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He C, Dong T, Tan J, Yang L, Qiu Y, Zhang J, Huang Y, Zhou A, Wang X, Huang Y, Zhu M, Lam SC, Deng R. Psychometric testing of the training needs for advance care planning scale for clinicians and nurses. BMC Nurs 2024; 23:476. [PMID: 39010077 PMCID: PMC11247906 DOI: 10.1186/s12912-024-01952-7] [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: 03/15/2023] [Accepted: 04/19/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Studies have shown that Chinese Clinicians and nurses have positive attitudes toward ACP, but no local tools exist to assess their need for ACP knowledge and skills training. resulting in their inability to initiate ACP conversations as well as poor end-of-life care for patients. Therefore, this study aims to assess the needs of Chinese Clinicians and nurses for ACP knowledge and skills training and assess the validity and reliability of a questionnaire on the Training Needs for Advance Care Planning (TNACP) scale. METHODS From October to November 2021, 170 clinicians and nurses were pre-surveyed using a preliminary draft of the questionnaire. The responses were screened using item analysis, Cronbach's alpha coefficient, and the intraclass correlation coefficient (ICC) to describe the internal consistency and stability of the questionnaire. The Content validity index (CVI), Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) were used to test the validity of the questionnaire. RESULTS After independent samples t-test analysis, Except for the entry "A2", the critical ratio between the two groups of the remaining 23 items was statistically significant (p < 0.05). Based on the above screening methods, the "A2" item was deleted, and the final number of questionnaire items was 23. The I-CVI was 0.79-1.00, and the S-CVI/Ave was 0.90. Three common factors were extracted-the cumulative contribution rate was 69.969%, and the factor loading of all items was 0.506-0.843 (all > 0.40). The results of confirmatory factor analysis showed that the Training Needs for Advance Care Planning (TNACP) scale model fit well(X2/df = 2.504, RMSEA = 0.092, GFI = 0.809, AGFI = 0.745, CFI = 0.931, IFI = 0.932, TLI = 0.916); the Cronbach's α = 0.888 for the total questionnaire, and the three dimensions of Cronbach's α were 0.729 to 0.959; and the ICC for the overall scores between the test-retest evaluations was 0.884 (p < 0.001). CONCLUSIONS The TNACP scale has good reliability and validity and can be used to assess Chinese Clinicians and nurses' training needs for implementing ACP.
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Affiliation(s)
- Chunju He
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Tiaoxia Dong
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Jin Tan
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Liu Yang
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Yeyin Qiu
- The Fifth Affiliated Hospital of Zunyi Medical University, Guangdong Province, China
| | - Jianghui Zhang
- The Fifth Affiliated Hospital of Zunyi Medical University, Guangdong Province, China
| | - Yi Huang
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Aiting Zhou
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Xianlin Wang
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Yuan Huang
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Minglan Zhu
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China.
| | | | - Renli Deng
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Guizhou Province, China.
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Sun AH, Crick M, Orosz Z, Hsu AT. An Evaluation of the Communication at End-of-Life Education Program for Personal Support Workers in Long-Term Care. J Palliat Med 2021; 25:89-96. [PMID: 34403594 DOI: 10.1089/jpm.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Communication skills are crucial for personal support workers (PSWs) to foster therapeutic relationships with the residents and their families in the long-term care (LTC) setting. Aim: To evaluate the impact of the Communication at End-of-Life (CEoL) Education Program on the competency and confidence of PSWs working in LTC to communicate about palliative and end-of-life care, and factors affecting their involvement in palliative and end-of-life care. Setting/Participants: PSWs from 35 LTC homes in Ontario, Canada, who participated in the CEoL Education Program between January and March 2019. Design: Mixed-methods evaluation using pre- (n = 178) and post-workshop (n = 113) surveys capturing the attitudes and beliefs toward death and dying; relationships with residents and families; and PSWs' participation in end-of-life care. Follow-up interviews were conducted between February and March 2019 with 21 PSWs to examine facilitators and barriers that affected their confidence in engaging in palliative care. Results: We observed significant improvements in all three domains, with the greatest increase (11%, p < 0.001) in the proportion of participants who responded "Often" or "Always" in the participation in end-of-life care domain. Specifically, we observed PSWs' elevated confidence in speaking with families of the residents about end-of-life, discussing goals and plans with the residents, and realizing that a "good death" is possible. Time constraints and staff shortages were recurrent themes that hindered many participants' ability to provide resident-centered care. Conclusions: This evaluation demonstrates that CEoL Education Program was associated with improved PSW competency and confidence in supporting palliative and end-of-life care in LTC settings.
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Affiliation(s)
- Annie H Sun
- Bruyère Research Institute, Ottawa, Ontario, Canada.,Ontario Centers for Learning, Research, and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada
| | - Michelle Crick
- Ontario Centers for Learning, Research, and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada
| | - Zsofia Orosz
- Ontario Centers for Learning, Research, and Innovation in Long-Term Care at Bruyère, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Lin HY, Chen CI, Lu CY, Lin SC, Huang CY. Nurses' knowledge, attitude, and competence regarding palliative and end-of-life care: a path analysis. PeerJ 2021; 9:e11864. [PMID: 34395091 PMCID: PMC8320516 DOI: 10.7717/peerj.11864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nurses’ knowledge regarding palliative and end-of-life (EOL) care has been documented, but the competence of nurses in Taiwan has not been deeply analyzed and may affect the use of EOL care. Purpose We aimed to (1) assess the palliative care knowledge, competence and attitude of nurses in a general hospital and (2) examine the paths connecting nurses’ demographic characteristics, previous experiences, knowledge, competence, and attitude. Method A correlational, cross-sectional survey design was implemented to recruit 682 eligible nurses. The questionnaires included demographic information and palliative and EOL care knowledge, attitude, and competence scales. Path analysis was employed for statistical analysis using structural equation modeling. Results Overall, 76% of the questions assessing palliative and hospice knowledge were answered correctly. Nurses’ palliative attitudes were divided into “positive perception” and “negative perception”. “Positive perception” was highly correlated with competence (r = 0.48, p < 0.001), but “negative perception” was not significantly correlated with competence (r = −0.07, p = 0.25). “Positive perception” (β = −0.01, p = 0.84) and competence (β = 0.02, p = 0.80) were not related to palliative knowledge. “Negative perception”, however, was negatively associated with palliative knowledge (β = −0.20, p < 0.01). Conclusions This study suggests continuing education to decrease nurses’ “negative perception” attitude regarding the provision of information to patients and families to provide better palliative and EOL care. Implications for Practice Nurses’ attitudes and competences with respect to palliative care and EOL care are critical. Areas for further research and advanced palliative and EOL care-related education and training are suggested and may be applied in future clinical interventions.
