1
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Uno A. How Views on Death and Time Perspectives Relate to Palliative Care Nurses' Attitudes Toward Terminal Care? OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1031-1050. [PMID: 34872421 DOI: 10.1177/00302228211055269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study's purpose was to explore how palliative care nurses' views on death and time perspectives are related to their terminal care attitudes. A questionnaire survey-consisting of the Death Attitude Inventory, Experiential Time Perspective Scale, and the Japanese version of the Frommelt Attitudes Toward Care of the Dying Scale-was administered to 300 individuals. Cluster analysis was conducted to categorize the way nurses perceive death, which revealed four types: Avoidant, middle, accepting, and indifferent. As a result of the analysis of variance on the terminal care attitudes, based on the types of views on death and time attitudes, it was found that the middle and accepting types, as well as the adaptive formation of time attitudes, were related to positive terminal care attitudes. In conclusion, more effective improvements in attitudes toward terminal care can be expected by incorporating time perspective, in addition to the conventional approaches focusing on death.
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Affiliation(s)
- Akari Uno
- Graduate School of Education, Tohoku University, Sendai, Japan
- Japan Society for the Promotion of Science Research Fellow, Japan
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2
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Mukinda FK, Van Belle S, Schneider H. Local Dynamics of Collaboration for Maternal, Newborn and Child Health: A Social Network Analysis of Healthcare Providers and Their Managers in Gert Sibande District, South Africa. Int J Health Policy Manag 2022; 11:2135-2145. [PMID: 34523867 PMCID: PMC9808286 DOI: 10.34172/ijhpm.2021.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/11/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Accountability for maternal, newborn and child health (MNCH) is a collaborative endeavour and documenting collaboration dynamics may be key to understanding variations in the performance of MNCH services. This study explored the dynamics of collaboration among frontline health professionals participating in two MNCH coordination structures in a rural South African district. It examined the role and position of actors, the nature of their relationships, and the overall structure of the collaborative network in two sub-districts. METHODS Cross-sectional survey using a social network analysis (SNA) methodology of 42 district and sub district actors involved in MNCH coordination structures. Different domains of collaboration (eg, communication, professional support, innovation) were surveyed at key interfaces (district-sub-district, across service delivery levels, and within teams). RESULTS The overall network structure reflected a predominantly hierarchical mode of clustering of organisational relationships around hospitals and their referring primary healthcare (PHC) facilities. Clusters were linked through (and dependent on) a combination of district MNCH programme and line managers, identified as central connectors or boundary spanners. Overall network density remained low suggesting potential for strengthening collaborative relationships. Within cluster collaborative patterns (inter-professional and across levels) varied, highlighting the significance of small units in district functioning. CONCLUSION SNA provides a mechanism to uncover the nature of relationships and key actors in collaborative dynamics which could point to system strengths and weaknesses. It offers insights on the level of fragmentation within and across small units, and the need to strengthen cohesion and improve collaborative relationships, and ultimately, the delivery of health services.
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Affiliation(s)
| | | | - Helen Schneider
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa
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3
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Takemura N, Fong DYT, Lin CC. Evaluating end-of-life care capacity building training for home care nurses. NURSE EDUCATION TODAY 2022; 117:105478. [PMID: 35841686 DOI: 10.1016/j.nedt.2022.105478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND With the rapidly aging population, the quality of end-of-life (EOL) care has become a significant issue. As the majority of deaths in Hong Kong (HK) currently occur in public hospitals, promoting palliative home care can relieve hospital burden and provide good deaths. There is a practical need to properly educate and train nurses on the skills to provide EOL care in home care settings. OBJECTIVES To evaluate the effect of the first EOL care training program for nurses working in home care settings or nursing homes on quality of life at work, orientation toward dying and death, and self-competence in death work. DESIGN A pre-experimental research design was utilized to conduct this study using a one-group pretest and posttest approach. SETTINGS AND PARTICIPANTS A convenience sample of 153 nurses working in home care settings or nursing homes in HK was selected. METHODS Participating nurses attended two-day entry-level and seven-day advanced-level courses. Quality of life at work, multidimensional orientation toward dying and death, and self-competence in death work were assessed using questionnaires at baseline and immediately after entry- and advanced-level training. RESULTS The results revealed that nurses reported a higher level of compassion satisfaction (d = 2.52, p < 0.001), less burnout at work (d = -3.25, p = 0.045), less fear about their own death (d = -1.33, p = 0.019), and more acceptance of others' deaths (d = 1.07, p = 0.004) in post-advanced-level courses. In general, participants were satisfied with the delivery method, duration, and logistical arrangement of the courses. CONCLUSIONS Nurses reported improved professional quality of life, less fear, and more acceptance toward death and dying after the training program. More educational strategies, such as role-play and case study discussions, are needed to improve the overall learning experience and effectiveness of the program. Future studies could add a qualitative component to yield deeper insights through the findings. As training programs allow nurses to cultivate their skills in clinical situations, there is an undeniable need to continue implementing standardized education and training for palliative care nurses to improve EOL care quality.
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Affiliation(s)
- Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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4
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Finotto S, Artioli G, Bodecchi S, Mainini C, Pedroni C, Di Leo S, Ghirotto L, Hayter M, Tanzi S. “Challenging Professional Boundaries”: A Grounded Theory Study of Health Professionals’ First Experiences of End-of-Life Care in Hospital. OMEGA-JOURNAL OF DEATH AND DYING 2022; 85:753-771. [DOI: 10.1177/0030222820954957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is known about health professionals first experiences of End-of-Life care in hospital. This study aims to understand the psycho-social process that occurs when hospital-based health professionals engage in caring for a dying patient for the first time. We conducted a Grounded Theory study, with 19 health professionals. Challenging professional boundaries is the core category which explains the overall process. The theoretical model we conceptualized evidenced three phases: 1) building a relationship between patient/family and professionals, 2) the disrupting impact and 3) the reaction phase. Our analysis highlighted the initial strong impact of this experience, which brought professionals to perceive emotional suffering and feelings of inadequacy. The new aspect our grounded theory revealed is that all the categories are pertinent to all the professionals involved, therefore they explain important aspects of interprofessional collaboration in End-of-Life care.
