Shulman Caroline, Hudson Briony F, Kennedy Peter, Brophy Niamh, Stone Patrick
Pathway, 5th Floor East, 250 Euston Road, London NW1 2PG, UK; Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Kings Health Partners, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
Pathway, 5th Floor East, 250 Euston Road, London NW1 2PG, UK; Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
Nurse Educ Today. 2018 Dec;71:135-144. doi: 10.1016/j.nedt.2018.09.022. Epub 2018 Sep 29.
In the UK, many people experiencing homelessness whose health is deteriorating remain in homeless hostels due to few suitable alternative places of care. Hostel staff struggle to support residents with deteriorating health and palliative care services are rarely involved. There is recognition of the need for multiagency working to support this group.
To pilot and evaluate the impact of a two-day training course for hostel staff around supporting clients with palliative care needs, and increasing multiagency working.
Mixed methods evaluation using pre-and-post training data collection.
Frontline staff from two London homeless hostels.
Staff from two hostels attended a two day training course. Self-perceived confidence in supporting residents with deteriorating health, knowledge of palliative care, openness to discussing deteriorating health and work related stress were assessed at baseline and immediately after training using a novel questionnaire. Qualitative data was collected via focus groups immediately after and three months post-training.
Twenty four participants attended at least one day of training, 21 (87%) completed the course. Training was reported to be useful and relevant. Modest improvements in self-perceived work related stress, knowledge, confidence and openness were observed following training. At three months, qualitative data indicated the beginnings of a shift in how palliative care was conceptualised and an increase in knowledge and confidence around supporting residents. Anxiety regarding the role of the hostel in palliative care, the recovery focused ethos of homelessness services and fragmented systems and services presented challenges to establishing changes.
Training can be useful for improving knowledge, confidence, openness and work related stress. Recommendations for implementing changes in how people experiencing homelessness are supported include embedding training into routine practice, promoting multidisciplinary working, incorporating flexibility within the recovery focused approach of services and recognising the need for emotional support for staff.
在英国，许多健康状况日益恶化的无家可归者仍留在收容所，因为几乎没有合适的替代护理场所。收容所工作人员难以支持健康状况恶化的居民，姑息治疗服务很少参与其中。人们认识到需要多机构合作来支持这一群体。
试点并评估为期两天的培训课程对收容所工作人员在支持有姑息治疗需求的客户以及加强多机构合作方面的影响。
采用培训前后数据收集的混合方法评估。
来自伦敦两家无家可归者收容所的一线工作人员。
两家收容所的工作人员参加了为期两天的培训课程。使用一份新颖的问卷在基线时以及培训结束后立即评估工作人员在支持健康状况恶化的居民方面的自我感知信心、姑息治疗知识、对讨论健康状况恶化的开放程度以及工作相关压力。在培训结束后立即以及培训后三个月通过焦点小组收集定性数据。
24名参与者至少参加了一天的培训，21人（87%）完成了课程。据报告培训是有用且相关的。培训后观察到在自我感知的工作相关压力、知识、信心和开放程度方面有适度改善。在三个月时，定性数据表明在姑息治疗的概念化方式上开始出现转变，并且在支持居民方面的知识和信心有所增加。对收容所在姑息治疗中的作用的焦虑、无家可归者服务以康复为重点的理念以及零散的系统和服务给实施变革带来了挑战。
培训有助于提高知识、信心、开放程度和工作相关压力。关于改变支持无家可归者方式的建议包括将培训融入日常实践、促进多学科合作、在以康复为重点的服务方法中纳入灵活性以及认识到工作人员需要情感支持。
