School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797 Penrith NSW 2751 Australia
Received date: October 06, 2015; Accepted date: November 05, 2015; Published date: November 12, 2015
Citation: Karacsony S (2015) A Critical Review of Instruments for Nursing Assistants’ Scope of Practice and a Palliative Approach in Long-Term Care Settings. J Comm Pub Health Nursing 1:105. doi:10.4172/2471-9846.1000105
Copyright: © 2015 Karacsony S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Nursing assistants are the largest aged care workforce providing most direct care to older people in long-term care settings. Many older people who require permanent care have palliative care needs on admission due to the longer dying trajectories associated with chronic diseases and frailty . A palliative approach is a recognised framework to enhance older peoples’ quality of life as they approach the end of life. Nursing assistants are increasingly required to provide care with a palliative approach yet studies have shown they perform poorly when their knowledge has been evaluated with existing instruments.
The aim of the above mentioned recent literature review (period 2004-2014) was to examine what instruments have been used to evaluate nursing assistants’ knowledge of, skills in and attitudes towards a palliative approach in long-term care settings. The review also aimed to critically examine the development and psychometric processes of existing instruments and their strengths and limitations for the population of nursing assistants.
A combination of key words for nursing assistants, a palliative approach and instruments were searched in selected databases using MeSH (medical subject headings) where available. Articles were restricted to those published between 2004-2014. Selected literature had to include an instrument that had been used to assess nursing assistants’ knowledge of, skills in or attitudes towards a palliative approach. Studies with mixed samples from which nursing assistant data could be extrapolated were also included.
Following the removal of articles which did not relate to the specific aim of the search strategy and duplicates, ten articles which referred to seven instruments were included in the review. Instruments used in the included research studies were examined for development, structure and psychometric properties. A checklist of recommended psychometric processes for instrument development developed by De Von, Block, Moyle-Wright, and colleagues  was used to evaluate development processes. Additionally, the recommendation by Ugalde, Krishnasamy and Schofield  to tailor specific instruments to the target group and use qualitative data to capture relevant issues was considered. Based on these criteria, the literature review concluded that there is no single valid and reliable instrument to evaluate nursing assistants’ knowledge of, skills in and attitudes towards a palliative approach. The lack of such an instrument means that research findings may not accurately reflect the specific learning and development needs of this population. Evaluating nursing assistants’ level of competence to provide care with a palliative approach warrants a valid and reliable measurement tool suitable for nursing assistants’ scope of practice. Tailoring an instrument specifically to required knowledge, skills and attitudes will demonstrate construct, content and criterion validity with the ability to discriminate across this population.