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Stuart P. How do hospital nurses experience end-of-life care provision? A creative phenomenological approach. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:997-1002. [PMID: 36306234 DOI: 10.12968/bjon.2022.31.19.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Current evidence suggests that hospital nurses' end-of-life care is complex due to the conflicting tasks of treatment-focused care and palliation. This is a topic that needs further exploration. AIM To understand hospital nurses' experiences of end-of-life care. METHOD Interpretive phenomenology was used to explore 10 hospital nurses' experiences. FINDINGS Nurses' individual experience of death informed their attitudes to death. The dominant theme was death-as-calm, accompanied by human connection, and death-as-process. The nurses' actions indicated their end-of-life care included love, defined as a desire to create calm, grounded by the virtue of natural goodness, responsibility and dedication, with a willingness to focus on the individual and their family, making the most of whatever time they have left. To continue providing end-of-life care the nurses successfully protected their authentic self by using a 'professional identity' and employing 'defence of self'. The nurses found the unpredictable nature of hospital end-of-life care difficult but used a collaborative power to manage situations. CONCLUSION This study suggests hospital nurses successfully navigate an approach to hospital end-of-life nursing care, represented as a 'harbour', which facilitates transitioning from 'stormy' treatment to calm end-of-life care and death.
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Affiliation(s)
- Peter Stuart
- Senior Lecturer in Nursing, Faculty of Health, Education and Society, University of Northampton
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Somanadhan S, Bristow H, Crushell E, Pastores G, Nicholson E, Kroll T, Larkin PJ, Brinkley A. IMPACT study: measuring the impact of caregiving on families and healthcare professionals of children and adults living with mucopolysaccharidoses in Ireland. THERAPEUTIC ADVANCES IN RARE DISEASE 2021; 2:26330040211020764. [PMID: 37181103 PMCID: PMC10032429 DOI: 10.1177/26330040211020764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/05/2021] [Indexed: 05/16/2023]
Abstract
Introduction Disease trajectories are often uncertain among individuals living with mucopolysaccharidoses (MPS) due to the progressive nature of the illness and the goal of care. This study investigated the impact on caregivers and care providers of children and adults living with MPS. Methods The study used a cross-sectional design and a convenience sampling strategy which involved two sequential study components. The stage 1 quantitative component included three validated scales: the abbreviated World Health Organization Quality of Life (WHOQOL-BREF), the Paediatric Inventory for Parents (PIP) and the 14-item Resilience Scale (RS-14). The stage 2 qualitative component consisted of two focus groups with healthcare professionals (HCPs) (n = 9) working with children and adults living with MPS across three clinical sites in Ireland. Data were collected between November 2017 and July 2019. Results A total of 31 parents identified as caregivers participated in this study. The mean quality of life (QoL) score was 93.81, indicating a significantly high QoL. The PIP frequency total mean was 102.74 and difficulty mean 104.94. The mean score for the RS-14 was notably high, 81.42 out of a maximum of 98. The majority of the results showed high levels of concern for the future, with just under 50% finding themselves very often feeling scared that their child's condition will deteriorate or that their child will die and finding these thoughts very difficult. The healthcare professionals' (HCPs) perceptions were focused on the complexity of MPS, coping strategies, managing expectations and support services. Conclusion The overall findings of the study reinforced the need for sustained and enhanced psychological support to ensure both families of children and adults living with MPS and the HCPs are supported in the continued delivery of quality patient care and outcomes. Subjective and objective measures from family caregivers and HCPs yield results that can decrease stress and improve psychological support. Plain language summary Impact of caregiving on families and healthcare professionals of children and adults living with mucopolysaccharidoses in Ireland Mucopolysaccharidoses (MPS) is a group of one of the many rare inherited metabolic disorders that come under category three of life-limiting conditions. Children born with this genetic condition show no change at birth, but effects start to show in subsequent years as it is a progressive disease. The severity of the condition varies according to the specific type, ranging from very mild symptoms to, in most cases, multisystemic, restricted growth or mental and physical disabilities. Recent developments in treatments for some forms of MPS have dramatically changed the quality of life (QoL) for patients. Other forms of treatment are currently under investigation and development. This study aimed to provide a detailed and reliable evidence base on the impact of caregiving for patients living with MPS on family caregivers and healthcare providers. Paper questionnaires were completed by the family caregivers of children and adults living with MPS. These three questionnaires focused on measuring QoL, parental stress and anxiety, and resilience among these families. Two focus group interviews were carried out with healthcare professionals working with children and adults living with MPS across three clinical sites in Ireland.A total of 31 parents completed the questionnaires in this study, indicating a significantly high QoL and notably high resilience. The majority of the parental stress results were related to concern for the future, with just half of the families finding themselves very often scared that their child's condition will deteriorate or that their child will die and find these thoughts very difficult. The healthcare providers also spoke about the complexity of MPS, coping strategies, managing expectations and support services for the families of children and adults living with MPS. This study provided evidence for clinicians and policymakers to improve the availability of appropriate healthcare provisions for people living with MPS and their families.
