1
|
Granrud MD, Grøndahl VA, Helgesen AK, Bååth C, Olsson C, Tillfors M, Melin-Johansson C, Österlind J, Larsson M, Hov R, Sandsdalen T. Health Care Personnel's Perspectives on Quality of Palliative Care During the COVID-19 Pandemic - A Cross-Sectional Study. J Multidiscip Healthc 2023; 16:2893-2903. [PMID: 37790989 PMCID: PMC10543989 DOI: 10.2147/jmdh.s419442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose The provision of high-quality palliative care is challenging, especially during a pandemic like COVID-19. The latter entailed major consequences for health care systems and health care personnel (HCP) in both specialist and community health care services, in Norway and worldwide. The aim of this study was to explore how the HCP perceived the quality of palliative care in nursing homes, medical care units, and intensive care units during the COVID-19 pandemic. Methods This study had a cross-sectional design. A total of 290 HCP from Norway participated in the study (RR = 25.8%) between October and December 2021. The questionnaire comprised items concerning respondents' demographics and quality of care, the latter measured by the short form of the Quality from the Patient's Perspective-Palliative Care instrument, adapted for HCP. The STROBE checklist was used. Results This study shows that the HCP scored subjective importance as higher in all dimensions, items and single items than their perception of the actual care received. This could indicate a need for improvement in all areas. Information about medication, opportunity to participate in decisions about medical and nursing care and continuity regarding receiving help from the same physician and nurse are examples of areas for improvement. Conclusion Study results indicate that HCP from nursing homes, medical care units, and intensive care units perceived that quality of palliative care provided was not in line with what they perceived to be important for the patient. This indicate that it was challenging to provide high-quality palliative care during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Marie Dahlen Granrud
- Department of Social Sciences and Guidance, Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Vigdis Abrahamsen Grøndahl
- Department of Nursing, Health and Laboratory Science, Faculty of Health, Welfare and Organization, Østfold University College, Halden, Norway
| | - Ann Karin Helgesen
- Department of Nursing, Health and Laboratory Science, Faculty of Health, Welfare and Organization, Østfold University College, Halden, Norway
| | - Carina Bååth
- Department of Nursing, Health and Laboratory Science, Faculty of Health, Welfare and Organization, Østfold University College, Halden, Norway
- Department of Health Sciences, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
| | - Cecilia Olsson
- Department of Health Sciences, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
- Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Oslo, Norway
| | - Maria Tillfors
- Department of Social and Psychological Sciences, Faculty of Arts and Social Sciences, Karlstad University, Karlstad, Sweden
| | | | - Jane Österlind
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Maria Larsson
- Department of Health Sciences, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
| | - Reidun Hov
- Centre of Development of Institutional and Home Care Services, Innland (Hedmark), Hamar Municipality, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| |
Collapse
|
2
|
Reid JC, Hoad N, Willison K, Hanmiah R, Brandt Vegas D, Mitri M, Boyle A, Weatherston A, Lohin S, McInnes D, Rudkowski JC, Joyner M, Cook DJ. Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards. BMJ Open Qual 2023; 12:bmjoq-2022-002219. [PMID: 37024148 PMCID: PMC10083844 DOI: 10.1136/bmjoq-2022-002219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES Caring for dying hospitalised patients is a healthcare priority. Our objective was to understand the learning needs of front-line nurses on the general internal medicine (GIM) hospital wards, and perceived barriers to, and facilitators of, optimal end-of-life care. METHODS We developed an 85-item survey informed by the Theoretical Domains Framework and Capability-Opportunity-Motivation-Behaviour system. We included demographics and two main domains (knowledge and practice; delivering end-of-life care) with seven subsections. Nurses from four GIM wards and the nursing resource team completed this survey. We analysed and compared results overall, by Capability, Opportunity, and Motivation, and by survey domain. We considered items with median scores <4/7 barriers. We conducted an a priori subgroup analysis based on duration of practice (≤5 and >5 years). RESULTS Our response rate was 60.5% (144/238). 51% had been practising for >5 years; most respondents were female (93.1%). Nurses had similar scores on the knowledge (mean 76.0%; SD 11.6%) and delivering care (mean 74.5% (8.6%)) domains. Scores for items associated with Capability were higher than those associated with Opportunity (median (first, third quartiles) 78.6% (67.9%, 87.5%) vs 73.9% (66.0%, 81.8%); p=0.04). Nurses practising >5 years had significantly higher scores on all analyses. Barriers included engaging with families having strong emotional reactions, managing goals of care conflicts between patients and families, and staffing challenges on the ward. Additional requested resources included formal training, information binders and more staff. Opportunities for consideration include formalised on-the-job training, access to comprehensive information, including symptom management at the end of life, and debriefing sessions. CONCLUSIONS Front-line nurses reported an interest in learning more about end-of-life care and identified important barriers that are feasible to address. These results will inform specific knowledge translation strategies to build capacity among bedside nurses to enhance end-of-life care practices for dying patients on GIM wards.
Collapse
Affiliation(s)
- Julie C Reid
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Neala Hoad
- Department of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Kathleen Willison
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Division of Palliative Care, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Rajendar Hanmiah
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Daniel Brandt Vegas
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mino Mitri
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Family Medicine, Division of Palliative Care, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Anne Boyle
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Family Medicine, Division of Palliative Care, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Amanda Weatherston
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Susan Lohin
- Department of Patient Experience, Quality, and Patient Safety, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Deborah McInnes
- Department of Patient Experience, Quality, and Patient Safety, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jill C Rudkowski
- Department of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Michelle Joyner
- Department of Patient Experience, Quality, and Patient Safety, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, Hamilton, Ontario, Canada
- Department of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Durieux BN, Berrier A, Catzen HZ, Gray TF, Lakin JR, Cunningham R, Morris SE, Tulsky JA, Sanders JJ. " I think that she would have wanted. . .": Qualitative interviews with bereaved caregivers reveal complexity in measuring goal-concordant care at the end of life. Palliat Med 2022; 36:742-750. [PMID: 35164612 DOI: 10.1177/02692163221078472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experts consider goal-concordant care an important healthcare outcome for individuals with serious illness. Despite their relationship to the patient and knowledge about the patient's wishes and values, little is known about bereaved family caregivers' perceptions of how end-of-life care aligns with patient goals and preferences. AIM To understand caregivers' perceptions about patients' care experiences, the extent to which care was perceived as goal-concordant, and the factors that contextualized the end-of-life care experience. DESIGN Qualitative interview study employing a semi-structured interview guide based on the National Health and Aging Trends Survey end-of-life planning module. Template analysis was used to identify themes. SETTING/PARTICIPANTS Nineteen recently bereaved family caregivers of people with serious illness in two academic medical centers in the Northeastern United States. RESULTS Most caregivers reported goal-concordant care, though many also recalled experiences of goal discordance. Three themes characterized care perceptions and related to perceived quality: communication, relationships and humanistic care, and care transitions. Within communication, caregivers described the importance of clear communication, inadequate prognostic communication, and information gaps that undermined caregiver confidence in decision making. Patient-clinician relationships enriched care and were considered higher-quality when felt to be humanistic. Finally, care transitions impacted goal discordance when marked by logistical barriers, a need to establish relationships with new providers, inadequate information transfer, and poor care coordination. CONCLUSIONS Bereaved caregivers commonly rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Communication, relationships and humanistic care, and care transitions are modifiable quality improvement targets for patients with advanced cancer.
