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Having to focus on doing rather than being: nurse assistants' experience of palliative care in municipal residential care settings
Lund University.ORCID iD: 0000-0002-7790-6906
Lund University.
Lund University.
Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Platform for Collaboration for Health.ORCID iD: 0000-0003-0161-4795
2012 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 49, no 4, 455-464 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Palliative care should be provided, irrespective of setting to all patients facing a life-threatening illness and to their families. The situation and needs of older people differ from those of younger people since they often have several co-existing diseases and health complaints. This implies an extensive need for care and for longer periods of palliative care. The main providers of palliative care for older people are nurse assistants, who are also those with the shortest education. AIM: The aim of this study was to illuminate nurse assistants' experience of palliative care for older people in residential care. DESIGN: The study had an explorative, descriptive design. SETTINGS: Thirteen residential care units in three different districts in a large city in southern Sweden. PARTICIPANTS: Twenty-five nurse assistants selected to represent variations in age, gender workplace and work experience. METHODS: Data were collected from six focus-group interviews and subjected to content analysis to gain an understanding of the phenomenon. RESULTS: The nurse assistants described palliative care as a contrast to the everyday care they performed in that they had a legitimate possibility to provide the care needed and a clear assignment in relation to relatives. Palliative care also meant having to face death and dying while feeling simultaneous that it was unnatural to talk about death and having to deal with their own emotions. They emphasised that they were in need of support and experienced leadership as invisible and opaque, but gained strength from being recognized. CONCLUSION: In order to support nurse assistants in providing high quality end-of-life care, more focus is needed on the trajectory of older peoples' dying, on the importance of involving relatives throughout the period of care provision, and on support when encountering death and dying. There is also a need for engaged care leaders, both registered nurses and managers, to recognize the work of nurse assistants and to support care provision for older people within the framework of palliative care philosophy.

Place, publisher, year, edition, pages
2012. Vol. 49, no 4, 455-464 p.
Keyword [sv]
Focus group, Frail elderly, Nursing assistants, Nursing homes, Palliative care, Support
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hkr:diva-8879DOI: 10.1016/j.ijnurstu.2011.10.016ISI: 000302980200010PubMedID: 22079261OAI: oai:DiVA.org:hkr-8879DiVA: diva2:477102
Funder
Vårdal Foundation
Available from: 2012-01-12 Created: 2012-01-12 Last updated: 2017-05-12Bibliographically 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. 96 p.
Series
Lund University, Faculty of Medicine doctoral dissertation series, ISSN 1652-8220 ; 2013:25
Keyword
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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