End-of-Life Nursing Education Consortium. Geriatric Training Program: improving palliative care in community geriatric care settings

Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)-Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC-Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC-Geriatric Training Program and follow-up evaluation of the "train-the-trainer" model to disseminate comprehensive palliative care education in geriatric settings.     

Development of a palliative care education program in rural long-term care facilities

In North America, people 85 years and older are the fastest growing age cohort and long-term care homes are increasingly becoming the place of end-of-life care. This is especially true in rural communities where services are lacking. Staff in long-term care homes lack education about palliative care, but in rural areas, accessing education and the lack of relevant curricula are barriers. The focus of this paper is to describe an approach to developing and delivering a research-based palliative care education curriculum in rural long-term care homes. The approach included conducting a detailed assessment of staffs' educational needs and preferred educational formats; developing a 15-hour interprofessional curriculum tailored to the identified needs; and delivering the curriculum on site in rural long-term care homes. Staff confidence and participation in delivering palliative care increased. Based on work in northwestern Ontario, Canada, this approach can serve as a model for palliative care education in other rural areas.     

Nursing staff competence, work strain, stress and satisfaction in elderly care: a comparison of home-based care and nursing homes

Abstract Aims. The aims of this study were to: (1) compare older people care nursing staff's perceptions of their competence, work strain and work satisfaction in nursing homes and home‐based care; and (2) to examine determinants of work satisfaction in both care settings. Background. The shift in older people care from hospitals to community‐based facilities and home care has had implications for nursing practice. Lack of competence development, high levels of work strain and low levels of work satisfaction among nursing staff in both care settings have been associated with high turnover. Few studies have compared staff perceptions of their competence and work in nursing homes as opposed to home‐based care. Design. A cross‐sectional questionnaire survey. Methods. Nursing staff perceptions of their competence, work strain, stress and satisfaction were measured by questionnaire in 2003 in two older people care organizations in Sweden. Comparisons of all outcome variables were made between care settings both within and between the two organizations. Multiple regression analysis was used to determine predictors of work satisfaction in home care and nursing homes respectively. Results. In general, staff in home‐based care reported significantly less sufficient knowledge compared with staff in nursing homes. However, home care staff experienced significantly less physical and emotional strain compared with staff in nursing homes. Ratings of work‐related exhaustion, mental energy and overall work satisfaction did not differ significantly between care settings. In both care settings, work‐related exhaustion was the strongest (inverse) predictor of work satisfaction. Conclusions. Future interventions should focus on counteracting work‐related exhaustion and improving competence development to improve work satisfaction among older people care nursing staff in both care settings. Relevance to clinical practice. Work‐related exhaustion and lack of competence development may have significant negative implications for work satisfaction among older people care nursing staff in both home care and nursing homes.     

The provision of palliative care in nursing homes and residential care homes: a survey of clinical nurse specialist work

The provision of end-of-life care within nursing and residential care homes is of concern to policy makers and specialist palliative care providers. There is evidence of an increasing number of initiatives involving clinical nurse specialists (CNS) with the care of residents within these care settings, but the extent to which this is occurring in the UK has not been documented. A survey of 730 community CNS in palliative care was undertaken to describe the extent to which these practitioners are involved with the care of residents in nursing and residential care homes and the nature of this work. Although 92% of the CNS surveyed had worked with nursing homes and 80% of the CNS with residential care homes, the responses showed that this work was primarily reactive and undertaken infrequently. The majority of the work undertaken by CNS involved caring for patients with malignant conditions with a clinical focus addressing the management of physical symptoms.     

