Home care nurses more positive about the palliative care that is provided and their own competence than hospital nurses: a nationwide survey

Abstract

Background People often prefer to stay at home until the end of life, but hospital admissions are quite common. In previous research bereaved relatives were found to be less positive about palliative care in hospital. However, it was not known how the content and quality of palliative care differ between home care and hospitals from the perspectives of hospital nurses and home care nurses and how palliative care in these settings could be improved. Methods A survey was held among hospital and home care nurses, recruited from a nationwide Nursing Staff Panel and through open calls on social media and in an online newsletter. The pre-structured online survey included questions on the palliative care provided, the quality of this care and the respondent’s perceived competence in providing palliative care. The questionnaire was completed by 229 home care nurses and 106 hospital nurses. Results Most nurses provided palliative care in the physical and psychological domains, fewer provided care in the social and spiritual domains. A higher percentage of home care nurses stated that they provided care in these domains than hospital nurses. Overall, 70% of the nurses rated the quality of palliative care as very good to excellent. This percentage was higher among home care nurses (76.4%) than hospital nurses (59.4%). Moreover, a higher percentage of home care nurses (94.4%) stated they felt competent to a great extent to provide palliative care compared to hospital nurses (84.7%). Competencies regarding the physical domain were perceived as better compared to the competencies concerning the other domains. The nurses recommended paying more attention to inter-professional collaboration and communication, timely identification of the palliative phase and advance care planning, and more time available for palliative care patients. Conclusion Although the quality of palliative care was rated as very good to excellent by nurses, improvements can still be made, particularly regarding palliative care in hospitals. Although patients often prefer to die at home rather than in hospital, still a considerable number of people do die in hospital; therefore hospital nurses must also be trained and be able to provide high-quality palliative care.

Timely Identification of Patients With Cancer and Family Caregivers in Need of End-of-Life Discussions by Home-Visit Nurses in Japan: A Qualitative Descriptive Study

“…Second, previous research indicated that a higher percentage of home-visit nurses stated that they provided care in the physical and psychological domains and discussed EOL decisions with patients than hospital nurses ( Joren et al, 2021 ). These results may support our findings that home-visit nurses assess patients’ physical and mental care needs in conjunction with determining the timing of EOL discussions.…”

“…In addition, it has been pointed out that although smaller percentages of nurses in both home care and hospitals provided care in the social and spiritual care domains, relatively more home-visit nurses provided care in these domains than hospital nurses ( Joren et al., 2021 ). This was similar to our findings that home-visit nurses paid attention to patients’ existential distress.…”

“…This was similar to our findings that home-visit nurses paid attention to patients’ existential distress. We believe this may be because feeling more secure at home and being able to discuss and talk about existential questions influences the provision of spiritual and social care ( Joren et al, 2021 ). Participants in our study included those with highly developed communication skills, such as certified nurse specialists and clinical specialists, allowing them to notice existential distress, which is an intangible symptom.…”

“…Home-visit nurses visit patients’ homes alone to provide care, including basic nursing care (bathing, toileting, and eating), skilled nursing care (physical assessment, injection, and pressure ulcer care), and EOL care in collaboration with primary physicians and health and social care professionals. Although a previous study has shown that a higher percentage of home-visit nurses discussed EOL decisions with patients compared with hospital nurses ( Joren et al, 2021 ), another reported that hospital nurses were more willing to engage in EOL discussions compared with home-visit nurses because of differences in work settings and level of nursing education ( Albers et al, 2014 ). Furthermore, another study reported that new graduate home-visit nurses experienced difficulties in understanding and providing care based on the patient’s needs ( Akiyama & Fukuyama, 2020 ), and that working at a home-visit nurse station was not a realistic option for them because it required specialized and extensive experience ( Abiodun et al, 2019 ; van Iersel et al, 2016 ).…”

Improvement of palliative care for people with intellectual disabilities: A multi‐site evaluation

“…The data sources that were used were: A questionnaire administered via email to professionals at the beginning (pre‐test) and end (post‐test) of the implementation period. The questionnaire items were based on a previously validated questionnaire on experiences with palliative care (Joren et al, 2021). The questionnaires were completed fully by 299 professionals at baseline (response 45.2%) and 250 professionals at the end of the intervention period (response 35.1%). Group interviews conducted at the end of the intervention period (YDM, ADV), using a topic list.…”