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Leclerc-Loiselle J, Gendron S, Daneault S. Nursing activities for health promotion in palliative home care: an integrative review. Palliat Care Soc Pract 2024; 18:26323524241235191. [PMID: 38487793 PMCID: PMC10938613 DOI: 10.1177/26323524241235191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.
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Affiliation(s)
- Jérôme Leclerc-Loiselle
- School of Nursing, Université de Sherbrooke, 150, Pl. Charles-Le Moyne, L1-7730, Longueuil, QC J4K 0A8, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - Sylvie Gendron
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Serge Daneault
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
- Research centre of Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
- Integrated University Health and Social Services Centre of Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
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Taylor J, Fradgley EA, Clinton‐McHarg T, Hall A, Paul CL. Perceived importance of emotional support provided by health care professionals and social networks: Should we broaden our focus for the delivery of supportive care? Asia Pac J Clin Oncol 2023; 19:681-689. [PMID: 36698247 PMCID: PMC10947305 DOI: 10.1111/ajco.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Emotional support provided by health care professionals (HCPs) for people diagnosed with cancer is associated with improved outcomes. Support via social networks may also be important. AIMS To report among a sample of distressed patients and caregivers, (1) the importance attributed to different sources of emotional support (HCPs and social networks) by distressed cancer patients and caregivers; (2) the proportion who indicate they did not receive sufficient levels of emotional support; and (3) potential associations between respondents' demographic and clinical characteristics and reported lack of emotional support. METHODS This study utilised cross-sectional data from telephone interviews collected during the usual-care phase of the Structured Triage and Referral by Telephone (START) trial. Participants completed a telephone interview 6 months after their initial call to the Cancer Council Information and Support service and included recall of importance and sufficiency of emotional support. RESULTS More than two-thirds of patients (n = 234) and caregivers (n = 152) reported that family and friends were very important sources of emotional support. Nurses (69% and 42%) and doctors (68% and 47%) were reported very important, while a lower proportion reported that psychologists and psychiatrists were very important (39%, and 43%). Insufficient levels of support were reported by 36% of participants. Perceptions of insufficient support were significantly associated with distress levels (p < .0001) and not having a partner (p = .0115). CONCLUSION Social networks, particularly family, are an important source of emotional support. Higher levels of distress, those without partners, and caregivers may require targeted interventions to increase their access to emotional support.
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Affiliation(s)
- Jo Taylor
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
| | - Elizabeth A. Fradgley
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
- Cancer Institute New South WalesCancer Institute New South Wales, EveleighSydneyAustralia
| | - Tara Clinton‐McHarg
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- School of PsychologyUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Alix Hall
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
- Hunter New England Population HealthHunter New England Area Health ServiceNewcastleNew South WalesAustralia
| | - Christine L. Paul
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
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Grant MP, Philip JAM, Deliens L, Komesaroff PA. Understanding Complexity in Care: Opportunities for Ethnographic Research in Palliative Care. J Palliat Care 2022:8258597221078375. [PMID: 35167402 DOI: 10.1177/08258597221078375] [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: 11/16/2022]
Abstract
Background: Ethnography has been used to address a broad range of research questions in health care. With ethnographic research methods it is possible to gain access to the complex realities of health care practice as it occurs, through interpreting the nuances of individual and team behaviours, the roles and dynamics of care provision, and the social impacts and influences of illness. The provision of clinical palliative care is complex, involving multidisciplinary collaboration across different health systems, and is subject to a multitude of personal, cultural and environmental influences. This complexity demands creative methodological approaches to research in palliative care, of which ethnography plays an important, if infrequently utilised, role. Aim: This article aims to explore potential opportunities of ethnographic methods for palliative care research. Findings: Ethnographic methods focuses on behaviour in the 'natural' setting of participants, to create theoretical descriptions of events, cultures, interactions and experiences. In palliative care these methods may provide nuanced understandings of illness, relationships and teams, communication, medical education, complex care provision, and novel or changing health practices. Of particular importance is the potential of these methods to understand complex practices and processes, and engage with under-represented population groups who may be excluded from interview research. Conclusion: Ethnography offers important opportunities for future research in palliative care and should be considered as part of the 'research toolbox' to improve understanding of the complex nature of care provision and the experiences of illness and loss.
