Palliative care education for care workers in aged care: A scoping review

BackgroundGlobally, residential aged care is a common place to receive palliative care. Yet 70% of the workforce is made up of unregulated health care workers, many of whom have no formal palliative care education and report a lack of knowledge and ability to provide best practice palliative care.QuestionDoes the provision of palliative care education to unregulated health care workers in residential aged care, improve knowledge, confidence, and ability to provide best practice care to residents with palliative care needs?MethodsA literature search utilising health care databases CINAHL, MEDLINE, and AgeLine was conducted. Citations were screened against the inclusion criteria and the methodology from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis, assisted in selecting articles that informed the research question.FindingsNine articles met the inclusion criteria. Four areas of interest were derived: (i) Palliative Care knowledge and confidence; (ii) Communication skills; (iii) Roles and responsibilities; (iv) Barriers to implementation and sustainability.DiscussionEvidence suggests the provision of palliative care education to unregulated health care workers may be beneficial in imparting knowledge and confidence, ultimately resulting in an improved ability to provide best practice care. However, barriers within the aged care system may interfere with the implementation and sustainability of newly acquired knowledge. Limitations of the review include the unknown quality of the educational content provided.ConclusionPalliative care education is part of the solution to enhanced outcomes for aged care residents but is not the complete answer. Systemic industry change is required to achieve sustainable outcomes.     

Simulation to educate healthcare providers working within residential age care settings: A scoping review

BackgroundSimulation is used widely in health education to develop healthcare providers' knowledge and skills. The use of simulation however, as an educational strategy among aged care worker is not well understood.ObjectivesThis review sought to describe studies where simulation is used to educate healthcare providers working within aged care settings; describe the method and structure used in simulations in residential aged care; the key learning outcomes for the participants in this setting; and identify any gaps in the current literature to illuminate future research opportunities.DesignThe review follows the Joanna Briggs Institute Scoping Review methodology and utilises the PRISMA-ScR Checklist. Searches of CINAHL Complete, PubMed and Scopus databases were completed using the search terms “Simulation” AND “training” AND “Aged Care” OR “Elderly” OR “Older People”. Inclusion criteria were peer-reviewed, English, full-text articles published from database inception to July 2018.ResultsTwenty studies were included in this review. Studies differed in their methodology, sample size and participants and their findings varied significantly. Fourteen studies originated from the United States of America, five from Canada, and one from Taiwan. Studies were published between 1977 and July 2018. Clinical topics used in simulation were aggression and violence; dementia; aging; death and dying; range of motion exercises; person-centred care; sepsis; and dressing residents. Simulation types were role play, simulated patients, and mannequins. Debrief was described in less than a third of studies. Just over half of the studies evaluated participant outcomes.Discussion/conclusionThis study demonstrated a large paucity of evidence utilising simulation for training within aged care settings. It highlights the need for future research in this area where simulation could be utilised to meet the unique learning needs of nurses working in aged care.     

A thematic literature review of innovative strategies to prepare nursing students for aged-care

BackgroundThe exponential rise in people living longer but requiring residential care is adding pressure to already overstretched aged care nurses. Consequently, a person-centred care culture in residential care remains aspirational, rather than a reality. For nursing students in Australia and elsewhere, clinical placements in aged care facilities are under-utilised due to negative perceptions about the likelihood for learning. Creative strategies to engage students to safely challenge ageist thinking and to inspire enthusiasm for learning in this context are needed.ObjectivesThe purpose of this thematic review of the literature is to better understand challenges related to learning in aged care settings and identify innovative strategies to enhance nursing student learning experiences in residential aged care placements.Review methodsA literature review was undertaken in 2019 using CINAHL, PUBMED, Elsevier, Medline, ProQuest and Google Scholar. The search was limited to papers that were peer reviewed, in English, and published between 2001 and the date of review (mid-2019) in order to situate the review in the new millennium.Results47 articles and books were included in the review that introduce solutions and innovative strategies that could be used to improve students' attitudes to learning in aged care and from older people. The literature review was categorized into three main themes, including: barriers to working with older people; the need for pedagogical change to foster empathy; and innovative strategies to address barriers.ConclusionThese themes are useful to consider in designing engaging learning and teaching for nursing students to be effective in working in aged care.     

