The nurse's role in palliative care: A qualitative meta-synthesis

Fostering nurse-patient relationships in palliative care: An integrative review with narrative synthesis

BACKGROUND

Nurse-patient relationships are an integral component of person-centred palliative care. Greater understanding of how nurse-patient relationships are fostered and perceived by patients and nurses can be used to inform nursing practice.

AIM

To systematically identify and synthesise how nurse-patient relationships are fostered in specialist inpatient palliative care settings, and how nurse-patient relationships were perceived by patients and nurses.

DESIGN

Integrative review with narrative synthesis. The review protocol was registered with PROSPERO (CRD42022336148, updated April, 2023).

DATA SOURCES

Five electronic databases (PubMed, CINAHL Complete, Medline, Web of Science and PsycINFO) were searched for articles published from their inception to December 2023. Studies were included if they (i) examined nurse and/or patient perspectives and experiences of nurse-patient relationships in specialist inpatient palliative care, (ii) were published in English in a (iii) peer-reviewed journal. The Mixed Methods Appraisal Tool was used to evaluate study quality. Data were synthesised using narrative synthesis.

RESULTS

Thirty-four papers from 31 studies were included in this review. Studies were mostly qualitative and were of high methodological quality. Four themes were identified: (a) creating connections; (b) fostering meaningful patient engagement; (c) negotiating choices and (d) building trust.

CONCLUSIONS

Nurses and patients are invested in the nurse-patient relationship, benefitting when it is positive, therapeutic and both parties are valued partners in the care. Key elements of fostering the nurse-patient relationship in palliative care were revealed, however, the dominance of the nurses' perspectives signifies that the nature and impact of these relationships may not be well understood.

Family perspectives on and experiences with advance care planning in nursing homes: A thematic synthesis

OBJECTIVES

To synthesize family members' experiences and perspectives on advance care planning (ACP) in nursing homes.

METHODS

The thematic synthesis is reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. A systematic search of the APA PsycINFO, CINAHL Plus, Embase and PubMed databases is initially conducted in October 2022, and the search is updated in January 2024. Qualitative studies that presented family members' quotes regarding advance care planning in nursing homes published in a peer-reviewed journal were included. Screening and data extraction were independently performed by two reviewers, and any discrepancies were resolved with the assistance of the third author.

RESULTS

A total of 1027 articles were identified, and 23 articles were included in the full-text review. Subsequently, a total of 17 studies were ultimately included, and 127 quotes were extracted and analysed. The main findings were categorized into three themes: (1) invitation to conversation and care, (2) the resident's surrogate and (3) nurses. Considering the importance of family members' roles in ACP conversations in a nursing home setting, this study provided an in-depth understanding of family members' perceptions and experiences of ACP by synthesizing qualitative studies. Family members' lack of knowledge regarding the timing and pursuits of ACP was also identified.

CONCLUSION

The findings of this study provide synthesized qualitative evidence of family members' perspectives on ACP, which can inform care and treatment in nursing homes. As this study synthesizes the experiences of family members in nursing homes about ACP, the findings of this study contribute to reflecting family members' experiences and providing evidence for nursing home healthcare professionals.

PATIENT OR PUBLIC CONTRIBUTION

This study reports the experiences of family members in ACP nursing homes. The findings of this study contribute to reflecting family members' experiences and building evidence for nursing home healthcare professionals.

The Involvement of Caregivers in the End-of-life Care of an Older Adult Living in a Long-term Care Home: A Qualitative Case Study with Nurses and Relatives

BACKGROUND

A key role of nurses working in long-term care homes (LTCHs) is to promote the involvement of care partners in end-of-life (EOL) care. However, studies on the involvement of care partners in EOL care in LTCHs have focused on care planning and decision-making. While care partners can participate in other ways, it's unclear how they are currently involved in EOL care by staff.

PURPOSE

We aimed to explore the involvement of care partners in the EOL care of an older adult living in a LTCH.

METHODS

A qualitative case study was conducted. Data was collected from a sample of four nurses and three care partners, using sociodemographic questionnaires, individual semi-structured interviews, documents pertaining to the LTCH's philosophy for EOL care, and a field diary.

RESULTS

The results of a thematic analysis showed the broad scope of care partners' possible involvement, including contributing to care, obtaining information, and being present. As there was some variation in care partners' desire to be involved, nurses seemed to rely on them to convey their wishes. To promote this involvement, some strategies aimed at health professionals and managers were suggested.

CONCLUSIONS

These results can guide improvement in clinical practices and raise awareness on the EOL care experiences of care partners.

Barriers and facilitators to early initiation of palliative care as perceived by nurses working on pneumology and nephrology, a descriptive qualitative study

AIMS AND OBJECTIVES

Initiation of palliative care early in the disease trajectory is beneficial for patients with a life-limiting disease. However, palliative care is still introduced rather late or not at all. Therefore, this study aims to explore barriers and facilitators to early initiation of palliative care as perceived by nurses working on pneumology and nephrology.

METHODS

A descriptive interview-based study was conducted from a critical realist perspective until data sufficiency was reached. Fifteen nurses presented and discussed a patient for whom palliative care was initiated too late. Template analysis was conducted to develop themes and subthemes.

RESULTS

Five key themes were extracted: (1) communication, (2) fear, (3) personal beliefs about life and death, (4) ambiguity in terminology and (5) workload and time pressure. Barriers related to poor interdisciplinary communication were therapeutic obstinance, hierarchy, unawareness of the patient's wishes and fear of saying something inappropriate. Other barriers were patients' religious beliefs which often hindered the use of sedatives or morphine and led to discomfort and time restraints. A palliative support team in hospital and advance care planning (ACP) were enablers for early palliative care.

STUDY LIMITATIONS

This study started from a negative experience, leading to identification of a lot of barriers and only a few facilitators. The limited sample size and the restriction to two wards within one single hospital limit the diversity of perspectives and the generalisability of the findings.

CONCLUSION

More attention is needed for ACP and interdisciplinary communication. Palliative care, including ACP, and interdisciplinary communication should be included in the basic curricula of all healthcare professional courses. Further research is needed to explore barriers and facilitators to early initiation of palliative care in other healthcare settings and patient populations. This is crucial in order to develop and implement sustainable interventions for specific groups of patients.

Exploring Nurses' Emotional Resilience and Coping Strategies in Palliative and End-of-Life Care Settings in Saudi Arabia: A Qualitative Study

BACKGROUND

Nurses working in palliative and end-of-life care settings face significant emotional challenges due to the demanding nature of their profession. This study aimed to explore the emotional resilience of these nurses, understanding the factors that contribute to their resilience, the impact on their professional well-being and performance, and strategies to enhance resilience.

METHODS

A qualitative study was conducted involving 15 registered nurses from various healthcare facilities in Riyadh, Saudi Arabia. Data were collected through semi-structured interviews, document analysis, and observational data. Thematic analysis was employed to identify recurring themes.

RESULTS

The study identified three key themes: Emotional Challenges and Resilience-Building, Support Systems and Resources for Resilience, and Professional Growth and Fulfillment as Resilience Factors. The findings revealed the emotional toll of patient suffering, highlighting resilience-building strategies, such as peer support, mindfulness, and reflective practices. Support systems, including workplace support, organizational resources, and mentorship, were identified as crucial for fostering resilience. Professional growth, a sense of purpose, and recognition emerged as factors contributing to resilience.

CONCLUSIONS

This study underscores the importance of emotional resilience for nurses in palliative and end-of-life care settings. Healthcare organizations can enhance resilience by implementing resilience training, providing counseling services, fostering a supportive culture, and offering professional development opportunities. Addressing the emotional needs of nurses is vital for their well-being and the delivery of compassionate care.

Nurses' experiences of ethical challenges concerning thirst in dying patients in specialist palliative care: a qualitative study

AIM

To describe nurses' experiences of ethical challenges in relation to thirst in terminally ill patients in specialist palliative care units.

RESEARCH DESIGN

A qualitative, reflexive thematic design with an inductive analysis was used.

PARTICIPANTS AND RESEARCH CONTEXT

Eighteen qualitative interviews with nurses working in six different specialist palliative care units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis.

RESULTS

This study identified four themes that reflect ethical challenges experienced by nurses in the palliative care regarding thirst: Harmful infusions interfere with peaceful dying; conflict between tradition and personal experience; What is the right intervention to quench thirst? and; Lack of standard procedures, competence and interest among team members.

