Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-06T06:47:45.010Z Has data issue: false hasContentIssue false

Rural community-based nurses’ self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers

Published online by Cambridge University Press:  13 October 2021

Eli Ristevski*
Affiliation:
Monash Rural Health Warragul, Monash University, Victoria, Australia
Michael Leach
Affiliation:
Monash Rural Health Bendigo, Monash University, Victoria, Australia
Ellen Bolton
Affiliation:
Monash Rural Health Warragul, Monash University, Victoria, Australia
Melissa Spargo
Affiliation:
Gippsland Region Palliative Care Consortium, Victoria, Australia
Anny Byrne
Affiliation:
Gippsland Region Palliative Care Consortium, Victoria, Australia
Hanan Khalil
Affiliation:
College of Science, Health & Engineering, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
*
Author for correspondence: Eli Ristevski, Monash Rural Health Warragul, Monash University, 15 Sargeant Street, Warragul, Victoria 3820, Australia. E-mail: [email protected]

Abstract

Objective

This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning.

Method

Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data.

Results

A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps.

Significance of results

Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Australian Bureau of Statistics (2017) 2016 Census QuickStats: Latrobe - Gippsland. Canberra, ACT: Australian Bureau of Statistics.Google Scholar
Australian College of Nursing (ACN) (2019) Achieving Quality Palliative Care for All: The Essential Role of Nurses . A White Paper by ACN 2019. Canberra: ACN.Google Scholar
Australian Commission on Safety and Quality in Health Care (2015) National Consensus Statement: Essential Elements for Safe and High-Quality End-of-Life Care. Sydney: ACSQHC.Google Scholar
Australian Institute of Health Welfare (2020) Palliative Care Services in Australia. Canberra: AIHW.Google Scholar
Bakitas, MA, Elk, R, Astin, M, et al. (2015) Systematic review of palliative care in the rural setting. Cancer Control 22(4), 450464.CrossRefGoogle ScholarPubMed
Benner, P (1982) From novice to expert. American Journal of Nursing 82(3), 402407.Google ScholarPubMed
Boerner, K and Schulz, R (2009) Caregiving, bereavement and complicated grief. Bereavement Care 28(3), 1013.CrossRefGoogle ScholarPubMed
Brazil, K, Kaasalainen, S, Williams, A, et al. (2014) A comparison of support needs between rural and urban family caregivers providing palliative care. American Journal of Hospice and Palliative Medicine 31(1), 1319.CrossRefGoogle Scholar
Broad, JB, Gott, M, Kim, H, et al. (2013) Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. International Journal of Public Health 58(2), 257267.CrossRefGoogle Scholar
Byrne, A, Barbeler, C and Earwicker, L (2019) Pathways to Palliative Care in Rural Victoria — Gippsland Region. Warragul, Victoria, Australia: Gippsland Regional Palliative Care Consortium, pp. 129.Google Scholar
Caxaj, CS, Schill, K and Janke, R (2018) Priorities and challenges for a palliative approach to care for rural indigenous populations: A scoping review. Health & Social Care in the Community 26(3), e329e336.CrossRefGoogle ScholarPubMed
Cole, MA and Foito, K (2019) Pediatric end-of-life simulation: Preparing the future nurse to care for the needs of the child and family. Journal of Pediatric Nursing 44, e9e12.CrossRefGoogle ScholarPubMed
Connolly, A, Burns, S, Allingham, S, et al. (2019) Patient Outcomes in Palliative Care in Australia: National Report for January – June 2019. Palliative Care Outcomes Collaboration. Australian Health Services Research Institute, University of Wollongong. https://ro.uow.edu.au/ahsri/1040.Google Scholar