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Affiliation(s)
- Hung-Yu Lin
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan, ROC.,Division of Urology, Department of Surgery, E-Da Cancer & E-Da Hospital, Kaohsiung, Taiwan, ROC
| | - Chun-I Chen
- Management College, I-Shou University, Kaohsiung, Taiwan
| | - Chu-Yun Lu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Chuan Lin
- Department of Nursing, E-Da Hospital, Kaohsiung, Taiwan
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4
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Vohra JU, Brazil K, Szala-Meneok K. The Last Word: Family Members’ Descriptions of End-of-Life Care in Long-Term Care Facilities. J Palliat Care 2019. [DOI: 10.1177/082585970602200106] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A postal survey was used to collect data from family members of deceased residents of six long-term care (LTC) facilities in order to explore end-of-life (EOL) care using the Family Perception of Care Scale. This article reports on the results of thematic analysis of family member comments provided while completing the survey. Family comments fell into two themes: 1) appreciation for care and 2) concerns with care. The appreciation for care theme included the following subthemes: psychosocial support, family care, and spiritual care. The concerns with care theme included the subthemes: physical care, staffing levels, staff knowledge, physician availability, communication, and physical environment. This study identified the need for improvement in EOL care skills among LTC staff and attending physicians. As such, there is a need to implement continuing education to address these issues.
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Affiliation(s)
- Julie Uma Vohra
- St. Joseph's Health System Research Network, McMaster University and St. Joseph's Health System Research Network
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University and St. Joseph's Health System Research Network
| | - Karen Szala-Meneok
- School for Rehabilitation Sciences, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Abstract
Education appears to be a useful strategy for improving quality of care and work-related stress management. The present study assesses the educational needs of palliative care nurses working in acute care hospitals (n=88) and CLSCs (Centre Local de Services Communautaires, home-based, n=109) of the larger Quebec City area. It also describes relationships between educational needs, psychological distress, and self-efficacy. Nurses were surveyed and compared on training needs, preferred learning format, as well as barriers and factors facilitating attendance to workshops. Similar educational needs were observed in both work settings. Crisis, stress, and emotion management were rated as the most useful topics, followed by nonpharmacological ways to manage pain. Preferred educational formats were lectures and group discussions. Attending free training sessions during work hours was described as the best way to promote participation. Educational needs were positively related to psychological distress, and negatively related to perceived self-efficacy in providing good palliative care.
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Affiliation(s)
- Use Fillion
- Laval University, Faculty of Nursing, and Laval University Cancer Research Centre (CRC) CHUQ
| | | | - Richard L. Goupil
- Laval University Cancer Research Centre (CRC), CHUQ, Quebec, Quebec, Canada
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6
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Mohlman WL, Dassel K, Supiano KP, Caserta M. End-of-Life Education and Discussions With Assisted Living Certified Nursing Assistants. J Gerontol Nurs 2018; 44:41-48. [DOI: 10.3928/00989134-20180327-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/05/2018] [Indexed: 01/15/2023]
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Halifax E, Miaskowski C, Wallhagen M. Certified Nursing Assistants' Understanding of Nursing Home Residents' Pain. J Gerontol Nurs 2018; 44:29-36. [PMID: 29437185 DOI: 10.3928/00989134-20180131-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 12/19/2017] [Indexed: 01/12/2023]
Abstract
Pain is a significant problem for nursing home residents, yet its assessment is complex. Certified nursing assistants (CNAs) spend significant time with residents, but their role in understanding residents' pain is largely unexplored. The current qualitative grounded theory study analyzed interviews with 16 CNAs who described their experiences caring for residents in pain. Findings revealed how CNAs understood, recognized, interpreted, and responded to residents' pain. CNAs were found to differentiate between pain that they considered normal (everyday pain) and new pain judged significant enough to report to licensed nurses. CNAs exhibited a holistic understanding of pain, knowledge of strategies to identify and interpret pain, and actions to independently mitigate and report pain. Although additional confirmatory data are needed, the differentiation made between everyday and reportable pain may have important clinical implications suggesting that CNAs should always report to a licensed nurse when they perceive or suspect that residents have pain. [Journal of Gerontological Nursing, 44(4), 29-36.].
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8
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Afzal A, Stolee P, Heckman GA, Boscart VM, Sanyal C. The role of unregulated care providers in Canada-A scoping review. Int J Older People Nurs 2018; 13:e12190. [PMID: 29575512 DOI: 10.1111/opn.12190] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 02/01/2018] [Indexed: 12/24/2022]
Abstract
AIMS AND OBJECTIVES This scoping review explored: (i) the role of unregulated care providers in the healthcare system; (ii) their potential role on interprofessional teams; (iii) the impact of unregulated care provider's role on quality of care and patient safety; and (iv) education and employment standards. BACKGROUND Unregulated care providers in Canada assist older adults with personal support and activities of daily living in a variety of care settings. As the care needs of an aging population become increasingly complex, the role of unregulated care providers in healthcare delivery has also evolved. Currently, many unregulated care providers are performing tasks previously performed by regulated health professionals, with potential implications for quality of care and patient safety. Information is fragmented on the role, education and employment standards of unregulated care providers. METHODS A scoping review was conducted following the methods outlined by Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) and Levac, Colquhoun, and O'Brien (Implementation Science, 5, 2010, 69). An iterative search of published and grey literature was conducted from January 2000 to September 2016 using Medline, CINAHL, SCOPUS and Google. Inclusion and exclusion criteria were applied to identify relevant studies published in English. RESULTS The search yielded 63 papers for review. Results highlight the evolving role of unregulated care providers, a lack of recognition and a lack of authority for unregulated care provider decision-making in patient care. Unregulated care providers do not have a defined scope of practice. However, their role has evolved to include activities previously performed by regulated professionals. Variations in education and employment standards have implications for quality of care and patient safety. CONCLUSIONS Unregulated care providers are part of an important workforce in the long-term care and community sectors in Canada. Their evolving role should be recognised and efforts made to leverage their experience on interprofessional teams and reduce variations in education and employment standards. IMPLICATIONS FOR PRACTICE This study highlights the evolving role of unregulated care providers in Canada and presents a set of recommendations for implementation at micro, meso, and macro policy levels.
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Affiliation(s)
- Arsalan Afzal
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - George A Heckman
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Veronique M Boscart
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada.,Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology & Advanced Learning Applied Research, Kitchener, ON, Canada
| | - Chiranjeev Sanyal
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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9
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Abstract
The overall purpose of the study reported here was to explore the experience of being old and in chronic pain while living in a nursing home. The aims of the study were to discover what it was like for older people to live with chronic pain, and how and in what way chronic pain impacts on their lives. One major theme from the study is presented here, ‘Being constantly pained’, as it represents the essential feature of the lived experience of pain. In presenting the findings, seven sub-themes are discussed, including: ‘the painfulness of pain’, ‘the certainty/uncertainty of pain’, ‘overwhelming pain’, ‘unvoicing pain’, ‘being old and worn out’, ‘being forgotten’ and ‘taking punishment’. The findings of this study have the potential to increase understanding of the experience of chronic pain in elderly people by nurses and other healthcare professionals. In addition, the findings also have implications for the provision of healthcare in nursing homes and for conducting research with those who are very old. In a climate of limited government funding and support for services in nursing homes, the data highlight concerns about the role of unqualified staff in this setting.