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Affiliation(s)
- Matthew P Grant
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital Melbourne
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Monash University
| | - Jennifer A M Philip
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital Melbourne
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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Rusli KDB, Tan AJQ, Ong SF, Speed S, Lau Y, Liaw SY. Home-based nursing care competencies: A scoping review. J Clin Nurs 2021; 32:1723-1737. [PMID: 34897853 DOI: 10.1111/jocn.16169] [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] [Received: 09/11/2021] [Revised: 11/03/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
AIMS AND OBJECTIVES To identify and consolidate the available evidence about nursing-related competencies for home-based care. BACKGROUND Over recent years, the demand for home-based nursing care has increased because of the need to meet the increasing need for chronic disease care to be delivered in patients' homes. However, knowledge is lacking about the expected competencies for home-based care nurses. DESIGN A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. The review identified literature using five electronic databases (CINAHL, PubMed, Embase, Cochrane and Scopus) and a hand search for grey literature in relevant home-based care journals and online searches. Key search terms and inclusion and exclusion criteria were used as strategies to identify relevant articles. RESULTS Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified the following 10 competencies: (1) care assessments; (2) performance of nursing procedures; (3) management of health conditions; (4) critical thinking and problem-solving skills; (5) interpersonal relationships and communication; (6) interdisciplinary collaboration; (7) leadership and resource management; (8) professional development; (9) technological literacy; (10) quality and safety. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses' competence level for home-based care or for development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardisation of home-based nursing care expectations across various stakeholders.
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Affiliation(s)
- Khairul Dzakirin Bin Rusli
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shu Fen Ong
- APN & Speciality Nurse Department, Khoo Teck Puat Hospital, Yishun Health, Singapore, Singapore
| | - Shaun Speed
- Faculty of Health and Social Care, University of Chester, Wirral, UK
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Nagington M, Holman D, Mumford C, McCann L. Theorising the hospice gaze: A Foucauldian collaborative ethnography of a palliative day care service. Soc Sci Med 2021; 291:114470. [PMID: 34662763 DOI: 10.1016/j.socscimed.2021.114470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
Foucault's medical gaze has only been minimally applied to palliative care through the analysis of key policy documents. This paper develops the conceptualisation of Foucault's medical gaze using empirical data gathered from a group ethnography of a hospice daycare centre. Using Foucault's medical gaze as a theoretical aporia we conceptualise the "hospice gaze". We argue the hospice gaze is the antithesis of the Foucauldian medical gaze, suggesting it operates reflexively so that professionals adapt to patients, rather than patients to professionals; that it is directed towards enabling patients and their loved ones to narrate severe illness and death in ways that develop more patient-centred narratives; and, structures the processes of care in direct resistance to the neoliberalisation of healthcare by engaging in slow practices of care with patient's bodies and minds. Finally, key to all of this is how the hospice gaze manages the spaces of care to ensure that it always and already appears slow to the patients. Therefore, the hospice gaze ensures a (re)distribution of power and knowledge that minimises the corrosive qualities of busyness and maximises the ethical potentials of slowness. We conclude by arguing that the operation of the hospice gaze should be examined in other settings where palliative care is practiced such as in-patient and home care services.
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Affiliation(s)
| | - David Holman
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Clare Mumford
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK; Manchester Metropolitan University, Oxford Road, Manchester, M15 6BH, UK
| | - Leo McCann
- University of Manchester, Oxford Road, Manchester, M13 9PL, UK; University of York, Heslington, York, YO19 5DD, UK
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Walshe C. Aims, actions and advance care planning by district nurses providing palliative care: an ethnographic observational study. Br J Community Nurs 2020; 25:276-286. [PMID: 32496856 DOI: 10.12968/bjcn.2020.25.6.276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
District nurses are core providers of palliative care, yet little is known about the way that they provide care to people at home. This study aimed to investigate the role and practice of the district nurse in palliative care provision. This was an ethnographic study, with non-participant observation of district nurse-palliative care patient encounters, and post-observation interviews. District nurse teams from three geographical areas in northwest England participated. Data were analysed iteratively, facilitated by the use of NVivo, using techniques of constant comparison. Some 17 encounters were observed, with 23 post-observation interviews (11 with district nurses, 12 with patients/carers). Core themes were 'planning for the future' and 'caring in the moment'. District nurses described how they provided and planned future care, but observations showed that this care focused on physical symptom management. District nurses engaged in friendly relationship building, which allows detailed management of symptomatology, but with little evidence of advance care planning.
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Affiliation(s)
- Catherine Walshe
- Professor of Palliative Care, International Observatory on End of Life Care, Lancaster University, Bailrigg, Lancaster
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Griffiths J. Person-centred communication for emotional support in district nursing: SAGE and THYME model. Br J Community Nurs 2017; 22:593-597. [PMID: 29189053 DOI: 10.12968/bjcn.2017.22.12.593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients on district nursing caseloads have multiple physical morbidities, and related emotional concerns. District nurses are ideally placed to assess and meet patients' emotional needs but in increasingly stretched workplaces, it is difficult to find time. There is also evidence that district nurses sometimes believe they lack skills to address patients' concerns. Traditional communication skills training is useful for encouraging patients to open up about their concerns, but less helpful at finding workable solutions. District nurses can be afraid to open a 'can of worms' of concerns that they are unable to deal with. SAGE and THYME is a person-centred, evidence-based communication skills model that addresses district nurses' concerns about time and skills. It provides a structure for conversations about concerns, and empowers patients to work with district nurses to find solutions. Research suggests that it is a promising model for district nursing practice.