Factors influencing use of home care and nursing homes

AIM: This paper reports a study comparing the characteristics of patients who use home care services and those who are cared for in nursing homes, and identifying the factors that influence the use of these care settings. BACKGROUND: The increase in the functionally dependent older population has led to an increase in the number of nursing homes and home care agencies. It has become clear that, rather than disputing which is the better of these options, it would be better to determine the characteristics of patients who use the two long-term care services. Gaining an understanding of the unique characteristics of patients who are cared for by home care agencies and those who are cared for in nursing homes will be imperative for reforming and developing long-term care systems. METHOD: The research model was based on the Anderson Model of Health Services Utilization. Interviews were conducted with 99 stroke survivors from two home care agencies and four nursing homes, and their family members, between May and December 2001. RESULTS: The patient characteristics that predicted greater use of home care rather than nursing home services were: being married, poor physical function, impaired cognitive function, higher rates of comorbidity, various medical complications, and/or number of catheters (e.g. urinary catheter, naso-gastric tube). CONCLUSION: Contrary to the findings of previous studies conducted in countries with ageing populations, our findings indicate that in South Korea home care agencies, rather than nursing homes, provide care for severely impaired patients. This may be due to differences between countries in their long-term care systems and cultural attitudes toward end-of-life care. Our results will contribute to the development or reformation of long-term care systems in countries with ageing populations, and to the development of strategies for increasing access to these services.     

Evaluating palliative care skills for community matrons

The role of the community matron was developed to improve standards of care for people with complex long-term conditions. Initial emphasis was to support patients to help take control of their condition and reduce unnecessary use of urgent care services and hospital admissions. The community matron caseload requires skill to balance the risks involved in keeping people in their own homes. Recent audits show that end-of-life planning and palliative care are crucial aspects of their work so matrons need training and support to ensure positive outcomes for patients at the end of life.     

Measuring nursing work in long-term care. The reliability and validity of the Leatt Measure of Nursing Technology

A projected 400% increase in the number of people age 85 and older by the year 2010, with one fourth of them needing nursing home care, forces attention on long-term care. This study establishes the validity and reliability of the Leatt Measure of Nursing Technology (LMNT) as a measure of the nature of nursing work in long-term care settings. The LMNT subscales measure the amount of uncertainty, instability, and variability of work which includes, but is not limited to, the technical equipment used. The LMNT was administered to licensed nursing staff in nine long-term care facilities in the Seattle area to evaluate its use in this environment. The nursing homes represented both for-profit and not-for-profit, and large (more than 250 beds) and small (70 beds) facilities. A total of 113 usable questionnaires were returned (45% response rate). Cronbach's alpha for subscales were .71 for Uncertainty, .66 for Instability, and .56 for Variability, with .77 for the total scale. Construct validity was evaluated by factor analysis, which confirmed the original factor structure. Content validity was evaluated using focus group discussions with key informants at each facility. A comparative analysis was used to determine major and minor themes in each of the instrument subscale topic areas. Qualitative analysis, combined with reliability and item level analyses, resulted in suggested minor changes in the instrument to make it more usable in long-term care settings. While some revisions are suggested, a concerted effort must be made to preserve the ability to compare findings with those obtained using the LMNT in acute care settings by retaining the general structures and factors of the measure.     

The management of pain in long-term care

OBJECTIVE: The purpose of this paper is to present salient principles of pain management in nursing homes and other long-term care settings. METHODS: Review and author opinion. RESULTS: Pain is a common problem in nursing homes and other long-term care facilities. Often unrecognized and under-treated, pain is a major source of suffering and functional impairment. These patients present substantial barriers to pain assessment and management. Multiple concurrent disease processes, cognitive impairment and communication difficulties, and limited access to diagnostic technologies make assessment more difficult. Multiple medications, altered physiology and pharmacology and limited access to a variety of drug and non-drug interventions make treatment strategies more difficult to implement. DISCUSSION: Clinicians who care for patients receiving long-term care services must help establish a treatment plan that is reasonable given the limited resources and skills available in nursing homes and other long-term care facilities. Medication regimens should be simplified as much as possible. Contingency plans for pain management must be anticipated and made available so that delays do not occur during medication changes or dosage adjustments. Long-term care facilities need substantial support from physicians and other pain experts for education to continuously update their skills and knowledge. As the need for health systems for frail elderly persons continues to grow, it is important to provide comfort and effective pain control appropriate for these new settings.     

Leading end-of-life care: an action learning set approach in nursing homes

If the end-of-life care needs of people living in nursing homes are to be met, effective leadership is necessary. This in turn requires that appropriate training and support are provided for nursing home managers. To meet this need, an action learning set (ALS) involving nursing home managers was developed, and as a result of the continuous process of learning and reflection that characterizes ALS work the managers brought about a number of improvements in end-of-life care. These included more consistent use of care plans, increased involvement of clients and their families in planning end-of-life care, more training for staff, and the use of events and techniques to create opportunities for discussing the end of life. The managers set specific individual objectives focused on improving end-of-life care and were supported in meeting them through their membership of the set.     