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10
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Oliver DP, Porock D, Oliver DB. Managing the Secrets of Dying Backstage: The Voices of Nursing Home Staff. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/3p8g-5jad-j2nf-bkgk] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The project analyzed staff descriptions of undocumented care given to dying nursing home residents. Registered nurses, licensed practical nurses, certified nurse aids, and social service designees were interviewed using an unstructured interview guide. Transcripts were coded by two members of the team and a thematic analysis was guided with the theoretical framework of Erving Goffman's dramaturgical model of social interaction. Analysis of interview transcripts revealed practices related to end of life care that went undocumented. Viewed through the lens of Goffman's theoretical model, this undocumented care revealed “secrets” related to socialization processes, communication, tension, superstitions, and interactions between staff and dying residents. Findings show that while dying is not formally acknowledged in the nursing home setting, staff experiences the reality of death and informally responds to the special needs of residents.
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Affiliation(s)
| | | | - David B. Oliver
- Assistant Administrator of Long Term Care, Columbia, Missouri
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11
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Saini G, Sampson EL, Davis S, Kupeli N, Harrington J, Leavey G, Nazareth I, Jones L, Moore KJ. An ethnographic study of strategies to support discussions with family members on end-of-life care for people with advanced dementia in nursing homes. BMC Palliat Care 2016; 15:55. [PMID: 27388766 PMCID: PMC4936120 DOI: 10.1186/s12904-016-0127-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most people with advanced dementia die in nursing homes where families may have to make decisions as death approaches. Discussions about end-of-life care between families and nursing home staff are uncommon, despite a range of potential benefits. In this study we aimed to examine practices relating to end-of-life discussions with family members of people with advanced dementia residing in nursing homes and to explore strategies for improving practice. METHODS An ethnographic study in two nursing homes where the Compassion Intervention was delivered. The Compassion Intervention provides a model of end-of-life care engaging an Interdisciplinary Care Leader to promote integrated care, educate staff, support holistic assessments and discuss end of life with families. We used a framework approach, undertaking a thematic analysis of fieldwork notes and observations recorded in a reflective diary kept by the Interdisciplinary Care Leader, and data from in-depth interviews with 23 informants: family members, GPs, nursing home staff, and external healthcare professionals. RESULTS Four major themes described strategies for improving practice: (i) educating families and staff about dementia progression and end-of-life care; (ii) appreciating the greater value of in-depth end-of-life discussions compared with simple documentation of care preferences; (iii) providing time and space for sensitive discussions; and (iv) having an independent healthcare professional or team with responsibility for end-of-life discussions. CONCLUSIONS The Interdisciplinary Care Leader role offers a promising method for supporting and improving end-of-life care discussions between families of people with advanced dementia and nursing home staff. These strategies warrant further evaluation in nursing home settings.
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Affiliation(s)
- Geena Saini
- Centre for Mental Health, Maya House, 134-138 Borough High Street, London, SE1 1LB, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Magee Campus, Northland Road, Derry Londonderry, BT48 7JL, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, UCL Royal Free Site, Rowland Hill Street, London, NW3, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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Travers J, Herzig CTA, Pogorzelska-Maziarz M, Carter E, Cohen CC, Semeraro PK, Bjarnadottir RI, Stone PW. Perceived barriers to infection prevention and control for nursing home certified nursing assistants: a qualitative study. Geriatr Nurs 2015; 36:355-60. [PMID: 26071320 PMCID: PMC4600411 DOI: 10.1016/j.gerinurse.2015.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/24/2015] [Accepted: 05/02/2015] [Indexed: 11/29/2022]
Abstract
Healthcare-associated infections, while preventable, result in increased morbidity and mortality in nursing home (NH) residents. Frontline personnel, such as certified nursing assistants (CNAs), are crucial to successful implementation of infection prevention and control (IPC) practices. The purpose of this study was to explore barriers to implementing and maintaining IPC practices for NH CNAs as well as to describe strategies used to overcome these barriers. We conducted a multi-site qualitative study of NH personnel important to infection control. Audio-recorded interviews were transcribed verbatim and transcripts were analyzed using conventional content analysis. Five key themes emerged as perceived barriers to effective IPC for CNAs: 1) language/culture; 2) knowledge/training; 3) per-diem/part-time staff; 4) workload; and 5) accountability. Strategies used to overcome these barriers included: translating in-services, hands on training, on-the-spot training for per-diem/part-time staff, increased staffing ratios, and inclusion/empowerment of CNAs. Understanding IPC barriers and strategies to overcome these barriers may better enable NHs to achieve infection reduction goals.
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Affiliation(s)
- Jasmine Travers
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA.
| | - Carolyn T A Herzig
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Monika Pogorzelska-Maziarz
- Jefferson School of Nursing, Thomas Jefferson University, 130 South 9th Street, Suite 847, Philadelphia, PA 19107, USA
| | - Eileen Carter
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Catherine C Cohen
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Patricia K Semeraro
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Ragnhildur I Bjarnadottir
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
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Wickson-Griffiths A, Kaasalainen S, Brazil K, McAiney C, Crawshaw D, Turner M, Kelley ML. Comfort Care Rounds: A Staff Capacity-Building Initiative in Long-Term Care Homes. J Gerontol Nurs 2015; 41:42-8. [DOI: 10.3928/00989134-20140611-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/21/2014] [Indexed: 11/20/2022]
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Knowledge, Skills, and Attitudes in Caring for Older Adults With Advanced Illness Among Staff Members of Long-Term Care and Assisted Living Facilities. Am J Hosp Palliat Care 2014; 33:327-34. [DOI: 10.1177/1049909114561996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In long-term care and assisted living facilities, many groups of health care professionals contribute to the work of the health care team. These staff members perform essential, direct patient care activities. An educational needs assessment was conducted to determine the learning needs and preferences of staff members related to providing care for patients with life-limiting illnesses. Staff members placed importance on understanding topics such as principles of palliative care, pain assessment, pain management, and nonpain symptom management. The majority of survey respondents were also interested in learning more about these topics. The results of this educational needs analysis suggest staff members would benefit from a course tailored to these identified educational needs and designed to overcome previously identified educational barriers.
