Home Care Organizations Research Articles

Robust nurse-to-patient assignment in home care services to minimize overtimes under continuity of care

Abstract Home Care (HC) providers are complex organizations that manage a large number of patients, different categories of operators, support staff and material resources in a context affected by high variability. Hence, robust resource planning is crucial for operations in HC organizations, in order to avoid process inefficiencies, treatment delays, and low quality of service. Under continuity of care, one of the main issues in HC planning is the assignment of a reference nurse to each assisted patient, because this decision has an impact on the workload assigned to the nurse for the entire patient’s length of stay. In this paper, we derive an analytical structural policy for solving the nurse-to-patient assignment problem in the HC context under continuity of care. This policy accounts for randomness related to both the demands from patients already assigned to nurses and the demands from new patients who need assignments. The policy is compared to other previously developed approaches, and applied to a relevant real case.

Task shifting policy in Ontario, Canada: Does it help personal support workers’ intention to stay?

The objective of this paper is to analyze the impact of task shifting policy on personal support workers’ (PSWs) intention to stay in home care. Data were collected through interviews with 46 home care staff of a large home care organization in Ontario, Canada. Interviews were transcribed, coded, and a thematic analysis was conducted using a qualitative software package. Half of the study participants mentioned that task shifting increases PSWs’ intention to stay in home care, while less than a quarter commented that task shifting increases PSWs intention to leave. Results show that the implementation of task shifting policy in Ontario, Canada may contribute to personal support workers’ intention to stay; however, inadequate compensation may negatively affect intention to stay and should be addressed. We recommend policy-makers consider appropriate compensation to assist PSWs in effectively executing shifted tasks.

Signs and Symptoms Indicative of Potential Adverse Drug Reactions in Homecare Patients

The purpose of this study was to determine whether homecare workers can detect signs and symptoms indicative of potential adverse drug reactions (ADRs) in homecare patients, using a standardized observation list. This observational study involved 115 patients cared for by 2 homecare organizations in The Netherlands between April 2011 and August 2011. During routine home visits, homecare workers filled out a standardized observation list of signs and symptoms indicative of potential ADRs, namely, gastrointestinal and other bleedings, electrolyte disturbances, renal and heart failure, digoxin intoxication, constipation, disturbances of diabetic control, and falls. Their observations were compared against the medications that the patients were using and their known side effects, by a panel of clinical pharmacology experts. Sensitivity, specificity, and positive and negative predicted values of the standardized observations were calculated. In total, 234 signs and symptoms indicative of potential ADRs were observed by the homecare workers, 116 (49.6%) of which were considered drug related. More than one-half of the observed signs of gastrointestinal bleeding could be considered as drug related. Observed dizziness (64.1%) and drowsiness (53.3%) could be drug related in most cases, as could most cases (71.4%) of fainting spells (indicative of renal or heart failure). Seventeen of 20 observed falls could be drug related. The specificity of the standardized observation list was high, varying from 0.70 (confidence interval 0.62-0.77) to 0.97 (confidence interval 0.95-0.98). Signs and symptoms indicative of potential ADRs recorded by homecare workers using a standardized observation list can aid in the early recognition of ADRs in homecare patients.

Zicht op Evenwicht. Evaluatie van een landelijk geïmplementeerde cursus gericht op het verminderen van bezorgdheid om te vallen bij zelfstandig wonende ouderen

A cognitive behavioral program reduced concerns about falling and related avoidance behavior among older community-dwelling adults in a randomized controlled trial. In the current study we examined the effects and acceptability of the program after nation-wide implementation into home care organizations in The Netherlands. In a one-group pretest-posttest study with data collection before the start of the program and at 2 and 4 months, the effects and acceptability of the program were assessed in 125 community-dwelling older people. The outcomes of the effect evaluation included concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of anxiety, symptoms of depression, and loneliness. Pretest-posttest analyses with the Wilcoxon signed-rank test and the paired t-test showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for the other outcomes. After implementation in home care organizations, the outcomes indicate positive program effects on concerns about falls, avoidance behavior, and falls in community-dwelling older people. Given the similarity in results, i.e. between those of the previously performed randomized controlled trial and those of the current pretest-posttest study, we conclude that the program can be successfully implemented in practice. This article is an adjusted, Dutch version of Zijlstra GA, van Haastregt JC, Du Moulin MF, de Jonge MC, van der Poel A, Kempen GI. Effects of the implementation of an evidenc-based program to manage concerns about falls in older adults. The Gerontologist 2013;53(5):839-849; doi: 10.1093/geront/gns142.

