1
|
Robinson J, Raphael D, Moeke-Maxwell T, Parr J, Gott M, Slark J. Implementing interventions to improve compassionate nursing care: A literature review. Int Nurs Rev 2024; 71:457-467. [PMID: 37975578 DOI: 10.1111/inr.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
AIM To identify strategies which support the implementation of interventions to promote compassionate nursing care with a focus on interventions designed to support improved patient outcomes and/or patient experience in acute hospitals. METHODS An integrative review using the PRISMA guidelines and a 5-stage framework consisting of problem identification, literature search, data evaluation, data analysis and presentation. CINAHL, Embase, Medline, PsychInfo and Web of Science were systematically searched using key search terms. Hand searches were conducted of the reference lists of eligible articles and searching key journals. RESULTS Six articles met the inclusion criteria with six different interventions described. A thematic analysis of the findings identified three key themes relating to the implementation of interventions which promote compassionate nursing care: (1) the importance of evidence; (2) support for nursing development; and (3) planning for and leading implementation. CONCLUSION Compassionate care improves quality of life, the hospital experience and overall recovery. Strong nursing leadership and a supportive team environment are facilitators for delivery of compassionate care in acute settings. Excessive workload, overly rigid reporting and organisational indifference are barriers to delivery of compassionate care. IMPLICATIONS FOR NURSING POLICY Health policy is used to inform the systematic implementation and delivery of patient care informed by best evidence. Health setting, environment and culture are important facets of the implementation of a compassionate care framework. Furthermore, nurse engagement, teamwork and nurse leadership are key facilitators for delivery of compassionate care in acute hospital settings. These findings need to be taken into consideration by policy makers and nursing leaders when designing and implementing compassionate care interventions. IMPLICATIONS FOR NURSING POLICY Implementing interventions to improve compassionate nursing care can be challenging. This review identified the factors which should be considered by policy makers when implementing these interventions systematically throughout the healthcare system.
Collapse
Affiliation(s)
- Jackie Robinson
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| | - Deborah Raphael
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Merryn Gott
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| | - Julia Slark
- Faculty of Medical Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Johnson FN, Wehi P, Neha T, Ross M, Thompson V, Tibble S, Tassell-Matamua N, Shedlock K, Fox R, Penman Z, Ritchie T, Winter T, Arahanga-Doyle H, Jose PE. Introducing 'Ngaruroro', a New Model for Understanding Māori Wellbeing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:445. [PMID: 38673356 PMCID: PMC11050006 DOI: 10.3390/ijerph21040445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Indigenous peoples around the world are revitalising their ancestral beliefs, practices, and languages, including traditional understandings of health and wellbeing. In the Aotearoa (New Zealand) context, a number of ground-breaking Māori health- and wellbeing-related models have emerged, each with their own scope and applications. We sought in our qualitative studies to explore and identify several key sources of wellbeing for Māori individuals. Nine interviews were conducted with members of Māori communities to identify key themes of Māori wellbeing. We performed a Reflexive Thematic Analysis on these data and then conducted a further fifteen interviews to revise, refine, and reposition the previously generated themes. The Ngaruroro model describes wellbeing as the embodied and active process of being well in relation with one's (1) here tāngata (social and familial ties), (2) te taiao (the environment), and (3) taonga tuku iho (cultural treasures) while doing what one can to make lifestyle choices that are conducive to the health of one's (4) tinana (body) and (5) wairua (spirit) while cultivating a balanced (6) ngākau (inner-system), fulfilling (7) matea (core needs) and exercising your (8) mana (authority). These themes illustrate that Māori wellbeing is dynamic, interconnected, and holistic.
