| Abstract [eng] |
Summary. With the increasing number of elderly individuals and those suffering from chronic and oncological diseases, as well as patients' desire to receive healthcare services at home, it is important to ensure the effectiveness of palliative care services provided at home. In order to achieve the goal of palliative care services — to reduce the suffering of patients and their families and to improve quality of life — it is essential to address the physical, psychological, and social needs of the patients. Aim – to determine nurses’ experiences regarding the effectiveness of palliative care services provided at home. Tasks: 1. To identify the advantages of palliative care provided at home, based on nurses' experiences. 2. To examine the disadvantages of palliative care provided at home, based on nurses' experiences. 3. To reveal nurses’ opinions on improving the effectiveness of palliative care services provided at home. Method: a qualitative semi-structured interview study was conducted, involving 12 nurses who provide palliative care services at patients’ home. The questionnaire consisted of 14 questions covering topics such as work organization, patient needs, advantages and challenges of palliative care services provided at home, and nurses' opinions on improving the effectiveness of these services. Each participant was assigned a code name (S1, S2 ...). Approval for the use of the research instrument was obtained from the Research Ethics Committee of the Faculty of Medicine at Vilnius University (VU MF). Results: all respondents stated that providing palliative care services at home allows to manage patients’ symptoms, supports vital activities, and enables individualized attention to each patient. According to all respondents, ensuring not only the physical but also the psychological and social needs of patients is crucial for the effectiveness of these services. It was found that, in nurses' opinion, patients improved emotional well-being when receiving palliative care services at home also contributes significantly to service effectiveness. Nurses' experiences show that "this entire complex — namely medical assistance, social, and emotional support — improves a person’s condition" [S11], and that "<…> our support to both relatives and the patient, the attention we provide, consultations from psychologists, social workers, and the actions we take, truly contribute to symptom management and better quality of life" [S12]. Nevertheless, 8 out of 12 nurses mentioned facing professional challenges when providing these services, such as the limited number of reimbursed services per day per patient, lack of time due to heavy workload, insufficient supply of medical equipment in institutions, shortage of other healthcare professionals (such as surgeons and dietitians) in the team, and the unwillingness of relatives to administer medications or purchase necessary assistive devices. Conclusions: based on nurses’ experiences, the effectiveness of palliative care services provided at home is demonstrated through several advantages, such as the provision of emotional and social support, the opportunity for patients to remain at home, symptom management, and improvement in health condition. However, these services still do not fully match inpatient palliative care services due to the limited number of reimbursed services, the lack of 24/7 assistance, insufficient medical equipment, and the shortage of healthcare professionals from other specialties. Keywords: home-based palliative care services, symptom management, emotional support, social assistance, service effectiveness. |