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Affiliation(s)
| | | | | | | | | | | | | | - Mark Hayter
- Faculty of Health Sciences, University of Hull, UK
| | - Silvia Tanzi
- Faculty of Health Sciences, University of Hull, UK
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5
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Shi H, Shan B, Zheng J, Zhang Y, Zhang J, Hu X. Grief as a mediator of the relationship between empathy and compassion fatigue. Psychooncology 2022; 31:840-847. [PMID: 34997672 DOI: 10.1002/pon.5875] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/23/2021] [Accepted: 01/14/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and death. Empathy is a prerequisite cognitive reaction for CF. Nurses with greater empathy levels are more prone to develop an emotional connection with patients. However, it is this kind of close bonds that led nurses to experience a deep sense of grief. Cumulative grief may eventually develop into CF. This study examined the levels of grief, empathy and CF, evaluated the correlation among empathy, grief and CF, and verified the role grief as a mediator of the relationship between empathy and CF. METHODS Participants were 794 Chinese oncology nurses in a cross-sectional study. We measures consisted a demographic questionnaire, the Interpersonal Reactivity Index, the Texas Revised Inventory of Grief-Present, and the Professional Quality of Life Scale. RESULTS Oncology nurses showed moderate levels of empathy and grief, moderate to high levels of CF. Perspective taking was negatively related to grief and secondary traumatic stress (STS). Empathic concern was negatively related to burnout (BO). Personal distress was positively related to grief, STS and BO. Grief was positively related to STS and BO. Grief played a partial mediating role between empathy and STS. CONCLUSIONS Oncology nurses commonly experience CF. There is a need to provide interventions and effective supports for oncology nurses to improve their empathy ability, and help them cope with grief and CF.
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Affiliation(s)
- Hongrui Shi
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China.,Department of Nursing, Changzhi Medical College, Changzhi, China.,Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Baifeng Shan
- Department of Clinical Lab, Blood Centre of Taiyuan City, Taiyuan, China
| | - Jianzhong Zheng
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Ying Zhang
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Jing Zhang
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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6
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Griffith S, Gelling L. How do hospice nurses prepare to give end-of-life care? A grounded theory study of nurses in one UK hospice. Int J Palliat Nurs 2021; 27:334-350. [PMID: 34569281 DOI: 10.12968/ijpn.2021.27.7.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Literature for preparing hospice nurses to deliver end-of-life care is sparse. AIM To investigate how nurses in one UK hospice prepared to deliver end-of-life care in their role. METHODS A classic grounded theory approach was used to investigate the experiences of 22 registered nurses in one UK hospice, to discover how they prepared for their role. A total of 17 individual interviews and one focus group were conducted. Constant comparison of data and member checking were performed to establish validity. FINDINGS Findings were synthesised into five categories: the 'shared ideal', feeling good at the job, making a difference, experience/exposure to hospice work and the importance of role models. The shared ideal formed the core category, which explained how hospice nurses feel a sense of 'fit' with their work. CONCLUSION The feeling of a nurse feeling well-suited to the work and that there the work was a good 'fit' for them was identified as a core element to nurses' feelings of preparedness to provide end-of-life care.
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Affiliation(s)
- Sue Griffith
- Education Department, Farleigh Hospice, Chelmsford, Essex, UK
| | - Leslie Gelling
- Department of Nursing Science, Bournemouth University, Bournemouth, UK
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7
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Undergraduate nursing students' transformative learning through disorientating dilemmas associated with end-of-life care simulation: A narrative inquiry study. Nurse Educ Pract 2021; 55:103174. [PMID: 34428723 DOI: 10.1016/j.nepr.2021.103174] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/20/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite attempts, there remains a theory practice gap for undergraduate nursing students transitioning to clinical practice on graduation, especially for specialty areas of clinical practice, such as palliative care, where there are limited opportunities to gain specialty knowledge and skills. As a result, undergraduate nursing students largely feel unprepared for end-of-life care in clinical practice. End-of-life care simulation is gaining momentum for helping prepare students to undertake this important care. However, little is known of whether end-of-life care simulation is a transformative learning strategy that can be transferred to clinical practice. AIM The aim of this paper is to report on undergraduate nursing students transformative learning through end-of-life care simulation. DESIGN A qualitative research design using narrative inquiry was used with data collected through semi-structured interviews and analysed using Clandinin and Connelly's three dimensions of narrative inquiry. METHODS Eighteen 3rd year undergraduate nursing students enrolled in a compulsory palliative care unit, at an Australian university participated in an immersive end-of-life care simulation. Data were collected through semi-structured interviews and analysed using Clandinin and Connelly's three dimensions of narrative inquiry. RESULTS This study revealed that transformative learning occurred through three disorientating dilemmas of: caring for a dying patient; approaching difficult conversations; and witnessing death for the first time. Knowledge of palliative care and clinical skills were also found to be transferred to clinical practice. CONCLUSIONS End-of-life care simulation can be an effective method of promoting transformative learning and can help to reduce the gap from nursing theory to clinical practice.
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8
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Hov L, Tveit B, Synnes O. Nobody Dies Alone in the Electronic Patient Record-A Qualitative Analysis of the Textual Practices of Documenting Dying and Death. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:246-261. [PMID: 34038173 PMCID: PMC10064451 DOI: 10.1177/00302228211019197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we analyse the electronic patient record (EPR) as a genre and investigate how a death is documented as part of the EPR, that is, what kind of textual practices can be found, and how they can be understood based on extracts from 42 EPRs from medical wards in Norwegian hospitals. Following from our analysis, we see four distinct patterns in the documentation of patient death: a) registering the bare minimum of information, b) registering a body stopped working, c) documenting dying quietly and placing it in peaceful surroundings, and d) highlighting the accompanied death. The textual practices of documenting the transition to death in the EPR make death appear manageable and sanitised, depicting death as either uneventful or good. While the EPR genre is steeped in biomedical language, other discourses relating to death can be seen as ways to accommodate the ideal of a dignified death.
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Affiliation(s)
- Laila Hov
- 87368VID Specialized University, Oslo, Norway
| | - Bodil Tveit
- 87368VID Specialized University, Oslo, Norway
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9
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Povedano-Jimenez M, Granados-Gamez G, Garcia-Caro MP. Work environment factors in coping with patient death among Spanish nurses: a cross-sectional survey. Rev Lat Am Enfermagem 2020; 28:e3234. [PMID: 32321038 PMCID: PMC7164927 DOI: 10.1590/1518-8345.3279.3234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/19/2019] [Indexed: 12/04/2022] Open
Abstract
Objective: to explore self-perception competence among Spanish nurses dealing with
patient death and its relationship with work environment, evidence-based
practice, and occupational stress. Method: a cross-sectional web-based survey collected information from a convenience
sample of 534 nurses from professional Spanish Colleges who answered four
validated questionnaires: Coping with Death Scale, Practice Environment
Scale of the Nursing Work Index, Perception of Evidence-Based Practice (EBP)
and Nursing Stress Scale. Results: a total of 79% of the participants were women, the average age was 40 years
old, 38% had a postgraduate degree and 77% worked in public health settings.
