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Nurse assistants’ experience of an intervention focused on a palliative care approach for older people in residential care
Lund University.ORCID-id: 0000-0002-7790-6906
Lund University.
Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap II. Högskolan Kristianstad, Forskningsplattformen Hälsa i samverkan.ORCID-id: 0000-0003-0161-4795
2012 (Engelska)Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 9, nr 2, s. 140-150Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background.  Nurse assistants working in residential care facilities need support to ensure that they provide high-quality care for the residents and support for relatives, from admission to bereavement.

Aim.  The aim was to describe the nurse assistants’ experience of how an intervention with a palliative care approach, had influenced them in their work in residential care for older people.

Participants.  Fourteen nurse assistants working in three different municipal residential care facilities.

Methods.  Data were collected by means of semi-structured individual interviews following an intervention consisting of study circles combined with workshops. The data were analysed using content analysis.

Result.  The nurse assistants felt that, through the intervention, they had gained insight into their understanding of the importance of quality of care. This included an increased awareness of, and respect for, residents’ and relatives’ needs, and an increased understanding of the importance of the outcome of encounters with residents and their relatives. After the intervention, they also felt there was increased openness and understanding between colleagues. However, the nurse assistants also expressed frustration over obstacles to implementing a palliative care approach, such as lack of resources and supportive leadership.

Conclusion.  The nurse assistants felt that the intervention was positive and encouraged them to provide more person-centred care within the framework of a palliative care approach. Although the intervention was intended to involve and support the management, it was not sufficient. Nurse assistants described lack of resources and supportive leadership. There is, therefore, a need to place greater emphasis on leadership and their support of nurse assistants so that they can provide high-quality care.

Implications for practice.  To support nurse assistants in the provision of care, clear leadership and opportunities to discuss and reflect on issues associated with care, including systematic improvement work in practice, appear to be essential to ensure high-quality care.

Ort, förlag, år, upplaga, sidor
2012. Vol. 9, nr 2, s. 140-150
Nyckelord [en]
intervention, nurse assistants, older people, qualitative study, residential care, support
Nationell ämneskategori
Omvårdnad
Identifikatorer
URN: urn:nbn:se:hkr:diva-9712DOI: 10.1111/j.1748-3743.2012.00343.xPubMedID: 22928728OAI: oai:DiVA.org:hkr-9712DiVA, id: diva2:552910
Tillgänglig från: 2012-09-17 Skapad: 2012-09-17 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
Ingår i avhandling
1. Att fokusera på "varandet" i en värld av görande: stöd till personalen i ett palliativt förhållningssätt vid vård- och omsorgsboende för äldre
Öppna denna publikation i ny flik eller fönster >>Att fokusera på "varandet" i en värld av görande: stöd till personalen i ett palliativt förhållningssätt vid vård- och omsorgsboende för äldre
2013 (Svenska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[en]
To focus on "being" in a world of doing : support to nurse assistants in applying a palliative care approach in residential care for older people
Abstract [en]

The aim of this thesis was to study nurse assistants’ experience of palliative care and to investigate how an intervention with a focus on a palliative care approach in residential care facilities influenced the nurse assistants and their work situation. The thesis is based on two qualitative and two quantitative studies, focusing on nurse assistants working at residential care facilities for older people. The qualitative studies were based on focus-group interviews before the intervention (I) and individual interviews after the intervention (IV). The quantitative studies (II, III) were based on a questionnaire, including several measurements, that was answered pre-, and post- intervention. The intervention consisted of study circles with nurse assistants, and workshops together with their leaders, focusing on improvement work. A total of 75 nurse assistants participated in the intervention and answered the questionnaire at baseline and at two follow-ups, in comparison with 110 nurse assistants who served as controls. The results show that the nurse assistants experienced that it was difficult to focus on “being”, i.e. on relationship aspects in their work, since the main discourse in residential care focused on “doing”, i.e. on task oriented aspects. Palliative care was described as something that was only applied during a short and defined phase, namely the very last days of the residents’ life. The results also show that nurse assistants experienced difficulties facing emotional and existential issues with regards to both the residents and their relatives (I). The results of study I were, in turn, used as a basis for the development of the intervention. The evaluation of the intervention showed that the nurse assistants, after the intervention, had increased their focus on the residents’ situation and to a greater extent stated that they focused on the residents’ life stories and on aspects that brought meaning to their lives (III). The nurse assistants also stated that they experienced less criticism from their superiors as well as from the residents after the intervention (II). However, the evaluation also showed that the nurse assistants had a more negative view of the leadership (II), were more critical to the medical and the nursing care (III), and that their job satisfaction had decreased (II) after the intervention. Interviews after the intervention showed that they, as a result of the intervention, had not only gained increased insight into their own significance in their encounter with residents and their relatives, but also an increased awareness of the needs of the residents and their relatives. The intervention also contributed to an increased openness in the workgroup. However, the nurse assistants also expressed frustration over barriers, primarily in the form of a lack of resources and limited leadership (IV), standing in the way of the implementation of changes. The results indicate that the nurse assistants, through discussions and reflections over praxis in their ordinary work group, developed an increased awareness about, and focus on “being”, i.e. on relationship aspects. However, it would seem that essential prerequisites, such as support from the leaders and sufficient resources for working in line with a palliative care approach, were not provided. When implementing a palliative care approach in residential care facilities, more focus on support to the leaders is needed in order to maintain sustainable changes.

Ort, förlag, år, upplaga, sidor
Lund: Institutionen för hälsa, vård och samhälle, Medicinska fakulteten, Lunds universitet, 2013. s. 96
Serie
Lund University, Faculty of Medicine doctoral dissertation series, ISSN 1652-8220 ; 2013:25
Nyckelord
palliativt förhållningssätt, Stöd, Lärande, Intervention, Undersköterskor, Vårdbiträde, Personal, Särskilt boende, Arbetstillfredställelse, Påfrestning, Vårdkvalitet, Personcentrerad vård, Vårdklimat
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:hkr:diva-11206 (URN)978-91-87189-94-4 (ISBN)
Tillgänglig från: 2013-10-29 Skapad: 2013-10-28 Senast uppdaterad: 2015-01-27Bibliografiskt granskad

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