Collapse
Affiliation(s)
| | - Anna Berrier
- Dana-Farber Cancer Institute, Boston, MA, USA.,Gillings School of Global Public Health at The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Tamryn F Gray
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Joshua R Lakin
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Rebecca Cunningham
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sue E Morris
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Justin J Sanders
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Alshammari F, Jenny Sim RN, Lapkin S, Moira Stephens RN. Registered nurses’ knowledge, attitudes and beliefs about end-of-life care in non-specialist palliative care settings: A mixed studies review. Nurse Educ Pract 2022; 59:103294. [DOI: 10.1016/j.nepr.2022.103294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/17/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
|
5
|
Limbu T, Taylor PM. Experiences of surgical nurses in providing end-of-life care in an acute care setting: a qualitative study. ACTA ACUST UNITED AC 2021; 30:1084-1089. [PMID: 34645337 DOI: 10.12968/bjon.2021.30.18.1084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The number of deaths occurring in hospitals is rising, and many occur in settings other than specialist palliative care, oncology or critical care. Nurses working outside these specialist environments report end-of-life (EoL) care as a source of stress. This research aimed to explore these experiences. AIMS AND METHODS This qualitative study, using semi-structured interviews as a research technique, aimed to investigate the experiences of surgical nurses caring for dying patients. RESULTS Five themes emerged: understanding of and preference for EoL care; perceived barriers while providing EoL care; robust support from the team as a facilitator while providing EoL care; symptom management; future training and support. CONCLUSION Participants considered providing EoL care as part of their professional role and reported that they were able to provide appropriate physical care. Participants identified challenges in providing emotional and psychological support to dying patients and their families in an acute surgical setting.
Collapse
Affiliation(s)
- Teju Limbu
- Staff Nurse, Nottingham City Hospital, Nottingham University Hospitals NHS Trust
| | - Paul M Taylor
- St Luke's Senior Clinical Lecturer in Palliative Medicine, School of Health and Related Research, University of Sheffield
| |
Collapse
|
6
|
Dokmai P, Meemon N, Paek SC, Tayjasanant S. Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand. BMC Health Serv Res 2021; 21:616. [PMID: 34183000 PMCID: PMC8240380 DOI: 10.1186/s12913-021-06623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals. Methods A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand. Results The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication. Conclusion This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.
Collapse
Affiliation(s)
- Parichat Dokmai
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
| | - Seung Chun Paek
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Supakarn Tayjasanant
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand
| |
Collapse
|
7
|
Nevin M, Hynes G, Smith V. Healthcare providers' views and experiences of non-specialist palliative care in hospitals: A qualitative systematic review and thematic synthesis. Palliat Med 2020; 34:605-618. [PMID: 32020829 DOI: 10.1177/0269216319899335] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Healthcare providers working in hospitals are frequently exposed to patients with palliative care needs. For most patients, these reflect non-specialist rather than specialist palliative care needs. Embedding palliative care principles early in patients' disease trajectories within acute care delivery in hospitals, however, is a challenge. How to best understand the experiences of those providing non-specialist palliative care in hospitals has not been systematically assessed. AIM To synthesise the evidence on healthcare providers' views and experiences of non-specialist palliative care in hospitals. DESIGN A qualitative systematic review and thematic synthesis using Thomas and Harden's thematic synthesis framework. DATA SOURCES Databases of MEDLINE, CINAHL, PsycINFO and EMBASE were searched from date of inception to March 2018. Studies were eligible for inclusion if they reported on healthcare providers' views and experiences of non-specialist palliative care in hospitals. Studies were appraised for quality but not excluded on that basis. The review was prospectively registered with the International Prospective Register of Systematic Reviews. RESULTS Thirty-nine papers of 37 studies were included, representing 985 hospital healthcare providers' views and experiences. Four major analytical themes emerged; 'Understanding of Palliative Care', 'Complexities of Communication', 'Hospital Ecosystem' and 'Doctors and Nurses - a Different Lens'. CONCLUSIONS Non-specialist palliative care in hospitals is operationalised as care in the last weeks and days of life. The organisation of acute care, inter-disciplinary working practices, clinician attitudes, poor communication structures and lack of education and training in palliative care principles exacerbates poor implementation of this care earlier for patients in hospitals.
Collapse
Affiliation(s)
- Mary Nevin
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Geralyn Hynes
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| |
Collapse
|
8
|
Hennessy N, Neenan K, Brady V, Sullivan M, Eustace-Cooke J, Timmins F. End of life in acute hospital setting-A systematic review of families' experience of spiritual care. J Clin Nurs 2020; 29:1041-1052. [PMID: 31891203 DOI: 10.1111/jocn.15164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/03/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To systematically review qualitative studies exploring families' experiences of spiritual care at the end of life in acute hospital settings. BACKGROUND Although there is a widespread belief that the consideration of spiritual and religious needs is outdated in the context of secularism, from a practical perspective patients and families appear to benefit from spiritual support at the end of life. METHODS Six key databases, CINAHL, MEDLINE, EMBASE, Global Health Library, Web of Science and Applied Social Sciences Index and Abstracts (ASSIA), were searched, and three reviewers independently extracted the data and coded them into themes and subthemes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used as a reporting framework. RESULTS Five main themes emerged: anticipating needs; honouring the family by honouring the patient; personal connection; lack of sensitivity; and making space for religious and spiritual practices. CONCLUSIONS Families experiencing end-of-life care in acute hospital settings may benefit from spiritual care. While this can also be considered as fundamental care, understanding this through the lenses of spiritual care allows for incorporation of religious and spiritual practices that many seek at this time, irrespective of their faith perspectives. RELEVANCE TO CLINICAL PRACTICE Although hospice care is well established internationally, many families experience end-of-life care in acute hospital settings. Nurses usually get to know families well during this time; however, the demands of the clinical environment place restrictions on family care and perceptions of lack of communication, limited support and/or limited sensitivity can compound families' suffering. Consideration of families' spiritual needs can help to support families during this time. Nurses are ideally placed for this and can anticipate and plan for patient and family needs in this regard, or refer to a specialist, such as the Healthcare Chaplain.
Collapse
Affiliation(s)
- Nora Hennessy
- The University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kathleen Neenan
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Vivienne Brady
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Melissa Sullivan
- The University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Fiona Timmins
- The School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| |
Collapse
|
9
|
Bergenholtz H, Timm HU, Missel M. Talking about end of life in general palliative care - what's going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark. BMC Palliat Care 2019; 18:62. [PMID: 31345196 PMCID: PMC6657144 DOI: 10.1186/s12904-019-0448-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/18/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND End-of-life (EOL) conversations in hospital should serve to give patients the opportunity to consider future treatment options and help them clarify their values and wishes before it becomes relevant to make decisions about treatment. However, it is known that EOL conversations are not performed systematically in hospital. This may mean that patients and their relatives do not address EOL issues. There is a lack of knowledge about who is responsible for conducting these conversations, and when and under what circumstances they are conducted. The aim of this study was to explore the existing practices regarding EOL conversations in an acute care hospital setting. METHODS The design was Interpretive Description and the methods for the data collection included: 1. Participatory observational studies in a pulmonary medical and surgical ward (a total of 66 h); 2. Four focus group interviews with healthcare professionals (n = 14) from the wards. The analysis followed Spradley's ethnosemantic analysis. RESULTS The results revealed three cultural categories related to: 1. The physical and organizational setting; 2. The timing of EOL conversations and competencies and roles in addressing EOL issues and 3. Topics addressed in EOL conversations. The EOL conversations were part of daily clinical practice, but there was a lack of competencies, roles were unclear and the physical and organizational environment was not conducive to the conversations. The topics of the EOL conversations revolved around a "here-and-now" status of the patient's disease progression and decisions about the level of treatment. To a lesser extent, the conversations included the patient's and relatives' thoughts and wishes concerning EOL, which allowed long-term care planning. CONCLUSION This study demonstrates that there are several barriers to talking about EOL in an acute care hospital setting, and future strategies must address an overall approach. In order to provide patients and their relatives with better opportunities to express their EOL wishes, there is a need for clearer roles and guidelines in an interdisciplinary approach to EOL conversations, alongside improved staff competencies and changes to the organizational and physical environment.
