1
|
Rietze LL, Stajduhar KI, Purkis ME, Cloutier D. The Challenges of Advance Care Planning for Acute Care Registered Nurses. Can J Nurs Res 2024; 56:293-302. [PMID: 38576275 PMCID: PMC11308282 DOI: 10.1177/08445621241244532] [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: 04/06/2024] Open
Abstract
STUDY BACKGROUND The practice of acute care nurses is shaped by organizational factors such as lack of privacy, heavy workloads, unclear roles, lack of time, and lack of specific policies and procedures. We know little about the social and organizational structures and processes that influence nurses' uptake of valuable patient-centered discussions like advance care planning (ACP). ACP is beneficial for patients, their substitute decision makers, and healthcare providers. PURPOSE To describe the operational, organizational, and societal influences shaping nurses' ACP work in acute care settings. METHODS This ethnographic study purposively sampled 14 registered nurses and 9 administrators who worked in two acute care hospitals in Northeastern Ontario. Methods consisted of 23 open-ended, semi-structured interviews, 20 hours of observational fieldwork, and a collection of publicly available organizational documents. Data were inductively analyzed using an iterative constant comparative approach. RESULTS Nurses were challenged to meet multiple competing demands, leaving them to scramble to manage complex and critically ill acute care patients while also fulfilling organizational tasks aligned with funding metrics, accreditation, and strategic planning priorities. Such factors limited nurses' capacity to engage their patients in ACP. CONCLUSIONS Acute care settings that align patient values and medical treatment need to foster ACP practices by revising organizational policies and processes to support this outcome, analyzing the tasks of healthcare providers to determine who might best address it, and budgeting how to support it with additional resources.
Collapse
Affiliation(s)
- Lori L. Rietze
- School of Nursing, Laurentian University, Sudbury, ON, Canada
| | | | | | | |
Collapse
|
2
|
Hession A, Luckett T, Currow D, Barbato M. Nurses' encounters with patients having end-of-life dreams and visions in an acute care setting - A cross-sectional survey study. J Adv Nurs 2024; 80:3190-3198. [PMID: 38297455 DOI: 10.1111/jan.16079] [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: 10/29/2023] [Revised: 12/16/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
AIM This study aimed to estimate the proportion of acute care nurses witnessing end-of-life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. DESIGN A cross-sectional survey study was conducted from February 2023 to May 2023. SETTING/PARTICIPANTS Participants were medical and surgical nurses from a 200-bed acute care hospital in metropolitan Australia. RESULTS Fifty-seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end-of-life dreams and visions. The nature of end-of-life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end-of-life dreams and visions but identified an unmet need for education and training on this aspect of end-of-life care. CONCLUSION Our results suggest that nurses in acute care encounter end-of-life dreams and visions in a similar proportion to oncology and long-term care but lower than in palliative care settings. Education and training regarding end-of-life dreams and visions are needed to ensure the provision of comprehensive, patient-centred end-of-life care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT Research in sub-acute and long-term care settings suggests that end-of-life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high-income countries. This study demonstrates that acute care nurses encounter end-of-life dreams and visions in similar proportions to oncology and long-term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end-of-life dreams and visions to enable the provision of holistic person-centred end-of-life care. REPORTING METHOD This study was reported using the STROBE Checklist for cross-sectional studies.
Collapse
Affiliation(s)
- Alison Hession
- Supportive and Palliative Care Network, Northern Sydney Local Health District, Hornsby Kuringai Hospital, Hornsby, New South Wales, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Barbato
- Department of Palliative Care, Port Kembla Hospital, Port Kembla, New South Wales, Australia
| |
Collapse
|
3
|
Bearzot S, Ortez G, Cadorin L, Ghirotto L, Bressan V. Navigating Improper Care Settings: Nurses' Experiences Assisting Oncological Patients at the End of Life in Surgical Departments. Cancer Nurs 2024:00002820-990000000-00277. [PMID: 39106445 DOI: 10.1097/ncc.0000000000001388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
BACKGROUND Despite the growing preference for end-of-life care at home, numerous oncological patients continue to spend their final moments in surgical wards. This incongruity in settings may contribute to "dysthanasia," unnecessarily prolonging futile treatments and resulting in undue suffering. As frontline caregivers, nurses frequently bear the brunt of these challenging situations for patients and their families. OBJECTIVE To investigate the experiences of nurses providing care to terminally ill oncological patients inappropriately admitted to surgical departments. METHODS We adopted a phenomenological descriptive study. Nurses purposefully selected from 7 distinct surgical units at a University Hospital in Northeast Italy were recruited. Data collection took place through open-ended semistructured interviews. The interview content was analyzed using Colaizzi's framework. RESULTS The study with 26 participants revealed emotional challenges, especially for less-experienced nurses. Diverse perspectives among nurses emphasized the need for better palliative care knowledge. Despite the commitment to quality care, collaboration challenges and discordant goals with physicians impacted comprehensive care delivery. CONCLUSIONS Dysthanasia relates to participants' challenges in caring for oncological patients in inappropriate settings, hindering transparent communication and exacerbating discordance with doctors. IMPLICATIONS FOR PRACTICE Communication and collaboration among healthcare professionals, particularly nurses, and surgeons are crucial. Ongoing education in end-of-life care, coupled with advance care planning, empowers patients, aligns treatment choices, and prevents dysthanasia across diverse healthcare settings.
