Fabulous research by Brazil et al.
Did you know?….
*In Canada, 75% of all deaths occur in
people over 65 years of age, and 75% of these
deaths take place in hospitals and LTC homes (Subcommittee to Update ‘Of Life and Death’, 2000).
Recent estimates for the USA reveal that
approximately 20% of all deaths occur in nursing homes; it has been suggested that this number will climb to approximately 40% by 2020 (Carter and Chichin, 2003).
For most people admitted to a Living Term Care facility, this will be their last home. Unless transfered to hospital to die, most residents will die in the facility that has become their home. As mentioned in the above quote, the number of deaths in Long Term Care will increase in the coming decades.
In the article (see reference) they suggest that education needs to build on the experience of the nurses, include a focus on the trajectory of dying with chronic disease, and acknowledge the existing culture of care.
This research by Brazil et al suggests that although licensed nurses have much experience with death and dying and perceive themselves as having palliative expertise, there is a gap in palliative care knowledge and skill.
This study highlighted specific knowledge
gaps among licensed nurses, particularly related to managing pain for a resident who is dying. This result is consistent with findings from other studies (Takai et al, 2010). Pain management can be challenging in LTC homes owing to the high prevalence of cognitive impairment and the lack of appropriate tools for its assessment.
Without adequate knowledge and skills, nurses struggle to manage both pain and other PC symptoms effectively.
Challenges to providing education include lack of funding for continuing education, and staff shortages that make attending education sessions difficult.
I would suggest that another challenge is the same old same old issue… “you don’t know what you don’t know”. If you don’t know that your beliefs are false, or that your knowledge is limited, then you don’t take the time and make the effort to find education! Hence the need to include some basics in core curriculum!
Registered Nurses and Registered Practical Nurses believe in their ability to per-form end-of-life care (from the Self-Efficacy in End-of-Life Care Survey, pg. ) which is not consistent to their knowledge of palliative care, with the average score on the Palliative Care Quiz being 60 % (from the Palliative Care Quiz,) (Palliativealliance.ca )
For those working in Long Term Care – what education has helped you provide better care?
NB. I found this article through the wonderful site “Quality Palliative Care in Long Term Care” . Exciting research!
*(Brazil, Kevin; Brink, Peter; Kaasalainen, Sharon; Kelly, Mary Lou; McAiney, Carrie; International Journal of Palliative Nursing, 2012 Feb; 18 (2): 77-83 (journal article – research, tables/charts) ISSN: 1357-6321 PMID: 22399045 “Knowledge and perceived competence among nurses caring for the dying in long-term care homes”)