Many nurses evaluated their work environment as unfavorable (66%), reported
high occupational stress (83.5±14.9), and had high scores on
knowledge/skills in EBP (47.9±11.3). However, 61.2% of them perceived an
optimal coping (>157 score). The multivariate logistic model indicated
positive associations with work environment and EBP characteristics (OR:
1.30, p=0.054; OR: 1.04, p=0.007; OR:
1.13, p<0.001, respectively) but negative associations
with occupational stress and short work experience (OR: 0.98,
p=0.0043; OR: 0.74, p<0.002,
respectively). These factors explained 23.1% of the coping variance
(p<0.001). Conclusion: although most nurses perceived optimal coping, the situation could be
enhanced by modifying several contextual factors. The identification of
these factors would improve the quality of end-of-life care by facilitating
nursing management.
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10
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Cramond L, Fletcher I, Rehan C. Experiences of clinical psychologists working in palliative care: A qualitative study. Eur J Cancer Care (Engl) 2020; 29:e13220. [PMID: 31903695 DOI: 10.1111/ecc.13220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 08/09/2019] [Accepted: 12/17/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Compassion fatigue refers to the emotional and physical exhaustion felt by professionals in caring roles, whereas compassion satisfaction encompasses the positive aspects of helping others. Levels of compassion satisfaction and fatigue have been found to be inconsistent in palliative care professionals, which could have serious implications for patients, professionals and organisations. OBJECTIVES This study explored the experiences of clinical psychologists working in palliative care, all worked with adults with cancer, to gain an understanding of the impact this work has on their self and how they manage this. METHODS A qualitative approach was taken, using semi-structured interviews and interpretative phenomenological analysis. RESULTS Three superordinate themes were identified: commitment, existential impact on the self and the oracle. The participants' experiences were characterised by the relationship between themselves and their patients, the influence of working in palliative services on their world view and the impact of organisational changes. Differences between working as a clinical psychologist in palliative care versus non-palliative settings were considered. CONCLUSIONS Professionals working in palliative care should be supported to reflect on their experiences of compassion and resilience, and services should provide resources that facilitate staff to practice positive self-care to maintain their well-being.
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Affiliation(s)
- Laura Cramond
- Department of Clinical Health Psychology, Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, UK
| | - Ian Fletcher
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Claire Rehan
- Department of Clinical Health Psychology, Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, UK
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11
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Pehlivan S, Lafçı D, Vatansever N, Yıldız E. Relationship Between Death Anxiety of Turkish Nurses and Their Attitudes Toward the Dying Patients. OMEGA-JOURNAL OF DEATH AND DYING 2019; 82:128-140. [PMID: 31856657 DOI: 10.1177/0030222819895122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to investigate the relationship between death anxiety of the Turkish nurses and their attitudes toward the dying patient. This study involved 203 nurses who were working at a university hospital. The data were collected using "Nurse Information Form" (which was prepared by the authors of this research), "Thorson-Powell Death Anxiety Scale," and "Attitude Scale about Euthanasia, Death, and Dying Patient." There was a positive correlation between death anxiety and dying patient avoidance behavior and euthanasia score (p < .05). The findings showed that nurses, death anxiety, and death scores were high in the loss of a close relatives (p < .05). Our findings suggest that the situation of the dying patients and their families and also nurses should be improved. Thus, special psychological education/training should be given to the nurses to deal with death anxiety and their attitude to the dying patient.
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Affiliation(s)
- Seda Pehlivan
- Department of Internal Medicine Nursing, Health Science Faculty, Uludag University, Bursa, Turkey
| | - Diğdem Lafçı
- Department of Fundamentals Nursing, Faculty of Nursing, Mersin University, Turkey
| | - Nursel Vatansever
- Department of Surgery Nursing, Health Science Faculty, Uludag University, Bursa, Turkey
| | - Ebru Yıldız
- Department of Fundamentals Nursing, Faculty of Nursing, Mersin University, Turkey
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12
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Hemberg J, Bergdahl E. Dealing with ethical and existential issues at end of life through co-creation. Nurs Ethics 2019; 27:1012-1031. [PMID: 31522601 DOI: 10.1177/0969733019874496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In research on co-creation in nursing, a caring manner can be used to create opportunities for the patient to reach vital goals and thereby increase the patient's quality of life in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. Nurses must be extra sensitive to patients' and their relatives' needs with regard to ethical and existential issues and situations in home care encounters, especially at the end of life. AIM The aim of this study was to explore nurses' experiences of dealing with ethical and existential issues through co-creation at the end of life in palliative home care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT The material consisted of texts from interviews with 12 nurses in a home care context. A hermeneutical approach was used, and the method was inspired by a thematic analysis. ETHICAL CONSIDERATIONS Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Ethical permission to conduct the study was given from organizations that participated in this study. FINDINGS A main theme and four subthemes emerged. The main theme was "Deep co-creative relationships are needed to manage ethical and existential issues at the end of life." A model was created to display the findings and relations between ethical issues and situations and the need for a deep trustful caring relationship to solve problems in palliative home care. DISCUSSION Together, the themes can be considered as a tool for learning and dealing with ethical and existential issues at the end of life in home care. The themes can also be seen as a part of nurses' ethical competence within this context. CONCLUSION The quality of life at the end of life can be improved through co-creation, despite difficult ethical and existential issues. Future research should focus on co-creation from the patients' perspective.
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13
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Hussain FA. Using a frame of reference for talking to patients about death and dying. ACTA ACUST UNITED AC 2019; 28:1069-1075. [DOI: 10.12968/bjon.2019.28.16.1069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent years have seen a recognition of the importance of talking openly to patients at the end of life about death and dying. This article aims to add to the existing body of literature on this subject. Conversations at the end of life can be difficult, particularly if the patient is experiencing mental distress alongside their terminal illness. A number of factors can disrupt a constructive and supportive conversation around death and dying. This article offers a frame of reference for nurses to consider when having such conversations.
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Affiliation(s)
- Feryad A Hussain
- Clinical Psychologist, North East London NHS Foundation Trust, London, at time of writing
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14
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Meller N, Parker D, Hatcher D, Sheehan A. Grief experiences of nurses after the death of an adult patient in an acute hospital setting: An integrative review of literature. Collegian 2019. [DOI: 10.1016/j.colegn.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Bellali T, Giannopoulou I, Tsourti Z, Malliarou M, Sarafis P, Minasidou E, Papadatou D. Psychometric Properties of the Revised Death Attitude Profile in a Greek Sample of Nurses. J Nurs Meas 2018; 26:264-277. [PMID: 30567944 DOI: 10.1891/1061-3749.26.2.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to examine the psychometric properties of the Revised Death Attitude Profile (DAP-R) in a sample of Greek nurses and nursing students. METHODS A convenience sample (n = 934) was used from six National Health System hospitals, and two University Schools of Nursing in central and northern Greece completed the Greek version of the DAP-R (Gr-DAP-R). RESULTS Principal component analysis with varimax rotation revealed a six-factor solution, including approach acceptance, death avoidance, escape acceptance, neutral acceptance, fear of death, and after death concerns. The internal consistency for each of the subscales ranged from 0.64 to 0.88. Intercorrelations between the Gr-DAP-R subscales supported the relative independence of death attitudes dimensions. CONCLUSIONS The Gr-DAP-R can be used as a research and clinical tool in assessing death attitudes among Greek nurses.