Collapse
Affiliation(s)
- Sara Bearzot
- Author Affiliations: Azienda Sanitaria Universitaria Friuli Centrale (Mrs Bearzot, Mrs Ortez, and Dr Bressan); Centro di Riferimento Oncologico di Aviano-IRCCS, Aviano (Dr Cadorin); Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia (Dr Ghirotto), Italy
| | | | | | | | | |
Collapse
|
4
|
Bakken J, Wallgren GC, Furnes B, Kørner H, Ueland V. Organizational structures influencing timely recognition and acknowledgment of end-of-life in hospitals - A qualitative study of nurses' and doctors' experiences. Eur J Oncol Nurs 2023; 67:102420. [PMID: 37883907 DOI: 10.1016/j.ejon.2023.102420] [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: 07/27/2023] [Accepted: 09/10/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Healthcare personnel's timely recognition and acknowledgment of end-of-life (EOL) is fundamental for reducing futile treatment, enabling informed decisions regarding the last days or weeks of life, and focusing on high-quality palliative care. The aim of this study is to explore and describe nurses' and doctors' experiences of how organizational structures in hospitals influence timely recognition and acknowledgment of EOL. METHODS A qualitative explorative design was applied, with data collected through 12 individual in-depth interviews using a semi-structured interview guide. A total of 6 nurses and 6 doctors were strategically recruited from medical and surgical wards in a Norwegian hospital. Qualitative content analysis was used. RESULTS The analysis revealed the theme The importance of hospital organizational structures in timely recognition and acknowledgment of EOL and a subtheme comprising three areas of organizational structures influencing timely recognition and acknowledgment of EOL; Challenges to and demands of continuity, collaboration, and time. CONCLUSIONS The study's results show challenges in identifying when cancer patients approach the last weeks and days of life within hospital wards. For nurses and doctors to be able to recognize and acknowledge EOL, continuity of care, collaboration, and time is needed. A fragmented healthcare system, with a predominant focus on treatment and cure, may prevent cancer patients from receiving timely palliative, care causing unnecessary suffering.
Collapse
Affiliation(s)
- Janet Bakken
- Faculty of Health Sciences, University of Stavanger, N-4021, Norway.
| | | | - Bodil Furnes
- Faculty of Health Sciences, University of Stavanger, N-4021, Norway.
| | - Hartwig Kørner
- Department of Gastro-Intestinal Surgery, Stavanger University Hospital, N-4068, Norway; Regional Center of Excellence of Palliative Care Western Norway, Haukeland University Hospital, N-5021, Bergen, Norway; Department of Clinical Science, University of Bergen, N-5020, Bergen, Norway.
| | - Venke Ueland
- Faculty of Health Sciences, University of Stavanger, N-4021, Norway.
| |
Collapse
|
5
|
Jung SY, Song HS, Kim JY, Koo HJ, Shin YS, Kim SR, Kim JH. Nurses' Perception and Performance of End-of-Life Care in a Tertiary Hospital. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2023; 26:101-111. [PMID: 37790737 PMCID: PMC10542992 DOI: 10.14475/jhpc.2023.26.3.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 10/05/2023]
Abstract
Purpose This study aimed to identify levels of perception and performance of end-of-life care among nurses and to investigate correlations between perception and performance. Methods This cross-sectional descriptive survey included 321 nurses from a tertiary hospital in Seoul, Korea. The participants had at least 6 months of work experience and had been involved in end-of-life care at least once, in either ward or intensive care unit settings. A structured questionnaire was utilized to assess their perception and performance of end-of-life care. Results The mean score for perception of end-of-life care was 3.23±0.34, while the score for performance of end-of-life care was 3.08±0.34. There was a significant positive correlation between nurses' perception of end-of-life care and their performance in this area (r=0.78, P<0.001). Conclusion It is necessary to change perceptions regarding end-of-life care and to develop systematic and standardized education programs including content such as assessing the hydration status of dying patients, evaluating mental aspects such as suicidal ideation, and providing spiritual care for nurses working in end-of-life departments.
Collapse
Affiliation(s)
- Seo Yeon Jung
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | | | - Ji Youn Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Hoi Jung Koo
- Clinical Directorate, Asan Medical Center, Seoul, Korea
| | | | | | - Jeong Hye Kim
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
| |
Collapse
|
6
|
Hammer K, Højgaard HS, Á Steig B, Wang AG, Bergenholtz HM, Rosted EE. Hope pictured in drawings by patients newly diagnosed with advanced cancer. J Clin Nurs 2023; 32:1262-1275. [PMID: 35277902 DOI: 10.1111/jocn.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hope is an integral part of a dying person's needs and an important phenomenon that has not been satisfactorily explored. The tension between hope for a cure and the reality of being terminally ill is a paradox, which in the context of palliative cancer care, nurses and health care professionals must take into consideration. OBJECTIVE The purpose of this study was to elucidate the phenomenon of hope and to investigate the lived experiences of hope among newly diagnosed patients with advanced cancer. METHOD The study used a phenomenological-visual method where drawings and post-drawing interviews were used. The participants were six patients who recently had been offered specialised palliative care treatment. They were five women and one man with different cancer diagnoses and between 30 and 82 years of age (median 65 years). The data consisted of six drawings and individual post-drawing interviews with the participants. The study was reported using the COREQ checklist. RESULTS The study revealed one main concern 'Being in hope' and hope appeared in four different dimensions; internal, external, relational and transcendental. Hopelessness was present at all times. CONCLUSION Hope pictured in drawings was expressed through colour, shape, lines, symbols and metaphors, and hope incorporated internal, external, relational and transcendental aspects. Hope was constantly fighting against hopelessness and hope integrated with past, present and future. RELEVANCE TO CLINICAL PRACTICE Drawings, as well as other visual representations, are suitable tools when trying to understand an ineffable phenomenon such as hope experienced by people newly diagnosed with cancer.
Collapse
Affiliation(s)
- Kristianna Hammer
- Department of Palliative Care, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | | | - Bjarni Á Steig
- Department of Hematology and Palliative Care, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - August G Wang
- Faculty of Health, University of Faroe Islands, Tórshavn, Faroe Islands.,Centre of Psychiatry, Copenhagen University Hospital Amager, Copenhagen S, Denmark
| | - Heidi M Bergenholtz
- Department of Surgery, Holbaek Hospital, Holbaek, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, UK
| | - Elizabeth E Rosted
- Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark.,University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Nguyen PT, Liaw SY, Tan AJQ, Rusli KDB, Tan LLC, Goh HS, Chua WL. “Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Friedrichsen M, Hajradinovic Y, Jakobsson M, Brachfeld K, Milberg A. Cultures that collide: an ethnographic study of the introduction of a palliative care consultation team on acute wards. BMC Palliat Care 2021; 20:180. [PMID: 34802436 PMCID: PMC8606051 DOI: 10.1186/s12904-021-00877-1] [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: 05/24/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
Background Acute care and palliative care (PC) are described as different incompatible organisational care cultures. Few studies have observed the actual meeting between these two cultures. In this paper we report part of ethnographic results from an intervention study where a palliative care consultation team (PCCT) used an integrative bedside education approach, trying to embed PC principles and interventions into daily practice in acute wards. Purpose To study the meeting and interaction of two different care cultures, palliative care and curative acute wards, when a PCCT introduces consulting services to acute wards regarding end-of-life palliative care, focusing on the differences between the cultures. Methods An ethnographic study design was used, including observations, interviews and diary entries. A PCCT visited acute care wards during 1 year. The analysis was inspired by Spradleys ethnography. Results Three themes were found: 1) Anticipations meets reality; 2) Valuation of time and prioritising; and 3) The content and creation of palliative care. Conclusion There are many differences in values, and the way PC are provided in the acute care wards compared to what a PCCT expects. The didactic challenges are many and the PC require effort.