Collapse
Affiliation(s)
- Heidi Bergenholtz
- Holbaek Hospital, Smedelundsgade 60, 4300, Holbæk, Region Zealand, Denmark. .,REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark.
| | - Helle Ussing Timm
- REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark
| | - Malene Missel
- Rigshospitalet, Blegdamsvej 9, 2000, Copenhagen, Denmark
| |
Collapse
|
10
|
Thompson GN, Mcclement SE, Daeninck PJ. “Changing Lanes”: Facilitating the Transition from Curative to Palliative Care. J Palliat Care 2019. [DOI: 10.1177/082585970602200205] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little empirical work has been conducted assessing the perspectives of nurses regarding the barriers, facilitators, and strategies associated with achieving quality patient care at the end of life. A grounded theory study was conducted examining nursing behaviours and social processes inherent in the provision of quality end-of-life care from the perspective of generalist nurses (n=10) working in an acute care setting. An inductively derived preliminary model, “creating a haven for safe passage”, was developed based on the findings from this study and has been published elsewhere (1). This article provides a detailed description of one of the subprocesses of the model regarding the transition from curative to palliative care—the subprocess of “facilitating and maintaining a lane change”. The various strategies which nurses used to effect a lane change, as well as the facilitators and barriers they encountered in this process, are presented. The consequences associated with both successful and unsuccessful lane changes are reported.
Collapse
Affiliation(s)
| | - Susan E. Mcclement
- Faculty of Nursing, University of Manitoba, and Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg
| | - Paul J. Daeninck
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
11
|
Meeker MA, McGinley JM, Jezewski MA. Metasynthesis: Dying adults' transition process from cure-focused to comfort-focused care. J Adv Nurs 2019; 75:2059-2071. [PMID: 30734354 DOI: 10.1111/jan.13970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
AIM To describe and explain the process of transition from cure-focused to comfort-focused health care as perceived and reported by patients, family members, and healthcare providers. BACKGROUND Moving into the last phase of life due to advanced illness constitutes a developmental transition with increased vulnerability for patients and family. DESIGN Qualitative metasynthesis. DATA SOURCES Medline, CINAHL, and PsycInfo databases searched from inception through March 2016. Primary research reports published from 1990 to 2015, using qualitative designs to report transition experiences of patients, family members, and/or healthcare providers were included. REVIEW METHODS Key elements were extracted and organized into matrices. Findings from each report were analysed using qualitative coding. RESULTS The sample was 56 unique reports from 50 primary studies. Patients and families emphasized the importance of receiving understandable information, emotional support, respect for personhood and control. The critical juncture of 'realizing terminality' preceded a transition to comfort-focused care. Subsequently, a shift in goals of care emphasizing comfort and quality of life could occur. Continued provision of information, effective support, respect and control promoted 'reframing perceptions' and capacity to embrace a changed identity. Reframing allowed patient and family to find meaning and value in this last phase of life and to embrace the opportunity to prepare for death, nurture relationships, and focus on quality of living. CONCLUSION Understanding the developmental process that can be engaged by patients and families at the end of life provides a theoretical basis that can inform choice and timing of interventions to reduce suffering and enhance positive outcomes.
Collapse
|
12
|
Muskat B, Greenblatt A, Anthony S, Beaune L, Hubley P, Newman C, Brownstone D, Rapoport A. The experiences of physicians, nurses, and social workers providing end-of-life care in a pediatric acute-care hospital. DEATH STUDIES 2019; 44:105-116. [PMID: 30832553 DOI: 10.1080/07481187.2018.1526829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This qualitative study explored the experiences of social workers, nurses, and physicians providing end-of-life care to children in a pediatric acute-care hospital setting. Findings demonstrated that participants experienced both professional and personal impacts of their work and employed various coping strategies under each of these domains. The acute-care setting was found to create unique challenges in providing end-of-life care. Implications for policy and practice include promotion of both individual and institutional-level coping strategies and supports that meet the various needs of staff. Implications for future research include a nuanced examination of differences in experiences among nurses, social workers, and physicians.
Collapse
Affiliation(s)
- Barbara Muskat
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Greenblatt
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha Anthony
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laura Beaune
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pam Hubley
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christine Newman
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Brownstone
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Rapoport
- Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Karbasi C, Pacheco E, Bull C, Evanson A, Chaboyer W. Registered nurses' provision of end-of-life care to hospitalised adults: A mixed studies review. NURSE EDUCATION TODAY 2018; 71:60-74. [PMID: 30245257 DOI: 10.1016/j.nedt.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/04/2018] [Accepted: 09/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe, critically appraise and synthesise research regarding nurses' perceptions of their knowledge, skills or experiences in providing end-of-life care to hospitalised adults to help inform both future educational and practice initiatives. DESIGN Mixed studies review. DATA SOURCES MEDLINE, CINAHL, Cochrane Library, Web of Science and SCOPUS databases were searched for the years 2004-June 2018, along with journal hand-searching and reference list searching. REVIEW METHODS Two independent reviewers screened the titles and abstracts of studies. Data extraction and quality assessment using the Mixed Methods Appraisal Tool was conducted independently by two reviewers. Disagreements were adjudicated by a third reviewer. Study findings were synthesised thematically. RESULTS Nineteen studies met the inclusion criteria. Of them, ten were quantitative, eight qualitative and one mixed-method. All but one quantitative study were conducted in the United States and all but one used some form of survey. The qualitative studies were conducted in a variety of countries and all but one used some form of interview for data collection. Five themes were identified including nurse as a protecting provider, nurse as an advocate, nurse as a reflective practitioner, obstacles to providing quality end-of-life care and aids to providing quality end-of-life care. CONCLUSIONS Registered Nurses have aligned their end-of-life care with practice with the profession's expectations and are enacting a patient centred approach to their practice. They rely on reflective practices and on the support of others to overcome organisational, educational and emotional the challenges they to providing quality end-of-life care.
Collapse
Affiliation(s)
- C Karbasi
- Nursing, Physiotherapy and Podiatry Faculty of the Complutense University of Madrid, 28040 Madrid, Spain.
| | - E Pacheco
- Nursing, Physiotherapy and Podiatry Faculty of the Complutense University of Madrid, 28040 Madrid, Spain.
| | - C Bull
- Centre for Applied Health Economics (CAHE), Griffith University, Nathan Campus, 4111 QLD, Australia.
| | - A Evanson
- North West Hospital and Health Service, Mount Isa Hospital, 30 Camooweal Street, QLD 4825, Australia.
| | - W Chaboyer
- Menzies Health Institute Queensland, Griffith University, 4215 QLD, Australia.
| |
Collapse
|
14
|
Donnelly S, Prizeman G, Coimín DÓ, Korn B, Hynes G. Voices that matter: end-of-life care in two acute hospitals from the perspective of bereaved relatives. BMC Palliat Care 2018; 17:117. [PMID: 30340568 PMCID: PMC6195738 DOI: 10.1186/s12904-018-0365-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland. Methods This was a quantitative descriptive post-bereavement postal survey, gathering data retrospectively from relatives or friends of patients who died, utilising an adapted version of the VOICES (Views of Informal Carers - Evaluation of Services) questionnaire. VOICES MaJam has 29 core questions, seven questions requesting personal demographic information and four open-ended questions gathering descriptive data about the care experience during the patient’s last admission to hospital. A total of 356 valid questionnaires were returned. Qualitative data were managed, coded and analysed with NVivo 10, using a template analysis framework approach. Results Three quarters (75%: n = 268) responded to at least one of the open-ended questions. Several key themes emerged, indicating areas that require particular attention in EoLC. Two themes relate to how care needs are met and how the hospital environment has a critical influence on EoLC experiences. The remaining three themes relate more to the interpersonal context including whether patients are treated with dignity and respect, the psychological, emotional and spiritual needs of patients and their family members and communication. Conclusions Acute hospitals need to ensure that patients and their relatives receive high quality EoLC. Seeking the views of bereaved relatives should be considered by all hospitals and healthcare settings to ascertain the quality of care at end of life. This study contributes to our understanding and knowledge of what good EoLC looks like and where care can be improved, thus enabling hospitals to direct and inform quality improvement.
