifani
- Nursing Degree Course of Modena, University of Modena and Reggio Emilia.
| | - Elena Morotti
- Nursing Degree Course of Modena, University of Modena and Reggio Emilia.
| | | | | | - Antonio Bonacaro
- Department of Adult and Mental Health Nursing, Anglia Ruskin University.
| | | | - Ivan Rubbi
- Nursing Degree Course of Faenza, University of Bologna.
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Manson J, Gardiner C, Taylor P, Ghasemi L, Westerdale-Shaw E, Sutton L, Cawley H. 'Palliative care education in nursing homes: a qualitative evaluation of telementoring. BMJ Support Palliat Care 2021:bmjspcare-2020-002727. [PMID: 33627368 DOI: 10.1136/bmjspcare-2020-002727] [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: 10/08/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 01/08/2023]
Abstract
There is an increasing need to support nursing homes in palliative care to reduce suffering and avoid unnecessary hospital admissions at the end of life. Providing education to nursing homes faces many barriers including structural systems and cultural issues. In order to overcome some of these barriers, education using Project Extension for Community Health Outcomes (ECHO) methodology has been delivered to nursing homes throughout a large city in England. This paper aims to explore participant experience in Project ECHO for nursing homes. METHODOLOGY Qualitative semistructured interviews with a purposive sample of nursing home staff. Interviews were conducted by one researcher and transcribed verbatim. Line-by-line coding and categorisation were used to form themes. RESULTS Eleven interviews were completed with data saturation reached by interview eight. The following themes were revealed: Barriers and facilitators to accessing Project ECHO, Community of Practice and Communication with nursing homes and data extraction. CONCLUSION Project ECHO is an accessible, acceptable and engaging way of delivering palliative care education to nursing homes combatting some of the traditional barriers that nursing homes face in accessing training.
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Affiliation(s)
- Jane Manson
- Project ECHO Team, St Luke's Hospice, Sheffield, UK
| | - Clare Gardiner
- School of Nursing, University of Sheffield, Sheffield, UK
| | - Paul Taylor
- Project ECHO Team, St Luke's Hospice, Sheffield, UK
| | | | | | - Lucy Sutton
- Therapy Services, Ashgate Hospice, Chesterfield, Derbyshire, UK
| | - Helen Cawley
- Project ECHO Team, St Luke's Hospice, Sheffield, UK
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Macgregor A, Rutherford A, McCormack B, Hockley J, Ogden M, Soulsby I, McKenzie M, Spilsbury K, Hanratty B, Forbat L. Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK. BMJ Open 2021; 11:e049486. [PMID: 33619205 PMCID: PMC7903098 DOI: 10.1136/bmjopen-2021-049486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called 'Palliative Care Needs Rounds' (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life. METHODS AND ANALYSIS This implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4-6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents' quality of death and care home staff capability of adopting a palliative approach. ETHICS AND DISSEMINATION Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds. REGISTRATION DETAILS Registration details: ISRCTN15863801.
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Affiliation(s)
- Aisha Macgregor
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Divisions of Nursing, Occupational Therapy & Arts Therapies, Queen Margaret University, Edinburgh, UK
| | - Jo Hockley
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Margaret Ogden
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Irene Soulsby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Maisie McKenzie
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
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Menekli T, Doğan R, Erce Ç, Toygar İ. Effect of educational intervention on nurses knowledge about palliative care: Quasi-experimental study. Nurse Educ Pract 2021; 51:102991. [PMID: 33610970 DOI: 10.1016/j.nepr.2021.102991] [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: 01/29/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
The aim of the study was to determine the level of knowledge of registered nurses about palliative care and to determine the effect of educational intervention on this level of knowledge in Turkey. The study was a quasi-experimental study and consists of 136 nurses. The study was conducted between April and June 2019 in a university hospital in Malatya, Turkey. Nurse are educated on the definition, history, and philosophy of palliative care, the responsibilities of palliative care nurses, symptom management, and end of life care. The education was applied in five sessions. Each session took approximately 40 min and sessions were conducted once a week. Data were collected before and after the education via nurse identification form developed by the research team and the Palliative Care Knowledge Test. It was determined that the nurses received 8.9 ± 1.1 out of 20 points before and 17.5 ± 1.9 points after the education. There was a statistically significant difference between the mean scores of nurses before and after training (p < 0.001). It was found that educational intervention has a large effect (Cohen's d = 5.540) on nurses' knowledge about palliative care. It was determined that educational intervention was an effective way to improve nurses' knowledge about palliative care.
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Affiliation(s)
- Tuğba Menekli
- Department of Nursing, Malatya Turgut Özal University, Faculty of Health Sciences, Malatya, Turkey
| | - Runida Doğan
- Department of Surgical Nursing, Inonu University, Faculty of Nursing, Malatya, Turkey
| | - Çiğdem Erce
- Palliative Care Unit, Malatya State Hospital, Malatya, Turkey
| | - İsmail Toygar
- Department of Internal Medicine Nursing, Ege University, Faculty of Nursing, İzmir, Turkey.