Musculoskeletal disorders in support workers in the aged care sector

Abstract

Background: With the proportion of the population aged over 65 expecting to rise from 15 to 26% within the next 50 years, the demand for formal support workers for older adults will rise substantially. It is essential that this workforce remain healthy; however, due to the nature of elder care, musculoskeletal complaints are commonplace in support workers.

Objectives: The aim of this systematic review was to determine the current work-related musculoskeletal disorders which are present in workers in the aged care sector.

Method: Five databases were searched: AMED, CINAHL, EMBASE, Medline, and Web of Science. Four main concepts: aged care, physical health, carer/support worker, and work, were included in the search. All study design types where participants were involved in the formal care of the older adults were included.

Results: The search yielded 17 articles after the implementation of strict inclusion and exclusion criteria. Common musculoskeletal complaints included neck, shoulder, and back pain with a prevalence ranging between 5 and 51%. Associated risk factors for injury included: high physical job demands, psychosocial factors, effort-reward imbalance, lack of career opportunities, increased age, and decreased education levels.

Conclusion: Current evidence shows that the back, neck, and shoulder are the main musculoskeletal complaints of workers in the aged care sector. However specific diagnoses of these injuries have not been investigated. Further research should focus on quantifying specific disorders, determining risk factors, and developing prevention strategies.     

Personal and Interpersonal Factors and Their Associations With Advance Care Planning Documentation: A Cross-sectional Survey of Older Adults in Australia

ContextPersonal and interpersonal factors may be influential in a person's decision to engage in advance care planning (ACP), including completion of ACP documentation.ObjectivesTo conduct a cross-sectional survey of older adults accessing Australian general practices, hospitals, and residential aged care facilities, with the aim of describing associations between personal and interpersonal factors and self-reported ACP documentation completion.MethodsEligible participants included in a national health record audit were approached to complete a survey measuring demographic and health characteristics, preferences for care, worries about the future, and experiences talking with others about ACP and completing ACP documentation.ResultsOf 1082 people eligible to participate in the survey, 507 completed the survey (response rate = 47%; median age 82 years) and 54% (n = 272) reported having completed ACP documentation. Having ever discussed ACP with other people (anyone) or a doctor were both significant predictors of ACP documentation completion, whereas having previously spoken specifically to a partner about ACP, currently living with children compared to living alone, and being aged 55–69 versus 90–99 years were associated with reduced odds of ACP documentation completion.ConclusionApproximately half the participants reported having completed ACP documentation. The strongest predictor of ACP documentation completion was having spoken to anyone about ACP followed by having spoken to a doctor about ACP. These findings suggest that discussions about ACP are an important part of the process of completing ACP documentation.     

Exploration of personal recovery-oriented care on an acute mental health unit

BackgroundPersonal recovery should be the cornerstone of mental health nursing practice. Nursing interventions should build on consumers' strengths to provide hope, so consumers are empowered to achieve their own personal goals.AimThe aim of this study was to explore mental health nurses’ lived experience of their practice, understanding and knowledge of personal recovery-oriented care on acute mental health units.MethodVan Manen's methodology was utilised in this study. Data was gathered through semistructured conversational interviews with mental health nurses working on an acute unit.FindingsParticipants found personal recovery was difficult on an acute mental health unit. Factors that participants identified that impeded personal recovery-oriented care on acute mental health units included: the acuity of consumers in a low dependency area, lack of time to engage consumers, and loss of the therapeutic role for mental health nurses on acute units.DiscussionMental health nurses are expected to focus on the personal recovery needs of mental health consumers while managing clinical risks to consumers and others on the acute unit. This has the mental health nurse navigating a course between two worlds, and results in mental health nurses being confused between concepts of personal recovery and clinical recovery.ConclusionIf acute mental health nurses cannot define personal recovery, they will not be able to effectively implement interventions that support consumers in their personal recovery journey on acute units and will be drawn into the clinical recovery paradigm.     

How are older people’s care preferences documented towards the end of life?