Collapse
Affiliation(s)
- Maria Friedrichsen
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden.
| | | | - Maria Jakobsson
- Department of Palliative Medicine, Vrinnevi Hospital, Norrköping, Sweden
| | - Kerstin Brachfeld
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden
| | - Anna Milberg
- Palliative Education and Research Centre in Region Östergötland, Vrinnevi Hospital, 601 82, Norrköping, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
9
|
Limbu T, Taylor PM. Experiences of surgical nurses in providing end-of-life care in an acute care setting: a qualitative study. ACTA ACUST UNITED AC 2021; 30:1084-1089. [PMID: 34645337 DOI: 10.12968/bjon.2021.30.18.1084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The number of deaths occurring in hospitals is rising, and many occur in settings other than specialist palliative care, oncology or critical care. Nurses working outside these specialist environments report end-of-life (EoL) care as a source of stress. This research aimed to explore these experiences. AIMS AND METHODS This qualitative study, using semi-structured interviews as a research technique, aimed to investigate the experiences of surgical nurses caring for dying patients. RESULTS Five themes emerged: understanding of and preference for EoL care; perceived barriers while providing EoL care; robust support from the team as a facilitator while providing EoL care; symptom management; future training and support. CONCLUSION Participants considered providing EoL care as part of their professional role and reported that they were able to provide appropriate physical care. Participants identified challenges in providing emotional and psychological support to dying patients and their families in an acute surgical setting.
Collapse
Affiliation(s)
- Teju Limbu
- Staff Nurse, Nottingham City Hospital, Nottingham University Hospitals NHS Trust
| | - Paul M Taylor
- St Luke's Senior Clinical Lecturer in Palliative Medicine, School of Health and Related Research, University of Sheffield
| |
Collapse
|
10
|
Montagnini M, Smith HM, Price DM, Strodtman L, Ghosh B. An Instrument to Assess Self-Perceived Competencies in End-of-Life Care for Health Care Professionals: The End-of-Life Care Questionnaire. Am J Hosp Palliat Care 2021; 38:1426-1432. [PMID: 33787330 DOI: 10.1177/10499091211005735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We describe the development and the psychometric properties of an instrument to assess self-perceived EOL care competencies for healthcare professionals: The End-of-Life Care Questionnaire (EOL-Q). METHODS The EOL-Q consists of 28 questions assessing knowledge, attitudes and behaviors with subscale items addressing seven domains of care: decision-making, communication, continuity of care, emotional support for patients/families, symptom management, spiritual support for patients/families, and support for clinicians. The EOL-Q was used to assess competencies of 1,197 healthcare professionals from multiple work units at a large medical center. Cronbach's alpha coefficients were calculated for the survey and subscales. A factor analysis was also conducted. RESULTS Internal consistency reliability was for was high for the total scale (0.93) and for the subscales addressing knowledge, behaviors, decision-making, communication, emotional support and symptom management (0.84-0.92); and moderate (>0.68) for the attitudes and continuity of care subscales. The factor analysis demonstrated robust consolidation of the communication and continuity of care subscales (eigenvalue 9.47), decision-making subscale (eigenvalue 3.38), symptom management subscale (eigenvalue 1.51), and emotional and spiritual support subscales (eigenvalue 1.13). CONCLUSION Analysis of the psychometric properties of the EOL-Q care across settings supports its reliability and validity as a measure of self-perceived EOL care competencies in the domains of communication and continuity of care, decision-making, symptom management, and emotional and spiritual support. The EOL-Q displays promise as a tool for use in a variety of educational, research, and program development initiatives in EOL care.
Collapse
Affiliation(s)
| | - Heather M Smith
- Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Deborah M Price
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Linda Strodtman
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Bidisha Ghosh
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Ruíz-Fernández MD, Fernández-Medina IM, Granero-Molina J, Hernández-Padilla JM, Correa-Casado M, Fernández-Sola C. Social acceptance of death and its implication for end-of-life care. J Adv Nurs 2021; 77:3132-3141. [PMID: 33755231 DOI: 10.1111/jan.14836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/08/2021] [Accepted: 03/07/2021] [Indexed: 12/15/2022]
Abstract
AIMS To understand how the social patterns about death influence end-of-life care from the perspective of healthcare professionals. DESIGN A qualitative study according to the theory of Glaser and Strauss. METHODS A purposeful sample of 47 participants with different roles (nurses, physicians and clinical psychologists) were involved in four focus groups and 17 interviews in 2017-2019. Responses were audio-recorded, transcribed verbatim and analysed using computer-assisted qualitative data. RESULTS A core category 'the theory of social patterns about death' emerged, which is explained by three categories: the culture of concealment and stubbornness towards death, the effort and internal work to make death a part of existence, and the influence of the social patterns of coping with death on end-of life care and healthcare professionals. Our results suggest that social coping with death is affected by a network of concealment and obstinacy towards death. CONCLUSION Recognizing death as part of life and thinking about death itself are social coping strategies. Although healthcare professionals occupy a privileged place in this process, the culture of concealment of death influences end-of-life care. IMPACT The social process that leads to the loneliness of the dying in our days has been theorized. However, social acceptance of death also influences healthcare professionals' attitudes towards death. Thus, healthcare professionals' own attitudes may affect the end-of-life care given to dying individuals and their families. The social patterns of death may contribute to the healthcare professionals' negative attitudes towards death. The concept of dignified death has been linked to the notion of humanization of healthcare. Death should be approached from a more naturalistic perspective by healthcare professionals, healthcare and academic institutions.