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Finucane AM, Bone AE, Etkind S, Carr D, Meade R, Munoz-Arroyo R, Moine S, Iyayi-Igbinovia A, Evans CJ, Higginson IJ, Murray SA. How many people will need palliative care in Scotland by 2040? A mixed-method study of projected palliative care need and recommendations for service delivery. BMJ Open 2021; 11:e041317. [PMID: 33536318 PMCID: PMC7868264 DOI: 10.1136/bmjopen-2020-041317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To estimate future palliative care need and complexity of need in Scotland, and to identify priorities for future service delivery. DESIGN We estimated the prevalence of palliative care need by analysing the proportion of deaths from defined chronic progressive illnesses. We described linear projections up to 2040 using national death registry data and official mortality forecasts. An expert consultation and subsequent online consensus survey generated recommendations on meeting future palliative care need. SETTING Scotland, population of 5.4 million. PARTICIPANTS All decedents in Scotland over 11 years (2007 to 2017). The consultation had 34 participants; 24 completed the consensus survey. PRIMARY AND SECONDARY OUTCOMES Estimates of past and future palliative care need in Scotland from 2007 up to 2040. Multimorbidity was operationalised as two or more registered causes of death from different disease groups (cancer, organ failure, dementia, other). Consultation and survey data were analysed descriptively. RESULTS We project that by 2040, the number of people requiring palliative care will increase by at least 14%; and by 20% if we factor in multimorbidity. The number of people dying from multiple diseases associated with different disease groups is projected to increase from 27% of all deaths in 2017 to 43% by 2040. To address increased need and complexity, experts prioritised sustained investment in a national digital platform, roll-out of integrated electronic health and social care records; and approaches that remain person-centred. CONCLUSIONS By 2040 more people in Scotland are projected to die with palliative care needs, and the complexity of need will increase markedly. Service delivery models must adapt to serve growing demand and complexity associated with dying from multiple diseases from different disease groups. We need sustained investment in secure, accessible, integrated and person-centred health and social care digital systems, to improve care coordination and optimise palliative care for people across care settings.
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Affiliation(s)
- Anne M Finucane
- Research, Marie Curie Hospice Edinburgh, Edinburgh, UK
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Simon Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Richard Meade
- Policy and Public Affairs, Marie Curie, Edinburgh, UK
| | | | - Sébastien Moine
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Education, Université Paris, Paris, UK
| | | | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
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Morales A, Murphy A, Fanning JB, Gao S, Schultz K, Hall DE, Barnato A. Key Physician Behaviors that Predict Prudent, Preference Concordant Decisions at the End of Life. AJOB Empir Bioeth 2020; 12:215-226. [PMID: 33382633 DOI: 10.1080/23294515.2020.1865476] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study introduces an empirical approach for studying the role of prudence in physician treatment of end-of-life (EOL) decision making. METHODS A mixed-methods analysis of transcripts from 88 simulated patient encounters in a multicenter study on EOL decision making. Physicians in internal medicine, emergency medicine, and critical care medicine were asked to evaluate a decompensating, end-stage cancer patient. Transcripts of the encounters were coded for actor, action, and content to capture the concept of Aristotelian prudence, and then quantitatively and qualitatively analyzed to identify actions associated with preference-concordant treatment. RESULTS Focusing on codes that describe characteristics of physician-patient interaction, the code for physicians restating patient preferences was associated with avoiding intubation. Multiple codes were associated with secondary measures of preference-concordant treatment. CONCLUSIONS Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care.
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Affiliation(s)
- Andre Morales
- Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Joseph B Fanning
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, Tennessee, USA
| | - Shasha Gao
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Kevan Schultz
- Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel E Hall
- General Surgery, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,General Surgery, UPMC Presbyterian, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amber Barnato
- Dartmouth College, Dartmouth Institute for Health Policy & Clinical Practice, Hanover, New Hampshire, USA
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Lamppu PJ, Pitkala KH. Staff Training Interventions to Improve End-of-Life Care of Nursing Home Residents: A Systematic Review. J Am Med Dir Assoc 2020; 22:268-278. [PMID: 33121871 DOI: 10.1016/j.jamda.2020.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim was to review evidence from all randomized controlled trials (RCTs) using palliative care education or staff training as an intervention to improve nursing home residents' quality of life (QOL) or quality of dying (QOD) or to reduce burdensome hospitalizations. DESIGN A systematic review with a narrative summary. SETTING AND PARTICIPANTS Residents in nursing homes and other long-term care facilities. METHODS We searched MEDLINE, CINAHL, PsycINFO, the Cochrane Library, Scopus, and Google Scholar, references of known articles, previous reviews, and recent volumes of key journals. RCTs were included in the review. Methodologic quality was assessed. RESULTS The search yielded 932 articles after removing the duplicates. Of them, 16 cluster RCTs fulfilled inclusion criteria for analysis. There was a great variety in the interventions with respect to learning methods, intensity, complexity, and length of staff training. Most interventions featured other elements besides staff training. In the 6 high-quality trials, only 1 showed a reduction in hospitalizations, whereas among 6 moderate-quality trials 2 suggested a reduction in hospitalizations. None of the high-quality trials showed effects on residents' QOL or QOD. Staff reported an improved QOD in 1 moderate-quality trial. CONCLUSIONS AND IMPLICATIONS Irrespective of the means of staff training, there were surprisingly few effects of education on residents' QOL, QOD, or burdensome hospitalizations. Further studies are needed to explore the reasons behind these findings.
