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Tan M, Tang S, Feder S, Xiao J, Huang C, Cook A, Johnson CE, Ding J. Interventions to promote readiness for advance care planning: A systematic review and meta-analysis. Int J Nurs Stud 2024; 156:104778. [PMID: 38761437 DOI: 10.1016/j.ijnurstu.2024.104778] [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] [Received: 11/29/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Advance care planning is recommended as part of standard medical services. Readiness, denoting stages of behavior change, exerts a substantial influence on its uptake. However, the characteristics and impacts of advance care planning interventions on readiness are not well-established. METHOD We systematically reviewed and conducted a meta-analysis of randomized controlled trials assessing the effects of advance care planning interventions on readiness. Studies were appraised using Joanna Briggs Institute Critical Appraisal tools. Meta-analyses were performed using mean difference of continuous variables or risk ratios of binary variables and their 95 % confidence interval as the pooled effect sizes. RESULTS Eight studies were included in this review and were all rated low quality. Meta-analysis showed that interventions resulted in slight improvement in overall readiness (mean difference = 0.19, 95 % confidence interval: 0.02-0.36) for advance care planning. However, statistically significant effects of interventions were not identified for readiness in relation to specific behaviors (appointment of a healthcare proxy, talking to a healthcare proxy, talking to a medical practitioner about living wills, and signing a living will). CONCLUSION Our meta-analyses demonstrated that interventions can improve the overall readiness for advance care planning, suggesting the necessity to integrate readiness into future health policies and clinical practices. Nevertheless, the absence of significant effects on specific behavioral readiness underscores the requirement for additional refinement in intervention design, advanced technologies, and theoretical foundations. REGISTRATION Not registered.
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Affiliation(s)
- Minghui Tan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Shelli Feder
- Yale School of Nursing, West Haven, CT, United States
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Angus Cook
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Claire E Johnson
- Palliative Aged Care Outcomes Program, University of Wollongong, Wollongong, Australia
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China.
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He C, Dong T, Tan J, Yang L, Qiu Y, Zhang J, Huang Y, Zhou A, Wang X, Huang Y, Zhu M, Lam SC, Deng R. Psychometric testing of the training needs for advance care planning scale for clinicians and nurses. BMC Nurs 2024; 23:476. [PMID: 39010077 PMCID: PMC11247906 DOI: 10.1186/s12912-024-01952-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/19/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Studies have shown that Chinese Clinicians and nurses have positive attitudes toward ACP, but no local tools exist to assess their need for ACP knowledge and skills training. resulting in their inability to initiate ACP conversations as well as poor end-of-life care for patients. Therefore, this study aims to assess the needs of Chinese Clinicians and nurses for ACP knowledge and skills training and assess the validity and reliability of a questionnaire on the Training Needs for Advance Care Planning (TNACP) scale. METHODS From October to November 2021, 170 clinicians and nurses were pre-surveyed using a preliminary draft of the questionnaire. The responses were screened using item analysis, Cronbach's alpha coefficient, and the intraclass correlation coefficient (ICC) to describe the internal consistency and stability of the questionnaire. The Content validity index (CVI), Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) were used to test the validity of the questionnaire. RESULTS After independent samples t-test analysis, Except for the entry "A2", the critical ratio between the two groups of the remaining 23 items was statistically significant (p < 0.05). Based on the above screening methods, the "A2" item was deleted, and the final number of questionnaire items was 23. The I-CVI was 0.79-1.00, and the S-CVI/Ave was 0.90. Three common factors were extracted-the cumulative contribution rate was 69.969%, and the factor loading of all items was 0.506-0.843 (all > 0.40). The results of confirmatory factor analysis showed that the Training Needs for Advance Care Planning (TNACP) scale model fit well(X2/df = 2.504, RMSEA = 0.092, GFI = 0.809, AGFI = 0.745, CFI = 0.931, IFI = 0.932, TLI = 0.916); the Cronbach's α = 0.888 for the total questionnaire, and the three dimensions of Cronbach's α were 0.729 to 0.959; and the ICC for the overall scores between the test-retest evaluations was 0.884 (p < 0.001). CONCLUSIONS The TNACP scale has good reliability and validity and can be used to assess Chinese Clinicians and nurses' training needs for implementing ACP.
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Affiliation(s)
- Chunju He
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Tiaoxia Dong
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Jin Tan
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Liu Yang
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Yeyin Qiu
- The Fifth Affiliated Hospital of Zunyi Medical University, Guangdong Province, China
| | - Jianghui Zhang
- The Fifth Affiliated Hospital of Zunyi Medical University, Guangdong Province, China
| | - Yi Huang
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Aiting Zhou
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Xianlin Wang
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Yuan Huang
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China
| | - Minglan Zhu
- Affiliated Hospital of Zunyi Medical University, Guizhou Province, China.
| | | | - Renli Deng
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Guizhou Province, China.
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Khemai C, Leão DLL, Janssen DJA, Schols JMGA, Meijers JMM. Interprofessional collaboration in palliative dementia care. J Interprof Care 2024; 38:675-694. [PMID: 38757957 DOI: 10.1080/13561820.2024.2345828] [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] [Received: 05/04/2022] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Interprofessional collaboration (IPC) is essential for high-quality palliative care (PC) for persons with dementia. The aim of this scoping review was to identify IPC approaches in palliative dementia care and explore the elements constituting these approaches. We performed a search in PubMed, CINAHL, and PsychINFO using the Joanna Briggs Institute Reviewers' manual and PRISMA guidelines, and conducted content analysis of the included articles. In total, 28 articles were included, which described 16 IPC approaches in palliative dementia care. The content analysis revealed three overall elements of these approaches: 1) collaborative themes, 2) collaborative processes, and 3) resources facilitating collaboration. Frequently reported collaborative themes embraced pain management and providing care in the dying phase. These themes were addressed through intertwined collaborative processes including communication, coordination, assessing and monitoring, and reflecting and evaluating. To ensure optimal IPC in palliative dementia care, various resources were required, such as PC knowledge, skills to manage symptoms, skills to communicate with collaborators, and a facilitating environment. In conclusion, the identified IPC approaches in palliative dementia care involve diverse collaborating professionals who mainly manage symptoms, prepare for the dying phase and require material and immaterial resources to enable optimal IPC in palliative dementia care.