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Affiliation(s)
- Jane Griffiths
- Senior Lecturer, School of Health Sciences, Division of Nursing Midwifery and Social Work, University of Manchester
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8
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Barriers to Addressing Social Determinants of Health in Pediatric Nursing Practice: An Integrative Review. J Pediatr Nurs 2017; 37:51-56. [PMID: 28676190 DOI: 10.1016/j.pedn.2017.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/17/2017] [Indexed: 12/26/2022]
Abstract
PROBLEM Despite a substantial body of knowledge regarding the importance of the social determinants of health, recognizing and responding to the psychosocial circumstances of seriously and chronically ill children and their families is not well established in routine pediatric nursing care. ELIGIBILITY CRITERIA The search process focused on psychological and social determinants and care in the healthcare setting. Searches were limited to research and review publications written in the English language. The quality of evidence was graded using the National Health and Medical Research Council evidence hierarchy. RESULTS Thirteen publications were identified for inclusion. Healthcare providers do recognize emotional distress experienced by patients, but feel unable to address psychosocial issues due to the lack of time, a lack of confidence in their own communication skills, and the perception that patients and their families prioritize physical care over psychosocial care. For patients and their families the main issue was that the healthcare system was focused on physical care with little opportunity to talk about psychosocial concerns. CONCLUSIONS The greatest barrier to addressing the social determinants of health in the pediatric context is the dominance of the 'medical model' of care. Also, many healthcare providers believe that they lack the communication skills necessary to talk about psychosocial issues. IMPLICATIONS The way forward will be to empower nurses through the sharing of knowledge of the social determinants of health, the development of skills in relationship building and therapeutic communication, and the mentorship of compassionate family-centered care.
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Bowers B, Redsell SA. A qualitative study of community nurses' decision-making around the anticipatory prescribing of end-of-life medications. J Adv Nurs 2017; 73:2385-2394. [PMID: 28423478 DOI: 10.1111/jan.13319] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to explore community nurses' decision-making processes around the prescribing of anticipatory medications for people who are dying. BACKGROUND Community nurses frequently initiate the prescribing of anticipatory medications to help control symptoms in those who are dying. However, little is known about their decision-making processes in relation to when they instigate anticipatory prescribing and their discussions with families and General Practitioners. DESIGN A qualitative interpretive descriptive enquiry. METHODS A purposive sample of 11 Community Palliative Nurses and District Nurses working in one geographical area participated. Data were collected between March and June 2016 via audio recorded semi-structured interviews and analysed inductively using Braun and Clarke's thematic analysis. RESULTS Three themes were identified: (1) Drugs as a safety net. Anticipatory medications give nurses a sense of control in last days of life symptom management; (2) Reading the situation. The nurse judges when to introduce conversations around anticipatory medications, balancing the need for discussion with the dying person and their family's likely response; (3) Playing the game. The nurse owns the decision to initiate anticipatory medication prescribing and carefully negotiates with the General Practitioner. CONCLUSION Nurses view pain control through prescribed medication as key to symptom management for dying people. Consequently, they own the role of ascertaining when to initiate discussions with families about anticipatory medicines. Nurses believe they advocate for dying person and their families' needs and lead negotiations with General Practitioners for medications to go into the home. This nurse led care alters the traditional boundaries of the General Practitioners-nurse professional relationship.
