The needs, current knowledge, and attitudes of care staff toward the implementation of palliative care in old age homes.
01 Jun 2010-American Journal of Hospice and Palliative Medicine (SAGE Publications)-Vol. 27, Iss: 4, pp 266-271
TL;DR: 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.
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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TL;DR: Despite their confidence in PC practice, participants' PC knowledge gap reveals a need for PC training for staff working in LTC homes, which should both include a gerontological perspective and address the expertise and knowledge already held by staff.
Abstract: Background: The quality of care provided to dying long-term care (LTC) residents is often inadequate, which may be due to the lack of formal training that LTC staff receive in palliative care (PC). This cross-sectional study assessed PC knowledge and self-efficacy in ability to provide PC in a sample of registered nurses working in LTC homes. Method: A survey was conducted in four LTC homes in October 2009 to June 2010. Nursing staff knowledge of PC was evaluated using the Palliative Care Quiz for Nurses (PCQN). The Self-Efficacy in End-of-Life Care Survey (S-EOLC) was used to measure nursing staff confidence in their ability to provide PC. Findings: Close to 60% of the nursing staff participated (69 of 119). The participants did not score highly on the PCQN: the average correct score ranged from 52.50% to 63.41% across the homes. There were no significant differences between the homes for the mean number of correct responses on the PCQN (P=0.329) or mean scores for the three S-EOLC subscales. Rank orderi...
86 citations
TL;DR: In this article, the palliative care knowledge of nurses and care assistants in nursing homes in Belgium, the Netherlands, England, Finland, Poland and Italy was assessed with the Palliative Care Survey.
Abstract: Background:The provision of high-quality palliative care in nursing homes (NHs) is a major challenge and places demands on the knowledge and skills of the staff.Aim:This study assesses the palliative care knowledge of staff in NHs in Europe.Design:Cross-sectional study using structured surveySetting/participants:Nurses and care assistants working in 322 representative samples of NHs in Belgium, the Netherlands, England, Finland, Poland and Italy. Palliative care knowledge is measured with the Palliative Care Survey. Scores on the scales range between 0 and 1; higher scores indicate more knowledge.Results:A total of 3392 NH-staff were given a questionnaire, and 2275 responded (67%). Knowledge of basic palliative care issues ranged between 0.20 in Poland (95% confidence interval (CI) 0.19; 0.24) and 0.61 in Belgium (95% CI 0.59; 0.63), knowledge of physical aspects that can contribute to pain ranged between 0.81 in Poland (95% CI 0.79; 0.84) and 0.91 in the Netherlands (95% CI 0.89; 0.93), and knowledge of ...
72 citations
01 Jan 2018
TL;DR: Knowledge of nurses and care assistants concerning basic palliative care issues appears to be suboptimal in all participating countries, although there is substantial heterogeneity.
Abstract: Background:The provision of high-quality palliative care in nursing homes (NHs) is a major challenge and places demands on the knowledge and skills of the staff.Aim:This study assesses the palliative care knowledge of staff in NHs in Europe.Design:Cross-sectional study using structured surveySetting/participants:Nurses and care assistants working in 322 representative samples of NHs in Belgium, the Netherlands, England, Finland, Poland and Italy. Palliative care knowledge is measured with the Palliative Care Survey. Scores on the scales range between 0 and 1; higher scores indicate more knowledge.Results:A total of 3392 NH-staff were given a questionnaire, and 2275 responded (67%). Knowledge of basic palliative care issues ranged between 0.20 in Poland (95% confidence interval (CI) 0.19; 0.24) and 0.61 in Belgium (95% CI 0.59; 0.63), knowledge of physical aspects that can contribute to pain ranged between 0.81 in Poland (95% CI 0.79; 0.84) and 0.91 in the Netherlands (95% CI 0.89; 0.93), and knowledge of ...
51 citations
TL;DR: There is a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end-of-life discussions, as shown in the results of this study.