Collapse
Affiliation(s)
| | | | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Department of Adult, Child and Midwifery, School of Health and Education, Middlesex University, London, UK
| | - Matías Correa-Casado
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| |
Collapse
|
12
|
Bove DG, Sørensen N, Timm H, Herling SF, Gjersøe P. Patient Characteristics of Persons Dead on Arrival Received in a Danish Emergency Department: A Retrospective Review of Health Records. J Emerg Nurs 2021; 47:582-589.e1. [PMID: 33642054 DOI: 10.1016/j.jen.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/30/2020] [Accepted: 01/13/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION In addition to treating living patients, emergency nurses are also responsible for receiving and caring for persons who are dead on arrival and their relatives. There is limited knowledge about the dead on arrival patient and family population as well as care practice for the dead and their relatives. The first step in improving care for dead on arrival persons is to know the size and characteristics of the population. Therefore, the aim of this study was to describe the size and characteristics of the dead on arrival population in a Danish emergency department. METHODS A retrospective review of health records was undertaken for all consecutive dead on arrival persons received in 1 Danish emergency department between January 2018 and December 2019. RESULTS A total of 719 dead on arrival persons were included, 350 in 2018 and 369 in 2019. Males accounted for 64%. The mean age was 71 years with a range from 18 to 102 years. The place of death was 80% at home, and more than half (54%) were found either dead or dying by a spouse, cohabitant, or son/daughter. In most cases, the cause of death was described as unknown (92%), whereas suicide and accidents accounted for 8%. DISCUSSION The population of dead on arrival persons in a Danish emergency department were mainly men, found dying or dead by relatives and brought in from home. Additional research and development are warranted regarding care practices for dead on arrival and their families in the emergency department.
Collapse
|
13
|
Rawlings D, Yin H, Devery K, Morgan D, Tieman J. End-of-Life Care in Acute Hospitals: Practice Change Reported by Health Professionals Following Online Education. Healthcare (Basel) 2020; 8:healthcare8030254. [PMID: 32781639 PMCID: PMC7551093 DOI: 10.3390/healthcare8030254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022] Open
Abstract
Providing quality care for those dying in hospital is challenging for health professionals who receive little training in this. “End of Life Essentials” (EOLE) was developed to address gaps in health professionals’ knowledge, skills and confidence in end-of-life care via the provision of online learning modules and practice resources. This study aimed to determine whether respondents could describe clinical practice change as a result of module completion. Deidentified data were collected between October and November 2018 from learners registered for the online learning modules. Both quantitative and qualitative data were extracted and analysed. The survey design and conduct were reviewed, and ethical approval was obtained. Although the response rate was very low, results from n = 122 learners show improvements in knowledge, skills, awareness and confidence as a result of the undertaking of the learning modules. Two thirds self-reported practice changes (71%, n = 59) following the education, with “communication” cited most commonly (n = 19). The findings suggest that the EOLE education modules can help to improve end-of-life care by increasing health professionals’ awareness of good practice as well as their knowledge, skills and confidence. Online learning has also been reinforced as an appropriate forum for end-of-life education. Following education, implementing what has been learned occurs more easily at a personal level rather than at a team and organisational level. Barriers to and enablers of clinical practice change in hospital are described, including the fact that the organisation may not be responsive to changes or have the relevant resources to support change.
Collapse
|
14
|
Kalocsai C, des Ordons AR, Sinuff T, Koo E, Smith O, Cook D, Golan E, Hales S, Tomlinson G, Strachan D, MacKinnon CJ, Downar J. Critical care providers' support of families in bereavement: a mixed-methods study. Can J Anaesth 2020; 67:857-865. [PMID: 32240521 DOI: 10.1007/s12630-020-01645-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/13/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. METHODS Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. RESULTS Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. CONCLUSIONS Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.
Collapse
Affiliation(s)
- Csilla Kalocsai
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, CAMH Education, 33 Russell Street, Rm. 2054, Toronto, ON, M5S 2S1, Canada.
| | - Amanda Roze des Ordons
- Division of Palliative Medicine, Department of Critical Care Medicine, Department of Oncology, Department of Anesthesiology, University of Calgary, Calgary, AB, Canada
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ellen Koo
- University Health Network, Toronto, ON, Canada
| | - Orla Smith
- St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah Cook
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Eyal Golan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - James Downar
- Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
15
|
Haavisto E, Soikkeli-Jalonen A, Tonteri M, Hupli M. Nurses' required end-of-life care competence in health centres inpatient ward - a qualitative descriptive study. Scand J Caring Sci 2020; 35:577-585. [PMID: 32400040 DOI: 10.1111/scs.12874] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies of nurses' required competence in EOL care in health centres are rare. It is important to produce information about experienced nurses' perceptions of the competence they consider important in their practical work. AIM The aim of this study was to describe nurses' required competence in EOL care in health centre inpatient wards as experienced by nurses. METHOD A descriptive qualitative study using four semi-structured group interviews (20 nurses) and inductive descriptive content analysis. RESULTS Five categories describing nurses' required competence in EOL care in a health centre inpatient ward were identified: (1) ethics and courage in action, (2) support for the patient, (3) support for the family, (4) care planning and (5) physical care. Factors promoting nurses' competence in EOL care comprised two categories: (1) professional development in EOL care and (2) an organisation that supports EOL care. CONCLUSIONS End-of-life care in health centre inpatient wards requires wide and complex competence from nurses. Nurses' experiences of required competence are associated with holistic care of the patient, encountering the family and multiprofessional cooperation. Nurses' competence in EOL care could be enhanced with postgraduate education, and educational planning should be given more attention in the future.
