Instruments for assessing nurses' palliative care knowledge and skills in specialised care setting: An integrative review.

AIMS AND OBJECTIVES: To examine the content and reported psychometric properties of instruments for assessing nurses' palliative care knowledge and skills in specialised healthcare units. BACKGROUND: Knowledge of palliative care, and competence in the delivery of care, is essential. Assessment of competence is an important means of evaluating the knowledge and skills of practitioners in order to improve the quality of care provided for patients and their families. DESIGN: An integrative review. METHODS: A systematic literature search was conducted in November 2018 in five databases: CINAHL, PubMed (Medline), Cochrane, Scopus and Web of Science. The quality assessment was conducted using the Joanna Briggs Institute's (JBI) Checklist for Analytical Cross-Sectional Studies. The data were analysed using content analysis. PRISMA guidelines were followed to ensure explicit reporting. RESULTS: Overall, 5,413 studies were identified and 23 met the inclusion criteria. Nurses' knowledge and skills, as assessed by the instruments, were as follows: (a) care for the patient, (b) care for the patient's family and (c) professional requirements. Ten instruments were identified assessing nurses' knowledge and skills through knowledge tests and skill evaluation self-tests. The psychometric properties of the instruments were reported to varying degrees, mainly focusing on internal consistency and content validation. CONCLUSIONS: Nurses' knowledge and skills were seen to contribute to the holistic care of the patient and his or her family, and the possession of adequate information and skills is essential when dealing with death and dying. The instruments are commonly available and potentially reliable, although reliability must be determined with caution, so validation studies in other cultures are recommended. RELEVANCE TO CLINICAL PRACTICE: These results could be utilised to improve the quality of palliative care by evaluating the knowledge and skills of nursing staff or when considering the needs of palliative care education.

Migrants' Healthcare Experience: A Meta-Ethnography Review of the Literature.

PURPOSE: Worldwide, more than 214 million people have left their country of origin. This unprecedented mass migration impacts health care in host countries. This article explores and synthesizes literature on the healthcare experiences of migrants. DESIGN: A meta-ethnography study of qualitative studies was conducted. METHODS: Eight databases (Medline, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], PsycINFO, Embase, Web of Science, Migration Observatory, National Health Service Scotland Knowledge Network, and Adaptive Spectrum and Signal Alignment [ASSIA]) were searched for relevant full-text articles in English, published between January 2006 and June 2016. Articles were screened against inclusion criteria for eligibility. Included articles were assessed for quality and analyzed using Noblit and Hare's seven-step meta-ethnography process. FINDINGS: Twenty-seven studies were included in the review. Five key contextualization dimensions were identified: personal factors, the healthcare system, accessing healthcare, the encounter, and the healthcare experience. These five areas all underlined the uniqueness of each individual migrant, emphasizing the need to treat a person rather than a population. Within a true person-centered approach, the individual's cultural background is fundamental to effective care. CONCLUSIONS: From the findings, a model has been designed using the five dimensions and grounded in a person-centered care approach. This may help healthcare providers to identify weak points, as well as to improve the organization and healthcare professionals' ability to provide person-centered care to migrant patients. CLINICAL RELEVANCE: The proposed model facilitates identification of points of weakness in the care of migrant patients. Employing a person-centered care approach may contribute to improve health outcomes for migrant patients.

Dignity in nursing care: What does it mean to nursing students?

BACKGROUND:: Despite growing interest in the potential of nursing education to enhance dignity in nursing care, relatively little is known about what dignity means to nursing students. RESEARCH QUESTION:: What meaning does dignity in nursing care have for nursing students? RESEARCH DESIGN:: Photo-elicitation was embedded within a Nominal Group Technique and responses were analysed by qualitative and quantitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT:: Participants were recruited from each year of a 3-year undergraduate preregistration adult nursing programme in Scotland. In total, 31 nursing students participated in the study. ETHICAL CONSIDERATIONS:: The study was approved by the Ethics Committee of the School of Health, Nursing and Midwifery, University of the West of Scotland. FINDINGS:: Participants articulated the meaning of dignity in nursing care in terms of the relationships and feelings involved. A total of 10 categories of meaning were identified. DISCUSSION:: The significance of the nature of the nurse-patient interaction to preserving dignity in nursing care is highlighted. CONCLUSION:: Understanding the meaning of dignity for nursing students may help prepare future nurses more able to preserve dignity in nursing care.