Outcomes from the work of registered nurses working with older people in UK care homes

heath h. (2010) Outcomes from the work of Registered Nurses working with older people in UK care homes. International Journal of Older People Nursing 5 , 116–127 Aims and objectives. This research sought to illuminate the distinct contributions made by Registered Nurses (RNs) and Care Assistants (CAs) to outcomes for older people in UK (nursing) care homes and to identify the outcomes of their work. This paper reports on aspects relevant to RNs. Background. Older people living in long-term residential care settings around the world are among the most vulnerable individuals within their communities and those with the most complex needs. Nursing has historically been fundamental in the delivery of these services but, in some countries, the role of Registered Nurses in residential care is coming under increasing scrutiny, particularly in the context of escalating costs and funding restrictions, a questioning of the need for a 24-hour ‘health’ professional presence in a ‘social care’ service and a lack of evidence on the distinct contribution that RNs make to outcomes in these settings. Design. A multi-method qualitative interpretive approach, adopting a structure–process–outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer (2003) . Methods. For Phase 1 of the study, RNs and CAs from care homes around the UK contributed examples of their work, which they identified as having made a ‘significant’ difference to older individuals. Phase 2 comprised researcher fieldwork (observations, interviews and documentary analysis) in three care homes around UK. Research participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes. Results. RN roles in care homes are broad and multifaceted. Distinct outcomes of RN work are consequent to their caring and their knowledge and skills developed through broad experience in a range of healthcare settings. Outcomes for residents from RN work include enhanced personhood and wellbeing, improved health and function, the prevention of problems/adverse outcomes and enhanced quality of life. RN outcomes have positive impact on relatives, staff and the homes in general. Conclusions. There is potential to reconsider the broad, ‘anything and everything’ nature of the RN role in care homes identified in the research. However, given the complex healthcare needs of the current resident population, the 24-hour RN presence is deemed essential.     

Supporting care home residents at the end of life

The English Department of Health's 2008 End of Life Care Strategy reported that 17% of deaths in England occur in care homes, with the majority of these in the 85 years and over age group. Given this, the ageing population, and the projected increase in the number of people dying, it is evident that the number of deaths in care homes is likely to increase. The research presented here seeks to consider the factors that support residents to remain in care homes towards the end of life. This study is based on four case studies of care homes in England and on interviews with external health and social care professionals who interact with these care homes. The findings indicate that three core features are fundamental to the delivery of high-quality end-of-life care in care homes: advance care planning, multidisciplinary communication and working, and provision of dignified and compassionate care. Previous research has uncovered some of these issues; this study suggests that it is the combination of these factors that makes them fundamental to meeting residents' care preferences and ensuring high-quality care.     

Developing competencies for end-of-life care in care homes

The English Department of Health's End of Life Care Strategy suggests that suboptimal end-of-life care in care homes results from inadequate training of staff at all levels. This article reports on one hospice's pilot project that addressed the question, 'Does a competency development package provide a way in which the hospice can support improved end-of-life care in care homes in a sustainable way through education?' The project followed the Medical Research Council framework for the development and evaluation of complex interventions. Competency domains were identified and statements written with participating care homes. A five-day education course was delivered to support the competencies and an assessment workshop explored how the framework could be integrated into existing appraisal systems. At the end of the project, the care homes identified aspects of education and support that would ensure the competencies became fully embedded. From the conclusions drawn, a collaborative model of competency development, education, and assessment is proposed to enable a measurable and sustainable improvement in end-of-life care in the care home setting.     

The development of palliative care knowledge in care homes for older people: the place of action research

Action research in health care is a relatively new research approach, which is adopted when one aim of the research is to bring about change in practice and to research the process of that change. This paper describes the way action research, as a research methodology, can be used to develop palliative care knowledge in generalist care settings. An overview of action research is presented and its relationship to more conventional research paradigms. Two action research projects, undertaken to develop knowledge about end-of-life care for older people in care homes, are used to illustrate the key principles of action research, methods of data collection and data analysis. Finally, the challenges of such, utilising an action research approach and its strengths, are discussed.     

