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Towards evidence-based palliative care in nursing homes in Sweden: a qualitative study informed by the organizational readiness to change theory
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linnaeus University, Sweden.
Lund University, Sweden.
Lund University, Sweden.
2018 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 13, article id 1Article in journal (Refereed) Published
Abstract [en]

Background: Sweden has a policy of supporting older people to live a normal life at home for as long as possible. Therefore, it is often the oldest, most frail people who move into nursing homes. Nursing home staff are expected to meet the existential needs of the residents, yet conversations about death and dying tend to cause emotional strain. This study explores organizational readiness to implement palliative care based on evidence-based guidelines in nursing homes in Sweden. The aim was to identify barriers and facilitators to implementing evidence-based palliative care in nursing homes. Methods: Interviews were carried out with 20 managers from 20 nursing homes in two municipalities who had participated along with staff members in seminars aimed at conveying knowledge and skills of relevance for providing evidence-based palliative care. Two managers responsible for all elderly care in each municipality were also interviewed. The questions were informed by the theory of Organizational Readiness for Change (ORC). ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care. Results: Analysis of the data yielded ten factors (i.e., sub-categories) acting as facilitators and/or barriers. Four factors constituted barriers: the staffs beliefs in their capabilities to face dying residents, their attitudes to changes at work as well as the resources and time required. Five factors functioned as either facilitators or barriers because there was considerable variation with regard to the staffs competence and confidence, motivation, and attitudes to work in general, as well as the managers plans and decisional latitude concerning efforts to develop evidence-based palliative care. Leadership was a facilitator to implementing evidence-based palliative care. Conclusions: There is a limited organizational readiness to develop evidence-based palliative care as a result of variation in the nursing home staffs change efficacy and change commitment as well as restrictions in many contextual conditions. There are considerable individual-and organizational-level challenges to achieving evidence-based palliative care in this setting. The educational intervention represents one of many steps towards developing a culture conducive to evidence-based nursing home palliative care.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2018. Vol. 13, article id 1
Keywords [en]
Organizational readiness to change; Nursing homes; Palliative care; Leadership; Context
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-144440DOI: 10.1186/s13012-017-0699-0ISI: 000419198200001PubMedID: 29301543OAI: oai:DiVA.org:liu-144440DiVA, id: diva2:1176702
Note

Funding Agencies|Swedish Research Council; Vardal Foundation; Medical Faculty, Lund University; City of Lund; Centre for Collaborative Palliative Care, Linnaeus University; Palliative Care Institute at Lund University and Region Skane; Greta and Johan Kock Foundation; Ribbingska Memorial Foundation

Available from: 2018-01-23 Created: 2018-01-23 Last updated: 2018-02-21

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CiteExportLink to record
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Citation style
  • apa
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Output format
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