Exploring the role of home care organisations in the composition and functioning of mixed care networks of frail older adults

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Evaluation of health care providers’ role transition and satisfaction in hospital-at-home for chronic obstructive pulmonary disease exacerbations: a survey study

BackgroundHospital-at-home is an accepted alternative for usual hospital treatment for patients with a Chronic Obstructive Pulmonary Disease (COPD) exacerbation. The introduction of hospital-at-home may lead to changes in health care providers’ roles and responsibilities. To date, the impact on providers’ roles is unknown and in addition, little is known about the satisfaction and acceptance of care providers involved in hospital-at-home.MethodsObjective of this survey study was to investigate the role differentiation, role transitions and satisfaction of professional care providers (i.e. pulmonologists, residents, hospital respiratory nurses, generic and specialised community nurses and general practitioners) from 3 hospitals and 2 home care organisations, involved in a community-based hospital-at-home scheme. A combined multiple-choice and open-end questionnaire was administered in study participants.ResultsResponse rate was 10/17 in pulmonologists, 10/23 in residents, 9/12 in hospital respiratory nurses, 15/60 in generic community nurses, 6/10 in specialised community nurses and 25/47 in general practitioners. For between 66% and 100% of respondents the role in early discharge was clear and between 57% and 78% of respondents was satisfied with their role in early discharge. For nurses the role in early discharge was different compared to their role in usual care. 67% of generic community nurses felt they had sufficient knowledge and skills to monitor patients at home, compared to 100% of specialised community nurses. Specialised community nurses felt they should monitor patients. 60% of generic community nurses responded they should monitor patients at home. 78% of pulmonologists, 12% of general practitioners, 55% of hospital respiratory nurses and 48 of community nurses was satisfied with early discharge in general. For coordination of care 29% of community nurses had an unsatisfied response. For continuity of care this was 12% and 10% for hospital respiratory nurses and community nurses, respectively.ConclusionA community-based early assisted discharge for COPD exacerbations is possible and well accepted from the perspective of health care providers’ involved. Satisfaction with the different aspects is good and the transfer of patients in the community while supervised by generic community nurses is possible. Attention should be paid to coordination and continuity of care, especially information transfer between providers.

The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting

BackgroundThe interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons’ medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients’ data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context.MethodsIn a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants.ResultsThe primary strengths of the BelRAI-system were a structured overview of the patients’ condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of funding of personnel to coordinate the assessment process is the most important threat.ConclusionThe BelRAI-software allows standardized transmural information transfer and the centralization of medical, allied health professionals and nursing data. It is strictly secured and follows strict privacy regulations, allowing hospitals to optimize (transmural) communication and interaction. However, weaknesses and threats exist and must be tackled in order to promote large scale implementation.

Medication management capacity in relation to cognition and self-management skills in older people on polypharmacy

