1Collaborative Science and Innovation, Billings Clinic, Montana State University College of Nursing, Billings, Montana.
2College of Nursing and School of Medicine, University of Colorado, Aurora, Colorado.
J Palliat Med. 2019 Aug;22(8):945-960. doi: 10.1089/jpm.2018.0566.
The World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. To globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Needs assessment survey. Five hundred thirty-two home health care nurses in 29 countries. A needs assessment, developed through literature review and cognitive interviewing. Nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. It is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity.
世界卫生大会敦促各成员国将姑息治疗(PC)能力建设作为一项道德使命。护士在各种环境中提供 PC 服务,包括家庭,并且可能是唯一能够接触到一些不同人群的卫生保健专业人员。确定当前的护理服务、资源以及护理实践的满意度和障碍对于建立全球 PC 能力至关重要。为了在全球范围内检查姑息治疗居家护理的实践、满意度和障碍,我们对 29 个国家的 532 名居家护理护士进行了需求评估调查。我们使用文献回顾和认知访谈开发了一种需求评估工具。与高收入国家的护士相比,发展中国家的护士承担了更多的职责,这表明发展中国家资源匮乏。提供居家护理存在着显著的障碍:人员短缺、缺乏资金和政策、临终或姑息治疗服务获取困难以及社区对所提供服务的认识度下降。受访者认为缺乏时间、资金和覆盖范围是主要的教育障碍。他们建议采用现场当地会议和在线课程等策略来促进学习。至关重要的是,全球范围内的姑息治疗居家护理护士必须拥有足够的资源来建立姑息治疗能力,这是非常迫切需要的。护士必须掌握基于证据的姑息治疗框架内的最新证据和实践。需要制定卫生保健政策来增加必要的资源,并制定多方面的干预措施,以促进姑息治疗教育,从而建立全球能力。