Nursing activities for health promotion in palliative home care: an integrative review

Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.

Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review

Objectives: This scoping review identifies and details the scope of practice of health professionals who provide palliative care within the primary health setting in Australia.

Methods: A scoping review approach was conducted on the Cinahl (Ebsco), Scopus, Medline (Ovid) and PubMed databases to extract articles from 1 December 2015 to 1 December 2020. Broad text words and MeSH headings were used with relevance to palliative care, general practice, primary health, and community setting. Extracted journal articles were limited to those based on the Australian population or Australian health system.

Results: Eighty-four papers met the inclusion criteria and were included in the review. The review identified the following health professional roles within the Primary Health Care setting undertaking palliative care: General Practitioner, Nurse, Pharmacist, Paramedics, Carers, and Allied Health professionals.

Conclusion: This review offers a first understanding of the individual health professional roles and multidisciplinary team approach to actively providing palliative care within the Primary Health Care setting in Australia.

Incontinence in palliative care: assessment to promote dignity

This article will explore the district nurse (DN) role in caring for palliative service users and their responsibility to prepare them and their family members to understand the trajectory of their prognosis and the possible decline in urinary function and incontinence. Educating DNs to advise service users in appropriate management options and collaborating with the wider multidisciplinary team (MDT) to ensure service users' individual goals and aims are followed as closely as possible. Urinary incontinence (UI) is not a natural part of the ageing process, although the prevalence of UI is increased as people age, through multi-morbidities, polypharmacy, cognitive decline, mobility limitations or life-limiting conditions. UI affects an individual's dignity and can cause a negative impact on self-esteem, and it is often accompanied by a perceived stigma that can lead to anxiety, depression and a reluctance to ask for help and advice.

Rural influences on the social network dynamics of district nursing services: A qualitative meta-synthesis

BACKGROUND AND AIMS

As demands on healthcare services grow, fiscal restrictions place increased emphasis on services outside of traditional healthcare settings. Previous research into long-term-conditions suggests that social network members (including weaker ties such as acquaintances, community groups, and healthcare professionals) play a key role in illness management. There is limited knowledge about the engagement of social networks in supporting people who are receiving medical interventions at home. This qualitative metasynthesis explores the work and the interactions between district nurses (DN) and informal network members supporting people who are receiving medical interventions at home and living in rural areas.

METHODS

A search was undertaken on CINAHL, Medline, and PsychINFO for qualitative research articles from 2009 to 2019. Studies that examined DN in rural locations and/or social network support in rural locations were eligible. Fourteen articles were selected.

RESULTS

Thematic analysis of results and discussion data from the studies resulted in four themes being developed: the development of both transactional and friend-like nurse-patient ties in rural localities, engagement of the wider network in the delivery of good care, blurring of professional boundaries in close community relationships, and issues accessing and navigating formal and informal support in the context of diminishing resources in rural areas.These findings suggest that DNs in rural localities work beyond professional specialties and experience to provide emotional support, help with daily tasks, and build links to communities. There was also evidence that nurses embedded within rural localities developed friend-like relationships with patients, and negotiated with existing support networks and communities to find support for the patient.

CONCLUSIONS

Findings indicated that developing strong links with patients and members of their networks does not automatically translate into positive outcomes for patients, and can be unsustainable, burdensome, and disruptive. DNs developing weak ties with patients and building awareness of the structure of individual networks and local sources of support offers avenues for sustainable and tailored community-based nursing support.

Nurses' required end-of-life care competence in health centres inpatient ward - a qualitative descriptive study

BACKGROUND

Studies of nurses' required competence in EOL care in health centres are rare. It is important to produce information about experienced nurses' perceptions of the competence they consider important in their practical work.

AIM

The aim of this study was to describe nurses' required competence in EOL care in health centre inpatient wards as experienced by nurses.

METHOD

A descriptive qualitative study using four semi-structured group interviews (20 nurses) and inductive descriptive content analysis.

RESULTS

Five categories describing nurses' required competence in EOL care in a health centre inpatient ward were identified: (1) ethics and courage in action, (2) support for the patient, (3) support for the family, (4) care planning and (5) physical care. Factors promoting nurses' competence in EOL care comprised two categories: (1) professional development in EOL care and (2) an organisation that supports EOL care.

CONCLUSIONS

End-of-life care in health centre inpatient wards requires wide and complex competence from nurses. Nurses' experiences of required competence are associated with holistic care of the patient, encountering the family and multiprofessional cooperation. Nurses' competence in EOL care could be enhanced with postgraduate education, and educational planning should be given more attention in the future.

Advocacy: Perspectives of Future Nurse Administrators

Advocacy is a core competency of the nurse, and especially the nurse leader. It is a multidimensional concept that requires knowledge, experience, self-confidence, and above all, courage. This article describes and illustrates the perspectives of nursing administration graduate students, as they depict advocacy in many relationships. These include advocacy for the patient, family, self, community, organization, profession, and society. The themes that emerged from narratives written by these nurse leaders were the development of courage and the finding of their voices. Stories demonstrate participants' courage to speak up despite feeling conflicted due to issues of autonomy, moral distress, or fear of retribution. Implications for nurse administrators to support advocacy at all levels are presented.

A practice model for rural district nursing success in end-of-life advocacy care

AIM

The development of a practice model for rural district nursing successful end-of-life advocacy care.

BACKGROUND

Resources to help people live well in the end stages of life in rural areas can be limited and difficult to access. District nurse advocacy may promote end-of-life choice for people living at home in rural Australia. The lack of evidence available internationally to inform practice in this context was addressed by exploratory study.

METHOD

A pragmatic mixed method study approved by the University Faculty Ethics Committee and conducted from March 2014 to August 2015 was used to explore the successful end-of-life advocacy of 98 rural Australian district nurses. The findings and results were integrated then compared with theory in this article to develop concepts for a practice model.

RESULTS

The model illustrates rural district nurse advocacy success based on respect for the rights and values of people. Advocacy action is motivated by the emotional responses of nurses to the end-of-life vulnerability people experience. The combination of willing investment in relationships, knowing the rural people and resources, and feeling supported, together enables district nurses to develop therapeutic emotional intelligence. This skill promotes moral agency in reflection and advocacy action to overcome emotional and ethical care challenges of access and choice using holistic assessment, communication, organisation of resources and empowering support for the self-determination of person-centred end-of-life goals. Recommendations are proposed from the theoretical concepts in the model.

LIMITATIONS

Testing the model in practice is recommended to gain the perceptions of a broader range of rural people both giving and receiving end-of-life-care.

CONCLUSION

A model developed by gathering and comparing district nursing experiences and understanding using mixed methods and existing theory offers evidence for practice of a philosophy of successful person-centred advocacy care in a field of nursing that lacks specific guidance.