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Affiliation(s)
- Suja Somanadhan
- UCD School of Nursing, Midwifery and Health
Systems, University College Dublin, Stillorgan Road, Belfield, County Dublin
D04 V1W8, Ireland
| | | | - Ellen Crushell
- CHI at Crumlin, Dublin, Ireland, and CHI at
Temple Street, Dublin, Ireland
| | | | | | - Thilo Kroll
- University College Dublin, Belfield, Dublin,
Ireland
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Nevin M, Hynes G, Smith V. Healthcare providers' views and experiences of non-specialist palliative care in hospitals: A qualitative systematic review and thematic synthesis. Palliat Med 2020; 34:605-618. [PMID: 32020829 DOI: 10.1177/0269216319899335] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Healthcare providers working in hospitals are frequently exposed to patients with palliative care needs. For most patients, these reflect non-specialist rather than specialist palliative care needs. Embedding palliative care principles early in patients' disease trajectories within acute care delivery in hospitals, however, is a challenge. How to best understand the experiences of those providing non-specialist palliative care in hospitals has not been systematically assessed. AIM To synthesise the evidence on healthcare providers' views and experiences of non-specialist palliative care in hospitals. DESIGN A qualitative systematic review and thematic synthesis using Thomas and Harden's thematic synthesis framework. DATA SOURCES Databases of MEDLINE, CINAHL, PsycINFO and EMBASE were searched from date of inception to March 2018. Studies were eligible for inclusion if they reported on healthcare providers' views and experiences of non-specialist palliative care in hospitals. Studies were appraised for quality but not excluded on that basis. The review was prospectively registered with the International Prospective Register of Systematic Reviews. RESULTS Thirty-nine papers of 37 studies were included, representing 985 hospital healthcare providers' views and experiences. Four major analytical themes emerged; 'Understanding of Palliative Care', 'Complexities of Communication', 'Hospital Ecosystem' and 'Doctors and Nurses - a Different Lens'. CONCLUSIONS Non-specialist palliative care in hospitals is operationalised as care in the last weeks and days of life. The organisation of acute care, inter-disciplinary working practices, clinician attitudes, poor communication structures and lack of education and training in palliative care principles exacerbates poor implementation of this care earlier for patients in hospitals.
