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

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.

Keywords

home health nursing nurses palliative care professional competence review self-efficacy

Introduction

Home-based palliative care (PC) has emerged as a widely recognized model of care globally, as more individuals wish to receive care within the comfort and privacy of their homes.¹ This shift enhances quality of life by promoting autonomy, strengthening family involvement, and reducing unnecessary healthcare expenditures.¹ Home-based PC aims to optimize quality of life through symptom management and psychosocial support.² As home care gains policy support, expanding home-based PC requires nurses equipped to deliver high-quality, holistic care in complex, unpredictable settings.³ Understanding what enables nurses to feel capable and confident in this setting is thus central to workforce sustainability and the quality of home-based PC.^4-6

Perceived competence refers to nurses’ knowledge, skills, and attitudes, whereas self-efficacy refers to their belief in their ability to perform tasks under specific conditions.^5,6 Bandura’s self-efficacy theory was chosen because a guiding framework as both constructs influence the extent and duration of nurses’ efforts in clinical practice.⁵ This theory offers a useful lens for examining how nurses’ confidence in PC delivery develops through mastery experiences, vicarious learning (peer modeling), verbal persuasion (feedback), and emotional or physiological states.⁵ These 4 sources informed the synthesis of evidence, providing a structure for interpreting factors that shape home care nurses’ perceived competence and self-efficacy in PC. In home care, these sources may be shaped by service organizations and the realities of autonomous practice, which can influence confidence and competence in different ways.⁷

While research has explored competence^8,9 and self-efficacy^7,10 in home care nursing, evidence specific to home-based PC is heterogeneous in study design and largely treats these concepts in isolation. In addition, while both are distinct constructs, they are related; one may have the competence to complete a task yet fail to perform effectively under stressful circumstances.^11-13 Mohamadirizi et al¹³ suggest that self-efficacy may be a predictor of clinical competence, highlighting the association between both constructs. This is further supported by Bandura,⁵ who identifies a relationship between the 2.

Despite previous studies exploring this association, limited studies have examined both constructs within home-based PC, where nurses make independent decisions with limited support.^11-13 Thus, it remains unclear how these constructs are described, how they relate and what factors shape them, making a synthesis necessary to inform research, education, and policy aimed at strengthening the home-based PC workforce.

Aim

To synthesize evidence on home care nurses’ perceived competence and self-efficacy in home-based PC and the factors associated with these constructs.

Methods

Design

An integrative review was used to synthesize empirical literature on home care nurses’ perceived competence and self-efficacy in PC, selected for its flexibility across heterogeneous study designs.¹⁴ The review followed Whittemore and Knafl’s 5-stage framework: problem formulation, data collection or literature search, evaluation of data, data analysis, and interpretation and presentation of results.¹⁴ Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and quality appraisal was conducted using the Critical Appraisal Skills Program (CASP) checklists and the Mixed Methods Appraisal Tool (MMAT).^15-17

Eligibility Criteria

Inclusion criteria were developed collaboratively (JTa, JTay, KP). Studies were included if they were primary peer-reviewed articles (qualitative, quantitative, or mixed-methods); focused on RNs, RPNs, or LPNs; and focused exclusively on home care or included a distinct home care subsample with separate results. No date or geographical restrictions were applied given the limited literature on both constructs in palliative home care. Studies were excluded if they were: literature reviews of any form, as these are considered secondary sources or gray literature; focused on non-RN/RPN/LPN professionals, patients, or families; or published in a language other than English.

Search Strategy

The search was carried out with a librarian’s (AM) assistance in November 2024. Nine databases were searched: 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. This search yielded 119 articles for eligibility screening. See supplementary material for the search strategy.

Study Selection

The screening process was conducted using Covidence^®. After removing duplicates and ineligible articles, 76 articles proceeded to title and abstract screening, with 21 advancing to full-text review, yielding 7 studies. To ensure comprehensive coverage, references and citation searching of the 7 included articles in Scopus identified 406 additional studies, of which 6 met inclusion criteria. The final literature sample comprised 13 articles (Table 1), with the complete process shown in the PRISMA flowchart (Figure 1).

Table 1.

Literature Review Table and Quality Appraisal.