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15
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Ersek M, Jablonski A. A mixed-methods approach to investigating the adoption of evidence-based pain practices in nursing homes. J Gerontol Nurs 2014; 40:52-60. [PMID: 24640959 DOI: 10.3928/00989134-20140311-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 12/18/2013] [Indexed: 11/20/2022]
Abstract
This mixed methods study examined perceived facilitators and obstacles to adopting evidence-based pain management protocols vis-a-vis documented practice changes that were measured using a chart audit tool. This analysis used data from a subgroup of four nursing homes that participated in a clinical trial. Focus group interviews with staff yielded qualitative data about perceived factors that affected their willingness and ability to use the protocols. Chart audits determined whether pain assessment and management practices changed over time in light of these reported facilitators and barriers. Reported facilitators included administrative support, staff consistency, and policy and procedure changes. Barriers were staff attitudes, regulatory issues, and provider mistrust of nurses' judgment. Overall, staff reported improvements in pain practices. These reports were corroborated by modest but significant increases in adherence to recommended practices. Change in clinical practice is complex and requires attention to both structural and process aspects of care.
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16
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The need for palliative care education, support, and reflection among rural nurses and other staff: A quantitative study. Palliat Support Care 2014; 13:265-74. [DOI: 10.1017/s1478951513001272] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Many people now die in community care, and, considering the aging population, all healthcare staff members must be prepared to provide palliative care. Our objectives were to describe the total staff working in different care organizations in a rural community in Sweden and to explore palliative care competence, to describe educational gaps and the need for support and reflection, and to determine whether there are differences in care organizations, professions, age, and gender.Method:A 4-section 20-item questionnaire was distributed to 1686 staff (65% response rate): in nursing homes (n = 395), home care (n = 240), and group residential settings (n = 365). Registered nurses (n = 70), assistant nurses (n = 916), managers (n = 43), and paramedics (n = 33) participated. Descriptive and correlational statistics were employed.Results:Significant differences were found, and 40% (53% among men) lacked palliative care education, Fewer than 50% lacked education in the spiritual/existential areas, and 75% of those aged 20–66 (75% women, 55% men) needed further education. More women than men and staff aged 50–59 had an increased need to reflect.Significance of Results:Our study may provide guidance for managers in rural communities when planning educational interventions in palliative care for healthcare staff and may support direct education with content for specific professions.
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Funk LM, Waskiewich S, Stajduhar KI. Meaning-Making and Managing Difficult Feelings: Providing Front-Line End-of-Life Care. OMEGA-JOURNAL OF DEATH AND DYING 2014; 68:23-43. [DOI: 10.2190/om.68.1.b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Managing grief and difficult emotions related to end-of-life (EOL) care is an often under-recognized part of the work of resident care aides (RCAs). In this interpretive analysis we explore the shared and socially constructed ideas that 11 RCAs in 1 Canadian city employ to make sense of death and the provision of EOL care. RCAs spoke of personal challenges involved in witnessing death and experiencing loss, as well as helplessness and frustration when they could not provide quality EOL care. RCAs invoked “consoling refrains” to manage grief, including “such is life,” “they are better off,” and “they had a full life.” To manage guilt and moral distress, RCAs reminded themselves “I did my best” and “I experience rewards.” Though these ideas help RCAs, some may need to be reframed through coaching and mentorship, to prevent unintended negative effects on care or the reproduction of ageist beliefs more broadly.
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Tsai HH, Tsai YF, Weng LC, Chou HF. More than communication skills: experiences of communication conflict in nursing home nurses. MEDICAL EDUCATION 2013; 47:990-1000. [PMID: 24016169 DOI: 10.1111/medu.12233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/10/2012] [Accepted: 03/15/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT Communication conflicts are inevitable in nursing homes. Understanding communication conflicts experienced by practising nurses could provide insights to guide the development of sound communication education programmes. OBJECTIVES The purpose of this study was to explore the experiences of nurses in nursing homes of communication conflict in encounters with nursing home residents and their families in Taiwan. METHODS Data were collected from April 2010 to December 2011 through audiotaped, individual, in-depth interviews with 26 nurses at five nursing homes in Taiwan. Data were analysed according to van Manen's interpretive phenomenological method. RESULTS Data analysis revealed that nurses' experiences of communication conflicts during encounters with nursing home residents and their families could be categorised under three themes: differences in perspectives of nursing home services; differences in views of nurturing health, and mediation between family members and others. CONCLUSIONS The findings of this study can be considered by clinical educators and policymakers when designing communication education programmes for nurses and other clinicians. These programmes should include ways to increase nurses' independent thinking in settings in which power differences exist, as well as their cultural sensitivity as embodied in Leininger's culture care theory. These programmes should also include education in telephone communication and alternative methods of communication (e.g. videoconferencing).
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Affiliation(s)
- Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Zheng NT, Mukamel DB, Caprio TV, Temkin-Greener H. Hospice utilization in nursing homes: association with facility end-of-life care practices. THE GERONTOLOGIST 2012; 53:817-27. [PMID: 23231947 DOI: 10.1093/geront/gns153] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Hospice care provided to nursing home (NH) residents has been shown to improve the quality of end-of-life (EOL) care. However, hospice utilization in NHs is typically low. This study examined the relationship between facility self-reported EOL practices and residents' hospice use and length of stay. DESIGN The study was based on a retrospective cohort of NH residents. Medicare hospice claims, Minimum Data Set, Online Survey, Certification, and Reporting system and the Area Resource File were linked with a survey of directors of nursing (DON) regarding institutional EOL practice patterns (EOLC Survey). SETTING AND PARTICIPANTS In total, 4,540 long-term-care residents who died in 2007 in 290 facilities which participated in the EOLC Survey were included in this study. MEASUREMENTS We measured NHs' tendency to offer hospice to residents and to initiate aggressive treatments (hospital transfers and feeding tubes) for EOL residents based on DON's responses to survey items. Residents' hospice utilization was determined using Medicare hospice claims. RESULTS The prevalence of hospice use was 18%. The average length of stay was 93 days. After controlling for individual risk factors, facilities' self-reported practice measures associated with residents' likelihood of using hospice were tendency to offer hospice (p = .048) and tendency to hospitalize (p = .002). Residents in NHs reporting higher tendency to hospitalize tended to enroll in hospice closer to death. CONCLUSION Residents' hospice utilization is not only associated with individual and facility characteristics but also with NHs' self-reported EOL care practices. Potential interventions to effect greater use of hospice may need to focus on facility-level care processes and practices.
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Affiliation(s)
- Nan Tracy Zheng
- *Address correspondence to Nan Tracy Zheng, Aging, Disability and Long-Term Care, RTI International-Waltham office, 1440 Main Street, Suite 310, Waltham, MA 02451-1623, USA. E-mail:
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Abstract
RÉSUMÉNous avons examiné les caractéristiques contextuelles qui façonnent les soins de fin de vie (SFV) dans les établissements de soins pour bénéficiaires, en s’appuyant sur les perspectives de 11 aidants résidents (AR) dans un centre urbain canadien de l’Ouest. ARs décrivent les soins de fin de vie comme “offrant un confort,” y compris le bien-être physique et émotionnel. Les inquiétudes au sujet des défis posés par le temps et la charge de travail ont dominé les comptes et ont généré la culpabilité, la tristesse et de la frustration. ARs ont essayé de “trouver le temps” en le prenant d’eux-mêmes ou les autres résidents, et en s’appuyant sur l’engagement des collègues et sur les familles. Les résultats soulignent l’importance du rôle d’AR (en particulier en offrant un confort émotionnel), mais faire appel à l’attention à l’interprétation de ce qui est impliqué dans ce travail, et à la définition du portée de la pratique et de la formation. Les résultats également réitère l’importance, entre aidants résidents canadiens, des charges de travail adéquates pour faciliter les soins de fin de vie de qualité, et soulève des préoccupations au sujet des contraintes et comment elles forment la pratique de soins de fin de vie et les significations qui infusent une telle pratique.
