Nurses’ Perceptions of Resources to Improve the Quality of Palliative and End of Life Care in Saskatchewan Practice Settings SHPCA Annual Conference 2014 “All Ages, All Stages: Transitions in the Continuum of Hospice Palliative Care” May 14 th – 15 th 2014, Saskatoon Saskatchewan Dr. Kelly Penz 1
2 Background By 2025, death rates in Canada are projected to increase to approximately 310,000 per year, greater than 50% increase from the year 2000 (Statistics Canada, 2010) Considerable disparity between the growing demand for palliative and end of life (P/EOL) and the health care systems capacity to provide this care (Carstairs, 2005; Parliamentary Committee on Palliative and Compassionate Care, 2011) Many nurses in rural and urban settings feel inadequately prepared or under-resourced in caring for dying patients (Martens, 2009; Rose & Glass, 2006)
3 Background Job Demands Job Resources as part of nurses’ “Professional Quality of Life” “Job or work -related demands are defined as the physical, psychological, social and/or organizational aspects of the job that require sustained cognitive and/or emotional effort and are associated with job related stress” (Demerouti & Bakker, 2011)
4 Background “Job or work -related resources are defined as the physical, psychological, social and/or organizational aspects of the job that reduce demands, and stimulate professional growth” (Demerouti & Bakker, 2011)
5 Research Question What are nurses’ experiences of their work-related demands/resources and personal resources within the context of palliative and end of life care practice in Saskatchewan?
6 Methods: Design Interpretive Description methodology
7 Methods: Recruitment and Procedure Purposeful sampling Saskatchewan Hospice Palliative Care Association Annual Conference Open-ended interviewing techniques Writing exercise
8 Methods: Interview Guide 1. What do you consider your most significant demands when you are providing palliative and/or end of life care? Prompt: What are the aspects of your work that make it difficult to provide quality palliative and/or end of life care? 2. What are the key resources that are present in your work that help you to provide palliative and/or end of life care? Prompt: What are the aspects of your work that help you the most to provide quality palliative and/or end of life care? 3. What personal resources are present in your life that help you to work with patients receiving palliative care and their families? Prompt: What personal aspects/traits of yourself help you to work in this area?
9 Methods: Analysis All interviews and written exercises were transcribed verbatim for analysis Critical analysis for broad categories of themes/patterns Selective organizing and sorting for what is meaningful in the data
10 Preliminary Findings: Sample Variety of practice settings (acute, long- term care, community), geographical locations (rural/urban), nursing positions represented
11 Findings: Work-related Resources 1. Healthy Environmental Climate a) Access to appropriate spaces b) Resources, Equipment and Supplies c) Leadership, Recognition and Feedback
12 1. Healthy Environmental Climate a) Access to Appropriate Spaces “We have an excellent palliative set up in our hospital… we have what we call a family room… so we have room that they can, you know, make little meals, they can stay just right there with their family; it’s awesome; it’s the perfect set - up.”
13 1. Healthy Environmental Climate b) Resources, Equipment & Supplies “I’ll set up the admission. We have charts premade so we have like the palliative charts all ready to go with the pain scale and all the papers that I need. And we have [type of] packages, the sub-q sites all ready to go. And little things that are written, the nutritional packages… I can just do a real quick grab and, and off I go.”
14 1. Healthy Environmental Climate c) Leadership, Recognition, & Feedback “We had the best nursing director out here …within a few weeks of being there, she knew what everybody in [specific setting], and what everybody in the hospital was doing…and what kind of a job they were doing and she was just phenomenal, you know?...”
15 Findings: Work-related Resources 2. Collaborative Family Centered Teams a) Role Clarity b) Team Cohesiveness c) Collegial Support
16 2. Collaborative Family Centered Teams a) Role Clarity “I really truly appreciate that it is a multi-disciplinary team. Because at our weekly palliative meetings, we will talk…We have a family doctor on our team and [name] is just a great physician. I really respect [their] opinion… And uh, so I’ll just say, you know, this is what I’m seeing, what do you guys think.”
17 2. Collaborative Family Centered Teams b) Team Cohesiveness “Perhaps there’s a trust borne of experience now with our palliative care team…we respect best practice gold standard… and that our altruistic, that our internal motivation is only, for that patient.”
18 2. Collaborative Family Centered Teams c) Collegial Support “[a resource] I think is having those of us who frequently work [in the area of palliative care] be there, be available, bounce ideas off of each other. Co-workers as resources are probably the most fragile, but also the most important resources that we have.” “We really are a resilient bunch. We just take joy in what we do. I am so blessed, to be where I’m at with the nurses that I work with… because it’s the best place on the planet.”
19 Findings: Work-related Resources 3. Forming Bonds of Trust a) Care recipient and their family members b) Quality of Communication
20 3. Forming Bonds of Trust a) Care Recipient and their Family Members “[Families]… some are terrific support systems . It makes a tremendous difference…it almost feels like they’re part of the team too. And, I think it’s better for them too, because then they are more pro- active in what’s happening…I think it’s good for everybody.”
21 3. Forming Bonds of Trust b) Quality of Communication “…the referrals are really well read and [co - worker] goes through them with a fine tooth comb… to make sure that everything’s picked up, and then it comes to my desk.” “…we’re there to try and provide comfort, care, quality of life and sorting through how to deal with what’s at hand. We have to establish a sense of trust with both the family and the client. That takes time.“
22 Findings: Work-related Resources 4. Demystifying Palliation and the Experience of Dying
23 “Death is also a very important time and it’s a privilege to be able to share with people.” “They have the idea…in 14 days if they are palliative, they should be dead and that is just not the way it works… Sometimes it feels like, you hear the word “palliative care” and you think death, but really it’s, you know, people can receive palliative pain control, palliative symptom management for years, sometimes …and, really it’s not about end of life, it’s part of it .”
24 Next Steps Foundation research grant application for large- scale, mixed-methods study of the professional quality of life of RNs who provide P/EOL care in Saskatchewan (March 2013) June 2013: Funded by the Saskatchewan Health Research Foundation (SHRF) Establishment Grant for 3 years (Oct 2013-Sept 2016, $119,859) (Kelly Penz, Donna Goodridge, & Laurie Hellsten) Important data for conceptual framework and development of new scales to measure the Practice- Demands, Practice-Resources, and Personal- Resources for nurses who provide P/EOL care
25 Pilot Testing of Professional Quality of Life Survey Pilot testing of an online survey questionnaire began in March 2014 Seeking RNs who have current or previous experience providing P/EOL care as part of their role Online survey includes: Demographics questions Practice characteristics Work Related Resources Work Related Demands Personal Resources Pilot data will inform the development of the full survey to be distributed to RNs provincially in the fall of 2014
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