Author country	Study design	Sample	Results			Quality
Author country	Study design	Sample	Current state of perceived competence and self-efficacy	Factors influencing perceived competence and self-efficacy	Mechanisms of impact	Quality
Castor et al¹⁸ Sweden	Qualitative	24 HCNs	Pediatric PC evokes inadequacy, fear, and anxiety, though increased exposure promotes growth and perceived competence.	Limited pediatric training, interdisciplinary access, and experience. Late referrals and time constraints.	Insufficient training and limited pediatric exposure reduce confidence even in experienced nurses, while late referrals hinder rapport and effective care.	8/10
Dunne et al¹⁹ England	Qualitative	25 HCNs	Pain was the most challenging symptom, with dyspnea and fatigue also difficult to manage; emotional demands of communication further reduced confidence.	Lack of education, training, after-hours support, and late referrals.	Limited education, training, and interdisciplinary support increased stress and reduced perceived competence and self-efficacy, while late referrals hindered relationship development.	8/10
Fillion et al²⁰ Canada	Cross-sectional	197 HCNs	Significant negative correlations were found between educational needs and self-efficacy (r = −.23, p < .01) and between psychological distress and self-efficacy (r = −.31, p < .01).	Education level and access barriers to continuing education.	Restricted access to continuing education limits skill development and increases distress, lowering self-efficacy.	9/11
Glajchen and Bookbinder²¹ USA	Cross-sectional	1236 community care nurses	PC knowledge and skills varied. Pain assessment knowledge was highest and pain management was lowest. Perceived competence was highest in patient/family communication and lowest in spinal analgesia pump use. Pain management knowledge positively correlated with perceived competence (chi-square = 83.420, p = .0001).	Education and PC knowledge.	Limited pain education contributed to knowledge gaps, reducing perceived competence.	9/11
Griffiths et al²² England	Qualitative	34 HCNs	Nurses valued holistic care but felt more comfortable with practical tasks; role uncertainty around emotional support limited therapeutic communication.	Late referrals, ambiguity in nursing responsibilities, and a lack of confidence in psychological support.	Late referrals and unclear role expectations around psychological support hindered rapport-building, leading to avoidance and reduced confidence in sensitive discussions.	8/10
Griffiths et al²³ England	Mixed methods	33 HCNs	Training improved perceived competence in communication (p > .05). Qualitative findings showed varying confidence, with most developing skills through experience and exposure.	Structured training, time constraints, experience, exposure, and family dynamics.	Without formal communication training, nurses were often unprepared for complex psychological and emotional aspects of PC, defaulting to passive listening and advice-giving.	12/15
Iranmanesh et al²⁴ Sweden	Qualitative	4 HCNs	Self-efficacy in communication about death and dying was low, though nurses who perceived themselves as competent reported higher job satisfaction, greater confidence, and less avoidance of challenging situations.	Experience, exposure, family dynamics, feedback, and team collaboration.	Experiential learning and family feedback enhanced confidence, while complex family dynamics challenged effective care. Supportive team environments with reflection and debriefing strengthened competence and self-efficacy.	8/10
Joren et al²⁵ Netherlands	Cross-sectional	229 HCNs	Most nurses (75%) rated physical care competence highly, while social (47%), psychological (52%), and spiritual care (54%) competence ratings were more moderate.	Experience, workload, time constraints, and team collaboration.	Frequent physical care experience reinforces competence and self-efficacy, while workload, time constraints, and limited interdisciplinary support hinder holistic care delivery.	9/11
Khalil et al²⁶ Australia	Cross-sectional	122 HCNs	Nurses showed significantly higher odds of no/basic knowledge across multiple domains, including opioid use (MOR = 6.88, 95% CI = 1.98-23.9), delirium management (MOR = 6.23, 95% CI = 1.91-35.5), and PC emergencies. Clinical experience was significantly correlated with greater PC emergency knowledge.	Experience, knowledge, training, and mentorship.	Limited exposure and insufficient training reduce perceived competence and self-efficacy, while experience, structured training, and mentorship enhance skills, confidence, and care quality.	8/11
Neilson et al²⁷ England	Qualitative	30 community nurses	Nurses identified symptom management as their main knowledge deficit and reported low self-efficacy in pediatric PC due to infrequent encounters.	Experience, knowledge, workload, family dynamics, geographical coverage, emotional investment, and team collaboration.	Limited exposure, high workload, and emotional demands reduce self-efficacy and perceived competence, with the solitary nature of home care increasing burnout risk. Team support and mentorship improved both constructs.	8/10
Ristevski et al²⁸ Australia	Cross-sectional	122 HCNs	Overall high competence in psychosocial care but gaps in pediatric and bereavement care.	Own experiences, training, mentoring, and reflective practices.	Most reported frequent supervision (66%) as helpful, while mentoring (50%) and reflective practice (52%) were considered self-care tools.	9/11
Sato et al²⁹ Japan	Cross-sectional	177 HCNs	Strong knowledge and skills in PC philosophy (90 ± 23%), moderate in pain management (54 ± 29%), but limited in psychological support (37 ± 29%).	Experiences and knowledge.	Clinical experience was associated with self-efficacy, though insufficient pain management knowledge remained a barrier.	8/11
Sawatzky et al³⁰ Canada	Cross-sectional	215 HCNs	Highest perceived competence in interprofessional collaboration and communication (mean = 4.06, SE = 0.05) and lowest in spiritual support (mean = 3.24, SE = 0.06) on a scale of 1 to 5.	Time constraints, ambiguity in roles, and inadequate resources.	Unclear roles and inadequate resources reduced perceived competence and confidence, while time constraints led nurses to prioritize physical over spiritual and other care domains.	10/11