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Kaasalainen S, Brazil K, Kelley ML. Building capacity in palliative care for personal support workers in long-term care through experiential learning. Int J Older People Nurs 2012; 9:151-8. [PMID: 23051621 DOI: 10.1111/opn.12008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/16/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Providing palliative care in long-term care (LTC) homes is an area of growing importance. As a result, attention is being given to exploring effective palliative care learning strategies for personal support workers (PSWs) who provide the most hands-on care to LTC residents. AIM The purpose of this intervention was to explore hospice visits as an experiential learning strategy to increase the capacity of PSWs in palliative care, specifically related to their new learning, and how they anticipated this experience changed their practices in LTC. DESIGN This study utilised a qualitative descriptive design. METHODS Eleven PSWs from four Ontario LTC homes were sent to their local hospice to shadow staff for one to two days. After the visit, PSWs completed a questionnaire with open-ended questions based on critical reflection. Data were analysed using thematic content analysis. RESULTS PSWs commented on the extent of resident-focused care at the hospice and how palliative care interventions were tailored to meet the needs of residents. PSWs were surprised with the lack of routine at the hospice but felt that hospice staff prioritised their time effectively in order to meet family and client care needs. Some PSWs were pleased to see how well integrated the PSW role is on the community hospice team without any hierarchical relationships. Finally, PSWs felt that other LTC staff would benefit from palliative care education and becoming more comfortable with talking about death and dying with other staff, residents and family members. CONCLUSION This study highlighted the benefits of PSWs attending a hospice as an experiential learning strategy. Future work is needed to evaluate this strategy using more rigorous designs as a way to build capacity within PSWs to provide optimal palliative care for LTC residents and their family members. IMPLICATIONS FOR PRACTICE PSWs need to be recognised as important members within the interdisciplinary team. PSWs who shadow staff at hospices view this experience as a positive strategy to meet their learning needs related to palliative care.
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Reducing staff isolation and developing evidence-informed practice in the aged care environment through an action research approach to falls prevention. ANS Adv Nurs Sci 2012; 35:3-13. [PMID: 22228387 DOI: 10.1097/ans.0b013e3182433b27] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to examine whether an action research approach was effective in reducing the isolation of staff in 2 residential aged care facilities, within the context of an evidence-informed falls prevention program. A Falls Action Research Group comprising 12 nursing/nonnursing staff across 2 residential aged care facilities was established and engaged in critical dialogue and action over 12 months to improve their fall prevention activities. Through the group members' engagement, a research community was established that diminished staff isolation by engaging members in a sustained process of collaboration around falls prevention, which worked to disrupt occupational silos and challenge traditional staff hierarchies.
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Liu LM, Guarino AJ, Lopez RP. Family Satisfaction With Care Provided by Nurse Practitioners to Nursing Home Residents With Dementia at the End of Life. Clin Nurs Res 2011; 21:350-67. [DOI: 10.1177/1054773811431883] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine family satisfaction with care provided by nurse practitioners (NP) to nursing home (NH) residents with dementia. A survey was mailed to 239 family members of nursing home residents who died with dementia. One open-ended question was added to provide comment about the care provided by the NP. A total of 131 surveys were returned (response rate 55%). The study revealed that 98% of family members agreed that they were satisfied with the end-of-life care provided by the NP. Survey responses were used to analyze the associations of communication, comfort, and satisfaction with NPs to total satisfaction with end-of-life care. Pearson’s correlations demonstrated that overall satisfaction was significantly associated with NP–family communication, resident comfort, and satisfaction with NP care. Findings suggested that NPs using a model of care that emphasizes advance care planning, communication, and comfort results in high satisfaction of family members.
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Affiliation(s)
| | - A. J. Guarino
- MGH Institute of Health Professions, Boston, MA, USA
| | - Ruth Palan Lopez
- MGH Institute of Health Professions School of Nursing, Boston, MA, USA
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DeForge R, van Wyk P, Hall J, Salmoni A. Afraid to care; unable to care: A critical ethnography within a long-term care home. J Aging Stud 2011. [DOI: 10.1016/j.jaging.2011.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McClement S, Lobchuk M, Chochinov HM, Dean R. “Broken Covenant”: Healthcare Aides’ “Experience of the Ethical” in Caring for Dying Seniors in a Personal Care Home. THE JOURNAL OF CLINICAL ETHICS 2010. [DOI: 10.1086/jce201021303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Zheng NT, Temkin-Greener H. End-of-life care in nursing homes: the importance of CNA staff communication. J Am Med Dir Assoc 2010; 11:494-9. [PMID: 20816337 DOI: 10.1016/j.jamda.2010.01.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/12/2010] [Accepted: 01/14/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Staff communication has been shown to influence overall nursing home (NH) performance. However, no empirical studies have focused specifically on the impact of CNA communication on end-of-life (EOL) care processes. This study examines the relationship between CNA communication and nursing home performance in EOL care processes. DESIGN Secondary data analysis of 2 NH surveys conducted in 2006-2007. SETTING One hundred seven nursing homes in New York State. PARTICIPANTS Participants were 2636 CNAs and 107 directors of nursing (DON). MEASUREMENTS The measures of EOL care processes-EOL assessment and care delivery (5-point Likert scale scores)-were obtained from survey responses provided by 107 DONs. The measure of CNA communication was derived from survey responses obtained from 2636 CNAs. Other independent variables included staff education, hospice use intensity, staffing ratio, staff-resident ethnic overlap index, facility religious affiliation, and ownership. METHODS The reliability and validity of the measures of EOL care processes and CNA communication were tested in the current study sample. Multivariate linear regression models with probability weights were used. The analysis was conducted at the facility level. RESULTS We found better CNA communication to be significantly associated with better EOL assessment (P = .043) and care delivery (P = .098). Two potentially modifiable factors-staff education and hospice use intensity-were associated with NHs' performance in EOL care processes. Facilities with greater ethnic overlap between staff and residents demonstrated better EOL assessment (P = .051) and care delivery scores (P = .029). CONCLUSION Better CNA communication was associated with better performance in EOL care processes. Our findings provide specific insights for NH leaders striving to improve EOL care processes and ultimately the quality of care for dying residents.
