An integrative review to identify how nurses practicing in inpatient specialist palliative care units uphold the values of nursing

"Unless someone sees and hears you, how do you know you exist?" Meanings of confidential conversations - a hermeneutic study of the experiences of patients with palliative care needs

BACKGROUND

Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs.

METHODS

In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations.

RESULTS

The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life's challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences.

CONCLUSIONS

Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients' suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients' varying preferences.

Slum compassionate community: expanding access to palliative care in Brazil

OBJECTIVE

To describe the implementation of a compassionate community in Rocinha and Vidigal slums, located in the city of Rio de Janeiro.

METHOD

Report on the experience of implementing a Compassionate Community based on the World Health Organization conceptual bases, supported by university extension guidelines.

RESULTS

Initially, local leaders and residents were recruited and trained in palliative care. Subsequently, health professionals from different specialties engaged in the project through volunteering. Home visits were instituted in the form of interconsultation and "sponsorships" by residents and health professionals to people in palliative care and family members. Finally, the health care network in the territory was integrated in order to recognize the project as a support network.

CONCLUSION

We highlight the experience as living work in health, which involves relationships and creative processes, which mobilize structured technical knowledge and relationships between people and soft-hard and soft technologies, making it possible to recognize powers in the territory.

"Daring to deal with the difficult and unexpected" registered nurses' confidential conversations with patients with palliative care needs: a qualitative interview study

BACKGROUND

In palliative care, registered nurses provide advanced nursing care to relieve patients' symptoms and increase their quality of life based on physical, mental, social and existential dimensions. Conversations, often about existential issues, are an important part of nursing and can affect quality of life positively. Confidential conversations between patients and nurses occur naturally while other nursing activities are being performed. Despite their great importance for palliative care these are rarely described.

AIM

To gain a deeper understanding of how nurses in palliative care experience and describe confidential conversations with patients.

METHOD

Secondary analysis of data from 17 open-ended face-to-face interviews with registered nurses in palliative care was conducted. Qualitative content analysis using an inductive approach was used to gain a deeper understanding and analyse the latent content.

RESULTS

The confidential conversation was considered an important part of palliative care and is the nurse's responsibility. This responsibility was described as complex and placed various demands on the nurses, both personal and professional. A prerequisite for the conversation was the interpersonal relationship. The conversation allowed the patient to process important matters not previously addressed or put into words. It had no predetermined content, was unplanned and entirely on the patient's terms. For nurses the conversation could be experienced both as draining and a source of power and strength. The nurses also described safeguarding the patient through the conversation.

CONCLUSION

Nurses' confidential conversations with patients are essential in palliative care and must be highlighted more to increase the quality of palliative care. The confidential conversations often have an existential content and are challenging for the nurses. Therefore, nurses need time, knowledge, and supervision to increase their conversation skills.

The Nurses' Perception of Expressive Touch: An Integrative Review

Introduction: Nurses use physical touch to interact with patients and address their needs. Human touch benefits social development, stress/anxiety reduction, and rapport building. Touch has been a part of nursing care for centuries, however nurses' perceptions of expressive touch are not easily ascertained from the literature. Literature currently offers one review on the perceptions of various medical professionals regarding touch of all kinds. No reviews specific to the nurses' perception of expressive touch exist. This integrative review provides a greater understanding of nurses' perceptions of expressive touch. Methods: Using Cooper's steps for integrative review, CINAHL, Medline, Academic Search Premier, and Complimentary Index were searched from 2000-2022; using search term expressive touch or caring touch or compassionate touch and nurse/nurses/nursing and perception or perspective. Results: Of 283 articles identified, 22 articles remained for full-text review after duplicate removal and application of inclusion/exclusion criteria. Five topics on nurses' perceptions of expressive touch were identified: Comfort with touch and job satisfaction, expressive touch as an essential part of nursing practice, expressive touch as a form of compassion and/or communication, the impact of expressive touch on the humanization of patients in the nurses' perception, and nurse discomfort with expressive touch. Conclusion: This integrative review provides findings that assist in understanding nurses' perceptions of expressive touch. Further research should examine the impact of gender, education, and experiences on nurses' perceptions as they use expressive touch in nursing practice.