BackgroundMeeting individuals’ preferences is essential to achieve quality care at the end of life. Documenting these preferences in the healthcare system is an essential step to achieve them.AimTo investigate the documentation of older people’s care preferences including end of life care preferences in health records.MethodsRetrospective audit of health records for the last six months of life of people aged over 74 years who died in hospitals, residential aged care facilities, or community palliative care.FindingsFifty records were audited, including 28 hospital, 12 residential aged care facilities, and 10 community palliative care records with overall 297 documented care preferences. 30% of preferences were recorded on institution-specific forms at admission which focussed on patients’ medical/healthcare needs and less on personal/lifestyle preferences. Documentation mainly included clinical care preferences (35%), resuscitation plans (28%), and place of care (20%). Preferred place of death was not documented in 70% of cases. Increased documentation occurred closer to death with 63% of preferences recorded in the last week of life.DiscussionThe low rates of recorded preferences, especially non-medical choices like preferred place of death, may indicate low rates of preference discussions and/or poor documentation of these conversations. The increase in documentation closer to death may be explained by increased care needs and higher rates of care place transitions towards the end of life.ConclusionDiscussion and documentation of older people’s care preferences needs to be further encouraged within the healthcare system. It is essential not to wait for a crisis at the end of life to begin these processes.     

Evaluation of a nurse-led education program to improve cross-cultural care for older people in aged care

BackgroundCultural diversity is significant in aged care facilities. Registered nurses play a leading role in the care setting. Nurse-led education interventions to improve the cultural competence of aged care workers are in high demand.AimThe aims of the study were to evaluate the effect of a nurse-led cross-cultural care program on cultural competence of Australian and overseas-born care workers.DesignA pre- and post-evaluation design and a sub-group analysis.Settings and participantsThis study was undertaken in four large-sized aged care facilities in Australia. Direct care workers were invited to participate in the study.MethodsThe intervention lasted 12 months. Data were collected at baseline, 6 months and 12 months using the Clinical Cultural Competency Questionnaire and site champion reports. One-way ANOVA was applied to determine the changes of outcomes over time for the whole group. A mixed effect linear regression model was applied in the sub-group analyses to compare the differences of outcomes between the Australian-born and overseas-born groups.ResultsOne hundred and thirteen staff participated in the study including Australian-born (n = 62) and overseas-born (n = 51). Registered nurses were trained as site champions to lead the program. The results showed a statistically significant increase in participants' scores in Knowledge (p = .000), Skills (p = .000), Comfort Level (p = .000), Importance of awareness (p = .01) and Self-Awareness (p = .000) in a 12-month follow-up. The increased scores in the Skills (p = .02) and Comfort Level (p = .001) were higher in the Australian-born group compared to the overseas-born group. The results also showed a statistically significant increase in participants' overall satisfaction scores with the program at 12 months (p = .009). The overseas-born group demonstrated a higher score in Desire to Learn More (p = .016) and Impact of the Program on Practice (p = .014) compared to the Australian-born group.ConclusionA nurse-led cross-cultural care program can improve aged care workers' cultural competence.     

Interprofessional education in practice: Evaluation of a work integrated aged care program

Health professional clinical education is commonly conducted in single discipline modes, thus limiting student collaboration skills. Aged care residential facilities, due to the chronic and complex health care needs of residents, provide an ideal placement to provide a collaborative experience. Interprofessional education is widely acknowledged as the pedagogical framework through which to facilitate collaboration. The aim of the evaluation was to assess student attitudes towards collaboration after active involvement in an interprofessional education program. Students studying nursing, occupational therapy, and aged care were invited to complete a version of the Readiness for Interprofessional Learning Scale before and after participating in a three-week pilot interprofessional program. A positive change in student attitudes towards other health professionals and the importance of working in interprofessional teams was reported with significant differences between two statements indicated: Learning with health-care students before qualifications would improve relationships after qualifications; and I learned a lot from the students from the other disciplines. The innovative pilot project was found to enhance student learning in interprofessional teams and the aged care environment. Further development of this and similar interprofessional programs is required to develop sustainable student projects that have health benefits for residents in aged care residential facilities.     

