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Robinson J, Goodwin H, Williams L, Anderson N, Parr J, Irwin R, Gott M. The work of palliative care from the perspectives of district nurses: A qualitative study. J Adv Nurs 2024; 80:3323-3332. [PMID: 38108192 DOI: 10.1111/jan.16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
AIM To explore the work of palliative care from the perspectives of district nurses with a focus on the strategies they use to achieve positive outcomes for patients. DESIGN An exploratory descriptive qualitative study. METHODS A combination of group and individual interviews using semi-structured interviewing were used to explore district nurses' views of providing palliative care across two large urban community nursing services. RESULTS Sixteen district nurse participants were interviewed. Three key themes were identified: "Getting what was needed" involved finding solutions, selling a story and establishing relationships. District nurses sought ways to "Stay involved" recognizing the benefit of delaying discharge for some patients. "Completing a nursing task" was a way of managing time constraints and a form of self-protection from having difficult conversations. CONCLUSION This study highlights the importance of understanding the contextual nature of the practice setting in relation to the provision of palliative care. In doing so, it has revealed the strategies district nurses use to overcome the challenges associated with providing palliative care within a generalist workload. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE District nurses experience a tension between managing high patient workloads and remaining patient centred in palliative care. Being task focused is a way of remaining safe while managing a high volume of work and is not always a negative factor in the care they provide. However, focusing on a task while at the same time addressing other unmet needs requires a set of skills that less experienced nurses may not have. IMPACT Palliative care education alone will not improve the quality of palliative care provided by generalist community district nurses. The practice context is an important factor to take into consideration when supporting the integration of palliative care in district nursing. NO PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was made to this study. REPORTING METHOD We have adhered to the relevant EQUATOR guidelines and used the COREQ reporting method.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Natalie Anderson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- Te Whatu Oral Health Counties Manukau, Auckland, New Zealand
| | - Rebekah Irwin
- Te Whatu Oral Health Counties Manukau, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Vesel T, Covaleski A, Burkarth V, Ernst E, Vesel L. Leadership's Perceptions of Palliative Care During the COVID-19 Pandemic: A Qualitative Study. J Pain Symptom Manage 2024; 68:105-114.e4. [PMID: 38643955 DOI: 10.1016/j.jpainsymman.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
CONTEXT Palliative care (PC) played a leading role in the COVID-19 pandemic. However, little is known regarding health system leadership's perceptions. BACKGROUND This study aimed to explore the perceptions, understanding, and utilization of PC before compared to during the COVID-19 pandemic among health system leadership. METHODS Semi-structured, in-depth interviews were conducted with leaders in a large healthcare system based in Massachusetts, United States. RESULTS A total of 22 in-depth interviews were completed at four facilities. Emerging themes included the role of PC before compared to during the COVID-19 pandemic, facilitators and barriers to PC delivery, and recommendations for future practice. Participants reported that the COVID-19 pandemic increased PC utilization, reinforced positive perceptions of the specialty, and emphasized its role in maximizing healthcare efficiency. Many participants found PC financing to be a barrier to delivery; some had an inaccurate understanding of how PC is reimbursed. When asked about their recommendations for improving future practice, participants noted improvements in coordination within the healthcare system and education of healthcare providers and future physicians in primary PC skills. CONCLUSIONS Our findings suggest that healthcare leadership increasingly understands the value of PC and its critical role within the health system and during future public health emergencies; this was further reinforced during the COVID-19 pandemic. Healthcare leadership recognizes and highlights the need to increase investments in this specialty, both financially and educationally. In doing so, healthcare costs will be lowered, patient satisfaction will increase, and care will be better coordinated.
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Affiliation(s)
- Tamara Vesel
- Division of Palliative Care, Tufts Medical Center (T.V., V.B.), Tufts University School of Medicine, Boston, Massachusetts, USA.
| | - Audrey Covaleski
- Department of Community Health (A.C.), Tufts University, Medford, Massachusetts, USA
| | - Veronica Burkarth
- Division of Palliative Care, Tufts Medical Center (T.V., V.B.), Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Emma Ernst
- Department of Family Medicine (E.E.), University of Michigan, Ann Arbor, Michigan, USA
| | - Linda Vesel
- Ariadne Labs (L.V.), Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Sánchez-Cárdenas MA, Tibaquirá CAN, Mantilla-Manosalva N, Fonseca DA, Morales AM, Delgado MXL. Palliative care education in undergraduate medical and nursing programs in Colombia: a cross-sectional analysis. BMC Palliat Care 2024; 23:149. [PMID: 38872162 PMCID: PMC11170879 DOI: 10.1186/s12904-024-01477-5] [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: 02/13/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND The number of people suffering from chronic diseases requiring palliative care (PC) is increasing rapidly. Therefore, PC teaching in undergraduate health science programs is necessary to improve primary PC based on international recommendations and available scientific evidence. METHODS A descriptive cross-sectional study was conducted. Active undergraduate medical and nursing programs that were approved by the Colombian Ministry of Education and integrated PC teaching into their curricula were included in the study. The total sample consisted of 48 programs: 31 nursing and 17 medical programs. RESULTS PC competencies are distributed throughout the curriculum in 41.67% of programs, in elective courses in 31.25%, and in mandatory courses in 27.08% of the programs. The average PC teaching hours is 81 for nursing and 57.6 for medicine. PC clinical rotations are not offered in 75% of the programs. For undergraduate nursing programs, the most frequent competencies taught are the definition and history of PC and identifying common symptoms associated with advanced disease. In undergraduate medicine, the most common competencies are pharmacological and non-pharmacological pain management and identification of PC needs. CONCLUSIONS PC teaching in undergraduate health science programs mainly addresses the conceptual and theoretical aspects of PC, which are part of the competencies present throughout the programs' curricula. Low availability of PC clinical rotations was identified. Future studies should assess whether the low availability of clinical rotations in PC limits the ability of students to develop the practical competencies necessary to provide quality PC. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | | | | | - David Andrade Fonseca
- School of Nursing, Universidad El Bosque. Bogotá D.C. Colombia, Bogotá, D.C, Colombia
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Matthys M, Chambaere K, Beernaert K, Cohen J, Van Brussel L, Deforche B, Quintiens B, Deliens L, Dhollander N. What does the general public know about palliative care? A population-based survey. BMJ Support Palliat Care 2024:spcare-2023-004384. [PMID: 37699664 DOI: 10.1136/spcare-2023-004384] [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: 05/18/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES The need for public education on palliative care has been widely argued for. To develop effective educational strategies, a stronger evidence base is needed on what exactly is known and unknown about palliative care as well as what the differences are between subgroups. METHODS We conducted a cross-sectional population-based survey. Mail questionnaires were sent to a random sample of 4400 citizens (aged ≥16 years) within 4 municipalities in Flanders, Belgium. The Palliative Care Knowledge Scale (PaCKS) was used to measure knowledge. Associations between knowledge and sociodemographics and various experiential factors were tested, as well as the congruence between actual and self-perceived knowledge scores. RESULTS Response was obtained from 2008 (45.6%) citizens. The mean PaCKS score was 7.87 (SD 3.41; range 0-13) with the highest proportion (84.7%) correctly answering that palliative care is not specifically for older adults and the lowest (32.1%) correctly answering that improving the ability to participate in daily life is a palliative care goal. Being aged between 30 and 59, non-religious, more highly educated, having professional healthcare experience and knowing palliative care through personal experience were significantly associated with higher knowledge, while sex and informal caregiving experience were not. 52.4% self-perceived their knowledge as lower than it actually was. CONCLUSIONS While the general public seems to be familiar with some basic concepts of palliative care, several key aspects remain unknown. Educational strategies, with suggested potential for community-based and experience-based approaches, may need to focus specifically on these aspects and not just on the broader palliative care concept.
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Affiliation(s)
- Marjolein Matthys
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Medicine & Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - Benedicte Deforche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Movement and Nutrition for Health and Performance Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bert Quintiens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Medicine & Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Naomi Dhollander
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Department of Medicine & Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Ibrahim AM, Elnaghy SF, Abo Elmatty GM, Mohamed Ghida NI, Mohamed MA. Effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy in Port Said City: A pre-post quasi-experimental study. Palliat Support Care 2024; 22:546-562. [PMID: 38287515 DOI: 10.1017/s1478951523002067] [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: 01/31/2024]
Abstract
BACKGROUND Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment. OBJECTIVES To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy. METHODS The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program. RESULTS Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program. SIGNIFICANCE OF THE RESULTS The palliative care education program significantly improved caregivers' knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.
