1
|
Newsome K, Sauder M, Spardy J, Kodadek L, Ang D, Michetti CP, Bilski T, Elkbuli A. Palliative Care in the Trauma and Surgical Critical Care Settings: A Narrative Review. Am Surg 2022:31348221101597. [PMID: 35574733 DOI: 10.1177/00031348221101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to conduct a narrative review of available literature to understand the use of palliative care in the trauma and surgical critical care setting. METHODS PubMed, EMBASE, and Google Scholar databases were searched for studies investigating the use of palliative care in the trauma and surgical critical care setting. The search included all studies published through January 9th, 2022. The risk of bias of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist tools. Outcomes were summarized in tables and synthesized qualitatively. RESULTS A total of 22 studies were included in this review. Key elements of successful palliative care include communication, shared decision-making, family involvement, pain control, establishing a patient's prognosis, and end-of-life management. Approaches to implementation based upon these key elements include best-case/worst-case scenarios, consultation trigger systems, and integrated institutional palliative care programs. Palliative care may reduce hospital length of stay, improve symptom management, and increase patient satisfaction, but the impact on mortality is unclear. CONCLUSION The core elements of palliative care have been identified and palliative care has been shown to improve outcomes in trauma and surgical critical care. However, the approaches for implementation still require development. The underutilization of palliative care for trauma patients reveals the need for refining criteria for use of palliative care and improvement in the education of surgical critical care teams to provide primary palliative care services.
Collapse
Affiliation(s)
- Kevin Newsome
- Florida International University, 158263Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Matthew Sauder
- NSU NOVA Southeastern University, 2814Dr Kiran, C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Jeffrey Spardy
- Florida International University, 158263Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Lisa Kodadek
- Department of Surgery, 12228Yale School of Medicine, New Haven, CT, USA
| | - Darwin Ang
- Department of Surgery, Division of Trauma and Surgical Critical Care, 23703Ocala Regional Medical Center, Ocala, FL, USA
| | | | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
| |
Collapse
|
2
|
Rørtveit K, Saetre Hansen B, Joa I, Lode K, Severinsson E. Qualitative evaluation in nursing interventions-A review of the literature. Nurs Open 2020; 7:1285-1298. [PMID: 32802349 PMCID: PMC7424442 DOI: 10.1002/nop2.519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/01/2020] [Indexed: 11/17/2022] Open
Abstract
Aim To identify and synthesize qualitative evaluation methods used in nursing interventions. Design A systematic qualitative review with a content analysis. Four databases were used: MEDLINE, PsycINFO, Embase and CINAHL using pre-defined terms. The included papers were published from 2014-2018. Methods We followed the guidelines of Dixon-Woods et al., Sandelowski and Barroso, the Critical Appraisal Skills Programme qualitative checklist and The Confidence in the Evidence from Reviews of Qualitative Research Approach. Results Of 103 papers, 15 were eligible for inclusion. The main theme Challenging complexity by evaluating qualitatively described processes and characteristics of qualitative evaluation. Two analytic themes emerged: Evaluating the implementation process and Evaluating improvements brought about by the programme. Conclusion Different qualitative evaluation methods in nursing are a way of documenting knowledge that is difficult to illuminate in natural settings and make an important contribution when determining the pros and cons of an intervention.
Collapse
Affiliation(s)
- Kristine Rørtveit
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| | - Britt Saetre Hansen
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| | - Inge Joa
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| | - Kirsten Lode
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| | - Elisabeth Severinsson
- Department of Research, Nursing and Healthcare Research GroupStavanger University HospitalStavangerNorway
| |
Collapse
|
3
|
Böling S, Berlin JM, Berglund H, Öhlén J. No ordinary consultation - a qualitative inquiry of hospital palliative care consultation services. J Health Organ Manag 2020; ahead-of-print. [PMID: 32744038 DOI: 10.1108/jhom-04-2020-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Considering the great need for palliative care in hospitals, it is essential for hospital staff to have palliative care knowledge. Palliative consultations have been shown to have positive effects on in-hospital care. However, barriers to contact with and uptake of palliative consultation advice are reported, posing a need for further knowledge about the process of palliative consultations. The purpose of this study therefore was to examine how palliative consultations in hospitals are practised, as perceived by consultants and health care professionals on receiving wards. DESIGN/METHODOLOGY/APPROACH Focus groups with palliative care consultation services, health care personnel from receiving wards and managers of consultation services. Interpretive description and constant comparative method guided the analysis. FINDINGS Variations were seen in several aspects of practice, including approach to practice and represented professions. The palliative consultants were perceived to contribute by creating space for palliative care, adding palliative knowledge and approach, enhancing cooperation and creating opportunity to ameliorate transition. Based on a perception of carrying valuable perspectives and knowledge, a number of consultation services utilised proactive practices that took the initiative in relation to the receiving wards. ORIGINALITY/VALUE A lack of policy and divergent views on how to conceptualise palliative care appeared to be associated with variations in consultation practices, tentative approaches and a bottom-up driven development. This study adds knowledge, implying theoretical transferability as to how palliative care consultations can be practised, which is useful when designing and starting new consultation services.
