1
|
McMillan K, Wright DK, McPherson CJ, Ma K, Bitzas V. Visitor Restrictions, Palliative Care, and Epistemic Agency: A Qualitative Study of Nurses' Relational Practice During the Coronavirus Pandemic. Glob Qual Nurs Res 2021; 8:23333936211051702. [PMID: 34761076 PMCID: PMC8573617 DOI: 10.1177/23333936211051702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Efforts to curb spread of COVID-19 has led to restrictive visitor policies in healthcare, which disrupt social connection between patients and their families at end of life. We interviewed 17 Canadian nurses providing palliative care, to solicit their descriptions of, and responses to, ethical issues experienced as a result of COVID-19 related circumstances. Our analysis was inductive and scaffolded on notions of nurses' moral agency, palliative care values, and our clinical practice in end-of-life care. Our findings reveal that while participants appreciated the need for pandemic measures, they found blanket policies separating patients and families to be antithetical to their philosophy of palliative care. In navigating this tension, nurses drew on the foundational values of their practice, engaging in ethical reasoning and action to integrate safety and humanity into their work. These findings underscore the epistemic agency of nurses and highlight the limits of a purely biomedical logic for guiding the nursing ethics of the pandemic response.
Collapse
Affiliation(s)
- Kim McMillan
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - David K Wright
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Kristina Ma
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Vasiliki Bitzas
- Clinical Administrative Coordinator, Geriatrics and Palliative Care, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada
| |
Collapse
|
2
|
De Brasi EL, Giannetta N, Ercolani S, Gandini ELM, Moranda D, Villa G, Manara DF. Nurses' moral distress in end-of-life care: A qualitative study. Nurs Ethics 2020; 28:614-627. [PMID: 33267730 DOI: 10.1177/0969733020964859] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff. RESEARCH QUESTION The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events. RESEARCH DESIGN A hermeneutic-phenomenological qualitative study was performed. PARTICIPANTS AND RESEARCH CONTEXT Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim. ETHICAL CONSIDERATIONS Ethical approval was obtained from the Institutional Review Hospital Board. FINDINGS Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured. DISCUSSION In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients' last requests. According to our findings, the concept of 'good' end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events. CONCLUSION Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.
Collapse
Affiliation(s)
| | - Noemi Giannetta
- 18985Vita-Salute San Raffaele University, Italy; Tor Vergata University of Rome, Italy
| | - Sara Ercolani
- 9338ASST Grande Ospedale Metropolitano Niguarda, Italy
| | | | | | - Giulia Villa
- 9372IRCCS San Raffaele Scientific Institute, Italy
| | | |
Collapse
|
3
|
Barnett MD, Cantu C, Clark KA. Multidimensional emotion regulation strategies among hospice nurses. DEATH STUDIES 2019; 44:463-468. [PMID: 30938580 DOI: 10.1080/07481187.2019.1586790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to investigate relationships between four emotion regulation strategies (intrinsic affect-improving, intrinsic affect-worsening, extrinsic affect-improving, and extrinsic affect-worsening) and compassion fatigue, job satisfaction, and life satisfaction among 90 hospice nurses who completed an online survey. Intrinsic affect-improving was associated with higher life satisfaction. Intrinsic affect-worsening was associated with higher compassion fatigue and lower life satisfaction. Extrinsic affect-worsening was associated with lower job satisfaction. Overall, these findings support a multidimensional approach to understanding emotion regulation among hospice nurses.
