Family perceptions of care at the end of life in UK nursing care homes

Dimensions of good palliative nursing care: Expert panel consensus and perceptions of palliative professionals

AIMS AND OBJECTIVES

To analyse the dimensions of quality of palliative nursing care and to explore the perceptions of professionals for the development and validation of the Palliative Nursing Care Quality Scale.

BACKGROUND

The study of palliative nursing care quality has been approached from analysis of the competencies of palliative care nurses, based on various theoretical models. However, there are fewer qualitative empirical studies that have evaluated what good palliative nursing care is and what its dimensions are.

DESIGN

Mixed-method, Delphi approach and exploratory qualitative study.

METHODS

Consensus by a panel of experts using the Delphi technique and semi-structured interviews. The study was reported in a comprehensive manner following COREQ criteria. Data collection took place between January and June 2018.

RESULTS

The eight-person expert panel reached consensus on the following dimensions of the Palliative Nursing Care Quality Scale: control and relief of symptoms, family and/or primary caregiver, therapeutic relationship, spiritual support and continuity of care. Thematic analysis of ten interviews identified four emergent themes related to good nursing care: (1) the patient and family as a whole; (2) finding meaning; (3) responsible communication; and (4) caring for the human element.

CONCLUSIONS

The quality of palliative nursing care goes beyond providing comprehensive care; it means meticulously looking after every detail of what is important to the patient. The expectations of professionals are not as important. Instead, care should be based primarily on the needs and respect for the wishes of the patient and their family.

RELEVANCE TO CLINICAL PRACTICE

Specifying the quality of nursing care in routine practice and reaching a consensus on its dimensions means moving towards excellence in care, as well as improving the professional profile of advanced practice palliative care nurses.

PATIENT OR PUBLIC CONTRIBUTION

Two primary caregivers participated in the panel of experts and the semi-structured interview.

Promise, Provision, and Potential: A Hopeful Trajectory for Spiritual Care in Long-Term Care

This Canadian study aimed to better understand the provision of spiritual care in long-term care homes, its purpose/importance, the role of a spiritual care provider (SCP)/chaplain, effective practices, and challenges. Online survey responses revealed the need for spiritual care and the robust role of SCPs. Recommendations are made for more consistent employ and integration of SCPs, supported by sector-specific training and a system to connect LTC homes with skilled SCPs.

Development and Exploration of Psychometric Properties of the Family Adjustment Questionnaire for Admitting an Older Adult to a Nursing Home (CAFIAR)

Background: Admitting an older adult to a nursing home involves significant adjustment efforts by the family. Our goal was to prepare an assessment instrument for this, given that there was none to date. Method: Participants-134 relatives from different nursing homes in the region of Murcia. Instruments-structured interview for socio-demographic information, satisfaction with the nursing home, well-being and health self-assessment, Radloff's Depression Questionnaire (CES-D), and the first version of CAFIAR. Results: A 15-item instrument with three factors was obtained: Factor 1 (Unease due to admitting an older adult to a nursing home), Factor 2 (Relief), and Factor 3 (Nostalgia and concern for the older adult), in addition to a general adjustment index, with a Cronbach's alpha of 0.74. The general adjustment index and the subscales that demonstrate poor adjustment were significantly correlated with depression and a worse health self-assessment, while the Relief subscale, which indicates better adjustment, was significantly correlated with well-being and a positive health self-assessment. Conclusions: The family adjustment in admitting an older adult to a nursing home questionnaire (CAFIAR) has adequate psychometric properties to assess family adaptation in admitting an older adult to an institution.