Collapse
Affiliation(s)
- Susanna Böling
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan M Berlin
- Department of Social and Behavioural Studies, University West, Trollhättan, Sweden
| | - Helene Berglund
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- The Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-centred Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
4
|
Mills J, Munday J. Perioperative palliative care is essential. Int J Palliat Nurs 2020; 26:151-152. [PMID: 32378486 DOI: 10.12968/ijpn.2020.26.4.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jason Mills
- University of the Sunshine Coast, Queensland, Australia
| | - Judy Munday
- Queensland University of Technology, Queensland, Australia
| |
Collapse
|
5
|
Engberink AO, Mailly M, Marco V, Bourrie D, Benezech JP, Chevallier J, Vanderhoeven S, Crosnier R, Bourrel G, Lognos B. A phenomenological study of nurses experience about their palliative approach and their use of mobile palliative care teams in medical and surgical care units in France. BMC Palliat Care 2020; 19:34. [PMID: 32197609 PMCID: PMC7085140 DOI: 10.1186/s12904-020-0536-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022] Open
Abstract
Background Despite a broad consensus and recommendations, numerous international reports or studies have shown the difficulties of implementing palliative care within healthcare services. The objective of this study was to understand the palliative approach of registered nurses in hospital medical and surgical care units and their use of mobile palliative care teams. Methods Qualitative study using individual in depth semi-structured interviews and focus group of registered nurses. Data were analyzed using a semiopragmatic phenomenological analysis. Expert nurses of mobile palliative care team carried out this study. 20 registered nurses from three different hospitals in France agreed to participate. Results Nurses recognize their role as being witnesses to the patient’s experience through their constant presence. This is in line with their professional values and gives them an “alert role” that can anticipate a patient-centered palliative approach. The physician’s positioning on palliative care plays a key role in its implementation. The lack of recognition of the individual role of the nurse leads to a questioning of her/his professional values, causing inappropriate behavior and distress. According to nurses, “rethinking care within a team environment” allows for the anticipation of a patient-centered palliative approach. Mobile Palliative Care Team highlights the major role of physicians-nurses “balance” while providing personal and professional support. Conclusions The Physician’s positioning and attitude toward palliative approach sets the tone for its early implementation and determines the behavior of different staff members within healthcare service. “Recognition at work”, specifically “recognition of the individual role of nurse” is an essential concept for understanding what causes the delay in the implementation of a palliative approach. Interprofessional training (physicians and nurses) could optimize sharing expertise. Registered nurses consider MPCT as a “facilitating intermediary” within the healthcare service improving communication. Restoring a balance in sharing care and decision between physicians and other caregivers lead care teams to an anticipated and patient-centered palliative approach according to guidelines.
Collapse
Affiliation(s)
- Agnès Oude Engberink
- University of montpellier CEPS platform, site Saint Charles, 34000, Montpellier, France. .,Maison de Santé Pluriprofessionnelle Universitaire Avicenne, 2 rue IBN Sinai dit Avicenne, 66330, Cabestany, France. .,Department of Palliative Care, CHU Montpellier, Montpellier, France.
| | - Maryse Mailly
- Mobile Palliative Care Team, CHU Montpellier, Montpellier, France
| | - Valerie Marco
- Department of General Medecine, University of Montpellier, avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Daniele Bourrie
- Department of General Medecine, University of Montpellier, avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Jean-Pierre Benezech
- Department of General Medecine, University of Montpellier, avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | | | - Sandrine Vanderhoeven
- Department of General Medecine, University of Montpellier, avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Remy Crosnier
- Mobile Palliative Care Team, CHU Montpellier, Montpellier, France
| | - Gérard Bourrel
- Maison de Santé Pluriprofessionnelle Universitaire Avicenne, 2 rue IBN Sinai dit Avicenne, 66330, Cabestany, France.,Department of Palliative Care, CHU Montpellier, Montpellier, France
| | - Béatrice Lognos
- University of montpellier CEPS platform, site Saint Charles, 34000, Montpellier, France.,Department of Palliative Care, CHU Montpellier, Montpellier, France
| |
Collapse
|
6
|
Pereira J, Chary S, Moat JB, Faulkner J, Gravelle-Ray N, Carreira O, Vincze D, Parsons G, Riordan B, Hayawi L, Tsang TWY, Ndoria L. Pallium Canada's Curriculum Development Model: A Framework to Support Large-Scale Courseware Development and Deployment. J Palliat Med 2020; 23:759-766. [PMID: 32155359 PMCID: PMC7249472 DOI: 10.1089/jpm.2019.0292] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The need to improve access to palliative care across multiple settings and disease groups has been identified. This requires equipping health care professionals from many different professions, including physicians and nurses, among others, with basic palliative care competencies to provide a palliative care approach. Pallium Canada's Curriculum Development Framework supports the development, deployment, and dissemination, on a large scale, of multiple courses targeting health care professionals across multiple settings of care and disease groups. The Framework is made up of eight phases: (1) Concept, (2) Decision, (3) Curriculum Planning, (4) Prototype Development, (5) Piloting, (6) Dissemination, (7) Language and Cultural Adaptation, and (8) Ongoing Maintenance and Updates. Several of these phases include iterative cyclical activities. The framework allows multiple courses to be developed simultaneously, staggered in a production line with each phase and their corresponding activities requiring different levels of resources and stakeholder engagement. The framework has allowed Pallium Canada to develop, launch, and maintain numerous versions of its Learning Essential Approaches to Palliative Care (LEAP) courses concurrently. It leverages existing LEAP courses and curriculum materials to produce new LEAP courses, allowing significant efficiencies and maximizing output. This article describes the framework and its various activities, which we believe could be very useful for other jurisdictions undertaking the work of developing education programs to spread the palliative care approach across multiple settings, specialties, and disease groups.
Collapse
Affiliation(s)
- José Pereira
- Pallium Canada, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; University of Navarra, Navarra, Spain
| | - Srini Chary
- Pallium Canada, Ottawa, Ontario, Canada.,Palliative Care Services, Alberta Health Services, Calgary Zone, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | | | - Tammy W Y Tsang
- Pallium Canada, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | | |
Collapse
|