1
|
Zhang Y, Stayt L, Sutherland S, Greenway K. How clinicians make decisions for patient management plans in telehealth. J Adv Nurs 2024; 80:3516-3532. [PMID: 38380577 DOI: 10.1111/jan.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth. BACKGROUND Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood. DESIGN A systematic integrative review. DATA SOURCES Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar. REVIEW METHODS This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data. RESULTS The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor. CONCLUSIONS The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors. IMPACT Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth. PATIENT OR PUBLIC CONTRIBUTION Not applicable.
Collapse
Affiliation(s)
- Yuhan Zhang
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
| | - Louise Stayt
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
| | | | | |
Collapse
|
2
|
Jalali A, Darvishi N, Kalhory P, Merati F, Vatandost S, Moradi K. Intensive care unit dignified care: Persian translation and psychometric evaluation. Nurs Open 2024; 11:e2238. [PMID: 38978289 PMCID: PMC11231042 DOI: 10.1002/nop2.2238] [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: 04/09/2023] [Revised: 04/30/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
AIM The present study aimed to evaluate the psychometric properties of the Persian version of the 'Intensive Care Unit Dignified Care Questionnaire (IDCQ)' among Iranian nurses. DESIGN A methodological and psychometric study was conducted in 2022, involving nurses from six teaching hospitals in Kermanshah, Western Iran. METHODS The IDCQ was translated into Persian using a forward-backward translation method. Construct validity was assessed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), employing a stratified sampling method with 455 critical care nurses. Internal consistency was gauged using Cronbach's alpha coefficient, while reliability was determined through the test-retest method. Analyses were performed using SPSS version 26 and Lisrel version 8 software. RESULTS EFA and CFA validated the instrument's two-factor, 17-item structure. The CFA indicated a well-fitting model with fit indices: CFI = 0.93, NNFI = 0.92, GFI = 0.861, RMSEA = 0.051 and SRMR = 0.046. Pearson's correlation coefficient substantiated a significant relationship between the items, subscales and the overall scale. The instrument's reliability was confirmed by a Cronbach's α coefficient of 0.88 and a test-retest reliability of 0.86. CONCLUSION The Persian version of the IDCQ, comprising two factors and 17 items, has been validated as a reliable and applicable tool for use within the Iranian nursing community.
Collapse
Affiliation(s)
- Amir Jalali
- Substance Abuse Prevention Research Center, Research Institute for HealthKermanshah University of Medical SciencesKermanshahIran
| | - Niloufar Darvishi
- Student Research CommitteeKermanshah University of Medical SciencesKermanshahIran
| | - Parnia Kalhory
- Department of Emergency and Critical Care Nursing, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
| | - Fateme Merati
- Department of Emergency and Critical Care Nursing, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
| | - Salam Vatandost
- Clinical Care Research Center, Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
| | - Khalil Moradi
- Department of Emergency and Critical Care Nursing, School of Nursing and MidwiferyKermanshah University of Medical SciencesKermanshahIran
| |
Collapse
|
3
|
Sailian SD, Salifu Y, Preston N. Dignity enhanced through faith & family support in palliative care: a qualitative study. BMC Palliat Care 2024; 23:142. [PMID: 38849809 PMCID: PMC11157805 DOI: 10.1186/s12904-024-01478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Dignity is integral to palliative care. Illness can diminish it, causing hopelessness and the wish to hasten death. Yet, dignity is a complex multidimensional phenomenon, influenced by values and context. Understanding its varying interpretations can inform practice and policy. The aim of the study is to explore the understanding of dignity in adult patients with palliative care needs from a Lebanese perspective and how it is preserved during illness and while receiving health services. DESIGN Qualitative interview study underpinned with a social constructionist lens. Fourteen patients recruited from home-based hospice and outpatient clinics in Lebanon. Data analysed using reflexive thematic analysis. RESULTS Four themes were developed across all the interviews: (a) Dignity anchored through faith in God and religious practices; (b) Family support in maintaining physical, psychological wellbeing, and social connectedness; (c) Physical fitness, mental acuity, and healthy appearance through which patients may escape the stigma of disease, (d) accessible, equitable, and compassionate healthcare. DISCUSSION Dignity is elusive and difficult to define but faith and religious beliefs play a significant contribution in this study. For the participants, illness is seen as a natural part of life that does not necessarily diminish dignity, but it is the illness related changes that potentially affect dignity. Findings show the importance of family and children in preserving dignity during illness and how their active presence provide a sense of pride and identity. Participants aspired to restore physical, social, and mental well-being to reclaim their dignity and normalize their lives. Challenges related to physical appearance, memory loss, vitality, and social stigma associated with illness diminished dignity. Accessible, equitable and compassionate healthcare services are also crucial in preserving dignity. Participants valued clear communication, respect, and empathy from healthcare providers and identified affordability of care essential for maintaining dignity. CONCLUSION Faith in God, and strong family ties are dominant elements to maintaining dignity in the Lebanese context. Relational connectedness with family, children or God is also a need in maintaining dignity in other communal countries with variations in emphasis. The study indicates that religious and cultural context shapes the needs and perceptions of dignity during illness. These findings are likely to be transferable to many Middle Eastern countries but also countries with strong religious and family ties globally.