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Affiliation(s)
- Mary Nevin
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Geralyn Hynes
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
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Hope to hope: Experiences of older people with cancer in diverse settings. Eur J Oncol Nurs 2019; 40:71-77. [PMID: 31229209 DOI: 10.1016/j.ejon.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the study was to explore experiences of older people with cancer in ascertaining the attributes of a person-centred approach in sustaining hope and enabling human flourishing. This was a qualitative study comparing patients and professional experiences and perceptions of care across to ward settings. METHODS Methods involved 10 semi-structured interviews conducted with patients and focus groups (n = 6) and 10 semi-structured interviews with health professionals. Three dissemination focus groups (n = 14) were also carried out with professionals to allow further analysis of the data. RESULTS Two main themes were identified, including 'Emotional adaptations of hope: wants and expectations' and 'Hope through belittling their illness'. Findings highlight the way hope is conveyed and the emphasis' accorded to issues such as societal perceptions, knowledge, expectations of care, life stage, relationships, identity, and emotions. Findings also reinforce the importance of maintaining hope, recognising the different ways hope is used, and enabling patients to flourish. CONCLUSION This study highlights how hope is facilitated through the interaction between patients and professionals and that the relational interactive stance. This current study establishes that hope seemed to be temporal, contextual and dynamic in nature, involving an ongoing process. Helping older people with cancer to understand their illness considering the situation of lives and experiences is essential to address expectations and wants.
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Martínez-Serrano P, Pedraz-Marcos A, Solís-Muñoz M, Palmar-Santos AM. The experience of mothers and fathers in cases of stillbirth in Spain. A qualitative study. Midwifery 2019; 77:37-44. [PMID: 31254962 DOI: 10.1016/j.midw.2019.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
AIM To explore the experience of both the mothers and the fathers regarding the care received during delivery in cases of stillbirth. DESIGN A hermeneutic phenomenological study based on semi-structured interviews with eleven mothers and fathers who experienced stillbirth. PARTICIPANTS A purposive sample was recruited in Hospital XXX of XX and through a local pregnancy loss support organization. METHODS Interviews were recorded and transcribed verbatim and analysed using inductive thematic analysis. FINDINGS Four main categories identified: 1) denial of grief, 2) the life and death paradox, 3) guilt, and 4) go through and overcome the loss. The parents manifested a lack of recognition of their loss and their parenthood. Although the midwife was the highest valued professional, not all the experiences were positive and the parents would have appreciated being accompanied by trained people with good communication skills. They also referred to in-hospital logistic barriers that complicated the process, as well as the fact that these births occurred in the same place where healthy deliveries were attended. CONCLUSION Findings highlight the importance of tailoring support systems according to mothers' and fathers' needs. Promoting social and institutional recognition of this kind of loss and training healthcare professionals in the accompaniment of this type of mourning is useful to plan comprehensive care to facilitate the initiation and subsequent evolution of healthy mourning.
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Affiliation(s)
- Paloma Martínez-Serrano
- Obstetric and Ginecology Service, Puerta de Hierro Majadahonda University Hospital, C/ Joaquín Rodrigo, 2. 28222 Majadahonda (Madrid), Madrid, Spain.
| | - Azucena Pedraz-Marcos
- Faculty of Medicine, University Autonoma of Madrid, C/ Arzobispo Morcillo n° 4, Madrid 28029, Spain.
| | - Montserrat Solís-Muñoz
- Nursing and Healthcare, Research Area, Puerta de Hierro Majadahonda University Hospital, C/ Joaquín Rodrigo, 2, Majadahonda (Madrid) 28222, Spain.
| | - Ana María Palmar-Santos
- Faculty of Medicine, University Autonoma of Madrid, C/ Arzobispo Morcillo n° 4, Madrid 28029, Spain.
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Abstract
OBJECTIVE Symptomatic therapy is an intervention centered entirely on symptom management and pain relief. The utilization of charcoal in diarrhea management is a pertinent example of this type of medical care. Diarrhea is an ailment defined as an escalation in the frequency of bowel movements, unformed stool, abdominal discomfort, and pain. These symptoms can be extremely debilitating for patients, and effectuate frustration as well as severely dampening mood and overall well-being. This narrative review aims to explore the use of charcoal in diarrhea management and its possible benefits in alleviating discomfort associated with these symptoms. METHODS The authors used PubMed, MEDLINE, and Google Scholar searches on recent literature available on the role of activated charcoal in diarrhea management. RESULTS It was found that the main precursors of diarrhea include drugs and bacterial infection. Activated charcoal has a firm history in its ability to attract and expel ingested toxins from the gastrointestinal tract. It acts to prevent system absorption of these adverse entities, adsorbing them on the surface of its particles, making it a suitable diarrheal treatment. CONCLUSIONS Diarrhea can present itself alongside a multitude of treatments and conditions, such as chemotherapy, primary malignancy, intestinal, colorectal and pancreatic cancer, bacterial infection, and irritable bowel syndrome, making activated charcoal a potential therapy in these conditions. In comparison, with other common anti-diarrheal treatments, activated charcoal has exceptionally few side-effects. Overall, further research is necessary in order to wholly determine the effectiveness of charcoal in the management of diarrhea.
