Palliative care nursing interventions in Thailand

Nursing interventions in palliative care in the intensive care unit: A systematic review

CONTEXT

Patients in palliative care are found in different places where care is provided, including the intensive care environment with important role of the nursing staff.

OBJECTIVE

The aim of this systematic review was to answer the following question: which nursing interventions are aimed to the palliative care patients who are in the intensive care unit (ICU).

DATA SOURCES

US National Library of Medicine (PUBMED), Virtual Health Library (BVS), SciELO, The Cochrane Library (Cochrane) and Lilacs databases were used.

DATA EXTRACTION

After applying inclusion and exclusion criteria in accordance with the PRISMA method, a total of 36 entries published between 2010 and 2020 were used.

DATA ANALYSIS

The records extracted were analyzed from a qualitative approach, so no statistical analysis was carried out.

RESULTS

The findings demonstrated that the interventions that focus on promoting the patient's autonomy and respect their needs on ICU involves effective communication, promoting shared decision with patient and family, individualize care for each patient including the family on the daily care and decisions, maintaining basic nursing care as hygiene and comfort and encouraging self-care, as well as the involvement of nursing palliative care specialists the care is important. Other interventions included promoting a continuing education program for the nursing staff and other professionals involved in caring for patients in palliative care at ICU.

CONCLUSION

This review highlighted the need for specific nursing interventions aimed at palliative care patients at ICU to promote patient autonomy and the focus on patient needs, always sharing decisions with the patient and family. However, it showed that there is a need for the continuous training of the nursing staff because factors such as the nurses' lack of technical-scientific knowledge and, concomitantly, the absence of a standardized and specific intervention model linked to a bureaucratic system, make it difficult to carry out a specialized care for this type of patient.

Palliative Nursing in Africa: Scoping the Landscape of Evidence Focusing on Cancer Care

AIM

The aim of this study was to describe the research output of African's nurses in the field of palliative care from January 1, 2012 to December 31, 2021.

METHODS

A scoping review was conducted. The key words Africa and nursing in combination with palliative care, end of life, terminal care, hospice, and supportive care were used to search the databases Cumulative Index to Nursing and Allied Health Literature, PsychINFO, PubMed, Scopus, and Web of Science. Only studies authored by a nurse with an African affiliation focusing on issues related to advanced cancer were included. The data were captured onto an extraction sheet and analyzed by means of descriptive statistics and content analyses.

RESULTS

Of the 522 articles identified, only 16 met the inclusion criteria. The work originated from eight African countries was primarily qualitative and focused on the family and caregivers. Pain was the only symptom investigated.

CONCLUSIONS

Studies focusing on symptoms, psychosocial, spiritual, end of life care as well as studies testing nursing interventions are urgently needed. Interregional research could also assist with building the current evidence.

Nursing interventions for people in palliative care, based on the Dignity Model

BACKGROUND

The use of the standardised nursing language aims to accurately represent clinical practice, contributing to proper documentation and the creation of evidence-based practice.

AIMS

To validate nursing interventions (NI) for patients in palliative care, structuring these using the Dignity-Conserving Care Model.

METHODS

A methodological study was conducted, developed according to the recommendations of the International Council of Nurses (ICN) and anchored in the Dignity-Conserving Care Model. The NI were developed in four stages: 1) construction of NI, based in the International Standards Organisation's standard (18.104:2014); 2) content validation by 26 expert nurses; 3) cross-mapping with the NIs contained in the International Classification for Nursing Practice (ICNP^®) catalogue, Palliative Care for Dignified Dying, to identify those already existing in the catalogue; and 4) structuring the NI based on the concepts of the Dignity-Conserving Care Model.

FINDINGS

209 NI were validated and grouped into categories, namely: illness-related concerns; dignity-conservation repertoire; social dignity inventory. Of these, 183 were new and 26 already existed in the ICNP^® Catalogue.

CONCLUSION

The study presents new insights into palliative care in Brazil and presents 183 new NI in addition to those already published by the ICN.

Opportunities for Integrating Palliative Care in Ghana

INTRODUCTION

The integration of palliative care (PC) services is characterized by several barriers and challenges, which may include misperception of PC services as end-of-life care, poor referral systems, inadequate financial support, regulatory barriers, and the small size of PC professional workforce. Beyond these barriers, the question remains: what opportunities exist to facilitate the integration of PC in managing patients' conditions? Notably, for a resource-constrained country like Ghana, unearthing existing facilitating factors would enable the country to leverage the opportunities these factors present to promote PC integration.

OBJECTIVE

The aim of this study is to explore opportunities that exist to facilitate PC integration from the perspective of PC service providers.

METHODS

An exploratory descriptive qualitative research design was used. Using semi-structured interview guides, seven face-to-face interviews were conducted with PC service providers in a tertiary hospital in Ghana. Data were managed using QSR NVivo-12. Inductive thematic analysis was carried out following Haase's modification of Colaizzi's approach to qualitative research analysis.

RESULTS

From the inductive thematic analysis, it was revealed that four main opportunities exist to facilitate PC integration. These included the availability of a PC team and teamwork, knowledge level of service providers, enabling attitudes of service providers, and the incorporation of PC in the medical school curriculum.