Collapse
Affiliation(s)
- Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Geraldine Prizeman
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
| | - Diarmuid Ó Coimín
- Mater Misericordiae University Hospital, Quality and Patient Safety Directorate, Eccles Street, Dublin 7, Ireland
| | - Bettina Korn
- 1st Floor CEO Building, St. James's Hospital, James Street, Dublin 8, Ireland
| | - Geralyn Hynes
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
| |
Collapse
|
15
|
Oliveira I, Fothergill-Bourbonnais F, McPherson C, Vanderspank-Wright B. Battling a Tangled Web: The Lived Experience of Nurses Providing End-of-Life Care on an Acute Medical Unit. Res Theory Nurs Pract 2018; 30:353-378. [PMID: 28304263 DOI: 10.1891/1541-6577.30.4.353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Meeting the heath care needs of patients at the end of life is becoming more complex. In Canada, most patients with life-limiting illness will die in hospitals, many on medical units. Yet, few studies have qualitatively investigated end-of-life care (EOLC) in this context, or from the perspectives of nurses providing EOLC. The purpose of this study was to seek to understand the lived experience of nurses on a medical unit providing EOLC to patients. Interpretive phenomenology guided the method and analysis. Individual face-to-face interviews were conducted with 10 nurses from 2 hospital medical units. The underlying essence of these nurses' experiences was that of "battling a tangled web." Battling a tangled web represented their struggles in attempting to provide EOLC in an environment that was not always conducive to it. Seven themes were generated from the analysis: caring in complexity, caught in a tangled web, bearing witness to suffering, weaving a way to get there: struggling through the process, creating comfort for the patient, working through the dying process with the family, and finding a way through the web. The findings contribute to an understanding of the experiences of nurses in providing EOLC on a medical unit including perceived facilitators and barriers.
Collapse
|
16
|
Ranse K, Ranse J, Pelkowitz M. Third-year nursing students' lived experience of caring for the dying: a hermeneutic phenomenological approach. Contemp Nurse 2018; 54:160-170. [PMID: 29669455 DOI: 10.1080/10376178.2018.1461572] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In preparation for practice as a Registered Nurse, it is essential that students are equipped to care for the dying patient and their family. AIM To explore nursing students' lived experience of caring for a dying patient and their family. DESIGN Hermeneutic phenomenology. METHODS Students who had cared for a dying patient in their final year of study were invited to participate in an interview. Participants' narratives (n = 6) were thematically analysed. FINDINGS Analysis revealed three themes: being caring, unexpectedness in witnessing an expected death and experiencing loss. Students demonstrated family-centred care but recounted unexpectedness in both the dying trajectory and physical changes in the dying patient. When reflecting on experiencing loss, students questioned their own actions, acknowledged the value of relationships and identified ways to cope. CONCLUSIONS Engaging students in the care of dying patients and providing appropriate preparation/support can influence their experience and the care they provide in the future.
Collapse
Affiliation(s)
- Kristen Ranse
- a School of Nursing & Midwifery, Gold Coast Campus , Griffith University , Southport , Queensland , Australia.,b School of Nursing & Midwifery, Faculty of Health , University of Canberra , Canberra , Australia
| | - Jamie Ranse
- a School of Nursing & Midwifery, Gold Coast Campus , Griffith University , Southport , Queensland , Australia.,c Department of Emergency Medicine , Gold Coast Hospital and Health Services , Southport , Queensland , Australia
| | - Mikayla Pelkowitz
- b School of Nursing & Midwifery, Faculty of Health , University of Canberra , Canberra , Australia
| |
Collapse
|
17
|
Listening to How Experienced Nurses Care for the Dying Husband and His Spouse. Dimens Crit Care Nurs 2018; 36:193-201. [PMID: 28375996 DOI: 10.1097/dcc.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although most nurses in critical care settings provide nursing care for marital couples when 1 of the partners is dying, this is a relatively new area of research. OBJECTIVE The aim of this study is to describe the nature of nursing care provided for marital couples in the critical care unit when the husbands were dying. METHOD A qualitative interpretive description was used to construct this study. Data were collected by conducting semistructured individual interviews with 15 experienced critical care nurses in quiet conference rooms. The initial sample was recruited by invitation, and then followed by the snowball method. Institutional review board approval was obtained at the supporting institution. Interviews were recorded and transcribed to facilitate analysis. Data were analyzed line by line with constant comparison to formulate key ideas and then organized into themes. RESULTS Three themes were identified: (a) experienced nurses support the wife and husband, (b) experienced nurses connect spiritually with the wife and husband, and (c) experienced nurses provide skillful care for the wife and her husband who is dying. These themes form a description of the nature of nursing care needed by novice nurses. Emphasis for novice nurses includes focusing on the uniqueness of the marital couple as the patient, being less task oriented, and being more emotionally sensitive to the needs of the marital dyad. In this study, experienced nurses relay the importance of engaging self with these couples and being present at the end of life. DISCUSSION Future research directions are to explore innovative ways nurses may provide spiritual and emotional support to these marital couples and to measure what care activities the wife deems most beneficial for her and her husband at his end of life.
Collapse
|
18
|
Sagha Zadeh R, Eshelman P, Setla J, Kennedy L, Hon E, Basara A. Environmental Design for End-of-Life Care: An Integrative Review on Improving the Quality of Life and Managing Symptoms for Patients in Institutional Settings. J Pain Symptom Manage 2018; 55:1018-1034. [PMID: 28935129 PMCID: PMC5856462 DOI: 10.1016/j.jpainsymman.2017.09.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT The environment in which end-of-life (EOL) care is delivered can support or detract from the physical, psychological, social, and spiritual needs of patients, their families, and their caretakers. OBJECTIVES This review aims to organize and analyze the existing evidence related to environmental design factors that improve the quality of life and total well-being of people involved in EOL care and to clarify directions for future research. METHODS This integrated literature review synthesized and summarized research evidence from the fields of medicine, environmental psychology, nursing, palliative care, architecture, interior design, and evidence-based design. RESULTS This synthesis analyzed 225 documents, including nine systematic literature reviews, 40 integrative reviews, three randomized controlled trials, 118 empirical research studies, and 55 anecdotal evidence. Of the documents, 192 were peer-reviewed, whereas 33 were not. The key environmental factors shown to affect EOL care were those that improved 1) social interaction, 2) positive distractions, 3) privacy, 4) personalization and creation of a home-like environment, and 5) the ambient environment. Possible design interventions relating to these topics are discussed. Examples include improvement of visibility and line of sight, view of nature, hidden medical equipment, and optimization of light and temperature. CONCLUSION Studies indicate several critical components of the physical environment that can reduce total suffering and improve quality of life for EOL patients, their families, and their caregivers. These factors should be considered when making design decisions for care facilities to improve physical, psychological, social, and spiritual needs at EOL.
Collapse
Affiliation(s)
- Rana Sagha Zadeh
- Design and Environmental Analysis, Cornell University, Ithaca, New York, USA.