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Affiliation(s)
- Helen Senderovich
- a Baycrest Health Sciences, Department of Family and Community Medicine , Toronto , ON , Canada
- b Assistant Professor of the University of Toronto
- c Department of Family and Community Medicine
- d Division of Palliative Care , Toronto , ON , Canada
| | - Megan J Vierhout
- a Baycrest Health Sciences, Department of Family and Community Medicine , Toronto , ON , Canada
- e McMaster University, School of Interdisciplinary Sciences , Hamilton , ON , Canada
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Filej B, Breznik K, Kaučič BM, Saje M. HOLISTIC MODEL OF PALLIATIVE CARE IN HOSPITAL AND COMMUNITY NURSING: THE EXAMPLE OF SOUTH-EASTERN SLOVENIA. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2018. [DOI: 10.15452/cejnm.2018.09.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wensley C, Botti M, McKillop A, Merry AF. A framework of comfort for practice: An integrative review identifying the multiple influences on patients' experience of comfort in healthcare settings. Int J Qual Health Care 2017; 29:151-162. [PMID: 28096279 DOI: 10.1093/intqhc/mzw158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 12/25/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose Comfort is central to patient experience but the concept of comfort is poorly defined. This review aims to develop a framework representing patients' complex perspective of comfort to inform practice and guide initiatives to improve the quality of healthcare. Data sources CINAHL, MEDLINE Complete, PsycINFO and Google Scholar (November 2016); reference lists of included publications. Study selection Qualitative and theoretical studies advancing knowledge about the concept of comfort in healthcare settings. Studies rated for methodological quality and relevance to patients' perspectives. Data extraction Data on design, methods, features of the concept of comfort, influences on patients' comfort. Data were systematically coded and categorized using Framework method. Results of data synthesis Sixty-two studies (14 theoretical and 48 qualitative) were included. Qualitative studies explored patient and staff perspectives in varying healthcare settings including hospice, emergency departments, paediatric, medical and surgical wards and residential care for the elderly. From patients' perspective, comfort is multidimensional, characterized by relief from physical discomfort and feeling positive and strengthened in one's ability to cope with the challenges of illness, injury and disability. Different factors are important to different individuals. We identified 10 areas of influence within four interrelated levels: patients' use of self-comforting strategies; family presence; staff actions and behaviours; and environmental factors. Conclusion Our data provide new insights into the nature of comfort as a highly personal and contextual experience influenced in different individuals by different factors that we have classified into a framework to guide practice and quality improvement initiatives.
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Affiliation(s)
- Cynthia Wensley
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, Epworth Deakin Centre for Clinical Nursing Research, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Ann McKillop
- School of Nursing, University of Auckland, 89-91 Grafton Rd, Grafton, Auckland 1010, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, School of Medicine, University of Auckland and Specialist Anaesthetist Auckland City Hospital>, 2 Park Rd, Grafton, Auckland 1023, New Zealand
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Integration of naturopathic medicine into acute inpatient care: An approach for patient-centred medicine under diagnosis-related groups. Complement Ther Clin Pract 2017; 28:9-17. [DOI: 10.1016/j.ctcp.2017.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/05/2017] [Accepted: 04/12/2017] [Indexed: 12/29/2022]
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Marchuk A. End-of-life care in the neonatal intensive care unit: applying comfort theory. Int J Palliat Nurs 2017; 22:317-23. [PMID: 27444160 DOI: 10.12968/ijpn.2016.22.7.317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The provision of quality end-of-life care is essential when a neonate is dying. End-of-life care delivered in a neonatal intensive care unit (NICU) must consider the needs of both the newborn and their family. The purpose of this paper is to demonstrate how comfort theory and its associated taxonomic structure can be used as a conceptual framework for nurses and midwives providing end-of-life care to neonates and their families. Comfort theory and its taxonomic structure are presented and issues related to end-of-life care in the NICU are highlighted. A case study is used to illustrate the application of comfort theory and issues related to implementation are discussed. The delivery of end-of-life care in the NICU can be improved through the application of comfort.
