Competências do enfermeiro para o cuidado paliativo na atenção domiciliar

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.

Factors affecting nurses' willingness and competency to provide anticipatory grief counseling for family caregivers of patients with terminal cancer

AIM AND OBJECTIVES

To explore factors associated with nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer.

BACKGROUND

Family caregivers often experience anticipatory grief due to the imminence of a loved one's death. However, few studies have identified factors associated with nurses' willingness or competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer.

METHODS

This descriptive correlational study recruited a convenience sample of nurses from cancer-related wards at a regional teaching hospital in Taiwan. The Anticipatory Grief Counseling Willingness Scale and Anticipatory Grief Counseling Competency Scale were employed. This cross-sectional study followed the STROBE checklist.

RESULTS

The nurses' average scores for willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer were 44.28 ± 8.36 and 171.84 ± 30.83, respectively. Multivariate linear regression revealed that interest in participating in anticipatory grief counselling for the family caregivers of patients with terminal cancer was significantly associated with the nurses' willingness to provide such counselling. Similarly, their willingness to provide such counselling was significantly associated with their counselling competency.

CONCLUSIONS

Nurses' willingness and competency to provide anticipatory grief counselling for the family caregivers of patients with terminal cancer can be enhanced through in-service education programmes, including bedside teaching and scenario simulation.

RELEVANCE TO CLINICAL PRACTICE

To improve nurses' competency in anticipatory grief counselling for the family caregivers of patients with terminal cancer, factors related to nurses' willingness to provide such grief counselling must be addressed. Diverse strategies of in-service education can be adopted to promote nurses' competency in anticipatory grief counselling.

End of life decisions and preference of place of death among geriatric and chronic disease patients: A scoping review

Background

Geriatric and chronic disease patients and families consider the nature, time, and place of death because issues related to the end of life are rarely discussed. This study assessed the end of life decisions and preferences among geriatric and chronic disease patients.

Methods

There was an in-depth search in five electronic databases (PubMed Central, CINAHL, Embase, Web of Science, and Scopus) using the population, concept, and context, framework. A matrix was developed, discussed, accepted, and used for data extraction. Convergent synthesis and thematic data analysis technique were adopted for the analysis. The reporting of findings was done in accordance with the JBI and PRISMA guidelines for reviews.

Results

From the data analysis, home-based end of life care was intuitive and included home visits, telephone follow-up, and patient-initiated services. The key themes that emerged from our analysis that sought to influence end end of life decisions were 1) approach to home-based end of life care, 2) patient and family characteristics, 3) clinical characteristics of the patient, 4) health care provider factors, 5) satisfaction and care rendered to the patient and family, 6) family preference of the place of death, 7) collaboration between multidisciplinary teams of care, and 8) challenges associated with the home-based end of life care. The personal characteristics of the nurse (age, personal and work experience, nursing perspective, and competence) and conducting a home visit influenced patient and family end of life decision. Multidisciplinary care teams (nurses and palliative care specialists) were important in delivering effective end-of-life services.

Conclusion

To support patients in making informed decisions, they must be educated on expected outcomes and implications, adverse impacts of decisions, and the emotional influence on the bereaved family. It is important that divergent technological methods are leveraged to provide essential care to patients nearing the end of life at home. Advancing the quality of end of life care techniques through home visiting will improve the feeling of patients and families about the dying process.

Tweetable abstracts

End-of-life preferences warrants that, divergent technological methods are leveraged to provide care to patients nearing the end of life.

"Spanish Palliative Care Nurses' Degree of Acceptance of a Proposal for Nursing Competencies in Palliative Care"

Background: In Spain, palliative care (PC) nursing is not a recognized specialization and PC nurses do not receive systematic specialized academic training in PC. To ensure the quality of PC in Spain, the Spanish Association of Palliative Care Nursing has been working since 2011 to design a model of competencies for PC nurses. Objective: Verify whether a sample of Spanish PC nurses accepts the proposed model of PC nursing competencies describing their work. Methods: Descriptive cross-sectional observational study based on an ad-hoc questionnaire about 98 proposed competencies, which participants rated for whether they belong to the purview of PC nurses and for their degree of concordance with their own practice and their degree of importance in PC nursing. Competencies receiving approval by more than 75% of participants for the three dimensions were considered to have been accepted by consensus. Mixed logistical models were developed to study the association between demographic variables and the responses. Results: Sixty-two out of 98 proposed competencies were accepted by more than 75% of participants. We therefore considered these competencies to have been accepted by consensus. Thirty-six proposed competencies failed to meet the threshold of 75% acceptance. For competencies that were accepted overall, participants with more than 10 years of experience in PC and participants with specialized training in PC were more likely to report that these competencies were part of the purview of PC nursing. Participants age >50 were less likely to report that competencies related to research concorded with their practice. Participants accepted the importance of all 98 proposed competencies. Conclusion: The variables of experience, training and age had a statistically significant relationship with the acceptance or rejection of the proposed competencies on the basis of purview and concordance. Further research is necessary to understand more fully these relationships to eventually arrive at a consensus model for the competencies of PC nurses.