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Affiliation(s)
- Ben Bowers
- Hinchingbrooke Health Care NHS Trust, Huntingdon, Cambridgeshire, UK
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McIlfatrick S, Connolly M, Collins R, Murphy T, Johnston B, Larkin P. Evaluating a dignity care intervention for palliative care in the community setting: community nurses’ perspectives. J Clin Nurs 2017; 26:4300-4312. [DOI: 10.1111/jocn.13757] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sonja McIlfatrick
- Institute of Nursing and Health Research; Ulster University; Newtownabbey UK
- All Ireland Institute of Hospice and Palliative Care; Dublin Ireland
| | - Michael Connolly
- School of Nursing, Midwifery & Health Sciences Centre; University College Dublin; Dublin Ireland
| | - Rita Collins
- All Ireland Institute of Hospice and Palliative Care; c/o Our Lady's Hospice & Care Services; Dublin Ireland
| | - Tara Murphy
- All Ireland Institute of Hospice and Palliative Care; c/o Our Lady's Hospice & Care Services; Dublin Ireland
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing; University of Glasgow; Glasgow UK
| | - Philip Larkin
- School of Nursing, Midwifery & Health Sciences Centre; University College Dublin; Dublin Ireland
- Education and Research; Our Lady's Hospice & Care Services; Dublin Ireland
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Fan SY, Lin IM, Hsieh JG, Chang CJ. Psychosocial Care Provided by Physicians and Nurses in Palliative Care: A Mixed Methods Study. J Pain Symptom Manage 2017; 53:216-223. [PMID: 27756622 DOI: 10.1016/j.jpainsymman.2016.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/21/2022]
Abstract
CONTEXT Psychosocial care is an important component of palliative care, which is also provided by physicians and nurses. OBJECTIVE The aim of this study was to explore the experiences of physicians and nurses in palliative care regarding the process of psychosocial care, the difficulties, and the support needs from "psychosocial care professionals." METHODS A two-phase mixed methods study was conducted. In the first phase, 16 physicians and nurses with palliative care experience were recruited. A semi-structured interview was used to collect data about their experience of providing psychosocial care, and these were analyzed using thematic analysis. In the second phase, 88 physicians and nurses completed an online survey that was developed from the qualitative results. RESULTS Qualitative results revealed three themes: 1) the contents of psychosocial care included not only disease-related events but also emotional and family support, 2) providing psychosocial care was a dynamic process including assessment, interventions, and evaluation, and 3) there were difficulties from the participants themselves, patients and families, and the system. Participants also reflected on what they did and the influences of providing care on themselves. Quantitative results showed that the most common psychosocial care was discussion about the progress of the disease and future care plan; the difficulty was the long-term problems in families; and the psychosocial care professionals most needed were social workers and clinical/counseling psychologists. CONCLUSIONS Understanding the process of psychosocial care and integrating it with specialized mental health care in a team could improve the quality of psychosocial care in palliative care.
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Affiliation(s)
- Sheng-Yu Fan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - I-Mei Lin
- Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jyh-Gang Hsieh
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chih-Jung Chang
- Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Nagington MG. Judith Butler's theories: reflections for nursing research and practice. Nurs Philos 2016; 17:307-16. [PMID: 27321751 DOI: 10.1111/nup.12134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Judith Butler is one of the most influential late 20th and early 21st century philosophers in regard to left wing politics, as well as an active campaigner for social justice within the United States and worldwide. Her academic work has been foundational to the academic discipline of queer theory and has been extensively critiqued and applied across a hugely wide range of disciplines. In addition, Butler's work itself is extensive covering topics such as gender, sexuality, race, literary theory, and warfare. This article can only serve as a taster for the potential application of her work in relation to nursing, which is in its infancy. This introduction covers three of the potentially most productive themes in Butler's work, namely power, performativity, and ethics. Each of these themes are critically explored in turn, sometimes in relation to their actual application in nursing literature, but also in relation to their potential for producing novel critiques of nursing practice. Suggestions are made about how Butler's work can develop nursing research and practice. The article concludes with a short summary of Butler's key works as well as suggested reading for people interested in examining how her theories have been applied across different academic settings.
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Affiliation(s)
- Maurice G Nagington
- School of Nursing Midwifery and Social Work, University of Manchester, Manchester, England.
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13
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Berggren E, Orrevall Y, Olin AÖ, Strang P, Szulkin R, Törnkvist L. Evaluation of a Continuing Educational Intervention for Primary Health Care Professionals about Nutritional Care of Patients at Home. J Nutr Health Aging 2016; 20:428-38. [PMID: 26999244 DOI: 10.1007/s12603-015-0596-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluate the effectiveness of a continuing educational intervention on primary health care professionals' familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care. DESIGN Observational cohort study. SETTING 10 primary health care centers in Stockholm County, Sweden. PARTICIPANTS 140 district nurses/registered nurses and general practitioners/physicians working with home care. INTERVENTION 87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection. MEASUREMENTS The intervention's effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression. RESULTS In the intra-group analyses, statistically significant changes occurred in the IG's responses to 28 of 32 items and the CG's responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0. CONCLUSION The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals' level of knowledge about important aspects of nutritional care.
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Affiliation(s)
- E Berggren
- Erika Berggren, Academic Primary Health Care Centre, Karolinska Institutet, Alfred Nobels allé 12, S-141 83 Huddinge, Sweden, , phone: +46 8 52488717
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Nagington M, Walshe C, Luker KA. A poststructural rethinking of the ethics of technology in relation to the provision of palliative home care by district nurses. Nurs Philos 2016; 17:59-70. [PMID: 26333295 PMCID: PMC5049488 DOI: 10.1111/nup.12099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Technology and its interfaces with nursing care, patients and carers, and the home are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes the home more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order to explore this, poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of 'plugged in' as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of the home as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over the home and their subjectivities. Finally, the dichotomy between the home and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliative care.
