Enhancing palliative care at home: a generalist community nursing case study

Abstract

Objective: This quality improvement project aimed to explore the experience of home care nurse managers implementing a general palliative approach to care. Implementation comprised several interlinking activities encompassing stakeholder engagement and an education program in the outer eastern region of a home care and nursing organisation in Melbourne, Australia, between September 2019 and December 2020. Background: High quality provision of community based palliative and end-of-life care means people are much more likely to die at home, supported by family, friends and services. To achieve this, care staff must be adequately trained and supported, alongside a collaborative approach with other generalist and specialist providers. Study design and methods: This Case Study reports on the participant perspectives of the stakeholder engagement and education program. Focus groups and an interview were used to elucidate the experience of nursing and allied health professionals providing a general palliative approach in the community. The 2006 National Institute of Clinical Studies framework to identify barriers to best practice healthcare guided the development of focus group questions and the deductive analysis of data. Results: Seven Nursing Care Managers and one Social Worker participated in two online focus groups and one interview. Three overarching themes highlighted the value of tailored education in increasing staff knowledge and confidence, the factors for a successful generalist-specialist partnership, and the unique nature of the home care setting which requires accessible systems and processes. Discussion: This project supports assertions that generalist services can play a valuable role when a palliative approach to care is incorporated. It also underscores the importance of collaborative working partnerships between generalist and specialist services in providing quality community-based palliative care. Future research should examine the needs and perspective of clients, carers and families receiving a general palliative care approach in the community. Implications for research, policy and practice: Investment in developing the capacity and capability of generalist service staff to deliver palliative care is vital, particularly when caring for people in their homes. Although small, this study demonstrates that consideration should be given to embedding staff with specialist palliative care training within generalist organisations to drive and champion evidence-based palliative care provision, training, policies and procedures that meet the unique needs of mobile workforces. Future research should examine the effectiveness of different models and methods for education and generalist-specialist partnerships that meet the needs of mobile home nurses, particularly regarding long-term impact and sustainability. What is already known about the topic? Most Australians prefer to be cared for and die in their own home. Home care nurses are key generalist health professionals who support community-based palliative and end-of-life care, organising and providing care, coordinating the input of other health and social care professionals. Home care nurses face challenges in meeting their clients’ palliative care needs (such as symptom management and communication) and have deficits in their knowledge and confidence of caring for palliative clients. What this paper adds: This case study demonstrated that facilitating ongoing education opportunities that draw on the expertise of local palliative care champions or internal specialists can enhance care provision. Nurse care managers believe the value of generalist services, particularly home care services, in the generalist-specialist palliative care partnership, needs to be understood and respected. Tailored investment in home care to provide a general palliative approach would be beneficial given the unique challenges of this mobile workforce.