| | - Paul Eshelman
- Design and Environmental Analysis, Cornell University, Ithaca, New York, USA
| | - Judith Setla
- Department of Medicine Voluntary Faculty, SUNY Upstate Medical University, Syracuse, New York, USA; The Hospice of Central New York, Liverpool, New York, USA
| | - Laura Kennedy
- Design & Environmental Analysis, Cornell University, Portland, Oregon, USA
| | - Emily Hon
- New York Medical College, Valhalla, New York, USA
| | - Aleksa Basara
- Department of Economics, Cornell University, Ithaca, New York, USA
| |
Collapse
|
19
|
Omar Daw Hussin E, Wong LP, Chong MC, Subramanian P. Nurses’ perceptions of barriers and facilitators and their associations with the quality of end‐of‐life care. J Clin Nurs 2017; 27:e688-e702. [DOI: 10.1111/jocn.14130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emni Omar Daw Hussin
- Department of Nursing Science Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Mei Chan Chong
- Department of Nursing Science Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Pathmawathi Subramanian
- Pathmawathi Subramanian Nursing Synergy Ptd Ltd. 18.USJ 1/3K, USJ 1 Subang Jaya 47100 Malaysia
| |
Collapse
|
20
|
Odachi R, Tamaki T, Ito M, Okita T, Kitamura Y, Sobue T. Nurses' Experiences of End-of-life Care in Long-term Care Hospitals in Japan: Balancing Improving the Quality of Life and Sustaining the Lives of Patients Dying at Hospitals. Asian Nurs Res (Korean Soc Nurs Sci) 2017; 11:207-215. [DOI: 10.1016/j.anr.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 12/24/2022] Open
|
21
|
Abstract
The purpose of this concept analysis paper is to delineate the meaning of good death in long term care (LTC) settings and examine its implications for nursing. The Walker and Avant (2011) method was chosen for this analysis. An in depth literature review identifies uses of the concept and determines the defining attributes of the good death. This paper also illustrates case presentations, antecedents, consequences, empirical referents and implications for clinical practice to clarify the concept of 'good death' in this population. In LTC, death is experienced frequently and is considered the ultimate outcome for most admissions. Much of the existing research on end-of-life care has focused on community dwelling cancer patients whose death trajectory is predictable and who may remain cognitively intact until actively dying. In contrast, the LTC population is older and more likely to suffer from dementia and experience chronic illness for long periods prior to death, and they follow a less predictable death trajectory. In this century, death became the province of older people and the assurance of a good death became the responsibility of those caring for them.
Collapse
Affiliation(s)
- Preetha Krishnan
- Nurse Practitioner, Winnipeg Regional Health Authority, Winnipeg, Canada
| |
Collapse
|
22
|
Raymond A, Lee SF, Bloomer MJ. Understanding the bereavement care roles of nurses within acute care: a systematic review. J Clin Nurs 2017; 26:1787-1800. [DOI: 10.1111/jocn.13503] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Anita Raymond
- School of Nursing and Midwifery; Monash University; Frankston Australia
- Federation University Australia; Churchill Australia
| | - Susan F Lee
- School of Nursing and Midwifery; Monash University; Frankston Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery; Deakin University and Centre for Quality and Patient Safety Research; Geelong Australia
| |
Collapse
|
23
|
Chuah PF, Lim ML, Choo SL, Woo GY, To HK, Lau KY, Chen J, Lian SB. A qualitative study on oncology nurses’ experiences of providing palliative care in the acute care setting. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816660322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: With the renewed emphasis on palliative care in Singapore, coupled with a dearth of studies on provision of palliative care in acute services, it is timely to explore the experiences, barriers and challenges faced by oncology nurses in the acute care setting. Aim: This study aimed to explore nurses’ experiences of providing palliative care in the acute oncology care unit. Method: An exploratory descriptive research methodology was adopted. Focus group interviews, involving a total of 24 nurses, were conducted. Interviews were audio-taped and transcribed verbatim. Data was analyzed using an inductive content analysis approach. Results: Five key themes emerged from the analysis: (1) nurses’ perceptions of palliative care; (2) multiple roles of nurses in palliative care; (3) emotional burden of providing palliative care; (4) misconceptions of palliative care; (5) challenges in providing palliative care. Conclusion: The provision of palliative care in the acute care setting remained challenging. This is partly due to the attitudes of patients, families and healthcare workers, as well as organizational factors such as lack of training. Nurses play an important role in giving and facilitating palliative care for patients in the hospitals. Future studies can explore interventions to help overcome the challenges that are impeding nurses from providing high-quality palliative care in the acute care setting.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Juan Chen
- Singapore General Hospital, Singapore
| | | |
Collapse
|
24
|
Perkins E, Gambles M, Houten R, Harper S, Haycox A, O’Brien T, Richards S, Chen H, Nolan K, Ellershaw JE. The care of dying people in nursing homes and intensive care units: a qualitative mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn England and Wales the two most likely places of death are hospitals (52%) and nursing homes (22%). The Department of Health published its National End of Life Care Strategy in July 2008 (Department of Health.End of Life Care Strategy: Promoting High Quality Care For All Adults at the End of Life. London: Department of Health; 2008) to improve the provision of care, recommending the use of the Liverpool Care Pathway for the Dying Patient (LCP).AimThe original aim was to assess the impact of the LCP on care in two settings: nursing homes and intensive care units (ICUs).DesignQualitative, matched case study.MethodsData were collected from 12 ICUs and 11 nursing homes in England: (1) documentary analysis of provider end-of-life care policy documents; (2) retrospective analysis of 10 deaths in each location using written case notes; (3) interviews with staff about end-of-life care; (4) observation of the care of dying patients; (5) analysis of the case notes pertaining to the observed patient’s death; (6) interview with a member of staff providing care during the observed period; (7) interview with a bereaved relative present during the observation; (8) economic analysis focused on the observed patients; and (9) strict inclusion and selection criteria for nursing homes and ICUs applied to match sites on LCP use/non-LCP use.ResultsIt was not possible to meet the stated aims of the study. Although 23 sites were recruited, observations were conducted in only 12 sites (eight using the LCP). A robust comparison on the basis of LCP use could not, therefore, take place. Although nurses in both settings reported that the LCP supported good care, the LCP was interpreted and used differently across sites, with the greatest variation in ICUs. Although not able to address the original research question, this study provides an unprecedented insight into care at the end of life in two different settings. The majority of nursing homes had implemented some kind of ‘pathway’ for dying patients and most homes participating in the observational stage were using the LCP. However, training in care of the dying was variable and specific issues were identified relating to general practitioner involvement, the use of anticipatory drugs and the assessment of consciousness and the swallowing reflex. In ICUs, end-of-life care was inextricably linked with the withdrawal of active treatment and controlling the pace of death. The data highlight how the decision to withdraw was made and, importantly, how relatives were involved in this process. The fact that most patients died soon after the withdrawal of interventions was reported to limit the appropriateness of the LCP in this setting.LimitationsAlthough the recruitment of matched sites was achieved, variable site participation resulted in a skewed sample. Issues with the sample size and a blurring of LCP use and non-use limit the extent to which the ambitious aims of the study were achieved.ConclusionsThis study makes a unique contribution to understanding the complexity of care at the end of life in two very different settings. More research is needed into the ways in which an organisational culture can be created within which the principles of good end-of-life care become translated into practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Elizabeth Perkins
- Health and Community Care Research Unit, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Maureen Gambles
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Rachel Houten
- Management School, University of Liverpool, Liverpool, UK
| | - Sheila Harper
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Alan Haycox
- Management School, University of Liverpool, Liverpool, UK
| | - Terri O’Brien
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sarah Richards
- Management School, University of Liverpool, Liverpool, UK
| | - Hong Chen
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kate Nolan
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John E Ellershaw
- Marie Curie Palliative Care Institute Liverpool, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
25
|
Abu-Ghori IK, Bodrick MM, Hussain R, Rassool GH. Nurses’ involvement in end-of-life care of patients after a do not resuscitate decision on general medical units in Saudi Arabia. Intensive Crit Care Nurs 2016; 33:21-9. [DOI: 10.1016/j.iccn.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/26/2022]
|
26
|
Ranse K, Yates P, Coyer F. Modelling end-of-life care practices: Factors associated with critical care nurse engagement in care provision. Intensive Crit Care Nurs 2016; 33:48-55. [DOI: 10.1016/j.iccn.2015.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/29/2015] [Accepted: 11/23/2015] [Indexed: 11/16/2022]
|
27
|
Pringle J, Johnston B, Buchanan D. Dignity and patient-centred care for people with palliative care needs in the acute hospital setting: A systematic review. Palliat Med 2015; 29:675-94. [PMID: 25802322 DOI: 10.1177/0269216315575681] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A core concept behind patient-centred approaches is the need to treat people with, and preserve, dignity in care settings. People receiving palliative care are one group who may have particularly sensitive needs in terms of their condition, symptoms and life expectancy. Dignity is more likely to be violated in hospital settings. Given the high percentage of people with palliative care needs who are admitted to hospital during their last year of life, the provision of dignity enhancing and preserving care in that setting is of vital importance. AIM To examine international evidence relating to dignity and person-centred care for people with palliative care needs in the acute hospital setting. DESIGN A systematic literature review was conducted, incorporating data extraction, analysis and quality appraisal of included papers. DATA SOURCES MEDLINE, CINAHL, PsycINFO, ASSIA, EMBASE, Cochrane Database and Web of Science. Inclusion dates: 1 January 2000-1 April 2014. ELIGIBILITY CRITERIA Adult palliative care, acute care setting, dignity or person-centred care. RESULTS In all, 33 papers met the inclusion criteria for the review. Papers highlighted the many and varied potential threats to dignity for people with palliative care needs in acute settings, including symptom control and existential distress, approaches and models in care provision and healthcare settings and design. CONCLUSION Acute hospital staff require adequate training, including symptom control, and the correct environment in which to deliver dignified and person-centred end-of-life care. Specific models/approaches to care can be beneficial, if adequate training regarding implementation is given. The needs of family members also require consideration, particularly following bereavement.