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Affiliation(s)
- Ateya Megahed Ibrahim
- College of Nursing, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia
- Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt
| | - Sara Fawzy Elnaghy
- Family and Community Health Nursing Department, Health Technical Institute in Port Said, Port Said, Egypt
| | - Gehad Mohamed Abo Elmatty
- Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt
| | | | - Magda Ali Mohamed
- Family and Community Health Nursing Department, Faculty of Nursing, Port Said University, Port Said, Egypt
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Salikhanov I, Yuliya S, Aceti M, Schweighoffer R, Kunirova G, Khashagulgova F, Crape BL, Katapodi MC. Challenges of palliative care identified by stakeholders in resource-limited settings: A multi-regional study in Kazakhstan. J Cancer Policy 2024; 40:100474. [PMID: 38513969 DOI: 10.1016/j.jcpo.2024.100474] [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: 11/14/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION In Kazakhstan, a country of 19 million residents, more than 100,000 patients need palliative care. Since at least one family member is usually involved in the care of a terminal patient, more than 200,000 people would benefit from high-quality palliative care services in the country. However, with only 45 physicians and 101 nurses attending to 1925 palliative beds, Kazakhstan seeks to develop palliative services that meet the national needs in resource-limited settings and international standards. The objectives of this study are to explore the challenges faced by stakeholders involved in palliative care in Kazakhstan and to subsequently provide recommendations that can guide policymakers towards further developing palliative care services in the country. METHODS This cross-sectional descriptive study collected narrative data with in-depth interviews from n= 29 palliative stakeholders (family caregivers n= 12, healthcare professionals =12, administrators n= 5) across five regions of Kazakhstan. Verbatim transcripts of interviews were analyzed using content analysis to identify needs and challenges of stakeholders involved in palliative care. RESULTS Our analysis identified seven main challenges of palliative care stakeholders: high out-of-pocket expenditures; lack of mobile palliative care services for home-based care; severe shortages of opioids to prevent pain suffering; poor formal palliative care education; absence of practical skills training for family caregivers; lack of awareness about palliative care in the society, and lack of state support. CONCLUSION Implementation of national palliative care strategies and policies require a large-scale coordinated involvement of all stakeholders. Our recommendations are based on the idea that coordinated, targeted, and tailored stakeholder engagement is preferred to a one-size-fits-all strategy.
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Affiliation(s)
- Islam Salikhanov
- University of Basel, Department of Clinical Research, Davidsbodenstrasse 28, Basel 4056, Switzerland.
| | - Savinova Yuliya
- Kostanay City Oncological Multidisciplinary Hospital, Kostanay, Kazakhstan
| | - Monica Aceti
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Reka Schweighoffer
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Gulnara Kunirova
- President of the Kazakhstan Association of Palliative Care, Almaty, Kazakhstan
| | | | | | - Maria C Katapodi
- University of Basel, Department of Clinical Research, Switzerland
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Black R, Hasson F, Slater P, Beck E, McIlfatrick S. Building public engagement and access to palliative care and advance care planning: a qualitative study. BMC Palliat Care 2024; 23:98. [PMID: 38605315 PMCID: PMC11010379 DOI: 10.1186/s12904-024-01420-8] [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: 09/08/2023] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Research evidence suggests that a lack of engagement with palliative care and advance care planning could be attributed to a lack of knowledge, presence of misconceptions and stigma within the general public. However, the importance of how death, dying and bereavement are viewed and experienced has been highlighted as an important aspect in enabling public health approaches to palliative care. Therefore, research which explores the public views on strategies to facilitate engagement with palliative care and advance care planning is required. METHODS Exploratory, qualitative design, utilising purposive random sampling from a database of participants involved in a larger mixed methods study. Online semi-structured interviews were conducted (n = 28) and analysed using reflexive thematic analysis. Thematic findings were mapped to the social-ecological model framework to provide a holistic understanding of public behaviours in relation to palliative care and advance care planning engagement. RESULTS Three themes were generated from the data: "Visibility and relatability"; "Embedding opportunities for engagement into everyday life"; "Societal and cultural barriers to open discussion". Evidence of interaction across all five social ecological model levels was identified across the themes, suggesting a multi-level public health approach incorporating individual, social, structural and cultural aspects is required for effective public engagement. CONCLUSIONS Public views around potential strategies for effective engagement in palliative care and advance care planning services were found to be multifaceted. Participants suggested an increase in visibility within the public domain to be a significant area of consideration. Additionally, enhancing opportunities for the public to engage in palliative care and advance care planning within everyday life, such as education within schools, is suggested to improve death literacy and reduce stigma. For effective communication, socio-cultural aspects need to be explored when developing strategies for engagement with all members of society.
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Affiliation(s)
- Rachel Black
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1AD, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1AD, Northern Ireland
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1ED, Northern Ireland
| | - Esther Beck
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1ED, Northern Ireland
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Belfast, BT15 1AD, Northern Ireland.
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Freedman B, Li WW, Liang Z, Hartin P, Biedermann N. The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38515008 DOI: 10.1111/jan.16111] [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: 09/14/2023] [Revised: 12/15/2023] [Accepted: 02/06/2024] [Indexed: 03/23/2024]
Abstract
AIM Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety. METHODS A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies. DATA SOURCES Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023. RESULTS The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety. CONCLUSION Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility. REPORTING METHOD This report adheres to PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.
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Affiliation(s)
- Benjamin Freedman
- James Cook University, Townsville, Queensland, Australia
- Townsville University Hospital, Douglas, Townsville, Australia
| | - Wendy Wen Li
- James Cook University, Townsville, Queensland, Australia
| | - Zhanming Liang
- James Cook University, Townsville, Queensland, Australia
| | - Peter Hartin
- James Cook University, Townsville, Queensland, Australia
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Çakmak B, Inkaya B. The Effect of a Repeated Standardized Patient-Based End-of-Life Care Training Program on Nursing Students' Knowledge, Attitudes, and Emotions Toward End-of-Life Patients. Am J Hosp Palliat Care 2024:10499091241236921. [PMID: 38437522 DOI: 10.1177/10499091241236921] [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: 03/06/2024] Open
Abstract
BACKGROUND Sufficient knowledge of end-of-life care, positive attitudes, and emotions regarding death and dying are essential criteria for showcasing favorable palliative care educational results to undergraduate nursing students. However, nursing students have negative attitudes toward end-of-life care and know little about it. AIM This study aimed to examine the effect of a repeated standardized patient-based training program (intervention) on nursing students' knowledge, attitudes, and emotions about end-of-life patients. METHOD This study adopted a pretest-posttest quasi-experimental research design. The sample consisted of 50 fourth-year nursing students divided into intervention (n = 25) and control (n = 25) groups. All participants attended the intervention. The intervention group attended the intervention twice, while the control group attended it only once. Data were collected using a personal information form, the Frommelt Attitudes Toward Care of the Dying Scale, the Positive and Negative Affect Schedule, and the End-of-Life Care Nursing Questionnaire. The data were analyzed using descriptive statistics, Pearson's Chi-square test, dependent groups t test, Pearson-Spearman, Mann-Whitney test, Wilcoxon test, and Friedman test. RESULTS The intervention helped participants learn more about end-of-life care (χ2 = 27.167, P = .000; F = 42.725, P = .000) and develop more positive attitudes toward end-of-life patients (F = 13.279, P = .000; F = 6.934, P = .000). The intervention also helped participants develop communication skills. CONCLUSION Universities should integrate repeated standardized patient-based into nursing curricula.
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Affiliation(s)
- Betül Çakmak
- Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bahar Inkaya
- Department of Nursing, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara, Turkey
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He X, Li B, Liu X, Jiao P, Zhao Y. Correlation between hospice competence and death coping ability among nursing students in China: A cross-sectional survey. NURSE EDUCATION TODAY 2024; 134:106080. [PMID: 38163389 DOI: 10.1016/j.nedt.2023.106080] [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: 02/21/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Palliative care involves providing comprehensive physical, psychological, and social care to improve clinical symptoms and quality of life, as well as to ensure patients' dignity at the end of life. Nurses are important members of hospice care teams, and undergraduate nursing students are the hospice care providers of the future. The ability of undergraduate nursing students to provide hospice care will, thus, directly affect service quality. OBJECTIVE To understand the relationship between hospice competence and the death-coping abilities of nursing students and provide a theoretical basis for promoting the development of hospice education for nursing students. METHODS A convenience sample of 204 nursing students from a university in China completed the general conditions questionnaire, Hospice Competency Assessment Questionnaire, and a simplified version of the Coping with Death Scale. RESULTS The participants' overall average hospice competency score was 46 (35-52), with an average score of 3.0 (2.3-3.3) for effective caregiving skills, 2.6 (2.0-3.0) for cultural and ethical values, and 3.0 (2.2-3.4) for interprofessional teamwork. The average death-coping competency score was 92 (72-107). Multivariate logistic regression and Spearman's correlation analysis showed a positive correlation between death-coping and hospice competencies (P < 0.05). CONCLUSION Nursing students' overall hospice competency is low to moderate. Consequently, nurse educators should effectively modify the hospice education curriculum using the Dedicated Education Unit model.