Living with an indwelling urethral catheter in a community setting: Exploring triggers for unscheduled community nurse "out-of-hours" visits.

AIMS AND OBJECTIVE: To explore the experiences of community patients living with a urethral catheter and those caring for them. BACKGROUND: Living at home with an indwelling urethral catheter often results in consequences that create a double-edged burden: first, on patients and their relative carers and second, in terms of unscheduled community nurse service "out-of-hours" provision. DESIGN: One-to-one interviews were conducted with patients living at home, their relative carers, qualified community nurses, augmented home carers and healthcare assistant. Quantitative data in relation to frequency, duration and reason for visits were extracted from the community nurse "out-of-hours" service database. RESULTS: Quantitative data showed that 20% of all community nurses unscheduled "out-of-hours" visits were triggered by an indwelling urethral catheter consequence. Qualitative data revealed that health and social care staff felt knowledgeable and skilled in urethral catheter management. Conversely, patients and relative carers felt poorly equipped to manage the situation when something went wrong. The majority of patients described the catheter as being a debilitating source of anxiety and pain that reduced their quality of life. CONCLUSION: Urethral catheter complications are frequent and impact seriously on quality of life with informal carers also affected. Community nurses experienced frequent unscheduled visits. Patients often feel isolated as well as lacking in knowledge, skills and information on catheter management. Having better urethral catheter information resources could increase patient and relative carer confidence, encourage self-care and problem solving, as well as facilitate meaningful consistent dialogue between patients and those who provide them with help and support. RELEVANCE TO CLINICAL PRACTICE: Better patient information resources regarding urethral catheter management have potential to improve patient and relative carer quality of life and reduce service provision burden.

Digital skills training in care homes: achievement.

This article describes digital skills training (DST) for staff and later, residents, as part of a programme of culture change in a large care home with nursing in Glasgow. It presents the successes and challenges arising from DST from the perspectives of the two volunteer information technology (IT) champions (Thomas Sloan and John Thomson), who were also staff members. Using their written reports, questionnaires and subsequent conversations, the IT champions recall the challenges and gains for staff and residents as a result of their initial training. This is supplemented by a follow-up on IT activities in the 18 months after the introduction period.

Culture change in care homes: development and facilitation.

This article is the second of a two-part series that explores a programme of culture change in care homes. In this article, the authors describe their independent development and facilitation of a flexible learning programme for care homes, designed to meet a quality improvement request made by a care home company. The two selected care homes' staff conducted a review of their care culture, as a precursor to their creation of a new care philosophy. These activities provided a firm foundation from which the homes could, in theory, become a Remedial Enterprise Active Learning care home. Although the learning programme was not completed due to unavoidable circumstances, the staff's experiences highlight some of the challenges and successes that may be experienced when seeking to improve care homes' learning culture and practice.

Culture change in care homes: a literature review.

This article is the first of a two-part series that explores a programme of culture change in care homes. A UK care home company sought the authors' expertise to design and facilitate an independent programme of learning to encourage and support staff in two of its homes to become the architects of their own quality improvement. The article reviews the literature that was an essential information base for the authors in their dual roles as designers of the learning programme and facilitators of its delivery to participant staff. The literature is necessarily broad in reflecting the nature and context of care homes, residents' needs and wants from care, and the particular challenges that might be faced by care home staff and managers when making quality improvements. In the second article, the reality of running the programme in the two homes is described.

Implementing digital skills training in care homes: a literature review.

This article is the first of a two-part series that informs and describes digital skills training using a dedicated console computer provided for staff and residents in a care home setting. This was part of a programme of culture change in a large care home with nursing in Glasgow, Scotland. The literature review shows that over the past decade there has been a gradual increase in the use of digital technology by staff and older people in community settings including care homes. Policy from the European Commission presents a persuasive argument for the advancement of technology-enabled care to counter the future impact of an increased number of people of advanced age on finite health and social care resources. The psychosocial and environmental issues that inhibit or enhance the acquisition of digital skills in care homes are considered and include the identification of exemplar schemes and the support involved.

Ethical issues when involving people newly diagnosed with dementia in research.

