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ObjectivesWith an increased dependency on nursing homes to provide care to the ageing population, it is likely that ethical issues will also increase. This study aimed to identify the type of ethical issues and level of associated distress experienced by nurses providing palliative care in nursing homes in the UK and Canada, and pilot the Ethical issues in Palliative Care for Nursing Homes (EPiCNH) instrument in Canada.MethodsA cross-sectional survey design was used. One hundred and twenty-three nurses located in 21 nursing homes across the UK and Canada completed the EPiCNH instrument.ResultsFrequent ethical issues include upholding resident autonomy, managing family distress, lack of staff communication and lack of time in both countries. Higher levels of distress resulted from poor communication, insufficient training, lack of time and family disagreements. Nurses in Canada experienced a greater frequency of ethical issues (p=0.022); however, there was no statistical difference in reported distress levels (p=0.53). The survey was positively rated for ease of completion, relevance and comprehensiveness.ConclusionsNurses’ reported comparable experiences of providing palliative care in UK and Canadian nursing homes. These findings have implications on the practice of care in nursing homes, including how care is organised as well as capacity of staff to care for residents at the end of life. Training staff to take account of patient and family values during decision-making may address many ethical issues, in line with global policy recommendations. The EPiCNH instrument has demonstrated international relevance and applicability.

Commentary on : Lord A, Field S, Smith IC. The experiences of staff who support people with intellectual disability on issues about death, dying and bereavement: a metasynthesis. J Appl Res Intellect Disabil 2017;30:1007–21. Research studies evidence that staff in both intellectual disability and palliative care services lack confidence, knowledge …

Background The importance of good end-of-life care for older people in nursing homes is recognised internationally and competence based training has been highlighted to improve palliative care provision in this care setting. Aim This aim of this study was to evaluate a three day competency based, Regional Palliative and End-of-Life Care Learning and Development Programme targeted at nursing staff (n=1330) working within nursing homes (n=266) in Northern Ireland. Methods Both quantitative and qualitative methods were used in two key phases. In Phase 1 participants were asked to complete the Regional Palliative and End-of-Life Care Competency Assessment Tool before and after the training. The content of the programme was mapped to the domains of this tool. In Phase 2, following the programme, seven focus groups with registered nurses (n=29), telephone interviews with managers (n=8) and one focus group, which two managers chose, took place. Results 619 participants completed the programme and 95.3% (n=590) completed the competency tool before and after the training. Descriptive statistics show participants self-reported a significant increase in core palliative care knowledge and skills across all five competency domains after training. Common themes emerging from focus groups and telephone interviews were: ‘Outcomes of attending the programme’, programme delivery and issues of access9, challenges to palliative care in care homes9 and ‘enablers to palliative care in the nursing home setting’. Conclusions This example of training mapped to a competency tool may have relevance given other national and international competency frameworks which exist. Factors relating to attrition have also been identified.

Introduction The symptoms of PD vary but with no cure, people with advanced disease experience distressing symptoms, such as motor complications, dementia, depression, pain and gastro intestinal symptoms which can be difficult to manage. There are many unmet needs such as lack of information, ad hoc delivery of services and a lack of preparation. Aims & Methods To investigate the palliative care needs of people with Parkinson9s Disease as perceived by support workers. Semi structured interviews were undertaken with seven PDUK support workers. With permission interviews were audio recorded, transcribed and analysed using content analysis. Demographic variables were recorded. Results Participants included two information and support workers, an information manager, a branch and voluntary support officer, a manager, a service development officer and an education and training officer who provide advice to people with PD. Seminars with nursing home staff and in-service GP training sessions are held to increase understanding of PD and its symptoms such as ‘freezing’. The participants stressed the importance of clients9 PD medication timetable when in a hospital or nursing home settings. They also advocate for more nurse specialists and for early referral to therapists for clients to learn how to deal with symptoms and improve their quality of life. Conclusion People with PD can experience distressing symptoms both physically and psychologically. Increasing the knowledge and understanding of their health professionals regarding PD symptom control and medication effects within a palliative care approach would help alleviate their distress and increase their quality of life.