Impact of a Hospital Palliative Care Service: Perspective of the Hospital Staff

The first New Zealand hospital palliative care support service was established in 1985. Different service models have now been adopted by various major hospitals. In 1998, a palliative care service, funded by Mary Potter Hospice, was piloted at Wellington Public Hospital. Twelve months post-implementation, the hospital staff's views of the service were evaluated. It was found that referrals to palliative care from hospital specialities outside the Cancer Centre increased. While most doctors, nurses and social workers strongly agreed or agreed that the service positively influenced patients’ care and effectively addressed their symptom management needs, spiritual needs were less often met. Over 90 percent of each discipline strongly agreed or agreed that the service had assisted them in caring for patients, but, only about a half agreed that useful discharge planning advice and staff support was provided. Significant differences in responses were found between different disciplines and specialities. One fifth of the staff identified palliative care education needs. Recommendations are made concerning the development of a future hospital palliative care service.

A literature review of the role of the specialist palliative care community nurse

This article reviewed international research to obtain an improved understanding of the role defined in the literature as the specialist palliative care community nurse (SPCCN). Developments in cancer treatment and palliative care have lead to improved symptom control and increased prognosis for palliative care patients. In response, there has been a change to the role of the SPCCN indicating a move from a generalized, to specialist, community nurse who provides a consultancy service, thus causing role ambiguity. Within the literature, three themes emerged in defining the role of the community palliative care nurse: communication and collaboration; a clarification of the role; and the role of referral. This review found that there was a blurring of professional boundaries amongst the palliative care team and that the SPCCN has a capacity to coordinate and provide expertise in delivering complex symptom control to patients and their families.

Oncology Nurses' Teaching and Support for Suicidal Patients

Although the nursing literature contains many references to the nurses' teaching, support, and advocacy functions, the consumer and other health care professional literature suggests that the potential importance of nurses in these roles is not widely accepted. In a secondary analysis, we examined nurses' interventions for teaching and support in survey of a random sample of oncology nurses in a national organization. Clinical oncology nurses (n = 454) reported their attitudes to and knowledge about suicidal patients. They reported their goals, interventions, and emotional support for a suicidal patient. When nurses described their care, they rarely mentioned patient teaching, emotional support, and advocacy. A gap also existed between the recommended assessments, related goals, and interventions. The nurses' difficulties in responding therapeutically to suicidal patients also emerged from their religious/other values, uncomfortable feelings, inadequate knowledge, personal experiences, and weight of professional responsibility. A small percentage of oncology nurses with good psychiatric skills reported they had no difficulty in their caregiving role including teaching, support, and advocacy.

'Would you like to talk about your future treatment options'? Discussing the transition from curative cancer treatment to palliative care

Palliative care focuses on improving quality of life for patients with life-threatening illness and their families. There comes a time when actively pursuing aggressive curative treatment may do more harm than good. The cessation of curative treatment is often viewed as a distinct event; however, current practice guidelines suggest that a palliative approach should be gradually adopted as the disease progresses. The challenge is how to facilitate a sensitive transition from curative to palliative care. On the basis of an extensive literature review, recommended steps for facilitating this transition have been outlined. The recommendations cover: the timing of the discussion; preparing for this discussion; the environment and circumstances of the consultation; initiating the discussion; identifying the information to be provided; responding to the person's emotional reaction; introducing palliative care services; continuity of care; family concerns; cultural and linguistic diversity; concluding the discussion. These steps were based on the best available evidence. However, as there is a paucity of research in this area, only three relevant systematic reviews of randomized controlled trials were identified and only one of these reviews related directly to palliative care. The majority of the relevant research was descriptive evidence. There is a need for more high quality research in this area.

Barriers to suicide risk management in clinical practice: a national survey of oncology nurses

Standards of practice identify the nurse's pivotal role in risk detection, assessment, intervention, and management of suicidal patients, but scant research explores the barriers that hinder this role. This study describes the analysis of barriers to suicide risk management from a survey of a random sample of members of a national organization, the Oncology Nursing Society (n = 1200), who participated in a descriptive study exploring nurses' knowledge and attitudes about suicide. The 454 (37%) respondents included respondents from the United States, Canada, and Puerto Rico. Instruments included a demographic inventory, the Suicide Opinion Questionnaire (SOQ), a suicide attitude measure (SUIATT), and a vignette of a suicidal patient. Nurses knew an average of 4.8 out of 9 suicide risk factors and 49.4% miscalculated the risk of suicide. In contrast with their moderate to high ratings of suicide risk, they indicated minimal interventions. Barriers to management of suicidal patients included deficits in skill, knowledge, referrals, patient teaching, advocacy, or consultation as well as participants' and religious/other values, uncomfortable feelings, personal experiences, and the weight of professional responsibility. Strategies for intervention include: suicide prevention education, consultation, values clarification, ethical analysis, and conflict resolution and psychosocial support to reduce barriers. Nurses are not alone in their request for more education about suicide prevention; this study confirms earlier research of psychologists and psychiatrists who report they need more education in suicide risk management.