Abbreviation: HCN, home care nurses.

For the CASP, scores of 8 or higher indicate high methodological quality. For the MMAT, studies scoring 12 indicate moderate quality.

Figure 1.

PRISMA flowchart.

Quality Appraisal

Data screening and quality appraisal were conducted independently by 2 reviewers (JTa and AR), with discrepancies resolved through discussion. Twelve studies were assessed using the CASP checklist for their reliability, transferability, and usefulness.¹⁶ One mixed-methods study was appraised using MMAT.¹⁷ Each criterion was scored as 1 (met) or 0 (not met/unclear). For the CASP, 5 qualitative studies scored either 8 or 9 out of a maximum of 10, indicating high methodological quality studies.³¹ Similarly, quantitative studies scored between 8 and 10 out of a maximum of 11.³¹ For the MMAT, 1 mixed-methods study scored 12 out of a maximum of 15, indicating moderate quality.³² The quality appraisal scores for all included studies are presented in Table 1.

Data Charting

Following Whittemore and Knafl’s framework,¹⁴ data were extracted and analyzed interarively (JTa, JTay, AM, KP) with key themes verified against source studies to ensure accurate representation of study findings. Bandura’s theory⁵ served as a theoretical lens to interpret findings and understand how identified factors shape the relationship between perceived competence and self-efficacy in home-based PC.

Results

Of the 13 included articles, 5 were qualitative, 7 quantitative, and 1 mixed-methods. Only 4 were published in the last 5 years. Studies were conducted in England (n = 4), Sweden (n = 2), Australia (n = 2), Canada (n = 2), Japan, the Netherlands, and the United States. Nine focused on adult PC and 4 on pediatric PC. Two overarching themes were identified: structural and relational challenges and educational and training gaps in PC.

Structural and Relational Challenges

Organizational structures, such as time constraints, heavy workloads, late referrals, and isolated work environments, can limit access to timely and comprehensive PC. Compounded by resource constraints, such as limited access to interdisciplinary support and inadequate after-hours coverage, nurses are often left to function in time-pressured visits that prioritize task completion over relationship-based care. These conditions often reduce nurses’ confidence in providing holistic support.

Time Constraints and Workload Pressures

Time constraints were commonly reported as a barrier, often impacting nurses’ ability to provide comprehensive care.^18,22,25 Factors such as time pressure, nursing shortages, high patient demands, number of patients per day, and working hours contribute to task-oriented care.^25,30 This environment prioritizes physical tasks over psychosocial and spiritual support, which are often perceived to be more time-consuming, abstract, and emotionally complex.^22,25,30 This is further reinforced by nurses reporting greater comfort and sense of accomplishment in completing tangible tasks.^22-25,29,30 Limited time is a significant barrier to caring for end-of-life and pediatric patients, whose needs are more complex and unpredictable.¹⁸