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Affiliation(s)
- Pauli J Lamppu
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Department of Social Services and Health Care, Geriatric Clinic, Helsinki Hospital, Helsinki, Finland.
| | - Kaisu H Pitkala
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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Werner P, Schiffman IK. Nursing home staff members' attitudes regarding advance care planning: relationships with different types of knowledge. Aging Clin Exp Res 2020; 32:2091-2098. [PMID: 31686389 DOI: 10.1007/s40520-019-01398-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advanced care planning (ACP) is an essential component of quality palliative care in nursing homes. Despite the benefits associated with ACP in nursing homes, completion rates are low. Staff members' knowledge and attitudes toward ACP were found to be main determinants of ACP completion. AIMS To assess nursing home staff members' attitudes towards ACP and their association to different types of knowledge. METHODS A convenience sample of 138 nursing home staff members (69% female, 53% non-Jewish, 46% nurses) who reported having heard the terms advanced directives and durable power of attorney completed a structured questionnaire assessing attitudes toward ACP, subjective knowledge, and three types of objective knowledge (declarative, legal and procedural) regarding ACP, as well as socio-demographic and professional factors. RESULTS Participants expressed positive attitudes toward formal and informal aspect of ACP, although their subjective and objective knowledge in the topic was moderate. Hierarchical regression analyses revealed that the three dimensions of objective knowledge improved significantly the participants' attitude scores. DISCUSSION There is a need to integrate different types of knowledge in educational programs provided to nursing home staff members to improve their involvement in ACP initiatives with residents and family members.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa, Israel.
| | - Ile Kermel Schiffman
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa, Israel
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Iida K, Ryan A, Hasson F, Payne S, McIlfatrick S. Palliative and end-of-life educational interventions for staff working in long-term care facilities: An integrative review of the literature. Int J Older People Nurs 2020; 16:e12347. [PMID: 32918793 DOI: 10.1111/opn.12347] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/01/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given the increase in the number of deaths within long-term care facilities (LTCFs), the need for palliative and end-of-life (EOL) care education among such facilities has been increasing. As such, a systematic synthesis of global palliative and EOL care educational approaches and evaluation can aid further educational development. OBJECTIVE To synthesise the current literature on palliative and EOL care educational interventions for staff working in LTCFs and identify barriers to, and facilitators of, intervention implementation. METHODS The study used an integrative review framework wherein indexed databases, namely, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library and Japan Medical Abstract Society, were systematically searched for studies published in English and Japanese between 2007 and 2019. Search terms that are related to palliative care, LTCF, and education were combined to increase search sensitivity. The quality of the papers was assessed using Joanna Briggs Institute Critical Appraisal Tools and the Mixed-Methods Appraisal Tool. RESULTS A total of 52 studies were included in the review. Our results suggested that although studies in this area and setting have been evolving, suboptimal developmental research and educational practices, global variability and unstandardised approaches to education and lacking viewpoints from service users have remained. Barriers to intervention implementation were also reported due to the specific characteristics of LTCFs, which include high staff turnover and considerable variation in professional skills and experience. CONCLUSIONS Given the different LTCF types, systems and policies across each country or region, further research on standardised educational interventions with contextual considerations using large-scale studies with robust methodology is needed to meet the increasing demand for palliative and EOL care among the global ageing population. IMPLICATIONS FOR PRACTICE Palliative and EOL care educational intervention for LTCF staff need to include more consideration of context, organisational culture and the user involvement throughout the process of education and research to enhance the quality of care in this complex setting.
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Affiliation(s)
- Kieko Iida
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
| | - Assumpta Ryan
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Londonderry, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
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Firnhaber GC, Roberson DW, Kolasa KM. Nursing staff participation in end-of-life nutrition and hydration decision-making in a nursing home: A qualitative study. J Adv Nurs 2020; 76:3059-3068. [PMID: 32820543 DOI: 10.1111/jan.14491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 01/25/2023]
Abstract
AIM To better understand the participation of nursing staff in end-of-life nutrition and hydration decision-making in an American nursing home. DESIGN A qualitative exploration with ethnographic focus. METHODS In April 2017, in-person, semi-structured interviews were performed with 19 nursing staff members in a nursing home located in the south-eastern United States. Additional information was gathered through participant observation during interviews and review of organizational and regulatory policies. Transcripts were coded and analysed using qualitative methods described by Roper and Shapira (2000). RESULTS Three primary themes relating to nursing staff participation in end-of-life nutrition and hydration decision-making were identified: (a) Formal decision-making: decisions made and implemented by persons with the authority to make legal and binding care decisions in the nursing home setting; (b) Informal decision-making: decisions not requiring medical orders; and (c) Influential factors: factors that influence actions of nursing staff. CONCLUSION A variety of factors have an impact on nursing staff participation in end-of-life nutrition and hydration decision-making. Participation is closely aligned with the type of decision, whether formal or informal, and role, whether Certified Nursing Assistant/Aide, Licensed Practical/Vocational Nurse, or Registered Nurse. IMPACT End-of-life nutrition and hydration decision-making in nursing homes differs from decision-making in other care settings and presents a challenge globally. Interventions that support the participation of nursing staff in end-of-life nutrition and hydration decision-making have the potential to positively impact the experiences of residents and family members faced with these issues in the nursing home setting.