CONCLUSION

Palliative care nurses experience a number ethical challenges in relation to thirst in dying patients. The main challenge is the provision of fluids to dying patients via artificial infusions, which nurses struggle with, as they do not want to interfere with a peaceful dying process.

Intensive Care Unit Nurses' Experiences in Caring for End-of-Life Patients in Saudi Arabia: A Qualitative Study

Background: Although extensive research on appropriate treatments has been conducted, how nurses provide care to patients at the end-of-life (EOL) is unclear, particularly among intensive care unit (ICU) nurses in Saudi Arabia. Purpose: To explore intensive care unit nurses' experiences in providing end-of-life care in Saudi Arabia. Methods: This study utilized an exploratory, descriptive, qualitative approach. A purposive sampling technique was used to recruit ICU nurses (n = 10) working in ICUs at a tertiary teaching hospital in Riyadh, Saudi Arabia. Using a semi-structured interview guide, ten individual interviews were conducted. Data were analyzed using thematic analysis. The trustworthiness of this study was ensured by following Lincoln and Guba's (1985) criteria. Findings: Four major themes related to ICU nurses' experiences of providing EOL care emerged, including: "feeling challenged but driven", "holistic caring", "collaborative working ethics", and "caring for the undying and dying". Conclusions: This study adds to the body of knowledge about the experience of ICU nurses caring for EOL patients. It offers valuable insights into challenges, coping strategies, holistic caring, collaboration, and the management of critical or dying patients at EOL in the ICUs.

Exploring the barriers and facilitators of palliative care in the adult intensive care unit from nurses' perspectives in China: A qualitative study

BACKGROUND

Intensive care units (ICUs) in China primarily focus on active rescue efforts, and it is not common to provide palliative care services within the ICU. As nurses play a primary role as caregivers for end-of-life patients in the ICU, it is necessary to explore the factors that impede or facilitate palliative care from their perspective.

AIM

To explore the barriers and facilitators associated with implementing palliative care in Chinese adult ICUs from nurses' perspectives.

STUDY DESIGN

This study utilized a descriptive phenomenological research approach and purposive sampling to conduct face-to-face semi-structured interviews with nurses working in adult ICUs from three comprehensive hospitals in China during the period between February and May 2023. A total of 17 nurses were interviewed, and the collected data were transcribed, coded, and synthesized thematically.

RESULTS

Two themes of barriers and facilitators of palliative care in the Chinese adult ICU were extracted. The three sub-themes of hindering factors are as follows: (1) The influence of Chinese traditional culture. (2) The specificity of the ICU context. (3) Lacking sufficient attention in the ICU. The three sub-themes of the promoting factors are as follows: (1) Government and society value palliative care. (2) Patients and their families have palliative care needs. (3) Nurses view palliative care positively.

CONCLUSION

Currently, integrating palliative care into the ICU may face challenges such as cultural factors, the specificity of the ICU context, and insufficient attention. However, it is worth noting that as the government and society place more emphasis on palliative care, more and more people are gradually paying attention to the palliative care needs of critically ill patients and their families.

RELEVANCE TO CLINICAL PRACTICE

This study serves as a reference for exploring an ICU palliative care service model that is suitable for China's national conditions, such as education and training, resource allocation, service processes, and the palliative care environment, among others.

The role of psychologists in supporting illness-related dying and death: A systematic mixed studies review

Psychologists remain underrepresented in end-of-life care, and there is limited understanding of their role among healthcare professionals, patients, and caregivers. This systematic mixed-studies review, prospectively registered on PROSPERO (CRD42020215775), explored the role of psychologists, and the facilitators and barriers they experience, in supporting clients with illness-related dying and death. A search of six research databases was conducted in October 2023. Fifty-one studies, mainly qualitative and from the perspectives of psychologists, met inclusion criteria. Thematic synthesis highlighted how psychologists provided expertise across various contexts. They supported clients with preparing for death, and adjusting to dying, provided professional consultancy and support, and undertook leadership in enhancing psychological end-of-life care. Results illustrated the sustaining factors and ongoing challenges working in end-of-life care, namely, the unique nature of navigating the death space, recognition and awareness of psychologists' contribution, and the support, training and development required. Given the universality of dying and death, this review is relevant to psychologists working within and beyond more traditional end-of-life care contexts, such as employee assistance programs, private practice, schools, and other psychological services. Policy, clinical and research implications are discussed, including the need for greater engagement and training of psychologists in the dying and death space.

Effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy in Port Said City: A pre-post quasi-experimental study

BACKGROUND

Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment.

OBJECTIVES

To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy.

METHODS

The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program.

RESULTS

Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program.

SIGNIFICANCE OF THE RESULTS

The palliative care education program significantly improved caregivers' knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.

"Unless someone sees and hears you, how do you know you exist?" Meanings of confidential conversations - a hermeneutic study of the experiences of patients with palliative care needs

BACKGROUND

Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs.

METHODS

In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations.

RESULTS

The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life's challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences.

CONCLUSIONS

Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients' suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients' varying preferences.

Priorities for enhancing nurses' and social workers' competence and confidence in helping families support dependent children through parental death. A classic-Delphi survey

BACKGROUND

Annually, approximately five per cent of dependent children - aged under eighteen years - in the United Kingdom (UK), experience parental death. Nurses and social workers caring for parents with life-limiting illnesses, including cancer, help families support their children. However, these professionals have been found to lack confidence and competence in fulfilling this role.

METHODS

We conducted three rounds of a classic-Delphi survey to identify and measure a panel of topic experts' consensus on the priorities and issues for nurses and social workers when supporting families and children through parental death. The Delphi survey was conducted with a panel of UK topic experts (n=43) including lead health and social care professionals (n=30), parents bereaved of a partner whilst parenting dependent children (n=6), academics (n=4) and bereaved young adults (n=3).

RESULTS

Ninety per cent (n=18/20) of the issues for nurses and social workers and all (7/7) of the priorities rated and ordered in the survey achieved consensus. Key priorities were 1) training in opening conversations with families about dependent children, 2) training and support for nurses and social workers to manage their own and others' emotions arising from conversations with parents about children's needs regarding parental death, and 3) increasing nurses' and social workers' knowledge of sources of information to support families before the death of a parent.

CONCLUSION

We identified priorities for UK nurses and social workers. Further research is needed to identify which of these nurses and social workers would benefit most from support, and how any resultant interventions could enhance confidence and competence in helping families to support children through parental death.

In-Home Respite Care Services Available to Families With Palliative Care Needs in Quebec: Novel Digital Environmental Scan

BACKGROUND

Caregiving dyads in palliative care are confronted with complex care needs. Respite care services can be highly beneficial in alleviating the caregiving burden, supporting survivorship and dying at home. Yet, respite care services are difficult to locate and access in the province of Quebec, Canada, particularly when navigating ubiquitous sources of online health information of varying quality.

OBJECTIVE

This project aimed to (1) compile a list of at-home palliative respite care services in Quebec, Canada; (2) describe key accessibility features for each respite care service; (3) identify accessibility gaps and opportunities; and (4) describe a novel method for conducting environmental scans using internet search engines, internet-based community health databases, and member checking.

METHODS

A novel environmental scan methodology using 2 internet-based targeted databases and 1 internet search engine was conducted. Results were screened and data were extracted, descriptively analyzed, and geographically schematized.

RESULTS

A total of 401 services were screened, and 52 at-home respite care services specific to palliative populations were identified, compiled, and analyzed. These respite care services were characterized by various types of assistance, providers, fees, and serviced geographical regions. Accessibility was explored through the lens of service amenability, availability, eligibility, and compatibility. The data revealed important barriers to accessing respite care services, such as a lack of readily available information on service characteristics, limited availability, and a time-consuming, technical search process for potential respite care users and clinicians to identify appropriate services.

CONCLUSIONS

Both methodological and contextual knowledge have been gained through this environmental scan. Few methodologies for conducting internet-based environmental scans have been clearly articulated, so we applied several learnings from other scans and devised a methodology for conducting an environmental scan using the mixed methods of internet search engines, internet-based community health databases, and member checking. We have carefully reported our methods, so that others conducting community health environmental scans may replicate our process. Furthermore, through this scan, we identified assorted respite care services and pinpointed needs in the provision of these services. The findings highlighted that more easily accessible and centralized information about respite care services is needed in Quebec. The data will enable the creation of a user-friendly tool to share with community support services across Quebec and ultimately help alleviate the added burden caregivers and clinicians face when looking for respite care services in fragmented and complex digital spaces.