AIM: To discuss the methodological and ethical review challenges encountered by researchers who want to enable people with dementia to be involved in research. BACKGROUND: There has been increasing recognition of the importance of involving people with dementia in research. However, an argument has centred on the protection of these vulnerable clients versus their freedom to be involved as participants in research. People with dementia do have the right to have their experiences explored. Involving this client group in research is essential to gain a true understanding of their needs. DATA SOURCES: The lead author's experience of conducting a study in which people newly diagnosed with dementia were recruited as research participants. REVIEW METHODS: An interpretive phenomenological approach was adopted during this qualitative study, with data collected by means of one to one interviews with people newly diagnosed with dementia. DISCUSSION: This study was completed within the set timeframe, but a large part of the work was spent gaining ethical approval. This meant that the timeframe of the study period was reduced and as a result, it was only possible to recruit three participants. However, people with dementia are perhaps one of the most vulnerable client groups and it is only right that they should not be subjected to harm. CONCLUSION: Ethical review is an important part of research. Meeting the ethical requirements of research involving people with dementia requires time and careful preparation to ensure that researchers safeguard the interests of this vulnerable client group, while also allowing the participants the opportunity to exercise their autonomy to their fullest potential. IMPLICATIONS FOR RESEARCH/PRACTICE: Conducting research that involves people with dementia may be time consuming, but it is only fair that this client group are afforded the freedom to be involved in research. This small time-limited study points to the need for larger pilot studies to hear from individuals what needs they have following a diagnosis of dementia.

A study of the lived experiences of registered nurses who have provided end-of-life care within an intensive care unit.

BACKGROUND: End-of-life care (EOLC) in the intensive care unit (ICU) has received little attention in the literature in comparison to the considerable amount of existing literature available on EOLC in other areas of nursing. The ethos of the ICU is to preserve life, but as many patients die in this environment, EOLC should be an integral part of the ICU nurse's role. This qualitative study explored the experiences of ICU nurses who had provided EOLC to patients and their families. METHOD: Participants were purposively recruited within one local ICU (n=5). A semi-structured interview format was used to guide in-depth interviews. FINDINGS: The themes identified from the interview analysis were; use of integrated care systems, communication, the environment, education and training, staff distress. CONCLUSIONS: The findings suggest that ICU nurses do not feel adequately prepared to give proficient EOLC. Those who felt more confident in EOLC had learned what to do over time. Appropriate training, support and improved communication between staff, patients and families is necessary for good EOLC in ICUs.

Attitudes towards caring for older people in Scotland, Sweden and the United States.

AIM: To explore the attitudes of nurses and nursing students in Scotland, Sweden and the US towards working with older people. METHOD: This quantitative study used the 20-item Multifactorial Attitudes Questionnaire (MAQ) to elicit attitudes on ageism, resources, working environment, education and professional esteem. Researchers from each country distributed the questionnaires to nursing students and nurses, giving a convenience sample of 1,587 respondents. Data were entered on the Statistical Package for Social Sciences version 18 and merged into one large dataset. RESULTS: Scottish participants had the highest (positive) and Swedish participants the lowest mean MAQ score. The Kruskal-Wallis test showed significant differences in mean scores across the countries in 18 of the 20 statements, even when controlling for age and experience. Most participants gave positive responses, but agreed that negative attitudes towards working with older people pervade among peers due to working conditions, poor career prospects and a perceived lack of professional esteem. CONCLUSION: Inspirational educators, excellent clinical placements and increasing the professional esteem of those working with older people are required to promote the specialty as an attractive career option.

Is age discrimination a risk factor for frailty progression and frailty development among older adults? A prospective cohort analysis of the English Longitudinal Study of Ageing.

BACKGROUND: With the increasing global burden of frailty on healthcare resources, it is important to understand the modifiable risk factors of frailty. This study examined perceived age discrimination as a potential risk factor for frailty progression and frailty development among older adults. METHODS: Prospective cohort study using data from Waves 5 to 9 of the English Longitudinal Study of Ageing (ELSA). Data on perceived age discrimination was collected only in Wave 5 of ELSA and analysed as baseline data in this study. Frailty was defined using the Frailty Index (FI) scores (0 to 1), calculated using the multidimensional deficits (scores ≥ 0.25 were considered frail). Binomial generalised estimating equation models (GEE) were fitted in R studio using perceived age discrimination as the main predictor with age, gender, long-standing illness, cognition, subjective social status status (SSS) and psychological wellbeing as covariates. Odd ratios were reported with 95 % confidence intervals (CI). RESULTS: A total sample of 2,385 ELSA participants were included in the analysis. 55.8 % (n = 1312) were female, mean age 71.9 (SD ± 5.27) years and baseline frailty prevalence was 12.1 % (n = 288). Perceived age discrimination was reported by 38.4 % (n = 916) of the participants. Both frailty progression (OR 1.50, CI [1.26- 1.70]) and frailty development (OR 1.39, CI [1.14-1.62]) were significantly associated with perceived age discrimination in the fully adjusted models. Age (80+ years) (OR 3.72, CI [2.84-4.86]) and long-standing illness (OR 5.45, CI [4.43-6.67]) had the strongest association with respondents' frailty progression. CONCLUSION: Perceived age discrimination significantly increased the risk of frailty progression and frailty development among ELSA participants.