Late Referrals to PC Services

Late PC referrals were identified as a recurring barrier, limiting nurses’ ability to build rapport, establish trust, and deliver effective care.^18,19,30 This challenge is pronounced in pediatric PC, where children require additional time to develop comfort with unfamiliar providers.¹⁸ Earlier PC integration, ideally near diagnosis, could foster routine, enhance family trust, and strengthen nurses’ competence and confidence through consistent involvement in care.¹⁹

Relational Challenges With Families

A distinct theme is the relational complexity of working within family homes, requiring nurses to navigate family dynamics and expectations while providing family-centered care.^19,24,25 The literature highlights the emotional difficulty of being positioned as intermediaries in family conflicts, particularly with sensitive discussions around goals of care and prognosis.^19,24,25 Emotional intensity can be heightened in pediatric PC where nurses often form deep bonds with children and parents, making the experience both rewarding and emotionally challenging.²⁴ Despite the emotional toll, nurses reflected on the benefits of personal interactions with families, highlighting the positive impact feedback has on their perceived competence and self-efficacy.¹⁶ Exposure to these challenging experiences, rather than avoidance, was associated with greater satisfaction, self-esteem, and self-efficacy.^24,28,29

Professional Isolation and Limited Support

Home care nurses practice in professional isolation, without immediate access to interdisciplinary teams or clinical supervision.^{18,19,24,25,27,30} This is intensified by travel demands and administrative tasks that compete with direct care.³⁰ It also limits opportunities for real-time consultation, particularly critical in pediatric cases requiring specialized expertise.^18,25 Rural settings compound these challenges, with nurses covering large geographical locations, often leading to burnout.²⁷

Professional isolation was associated with emotional and mental stress, particularly when nurses practice with limited supervision and resources.^18,19,24,30 Limited access to clinical guidance during evenings, weekends, and holidays increases stress and administrative burden, adding to nurses’ existing responsibilities.¹⁹ One study found a negative correlation between psychological distress and nurses’ self-efficacy in delivering PC (r = −.31, p < .01), indicating that emotional strain is associated with reduced confidence in care delivery.²⁰ To compensate, nurses rely on peer support networks and trusting relationships to navigate difficult situations, with some reporting that managing uncertainty independently fosters autonomy and learning over time.²⁴

Educational and Training Gaps in PC

A consistent theme is the lack of comprehensive PC education and training. While some nurses reported confidence in specific areas,^21,25,28 persistent gaps were identified in pediatric-specific PC,^18,28 communication skills,^19,23 pain and symptom management,^19,21,27,29 and psychosocial and spiritual care.^{20,22,25,29,30}

Inadequate Pediatric PC Preparation

Several studies reported minimal pediatric-specific PC content in both formal nursing curricula and organizational training. Nurses frequently describe feeling unprepared to care for children with life-limiting illnesses, often defaulting to strategies learned in adult PC practice.^18,28 Given the infrequent and highly variable nature of pediatric PC encounters, nurses report difficulty in maintaining competence over time, reinforcing feelings of uncertainty, stress, and reduced confidence in care delivery.^18,27 Several studies note that home care nurses express a strong desire for increased mentorship, clinical guidance, and opportunities to collaborate with pediatric-specific PC clinics.^26,28 Such partnerships are seen as valuable sources of support, enabling nurses to seek assistance, consult on complex cases, and engage in collegial learning.^18,27,28

Communication Skills for Death and Dying Discussions

When rating overall competence domains, nurses reported communication skills as their highest area of perceived competence.²¹ However, communication with children and youth about death and dying is highlighted as a key challenge where nurses report feeling uncomfortable initiating sensitive conversations and excluding children from care-related conversations.^19,24,28,29 Some nurses report a lack of confidence with initiating discussions with patients or families, often relying on them to initiate these conversations.²³ Most nurses relied on informal learning through past clinical experiences and patient feedback.^23,24 There is evidence that structured training programs, such as simulations or role-playing, can significantly improve nurses’ confidence in their communication skills.²³

