Development of an Ideal Set of Nursing Care Activities for Home-Based Palliative care to Enhance Care Quality and Reduce Caregiving Burden among the Family Caregivers of Thai Elderly

Abstract

The purpose of this technical action research was to develop an ideal set of nursing care activities for home-based palliative care to enhance care quality and reduce caregiving burden among the family caregivers of Thai elderly. Ten elderly participants, and their family caregivers who met inclusion criteria participated in this study. The researcher acted as a nurse. The elderly and their family caregivers resided in the areas which received health services from two out of fourteen primary care centers located in Hat Yai, Songkhla Province. This study was carried out from May to December 2017. The data collection consisted of in-depth interviews, non- participatory observation, field notes, photos, and an outcome evaluation questionnaire: 1) the Thai version of the Palliative Care Outcome Scale (POS), 2) the preferences of the elderly and their surrogates for advance directives at the end of life, 3) the caregivers' capabilities in responding to the spiritual needs and the perceived caregivers' compassion to the spiritual needs, and the 4) Thai version of the Burden Interview. Content analysis, descriptive statistics, Wilcoxon matched pair and signed rank test were employed to analyze the data. The major findings were presented in three parts: reconnaissance phase, spiral action research process, and outcome evaluation. The reconnaissance phase revealed the main situations of: 1) situation analysis of home-based palliative care for the Thai elderly, 2) caregivers' perspectives on improving care for Thai elderly in the palliative stage, and 3) caregiving burden among family caregivers. During the spiral action research process, three activities were developed through this study: 1) mutual understanding on care requirements, 2) skill building in the caregiver role, and 3) enabling the family environment to promote spiritual well being. The outcome evaluation on this model revealed significant enhancing of care quality and reduced caring burden. Moreover, after implementation on three nursing care activities, the findings were emerged to evaluate by observing as: 1) fulfilling the elderly family member's needs and 2) improving the ability of care giving skills. This study provided essential care in the use of nursing care for the elderly and their caregivers in the palliative stage at home in Thai culture. The study proposes and assists the nurses in a primary care center in providing for the elderly and their family caregivers. It is encouraged that other primary care centers should develop similar care activities to serve as guidelines for nurses on their practice for patients and caregivers with palliative and end of life care. In the future, an ideal set of nursing care activities will be applied for the development of the program to provide accurate evidence on the effects of the model on care quality and caregiving burden.