The Development of an Instrument to Evaluate Nursing Assistants’ Knowledge, Skills and Attitudes within a Palliative Approach

Older people entering Residential Aged Care Facilities (RACF) have complex health care needs, with many requiring a palliative approach on admission. The focus of a palliative approach is on managing physical and emotional symptoms to reduce suffering, promote comfort, and enable a peaceful death. Providing this level of care however, requires essential knowledge, skills and attitudes in care processes.

‘Nursing assistant’ is the umbrella term used in this study to describe the largest aged care workforce. At present nursing assistants make up 70% of the RACF workforce, and are increasingly assuming more direct care of residents with limited supervision and support. Determining nursing assistants’ knowledge, skills and attitudes to provide care with a palliative approach is particularly important given their level of involvement in care processes.

This study aims to develop a valid and reliable instrument capable of determining the training and development needs of nursing assistants providing a palliative approach in RACFs.

The development and testing of the instrument follows recommended psychometric processes and comprises four separate sequential phases, using a mixed methods approach. In Phase 1, items were generated from qualitative interviews with nursing assistants (n=25). In Phase 2, item content was validated with four groups of experts. In Phase 3, three separate questionnaires entitled PANA (Palliative Approach for Nursing Assistants) were pilot tested as a single instrument. In Phase 4, the psychometric properties of the new instrument were evaluated using a random sample of 348 nursing assistants across 17 RACFs in the Greater Sydney region.

Individual item properties were analysed for difficulty, discrimination and item-total correlations, reducing the item set to 40. Psychometric testing included translational (face and content) and construct validity. Three separate questionnaires were finalised: the PANA_Knowledge Questionnaire, the PANA_Skills Questionnaire and the PANA_Attitudes Questionnaire. Internal consistency for the instruments ranged from α=0.81 to 0.74. Test-retest reliabilities using the intra-class correlation were in the range of 0.709-0.335 for the three instruments. Five discriminative and divergent hypotheses were made; four were supported.

The study’s results show that experience in the role, rather than the level of education, results in higher knowledge and attitude scores across groups of nursing assistants, while their skills largely remain static. What emerges is an identification of the gaps and current educational shortfalls affecting nursing assistants’ competence to deliver care with a palliative approach.

The PANA questionnaires demonstrate sensitivity for nursing assistants’ level of education and scope of practice and, as such, are reliable tools by which to identify the educational needs of the largest cohort of the aged care workforce.