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Affiliation(s)
- Allison Marchuk
- Registered Nurse, Neonatal Intensive Care Unit, Alberta Children's Hospital, Calgary, Canada
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Chuah PF, Lim ML, Choo SL, Woo GY, To HK, Lau KY, Chen J, Lian SB. A qualitative study on oncology nurses’ experiences of providing palliative care in the acute care setting. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816660322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: With the renewed emphasis on palliative care in Singapore, coupled with a dearth of studies on provision of palliative care in acute services, it is timely to explore the experiences, barriers and challenges faced by oncology nurses in the acute care setting. Aim: This study aimed to explore nurses’ experiences of providing palliative care in the acute oncology care unit. Method: An exploratory descriptive research methodology was adopted. Focus group interviews, involving a total of 24 nurses, were conducted. Interviews were audio-taped and transcribed verbatim. Data was analyzed using an inductive content analysis approach. Results: Five key themes emerged from the analysis: (1) nurses’ perceptions of palliative care; (2) multiple roles of nurses in palliative care; (3) emotional burden of providing palliative care; (4) misconceptions of palliative care; (5) challenges in providing palliative care. Conclusion: The provision of palliative care in the acute care setting remained challenging. This is partly due to the attitudes of patients, families and healthcare workers, as well as organizational factors such as lack of training. Nurses play an important role in giving and facilitating palliative care for patients in the hospitals. Future studies can explore interventions to help overcome the challenges that are impeding nurses from providing high-quality palliative care in the acute care setting.
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Affiliation(s)
| | | | | | | | | | | | - Juan Chen
- Singapore General Hospital, Singapore
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Hill H, Evans JM, Forbat L. Nurses respond to patients' psychosocial needs by dealing, ducking, diverting and deferring: an observational study of a hospice ward. BMC Nurs 2015; 14:60. [PMID: 26582969 PMCID: PMC4650322 DOI: 10.1186/s12912-015-0112-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosocial support is considered a central component of nursing care but it remains unclear as to exactly how this is implemented in practice. The aim of this study was to provide a descriptive exploration of how psychosocial needs (PNs) of patients in a hospice ward are expressed and met, in order to develop an understanding of the provision of psychosocial support in practice. METHODS An embedded mixed-methods study was conducted in one hospice ward. Data collection included observations of patients' expressions of PNs and nurses' responses to those expressed PNs, shift hand-overs and multi-disciplinary meetings. Interviews about the observed care were conducted with the patients and nurses and nursing documentation pertaining to psychosocial care was collated. Descriptive statistical techniques were applied to quantitative data in order to explore and support the qualitative observational, interview and documentary data. RESULTS During the 8-month period of observation, 227 encounters within 38 episodes of care were observed among 38 nurses and 47 patients. Within these encounters, 330 PNs were expressed. Nurses were observed immediately responding to expressed PNs in one of four ways: dealing (44.2 %), deferring (14.8 %), diverting (10.3 %) and ducking (30.7 %). However, it is rare that one type of PN was clearly expressed on its own: many were expressed at the same time and usually while the patient was interacting with the nurse for another reason, thus making the provision of psychosocial support challenging. The nurses' response patterns varied little according to type of need. CONCLUSIONS The provision of psychosocial support is very complex and PNs are not always easily recognised. This study has allowed an exploration of the actual PNs of patients in a hospice setting, the way in which they were expressed, and how nurses responded to them. The nurses faced the challenge of responding to PNs whilst carrying out the other duties of their shift, and the fact that nurses can provide psychosocial support as an inherent component of practice was verified. The data included in this paper, and the discussions around the observed care, provides nurses everywhere with an example against which to compare their own practice.