Collapse
Affiliation(s)
- Finley Ngarangi Johnson
- School of Psychology, Victoria University of Wellington, Wellington 6140, New Zealand; (T.N.); (T.R.); (P.E.J.)
| | - Priscilla Wehi
- Centre for Sustainability, University of Otago, Dunedin 9016, New Zealand;
| | - Tia Neha
- School of Psychology, Victoria University of Wellington, Wellington 6140, New Zealand; (T.N.); (T.R.); (P.E.J.)
| | - Mike Ross
- Te Kawa a Māui—School of Māori Studies, Victoria University of Wellington, Wellington 6140, New Zealand;
| | | | | | | | - Kevin Shedlock
- School of Engineering and Computer Science, Victoria University of Wellington, Wellington 6140, New Zealand;
| | - Ririwai Fox
- School of Psychology, University of Waikato, Hamilton 3216, New Zealand;
| | - Zachary Penman
- Ministry of Social Development, Wellington 6140, New Zealand;
| | - Tyler Ritchie
- School of Psychology, Victoria University of Wellington, Wellington 6140, New Zealand; (T.N.); (T.R.); (P.E.J.)
| | - Taylor Winter
- School of Mathematics and Statistics, University of Canterbury, Christchurch 8041, New Zealand;
| | | | - Paul E. Jose
- School of Psychology, Victoria University of Wellington, Wellington 6140, New Zealand; (T.N.); (T.R.); (P.E.J.)
| |
Collapse
|
3
|
Walker W, Jones J, Astley M. In-hospital end-of-life care: an appreciative analysis of bereaved family feedback. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:126-131. [PMID: 38335107 DOI: 10.12968/bjon.2024.33.3.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Experience feedback data is increasingly recognised as being helpful in improving healthcare services, and in meeting patient and family needs. This end-of-life care project, based on the principles of appreciative inquiry, sought to learn from the experiences of bereaved people whose relative had died in an acute hospital setting. Informal feedback, offered during a routine telephone call, was thematically analysed and interpreted in an appreciative manner. Confirmatory representations of caring practices and behaviours were identified, categorised and disseminated in a way that enabled staff to come to know and understand end-of-life care at its best, rather than as a set of problematised events. The findings served as a benchmark for individuals and teams to assess and progress their practice reflectively. The authors conclude that staff receptiveness to informal bereaved family feedback may be enhanced by focusing on the positive qualities of end-of-life care within existing practices.
Collapse
Affiliation(s)
- Wendy Walker
- Reader in Nursing (End-of-life Care and Bereavement), The Royal Wolverhampton NHS Trust
| | - Jennifer Jones
- Specialist Nurse-Bereavement/Lead Medical Examiner Officer, The Royal Wolverhampton NHS Trust
| | - Melanie Astley
- Clinical Nurse Specialist-Palliative Care, The Royal Wolverhampton NHS Trust
| |
Collapse
|
4
|
Hill L, Baruah R, Beattie JM, Bistola V, Castiello T, Celutkienė J, Di Stolfo G, Geller TP, Lambrinou E, Mindham R, McIlfatrick S, Strömberg A, Jaarsma T. Culture, ethnicity, and socio-economic status as determinants of the management of patients with advanced heart failure who need palliative care: A clinical consensus statement from the Heart Failure Association (HFA) of the ESC, the ESC Patient Forum, and the European Association of Palliative Care. Eur J Heart Fail 2023; 25:1481-1492. [PMID: 37477052 DOI: 10.1002/ejhf.2973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023] Open
Abstract
The delivery of effective healthcare entails the configuration and resourcing of health economies to address the burden of disease, including acute and chronic heart failure, that affects local populations. Increasing migration is leading to more multicultural and ethnically diverse societies worldwide, with migration research suggesting that minority populations are often subject to discrimination, socio-economic disadvantage, and inequity of access to optimal clinical support. Within these contexts, the provision of person-centred care requires medical and nursing staff to be aware of and become adept in navigating the nuances of cultural diversity, and how that can impact some individuals and families entrusted to their care. This paper will examine current evidence, provide practical guidance, and signpost professionals on developing cultural competence within the setting of patients with advanced heart failure who may benefit from palliative care.
Collapse
Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
- College of Nursing and Midwifery, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | - Resham Baruah
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - James M Beattie
- Cicely Saunders Institute, King's College London, London, UK
| | - Vasiliki Bistola
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - Teresa Castiello
- Department of Cardiovascular Imaging, King's College London, Croydon Health Service London, London, UK
| | - Jelena Celutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Tal Prager Geller
- Palliative care centre DOROT medical centre Netanya, Netanya, Israel
| | | | - Richard Mindham
- United Kingdom European Society of Cardiology Patient Forum, Sophia Antipolis, France
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Anna Strömberg
- Department of Health, Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
Abstract
OBJECTIVES The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs. METHODS An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach. RESULTS Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying. SIGNIFICANCE OF RESULTS In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.
