Mind the gap: is the Canadian long-term care workforce ready for a palliative care mandate?

Abstract

The average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.

Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis

“…Other suggestions for improving pain assessment and management practices in LTC include an increase of physiotherapists embedded within LTC facilities and implementing a virtual consultation service to communicate with specialist physicians working in pain medicine [ 23 , 50 ]. Finally, ineffective pain assessment and management practices has influenced the development of clinical guidelines in palliative care [ 52 , 71 ] given the importance placed on appropriate end-of-life management of pain among residents in LTC facilities [ 60 ].…”

Palliative care nurse specialists' reflections on a palliative care educational intervention in long-term care: An inductive content analysis

“…(11) Addressing the palliative care knowledge and skills deficit, as well as the emotional readiness of longterm care facility staff is therefore of critical importance to delivering quality palliative care. (7,12,13) However, a major challenge continues to be the translation of educational interventions to the reality of the long-term care environment. (14) The negative impact of burnout on education uptake and the lack of consideration of organisational factors (e.g.…”

Palliative care nurse specialists’ reflections on a palliative care educational intervention in long-term care: an inductive content analysis

“…There is also evidence that long-term care facility staff (both registered nurses and health care assistants) feel inadequately supported in coping with multiple bereavement experiences [11]. Addressing the palliative care knowledge and skills deficit, as well as the emotional readiness of long-term care facility staff is therefore of critical importance to delivering quality palliative care [7, 12, 13].…”