Atuação do Enfermeiro em Cuidados Paliativos na Atenção Primária à Saúde: Revisão Integrativa

Introdução: A atuação da enfermagem ao indivíduo em cuidados paliativos (CP) na Atenção Primária à Saúde (APS) visa a promover a qualidade de vida dos indivíduos e da sua família como garantia da assistência integral, para um cuidado humanizado e digno, melhorando a maneira de enfrentar a doença e minimizando o sofrimento. Objetivo: Analisar e sintetizar a produção científica relacionada à assistência do enfermeiro ao indivíduo em CP nas APS. Método: Revisão integrativa da literatura realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Base de Dados de Enfermagem (BDENF) e Scientific Electronic Library Online (SciELO), utilizando os descritores: Palliative Care, Nursing e Primary Health Care. Resultados: Foram analisados 17 artigos após seleção sistemática, sintetizados em um quadro com seus principais resultados e agrupados em três categorias: capacitação em CP: uma barreira para atuação do enfermeiro na APS; percepções, experiências e práticas dos enfermeiros nos CP; o papel do enfermeiro na equipe multiprofissional de CP. Conclusão: Notou-se que os enfermeiros possuíam conhecimento superficial acerca dos CP na APS, evidenciando a necessidade de educação continuada para promover a sua atuação em CP. Ademais, estudos com maior rigor metodológico com o foco no enfermeiro como agente disseminador da prática são necessários.

Future palliative competence needs - a qualitative study of physicians' and registered nurses' views

BACKGROUND

Globally, the need for palliative care will increase as a result of the ageing of populations and the rising burden of cancer, non-communicable diseases as well as some communicable diseases. Physicians and registered nurses working in palliative care should have a sufficient level of education and competence in managing the changing needs and requirements of palliative care. There is, however, need for evidence-based palliative care training and education of physicians and registered nurses. The purpose of this study was to describe the views of physicians and registered nurses regarding future competence needs within palliative care.

METHODS

The study was conducted through use of a cross-sectional qualitative design. A total of 54 physicians and 110 registered nurses completed an open-ended questionnaire about the future competence needs of palliative care. The data were analyzed using inductive content analysis.

RESULTS

The results revealed four main competence needs within palliative care for the coming decade: palliative care competence at all levels within healthcare and social welfare services; individualized palliative care competence; person-centered encounters competence; and systematic competence development within palliative care.

CONCLUSIONS

The results offer cues for education and professional development, which can be used to support physicians and registered nurses when future palliative care competences are included in educational programs. Seamless cooperation between palliative care services and educational institutions is recommended to ensure that undergraduate and postgraduate education is based on a continuous assessment of competence requirements within the field of palliative care. Therefore, online multi-professional simulations, for example, could be used to enhance future competencies within palliative care; undergraduate medical, nursing and allied healthcare students as well as postgraduate palliative care professionals and experts of experience could work together during simulations.

Nurses' competency in Saudi Arabian healthcare context: A cross-sectional correlational study

AIM

To measure the competence and characteristics of nurses in Saudi Arabia delivering health care with significant correlations.

DESIGN

A cross-sectional correlational study.

METHODS

Data were collected in 2019 using a standardized questionnaire, Competency Inventory for Registered Nurses (CIRN), that included a purposive sample of 621 nurses working in Saudi Arabia.

RESULTS

A positive evaluation of nurses' overall core competency components is recognizably measured with greater competency levels in their workplace, scoring highest in "legal/ethical practice" while "critical thinking and research aptitude" represented the lowest dimension. Nurses' marital status, years of graduation, length of service, duty hours and nurse-patient ratio affect their competency level. Nurses' competence and their sociodemographic characteristics are significantly correlated attributes. Medical ward nurses are likely to have the greatest competence in delivering safe nursing care within training's legal borders.