Limited Training in Pain and Symptom Management

Limited training in pain^19-21,27 and other symptom management^19,26,27,29 emerged as a persistent concern. While nurses feel relatively confident in the philosophy of pain and its assessment, they lack competence in implementing effective pain management strategies.^21,29 Supporting this finding, only 38% of home care nurses received minimal pain education (1 hour), while 34% had up to 5 hours of training.²¹ Complex pain tools and medication calculations were frequently cited as barriers to effective care, as nurses lacked the knowledge and confidence to utilize these tools (e.g., patient controlled analgesia, continuous subcutaneous infusions) to adequately address patients’ distress.²¹ Instead, there is reliance on single opioid usage in combination with non-pharmacological interventions.²¹ In addition to pain management, symptom management, particularly dyspnea, fatigue, and delirium, were also cited as challenging due to limited knowledge of symptom recognition¹⁹ and inadequate training in the use of screening tools.²⁶ Notably, a strong correlation between knowledge and perceived competence (chi-square = 83.42, P = .0001) was found in 1 study.²¹

Psychosocial and Spiritual Care Competence Gaps

Despite psychosocial care being within nurses’ scope of practice, nurses consistently report low confidence in addressing psychosocial distress and frequently defer to other professionals.^22,30 Discomfort and low perceived competence drive this avoidance,²² and while 1 study reported high overall psychosocial competence, gaps in grief support were identified.²⁸ Role ambiguity around bereavement care further compounds these gaps and hinders comprehensive PC.³⁰

Discussion

This integrative review synthesizes current knowledge on home care nurses’ perceived competence and self-efficacy in PC, including factors that shape them. Analysis of 13 articles generated 2 themes: structural and relational challenges and educational and training gaps in PC, discussed in the context of existing literature and Bandura’s self-efficacy theory.⁵

Unmet Educational and Training Needs

Educational gaps in home-based PC persist not only due to limited training, but also because home care is often organized in ways that restrict the experiences through which competence is built. Across international contexts, nurses have fewer opportunities for mastery, peer modeling, and timely feedback when care is delivered under time pressure and professional isolation.^{4,5,9,18,22,25,30,33-35} Lower confidence in communication or symptom management may be reinforced by avoidance, further limiting the repeated practice needed to consolidate skills.^33,34 This mechanism helps explain why training interventions can show limited uptake or impact when implementation supports are weak.^18,23,33 Rather than framing this as a knowledge gap, these findings highlight organizational levers as central to improvement. Drawing on Bandura’s theory, targeted interventions should include protected time for relationship-based care, accessible clinical consultation, mentorship and coaching to facilitate vicarious learning, and structured feedback to reinforce verbal persuasion and support transfer of learning into practice.⁵

Organizational and Resource Limitations

Home-based PC constraints reflect not only individual preparation but also service designs that combine professional isolation with chronic time scarcity, limiting conditions under which competence and self-efficacy are built. Through Bandura’s theory, nurses may have fewer opportunities for mastery experiences, peer modeling, and timely feedback when visits are compressed, and consultation is not readily accessible.^5,10,18,25 Limited support and time interact to restrict repeated practice and reinforce task prioritization, helping explain why education-focused interventions show limited impact when conditions for skills transfer are weak.^36,37 These constraints also represent quality and equity concerns, particularly in rural and after-hours contexts where isolation is most pronounced.^20,27,30 Targeted strategies such as proactive weekend planning, clear escalation contacts, and reliable after-hours consultation may be particularly important in geographically dispersed regions.^19,25 Geography further intensifies constraints, as travel between dispersed households and administrative demands reduce time for direct care and real-time consultation.^19,30 This helps explain why isolation and stress may be more pronounced in rural and after-hours contexts, with downstream effects on self-efficacy and continuity of PC.^20,27,30 Consistent with Bandura’s theory, improvement efforts should therefore focus on organizing home-based PC to allow adequate time for relationship-based care, ensure access to mentorship or clinical consultation, and embedded regular debriefs or case reviews to reinforce learning in practice.^{5,18,19,24,25,33}

Navigating Family Dynamics

Providing PC in patients’ homes requires nurses to continually negotiate professional boundaries within a private, family-controlled setting, where their position as guests can complicate decision-making and communication.^19,24,25,35 The complexity of family dynamics has been documented across cultural contexts,³⁸ often placing nurses in the role of intermediary between patients, families, and interdisciplinary teams, particularly during sensitive discussions about goals of care and prognosis.^4,10 This relational complexity shapes perceived competence and self-efficacy, as uncertainty about roles, authority, and family expectations increases emotional and communicative demands and contributes to hesitancy in difficult conversations.^19,24,25 At the same time, strong relationships and affirming family feedback can reinforce confidence through Bandura’s verbal persuasion.^5,33,39 Emotional arousal is particularly relevant in home-based PC, where nurses often navigate emotionally charged encounters.⁵ Thus, reflective practice has been identified as a strategy to process these experiences and strengthen confidence over time, highlighting the need for supports that build relational skill and self-efficacy alongside clinical competence.^33,39