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Affiliation(s)
- Maurice Nagington
- School of Nursing, Midwifery and Social WorkUniversity of ManchesterManchester
| | - Catherine Walshe
- International Observatory on End of Life CareDivision of Health Research C52Lancaster UniversityLancasterUK
| | - Karen A. Luker
- School of Nursing, Midwifery and Social WorkUniversity of ManchesterManchester
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15
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Nagington M, Walshe C, Luker KA. Quality care as ethical care: a poststructural analysis of palliative and supportive district nursing care. Nurs Inq 2015; 23:12-23. [PMID: 26189362 PMCID: PMC5034813 DOI: 10.1111/nin.12109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2015] [Indexed: 11/29/2022]
Abstract
Quality of care is a prominent discourse in modern health‐care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse–patient–carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi‐structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health‐care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved.
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van der Plas AG, Francke AL, Vissers KC, Jansen WJ, Deliens L, Onwuteaka-Philipsen BD. Case management in primary palliative care is associated more strongly with organisational than with patient characteristics: results from a cross-sectional prospective study. BMC Palliat Care 2015; 14:31. [PMID: 26134403 PMCID: PMC4488052 DOI: 10.1186/s12904-015-0029-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Case managers have been introduced in Dutch primary palliative care; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner and home care nurses. This study aims to describe support and investigate what characteristics of patients and the organizational setting are related to the number of contacts and to the number of times topics are discussed between the case manager and patients and/or informal carers. METHODS Prospective study following cancer patients (n = 662) receiving support from a palliative care case manager in Dutch primary care, using registration forms filled out by the case manager after contact with the patient and/or informal carer. In backward linear regression, the association was studied between patient or organizational characteristics and the number of contacts and the number of times conversation topics were discussed. RESULTS Organizational characteristics add more to explained variability in data than patient characteristics. Case managers provide support in a flexible manner with regard to the number, mode, persons present, and duration of contacts. Support covered all domains of palliative care, with most attention given to physical complaints, life expectancy and psychological aspects. CONCLUSIONS Support offered by the case managers is prompted by characteristics of the organization for which they work. This is contradictory to the idea of patient centered care highly valued in palliative care.
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Affiliation(s)
- Annicka Gm van der Plas
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Anneke L Francke
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Kris C Vissers
- Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Wim Jj Jansen
- Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Anaesthesiology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Luc Deliens
- Vrije Universiteit Brussel and Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, B-1090, Brussels, Belgium.
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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17
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Gillett K, Bryan L. ‘Quality End of Life Care for All’ (QELCA): the national rollout of an end-of-life workforce development initiative. BMJ Support Palliat Care 2015; 6:225-30. [DOI: 10.1136/bmjspcare-2014-000816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 03/11/2015] [Indexed: 11/04/2022]
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18
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Griffiths J, Wilson C, Ewing G, Connolly M, Grande G. Improving communication with palliative care cancer patients at home - A pilot study of SAGE & THYME communication skills model. Eur J Oncol Nurs 2015; 19:465-72. [PMID: 25782722 DOI: 10.1016/j.ejon.2015.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To pilot an evidence-based communication skills model (SAGE & THYME) with UK District Nurses (DNs) who visit patients with advanced cancer early in the dying trajectory. Evidence suggests that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time. SAGE & THYME is a highly structured model for teaching patient centred interactions. It addresses concerns about confidence and time. METHOD Mixed methods. 33 DNs were trained in SAGE & THYME in a three hour workshop and interviewed in focus groups on three occasions: pre-training, immediately post-training and two months post-training. Questionnaires measuring perceived outcomes of communication, confidence in communication and motivation to use SAGE & THYME were administered at the focus groups. RESULTS SAGE & THYME provided a structure for conversations and facilitated opening and closing of interactions. The main principle of patient centeredness was reportedly used by all. Knowledge about communication behaviours helpful to patients improved and was sustained two months after training. Increased confidence in communication skills was also sustained. Motivation to use SAGE & THYME was high and remained so at two months, and some said the model saved them time. Challenges with using the model included controlling the home environment and a change in style of communication which was so marked some DNs preferred to use it with new patients. CONCLUSION Training DNs in SAGE & THYME in a three hour workshop appears to be a promising model for improving communication skills when working with cancer patients.