Residential aged care: the last frontier for palliative care

AIM: This paper is a report of an explorative study describing the perceptions and beliefs about palliative care among nurses and care assistants working in residential aged care facilities in Australia. BACKGROUND: Internationally, the number of people dying in residential aged care facilities is growing. In Australia, aged care providers are being encouraged and supported by a positive policy platform to deliver a palliative approach to care, which has generated significant interest from clinicians, academics and researchers. However, a little is known about the ability and capacity of residential aged care services to adopt and provide a palliative approach to care. METHODS: Focus groups were used to investigate the collective perceptions and beliefs about palliative care in a convenience sample of nurses and care assistants working in residential aged care facilities in Australia. Thematic content analysis was used to analyse the data, which were collected during 2004. RESULTS: Four major themes emerged: (1) being like family; (2) advocacy as a key role; (3) challenges in communicating with other healthcare providers; (4) battling and striving to succeed against the odds. Although participants described involvement and commitment to quality palliative care, they also expressed a need for additional education and support about symptom control, language and access to specialist services and resources. CONCLUSION: The residential aged care sector is in need of support for providing palliative care, yet there are significant professional and system barriers to care delivery. The provision of enhanced palliative care educational and networking opportunities for nurses and care assistants in residential aged care, augmented by a supportive organizational culture, would assist in the adoption of a palliative approach to service delivery and requires systematic investigation.     

Communication between residential aged care facilities and the emergency department: A review of the literature

BackgroundWestern countries have encountered an increase in elderly patients transferred from residential aged care facilities to emergency departments. This patient cohort frequently experiences impaired physical and cognitive function. Emergency department staff require important clinical and personal patient information to provide quality care. International studies show that documentation and handover deficiencies are common.ObjectiveThe purpose of this literature review was to explore transitional communication practices, and to consider the specific patient information deemed essential for the management of residents in the emergency department.MethodsA literature review was conducted to examine the studies exploring the documentation accompanying elderly people who were transferred from residential aged care facilities to emergency departments. Scopus, OVID Medline and Cinahl Plus data bases were searched using combinations of the following key words: ‘nursing home’, ‘long-term care’, ‘skilled nursing facility’, ‘aged care facility’, ‘communication’, ‘documentation’, ‘emergency department’, ‘emergency room’, ‘hospital’, ‘acute’, ‘transfer’, and ‘transition’. Additional data was located with the use of Google Scholar. Review of titles and exclusion of duplicates identified 69 relevant studies. These 69 papers were independently reviewed by three members of the research team for eligibility for inclusion in the review, and seven papers were retained.ResultsThere is currently no consensus regarding what information is essential when residents are transferred from aged care facilities to emergency departments, and practices vary. Key information which should accompany the resident has been reported by various authors and include the reason for transfer, past medical history, current medications, cognitive function and advance directives. Some authors also suggest that facility contact details are essential. Without agreement by key stakeholders as to what constitutes ‘essential transfer information’, clinical practices will continue to vary and resident care will be affected.ConclusionThis paper identifies frequent communication deficits in the information provided to the emergency department from aged care facilities. There is an imperative to identify suitable items of information which health care professionals agree are essential. Future research should focus on methods to improve the transfer of information between facilities, including consensus regarding what information is essential transfer data.     

A survey of commitment and compassion among nurses in residential aged care

AIM: To assess the views and attitudes of aged care staff providing direct care towards palliative care and to identify their learning needs. DESIGN: Survey design using purposive sampling methods. FINDINGS: Nurses and care assistants (n=222) employed within nine residential aged care facilities in regional Australia completed the survey. The majority had received 'on the job training' and were committed to providing end-of-life care. Differences in the level of confidence to deal with patient/family interactions and manage complex palliative care scenarios were evident between nurses and care assistants (p<0.05). Both nurses and care assistants perceived a need for further education in symptom management and communication, yet their content need differed significantly between groups. CONCLUSIONS: Nurses and care assistants in residential aged care facilities demonstrate commitment to the delivery of palliative care and express a need for increased palliative care competencies. The heterogeneity of roles and educational preparation within the aged care workforce indicate that tailored palliative care education initiatives are required to meet the learning needs of aged care nurses and care assistants, particularly in relation to end-of-life care. These data have implications for skill-mix and model of care development.     

Australian nursing students’ clinical experiences in residential aged care: Reports from nurse academics

BackgroundNurses are the largest group of registered healthcare professionals and are fundamental to delivering health and aged care in Australia.AimTo explore how nursing students report clinical experiences when caring for older people as part of a larger study investigating how care of the older person content is included in Australian undergraduate nursing curricula.MethodsA population sample of all Australian nursing schools that offered a Bachelor of Nursing degree (n = 35) in 2019. Nurse academics involved in curriculum development or delivery were recruited. A telephone-assisted survey was used, and qualitative content analysis undertaken.ResultsAll schools of nursing participated in the survey, representing a response rate of 100%. The acute care focus of nursing curricula meant clinical experiences for nursing students related to older person's care commonly occurred in residential aged care facilities in the first year of the degree. Student reports of these experiences varied, with a majority of respondents reporting mixed or negative feedback associated with a lack of preparation and inadequate supervision.ConclusionsThis study highlights the: significance of the timing of nursing students’ clinical placements in residential aged care; the selection of appropriate care homes; and the need for the right clinical teaching staff who can supervise high quality learning experiences for students.     

