Integration of a Palliative Approach in Home, Acute Medical, and Residential Care Settings: Findings from a Province-Wide Survey
iPANEL investigators have conducted a mixed-methods province-wide survey of registered nurses (RNs), licensed practical nurses (LPNs) and health care workers in three settings: acute medical units, residential care facilities and home care settings. The results of this survey provides descriptive information relevant to implementing a palliative approach to better serve the needs of people with advancing chronic life-limiting conditions.
Supporting people with advancing chronic and life-limiting conditions will be a dominant challenge for healthcare delivery in the next half-century. The Initiative for a Palliative Approach in Nursing: Evidence and Leadership (www.iPANEL.ca) is a practice-relevant nursing health services research initiative funded by the Michael Smith Foundation for Health Research to inform how we can best integrate a palliative approach into the care of people with advancing chronic life-limiting conditions. This iPANEL report focuses on findings from a mixed-methods province-wide survey designed to obtain baseline descriptive information relevant to the integration of a palliative approach from Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Healthcare Workers (HCWs) in acute medical care units, residential care facilities, and home care settings.
The survey included 114 randomly selected healthcare settings equally drawn from a listing of all eligible settings in five regional health authorities. A total of 1,468 RNs, LPNs, and HCWs across urban and rural settings completed the survey questionnaire. Additionally, 25 nurses (either RNs or LPNs), and 5 HCWs participated in follow-up qualitative interviews.
The following summary recommendations are supported by the survey findings and provide important information for regional health authorities regarding the integration of a palliative approach. These findings will also inform ongoing iPANEL research into the care delivery systems, education, and practice supports needed to integrate a palliative approach.
- Improved recognition of the life-limiting nature of chronic conditions is needed, most urgently by nurses in acute medical care units, but also by nurses and HCWs in home care and residential care settings. On average, RNs, LPNs, and HCWs in acute medical care and home care settings identified only half of their patients as having life-limiting conditions. In residential care settings nurses and HCWs on average identified approximately 70% of the residents as having life-limiting conditions. Given the high prevalence of chronic life-limiting conditions in the sampled acute medical care units, a higher percentage was expected. Similarly, given that nearly all people admitted to residential care have chronic life-limiting conditions, it was expected that closer to 100% of staff would recognize that nearly all patients are on a progressive illness trajectory that will end their lives.
- There is a need for consistent application of a palliative approach for people with chronic life-limiting conditions in all settings. A palliative approach is not consistently applied by all RNs, LPNs and HCWs in acute medical, home, and residential care settings. Infrequent application of a palliative approach in acute care environments is of particular concern. RNs and LPNs in acute care reported providing a palliative approach to only 50% of patients who they identified as having chronic life-limiting conditions.
- There is a need for improved confidence and knowledge regarding a palliative approach focussing on spiritual, psychological, social, loss & grief support needs, and ethical & legal issues. Nurses and HCWs reported feeling least confident and knowledgeable in areas of spiritual and social needs and ethical and legal issues. These areas are dimensions of care addressed through conversation and relationship with patients and families. Nurses and HCWs feel most confident in the physical care of patients, as well as in personal, professional and inter-professional collaboration.
- Interactional approaches to learning that draws on expertise of colleagues, managers, clinical coordinators and nurse specialists are foundational to the way that nurses and HCWs learn about how to apply a palliative approach in their practice. Nurses and HCWs rely heavily on colleagues to inform their practice of a palliative approach. In addition, face-to-face learning is the most preferred method for receiving education for nurses and HCWs across settings.
Download a copy of the full report for more information: Integration of a Palliative Approach in Home, Acute Medical, and Residential Care Settings: Findings from a Province-Wide Survey.
Life-limiting conditions: Chronic conditions (or illnesses) expected to limit how long a person has to live, including dementia, lung, kidney and heart diseases, and cancer.
Palliative approach: An approach to care focused on improving the quality of life of people with life-limiting conditions and their family. It is provided in all healthcare settings. It involves physical, psychological, social and spiritual care. The palliative approach is not delayed until the end stages of an illness but is applied earlier to provide active comfort-focused care and a positive approach to reducing suffering. It also promotes understanding of loss and bereavement.