Strengths and Limitations

This integrative review synthesizes international evidence on home care nurses’ perceived competence and self-efficacy in PC, 2 constructs rarely examined together. Strengths include a comprehensive database search, 2 rounds of data collection, and independent screening and quality appraisal by 2 reviewers. Overall study quality was moderate, with sound methods but variable reporting and measurement. Limitations include restriction to English-language studies, only 4 articles published within the last 5 years, and a majority of studies conducted in Western or high-income countries. This may not fully reflect the current state of an evolving field and may limit generalizability to other contexts, such as low- and middle-income countries or regions with different home care models.

Implications

Organizations providing home-based PC should strengthen professional development to reflect the realities of isolated, time-pressured practice, and limited specialist access.³⁶ Drawing on Bandura’s mastery experiences,⁵ training should extend beyond didactic content to include case-based learning, simulation, and structured repetition, feedback, and debriefing to build confidence in communication, psychosocial support, and advance care planning.^34,36,37,40 Partnerships with external PC organizations can support timely, targeted upskilling for specialized scenarios such as pediatric PC, while organizations should reduce access barriers by funding registration and offering education during paid hours.^20,34 To support skills transfer and reduce isolation, agencies should consider developing buddy systems to facilitate vicarious learning through peer observation and shared experience.^5,18,41 Reflective practice and routine debriefing or case review may help nurses process difficult encounters and mitigate burnout and compassion fatigue.^5,33 Future research should examine perceived competence and self-efficacy together in home care contexts to clarify how practice environments shape these constructs and their relationship to PC delivery and patient outcomes.

Conclusions

Home care nurses’ perceived competence and self-efficacy in PC are shaped by more than individual preparation. Practice conditions determine whether nurses have the time, support, and feedback to translate knowledge into skilled, relational care. Strengthening this workforce requires coordinated educational and organizational approaches that enable learning in practice, guiding educators, administrators, and policymakers in building systems that support high-quality, holistic care.

Supplemental Material

sj-docx-1-hhc-10.1177_10848223261443225 – Supplemental material for Home Care Nurses’ Perceived Competence and Self-Efficacy in Palliative Care: An Integrative Review

Supplemental material, sj-docx-1-hhc-10.1177_10848223261443225 for Home Care Nurses’ Perceived Competence and Self-Efficacy in Palliative Care: An Integrative Review by Joanne Ta, Joanne Tay, Adam Mulcaster, Amanda Rilett and Kathryn Pfaff in Home Health Care Management & Practice

Footnotes

ORCID iDs

Joanne Ta

Joanne Tay

Adam Mulcaster

Kathryn Pfaff

Author Contributions

CRediT authorship contribution statement: JTa: Conceptualization, Methodology, Investigation, Writing – Original Draft, Review & Editing, Project Administration, Funding Acquisition. JTay: Conceptualization, Methodology, Investigation, Writing – Review & Editing, Supervision, Funding Acquisition. AM: Resources, Writing – Review & Editing. AR: Data Curation, Writing – Review & Editing. KP: Conceptualization, Methodology, Investigation, Writing – Review & Editing, Supervision, Funding Acquisition.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author (JTa) received a VHA Home HealthCare Graduate Research Award in support of her master’s thesis, of which this work forms a part.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

References

Lin

Chu

WM.

Home-based palliative care: benefits, challenges, opportunities and future directions in a super-aged society. J Hosp Palliat Care. 2025;28(3):81-88. doi:10.14475/jhpc.2025.28.3.81

World Health Organization. Palliative Care. 2023. https://www.who.int/europe/news-room/fact-sheets/item/palliative-care

Hsieh

Kuo

CY.

