Managers’ experiences of implementing palliative care in nursing homes: a qualitative follow-up study after an educational intervention for the staff

Abstract

BACKGROUND: It is crucial to implement knowledge-based, high-quality palliative care for the increasing number of frail older people with multimorbidities in nursing homes. The manager's role in a successful implementation is often taken for granted despite scarce evidence. Therefore, the aim of this long-term follow-up study was to explore how managers experienced the implementation of palliative care in nursing homes after a multicentre educational intervention for staff. This Implementation of Knowledge-Based Palliative Care in Nursing Homes (KUPA) program consisted of workplace seminars, reflective activities, and practice-based tasks between seminars. The implementation was research-led before the participating managers took over its governance. METHODS: This qualitative follow-up study considered semi-structured interviews with 22 managers responsible for implementing palliative care in 20 nursing homes in Sweden. The analysis was conducted using a reflexive thematic approach. RESULTS: Our findings are presented under three main themes: Navigating Organisational Barriers, Empowering the Action Plan, and Ripple Benefits of Education. The managers navigate organisational barriers by establishing stability, maintaining continuity and supporting staff members' knowledge development despite structural barriers and limited resources. Empowering the action plan meant supporting staff to maintain motivation and a positive attitude towards workplace change. Managers emphasised their responsibility for the continuation of implementation of palliative care. The ripple benefits of education, from the managers' perspective, include increased knowledge and use of holistic palliative care, a shared language, and a consensus on the meaning of palliative care, thereby expanding cooperation and mutual understanding across the team's professions. CONCLUSIONS: This long-term follow-up study revealed several challenges to the implementation of palliative care and underscored the demanding work of managers. Staff shortage, limited budget and support led to work-related instability. Closer interprofessional collaboration and a broader approach to palliative care as a process from early signs to the end of life need to continue and deepen to be knowledge-based nursing care. From a leadership perspective, a successful implementation requires a long-term commitment, financial resources, a supportive organisation, and manager competence. TRIAL REGISTRATION: NCT02708498. Date of registration: 26 February 2016.