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Affiliation(s)
- Xiaona He
- Nursing Department of Xinjiang Medical University, China
| | - Boya Li
- Nursing Department of Xinjiang Medical University, China
| | - Xinxin Liu
- Nursing Department of Xinjiang Medical University, China
| | - Peijuan Jiao
- Nursing Department of Xinjiang Medical University, China
| | - Yue Zhao
- Nursing Department of Xinjiang Medical University, China.
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Zhao DW, Robinson SG, Pozzar R, Leiter R, Walsh C, Siemens I, Lovrics E, Cellarius V, Mahtani R, Jia Z. The Evolving Roles and Expectations of Inpatient Palliative Care Through COVID-19: a Systematic Review and Meta-synthesis. J Gen Intern Med 2024; 39:661-682. [PMID: 38100009 DOI: 10.1007/s11606-023-08564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/01/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Palliative care performed a central role in responding to the systemic suffering incurred by the COVID-19 pandemic. Yet, few studies have elucidated the inpatient palliative care specialists' experiences and perceptions. OBJECTIVE Systematically review and synthesize the evolving roles and expectations of inpatient palliative care specialists in response to COVID-19. DESIGN A systematic review and meta-synthesis informed by Thomas and Harden's framework and Pozzar et al.'s approach was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA SOURCES MEDLINE, EMBASE, CINAHL, and PubMed were systematically searched for articles published between December 2019 and March 2023. We included all peer-reviewed qualitative and mixed-method literature studying the roles and expectations of inpatient palliative care specialists. A mixed-method appraisal tool was used for quality assessment. RESULTS Of 3869 unique articles, 52 were included. Studies represented North American (n = 23), European (n = 16), South American (n = 4), Oceanic (n = 2), Asian (n = 2), West African (n = 1), Middle Eastern (n = 1), and inter-continental settings (n = 3). Most were reported in English (n = 50), conducted in 2020 (n = 28), and focused on the perspectives of inpatient palliative care clinicians (n = 28). Three descriptive themes captured the roles and expectations of inpatient palliative care specialists: shifting foundations, reorienting to relationships, and evolving identity. Two analytical themes were synthesized: palliative care propagates compassion through a healing presence, and palliative care enhances the systemic response to suffering through nimble leadership. CONCLUSION Inpatient palliative care specialists responded to the COVID-19 pandemic by establishing their healing presence and leading with their adaptability. To develop institutionally tailored and collaborative responses to future pandemics, future studies are needed to understand how inpatient palliative care clinicians are recognized and valued within their institutions.
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Affiliation(s)
- Dylan Weisman Zhao
- Department of Translational Medicine, School of Medicine, Queen's University, Kingston, Ontario, Canada.
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada.
| | - Shahar Geva Robinson
- Faculty of Health Sciences, Ben-Gurion University of Negev, Soroka University Medical Centre, Beer Sheva, Israel
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Richard Leiter
- Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Chris Walsh
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Isaac Siemens
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lovrics
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victor Cellarius
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ramona Mahtani
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Global Palliative Care, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Tian X, Zheng X, Peng Y, Zhou X, Huang B, Xie Y, Xiao W. The effects of hospice care education on first-year undergraduate nursing students in mainland China: A mixed-methods study. NURSE EDUCATION TODAY 2024; 134:106095. [PMID: 38266431 DOI: 10.1016/j.nedt.2024.106095] [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: 09/26/2023] [Revised: 12/18/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND With the rising number of people with end-stage chronic diseases, the demand for hospice care has increased dramatically. As the future health professionals for the implementation of hospice care, undergraduate nursing students in mainland China still lack knowledge and skills of hospice care, thus hospice care education plays a vital role in its development. OBJECTIVES To understand the effects of hospice care education on nursing students' death attitudes, end-of-life attitudes, humanistic care qualities, and their learning experiences. DESIGN This study used a mixed-methods design. SETTING A University of Chinese Medicine in mainland China. PARTICIPANTS The first-year undergraduate nursing students (n = 65). METHODS A mixed-methods study was conducted to evaluate the impact of a hospice care course from March to June 2021. The quantitative part included a quasi-experimental study designed with pre- and post-intervention measurements and the qualitative part included a descriptive qualitative study with semi-structured individual interviews. RESULTS The quantitative data revealed that after the course, nursing students experienced improvements in their death attitudes, end-of-life attitudes, and humanistic care qualities. Two categories were identified from the qualitative data. The category of "Gain from learning" included 4 themes (Confronting death and thinking about life; Understanding and agreeing with the idea of hospice care; Perceiving the humanistic spirit of medicine; Enhancing of the nursing discipline cognition and professional identity) and the category of "Course feedback" included 2 themes (Expressing recognition for the course arrangement; Making suggestions on the course optimization). CONCLUSIONS Hospice care education had a positive influence on nursing students. Students expressed satisfaction with the course arrangement. However, future hospice care courses should further optimize the curriculum designs by increasing the discussion of death-related topics, sharing more real clinical cases, recruiting students from different majors, and providing clinical practice, to provide high-quality nursing education for the development of hospice care.
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Affiliation(s)
- Xia Tian
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Xiaoting Zheng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Yunyi Peng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Xiaojun Zhou
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Baoxin Huang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Yaqian Xie
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China
| | - Wenli Xiao
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong, PR China.
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Ibrahim AM, Zaghamir DEF, Sultan Sultan HM, Ibrahim FM, Abdel-Aziz HR. Optimizing geriatric palliative care in Egypt: Comprehensive patient and family perspectives. Palliat Support Care 2024:1-10. [PMID: 38379421 DOI: 10.1017/s1478951524000221] [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: 02/22/2024]
Abstract
OBJECTIVES In Egypt, palliative care for geriatric patients is understudied, necessitating exploration for service optimization. Amidst rising chronic illnesses and aging, understanding perspectives of geriatric patients and families is crucial for targeted improvements. This study aims to explore geriatric patients' and their families' perspectives on palliative care in Egypt, seeking opportunities to optimize service delivery for the elderly. METHODS Employing a cross-sectional design with 110 geriatric patients and an equal number of family caregivers from the Damietta Oncology Institute and the pain treatment clinics for cancer patients at Zagazig University Hospital, the study focuses on a specialized pain clinic. Validated tools (Palliative Care Outcome Scale, Family Satisfaction with End-of-Life Care [FAMCARE] Scale, Edmonton Symptom Assessment System [ESAS], Caregiver Strain Index [CSI]) assess quality of life, family satisfaction, symptom severity, and caregiver strain. RESULTS Geriatric patients (mean age: 65.0 ± 8.1 years; 45.5% male, 55.5% female) have diverse diagnoses (e.g., breast cancer 22%). Palliative care outcomes reveal challenges: low emotional well-being (2.6 ± 0.0) and alarming overall quality of life (1.8 ± 0.0). Family dissatisfaction (FAMCARE) is pervasive (total mean score 2.6 ± 0.5). Symptom severity (ESAS) is high, and caregiver strain (CSI) is notable (8.5 ± 2.2). SIGNIFICANCE OF THE RESULTS The findings underscore the significance of the challenges faced by geriatric patients and caregivers in palliative care. Patients confront considerable symptom burdens and emotional distress, while caregivers experience notable strain. Urgently needed are targeted interventions designed to enhance patient well-being, alleviate caregiver burden, and elevate satisfaction. The critical importance of implementing these interventions promptly is highlighted, as they are instrumental in improving the overall care experience for geriatric patients and their caregivers. Moreover, the results underscore the imperative of developing comprehensive support mechanisms to address the intricate dimensions of palliative care, ultimately contributing to a more compassionate and effective care continuum.