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Affiliation(s)
- Jane Griffiths
- University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom.
| | - Charlotte Wilson
- Barts & The London School of Medicine, Centre for Primary Care and Public Health, Yvonne Carter Building, 58 Turnser Street, London, United Kingdom
| | - Gail Ewing
- University of Cambridge, Centre for Family Research, Free School Lane, Cambridge, United Kingdom
| | - Michael Connolly
- University Hospital of South Manchester NHS Foundation Trust, Southmoor Lane, Wythenshawe, Manchester, United Kingdom
| | - Gunn Grande
- University of Manchester, School of Nursing Midwifery and Social Work, Jean McFarlane Building, Manchester, United Kingdom
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19
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Offen J. The role of UK district nurses in providing care for adult patients with a terminal diagnosis: a meta-ethnography. Int J Palliat Nurs 2015; 21:134-41. [DOI: 10.12968/ijpn.2015.21.3.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John Offen
- Community Staff Nurse, York Teaching Hospitals NHS Foundation Trust, York, UK
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20
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Griffiths J, Ewing G, Wilson C, Connolly M, Grande G. Breaking bad news about transitions to dying: a qualitative exploration of the role of the District Nurse. Palliat Med 2015; 29:138-46. [PMID: 25249242 DOI: 10.1177/0269216314551813] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND UK District Nurses have an important role in enabling a good death. Patients and families need to know the patient is approaching the dying phase, yet evidence suggests breaking bad news about the patient's transition to dying rarely happens. District Nurses spend a lot of time with patients and families during the dying phase and are ideally placed to recognise and discuss the transition to dying. AIM To explore the role of District Nurses in breaking bad news of transition to dying. DESIGN Qualitative focus groups. SETTING Primary care (District Nurse service); Four National Health Service Trusts, North West England. PARTICIPANTS A total of 40 District Nurses across the Trusts, all Registered General Nurse qualified. Median number of years as a District Nurse was 12.5. All had palliative cancer patients on their caseloads. RESULTS District Nurses' role in breaking bad news of transition to dying was challenging, but the conversation was described as essential preparation for a good death. Four main challenges with the conversations were patients' responses to the prognosis (unawareness, denial and anger), timing the conversation, complexities of the home environment and limited preparation in this aspect of their work. CONCLUSIONS District Nurses are with patients during their last weeks of life. While other colleagues can avoid breaking bad news of transition to dying, District Nurses have no choice if they are to provide optimal end of life care. While ideally placed to carry out this work, it is complex and they are unprepared for it. They urgently need carefully tailored training in this aspect of their work, to enable them to provide optimal end of life care.
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Affiliation(s)
- Jane Griffiths
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Charlotte Wilson
- Barts & The London School of Medicine Centre for Primarly care and Public Health, London, UK
| | - Michael Connolly
- Supportive and Palliative Care, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Gunn Grande
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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21
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van der Plas AGM, Onwuteaka-Philipsen BD, Francke AL, Jansen WJJ, Vissers KC, Deliens L. Palliative care case managers in primary care: a descriptive study of referrals in relation to treatment aims. J Palliat Med 2014; 18:324-31. [PMID: 25495143 DOI: 10.1089/jpm.2014.0269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Three important elements of the World Health Organization (WHO) definition of palliative care are: 1) it includes patients who may have cure or life prolongation as treatment aims besides palliative care; 2) it is not exclusively for cancer patients; and 3) it includes attention to the medical, psychological, social, and spiritual needs of the patients and their families. Case managers (nurses with expertise in palliative care) may assist generalist primary care providers in delivery of good palliative care. OBJECTIVES This study investigates the referral of patients to case managers in primary care with regard to the three elements mentioned: diagnosis, treatment aims, and needs as reflected in reasons given for referral. METHODS In this cross-sectional survey in primary care among case managers and referrers to case management, case managers completed questionnaires for 687 patients; referrers completed 448 (65%). RESULTS Most patients referred have a combination of treatment aims (69%). Life expectancy and functional status of patients are lower for those with a treatment aim of palliation. Almost all (96%) of those referred are cancer patients. A need for psychosocial support is frequently given as a reason for referral (66%) regardless of treatment aim. CONCLUSIONS Referrals to case managers reflect two of three elements of the WHO definition. Mainly, patients are referred for support complementary to medical care, and relatively early in their disease trajectory. However, most of those referred are cancer patients. Thus, to fully reflect the definition, broadening the scope to reach other patient groups is important.
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Affiliation(s)
- Annicka G M van der Plas
- 1 Department of Public and Occupational Health, VU University Medical Center , Amsterdam, the Netherlands
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22
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Reed FM, Fitzgerald L, Bish MR. District nurse advocacy for choice to live and die at home in rural Australia: a scoping study. Nurs Ethics 2014; 22:479-92. [PMID: 24981253 DOI: 10.1177/0969733014538889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. OBJECTIVES The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. METHOD Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. RESULTS 34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role. DISCUSSION Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. CONCLUSION It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.