Attitudes towards caring for older people: literature review and methodology.

Care of older people is often referred to as a 'Cinderella' service and is not seen as an attractive career option in health care, but with the global population continuing to age, caring for this group will become increasingly important. This article outlines the literature that formed the basis for two studies investigating the attitudes of healthcare staff towards working with older people, including respondents' perceptions of other healthcare professionals' attitudes toward this important area of work. The Multifactorial Attitudes Questionnaire was designed to examine five major themes identified from the literature: ageism; learning environment; working environment; professional esteem; and specialist status. This study is presented in two parts: this article discusses the literature and the design of the questionnaire. The second article, to be published in a subsequent issue of the journal, presents the results from two studies done in Scotland, the first in 1999, with a replication study in 2009.

Attitudes towards caring for older people: findings and recommendations for practice.

AIM: To investigate the attitudes of healthcare professionals towards working with older people, including their perception of how other professionals perceived their work in gerontology. METHOD: Data were collected using a 20-item Multifactorial Attitudes Questionnaire (MAQ) in the West of Scotland with a five-point Likert scale for responses ranging from strongly agree to strongly disagree. Questionnaires were distributed to hospitals and community settings by post and by hand in 1999 and 2009, and also by email in 2009. RESULTS: In total, 376 healthcare staff working in primary and secondary services not exclusive to older people completed the MAQ in 1999, and 546 staff responded in 2009. The results showed that, although the respondents in 1999 and 2009 were enthusiastic and positive in their approach towards caring for older people, their work carried little professional kudos. Working conditions and the working environment were regarded as detrimental to recruitment of staff in gerontology, and respondents did not think that other health professionals valued their gerontological expertise. CONCLUSION: The use of the MAQ in 1999 and 2009 enabled a comparative analysis of two studies completed a decade apart. Comparison of the MAQ results from 1999 and 2009 show that attitudes towards the care of older people as a recognised specialism have remained largely unchanged, despite a decade of major policy changes to include gerontology in pre- and post-registration nurse training. This finding does not bode well for attracting nurses into a career in gerontology. As a consequence, with increasing numbers of older people living in Scotland, and worldwide, the care and wellbeing of this group may be compromised at a time when it is most needed. The lead author (AK) has used the MAQ for an international study with colleagues from Germany, Sweden, Japan, Slovenia and the US, the results of which will be available shortly.

An exploration of palliative care provision in Scottish care homes.

This paper suggests that there is an imbalance between the ideal and the actual palliative care provision for some older people living and dying in care homes in Scotland. Successive studies demonstrate that care home residents are increasingly frail and disabled. Many experience challenging physical and psychosocial symptoms which could benefit from a palliative approach to alleviate suffering and promote comfort. However, palliative needs for people with non-malignant conditions, such as dementia, can be complex, and not easily identified or managed. A range of challenging factors currently impact palliative care provision for care home residents in Scotland including: the insufficiency of robust NHS healthcare support, the skill mix of the care home workforce, and the promotion of palliative tools as the primary means of improving the quality of palliative care in non-specialist settings. Issues highlighted in this paper give cause for concern on a number of levels, particularly as the demand for palliative care in care homes is likely to increase in the near future. Therefore, sustained collaborative effort from leaders in the health, social and care home sectors is recommended if practical solutions are to be found for this vulnerable population.

A new model of care for the older person.

This first in a three-part series explores the nature of the caring relationship between caregivers and older people in nursing and residential homes. It proposes a revision of the Caring For and Caring About model. Using this model, where appropriate, staff move their care approach from a protective focus of "caring for" residents to a remedial focus of "caring about" them; the latter aims to promote self-help and autonomy as much as possible.

Implementing a care model for the older person.

This second in a three-part series shows how to use the Caring For and Caring About model in practice. Part 1, published last week, described the model; part 3, to be published online on 10 April, shows how to manage care using existing resources.