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Affiliation(s)
- C Khemai
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - D L L Leão
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - D J A Janssen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Department of Research and Development, Ciro, Horn, the Netherlands
| | - J M G A Schols
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - J M M Meijers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
- Zuyderland Care, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
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Shih YA, Lu Q. Oncology nurses' knowledge, attitudes, and practice behaviours towards advance care planning: A nationwide cross-sectional study. NURSE EDUCATION TODAY 2024; 134:106076. [PMID: 38159386 DOI: 10.1016/j.nedt.2023.106076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND With the increasing cancer prevalence in China, discussions surrounding end-of-life care have become more frequent within the purview of oncology nursing. Nonetheless, limited research has explored the current state of Advance Care Planning (ACP) among oncology nurses in China. Hence, it is essential to comprehensively assesses oncology nurses' ACP knowledge, attitudes, and practice behaviours, addressing existing literature gaps and revealing China's oncology nursing ACP status. OBJECTIVES To explore oncology nurses' knowledge, attitudes, and practice behaviours regarding ACP and identify factors impacting ACP practice behaviours. DESIGN A multi-centre, observational, cross-sectional study. SETTINGS The research is conducted in oncology hospitals across 22 provinces, 4 municipalities, and 5 autonomous regions across China. PARTICIPANTS Convenience sampling was used to recruit 1800 registered oncology nurses. METHODS Data were collected via an electronic questionnaire between December 2021 and January 2022. Univariate and hierarchical multiple regression analyses were used for data prediction (P < 0.05). RESULTS In the knowledge section, respondents achieved an average accuracy rate of 51.94 % and demonstrated moderate positive attitudes towards ACP. Their practice behaviour scores were moderately graded. Sociodemographic characteristics and attitude were included as predictors of practice behaviour in the hierarchical multiple regression analysis, explaining 12.2 % and 31.1 % of the variance, respectively. The final model accounted for 43.3 % of the variance. The results indicated that attitudes had a significant and positive impact on practice behaviours, indicating that nurses with more positive attitudes were more likely to engage in ACP practice. CONCLUSIONS Chinese oncology nurses seem to have more positive attitudes towards ACP, but they do not prepare adequately in practice. By enhancing workplace values, beliefs, and policies, it is feasible to enhance the attitudes of oncology nurses towards ACP and, consequently, promote practice behaviours. Furthermore, this study underscores the need for targeted interventions to bridge the gap between positive attitudes and actual ACP implementation among oncology nurses in China.
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Affiliation(s)
- Yi-An Shih
- School of Nursing, Peking University, Beijing, China
| | - Qian Lu
- School of Nursing, Peking University, Beijing, China.
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5
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Gong M, Ding F, Zhu YP, Liu NW, Li YL, Qiu D, Fang Q. Knowledge, attitudes and practices towards advance directives among clinical nurses: Multicenter cross-sectional survey. J Clin Nurs 2024; 33:740-751. [PMID: 37888145 DOI: 10.1111/jocn.16911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to describe the knowledge, attitudes and practices (KAP) of nurses in implementing advance directives (ADs) for older patients and analyze the influencing factors before the establishment of the first advance directives act in China. DESIGN Multicenter cross-sectional survey. The standards for reporting the STROBE checklist are used. METHODS This cross-sectional study developed a self-designed structured questionnaire to assess nurses' knowledge, attitudes and practices about ADs. Nurses were recruited by stratified random sampling through the Nursing Departments of 12 hospitals in southwest China and were asked to fill out the questionnaire face to face about knowledge, attitudes and practices. Data were analyzed following descriptive statistics, rank-sum test and multiple linear regression. RESULTS This study included 950 nurses. The study found that nurses were extremely supportive of ADs. Unmarried nurses had better knowledge of ADs than married ones. Nevertheless, there was a discrepancy between the participants' knowledge, attitude and practice. The participants' practice was lower (4.3%) compared with their attitude (81.9%) and knowledge (42.2%). Knowledge on, attitudes towards and standardized procedures for ADs in the workplace affected nursing practice. CONCLUSIONS The study recommends that courses on ADs and appropriate support from medical institutions should be provided to nurses to increase their knowledge and confidence in implementing ADs. Healthcare professionals should be sufficiently equipped to implement ADs and handle their execution appropriately to provide adequate end-of-life care corresponding to patients' wishes. RELEVANCE TO CLINICAL PRACTICE The study results inform rich insights as it discusses the numerous interrelating factors influencing these three fundamental aspects that affect the success of any AD policy by surveying the knowledge, attitudes and practices of clinical nurses. Furthermore, our results hint at distinct areas of improvement in the nursing practice to facilitate the wider implementation and acceptance of ADs in China. PATIENT OR PUBLIC CONTRIBUTION This study involved no patient.
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Affiliation(s)
- Miao Gong
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fu Ding
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Ping Zhu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Na Wei Liu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ya Ling Li
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Qiu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Fang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Che SL, Leong SM, Lau WS, Tam KI. Reliability and Validation Study of Advance Care Planning Practice Scale among Health and Social Care Professionals. Healthcare (Basel) 2024; 12:200. [PMID: 38255087 PMCID: PMC10815370 DOI: 10.3390/healthcare12020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Advance care planning (ACP) is a crucial process in clinical practice, enabling individuals to articulate their care preferences and goals, with significant implications for future healthcare. However, ACP practice of health and social care professionals (HSCPs) concerning patients, or their family members are rarely explored. The objective of the study was to adapt and validate a four-item scale assessing ACP practices of HSCPs toward patients or their family members. The ACP Practice Scale was evaluated through a cross-sectional online survey administered to HSCPs in Macao, assessing its factor structure, validity, and reliability. Based on a sample of 186 valid responses, the ACP Practice Scale demonstrated satisfactory levels of validity and reliability among HSPCs in Macao. The four-item scale explained 65.87% of the variance in ACP practice and exhibited strong internal consistency, with Cronbach's alpha and McDonald's omega coefficients of 0.82. Furthermore, item factor loadings ranged from 0.71 to 0.90. The ACP Practice Scale provides reliable and valid measurements of ACP practice among HSCPs. This instrument can help to enhance our understanding of ACP practices in clinical settings and support the advancement of advance care planning.