CONCLUSION

The study concludes that to facilitate the integration of PC in a tertiary health facility, there is a need to leverage on the supportive attitudes of service providers. Also, there is a need to expand the incorporation of PC education in the curriculum of all health and allied health courses. This could help create a pool of primary healthcare providers who can provide generalist PC services promptly. The study also underscores a need for continuous professional development.

Non-drug Stress Management for Patients with Cancer: A Systematic Review

Background:

Patients with cancer suffer from the physical impacts of the disease, including pain in organs where cancer has spread to and treatment side effects. Many factors affect the mental state of cancer patients, especially stress which can cause muscle tension around the affected area and create a higher degree of pain. Stress impacts physical conditions and results in a worse quality of life. Thus, an appropriate approach to cope with, evaluate, and manage stress in cancer patients is considered crucial.

Objective:

The purpose of this systematic review was to determine and evaluate non-drug stress management guidelines for cancer patients.

Methods:

A systematic review was undertaken to synthesize knowledge concerning stress and non-drug stress management for cancer patients. Information was sourced from documents and articles published by related institutions in relevant electronic databases, including PubMed, PsycINFO, Dynamed, and ScienceDirect between 2013 and 2019. No limitations were imposed regarding the type of study design previously used. Conference abstracts were not accepted. The quality of all included studies was independently appraised by two review writers.

Results:

The search generated 129 studies, of which only 20 met the inclusion criteria. The 20 studies cover 11 studies of music for cancer prevention and 6 studies of mindfulness-based stress reduction in cancer patients. The studies utilized both quantitative and qualitative approaches, while three studies of biofeedback in cancer patients only collected quantitative data. For the outcome from the reviews, 6 studies found that music therapy, biofeedback, and mindfulness greatly impact physical alterations such as insomnia, nausea or vomiting, and pain. Furthermore, 17 studies found that non-drug management techniques had a positive impact on psychological adjustments such as stress and anxiety reduction and relaxation promotion. Non-drug stress management such as music, biofeedback, and mindfulness was found to reduce stress among patients.

Conclusion:

This review confirms that non-drug stress management approaches can reduce suffering, lead to a better quality of life, reduce mortality rates, minimize treatment costs, and prevent and mitigate unwanted symptoms in cancer patients. This approach can be adapted and applied to patients with other diseases in the future. However, because several of the reviewed studies did not have a follow-up period, the present study was unable to collect evidence suggesting how long the observed benefits will remain.

Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand

Background

The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals.

Methods

A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand.

Results

The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication.

Conclusion

This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.

Reliability and Validity Testing of the FAMCARE-2 Scale: Thai Translation

Objective

Measuring the satisfaction of family caregivers regarding the palliative care provided to their family members is very important for quality improvement in the palliative care system. The aim of this study was to test the psychometric properties (i.e., reliability and validity) of the FAMCARE-2 Scale: Thai Translation for measuring family caregiver satisfaction.

Methods

A forward-backward translation process was utilized to produce the 17-item FAMCARE-2 Scale: Thai Translation. The questionnaire and the demographic data form were hand-delivered to the primary family caregivers of 66 palliative care patients of the inpatient wards at Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, on the patient discharge date. Internal consistency reliability testing of the FAMCARE-2 Scale: Thai Translation was assessed by calculating the Cronbach's alpha coefficient. Factor analysis was used to test construct validity.

Results

The FAMCARE-2 Scale: Thai Translation showed a high level of internal consistency (Cronbach's alpha coefficient of 0.94) and an item-to-total correlation coefficient of 0.13-0.77. Factor analysis of FAMCARE-2 revealed a four-factor structure: management of physical symptoms and comfort, patient care and sharing information, symptoms and side effects, and family and patient support.

Conclusions

The FAMCARE-2 Scale: Thai Translation was found to be a valid psychometric tool for measuring family caregiver satisfaction within the Thai context of palliative care.

Developing Stress Assessment forms for Thai Cancer Patients: The Thai Version of the Modified Symptoms of Stress Inventory (Modified SOSI)

Background:

Cancer is a progressive illness that often has a prolonged treatment time and that severely impacts a person’s quality of life. In Thailand, approximately 113,000 new cancer patients are diagnosed each year. Furthermore, cancer patients also have a high mortality rate of 90%, indicating that cancer is a major health problem both in Thailand and around the world. Physical manifestations of cancer include pain in the organs where cancer has already spread and side effects of treatment, such as chemotherapy and radiation, which adversely impact the mental state of cancer patients. Increased stress often results in other subsequent health conditions. Thus, identifying stress quickly and promptly in cancer patients through proper stress management is important.

Objective:

To develop and monitor accurate stress evaluation according to the self-perceptions (Thai version of the Modified Symptoms of Stress Inventory, Modified SOSI) of cancer patients in Thailand.

Research Methodology:

This study consists of three steps according to the research guidelines of Wongwiwatthananukit, Newton, and Popovich (2002): (1) the process of creating and developing tools; (2) the process of reviewing questions concerning the tools by experts; and (3) testing procedures for the use of the tools.