Abstract: Objective: Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes. Method: Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end-of-life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics. Results: The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2%) and dementia (22.7%). The most prevalent symptom was pain (58.7%), followed by rattles (42.4%), anxiety (33.0%), confusion (21.8%), shortness of breath (14.0%), and nausea (11.1%). Pain was the symptom with the highest degree of total relief (46.3%), whereas shortness of breath and confusion were totally relieved in 6.1 and 4.3% of all individuals, respectively. The use of valid instruments for symptom assessment was reported for pain in 12.3% and for other symptoms in 7.8% of subjects. The most prevalent individual prescriptions for injection PRN (pro re nata, according to circumstances) were for pain treatment (79.5%) and rattles (72.8%). End-of-life discussions were performed with 27.3% of all the deceased individuals and with 53.9% of their relatives. Of all individuals, 82.1% had someone present at death, and 15.8% died alone. Of all the nursing home resident deaths recorded, 45.3% died in their preferred place. Significance of results: There were large variations in degree of relief from different symptoms during the final week of life. Pain was the most prevalent symptom, and it was also the symptom with the highest proportion of total/partial relief. Other symptoms were less prevalent but also less well-relieved. Our results indicate a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end-of-life discussions.
50 citations
Cites background from "The needs, current knowledge, and a..."
...Along with a lack of palliative care competence, insufficient leadership and organizational strains have been defined as other barriers to the implementation of palliative care in nursing homes (Lo et al., 2010; Dwyer, 2011; Handley et al., 2014)....
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TL;DR: Evaluating quantitatively the publication trends and collaboration performance of China in healthcare science and services (HSS) research could help scholars and decision-makers understand the current status and likely future trends of the Chinese HSS research, and help them select the most appropriate collaboration partners and policies.
Abstract: In recent years, China’s healthcare reforms and related studies have drawn particular global attention. The main objective of this study is to evaluate quantitatively the publication trends and collaboration performance of China in healthcare science and services (HSS) research. Scientometric methods and visualization technology were used to survey the growth and development trends of HSS research based on the Web of Science publications during the past 15 years. China’s international publications on HSS research increased rapidly compared to those of the global HSS and Chinese scientific studies. Growth trends indicate that collaboration among countries, institutions and authors has also increased. China’s leading partners were all developed countries, such as the US, the UK, Australia and Canada, which have contributed to the majority of the joint publications. The academic impact of publications involving partners from European and American countries was relatively higher than those involving partners from Asian countries. Prominent institutions were universities that could be primarily classified into two groups, namely, Mainland China on the one hand and Hong Kong universities and foreign universities on the other. The most prominent actors were elite institutions, such as Peking University, Fudan University, Chinese University of Hong Kong, University of Hong Kong. The papers published by the Chinese Ministry of Health had relatively high academic impact, whereas those published by Mainland China universities alone had a lower academic impact compared to foreign cooperation papers. Issues related to the Chinese healthcare reform, priority diseases (e.g., breast cancer, HIV/AIDS, tuberculosis, etc.), health systems performance, quality of life and measurement tools, aging problems and research methods have been the most popular HSS topics in China in recent years. Despite the extensive achievement of the Chinese HSS reforms and research, gaps and challenges remain to be addressed, including those related to health insurance and the effects of the evaluation of essential medicine systems, human resources training and allocation in the health sector, government hospitals reforms and health services systems remodeling. These findings could help scholars and decision-makers understand the current status and likely future trends of the Chinese HSS research, and help them select the most appropriate collaboration partners and policies.
32 citations
Cites background from "The needs, current knowledge, and a..."
...Meanwhile, the needs, current knowledge and attitudes of old people who come from staffed homes in Hong Kong are marked differently [56]....
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References
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09 Sep 2002
TL;DR: The last two decades have seen a notable growth in the use of qualitative methods for applied social policy research as discussed by the authors, which is underpinned by the persistent requirement in social policy fields to understand complex behaviours, needs, systems and cultures.
Abstract: The last two decades have seen a notable growth in the use of qualitative methods
for applied social policy research. Qualitative research is now used to explore
and understand a diversity of social and public policy issues, either as an
independent research strategy or in combination with some form of statistical
inquiry. The wider use of qualitative methods has come about for a number of
reasons but is underpinned by the persistent requirement in social policy fields
to understand complex behaviours, needs, systems and cultures.
7,396 citations
"The needs, current knowledge, and a..." refers methods in this paper
...The discussions and interviews were analyzed using framework analysis.(18) This method follows a more structural approach based on findings and knowledge from previous studies....
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TL;DR: These domains, which characterize patients' perspectives on end-of-life care, can serve as focal points for improving the quality of end- of- life care.
