Abstract
BackgroundPeople often prefer to stay at home until the end of life, but hospital admissions are quite common. In previous research bereaved relatives were found to be less positive about palliative care in hospital. However, it was not known how the content and quality of palliative care differ between home care and hospitals from the perspectives of hospital nurses and home care nurses and how palliative care in these settings could be improved.MethodsA survey was held among hospital and home care nurses, recruited from a nationwide Nursing Staff Panel and through open calls on social media and in an online newsletter. The pre-structured online survey included questions on the palliative care provided, the quality of this care and the respondent’s perceived competence in providing palliative care. The questionnaire was completed by 229 home care nurses and 106 hospital nurses.ResultsMost nurses provided palliative care in the physical and psychological domains, fewer provided care in the social and spiritual domains. A higher percentage of home care nurses stated that they provided care in these domains than hospital nurses. Overall, 70% of the nurses rated the quality of palliative care as very good to excellent. This percentage was higher among home care nurses (76.4%) than hospital nurses (59.4%). Moreover, a higher percentage of home care nurses (94.4%) stated they felt competent to a great extent to provide palliative care compared to hospital nurses (84.7%). Competencies regarding the physical domain were perceived as better compared to the competencies concerning the other domains. The nurses recommended paying more attention to inter-professional collaboration and communication, timely identification of the palliative phase and advance care planning, and more time available for palliative care patients.ConclusionAlthough the quality of palliative care was rated as very good to excellent by nurses, improvements can still be made, particularly regarding palliative care in hospitals. Although patients often prefer to die at home rather than in hospital, still a considerable number of people do die in hospital; therefore hospital nurses must also be trained and be able to provide high-quality palliative care.
Highlights
People often prefer to stay at home until the end of life, but hospital admissions are quite common
Gott et al found that transition to a palliative care approach in hospitals typically occurred close to death [21]. In line with these studies, hospital nurses in our study indicated that the identification that the patient is in the palliative phase, and subsequently advance care planning, could still improve
Home care nurses are more positive than hospital nurses in various regards: relatively more home care nurses reported that they provided care in the physical and psychological domains, they were more positive about the quality of palliative care and they were more likely to feel competent to give this care
Summary
People often prefer to stay at home until the end of life, but hospital admissions are quite common. In previous research bereaved relatives were found to be less positive about palliative care in hospital. It was not known how the content and quality of palliative care differ between home care and hospitals from the perspectives of hospital nurses and home care nurses and how palliative care in these settings could be improved. Dutch healthcare policy assumes that patients should be able to stay at home as long as possible [7]; its guiding principle is that palliative care should be an integral part of generalist care, e.g. provided by home care nurses and general practitioners. Dutch home care nurses provide nursing care, including palliative care, for patients living independently in the community. Home care nurses and general practitioners can consult specialised palliative care teams [8]
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