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Affiliation(s)
- Thalia Bellali
- Alexandreio Technological Educational Institute, Thessaloniki, Greece
| | | | - Zoi Tsourti
- Frontier Science Foundation-Hellas, Athens, Greece
| | - Maria Malliarou
- Technological Educational Institute of Thessaly, Larisa, Greece
| | | | - Evgenia Minasidou
- Alexandreio Technological Educational Institute, Thessaloniki, Greece
| | - Danai Papadatou
- National and Kapodistrian University of Athens, Athens, Greece
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16
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Funk LM, Peters S, Roger KS. Caring about dying persons and their families: Interpretation, practice and emotional labour. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:519-526. [PMID: 29462841 DOI: 10.1111/hsc.12559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 06/08/2023]
Abstract
The importance of emotional support for dying persons and their families has been well established, yet we know less about how care workers understand emotional processes related to death and dying, or how these understandings are connected to care practices and emotional labour at the end of life. The aim of this study was to explore how healthcare workers interpret and respond to emotional needs of dying persons and their families. Qualitative data were collected between 2013 and 2014 through in-depth, in-person interviews with 14 nurses and 12 healthcare aides in one Western Canadian city. Transcripts were analysed using an inductive, interpretive thematic coding approach and the analytic lens of emotional labour. Dominant interpretive frames of a "good death" informed participants' emotionally supportive practice. This included guiding patients and families to "open up" about their emotions to activate the grief process. There was concern that incomplete grieving would result in anger being directed towards care staff. The goal of promoting emotional sharing informed the work of "caring about." Although palliative philosophies opened up moral and professional space for "caring about" in the context of organisational norms which often discouraged these practices, the tension between the two, and the lack of time for this work, may encourage surface expressions rather than authentic emotional care.
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Affiliation(s)
- Laura M Funk
- Department of Sociology, University of Manitoba, Winnipeg, MB, Canada
| | - Sheryl Peters
- School of Nursing, University of Manitoba, Winnipeg, MB, Canada
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17
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Oliveira I, Fothergill-Bourbonnais F, McPherson C, Vanderspank-Wright B. Battling a Tangled Web: The Lived Experience of Nurses Providing End-of-Life Care on an Acute Medical Unit. Res Theory Nurs Pract 2018; 30:353-378. [PMID: 28304263 DOI: 10.1891/1541-6577.30.4.353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Meeting the heath care needs of patients at the end of life is becoming more complex. In Canada, most patients with life-limiting illness will die in hospitals, many on medical units. Yet, few studies have qualitatively investigated end-of-life care (EOLC) in this context, or from the perspectives of nurses providing EOLC. The purpose of this study was to seek to understand the lived experience of nurses on a medical unit providing EOLC to patients. Interpretive phenomenology guided the method and analysis. Individual face-to-face interviews were conducted with 10 nurses from 2 hospital medical units. The underlying essence of these nurses' experiences was that of "battling a tangled web." Battling a tangled web represented their struggles in attempting to provide EOLC in an environment that was not always conducive to it. Seven themes were generated from the analysis: caring in complexity, caught in a tangled web, bearing witness to suffering, weaving a way to get there: struggling through the process, creating comfort for the patient, working through the dying process with the family, and finding a way through the web. The findings contribute to an understanding of the experiences of nurses in providing EOLC on a medical unit including perceived facilitators and barriers.
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Omar Daw Hussin E, Wong LP, Chong MC, Subramanian P. Nurses’ perceptions of barriers and facilitators and their associations with the quality of end‐of‐life care. J Clin Nurs 2017; 27:e688-e702. [DOI: 10.1111/jocn.14130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emni Omar Daw Hussin
- Department of Nursing Science Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Mei Chan Chong
- Department of Nursing Science Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Pathmawathi Subramanian
- Pathmawathi Subramanian Nursing Synergy Ptd Ltd. 18.USJ 1/3K, USJ 1 Subang Jaya 47100 Malaysia
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Zheng R, Lee SF, Bloomer MJ. How nurses cope with patient death: A systematic review and qualitative meta-synthesis. J Clin Nurs 2017; 27:e39-e49. [DOI: 10.1111/jocn.13975] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Ruishuang Zheng
- School of Nursing and Midwifery; Monash University; Melbourne Vic Australia
| | - Susan Fiona Lee
- School of Nursing and Midwifery; Monash University; Melbourne Vic Australia
| | - Melissa Jane Bloomer
- School of Nursing and Midwifery; Faculty of Health; Deakin University; Geelong Vic Australia
- Centre for Quality and Patient Safety Research; Deakin University; Geelong Vic Australia
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Funk LM, Peters S, Roger KS. The Emotional Labor of Personal Grief in Palliative Care: Balancing Caring and Professional Identities. QUALITATIVE HEALTH RESEARCH 2017; 27:2211-2221. [PMID: 28891373 DOI: 10.1177/1049732317729139] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The paid provision of care for dying persons and their families blends commodified emotion work and attachments to two often-conflicting role identities: the caring person and the professional. We explore how health care employees interpret personal grief related to patient death, drawing on interviews with 12 health care aides and 13 nurses. Data were analyzed collaboratively using an interpretively embedded thematic coding approach and constant comparison. Participant accounts of preventing, postponing, suppressing, and coping with grief revealed implicit meanings about the nature of grief and the appropriateness of grief display. Employees often struggled to find the time and space to deal with grief, and faced normative constraints on grief expression at work. Findings illustrate the complex ways health care employees negotiate and maintain both caring and professional identities in the context of cultural and material constraints. Implications of emotional labor for discourse and practice in health care settings are discussed.