Collapse
Affiliation(s)
- Silva Dakessian Sailian
- American University of Beirut, Hariri School of Nursing, Riad El Solh, PO Box: 11 0236, Beirut, 1107, 2020, Lebanon.
| | - Yakubu Salifu
- International Observatory on End-of-Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4YW, UK
| | - Nancy Preston
- International Observatory on End-of-Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Sir John Fisher Drive, Lancaster, LA1 4YW, UK
| |
Collapse
|
4
|
Söderman A, Hälleberg Nyman M, Werkander Harstäde C, Johnston B, Blomberg K. Grasping a new approach to older persons' dignity: A process evaluation of the Swedish Dignity Care Intervention in municipal palliative care. Scand J Caring Sci 2024; 38:496-511. [PMID: 37882233 DOI: 10.1111/scs.13222] [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: 03/29/2023] [Revised: 09/19/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023]
Abstract
AIM Dignity in older persons is a goal of palliative care. This study aimed to perform a process evaluation of the Swedish Dignity Care Intervention (DCI-SWE) in municipal palliative care in Sweden, focusing on implementation, context, and mechanism of impact. METHODS This study had a process evaluation design. The Knowledge to Action framework supported the implementation of the DCI-SWE. The intervention was used by community nurses with older persons (n = 18) in home healthcare and nursing homes. Data were collected by focus groups- and individual interviews with community nurses (n = 11), health care professionals (n = 5) and managers (n = 5), reflective diaries, and field notes. RESULTS Grasping the DCI-SWE was challenging for some community nurses. Enhanced communication training and increased engagement from managers were requested. However, the DCI-SWE was perceived to enhance professional pride in nursing. In terms of fidelity, dose and reach the project was not fully achieved. Regarding mechanism of impact the DCI-SWE contributes to address older persons' loneliness and existential life issues, as it put conversations with older persons on community nurses' agenda. CONCLUSIONS The DCI-SWE provided opportunities to maintain older persons' dignity and quality of life. However, with refinements of design and the DCI-SWE, the sustainability in the context may increase.
Collapse
Affiliation(s)
- Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Carina Werkander Harstäde
- Centre for Collaborative Palliative Care, Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
5
|
Bovero A, Botto R, Mellano E, Gottardo F, Berchialla P, Carletto S, Geminiani GC. Loss of Personal Autonomy and Dignity-Related Distress in End-Of-Life Cancer Patients. Am J Hosp Palliat Care 2024; 41:179-186. [PMID: 36974952 DOI: 10.1177/10499091231166373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
The objective of this cross-sectional study is to investigate Dignity-Related Loss of Personal Autonomy (DR-LPA) intended as loss of relational independence causing dignity-related distress. Moreover, it analyzes its possible relationships with demoralization, spirituality, quality of life, hope, and coping styles in a sample composed of 207 end-of-life cancer patients. These variables have been assessed through the following rating scales: Patient Dignity Inventory - Italian version, Demoralization Scale - Italian version, Functional Assessment of Cancer Therapy Scale - General Measure, Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being, Brief Coping Orientation to Problem Experienced, and Herth Hope Index. The results have shown that most of the DR-LPA items were considered a problem by most patients. Functional, social, emotional, and spiritual wellbeing, disheartenment, age, and sex emerged as significant predictors of DR-LPA. In conclusion, this study showed that DR-LPA can be a relevant concern for patients at the end-of-life and for this reason it becomes necessary for psychosocial provides to consider it to deliver better dignity conserving care.
Collapse
Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Rossana Botto
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Elena Mellano
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Francesco Gottardo
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Sara Carletto
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Giuliano C Geminiani
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| |
Collapse
|
6
|
Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
Collapse
Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
7
|
Gattinger H, Ott S, Maurer C, Marty-Teuber B, Hantikainen V, Fringer A. Effect of an educational intervention on nurses' competence in activities of daily living support in end-of-life care using a pretest-posttest repeated measures design. BMC Palliat Care 2023; 22:119. [PMID: 37605181 PMCID: PMC10464419 DOI: 10.1186/s12904-023-01232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 07/23/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Most patients in specialized palliative care units need nursing support to perform activities of daily living (ADL), such as using a toilet or transferring out of a bed or chair. To deliver high-quality ADL support that facilitates patients' movement and protects nurses' musculoskeletal health, nurses need appropriate knowledge and skills. The objective of this study is to investigate the impact of education based on the "Advanced Kinaesthetics in Palliative care (AdKinPal) program" on the competence in Kinaesthetics, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints of nurses from specialist palliative care units. METHODS A pretest-posttest repeated measures design was applied. The study took place in three specialised units for palliative care in Switzerland between June 2018 and April 2020. All the nurses who worked in participating wards (n = 62) and fulfilled the inclusion criteria were asked to participate. The intervention - the AdKinPal program - is an education-based training program conducted for six months. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, repeated measurement analysis of variance (ANOVA) and independent-samples t-tests, we analysed the participants' demographic characteristics as well as developments over time and relationships between the three outcome variables: Kinaesthetics competence, self-efficacy regarding ADL support in end-of-life care and musculoskeletal complaints. RESULTS Fifty-nine nurses and one physiotherapist participated, and 38 participants (63%) responded to all three questionnaires. The AdKinPal training improved the nurses' perceived Kinaesthetics competence and self-efficacy regarding ADL support in end-of-life care. Participants who reported lower back, neck or shoulder pain had a significantly lower Kinaesthetics competence. CONCLUSIONS The AdKinPal program can raise nurses' Kinaesthetics competence. Thereby, patients' autonomy and quality of life could be supported, and symptom management could be enhanced in a holistic manner. Furthermore, the AdKinPal program fosters nurses' self-efficacy in ADL support in end-of-life care. A strong sense of self-efficacy enhances professional well-being in many ways. Additionally, the nursing staff's musculoskeletal health can be promoted by enhancing their Kinaesthetics competence. TRIAL REGISTRATION DRKS00015908. Registration Date 23.11.2018.
