Factors related to the provision of home-based end-of-life care among home-care nursing, home help, and care management agencies in Japan

Homecare workers needs and experiences in end of life care: rapid review

BACKGROUND

Social homecare workers provide essential care to those living at home at the end of life. In the context of a service experiencing difficulties in attracting and retaining staff, we have limited knowledge about the training, support needs and experiences of this group.

AIM

To gain a timely understanding from the international literature of the experience, training and support needs of homecare workers providing end-of-life care.

METHODS

We conducted a rapid review and narrative synthesis using the recommendations of the Cochrane Rapid Reviews Methods Group. Building on a previous review, social homecare worker and end-of-life search terms were used to identify studies. Quality appraisal was conducted using a multimethods tool.

DATA SOURCES

CINAHL and Medline databases (2011-2023; English language).

RESULTS

19 papers were included representing 2510 participants (91% women) providing new and deeper insights. Four themes were generated: (1) emotional support; homecare workers need to manage complex and distressing situations, navigating their own, their clients' and clients' family, emotions; (2) interaction with other social and healthcare workers; homecare workers are isolated from, and undervalued and poorly understood by the wider healthcare team; (3) training and support; recognising the deteriorating client, symptom management, practicalities around death, communications skills and supervision; (4) recognising good practice; examples of good practice exist but data regarding effectiveness or implementation of interventions are scant.

CONCLUSIONS

Social homecare workers are essential for end-of-life care at home but are inadequately trained, often isolated and underappreciated. Our findings are important for policy-makers addressing this crucial challenge, and service providers in social and healthcare.

Development of a home-visit nursing scale for helping spousal caregivers of terminal cancer patients develop positive perspectives of their caregiving experiences: a cross-sectional study

OBJECTIVE

Home-visit nurses play a key role in supporting the spouses of terminal cancer patients and encouraging positive perspectives of the caregiving experience. This study aimed to develop a scale to support nurses in self-assessing their practice around this important role.

DESIGN

Cross-sectional questionnaire study.

SETTING

The Home Nursing Scale to Help Spousal Caregivers (HNS-HSC) questionnaire for self-assessment of home-visit nursing to spouses was developed based on interviews with spouses and literature reviews.

PARTICIPANTS

Overall, 1500 home-visit nurses nationwide who had experience in supporting spousal caregivers and their patients in the predeath and postdeath periods were approached for participation.

MAIN OUTCOME MEASURE

Planned exploratory and confirmatory factor analyses were used to assess the underlying dimensions of the HNS-HSC; Cronbach's α was used to determine the reliability. The Japanese version of Frommelt Attitude Toward Care of the Dying Scale Form B (FAT-COD-B-J) and Grief Care scale were administered to assess convergent and discriminant validity.

RESULTS

Exploratory and confirmatory factor analyses identified 26 items on five factors: 'helping spouses plan their futures' 'helping caregivers alleviate any regrets regarding their care', 'understanding the bond between a couple', 'providing support for anticipatory grief', and 'addressing spousal caregivers' emotions after their spouses' deaths'. The final model showed acceptable goodness-of-fit indices. The Cronbach's α for the entire scale was 0.949 and exceeded 0.822 for each factor. The correlation coefficient with the FAT-COD-B-J, which served as an external validation, was 0.35. The correlation coefficients for the three grief care scales were 0.64, 0.45 and 0.72, respectively.

CONCLUSIONS

This scale is a reliable and valid tool for visiting nurses to self-assess their knowledge, skills and practice around helping spousal caregivers. By using this scale, it is expected to change nursing practice in pursuit of improving quality of life of spouses.

Training opportunities and the increase in the number of nurses in home-visit nursing agencies in Japan: a panel data analysis

Background

A training opportunity in which ongoing education is encouraged is one of the determinants in recruiting and retaining nurses in home-visit nursing care agencies. We investigated the association between ensuring training opportunities through scheduled training programs and the change in the number of nurses in home-visit nursing agencies using nationwide panel data at the agency level.

Methods

We used nationwide registry panel data of home-visit nursing agencies from 2012 to 2015 in Japan. To investigate the association between planning training programs and the change in the number of nurses in the following year, we conducted fixed-effect panel data regression analysis.

Results

We identified 4760, 5160 and 5025 agencies in 2012, 2013, and 2014, respectively. Approximately 60–80% of the agencies planned training programs for all staff, both new and former, during the study period. The means and standard deviations of the percentage change in the number of full time equivalent (FTE) nurses in the following year were 4.2 (19.8), 5.7 (23.5), and 5.8 (25.1), respectively. Overall, we found no statistically significant association between scheduled training programs and the change in the number of FTE nurses in the following year. However, the associations varied by agency size. Results of analysis stratified by agency size suggested that the first and second quartile sized agencies (2.5–4.0 FTE nurses) with scheduled training programs for all employees were more likely to see a 9.0% (95% confidence interval [CI]: 4.5, 13.5) and 8.5% (95% CI: 2.4, 14.5) increase in the number of FTE nurses in the following year, respectively. Similarly, the first and second quartile sized agencies with scheduled training programs for new employees were more likely to see a 4.7% (95% CI: 2.1, 7.2) and 3.3% (95% CI: 0.4, 6.2) increase in the number of FTE nurses in the following year, respectively.

