Results of a province-wide survey
By Richard Sawatzky, RN, PhD; Kelli Stajduhar, RN, PhD; and Della Roberts, RN, MSN
The rising number of people who will be facing old age makes it likely that nursing support for persons with advancing chronic and life-limiting illness will be a dominant challenge for health care delivery in the next half-century. Most individuals with advancing chronic and life-limiting illness do not access palliative care services but would greatly benefit from the application of the principles of palliative care (a palliative approach).
By incorporating a palliative approach in care, nurses can better support people with life-limiting conditions and their families. This approach to care involves the application of palliative care principles, upstream, by healthcare professionals, to address the quality of life concerns and suffering of people who have advancing chronic life-limiting illness, regardless of their context of care and stage in the disease trajectory. A palliative approach can be provided in any care setting by healthcare professionals, from a range of disciplines, who do not necessarily specialize exclusively in palliation, including residential care, home care, hospital in-patient and out-patient care, and primary care.
As part of our Initiative for a Palliative Approach in Nursing: Evidence and Leadership (www.iPANEL.ca; funded by the Michael Smith Foundation for Health Research – BC Nursing Research Initiative), our team has completed a mixed-methods province-wide survey to obtain perspectives from nurses and healthcare
workers about a palliative approach in BC nursing care settings. All registered nurses, licensed practical nurses, care aides and community health workers (N = 1,468) in 114 randomly sampled acute medical, residential care and home health settings in five BC Health Authorities were invited to complete a questionnaire about their competencies, education, and application of a palliative approach and to participate in qualitative interviews.
A stratified and clustered sampling approach was used to obtain provincial coverage of both urban and rural settings across the province. The survey questionnaire included the 50-items of the Self-Perceived Palliative Care Nursing Competencies instrument (JF Desbiens) that measures nurses’ self-perceived competence in dimensions of palliative care; questions about the sources and adequacy of educational preparation and knowledge for a palliative approach; questions regarding the extent to which a palliative approach is integrated; and questions about characteristics of the nursing care setting, work environment and demographics.
The results revealed substantial variability in the extent to which nurses and healthcare workers integrate a palliative approach into their care. This variability was explained in part by the extent to which nurses and healthcare workers identify their patients as having a life-limiting chronic condition. The integration of a palliative approach was also significantly explained by self-perceived competence in addressing important needs of patients with life-limiting chronic conditions.
Though nurses and healthcare workers reported feeling quite confident in most aspects of care, they felt relatively less confident in addressing spiritual needs, social needs, ethical and legal issues, and in applying interventions to relieve complex symptoms and support family caregivers. The qualitative interviews helped to further enrich understandings of experiences and challenges related to a palliative approach.
We are now using the survey results to inform the next phases of our iPANEL research program, and to identify settings in particular need of attention. Survey findings along with several other funded iPANEL studies will help us to address our overarching research question: How and in which contexts can a palliative approach better meet the needs of patients with a life-limiting illness and their family members and guide the development of innovations in health care delivery systems to better support nursing practice.
Richard Sawatzky is an Associate Professor at the School of Nursing, Trinity Western University. Kelli Stajduhar is a Professor at the UVic School of Nursing and Centre on Aging. Della Roberts, is an Adjunct Professor at the University of British Columbia School of Nursing.
From the 2013 Spring Communiqué — Palliative Care
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