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An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities.

ABSTRACT: BACKGROUND:Providing quality palliative care in residential aged care facilities (RACFs) (aged care homes) is a high priority for ageing populations worldwide. Older people admitted to these facilities have palliative care needs. Nursing assistants (however termed) are the least qualified staff and provide most of the direct care. They have an important role at the frontline of care spending more time with residents than any other care provider but have been found to lack the necessary knowledge and skills to provide palliative care. The level of competence of this workforce to provide palliative care requires evaluation using a valid and reliable instrument designed for nursing assistants' level of education and the responsibilities and practices of their role. METHOD:The overall study purpose was to develop and test an instrument capable of evaluating the knowledge, skills and attitudes of nursing assistants within a palliative approach in RACFs. Development consisted of a four-phase mixed-methods sequential design. In this paper, the results and key findings following psychometric testing of the instrument in Phase 4 is reported using data collected from a random sample of 17 RACFs and 348 nursing assistants in the Greater Sydney region. Study hypotheses were tested to confirm discriminative validity and establish the utility of the instrument in both research and training assessment. RESULTS:Individual item properties were analysed for difficulty, discrimination and item-total correlations. Discriminative and structural validity, and internal consistency and test-retest reliability were demonstrated. Three separate questionnaires comprising 40 items were finalised: The Palliative Approach for Nursing Assistants (PANA)_Knowledge Questionnaire (17 items), the PANA_Skills Questionnaire (13 items) and the PANA_Attitudes Questionnaire (10 items). CONCLUSIONS:This study provides preliminary evidence for the validity and reliability of three new questionnaires that demonstrate sensitivity for nursing assistants' level of education and required knowledge, skills and attitudes for providing a palliative approach. Implications for practice include the development of palliative care competencies through structured education and training across this workforce, and ongoing professional development opportunities for nursing assistants, especially for those with the longest tenure.

SUBMITTER: Karacsony S

PROVIDER: S-EPMC6647142 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities.

Karacsony Sara S Good Anthony A Chang Esther E Johnson Amanda A Edenborough Michel M

BMC palliative care 20190723 1

<h4>Background</h4>Providing quality palliative care in residential aged care facilities (RACFs) (aged care homes) is a high priority for ageing populations worldwide. Older people admitted to these facilities have palliative care needs. Nursing assistants (however termed) are the least qualified staff and provide most of the direct care. They have an important role at the frontline of care spending more time with residents than any other care provider but have been found to lack the necessary k ...[more]

PMID: 31337388

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Project description:BackgroundNurses have an essential role in providing high-quality palliative care to patients and their families. Hence, they require adequate palliative care education. However, there is only limited insight into how final-year nursing students perceive palliative care education in undergraduate nursing programs. This study aimed to describe nursing students' perspectives of the development needs of palliative care education. An additional two aims emerged based on the collected data, namely, to describe the preferred education for palliative care and the factors which promote or hinder palliative care learning during undergraduate nursing studies.MethodsThe research was guided by a descriptive qualitative approach and applied inductive content analysis. The frequencies (f) of identified codes (reduced expressions) were counted to show the noteworthiness of each category in relation to the entirety. The participants were final-year nursing students (n = 766) who had participated in a national survey.ResultsThe inductive content analysis identified three unifying categories. The first was 'Development needs and views of palliative care education' (f = 524), which consisted of the main categories 'the need to develop palliative care education' (f = 414) and 'meaning of palliative care and its education' (f = 110). Secondly 'Preferred types of palliative care education' (f = 1379), including the main categories 'teaching contents in palliative care education' (f = 905), 'teaching methods for palliative care learning' (f = 393), and 'placement of palliative care studies' (f = 81). Thirdly 'The facilitators and barriers to palliative care learning' (f = 401), consisting of the main categories 'factors facilitating palliative care learning' (f = 66) and 'barriers to palliative care learning' (f = 335).ConclusionsThis study provides detailed information about nursing student's perspectives of palliative care education and its development needs. Hence, the results are relevant to decision-makers who want to develop undergraduate nursing curricula. This study highlights that palliative care education should be developed by ensuring that all students have equal access to palliative care education provided by highly competent teachers. Possibilities for clinical placements or visits to palliative care units during the education should also be improved. The participating students felt unprepared to provide high-quality palliative care even though they responded that palliative care is an important topic in their nursing studies.