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Affiliation(s)
- Sok-Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China;
| | - Sok-Man Leong
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China;
| | - Wing-Sze Lau
- Lar de Cuidados de Ká Hó da Federação das Associações dos Operários de Macau, Estr. de Nossa Sra. de Ka Ho, Macao SAR, China
| | - Kuai-In Tam
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China;
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Macedo JC, Macedo E, Nunes R. Advance Directives in Portugal: A Qualitative Survey. Healthcare (Basel) 2024; 12:195. [PMID: 38255083 PMCID: PMC10815462 DOI: 10.3390/healthcare12020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Advance directives (ADs) in Portugal have been legalized since 2012. What has been observed over time, from the few studies carried out, is that despite the positive attitudes in the population, there is a low level of adherence to ADs. To try to understand the reasons for these data, the current study aimed to explore and describe the experiences of the Portuguese population regarding AD. (2) Methods: For this exploratory and descriptive qualitative study, the researchers conducted open (unstructured) interviews with a convenience sample aged over 18 years until data saturation was achieved. (3) Results: A total of fifteen interviews were conducted-eight with women and seven with men. The following four categories emerged from the content analysis of the interviews: (1) AD literacy, (2) AD relevance, (3) AD attitudes, and (4) conditionalities for compiling the ADs. (4) Conclusions: The study pointed out the good receptivity of the participants to the ADs; however, literacy on this subject was low, and identifying the conditionalities in the development of ADs could contribute to improvements in implementation in the population. The data from this study suggest the need to implement measures to increase the literacy of the Portuguese population on ADs and review the legal framework for improving the accessibility of the citizen population. There is also a need to continue researching and obtain more evidence about the ways in which the Portuguese population perceives ADs; thus, in this way, a society can better respond to its citizens' right to freely exercise their prospective autonomy at the end of their lives.
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Affiliation(s)
- João Carlos Macedo
- Nursing School, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Av. Bissaya Barreto, 3046-851 Coimbra, Portugal
- Research Center for Justice and Governance (JusGov), School of Law, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Ermelinda Macedo
- Nursing School, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Av. Bissaya Barreto, 3046-851 Coimbra, Portugal
| | - Rui Nunes
- Center of Bioethics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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Macedo JC, Rego F, Nunes R. Perceptions, Attitudes, and Knowledge toward Advance Directives: A Scoping Review. Healthcare (Basel) 2023; 11:2755. [PMID: 37893829 PMCID: PMC10606563 DOI: 10.3390/healthcare11202755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Advance directives are an expression of a person's autonomy regarding end-of-life care. Several studies have shown that the level of completion in countries where advance directives are legalised is low. To better understand this phenomenon, it is important to know the perceptions, attitudes, and knowledge that the population has about this instrument. The aim of this article was to explore a population's perceptions and/or attitudes and/or knowledge toward advance directives. (2) Methods: A search was conducted in March 2023 in the ISI Web of Knowledge, Scopus, and PubMed databases using the following keywords: "advance care directives", "advance care planning", "perceptions", "attitudes", and "knowledge". Two hundred and twenty-four (224) articles were identified, and thirteen (13) were included for analysis. (3) Results: The selected articles point to a low level of knowledge toward advance directives: they recognise a strong positive attitude of the population toward the implementation of advance directives but a low level of achievement. (4) Conclusions: Studies on perceptions/attitudes/knowledge toward advance directives are important to understand the real needs of the population regarding this issue and to implement more adequate and effective promotion and dissemination measures.
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Affiliation(s)
- João Carlos Macedo
- Nursing School, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Av. Bissaya Barreto, 3046-851 Coimbra, Portugal
- Research Centre for Justice and Governance (JusGov), School of Law, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Rui Nunes
- Center of Bioethics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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Waller A, Bryant J, Bowman A, White BP, Willmott L, Pickles R, Hullick C, Price E, Knight A, Ryall MA, Clapham M, Sanson-Fisher R. Junior medical doctors' decision making when using advance care directives to guide treatment for people with dementia: a cross-sectional vignette study. BMC Med Ethics 2022; 23:73. [PMID: 35836232 PMCID: PMC9284793 DOI: 10.1186/s12910-022-00811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Junior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives (ACDs), or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: (1) their legal compliance and decision-making process related to treatment decisions; (2) the factors influencing their clinical decision-making; and (3) the factors associated with accurate responses to one hypothetical vignette.
Method A cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: (1) bacterial pneumonia; or (2) suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette. Results Overall, 116 junior doctors responded (35% consent rate). In Vignette 1, 58% of respondents (n = 67/116) selected the legally compliant option (i.e. not commence treatment). Participants who chose the legally compliant option perceived ‘following patient wishes’ (n = 32/67; 48%) and ‘legal requirements to follow ACDs’ (n = 32/67; 48%) as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’ (n = 14/37; 38%). In Vignette 2, 72% of respondents (n = 83/116) indicated they would commence treatment (i.e. not follow the ACD) and 18% (n = 21/116) selected they would not commence treatment. (i.e. follow the ACD). Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario. Conclusions There are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia. .,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Alison Bowman
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Robert Pickles
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Carolyn Hullick
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Emma Price
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Anne Knight
- Manning Education Centre, Department of Rural Health, University of Newcastle, 69a High St, Taree, NSW, Australia
| | - Mary-Ann Ryall
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Central Coast Clinical School, University of Newcastle, Callaghan, NSW, Australia
| | - Mathew Clapham
- Clinical Research Design and Statistical Services, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Chaverra Castellar MI, Osorio Castaño JH. Voluntades anticipadas como referente ético de conocimiento en los enfermeros que laboran en servicios de oncología. REVISTA LATINOAMERICANA DE BIOÉTICA 2022. [DOI: 10.18359/rlbi.5694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
El propósito del presente artículo es identificar los conocimientos sobre la Voluntad Anticipada (VA) en enfermeros que laboran en servicios de oncología. Para ello, se utilizó como metodología un estudio observacional con intención analítica que midió el nivel de conocimiento a través de un cuestionario autodiligenciado. En él participaron 50 enfermeros, seleccionados por muestreo no probabilístico. Así, se analizaron las variables cualitativas con distribuciones de frecuencia, y las cuantitativas con estadística descriptiva y análisis bivariado. El nivel de conocimiento se categorizó así: 0 a 10 puntos (nivel bajo), 11 a 20 puntos (nivel medio), 21 a 30 puntos (nivel alto). Los resultados de la investigación arrojaron como dato que, para un grupo donde el 86 % eran mujeres, con promedio de edad de 37 años, el promedio de años de experiencia como enfermeros fue de 11.5 años. Por otra parte, el promedio de años de experiencia en el área de oncología fue de 6.2 años. De los que hacían parte de este último promedio, el 48 % tenían diplomado en oncología y el 46 % especialización. El 70 % de los participantes tenía un conocimiento medio, el 26 % un conocimiento alto, y el 4 %un nivel bajo. Cabe mencionar que solo el nivel de formación de postgrado se relacionó de manera significativa con el nivel de conocimientos. Como conclusión, se encontró que los profesionales en enfermería poseen un nivel de conocimiento medio sobre la legislación que aborda las voluntades anticipadas en Colombia y esto está relacionado con el nivel de formación.