Collapse
Affiliation(s)
- Elina Haavisto
- Department of Nursing Science, Satakunta Central Hospital, University of Turku, Pori, Finland
| | | | - Mia Tonteri
- Department of Nursing Science, University of Turku, Pori, Finland
| | - Maija Hupli
- Department of Nursing Science, University of Turku, Pori, Finland
| |
Collapse
|
16
|
Magro-Morillo A, Boulayoune-Zaagougui S, Cantón-Habas V, Molina-Luque R, Hernández-Ascanio J, Ventura-Puertos PE. Emotional universe of intensive care unit nurses from Spain and the United Kingdom: A hermeneutic approach. Intensive Crit Care Nurs 2020; 59:102850. [PMID: 32229184 DOI: 10.1016/j.iccn.2020.102850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 02/20/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Abstract
AIM To acquire an understanding of the emotional universe of intensive care unit nurses, working in Spain and the United Kingdom. METHODOLOGY The study used a hermeneutic study design and was set in an academic environment. Participants included nurses with clinical experience in intensive care units. Data were collected from seven in-depth interviews, four in Spanish and three in English. The analysis followed Ricoeur's Theory of Interpretation. The affective taxonomy Universe of Emotions, served to establish starting categories in it. FINDINGS Six themes were identified: 1) Critical patient care, critical context; 2) Intensive care… for whom?; 3) Nursing a dying patient; 4) In the company of others; 5) But… is it worth it? and 6) Emotional labour is crucial. These all describe different, multifaceted nurses' affective journeys, through categories such as: So little time-so much to do, Relatives, Young death vs. elderly death, Poorly-valued work and I'm in the profession I want to be. CONCLUSION The sociocultural context shared by the Spanish and English nurses working in intensive care units generates a complex emotional universe, with opposing affective experiences, such as those related to fear, anxiety, sadness, anger, shame, love, surprise and happiness.
Collapse
Affiliation(s)
- Ana Magro-Morillo
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain
| | - Salma Boulayoune-Zaagougui
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain.
| | - Vanesa Cantón-Habas
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain.
| | - Rafael Molina-Luque
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain.
| | - José Hernández-Ascanio
- Department of Sociology, Department of Social Sciences and Humanities, Calle San Alberto Magno, s/n, P.C. 14071, Córdoba, Spain
| | - Pedro E Ventura-Puertos
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain.
| |
Collapse
|
17
|
Abstract
Many, especially newer, nurses lack the experience for nuanced skillful communication at end of life. This study incorporated the End-of-Life Nursing Education Consortium (ELNEC) Core Curriculum Communication module into a nurse residency program and tested for change in attitudes toward end-of-life (EOL) care. Researchers found significant differences in attitudes toward care of the dying before and after the ELNEC training, and between nurses with greater than and less than 5 years experience. Findings support that ELNEC education can significantly impact nurse attitudes about EOL care.
Collapse
|
18
|
Conflict Experienced by Nurses Providing End-of-life Care in Emergency Departments in Japan. J Trauma Nurs 2019; 26:154-163. [PMID: 31483774 DOI: 10.1097/jtn.0000000000000441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Saving lives is the first priority in emergency departments. However, it is important to provide end-of-life care (EOLC) for patients and their families in these departments when the patient's life cannot be saved. Existing work reporting the obstacles and difficulties of nursing practice has found that the perceptions of nurses who provide EOLC include distress and conflict. The primary aims of this study were (i) to clarify the structure of the conflict experienced by nurses providing EOLC in emergency departments and (ii) to explore factors influencing this experience of conflict. A questionnaire survey was conducted among nurses working in emergency departments in Japan. The participants were sampled using a random sampling design. In total, 290 (55.3%) nurses responded to the survey and 288 (55.0%) responses were usable for the analysis. Seven components comprising 31 items were identified: (1) conflict about ability to practice EOLC; (2) conflict about relationships with the medical team; (3) conflict about the environment for EOLC; (4) conflict about decision making; (5) conflict about family nursing; (6) conflict about patients' pain; and (7) conflict about medical limitations. The nurses' individual backgrounds and support systems were found to influence their experience of conflict. To support nurses providing EOLC in emergency departments, we need to understand the conflict they experience, including how their backgrounds affect this experience, and construct a system that incorporates support from the specialized field of EOLC.
Collapse
|
19
|
Vanderhaeghen B, Bossuyt I. Helping hospital professionals to implement Advance Care Planning in daily practice: a European Delphi study from field experts. J Res Nurs 2019; 24:433-443. [PMID: 34394558 PMCID: PMC7932268 DOI: 10.1177/1744987118772604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience implementation barriers in practice. AIMS The aim of this study was to investigate what is valued in having ACP conversations by hospital professionals (physicians, nurses, psychologists and social workers) and what they experience as barriers and facilitating factors for having ACP conversations with patients. METHODS A Delphi study consisting of two rounds with respectively 21 and 19 multidisciplinary experts from seven European countries was organised. Data were analysed using content analysis and descriptive statistics. RESULTS Participants agreed that ACP is valued mostly because it is seen to improve transmural continuation of care, emotional processing of the loss of a patient, and serenity at the end of life. Reported barriers are patient characteristics blocking patient-centred communication and a lack of knowledge to have these conversations. An important facilitator is multidisciplinary cooperation. CONCLUSIONS There is consensus by experts from different settings and countries suggesting that these results can theoretically be applied to hospital settings in Europe. This study reveals that hospital professionals value ACP in hospital practice, but that they encounter several barriers to its implementation.
Collapse
Affiliation(s)
- Birgit Vanderhaeghen
- Birgit Vanderhaeghen, c/o Palliative Support Team, UZLeuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Inge Bossuyt
- Palliative Support Team, University Hospitals Leuven, Belgium
| |
Collapse
|
20
|
Rawlings D, Devery K, Poole N. Improving quality in hospital end-of-life care: honest communication, compassion and empathy. BMJ Open Qual 2019; 8:e000669. [PMID: 31259290 PMCID: PMC6567943 DOI: 10.1136/bmjoq-2019-000669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/03/2022] Open
Abstract
Background With over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: 'Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…'. Methods The modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated. Findings Five themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice. Conclusion Learners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention-behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.
