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Integrating home-based palliative care (PC) allows patients to remain in familiar surroundings while significantly reducing healthcare costs. However, achieving high-quality outcomes depends heavily on palliative care nursing competence and self-efficacy. A recent cross-sectional study explored these constructs among home care nurses in Ontario. The findings indicate that while nurses feel capable in certain domains, significant gaps remain in others, particularly concerning holistic and spiritual support. Consequently, identifying these gaps is essential for improving end-of-life care delivery.
The research utilized two validated survey tools to assess nurses' perceptions. Specifically, researchers employed the Palliative Care Nursing Self-Competence scale and the Palliative Care Self-Efficacy scale. After analyzing data from registered nurses and registered practical nurses, several key trends emerged. Most participants reported high levels of confidence in functional care. In contrast, spiritual care was consistently identified as the most challenging domain for practitioners. Therefore, addressing these specific areas through targeted education is vital for the nursing workforce.
While functional tasks like physical assistance were viewed as strengths, symptom management presented more hurdles than psychosocial care. Furthermore, a strong positive correlation exists between perceived competence and self-efficacy. This suggests that as a nurse’s sense of professional ability grows, their confidence in handling complex clinical situations also increases. Notably, nurses often feel less prepared for the existential questions that arise during end-of-life care. This highlights a need for curriculum adjustments that emphasize the spiritual and psychological aspects of patient support.
Moreover, the integration of home-based PC fosters deeper family involvement. This involvement requires nurses to possess robust communication skills to manage family expectations effectively. In addition, providing care at home often involves higher autonomy for nurses compared to hospital settings. This independence necessitates a higher baseline of palliative care nursing competence to ensure patient safety and comfort. Future professional development should focus on these psychosocial dimensions to bridge the current gap in comprehensive care.
Continuous training remains the cornerstone of professional growth in palliative care. Because the study found that spiritual care is often neglected, specialized workshops could provide nurses with the tools to initiate meaningful conversations. In addition, mentors can help junior nurses develop self-efficacy in symptom management. Consequently, healthcare organizations must prioritize these educational resources to maintain a high standard of home-based services. By fostering both competence and confidence, home care teams can deliver more compassionate and effective end-of-life support.
Competence refers to the actual knowledge and skills a nurse possesses, while self-efficacy is the individual's belief in their ability to perform those skills successfully in various clinical situations. The two are strongly correlated.
Many nurses report that their formal education lacks sufficient training in existential and spiritual communication. This makes them feel less prepared to address a patient's spiritual distress or religious needs during end-of-life care.
Organizations can focus on longitudinal training programs that target psychosocial and spiritual care domains. Providing regular debriefing sessions and mentorship can also boost a nurse’s self-efficacy in managing complex symptoms at home.
Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider regarding any medical condition or treatment. Refer to the latest local and national guidelines for clinical practice.
References
Ta J et al. Exploring home care nurses' perceived competence and self-efficacy in palliative care delivery: A cross-sectional study. Palliat Support Care. 2026 May 07. doi: 10.1017/S1478951526102594. PMID: 42095321.
de Veer AJ et al. Home care nurses more positive about the palliative care that is provided and their own competence than hospital nurses: a nationwide survey. BMC Palliat Care. 2021;20(1):170.
Osman N, Tekeste H. Nurses' experiences of caring for patients' spiritual health needs in palliative care in India. Diva-portal. 2020.
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