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Chen X, Zhang Y, Arber A, Huo X, Liu J, Sun C, Yuan L, Wang X, Wang D, Wu J, Du J. The training effects of a continuing education program on nurses’ knowledge and attitudes to palliative care: a cross sectional study. Palliat Care 2022; 21:56. [PMID: 35473551 PMCID: PMC9040326 DOI: 10.1186/s12904-022-00953-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Most nurses in China have not been trained to take care of end-of-life patients appropriately due to lack of educational resources and insufficient training. A palliative care program was launched by the Jiangsu Nursing Association (JNA training program) and to identify gaps in palliative care training. The main aim of this study was to evaluate the training effects of the JNA training program on nurses’ knowledge and attitudes to palliative care.
Methods
A cross-sectional study was conducted with 10 048 registered nurses in all regions of Jiangsu. All participants completed an online questionnaire using the Chinese version of The Palliative Care Quiz for Nursing (PCQN-C) and the Frommelt Attitude Toward Care of the Dying scale (FATCOD-B-C). A propensity score matched analysis was performed between the nurses who had attended the JNA training program and whose who hadn’t.
Results
The average score of PCQN-C among all nurses was 8.79, while the mean score of the FATCOD-B-C was 103.62. Those participants who attended the JNA training program had significantly better scores than those who did not. Propensity score matching analysis showed that the palliative care training program failed to improve nurses’ knowledge in psychosocial and spiritual care or their attitudes towards the necessity of family support although there was positive impact on other aspects of palliative care.
Conclusions
Knowledge of palliative care among Chinese nurses remains low. Training programs may improve general knowledge and attitudes to palliative care. However, important aspects of knowledge such as communication skills, family support, and psychosocial aspects of care, are missing. These gaps should be filled in future palliative care training programs targeting nurses with oriental culture background.
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Yang M, Wu Y, Peng L, Kuang X. Analysis on Influencing Factors of Knowledge-Based Attitude and Behavior Change of Cardiovascular Disease Nurses. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8132478. [PMID: 35469228 PMCID: PMC9034923 DOI: 10.1155/2022/8132478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
Abstract
The study explores the influencing factors of knowledge, attitude, and behavior of cardiovascular disease nurses. A total of 500 CVD nurses from 10 hospitals in the province from January 2020 to 2021 are selected as the survey subjects. After reviewing the literature, a questionnaire is developed to investigate the knowledge, belief, and practice level of cardiovascular disease nurses. The demographic information, job information and knowledge, attitude, and behavior of cardiovascular disease nurses are investigated in the form of questionnaires. Univariate analysis is made on the knowledge, attitude, and behavior scores of the nurses with cardiovascular diseases in demographic characteristics and job characteristics, and multivariate stepwise analysis is made on the factors affecting the knowledge, attitude, and behavior of the nurses with cardiovascular diseases. Cardiovascular disease nurses' knowledge, attitude, and behavior are the medium level, should be regular training activities and psychological counseling, and cultivate high title, long working life, older nursing staff, and practice level.
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Affiliation(s)
- Manmei Yang
- Department of Cardiovascular Medicine, Chenzhou No. 1 People's Hospital, Chenzhou 423000, China
| | - Yongping Wu
- Outpatient Department, Chenzhou No. 1 People's Hospital, Chenzhou 423000, China
| | - Lihua Peng
- Department of Nursing, Chenzhou No. 1 People's Hospital, Chenzhou 423000, China
| | - Xuhuan Kuang
- Department of Nursing, Chenzhou No. 1 People's Hospital, Chenzhou 423000, China
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Chen JO, Lin CC. Exploring the Barriers Faced by Nephrology Nurses in Initiating Patients With Chronic Kidney Disease Into Advance Care Planning Using Focus-Group Interviews. J Nurs Res 2021; 29:e179. [PMID: 34607991 DOI: 10.1097/jnr.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The prevalence of end-stage renal disease in Taiwan is the highest in the world. The rate of signing advance directives in Taiwan is lower than in Western countries, and most of the barriers that have been identified relate to initiating advance care planning (ACP). PURPOSE This study was designed to explore the barriers to discussing ACP with patients with chronic kidney disease faced by nephrology nurses. METHODS A descriptive qualitative study design was adopted. The Consolidated Criteria for Reporting Qualitative Research was used to report the findings of this study. Data were collected using purposive sampling. A total of 34 nephrology nurses were recruited from hospitals in northern (2 groups, 10 participants), central (1 group, 4 participants), and southern (5 groups, 20 participants) Taiwan. A qualitative content analysis was conducted to analyze the transcripts of the eight focus groups. RESULTS Five themes were identified, including (a) lacking the confidence to discuss ACP, (b) difficulty in finding an appropriate opportunity to initiate ACP discussion, (c) personally lacking the characteristics to discuss ACP, (d) conflicting perspectives between doctors and nurses over ACP, and (e) culture and belief-based barriers to discussing ACP. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings obtained from the interviews revealed that nurses must enhance their ACP-related knowledge and communication skills and foster personal confidence in initiating ACP discussions. Furthermore, nurses must be empowered to work with other healthcare professionals. To implement the initial process of discussing ACP in clinical settings, clinical guidelines should be developed for healthcare professionals on initiating ACP. These measures may facilitate improved collaboration in healthcare settings and further encourage patients and their families to participate in shared decision-making that may help patients complete advance directives and thereby achieve better care quality at the end of life.