Collapse
Affiliation(s)
- Deb Rawlings
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Kim Devery
- Palliative and Supportive Services, Flinders University Faculty of Medicine, Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Naomi Poole
- Director, Partnering with Consumers, Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| |
Collapse
|
21
|
Moon F, Fraser L, McDermott F. Sitting with silence: hospital social work interventions for dying patients and their Families. SOCIAL WORK IN HEALTH CARE 2019; 58:444-458. [PMID: 30887906 DOI: 10.1080/00981389.2019.1586027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
The recent controversy around the hospital end of life care has highlighted the vulnerability of dying patients and their families. However, little is known about how social workers provide support and intervention around the end of life in the hospital. Eight hospital social workers provided qualitative descriptions of their clinical practice for adult patients and their families. Highlighting a theoretical orientation towards a person-in-environment approach, social workers develop unique interventions to contribute to multidisciplinary care. Findings emphasize the need to prepare social work students and clinicians for the reality of working with end of life issues.
Collapse
Affiliation(s)
- Felicity Moon
- a Social Work Department , Monash Medical Centre Clayton , Clayton , Australia
| | - Lucinda Fraser
- a Social Work Department , Monash Medical Centre Clayton , Clayton , Australia
| | - Fiona McDermott
- b Monash Medical Centre Clayton , Monash Health & Monash University , Clayton , Australia
| |
Collapse
|
22
|
Meziane D, Ramirez-Garcia MP, Fortin ML. A reflective practice intervention to act on the moral distress of nurses providing end-of-life care on acute care units. Int J Palliat Nurs 2018; 24:444-451. [DOI: 10.12968/ijpn.2018.24.9.444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dounia Meziane
- Pivot nurse in oncology Montreal-West Intergrated University Health and Social Services Center, Montréal, Canada
| | | | - Marie-Laurence Fortin
- Palliative care clinical nurse specialist Montreal-West-Central Integrated University Health and Social Services Centre, Montréal, Canada
| |
Collapse
|
23
|
McCallum KJ, Jackson D, Walthall H, Aveyard H. Exploring the quality of the dying and death experience in the Emergency Department: An integrative literature review. Int J Nurs Stud 2018; 85:106-117. [DOI: 10.1016/j.ijnurstu.2018.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
|
24
|
Psychometric evaluation and cultural adaptation of the Spanish version of the "Scale for End-of Life Caregiving Appraisal". Palliat Support Care 2018; 17:314-321. [PMID: 30073939 DOI: 10.1017/s1478951518000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To translate, culturally adapt, and psychometrically evaluate the Spanish version of the "Scale for End-of Life Caregiving Appraisal" (SEOLCAS). METHOD Observational cross-sectional study. Convenience sample of 201 informal end-of-life caregivers recruited in a southern Spanish hospital. The reliability of the questionnaire was assessed through its internal consistency (Cronbach's α) and temporal stability (Pearson's correlation coefficient [r] between test-retest). The content validity index of the items and the scale was calculated. Criterion validity was explored through performing a linear regression analysis to evaluate the SEOLCAS' predictive validity. Exploratory factor analysis was used to examine its construct validity. RESULTS The SEOLCAS' reliability was very high (Cronbach's α = 0.92). Its content validity was excellent (all items' content validity index = 0.8-1; scale's validity index = 0.88). Evidence of the SEOLCAS' criterion validity showed that the participants' scores on the SEOLCAS explained approximately 79.3% of the between-subject variation of their results on the Zarit Burden Interview. Exploratory factor analysis provided evidence of the SEOLCAS' construct validity. This analysis revealed that two factors ("internal contingencies" and "external contingencies") explained 53.77% of the total variance found and reflected the stoic Hispanic attitude toward adversity.Significance of resultsThe Spanish version of the SEOLCAS has shown to be an easily applicable, valid, reliable, and culturally appropriate tool to measure the impact of end-of-life care provision on Hispanic informal caregivers. This tool offers healthcare professionals the opportunity to easily explore Hispanic informal end-of-life caregivers' experiences and discover the type of support they may need (instrumental or emotional) even when there are communicational and organizational constraints.
Collapse
|
25
|
Bennett MP, Lovan S, Hager K, Canonica L, Taylor B. A one hour teaching intervention can improve end-of-life care. NURSE EDUCATION TODAY 2018; 67:93-99. [PMID: 29807249 DOI: 10.1016/j.nedt.2018.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/10/2018] [Accepted: 05/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND It is not known if standard nursing actions are tailored to patient preferences for comfort measures during End of Life (EOL) care. OBJECTIVES Determine the effect of a brief teaching intervention on student care of EOL patients. DESIGN Pre-test/post-test intervention design. SETTINGS Two large public universities and one smaller private Catholic institution (all in the United States [U.S.]). PARTICIPANTS 471 nursing students attending class as part of their required nursing curriculum. METHODS A previously developed aggressiveness of nursing care scale was modified to determine students' behavioral intentions for the care of the EOL patient before and after a standardized lecture. The lecture was designed to help students recognize that nursing care priorities for the EOL patient may need to be different than for other patients in order to provide the best quality of remaining life. RESULTS Nursing students prior to the lecture had aggressiveness of care scores similar to those of experienced staff nurses, and were more likely to provide more aggressive care to younger patients without DNR orders than to older patients with a DNR order. Following the lecture, aggressiveness of nursing care scores decreased significantly for all EOL patients, and students reported similar behavioral intentions for all EOL patients, regardless of patient age or code status. Student age was marginally related to change in behavior following the lecture. Prior experience in caring for a dying patient or relative did not have a significant effect on aggressiveness of care scores before or after the lecture. CONCLUSIONS This study demonstrates the effectiveness of a brief teaching intervention to help student nurses take patient preferences and needs into consideration when selecting nursing interventions for the EOL patient.