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Affiliation(s)
- Hazel Hill
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Josie Mm Evans
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Liz Forbat
- Australian Catholic University and Calvary Health Care, Canberra, 2600 Australia
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Affiliation(s)
- Claire Nunn
- Acute oncology clinical nurse specialist and nurse independent prescriber
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Panzavecchia L, Pearce R. Are preceptors adequately prepared for their role in supporting newly qualified staff? NURSE EDUCATION TODAY 2014; 34:1119-24. [PMID: 24679925 DOI: 10.1016/j.nedt.2014.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/26/2014] [Accepted: 03/06/2014] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The purpose of this UK based study is to ascertain the support provided to preceptors and the qualities they require to carry out their role supporting newly qualified professionals. DESIGN A qualitative descriptive approach was adopted to elicit the experiences and perceptions of the preceptors in practice. SAMPLE AND METHODS A cross-section of 30 preceptors were randomised across 3 hospital sites within one acute Trust. Questionnaires were distributed with a response rate of 37% (n=11). Five preceptors participated in a semi-structured interview (n=5). FINDINGS AND DISCUSSION The themes that emerged from the analysis were lack of preparation for their role, expectations of the preceptors and how they perceive the role and the limitations and difficulties associated with being a preceptor. CONCLUSIONS Preceptor attributes and programme approaches have been discussed in the existing literature although guidance concerning preparation and training for the role in the UK is less well documented. The findings of this small scale study may be useful in planning and developing preceptorship programmes in the future to provide sustainable support to develop the preceptor as well as the preceptee.
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Thon Aamodt IM, Lie I, Hellesø R. Nurses' perspectives on the discharge of cancer patients with palliative care needs from a gastroenterology ward. Int J Palliat Nurs 2013; 19:396-402. [PMID: 23970296 DOI: 10.12968/ijpn.2013.19.8.396] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND People with cancer usually like to spend as much time as possible at home rather than in the hospital. Nurses have a pivotal role when patients are discharged to a unit in hospital or from hospital to the community health-care system. AIM To explore how frontline surgical nurses assess patients with gastrointestinal cancer receiving palliative care and the implications of their assessment and competency for the patients' discharge destinations. METHODS A descriptive exploratory approach was used involving focus group interviews with a purposive sample of ten nurses from an inpatient gastroenterology surgical ward at a university hospital in Norway. Transcriptions of the interviews were analysed using Kvale and Brinkman's thematic approach. RESULTS Two overall themes emerged that had implications for the nurses' recommendations for optimal patient follow-up care after discharge: 'the complexity of and fluctuations in the patients' health status' and 'considering the competency of the nurses at the discharge destinations'. CONCLUSIONS This study illustrates surgical nurses' perspectives on the discharge destinations of cancer patients receiving palliative care. The findings have implications for initiatives aimed at providing more home-based palliative care.