To determine the medication management capacity of independently living older people (≥75 years) on polypharmacy (≥ 5 medications) in relation to their cognitive- and self-management skills. Cross-sectional study. Two homecare organizations in the Netherlands. Homecare clients aged 75 and older on polypharmacy (N=95). The primary outcome measure was medication management capacity, quantified as the number of 'yes' answers (range = 0-17) on the Medication Management Capacity (MMC) questionnaire. Other measures included self-management ability (assessed with the SMAS30) and cognitive skills (assessed with the clock drawing test). Overall, 48.4% (n= 46) of the participants were able to manage their medication by themselves at home. About 40% of the participants were unable to state the names of their medications, even with the aid of a medication list, and about 25% reported having problems with opening medication packages. Correlations were found between self-management ability (Rs = 0.473; p < 0.001), cognitive skills (Rs = 0.372; p < 0.001), and age (Rs = 0.216; p < 0.005) and Medication Management Capacity score. Self-management ability and medication management support were significantly associated with medication management capacity. A considerable proportion of independently living older people who receive home care and regularly use five or more medications lack the knowledge and skills needed to independently manage their own medications. Cognition and self management ability were related to medication management capacity. Self-management ability and medication management support were predictors of medication management capacity.

Writing a reflective assignment as a student HCA in Ireland

Over recent years in the Republic of Ireland, there has been a major transformation in the healthcare workforce, especially those caring for older people. With the prompt induction of healthcare assistants (HCAs) to residential care facilities and more specifically to home care organisations, there has been an increase in demand for HCAs in Ireland. Consequently, the number of students undertaking Further Education and Training Awards Council (FETAC) Level 5 training programmes for these positions has increased and the Irish Government is providing free training programmes for jobseekers to retrain as HCAs. One such programme is the CPL Momentum project, retraining job seekers to qualify as HCAs. Many students struggle with academic writing and, in particular, with writing reflective assignments. In this article, one CPL Momentum student HCA and her reflective critical friend and course co-ordinator attempt to demystify the reflective writing process to empower other HCA students to critically analyse their own practice through reflective writing.

A framework to evaluate the complexity of home care services

PurposeThe purpose of this paper is to assess the potential factors that may generate complexity in managing operations in home care (HC) organizations. Hence, a framework which might assist decision making regarding complexity‐driven issues in HC organizations is developed.Design/methodology/approachBased on a systems thinking view, a framework was developed identifying complexity factors in HC organizations. The paper is based on field research to explore the practical challenges of managing operations in HC structures. The authors additionally give a state of the art in many scientific domains; definition of complexity and its implications; complexity in health care; description of home care operations and their management. The literature review enlightens the lack of consensus on HC complexity and thus provides a broad view and a critical analysis of the underlying concepts.FindingsProposal of a HC operations complexity model (and validation due to a practical application).Practical implicationsThe framework developed by the authors permits one to identify rapidly the existing complexity factors which may create potential damages regarding value creation and cost improvement in HC. Two kinds of HC complexity are identified: HC organization complexity and HC individual patients' therapeutical projects complexity. Complexity factors are grouped into five categories: factors related to size; factors related to variety; interdependence factors; factors related to uncertainties; and factors related to context. By identifying the factors, decision support systems and response plans may be more adapted to the potential existing short comings of operations.Originality/valueBased on authors' extensive knowledge of HC practices, as well as an international systematic review of literature, this paper contributes to a better characterization of factors inducing complexity in the HC context. To the best of the authors' knowledge, operations management literature lacks a general framework enabling a better identification and understanding of what makes HC operations specific. The paper presents an innovative way to analyze HC complexity using a systems thinking‐based approach. In this sense, its contribution is very complementary to traditional operations management models.

Zicht op Evenwicht Landelijke implementatie van een cursus gericht op het verminderen van angst om te vallen bij zelfstandig wonende ouderen

The Dutch version of A Matter of Balance (AMB-NL) is a cognitive behavioral group program to reduce fear of falling and related activity avoidance in community-living older persons. This paper presents the strategy for implementation of AMB-NL in Dutch homecare organizations and the outcomes of this implementation. The aim was to implement AMB-NL in at least 50 % of 64 homecare organizations in The Netherlands in 2009 and 2010. The implementation strategy was based on the four phases of the Replicating Effective Interventions: pre-conditions, pre-implementation, implementation, and maintenance and evolution. After preparing the implementation activities, such as identifying implementation barriers, consulting stakeholders, preparing the materials involved in the implementation, and training the facilitators of the program (n = 53), AMB-NL was implemented in 16 of the 64 homecare organizations (25 %). Another five homecare organizations indicated that they would shortly include AMB-NL in their care program. These organizations conducted the intervention 19 times to a total of 178 participants. After the implementation phase another 16 facilitators were trained, and program materials were successfully disseminated. The implementation of AMB-NL was well performed. The targeted aim is not fully reached within the two-year timeframe, but the program is well received by participants, trainers and homecare organizations. Further implementation and maintenance of AMB-NL in primary health care is recommended.