Evaluating ICU nurses' education, practice, and competence in palliative and end-of-life care in Saudi Arabia: A cross-sectional study

Background

In palliative and end-of-life (PEOL) care, especially within intensive care units (ICUs), nurses' unique skills are critical, yet their expertise remains under-explored, particularly in Saudi Arabia.

Objective

This study aimed to evaluate the education, practice, and perceived competence of adult ICU nurses in Saudi Arabia regarding PEOL care and to pinpoint key factors that influence this aspect of healthcare delivery.

Methods

A cross-sectional design was utilized in this study. Participants were recruited from five public hospitals and one specialized center in Hail, Saudi Arabia. Data were gathered in September 2023 using the PEOL Care Index, which measures various care dimensions on a Likert scale in Arabic and English. IBM SPSS Statistics 29.0 was used for statistical analysis, particularly to conduct ANOVA, t-test, and multiple regression.

Results

142 out of the targeted 171 ICU nurses completed the survey, yielding a response rate of 83.04%. Although 81% of the nurses had experience caring for dying patients, only 30.3% had received in-service PEOL care training. Those with this training demonstrated significantly higher scores in education, clinical practice, and perceived competence than their counterparts (p <0.05). Mean scores across these areas were 69.67, 71.01, and 71.61, respectively. In-service training positively correlated with these metrics (p <0.05). Multiple regressions also revealed that in-service training, job satisfaction, and communication authority are strong influencers, explaining 21.6% of the variation in clinical practice and 16.9% in perceived competence.

Conclusion

The study highlighted the proficiency of ICU nurses in PEOL care, emphasizing that in-service training, job satisfaction, and the authority to communicate effectively with patients and their families significantly improved clinical practice and nurses' competence in PEOL care. This underlines the critical need for healthcare institutions to acknowledge and address these key factors to optimize patient care outcomes.

Towards a set of competencies in palliative care nursing in Spain: what's getting in the way of consensus?

BACKGROUND

Spain currently lacks a competency framework for palliative care nursing. Having such a framework would help to advance this field in academic, governmental, and health management contexts. In phase I of a mixed-methods sequential study, we collected quantitative data, proposing 98 competencies to a sample of palliative care nurses. They accepted 62 of them and rejected 36.

METHODS

Phase II is a qualitative phase in which we used consensus techniques with two modified nominal groups to interpret the quantitative findings with the objective of understanding of why the 36 competencies had been rejected. Twenty nurses from different areas of palliative care (direct care, teaching, management, research) participated. We conducted a thematic analysis using NVivo12 to identify meaning units and group them into larger thematic categories.

RESULTS

Participants attributed the lack of consensus on the 36 competencies to four main reasons: the rejection of standardised nursing language, the context in which nurses carry out palliative care and other factors that are external to the care itself, the degree of specificity of the proposed competency (too little or too great), and the complexity of nursing care related to the end of life and/or death.

CONCLUSIONS

Based on the results, we propose reparative actions, such as reformulating the competencies expressed in nursing terminology to describe them as specific behaviours and insisting on the participation of nurses in developing institutional policies and strategies so that competencies related to development, leadership and professional commitment can be implemented. It is essential ​​to promote greater consensus on the definition and levels of nursing intervention according to criteria of complexity and to advocate for adequate training, regulation, and accreditation of palliative care expert practice. Locally, understanding why the 36 competencies were rejected can help Spanish palliative care nurses reach a shared competency framework. More broadly, our consensus methodology and our findings regarding the causes for rejection may be useful to other countries that are in the process of formalising or reviewing their palliative care nursing model.

Beneficiary's Satisfaction with Primary Palliative Care Services in Kerala - A Cross-Sectional Survey

Objectives

Kerala was the first state to implement a community-based, sustainable primary palliative care (PC) home care (HC) model. Beneficiary satisfaction, an important indicator to assess the quality of service provision with the HC program, has not been assessed since the programme was launched 14 years ago. This study tried to assess the satisfaction of beneficiaries receiving primary PC services through the Kerala State PC programme and the factors associated with the same.

Materials and Methods

The cross-sectional survey was conducted among 450 patients registered under the Kerala State Primary PC Programme. Data were collected using a semi-structured questionnaire from October 2022 to January 2023. We summarised the data as proportions and performed Chi-square tests to make comparisons wherever applicable.

Results

Most of the beneficiaries (69.1%) were satisfied with HC services. The mean age of the beneficiaries was 65.51 ± 17 years. More than 80% of the participants (88.4%) were married, and the primary caregivers were wives (31.8%) and daughters/daughters-in-law (35.3%). The primary diagnosis of the beneficiaries was a cerebrovascular accident (27.4%), cancer (18.8%), and spinal cord injury (13.2%). The study examined the needs of beneficiaries and found that the top three requirements reported by the patients were the inclusion of doctor visits in HC (71.8%), medicine distribution at home (67.4%), and physical rehabilitation services at home with a minimum of three sessions per month (52.3%). The study found a statistically significant association (P < 0.05) between the Beneficiary's satisfaction and behaviour of PC nurses and certain services, including physiotherapy, procedural care specifically catheterisation and wound dressing, and health check-ups received through the HC program. Satisfaction was reported more in Thiruvananthapuram district, followed by Malappuram.

Conclusion

The overall satisfaction with the Kerala State Primary PC Programme was found to be high at about 69%. Despite the fact that the study identified significant relationships between nurses' behaviour, services provided (physical therapy, procedures, and health checks), and satisfaction, the findings suggested expanding the scope of the HC programme by including doctor visits and medicine delivery at patient's home.

The Chinese Version of the Palliative Nursing Care Quality Scale: Translation, Cross-Cultural Adaptation, and Validity

BACKGROUND

Nurses play an important role in palliative care, and high-quality assessment tools can help standardize palliative-related nursing behaviors, but there are no such tools in China.

OBJECTIVE

This study aimed to revise, cross-culturally adapt, and validate the Palliative Nursing Care Quality Scale (PNCQS) to provide an effective tool that can help nurses in mainland China assess the quality of palliative care.

METHODS

This study involved a 2-steps process. First, the PNCQS was translated, back-translated, and cross-cultural adapted using Brislin's translation model. Second, a cross-sectional study was used to evaluate the reliability and validity of the revised scale. From January to February 2023, 367 nurses engaged in palliative care-related nursing from 3 tertiary A general hospitals were surveyed with the revised scale. The evaluation methods used in this study included item analysis, test-retest reliability, internal consistency, criterion-related validity, content validity, and construct validity.

RESULTS

The PNCQS-Chinese included 20 items. In this study, the item-total correlation coefficients ranged from 0.67 to 0.83 (P < .01), and the critical ratio value of the items was 12.10 to 23.34 (P < .01). The scale-level content validity index was 0.98, and the item-level content validity ranged from 0.86 to 1.00. The total Cronbach's α and test-retest reliability of the scale were 0.96 and 0.79, respectively. Factor analysis of 20 items extracted 1 factor, and the contribution rate of cumulative variance was 60.03%.

CONCLUSIONS

PNCQS-Chinese shows acceptable validity and reliability for assessing the quality of palliative care-related nursing in mainland China.

Competencies of the nurses in the limitation of therapeutic effort in the intensive care unit: An integrative review

Objective

Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU.

Method

An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation.

Result

A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life.

Conclusion

The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient's quality of life, dignity of their death, and comprehensive family support for coping with grief.

Nurses' perceptions to alleviate dyspnoea in inpatients with advanced cancer while receiving palliative care

AIM

To explore nurses' perceptions to alleviate dyspnoea in inpatients with advanced cancer while receiving palliative care.

DESIGN

A descriptive qualitative design.

METHODS

Seven focus groups were conducted with nurses (n = 27) from five specialized palliative care wards in four hospitals in south and southwest Finland. The focus groups were conducted between June and November 2019, and the transcripts were analysed using inductive analysis.

RESULTS

The findings revealed three categories: recognizing dyspnoea is a multi-faceted problem, dealing with the complexity of assessment of dyspnoea and strategies for relieving dyspnoea. Nurses perceived the complexity of dyspnoea as a symptom and emphasized the importance of utilizing patients' subjective experiences and consistent assessment scales to determine its severity. Furthermore, nonpharmacological interventions are as pertinent as pharmacological and medical interventions. The findings can assist nurses in selecting appropriate interventions for dyspnoea care, ultimately enhancing the quality of patient care and patient safety.

