Professionals’ Expectations and Preparedness to Implement Knowledge-Based Palliative Care at Nursing Homes before an Educational Intervention: A Focus Group Interview Study

Helene Åvik Persson,Anna Ekwall,Gerd Ahlström

doi:10.3390/ijerph18178977

Helene Åvik Persson, Anna Ekwall + Show 1 more

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https://doi.org/10.3390/ijerph18178977

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Abstract

The provision of knowledge-based palliative care is rare in nursing homes. There are obstacles to practically performing this because it can be difficult to identify when the final stage of life begins for older persons. Educational interventions in palliative care in nursing homes are a challenge, and joint efforts are needed in an organisation, including preparedness. The aim was to explore professionals’ expectations and preparedness to implement knowledge-based palliative care in nursing homes before an educational intervention. This study has a qualitative focus group design, and a total of 48 professionals working in nursing homes were interviewed with a semi-structured interview guide. Qualitative content analysis with an inductive approach was used for the analysis. One major theme was identified: professionals were hopeful yet doubtful about the organisation’s readiness. The main categories of increased knowledge, consensus in the team, and a vision for the future illustrate the hopefulness, while insufficient resources and prioritisation illustrate the doubts about the organisation’s readiness. This study contributes valuable knowledge about professionals’ expectations and preparedness, which are essential for researchers to consider in the planning phase of an implementation study. The successful implementation of changes needs to involve strategies that circumvent the identified obstacles to organisations’ readiness.

Highlights

The global population is ageing; the United Nations [1] estimates that the number of people aged 65 or more will have doubled to 1 in 6 by 2050, from 1 in 11 in 2019.In Sweden, about 20% of the population was aged 65 years or older in 2020 [2]
The professionals indicated that palliative care starts well before the older person’s last days and can, be a long process that begins the day the older person moves into a nursing home
The participants emphasised that it was important for them to gain knowledge about palliative care so that they can start this care as soon as the older person is informed about their incurable health condition

Summary

Introduction

The global population is ageing; the United Nations [1] estimates that the number of people aged 65 or more will have doubled to 1 in 6 by 2050, from 1 in 11 in 2019.In Sweden, about 20% of the population was aged 65 years or older in 2020 [2]. It can be difficult to predict when an older person is dying because of an often prolonged period of suffering, and the illness trajectory can include both decline and improvement in condition before death [3–5]. The places with the highest need for palliative care are nursing homes [7]. A large proportion of the older persons who move into nursing homes suffer, alongside normal ageing, multi-morbidities that indicate a need for palliative care [7–9]. This will pose challenges for elderly care because delivering high-quality palliative care demands knowledge that can support the older person [10,11]. Because of the possibility of slow dying, the early introduction of a palliative care approach in a nursing home may be of importance to optimise the older person’s well-being [12,13]

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