Collapse
Affiliation(s)
- Michael D Barnett
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Christina Cantu
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Kametrice A Clark
- Department of Psychology, The University of Texas, Arlington, TX, USA
| |
Collapse
|
4
|
Tsui EK, Franzosa E, Cribbs KA, Baron S. Home Care Workers' Experiences of Client Death and Disenfranchised Grief. QUALITATIVE HEALTH RESEARCH 2019; 29:382-392. [PMID: 30264669 DOI: 10.1177/1049732318800461] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
While many types of health care workers experience patient death, home care workers do so under vastly different social and economic circumstances. When a client dies, home care workers often lose both a close relationship and a job. Though research suggests that health care workers' grief may frequently be disenfranchised, there is no in-depth study of the mechanisms that disenfranchise home care workers' grief specifically. To address this gap, our study used focus groups and peer interviews between home care workers in New York City. We describe four interrelated grief strategies they employ to navigate social and employer-based "grieving rules." Our findings suggest that home care workers' grief is disenfranchised via employer and societal underestimations of their relationships with clients and their losses when clients die, particularly job loss. Building on our findings, we suggest alterations to agency practices and home care systems to improve support for workers.
Collapse
Affiliation(s)
- Emma K Tsui
- 1 CUNY Graduate School of Public Health & Health Policy, New York City, New York, USA
| | - Emily Franzosa
- 1 CUNY Graduate School of Public Health & Health Policy, New York City, New York, USA
| | - Kristen A Cribbs
- 1 CUNY Graduate School of Public Health & Health Policy, New York City, New York, USA
| | | |
Collapse
|
5
|
McKee M, Kelley ML, Guirguis-Younger M, MacLean M, Nadin S. It Takes a Whole Community: The contribution of Rural Hospice Volunteers to Whole-Person Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971002600206] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although volunteers are widely acknowledged as important members of the palliative care team, their unique contribution to whole-person care has not been well documented or theorized, especially in rural communities. We conducted a focused ethnography in a small rural community, asking key community informants about their understanding of the role of hospice volunteers with dying people and their families. Our results show that these volunteers inhabit a unique third culture of care that fuses elements of formal care with the informal visiting of friends and neighbours. Their role is shaped to a community context where dying is not a private medical event, but rather a whole-person-in-community event, and where care is offered as a natural expression of the interdependence and reciprocity that characterizes rural community life. Our results are a reminder that it takes an entire community to care for the dying, and that hospice volunteers are a crucial link in the network of care that allows people to die with dignity and quality of life.
Collapse
Affiliation(s)
- Margaret McKee
- M McKee (corresponding author): School of Social Work, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario,
| | - Mary Lou Kelley
- ML Kelley: School of Social Work, Centre for Education and Research on Aging and Health, Lakehead University
| | | | - Michael MacLean
- M MacLean: Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada
| | - Shevaun Nadin
- S Nadin: Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| |
Collapse
|
6
|
Mehta A, Cohen SR, Carnevale FA, Ezer H, Ducharme F. Family Caregivers of Palliative Cancer Patients at Home: The puzzle of Pain Management. J Palliat Care 2018. [DOI: 10.1177/082585971002600203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this grounded theory study was to understand the processes used by family care-givers to manage the pain of cancer patients at home. A total of 24 family caregivers participated. They were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews and field notes. Data analysis was based on Strauss and Corbin's (1998) requirements for open, axial, and selective coding. The result was an explanatory model titled “the puzzle of pain management,” which includes four main processes: “drawing on past experiences”; “strategizing a game plan”; “striving to respond to pain”; and “gauging the best fit,” a decision-making process that joins the puzzle pieces. Understanding how family caregivers assemble their puzzle pieces can help health care professionals make decisions related to the care plans they create for pain control and help them to recognize the importance of providing information as part of resolving the puzzle of pain management.