Contro, NA, Larson, J, Scofield, S, et al. (2004) Hospital staff and family perspectives regarding quality of pediatric palliative care. Pediatrics 114(5), 12481252.CrossRefGoogle ScholarPubMed
Coroners Court of Victoria (2019) Reportable Deaths. Available at: https://www.coronerscourt.vic.gov.au/report-death-or-fire/reportable-deaths.Google Scholar
Desbiens, J-F and Fillion, L (2011) Development of the palliative care nursing self-competence scale. Journal of Hospice & Palliative Nursing 13(4), 230241.CrossRefGoogle Scholar
Eriksson, G, Bergstedt, TW and Melin-Johansson, C (2015) The need for palliative care education, support, and reflection among rural nurses and other staff: A quantitative study. Palliative & Supportive Care 13(2), 265.CrossRefGoogle ScholarPubMed
Friedrichsdorf, SJ, Remke, S, Hauser, J, et al. (2019) Development of a pediatric palliative care curriculum and dissemination model: Education in Palliative and End-of-Life Care (EPEC) Pediatrics. Journal of Pain and Symptom Management 58(4), 707-720.e703.CrossRefGoogle ScholarPubMed
Gomes, B, Calanzani, N, Gysels, M, et al. (2013) Heterogeneity and changes in preferences for dying at home: A systematic review. BMC Palliative Care 12(1), 7.CrossRefGoogle ScholarPubMed
Green, A, Jerzmanowska, N, Thristiawati, S, et al. (2019) Culturally and linguistically diverse palliative care patients’ journeys at the end-of-life. Palliative and Supportive Care 17(2), 227233.CrossRefGoogle ScholarPubMed
Hosmer, DWJ, Lemeshow, S and May, S (2008) Applied Survival Analysis, 2nd ed. New York: John Wiley & Sons.CrossRefGoogle Scholar
IPEPA Project Team (2020) PEPA Cultural Considerations Providing End-of-Life Care for Aboriginal peoples and Torres Strait Islander Peoples.Google Scholar
Johnston, G, Vukic, A and Parker, S (2013) Cultural understanding in the provision of supportive and palliative care: Perspectives in relation to an indigenous population. BMJ Supportive & Palliative Care 3(1), 6168.CrossRefGoogle Scholar
Kaasalainen, S, Brazil, K, Willison, K, et al. (2011) Palliative care nursing in rural and urban community settings: A comparative analysis. International Journal of Palliative Nursing 17(7), 344352.CrossRefGoogle Scholar
Kaye, EC, Applegarth, J, Gattas, M, et al. (2020) Hospice nurses request paediatric-specific educational resources and training programs to improve care for children and families in the community: Qualitative data analysis from a population-level survey. Palliative Medicine 34(3), 403412.CrossRefGoogle ScholarPubMed
Khalil, H, Byrne, A and Ristevski, E (2019) The development and implementation of a clinical skills matrix to plan and monitor palliative care nurses’ skills. Collegian 26(6), 634639.CrossRefGoogle Scholar
Kirby, S, Barlow, V, Saurman, E, et al. (2016) Are rural and remote patients, families and caregivers needs in life-limiting illness different from those of urban dwellers? A narrative synthesis of the evidence. Australian Journal of Rural Health 24(5), 289299.CrossRefGoogle Scholar
Kruger, J and Dunning, D (1999) Unskilled and unaware of it: How difficulties in recognizing one's own incompetence lead to inflated self-assessments. Journal of Personality & Social Psychology 77(6), 11211134.CrossRefGoogle ScholarPubMed
Luckett, T, Phillips, J, Agar, M, et al. (2014) Elements of effective palliative care models: A rapid review. BMC Health Services Research 14(1), 136.CrossRefGoogle ScholarPubMed
Mitchell, AJ (2013) Screening for cancer-related distress: When is implementation successful and when is it unsuccessful? Acta Oncologica 52(2), 216224.CrossRefGoogle ScholarPubMed
Monterosso, L, Kristjanson, L and Phillips, M (2009) The supportive and palliative care needs of Australian families of children who die from cancer. Palliative Medicine 23(6), 526536.CrossRefGoogle Scholar