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Affiliation(s)
- Ateya Megahed Ibrahim
- Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Family and Community Health Nursing, Faculty of Nursing, Port Said University, Port Said, Egypt
| | - Donia Elsaid Fathi Zaghamir
- Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Lecturer of Pediatric Nursing, Faculty of Nursing, Port Said University, Port Said, Egypt
| | | | - Fatma Magdi Ibrahim
- Geriatric Nursing, Mansoura University, Mansoura, Egypt
- Community Health Nursing, RAK Medical and Health Sciences University, RAS Al-Khaimah, UAE
| | - Hassanat Ramadan Abdel-Aziz
- Nursing College, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Gerontological Nursing Department, Faculty of Nursing, Zagazig University, Zagazig, Egypt
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Smith GM, Singh N, Hui F, Sossenheimer PH, Hannah JM, Romano P, Wong HN, Heidari SN, Harman SM. Education About Specialty Palliative Care Among Nonhealthcare Workers: A Systematic Review. J Pain Symptom Manage 2024; 67:e70-e89. [PMID: 37797678 DOI: 10.1016/j.jpainsymman.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/15/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
CONTEXT Despite the expansion of palliative care (PC) services, the public has little knowledge and holds misperceptions about PC, creating barriers to accessing timely specialty PC. OBJECTIVES To systematically review the evidence regarding the efficacy of educational interventions to improve knowledge and attitudes about PC among nonhealthcare workers. METHODS We searched five databases (PubMed/MEDLINE, Embase, CIANHL, Web of Science, and Scopus) for studies investigating educational interventions about specialty PC in adults who identified as patients, caregivers, or members of the public. We included studies that were available in English and had a comparator group. We excluded studies that only sampled health professionals or children. We used the Mixed Methods Appraisal Tool to assess quality and risk of bias. RESULTS Of 12,420 records identified, we screened 5948 abstracts and assessed 526 full texts for eligibility. Twenty-one articles were extracted for analysis, representing 20 unique educational interventions. Common methodologies included quasi-experimental (9, 45%), randomized controlled trial (4, 20%), and nonrandomized trial (2, 10%). Common components of the educational interventions included video presentations (9, 45%), written materials (8, 40%), and lectures (4, 20%). Content included definition (14, 70%) and philosophy (14, 70%) of PC, distinctions between PC and hospice (11, 55%), and eligibility for PC (11, 55%). Fourteen (70%) interventions showed statistically significant positive differences in either knowledge or attitudes about PC. CONCLUSIONS While educational interventions can positively impact knowledge and attitudes about PC among nonhealthcare workers, more research is needed to inform the design, delivery, and evaluation of interventions to increase knowledge and attitudes about PC.
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Affiliation(s)
- Grant M Smith
- Stanford University School of Medicine (G.M.S., N.S., F.H., P.H.S., H.W., S.N.H., S.M.H.), Stanford, CA.
| | - Nainwant Singh
- Stanford University School of Medicine (G.M.S., N.S., F.H., P.H.S., H.W., S.N.H., S.M.H.), Stanford, CA
| | - Felicia Hui
- Stanford University School of Medicine (G.M.S., N.S., F.H., P.H.S., H.W., S.N.H., S.M.H.), Stanford, CA
| | - Philip H Sossenheimer
- Stanford University School of Medicine (G.M.S., N.S., F.H., P.H.S., H.W., S.N.H., S.M.H.), Stanford, CA
| | - Josef M Hannah
- Stanford University School of Medicine (G.M.S., N.S., F.H., P.H.S., H.W., S.N.H., S.M.H.), Stanford, CA
| | - Pablo Romano
- Columbia University Vagelos College of Physicians and Surgeons (P.R.), New York, NY
| | - Hong-Nei Wong
- Stanford University School of Medicine (G.M.S., N.S., F.H., P.H.S., H.W., S.N.H., S.M.H.), Stanford, CA
| | - Shireen N Heidari
- Stanford University School of Medicine (G.M.S., N.S., F.H., P.H.S., H.W., S.N.H., S.M.H.), Stanford, CA
| | - Stephanie M Harman
- Stanford University School of Medicine (G.M.S., N.S., F.H., P.H.S., H.W., S.N.H., S.M.H.), Stanford, CA
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Tong-Hui S, Qi L, Xiao-Li R, Guo-Qin Y, Li-Ping W, Lin W. Chinese Neonatal Nurses' Lived Experiences of Providing End-of-Life Care in the NICU: A Descriptive Phenomenological Study. Adv Neonatal Care 2023; 23:532-540. [PMID: 38038670 DOI: 10.1097/anc.0000000000001113] [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: 12/02/2023]
Abstract
BACKGROUND Although end-of-life care (EOLC) has been well-studied, the experience of neonatal intensive care unit (NICU) nurses in China, where little EOLC training is provided, requires further investigation. PURPOSE To explore the lived experience of EOLC delivery among NICU nurses, to provide evidence to enhance nurses' EOLC skills and improve their overall quality. METHODS This qualitative study adopted a phenomenological approach. A total of 11 NICU nurses participated in semistructured in-depth interviews between June and July 2022 at the First Affiliated Hospital of University of Science and Technology of China (USTC). Colaizzi's 7-step method was used to analyze the data. RESULTS Five main themes were identified: (a) multiple emotions are experienced during EOLC delivery; (b) EOLC delivery is stressful from various sources for nurses; (c) expressing empathy and compassion is important; (d) ethical and clinical decision-making are key components of EOLC delivery; and (e) there are challenges in improving neonatal EOLC understanding and delivery. IMPLICATIONS FOR PRACTICE AND RESEARCH The experience of EOLC among Chinese NICU nurses is multidimensional and intensive. Institutions or units must establish and implement related protocols and guidelines to address differences between clinical practice and ideal protocols for neonatal EOLC. Educational programs that consider nurses' personal and interpersonal factors, including local culture, must be developed. Neonatal nurses in Western countries encountering Chinese-born parents who have lost their infants can gain an understanding of parents' perceptions from this study. Future research should focus on developing and testing interventions to train and support NICU nurses working with end-of-life neonates.
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Affiliation(s)
- Suo Tong-Hui
- Department of Nursing & NICU, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui
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Chen X, Su M, Arber A, Qiao C, Wu J, Sun C, Wang D, Zhou H, Zhu Z. Exploring the variations in death anxiety among oncology nurses in China: a latent class analysis. BMC Palliat Care 2023; 22:176. [PMID: 37946173 PMCID: PMC10634125 DOI: 10.1186/s12904-023-01282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Various factors have been found to be associated with high levels of death anxiety experienced by oncology nurses. The aim of this study was to use a person-oriented approach to examine the death anxiety patterns of Chinese oncology nurses and to analyze the differences in anxiety characteristics and their associated influencing factors. METHODS A cross-sectional survey regarding palliative care among registered oncology nurses was conducted in Jiangsu Province, China.Latent class analyses was applied to identify their patterns of death anxiety. The score of PCQN-C (The Chinese version of the Palliative Care Quiz for Nursing) and FATCOD-B-C (The Chinese version of the Frommelt Attitude Toward Care of the Dying scale), the demographic and working characteristics were further analyzed through covariance analysis (ANCOVA) and multivariate (or logistic) regression across the subgroups. RESULTS A two-potential-category model was selected based on the fit index. The results showed that 79% of oncology nurses belonged to the high pressure and pain group and 21% belonged to the low death anxiety group. The high pressure and pain group had significantly higher scores in the dimensions of emotion, stress and pain, time awareness, and cognition compared to the low death anxiety group. Factors influencing the high pressure and pain group included shorter working years, non-national or provincial oncology nursing specialists, non-national palliative care specialists, never discussing the topic of death with patients or family members, no palliative care related training, and PCQN and FATCOD scores. CONCLUSIONS Our study suggests that oncology nurses' death anxiety can be divided into two categories: low death anxiety and high stress pain, and certain factors, such as being female, having a short work experience, and lacking palliative care-related training, increase the likelihood of death anxiety.
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Affiliation(s)
- Xian Chen
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital), Nanjing, Nanjing, 210004, China
| | - Mengyu Su
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Anne Arber
- School of Health and Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Chengping Qiao
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital), Nanjing, Nanjing, 210004, China
| | - Jinfeng Wu
- Geriatrics Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Cuihua Sun
- Jiangsu Nursing Association, Nanjing, 210008, China
| | - Dan Wang
- Oncology Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Hui Zhou
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital), Nanjing, Nanjing, 210004, China.
| | - Zhu Zhu
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital), Nanjing, Nanjing, 210004, China.
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Fisher V, Li WW, Malabu U. The effectiveness of mindfulness-based stress reduction (MBSR) on the mental health, HbA1C, and mindfulness of diabetes patients: A systematic review and meta-analysis of randomised controlled trials. Appl Psychol Health Well Being 2023; 15:1733-1749. [PMID: 36855248 DOI: 10.1111/aphw.12441] [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: 01/15/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
The clinically standardised mindfulness-based stress reduction (MBSR) has been utilised as an intervention for improving mental health among diabetes patients The present study aimed to assess the effectiveness of mindfulness-based stress reduction (MBSR) on the mental health, haemoglobin A1c (HbA1C), and mindfulness of diabetes patients. A systematic review and meta-analysis approach was employed to review randomised controlled trials published in the English language between the inception of eight databases to July 2022. Eleven articles from 10 studies, with a combined sample size of 718 participants, were included in the systematic review, and nine studies were included in the meta-analysis. In the meta-analysis, outcomes at post-intervention and follow-up were compared between the MBSR intervention and control groups with an adjustment of the baseline values. The results showed that MBSR demonstrated effects at post-intervention and follow-up (in a period between one to 12 months with a mean length of 4.3 months) in reducing anxiety and depressive symptoms, and enhancing mindfulness, with large effect sizes. However, the effect of MBSR on reducing stress was observed at follow-up, but not at post-intervention. Effects of MBSR on HbA1C were not detected at post-intervention and follow-up. The findings suggest that MBSR appears to be an effective treatment for improving mental health conditions and mindfulness in people with diabetes. The measurement of cortisol is recommended to be used as a biological measure to evaluate the effectiveness of MBSR in diabetes patients in future research.