Collapse
Affiliation(s)
- Heidrun Gattinger
- Institut of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St. Gallen, Postfach, St. Gallen, 9001, Switzerland.
| | - Stefan Ott
- School of Management, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St. Gallen, Postfach, St. Gallen, 9001, Switzerland
| | - Carola Maurer
- Institut of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, St. Gallen, Postfach, St. Gallen, 9001, Switzerland
| | | | - Virpi Hantikainen
- Department of Nursing Science, University of Turku, Turku, Turun yliopisto, 20014, Finland
| | - André Fringer
- ZHAW School of Health Sciences, Institute of Nursing, Katharina-Sulzer-Platz 9, Winterthur, 8400, Switzerland
| |
Collapse
|
8
|
Laranjeira C. Dignity promotion in people with advanced chronic diseases: contributions for a value-based healthcare practice. Front Public Health 2023; 11:1156830. [PMID: 37575126 PMCID: PMC10415073 DOI: 10.3389/fpubh.2023.1156830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Carlos Laranjeira
- Department of Nursing Science, School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
| |
Collapse
|
9
|
Liang M, Xie X, Pan Y, Cheng ASK, Ye Z. A qualitative meta-synthesis of patient dignity from the perspective of caregivers. BMC Geriatr 2023; 23:351. [PMID: 37277725 DOI: 10.1186/s12877-023-04071-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 05/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The concept of dignity remains disputed, with most studies defining dignity based on its external dimension. Although its inherent dimension is a rooted attribute of dignity, it has received scarce attention. Caregivers have close relationships with their care recipients and thus may perceive their patient's inherent as well as external dimensions of dignity. Therefore, in this study, we aimed to identify, analyze, and synthesize evidence on human dignity presented in qualitative studies from the perspective of caregivers to gain a deeper comprehension of the preservation of patients' dignity by their caregivers. METHODS A qualitative meta-synthesis was performed by searching for relevant qualitative literature via systematic electronic databases, including MEDLINE, PsycINFO, ProQuest, CINAHL, Embase, Health Source, and Web of Science, from inception to March 15, 2022. RESULTS Nine studies were eligible for inclusion and included in the meta-synthesis. Three overarching categories were identified: integrated person, "rootedness" and "growth" atmosphere, and balanced state. CONCLUSIONS Dignity is rooted in its inherent dimension, whereas its external dimension may promote individual dignity. Furthermore, caregiver-patient relationships may be a key factor linking the inherent dimension of dignity with its external dimension. Thus, further studies should focus on the mechanism of relationships in preserving dignity.
Collapse
Affiliation(s)
- Minyu Liang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xiyan Xie
- Nursing Department, Home for the Aged Guangzhou, Guangzhou, Guangdong Province, China
| | - Yichao Pan
- Department of Cardiovascular Medicine, Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zengjie Ye
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
| |
Collapse
|
10
|
Söderman A, Werkander Harstäde C, Hälleberg Nyman M, Blomberg K. Valuing the individual - evaluating the Dignity Care Intervention. Nurs Ethics 2023; 30:86-105. [PMID: 36206197 PMCID: PMC9902983 DOI: 10.1177/09697330221122902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care needs in older persons can endanger their dignity. To provide dignity-conserving care to older persons, the Swedish Dignity Care Intervention (DCI-SWE) can be used. The DCI-SWE is built on Chochinov's dignity model and the original version, developed and tested in UK and Scotland. AIM To describe older persons' and their relatives' experiences of dignity and dignity-conserving care when using the DCI-SWE in municipal health care. RESEARCH DESIGN A mixed method study with convergent parallel design. PARTICIPANTS AND RESEARCH CONTEXT The DCI-SWE was used and evaluated in a Swedish municipality health care context. Older persons' (n=17) dignity-related distress and quality of life were assessed after the intervention. Interviews with older persons (n=10) and their relatives (n=8) were analysed using thematic analysis. ETHICAL CONSIDERATIONS The study followed the World Medical Association Declaration of Helsinki. Ethical approval was obtained from the Regional Ethical Review Board in Uppsala, Sweden (Reg No. 2014/312) and the National Swedish Ethical Review Authority (Reg. No. Ö 10-2019). Informed consent was collected from older persons and their relatives. FINDINGS The older persons' dignity-related distress did not significantly change over time (p = 0.44) neither was their overall quality of life (p = .64). Only psychological quality of life was decreased significantly (p = 0.01). The older persons and their relatives emphasized the importance of valuing the individual. CONCLUSIONS The DCI-SWE provides a forum to talk about dignity issues, but relevant competence, continuity and resources are needed. Psychological care actions and health care professionals' communication skills training are important. To fully evaluate, the DCI-SWE a larger sample and validated instruments are necessary.
Collapse
Affiliation(s)
- Annika Söderman
- Annika Söderman, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro 701 82, Sweden.
| | - Carina Werkander Harstäde
- Centre for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden; Department of Orthopaedics, Faculty of Medicine and Health, 6233Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, 6233Örebro University, Örebro, Sweden
| |
Collapse
|
11
|
Laranjeira C, Dourado M. "Dignity as a Small Candle Flame That Doesn't Go Out!": An Interpretative Phenomenological Study with Patients Living with Advanced Chronic Obstructive Pulmonary Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17029. [PMID: 36554911 PMCID: PMC9778832 DOI: 10.3390/ijerph192417029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Long-term illness, such as chronic obstructive pulmonary disease (COPD), can expose people to existential suffering that threatens their dignity. This qualitative study explored the lived experiences of patients with advanced COPD in relation to dignity. An interpretative phenomenological approach based on lifeworld existentials was conducted to explore and understand the world of the lived experience. Twenty individuals with advanced COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages III and IV) were selected using a purposive sampling strategy. In-depth interviews were used to collect data, which were then analysed using Van Manen's phenomenology of practice. The existential experience of dignity was understood, in essence, as "a small candle flame that doesn't go out!". Four intertwined constituents illuminated the phenomenon: "Lived body-balancing between sick body and willingness to continue"; "Lived relations-balancing between self-control and belongingness"; "Lived Time-balancing between past, present and a limited future"; and "Lived space-balancing between safe places and non-compassionate places". This study explains how existential life phenomena are experienced during the final phases of the COPD trajectory and provides ethical awareness of how dignity is lived. More research is needed to investigate innovative approaches to manage complex care in advanced COPD, in order to assist patients in discovering their inner resources to develop and promote dignity.