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Affiliation(s)
- Jui-O Chen
- PhD, RN, Assistant Professor, Department of Nursing, Tajen University, Pingtung, Taiwan, ROC
| | - Chiu-Chu Lin
- PhD, RN, Professor, School of Nursing; Department of Renal Care, College of Medicine; and Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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The Role Complexities in Advance Care Planning for End-of-Life Care-Nursing Students' Perception of the Nursing Profession. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126574. [PMID: 34207258 PMCID: PMC8296407 DOI: 10.3390/ijerph18126574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
Nurses’ perceptions of being responsible for advance care planning (ACP) vary greatly across different studies. It could, however, affect their involvement in advance care planning and patients’ quality of death. Recent studies on this topic have mostly focused on advance directives but not ACP and nurses in the ward setting. This study aimed to assess the perception of Hong Kong nursing undergraduates of the nurse’s role in advance care planning and examine its associations with knowledge, attitude, and experience. A cross-sectional 57-item survey was delivered to nursing undergraduates between June and August 2020. The chi-squared test or Fisher’s exact test were used for univariate analysis. The multiple logistic regression model was used for multivariate analysis. A total of 469 participants were assessed for eligibility; 242 of them were included in the data analysis, with a response rate of 97.6%. The majority of respondents—77.3% (95% CI: 72.0–82.6%)—perceived having a role in ACP, but large discrepancies were found between their perception of their role regarding different aspects of ACP. Participants who had a better knowledge status (p = 0.029) or supported the use of ACP (p < 0.001) were more likely to have a positive perception of their role in ACP. A negative correlation was found between the experience of life threat and positive role perception (p < 0.001). Through strengthening training, the role clarity of nursing undergraduates could be achieved, maximizing their cooperation with and implementation of ACP in their future nursing career. The enhancement of end-of-life education could also be undertaken to fill nursing undergraduates’ knowledge gap in this area and change their attitudes.
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White BP, Willmott L, Feeney R, Neller P, Then SN, Bryant J, Waller A, Yates P. Limitations in health professionals' knowledge of end-of-life law: a cross-sectional survey. BMJ Support Palliat Care 2021:bmjspcare-2021-003061. [PMID: 34083318 DOI: 10.1136/bmjspcare-2021-003061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/19/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Insufficient knowledge about end-of-life law can impede the provision of safe and high-quality end-of-life care. Accurate legal knowledge across health professions is critical in palliative and end-of-life settings given the reliance on multidisciplinary care. Most research has focused on doctors, finding significant knowledge gaps. The limited evidence about other health professions also suggests legal knowledge deficits. OBJECTIVE To determine and compare levels of knowledge about end-of-life law across a broad sample of Australian health professionals and medical students, and to identify predictors of legal knowledge. METHODS An online pre-training survey was completed by participants enrolled in a national training programme on end-of-life law. The optional survey collected demographic data and measured baseline legal knowledge and attitudes towards end-of-life law. RESULTS Response rate was 67% (1653/2456). The final sample for analysis (n=1564, 95% of respondents), included doctors, medical students, nurses and a range of allied health professionals. Doctors and nurses had slightly higher levels of legal knowledge than did medical students and allied health professionals; all had critical knowledge gaps. Demographic and professional characteristics predicted knowledge levels, with experience of end-of-life law in practice, confidence applying law and recent continuing professional development being positively associated with legal knowledge. CONCLUSIONS This study provides new evidence about legal knowledge across a broad range of health professions. While knowledge levels varied somewhat across professions, knowledge gaps were observed in all professional groups. Education and training initiatives to enhance knowledge of end-of-life law should be tailored to meet the specific needs of each profession.
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Affiliation(s)
- Ben P White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rachel Feeney
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Penny Neller
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shin-Ning Then
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jamie Bryant
- School of Medicine and Public Health, Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Amy Waller
- School of Medicine and Public Health, Health Behaviour Research Collaborative, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Tang MY, Li XL, Shi ZY, Fu WJ. Knowledge of and willingness to promote advanced care planning among oncology nurses in southwest China. Int J Palliat Nurs 2021; 26:175-182. [PMID: 32378488 DOI: 10.12968/ijpn.2020.26.4.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nurses feature prominently in promoting advance care planning (ACP), but only a limited amount of relevant research has been conducted from the nurses' viewpoint, and little is known about the nurses' knowledge of and their willingness to promote ACP in China. AIMS The aims of this study were to investigate oncology nurses' knowledge of and their willingness to promote ACP, and to explore associated factors. METHODS A multi-centre study was conducted to investigate 350 nurses in the oncology departments of four university hospitals in southwestern China. Cluster sampling was used in data collection, which involved three categories of questionnaires concerning demographic characteristics, knowledge about ACP and willingness to promote ACP. Chi-squared tests and multiple linear regression were employed in data analysis. RESULTS Some 293 valid questionnaires were collected, among which, 60.1% of respondents never received palliative care education, 89.1% never received training about ACP and 72.7% had not even heard of ACP. Nurses with higher position titles (χ2=18.41, p<0.001) and longer working experience (χ2=12.25, p=0.001) were more likely to have received palliative care education; nurses with higher educational background levels (χ2=12.91, p<0.001), higher position titles (χ2=9.77, p=0.003) and longer working experience (χ2=7.92, p=0.006) were more likely to have learned about ACP; nurses with higher position titles had more access to relevant training (χ2=5.10, p=0.03). Furthermore, whether the nurse had 'heard about ACP' (B=3.113, p=0.018) and 'received training about ACP' (B=3.894, p=0.04) were both associated with their willingness to promote ACP. CONCLUSIONS The findings of this study indicated that oncology nurses were highly inclined to promote ACP, but limited by their lack of knowledge and understanding of it. Therefore, a systematic and adequate training programme about ACP for nurses is an urgent requirement to effectively enhance the implementation of ACP in China.
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Affiliation(s)
- Meng-Yan Tang
- Master's Student, School of Nursing, Sichuan University, China
| | - Xiao-Ling Li
- Professor, School of Nursing, Sichuan University; Department of Nursing, West China Hospital of Sichuan University, China
| | - Zheng-Yan Shi
- Master's Student, School of Nursing, Sichuan University, China
| | - Wen-Jing Fu
- Master's Student, School of Nursing, Sichuan University, China
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Cheng Q, Liu X, Li X, Qing L, Lin Q, Wen S, Chen Y. Discrepancies among knowledge, practice, and attitudes towards advance care planning among Chinese clinical nurses: A national cross-sectional study. Appl Nurs Res 2021; 58:151409. [PMID: 33745557 DOI: 10.1016/j.apnr.2021.151409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/31/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
AIMS AND OBJECTIVES To explore the Chinese nurses' knowledge and attitudes concerning advance care planning (ACP) and their engagement in ACP practice. BACKGROUND Nurses' knowledge, attitude, and practice of ACP are important in promoting ACP in patients, but little is known about knowledge, attitudes, and practice of ACP among nurses in countries where there are no national policies or regulations on ACP. DESIGN A descriptive study with a cross-sectional design. METHODS An online questionnaire survey was distributed to Chinese nurses who attended a national conference. RESULTS A total of 531 nurses completed the survey and were included in the final analysis. No nurses answered all questions correctly, while 31 (5.8%) answered all the survey questions wrong. The participants were most knowledgeable about the item "Once ACP is made, the content of advance directives cannot be revoked" and were least knowledgeable about the item "ACP is valid only when the patients are well informed of the medical condition". The implementation of ACP was favored by 92.5% of participants, but only 3.4% of them had actually engaged in all 5 ACP practices listed in the survey. Experience of dealing with death was positively associated with nurses' knowledge concerning ACP. The number of dying patients cared for in the past 6 months, school education of palliative care, knowledge of ACP, and age were related to engagement in the practice of ACP. CONCLUSION Chinese nurses have supportive attitudes towards ACP, but they have limited knowledge and little practice in ACP.
