Agreement of nursing home staff with palliative care principles : a pace cross-sectional study among nurses and care assistants in five european countries

Contains fulltext : 215538.pdf (publisher's version ) (Open Access)CONTEXT: To provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. OBJECTIVES: To evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. METHODS: This is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). RESULTS: Most staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09-0.43, P = 0.003), nurses (0.59; 95% CI: 0.43-0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08-0.34, P = 0.002). CONCLUSIONS: The level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed

Cooperative and coopetitive practices: Cases from the tourism industry

The purpose of our study is to disentangle interorganizational practices of spatially competing co-located actors in tourism destinations. Hence, we aim to understnd the dynamics through which cooperative and coopetitive arrangements are formed and maintained. As we focus both on the processes and their institutional features, we base our approach on practice theory theough which we are set to make sense of organized human activities.The purpose of our study is to disentangle interorganizational practices of spatially competing co-located actors in tourism destinations. Hence, we aim to understnd the dynamics through which cooperative and coopetitive arrangements are formed and maintained. As we focus both on the processes and their institutional features, we base our approach on practice theory theough which we are set to make sense of organized human activities

Unpacking the temporal dimension of coopetition in tourism destinations: evidence from Finnish and Italian theme parks

Coopetition, namely the co-presence of cooperation and competition, is a new strategy that goes beyond the established business paradigms of competition and cooperation. This type of strategy is relevant in tourism destinations, for instance in theme parks, where competing, co-located companies also collaborate. In this paper, we address the temporal dynamics of interorganizational relationships in Finnish and Italian theme parks (i.e. Lapland and Riviera Romagnola). Our comparative study shows that cooperation and coopetition among tourism businesses often shift from a prevalently short-term basis to a long term one when public and private stakeholders understand the benefits accruing to cooperation in terms of enhancement of the brand image of the destination and attraction of a higher number of visitors, by leveraging the destination\u2019s multifaceted assets

Unpacking the temporal dimension of coopetition in tourism destinations: evidence from Finnish and Italian theme parks

Coopetition, namely the co-presence of cooperation and competition, is a new strategy that goes beyond the established business paradigms of competition and cooperation. This type of strategy is relevant in tourism destinations, for instance in theme parks, where competing, co-located companies also collaborate. In this paper, we address the temporal dynamics of interorganizational relationships in Finnish and Italian theme parks (i.e. Lapland and Riviera Romagnola). Our comparative study shows that cooperation and coopetition among tourism businesses often shift from a prevalently short-term basis to a long term one when public and private stakeholders understand the benefits accruing to cooperation in terms of enhancement of the brand image of the destination and attraction of a higher number of visitors, by leveraging the destination’s multifaceted assets

Palliative Care Implementation in Long-Term Care Facilities:European Association for Palliative Care White Paper

Objectives The number of older people dying in long-term care facilities (LTCFs) is increasing globally, but care quality may be variable. A framework was developed drawing on empirical research findings from the Palliative Care for Older People (PACE) study and a scoping review of literature on the implementation of palliative care interventions in LTCFs. The PACE study mapped palliative care in LTCFs in Europe, evaluated quality of end-of-life care and quality of dying in a cross-sectional study of deceased residents of LTCFs in 6 countries, and undertook a cluster-randomized control trial that evaluated the impact of the PACE Steps to Success intervention in 7 countries. Working with the European Association for Palliative Care, a white paper was written that outlined recommendations for the implementation of interventions to improve palliative and end-of-life care for all older adults with serious illness, regardless of diagnosis, living in LTCFs. The goal of the article is to present these key domains and recommendations. Design Transparent expert consultation. Setting International experts in LTCFs. Participants Eighteen (of 20 invited) international experts from 15 countries participated in a 1-day face-to-face Transparent Expert Consultation (TEC) workshop in Bern, Switzerland, and 21 (of 28 invited) completed a follow-up online survey. Methods The TEC study used (1) a face-to-face workshop to discuss a scoping review and initial recommendations and (2) an online survey. Results Thirty recommendations about implementing palliative care for older people in LTCFs were refined during the TEC workshop and, of these, 20 were selected following the survey. These 20 recommendations cover domains at micro (within organizations), meso (across organizations), and macro (at national or regional) levels addressed in 3 phases: establishing conditions for action, embedding in everyday practice, and sustaining ongoing change. Conclusions and implications We developed a framework of 20 recommendations to guide implementation of improvements in palliative care in LTCFs