Collapse
Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena–Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Rua de Santo André—66–68, Campus 5, 2410-541 Leiria, Portugal
- Research in Education and Community Intervention (RECI I&D), Piaget Institute, 3515-776 Viseu, Portugal
- Center for Studies and Development of Continuous and Palliative Care (CEDCCP), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
| | - Marília Dourado
- Center for Studies and Development of Continuous and Palliative Care (CEDCCP), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, R. Larga, 3004-504 Coimbra, Portugal
| |
Collapse
|
12
|
Rehnsfeldt A, Slettebø Å, Lohne V, Sæteren B, Lindwall L, Heggestad AKT, Råholm MB, Høy B, Caspari S, Nåden D. Dignity in relationships and existence in nursing homes' cultures. Nurs Ethics 2022; 29:1761-1772. [PMID: 35801831 PMCID: PMC9667089 DOI: 10.1177/09697330211041739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed
by caregivers were investigated. A coherence could be detected between the
concepts and phenomena of existence and dignity in relationships and caring
culture as a context. A caring culture is interpreted by caregivers as the
meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in
relationships and caring culture is that suffering is a part of existence,
as well as compassion in relieving suffering, and ontological
interdependency. Aim: To describe different expressions of dignity in relationships and existence
in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the
theoretical preunderstanding as one horizon of understanding with empirical
data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for
example, preserve self-determination, integrity, dignity, confidentiality
and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs
that promote dignity in a caring culture; To amplify dignity in
relationships by the creative art of caring in a caring culture; Violation
of dignity by ignorance or neglect in a non-caring culture and The ethic of
words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are
adequate to see from the perspective of dignity in relationships and
existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as
the existential life is dependent on confirmation from others.
Collapse
Affiliation(s)
- Arne Rehnsfeldt
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Department of Health and Caring sciences
| | - Åshild Slettebø
- University of Agder, Faculty of Health and Sport Sciences, Department of Health and Nursing Sciences, Norway
| | | | - Berit Sæteren
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Norway
| | - Lillemor Lindwall
- Karlstad Univeristy, Faculty of Health, Science and Technology, Department of Health Sciences
| | | | - Maj-Britt Råholm
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences, Department of Health and Caring sciences
| | | | | | - Dagfinn Nåden
- Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Norway
| |
Collapse
|
13
|
Becqué YN, van der Geugten W, van der Heide A, Korfage IJ, Pasman HRW, Onwuteaka-Philipsen BD, Zee M, Witkamp E, Goossensen A. Dignity reflections based on experiences of end-of-life care during the first wave of the COVID-19 pandemic: A qualitative inquiry among bereaved relatives in the Netherlands (the CO-LIVE study). Scand J Caring Sci 2021; 36:769-781. [PMID: 34625992 PMCID: PMC8661881 DOI: 10.1111/scs.13038] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/26/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic affects care practices for critically ill patients, with or without a COVID-19 infection, and may have affected the experience of dying for patients and their relatives in the physical, psychological, social and spiritual domains. AIM To give insight into aspects of end-of-life care practices that might have jeopardised or supported the dignity of the patients and their family members during the first wave of the COVID-19 pandemic in the Netherlands. METHODOLOGY A qualitative study involving 25 in-depth interviews with purposively sampled bereaved relatives of patients who died during the COVID-19 pandemic between March and July 2020 in the Netherlands. We created a dignity-inspired framework for analysis, and used the models of Chochinov et al. and Van Gennip et al. as sensitising concepts. These focus on illness-related aspects and the individual, relational and societal/organisational level of dignity. RESULTS Four themes concerning aspects of end-of-life care practices were identified as possibly jeopardising the dignity of patients or relatives: 'Dealing with an unknown illness', 'Being isolated', 'Restricted farewells' and 'Lack of attentiveness and communication'. The analysis showed that 'Meaningful end-of-life moments' and 'Compassionate professional support' contributed to the dignity of patients and their relatives. CONCLUSION This study illuminates possible aspects of end-of-life care practices that jeopardised or supported dignity. Experienced dignity of bereaved relatives was associated with the unfamiliarity of the virus and issues associated with preventive measures. However, most aspects that had an impact on the dignity experiences of relatives were based in human action and relationships. Relatives experienced that preventive measures could be mitigated by health care professionals to make them less devastating.