Decision-making in nursing research and practice-Application of the Cognitive Continuum Theory: A meta-aggregative systematic review

AIM

To explore how the Cognitive Continuum Theory has been used in qualitative nursing research and to what extent it has been integrated in the research process using the Qualitative Network for Theory Use and Methodology (QUANTUM).

BACKGROUND

Theory, research and nursing are intrinsically linked, as are decision-making and nursing practice. With increasing pressure on nurses to improve patient outcomes, systematic knowledge regarding decision-making is critical and urgent.

DESIGN

A meta-aggregative systematic review.

METHODS

DATABASES: CINAHL, Medline, PsycINFO, Embase and PubMed were searched from inception until May 2022 for peer-reviewed research published in English. Seven studies were included and assessed for methodological quality using the Joanna Briggs Institute checklist for qualitative research. A meta-aggregative synthesis was conducted using Joanna Briggs methodology. The QUANTUM typology was used to evaluate the visibility of the Cognitive Continuum Theory in the research process.

RESULTS

The review identified five synthesised findings, namely: 1. the decision-making capacity of the individual nurse, 2. nurses' level of experience, 3. availability of decision support tools, 4. the availability of resources and 5. access to senior staff and peers. Only two of seven studies rigorously applied the theory. The included studies were mainly descriptive-exploratory in nature.

CONCLUSION

The transferability of the Cognitive Continuum Theory was demonstrated; however, evolution or critique was absent. A gap in the provision of a patient-centric approach to decision-making was identified. Education, support and research is needed to assist decision-making. A new Person-Centred Nursing Model of the Cognitive Continuum Theory has been proposed to guide future research in clinical decision-making.

RELEVANCE TO CLINICAL PRACTICE

Nurses make numerous decisions every day that directly impact patient care, therefore development and testing of new theories, modification and revision of older theories to reflect advances in knowledge and technology in contemporary health care are essential.

Nursing Support for Nausea and Vomiting in Patients With Cancer: A Scoping Review

Nausea and vomiting are symptoms commonly experienced by patients with advanced cancer and have a wide range of causes, including pharmacological interventions. Additionally, multiple factors often simultaneously cause nausea and vomiting. These highly distressing symptoms may be directly or indirectly related to the disease and can significantly impact both the physical and psychological well-being of patients. This study aims to identify the nursing support provided to reduce nausea and vomiting experienced by patients with cancer. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist and Arksey and O'Malley's framework. We searched the PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials in the Cochrane Library, and the Ichushi-Web of the Japan Medical Abstract Society databases for all content published from the inception of each database through July 31, 2023. A total of 4,625 scientific articles were identified after literature screening. In total, 58 articles were included for full-text review, and 10 articles were finally selected for review. The types of study designs comprised six randomized controlled trials, three prospective observational studies, and one before-after study with no controls. The types of cancers included in the articles were colorectal, breast, lung, pancreatic, gynecological, stomach, and sarcoma. The total sample size of the study population was 793 patients (range = 12-281) for intervention studies and 4,333 patients (range = 20-4,197) for observational studies. Nursing support, extracted from the 10 articles, was classified into the following six types: massage therapy, acupressure, early palliative care, psychosocial support, self-symptom monitoring, and coordinated care. The review yielded six classifications of nursing support for nausea and vomiting in cancer patients. Future research should examine the feasibility of providing nursing support for nausea and vomiting in cancer patients.

Family caregivers' experiences of discussing their needs with a nurse during specialised home care utilizing the carer support needs assessment tool intervention - A qualitative study

PURPOSE

The Carer Support Needs Assessment Tool Intervention (CSNAT-I) was designed to help family caregivers identify, reflect upon, and express their support needs in a conversation with a health care professional and gain tailored support. The CSNAT-I has shown positive effects for both nurses and family caregivers but for more comprehensive understanding this study aims to examine family caregivers' experiences of discussing their needs with a nurse during specialised home care, utilizing the CSNAT-I.

METHODS

The study used an inductive qualitative descriptive design based on framework analysis. Data was collected using individual semi-structured telephone interviews with 10 family caregivers, with a median age of 66, from four specialised home care services.

RESULTS

Family caregivers appreciated having scheduled meetings with nurses utilizing the CSNAT-I which gave them an opportunity to focus on what was important to them. Family caregivers experienced that the conversations were co-created with a flexible dialogue. The conversations provided new perspectives and insights which helped in finding possible solutions. Family caregivers felt empowered by the co-created conversation and took on a more active role in involving the rest of their family to find support to themselves and the patients.

CONCLUSION

The CSNAT-I can facilitate communication between family caregivers and nurses leading to adequate supportive inputs. The intervention gives family caregivers an increased opportunity to be involved in their own support, which may enhance their sense of security. According to family caregivers' experiences, CSNAT-I may be an adequate way to support family caregivers to reflect and discuss their needs.

Effective communication in palliative care from the perspectives of patients and relatives: A systematic review

OBJECTIVES

In palliative care, effective communication is essential to adequately meet the needs and preferences of patients and their relatives. Effective communication includes exchanging information, facilitates shared decision-making, and promotes an empathic care relationship. We explored the perspectives of patients with an advanced illness and their relatives on effective communication with health-care professionals.

METHODS

A systematic review was conducted. We searched Embase, Medline, Web of Science, CINAHL, and Cochrane for original empirical studies published between January 1, 2015 and March 4, 2021.

RESULTS

In total, 56 articles on 53 unique studies were included. We found 7 themes that from the perspectives of patients and relatives contribute to effective communication: (1) open and honest information. However, this open and honest communication can also trigger anxiety, stress, and existential disruption. Patients and relatives also indicated that they preferred (2) health-care professionals aligning to the patient's and relative's process of uptake and coping with information; (3) empathy; (4) clear and understandable language; (5) leaving room for positive coping strategies, (6) committed health-care professionals taking responsibility; and (7) recognition of relatives in their role as caregiver. Most studies in this review concerned communication with physicians in a hospital setting.

SIGNIFICANCE OF RESULTS

Most patients and relatives appreciate health-care professionals to not only pay attention to strictly medical issues but also to who they are as a person and the process they are going through. More research is needed on effective communication by nurses, in nonhospital settings and on communication by health-care professionals specialized in palliative care.

Clinical Decision Support Systems for Palliative Care Management: A Scoping Review

CONTEXT

With the expansion of palliative care services in clinical settings, clinical decision support systems (CDSSs) have become increasingly crucial for assisting bedside nurses and other clinicians in improving the quality of care to patients with life-limiting health conditions.

OBJECTIVES

To characterize palliative care CDSSs and explore end-users' actions taken, adherence recommendations, and clinical decision time.

METHODS

The CINAHL, Embase, and PubMed databases were searched from inception to September 2022. The review was developed following the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines. Qualified studies were described in tables and assessed the level of evidence.

RESULTS

A total of 284 abstracts were screened, and 12 studies comprised the final sample. The CDSSs selected focused on identifying patients who could benefit from palliative care based on their health status, making referrals to palliative care services, and managing medications and symptom control. Despite the variability of palliative CDSSs, all studies reported that CDSSs assisted clinicians in becoming more informed about palliative care options leading to better decisions and improved patient outcomes. Seven studies explored the impact of CDSSs on end-user adherence. Three studies revealed high adherence to recommendations while four had low adherence. Lack of feature customization and trust in guideline-based in the initial stages of feasibility and usability testing were evident, limiting the usefulness for nurses and other clinicians.

CONCLUSION

This study demonstrated that implementing palliative care CDSSs can assist nurses and other clinicians in improving the quality of care for palliative patients. The studies' different methodological approaches and variations in palliative CDSSs made it challenging to compare and validate the applicability under which CDSSs are effective. Further research utilizing rigorous methods to evaluate the impact of clinical decision support features and guideline-based actions on clinicians' adherence and efficiency is recommended.

"Daring to deal with the difficult and unexpected" registered nurses' confidential conversations with patients with palliative care needs: a qualitative interview study

BACKGROUND

In palliative care, registered nurses provide advanced nursing care to relieve patients' symptoms and increase their quality of life based on physical, mental, social and existential dimensions. Conversations, often about existential issues, are an important part of nursing and can affect quality of life positively. Confidential conversations between patients and nurses occur naturally while other nursing activities are being performed. Despite their great importance for palliative care these are rarely described.