Collapse
Affiliation(s)
- Jan Pringle
- School of Education, Social Work and Community Education, University of Dundee, Dundee, UK
| | - Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, The University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | | |
Collapse
|
28
|
Bergenholtz H, Hølge-Hazelton B, Jarlbaek L. Organization and evaluation of generalist palliative care in a Danish hospital. BMC Palliat Care 2015; 14:23. [PMID: 25943367 PMCID: PMC4431605 DOI: 10.1186/s12904-015-0022-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hospitals have a responsibility to ensure that palliative care is provided to all patients with life-threatening illnesses. Generalist palliative care should therefore be acknowledged and organized as a part of the clinical tasks. However, little is known about the organization and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. METHODS Results from three different data sets, all aiming to evaluate generalist palliative care, were compared retrospectively. The data-sets derived from; 1. a national accreditation of the hospital, 2. a national survey and 3. an internal self-evaluation performed in the hospital. The data were triangulated to investigate the organization and evaluation of palliative care in order to identify concordances and/or discrepancies. RESULTS The triangulation indicated poor validity of the results from existing methods used to evaluate palliative care in hospitals. When the datasets were compared, several discrepancies occurred with regard to the organization and the performance of generalist palliative care. Five types of discrepancies were found in 35 out of 56 sections in the fulfilment of the national accreditation standard for palliative care. Responses from the hospital management and the department managements indicated that generalist palliative care was organized locally--if at all--within the various departments and with no overall structure or policy. CONCLUSIONS This study demonstrates weaknesses in the existing evaluation methods for generalist palliative care and highlights the lack of an overall policy, organization and goals for the provision of palliative care in the hospital. More research is needed to focus on the organization of palliative care and to establish indicators for high quality palliative care provided by the hospital. The lack of valid indicators, both for the hospital's and the departments' provision of palliative care, calls for more qualitative insight in the clinical staff's daily work including their culture and acceptance of the provision of palliative care.
Collapse
Affiliation(s)
| | - Bibi Hølge-Hazelton
- Roskilde/Køge Hospitals, Region Zealand, Denmark.
- The Research Unit for General Practice and Section of General Practice Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Lene Jarlbaek
- PAVI, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| |
Collapse
|
29
|
Bergenholtz H, Jarlbaek L, Hølge-Hazelton B. The culture of general palliative nursing care in medical departments: an ethnographic study. Int J Palliat Nurs 2015; 21:193-201. [DOI: 10.12968/ijpn.2015.21.4.193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Heidi Bergenholtz
- PhD student, The Regional Research Unit, Region Zealand, Roskilde/Koege Hospitals, Denmark
| | - Lene Jarlbaek
- Consultant in Oncology, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Denmark
| | - Bibi Hølge-Hazelton
- Associate Research Professor at Roskilde/Koege Hospitals and The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| |
Collapse
|
30
|
Schouten B, Vlug-Mahabali M, Hermanns S, Spijker E, van Weert J. To Be Involved or Not to Be Involved? Using Entertainment-Education in an HIV-Prevention Program for Youngsters. HEALTH COMMUNICATION 2014; 29:762-772. [PMID: 24299216 DOI: 10.1080/10410236.2013.781938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The purpose of this study is to gain insight into factors that are associated with youngsters' involvement with dance4life, a global HIV-prevention program. The Youth Engagement Framework, which includes factors impacting youngsters' involvement on three levels (individual, social, and system), was used as a theoretical base. In total, 67 youngsters participated, with 21 of them still involved in dance4life's program, and 46 not. They either were individually interviewed or took part in subsequent online or face-to-face focus groups. Results show that both individual, social, and system-level factors are associated with youngsters' involvement. Involved youngsters have higher intrinsic motivation to prevent HIV, receive more social support from parents and friends, and are stimulated more by dance4life to remain part of their program than youngsters who are no longer involved. Hence, HIV-prevention programs should focus on all three levels simultaneously to successfully stimulate youngsters' involvement.
Collapse
Affiliation(s)
- Barbara Schouten
- a Department of Communication, Amsterdam School of Communication Research , University of Amsterdam
| | | | | | | | | |
Collapse
|
31
|
McCourt R, James Power J, Glackin M. General nurses' experiences of end-of-life care in the acute hospital setting: a literature review. Int J Palliat Nurs 2013; 19:510-6. [PMID: 24162282 DOI: 10.12968/ijpn.2013.19.10.510] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Approximately 90% of the UK population spend some time in hospital in their final year of life, and more than half of the population die in hospital. This review aims to explore the experiences of general nurses when providing end-of-life care to patients in the acute hospital setting. Nine studies were identified through a literature search, and each was then analysed and evaluated until themes emerged. Six themes were drawn from the literature: lack of education and knowledge, lack of time with patients, barriers arising in the culture of the health-care setting, communication barriers, symptom management, and nurses' personal issues. The themes cause concern about the quality of end-of-life care being provided in the acute care setting. The literature appears to be consistent in the view that terminally ill patients are best cared for in specialised care settings, such as palliative care units and hospices. However, increasing demands on health services will result in greater numbers of dying patients being admitted to the acute hospital setting. It is therefore paramount that general nurses' educational needs are met to ensure they develop clinical competence to provide high-quality holistic end-of-life care.
Collapse
|
32
|
The provision of end-of-life care by medical-surgical nurses working in acute care: a literature review. Palliat Support Care 2013; 12:393-408. [PMID: 24477088 DOI: 10.1017/s1478951513000965] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Caring for terminally ill patients is complex, stressful, and at times distressing for nurses. Acute care hospitals continue to be the predominant place of death for terminally ill patients in most Western countries. The objective of the present literature review was to explore and gain an in-depth understanding of the experience of providing end-of-life (EOL) care by medical-surgical RNs working in acute care hospitals, to identify knowledge gaps, and to recommend future research. METHOD A comprehensive literature review was conducted using the following electronic databases: CINAHL, MEDLINE, and PsyInfo (from 1992 to October 2012). RESULTS The findings from the 16 reviewed studies suggest that nurses felt a strong commitment to help terminally ill patients experience a good death. Nurses reported feeling deeply rewarded and privileged to share the EOL experience with patients/families. Organizational and individual factors influenced nurses' experience. Important challenges were associated with managing the divergent needs of a mixed patient load (i.e., curative and palliative care patients) in a biomedical culture of care that is heavily oriented toward cure and recovery. In this culture, nurses' emotional work and ideals of good EOL care are often not recognized and supported. SIGNIFICANCE OF RESULTS Managerial and organizational support that recognize the centrality of emotional work nurses provide to dying patients is needed. More research exploring ways to improve communication among nurses and medical colleagues is essential. Finally, a critical examination of the ideological assumptions guiding nurses' practice of EOL care within the context of acute care is recommended to help reveal their powerful influence in shaping nurses' overall understanding and experience of EOL care.
