Challenges and Affecting Factors for Nurses in the Integration of Home Health Service and Palliative Care

Year 2023, , 23 - 30, 31.10.2023

Rahime Atakoğlu Yılmaz , Sevda Türen , Dilek İstengir

https://doi.org/10.26650/CURARE.2023.1361787

Abstract

Objective: This study aimed to determine the difficulties experienced by nurses working in the integration process of home health service and palliative care, and the affecting factors.
Material and methods: This is a descriptive study, and data were collected using the “Palliative Care Difficulties Scale (PCDS),” and the “Palliative Care Self-Reported Practices Scale (PCPS).” The study was conducted using an online questionnaire through Google Survey.
Results: While 91.8% (n=141) of the participants reported that the integration of home health service and palliative care was necessary, 42.6% of them reported that they had problems with decision-making during the practices in the unit where they worked. The participants’ mean PCDS score was 42.3±10.3, and the mean PCPS score was 73.8±10.2. A statistically significant relationship was found between the educational status of the nurses, receiving education about the unit they work in, having problems with making decisions during practice, experiencing conflicts about home health service/ palliative care areas, and receiving consultancy services related to ethical dilemmas experienced and palliative care difficulties (p<0.05). A weak and significant negative correlation was found between the sub-dimension of PCPS, “care provided at the time of death”, and “communication”, which is both PCDS total and PCDS sub-dimension.
Conclusion: Although a weak but significant correlation was detected in some sub-dimensions, no significant correlation between the total PCDS score and the total PCPS score was found.

Keywords

Home health service, palliative care, integration, nurse

Ethical Statement

The research was conducted in accordance with the Helsinki Declaration and conformed to research and publication ethics. The study was approved by the University Institutional Review Board (IRB date and number: 06.03.2020/2020.08).

Supporting Institution

None

Thanks

None

References

• Öngel K, Erdoğmuş B, Önen E. Literature review on home health, home care, palliative care. I. International Health Science and Life Congress Abstract Book, Mehmet Akif Ersoy University, Burdur. 2018. https://www.researchgate.net/ publication/327110787 google scholar
• Directive on Implementation Procedures and Principles of Home Health Services Provided by the Ministry of Health, Date: 01.02.2010 Number: 3895 Access: 01.09.2022 https://www. saglik.gov.tr/TR,11271/saglik-bakanliginca-sunulan-evde-saglikhizmetlerinin- uygulama-usul-ve-esaslari-hakkinda-yonerge.html google scholar
• Işık O, Kandemir A, Erişen AM, Fidan C. Profile of patients who use home care health services and evaluation of provided service. Hacettepe Journal of Health Administration 2016;19(2):171-86. https://doi.org/10.5336/ healthsci.2020-77586 google scholar
• Aşiret DG, Çetinkaya F. The expectations to home care services of caregivers. E-Journal of Dokuz Eylul University Nursing Faculty 2016;9(4):120-5. Retrieved from https://dergipark.org.tr/tr/pub/ deuhfed/issue/46793/586768 google scholar
• Sarsılmaz H, Yıldırım Y, Fadıloğlu Ç. Burnout in home care nurses. AUHSJ 2015;6(1):13-20. http://journal.acibadem.edu.tr/tr/pub/ issue/61306/914322 google scholar
• Karaman D, Kara D, Yalçın Atar N. Care needs and disease states of individuals, who home health care services are provided evaluating: Example of Zonguldak province. Gümüşhane University Journal of Health Sciences 2015;4(3):347-59. Retrieved from https://dergipark.org.tr/tr/pub/gumussagbil/ issue/23834/253912 google scholar
• Eser U. Home care and palliative care integration. Klinik Tıp Aile Hekimliği Journal 2016;8(3):45-7. Retrieved from https:// dergipark.org.tr/tr/pub/ktah/issue/45394/487642 google scholar
• World Health Organization (WHO). Integrating palliative care and symptom relief into primary health care. https://apps.who. int/iris/bitstream/handle/10665/274559/9789241514477eng. pdf?ua=1 (Access: 01.09.2022) google scholar
• Demir M. Palliative care ethics. J Turk Soc Intens Care 2016;7(2):62-6. https://doi.org/10.5152/dcbybd.2016.1202 google scholar
• Benli AR, Sunay D. A model of collaboration between palliative care unit and home health care services: Karabük. Ankara Med J 2017;(3):143‐50. https://doi.org/10.17098/amj.339333 google scholar
• Aslan Y. Overview of the palliative care models in Turkey and the World. Anatolian Current Medical Journal 2020;2(1):19-27. https://doi.org/10.38053/agtd.632674 google scholar
• Yurtsever N, Yılmaz M. A determination of the working conditions, training requirements and difficulties they faced at work of nurses providing home-care. Izmir Katip Celebi University Faculty of Health Sciences Journal 2016;1(1):19- 25. Retrieved from https://dergipark.org.tr/tr/pub/ikcusbfd/ issue/25505/106552 google scholar
• Bag B. Palliative care practices in Germany’s health system. Turkish Journal of Oncology 2012;27(3):142-9. doi: 10.5505/ tjoncol.2012.687 google scholar
• European Association for Palliative Care (EAPC). Recommendations of the European Association for Palliative Care for the Development of Undergraduate Curricula in Palliative Medicine at European Medical Schools, 2013. (Access:06.09.2019) https://dadun. unav.edu/bitstream/10171/34516/1/Recommendations%20 of%20the%20EAPC%20for%20the%20Development%20of%20 Undergraduate%20Curricula%20in%20Palliative%20Medicine%20 At%20European%20Medical%20Schools.pdf google scholar
• Nakazawa Y, Miyashita M, Morita T, et al. The Palliative Care Self-Reported Practices Scale and the Palliative Care Difficulties Scale: reliability and validity of two scales evaluating selfreported practices and difficulties experienced in palliative care by health professionals. Journal of Palliative Medicine 2010;13(4):427-37. https://doi.org/10.1089/jpm.2009.0289. google scholar
• Kudubes AA, Bektas M, Ayar D, et al. Palliative Care Difficulties and Psychometric Properties of the Turkish Version of the Self-Esteem Based Palliative Care Practice Scale. International Journal of Caring Sciences 2019;12(1):162-75. http://www. internationaljournalofcaringsciences.org/docs/18_kabudes_12_1.pdf google scholar
• Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care, and health care expenditures among medicare beneficiaries: 15 Randomized Trials. JAMA 2009;301(6):603‐18. https://doi.org/10.1001/jama.2009.126 google scholar
• Danielsen BV, Sand AM, Rosland JH, Forlans O. Experiences and challenges of home care nurses and general practitioners in homebased palliative care – a qualitative study. BMC Palliative Care 2018;17(95):1-13. https://doi.org/10.1186/s12904-018-0350-0 google scholar
• O’Mahony S, Gerhart JI, Grosse J, Abrams I, Levy MM. Posttraumatic stress symptoms in palliative care professionals seeking mindfulness training: Prevalence and vulnerability. Palliat Med 2016;30(2):189-92. https://doi. org/10.1177/0269216315596459 google scholar
• Kamal AH, Bull JH, Wolf SP, et al. Prevalence and predictors of burnout among hospice and palliative care clinicians in the U.S. J Pain Symptom Manag 2016;51(4):690-6. https://doi. org/10.1016/j.jpainsymman.2015.10.020 google scholar
• Levine S, O’Mahony S, Baron A, et al. Training the workforce: Description of a longitudinal interdisciplinary education and mentoring program in palliative care. J Pain Symptom Manag 2017;53(4):728-37. https://doi.org/10.1016/j.jpainsymman.2016.11.009 google scholar