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Affiliation(s)
- Qinqin Cheng
- Pain Management Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Xiangyu Liu
- Health Management Centre, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Xuying Li
- Nursing Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Limin Qing
- Head and Neck Surgical Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Qin Lin
- Vascular Access Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Shiwu Wen
- OMNI Research Group, Ottawa Hospital Research Institute; Department of Obstetrics and Gynecology and School of Epidemiology and Public Health, University of Ottaw Faculty of Medicine.
| | - Yongyi Chen
- Administrative Office, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, P.R. China.
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Fliedner M, Halfens RJG, King CR, Eychmueller S, Lohrmann C, Schols JMGA. Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting: A Scoping Review. J Hosp Palliat Nurs 2021; 23:59-68. [PMID: 33284145 DOI: 10.1097/njh.0000000000000715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Palliative care focuses on symptom management, discussion of treatment and care decisions, network organization, and support of the family. As part of the advance care planning (ACP) process, staff nurses in the acute care setting are often involved in all of the above areas. It is yet unclear what nurses' roles and responsibilities are and what skills are needed in the ACP process. The themes that staff nurses and advanced practice registered nurses (APRNs) discuss in relationship to ACP are manifold. This scoping review demonstrates that staff nurses' core role is advocating for the wishes and values of patients with any life-limiting disease. Staff nurses also serve as facilitators, educators, and advocates to help start ACP conversations and ease patients' transitions between settings based on well-discussed decisions. To be able to engage in ACP discussions, APRNs must have excellent communication skills. Continuous training to improve these skills is mandatory. In the future, clarifying the contribution of staff nurses and APRNs in the ACP process in relation to other members of the interprofessional team can lay the groundwork for improved interprofessional collaboration.
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Effects of Dispositional Resilience and Self-Efficacy on Practice in Advanced Care Planning of Terminally Ill Patients among Taiwanese Nurses: A Study Using Path Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031236. [PMID: 33573116 PMCID: PMC7908438 DOI: 10.3390/ijerph18031236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
This study aimed to expand on previous research elucidating the effects of dispositional resilience and self-efficacy on practice in advanced care planning (ACP) of terminally ill patients among Taiwanese nurses using path modeling. This cross-sectional study was conducted using cluster sampling. Data were collected using demographics, nurses’ knowledge, attitude, and practice of ACP (KAP-ACP) inventory, Dispositional Resilience Scale, and General Self-Efficacy Scale. A total of 266 nurses from a tertiary medical center in northern Taiwan participated in this study in 2019. The results showed that gender and ward were significant K-ACP predictors among nurses. The ACP knowledge, ward, and experience of caring for terminally ill friends or relatives were significant A-ACP predictors, whereas ACP attitudes, dispositional resilience, self-efficacy, ward, and the frequency of caring for terminally ill patients were the key predictors of P-ACP. The path modeling showed that dispositional resilience; self-efficacy; medical, surgical, hematology and oncology wards; previous experience in caring for terminally ill friends or relatives; participating in the do-not-resuscitate signature; and the frequency of caring for terminally ill patients directly influenced ACP practices. We recommend that nurses enhance their dispositional resilience and self-efficacy, which may encourage them to appreciate the value of ACP practice of terminally ill patients and improve the quality of care.
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Chan HYL, Kwok AOL, Yuen KK, Au DKS, Yuen JKY. Association between training experience and readiness for advance care planning among healthcare professionals: a cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:451. [PMID: 33228655 PMCID: PMC7684716 DOI: 10.1186/s12909-020-02347-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/30/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Training has been found effective in improving healthcare professionals' knowledge, confidence, and skills in conducting advance care planning (ACP). However, the association between training and its actual practice in the clinical setting has not been well demonstrated. To fill this gap, this paper examines the association between their readiness for ACP, in terms of perceived relevancy of ACP with their clinical work, attitudes toward and confidence and willingness to perform it, based on the Theory Planned Behavior and relevant training experiences. METHODS An online survey about experiences about ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted. RESULTS Of 250 respondents, approximately half (52.0%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and different levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001-0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience. CONCLUSIONS This paper revealed the association between training and higher level of readiness toward ACP among healthcare professionals. The findings showed that training is a predictor of their readiness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.
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Affiliation(s)
- Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 7/F. Esther Lee Building, Hong Kong SAR, China.
| | - Annie Oi-Ling Kwok
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - Derrick Kit-Sing Au
- CUHK Centre for Bioethics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline Kwan-Yuk Yuen
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Werner P, Schiffman IK. Nursing home staff members' attitudes regarding advance care planning: relationships with different types of knowledge. Aging Clin Exp Res 2020; 32:2091-2098. [PMID: 31686389 DOI: 10.1007/s40520-019-01398-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advanced care planning (ACP) is an essential component of quality palliative care in nursing homes. Despite the benefits associated with ACP in nursing homes, completion rates are low. Staff members' knowledge and attitudes toward ACP were found to be main determinants of ACP completion. AIMS To assess nursing home staff members' attitudes towards ACP and their association to different types of knowledge. METHODS A convenience sample of 138 nursing home staff members (69% female, 53% non-Jewish, 46% nurses) who reported having heard the terms advanced directives and durable power of attorney completed a structured questionnaire assessing attitudes toward ACP, subjective knowledge, and three types of objective knowledge (declarative, legal and procedural) regarding ACP, as well as socio-demographic and professional factors. RESULTS Participants expressed positive attitudes toward formal and informal aspect of ACP, although their subjective and objective knowledge in the topic was moderate. Hierarchical regression analyses revealed that the three dimensions of objective knowledge improved significantly the participants' attitude scores. DISCUSSION There is a need to integrate different types of knowledge in educational programs provided to nursing home staff members to improve their involvement in ACP initiatives with residents and family members.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa, Israel.