Collapse
|
6
|
Wilson D, Moloney E, Parr JM, Aspinall C, Slark J. Creating an Indigenous Māori-centred model of relational health: A literature review of Māori models of health. J Clin Nurs 2021; 30:3539-3555. [PMID: 34046956 PMCID: PMC8597078 DOI: 10.1111/jocn.15859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Identify the key concepts, principles and values embedded within Indigenous Māori models of health and wellbeing; and determine how these could inform the development of a Māori-centred relational model of care. BACKGROUND Improving health equity for Māori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners' engagement with Indigenous Māori accessing health services is one area that could support improving Māori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whānau or family, and spirituality, important for Indigenous health and wellbeing. DESIGN AND METHODS A qualitative literature review on Māori models of health and wellbeing yielded nine models to inform a Māori-centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews. RESULTS Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio-political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Māori is a holistic and relational concept. Building relationships that include whānau (extended family) is a cultural imperative. CONCLUSIONS This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing). RELEVANCE TO CLINICAL PRACTICE Culturally-based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Māori-centred relational model of care to address inequity.
Collapse
Affiliation(s)
- Denise Wilson
- Taupua Waiora Māori Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Eleanor Moloney
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand
| | - Jenny M Parr
- Counties Manukau Health District Health Board, Middlemore Hospital, Auckland, New Zealand
| | - Cathleen Aspinall
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand.,Counties Manukau Health, Otahuhu, Auckland, New Zealand
| | - Julia Slark
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand
| |
Collapse
|
7
|
Skorpen Tarberg A, Landstad BJ, Hole T, Thronaes M, Kvangarsnes M. Nurses' experiences of compassionate care in the palliative pathway. J Clin Nurs 2020; 29:4818-4826. [PMID: 33031582 PMCID: PMC7756377 DOI: 10.1111/jocn.15528] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 01/10/2023]
Abstract
Aims and objectives The aim was to explore how nurses experience compassionate care for patients with cancer and family caregivers in different phases of the palliative pathway. Background Compassion is fundamental to palliative care and viewed as a cornerstone of high‐quality care provision. Healthcare authorities emphasize that patients should have the opportunity to stay at home for as long as possible. There are, however, care deficiencies in the palliative pathway. Design This study employed a qualitative design using focus groups and a hermeneutic approach. Methods Four focus groups with three to seven female nurses in each group were conducted in Mid‐Norway in 2018. Nurses’ ages ranged from 28–60 years (mean age = 45 years), and they were recruited through purposive sampling (N = 21). Compassionate care was chosen as the theoretical framework. Reporting followed the COREQ guidelines. Results Three themes expressing compassionate care related to different phases of the pathway were identified: (a) information and dialogue, (b) creating a space for dying and (c) family caregivers’ acceptance of death. Conclusions This study showed that it was crucial to create a space for dying, characterized by trust, collaboration, good relationships, empathy, attention, silence, caution, slowness, symptom relief and the absence of noise and conflict. Relevance to clinical practice The quality of compassion possessed by individual practitioners, as well as the overall design of the healthcare system, must be considered when creating compassionate care for patients and their family caregivers. Nursing educators and health authorities should pay attention to the development of compassion in education and practice. Further research should highlight patients’ and family caregivers’ experiences of compassionate care and determine how healthcare systems can support compassionate care.
Collapse
Affiliation(s)
- Anett Skorpen Tarberg
- Medical department, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, European Palliative Care Centre (PRC), Norwegian University of science and Technology (NTNU, Trondheim, Norway
| | - Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torstein Hole
- Medical department, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Thronaes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, European Palliative Care Centre (PRC), Norwegian University of science and Technology (NTNU, Trondheim, Norway.,Cancer Clinic, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Ålesund, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| |
Collapse
|