Collapse
Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Masha Zee
- Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | |
Collapse
|
14
|
Robertson SB, Hjörleifsdóttir E, Sigurðardóttir Þ. Family caregivers' experiences of end-of-life care in the acute hospital setting. A qualitative study. Scand J Caring Sci 2021; 36:686-698. [PMID: 34382701 PMCID: PMC9545473 DOI: 10.1111/scs.13025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute hospital settings are generally not considered adequate places for end-of-life care, but terminally ill patients will continue to die in acute medical wards in the unforeseeable future. AIM The aim of this study was to investigate family caregivers' experiences of end-of-life care in an acute community hospital in Iceland. METHODS Fifteen in-depth qualitative semi-structured interviews were conducted with participants who had been primary caregivers. The transcribed interviews were analysed using thematic content analysis. FINDINGS Findings indicated that the acute hospital setting is not a suitable environment for end-of-life care. Effective communication and management of symptoms characterised by warmth and security give a sense of resilience. Three main themes emerged: (1) Environmental influences on quality of care; (2) Communication in end-of-life care; (3) The dying process. Each of the themes encompassed a variety of subthemes. CONCLUSIONS Findings suggest that effective communication is the cornerstone of quality of care in the acute hospital environment and essential for establishing a sense of security. The severity of symptoms can deeply affect family caregivers' well-being. Acknowledging and appreciating the meaning of respect and dignity at the end-of-life from family caregivers' perspective is vital.
Collapse
Affiliation(s)
- Svala Berglind Robertson
- Palliative Home-Care Unit, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Department of Nursing, University of Akureyri, Akureyri, Iceland
| | | | - Þórhalla Sigurðardóttir
- Department of Nursing, University of Akureyri, Akureyri, Iceland.,Department of Accident and Emergency, Akureyri Regional Hospital, Akureyri, Iceland
| |
Collapse
|
15
|
Park SA, Park HJ. The Relationships Between Oncology Nurses' Attitudes Toward a Dignified Death, Compassion Competence, Resilience, and Occupational Stress in South Korea. Semin Oncol Nurs 2021; 37:151147. [PMID: 33895014 DOI: 10.1016/j.soncn.2021.151147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/27/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In recent years, South Korea has become more concerned about a dignified death and the 'well-dying' law has been enacted. Oncology nurses' perceptions of death are crucial in maintaining dying patients' sense of dignity; fostering their physical, mental, and spiritual quality of life; and ensuring that they die a comfortable death. This study accordingly examined the relationships between attitudes towards a dignified death, compassion competence, resilience, and occupational stress to provide basic data to promote better attitudes towards death among oncology nurses in South Korea. DATA SOURCES This study, conducted between 2 to 31 January 2018, adopted a descriptive cross-sectional design. Oncology nurses (N = 329) participated, and the differences in their attitudes towards a dignified death correlating to their demographic and work-related characteristics were analysed using t-tests and analyses of variance. Pearson's correlations were used to examine the relationships between nurses' attitudes towards a dignified death, compassion competence, resilience, and occupational stress. CONCLUSION Participants' attitudes towards a dignified death were weaker than those of the general population but stronger than those of non-oncology nurses. Attitudes towards a dignified death were significantly correlated with compassion competence and resilience-traits that appear to enable nurses' efficient response to various stressful situations. IMPLICATIONS FOR NURSING PRACTICE Educational programmes should promote nurses' compassion competence and resilience. Nurses should receive death-related education to reduce the stress that arises from providing end-of-life care and enhance their attitudes towards a dignified death.
Collapse
Affiliation(s)
- Sun-A Park
- Assistant Professor, Department of Nursing, University of Suwon, Hwaseong-si, Gyeonggi-do, South Korea.
| | - Hee Jung Park
- Deputy Chief of Ward Nursing, National Cancer Center, Goyang, Gyonggi, Korea
| |
Collapse
|
16
|
Söderman A, Werkander Harstäde C, Östlund U, Blomberg K. Community nurses' experiences of the Swedish Dignity Care Intervention for older persons with palliative care needs - A qualitative feasibility study in municipal home health care. Int J Older People Nurs 2021; 16:e12372. [PMID: 33713554 DOI: 10.1111/opn.12372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/17/2020] [Accepted: 02/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The Swedish Dignity Care Intervention (DCI-SWE) is an intervention for people with palliative care needs to enhance their dignity. The original DCI was developed in Scotland, where it was tested by nurses in municipal care. In this study, the DCI has been tested for the first time in a Swedish home health care context. The aim was to describe experiences of the DCI-SWE from the perspectives of community nurses (CNs). METHODS This was a feasibility study with a qualitative design. Three focus group interviews and one individual interview were performed with CNs (n = 11). Reflective diaries and field notes were written by the CNs and researchers, respectively. Data were analysed using inductive content analysis. RESULTS Two main categories and six subcategories were identified. The first main category, 'Practising the palliative approach while responding to palliative care needs', consisted of the subcategories: gives structure while providing palliative care; gives older people opportunities to be confirmed; and responding to existential and sensitive needs. The second main category, 'Aspects influencing the use of the DCI-SWE' had two subcategories about facilitators and barriers to the use of the DCI-SWE, and another about how to establish the DCI-SWE in the context of home health care. CONCLUSION The DCI-SWE offers CNs an overview of older people's concerns while providing palliative care, and gives the older people opportunities to be listened to. Essential prerequisites for using the DCI-SWE in municipal home health care are that CNs are comfortable holding conversations and are given time and space for these by the organisation. Other aspects facilitating the use of the DCI-SWE are managers' engagement and support, continuing training for CNs and CNs' opportunities for reflection.