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Affiliation(s)
- Nan Tracy Zheng
- Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Fillion L, Duval S, Dumont S, Gagnon P, Tremblay I, Bairati I, Breitbart WS. Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses. Psychooncology 2010; 18:1300-10. [PMID: 19165757 DOI: 10.1002/pon.1513] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Palliative care (PC) nurses experience several recurrent organizational, professional, and individual challenges. To address existential and emotional demands, the meaning-centered intervention was recently developed. The intervention applied didactic and process-oriented strategies, including guided reflections, experiential exercises, and education based on themes of Viktor Frankl's logotherapy. The objective of this study was to test its efficiency to improve job satisfaction and quality of life in PC nurses from three regional districts in Quebec Province, Canada. METHODS A randomized waiting-list group design was conducted, intervention group (n=56) versus waiting-list group (n=53). Job satisfaction, perception of benefits of working in PC, and spiritual and emotional quality of life were measured at pre-, posttest, and 3-month follow-up. RESULTS The PC nurses in the experimental group reported more perceived benefits of working in PC after the intervention and at follow-up. Spiritual and emotional quality of life remained, however, unaffected by the intervention. CONCLUSIONS To explain null findings, theoretical and methodological challenges, related to existential interventions, such as choice of outcomes, and selection bias (participants recruited were healthy workers) are discussed. Future directions and strategies to deal with those issues are proposed.
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Affiliation(s)
- Lise Fillion
- Faculty of Nursing, Laval University, Quebec G1V 0A6, Canada.
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Lo RSK, Kwan BHF, Lau KPK, Kwan CWM, Lam LM, Woo J. The needs, current knowledge, and attitudes of care staff toward the implementation of palliative care in old age homes. Am J Hosp Palliat Care 2009; 27:266-71. [PMID: 19959840 DOI: 10.1177/1049909109354993] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aims to explore in depth the needs, current knowledge, and attitudes of all ranks of old age home staff. A large-scale qualitative study with 13 semistructured focus groups was conducted in Hong Kong. Key themes were extracted by framework analysis. Three major themes were extracted, including role as a service provider, current knowledge, and attitude toward palliative care. There was a marked difference in familiarity with the concept of ''palliative care'' between different groups of staff, yet both shared the motivation for enhancement. The biggest concerns for the staff were elderly residents' readiness to accept palliative care, manpower, and resources. Care staff, regardless of rank, seemed to welcome and be ready to adopt a palliative care approach in caring for old age home residents, though not without worries and concerns.
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Affiliation(s)
- Raymond S K Lo
- Department of Medicine and Geriatrics, Shatin Hospital, New Territories, Hong Kong.
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McDonnell MM, McGuigan E, McElhinney J, McTeggart M, McClure D. An analysis of the palliative care education needs of RGNs and HCAs in nursing homes in Ireland. Int J Palliat Nurs 2009; 15:446, 448-55. [DOI: 10.12968/ijpn.2009.15.9.44257] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary M McDonnell
- Health Service Executive, Dublin North East, Louth, Meath, Cavan/Monaghan, Dóchas Centre, Drogheda, Co. Louth
| | - Eileen McGuigan
- SPCS, School of Nursing, Midwifery, Health Studies and Applied Science, Dundalk Institute of Technology, Dundalk
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Ersek M, Wood BB. Development and evaluation of a Nursing Assistant Computerized Education Programme. Int J Palliat Nurs 2008; 14:502-9. [DOI: 10.12968/ijpn.2008.14.10.31495] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary Ersek
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Becky B Wood
- Pain and Palliative Care Research Department, Swedish Medical Center, Seattle, USA
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Hasson F, Kernohan WG, Waldron M, Whittaker E, McLaughlin D. The palliative care link nurse role in nursing homes: barriers and facilitators. J Adv Nurs 2008; 64:233-42. [PMID: 18785884 DOI: 10.1111/j.1365-2648.2008.04803.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study to explore link nurses' views and experiences regarding the development, barriers and facilitators to the implementation of the role in palliative care in the nursing home. BACKGROUND The delivery of palliative care in nursing homes is widely advocated; one approach is to develop the link nurse role to cascade good practice and training to nurses and other care staff to enhance patient care. METHOD A descriptive qualitative study was conducted with a purposive sample of 14 link nurses from 10 nursing homes in Northern Ireland during 2006. Three focus groups, composed of all Registered Nurses currently acting as link nurses in their nursing homes participated, and the data were audio recorded, fully transcribed and content analysed. FINDINGS The link nurse system shows potential to enhance palliative care within nursing homes. However, link nurses experienced a number of difficulties in implementing education programmes. Facilitators of the role included external support, monthly meetings, access to a resource file and peer support among link nurses themselves. Lack of management support, a transient workforce and lack of adequate preparation for link nurses were barriers to fulfilling this role. CONCLUSION Whilst palliative care link nurses can improve care for residents in nursing homes, consideration must be given to overcome the types of barriers identified in order to enable the link nurse system to function effectively.
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Affiliation(s)
- Felicity Hasson
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey, UK.
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Keeney CE, Scharfenberger JA, O'Brien JG, Looney S, Pfeifer MP, Hermann CP. Initiating and sustaining a standardized pain management program in long-term care facilities. J Am Med Dir Assoc 2008; 9:347-53. [PMID: 18519117 DOI: 10.1016/j.jamda.2008.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 02/15/2008] [Accepted: 02/15/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To identify current pain management practices in the long-term care setting; and, implement and evaluate a comprehensive pain management program in the long-term care setting. DESIGN An interventional pilot study. SETTING Community-based long-term care facilities. METHODS This study was conducted in two phases. Phase I consisted of interviewing long-term care facility administrators to ascertain current pain management policies and practices. This information was used to develop the Phase II intervention that involved collecting benchmark data, creating or modifying pain policies and procedures, implementing a pain management program and presenting educational programs. MEASUREMENTS Interviews with long term care administrators; facility and resident demographic data; chart audits for pain assessment and management data; pharmacy audits; telephone surveys. RESULTS Pain management policies and practices were inadequate prior to the study intervention. No facilities had policies or procedures that required ongoing (daily, weekly, etc.) pain assessment. Only one facility had mechanisms in place for measuring the presence or intensity of pain in their non-verbal, cognitively-impaired residents. Following the pain management program intervention, pain assessment significantly increased. and treatment for pain was provided for the vast majority of those indicating pain. All sites had a standardized pain assessment program in place one-year post-study completion. CONCLUSIONS Standardized pain management programs are critical to improving pain management in long-term care settings. Improvement in long-term care pain management can be obtained through a comprehensive pain management program that involves staff education, changes in pain policies and procedures, and identifying pain management as a quality indicator.
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Affiliation(s)
- Cynthia E Keeney
- Interdisciplinary Program for Palliative Care and Chronic Illness, University of Louisville Department of Medicine, Louisville, KY 40202, USA.