Collapse
Affiliation(s)
- Anita Mehta
- McGill University Health Center, Psychosocial Oncology, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4
| | - S. Robin Cohen
- Departments of Oncology and Medicine, Faculty of Medicine, McGill University, Montreal, and Lady Davis Institute, SMBD Jewish General Hospital, Montreal
| | | | - Hélène Ezer
- School of Nursing, McGill University, Montreal
| | - Francine Ducharme
- Faculté des sciences infirmières, Université de Montréal, Montreal, and Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Boston P, Bruce A. Palliative Care Nursing, Technology, and Therapeutic Presence: Are They Reconcilable? J Palliat Care 2018. [DOI: 10.1177/082585971403000409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patricia Boston
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 1252 Oceanview Road, Bowen Island, British Columbia, Canada V0N 1G1
| | - Anne Bruce
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
8
|
Relational use of an electronic quality of life and practice support system in hospital palliative consult care: A pilot study. Palliat Support Care 2018. [PMID: 29516852 DOI: 10.1017/s1478951518000020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study is part of an overarching research initiative on the development and integration of an electronic Quality of Life and Practice Support System (QPSS) that uses patient-reported outcome and experience measures in clinical practice. The current study focused on palliative nurse consultants trialing the QPSS with older hospitalized adults receiving acute care. The primary aim of the study was to better understand consultants' and patients' experiences and perspectives of use. METHOD The project involved two nurse specialists within a larger palliative outreach consult team (POCT) and consenting older adult patients (age 55+) in a large tertiary acute care hospital in western Canada. User-centered design of the QPSS was informed by three focus groups with the entire POCT team, and implementation was evaluated by direct observation as well as interviews with the POCT nurses and three patients. Thematic analysis of interviews and field notes was informed by theoretical perspectives from social sciences. RESULT Over 9 weeks, the POCT nurses used the QPSS at least once with 20 patients, for a total of 47 administrations. The nurses most often assisted patients in using the QPSS. Participants referenced three primary benefits of relational use: enhanced communication, strengthened therapeutic relations, and cocreation of new insights about quality of life and care experiences. The nurses also reported increased visibility of quality of life concerns and positive development as relational care providers. SIGNIFICANCE OF RESULTS Participants expressed that QPSS use positively influenced relations of care and enhanced practices consistent with person-centered care. Results also indicate that electronic assessment systems may, in some instances, function as actor-objects enabling new knowledge and relations of care rather than merely as a neutral technological platform. This is the first study to examine hospital palliative consult clinicians' use of a tablet-based system for routine collection of patient-reported outcome and experience measures.
Collapse
|
9
|
Shaw J, Kearney C, Glenns B, McKay S. Interprofessional team building in the palliative home care setting: Use of a conceptual framework to inform a pilot evaluation. J Interprof Care 2017; 30:262-4. [PMID: 27026192 DOI: 10.3109/13561820.2015.1115395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants' accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emphasises sharing power among team members and addressing the need for mutual emotional support may help to maximise interprofessional teamwork in palliative home care. These findings may be used to develop and test more comprehensive efforts to promote stronger interprofessional teamwork in palliative home health care delivery.
Collapse
Affiliation(s)
- James Shaw
- a Toronto Rehabilitation Institute - UHN, Research , Toronto , Ontario , Canada.,b VHA Home Health Care , Toronto , Ontario , Canada
| | | | | | - Sandra McKay
- b VHA Home Health Care , Toronto , Ontario , Canada
| |
Collapse
|
10
|
Ingebretsen LP, Sagbakken M. Hospice nurses' emotional challenges in their encounters with the dying. Int J Qual Stud Health Well-being 2016; 11:31170. [PMID: 27258584 PMCID: PMC4891968 DOI: 10.3402/qhw.v11.31170] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to explore nurses’ emotional challenges when caring for the dying in hospices. The study has a qualitative design, and knowledge was developed through a dialectical exchange between theory and data. Ten individual in-depth interviews were conducted with nurses recruited from two hospices in Denmark. Although all of the nurses said that they experienced emotional challenges or felt emotionally touched during their work, the study found a variety of opinions related to the extent to which their emotional reactions should be revealed in their role as a hospice professional. The participants described their emotional challenges as being simultaneously draining and enriching experiences leading to personal and professional growth and development. The study may contribute to increased awareness of emotional challenges for hospice nurses, which involve continuous reflection and balancing between meeting the dying as a human being and meeting the dying as a hospice professional.