The challenges and opportunities in providing end-of-life care in nursing homes

Approximately 20% of deaths in the United States occur in nursing homes. That percentage is expected to increase as the population continues to age. As a setting for end-of-life care, nursing homes provide both challenges and opportunities. This article examines factors that impede the delivery of high-quality end-of-life care in nursing homes, such as inadequate staff and physician training, regulatory and reimbursement issues, poor symptom management, and lack of psychosocial support for staff, residents, and families. In addition to discussing hindrances to providing end-of-life care, this article explores characteristics of nursing homes and their staff that support the care of terminally ill residents. Also included is an overview of models for delivering end-of-life care in nursing homes, including provision of hospice services, specialized palliative care units, and consultation services. Finally, this article discusses educational programs and current educational initiatives to enhance end-of-life care in nursing homes.     

The palliative care education needs of nursing home staff

BACKGROUND: Palliative care is delivered in a number of settings, including nursing homes, where staff often have limited training in palliative care. AIM: We explored the level of palliative care knowledge among qualified staff delivering end-of-life care in nursing home settings, to inform the development of an appropriate education and training programme. DESIGN: An audit of the educational needs assessment was performed using an anonymous postal questionnaire sent to 528 qualified nursing staff within 48 nursing homes. FINDINGS: In total, 227 questionnaires were returned giving a response rate of 43%. Results indicated that less than half the sample had obtained formal training in the area of pain assessment and management and less than a quarter had obtained training in non-malignant conditions. Registered nurses in this study reported a lack of awareness of palliative care principles or national guidelines. CONCLUSION: Qualified nursing home staff agree that palliative care is a valuable model for care in their setting. There are clear opportunities for improvement in nursing home care, based on education and training in palliative care. Results also support the need for enhanced liaison between nursing homes and specialist palliative care services.     

A national Position Statement on adult end-of-life care in critical care

Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.     

Palliative care in nursing homes: exploring care assistants' knowledge

Aim.  To explore the level of palliative care knowledge and to identify educational needs of care assistants (CAs) working within a nursing home context.
Background.  In the United Kingdom (UK) many patients at the end-of-life are admitted to (or reside in) nursing homes, where they receive care from unqualified CAs who have little formal training. Mandatory training in specific skills to meet palliative care needs are absent.
Method.  Questionnaire to CAs in 48 of 91 private nursing homes in one UK region.
Findings.  A population of 1135 CAs were targeted with a response rate of 45% ( n  = 508). A high proportion of CAs in this sample required information about the philosophy and principles of palliative care. Results support the need for an educational initiative to improve palliative care in nursing homes.
Conclusion.  Although recognized as a common place of death for older people, CAs are often unprepared to provide end-of-life care to nursing home residents. It is recommended that attention be given towards developing the skills and knowledge of this staff group.     

养老机构照护服务质量评价指标的构建及信效度检验

目的 构建养老机构照护服务质量评价指标,并检验其信效度。 方法 以服务质量模型为基础,通过查阅相关文献、专家咨询、小组讨论等方法构建养老机构照护服务质量评价指标暂定版,采用暂定版评价指标对南通市7所养老机构中277例老年人进行问卷调查,对养老机构照护服务质量评价表的信效度进行检验,形成养老机构照护服务质量评价指标。 结果 养老机构照护服务质量评价指标包括4个维度（有形性、可靠性、响应性、移情性）、24个条目。养老机构照护服务质量评价表的Cronbach's α系数为0.945,折半信度为0.904;条目水平的内容效度为1.00,量表水平的内容效度为1.00;探索性因子分析提取4个公因子,方差累积贡献率为61.763%;各维度之间的相关系数为0.509~0.757,各维度与量表总分之间的相关系数为0.760~0.942。 结论 养老机构照护服务质量评价指标具有良好的信效度,可作为养老机构照护服务质量的评价工具。     

Social Isolation in Dementia: The Effects of COVID-19

The aim of this literature review is to identify the effects of social isolation and lonliness on persons with dementia and to highlight interventions for private homes and long-term care facilities. It includes articles published in the last 5 years for a total of 45 articles. Social isolation and/or lonliness is linked to reduced quality of life, neuropsychiatric symptoms, and psychotropic drug use in people living with demential. Interventions, including physical activity, should be individualized and patient centered.