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Affiliation(s)
| | | | - Usman Malabu
- James Cook University, Townsville, Australia
- Townsville University Hospital, Townsville, Australia
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Feeney R, Willmott L, Neller P, Then SN, Yates P, White B. Online modules to improve health professionals' end-of-life law knowledge and confidence: a pre-post survey study. BMC Palliat Care 2023; 22:165. [PMID: 37904194 PMCID: PMC10617044 DOI: 10.1186/s12904-023-01290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Health professionals and medical students have knowledge gaps about the law that governs end-of-life decision-making. There is a lack of dedicated training on end-of-life law and corresponding research on the impact of this type of training. OBJECTIVE To examine the impact of online training modules on key concepts of end-of-life law on Australian health professionals' legal knowledge and their self-reported confidence in applying the law in practice. METHODS Online pre- and post-training surveys were completed by training participants. The optional surveys collected demographic data, directly assessed legal knowledge and measured self-reported confidence in applying the law in clinical practice, before and after training. RESULTS Survey response rates were 66% (pre-training) and 12% (post-training). The final sample for analysis (n = 136 participants with matched pre- and post-training surveys), included nurses, doctors, allied health professionals, medical students and a small number of non-health professionals. Following completion of the online training modules, legal knowledge scores significantly increased overall and across each domain of end-of-life law. Participants were also more confident in applying the law in practice after training (median = 3.0, confident) than before training (median = 2.0, not confident). CONCLUSIONS This study found that completion of online training modules on end-of-life law increased Australian health professionals' legal knowledge and self-reported confidence in applying the law in clinical practice. Participants demonstrated some remaining knowledge gaps after training, suggesting that the training, while effective, should be undertaken as part of ongoing education on end-of-life law. Future research should examine longer term outcomes and impacts of the training.
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Affiliation(s)
- Rachel Feeney
- 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
| | - Penny Neller
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Shih-Ning Then
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ben White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
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Kristanti MS, Hidayati NW, Maryadi. Comparison of palliative care education for family caregivers in high-and-low-income countries: An integrative review. BELITUNG NURSING JOURNAL 2023; 9:411-420. [PMID: 37901381 PMCID: PMC10600708 DOI: 10.33546/bnj.2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/22/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Background In most resource-limited countries, palliative care is still under development. Despite the differences, the involvement of family caregivers is fundamental in both High-Income Countries (HICs) and Low-Income Countries (LICs). The lack of formal support in LICs implies that educational interventions to support family caregivers in this region could be more complex and urgently needed than in HICs. To comprehend the existing situation and identify the gaps in LICs, using HICs as a benchmark standard and conducting a review comparing educational interventions in both regions is essential. Objective To identify and compare the existing implementation of education for family caregivers of patients with advanced cancer in LICs and HICs. Design An integrative review guideline by Whittemore and Knafl was followed. Interventional studies related to education for family caregivers providing care for adult patients with cancer were included, and review articles were excluded. Data Sources Data were obtained from PubMed, EBSCO, ProQuest, and ClinicalKey. The search was conducted on 18 November 2021 and updated on 9 August 2023. Review methods Data reduction, data comparison, conclusion drawing, and data verification were conducted. Results Out of the 11 studies included, nine were randomized controlled trials, and two were quasi-experimental studies. Among them, seven (63%) were conducted in HICs, and four (37%) were carried out in LICs. In both regions, the psychological aspect was the most commonly addressed subject in palliative care education for family caregivers. However, in LICs, no articles specifically addressed the social and spiritual aspects of family caregivers' education. Research conducted in LICs mostly involved nurses, while studies in HICs included a more diverse range of healthcare professionals. Typically, these programs required two to three sessions, with 30-60 minutes duration for 3-12 weeks. Conclusion The social and spiritual aspects can be integrated into family caregivers' training programs in LICs in the near future. Nurses, as an integral part of the multidisciplinary team, are capable of contributing to the development of educational programs for family caregivers, especially in resource-limited countries where patients rely heavily on their caregivers and relatives. Support from nurses is fundamental in such contexts.
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Affiliation(s)
- Martina Sinta Kristanti
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nurdina Wahyu Hidayati
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Maryadi
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Matthew M, Bainbridge D, Bishop V, Sinding C, Winemaker S, Kilbertus F, Kortes-Miller K, Seow H. Implementing palliative care education into primary care practice: a qualitative case study of the CAPACITI pilot program. BMC Palliat Care 2023; 22:143. [PMID: 37759200 PMCID: PMC10537555 DOI: 10.1186/s12904-023-01265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND CAPACITI is a virtual education program that teaches primary care teams how to provide an early palliative approach to care. After piloting its implementation, we conducted an in-depth qualitative study with CAPACITI participants to assess the effectiveness of the components and to understand the challenges and enablers to virtual palliative care education. METHODS We applied a qualitative case study approach to assess and synthesize three sources of data collected from the teams that participated in CAPACITI: reflection survey data, open text survey data, and focus group transcriptions. We completed a thematic analysis of these responses to gain an understanding of participant experiences with the intervention and its application in practice. RESULTS The CAPACITI program was completed by 22 primary care teams consisting of 159 participants across Ontario, Canada. Qualitative data was obtained from all teams, including 15 teams that participated in focus groups and 21 teams that provided reflection survey data on CAPACITI content and how it translated into practice. Three major themes arose from cross-analysis of the data: changes in practice derived from involvement in CAPACITI, utility of specific elements of the program, and barriers and challenges to enacting CAPACITI in practice. Importantly, participants reported that the multifaceted approach of CAPACITI was helpful to them building their confidence and competence in applying a palliative approach to care. CONCLUSIONS Primary care teams perceived the CAPACITI facilitated program as effective towards incorporating palliative care into their practices. CAPACITI warrants further study on a national scale using a randomized trial methodology. Future iterations of CAPACITI need to help mitigate barriers identified by respondents, including team fragmentation and system-based challenges to encourage interprofessional collaboration and knowledge translation.
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Affiliation(s)
- Midori Matthew
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Valerie Bishop
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | | | | | - Frances Kilbertus
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
| | | | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada.
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Haroen H, Mirwanti R, Agustina HR, Pahria T, Harun H, Akuoko CP, Nadirawati N. A Qualitative Study of Perception and Experience Toward End-of-Life Care Among Nursing Students Who Witnessed Dying People in Their Family. J Multidiscip Healthc 2023; 16:2261-2270. [PMID: 37588170 PMCID: PMC10426403 DOI: 10.2147/jmdh.s423198] [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: 05/27/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction This study aims to explore nursing students' perception and experience of end-of-life care (EoLC) in Indonesia, particularly in the family environment. Methods This study used a qualitative research design to explore the experiences and perceptions of nursing students who have witnessed the dying of their family members. The study recruited 15 nursing students using a purposive sampling method, who were then invited to reflect and write their experiences in witnessing death of their families, and perceptions towards EoLC. The written reflections were analyzed using thematic analysis. Results Thematic analysis showed that the experience of witnessing dying of a family member shaped nursing students' perceptions and attitudes towards EoLC. Some themes that emerged in this study included the importance of effective communication with patients and their families, symptom management, spiritual, emotional, and social support, as well as the need to improve nursing education and training. Conclusion This present study shows that the experience of witnessing the death of a family member shapes nursing students' perceptions of EoLC in Indonesia. This present study provides recommendations that the students must be prepared emotionally and psychologically in caring EoL or dying patients. How attitude and readiness to care EoL patients are shaped by the experience in witnessing the dying family or loved one. As such, palliative and EoL curriculum should be included methods that allow desensitization and naturalization of dying for the students in order to make them ready to provide better EoLC for patients and their families. The results of this study can contribute to improving the quality of EoLC in Indonesia.
