The role of healthcare support workers in providing palliative and end‐of‐life care in the community: a systematic literature review

Despite the widespread use of Health Care Support Workers (HCSWs) in providing palliative and end‐of‐life care, there is little information available about their contributions towards supporting patients who want to be cared for at home or to die at home. Between January and April 2011, a systematic review was conducted to address two questions: (i) What particular tasks/roles do HCSWs perform when caring for people at the end of life and their families to comply with their desire to remain at home?; (ii) What are the challenges and supporting factors that influence HCSWs’ ability to provide palliative and end‐of‐life care in the community? Databases searched for relevant articles published between 1990 until April 2011 included CINAHL, EMBASE, PsychINFO, British Nursing Index, Web of Science, Medline and ASSIA. In total, 1695 papers were identified and their titles and abstracts were read. Ten papers met the eligibility criteria of the study. After the methodological quality of the studies was appraised, nine papers were included in the review. Judgements regarding eligibility and quality were undertaken independently by the authors. The findings indicate that HCSWs invest a great deal of their time on emotional and social support as well as on assisting in the provision of personal care. They are also involved in providing care for the dying, respite care for family members and offer domestic support. Although it is important to acknowledge the many positive aspects that HCSWs provide, the findings suggest three challenges in the HCSWs role: emotional attachment, role ambiguity and inadequate training. Support factors such as informal peer grief‐support groups, sense of cohesiveness among HCSWs and task orientation enabled HCSWs to overcome these challenges. To conclude, induction and training programmes, a defined period of preceptorship, appropriate support, supervision and clearly defined role boundaries may be helpful in reducing the challenges identified in HCSWs’ roles.     

Low postnatal care rates in two rural counties in Anhui Province, China: Perceptions of key stakeholders

Objective

to explore the perceptions of stakeholders on postnatal care and to describe the rate of postnatal home visits in two rural counties in Anhui Province, China.

Design

this was a mixed methods study which uses mainly qualitative methods including focus group discussions, in- depth interviews and key informant interviews. A household survey of postpartum women was used to calculate the rates of postnatal home visits.

Setting

two rural counties in Anhui Province, China.

Participants

qualitative study participants: officials responsible for maternal health care at county level, health providers at township and village level and maternal health-care users. Household survey participants: 2326 women who gave birth in the two counties from January 2005 to December 2006.

Findings

the survey of postpartum women revealed that only 4.2% and 4.5% of women received one or more postnatal visits at home in County A and County B. Qualitative interviews revealed a range of perceived reasons for this low rate of provision and utilisation of postnatal care, including: inadequate funding for maternal health care; limited human resources; lack of transport in township hospitals; and limited value placed on postnatal care by women and providers. In addition, where services were provided, a number of factors were likely to restrict health providers from delivering high-quality postnatal health service, such as: weak skills and knowledge of staff; inadequate in-service training; lack of equipment in township hospitals; and poor supervision and monitoring.

Key conclusions

the rate of postnatal visits was extremely low in two counties in rural China. Understaffing and inadequate funding are the main factors that affect provision of postnatal health care.

Implications for practice

more emphasis should be attached to political support and funding for postnatal care. Research into feasible ways to provide quality postnatal care needs to be conducted.     

Using Spradley: an ethnosemantic approach to research

The purpose of this paper is to demonstrate the use of Spradley's (1979) Developmental Research Sequence (DRS) as a research method In a recent study which I have carried out exploring the practice of expatriate nurses, I chose to use this method for data collection and analysis One major reason for the choice was that as a method within the qualitative paradigm it offered an explicit, systematic and rigorous approach to the collection and collation of the research data The aim of my study was to explore the common experience of expatriate nurses working in developing countries in primary health care and to identify the common values that influenced their practice DRS utilizes an ethnoscientific approach which incorporates a systematic study of the way of life of an individual or a community or group of people, understood through the process of ethnosemantic analysis or the study of the meaning within language Or more simply, it offers a way of understanding something of the reality of another person's experience from the way that he or she talks about it A major assumption of the method is that cultural groups or individuals organize their knowledge and subsequent rules for behaviour on the basis of culturally designated similarities and differences The paper sets out the DRS method using examples from my study It provides an opportunity to share my experience of using this method with others     

A practical approach to creative teaching: an experiment

The purpose of this experiment was to see if creative teaching methods would prove effective when included in a school of nursing teaching programme. This would be demonstrated by significant differences in levels of achievement in assessments and a demonstration that the knowledge gained was applied to the clinical situation. Didactic teaching methods were exchanged for a more creative approach without alteration of the course structure. The quasi experimental method was used, with four introductory courses of 20 nursing students at two separate district schools as the sample, two groups acting as the control groups and two as the experimental groups. The teaching sessions introduced medical problems associated with poor oxygenation, particularly those consequent to heart disease. The teaching was supported by appropriate care planning within the Roper et al. (1981) theoretical framework. Three distinct areas were identified;fact leaming, e.g. anatomy and physiology, problem identifications and planning for nursing, intervention and skill learning. Students in the experimental groups were given work sheets and facilities for self learning whilst those in the control groups continued with a traditional lecture/demonstration format. The results of the experiment were evaluated by testing all four groups using multiple choice objective tests, essays, problem solving and nursing intervention exercises and practical assessments. The findings showed that the experimental groups did no better in the multiple choice objective tests or in the essays than the control groups butthey did do significantly better in the problem identification and planning for nursing intervention exercise. In the assessment of practical skills there was no difference between the groups in skill performance but the experimental groups were able to apply the theory significantly better than the control groups.