Exploring the Supportive Care Model as a Framework for Pediatric Palliative Care

Person-centred care: an overview of reviews

BACKGROUND

Existing evidence suggests that a person-centred approach can improve coordination and access to health care and services.

OBJECTIVES

This overview sought to: (1) identify and define components of person-centred care; (2) explore nursing and health-care provider behaviours that are person-centred; and (3) identify systems level supports required to enable person-centred care.

METHODS

An overview of reviews was conducted to locate synthesized literature published between June 2005 and April 2014. Two independent reviewers screened, extracted data and quality appraised the sources. Results were synthesized narratively.

RESULTS

A total of 46 articles were deemed relevant to this overview. This paper synthesizes the results of 43 of the 46 articles. A universal definition of person-centred care was not found, however; common components, associated health-care provider behaviours and the organizational supports required for person-centred care are discussed.

CONCLUSIONS

Key findings from this review outline that health-care providers and organizations need to promote person-centred care by engaging persons in partnerships, shared decision-making, and meaningful participation in health system improvement.

Evaluation of the currency of the Davies and Oberle (1990) model of supportive care in specialist and specialised palliative care settings in England

AIMS AND OBJECTIVES

To evaluate the extent to which the Davies and Oberle (1990) model of supportive nursing has currency across specialist and specialised care settings in England.

BACKGROUND

The model describes attributes of palliative nursing for practice and associated educational curricula. It is influential but predates introduction of specialist/specialised care. Its applicability in contemporary care settings has not been evaluated.

DESIGN

Evaluation was undertaken using sequential mixed methods, predominantly qualitative. Data collected during 2008-2009.

METHODS

Four stages: (1) focus groups involving hospital and community palliative clinical nurse specialists and nurses from three hospice settings (total = 25) to identify setting-specific characteristics, (2) survey of nurses (n = 48 respondents/31%) with follow-up interviews (n = 25) to identify congruence with the model, (3) interviews with patients (n = 6) and carers (n = 13) for practice evidence and (4) reconvened focus groups (n = 19 nurses) for confirmation.

RESULTS

All major dimensions were evidenced. 'Connecting' had reduced emphasis in the hospital setting where specialist nurses spend limited time with patients, but diminishing time to 'connect' with patients and carers as service develops could potentially become problematic across all settings. Two new dimensions ('Displaying expertise' and 'Influencing other professionals') with subdimensions (e.g. 'Advanced communication skills') are proposed as additions to reflect advanced practice. Further new subdimensions ('Making the assessment', 'Prioritising', 'Agreeing the plan') are suggested to be best aligned with the existing dimension 'Connecting'.

CONCLUSIONS

A revised model of supportive care incorporating dimensions of advanced nursing has currency in contemporary specialist/specialised care settings, although evaluation is required as to the actual impact of the model on care outcomes. 'Connecting' is currently being affected by pace of work and lateness of referrals.

IMPLICATIONS FOR PRACTICE

'Spending time' is increasingly difficult to sustain so challenging nurses as to how they may continue to 'connect' with patients as service delivery continues to change.