Collapse
Affiliation(s)
- Lina Paola Ingebretsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway;
| | - Mette Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| |
Collapse
|
11
|
Effects of Chinese medicine five-element music on the quality of life for advanced cancer patients: A randomized controlled trial. Chin J Integr Med 2013; 19:736-40. [DOI: 10.1007/s11655-013-1593-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Indexed: 10/26/2022]
|
12
|
Boston P, Bruce A, Schreiber R. Existential suffering in the palliative care setting: an integrated literature review. J Pain Symptom Manage 2011; 41:604-18. [PMID: 21145202 DOI: 10.1016/j.jpainsymman.2010.05.010] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 05/26/2010] [Accepted: 05/28/2010] [Indexed: 11/29/2022]
Abstract
CONTEXT Existential and spiritual concerns in relation to palliative end-of-life care have received increasing attention over the past decade. OBJECTIVES To review the literature specifically related to existential suffering in palliative care in terms of the significance of existential suffering in end-of-life care, definitions, conceptual frameworks, and interventions. METHODS A systematic approach was undertaken with the aim of identifying emerging themes in the literature. Databases using CINAHL (1980-2009), MEDLINE (1970-2009), and PsychINFO (1980-2009) and the search engine of Google Scholar were searched under the key words existential suffering, existential distress, existential pain, palliative and end of life care. RESULTS The search yielded a total of 156 articles; 32% were peer-reviewed empirical research articles, 28% were peer-reviewed theoretical articles, and 14% were reviews or opinion-based articles. After manually searching bibliographies and related reference lists, 64 articles were considered relevant and are discussed in this review. Overall analysis identifies knowledge of the following: 1) emerging themes related to existential suffering, 2) critical review of those identified themes, 3) current gaps in the research literature, and 4) recommendations for future research. Findings from this comprehensive review reveal that existential suffering and deep personal anguish at the end of life are some of the most debilitating conditions that occur in patients who are dying, and yet the way such suffering is treated in the last days is not well understood. CONCLUSION Given the broad range of definitions attributed to existential suffering, palliative care clinicians may need to be mindful of their own choices and consider treatment options from a critical perspective.
Collapse
Affiliation(s)
- Patricia Boston
- Division of Palliative Care, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | |
Collapse
|
13
|
Bruce A, Schreiber R, Petrovskaya O, Boston P. Longing for ground in a ground(less) world: a qualitative inquiry of existential suffering. BMC Nurs 2011; 10:2. [PMID: 21272349 PMCID: PMC3045972 DOI: 10.1186/1472-6955-10-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 01/27/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Existential and spiritual concerns are fundamental issues in palliative care and patients frequently articulate these concerns. The purpose of this study was to understand the process of engaging with existential suffering at the end of life. METHODS A grounded theory approach was used to explore processes in the context of situated interaction and to explore the process of existential suffering. We began with in vivo codes of participants' words, and clustered these codes at increasingly higher levels of abstractions until we were able to theorize. RESULTS Findings suggest the process of existential suffering begins with an experience of groundlessness that results in an overarching process of Longing for Ground in a Ground(less) World, a wish to minimize the uncomfortable or anxiety-provoking instability of groundlessness. Longing for ground is enacted in three overlapping ways: by turning toward one's discomfort and learning to let go (engaging groundlessness), turning away from the discomfort, attempting to keep it out of consciousness by clinging to familiar thoughts and ideas (taking refuge in the habitual), and learning to live within the flux of instability and unknowing (living in-between). CONCLUSIONS Existential concerns are inherent in being human. This has implications for clinicians when considering how patients and colleagues may experience existential concerns in varying degrees, in their own fashion, either consciously or unconsciously. Findings emphasize a fluid and dynamic understanding of existential suffering and compel health providers to acknowledge the complexity of fear and anxiety while allowing space for the uniquely fluid nature of these processes for each person. Findings also have implications for health providers who may gravitate towards the transformational possibilities of encounters with mortality without inviting space for less optimistic possibilities of resistance, anger, and despondency that may concurrently arise.
Collapse
Affiliation(s)
- Anne Bruce
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Rita Schreiber
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Olga Petrovskaya
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Patricia Boston
- Director, Division of Palliative Care, Department of Family Practice, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
14
|
|