Collapse
Affiliation(s)
- Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Carina Werkander Harstäde
- Centre for Collaborative Palliative Care, Faculty of Health and Life Sciences, School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Ulrika Östlund
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
17
|
Viftrup DT, Hvidt NC, Prinds C. Dignity in end-of-life care at hospice: An Action Research Study. Scand J Caring Sci 2020; 35:420-429. [PMID: 32419195 DOI: 10.1111/scs.12872] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Safeguarding the dignity of patients at the end of life is a key objective in palliative care practice in Denmark. The concept of dignity and how it influences a dying persons' quality of life is thus influential in end-of-life care at hospices. However, what is meant by dignity, how dignity is understood and practiced by healthcare professionals in Danish hospices, and whether this relates to the patients' understandings and needs concerning dignity remains unanswered. AIM The aim of this study was to explore and improve dignity in care through an action research study with patients and hospice staff at two different hospices in Denmark. This was done by exploring how patients and healthcare professionals expressed their understandings and needs concerning dignity and involving participants in the research process with the goal of improving dignity in care. METHODS An action research method with reflection-of-praxis and action-in-praxis was applied. It was combined with methods of semi-structured individual interviews with twelve patients, five staff and nine focus-group interviews with staff. RESULTS Three themes emerged from the analysis of data. The themes were as follows: (1) being understood, (2) contributing and (3) holistic care. Deeper analysis indicated that staff understandings of dignity mostly focused on preserving patients' autonomy, whereas patients expressed needs for relational and spiritual aspects of dignity. Staff were mostly concerned about preserving patients' autonomy when providing dignity in care, however, through the action-in-praxis they increased their awareness on their own praxis and patients' needs and understanding concerning dignity. The theoretical model on dignity presented in the study also worked as a map to guide staffs' reflections on dignity in praxis and facilitated a broader focus on supporting and caring for patients' dignity in care. We believe this study has improved dignity in care at the two hospices involved in the study.
Collapse
Affiliation(s)
- Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Christina Prinds
- Institute of Clinical Research, Research Unit for Gynecology and Obstetrics, University of Southern Denmark, Odense C, Denmark.,University College South Denmark, Haderslev, Denmark
| |
Collapse
|
18
|
Dönmez ÇF, Johnston B. Living in the moment for people approaching the end of life: A concept analysis. Int J Nurs Stud 2020; 108:103584. [PMID: 32450405 DOI: 10.1016/j.ijnurstu.2020.103584] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/26/2020] [Accepted: 03/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND 'Living in the moment' is an essential part of dignity-conserving practice in end-of-life care settings. Although living in the moment is important for care at the end of life, from the perspective of both the person and their family, there is no clear conceptual understanding of what it represents. OBJECTIVE To explore the concept of 'living in the moment' in the context of dignity-conserving care at the end of life. DESIGN A concept analysis. DATA SOURCES The databases of Medline, CinAHL, PubMed, Web of Science, PsycINFO, SocINDEX and Cochrane were searched for studies published between 1941 and 2019, and searches of dictionaries and grey literature, as well as hand-searching were conducted, to yield qualitative, mixed methods and systematic reviews published in English, related to the term 'living in the moment'. METHOD The methods of Walker and Avant were used to identify antecedents, attributes and consequences of the concept of 'living in the moment'. RESULTS The literature review generated a total of 37 papers for this concept analysis. The attributes identified were (1) simple pleasure, (2) prioritising relationships, (3) living each day to the fullest, (4) maintaining normality, and (5) not worrying about the future. The antecedents were (1) awareness of dying, (2) living with life-threatening illness, (3) positive individual growth, and (4) living with an uncertain future. The consequences were (1) a good quality of life, (2) preserving dignity, and (3) coping with the uncertainty of life. CONCLUSIONS A universal definition and conceptual model of the main concept, including theoretical relationships between its antecedents, attributes and consequences, was developed. The definition and proposed conceptual model can allow instruments to be developed that measure the effects, existence or attributes of the concept, and identify a theoretical model, and can also lead to new perspectives and strategies for implementation by nurses to improve dignified person-centred care at the end of life.
Collapse
Affiliation(s)
- Çiğdem Fulya Dönmez
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; School of Heath Sciences, Department of Nursing, Istanbul Arel University, Istanbul, Turkey.
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; Florence Nightingale Foundation Clinical Professor of Nursing, School of Medicine, Dentistry & Nursing, and NHS Greater Glasgow and Clyde, College of Medical, Veterinary & Life Sciences, University of Glasgow, 57-61 Oakfield Avenue, Glasgow G12 8LL, Scotland, UK.
| |
Collapse
|
19
|
Dignity-conserving care for persons with palliative care needs — identifying outcomes studied in research: An integrative review. Palliat Support Care 2020; 18:722-740. [DOI: 10.1017/s1478951520000139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesWith people living longer, palliative care may be required for lengthier periods of time. This puts demands on healthcare organizations to provide optimal palliative care. Maintaining dignity is central for any person's health and quality of life, but especially for a person with palliative care needs. Dignity-conserving care needs to be evaluated to increase knowledge about outcomes and how to assess these. The purpose of this integrative review was to identify outcomes studied within dignity-conserving care and how these have been operationalized.MethodsAn integrative review was conducted in 26 quantitative or mixed-method studies and study protocols. Thematic synthesis with an abductive approach was used for analysis.ResultsSeven themes of studied outcomes were identified, as well as four cluster themes: themes related to Illness-Related Concerns, themes related to the Dignity-Conserving Repertoire, themes related to the Social Dignity Inventory, and themes regarding Overarching Dignity Issues. Most outcomes studied dealt with Illness-Related Concerns within the themes of “Performance, symptoms and emotional concerns” and “End-of-life and existential aspects”. Themes linked to the Social Dignity Inventory had the lowest number of outcomes studied. Outcomes regarding overarching dignity issues such as “Dignity-related distress” and “Quality of life” were common. However, the results lacked concrete communication outcomes.Significance of resultsThe results will underpin future research in which dignity-conserving care is implemented and evaluated, and contribute to the provision of evidence-based palliative care. A greater focus on outcomes within cluster themes related to the Dignity-Conserving Repertoire and the Social Dignity Inventory is needed, as is more focus on communication outcomes.
