Palliative Care Service Situation of Palliative Care Ward Nurses in Srinagarind Hospital

Abstract

Introduction Exploring the situation of palliative care services led by palliative care ward nurses (PCWNs) will lead to the development of more efficient and effective palliative care services.

Objectives To describe the provision of palliative care services by PCWN in the nursing department at Srinagarind Hospital 

Design A cross-sectional descriptive design 

Methodology This study was conducted in a population of 103 PCWPs who met the inclusion criteria. Data were collected using a questionnaire developed based on the nurse role effectiveness model by Lukewich et al. The questionnaire consisted of three dimensions: 1) Structure included personal data, organization data consisting of policy, support from the administrative team in delivering services according to the nurse’s role, and support for training; 2) Process included challenges and needs related to providing palliative care services following the major role of nurses, and 3) Outcomes consisted of outcomes of the nurses’ role in palliative care, including assisting patients and families access to palliative care, setting palliative care indicators such as pain and discomfort management, and patient and family satisfaction. The questionnaire was examined by three experts, yielding an index of item objective congruent of .85. The researchers distributed the questionnaire for self-administration by the participants, and data were collected from December 2022 to February 2023. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using simple content analysis. 

Results Almost half of the participants aged 31-40 (47.5%) worked at a practitioner level (57.0%). Most of them worked for more than 10 years (81.6%), worked as PCWNs for 7-10 years (40.8%), and were trained for 6-week palliative care training (51.5%). Organizational information included 1) policy for training support from the administrative team. The PCWNs had a perception of policy on the organization’s palliative care (90.3%), perceived that policy transmitted through the headward and that a palliative care center is a core unit for training for hospital staff; 2) On average, each ward had 1-2 PCWNs (61.2%) providing care to 3-5 patients per month (43.7%). Regarding the process, challenges and obstacles included 1) Support from the administrative team including limited support, lack of clear role definitions and work instructions, and lack of continuous training for skill enhancement; 2) Support from teams of all professions consisting of lack of knowledge, skills, and understanding of palliative care concepts and limited teamwork efficiency; 3) workload including a heavy, time-intensive workload, inadequate manpower, and unable to manage workload effectively; and 4) lack of preparedness and attitude towards palliative care, lack of major caregiver and confidence in care, and misconception of care concept. Needs of the PCWNs included 1) Service development strategies, including increasing PCWN staffing, training palliative care concepts for physicians, and facilitating case-based learning between physicians and nurses’ teams; 2) Work support for PCWNs, including updated knowledge and continuous skill development. Administrators should clearly define the roles and responsibilities of PCWNs and provide support with tools and educational materials for patient and family care. Additionally, palliative care case conferences should be facilitated and supported for quality improvement initiatives and research efforts. The outcomes showed that: 1) PCWNs performed screenings and assisted with access to palliative care for patients and families (47.0%); 2) palliative care indicators were established (50.7%), and 3) patient and family satisfaction ranged from 83.3% to 97.9%. 

Recommendation The findings from this study can be used to develop a model of palliative care led by PCWNs to improve the screening process, ensuring that the patients and their families have better access to care, more effective management of pain and symptom distress, and greater satisfaction with the services.