Recognition of drug related problems by home healthcare employees: A Dutch observational study with self reports

Background: In the Netherlands, the majority (80%) of the older people (age&gt;65) do use prescribed drugs. 82% of the patients who receive home healthcare are 65 years of age or older. Because of natural changes in age-related drug metabolism, these older home healthcare patients are particularly vulnerable to drug - related problems. Purpose: To describe how home healthcare Nurse Assistants (NA), home healthcare Licensed Practical Nurses (LPN) and home healthcare Registered Nurses (RN) rate their knowledge, monitoring skills and ability to recognize adverse drug reactions and drug interactions of the most commonly used medication in older people, aged 75 or older, in the Netherlands. Methods: A survey design was conducted with the use of a questionnaire in a home care organization in the Netherlands. Results: Home healthcare workers most easily recognize side-effects of confusion, drowsiness and fatigue more easily than gastrointestinal disorders and dizziness. In addition, home healthcare Registered Nurses and home healthcare Licensed Practical Nurses were more likely than home healthcare assistants to recognize and report symptoms due to side- effects. Conclusion: There are differences between RN, LPN and NA in the knowledge and their skills to recognize adverse drug reactions and interactions in home care. Consequently, the allocation of clients to RNs, LPNs or NAs should be arranged well. Home healthcare workers are well positioned to act preventatively and alertly to potential drug related problems, if they have adequate access to information on side effects and interactions of medication.

Consultation Psychiatry in the Medical Home and Accountable Care Organizations: Achieving the Triple Aim

We are in a time of increasing concern about unsustainable increases inhealth care costs toMedicare, Medicaid, employers and individuals. At the same time, more than half of patients with mental health needs do not receive care in any given year [1], and untreated mental disorders can be important drivers of high health care costs. As in the rest of health care, we are challenged with achieving the “triple aim” of improving access to care while at the same time improving quality and outcomes of care and reducing total health care costs [2]. To achieve this triple aim, psychiatrists of the future will have to shift professional roles. In addition to traditional consultation liaison activities focused on individual patients in outpatient clinics or hospital settings, psychiatrists should have important roles in monitoring behavioral health needs, treatments and treatment outcomes for defined populations of patients and providing supervision and guidance to interdisciplinary teams of primary care and behavioral health providers caring for a defined panel of patients. Two important concepts that are being advocated to improve patients’ experience and satisfaction with care as well as the quality and cost-effectiveness of medical care are primary care-based patientcentered medical homes and accountable care organizations (ACOs). The principles of the medical home are aimed at enhancing the potential benefits of primary care by emphasizing access to care, long-term relationships with health care providers, and coordination and comprehensiveness of care [3]. These principles also emphasize the importance of health care teams using evidence-based approaches and effective quality improvement methods [1]. Payment systems are being developed to provide financial incentives for primary care practices to transform their practices into medical homes and to make “meaningful use” of electronic medical record systems and other health information technology to improve coordination, quality and outcomes of care. The National Committee for Quality Assurance (NCQA) has established criteria for levels of adaptation of practices to the medical home concept, with increasing payments for higher levels of development [4]. These criteria include the capacity to care for patients with behavioral health conditions. Federal and state payers are also developing criteria for quality of care including behavioral health care for populations that will gain insurance coverage under health care reform [5]. Accountable care organizations are built on the concept of physicians, nurses and other allied health professionals working as a team to provide the most efficient and cost-effective care of patients across different care settings [6]. The concept of ACOs assumes that primary and specialty care systems and hospitals will work closely together, often as single governing units [6]. Electronic records will integrate outpatient and inpatient systems and other information technologies such as patient registries are seen as key tools in improving the continuity and effectiveness of practice. ACOs will share with the federal government financial savings the organizationmay produce in medical costs to the population they are responsible for [7]. Given the changes in health care systems and the emphasis on improving quality of care and decreasing costs, what are the potential roles of consultation