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Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review. Psychooncology 2014; 23:601-12. [PMID: 24519814 DOI: 10.1002/pon.3474] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 11/29/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore the barriers experienced and perceived by health professionals and patients in the delivery of psychosocial care to adults with cancer. METHODS Systematic searches were undertaken using the PsychInfo, Medline and CINAHL electronic databases, up to October 2013. Research reporting health professional or patient experiences and perceptions of barriers to psychosocial care are included in the review. The systematic review includes studies that have non-experimental, exploratory and observational designs, as is appropriate to answer the review question. Included studies were critically appraised. The results of individual quantitative studies were aggregated. Qualitative content analysis was used to analyse the qualitative results. RESULTS Twenty-five papers met the pre-specified inclusion criteria for the final review. The most commonly perceived barrier for patients relates to receiving adequate support from elsewhere and a lack of perceived need for psychosocial care. Health professionals report barriers at an organisational level most frequently followed by cultural and then individual clinician-related barriers. CONCLUSIONS Barriers exist on a variety of levels. People with cancer need clear appropriate information and communication about psychosocial services, including information about the role of psychosocial care in addition to existing supports. Interventions that target the complex interplay of individual, organisational and cultural factors need to be developed. Strategies that improve health professional communication skills, identify clear referral pathways, improve acceptability of interventions and clearly identify the need for services could address many of the barriers identified in this review.
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Affiliation(s)
- Sophie Dilworth
- School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
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25
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van Gurp J, Hasselaar J, van Leeuwen E, Hoek P, Vissers K, van Selm M. Connecting with patients and instilling realism in an era of emerging communication possibilities: a review on palliative care communication heading to telecare practice. PATIENT EDUCATION AND COUNSELING 2013; 93:504-514. [PMID: 23906650 DOI: 10.1016/j.pec.2013.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Appropriate palliative care communication is pivotal to optimizing the quality of life in dying patients and their families. This review aims at describing communication patterns in palliative care and discussing potential relations between communication patterns and upcoming telecare in the practice of palliative care. METHODS This review builds on a systematic five-step qualitative analysis of the selected articles: 1. Development of a 'descriptive table of studies reviewed' based on the concept of genre, 2. Open coding of table content and first broad clustering of codes, 3. Intracluster categorization of inductive codes into substantive categories, 4. Constant inter- and intracluster comparison results in identification of genres, and 5. Labeling of genres. RESULTS This review includes 71 articles. In the analysis, two communication genres in palliative care proved to be dominant: the conversation to connect, about creating and maintaining a professional-patient/family relationship, and the conversation to instill realism, about telling a clinical truth without diminishing hope. CONCLUSION The abovementioned two genres clarify a logical intertwinement between communicative purposes, the socio-ethical background underlying palliative care practice and elements of form. PRACTICE IMPLICATIONS Our study supports understanding of current communication in palliative care and anticipates future communicative actions in an era of new communication technologies.
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Affiliation(s)
- Jelle van Gurp
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.
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Frey R, Gott M, Banfield R. What indicators are measured by tools designed to address palliative care competence among ‘generalist’ palliative care providers? A critical literature review. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x11y.0000000003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Griffiths J, Ewing G, Rogers M. Early support visits by district nurses to cancer patients at home: a multi-perspective qualitative study. Palliat Med 2013; 27:349-57. [PMID: 22801979 DOI: 10.1177/0269216312451949] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many palliative cancer patients spend much of their last year at home. In the UK, district nurses make frequent support visits to patients and carers at this time, yet surprisingly little is known about their supportive role in palliative care. Current studies are limited to district nurses' reports of practice, which offer limited insight into their content. Patients' and carers' views on district nurse support visits are largely unknown. AIM To present findings of a multi-perspective study that explored how district nurse early support visits are both described and carried out. DESIGN Focus groups with district nurses to explore views on the purpose of early support visits. Observation of support visits to identify how they are conducted. Patient and carer interviews to elucidate and verify district nurse data. SETTING AND PARTICIPANTS Participants included 58 district nurses, 10 palliative care patients and nine carers from four Primary Care Trusts in contrasting urban and rural locations. RESULTS District nurses had difficulty articulating early support visits. Observations however revealed a complex role comprising extensive physical and practical assessments, practical interventions, information giving, liaison, facilitation and referral. Patients and carers confirmed that they felt valued, reassured and supported by district nurses. CONCLUSIONS A multi-perspective approach provided new insights into district nurse support visits. Monitoring work described appears to have additional psycho-social benefits for patients and carers. The supportive role of district nurses needs to be clearly articulated and recognised so that colleagues, patients and carers access this valuable resource for palliative care patients.