Abstract: ContextQuality end-of-life care is increasingly recognized as
an ethical obligation of health care providers, both clinicians and
organizations. However, this concept has not been examined from the
perspective of patients.ObjectiveTo identify and describe elements of quality end-of-life
care from the patient's perspective.DesignQualitative study using in-depth, open-ended, face-to-face
interviews and content analysis.SettingToronto, Ontario.ParticipantsA total of 126 participants from 3 patient groups:
dialysis patients (n = 48), people with human immunodeficiency virus
infection (n = 40), and residents of a long-term care facility (n =
38).Outcome MeasuresParticipants' views on end-of-life issues.ResultsParticipants identified 5 domains of quality end-of-life
care: receiving adequate pain and symptom management, avoiding
inappropriate prolongation of dying, achieving a sense of control,
relieving burden, and strengthening relationships with loved ones.ConclusionThese domains, which characterize patients'
perspectives on end-of-life care, can serve as focal points for
improving the quality of end-of-life care.
1,278 citations
Book•
01 Jan 2004
TL;DR: The needs of older people, the different trajec-tories of illnesses they suffer, evidence of underassessment of pain and other symptoms, their need to be involved in decision-making, evidence for effective palliative care solutions, and issues for the future are presented.
Abstract: Most deaths in European and other developed countries occur in people aged over 65, but relatively little health policy concerns their needs in the last years of life. As life expectancy increases, the number of people living to older ages is also increasing in many countries. At the same time, the relative number of people of working age is declining and the age of potential caregivers is increasing. Palliative care is therefore of growing public health importance. Older people have traditionally received less palliative care than younger people and services have focused on cancer. This booklet is part of the WHO Regional Office for Europe's work to present evidence for health policy-and decision-makers in a clear and understandable form. It presents the needs of older people, the different trajec-tories of illnesses they suffer, evidence of underassessment of pain and other symptoms, their need to be involved in decision-making, evidence for effective palliative care solutions, and issues for the future. A companion booklet entitled Palliative care-the solid facts considers how to improve services and educate professionals and the public. ABSTRACT Acknowledgements for photographs
397 citations
"The needs, current knowledge, and a..." refers background in this paper
...It was recognized though that the dying phase in old age may be generally longer in length and can show various different trajectories.(9) It also may not always be appropriate to opt for a direct transfer of palliative care in acute settings to old age homes....
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TL;DR: To develop a conceptual model for a retrospective survey of bereaved family members that incorporates both professional and family perspectives on what constitutes good care at the end of life, a qualitative literature review of existing professional guidelines and six focus groups were performed.
314 citations
"The needs, current knowledge, and a..." refers result in this paper
...These themes were not dissimilar to previous studies done in the western society, from the perspectives of both care staff and bereaved family members.(19-25) Most participants showed a favorable attitude toward implementing palliative care in old age homes....
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TL;DR: The ethnographic study found that lack of attention to cultural needs, cognitive status, inadequate staffing, and inappropriate and inadequate communication between health care providers and nursing home residents and their families were the predominant factors that influenced the experience of dying.
Abstract: Purpose This article reviews the literature on "The Experience of Dying" and presents data from a larger, ongoing study of an ethnography of dying in nursing homes. The purpose of the ethnographic study was to investigate the process of providing end-of-life care to residents who were dying in nursing homes. Design and methods Participant observation, in-depth interviews, and event analysis were used to obtain data in three nursing facilities. Results The review of the literature disclosed that research on the experience of dying is limited; most of the studies have been conducted in acute care hospitals among people who were dying of cancer. The ethnographic study found that lack of attention to cultural needs, cognitive status, inadequate staffing, and inappropriate and inadequate communication between health care providers and nursing home residents and their families were the predominant factors that influenced the experience of dying. Implications Future research is needed on: The experience of dying for patients with dementia, for people in a comatose state, and for non-English speaking patients; symptom management; health care provider/patient-family interaction; the burden of caregiving for families; and the consequences of the constraints within our health care system for people who are dying in various settings.
179 citations
"The needs, current knowledge, and a..." refers background in this paper
...One of the major concerns would be resources and manpower, which was also brought up in a number of previous studies.(19-21,26-28) It is an issue that organizations have to consider seriously as it can be a potential barrier to the provision of palliative care in old age homes....
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