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Affiliation(s)
- Hartiah Haroen
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ristina Mirwanti
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Hana Rizmadewi Agustina
- Department of Fundamental Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Tuti Pahria
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Hasniatisari Harun
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Cynthia Pomaa Akuoko
- Department of Nursing and Midwifery, Faculty of Health and Applied Science, Christian Service University College, Kumasi, Ghana
| | - Nadirawati Nadirawati
- Nursing Sciences Program, Faculty of Health Science and Technology, Universitas Jenderal Ahmad Yani, Cimahi, Indonesia
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Astridge B, Li WW, McDermott B, Longhitano C. A systematic review and meta-analysis on adverse childhood experiences: Prevalence in youth offenders and their effects on youth recidivism. CHILD ABUSE & NEGLECT 2023; 140:106055. [PMID: 37142357 DOI: 10.1016/j.chiabu.2023.106055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/07/2023] [Accepted: 01/17/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been found to be more prevalent among youth involved with the criminal justice system compared to their counterparts in the general population. The present study aims to systematically review the existing empirical studies to provide a comprehensive understanding of the prevalence of ACEs among youth offenders aged between 10 and 19 years, and the effects of both cumulative ACEs and individual ACE items on youth recidivism. METHOD A systematic review approach was employed. Narrative synthesis and meta-analysis were performed to synthesise the data in 31 included studies. RESULTS The pooled prevalence of cumulative ACEs was 39.4 %. The pooled prevalence of individual ACEs ranged between 13.7 % to 51.4 %. Cumulative ACEs and neglect were positively associated with youth recidivism, with OR = 1.966, 95%CI [1.582, 2.444] and OR = 1.328, 95%CI [1.078, 1.637], respectively. Physical and sexual abuse were not significantly associated with youth recidivism. Regarding the mechanisms underlying the relationship between ACEs and recidivism; moderators included gender, positive childhood experiences, strong social bonds, and empathy. Mediators included child welfare placement, emotional and behavioural problems, drug use, mental health problems, and negative emotionality. CONCLUSION Developing programs to youth offenders aiming to address the impact of cumulative and individual ACE exposure, strengthen the protective factors and weaken the risk factors would be useful to reduce youth recidivism.
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Affiliation(s)
- Belinda Astridge
- James Cook University, Townsville, 1 James Cook Drive, Townsville, QLD 4818, Australia
| | - Wendy Wen Li
- James Cook University, Townsville, 1 James Cook Drive, Townsville, QLD 4818, Australia.
| | - Brett McDermott
- James Cook University, Townsville, 1 James Cook Drive, Townsville, QLD 4818, Australia; Child and Adolescent Mental Health Service, Department of Health, GPO Box 125, Hobart, TAS 7001, Australia
| | - Carlo Longhitano
- James Cook University, Townsville, 1 James Cook Drive, Townsville, QLD 4818, Australia
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23
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Hahn S, Butler EA, Ogle K. "We are Human too.": The Challenges of Being an End-of-Life Doula. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231160900. [PMID: 36876361 DOI: 10.1177/00302228231160900] [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: 03/07/2023]
Abstract
End-of-life (EOL) doulas are emerging professionals who provide an intimate approach to the death process by focusing on the psychological, social, spiritual, and emotional needs of dying individuals. EOL doula work is stressful; it exposes individuals to recurring stressors such as suffering and grief. Trained professionals are needed to help advocate for the dying individual and their families. Despite the growing literature on EOL doulas, information regarding the challenges of being an EOL doula is underrepresented in the literature. This paper is one of the first to address this concept. Twelve in-depth, semi-structured interviews regarding the EOL doula experience were conducted as a part of a larger exploratory study. Three overarching themes emerged from the larger project: motivations to become an EOL doula, roles of an EOL doula, and challenges of an EOL doula. In this article, only challenges of EOL are discussed, along with subsequent subordinate themes.
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Affiliation(s)
- Sarah Hahn
- School of Social and Behavioral Sciences, Mercy College, Dobbs Ferry, NY, USA
| | - Emily A Butler
- Department of Psychology, Mercy College, Dobbs Ferry, NY, USA
| | - Kimberly Ogle
- A Pathway Home: Grief Support Services and End of Life Preparation, Oxford, OH, USA
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24
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Meglič J, Lisec A, Lepej D, Loboda T, Bertok S, Lešnik Musek P, Kreft Hausmeister I, Oštir M, Ponjević T, Meglič A. Challenges in establishing optimal pediatric palliative care at the university hospital in Slovenia. Eur J Pediatr 2023; 182:1393-1401. [PMID: 36680577 PMCID: PMC10023644 DOI: 10.1007/s00431-023-04806-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
The integration of pediatric palliative care (PPC) should become a standard of care for all children with life-limiting and life-threatening illnesses. There are many barriers and misperceptions in pediatrics which hinder the early implementation of PPC. The aim of the study was to design starting points for the establishment of accessible PPC with early involvement of patients in a tertiary-level children's hospital. An intervention, presentation, and discussion on PPC were offered by the hospital PPC team to all employees in the hospital. A total of 237 participants (physicians 30.4%, nurses 49.4%, psychologists 8.4%, and others) completed a questionnaire before and after the intervention. The personnel's knowledge, self-assessment of their ability to perform PPC, attitude to participate in PPC, and their awareness and understanding of the need for PPC were evaluated. The results were analyzed using Pandas and SciPy libraries in Python. The knowledge, awareness, and attitude of the physicians, nurses, and other professionals improved significantly after the intervention. However, the self-assessment of their ability to perform PPC did not increase. Previous experience with the death of a patient has proven to be a stimulus for self-initiative in acquiring knowledge in PPC and was linked with a better attitude and higher awareness of the need for PPC.Conclusions: More education and practical work tailored to the different professional profiles are needed, with adjustments for specific subspecialist areas, especially where patients could be included in early PPC. Although additional studies are needed, we identified the main directions for the further implementation of PPC in clinical practice in our setting.
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Affiliation(s)
| | - Ajda Lisec
- University Medical Centre, Ljubljana, Slovenia.
| | - Dušanka Lepej
- Pediatric Palliative Team, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Tanja Loboda
- Pediatric Palliative Team, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Sara Bertok
- Pediatric Palliative Team, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Petra Lešnik Musek
- Pediatric Palliative Team, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Ivana Kreft Hausmeister
- Pediatric Palliative Team, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Majda Oštir
- Pediatric Palliative Team, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Tehvida Ponjević
- Pediatric Palliative Team, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Anamarija Meglič
- Pediatric Palliative Team, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
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Robinson J, Frey R, Gibbs G, Hayden M, Gott M. The contribution of generalist community nursing to palliative care: a retrospective case note review. Int J Palliat Nurs 2023; 29:75-82. [PMID: 36822619 DOI: 10.12968/ijpn.2023.29.2.75] [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: 02/25/2023]
Abstract
Background: There is a paucity of evidence regarding the contribution of generalist community nursing to palliative care. Aim: The aim of this study was to identity the proportion of patients referred to a generalist community nursing service who meet the criteria for palliative care need and explore key aspects of their management. Methods: A retrospective case note review of people known to a generalist community nursing service was undertaken to identify people with palliative care needs. Results: Of the 1284 people enrolled in the community nursing service, 21.1% (n=271) were identified as having palliative care needs, of which most (82.7%; n=224) had a non-cancer illness. However, palliative care need was largely unrecognised in the referrals to community nursing and there was little evidence of a palliative approach being integrated into nursing care. Conclusions: Nursing has a significant role in the provision of generalist palliative care in the community. However, research is needed to identify the barriers community nurses experience identifying needs and providing palliative care. A focus on education and support in implementing screening tools, which may assist community nurses in recognising needs and delivering palliative in the generalist setting, is urgently needed.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, Faculty of Medical Health Sciences; School of Nursing, University of Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, Faculty of Medical Health Sciences; School of Nursing, University of Auckland, New Zealand
| | - Gillian Gibbs
- Community and Long Term Conditions Directorate, Auckland District Health Board, New Zealand
| | - Meenu Hayden
- Community and Long Term Conditions Directorate, Auckland District Health Board, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical Health Sciences; School of Nursing, University of Auckland, New Zealand
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26
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Seow H, Bainbridge D, Winemaker S, Stajduhar K, Pond G, Kortes-Miller K, Marshall D, Kilbertus F, Myers J, Steinberg L, Incardona N, Levine O, Pereira J. Increasing palliative care capacity in primary care: study protocol of a cluster randomized controlled trial of the CAPACITI training program. BMC Palliat Care 2023; 22:2. [PMID: 36604714 PMCID: PMC9813458 DOI: 10.1186/s12904-022-01124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Primary care providers play a critical role in providing early palliative care to their patients. Despite the availability of clinical education on best practices in palliative care, primary care providers often lack practical guidance to help them operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to provide an early palliative approach to care. The entire program consists of 12 sessions (1 h each), divided evenly across three modules: (1) Identify and Assess; (2) Enhance Communication Skills; (3) Coordinate for Ongoing Care. We report the protocol for our planned evaluation of CAPACITI on its effectiveness in helping primary care providers increase their identification of patients requiring a palliative approach to care and to strengthen other core competencies. METHODS A cluster randomized controlled trial evaluating two modes of CAPACITI program delivery: 1) self-directed learning, consisting of online access to program materials; and 2) facilitated learning, which also includes live webinars where the online materials are presented and discussed. The primary outcomes are 1) percent of patients identified as requiring palliative care (PC), 2) timing of first initiation of PC, and self-reported PC competency (EPCS tool). Secondary outcomes include self-reported confidence in PC, practice change, and team collaboration (AITCS-II tool), as well as qualitative interviews. Covariates that will be examined are readiness for change (ORCA tool), learning preference, and team size. Primary care teams representing interdisciplinary providers, including physicians, nurse practitioners, registered nurses, care coordinators, and allied health professionals will be recruited from across Canada. The completion of all three modules is expected to take participating teams a total of six months. DISCUSSION CAPACITI is a national trial aimed at behavior change in primary care providers. This research will help inform future palliative care educational initiatives for generalist health care providers. Specifically, our findings will examine the effectiveness of the two models of education delivery and the participant experience associated with each modality. TRIAL REGISTRATION ClinicalTrials.gov NCT05120154.