Palliative care provision and its impact on psychological morbidity in cancer patients

In response to many influences, palliative care services in the UK are evolving rapidly, and are increasingly challenged to demonstrate equity, access and effectiveness. This article discusses the principles, philosophy and status of palliative care in the UK in the context of recent NHS developments. A case study is employed in order to critically evaluate the implementation of the palliative care approach, focusing on the specific issue of the assessment of anxiety and depression in the cancer setting. The provision of a comprehensive and integrated clinical service is a constant challenge in this patient group. In order to increase awareness and facilitate further development of patient services, and ultimately improve clinical practice, several factors are highlighted. These include the impact of multiprofessional team care, the problems inherent in the diagnosis of depression and the question of whether cancer nurses are adequately prepared to handle patients' psychological morbidity.

The experience of transition to palliative care services: perspectives of patients and nurses

The care of patients whose illnesses cannot be cured places many stresses on health professionals (both generalist and specialist), and more importantly on patients and families. The complexities for all concerned in the process of referral to palliative care services should not be underestimated, however there is evidence that the referral process could be better handled by all health professionals. With greater understanding of the dynamics of care, the crisis of living with an incurable illness and dying can be lessened for patients. This article reports on a qualitative research project undertaken at a large metropolitan palliative care service and its referring public hospital. Patients and nurses were interviewed to identify issues relating to the care of patients and families newly referred to palliative care. The findings of this research identify themes in relation to the transition of patients from acute curative to palliative care services, e.g. pace and timing of the transition, fear and (mis)understanding, accepting palliative care, information and education on palliative care, and peer support and supervision for palliative care nurses.

The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part one

The role of the palliative care nurse emphasizes the need for holistic care, and as this role has developed it has become evident that palliative care nurses require skills which, arguably, not all registered general nurses possess; particularly, skills pertaining to the psychological, social and spiritual domains of the person. In order to identify the skills that such nurses may require, there may be merit in considering other specialities of nursing which pay particular attention to the psychological, social and spiritual domains of the person. Consequently, this two-part paper explores the areas of commonality and synchronicity between palliative care nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non-physical care, the nurse--client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation, and the focus on physical care. Part one of this paper therefore focuses on the first three areas of alleged commonality, with part two focusing on the fourth commonality, the key differences and the implications of such similarity. Given these areas of similarity the authors argue there is a case for reconsidering if the RGN qualification is an essential requirement for working within palliative care or if those with other skills -- skills based on 'being with' rather than 'doing for' -- such as RMNs, should be thought of for such roles.

Sexuality in cancer and palliative care 1: Effects of disease and treatment

All cancers and related treatments have the potential to affect sexuality and sexual function. This may result from impaired body function or altered body image, or from the emotional and psychological distress that often accompany diagnosis and treatment. It is increasingly acknowledged that issues surrounding sexuality are an important factor in quality of life for patients with cancer, and that sexuality is a legitimate area of concern for nurses in oncology and palliative care. However, issues relating to sexuality remain among the most poorly addressed in cancer care--possibly owing to lack of knowledge and expertise. There are also societal norms, myths and assumptions that may prevent nurses from broaching these issues. To provide this component of care, nurses need to have good communication skills, an open and non-judgmental approach, and knowledge of the potential ramifications of disease and treatment on sexuality.

Ethical arguments for providing palliative care to non-cancer patients

Palliative care professionals have begun to address the issues surrounding the provision of palliative care to non-cancer patients. Yet the situation remains inconsistent and morally unjustifiable. The duty to provide care, non-maleficence, beneficence, protecting the patient's best interests and respecting patient autonomy are key responsibilities which palliative care professionals have for all their patients, regardless of their diagnosis. On the grounds of justice as fairness, equality and equity, the current inconsistencies in the provision of palliative care to non-cancer patients are unfair unequal and inequitable. Professionals can no longer ignore their moral responsibility to address these issues and change their practice to include the provision of care for dying patients regardless of their diagnoses.

Chemotherapy in palliative cancer care: changing perspectives

The role of chemotherapy for patients with advanced cancer is likely to expand, as new cytotoxic drugs and routes of administration are developed, and adverse effects are better controlled. The move towards integration of acute and palliative cancer care services should facilitate the use of chemotherapy to alleviate symptoms of advanced cancer, where appropriate and acceptable for individual patients. As the boundaries traditionally perceived between phases of cancer care become blurred, new challenges will arise for oncology and palliative care nurses.