Conclusions

Ensuring training opportunities through scheduled training programs for all staff, both new and former, in relatively small-sized home-visit nursing agencies might contribute to an increase in the number of nurses at each agency.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4225-8) contains supplementary material, which is available to authorized users.

Visiting Nurses' Perspectives on Practices to Achieve End-of-Life Cancer Patients' Wishes for Death at Home: A Qualitative Study

Objective:

This study aimed to clarify visiting nurses’ perspectives on critical practices to ensure they could advocate for patients who prefer to die at home.

Methods:

Sixteen nurses, working at home-visit nursing agencies in Japan, participated in this study. Data were generated by interviews with the nurses and participant observations from nursing home-visits for six end-of-life cancer patients and were analyzed using content analysis.

Results:

Five themes emerged: (1) nursing assessment, (2) support for comfortable daily life of the patient and their family, (3) advocating for the patient's views about continuing homecare until death, (4) supporting the patient's preparedness for death, and (5) coordination with other health professionals and related facilities for a comfortable environment for the patient. In addition, the nurses sometimes used humorous responses to death-related work to change the patient's melancholy thoughts.

Conclusion:

The present study found that the participants advocated for the patient's views about continuing homecare until death while coordinating views between the patient and their family; they further supported the patient's daily life while helping them prepare for death to achieve their wish for death at home. In addition, our study uncovered the visiting nurses’ unconscious practical wisdom of using humorous responses to death-related work to alleviate the patients’ feelings of hopelessness. To develop practical wisdom for using humor effectively in end-of-life care, nurses need to verbalize unconscious practices, and accumulate empirical knowledge about nursing interventions using humor, including cultural attitudes, through case study analysis.

Involvement of Japanese Care Managers and Social Workers in Advance Care Planning

Successful advance care planning relies heavily on effective communication between the elderly and their families, care managers, and social workers. However, care managers and social workers are often not adequately prepared to conduct such discussion. The aim of the present study was to identify the specific challenges facing Japanese care managers and social workers when involvement in advance care planning. Two focus group discussions were held between August and November 2017, involving eleven care managers and three social workers employed at two long-term care facilities actively pursuing advance care planning initiatives. Four main themes were identified, through content analysis, as barriers and facilitators: client readiness, communication, variation-rich client individuality, and difficult-to-explain end-of-life options. This study revealed the importance of building rapport with the residents and their families in order to assess their readiness to discuss care options and preferences. Obstacles included lack of medical knowledge of care managers and social workers. Study findings suggested that a multi-disciplinary team, facilitated by care managers and social workers, was fundamental to achieving the goals of advance care planning.

End of life care in nursing homes in Spain: Exploratory analysis and evidences of validity of a new scale

Quality end-of-life care is a central issue in nursing homes, requiring the assessment of individual and family needs by health professionals. Although previous instruments have been developed, they usually rely on family reports and have been adapted from other clinical contexts (hospital or primary care). It is important to consider how health care professionals working in nursing homes perceive what is necessary to achieve quality end-of-life care. In this study, the objective was to develop an instrument to assess quality of end-of-life care in the context of Spanish care homes. A 24 item scale Nursing Home End of Life Care Scale (NHEOLC) was developed through a systematic evaluation of existing tools combined with an iterative process of consultation with group experts in end of life care in long term care settings. A total of 307 health care professionals agreed to participate in the study and completed the scale. The scale was grouped in six dimensions: physical, psychological aspects and spiritual aspects of care, family care, bereavement, and patient/family preferences management. The results suggest an adequate factorial structure of the scale and good internal consistency for the total score and the subscales. In addition, the results showed significant differences depending on the size of the nursing home, the category of health professionals, and their own perceptions of his work regarding end-of-life care.

Gaps in Understanding the Experiences of Homecare Workers Providing Care for People with Dementia up to the End of Life: A Systematic Review

This systematic review of the literature explores the perspectives and experiences of homecare workers providing care for people with dementia living at home up to the end of life. A search of major English language databases in 2016 identified 378 studies on the topic, of which 12 met the inclusion criteria. No empirical research was identified that specifically addressed the research question. However, synthesis of the findings from the broader literature revealed three overarching themes: value of job role, emotional labour and poor information and communication. The role of homecare workers supporting a person with dementia up to the end of life remains under-researched, with unmet needs for informational, technical and emotional support reported. The effective components of training and support are yet to be identified.