| | - Ile Kermel Schiffman
- Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa, Israel
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22
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Waller A, Chan S, Chan CWH, Chow MCM, Kim M, Kang SJ, Oldmeadow C, Sanson-Fisher R. Perceptions of optimal end-of-life care in hospitals: A cross-sectional study of nurses in three locations. J Adv Nurs 2020; 76:3014-3025. [PMID: 32888206 DOI: 10.1111/jan.14510] [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: 12/17/2019] [Revised: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 12/28/2022]
Abstract
AIM To examine whether nurses' location of employment, demographics, or training influences their perceptions of what constitutes optimal care for dying patients in hospital. DESIGN Questionnaire-based, cross-sectional study. METHODS Between December 2016-June 2018, 582 registered or enrolled nurses from Australia (N = 153), South Korea (N = 241), and Hong Kong (N = 188) employed in a variety of hospital care units rated the extent to which they agreed with 29 indicators of optimal end-of-life care across four domains: patient, family, healthcare team, and healthcare system. Latent class analysis identified classes of respondents with similar responses. RESULTS Top five indicators rated by participants included: 'physical symptoms managed well'; 'private rooms and unlimited visiting hours'; 'spend as much time with the patient as families wish'; 'end-of-life care documents stored well and easily accessed' and 'families know and follow patient's wishes'. Four latent classes were generated: 'Whole system/holistic' (Class 1); 'Patient/provider-dominated' (Class 2); 'Family-dominated' (Class 3) and 'System-dominated' (Class 4). Class 1 had the highest proportion of nurses responding positively for all indicators. Location was an important correlate of perceptions, even after controlling for individual characteristics. CONCLUSION Nurses' perceptions of optimal end-of-life care are associated with location, but perhaps not in the direction that stereotypes would suggest. Findings highlight the importance of developing and implementing location-specific approaches to optimize end-of-life care in hospitals. IMPACT The findings may be useful to guide education and policy initiatives in Asian and Western countries that stress that end-of-life care is more than symptom management. Indicators can be used to collect data that help quantify differences between optimal care and the care actually being delivered, thereby determining where improvements might be made.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Sally Chan
- Pro Vice-Chancellor and Chief Executive Officer (UoN Singapore), The University of Newcastle, Singapore
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Meyrick C M Chow
- School of Nursing, Tung Wah College, Homantin, Hong Kong SAR, China
| | - Miyoung Kim
- College of Nursing, Ewha Womans University, Seodaemun-gu, Seoul, Republic of Korea
| | - Sook Jung Kang
- College of Nursing, Ewha Womans University, Seodaemun-gu, Seoul, Republic of Korea
| | - Christopher Oldmeadow
- Clinical Research Design and Statistics Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Robert Sanson-Fisher
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
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23
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Shepherd J, Waller A, Sanson-Fisher R, Clark K, Ball J. Where would acute care nurses prefer to receive end-of-life care? a cross-sectional survey. Int J Nurs Stud 2020; 109:103683. [PMID: 32663704 DOI: 10.1016/j.ijnurstu.2020.103683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hospital-based nurses can offer a unique perspective about factors that can contribute to a good end-of-life experience, including the location in which end-of-life care is delivered. OBJECTIVES To examine in a sample of hospital-based nurses, the location in which they personally would most and least prefer to be cared for at the end of life, and the reasons for these preferences. DESIGN Questionnaire-based, cross-sectional study. SETTING AND PARTICIPANTS 170 registered and enrolled nurses employed in acute care wards of three metropolitan hospitals in Australia between April 2016 and February 2017. RESULTS Nurses would most prefer to be cared for at home (53%) or in a hospice/palliative care unit (41%) at the end-of-life. Being in a familiar environment and feeling like dying is a more normal process were the main reasons reported for choosing these settings. The main reasons given by nurses for choosing a hospice/palliative care unit were that being cared for at home may place a burden on family/friends and hinder appropriate symptom management. Nurses would least prefer being cared for in an emergency department (49%) due to a perceived lack of privacy and adverse impact on the family; and residential aged care facilities (25%) due to perceived suboptimal symptom management and reduced likelihood of wishes being respected. CONCLUSION Nurses in this study value familiarity of environment and normalising the dying process. The majority do not wish to burden their family and friends at the end of their lives. Important next steps in providing services that meet the needs of people facing the end of their lives include understanding how nurses' personal views may influence decision-making conversations with patients and families about location of care at the end-of-life, as well as determining the capacity of available services to meet patient and family needs.
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Affiliation(s)
- Jan Shepherd
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Amy Waller
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Rob Sanson-Fisher
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Katherine Clark
- Northern Sydney Local Health District, Royal North Shore Hospital Campus, Reserve Road, St Leonards, NSW, 2065, Australia; Northern Clinical School, The University of Sydney, Royal North Shore Hospital Campus, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Jean Ball
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Khairuddin NNB, Lau ST, Ang WHD, Tan PH, Goh ZWD, Ang NKE, Lau Y. Implementing advance care planning: A qualitative exploration of nurses' perceived benefits and challenges. J Nurs Manag 2020; 28:1080-1087. [DOI: 10.1111/jonm.13056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nur Nadhirah Binte Khairuddin
- Department of Nursing Khoo Teck Puat Hospital Yishun Health Campus National Healthcare Group Singapore City Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Poh Hoon Tan
- Alexandra Hospital National University Health System Singapore City Singapore
| | | | - Neo Kim Emily Ang
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
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25
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Nurse Expertise: A Critical Resource in the COVID-19 Pandemic Response. Ann Glob Health 2020; 86:49. [PMID: 32435602 PMCID: PMC7227394 DOI: 10.5334/aogh.2898] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Kim MH, Lee YM. Factors Influencing General Hospital Nurses’ Confidence about Advance Directives. ACTA ACUST UNITED AC 2020. [DOI: 10.34250/jkccn.2020.13.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Chan CWH, Chow MCM, Chan S, Sanson-Fisher R, Waller A, Lai TTK, Kwan CWM. Nurses' perceptions of and barriers to the optimal end-of-life care in hospitals: A cross-sectional study. J Clin Nurs 2020; 29:1209-1219. [PMID: 31889355 DOI: 10.1111/jocn.15160] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/04/2019] [Accepted: 12/20/2019] [Indexed: 12/25/2022]
Abstract
AIMS AND OBJECTIVES To assess nurses' perceptions of what constitutes optimal end-of-life (EOL) care in hospital and evaluate nurses' perceived barriers to EOL care delivery. BACKGROUND Care of dying patients is common in hospitals. However, little is known about the important elements of and barriers to optimal EOL care from key service providers' perspective, which is crucial for quality EOL care in hospital settings. METHOD This is a cross-sectional survey. Nurses practising in hospitals recruited by convenience sampling completed self-report survey questionnaires. STROBE checklist was used in study reporting. RESULTS One hundred and-seventy-five nurses participated in the survey. The majority (70%) had experience in caring for dying patients. The five most highly perceived factors constituting optimal EOL care included the following: "families know and follow patient's EOL wishes"; "patients emotional concerns identified and managed well"; "patients participating in decision-making"; "EOL care documents stored well and easily accessed"; and "provide private rooms and unlimited visiting hours for families of dying patients". Top five barriers were "doctors are too busy"; "nurses are too busy"; "insufficient private room/space"; "nurses have limited training in EOL care"; and "families have unrealistic expectations of patient's prognosis." Multivariate regression analysis identified that nurses without experience in caring for dying patients reported a significantly higher number of perceived barriers towards EOL care (p = .012). Those with postgraduate degree training reported significantly fewer perceived barriers (p = .007). CONCLUSION Findings identified essential elements for optimal hospital EOL care not only involving patients and families in EOL decision and care, but also documentation and environmental issues in the healthcare system level and the needs for strengthening manpower and expertise at palliative care policy level. RELEVANCE TO CLINICAL PRACTICE This study revealed quantitative data to inform health service managers and policy makers in terms of training and service development/ re-design for EOL care in hospital settings.