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Affiliation(s)
- Gina C Firnhaber
- College of Nursing at East, Carolina University, Greenville, NC, USA
| | - Donna W Roberson
- College of Nursing at East, Carolina University, Greenville, NC, USA
| | - Kathryn M Kolasa
- Brody School of Medicine at East, Carolina University, Greenville, NC, USA
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Abstract
BACKGROUND Nearly 70% of nursing home residents are eligible for palliative care, yet few receive formal palliative care outside of hospice. Little is known about nursing home staff attitudes, knowledge, skills, and behaviors related to palliative care. METHODS We administered a modified survey measuring attitudes toward death to 146 nursing home staff members, including both clinical and nonclinical staff, from 14 nursing homes. RESULTS Nursing home staff generally reported feeling comfortable caring for the dying, but half believed the end of life is a time of great suffering. Pain control (63%), loneliness (52%), and depression (48%) were the most important issues identified with regard to these patients, and there was ambivalence about the use of strong pain medications and the utility of feeding tubes at the end of life. Top priorities identified for improving palliative care included greater family involvement (43%), education and training in pain control (50%) and in management of other symptoms (37%), and use of a palliative care team (35%) at their facility. CONCLUSIONS Findings show there is a need for more palliative care training and education, which should be built on current staff knowledge, skills, and attitudes toward palliative care.
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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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Haavisto E, Soikkeli-Jalonen A, Tonteri M, Hupli M. Nurses' required end-of-life care competence in health centres inpatient ward - a qualitative descriptive study. Scand J Caring Sci 2020; 35:577-585. [PMID: 32400040 DOI: 10.1111/scs.12874] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies of nurses' required competence in EOL care in health centres are rare. It is important to produce information about experienced nurses' perceptions of the competence they consider important in their practical work. AIM The aim of this study was to describe nurses' required competence in EOL care in health centre inpatient wards as experienced by nurses. METHOD A descriptive qualitative study using four semi-structured group interviews (20 nurses) and inductive descriptive content analysis. RESULTS Five categories describing nurses' required competence in EOL care in a health centre inpatient ward were identified: (1) ethics and courage in action, (2) support for the patient, (3) support for the family, (4) care planning and (5) physical care. Factors promoting nurses' competence in EOL care comprised two categories: (1) professional development in EOL care and (2) an organisation that supports EOL care. CONCLUSIONS End-of-life care in health centre inpatient wards requires wide and complex competence from nurses. Nurses' experiences of required competence are associated with holistic care of the patient, encountering the family and multiprofessional cooperation. Nurses' competence in EOL care could be enhanced with postgraduate education, and educational planning should be given more attention in the future.
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Affiliation(s)
- Elina Haavisto
- Department of Nursing Science, Satakunta Central Hospital, University of Turku, Pori, Finland
| | | | - Mia Tonteri
- Department of Nursing Science, University of Turku, Pori, Finland
| | - Maija Hupli
- Department of Nursing Science, University of Turku, Pori, Finland
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Pesut B, Greig M. Resources for Educating, Training, and Mentoring Nurses and Unregulated Nursing Care Providers in Palliative Care: A Review and Expert Consultation. J Palliat Med 2020; 21:S50-S56. [PMID: 29283870 DOI: 10.1089/jpm.2017.0395] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nurses and nursing care providers provide the most direct care to patients at end of life. Yet, evidence indicates that many feel ill-prepared for the complexity of palliative care. OBJECTIVE To review the resources required to ensure adequate education, training, and mentorship for nurses and nursing care providers who care for Canadians experiencing life-limiting illness and their families. METHODS This is a systematic search and narrative review in the Canadian context. RESULTS Six previous reviews and 26 primary studies were identified. Studies focusing on regulated nurses indicated that even amid variability in content, delivery methods, and duration, palliative education improves nurses' knowledge, confidence, attitudes, and communication abilities, and decreases nurses' stress. Results from palliative education in undergraduate curriculum were less definitive. However, studies on palliative simulation in undergraduate education suggest that it improves knowledge and confidence. Studies focusing on educating nursing care providers, either alone or in collaboration with regulated nurses, indicated positive outcomes in knowledge, confidence, communication, identification of clients who are dying, abilities to interact with patients and families, and a better understanding of their own contributions to care. Curricular resources in Canada have been developed. However, there is no dedicated and funded capacity-building strategy. DISCUSSION Resources exist to support palliative education for nurses and nursing care providers. Furthermore, the evidence suggests good outcomes from this education. However, there is no dedicated strategy for implementing those resources. Furthermore, there is little evidence of the critical role of knowledge translation in preparing nurses and nursing care providers for evidence-informed palliative practice.