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Affiliation(s)
- Laura M Funk
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheryl Peters
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
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Bacon CT. Nurses' Experiences With Patients Who Die From Failure to Rescue After Surgery. J Nurs Scholarsh 2017; 49:303-311. [PMID: 28384381 DOI: 10.1111/jnu.12294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the lived experiences of hospital nurses caring for surgical patients who died from failure to rescue (FTR). DESIGN A qualitative phenomenologic approach was used. Methods to ensure rigor and trustworthiness were incorporated into the design. METHODS The investigator conducted one-on-one semistructured interviews with 14 nurses, and data were analyzed using Colaizzi's methods. FINDINGS Six themes were identified: (a) the environment surrounding the FTR was unexpected; (b) FTR was unexpected but not preventable; (c) nurses were emotionally ill-prepared for the FTR; (d) nurse outcomes are different in unexpected versus expected death; (e) nurses' roles as protectors are important; and (f) FTR effects future nursing practice. CONCLUSIONS Nurses' reactions after an FTR surgical death may be different when there is no identified nursing error contributing to the event. There may be key differences between deaths that are simply unexpected and those that involve FTR. The importance of mentoring junior nurses in protective surveillance skills is vital. CLINICAL RELEVANCE Developing an understanding of nurses' experiences with FTR can assist nurse leaders to better support nurses who experience FTR deaths. Insight into the environment surrounding FTR deaths provides a foundation for future research aimed at improving patient safety and quality through an improved working environment for nurses.
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Affiliation(s)
- Cynthia Thornton Bacon
- Assistant Professor, University of North Carolina at Greensboro, School of Nursing, Greensboro, North Carolina
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McMeekin DE, Hickman RL, Douglas SL, Kelley CG. Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation. Am J Crit Care 2017; 26:128-135. [PMID: 28249865 DOI: 10.4037/ajcc2017916] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD). OBJECTIVES To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas. METHODS A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey. RESULTS Postcode stress and PTSD symptom severity were weakly associated (r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support. CONCLUSIONS Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession.
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Affiliation(s)
- Dawn E. McMeekin
- Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University
| | - Ronald L. Hickman
- Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University
| | - Sara L. Douglas
- Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University
| | - Carol G. Kelley
- Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University
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Abstract
The purpose of this study was to describe nurses' needs and how they are being met and not met after caring for surgical patients who died after a failure to rescue (FTR). A qualitative, phenomenologic approach was used for the interview and analysis framework. Methods to ensure rigor and trustworthiness were incorporated into the design. The investigator conducted semistructured 1:1 interviews with 14 nurses. Data were analyzed using Colaizzi's methods. Four themes were identified: (1) coping mechanisms are important; (2) immediate peer and supervisor feedback and support are needed for successful coping; (3) subsequent supervisor support is crucial to moving on; and (4) nurses desire both immediate support and subsequent follow-up from their nurse leaders after every FTR death. Nurses' needs after experiencing an FTR patient death across multiple practice areas and specialties were remarkably similar and clearly identified and articulated. Coping mechanisms vary and are not uniformly effective across different groups. Although most nurses in this study received support from their peers after the FTR event, many nurses did not receive the feedback and support that they needed from their nurse leaders. Immediate nurse leader support and follow-up debriefings should be mandatory after patient FTR deaths. Developing an understanding of nurses' needs after experiencing an FTR event can assist nurse leaders to better support nurses who experience FTR deaths. Insight into the environment surrounding FTR deaths also provides a foundation for future research aimed at improving patient safety and quality through an improved working environment for nurses.
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Shorey S, André B, Lopez V. The experiences and needs of healthcare professionals facing perinatal death: A scoping review. Int J Nurs Stud 2016; 68:25-39. [PMID: 28063339 DOI: 10.1016/j.ijnurstu.2016.12.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Globally, perinatal death is on a decline. However, its impact on the healthcare profession is huge. The existing literature focuses on examining perinatal death from parents' perspectives and patient death from the perspectives of nurses and a few doctors in critical care, oncology, and neonatology in the West. Due to the unique setting of maternity units where death is not routinely anticipated, as well as distinctive socio-cultural views surrounding death, there is a need to comprehensively review literature examining the impact of perinatal death on the perspectives of healthcare professionals working in maternity units. OBJECTIVES To examine available literature on the needs and experiences of healthcare professionals working in maternity units who have experienced perinatal death. DESIGN A scoping review of published and unpublished data. DATA SOURCES A systematic literature search from 1st January 1996 to 5th August 2016 was made in the following databases: PubMed, CINAHL, Embase, PsycINFO, ScienceDirect, and Web of Science. Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, York Centre for Reviews and Dissemination, Open Grey, ProQuest Dissertation and Theses, and Mednar were reviewed for grey literature. A hand search of the reference lists of the included papers was performed. REVIEW METHODS Based on the pre-set inclusion criteria, 1519 articles were screened for their titles and abstracts. Eighty-five full-text papers were reviewed, resulting in 30 papers included for this review. The data were extracted and cross-checked between the reviewers. Any discrepancy between the authors' views would be discussed with a third reviewer until consensus was reached. Thematic analysis was used to categorise the results into themes. RESULTS Two major themes emerged from the review: the experiences and needs of healthcare professionals. Six subthemes emerged from the experiences of healthcare professionals: 1) psychological impact, 2) physical impact, 3) positive feelings, 4) coping strategies, 5) personal factors influencing the experience, and 6) cultural factors influencing the experience. Three subthemes including 1) social support, 2) training and education, and 3) other needs explained the needs of healthcare professionals. Studies focusing on the experiences and needs of physicians were scarce. CONCLUSIONS Perinatal death has a profound impact on the psychological and physical wellbeing of healthcare professionals. They have unmet needs that need to be addressed. Though they use internal and external resources to combat their stress, institutional support acknowledging their stress and their needs is essential. Culturally-sensitive education and training are needed to provide support to these professionals.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore.
| | - Beate André
- Faculty of Nursing- Centre for Health Promotion Research, NTNU- Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore.
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Andersson E, Salickiene Z, Rosengren K. To be involved - A qualitative study of nurses' experiences of caring for dying patients. NURSE EDUCATION TODAY 2016; 38:144-149. [PMID: 26689734 DOI: 10.1016/j.nedt.2015.11.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to describe nurses' experiences (>two years) of caring for dying patients in surgical wards. BACKGROUND Palliative care is included in education for nurses. However, the training content varies, and nurse educators need to be committed to the curriculum regarding end-of-life situations. A lack of preparation among newly graduated nurses regarding dying and death could lead to anxiety, stress and burnout. Therefore, it is important to improve knowledge regarding end-of-life situations. SETTING, PARTICIPANTS AND METHOD A qualitative descriptive study was carried out in two surgical wards in the southern part of Sweden. The study comprised six interviews with registered nurses and was analysed using manifest qualitative content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nurses' perspectives and thoughts regarding dying patients. RESULTS The results formed one category (caring-to be involved) and three subcategories (being supportive, being frustrated and being sensitive in the caring processes). Nurses were personally affected and felt unprepared to face dying patients due to a lack of knowledge about the field of palliative care. Their experiences could be described as processes of transition from theory to practice by trial and error. CONCLUSION Supervision is a valuable tool for bridging the gap between theory and practice in nursing during the transition from novice to expert. Improved knowledge about palliative care during nursing education and committed nursing leadership at the ward level facilitate preparation for end-of-life situations.