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Affiliation(s)
- Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Sally Chan
- The University of Newcastle, Newcastle, NSW, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Theresa T K Lai
- Society for the Promotion of Hospice Care, Jockey Club Home for Hospice, Hong Kong SAR, China
| | - Cecilia W M Kwan
- Bradbury Hospice, New Territories East Cluster, Hospital Authority, Hong Kong SAR, China
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28
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Jeong SYS, Moon KJ, Lee WS, David M. Experience of gerotranscendence among community-dwelling older people: A cross-sectional study. Int J Older People Nurs 2019; 15:e12296. [PMID: 31885195 DOI: 10.1111/opn.12296] [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] [Received: 07/06/2019] [Revised: 10/26/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate the experience of gerotranscendence among older people in community in Korea and the factors that influence their experience. BACKGROUND While the literature provides estimates of how many older people are affected by negative aspects of ageing, it is not known to what extent and why some older people experience gerotranscendence, despite the challenges they encounter throughout their lifetime. DESIGN A cross-sectional survey. METHODS A 55-item questionnaire was distributed to 109 older people between March and June 2017. Univariable and multivariable linear regressions were conducted on the four question group sum scores to identify factors associated with gerotranscendence. RESULTS Older people aged 65-93 who live in a community in Korea reported the experience of gerotranscendence. Age and religion showed a statistically significant association with gerotranscendence. Religiosity showed a statistically significant association with beliefs about death and dying. Age and beliefs about death and dying have significant relationship with the experience of gerotranscendence. CONCLUSIONS Older people who have more positive views about death and dying are more likely to experience gerotranscendence. The study results provide nurses and other healthcare professionals with new understandings and insights about the factors potentially related to positive ageing process. IMPLICATIONS FOR PRACTICE It is essential for nurses to investigate their own beliefs about death and dying, and their understanding of gerotranscendence which will contribute to developing education programs and practice guidelines as an essential part of promoting gerotranscendence and positive ageing.
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Affiliation(s)
- Sarah Yeun-Sim Jeong
- The School of Nursing and Midwifery, The University of Newcastle, Ourimbah, NSW, Australia
| | | | - Woo Suck Lee
- College of Nursing, Teagu Science University, Daegu, Korea
| | - Michael David
- The School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
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29
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Hsieh CC, Huang HP, Tung TH, Chen IC, Beaton RD, Jane SW. The exploration of the knowledge, attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses. BMC Palliat Care 2019; 18:99. [PMID: 31711482 PMCID: PMC6849307 DOI: 10.1186/s12904-019-0483-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the documented and well known patient benefits of ACP, the completion of ACP, only a minority of patients, during the advanced or EOL stage of their illnesses, receive such care. The misconceptions about ACP for healthcare providers, such as nurses, might become potential barriers to the effective implication of ACP. Also, from the transcultural perspective, it is evident essential to explore Taiwanese nurses' attitudes, knowledge, and actions of ACP. The purposes of this study were to explore the implication of ACP or hospice care for nurses caring for non-cancer chronic illness patients at a regional teaching hospital in Taiwan; and, to identify predictors of those nurses' knowledge, attitudes, and actions toward ACP. METHODS This cross-sectional study with a purposive sample of 218 nurses was conducted at a teaching hospital in southern Taiwan. Structured questionnaires were employed and data were analyzed with descriptive statistics, t-test, one-way ANOVAs, Pearson's correlation and multiple regressions. RESULTS 16.1% of Taiwanese physicians actively initiated ACP issues or conversations with patients or their family members. Nurses' attitudes toward ACP were fairly positive but their knowledge about ACP was insufficient and actions of ACP were not positively executed. The predictors of ACP-Knowledge (ACP-K) included position title, education hours and lacking of educational training. The predictors of ACP-Attitude (ACP-A) included ACP-K and "fear of patient or family member not accepting", whereas ACP-A, position title, "patients do not feel necessary" and "not sure physician's concern" were the predictors of ACP-Act. CONCLUSION Continuous education and training for nurses regarding ACP needs to be improved by taking those predictors found in this current study into account, and more studies on the nurse's role in ACP also should be further examined. TRIAL REGISTRATION KAFGH 106-012. Date of registration 1 May 2017.
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Affiliation(s)
- Chiu-Chu Hsieh
- Department of Nursing, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Hsiang-Ping Huang
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, Republic of China
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan, Republic of China
| | - I-Chien Chen
- Department of Nursing, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Randal D Beaton
- Psychosocial & Community Health and Health Services, Schools of Nursing and Public Health, University of Washington, Seattle, USA
| | - Sui-Whi Jane
- Geriatric and Long-term Care Research Center, Graduate Institute of Nursing, Chang Gung University of Science and Technology, 261, Wen-Hua 1st Rd., Gui-Shan Dist, Tao-Yuan City, 33303, Taiwan, Republic of China. .,Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Lin-Ko, Taiwan, Republic of China.
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30
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Heggs K. Research roundup. Int J Palliat Nurs 2018. [DOI: 10.12968/ijpn.2018.24.9.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care
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Affiliation(s)
- Karen Heggs
- Lecturer in Adult Nursing, Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester
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