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Affiliation(s)
- Barbara Pesut
- 1 Canada Research Chair, Health, Ethics and Diversity, Faculty of Health and Social Development, University of British Columbia , Okanagan, Kelowna, British Columbia, Canada
| | - Madeleine Greig
- 2 Faculty of Health and Social Development, School of Nursing, University of British Columbia , Okanagan, Kelowna, British Columbia, Canada
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Okumura-Hiroshige A, Fukahori H, Yoshioka S, Nishiyama M, Takamichi K, Kuwata M. Effect of an end-of-life gerontological nursing education programme on the attitudes and knowledge of clinical nurses: A non-randomised controlled trial. Int J Older People Nurs 2020; 15:e12309. [PMID: 32103640 DOI: 10.1111/opn.12309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/08/2020] [Accepted: 01/18/2020] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate how a structured interactive two-day education programme for clinical nurses on end-of-life (EOL) care for older people affects nurses' attitudes and knowledge. DESIGN Non-randomised controlled trial. METHODS Nurses were recruited separately for intervention and control groups. The intervention group assisted older patients with EOL care and recruited patients for the programme. To prevent sampling bias, control group nurses were recruited from a facility with numerous EOL care opportunities. The intervention was a two-day educational programme. Using valid and reliable scales, we evaluated the attitudes (total score range: 26-130) and knowledge (total score range: 0-51) of the intervention group four times (pretraining, post-training, 3 months, 6 months) and the control group three times (baseline, 3 months, 6 months) between January 2016 and April 2017. Analysis of covariance examined both groups' score changes at 3 and 6 months while adjusting for confounding factors. RESULTS Participants were 338 nurses caring primarily for older people (intervention group: 164; control group: 174); 142 responded at all measurement points. The change in mean value of the attitude scale from baseline to 3 months (differences in the groups' attitude scores = 7.33; 95% CI = 2.43-12.24; p = .004) and 6 months (differences in groups' attitude scores = 5.77; 95% CI = 0.17-11.37; p = .044) was greater in the intervention group. Moreover, the mean knowledge scale score change from baseline to 3 months was greater in the intervention group (differences in groups' knowledge scores = 5.74; 95% CI = 4.07 to 7.39; p < .001). There was no evidence of a change in this score between baseline and 6 months. CONCLUSION The programme improved nurses' medium- to long-term attitudes and knowledge. Thus, it may help nurses enhance the quality of care they provide. IMPLICATIONS FOR PRACTICE A two-day educational program improves nurses' medium- to long-term attitudes and knowledge on end-oflife care. For quality end-of-life care for older people, a structured and evidence-based educational program should be provided to nursing staff.
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Affiliation(s)
- Akemi Okumura-Hiroshige
- Department of System Management in Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Japan
| | - Hiroki Fukahori
- Division of Gerontological Nursing, Faculty of Nursing and Medical Care, KEIO University, Kanagawa, Japan
| | | | | | - Kaori Takamichi
- National Hospital Organization Iou Hospital, Kanazawa, Japan
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Van den Block L, Honinx E, Pivodic L, Miranda R, Onwuteaka-Philipsen BD, van Hout H, Pasman HRW, Oosterveld-Vlug M, Ten Koppel M, Piers R, Van Den Noortgate N, Engels Y, Vernooij-Dassen M, Hockley J, Froggatt K, Payne S, Szczerbinska K, Kylänen M, Gambassi G, Pautex S, Bassal C, De Buysser S, Deliens L, Smets T. Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries: The PACE Cluster-Randomized Clinical Trial. JAMA Intern Med 2020; 180:233-242. [PMID: 31710345 PMCID: PMC6865772 DOI: 10.1001/jamainternmed.2019.5349] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE High-quality evidence on how to improve palliative care in nursing homes is lacking. OBJECTIVE To investigate the effect of the Palliative Care for Older People (PACE) Steps to Success Program on resident and staff outcomes. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized clinical trial (2015-2017) in 78 nursing homes in 7 countries comparing PACE Steps to Success Program (intervention) with usual care (control). Randomization was stratified by country and median number of beds in each country in a 1:1 ratio. INTERVENTIONS The PACE Steps to Success Program is a multicomponent intervention to integrate basic nonspecialist palliative care in nursing homes. Using a train-the-trainer approach, an external trainer supports staff in nursing homes to introduce a palliative care approach over the course of 1 year following a 6-steps program. The steps are (1) advance care planning with residents and family, (2) assessment, care planning, and review of needs and problems, (3) coordination of care via monthly multidisciplinary review meetings, (4) delivery of high-quality care focusing on pain and depression, (5) care in the last days of life, and (6) care after death. MAIN OUTCOMES AND MEASURES The primary resident outcome was comfort in the last week of life measured after death by staff using the End-of-Life in Dementia Scale Comfort Assessment While Dying (EOLD-CAD; range, 14-42). The primary staff outcome was knowledge of palliative care reported by staff using the Palliative Care Survey (PCS; range, 0-1). RESULTS Concerning deceased residents, we