Electronic Health Records and the Increasing Complexity of Medical Practice: “It Never Gets Easier, You Just Go Faster”

Electronic Health Records and the Increasing Complexity of Medical Practice: “It Never Gets Easier, You Just Go Faster”

Implementation of CareTV in care for the elderly: The effects on feelings of loneliness and safety and future challenges

Background: The number of lonely elderly is expected to increase due to demographic changes. CareTV is a technological solution, which allows users to interact with carers, family and friends from their home. In prior research users mentioned that CareTV expanded their social contacts, but it had not been measured if feelings of loneliness as a consequence have decreased. Objective: Investigate whether CareTV is a valid instrument for elderly to engage in meaningful social contacts by a video connection to avoid loneliness. Evaluate the implementation process and identify the remaining future challenges. Methods: From March 2008, elderly people receiving homecare from Proteion Thuis were informed about CareTV and asked to participate in the study. The CareTV duplex video/voice network allowed clients to communicate 24 hours, 7 days a week with a nurse practitioner. Applications of CareTV are (1) Alarm Service (2) Care Service (3) Good morning/good evening service (4) Welfare and housing and (5) Family Contact. During the one year trial period, feelings of loneliness and safety were measured using a questionnaire. In addition, clients' experiences were evaluated in open questions in the survey. The implementation was evaluated retrospectively with a framework developed by Broens. Results: 180 clients of homecare organization Proteion Thuis were connected to CareTV. 130 clients with the average age of 73.2 years were included in the study. The results show that the average feeling of loneliness at group level significantly ( p< 0.001) decreased from 5.97 (sd 2.77) to 4.02 (sd 3.91) between the start and end of the study on a scale from 0 till 11. Social loneliness (5-items) as well as emotional loneliness (6-items) showed significant decreases. To evaluate safety, no sum score could be calculated, but on item level: for 5 out of 9 items, most clients felt less safe after one year. For one item most clients had improved feelings of safety and for three items, most clients had an equal score. Evaluation of implementation shows what has been done and what needs to be done in future for the specific determinants. Conclusion: Feelings of loneliness significantly decreased within one year. As loneliness is a problem in an estimated 30-40% of the elderly, CareTV seems to be a suitable instrument for elderly, to live longer at home with less feelings of loneliness. Feelings of safety on item level did not seem to improve, this might be due to the fact that no validated scale was used. On the other hand, individual clients indicated that they felt safe with careTV. In future, a study with a validated safety scale should be performed in order to clarify the effect of CareTV on feelings of safety. The analysis of the development and implementation process indicates that the business development approach may be strengthened and that the homecare organization itself may take the lead in that process.

The patient-centered medical home and accountable care organizations

As the crisis regarding the cost of medical care in the United States continues to spiral out of control, new models of care are being touted as a means to fix the economics of healthcare. This review will examine newly proposed models of healthcare. The patient-centered medical home (PCMH) and accountable care organizations (ACOs) are two models that have leapt to the forefront of healthcare reform. The PCMH or medical home is a model predicated upon a primary care provider who will provide and coordinate comprehensive healthcare for the patient across the continuum with care that is evidence based and patient centered. The PCMH provides coordinated care, allowing for more appropriate utilization of resources resulting in improved care and outcomes while decreasing costs. The ACO agrees to be accountable for the overall care, quality and cost of the patients enrolled. The model links patient care to quality, safety and improved outcomes. This coordination reduces the costs of care, thus making it economically appealing to the patients, the providers, the ACO and the payer, whether it be government or private. Healthcare reform will require implementation of new models of care. The PCMH and ACO are two such models. Although both models have their share of supporters as well as detractors, both will play a significant role in the next chapter of healthcare reform in this country.

Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.

Theorizing accommodation in supportive home care for older people

This paper examines the issue of what thinking is necessary in order to advance a notion of accommodation in the organization and provision of supportive home care for older people. Accommodation in this context is understood as responsiveness to the singularity of older adults, and we consider how this idea might be used to support opportunities for (independent) living for elders as they age and become frailer. To elaborate the question we draw on examples from our empirical work – ethnographic studies of home care practice undertaken in Canada and Iceland – and consider these examples in light of critical philosophical and social theory, particularly Agamben's (1993) work, The Coming Community. This is a relevant frame through which to consider the potential for the accommodation of the unique needs of older adults in home care because it helps us to problematize the systems through which care is accomplished and the current, dominant terms of relations between individuals and collectives. We argue that giving substance to a notion of accommodation contributes an important dimension to aligned ideas, such as patient-centeredness in care, by working to shift the intentionality of these practices. That is, accommodation, as an orientation to care practices, contests the organizational impulse to carry on in the usual way.

Effects of the Implementation of an Evidence-Based Program to Manage Concerns About Falls in Older Adults

Concerns about falls and related activity avoidance are common in older people. A multicomponent program reduced these concerns and increased daily activity among older people in a randomized controlled trial. This study explored whether the effects and acceptability of the program maintain after its implementation into home care organizations. In a pretest-post-test study, the effects and acceptability of the 8-week cognitive behavioral program was evaluated in 125 community-living older adults. Data on concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of loneliness and anxiety, and symptoms of depression were collected prior to the start of the program and at 2 and 4 months. Pretest-post-test analyses showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for daily activity, feelings of loneliness, and fall-related medical attention. After implementation in home care organizations, the program reduced concerns about falls, avoidance behavior, and falls in community-living older adults. These findings are highly consistent with the outcomes of a previously performed randomized controlled trial, indicating that the program can be successfully implemented in practice. Further dissemination of the program is recommended to reduce concerns about falls and related activity avoidance in community-living older people.

Day-to-day care in palliative sedation: Survey of nurses’ experiences with decision-making and performance

ContextContinuous palliative sedation has been the focus of extensive international debates in the field of end-of-life decision making. Although nurses may be important participants in the performance of continuous palliative sedation, research has focused primarily on the role and experience of physicians. Nurses’ experiences differ from that of physicians; they more often describe that continuous palliative sedation is used with the intention of hastening death and to have experienced serious emotional burden. Therefore, it is important to understand the experience of nurses in continuous palliative sedation. ObjectiveTo describe nurses’ experiences with the decision-making and performance of continuous palliative sedation in terminally ill patients. MethodsCross-sectional study. In 2008, a structured questionnaire was sent to 576 nurses in six professional home care organizations, ten units for palliative care in nursing homes and in-patient hospices and seven hospitals in the western region of the Netherlands. Respondents provided information about the last patient receiving continuous palliative sedation whom they had cared for. ResultsTwo-hundred seventy-seven questionnaires were returned and 199 (71.84%) reported a case of continuous palliative sedation. Nurses felt involved in the decision to use sedation in 84% of cases, albeit to a lesser extent in home care (68.75%, p=0.002). They agreed with the performance of continuous palliative sedation in 95.97% of cases and they proposed the use of continuous palliative sedation in 16.16%. Nurses were present at the start of sedation in 81.40% of cases and reported physicians to be present in 45.22%. In 72.77%, arrangements had been made among caregivers about the coordination of health care regarding the sedation. ConclusionNurses seem to play an important role in the use of continuous sedation. This role is mainly supportive toward physicians and patients during the decision-making process, but shifts to an active performance of sedation, particularly in settings where they explicitly participate as members of a team. Nurses could develop the practice of palliative sedation by anticipating procedural obstacles in the performance of continuous palliative sedation. We recommend them to become more active participants in the decision-making to improve the care of patients receiving continuous palliative sedation.