Healthcare systems around the world face major challenges in providing care to a growing number of older adults living with long-term conditions.(1) New Zealand in fact, has the highest number of reported deaths internationally in long-term care (LTC), with 38% occurring in this setting.(2) Yet in New Zealand as in other industrialised countries the demand for services by direct care staff (nurses, health care assistants) in long-term care often exceeds the supply of available workers.(3) Increased workloads lead to higher levels of occupational stress (4), increased staff turnover (5), decreased job satisfaction(6) and negative impacts on staff health and well-being.(7)
Internationally, staff education has been seen as the most effective way of improving palliative care provision in LTC.(8) Yet the working conditions that exist within this setting decrease the likelihood of staff taking up palliative care education opportunities.(9) The Supportive Hospice and Aged Residential Exchange is a new model of education delivery that responds to both the psychosocial stressors inherent in LTC and facilitates the application of new learning, a vital component of sustained learning transfer into practice. A recently conducted evaluation study resulted in the refinement of SHARE to enhance the delivery of palliative care through collaboration and integration between 20 LTC providers and two hospices. SHARE provided opportunities for mutual learning and acknowledgement of specialist knowledge in both gerontology and palliative care.
Recently published evaluation results by the project researchers however, highlight the challenges that remain in building staff confidence to deliver palliative care. The mixed methods study(10) drawn from the contributions of 185 clinical staff found that resource constraints and organisational factors such as a rigid role hierarchy or the existence of professional ‘fiefdoms” in some of the 20 LTC facilities, created barriers to staff confidence in palliative care delivery. What can be done?
Results also highlighted how the mentoring of staff by the hospice nurses and colleagues through SHARE, could contribute to LTCF staff beliefs in their own ability to deliver palliative care. Given the continued staffing and resource shortages results of the study support the benefits of the presence of a mentor rather than one-off educations sessions to promote learning.
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