AIM

To gain a deeper understanding of how nurses in palliative care experience and describe confidential conversations with patients.

METHOD

Secondary analysis of data from 17 open-ended face-to-face interviews with registered nurses in palliative care was conducted. Qualitative content analysis using an inductive approach was used to gain a deeper understanding and analyse the latent content.

RESULTS

The confidential conversation was considered an important part of palliative care and is the nurse's responsibility. This responsibility was described as complex and placed various demands on the nurses, both personal and professional. A prerequisite for the conversation was the interpersonal relationship. The conversation allowed the patient to process important matters not previously addressed or put into words. It had no predetermined content, was unplanned and entirely on the patient's terms. For nurses the conversation could be experienced both as draining and a source of power and strength. The nurses also described safeguarding the patient through the conversation.

CONCLUSION

Nurses' confidential conversations with patients are essential in palliative care and must be highlighted more to increase the quality of palliative care. The confidential conversations often have an existential content and are challenging for the nurses. Therefore, nurses need time, knowledge, and supervision to increase their conversation skills.

Perception of Nurses' Knowledge about Palliative Care in West Bank/ Palestine: Levels and Influencing Factors

Objective: Healthcare professionals particularly nurses should be professionally prepared with knowledge about the standards of palliative care and their roles in providing palliative care. Nurses' knowledge about palliative care and influencing factors has not been examined adequately in Arab countries including Palestine. Thus, this study aimed to assess the adequacy of knowledge level and influencing factors (socio-demographic) about palliative care among nurses in West Bank/ Palestine. Methods: A descriptive-correlational design was utilized. A cluster random sampling method was applied to select 12 hospitals from the three regions in West Bank. Then, four hospitals were selected from each region using a simple random method. All registered nurses working in critical care units and medical and surgical wards in the selected hospitals were recruited. The sample consists of 424 registered nurses and data were collected using Palliative Care Quiz for Nursing (PCQN). Results: The Findings revealed that nurses' level of knowledge about palliative care was low/inadequate (M = 7.75, SD = 2.96). Knowledge about palliative care was influenced by age (B = -.106; p < 0.05), gender (B = -.223; p < 0.001), and hospital ward (B = -.597; p < 0.001), in which younger nurses, females, and those who work in critical care units reported higher levels of knowledge about palliative care. Conclusions: Findings of this study emphasized the need for developing educational and training courses, seminars, and workshops on palliative care to increase nurses' knowledge in order to enhance the quality of patient care. Also, policymakers should develop national strategic plans and policies regarding palliative care and apply these plans in all hospitals in West Bank/ Palestine.

Nurses knowledge of palliative care: systematic review and meta-analysis

Lack of knowledge about palliative care is one of the most common reasons for hindering the delivery of high-quality palliative care. Nurses play a major role in providing palliative care, and the degree of their mastery of this knowledge is crucial to whether they can effectively deliver the ideal palliative care. Therefore, it is necessary to understand the level of palliative care knowledge in this population. As of 8 November 8, 2022, we performed systematic searches in 10 databases. Meta-analysis of quantitative data that measuring the level of palliative care knowledge of nurses using the Palliative Care Quiz for Nursing (PCQN) was conducted using Stata software (version: V.15). A pooled mean score <10 indicated a low/insufficient knowledge level. The funnel plot and Egger's regression test were used to detect publication bias, and finally, the robustness of the results was evaluated through sensitivity analysis. The pooled mean score for the level of nurses' knowledge of palliative care was 9.68 (95% CI: 9.40 to 9.96). Among the three dimensions of the PCQN scale, the pooled mean score for the '"Philosophy and Principles of Palliative Care'" section was 1.73 (95% CI: 1.38 to 2.08); the '"Pain and Other Symptom Control'" section was 6.73 (95% CI: 6.41 to 7.05); and the '"Psychological, Spiritual and Social Care'" section was 1.21 (95% CI: 0.72 to 1.69). It can be seen that nurses' mastery of palliative care knowledge is not sufficient. It is recommended that relevant departments formulate and promote the implementation of targeted measures to improve the knowledge level of this population.

Psychometrics of the Persian version of the program in palliative care education and practice questionnaire (German revised - PPCEP-GR)

BACKGROUND

In order to improve the provision of palliative care by nurses, it is necessary to have a tool that measures different dimensions of palliative care and the knowledge and performance of nurses in this field. The Program in Palliative Care Education and Practice Questionnaire (German Revised) is psychometrically evaluated for the first time in Iran.

METHODS

To measure the psychometric properties, 360 nursing students (BSc, MSc, PhD) and clinical nurses completed the questionnaire. Face and content (CVR and CVI) validity were checked by quantitative and qualitative approach. Construct validity was performed with exploratory and confirmatory factor analysis. The total variance explained was equal to 43%; the internal consistency reported a Cronbach's alpha of more than 0.7; and the composite reliability was greater than 0.7.

RESULTS

After conducting construct validity and factor analysis, four factors (Knowledge and skill of managing patients' pain and symptoms, management of ethical and psychological issues in patients, communicating with patients and their families & management of patients' exposure to grief and attitudes towards death) were extracted. The total variance was equal to (%43) and coefficients of internal consistency were estimated more than 0.7. Also composite reliability was evaluated greater than 0.7.

CONCLUSION

Persian version of the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PPCEP-GR) is a valid and reliable questionnaire that can be used to measure the knowledge and performance of nurses and nursing graduates in the field of palliative care.

Death, dying and caring: exploring the student nurse experience of palliative and end-of-life education

BACKGROUND

Undergraduate education and training are fundamental in preparing student nurses for working in palliative and end-of-life care.

AIM

This article explores the experiences of student nurses in their palliative and end-of-life undergraduate nurse education.

METHODOLOGY

Sandelowski and Barroso's (2007) framework for undertaking a metasynthesis was used. Initial database searches returned 60 articles of interest. Re-reading the articles in the context of the research question identified 10 studies that met the inclusion criteria. Four key themes emerged.

FINDINGS

Student nurses voiced concerns regarding their feelings of unpreparedness, and lack of confidence and knowledge when dealing with the complexities of palliative and end-of-life care. Student nurses called for more training and education in palliative and end-of-life care.

CONCLUSION

Flexible nursing curricula responsive to the needs of student nurses and the changing landscape of healthcare provision, including care to ensure a good death experience, should be prioritised at undergraduate level.

Palliative care nurses' experiences of stress, anxiety, and burnout: A thematic synthesis

OBJECTIVES

This systematic literature review aimed to critically appraise empirical evidence investigating palliative care (PC) nurses' experiences of stress, anxiety, and burnout.

METHODS

Six databases (PsycINFO, MEDLINE, Scopus, CINAHL, PubMed, and Web of Science) covering literature within psychology, medicine and healthcare, and social sciences were searched from inception until December 2020. Studies were eligible if they included qualitative literature reporting on experiences of nurses working in a PC setting of stress, anxiety, or burnout, and were published in English. Eighteen studies satisfied the review's inclusion criteria and were considered relevant to the review aims. Critical appraisal was undertaken using the Critical Appraisal Skills Programme Qualitative Checklist.

RESULTS

Thematic synthesis identified three main themes: When work becomes personal, The burden on mind and body, and Finding meaning and connection. The findings suggested that stress, anxiety, and burnout are deeply personal feelings experienced by nurses both on an emotional and physical level. Additionally, PC nurses' experiences can differ in meaning and strength depending on their relationships with patients, patients' families, and colleagues.

SIGNIFICANCE OF THE RESULTS

The synthesis highlighted that PC nurses' experiences are complex, encompassing clinical and organizational challenges, and the personal impact their work has on them. Having a greater understanding of the factors that contribute to PC nurses' experiences may help in PC nurses' core training and continuing professional education, as well as the provision of effective supervision and staff support.

Attitudes and influencing factors of nursing assistants towards hospice and palliative care nursing in chinese nursing homes: a cross-sectional study

BACKGROUND

Hospice and palliative care nursing (HPCN) in China is mainly available at public primary care institutions, where nursing homes (NHs) are rarely involved. Nursing assistants (NAs) play an essential role in HPCN multidisciplinary teams, but little is known about their attitudes towards HPCN and related factors.