Project description:Background Hospice and palliative care nursing (HPCN) in China is mainly available at public primary care institutions, where nursing homes (NHs) are rarely involved. Nursing assistants (NAs) play an essential role in HPCN multidisciplinary teams, but little is known about their attitudes towards HPCN and related factors. Methods A cross-sectional study was designed to evaluate NAs’ attitudes towards HPCN with an indigenised scale in Shanghai. A total of 165 formal NAs were recruited from 3 urban and 2 suburban NHs between October 2021 and January 2022. The questionnaire was composed of four parts: demographic characteristics, attitudes (20 items with four sub-concepts), knowledge (nine items), and training needs (nine items). Descriptive statistics, independent samples t-test, one-way ANOVA, Pearson’s correlation, and multiple linear regression were performed to analyse NAs’ attitudes, influencing factors, and their correlations. Results A total of 156 questionnaires were valid. The mean score of attitudes was 72.44 ± 9.56 (range:55–99), with a mean item score of 3.6 ± 0.5 (range:1–5). The highest score rate was “perception of the benefits for the life quality promotion” (81.23%), and the lowest score rate was “perception of the threats from the worsening conditions of advanced patients” (59.92%). NAs’ attitudes towards HPCN were positively correlated with their knowledge score (r = 0.46, P < 0.01) and training needs (r = 0.33, P < 0.01). Marital status (β = 0.185), previous training experience (β = 0.201), location of NHs (β = 0.193), knowledge (β = 0.294), and training needs (β = 0.157) for HPCN constituted significant predictors of attitudes (P < 0.05), which explained 30.8% of the overall variance. Conclusion NAs’ attitudes towards HPCN were moderate, but their knowledge should be improved. Targeted training is highly recommended to improve the participation of positive and enabled NAs and to promote high-quality universal coverage of HPCN in NHs. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-023-01175-8.

Project description:BackgroundThe provision of residential aged care is underpinned by information, and is reliant upon systems that adequately capture and effectively utilise and communicate this information. The aim of this study was to explicate and quantify the volume and method by which information is collected, exchanged within facilities and with external providers, and retrieved from facility information systems and hospitals.MethodsA survey of staff (n = 119), including managers, health informatics officers (HIOs), quality improvement staff, registered nurses (RNs), enrolled nurses (ENs)/endorsed enrolled nurses (EENs) and assistants in nursing (AINs) was carried out in four residential aged care facilities in New South Wales and Victoria, Australia. Sites varied in size and displayed a range of information technology (IT) capabilities. The survey investigated how and by whom information is collected, retrieved and exchanged, and the frequency and amount of time devoted to these tasks. Descriptive analysis was performed using SPSS, and open responses to questions were coded into key themes.ResultsStaff completed a median of six forms each, taking a median of 30 min per shift. 68.8% of staff reported transferring information from paper to a computer system, which took a median of 30 min per shift. Handover and face-to-face communication was the most frequently used form of information exchange within facilities. There was a large amount of faxing and telephone communication between facility staff and General Practitioners and community pharmacists, with staff reporting sending a median of 2 faxes to pharmacy and 1.5 faxes to General Practitioners, and initiating 2 telephone calls to pharmacies and 1.5 calls to General Practitioners per shift. Only 38.5% of respondents reported that they always had information available at the point-of-care and only 35.4% of respondents reported that they always had access to hospital stay information of residents after hospital discharge.ConclusionsThis survey identified a high volume of information exchange activities, as well as inefficient procedures, such as the transfer of information from paper to computer systems and the reliance upon faxes for communication with external providers. These findings contribute to evidence for the need for interoperable IT systems to allow more efficient and reliable information exchange between facilities and external providers.

Project description:BackgroundInformation about the feasibility, barriers and facilitators of antimicrobial stewardship (AMS) in residential aged care facilities (RACFs) has been scant. Exploring the prevailing perceptions and attitudes of key healthcare providers towards antibiotic prescribing behaviour, antibiotic resistance and AMS in the RACF setting is imperative to guide AMS interventions.MethodsSemi-structured interviews and focus groups were conducted with key RACF healthcare providers until saturation of themes occurred. Participants were recruited using purposive and snowball sampling. The framework approach was applied for data analysis.ResultsA total of 40 nurses, 15 general practitioners (GPs) and 6 pharmacists from 12 RACFs were recruited. Five major themes emerged; perceptions of current antibiotic prescribing behaviour, perceptions of antibiotic resistance, attitude towards and understanding of AMS, perceived barriers to and facilitators of AMS implementation, and feasible AMS interventions. A higher proportion of GPs and pharmacists compared with nurses felt there was over-prescribing of antibiotics in the RACF setting. Antibiotic resistance was generally perceived as an issue for infection control rather than impacting clinical decisions. All key stakeholders were supportive of AMS implementation in RACFs; however, they recognized barriers related to workload and logistical issues. A range of practical AMS interventions were identified, with nursing-based education, aged-care specific antibiotic guidelines and regular antibiotic surveillance deemed most useful and feasible.ConclusionsAreas of antibiotic over-prescribing have been identified from different healthcare providers' perspectives. However, concern about the clinical impact of antibiotic resistance was generally lacking. Importantly, information gathered about feasibility, barriers and facilitators of various AMS interventions will provide important insights to guide development of AMS programs in the RACF setting.

Project description:BackgroundThe aged care system in Australia is under pressure. Residential aged care facilities (RACFs) and general practitioners (GPs) have difficulty providing the care needed by their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs.MethodsUsing the NASSS framework, we synthesised descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and a thematic analysis of interview data collected from GPs, RACF and MED service staff, and family members of residents.ResultsMost calls to MED (179/209) were resolved with in-house treatment thereby reducing ambulance usage and hospital admissions. Interviews further revealed that MED enabled timely care for residents who were unwell but did not need hospital transfer. Technology, training, and rapid access to MED assisted RACF staff and complemented usual GP care. MED potentially reduced GP burnout. Refresher training was considered important especially in RACFs with high staff turnover, as was greater afterhours access to medications.ConclusionsThe afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses.

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An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities.

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An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities.

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