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Affiliation(s)
- Jane Griffiths
- University of Manchester, School of Nursing Midwifery and Social Work, Manchester, UK.
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Palliative care case management in primary care settings: a nationwide survey. Int J Nurs Stud 2013; 50:1504-12. [PMID: 23545141 DOI: 10.1016/j.ijnurstu.2013.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 02/26/2013] [Accepted: 03/02/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the content of care and organisational characteristics of case management in palliative care is needed. OBJECTIVES To investigate how many case management initiatives for palliative care there are in the Netherlands for patients living at home; to describe the characteristics of these initiatives with regard to content and organisation of care. SETTING Primary care. DESIGN AND PARTICIPANTS A nationwide survey of all 50 coordinators of networks in palliative care in the Netherlands was conducted. Additional respondents were found through snowball sampling. We looked at 33 possible initiatives using interviews (n=33) and questionnaires (n=30). RESULTS We identified 20 initiatives for case management. All stated that case management is supplemental to other care. In all initiatives the case managers are registered nurses and most possess higher vocational education and/or further training. All initiatives seek to identify the multidimensional care needs of the patients and the relatives and friends who care for them. Almost all provide information and support and refer patients who need care. Differences are found between the organisations offering the case management, their target groups, the names of the initiatives and whether direct patient care is provided by the case manager. CONCLUSIONS In the Netherlands, case management in palliative care is new. Several models of delivery were identified. Research is needed to gain insight into the best way to deliver case management. By describing characteristics of case management in palliative care, an important first step is made in identifying effective elements of case management.
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Walshe C, Ewing G, Griffiths J. Using observation as a data collection method to help understand patient and professional roles and actions in palliative care settings. Palliat Med 2012; 26:1048-54. [PMID: 22179595 DOI: 10.1177/0269216311432897] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Observational research methods are important for understanding people's actions, roles and behaviour. However, these techniques are underused generally in healthcare research, including research in the palliative care field. AIM The aim in this paper is to place qualitative observational data collection methods in their methodological context and provide an overview of issues to consider when using observation as a method of data collection. This paper discusses practical considerations when conducting palliative care research using observation. FINDINGS Observational data collection methods span research paradigms, and qualitative approaches contribute by their focus on 'natural' settings which allow the explanation of social processes and phenomena. In particular, they can facilitate understanding of what people do and how these can alter in response to situations and over time, especially where people find their own practice difficult to articulate. Observational studies can be challenging to carry out: we focus on the potentially problematic areas of sampling, consent and ethics, data collection and recording, data management and analysis. CONCLUSION Qualitative observational data collection methods can contribute to theoretical and conceptual development and the explanation of social processes in palliative care. In particular this contribution to understanding care structures and processes should improve understanding of patients' experiences of their care journey and thus impact on care outcomes.
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Affiliation(s)
- Catherine Walshe
- The School of Nursing, Midwifery and Social Work, University of Manchester, UK.
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30
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Gott M, Seymour J, Ingleton C, Gardiner C, Bellamy G. 'That's part of everybody's job': the perspectives of health care staff in England and New Zealand on the meaning and remit of palliative care. Palliat Med 2012; 26:232-41. [PMID: 21677020 DOI: 10.1177/0269216311408993] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND the right for patients of all diagnoses to be in receipt of palliative care from an early point in the diagnosis of a life-limiting condition is now enshrined in policy in a number of countries and increased emphasis is placed upon the role of generalist palliative care. However, little is known as to how this policy is enacted on the ground. AIM to explore understandings of, and perceived roles in relation to, palliative care provision amongst generalist and specialist health care providers in England and New Zealand. DESIGN qualitative data were collected via individual interviews and focus groups. SETTING/PARTICIPANTS participants comprised generalist and specialist palliative care providers working in a variety of settings in England (n = 58) and New Zealand (n = 80). RESULTS the following issues with significant implications for this new phase of development for palliative care were identified: (1) difficulties with terminology and perceived roles/responsibilities; (2) problems of integrating palliative care into a generalist workload; (3) challenges in generalist/specialist partnership working; and (4) the potential negative consequences of specialization. CONCLUSIONS these data indicate that, within England and New Zealand, the policy rhetoric of universal palliative care provision is not being straightforwardly translated into service delivery and individual clinical practice. Further research is required to explore and evaluate different models of organization and service provision that empower 'generalists' to provide palliative care, without resulting in deskilling. Finally, definitional clarity at an academic/policy level is also needed.
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Affiliation(s)
- Merryn Gott
- The University of Auckland, School of Nursing, Auckland, New Zealand.
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