collected 551 of 610 questionnaires from staff at baseline and 984 of 1178 postintervention in 37 intervention and 36 control homes. Mean (SD) age at time of death ranged between 85.22 (9.13) and 85.91 (8.57) years, and between 60.6% (160/264) and 70.6% (190/269) of residents were women across the different groups. Residents' comfort in the last week of life did not differ between intervention and control groups (baseline-adjusted mean difference, -0.55; 95% CI, -1.71 to 0.61; P = .35). Concerning staff, we collected 2680 of 3638 questionnaires at baseline and 2437 of 3510 postintervention in 37 intervention and 38 control homes. Mean (SD) age of staff ranged between 42.3 (12.1) and 44.1 (11.7) years, and between 87.2% (1092/1253) and 89% (1224/1375) of staff were women across the different groups. Staff in the intervention group had statistically significantly better knowledge of palliative care than staff in the control group, but the clinical difference was minimal (baseline-adjusted mean difference, 0.04; 95% CI, 0.02-0.05; P < .001). Data analyses began on April 20, 2018. CONCLUSIONS AND RELEVANCE Residents' comfort in the last week of life did not improve after introducing the PACE Steps to Success Program. Improvements in staff knowledge of palliative care were clinically not important. TRIAL REGISTRATION ISRCTN Identifier: ISRCTN14741671.
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Affiliation(s)
- Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Elisabeth Honinx
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Lara Pivodic
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Rose Miranda
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hein van Hout
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mariska Oosterveld-Vlug
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maud Ten Koppel
- Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruth Piers
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Jo Hockley
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Katherine Froggatt
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Sheila Payne
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, United Kingdom
| | - Katarzyna Szczerbinska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sophie Pautex
- Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland
| | - Catherine Bassal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability (CIGEV), University of Geneva, Geneva, Switzerland
| | - Stefanie De Buysser
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Luc Deliens
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Public Health and Primary Care, Ghent University, Belgium
| | - Tinne Smets
- VUB-UGhent End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Brussel, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussel, Belgium
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Dowling MJ, Payne C, Larkin P, Ryan DJ. Does an Interactive, Teleconference-Delivered, Palliative Care Lecture Series Improve Nursing Home Staff Confidence? J Palliat Med 2020; 23:179-183. [DOI: 10.1089/jpm.2018.0549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael J. Dowling
- Department of Age-Related Health Care, Tallaght University Hospital, Dublin, Ireland
| | - Cathy Payne
- All-Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Philip Larkin
- School of Nursing and Midwifery, University College Dublin, Dublin, Ireland
| | - Daniel J. Ryan
- Department of Age-Related Health Care, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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Strautmann A, Allers K, Fassmer AM, Hoffmann F. Nursing home staff's perspective on end-of-life care of German nursing home residents: a cross-sectional survey. BMC Palliat Care 2020; 19:2. [PMID: 31900141 PMCID: PMC6942381 DOI: 10.1186/s12904-019-0512-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. METHODS A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. RESULTS 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. CONCLUSIONS Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.
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Affiliation(s)
- Anke Strautmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
- Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, D-26129, Oldenburg, Germany.
| | - Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | | | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Manson J, Gardiner C, McTague L. Barriers and facilitators to palliative care education in nursing and residential homes: a rapid review. Int J Palliat Nurs 2020; 26:32-44. [PMID: 32022638 DOI: 10.12968/ijpn.2020.26.1.32] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is insufficient high-quality evidence to suggest that palliative care education can impact care home settings. AIMS To identify, appraise and synthesise all available evidence on the barriers and facilitators to providing palliative care education in residential and nursing care homes and to generate recommendations to increase the effectiveness of future palliative care education programmes in care homes. METHODS A rapid review searching CINAHL, Medline and ProQuest. One author screened full-text articles for inclusion. Any uncertainties were discussed with a second author. FINDINGS Twenty-two articles were included in the full review. Analysis of the included articles revealed the following overlapping themes: structural systems; cultural and personal issues; and knowledge translation issues with interaction. CONCLUSION Addressing the barriers and facilitators when designing palliative care education programmes for care homes will lead to more successful outcomes.