Collapse
Affiliation(s)
- Mary P Bennett
- Western Kentucky University, School of Nursing, 1906 College Heights Blvd. #11036, Bowling Green, KY 42101, United States.
| | - Sherry Lovan
- Western Kentucky University, School of Nursing, 1906 College Heights Blvd. #11036, Bowling Green, KY 42101, United States.
| | - Kathy Hager
- Bellarmine University, 2001 Newburg Rd, Louisville, KY 40205, United States.
| | - Linda Canonica
- Rowan College of Nursing at Gloucester County, 1400 Tanyard Road, Sewell, NJ 08080, United States.
| | - Barbara Taylor
- Rowan College of Nursing at Gloucester County, 1400 Tanyard Road, Sewell, NJ 08080, United States.
| |
Collapse
|
26
|
Vanderhaeghen B, Van Beek K, De Pril M, Bossuyt I, Menten J, Rober P. What do hospitalists experience as barriers and helpful factors for having ACP conversations? A systematic qualitative evidence synthesis. Perspect Public Health 2018; 139:97-105. [PMID: 30010486 DOI: 10.1177/1757913918786524] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Hospitalists seem to struggle with advance care planning implementation. One strategy to help them is to understand which barriers and helpful factors they may encounter. AIMS: This review aims to give an overview on what hospitalists experience as barriers and helpful factors for having advance care planning conversations. METHOD: A systematic synthesis of the qualitative literature was conducted. DATA SOURCES: A bibliographic search of English peer-reviewed publications in PubMed, Embase, CINAHL, Central, PsycINFO, and Web of Science was undertaken. RESULTS: Hospitalists report lacking communication skills which lead to difficulties with exploring values and wishes of patients, dealing with emotions of patients and families and approaching the conversation about letting a patient die. Other barriers are related to different interpretations of the concept advance care planning, cultural factors, like being lost in translation, and medicolegal factors, like fearing prosecution. Furthermore, hospitalists report that decision-making is often based on irrational convictions, and it is highly personal. Physician and patient characteristics, like moral convictions, experience, and personality play a role in the decision-making process. Hospitalists report that experience and learning from more experienced colleagues is helpful. Furthermore, efficient multidisciplinary co-operation is helping. CONCLUSION: This systematic review shows that barriers are often related to communication issues and the convictions of the involved hospitalist. However, they seem to be preventable by creating a culture where experienced professionals can be consulted, where convictions can be questioned, and where co-operation within and between organizations is encouraged. This knowledge can serve as a basis for implementation.
Collapse
Affiliation(s)
- Birgit Vanderhaeghen
- Palliative Support Team, University Hospitals Leuven, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Karen Van Beek
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
- Department of Radiation-Oncology and Palliative Care, University Hospitals Leuven, Leuven, Belgium
| | - Mieke De Pril
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
| | - Inge Bossuyt
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
| | - Johan Menten
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
- Department of Radiation-Oncology and Palliative Care, University Hospitals Leuven, Leuven, Belgium
| | - Peter Rober
- UPC KU Leuven, Leuven, Belgium
- Institute for Family and Sexuality Studies, Department of Neurosciences, School of Medicine, KU Leuven, Leuven, Belgium
| |
Collapse
|
27
|
Wilson M, Oliver P, Malpas P. Nurses' views on legalising assisted dying in New Zealand: A cross-sectional study. Int J Nurs Stud 2018; 89:116-124. [PMID: 29669685 DOI: 10.1016/j.ijnurstu.2018.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
AIMS This study investigated New Zealand nurses' views on legalising assisted dying across a range of clinical conditions, nurses' willingness to engage in legal assisted dying, potential deterrents and enablers to such engagement, and nurses' perceptions of the proper role of their professional bodies in relation to legalising assisted dying. BACKGROUND A Bill for legalising assisted dying is currently before the New Zealand parliament. Of the 16 jurisdictions where assisted dying has been specifically legislated, only the Canadian federal statute provides nurses with explicit legal protection for their performance of assisted dying-related tasks. An absence of policy development and planning for safe nursing practice prior to legalisation of assisted dying results in a gap in professional support and guidance. DESIGN Exploratory cross-sectional survey. RESPONDENTS A self-selected sample of 475 New Zealand nurses responded to an anonymous online survey disseminated through the newsletters and websites of relevant medical and nursing professional bodies. A sub-sample of nurses who expressed support for or ambivalence about legalisation (n = 356): rated their level of support for legalising assisted dying in New Zealand across a range of medical conditions, and their willingness to participate in a range of assisted dying tasks; identified barriers and facilitators to potential participation; and assessed the responsibility of the professional bodies to provide practice supports. METHOD Mixed-method approach using descriptive analysis of quantitative data; qualitative data were analysed thematically. RESULTS Nurses supported legalisation at a rate (67%) significantly greater than that of doctors (37%) and for a diverse range of medical conditions. Most supporting nurses were willing to engage in the full range of relevant assisted dying roles. They identified several practical and ethical supports as essential to safe engagement, in particular practice guidelines, specific training, legal protections, clinical supervision and mentoring, and independent review of assisted dying service provision. They saw the facilitation of these supports as primarily the responsibility of their professional bodies. IMPLICATIONS FOR POLICY Nursing bodies should proactively facilitate workforce awareness and development of assisted dying policy and practice supports in anticipation of legalisation. This can be done through information campaigns and by adapting assisted dying policy, practice materials and systems already developed internationally. Nursing bodies need to engage in formulating legislation to ensure inclusion of explicit protections for participating nurses and to delegate relevant responsibilities to regulatory bodies.
Collapse
Affiliation(s)
- Michael Wilson
- Wilson Associates, 22 Pitt St, Marden, South Australia, Australia.
| | - Pam Oliver
- Pam Oliver Ltd., Research and Evaluation, 1 Newton Rd., Waiheke Island, New Zealand.