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Affiliation(s)
- Hsien Seow
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Daryl Bainbridge
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Samantha Winemaker
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Kelli Stajduhar
- grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, BC Canada
| | - Gregory Pond
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Kathy Kortes-Miller
- grid.258900.60000 0001 0687 7127Department of Social Work, Lakehead University, Thunder Bay, ON Canada
| | - Denise Marshall
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Frances Kilbertus
- grid.436533.40000 0000 8658 0974Northern Ontario School of Medicine University, Thunder Bay, ON Canada
| | - Jeff Myers
- grid.17063.330000 0001 2157 2938Division of Palliative Care, University of Toronto, Toronto, ON Canada
| | - Leah Steinberg
- grid.17063.330000 0001 2157 2938Division of Palliative Care, University of Toronto, Toronto, ON Canada
| | - Nadia Incardona
- grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| | - Oren Levine
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Jose Pereira
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, Hamilton, ON Canada
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Xu F, Zhu W, Chen Q, Tang Y. The relationship between mindfulness, anxiety and depression during the COVID-19 pandemic: A meta-analysis of correlational studies. Front Psychol 2023; 14:994205. [PMID: 36874851 PMCID: PMC9975722 DOI: 10.3389/fpsyg.2023.994205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
Background The emergence of the COVID-19 pandemic has created an environment in which numerous determinants of poor mental health are intensified. Lockdown, re-lockdown, and media coverage of the spread of the virus, have the potential to contribute to increased levels of anxiety and depression. Mindfulness may act as a buffer against COVID-19-related depressive and anxiety disorders. Methods We conducted a systematic review and meta-analysis by searching PubMed, PsycINFO, Web of Science, and Google Scholar for any study published between January 2020 and March 2022. In this study, Comprehensive Meta-Analysis Version 3.3 software was applied to evaluate the effect size by random effect model. In addition, the heterogeneity analysis was evaluated using indicators Q and I2 indicators. Three methods were used to test for publication bias: funnel plot, Classic Fail-safe N, and Egger's linear regression. According to the features of the included articles, subgroup analysis was utilized for the moderator analysis of this study. Results The analysis finally included 12 articles (16 samples, N = 10,940) and obtained 26 independent effect sizes. In accordance with the meta-analysis, in the random effect model, the correlation between mindfulness and anxiety was -0.330 (p < 0.001), and the correlation between mindfulness and depression was -0.353 (p < 0.001), which supported the effect of mindfulness on anxiety and depression. In the meta-analysis of the correlation between mindfulness and anxiety, study region had an essential moderating effect (p < 0.001). The Sample type did not produce a significant moderating effect (p = 0.190). The mode of action of mindfulness was a significant moderator (p = 0.038). In the meta-analysis of the linkage between mindfulness and depression, regional differences had a significant moderating effect (p < 0.001). The sample type had no discernible moderating impact (p = 0.213). The mode of action of mindfulness was a significant moderator (p = 0.003). Conclusion Our meta-analysis indicated that there was an essential correlation between public mindfulness and mental health. Our systematic review added evidence supporting the beneficial nature of mindfulness. A cascading development of beneficial traits that improve mental health may start with mindfulness.
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Affiliation(s)
- Fuming Xu
- School of Education Science, Nanning Normal University, Nanning, China.,School of Education Science, Nanning Normal University, Nanning, China
| | - Wanling Zhu
- School of Education Science, Nanning Normal University, Nanning, China
| | - Qian Chen
- School of Education Science, Nanning Normal University, Nanning, China
| | - Youmei Tang
- School of Education Science, Nanning Normal University, Nanning, China
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28
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Wang W, Wu C, Bai D, Chen H, Cai M, Gao J, Hou C. A meta-analysis of nursing students' knowledge and attitudes about end-of-life care. NURSE EDUCATION TODAY 2022; 119:105570. [PMID: 36182790 DOI: 10.1016/j.nedt.2022.105570] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/06/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To synthesize nursing students' knowledge and attitudes about end-of-life care and to identify strategic directions for optimizing end-of-life care education. DESIGN A meta-analysis of observational studies. DATA SOURCES PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, MEDLINE, CNKI, and WANFANG 8 electronic databases in English and Chinese were systematically searched from inception until 10 April 2022. REVIEW METHODS Two reviewers independently screened literature and extracted data using structured tables. The Agency for Healthcare Research and Quality (AHRQ) was used to appraise the methodological quality of included studies. The study outcomes were synthesized using a meta-analysis. RESULTS 26 cross-sectional studies of medium or high quality from 13 countries met the eligibility criteria, involving 9749 nursing students. In our review, nursing students demonstrated insufficient knowledge about end-of-life care, with a pooled mean score of 7.50 (95 % CI: 6.55-8.45); of these, knowledge about philosophy and principles, psychosocial and spiritual care, and pain and symptom management were all deficient, with pooled mean scores of 1.49 (95 % CI: 0.78-2.21), 1.00 (95 % CI: 0.35-1.65), and 3.44 (95 % CI: 2.25-4.63), respectively. Conversely, nursing students showed positive attitudes toward end-of-life care, with a pooled mean score of 102.97 (95 % CI: 99.43-106.51). The subgroup analysis revealed that male nursing students had lower pooled mean scores for end-of-life care knowledge and attitudes. CONCLUSION There is a mismatch between nursing students' knowledge and attitudes about end-of-life care, they have a positive attitude but lack the necessary knowledge. Male nursing students seem to have a greater deficit of knowledge and a relatively conservative attitude toward end-of-life care. These findings may provide a significant reference for nursing educators to adjust educational strategies promptly.
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Affiliation(s)
- Wei Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan Province 611137, China
| | - Chenxi Wu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan Province 611137, China
| | - Dingxi Bai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan Province 611137, China
| | - Huan Chen
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan Province 611137, China
| | - Mingjin Cai
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan Province 611137, China
| | - Jing Gao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan Province 611137, China.
| | - Chaoming Hou
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan Province 611137, China.
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Bainbridge D, Bishop V, Myers J, Marshall D, Stajduhar K, Seow H. Effectiveness of Training Programs About a Palliative Care Approach: A Systematic Review of Intervention Trials for Health Care Professionals. J Palliat Med 2022; 26:564-581. [PMID: 36378898 DOI: 10.1089/jpm.2022.0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Palliative care (PC) training initiatives have proliferated to assist generalist health care providers (HCPs) develop skills for applying an early PC approach. To date, there is little synthesis of high-level evidence to review the content and effectiveness of these programs. To address this gap in knowledge, we conducted a systematic review of trials of training inventions to build PC competency in HCPs, according to PRISMA guidelines (PROSPERO registration no. 271741). Materials and Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, HealthSTAR, Web of Science, and the Cochrane Database of Systematic Reviews and Clinical Trials for studies published since 2000. Eligible studies were trials assessing PC training for HCPs. Interventions had to address at least two of six PC-related components, adapted from the National Consensus Project: identification or assessment; illness understanding; symptom management; decision making; coping; and referral. Two reviewers independently assessed articles for inclusion, using Rayyan, and extracted relevant data. Risk of bias was assessed using the Cochrane ROB2 or ROBINS-I tools. Results: Of 1209 articles reviewed, 22 studies met the inclusion criteria, with the majority being conducted in the United States (n = 9) or Europe (n = 8). Nearly all studies (n = 19) collected data through self-reported surveys; administrative (n = 4), clinical outcomes (n = 4), or interaction analysis (n = 6) data were also or solely used. Interventions featured didactic, skill-based training followed by role-play and/or individual coaching. Communication around illness understanding was the most taught PC component. Few interventions involved comprehensive PC training, with 12 studies representing 3 or less of the 6 framework components. Most studies (n = 16) reported a significant positive impact on at least one outcome, most often HCP self-reported outcomes. Conclusions: While many of these interventions demonstrated improved confidence among HCPs in the PC components taught, findings were mixed on more objective outcome measures. Further trial-based evidence is required on comprehensive PC training to help inform these interventions.