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Affiliation(s)
- Jane Manson
- Leadership Fellow for Extension of Community Health Outcomes, St Luke's Hospice, Sheffield
| | - Clare Gardiner
- Senior Research Fellow, School of Nursing and Midwifery, University of Sheffield
| | - Laura McTague
- Consultant in Palliative Medicine, St Luke's Hospice, Sheffield
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Palliative care for people living with HIV/AIDS: Factors influencing healthcare workers' knowledge, attitude and practice in public health facilities, Abuja, Nigeria. PLoS One 2019; 14:e0207499. [PMID: 31891577 PMCID: PMC6938379 DOI: 10.1371/journal.pone.0207499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background Physicians and nurses play vital roles in addressing palliative care (PC) needs of people living with HIV/AIDS (PLWHA). The healthcare workers’ (HCWs) experiences determine the success of palliative care delivery. There is paucity of data on PC for PLWHA. For this reason, we assessed the knowledge, attitude and practice of PC for PLWHA and associated factors among health care professionals. Methods We conducted a cross-sectional descriptive study among HCWs in public health facilities in the Federal Capital Territory, Nigeria between February and May, 2017. Multistage sampling technique with proportionate-to-size allocation was used to determine facility sample size and HCWs per professional discipline. Data were collected with questionnaires adapted from Palliative Care Quiz for Nursing, Frommelt Attitude toward Care of the Dying and practical questions adapted from PC standard guidelines. Participants' knowledge, attitude and practice were assessed by awarding one (1) point for each correct answer; incorrect or “not sure” answers took a zero (0) score. Correct responses were summed up to get a total score for each participant. Descriptive statistics was done to describe frequencies and proportions displayed on tables. Linear regression was done to determine factors associated with HCW’s knowledge, attitude and practice of PC for PLWHA Result With a 100% response rate, the mean age of the 348 participants was 37.5 years (SD: ±8.9), 201 (57.8%) were female, 222 (63.8) were nurses and 230 (66.0%) had a work experience of 10 years or less. Majority of the participants, 310 (89.1%) agreed that palliative care focuses on the relief and prevention of suffering and 319 (91.7%) believe that PLWHA required palliative care. Misconceptions about palliative care include “palliative care is disease-oriented and not person oriented”, 252 (72.6%) believed; “palliative care is concerned with prolongation of life”, 279 (80.6%); and “use of placebos is appropriate in the treatment of some types of pain”, 252 (72.6%). Among the participants, 52% disagreed that “palliative care should be given only for dying PLWHA” while only 18 (5.2%) were right on “family should be involved in the physical care of the dying PLWHA”. Majority of the participants, 292 (84.1%) initiated palliative care discussion during patients’ diagnosis while 290 (83.6%) informed terminally ill patients about their diagnosis. Regarding psychological issues, 22 (6.3%) participants hid the truth from the patients while 196 (56.3%) provided emotional support to the patients. Morphine 240 (69.0%) and Pentazocine 194 (55.7%) were the most commonly used drugs for treatment of severe pain by participants across all centres. Conclusion In-service training and undergraduate training on palliative care were associated with knowledge and practice of palliative care for people living with HIV/AIDS. We recommended continuous quality in-service training and education on palliative care for HCWs. While we ensure voluntariness of participation and other ethical principles, the high response rate could be as a result of more motivated health worker than the norm. The results are unlikely to be representative of doctors and nurses in primary health care centres.
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Toscani F, Finetti S, Giunco F, Basso I, Rosa D, Pettenati F, Bussotti A, Villani D, Gentile S, Boncinelli L, Monti M, Spinsanti S, Piazza M, Charrier L, Di Giulio P. The last week of life of nursing home residents with advanced dementia: a retrospective study. BMC Palliat Care 2019; 18:117. [PMID: 31882007 PMCID: PMC6935223 DOI: 10.1186/s12904-019-0510-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/19/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. METHODS This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. RESULTS Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. CONCLUSIONS Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.