Collapse
|
20
|
Hemberg J, Bergdahl E. Ethical sensitivity and perceptiveness in palliative home care through co-creation. Nurs Ethics 2019; 27:446-460. [DOI: 10.1177/0969733019849464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In research on co-creation in nursing, a caring manner can be used to create opportunities whereby the patient’s quality of life can be increased in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. To promote quality of life, nurses must be sensitive to patients’ and their relatives’ needs in care encounters. Co-creation can be defined as the joint creation of vital goals for patients through the process of shared knowledge between nurses, patients and their relatives. Aim: The aim of this study was to explore nurses’ experiences of caring encounters and co-creation in palliative home care from an ethical perspective. Research design, participants, and research context: A hermeneutical approach was used. The material consisted of texts from interviews with 12 nurses in a home care context. The method was inspired by thematic analysis. Ethical considerations: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Findings: An overall theme, a main theme and four sub-themes emerged. Through ethical sensitivity and perceptivity, nurses can balance their actions in the moment and change their nursing care actions according to the patient’s wishes through co-creation in encounters. Here the time is crucial, as the time needed is unique to each patient. Discussion: The themes together can be considered prerequisites for good palliative home care. If nurses fail to be sensitive and perceptive in encounters with dying patients, good palliative home care cannot be achieved. Ethical sensitivity and perceptiveness can also be considered a part of nurses’ ethical competence. Conclusion: Patients’ dignity can be preserved through ethical sensitivity and perceptiveness, which is fundamental for good palliative care. Co-creation from patients’ perspectives should be the focus of future research.
Collapse
|
21
|
Blomberg K, Lindqvist O, Harstäde CW, Söderman A, Östlund U. Translating the Patient Dignity Inventory. Int J Palliat Nurs 2019; 25:334-343. [DOI: 10.12968/ijpn.2019.25.7.334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: The Patient Dignity Inventory (PDI) is based on an empirically-driven dignity model that has been developed and used for clinically assessing the various sources of dignity-related distress. In a recent review, it received the highest score as a useful instrument in both practice and research in palliative care. The PDI has been adapted to and validated for use in various countries, but not yet Sweden. Aims: To translate the PDI into Swedish, including cultural adaptation for clinical use. Methods: A multi-step process of translation, negotiated consensus, expert group discussion (n=7: four invited experts and three researchers) and cognitive interviewing (n=7: persons with palliative care needs). Findings: Discussion, by the expert reviewers, of both linguistic and cultural issues regarding the content and readability of the translated Swedish version resulted in revisions of items and response alternatives, focusing mainly on semantic, conceptual, and experiential equivalence. A pilot version for cognitive interviews was produced. The analysis of data showed that most of the items were judged to be relevant by the persons with palliative care needs. Conclusion: The process of translation and adaptation added clarity and consistency. The Swedish version of the PDI can be used in assessing dignity-related distress. The next step will be to test this Swedish version for psychometric properties in a larger group of patients with palliative care needs before use in research.
Collapse
Affiliation(s)
- Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | | | - Carina Werkander Harstäde
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| | - Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrika Östlund
- Center for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
22
|
Rejnö Å, Ternestedt BM, Nordenfelt L, Silfverberg G, Godskesen TE. Dignity at stake: Caring for persons with impaired autonomy. Nurs Ethics 2019; 27:104-115. [PMID: 31104584 DOI: 10.1177/0969733019845128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dignity, usually considered an essential ethical value in healthcare, is a relatively complex, multifaceted concept. However, healthcare professionals often have only a vague idea of what it means to respect dignity when providing care, especially for persons with impaired autonomy. This article focuses on two concepts of dignity, human dignity and dignity of identity, and aims to analyse how these concepts can be applied in the care for persons with impaired autonomy and in furthering the practice of respect and protection from harm. Three vignettes were designed to illustrate typical caring situations involving patients with mild to severely impaired autonomy, including patients with cognitive impairments. In situations like these, there is a risk of the patient's dignity being disrespected and violated. The vignettes were then analysed with respect to the two concepts of dignity to find out whether this approach can illuminate what is at stake in these situations and to provide an understanding of which measures could safeguard the dignity of these patients. The analysis showed that there are profound ethical challenges in the daily care of persons with impaired autonomy. We suggest that these two concepts of human dignity could help guide healthcare professionals to develop practical skills in person-centred, ethically grounded care, where the patient's wishes and needs are the starting point.