The experiences and needs of nurses providing home-based palliative care: a qualitative meta-synthesis. J Palliat Care. 2023;38(4):490-502. doi:10.1177/08258597221105167

Lotfi Fatemi

Karimi Moonaghi

Heydari

. Perceived challenges faced by nurses in home health care setting: a qualitative study. Int J Community Based Nurs Midwifery. 2019;7(2):118-127. doi:10.30476/IJCBNM.2019.44883

Bandura

Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215. doi:10.1037/0033-295x.84.2.191

Desbiens

Fillion

Development of the palliative care nursing self-competence scale. J Hosp Palliat Nurs. 2011;13(4):230-241. doi:10.1097/NJH.0b013e318213d300

Briese

PM.

Factors Associated with New Hospital Nurses’ Self-Efficacy in Providing Palliative End-of-Life Care. Doctoral dissertation, University of North Dakota. 2022.

Agoston

IB.

Northern Rural Nurses’ Self-Perceived Competence in Addressing the Spiritual Needs of Patients with Life-Limiting Conditions by Using a Palliative Approach. M.S.N. Trinity Western University. Canada; 2014. https://ledproxy2.uwindsor.ca/login?url=https://www.proquest.com/dissertations-theses/northern-rural-nurses-self-perceived-competence/docview/1626042150/se-2?accountid=14789

Nguyen

Yates

Osborne

Palliative care knowledge, attitudes and perceived self-competence of nurses working in Vietnam. Int J Palliat Nurs. 2014;20(9):448-456. doi:10.12968/ijpn.2014.20.9.448

10.

Dehghani

Barkhordari-Sharifabad

Sedaghati-Kasbakhi

Fallahzadeh

Effect of palliative care training on perceived self-efficacy of the nurses. BMC Palliat Care. 2020;19(1):63. doi:10.1186/s12904-020-00567-4

11.

Downey

Engelberg

Shannon

Curtis

JR.

Measuring intensive care nurses’ perspectives on family-centered end-of-life care: evaluation of 3 questionnaires. Am J Crit Care. 2006;15(6):568-579.

12.

Majors

SA.

Pediatric Airway Management to Improve Competence and Self-Efficacy in PACU Nurses. 2023. Accessed February 20, 2026. https://www.digitalgreensboro.org/record/16777

13.

Mohamadirizi

Kohan

Shafei

Mohamadirizi

The relationship between clinical competence and clinical self-efficacy among nursing and midwifery students. J Pediatr Perspect. 2015;3(6.2):1117-1123. doi:10.22038/ijp.2015.5222

14.

Whittemore

Knafl

The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-553. doi:10.1111/j.1365-2648.2005.03621.x

15.

Page

McKenzie

Bossuyt

, et al. PRISMA 2020 flow diagram. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. 2024. Accessed January 22, 2025. https://www.prisma-statement.org/prisma-2020-flow-diagram

16.

Critical Appraisal Skills Programme. Critical Appraisal Checklists. 2025. Accessed January 22, 2025. https://casp-uk.net/casp-tools-checklists/

17.

Hong

Pluye

Fàbregues

, et al. Reporting the Results of the MMAT (Version 2018). 2020. Accessed September 10, 2025. http://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/140056890/Reporting_the_results_of_the_MMAT.pdf

18.

Castor

Hallström

Hansson

Landgren

Home care services for sick children: healthcare professionals’ conceptions of challenges and facilitators. J Clin Nurs. 2017;26(17-18):2784-2793. doi:10.1111/jocn.13821

19.

Dunne

Sullivan

Kernohan

Palliative care for patients with cancer: district nurses’ experiences. J Adv Nurs. 2005;50(4):372-380. doi:10.1111/j.1365-2648.2005.03402.x

20.

Fillion

Fortier

Goupil

RL.

Educational needs of palliative care nurses in Quebec. J Palliat Care. 2005;21(1):12-18.doi:10.1177/082585970502100103

21.

Glajchen

Bookbinder

Knowledge and perceived competence of home care nurses in pain management: a national survey. J Pain Symptom Manag. 2001;21(4):307-316. doi:10.1016/S0885-3924(01)00247-0

22.

Griffiths

Ewing

Rogers

, et al. Supporting cancer patients with palliative care needs: district nurses’ role perceptions. Cancer Nurs. 2007;30(2):156-162. doi:10.1097/01.NCC.0000265013.63547.4a

23.

Griffiths

Wilson

Ewing

Connolly

Grande

Improving communication with palliative care cancer patients at home – a pilot study of SAGE & THYME communication skills model. Eur J Oncol Nurs. 2015;19(5):465-472. doi:10.1016/j.ejon.2015.02.005

24.