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Affiliation(s)
- Erika Andersson
- Department of Surgery, Norra Älvsborg County Hospital, SE-461 85 Trollhättan, Sweden.
| | - Zivile Salickiene
- Department of Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.
| | - Kristina Rosengren
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, SE-405 30 Gothenburg, Sweden.
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Lindqvist O, Tishelman C. Going public: reflections on developing the DöBra research program for health-promoting palliative care in Sweden. PROGRESS IN PALLIATIVE CARE 2016; 24:19-24. [PMID: 27134417 PMCID: PMC4832378 DOI: 10.1080/09699260.2015.1103497] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Public health approaches to end-of-life (EoL) research and care are relatively rare in Sweden, and health-promoting palliative care (HPPC) remains a foreign concept for most. We recently consolidated our HPPC endeavors into a cohesive research program, DöBra, to promote constructive change and awareness to support better quality of life and death among the general population, in specific sub-groups, and in interventions directed to professional groups caring for dying individuals, their friends and families. Objectives: In this article, we aim to share ideas, experiences, and reflections from the early stages of this research program, particularly in relation to how we try to work with new 'publics', to contribute to the development of HPPC as a new research field. Methods and Results: We discuss some considerations which arise in the Swedish context, and present the underlying ideas and approaches used in the research program, with examples of their application. HPPC, based on ideas from new public health, is essential as an umbrella for the DöBra program. Action research, experience-based co-design, and knowledge exchange, all aim to bring together a variety of stakeholders to exchange ideas and expertise, and co-create experience-based evidence through knowledge generation, dissemination, and sharing. Discussion: In reflecting on what we have learned about publics and partnerships in EoL research to date, we question distinctions made between professionals and publics, concluding that including publics in public health research, means also including ourselves and making public many of the reflections, the mistakes, and the experiences we all have, to foster collective learning.
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Affiliation(s)
- Olav Lindqvist
- Medical Management Center, LIME, Karolinska Institutet, Stockholm, Sweden; Department of Nursing, Umeå University, Sweden
| | - Carol Tishelman
- Medical Management Center, LIME, Karolinska Institutet, Stockholm, Sweden; The Innovation Center, Karolinska University Hospital, Stockholm, Sweden
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Mota Vargas R, Mahtani-Chugani V, Solano Pallero M, Rivero Jiménez B, Cabo Domínguez R, Robles Alonso V. The transformation process for palliative care professionals: The metamorphosis, a qualitative research study. Palliat Med 2016; 30:161-70. [PMID: 25895537 DOI: 10.1177/0269216315583434] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Palliative care professionals are exposed daily to high levels of suffering. This makes them particularly vulnerable to suffering from stress, which can lead to burnout and/or compassion fatigue. AIMS To analyse the professional trajectory of palliative care workers over time and the factors which influence this trajectory. DESIGN A qualitative study was designed based on the Grounded Theory approach, using semi-structured individual interviews. Interviews were recorded audio-visually and transcribed verbatim for subsequent analysis using the procedure described by Miles and Huberman. This process was supported using ATLAS.ti 6 software. SETTING/PARTICIPANTS A total of 10 palliative care professionals from Extremadura (Spain) took part in the study. RESULTS The analysis revealed a common trajectory followed by participants in their working lives: pre-palliative care/honeymoon/frustration/maturation. In addition, factors which influence this trajectory were identified. Details of the self-care strategies that these professionals have developed are described. The result of this process, which we have metaphorically termed 'metamorphosis', is the formation of a professional who can work satisfactorily within a palliative care context. CONCLUSION During their professional activity, palliative care professionals go through a series of phases, depending on the relationship between the cost of caring and the satisfaction of caring, which can influence both the care provided to patients and families and their own personal circumstances. Being aware of this risk, and implementing self-care strategies, can protect professionals and enable them to conduct their work in an optimal manner. Reflecting on the experiences of these professionals could be useful for other health professionals.
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Affiliation(s)
- Rafael Mota Vargas
- Palliative Care Team, Infanta Cristina Hospital Complex, Extremadura Health Service (Servicio Extremeño de Salud - SES), Badajoz, Spain
| | - Vinita Mahtani-Chugani
- Research Unit Hospital Nuestra Señora de la Candelaria, Canary Islands Health Care Services, Tenerife, Spain
| | - María Solano Pallero
- Palliative Care Regional Observatory, Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FUNDESALUD), Mérida, Spain
| | | | - Raquel Cabo Domínguez
- Palliative Care Team, Asociación Española contra el Cáncer (AECC) (Spanish Anti-Cancer Association), Badajoz, Spain
| | - Vicente Robles Alonso
- Palliative Care Team, Virgen del Puerto Hospital, Extremadura Health Service (Servicio Extremeño de Salud - SES), Plasencia, Spain
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Laporte P, Vonarx N. Le « bien mourir » perçu dans une approche de l’auto-transcendance et de la transition : deux théories de soin utiles pour l’infirmière. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.125.0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Chahal JK, Ewen HH, Anderson K, Miles TP. Institutional Bereavement Care for Fictive Kin: Staff Grief in CCRCs. J Am Med Dir Assoc 2015. [PMID: 26208900 DOI: 10.1016/j.jamda.2015.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to explore approaches used by administrators to respond to grief and bereavement among staff after the death of a resident. METHODS Continuing care retirement community (CCRC) facilities (n = 10) were randomly selected from a larger study of 31 facilities. Open-ended interviews were conducted using a structured interview protocol. Qualitative methods, specifically thematic analysis, were used to analyze the interview data. FINDINGS Emergent themes suggest that LTC facilities have freedom in how to provide support for staff members, family members, and other residents after the death of a loved one. However, results show variations in methods for notifying staff of a resident's death, inclusion of direct care staff in caring for the deceased, providing memorial services, and offering grief/bereavement support. When speaking of the loss of a resident and ways to provide grief/bereavement support, only 3 of the 10 administrators discussed the importance of extending such services to the staff. IMPLICATIONS Causes of staff burnout in the CCRC workplace is an unresolved issue. Research has shown that inadequate grief and bereavement support for staff contributes to factors associated with staff burnout and retention. Although administrators hold formal services after a resident has died, there are differences among facilities. It may be that organizations could improve bereavement services for staff.