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Affiliation(s)
- Ina Marie Thon Aamodt
- Assistant Professor, Lovisenberg Diaconal University College, Lovisenberg gata 15b, 0456 Oslo, Norway
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The provision of end-of-life care by medical-surgical nurses working in acute care: a literature review. Palliat Support Care 2013; 12:393-408. [PMID: 24477088 DOI: 10.1017/s1478951513000965] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Caring for terminally ill patients is complex, stressful, and at times distressing for nurses. Acute care hospitals continue to be the predominant place of death for terminally ill patients in most Western countries. The objective of the present literature review was to explore and gain an in-depth understanding of the experience of providing end-of-life (EOL) care by medical-surgical RNs working in acute care hospitals, to identify knowledge gaps, and to recommend future research. METHOD A comprehensive literature review was conducted using the following electronic databases: CINAHL, MEDLINE, and PsyInfo (from 1992 to October 2012). RESULTS The findings from the 16 reviewed studies suggest that nurses felt a strong commitment to help terminally ill patients experience a good death. Nurses reported feeling deeply rewarded and privileged to share the EOL experience with patients/families. Organizational and individual factors influenced nurses' experience. Important challenges were associated with managing the divergent needs of a mixed patient load (i.e., curative and palliative care patients) in a biomedical culture of care that is heavily oriented toward cure and recovery. In this culture, nurses' emotional work and ideals of good EOL care are often not recognized and supported. SIGNIFICANCE OF RESULTS Managerial and organizational support that recognize the centrality of emotional work nurses provide to dying patients is needed. More research exploring ways to improve communication among nurses and medical colleagues is essential. Finally, a critical examination of the ideological assumptions guiding nurses' practice of EOL care within the context of acute care is recommended to help reveal their powerful influence in shaping nurses' overall understanding and experience of EOL care.
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Understanding Nurses' Experiences of Providing End-of-Life Care in the US Hospital Setting. Holist Nurs Pract 2013; 27:318-28. [DOI: 10.1097/hnp.0b013e3182a72c83] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Croyère N, Belloir MN, Chantler L, McEwan L. Oral care in nursing practice: a pragmatic representation. Int J Palliat Nurs 2012; 18:435-40. [DOI: 10.12968/ijpn.2012.18.9.435] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Lyn Chantler
- Hospitalisation à Domicile, Croix-SaintSimon, Paris
| | - Lisa McEwan
- Centre Hospitalier de Rennes, Equipe Mobile de Soins Palliatifs, Bretagne
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Duffy A, Payne S, Timmins F. The Liverpool Care Pathway: does it improve quality of dying? [corrected]. ACTA ACUST UNITED AC 2011; 20:942-6. [PMID: 21841661 DOI: 10.12968/bjon.2011.20.15.942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Liverpool Care Pathway (LCP) for the dying patient is an integrated care pathway that was developed to assist non-specialist palliative care staff care for dying patients in acute clinical areas. The LCP has generated numerous debates among health professionals regarding its strengths and weaknesses. The complexity of patient needs at the end-of-life cannot be underestimated and the LCP provides the foundations of quality evidence-based care patients require, particularly in the final phase of dying. Nevertheless, not all health professionals are in agreement as to the advantages of using integrated care pathways in clinical practice. Despite the attention that has surrounded the LCP there is limited evidence to suggest that it improves end-of-life care. This article examines the evidence in relation to the LCP as a tool to improve palliative care for dying patients and their families in non-specialized palliative care practice.
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Affiliation(s)
- Anita Duffy
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Affiliation(s)
- Maria Parry
- Faculty of Health, Sport … Science, University Of Glamorgan, Pontypridd, CF37 1DL, Wales
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Begley AM, Glackin M, Henry R. Tolstoy, stories, and facilitating insight in end of life care: exploring ethics through vicarious experience. NURSE EDUCATION TODAY 2011; 31:516-520. [PMID: 20974506 DOI: 10.1016/j.nedt.2010.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 08/12/2010] [Accepted: 09/13/2010] [Indexed: 05/30/2023]
Abstract
Facilitating moral insight in end of life care can be challenging, and the purpose of this paper is to illustrate how this can be nurtured by means of creative literature. Tolstoy's Death of Ivan Ilych is presented as an example of such literature. Aristotle's Nichomean Ethics provides the philosophical underpinning for the method used. Sources also include the nursing literature, and students' evaluations of the impact of Tolstoy's novella on their ability to perceive the ethical issues arising in end of life care. Comments from evaluations were analysed and significant themes emerged. Students' comments clearly support the suggestion that use of this novella has facilitated insight into ethical issues at the end of life. Evaluations also indicate that vicarious experience gained through reading this novella has helped to nurture sensitivity and professional insight into the importance of compassion and offering 'comfort' to the dying person.
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Affiliation(s)
- Ann Marie Begley
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, BT 9 7HH, United Kingdom.
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