Iranmanesh

Häggström

Axelsson

Sävenstedt

Swedish nurses’ experiences of caring for dying people: a holistic approach. Holist Nurs Pract. 2009;23(4):243-252. doi:10.1097/HNP.0b013e3181aecf12

25.

Joren

de Veer

AJE

de Groot

Francke

AL.

Home care nurses more positive about the palliative care that is provided and their own competence than hospital nurses: a nationwide survey. BMC Palliat Care. 2021;20(1):170. doi:10.1186/s12904-021-00866-4

26.

Khalil

Leach

Bolton

Spargo

Byrne

Ristevski

Rural nurses’ self-rated knowledge and skills in pain, medication, symptom and emergency management in community-based palliative care: a cross-sectional survey. Collegian. 2023;30(1):84-93. doi:10.1016/j.colegn.2022.07.008

27.

Neilson

Kai

MacArthur

Greenfield

Exploring the experiences of community-based children’s nurses providing palliative care. Paediatr Nurs. 2010;22(3):31-36. doi:10.7748/paed2010.04.22.3.31.c7640

28.

Ristevski

Leach

Bolton

Spargo

Byrne

Khalil

Rural community-based nurses’ self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers. Palliat Support Care. 2022;20(6):823-831. doi:10.1017/S1478951521001644

29.

Sato

Inoue

Umeda

, et al. A Japanese region-wide survey of the knowledge, difficulties and self-reported palliative care practices among nurses. Jpn J Clin Oncol. 2014;44(8):718-728. doi:10.1093/jjco/hyu075

30.

Sawatzky

Roberts

Russell

, et al. Self-perceived competence of nurses and care aides providing a palliative approach in home, hospital, and residential care settings: a cross-sectional survey. Can J Nurs Res. 2021;53(1):64-77. doi:10.1177/0844562119881043

31.

Deng

Hounsri

Lopez

Tam

WW.

Family experiences, needs, and perceptions in home-based hospice care for patients with terminal cancer: meta-synthesis and systematic review. JMIR Cancer. 2025;11(1):e71596. doi:10.2196/71596

32.

Vernon

Hughes

Kowalczyk

Measuring effectiveness in community-based palliative care programs: a systematic review. Soc Sci Med. 2022;296:114731. doi:10.1016/j.socscimed.2022.114731

33.

Chong

Abdullah

Community palliative Care Nurses’ challenges and coping strategies on delivering home-based pediatric palliative care: a qualitative study. Am J Hosp Palliat Med. 2017;34(2):125-131. doi:10.1177/1049909115607296

34.

Farrag

Ibrahim

Anwr

Ibrahim Ibrahim

Saadoon

MM.

Pediatric nurses’ perceived competencies toward palliative care for terminally ill children. Asian Pac J Cancer Prev APJCP. 2023;24(9):3275-3282. doi:10.31557/APJCP.2023.24.9.3275

35.

Furåker

Nilsson

Registered nurses’ views on competencies in home care. Home Health Care Manage Pract. 2012;24(5):221-227. doi:10.1177/1084822312439579

36.

Artino

Jr.

Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ. 2012;1(2):76-85. doi:10.1007/s40037-012-0012-5

37.

Esteban-Burgos

Moya-Carramolino

Vinuesa-Box

, et al. Clinical simulation in palliative care for undergraduate nursing students: a randomized clinical trial and complementary qualitative study. Healthcare. 2024;12(4):421. doi:10.3390/healthcare12040421

38.

Anonjarn

Matchim

Effectiveness of end-of-life care in the community in the Asian context: a systematic review. Inq J Health Care Organ Provis Financ. 2025;62:00469580251382394. doi:10.1177/00469580251382394

39.

Iranmanesh

Razban

Tirgari

Zahra

Nurses’ knowledge about palliative care in southeast Iran. Palliat Support Care. 2014;12(3):203-210. doi:10.1017/S1478951512001058

40.

Zhang

Huang

, et al. Self-reported practices, competence and difficulties towards palliative care among nurses: a cross-sectional study. Eur J Cancer Care. 2022;31(6):e13688. doi:10.1111/ecc.13688

41.

Chong

Poon

WH.

The lived experience of palliative homecare nurses in Singapore. Singapore Med J. 2011;52(3):151-157.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB