Home Care Nurses’ Perceived Competence and Self-Efficacy in Palliative Care: An Integrative Review

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Abstract
Background: Patients’ homes are increasingly recognized as the preferred setting for palliative care (PC). As frontline providers, home care nurses face complex clinical and systemic challenges that demand high levels of knowledge and confidence. Thus, this review aimed to critically appraised and synthesized the literature on home care nurses’ perceived competence and self-efficacy in PC delivery, along with factors that influence both constructs. Methods: This integrative review employed Whittemore and Knafl’s framework and was guided by Bandura’s self-efficacy theory. The search was conducted in November 2024 using 9 databases: MEDLINE, Cochrane Central Register of Controlled Trials, Emcare, Cochrane Database of Systematic Reviews, CINAHL, ProQuest Nursing & Allied Health, ProQuest Dissertations & Theses Global, PsycINFO, and Scopus. Results: The search yielded 13 articles. Findings were categorized into 2 overarching themes: (1) structural and relational challenges and (2) educational and training gaps in PC. Time constraints resulted in task-oriented visits, while late PC referrals strained relationships by introducing nurses late in patients’ illness trajectories. Home care nurses often function in isolation with limited access to supervision and support. Persistent gaps were identified in knowledge and skills related to pediatric care, end-of-life discussions, symptom management, and psychosocial support. Conclusion: The findings suggest that nurses’ perceived competence and self-efficacy are shaped by individual, organizational, and systemic factors, highlighting areas for targeted training, organizational change, and policy development to support holistic PC. The review contributes to Bandura’s work by explaining self-efficacy and competence within the context of home-based PC.
Funding Information
  • VHA Home HealthCare Graduate Research Award

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