| Objectives To investigate and evaluate the nursing staffs practical ability of Palliative Care in 17 Palliative care pilot institutions in Hangzhou,and on this basis,to explore the influencing factors of medical staffs practical ability of Palliative care and the relationship between different factors,so as to provide a basis for constructing a targeted training program and assessment system of practical ability of Palliative care and promoting the construction of Palliative care teams in China.Methods This paper adopts the research method of combining quantitative research with qualitative research.1.Quantitative Study from February to April 2022,723 nursing staff from 17 Palliative care pilot institutions in Hangzhou were selected as study samples by random stratified sampling method,and the self-designed General Information Questionnaire,Palliative care Knowledge Questionnaire,Palliative care Difficulty Scale,and Self reporting Practice Scale were used to conduct the status survey,and descriptive statistical analysis,t-test/ANOVA,Pearson correlation analysis and multiple linear regression analysis were used to analyze the nursing practice ability and it’s influencing factors.2.Qualitative Study from February to May 2022,nurses from 17 Palliative care pilot institutions in Hangzhou were selected as the research objects.With the purpose sampling method,semi-structured interviews were conducted to investigate nurses’ Palliative care practice,feelings and difficult experiences,and explore the deep-seated reasons that affect the ability of Palliative care practice.3 Mixed Research This paper integrates the qualitative and quantitative research results through the research of the parallel triangle mixed method of mutual evidence to achieve a multi-dimensional in-depth discussion on the influence of nurses’ ability to practice Palliative care.The results explain each other and achieve complementary advantages.Results1.Quantitative Research Results:The results showed that the nursing practice ability of nursing staff in Hangzhou was in the upper middle level.The average score of practice was(64.17 ± 15.99 points)(n=723),of which 274 were high level(total score≥72 points),accounting for 37.70%;There are 300 people in the middle level(the total score is within the range of 54-71),accounting for 41.49%.149 people were at a low level(total score<54),accounting for 20.61%.The results of univariate analysis showed that nurses’ practical ability of Palliative care was related to 11 factors,such as workplace,gender,age,working years,professional title,whether they knew about Palliative care,whether they had participated in in-service Palliative care training,whether they had cared for dying patients,whether they were interested in Palliative care,whether they were willing to participate in voluntary Palliative care services,and their family’s attitude towards Palliative care;Multivariate logistic regression analysis showed that nurses’ gender,age and willingness to participate in voluntary services of Palliative care were independent factors affecting the effectiveness of Palliative care.2.Qualitative Research Results:Eight nurses with in-depth industry experience were selected from 17 hospice care pilot institutions in Hangzhou to conduct semi-structured interviews.The data is saturated,more than 70000 words of interview records are obtained,and 97 codes are obtained after sorting out,which were finally integrated into three themes:cognitive status,behavioral status,and practical difficulties through repeated induction and refinement.In terms of cognition:the interviewees’ cognition of hospice care is basically in place;It is believed that there is a general lack of professional knowledge related to hospice care;They all think that the public lacks basic knowledge of hospice care,and it is urgent to strengthen publicity and personal will,quality is very important.In terms of behavioral status,the interviewees believed that the employed nurses generally lacked the professional skills of hospice care;They generally face the challenge of difficulty in symptom control;Their willingness to receive systematic professional training is inconsistent;The support and care of the patient’s family is very important;It is believed that people with humanistic feelings and humanitarian spirit are more competent for hospice care.In terms of practical difficulties:the interviewees pointed out the lack of clinical norms and the authority of painkillers;Insufficient beds and religious facilities;The government investment is insufficient,and the medical insurance reimbursement policy is not matched;Insufficient time,human resources and communication;Lack of systematic training and comprehensive simulation teaching and other practical difficulties.3.Mixed Research The results of the mixed research combined qualitative research and quantitative research to explain the influencing factors of nurses’ Palliative care practice ability and the relationship between the factors from multiple perspectives:personal willingness,Palliative care cognition,social support and education training are the influencing factors that the results of the two research methods support together.Conclusion1.Nurses in Hangzhou are at an above average level in terms of their practical ability,knowledge and practical difficulties,and there is still a big gap between their ability and knowledge to carry out high-quality hospice care work.Systematic and professional hospice care training is urgently needed,especially in symptom management and communication.To improve the practice ability of palliative care in multiple dimensions.2.The capacity building of hospice care service supply is a systematic project that needs in-depth coordination and joint efforts of the government,society and medical institutions.It is necessary to further optimize the allocation of medical resources and improve supporting policies such as medical insurance reimbursement.Strengthen the specialized training system for hospice practitioners;Strengthen the propaganda of hospice care,advocate and spread the correct concept of life and death to the whole society,and improve social cognition. |
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