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Affiliation(s)
- Jasleen K Chahal
- Department of Sociology & Gerontology, Miami University, Oxford, OH
| | - Heidi H Ewen
- Institute of Gerontology, University of Georgia, Athens, GA.
| | - Keith Anderson
- School of Social Work, University of Montana, Missoula, MT
| | - Toni P Miles
- Institute of Gerontology, University of Georgia, Athens, GA
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Laporte P, Vonarx N. Les infirmières et la mort au quotidien : souffrances et enjeux. ACTA ACUST UNITED AC 2015. [DOI: 10.3917/inka.154.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cavaye J, Watts JH. Student Nurses Learning about Death, Dying, and Loss: Too Little, Too Late? ACTA ACUST UNITED AC 2014. [DOI: 10.2190/il.22.4.c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Concerns about the care provided to people dying from life-threatening illness have prompted a number of international reforms to improve the quality of palliative and end-of-life (EOL) care. The majority of this care is provided by nurses. They spend more time with dying patients than any other health professionals and therefore, need specific clinical skills and knowledge. Palliative and EOL care education is increasingly being positioned as a specialism, available only to a small number of registered nurses as part of continuing professional development. However, increasing numbers of patients with life-threatening illness are being treated in non-specialist settings by nurses with a generalist education. Furthermore, undergraduate nurse education has traditionally had a limited focus on palliative and EOL care, hence claims that undergraduate nursing curricula are inadequate. Drawing on an international literature, this review explores the evidence about the adequacy of undergraduate curricula in this area. It considers the extent to which palliative and EOL curriculum is included in undergraduate nurse education and draws upon evidence from students and registered nurses, who as consumers of education, report feeling unprepared to care for and communicate with, dying patients.
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Holms N, Milligan S, Kydd A. A study of the lived experiences of registered nurses who have provided end-of-life care within an intensive care unit. Int J Palliat Nurs 2014; 20:549-56. [PMID: 25426882 DOI: 10.12968/ijpn.2014.20.11.549] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Natalie Holms
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
| | - Stuart Milligan
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
| | - Angela Kydd
- NHS Lanarkshire; University of the West of Scotland, Scotland, United Kingdom
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Abstract
BACKGROUND The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. OBJECTIVE To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. RESEARCH DESIGN Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. PARTICIPANTS AND RESEARCH CONTEXT Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. ETHICAL CONSIDERATIONS Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. FINDINGS The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. CONCLUSION Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process.
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Bailey C, Hewison A. The impact of a 'Critical Moments' workshop on undergraduate nursing students' attitudes to caring for patients at the end of life: an evaluation. J Clin Nurs 2014; 23:3555-63. [PMID: 24942552 DOI: 10.1111/jocn.12642] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the impact of an educational workshop on nursing students' attitudes to caring for dying patients. BACKGROUND The quality of end-of-life care education provided in preregistration nursing programmes has been criticised. The lack of attention to the emotional content results in nursing students feeling ill-prepared to care for the dying and bereaved. This article reports the findings of a study conducted to evaluate the impact of an educational workshop on undergraduate nursing students' attitudes to caring for patients at the end of life. DESIGN A pre- and postintervention survey was used to determine nursing students' attitudes and feelings concerning end-of-life care prior to and following their involvement in an educational workshop. METHODS Third-year undergraduate nursing students completed two questionnaires incorporating the Frommelt Attitude Toward Care of the Dying Scale, before and after attending a 'Critical Moments' workshop. RESULTS The data revealed a statistically significant increase in positive attitudes to end-of-life care amongst the respondents. Free text responses confirmed the development of positive attitudes and indicated that the workshop was regarded as a valuable learning opportunity. CONCLUSIONS Workshops that use case studies based on 'real-life' episodes of end-of-life care can provide an effective learning opportunity that significantly improves the attitudes of nursing students to caring for the dying. RELEVANCE TO CLINICAL PRACTICE Identifying emotional labour is an important stage in the development of emotionally intelligent nurses. It may reduce the risk of occupational stress, burnout and potential withdrawal from nursing practice in the longer term. Timing, expert facilitation and peer support are important considerations for an educational workshop that aims to enable nurses to remain healthy whilst delivering high-quality care to patients and their relatives near the end of life.
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Affiliation(s)
- Cara Bailey
- Nursing, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Leclerc BS, Lessard S, Bechennec C, Le Gal E, Benoit S, Bellerose L. Attitudes Toward Death, Dying, End-of-Life Palliative Care, and Interdisciplinary Practice in Long Term Care Workers. J Am Med Dir Assoc 2014; 15:207-213. [DOI: 10.1016/j.jamda.2013.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/16/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
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Funk LM, Waskiewich S, Stajduhar KI. Meaning-Making and Managing Difficult Feelings: Providing Front-Line End-of-Life Care. OMEGA-JOURNAL OF DEATH AND DYING 2014; 68:23-43. [DOI: 10.2190/om.68.1.b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Managing grief and difficult emotions related to end-of-life (EOL) care is an often under-recognized part of the work of resident care aides (RCAs). In this interpretive analysis we explore the shared and socially constructed ideas that 11 RCAs in 1 Canadian city employ to make sense of death and the provision of EOL care. RCAs spoke of personal challenges involved in witnessing death and experiencing loss, as well as helplessness and frustration when they could not provide quality EOL care. RCAs invoked “consoling refrains” to manage grief, including “such is life,” “they are better off,” and “they had a full life.” To manage guilt and moral distress, RCAs reminded themselves “I did my best” and “I experience rewards.” Though these ideas help RCAs, some may need to be reframed through coaching and mentorship, to prevent unintended negative effects on care or the reproduction of ageist beliefs more broadly.
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An Integrated Literature Review of Death Education in Pre-Registration Nursing Curricula: Key Themes. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/564619] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recent policy has raised the profile of end-of-life care internationally, with the aim of increasing access to quality care for everyone experiencing life-limiting illness. This reflects an international shift in the provision of palliative care to encompass chronic conditions other than cancer. Nurses have an important role in delivering this care and need to be equipped with particular knowledge and skills. However, pre-registration nursing curricula have traditionally had a limited emphasis on death and dying and nurses report feeling unprepared to care for dying patients. This has led to claims that death education in pre-registration curricula is inadequate. This integrated review explores the published literature that reports on death education within pre-registration nurse education. Presenting an international overview, the aim of the review is to contribute to knowledge about the nature and extent of death education in pre-registration curricula. In the context of this paper, death education encompasses both palliative and end-of-life care. Electronic searches of major bibliographic databases found inconsistencies across educational provision with variations in quantity, content, and approach. Despite an increasing amount of death education in pre-registration curricula, there remains a deficit in key areas such as knowledge, skills, organisation of care, and teamwork.