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Affiliation(s)
- Daryl Bainbridge
- Department of Oncology and McMaster University, Hamilton, Ontario, Canada
| | - Valerie Bishop
- Department of Oncology and McMaster University, Hamilton, Ontario, Canada
| | - Jeff Myers
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Denise Marshall
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Hsien Seow
- Department of Oncology and McMaster University, Hamilton, Ontario, Canada
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30
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Seow H, Bainbridge D, Stajduhar K, Marshall D, Howard M, Brouwers M, Barwich D, Burge F, Kelley ML. Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program. Am J Hosp Palliat Care 2022:10499091221134709. [PMID: 36269212 DOI: 10.1177/10499091221134709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers (N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program (P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Kelli Stajduhar
- Department of School of Nursing and Institute on Aging and Lifelong Health, 8205University of Victoria, Victoria, BC, Canada
| | - Denise Marshall
- Department of Health Sciences, 62703McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, 152996McMaster University, Hamilton, ON, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, 177403University of Ottawa, Ottawa, ON, Canada
| | - Doris Barwich
- 12358The University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, 152980Dalhousie University, Halifax, NS, Canada
| | - Mary Lou Kelley
- School of Social Work, 157782Lakehead University, Thunder Bay, ON, Canada
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Haan MM, van Gurp JL, Knippenberg M, Olthuis G. Facilitators and barriers in using comics to support family caregivers of patients receiving palliative care at home: A qualitative study. Palliat Med 2022; 36:994-1005. [PMID: 35502800 PMCID: PMC9174613 DOI: 10.1177/02692163221093513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family caregiving at home is highly important for people receiving palliative treatment, but also a complex experience, subject to implicit social expectations. This study empirically explored the claim that comics benefit palliative care practice, through evaluating a graphic novel's value as an aid in supportive conversations with family caregivers. AIM To identify facilitators and barriers in using Naasten (Loved ones), a Dutch research-based graphic novel about family caregivers providing care at the end-of-life. DESIGN Qualitative study, following thematic content analysis. PARTICIPANTS Three focus groups with family caregiver consultants, palliative care volunteers, and healthcare professionals (total N = 23) who supported family caregivers; and individual telephone interviews with family caregivers to whom the book was presented (N = 4). RESULTS Barriers and facilitators related to: (1) the family caregiver, (2) impact on the family caregiver, (3) impact on the conversation between the person who provides support and the family caregiver, (4) their relationship, and (5) the person who provides support. Naasten was reported as recognizable and supportive, and powerful in raising emotions, awareness and conversation. Barriers concerned the book's impact due to its style and guidance of a conversation, and doubts about its surplus-value. CONCLUSIONS Emotionally impactful comics may support bereaved family caregivers, but should be introduced with care among current family caregivers, for example, ensuring a right fit, introduction, and follow-up-while taking into account a caregiver's individual situation, needs, abilities, and affinity with the medium. Comics are preferably used in educational settings, contributing to professional awareness and tailored support of family caregivers.
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Affiliation(s)
- Maaike M Haan
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jelle Lp van Gurp
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Marjan Knippenberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Gert Olthuis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
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Abu-Odah H, Molassiotis A, Liu JYW. Assessment of the Educational and Health Care System-Related Issues From Physicians' and Nurses' Perspectives Before Developing a Palliative Care Program Within the Palestinian Health Care System: A Cross-sectional Study. J Hosp Palliat Nurs 2022; 24:E59-E75. [PMID: 35085161 DOI: 10.1097/njh.0000000000000840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A scarcity in research assessing the palliative care (PC) educational and health care system-related issues has been reported in the Middle East region; the region comprises a wide range of economically diverse countries. Discrepancies across countries have created difficulties in adopting other countries' experiences. This study aimed to assess PC knowledge, attitude, educational needs, and health care system-related issues from physicians' and nurses' perspectives before developing PC services within the Palestinian health care system. One hundred sixty-nine professionals participated in this cross-sectional survey. Data were collected by validated instruments. Professionals had insufficient knowledge about PC, but they had positive attitudes toward end-of-life care and care of the dying. Patients'/families' avoidance of talking about issues around dying and lack of training for staff related to PC were the most 2 significant barriers to providing PC. Educational level and previous training were found to be associated significantly with knowledge and attitudes toward PC. Study conclusions support the recommendation for integration of education about PC within the health curricula and in-service training and should cover the basic and advanced principles of PC and symptom management.
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Li WW, Singh S, Keerthigha C. A Cross-Cultural Study of Filial Piety and Palliative Care Knowledge: Moderating Effect of Culture and Universality of Filial Piety. Front Psychol 2021; 12:787724. [PMID: 34925189 PMCID: PMC8678124 DOI: 10.3389/fpsyg.2021.787724] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Filial piety is a Confucian concept derived from Chinese culture, which advocates a set of moral norms, values, and practices of respect and caring for one’s parents. According to the dual-factor model of filial piety, reciprocal and authoritarian filial piety are two dimensions of filial piety. Reciprocal filial piety is concerned with sincere affection toward one’s parent and a longstanding positive parent-child relationship, while authoritarian filial piety is about obedience to social obligations to one’s parent, often by suppressing one’s own wishes to conform the demands of the parent. The primary aim of this study is to investigate the moderating effect of culture on the relationships between filial piety and palliative care knowledge. The secondary aim is to investigate whether filial piety is a universal construct across Singaporean and Australian cultures. A total of 508 participants living in Singapore and Australia were surveyed between May and October 2020. The final sample comprised of 406 participants, with 224 Singaporeans and 182 Australians. There were 289 females (71.1%), 115 males (28.3%), and two unspecified gender (0.6%) in the sample, with an average age of 27.27 years (SD = 9.79, range = 18–73). Results indicated a significant effect of culture on authoritarian filial piety and palliative care knowledge. Singaporeans showed higher authoritarian filial piety and higher palliative care knowledge than Australians. However, no effect of culture was found on reciprocal filial piety. Overall, no significant correlation existed between palliative care knowledge and reciprocal filial piety and authoritarian filial piety. For Singaporeans, a weak negative correlation was found between palliative care knowledge and authoritarian filial piety. In contrast, Australians and Singaporeans indicated a positive, moderate correlation between reciprocal and authoritarian filial piety. Further, culture moderated the relationship between authoritarian filial piety and palliative care knowledge. High authoritarian filial piety was associated with increased palliative care knowledge among Australians, while high authoritarian filial piety was associated with decreased palliative care knowledge among Singaporeans. The results support the conceptualization of filial piety as a possible psychological universal construct. In addition, the results point out an important implication that public health programs should target the appropriate filial piety types to enhance palliative care knowledge among Singaporeans and Australians.
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Affiliation(s)
- Wendy Wen Li
- College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| | - Smita Singh
- School of Social and Health Sciences, James Cook University, Singapore, Singapore
| | - C Keerthigha
- School of Social and Health Sciences, James Cook University, Singapore, Singapore
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Figueredo DVA, Souza ASR. Palliative care in fetal medicine. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000400001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tang ML, Goh HS, Zhang H, Lee CN. An Exploratory Study on Death Anxiety and Its Impact on Community Palliative Nurses in Singapore. J Hosp Palliat Nurs 2021; 23:469-477. [PMID: 34183589 DOI: 10.1097/njh.0000000000000782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurses working in palliative care settings encounter death and dying regularly and face a greater risk of developing death anxiety and negative attitudes than their counterparts. Such distress and apprehension can cause care fatigue and affect patients' quality of life. Death anxiety remains an underresearched area in Asia, where death and dying are still considered taboo. This study explored death anxiety and its impact on community palliative nurses in Singapore and was conducted at a community hospital in Singapore from January to June 2018. Purposive sampling was used to recruit 16 nurses of different job grades for the face-to-face interviews, which were transcribed verbatim and analyzed using the data analytical approach of Miles et al. Four overarching themes were generated: (1) intrinsic factors influencing death anxiety, (2) extrinsic factors influencing death anxiety, (3) emotional struggles and coping, and (4) need for death education and psychological support. Gaps in palliative care education and death education need to be contextualized to increase the community palliative nurses' awareness and acceptance of death and enhance their death literacy in a multicultural setting.
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Affiliation(s)
- Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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