METHODS

A cross-sectional study was designed to evaluate NAs' attitudes towards HPCN with an indigenised scale in Shanghai. A total of 165 formal NAs were recruited from 3 urban and 2 suburban NHs between October 2021 and January 2022. The questionnaire was composed of four parts: demographic characteristics, attitudes (20 items with four sub-concepts), knowledge (nine items), and training needs (nine items). Descriptive statistics, independent samples t-test, one-way ANOVA, Pearson's correlation, and multiple linear regression were performed to analyse NAs' attitudes, influencing factors, and their correlations.

RESULTS

A total of 156 questionnaires were valid. The mean score of attitudes was 72.44 ± 9.56 (range:55-99), with a mean item score of 3.6 ± 0.5 (range:1-5). The highest score rate was "perception of the benefits for the life quality promotion" (81.23%), and the lowest score rate was "perception of the threats from the worsening conditions of advanced patients" (59.92%). NAs' attitudes towards HPCN were positively correlated with their knowledge score (r = 0.46, P < 0.01) and training needs (r = 0.33, P < 0.01). Marital status (β = 0.185), previous training experience (β = 0.201), location of NHs (β = 0.193), knowledge (β = 0.294), and training needs (β = 0.157) for HPCN constituted significant predictors of attitudes (P < 0.05), which explained 30.8% of the overall variance.

CONCLUSION

NAs' attitudes towards HPCN were moderate, but their knowledge should be improved. Targeted training is highly recommended to improve the participation of positive and enabled NAs and to promote high-quality universal coverage of HPCN in NHs.

"The communication I had with him back then is still stuck in my mind." Bereaved families of cancer patients' experiences for end-of-life communication

PURPOSE

Communication with family members is important to end-of-life care for patients with cancer. It is an interactive engagement between terminally-ill cancer patients and their families through which they expand their mutual understanding to cope with losses and find meaning in death. This study aimed to describe the experiences of end-of-life communication between patients with cancer and their family members in South Korea.

METHODS

This is a qualitative descriptive study using in-depth semi-structured interviews. Ten bereaved family members with end-of-life communication experience with terminal cancer patients were recruited through purposive sampling. Data were analyzed using qualitative content analysis.

RESULTS

A total of 29 constructed meanings, 11 sub-categories, and the following 3 categories were derived: "Offering a space for patients to reminisce and reflect," "Building a bond," and "Reflections on what we need." End-of-life communication primarily centered on the patients, with families struggling to share their stories with them. Although the families coped well, they also regretted the lack of meaningful communication with the patients, indicating a need for support to facilitate effective end-of-life communication.

CONCLUSION

The study highlighted concrete communication for finding meaning at the end-of-life for cancer patients and their families. We found that the families have the potential to communicate appropriately to cope with the patients' end-of-life. Nevertheless, end-of-life presents a unique challenge in which families require adequate support. Given the increasing number of patients and families dealing with end-of-life care in hospitals, healthcare providers should be mindful of their needs and help them cope effectively.

Registered nurses' perceptions of their roles in medical-surgical units: A qualitative study

AIM

The aim of this study was to gain insight into the perception of nurses about their roles in medical-surgical units.

BACKGROUND

As a result of ever-changing work environments, medical-surgical nurses find it difficult to know and practice according to the full scope of their roles.

DESIGN

A qualitative descriptive study.

METHODS

Semi-structured individual interviews were conducted with 21 nurses on three campuses of a large tertiary care hospital located in Quebec, Canada. Thematic analysis was used to construe meaning from the interviews. This research adheres to the Standards for Reporting Qualitative Research guidelines and checklist.

RESULTS

The data analysis resulted in three main themes: (i) confusion in nurses' roles and scope of practice; (ii) challenges in the continuity of care and (iii) factors affecting the roles of nurses in medical-surgical units.

CONCLUSION

Attention must be paid to the care continuum as it represents a critical element for surgical patients' quality and safety of care.

RELEVANCE TO CLINICAL PRACTICE

Medical-surgical nurses should understand their roles and the factors that limit their full scope of practice in order to provide and manage complex care situations. Additionally, an interdisciplinary approach is a strategy that may better respond to patients' clinical needs across the surgical journey.

Use and impact of a novel nurse-led consultation model in a palliative care consultation service for terminally ill cancer patients in Taiwan: an 11-year observational study

PURPOSE

The early integration of palliative care for terminally ill cancer patients improves quality of life. We have developed a new nurse-led consultation model for use in a palliative care consultation service (PCCS) to initiate early palliative care for cancer patients.

METHODS

In this 11-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer patients who had received PCCS during the years 2011 to 2021 were enrolled. Trend analysis was performed in order to evaluate differences in outcomes seen within the categories of either a nurse-led consultation model or ordinary consultation model throughout the study period. Analysis included studying the duration of PCCS and DNR declaration, as well as awareness of disease by both patients and families before and after PCCS.

RESULTS

In total, 6923 cancer patients with an average age of 64.1 years received PCCS from 2011 to 2021, with the average duration of PCCS being 11.1 days. Three thousand four hundred twenty-one patients (49.4%) received both a nurse consultation and doctor consultation during PCCS. Being admitted to the Department of Hematology, a longer duration of hospitalization, a DNR declaration after PCCS, and having had a PCCS consultation by a nurse only or both with a nurse and a doctor were significant determinants of a PCCS duration of more than 7 days.

CONCLUSION

This 11-year observational study shows that the number of terminal cancer patients receiving a novel nurse-led consultation during PCCS has increased significantly during the past decade, while a nurse-led consultation model during PCCS was effective in improving the duration of PCCS among terminally ill cancer patients.

Simulation-based learning in palliative care in postgraduate nursing education: a scoping review

BACKGROUND

Nurses require advanced competence in palliative care, but they face wide variations in education and a shortage in opportunities for clinical placement. Simulation-based learning (SBL) can enable students to develop clinical skills, critical thinking and confidence. No scoping reviews to date have mapped the use of SBL in palliative care within postgraduate nursing education.

METHODS

The aim of this scoping review was to systematically map published studies on the use of SBL in palliative care in postgraduate nursing education. A scoping review was conducted using Arksey and O'Malley's (Int J Soc Res Meth 8(1):19-32, 2005) methodological framework. A systematic and comprehensive search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resources Information Center (ERIC), Ovid MEDLINE, Ovid EMBASE, Allied and Complementary Medicine and PsycINFO was performed for studies published between January 2000 and April 2022. Two authors independently assessed papers for inclusion and extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The protocol was registered on the Open Science Framework.

RESULTS

This review includes 10 studies. Three thematic groupings were identified: enhanced understanding of the importance of teamwork, interdisciplinarity and interpersonal skills; preparedness and confidence in one's ability to communicate during emotionally challenging situations; and impact and relevance to one's own clinical practice.

CONCLUSIONS

The use of SBL in palliative care in postgraduate nursing education seems to enhance students' understanding of the importance of teamwork and interdisciplinarity. The review shows contradictory results regarding whether SBL in palliative care increases students' confidence in their communication skills. Postgraduate nursing students experienced personal growth after participating in SBL. Because our findings indicate that limited research has been conducted within this field, future research should (1) explore postgraduate nursing students' experiences with SBL in palliative care with a focus on more practical content such as symptom management, (2) examine the relevance and application of SBL in clinical practice, and (3) be reported in line with recommendations on the reporting of simulation research.

Attitudes and knowledge of palliative care of Chinese undergraduate nursing students: A multicenter cross-sectional study

BACKGROUND

Helping patients and families to relieve severe pain and manage grief are issues that palliative care is designed to address, but integrating these topics in nursing education and practice requires increased attention. It is necessary to understand the knowledge and attitudes of nursing students to develop a targeted approach toward integrating palliative care in practice settings.

OBJECTIVES

To investigate attitudes and knowledge toward palliative care among undergraduate nursing students in China and to explore correlations and associated factors.

DESIGN

A cross-sectional study.

SETTINGS

Seven comprehensive universities in China.

PARTICIPANTS

A total of 582 undergraduate nursing students participated.

METHODS

Online questionnaires were available from December 2020 to February 2021. The Frommelt Attitude Toward Care of the Dying Scale and the Palliative Care Quiz for Nursing were used to measure students' attitude and knowledge of palliative care. Descriptive and correlational methods were used to analyse the associated factors and their correlation with knowledge and attitudes.