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The provision of end-of-life care by medical-surgical nurses working in acute care: a literature review. Palliat Support Care 2013; 12:393-408. [PMID: 24477088 DOI: 10.1017/s1478951513000965] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Caring for terminally ill patients is complex, stressful, and at times distressing for nurses. Acute care hospitals continue to be the predominant place of death for terminally ill patients in most Western countries. The objective of the present literature review was to explore and gain an in-depth understanding of the experience of providing end-of-life (EOL) care by medical-surgical RNs working in acute care hospitals, to identify knowledge gaps, and to recommend future research. METHOD A comprehensive literature review was conducted using the following electronic databases: CINAHL, MEDLINE, and PsyInfo (from 1992 to October 2012). RESULTS The findings from the 16 reviewed studies suggest that nurses felt a strong commitment to help terminally ill patients experience a good death. Nurses reported feeling deeply rewarded and privileged to share the EOL experience with patients/families. Organizational and individual factors influenced nurses' experience. Important challenges were associated with managing the divergent needs of a mixed patient load (i.e., curative and palliative care patients) in a biomedical culture of care that is heavily oriented toward cure and recovery. In this culture, nurses' emotional work and ideals of good EOL care are often not recognized and supported. SIGNIFICANCE OF RESULTS Managerial and organizational support that recognize the centrality of emotional work nurses provide to dying patients is needed. More research exploring ways to improve communication among nurses and medical colleagues is essential. Finally, a critical examination of the ideological assumptions guiding nurses' practice of EOL care within the context of acute care is recommended to help reveal their powerful influence in shaping nurses' overall understanding and experience of EOL care.
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Aradilla-Herrero A, Tomás-Sábado J, Gómez-Benito J. Perceived emotional intelligence in nursing: psychometric properties of the Trait Meta-Mood Scale. J Clin Nurs 2013; 23:955-66. [DOI: 10.1111/jocn.12259] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Juana Gómez-Benito
- Faculty of Psychology; Institute for Brain, Cognition and Behaviour (IR3C); University of Barcelona; Barcelona Spain
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Gibson JA, Henderson A, Jillings C, Kaan A. Nursing Patients with Ventricular Assist Devices: An Interpretive Description. Prog Transplant 2013; 23:147-53. [DOI: 10.7182/pit2013766] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context Although researchers have studied the experience of caring for patients with ventricular assist devices from the perspective of family caregivers, few reports address the experience of nursing patients with such devices. Objective To investigate the experience of nursing patients who have a ventricular assist device. Design A qualitative approach called interpretive description was used to conduct semistructured, 1-on-1 interviews. Participants Six registered nurses with a range of clinical experiences were interviewed in a 1-year period from 2009 to 2010. Data were transcribed and analyzed by the researcher in conjunction with a research team. Results Four distinct themes were interpreted from the interview data: exclusive knowledge, human connection, ethics, and interdisciplinary stress and technology. Conclusion Nursing patients who have a ventricular assist device is a complex experience. Nurses develop expert knowledge that is related to direct exposure to patients; this unique knowledge should be formally considered in team decision making. Nursing care of patients who have a ventricular assist device also has features that might result in overconnected nurse-patient relationships. Closely connected nurse-patient relationships intensified the emotional difficultly of experiences of exposure to illness or suffering, or exposure to an unpredictable dying trajectory. Nursing patients with ventricular assist devices can be difficult, and nursing leaders should be aware of the emotional reactions that can result from direct exposure to patients who might be perceived as very ill or suffering. Institutions with ventricular assist device programs should consider providing emotional support for health care workers who find this type of work emotionally difficult.
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Affiliation(s)
| | - Angela Henderson
- University of British Columbia School of Nursing, Vancouver, Canada
| | - Carol Jillings
- University of British Columbia School of Nursing, Vancouver, Canada
| | - Annemarie Kaan
- University of British Columbia School of Nursing, Vancouver, Canada
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Peters L, Cant R, Sellick K, O'Connor M, Lee S, Burney S, Karimi L. Is work stress in palliative care nurses a cause for concern? A literature review. Int J Palliat Nurs 2013; 18:561-7. [PMID: 23413505 DOI: 10.12968/ijpn.2012.18.11.561] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Palliative care nurses are at risk of work stress because their role involves exposure to frequent deaths and family grieving. Little is known about their degree of stress or whether they suffer stress or burnout more than nurses in other disciplines. AIM The aim of this paper is to critically examine the current literature concerning stress and burnout in palliative care nurses. RESULTS Sixteen papers were included in the review. Although work demands were a common cause of stress in the studies reported, there was no strong evidence that palliative care or hospice nurses experienced higher levels of stress than nurses in other disciplines. Common causes of stress were the work environment, role conflict, and issues with patients and their families. Constructive coping styles appeared to help nurses to manage stress. CONCLUSION Managers have a key role in providing education and training for palliative care nurses to support their personal development and to help reduce vulnerability to and the impact of stress in the workplace.
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Affiliation(s)
- Louise Peters
- Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Melbourne, Australia.
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Abstract
A qualitative study using phenomenological descriptive design was conducted to explore critical care nurses' experiences with patient death. Several themes emerged as a result of this study: coping, personal distress, emotional disconnect, and inevitable death. Understanding critical care nurses' reactions to patient death may help to improve the care provided to critically ill dying patients and their families and to meet the needs of the nurses who care for them.
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Nurses’ early experiences with patient death: The results of an on-line survey of Registered Nurses in New Zealand. Int J Nurs Stud 2012; 49:1255-65. [DOI: 10.1016/j.ijnurstu.2012.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 04/10/2012] [Accepted: 04/14/2012] [Indexed: 11/24/2022]
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Thurston J, Waterworth S. ‘Making sense’: nurses' experiences of changing practice in caring for dying patients in New Zealand. Int J Palliat Nurs 2012; 18:500-7. [DOI: 10.12968/ijpn.2012.18.10.500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jenny Thurston
- Auckland City Hospital, Private Bag 92-024, Auckland, 1023, New Zealand
| | - Susan Waterworth
- School of Nursing, The University of Auckland, Private Bag 92019, Auckland, New Zealand
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Choi M, Lee J, Kim SS, Kim D, Kim H. Nurses’ Knowledge About End-of-Life Care: Where Are We? J Contin Educ Nurs 2012; 43:379-84. [DOI: 10.3928/00220124-20120615-35] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 05/11/2012] [Indexed: 11/20/2022]
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Vachon M, Fillion L, Achille M. Death Confrontation, Spiritual-Existential Experience and Caring Attitudes in Palliative Care Nurses: An Interpretative Phenomenological Analysis. QUALITATIVE RESEARCH IN PSYCHOLOGY 2012. [DOI: 10.1080/14780881003663424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bailey C, Murphy R, Porock D. Professional tears: developing emotional intelligence around death and dying in emergency work. J Clin Nurs 2011; 20:3364-72. [DOI: 10.1111/j.1365-2702.2011.03860.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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