A study of nurses' knowledge of a palliative approach in residential aged care facilities

Aim. To identify residential aged care nurses’ current knowledge of palliative care for older residents in need of end‐of‐life care. Background. Recently, there has been a growing interest in the delivery of palliative care in residential aged care facilities. While it is recognized that aged care nurses do possess palliative care knowledge the actual level of their knowledge has not been well documented. Design/method. An analytical study using a validated questionnaire tool – Palliative Care Quiz for Nursing, developed by Ross et al. [Journal of Advanced Nursing 23 (1996) 126–137] , combined with a demographic survey of Registered Nurses and assistants in nursing working in five high care residential aged care facilities in inner city region of Sydney, Australia. Results. The total Palliative Care Quiz for Nursing score possible was 20. The mean score for Registered Nurses was 11.7 (SD 3.1) and for AINs 5.8 (SD 3.3), the difference between scores being significant (t = 8.7, df 95, P = 0.000). Misconceptions in palliative care were identified for both the groups of carers. Conclusion. This research has highlighted the need for ongoing palliative care education for both the groups of primary carers. Relevance to clinical practice. The findings of this research highlight the existing palliative care knowledge of residential aged care nurses and provides evidence for education programmes.     

Enablers and barriers to engaging in dementia-specific education: A cross-sectional survey

BackgroundPrevalence of dementia is increasing, with more than half of aged care residents having a dementia diagnosis in Australia. Aged care staff currently lack dementia-specific knowledge and skills to care for residents with dementia.AimTo examine residential aged care staff perceptions of enablers and barriers to completing dementia-specific education.MethodsA purpose-designed cross-sectional survey of staff (n=179) from 36 of the 177 Victorian public sector residential aged care facilities across metropolitan, regional, and rural Victoria, Australia.FindingsStaff were most commonly motivated to complete dementia-specific education by intrinsic factors such as a desire to provide better care to residents, and to develop or improve their skills. Availability of education online, readily accessible information about education opportunities, workplace resources, and management support were key enablers. Difficulty with access, lack of time, high workload, and lack of awareness were significant barriers. Cost, location, and mode of delivery were cited as both enablers and barriers.DiscussionResidential aged care staff require accessible education initiatives and workplace support to facilitate their participation in dementia-specific education to provide high quality, evidence-based care for people living with dementia.ConclusionFindings of this study can assist education providers, employers, and researchers to better understand participation and inform strategies and processes to increase uptake of dementia-specific education.     

Evaluation of palliative care nursing education seminars

PurposeMore than 50 million people die each year around the world. Nurses are crucial in providing care to these individuals and their families as they spend the most time at the bedside with patients and families. Yet many nurses have received little or no education about palliative care.Methods/SampleThe Open Society Institute (OSI) and the Open Medical Institute (OMI) partnered with End-of-Life Nursing Education Consortium (ELNEC) to develop an international nursing palliative care curriculum. This international curriculum was implemented with two training courses held in Salzburg, Austria in October 2006 (n = 38) and April 2008 (n = 39) representing 22 Eastern European/Central Asian countries. Participants were asked to establish goals in disseminating the palliative care information when they returned to their country. The participants were mentored/followed for a 12-month period to evaluate their palliative care knowledge as well as challenges encountered.Key ResultsThe participants provided excellent ratings for the training courses indicating that the courses were stimulating and met their expectations. The 12-month follow-up demonstrated many challenges (i.e., lack of funds, institutional support, fear of death), in advancing palliative care within each participant's setting/country as well as many examples of successful implementation.ConclusionsThere is an urgent need for improved palliative care throughout the world. The ELNEC-International curriculum is designed to address the need for increased palliative care education in nursing. In order to improve the quality of life for those facing life-threatening illnesses around the world, ongoing support is needed for world-wide palliative care educational efforts.