Collapse
|
33
|
Attitudes and Experiences of Nurses Toward Death and Caring for Dying Patients in Turkey. Cancer Nurs 2013; 36:E58-65. [DOI: 10.1097/ncc.0b013e318276924c] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Abstract
Recently there has been a rapid increase in the number of professional doctorates being undertaken in the UK. Nursing doctorates in particular are relatively new to the UK and therefore little is known about nurses' experiences of them, especially from a qualitative perspective. The aim of this study was to explore the experiences of nurses studying professional doctorates in health care, and in particular to determine what factors influence nurses in undertaking the programme, and to identity any challenges they encounter. Data were collected through semi-structured interviews and a purposeful sample of five was selected from a total of 24. Data were analysed using a grounded theory method. The desire to enhance professional and personal identity was the core influential factor, while challenges included the balance between family, social, work and academic responsibilities. Nurses created a system through the use of a range of coping mechanisms to overcome these challenges. Findings from this study could be informative for prospective students, academic staff and practitioners involved with doctorate students. This study could also be used as a preliminary analysis to form the basis for theoretical sampling in a larger scale study.
Collapse
|
35
|
Psychological impact of working with patients with cystic fibrosis at end-of-life, pre-transplant stage. Palliat Support Care 2012; 11:111-21. [PMID: 23234801 DOI: 10.1017/s147895151200079x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Multidisciplinary staff who work with end-of-life, pre-transplant patients with cystic fibrosis (CF) have to juggle two seemingly opposing care approaches; active care to maintain their patients' health and condition in anticipation of a transplant, and sensitive palliative care that takes their end-of-life wishes into consideration should they not receive a transplant. Little is known about the psychological impact on staff working within this care dichotomy. The aim of this study is to explore staff's experiences and understand more about the psychological impact of this work on them professionally and personally, and how this affects their ability to provide appropriate care for their patients. METHOD A qualitative explorative research design was used. Ten semistructured interviews with multidisciplinary staff working in cystic fibrosis centers and units across the United Kingdom were analyzed using interpretative phenomenological analysis (IPA). RESULTS Two superordinate themes emerged from the analysis: factors contributing to the "juggle" of active and palliative care, and extent of emotional impact on staff. SIGNIFICANCE OF RESULTS The study indicates that there is an emotional impact on staff working with patients with CF at end-of-life, pre-transplant stages. Specifically, it reveals the extent of the unpredictability that staff work with, and the range of emotions that staff experience, including uncertainty about professional identity and anxiety about working practices. The depth and intimacy of professional-patient relationships is highlighted, particularly for staff in close contact with and similar in age to their patients. Additionally, the strength of staff's commitment and desire to care for patients within broader humanistic terms that mesh with their own personal values is brought to light. Despite the difficulties with their work, the majority of staff adopted numerous coping strategies to manage their emotions, many of which emphasized the link between their professional and personal values in undertaking their roles.
Collapse
|
36
|
Nurses’ early experiences with patient death: The results of an on-line survey of Registered Nurses in New Zealand. Int J Nurs Stud 2012; 49:1255-65. [DOI: 10.1016/j.ijnurstu.2012.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 04/10/2012] [Accepted: 04/14/2012] [Indexed: 11/24/2022]
|
37
|
Allen M, Watts T. Promoting health and wellbeing at the end of life: the contribution of care pathways. Int J Palliat Nurs 2012; 18:348-54. [PMID: 22885967 DOI: 10.12968/ijpn.2012.18.7.348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Enhancing end-of-life care (EoLC) is a core component of international governments' health policies. Across the globe, nurses make significant contributions to EoLC and, at this delicate time, have the power to positively influence the health and wellbeing of those facing death. Indeed, health promotion is a core component of the nurse's role. Originating in the UK, EoLC pathways have been adopted around the world. Their broad aim is to optimise the quality of the dying process, enabling people to 'die well' across care settings. This paper examines EoLC pathways in terms of promoting health and wellbeing in this discrete stage of the dying trajectory. Concepts of health and health promotion are described briefly and the idea of health-promoting palliative care and its association with a good death examined. The ensuing discussion relates to two EoLC documents. While acknowledging that much has been achieved it is argued that, despite the potential for promoting health and wellbeing, a professionally led, biomedical approach predominates, and in terms of promoting health and wellbeing at the end of life there is a pressing need for proactive advance care planning at an earlier point in the illness trajectory.
Collapse
Affiliation(s)
- Michael Allen
- Sinngleton Hospital, Abertawe Bro-Morgannwg University Hospital Board, Swansea, Wales, UK
| | | |
Collapse
|
38
|
Clark JB, Sheward K, Marshall B, Allan SG. Staff perceptions of end-of-life care following implementation of the liverpool care pathway for the dying patient in the acute care setting: a New Zealand perspective. J Palliat Med 2012; 15:468-73. [PMID: 22500482 DOI: 10.1089/jpm.2011.0375] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND METHODS Ensuring appropriate palliative and end-of-life (EOL) care in the acute environment is complex and challenging. The Liverpool Care Pathway (LCP) aims to support staff to provide holistic EOL care utilizing a structured framework to prompt and guide care. We report on the post-implementation findings of a mixed methodology (survey and focus group [FG] forums) study into staff perceptions of EOL care following the pilot implementation of the LCP into two acute wards. RESULTS AND CONCLUSIONS Study results suggest that within acute settings staff perceive that the LCP improves EOL care overall, assists interdisciplinary communication around death and dying, and that is a useful tool to positively influence decision making and care delivery. Further research into aspects of staff communication, diagnosing dying, changing direction of care, and the physical environment is warranted.
Collapse
Affiliation(s)
- Jean B Clark
- MidCentral Health, Palmerston North, New Zealand.
| | | | | | | |
Collapse
|
39
|
Udo C, Danielson E, Melin-Johansson C. Existential issues among nurses in surgical care--a hermeneutical study of critical incidents. J Adv Nurs 2012; 69:569-77. [PMID: 22591004 DOI: 10.1111/j.1365-2648.2012.06032.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS To report a qualitative study conducted to gain a deeper understanding of surgical nurses' experiences of existential care situations. Background. Existential issues are common for all humans irrespective of culture or religion and constitute man's ultimate concerns of life. Nurses often lack the strategies to deal with patients' existential issues even if they are aware of them. DESIGN This is a qualitative study where critical incidents were collected and analysed hermeneutically. METHODS During June 2010, ten surgical nurses presented 41 critical incidents, which were collected for the study. The nurses were first asked to describe existential care incidents in writing, including their own emotions, thoughts, and reactions. After 1-2 weeks, individual interviews were conducted with the same nurses, in which they reflected on their written incidents. A hermeneutic analysis was used. FINDINGS The majority of incidents concerned nurses' experiences of caring for patients' dying of cancer. In the analysis, three themes were identified, emphasizing the impact of integration between nurses' personal self and professional role in existential care situations: inner dialogues for meaningful caring, searching for the right path in caring, and barriers in accompanying patients beyond medical care. CONCLUSION Findings are interpreted and discussed in the framework of Buber's philosophy of the relationships I-Thou and I-It, emphasizing nurses' different relationships with patients during the process of caring. Some nurses integrate their personal self into caring whereas others do not. The most important finding and new knowledge are that some nurses felt insecure and were caught somewhere in between I-Thou and I-It.
Collapse
Affiliation(s)
- Camilla Udo
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
| | | | | |
Collapse
|
40
|
|
41
|
Granda-Cameron C, Houldin A. Concept Analysis of Good Death in Terminally Ill Patients. Am J Hosp Palliat Care 2012; 29:632-9. [DOI: 10.1177/1049909111434976] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers’ evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient’s dignity, family presence, family support, and communication among patient, family, and health care providers.
