Activity of daily living support in end of life care: «AdKinPal» program for palliative care nurses
H. Gattinger1, C. Maurer1, S. Ott1, A. Fringer2 (1St.Gallen ; 2Winterthur)
Patients at the end of their life and in need of specialized palliative care often need activity of daily living (ADL) support, e.g. help with personal hygiene or movement. Nursing support can be very demanding in these situations. Nurses frequently suffer from musculoskeletal disorders related to physical care. The Advanced Kinaesthetics in Palliative care (AdKinPal) program aims to increase nurses' competence in Kinaesthetics to provide ADL support that is helpful for the patient, e.g. to decrease experience of pain and dyspnoea while moving and that is not harmful for their own health.
The aim of this study was to evaluate the effectiveness of the education-based program AdKinPal for nurses in a specialized palliative care hospital setting. The AdKinPal program went for six months and included six workshops, six workbooks, and individual coaching of nurses.
A phase II exploratory study using a pretest-posttest repeated-measures design, including a process evaluation was used. Measurement time points were before (T0) and after the education-based intervention (T1) and six months after the intervention was completed (T2). Instruments in the survey were Kinaesthetics Competence Self-Evaluation (KCSE) scale, nurses’ self-efficacy in ADL support in end of life care scale, and the Nordic questionnaire for analysis of musculoskeletal symptoms. Data were analyzed using a repeated measurement ANOVA. For the process evaluation qualitative (interviews, observation protocols) and quantitative data (survey) were collected and evaluated using the qualitative content analysis and a descriptive analysis.
From the eligible nursing staff (n=62), 59 nurses (95%) signed the informed consent, of which 38 participants (63%) responded to all three questionnaires. Nursing staff’s level of kinaesthetics competence and self-efficacy in ADL support significantly increased over time. There was no significant reduction of the musculoskeletal symptoms over time. A higher KCSE knowledge score was significantly associated with lower musculoskeletal symptoms. The process evaluation showed high satisfaction with training sessions. Participants stated that continuing support would be needed to ensure a sustainable implementation.
The AdKinPal program was shown to be a promising approach to foster a qualitative ADL support in end-of-life care. Kinaesthetics competence development is an ongoing process that needs to be supported by organizational factors, e.g. supportive learning culture.