Collapse
Affiliation(s)
- Åsa Rejnö
- University West, Sweden.,Skaraborg Hospital Skövde, Sweden
| | | | | | | | - Tove E Godskesen
- Ersta Sköndal Bräcke University College, Sweden.,Uppsala University, Sweden
| |
Collapse
|
23
|
Bylund-Grenklo T, Werkander-Harstäde C, Sandgren A, Benzein E, Östlund U. Dignity in life and care: the perspectives of Swedish patients in a palliative care context. Int J Palliat Nurs 2019; 25:193-201. [DOI: 10.12968/ijpn.2019.25.4.193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tove Bylund-Grenklo
- Senior Lecturer, Department of Caring Science, University of Gävle, and (affiliated) Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Carina Werkander-Harstäde
- Senior Lecturer, Department of Health and Caring Sciences, Linnaeus University, Växjö, and Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Anna Sandgren
- Associate Professor, Department of Health and Caring Sciences, Linnaeus University, Växjö and Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Eva Benzein
- Professor, Department of Health and Caring Sciences, Linnaeus University, Kalmar and Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Ulrika Östlund
- Associate Professor, Research Supervisor, Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle; (affiliated) Faculty of Medicine and Health, School of Health Sciences, Örebro University; and (affiliated) Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
24
|
Östlund U, Blomberg K, Söderman A, Werkander Harstäde C. How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care. BMC Palliat Care 2019; 18:10. [PMID: 30678669 PMCID: PMC6346549 DOI: 10.1186/s12904-019-0393-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 01/11/2019] [Indexed: 01/07/2024] Open
Abstract
Background An essential aspect of palliative care nursing is to conserve the dignity of the patient. A Dignity Care Intervention (DCI) has been developed in Scotland to facilitate this role for nurses. The DCI is now being adapted to a Swedish context (DCI-SWE) and a central step is to identify culturally relevant, dignity-conserving care actions. These care actions will be incorporated into the DCI-SWE. Therefore, the aim of this study was to suggest care actions for conserving dignity in palliative care from the perspectives of the patients, significant others (SOs), and health care professionals (HPs) in municipality care in Sweden. Methods This study used a descriptive design with a qualitative approach. Data from 20 participants were collected through semi-structured individual interviews with patients (n = 3), SOs (n = 4), two focus groups with nurses (n = 9) and one focus group with physicians (n = 4) in two Swedish municipalities. These data were deductively analysed using qualitative content analysis with the Chochinov model of dignity as framework. Results With the Chochinov model of dignity as a framework, care actions based on suggestions from the participants were identified and presented under three themes: Illness related concerns, Dignity conserving repertoire, and Social dignity inventory. The study found both specific concrete care actions and more general approaches. Such general approaches were found to be relevant for several dignity related issues as all-embracing attitudes and behaviours. However, these general approaches could also be relevant as specific care actions to conserve dignity in relation to certain issues. Care actions were also found to be linked to each other, showing the importance of a holistic perspective in conserving dignity. Conclusions As part of the adaption of the DCI from a Scottish to a Swedish context, this study added relevant care actions for collaborative planning of individualised care in mutual dialogues between nurses and those they care for. The adapted intervention, DCI-SWE, has the potential to help the nurses in providing palliative care of evidence-based quality.
Collapse
Affiliation(s)
- Ulrika Östlund
- Centre for Research & Development, Uppsala University/Region Gävleborg, 80188, Gävle, SE, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Carina Werkander Harstäde
- Centre for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
| |
Collapse
|
25
|
Bergdahl E, Ternestedt B, Berterö C, Andershed B. The theory of a co-creative process in advanced palliative home care nursing encounters: A qualitative deductive approach over time. Nurs Open 2019; 6:175-188. [PMID: 30534407 PMCID: PMC6279716 DOI: 10.1002/nop2.203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/02/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022] Open
Abstract
AIMS AND OBJECTIVES The aim of this study was to test the theoretical conceptualization of the co-creative process in home care nursing encounters over time. METHOD AND DESIGN This was a multiple case study with a deductive analysis of qualitative data over time, using interviews and observations collected from three cases. RESULTS The co-creative process was complex and contained main, sub- and micro-processes. Time was important and valuable, giving the patient and relatives space to adjust the process to their own pace. Some processes were worked on more intensively in accordance with the patients' and relatives' needs, and these are considered the main-process. The further developed theory of the co-creative process and its main, sub- and microprocesses can be understood as a concretization of how good nursing care can be performed within caring relationships in the context of advanced palliative home care.
Collapse
Affiliation(s)
| | - Britt‐Marie Ternestedt
- Department of Health Care Science/Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
| | - Carina Berterö
- Division of Nursing Science, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Birgitta Andershed
- Department of Health Care Science/Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
- Faculty of Health, Care and NursingNorwegian University of Science and TechnologyGjøvikNorway
| |
Collapse
|
26
|
Costello J. Research roundup. Int J Palliat Nurs 2018. [DOI: 10.12968/ijpn.2018.24.6.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care
Collapse
Affiliation(s)
- John Costello
- Honorary Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
| |
Collapse
|
27
|
Hilding U, Allvin R, Blomberg K. Striving for a balance between leading and following the patient and family - nurses' strategies to facilitate the transition from life-prolonging care to palliative care: an interview study. BMC Palliat Care 2018; 17:55. [PMID: 29615009 PMCID: PMC5883396 DOI: 10.1186/s12904-018-0311-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background The transition from life-prolonging to palliative care (PC) can be challenging often characterized by psychical, physiological, social and existential changes. Knowledge of how to support the patient and family in this specific care phase is lacking, and this area needs to be further explored. The aim of this study was to investigate strategies that registered nurses (RNs) use to ease the transition from life-prolonging care to PC for patients with incurable disease. Methods The study has a descriptive design. Fourteen RNs working in a specialized PC unit were interviewed. The data were analysed using content analysis. Results The RNs’ strategies can be described under the categories “Getting to know the patient and creating a relationship”, “Providing support”, “Adapting to individuals’ needs” and “Enabling conversations”. Conclusion The findings show that the RNs in this population used strategies that not only took time but also required knowledge about the transition process and required the ability to identify and meet patients’ and families’ unique needs. Patients’ difficult and exposed situation needs to be addressed through a structured follow-up after informing about the change from life-prolonging care to PC. RNs have a unique role of supporting both the patient and the family in the transition from life-prolonging care to PC for patients with incurable disease.
Collapse
Affiliation(s)
| | - Renée Allvin
- Clinical Skills Centre, Örebro University Hospital, Örebro, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-70182, Örebro, Sweden
| | - Karin Blomberg
- Örebro University Hospital, Örebro, Sweden. .,Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-70182, Örebro, Sweden.
| |
Collapse
|
28
|
Costello J. Research roundup. Int J Palliat Nurs 2017. [DOI: 10.12968/ijpn.2017.23.8.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
Collapse
Affiliation(s)
- John Costello
- Senior Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
| |
Collapse
|