Nurses Perceptions of Resources to Improve the Quality of Palliative - - PowerPoint PPT Presentation

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 14th – 15th 2014, Saskatoon Saskatchewan

• Dr. Kelly Penz

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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)

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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)

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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)

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Research Question

What are nurses’ experiences of their work-related demands/resources and personal resources within the context

• f palliative and end of life care

practice in Saskatchewan?

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Methods: Design

Interpretive Description methodology

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Methods: Recruitment and Procedure

 Purposeful sampling  Saskatchewan Hospice Palliative Care

Association Annual Conference

 Open-ended interviewing techniques  Writing exercise

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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?

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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

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Preliminary Findings: Sample

 Variety of practice settings (acute, long-

term care, community), geographical locations (rural/urban), nursing positions represented

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Findings: Work-related Resources

• 1. Healthy Environmental Climate

a) Access to appropriate spaces b) Resources, Equipment and Supplies c) Leadership, Recognition and

Feedback

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• 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.”

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• 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.”

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• 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?...”

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Findings: Work-related Resources

• 2. Collaborative Family

Centered Teams a) Role Clarity b) Team Cohesiveness c) Collegial Support

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• 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.”

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• 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.”

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• 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.”

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Findings: Work-related Resources

• 3. Forming Bonds of Trust

a) Care recipient and their family members b) Quality of Communication

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• 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.”

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• 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.“

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Findings: Work-related Resources

• 4. Demystifying Palliation and

the Experience of Dying

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“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 .”

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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

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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

• f 2014

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26 College of Nursing University of Saskatchewan RN PARTICIPANTS NEEDED FOR RESEARCH ON PALLIATIVE AND END OF LIFE CARE

We are seeking volunteers to help us test a survey questionnaire on the

Professional Quality of Life of Registered Nurses Who Provide Palliative and End of Life Care in Saskatchewan We are seeking volunteers who: a) Are a Registered Nurse (RN). b) Have current or previous experience providing palliative and end of life care as part of their nursing role. The survey will take approximately 25-35 minutes to complete. * You may access the survey online at: https://usaskssrl.qualtrics.com/SE/?SID=SV_7Ty5bNXNQWyKgct This survey is part of a three year study funded by the Saskatchewan Health Research Foundation (SHRF). Please feel free to distribute this information as widely as possible to other RNs who you may think would like to participate. The overall study will explore areas such as the work characteristics, roles, work settings, resources and demands, and overall work life of nurses within the context of palliative and end of life care. The data that is collected through this pilot phase of the study will help us make decisions about shortening/modifying the larger survey tool that will be distributed throughout the province in the next phase of the overall project. Thank you for your help in participating AND/OR recruiting others for this pilot study. If you have any questions or concerns, please contact the Principal Investigator for the project Dr. Kelly Penz by phone 306-337-3812 or email kelly.penz@usask.ca.

This study has been reviewed by, and received approval through, the Research Ethics Office, University of Saskatchewan and Regina Qu’Appelle Health Region

Thank you

• Dr. Kelly Penz

kelly.penz@usask.ca

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