Care staff's self-efficacy regarding end of life communication in long term care facilities: Results of a cross-sectional study in 6 European countries (PACE)

Research aims: Communicating about end-of-life (EOL) matters is an essential part of providing care to older people in long term care facilities (LTCFs). When care staff do not feel competent to discuss these issues, they could fail in starting conversations about EOL issues. However, not much is known about whether LTCF staff feel competent to engage in EOL conversations. This research compares among 6 European countries the care staff's level of self-efficacy regarding EOL communication in LTCFs. This study also assesses which country, facility and staff characteristics are related to care staff's self-efficacy regarding EOL communication. Study population: In total 2275 care staff members in 305 LTCFs participated in the research project, of whom 1680 in 290 LTCFs filled in all questions on self-efficacy and were included in the current study. Study design and methods: A cross-sectional survey of care staff (nurses and care assistants) was conducted in a random sample of representative LTCFs in Belgium, England, Finland, Italy, the Netherlands and Poland. Staff rated their self-efficacy on a scale of 0-7 (cannot do at all-certain can do) on the communication subscale of the Self-efficacy in End-of-Life Care survey, which comprises 8 statements regarding EOL communication. Method of statistical analysis: Generalized estimating equations were used to account for clustering of data on facility level. Results and interpretation: The proportion of staff with a mean selfefficacy score >5 was 76.4% in the Netherlands, ranged between 55.9% and 60.0% in Belgium, Poland, England and Finland and was only 29.6% in Italy. Factors related to higher self-efficacy scores included: staff >50 years of age, working as a nurse (compared to care assistant), completed higher secondary or tertiary education, formal training in palliative care, >10 years working in resident care, working in a facility with onsite nurses and offsite physicians, working in a facility with guidelines on palliative care and working in the Netherlands or England. In general perceived self-efficacy seems to be a precursor to actually performing a certain practice. LTCFs could improve staff's self-efficacy and practices on EOL communication by providing education and supporting staff with guidelines regarding palliative care

Physician involvement and recognition of the resident's last phase of life in long-term care facilities: Findings from an EU FP7 funded cross-sectional study in 6 European countries (PACE)

Research aims: Ensuring the delivery of prompt, comprehensive palliative care in long-term care facilities (LTCFs) requires a multidisciplinary approach, including involvement of the physician. This study aims to describe and compare among 6 European countries (1) to what extent physicians are involved in the care of residents living in LTCFs; (2) to what extent physicians recognize the resident's last phase of life and; (3) how (1) and (2) are associated. Study population: 1094 deceased residents of 239 LTCFs, about whom 505 physicians in Belgium (BE), Finland (FI), Poland (PL), Italy (IT), The Netherlands (NL) and England (EN) reported on the number of visits they paid to the resident, treatment goals, whether they recognized a resident's terminal illness and whether they expected death. Study design and methods: In each country, a cross-sectional study was conducted within representative samples of LTCFs. Participating LTCFs reported all deaths of residents in the previous 3 months, and structured questionnaires were sent to several proxies among which the treating physician. Method of statistical analysis: To control for clustering within LTCFs and countries, differences in involvement in care and recognition of the last phase of life were analyzed using multilevel analyses. Results and interpretation: Physician involvement varied widely between countries; in the last 3 months of life, residents from PL were visited most often (median: 15 times), compared to residents from FI (12), NL (10), BE (7), IT (6) and EN (5). In the last week of life, this ranged from 4 visits (NL) to 1 visit (EN). Among all countries, physicians from PL and IT least often recognized the resident's terminal phase in the last week of life (63.0% in PL up to 80.3% in NL), and least often initiated a palliative treatment (31.8% in IT up to 92.6% in NL). On overall level though, positive associations were found between the level of involvement and the recognition of the last phase of life and initiation of palliative care. LTCFs should therefore work together with and involve physicians as much as possible in caring for their residents