Sleep among bereaved caregivers of patients admitted to hospice: a 1-year longitudinal pilot study.

OBJECTIVES: This pilot study aimed to describe the sleep of partners and other family caregivers prior to and in the first year after a hospice patient's death. The study also evaluated the feasibility of the study protocol and determined the effect sizes in preparation for a full-scale study. DESIGN: The pilot study used a longitudinal, descriptive and comparative design. SETTING AND PARTICIPANTS: Participants included primary family caregivers of patients admitted to a hospice in Oslo, Norway. PRIMARY OUTCOME: Caregiver sleep was measured subjectively with the Pittsburgh Sleep Quality Index (PSQI) and objectively using wrist actigraphy for 4 nights and 3 days at three different times: during the hospice stay, and at 6 and 12 months after the patient's death. RESULTS: 16 family caregivers (10 partners and 6 other family members) completed the 1-year study protocol. Overall, sleep quality and quantity were stable over time and at each assessment, approximately half of the sample had poor sleep quality, both by self-report and objective measures. However, the sleep trajectories differed significantly over time, with older caregivers (≥ 65 years) having significantly longer sleep durations than younger caregivers (<65 years). Furthermore, sleep quality also differed over time depending on the caregiver's relationship to the patient, with partner caregivers having significantly worse sleep quality than other family caregivers. CONCLUSIONS: Caring for a dying family member is known to interfere with sleep, yet little is known about bereaved caregivers. The results of this pilot study demonstrate the feasibility of the longitudinal study protocol and indicate that sleep problems are common for caregivers and continue into the bereavement period, particularly for partner caregivers. The caregiver's relationship to the patient may be an important factor to consider in future studies.

Validation of a new instrument for self-assessment of nurses' core competencies in palliative care.

Competence can be seen as a prerequisite for high quality nursing in clinical settings. Few research studies have focused on nurses' core competencies in clinical palliative care and few measurement tools have been developed to explore these core competencies. The purpose of this study was to test and validate the nurses' core competence in palliative care (NCPC) instrument. A total of 122 clinical nurse specialists who had completed a postbachelor program in palliative care at two university colleges in Norway answered the questionnaire. The initial analysis, with structural equation modelling, was run in Mplus 7. A modified confirmatory factor analysis revealed the following five domains: knowledge in symptom management, systematic use of the Edmonton symptom assessment system, teamwork skills, interpersonal skills, and life closure skills. The actual instrument needs to be tested in a practice setting with a larger sample to confirm its usefulness. The instrument has the potential to be used to refine clinical competence in palliative care and be used for the training and evaluation of palliative care nurses.

Sleep in family caregivers of patients admitted to hospice: A pilot study.

OBJECTIVES: Caring for a dying family member is known to interfere with sleep, yet little is known about caregiver sleep once the patient is admitted to hospice. The aim of this pilot study was to describe the sleep of partners and other family caregivers of patients in hospice. METHODS: The pilot study used a cross-sectional, descriptive, and comparative design. Participants included the primary family caregivers of patients recently admitted to a hospice in Norway. Caregiver sleep during the prior month was measured with the Pittsburgh Sleep Quality Index (PSQI). During the patient's hospice stay, caregiver sleep was measured using wrist actigraphy for four nights and three days. RESULTS: Twenty family caregivers (12 partners and 8 other relatives) completed the study protocol without difficulty. On the PSQI, most caregivers (n = 13) reported clinically significant sleep problems during the prior month. Once the patient was admitted to hospice, actigraphy indicated that 10 caregivers had clinically significant sleep disruption (≥15% wake after sleep onset) and six averaged <7 hours of sleep per night. Partner caregivers reported more trouble falling asleep, and less sleep medication use, in the prior month than other types of family caregivers. However, once the patient was admitted to hospice, and after adjusting for caregiver age, partner caregivers experienced less sleep disruption than other caregivers. SIGNIFICANCE OF RESULTS: Findings demonstrate feasibility of the study protocol and indicate that sleep problems are common for caregivers of dying patients, even after the patient is admitted to hospice. The caregiver's relationship to the patient may be an important factor to consider in future studies.

Clinical competence in palliative nursing in Norway: the importance of good care routines.

AIM: This paper examines how clinical nurse specialists assessed their competences in relief of symptoms, and explores factors affecting good care routines in palliative care. METHODS: A prospective survey among 235 former post-bachelor (response rate 50.6 %) students at two university colleges in Norway. RESULTS: Correlations between the measured concepts showed a medium to high correlation between all five competences. Use of care routines correlated with all the other factors. The ability to identify lack of care showed significant correlation with one concept: time available for nursing. The results from the regression analysis supported a model with good care routines as a dependent variable (F=22.59, df=91, P<0.001). The independent variables in the model explained almost 57% of the variance in using care routines. Competences dealing with mouth problems, nausea, anxiety and the use of the Edmonton symptom assessment system (ESAS) had a positive effect on care routines. On the other hand, the ability to identify lack of care had a significant negative effect on the use of care routines. CONCLUSIONS: The importance of systematic assessment of the palliative patient;s care needs and symptom management are emphasized, and use of the ESAS, and good care routines was affected by post-bachelor competences.