| | - Phillipa Malpas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| |
Collapse
|
28
|
Hussin EOD, Wong LP, Chong MC, Subramanian P. Factors associated with nurses' perceptions about quality of end-of-life care. Int Nurs Rev 2018; 65:200-208. [PMID: 29430644 DOI: 10.1111/inr.12428] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To examine the factors associated with nurses' perceptions of the quality of end-of-life care. BACKGROUND With increasing demand for hospitals to provide end-of-life care, the low quality of palliative care provided in hospital settings is an issue of growing concern in developing countries. Most dying patients receive their care from general nurses, irrespective of the nurses' specialty or level of training. METHOD A structured cross-sectional questionnaire survey was conducted of 553 nurses working at a teaching hospital in Malaysia. RESULTS The mean scores for nurses' knowledge about end-of-life care, their attitudes towards end-of-life care and the perceived quality of end-of-life care were low. The factors identified as significantly associated with the quality of end-of-life care were nurses' levels of knowledge and their attitudes towards end-of-life care. DISCUSSION Factors that contributed to the low quality of end-of-life care were inadequate knowledge and negative attitudes. These findings may reflect that end-of-life care education is not well integrated into nursing education. CONCLUSION The findings of this study suggest that there is a need to increase the nurses' level of knowledge and improve their attitude towards end-of-life care in order to enhance the quality of care provided to dying patients. IMPLICATIONS FOR NURSING AND HEALTH POLICY Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of knowledge, as well as providing adequate emotional support for nurses who care for dying patients and their families. Nurses should be proactive in increasing their knowledge and adopting more positive attitudes towards end-of-life care.
Collapse
Affiliation(s)
- E O D Hussin
- Department of Nursing Science, University of Malaya, Kuala Lumpur, Malaysia
| | - L P Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M C Chong
- Department of Nursing Science, University of Malaya, Kuala Lumpur, Malaysia
| | - P Subramanian
- Nursing Synergy Ptd Ltd. 18.USJ 1/3K, USJ 1 Subang Jaya, 47100, Malaysia
| |
Collapse
|
29
|
Guardia-Mancilla P, Montoya-Juárez R, Expósito-Ruiz M, Hueso-Montoro C, García-Caro MP, Cruz-Quintana F. Variability in professional practice among departments explains the type of end-of-life care but not the difficulty of professionals with decision-making / La variabilidad de la práctica profesional entre los departamentos explica el tipo de cuidados sanitarios al final de la vida, pero no las dificultades que afrontan los profesionales respecto de la toma de decisiones. STUDIES IN PSYCHOLOGY 2017. [DOI: 10.1080/02109395.2017.1328845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
30
|
Elmore J, Wright DK, Paradis M. Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research. Nurs Ethics 2016; 25:955-972. [DOI: 10.1177/0969733016679468] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.
Collapse
Affiliation(s)
- James Elmore
- St. Mary’s Research Centre, Canada; McGill University, Canada
| | | | | |
Collapse
|
31
|
|
32
|
Heale R. Advance care planning in an acute care world. Evid Based Nurs 2016; 19:33. [PMID: 26880707 DOI: 10.1136/eb-2016-102333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Roberta Heale
- School of Nursing, Laurentian University, Sudbury, Canada
| |
Collapse
|
33
|
Andersson E, Salickiene Z, Rosengren K. To be involved - A qualitative study of nurses' experiences of caring for dying patients. NURSE EDUCATION TODAY 2016; 38:144-149. [PMID: 26689734 DOI: 10.1016/j.nedt.2015.11.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to describe nurses' experiences (>two years) of caring for dying patients in surgical wards. BACKGROUND Palliative care is included in education for nurses. However, the training content varies, and nurse educators need to be committed to the curriculum regarding end-of-life situations. A lack of preparation among newly graduated nurses regarding dying and death could lead to anxiety, stress and burnout. Therefore, it is important to improve knowledge regarding end-of-life situations. SETTING, PARTICIPANTS AND METHOD A qualitative descriptive study was carried out in two surgical wards in the southern part of Sweden. The study comprised six interviews with registered nurses and was analysed using manifest qualitative content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nurses' perspectives and thoughts regarding dying patients. RESULTS The results formed one category (caring-to be involved) and three subcategories (being supportive, being frustrated and being sensitive in the caring processes). Nurses were personally affected and felt unprepared to face dying patients due to a lack of knowledge about the field of palliative care. Their experiences could be described as processes of transition from theory to practice by trial and error. CONCLUSION Supervision is a valuable tool for bridging the gap between theory and practice in nursing during the transition from novice to expert. Improved knowledge about palliative care during nursing education and committed nursing leadership at the ward level facilitate preparation for end-of-life situations.
Collapse
Affiliation(s)
- Erika Andersson
- Department of Surgery, Norra Älvsborg County Hospital, SE-461 85 Trollhättan, Sweden.
| | - Zivile Salickiene
- Department of Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.
| | - Kristina Rosengren
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, SE-405 30 Gothenburg, Sweden.
| |
Collapse
|
34
|
|
35
|
Banerjee SC, Manna R, Coyle N, Shen MJ, Pehrson C, Zaider T, Hammonds S, Krueger CA, Parker PA, Bylund CL. Oncology nurses' communication challenges with patients and families: A qualitative study. Nurse Educ Pract 2015; 16:193-201. [PMID: 26278636 DOI: 10.1016/j.nepr.2015.07.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 07/08/2015] [Accepted: 07/14/2015] [Indexed: 11/16/2022]
Abstract
The benefits of effective communication in an oncology setting are multifold and include the overall well-being of patients and health professionals, adherence to treatment regimens, psychological functioning, and improvements in quality of life. Nevertheless, there are substantial barriers and communication challenges reported by oncology nurses. This study was conducted to present a summary of communication challenges faced by oncology nurses. From November 2012 to March 2014, 121 inpatient nurses working in the oncology setting participated in an online pre-training qualitative survey that asked nurses to describe common communication challenges in communicating empathy and discussing death, dying, and end-of-life (EOL) goals of care. The results revealed six themes that describe the challenges in communicating empathically: dialectic tensions, burden of carrying bad news, lack of skills for providing empathy, perceived institutional barriers, challenging situations, and perceived dissimilarities between the nurse and the patient. The results for challenges in discussing death, dying and EOL goals of care revealed five themes: dialectic tensions, discussing specific topics related to EOL, lack of skills for providing empathy, patient/family characteristics, and perceived institutional barriers. This study emphasizes the need for institutions to provide communication skills training to their oncology nurses for navigating through challenging patient interactions.
Collapse
Affiliation(s)
| | - Ruth Manna
- Memorial Sloan Kettering Cancer Center, USA
| | | | | | | | | | | | | | | | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, USA; Hamad Medical Corporation, Qatar
| |
Collapse
|