RESULTS

Attitude scores showed significant differences in gender, education level, religious preference, previous education in palliative care, experience in caring for dying patients and previous experience with bereavement. Knowledge of palliative care was influenced by gender, religious preference, prior education in palliative care, experience in caring for dying patients, and previous experience with bereavement. A positive correlation exists between knowledge and attitudes toward palliative care among undergraduate nursing students.

CONCLUSIONS

The findings highlight the need to offer palliative care courses in nursing education and practice settings in Chinese health care settings. Nurse educators need to integrate the concept of palliative care into the curriculum of nursing education programs. Healthcare administrators and nurse leaders should promote investment and training in the education of nurses in practice settings to deliver high-quality palliative care services.

Psycho-emotional recovery, the meaning of care in the process of providing palliative care to Iranian people with cancer: A grounded theory study

AIM

Despite the significance of palliative care in treating people with cancer, the provision of this type of care in Iran is vague and unorganized. This research intends to explore the meaning of care in the process of providing palliative care to Iranian people with cancer and to develop a theory that would explain the phenomenon.

DESIGN

This is a qualitative study in nature and Corbin and Strauss' Grounded Theory approach was used for data analysis.

METHODS

Data was collected through semi structured interviews that were held with 21 participants who have had experiences in receiving and providing palliative care. The study was conducted in April to December 2019 in palliative care centres of Tehran. Sampling first started purposefully and moved to theoretical once concepts began to emerge from the data. Comparative and continuous data analysis was undertaken using Corbin and Strauss' (Basics of qualitative research: Techniques and procedures for developing grounded theory, Sage, 2015) approach.

RESULTS

Main concerns of care providers in providing palliative care was to reduce the affliction and anxiety of patients by understanding the difficult state of patient and psycho-emotional recovery was identified as the core category, which was performed via three critical strategies: building emotional connection, reinforcing positive mindset and having a core value in care.

Patient and family members' experiences with language and environment when receiving bad news: A qualitative exploratory study

OBJECTIVES

Receiving bad news about one's health can be devastating, yet little is known about how the therapeutic nature of the environment where bad news is delivered affects the experience. The current study aimed to explore how patients and their families were affected by the language and the built, natural, social, and symbolic environments when receiving bad news, through the Therapeutic Landscapes theoretical framework.

METHODS

Patients diagnosed with a life-limiting illness living in regional Victoria who had a hospital admission within 24 months and a diagnostic/prognostic conversation were invited to participate, as well as a family member who witnessed the conversation. Participants were recruited through social media and snowballing, resulting in 14 online semi-structured interviews being conducted between November 2021 and March 2022, audio-recorded, and transcribed verbatim. Reflexive thematic analysis was used to develop the themes.

RESULTS

Fourteen semi-structured interviews were conducted with women aged between 30 and 77 years. Interviews lasted between 45 and 120 minutes, with an average of 69 minutes, and were conducted online or via mobile phone. Four central themes were developed: "Hearing bad news for the first time," "Preferences for having hard conversations," "Creating a sense of safety for ongoing care," and "The therapeutic nature of the ward."

SIGNIFICANCE OF RESULTS

This body of work will help inform practice and future policy regarding bad news delivery and the design and aesthetics of environments where bad news is delivered. It is essential that bad news is delivered within a quiet, calm, and emotionally safe environment within a supportive therapeutic relationship.

Palliative Care in Heart Failure: An Integrative Review of Nurse Practice

Introduction: Because it is a chronic disease of progressive evolution, heart failure requires nursing attitudes and practices that are articulated with palliative care, implemented in an interdisciplinary team along with patients and their families. Objective: Identifying nurses' attitudes and practices in palliative care in cardiology. Method: Integrative literature review. The searches were carried out in the following bases: Google Scholar, Virtual Health Library, LILACS, SciELO, Embase, MEDLINE, CINAHL, and Scopus; through the terms Palliative Care AND Cardiology AND Nursing. Results: We identified 1298 studies published in the last five years, 14 of which have been selected for the scope of this review. Nurse attitudes and practices were characterized as: approach to symptom control; promotion of comfort and well-being; integrality of care and family orientation; effective communication among patients, family members and nursing team; timely evaluation for palliative care. Most of the studies included in this review have evidence level 2C (n = 7) and 2B (n = 4). Therefore, the results can be interpreted as reliable. Conclusions: This study makes important contributions to the practice of nurses in palliative care for heart failure. Based on the evidence collected, nurses can develop actions with the nursing team and with the interdisciplinary team related to direct patient and family care, as well as professional training. However, the field lacks studies showing the practices and actions implemented by the nursing team.

Level of knowledge and attitudes towards palliative care for people with advanced dementia in Spain: role of professional and academic factors

BACKGROUND

Providing quality end-of-life care to individuals with advanced dementia is crucial. To date, little attention has been paid to palliative care knowledge and attitudes toward palliative care for people with advanced dementia in Spain Objectives: To investigate the knowledge of and attitudes toward palliative care for advanced dementia among registered nurses and physicians in Spain.

DESIGN AND METHODS

A descriptive, cross-sectional survey design was used. This study included a convenience sample of 402 nurses (n = 290) and physicians (n = 112). Two instruments were administered: demographic characteristics and Spanish version of the Questionnaire of Palliative Care for Advanced Dementia (qPAD-SV). Descriptive statistics and multiple regression were used for data analysis.

RESULTS

Overall, the nurses and physicians had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Physicians had a higher level of knowledge (p<0.05) compared to nurses. Additionally, physicians and nursing staff who had professional experience/education in geriatrics and those who had received palliative care and hospice training had greater (p<0.01) knowledge of palliative care. In addition, healthcare professionals who had received dementia care training and who had worked in nursing homes had higher levels (p<0.05) of knowledge and attitudes toward palliative care.

CONCLUSION

This study indicates the need to provide nurses and physicians with more education for select groups of professionals who have had limited education and experience in caring for older adults with advanced dementia.

Enhanced supportive care for advanced cancer patients: study protocol for a randomized controlled trial

BACKGROUND

Early palliative care along with standard cancer treatments is recommended in current clinical guidelines to improve the quality of life and survival of cancer patients. This study protocol aims to evaluate the effect of "Enhanced Supportive Care", an early primary palliative care provided by nurses.

METHODS

A randomized controlled trial (RCT) will be conducted including advanced cancer patients scheduled for first-line palliative chemotherapy (N=360) and their caregivers in South Korea. Participants will be randomly assigned to the intervention or control group in a 1:1 ratio. Participants in the intervention group will receive the "Enhanced Supportive Care", which provides five sessions of symptom management and coping enhancement counseling by nurses. The control group will receive symptom monitoring five times. The primary endpoints are symptoms, coping, and quality of life (QoL) at 3 months. Secondary endpoints are symptoms, coping, and QoL at 6 months, depression and self-efficacy for coping with cancer at 3 and 6 months, symptom and depression change from baseline to 3 months, survival at 6 and 12 months among patients, and depression among caregivers at 3 and 6 months.

DISCUSSION

This RCT will evaluate the effects of "Enhanced Supportive Care" on symptoms, depression, coping, self-efficacy for coping with cancer, QoL and survival of patients, as well as depression of caregivers. It will provide evidence of a strategy to implement early primary palliative care provided by nurses, which may consequently improve cancer care for newly diagnosed patients with advanced stage cancer.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04407013. Registered on May 29, 2020, https://www.

CLINICALTRIALS

gov/ct2/show/study/NCT04407013 . The protocol version is ESC 1.0.

A task service and a talking service: A qualitative exploration of bereaved family perceptions of community nursing care at the end of life

BACKGROUND

Greater emphasis on community-based care at the end of life is supported by the premise that most people want to be cared for and die at home. As such, it is important to understand the current state of palliative care nursing within an integrated generalist-specialist model of care in the community.

AIM

To explore bereaved family perceptions and experiences of community nursing at the end of life, with a particular focus on service integration.

DESIGN

A qualitative study design using semi-structured telephone interviews with bereaved family. A critical realist framework was used to inform the analysis of interview data and thematic analysis of data was used to identify key themes.

SETTING/PARTICIPANTS

Participants were the family carers of patients who had died within the catchment area of two large District Health Boards in Auckland, New Zealand.

RESULTS

Twenty-three participants were interviewed. Participants described their experiences of community nursing in terms of the service they provided. Hospice nursing roles were described in terms of a "talking service" and District Nursing as a "task service." There was minimal expectation of the general practice nurse in terms of palliative care support and little evidence of service integration.