Palliative Care Australia (2018) National Palliative Care Standards, 5th ed. Canberra: PCA.Google Scholar
Periyakoil, VS, Neri, E and Kraemer, H (2016) Patient-Reported barriers to high-quality, end-of-life care: A multiethnic, multilingual, mixed-methods study. Journal of Palliative Medicine 19(4), 373379.CrossRefGoogle ScholarPubMed
Pesut, B, Potter, G, Stajduhar, K, et al. (2015) Palliative approach education for rural nurses and health-care workers: A mixed-method study. Internation Journal of Palliative Nursing 21(3), 142151.CrossRefGoogle ScholarPubMed
Phillips, JL, Piza, M and Ingham, J (2012) Continuing professional development programmes for rural nurses involved in palliative care delivery: An integrative review. Nurse Education Today 32(4), 385392.CrossRefGoogle ScholarPubMed
Pidgeon, TM, Johnson, CE, Lester, L, et al. (2018) Perceptions of the care received from Australian palliative care services: A caregiver perspective. Palliative and Supportive Care 16(2), 198208.CrossRefGoogle ScholarPubMed
Redshaw, S, Harrison, K, Johnson, A, et al. (2013) Community nurses’ perceptions of providing bereavement care. International Journal of Nursing Practice 19(3), 344350.CrossRefGoogle ScholarPubMed
Ristevski, E, Breen, S and Regan, M (2011) Incorporating supportive care into routine cancer care: The benefits and challenges to clinicians’ practice. Oncology Nursing Forum 38(3), E204E211.CrossRefGoogle ScholarPubMed
Ristevski, E, Regan, M, Jones, R, et al. (2015) Cancer patient and clinician acceptability and feasibility of a supportive care screening and referral process. Health Expectations 18(3), 406418.CrossRefGoogle ScholarPubMed
Rose, C, Wainwright, W, Downing, M, et al. (2011) Inter-rater reliability of the bereavement risk assessment tool. Palliative & Supportive Care 9(2), 153164.CrossRefGoogle ScholarPubMed
Sawatzky, R, Roberts, D, Russell, L, et al. (2021) Self-perceived competence of nurses and care aides providing a palliative approach in home, hospital, and residential care settings: A cross-sectional survey. Canadian Journal of Nursing Research 53(1), 6477.CrossRefGoogle ScholarPubMed
Schill, K and Caxaj, S (2019) Cultural safety strategies for rural indigenous palliative care: A scoping review. BMC Palliative Care 18(1), 21.CrossRefGoogle ScholarPubMed
Shahid, S, Taylor, EV, Cheetham, S, et al. (2018) Key features of palliative care service delivery to indigenous peoples in Australia, New Zealand, Canada and the United States: A comprehensive review. BMC Palliative Care 17(1), 72.CrossRefGoogle ScholarPubMed
Shimizu, M, Nishimura, M, Ishii, Y, et al. (2016) Development and validation of scales for attitudes, self-reported practices, difficulties and knowledge among home care nurses providing palliative care. European Journal of Oncology Nursing 22, 822.CrossRefGoogle ScholarPubMed
Silva, MD, Genoff, M, Zaballa, A, et al. (2016) Interpreting at the end of life: A systematic review of the impact of interpreters on the delivery of palliative care services to cancer patients With limited English proficiency. Journal of Pain and Symptom Management 51(3), 569580.CrossRefGoogle ScholarPubMed
Singer, AE, Goebel, JR, Kim, YS, et al. (2016) Populations and interventions for palliative and end-of-life care: A systematic review. Journal of Palliative Medicine 19(9), 9951008.CrossRefGoogle ScholarPubMed
Slater, PJ, Herbert, AR, Baggio, SJ, et al. (2018) Evaluating the impact of national education in pediatric palliative care: The quality of care collaborative Australia. Advances in Medical Education and Practice 9, 927941.CrossRefGoogle ScholarPubMed
Slåtten, K, Hatlevik, O and Fagerström, L (2014) Validation of a new instrument for self-assessment of nurses’ core competencies in palliative care. Nursing Research and Practice 2014, 615498.CrossRefGoogle ScholarPubMed