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Applying a palliative care approach in residential care: effects on nurse assistants' experiences of care provision and caring climate
Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Platform for Collaboration for Health.ORCID iD: 0000-0002-7790-6906
Lund University.
Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap II. Kristianstad University, Research Platform for Collaboration for Health.ORCID iD: 0000-0003-0161-4795
2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 830-841Article in journal (Refereed) Published
Abstract [en]

Background

A palliative care approach aims to integrate psychosocial and existential as well as relationship aspects in the care and is an approach that can be used in residential care. Nurse assistants are the ones who are closest to the residents but have limited prerequisites for working in accordance with the palliative care approach. We aimed to investigate the effects on nurse assistants' experiences of care provision and the caring climate of an intervention applying a palliative care approach in residential care.

Methods

An intervention involving nurse assistants (n = 75) and their leaders (n = 9), in comparison with controls (n = 110), was evaluated using a questionnaire at three points in time.

Results

In the intervention group, positive effects were seen concerning the nurse assistants' reports of the care provision in that they focused more on the residents' stories about their lives and on communicating with the residents about what gave meaning to their lives. Also, negative effects were seen when the nurse assistants rated that the residents' needs for medical and nursing care had not been met at the facility directly after the intervention. No effects were seen concerning the caring climate or the prerequisites of providing more person-centred care.

Conclusion

The intervention seemed to have encouraged the nurse assistants to focus on relationship aspects with the residents. So as not to jeopardise the NAs' well-being and to support NAs in keeping themselves involved in existential issues, their support most certainly needs to be continuous and ongoing. However, in spite of the leaders' involvement, the intervention was not sufficient for changing the organisational prerequisites for more person-centred care.

Place, publisher, year, edition, pages
2014. Vol. 28, no 4, p. 830-841
Keywords [en]
intervention, palliative care, caring, longterm care, nurse assistants, quality of care, person-centred care, caring climate
National Category
Nursing
Identifiers
URN: urn:nbn:se:hkr:diva-11209DOI: 10.1111/scs.12117ISI: 000345314000024PubMedID: 24494588OAI: oai:DiVA.org:hkr-11209DiVA, id: diva2:660372
Available from: 2013-10-29 Created: 2013-10-29 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Att fokusera på "varandet" i en värld av görande: stöd till personalen i ett palliativt förhållningssätt vid vård- och omsorgsboende för äldre
Open this publication in new window or tab >>Att fokusera på "varandet" i en värld av görande: stöd till personalen i ett palliativt förhållningssätt vid vård- och omsorgsboende för äldre
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[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.

Place, publisher, year, edition, pages
Lund: Institutionen för hälsa, vård och samhälle, Medicinska fakulteten, Lunds universitet, 2013. p. 96
Series
Lund University, Faculty of Medicine doctoral dissertation series, ISSN 1652-8220 ; 2013:25
Keywords
palliativt förhållningssätt, Stöd, Lärande, Intervention, Undersköterskor, Vårdbiträde, Personal, Särskilt boende, Arbetstillfredställelse, Påfrestning, Vårdkvalitet, Personcentrerad vård, Vårdklimat
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-11206 (URN)978-91-87189-94-4 (ISBN)
Available from: 2013-10-29 Created: 2013-10-28 Last updated: 2015-01-27Bibliographically approved

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Beck, IngelaEdberg, Anna-Karin

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