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Trotta RL. Quality of Death: A Dimensional Analysis of Palliative Care in the Nursing Home. J Palliat Med 2007; 10:1116-27. [DOI: 10.1089/jpm.2006.0263] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rebecca L. Trotta
- Hartford Center of Geriatric Nursing Excellence, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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Abstract
The actual experience of dying in the United States is far different from the expressed desires of most Americans. Although most Americans express a preference for dying at home, 73% of Americans die in medical institutions, with 23% dying in nursing homes (Teno, 2004). In this article, the author examines end-of-life care in the nursing home. A literature review identified more than 100 published articles relevant to end-of-life care in nursing homes. Of these, the author evaluated empirical research studies from the perspectives of residents, family members, and nursing home staff with findings specific to seriously ill nursing home residents. By identifying problematic issues and contributing factors, nurses can modify their practice to improve end-of-life care and substantially reduce suffering for nursing home residents and their families.
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Whittaker E, George Kernohan W, Hasson F, Howard V, McLaughlin D. Palliative care in nursing homes: exploring care assistants? knowledge. Int J Older People Nurs 2007; 2:36-44. [DOI: 10.1111/j.1748-3743.2007.00038.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fillion L, Dupuis R, Tremblay I, De Grâce GR, Breitbart W. Enhancing meaning in palliative care practice: A meaning-centered
intervention to promote job satisfaction. Palliat Support Care 2006; 4:333-44. [PMID: 17133893 DOI: 10.1017/s1478951506060445] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: This article introduces a new meaning-centered
psycho-educational group intervention, called Enhancing meaning in
palliative care nursing, designed to support nurses providing
palliative care. This intervention aims at increasing job satisfaction and
quality of life, as well as preventing burnout in this particular
population.Theoretical frameworks: Its format and content are founded on
the meaning-centered psychotherapy approach developed for terminally ill
cancer patients (Breitbart, 2001; Greenstein
& Breitbart, 2000). Frankl's
existential therapeutic approach, called logotherapy, serves as
the underlying theoretical framework to this intervention.Development: Following the presentation of the context and
the development of the intervention, its content is described.Conclusion: A brief description of the ongoing randomized
controlled trial testing the intervention is then provided. Finally, the
way in which this intervention could contribute to nurses' quality of
life and suggestions for future developments are briefly discussed.
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Affiliation(s)
- Lise Fillion
- Faculty of Nursing, Laval University, Quebec City, Quebec, Canada.
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Whittaker E, George Kernohan W, Hasson F, Howard V, McLaughlin D. The palliative care education needs of nursing home staff. NURSE EDUCATION TODAY 2006; 26:501-10. [PMID: 16517029 DOI: 10.1016/j.nedt.2006.01.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 12/22/2005] [Accepted: 01/13/2006] [Indexed: 05/06/2023]
Abstract
BACKGROUND Palliative care is delivered in a number of settings, including nursing homes, where staff often have limited training in palliative care. AIM We explored the level of palliative care knowledge among qualified staff delivering end-of-life care in nursing home settings, to inform the development of an appropriate education and training programme. DESIGN An audit of the educational needs assessment was performed using an anonymous postal questionnaire sent to 528 qualified nursing staff within 48 nursing homes. FINDINGS In total, 227 questionnaires were returned giving a response rate of 43%. Results indicated that less than half the sample had obtained formal training in the area of pain assessment and management and less than a quarter had obtained training in non-malignant conditions. Registered nurses in this study reported a lack of awareness of palliative care principles or national guidelines. CONCLUSION Qualified nursing home staff agree that palliative care is a valuable model for care in their setting. There are clear opportunities for improvement in nursing home care, based on education and training in palliative care. Results also support the need for enhanced liaison between nursing homes and specialist palliative care services.
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Affiliation(s)
- Evelyn Whittaker
- Northern Ireland Hospice, 71A Saintfield Road, Belfast, BT8 7HN, United Kingdom.
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Watson J, Hockley J, Dewar B. Barriers to implementing an integrated care pathway for the last days of life in nursing homes. Int J Palliat Nurs 2006; 12:234-40. [PMID: 16835564 DOI: 10.12968/ijpn.2006.12.5.21177] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM this paper explores the barriers that needed to be overcome during the process of implementing an integrated care pathway for the last days of life as a way of developing quality end-of-life care in nursing homes. METHODS an action research methodology underpinned the study. Qualitative and quantitative data were collected in eight nursing homes before, during and after the implementation of the care pathway. FINDINGS six main barriers were identified: a lack of knowledge of palliative care drugs and control of symptoms at the end of life; lack of preparation for approaching death; not knowing when someone is dying or understanding the dying process; lack of multidisciplinary team working in nursing homes; lack of confidence in communicating about dying; some nursing homes are not ready or able to change. These findings highlight a functional 'rehabilitative' culture that may not be so appropriate in the current context of nursing home care, and one that makes implementing an integrated care pathway for the last days of life less straightforward than in other settings. CONCLUSION it cannot be presumed that the implementation of a care pathway for the last days of life in nursing homes is straightforward. This study suggests that an action research framework was extremely useful in highlighting and overcoming some obstacles when developing evidence-based practice. Action at both local and public policy level is required to fully address barriers that prevent quality end-of-life care in nursing homes.
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Affiliation(s)
- Julie Watson
- St Columbas Hospice, Boswall Road, Edinburgh, EH5 3RW.
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Stevenson KM, Dahl JL, Berry PH, Beck SL, Griffie J. Institutionalizing effective pain management practices: practice change programs to improve the quality of pain management in small health care organizations. J Pain Symptom Manage 2006; 31:248-61. [PMID: 16563319 DOI: 10.1016/j.jpainsymman.2005.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2005] [Indexed: 11/16/2022]
Abstract
The Resource Center of the American Alliance of Cancer Pain Initiatives provided templates, faculty, and ongoing consultation to assist seven state pain initiatives to implement programs to improve pain management practices. A total of 113 health care organizations participated. Each organization committed to support a team of two to three staff through a 10-month pain quality improvement process, which included a site visit, two educational conferences, pre- and postprogram analyses of the organizational structures in place to support pain assessment and management, quality improvement work plan development, and patient survey data collection. Postprogram results showed statistically significant increases in the presence of structural elements that are critical to effective pain management, as well as statistically significant, though modest, decreases in the percentage of patients who reported pain of any severity, and specifically moderate to severe pain, in the previous 24 hours. The largest changes occurred in long-term care facilities. Nevertheless, the percentage of patients in moderate to severe pain remained unacceptably high.
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Affiliation(s)
- Karen M Stevenson
- Department of Pharmacology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53706, USA.