CONCLUSION

Findings from this study support the need for a new integrated model of palliative care nursing which utilizes the unique skill set of nurses working across all community care settings including general practice, hospice and district nursing services. Accommodating different models of nursing care which can be responsive to patient need rather than limited to a defined service delivery model.

Registered nurses' experiences of caring for patients in hospitals transitioning from curative to palliative care: A qualitative study

The aim of this study was twofold: to illuminate registered nurses' experiences of palliative care and of caring for patients transitioning from curative to palliative care in hospitals. A qualitative descriptive design was used. Group interviews were conducted with 11 registered nurses in three different hospital settings. Content analysis was performed. The results are presented in four themes: "Understanding palliative care in a hospital setting"; "Involving, supporting, and caring for patients and families"; "Striving for consensus and common goals of care"; and "Struggling with the hospital environment." The registered nurses described struggling with the interpretation of palliative care and with how to transfer it into clinical practice in their specific care settings. Teamwork and collaboration were challenging and goals of care incongruent within the team. Further implementation of a palliative care approach, with core components symptom relief, teamwork, communication and relationship, and family support, is crucial to improve both patient care and the conditions enabling registered nurses to provide good care for the patients and their families in hospital settings.

A Systematic Review and Meta-analysis of Attitudes of Iranian Nurses and Related Factors Towards End-Of-Life Care

This meta-analysis aimed to summarize the evidence regarding attitudes of Iranian nurses and related factors towards end-of-life (EOL) care. PubMed, Web of Science, Scopus, Magiran, Iranmedex, Scientific Information Database, and Google Scholar search engine were searched using Persian and English appropriate keywords from the earliest records up to September 11, 2020. A total of 849 nurses were included in six studies. After a meta-analysis of the mean score of nurses' attitudes, the pooled mean was 80.07 out of 120 (Q(5)=4.32, I-squared=0.00%; 95%CI: 73.53-86.60; p < 0.001). Marital status, ward type, education level, a history of participating in EOL care workshops, personal study of EOL care, experience of caring for a dying family member or close people, natural and approach acceptance, fear of death, and professional autonomy had a significant positive relationship with nurses' attitudes towards EOL care. Therefore, further large-scale studies considering potential confounding variables are needed to confirm our findings.

Metodologías para la enseñanza de cuidados paliativos en estudiantes de áreas de la salud

Introducción: la necesidad de la enseñanza de los cuidados paliativos a los profesionales de la salud es cada vez más imperante en el mundo y en Latinoamérica. Los educadores deben reconocer los avances para la enseñanza de los cuidados paliativos a través de nuevas formas de aprendizaje. Objetivo: caracterizar las metodologías, contenidos y efectos de la enseñanza del cuidado paliativo en estudiantes del área de la salud en literatura publicada entre los años 2016 y 2020. Métodos: se realizó una revisión de literatura tipo scoping review.Se revisaron artículos publicados en revistas indexadas en las bases de datos Medline, Cuiden, Lilacs, CINAHL durante el periodo 2016-2020 en inglés, español y portugués. Se seleccionaron 25 investigaciones luego de realizar el proceso de crítica de la evidencia. Resultados: los estudios incluidos fueron en su mayoría realizados con metodologías cuantitativas, en Estados Unidos y con poblaciones de estudiantes de enfermería. La información extraída de los artículos se organizó en cuatro temas: 1) cursos educativos en cuidado paliativo, 2) estrategias de simulación, 3) conocimientos en cuidados paliativos de los estudiantes, y 4) actitudes y emociones de los estudiantes ante los cuidados paliativos. Conclusiones: las estrategias encontradas para enseñar los cuidados paliativos incluyen cursos completamente virtuales o en multimodalidad y simulación clínica o en laboratorios. En general, la evidencia muestra el interés que existe por parte de los estudiantes para recibir este tipo de curso y la importancia que tienen en su desarrollo profesional.

Perceived barriers and motivators of undergraduate nursing students in end-of-life care: A qualitative study based on lived experiences

PURPOSE

The aim of this study is to determine which barriers and motivators undergraduate nursing students perceived during their experience of providing end-of-life (EoL) care.

DESIGN AND METHODS

Qualitative phenomenological study leans on focus groups. The study was carried out with Zoom, a Web-based mobile video-conferencing application. Students were recruited from two universities in Turkey. Semistructured focus group interviews were conducted with 28 nursing students. The Heidegger phenomenological approach was adopted in this study.

FINDINGS

Three thematic categories and nine subcategories were determined. While the students stated that insufficient clinical experience, lack of knowledge, the inadequacy of communication techniques, and the insecurity of patients, relatives, and healthcare teams were barriers in EoL care, they stated they were motivated by witnessing the effect of nursing care on patients, integrating their theoretical knowledge into care, applying different communication techniques, and being positive role models of nurses in clinics.

PRACTICE IMPLICATIONS

As students were not adequately prepared to cope with clinical practices in EoL care, the nursing core curriculum needs revision in this regard. Providing adequate theoretical and clinical training in EoL care will help nursing students manage their emotions and provide high-quality care to patients and their families.

Perceptions of bereaved family members of nursing care on an inpatient hospice palliative care unit

BACKGROUND

Understanding family members' (FMs) perceptions of the care provided by nurses is crucial to facilitating positive outcomes for FMs.

AIMS

To better understand how bereaved FMs perceive the care nurses provide in an inpatient hospice palliative care unit.

METHODS

An exploratory study was conducted, with an interpretive description methodology. It was guided by the question: 'How do bereaved FMs perceive nursing care in our unit, and how does this influence their bereavement experiences?' A total of 10 FMs-or close friends-who had a significant other die on a palliative care unit were interviewed.

FINDINGS

Findings support the belief that positive relationships and interactions with nurses impact families' perceptions of end of life. Nurses create a therapeutic environment, building a sense of ease and meaning for patients and families.

CONCLUSION

Participation of nurses in rituals and patient-honouring practices after death may help families to cope and create positive memories during their grieving process.

Palliative Care for the Elderly in the Healthcare System: A Scoping Review

Objective: To map the scientific evidence related to the organization of palliative care practices provided for the elderly in the Healthcare System. Materials and methods: This is a scoping review following the Joanna Briggs Institute’s method. The search was conducted in the PubMed, Cinahl, Web of Science, Scopus, VHL/Lilacs, Embase, and Cochrane databases, identifying 1,150 articles managed using the Endnote software. After the selection, the study sample consisted of 12 articles. The data were organized in Microsoft Excel spreadsheets, submitted to descriptive analysis, and discussed with the literature. Results: The relevance of palliative care practices for older adults to be organized in the Healthcare System was noted, focusing on primary healthcare, at home, and interdisciplinary coordination. However, there is still a fragmented offer of this care with limited considerations regarding the challenges and possibilities of its effectiveness. Conclusions: The mapping of scientific evidence on the subject shows that discussions regarding the insertion of palliative care in the Healthcare System are modest. The studies explore the role of primary care as the organizer of these practices, although in a fragmented perspective, with limited coordination between the Healthcare System services.

Self-reported practices, competence and difficulties towards palliative care among nurses: A cross-sectional study

OBJECTIVE

Nurses' palliative care practice ability is the key to evaluating the quality of palliative care. This study aimed to identify the current situation of palliative care practices, competence and difficulties among nurses and determine whether difficulties play a mediating role between practices and competence.

METHODS

A cross-sectional study was conducted. The online survey comprised demographics, the Palliative Care Self-Reported Practices Scale, the Palliative Care Nursing Self-competence Scale and the Palliative Care Difficulties Scale. Data were analysed by using descriptive statistics, univariate analysis, linear regression and mediation analysis.

RESULTS

A total of 284 questionnaires were included for statistical analysis. The mean scores for practices, competence and difficulties were 67.81 (SD = 13.60), 124.28 (41.21) and 44.32 (12.68), respectively. There was a correlation between practices, competence and difficulties (p < 0.01). Competence and difficulties were independent predictors of practices (R² _adj  = 0.384, p < 0.001). Furthermore, difficulties mediated the relationship between practices and competence (b = 0.052, 95% confidence interval: 0.008-0.155).

CONCLUSIONS

Continuous efforts should be made to enhance nurses' practices, competence and problem-solving abilities in palliative care. This study suggested further targeted education programmes, especially in special symptom management, interagency and multidisciplinary communication.