An instrument to assess nurses’ and care assistants’ self-efficacy to provide a palliative approach to older people in residential aged care: A validation study

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Abstract

Objective

This study investigated the psychometric properties of the ‘Palliative care self-efficacy scale’, an instrument designed to assess clinicians’ degree of confidence in engaging in patient and family interactions at the end-of-life.

Design

The instrument was administered to 405 aged care professionals employed in nine aged care facilities. Exploratory factor analysis and internal consistency statistics were undertaken.

Results

A two-factor solution of the ‘Palliative care self-efficacy scale’ was extracted with factor loadings above the 0.4 cutoff. Cronbach's alpha of the scale and subscales ranged from 0.87 to 0.92. The ‘Palliative care self-efficacy scale’ demonstrates good validity and reliability.

Conclusions

The ‘Palliative care self-efficacy scale’ can be a useful tool in assessing and monitoring clinicians’ perceived capacity to provide a palliative approach. Further evaluation in other samples and settings is required.

Introduction

Care for people in the last year of life is a complex process and is challenging for clinicians, patients and their families. A palliative approach has been promoted as a framework to manage the complexity of care in the last year of life, particularly when prognosis is uncertain. In some jurisdictions, a palliative approach is frequently interchanged with the term end-of-life care. In this paper, a palliative approach refers to care provided in the last year of life. This approach aims to reduce suffering through the early identification, assessment and treatment of physical, psychosocial and spiritual needs, as well as addressing the family's needs for support. It is care that ought to be provided by all clinicians, regardless of care setting or specialty.

Clinician confidence to deliver a palliative approach is increasingly recommended as people live longer with a range of chronic diseases. Yet, few clinicians have any formal palliative care training, often resulting in sub-optimal end-of-life care, which is frequently attributed to inadequate knowledge and skills (Adriaansen and Van Achterberg, 2004). Educational interventions are essential for preparing clinicians to undertake new tasks and to enhance their palliative care capabilities. Particularly as these new responsibilities may be confronting, and test clinicians’ values and belief systems around end-of-life care as well as extending their scope of practice.

Section snippets

Self-efficacy

The capacity to engage in a designated behaviour is influenced by the individual's efficacy expectation or self-efficacy (Bandura, 1997). Self-efficacy is influenced by one's confidence and belief to attain a specific objective and achieve the desired behavioural change. As such the constructs of confidence and self-efficacy are strongly linked. Self-efficacy is a predictor of both individual and professional behaviours, as well as influencing the effort and commitment applied to achieving a

Aim

To investigate the psychometric properties of an instrument designed to assess clinicians’ self efficacy to provide end-of-life care.

Study setting and participants

As part of an action research study conducted in nine regional Australian aged care facilities, we sought to validate an instrument to assess aged care clinicians’ self-efficacy to provide end-of-life care. The multi-faceted intervention implemented as part of the project aimed to improve symptom assessment, promote teamwork and enhance communication. The intervention included the creation of: link nurse roles; short palliative care courses; and regular case conferencing (Phillips et al., 2008

Results

Survey data were collected at both pre (Time 1) and post-multi-faceted intervention and linked to various project related activities (Time 2).

Discussion

In order to successfully execute palliative care tasks, clinicians must believe that their action will lead to a positive outcome and that they have the capabilities to perform the required behaviour. The ‘Palliative care self-efficacy scale’ appraises an individual's belief in oneself and one's powers or abilities; self-confidence; self-reliance or assurance to do a specific palliative care related task. It is not considered that self-efficacy is a constant construct and as such it is the

Limitations

A number of study limitations need to be considered. Similar to any survey, a major limitation is the validity and reliability of participant responses. The use of a non-equivalent sample is a limitation of this study as the participants were not paired. In this study, the non-equivalent sample is balanced by the stability of this rural aged care workforce, who both aged overtime and potentially become more experienced and skilful as the intervention progressed. As the sample consisted of aged

Conclusions

Appreciating levels of perceived capability to perform tasks in palliative care is a tangible and viable way to assess the capacity of individuals and health care services to meet the needs of the dying. Undertaking evaluation of this instrument in other professional groups and settings is warranted given the increasing importance of a palliative approach in improving health care outcomes.

Contributors

JP, YS and PD were responsible for the study conception and design and drafting of the manuscript. JP and PD performed the data collection and data analysis. JP obtained funding and provided administrative support. YS and PD provided statistical expertise.

YS and PD made critical revisions to the paper.

Acknowledgements

The research team would like to acknowledge the contribution and support of the Mid North Coast (NSW) Division of General Practice and the generous participation of the nurses and care assistants working in residential aged care.Conflicts of interest: None.Funding: This research was funded by the Commonwealth Department of Health and Ageing, National Rural Palliative Care Program (2003–2006).Ethical approval: University of Western Sydney Human Research Ethics Committee (HREC), approval number:

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