Results:

Content consistency using Cronbach’s alpha coefficient from 30 samples were determined to be .906. Investigation of the construct validity of the SOSI found that the relationships indicated in stress consisted of physical, mental, and behavioral. Significant relationships between these three aspects were determined by the Kaiser-Meyer-Olkin (KMO) measure of sampling as adequacy = 0.80, and Bartlett’s test of sphericity gave statistical significance at 0.05. The most important indicator was the physical, followed by the mental, while the behavioral had the least weight importance.

Conclusion:

The results of this study confirm that the Thai version of the Modified Symptoms of Stress Inventory (Modified SOSI), comprising 30 questions, was able to evaluate stress, including physical, mental and behavioral responses to stress. This inventory was considered concise and appropriate for cancer patients and can be used with other populations.

The Development of the Community-based Palliative Care Model in a District Health System, Phitsanulok Province, Thailand

Context:

Palliative care (PC) refers to a set of basic health services in Thailand and is in the early stage of implementation.

Aim:

The aim of this study is to develop a community-based PC model in a district health system (DHS) based on the form of action and evaluation.

Methods:

A three-step action research: look, think, and act was designed with mixed methods of data collection.

Results:

A key finding was the confusion on the terminology of the PC, challenge of the referral system of PC patients in DHS, medical equipment and supplies for the PC patients, and insufficient access to opioid analgesics at home. The model of development comprised the training of health professionals, the management of the medical equipment and supplies by people sector, and the development of a referral guideline of the PC patient in DHS. The evaluation showed the higher score of the accessibility to PC than the score of accommodation for patients. It also showed the higher score of the care continuity over the longitudinal continuity for patients. For the carers, the score of guilt is higher than the score of the care burden.

Conclusions:

A community-based PC model should be monitored by district health managment. The methods of this study are expected to be useful advice on how to solve similar problems in the other regions of similar context.

Construction and validation of nursing diagnoses for people in palliative care

Objective:

to construct and validate nursing diagnoses for people in palliative care based on the Dignity-Conserving Care Model and the International Classification for Nursing Practice.

Method:

a two-stage methodological study: 1) construction of the database of clinically and culturally relevant terms for the nursing care for people in palliative care and 2) construction of nursing diagnoses from the database of terms, based on the guidelines of the International Council of Nurses.

Results:

the 262 terms validated constituted a database of terms from which 56 nursing diagnoses were developed. Of these, 33 were validated by a group of 26 experts, and classified in the three categories of the Dignity-Conserving Care Model: illness-related concerns (21); dignity-conserving repertoire (9); and social dignity inventory (3).

Conclusion:

of the 33 validated diagnoses, 18 of them could be included in the update of the Catalog of the International Classification for Nursing Practice - palliative care for a dignified death. The study contributes to support the clinical reasoning and decision making of the nurse.

Understanding the use of standardized nursing terminology and classification systems in published research: A case study using the International Classification for Nursing Practice(®)

BACKGROUND

In the era of evidenced based healthcare, nursing is required to demonstrate that care provided by nurses is associated with optimal patient outcomes, and a high degree of quality and safety. The use of standardized nursing terminologies and classification systems are a way that nursing documentation can be leveraged to generate evidence related to nursing practice. Several widely-reported nursing specific terminologies and classifications systems currently exist including the Clinical Care Classification System, International Classification for Nursing Practice(®), Nursing Intervention Classification, Nursing Outcome Classification, Omaha System, Perioperative Nursing Data Set and NANDA International. However, the influence of these systems on demonstrating the value of nursing and the professions' impact on quality, safety and patient outcomes in published research is relatively unknown.

PURPOSE

This paper seeks to understand the use of standardized nursing terminology and classification systems in published research, using the International Classification for Nursing Practice(®) as a case study.

METHODS

A systematic review of international published empirical studies on, or using, the International Classification for Nursing Practice(®) were completed using Medline and the Cumulative Index for Nursing and Allied Health Literature.

RESULTS

Since 2006, 38 studies have been published on the International Classification for Nursing Practice(®). The main objectives of the published studies have been to validate the appropriateness of the classification system for particular care areas or populations, further develop the classification system, or utilize it to support the generation of new nursing knowledge. To date, most studies have focused on the classification system itself, and a lesser number of studies have used the system to generate information about the outcomes of nursing practice.

CONCLUSIONS

Based on the published literature that features the International Classification for Nursing Practice, standardized nursing terminology and classification systems appear to be well developed for various populations, settings and to harmonize with other health-related terminology systems. However, the use of the systems to generate new nursing knowledge, and to validate nursing practice is still in its infancy. There is an opportunity now to utilize the well-developed systems in their current state to further what is know about nursing practice, and how best to demonstrate improvements in patient outcomes through nursing care.

Palliative care in Thailand

In Thailand, several barriers exist that prevent people with life-limiting illnesses from accessing good-quality palliative care, namely: lack of palliative care providers; lack of training and education for the palliative care workforce; and issues with availability and distribution of opioids. Without palliative care, people suffer needlessly during the last months of their life. This paper gives an analysis of these issues and provides recommendations for clinical practice, research and health policy that may help to alleviate these issues.