School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
School of Nursing, College of Health and Medicine, University of Tasmania, UTAS Education Centre, 1 Leichhardt Street, Darlinghurst, NSW, 2010, Australia.
BMC Palliat Care. 2019 Jul 23;18(1):61. doi: 10.1186/s12904-019-0447-0.
Providing quality palliative care in residential aged care facilities (RACFs) (aged care homes) is a high priority for ageing populations worldwide. Older people admitted to these facilities have palliative care needs. Nursing assistants (however termed) are the least qualified staff and provide most of the direct care. They have an important role at the frontline of care spending more time with residents than any other care provider but have been found to lack the necessary knowledge and skills to provide palliative care. The level of competence of this workforce to provide palliative care requires evaluation using a valid and reliable instrument designed for nursing assistants' level of education and the responsibilities and practices of their role.
The overall study purpose was to develop and test an instrument capable of evaluating the knowledge, skills and attitudes of nursing assistants within a palliative approach in RACFs. Development consisted of a four-phase mixed-methods sequential design. In this paper, the results and key findings following psychometric testing of the instrument in Phase 4 is reported using data collected from a random sample of 17 RACFs and 348 nursing assistants in the Greater Sydney region. Study hypotheses were tested to confirm discriminative validity and establish the utility of the instrument in both research and training assessment.
Individual item properties were analysed for difficulty, discrimination and item-total correlations. Discriminative and structural validity, and internal consistency and test-retest reliability were demonstrated. Three separate questionnaires comprising 40 items were finalised: The Palliative Approach for Nursing Assistants (PANA)_Knowledge Questionnaire (17 items), the PANA_Skills Questionnaire (13 items) and the PANA_Attitudes Questionnaire (10 items).
This study provides preliminary evidence for the validity and reliability of three new questionnaires that demonstrate sensitivity for nursing assistants' level of education and required knowledge, skills and attitudes for providing a palliative approach. Implications for practice include the development of palliative care competencies through structured education and training across this workforce, and ongoing professional development opportunities for nursing assistants, especially for those with the longest tenure.
为居住在养老院（养老院）中的老年人提供高质量的姑息治疗是世界范围内老龄化人口的首要任务。入住这些设施的老年人有姑息治疗的需求。护理助理（无论如何称呼）是最不合格的员工，提供了大部分直接护理。他们在护理前线扮演着重要的角色，与居民相处的时间比任何其他护理提供者都多，但却发现他们缺乏提供姑息治疗所需的必要知识和技能。需要评估护理助理提供姑息治疗的能力水平，这需要使用专门为护理助理的教育水平以及他们的角色的职责和实践而设计的有效和可靠的工具。
该研究的总体目的是开发和测试一种能够评估养老院中护理助理在姑息治疗方法中的知识、技能和态度的工具。开发过程包括一个四阶段的混合方法顺序设计。在本文中，报告了第 4 阶段工具的心理测量学测试后的结果和关键发现，该阶段的数据来自大悉尼地区的 17 个养老院和 348 名护理助理的随机样本。测试了研究假设，以确认判别有效性，并确定工具在研究和培训评估中的实用性。
对难度、区分度和项目-总分相关性进行了单个项目属性分析。证明了区分性和结构有效性，以及内部一致性和重测信度。最终确定了三个包含 40 个项目的单独问卷：护理助理姑息治疗方法（PANA）_知识问卷（17 个项目）、PANA_技能问卷（13 个项目）和 PANA_态度问卷（10 个项目）。
本研究初步证明了三个新问卷的有效性和可靠性，这些问卷证明了护理助理的教育水平以及提供姑息治疗方法所需的知识、技能和态度的敏感性。对实践的影响包括通过整个劳动力队伍的结构化教育和培训发展姑息治疗能力，以及为护理助理，特别是服务时间最长的护理助理提供持续的专业发展机会。