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Froggatt KA, Wilson D, Justice C, MacAdam M, Leibovici K, Kinch J, Thomas R, Choi J. End-of-life care in long-term care settings for older people: a literature review. Int J Older People Nurs 2006; 1:45-50. [DOI: 10.1111/j.1748-3743.2006.00008.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mpinga EK, Chastonay P, Rapin CH. Conflits et fin de vie dans le contexte des soins palliatifs : une revue systématique de littérature. Rech Soins Infirm 2006. [DOI: 10.3917/rsi.086.0068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Oliver DP, Porock D, Zweig S. End-of-life care in U.S. nursing homes: a review of the evidence. J Am Med Dir Assoc 2005; 6:S21-30. [PMID: 15890289 DOI: 10.1016/j.jamda.2005.03.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to systematically review the empiric evidence on end-of-life care in nursing homes in the United States The guiding research question for this review was what is the state of research evidence in end-of-life care in long-term care? DESIGN We conducted a systematic review of the literature. DATA The review was limited to published and indexed research in peer-reviewed journals in five major databases between 1995 and October 2002. RESULTS The initial search yielded a total of 395 articles. The search was narrowed, focusing on nursing homes in the United States and empiric research. The result was 43 articles related to research in end-of-life care in American nursing homes. It was categorized into eight foci: prognosis, pain, hospice, hospitalization, advanced care planning, communication, family perceptions, and miscellaneous. CONCLUSION There is a dearth of research published in end-of-life care in the nursing home setting. What is available is primarily descriptive. The empiric research only documents poor end-of-life care in U.S. nursing homes. Empiric evidence has grown in this area, but there is now a need for research of creative and innovative solutions aimed at improving the quality of end-of-life care in this setting.
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Affiliation(s)
- Debra Parker Oliver
- School of Social Work, University of Missouri-Columbia, Columbia, MO 65212, USA.
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Brazil K, Vohra JU. Identifying educational needs in end-of-life care for staff and families of residents in care facilities. Int J Palliat Nurs 2005; 11:475-80. [PMID: 16215526 DOI: 10.12968/ijpn.2005.11.9.19782] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM the purpose of this article is to describe educational needs in end-of-life (EoL) care for staff and families of residents in long-term care (LTC) facilities in the province of Ontario, Canada. Barriers to providing end-of-life care education in LTC facilities are also identified. DESIGN, SETTING AND PARTICIPANTS cross-sectional survey of directors of care in all licensed LTC facilities in the province of Ontario, Canada. RESULTS directors of care from 426 (76.9% response rate) licensed LTC facilities completed a postal-survey questionnaire. Topics identified as very important for staff education included pain and symptom management and communication with family members about EoL care. Priorities for family education included respecting the residents' expressed wishes for care and communication about EoL care. Having sufficient institutional resources was identified as a major barrier to providing continuing education to both staff and families. CONCLUSION through examining educational needs in EoL care this study identified an environment of inadequate staffing and over-burdened care providers. The importance of increased staffing concomitant with education is a priority for LTC facilities.
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Affiliation(s)
- Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University, and St Joseph's Health System Research Network, 105 Main Street East, Level P1, Hamilton, Ontario, Canada L8N 1G6, UK.
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Abstract
The purpose of this qualitative study was to explore spiritual care for dying nursing home residents from the perspectives of registered nurses, practical nurses, certified nursing assistants, advanced practice nurses, and physicians. Five major themes emerged: honoring the person's dignity, intimate knowing in the nursing home environment, wishing we could do more, personal knowing of self as caregiver, and struggling with end-of-life treatment decisions. Spiritual caring was described within the context of deep personal relationships, holistic care, and support for residents. Spiritual care responses and similarities and differences in the experiences of participants are presented. Education and research about how to assist residents and families as they struggle with difficult end-of-life decisions, adequate time and staff to provide the kind of care they "wished they could," and development of models that honor the close connection and attachment of staff to residents could enhance end-of-life care in this setting.
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Affiliation(s)
- Theris A Touhy
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL 33431, USA
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Siciliano P, Burrage R. Chronic pain in the elderly: a continuing education program for certified nursing assistants. Geriatr Nurs 2005; 26:252-8. [PMID: 16109299 DOI: 10.1016/j.gerinurse.2005.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the greatest challenges facing nursing today is the provision of proper pain management in patients suffering from both acute and chronic pain. The purpose of this article is to provide an introduction to a continuing education program for use by registered nurse instructors in teaching certified nursing assistants (CNAs) about their role in the management of pain in elderly persons. The article includes a summary of the program content.
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Affiliation(s)
- Paula Siciliano
- University of Utah College of Nursing, Salt Lake City, Utah, USA
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Stillman D, Strumpf N, Capezuti E, Tuch H. Staff Perceptions Concerning Barriers and Facilitators to End-of-Life Care in the Nursing Home. Geriatr Nurs 2005; 26:259-64. [PMID: 16109300 DOI: 10.1016/j.gerinurse.2005.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although many nursing home residents have chronic, life-limiting conditions, most die without the benefit of palliative care or with palliation delayed until the last days of life. The goal of this study was to determine whether the presence of a comprehensive palliative care program in nursing homes would affect the knowledge and attitudes of the staff. The intervention group was able to identify more problems in delivering palliative care than the control group, but this only reached statistical significance on 2 items. Nevertheless, the current study suggests that the presence of a palliative care program within a nursing home does increase general knowledge of the problems faced in caring for the dying.
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Affiliation(s)
- Diane Stillman
- University of Pennsylvania, School of Nursing, Philadelphia, USA
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Ersek M, Grant MM, Kraybill BM. Enhancing End-of-Life Care in Nursing Homes: Palliative Care Educational Resource Team (PERT) Program. J Palliat Med 2005; 8:556-66. [PMID: 15992197 DOI: 10.1089/jpm.2005.8.556] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND By the middle of this century, approximately 40% of people who will die from chronic illness are expected to do so in a nursing home. This trend will create challenges for nursing homes to ensure that staff possess the necessary knowledge and skills to care for dying residents. OBJECTIVE The purpose of this paper is to describe the development and evaluation of a comprehensive curriculum called Palliative Care Educational Resource Team (PERT), which is designed to enhance end-of-life (EOL) abilities of nursing assistants and licensed nurses working in nursing homes. SUBJECTS Sixty-one nursing assistants and 108 licensed nursing staff from 44 facilities have participated in PERT. Subjects were recruited in three successive cohorts, each targeting a different geographic area. MEASUREMENTS Program evaluation included multiple tools evaluating participants' knowledge, skills, and confidence in providing EOL care. RESULTS Evaluation of outcomes revealed significant increases in EOL knowledge, self-evaluation of EOL skills, and supervisors' evaluations of participants' EOL care. CONCLUSIONS These results show that the PERT Program is an effective means to enhance the palliative care expertise of nursing home staff. In addition to describing the PERT program and its evaluation, suggestions for implementing similar programs are included in this paper.
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Affiliation(s)
- Mary Ersek
- Pain Research Department, Swedish Medical Center, Seattle, Washington 98122-5711, USA.
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