Collapse
Affiliation(s)
- Clara Granda-Cameron
- Coordinator Palliative Care Program, Joan Karnell Cancer Center at Pennsylvania Hospital, Doctor Nursing Practice Student, Drexel University, Philadelphia, PA, USA
| | - Arlene Houldin
- Associate Professor of Psychosocial Oncology, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| |
Collapse
|
42
|
Ranse K, Yates P, Coyer F. End-of-life care in the intensive care setting: A descriptive exploratory qualitative study of nurses’ beliefs and practices. Aust Crit Care 2012; 25:4-12. [DOI: 10.1016/j.aucc.2011.04.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 03/15/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022] Open
|
43
|
Abstract
AIMS To discuss the intricacies of the decision-making process about initiating end-of-life care pathways. BACKGROUND Internationally, enhancing the quality of end-of-life care has become a central concern in governments' health policies. Despite limited empirical evaluation, end-of- life care pathways have been championed and widely adopted as complex interventions to enhance end-of-life care worldwide. DATA SOURCES A literature search of established electronic databases was conducted for published articles in English addressing decision-making and end-of-life care pathways between 1997-2010. Manual searches of relevant journals and internet sites were also undertaken. DISCUSSION The initiation of an end-of-life care pathway marks the transition to the terminal phase of care. Although guidance for commencing these pathways exists, this may not overcome the complexities of the decision-making process, which must be viewed in context, namely: marking the transition to terminal care, dealing with ambiguity, reaching professional consensus and engaging patients and families. Implications for nursing. Nurses in all care settings have an important role in easing the transition to end-of- life care. Accordingly, nurses need not only an appreciation of end-of-life care pathways, but the complexities surrounding the decision to commence a pathway and their role within. CONCLUSION The initiation of an end-of-life care pathway is contingent on the outcome of a complex decision-making process which is rarely explored and poorly understood.
Collapse
Affiliation(s)
- Tessa Watts
- Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, UK.
| |
Collapse
|
44
|
O'Hara T. Nurses' views on using the Liverpool care pathway in an acute hospital setting. Int J Palliat Nurs 2011; 17:239-44. [PMID: 21647078 DOI: 10.12968/ijpn.2011.17.5.239] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Liverpool Care Pathway (LCP) is one of three major recent UK initiatives to improve the care of people dying with malignant and non-malignant disease. This focus group research aimed to explore nurses' perceptions of using the LCP in an acute hospital setting, their perceptions of its impact on patient care, and their confidence in care at the end of life, as well as to generate new ideas among peers. Six themes were identified: use of the LCP as a care tool; improved confidence, training, and support; the nursing-medical relationship; dying in hospital; and end-of-life issues. The nurses reported that the LCP has increased their confidence and resulted in improved patient care. Exploring the effect of the LCP on patient care may provide valuable data that may inform how the LCP is integrated into practice in the future.
Collapse
|
45
|
Gannon M, Dowling M. Nurses’ experience of loss on the death of older persons in long-term residential care: findings from an interpretative phenomenological study. Int J Older People Nurs 2011; 7:243-52. [DOI: 10.1111/j.1748-3743.2011.00281.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
46
|
Nadimi F, Currow DC. As death approaches: a retrospective survey of the care of adults dying in Alice Springs Hospital. Aust J Rural Health 2011; 19:4-8. [PMID: 21265918 DOI: 10.1111/j.1440-1584.2010.01169.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Australians are more likely to die in a hospital than anywhere else, and most of these deaths are 'expected'. The aims of this survey were to identify if specific end-of-life issues were documented in clinical records of a regional hospital serving remote Australia. DESIGN A retrospective consecutive case-note audit covering 18 months from 1 January 2006. SETTING Alice Springs Hospital. PARTICIPANTS Adult deaths in Alice Springs Hospital. During this period there were 128 deaths. OUTCOME MEASURES Demographic, process (diagnosis of dying documented, 'not for resuscitation' documentation, intensive care unit (ICU) admission, social worker referral and specialised palliative care service referral) and outcome data ('comfort at end of life') were surveyed. RESULTS Of the 128 admissions, 55 cases were excluded: 10 were children under 18, 33 died in < 48 hours, nine were coroner's cases and three files could no't be found. Of the 73 deaths surveyed (33 men), 47 (64%) were Aboriginal. A diagnosis of dying was made in 84%, 88% had an 'not for resuscitation' order, 48% were admitted to ICU during their last admission, 66% were referred to social workers, 68% were referred to palliative care and 85% of people were documented to be 'comfortable' during the dying process with no differential outcomes for Aboriginal and non-Aboriginal decedents except age (P < 0.0001). CONCLUSION This survey highlights the continuing need to diagnose dying, understand optimal use of intensive care and improve comfort care at the end of life.
Collapse
Affiliation(s)
- Fariba Nadimi
- Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia.
| | | |
Collapse
|
47
|
Staff Perceptions of End-of-Life Care in the Acute Care Setting: A New Zealand Perspective. J Palliat Med 2011; 14:623-30. [DOI: 10.1089/jpm.2010.0470] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
48
|
Marshall B, Clark J, Sheward K, Allan S. Staff perceptions of end-of-life care in aged residential care: a New Zealand perspective. J Palliat Med 2011; 14:688-95. [PMID: 21495851 DOI: 10.1089/jpm.2010.0471] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasingly, aged residential care (ARC) facilities are places where the lives of older people with complex care needs end. Hence, end-of-life (EOL) care is a significant component of work for ARC staff. In the absence of New Zealand research, staff perceptions of EOL care were sought at three aged-care facilities in a New Zealand District Health Board region. The research provided valuable data regarding care delivery and can be used to inform the introduction of an integrated care pathway (ICP). EOL care pathways are not commonly used in New Zealand ARC facilities and the influence of ICPs, such as the Liverpool Care Pathway (LCP) for the dying patient has not been investigated. Additionally, most international studies report on the introduction of the LCP without baseline preimplementation data. DESIGN In the present study, staff (n = 195) involved in caring for residents, their families, and whānau at EOL were surveyed to obtain demographic data and staff perceptions of EOL care via Likert scale and open ended questions. RESULTS A response rate of 32% was obtained. Respondents indicated a relatively high level of confidence regarding their care of the dying, including aspects of communication, teamwork and use of documentation. However, this was often contradicted by their written responses. Written comments were analyzed thematically and six themes identified: the naturalness of dying; the character of care; care relationships; emotional response; knowledge; and the organizational environment. Data analysis provided a rich and informative description of staff perceptions of EOL and issues influencing care.
Collapse
Affiliation(s)
- Bridget Marshall
- Education and Research Unit, Arohanui Hospice, Palmerston North, New Zealand
| | | | | | | |
Collapse
|
49
|
|
50
|
James I, Andershed B, Gustavsson B, Ternestedt BM. Emotional knowing in nursing practice: In the encounter between life and death. Int J Qual Stud Health Well-being 2010; 5. [PMID: 20640014 PMCID: PMC2904589 DOI: 10.3402/qhw.v5i2.5367] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2010] [Indexed: 11/22/2022] Open
Abstract
Patients, next of kin and nurses in surgical wards often raise existential questions in the encounter between life and death. Nurses' emotional knowing at this encounter is crucial. Consequently, this study's purpose was to analyse and describe nurses' emotional knowing to reveal (a) how this knowing is expressed in daily work and (b) what emotions, thoughts and actions this knowing includes. This study used combined ethnographic and hermeneutic methodologies. Data were collected using participant observations, informal conversations and interviews. We found that nurses' emotional knowing could be interpreted in relation to various rooms of emotions, thoughts and actions. Nurses' judgements formed these rooms. They strived to do things correctly in the normative room; created a safe, secure milieu for patients and next of kin in the safety–security room; and questioned their actions in the critical room. They created affinity for co-operation that benefitted encounters with patients in their affinity room. And they demonstrated sensitivity and compassion to patients and next of kin; sensitivity and compassion were particularly evident in the closeness room. In our main interpretation, we found that nurses' judgements in various rooms (emotional knowing) constitute an expression of practical wisdom (phronesis) in nursing practice.
Collapse
Affiliation(s)
- Inger James
- School of Health and Medical Sciences, Orebro University, Orebro, Sweden
| | | | | | | |
Collapse
|