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Affiliation(s)
- Franco Toscani
- Lino Maestroni Foundation, Palliative Medicine Research Institute, via Palestro 1, 26100 Cremona, Italy
| | - Silvia Finetti
- Lino Maestroni Foundation, Palliative Medicine Research Institute, via Palestro 1, 26100 Cremona, Italy
| | - Fabrizio Giunco
- Department of Health and Social Services Polo Lombardia 2, Don Carlo Gnocchi Foundation ONLUS, Via Palazzolo, 21, 20149 Milan, Italy
| | - Ines Basso
- Intensive Care Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Via Venezia, 16, 15121 Alessandria, Italy
| | - Debora Rosa
- University of Milan, section of Don Carlo Gnocchi Foundation, Via A. Capecelatro, 66, 20148 Milan, Italy
| | - Francesca Pettenati
- Lino Maestroni Foundation, Palliative Medicine Research Institute, via Palestro 1, 26100 Cremona, Italy
| | - Alessandro Bussotti
- Agenzia Continuità Ospedale Territorio, Azienda Ospedaliero- Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Villani
- Neuro-Rehabilitation and Alzheimer Disease Evaluation Unit, Figlie di San Camillo Hospital, Via F. Filzi , 56, 26100 Cremona, Italy
| | - Simona Gentile
- Rehabilitation and Alzheimer Disease Evaluation Unit, Ancelle della Carità Hospital, Via G. Aselli, 14 Cremona, Italy
| | - Lorenzo Boncinelli
- Intensive Care Unit Geriatric, AOU Careggi-Largo Brambilla,3, 50134 Florence, Italy
| | - Massimo Monti
- Geriatric Institute Pio Albergo Trivulzio, via Trivulzio, 15, 20146 Milan, Italy
| | - Sandro Spinsanti
- Istituto Giano, Via Stazzo Quadro 7, 00060 Riano (Rm), Milan, Italy
| | - Massimo Piazza
- Italian Foundation of Leniterapia (FILE), Via San Niccolò, 1, 50125 Florence, Italy
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy
- SUPSI, Manno, Switzerland
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Tsui EK, Wang WQ, Franzosa E, Gonzalez T, Reckrey JM, Sterling MR, Baron S. Training to Reduce Home Care Aides' Work Stress Associated with Patient Death: A Scoping Review. J Palliat Med 2019; 23:1243-1249. [PMID: 31855094 DOI: 10.1089/jpm.2019.0441] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Home care workers (HCWs)-including home health aides, personal care aides, and other direct care workers-provide functional and other essential support that allows older, disabled, and seriously ill people to live at home. As a growing number of patients are aging and dying at home, HCWs are increasingly providing care at the end of life (EOL). Although prior qualitative studies have shown that patient death is an impactful and challenging experience for HCWs, the majority of HCWs receive almost no training on EOL issues. Objective: The goal of this scoping review is to identify intervention studies describing training of HCWs in EOL issues to map types of training and to assess the degree to which existing efforts address HCW health and well-being. Design: Our scoping review covered three databases and focused on articles published in English since 2000. Results: Of the 393 articles screened, 26 underwent full-text review and 6 met inclusion criteria. Only one article discussed training designed for and implemented with HCWs exclusively. Other trainings simultaneously targeted multiple kinds of workers. Supporting HCWs in reducing their stress and improving their coping skills was substantially addressed in only one article, although HCWs' emotional needs were addressed less centrally in several others. Conclusion: Our findings suggest that there is a paucity of EOL training interventions tailored specifically to the experiences and positioning of HCWs. We recommend that future intervention studies address the multiple facets of HCWs' stress related to patient death to improve EOL care in the home.
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Affiliation(s)
- Emma K Tsui
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Wei-Qian Wang
- Department of Counseling and Clinical Psychology, Columbia University, New York, New York, USA
| | - Emily Franzosa
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Tailisha Gonzalez
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Jennifer M Reckrey
- Departments of Medicine and Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Flushing, New York, USA
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Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework. Implement Sci 2019; 14:107. [PMID: 31856882 PMCID: PMC6924025 DOI: 10.1186/s13012-019-0953-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 11/08/2019] [Indexed: 11/12/2022] Open
Abstract
Background The PACE ‘Steps to Success’ programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. Methods The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. Results The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. Conclusions The implementation of the PACE Programme was feasible but leaves room for improvement. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve implementation in the LTC setting. The results of the process evaluation will be used to further adapt and improve the PACE Programme prior to its further dissemination. Trial registration The PACE study was registered at www.isrctn.com—ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) July 30, 2015.
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Spacey A, Scammell J, Board M, Porter S. Systematic critical realist review of interventions designed to improve end-of-life care in care homes. Nurs Health Sci 2019; 22:343-354. [PMID: 31797527 DOI: 10.1111/nhs.12665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/28/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Abstract
The demand for high-quality end-of-life care is rising. Frequently evidenced concerns about the provision of end-of-life in care homes relate to inter-disciplinary communication and engagement in advance care planning. A number of interventions employing different mechanisms have been designed to address these issues. Therefore, the aim of this systematic critical realist review was to describe and explain the effectiveness of interventions designed to improve end-of-life care in care homes. Electronic searches were conducted in ScienceDirect, MEDLINE, PubMed, PsychINFO, and CINAHL from January 2000 to August 2018. Forty one studies were included in the review. While most of the evidence identified in this review was not strong, there was evidence to suggest that education and inter-professional collaboration can be effective intervention mechanisms for improving end-of-life care in care homes. High staff turnover was a significant contextual mechanism impacting on the sustainability of interventions. In terms of human agency, it is important to note a consistent finding related to the dedication and enthusiasm of care home staff who deliver end-of-life care.
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Affiliation(s)
- Adam Spacey
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Janet Scammell
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Michele Board
- Department of Adult Nursing, Bournemouth University, Poole, UK
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
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50
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Blackman I, Henderson J, Weger K, Willis E. Causal links associated with missed residential aged care. J Nurs Manag 2019; 28:1909-1917. [DOI: 10.1111/jonm.12889] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/03/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Ian Blackman
- College of Nursing & Health Sciences Flinders University Adelaide South Australia Australia
| | - Julie Henderson
- College of Nursing & Health Sciences Flinders University Adelaide South Australia Australia
| | - Kate Weger
- Southern Cross Care (SA & NT) Glenside South Australia Australia
| | - Eileen Willis
- College of Nursing & Health Sciences Flinders University Adelaide South Australia Australia
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