The Home Healthcare Nurse: A Concept Analysis

The home healthcare nurse is a concept that has grown rapidly in the past two centuries, however, the role and meaning remain ambiguous. Continuous changes in the healthcare system have sparked confusion with patients and healthcare providers as to the essence of the home healthcare nurse. With the popularity and demand for home healthcare-based care on the rise, it is necessary to differentiate the concept of the home healthcare nurse from other related terms through a concept analysis. Using Walker and Avant's methodology, a literature search using Cumulative Index to Nursing and Allied Health Literature (CINAHL) along with dictionaries, encyclopedias, and professional organizations was performed to identify all the uses, attributes, and characteristics of the concept. Five defining attributes emerged during the analysis: autonomy, adaptability, person-centered holistic care, care coordination, and self-efficacy. Antecedents, consequences and empirical referents were identified. As a first step, this concept analysis brings clarity to the meaning and role of the home healthcare nurse from which arose an operational definition and proposed conceptual model. With the number of patients admitted to home healthcare accelerating, healthcare organizations and clinicians must distinctly understand the concept of the home healthcare nurse. Future research should include testing theoretical relationships between the home healthcare nurse and patient outcome variables to enhance nursing science and promote population health.

The development of competency frameworks in healthcare professions: a scoping review

Competency frameworks serve various roles including outlining characteristics of a competent workforce, facilitating mobility, and analysing or assessing expertise. Given these roles and their relevance in the health professions, we sought to understand the methods and strategies used in the development of existing competency frameworks. We applied the Arksey and O'Malley framework to undertake this scoping review. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, and ERIC) and three grey literature sources (greylit.org, Trove and Google Scholar) using keywords related to competency frameworks. We screened studies for inclusion by title and abstract, and we included studies of any type that described the development of a competency framework in a healthcare profession. Two reviewers independently extracted data including study characteristics. Data synthesis was both quantitative and qualitative. Among 5710 citations, we selected 190 for analysis. The majority of studies were conducted in medicine and nursing professions. Literature reviews and group techniques were conducted in 116 studies each (61%), and 85 (45%) outlined some form of stakeholder deliberation. We observed a significant degree of diversity in methodological strategies, inconsistent adherence to existing guidance on the selection of methods, who was involved, and based on the variation we observed in timeframes, combination, function, application and reporting of methods and strategies, there is no apparent gold standard or standardised approach to competency framework development. We observed significant variation within the conduct and reporting of the competency framework development process. While some variation can be expected given the differences across and within professions, our results suggest there is some difficulty in determining whether methods were fit-for-purpose, and therefore in making determinations regarding the appropriateness of the development process. This uncertainty may unwillingly create and legitimise uncertain or artificial outcomes. There is a need for improved guidance in the process for developing and reporting competency frameworks.

Nursing competencies across different levels of palliative care provision: A systematic integrative review with thematic synthesis

BACKGROUND

Palliative care exists in diverse healthcare settings. Nurses play a crucial role in its provision. Different levels of palliative care provision and education have been recognized in the literature. Therefore, nurses need a set of various competencies to provide high-quality palliative care.

AIMS

To systematically synthesize the empirical evidence of (1) nursing competencies needed in palliative care and (2) whether these competencies differ across the level of palliative care.

DESIGN

Systematic integrative review with thematic synthesis. Prospero: CRD42018114869.

DATA SOURCES

CINAHL, PubMed, Academic Search Premier, Scopus and Medic databases. Studies on nursing competencies linked to palliative care reported in English, Swedish, Finnish, Spanish, Portuguese or German were considered. Search terms: 'palliative care or hospice care or end-of-life care', 'competency or professional competence or skills' and 'nursing'. Articles were independently screened and reviewed by two researchers. Quality appraisal was conducted following Hawker's criteria.

RESULTS

A total of 7454 articles were retrieved, 21 articles were included in the analysis. Six diverse nursing competencies dimensions, namely leadership, communication, collaboration, clinical, ethico-legal and psycho-social and spiritual were identified. The reports rarely defined the level of palliative care and covered a wide array of healthcare settings.

CONCLUSION

Nurses need a wide range of competencies to provide quality palliative care. Few studies focused on which competencies are relevant to a specific level of palliative care. Further research is needed to systematize the nursing competencies and define which nursing competencies are central for different levels of palliative care to enhance palliative care development, education and practice.

Nursing interventions to support family caregivers in end-of-life care at home: A systematic narrative review

BACKGROUND

Family caregivers are crucial in end-of-life care. However, family caregiving may involve a significant burden with various negative health consequences. Although nurses are in a unique position to support family caregivers at home, little is known about which nursing interventions are effective in this context. Therefore, this study aims to provide insight into nursing interventions currently available to support family caregivers in end-of-life care at home and to describe their effects.

METHODS

A systematic search was conducted in Embase, Medline Ovid, Web of Science, Cochrane Central, CINAHL and Google Scholar. This review included quantitative studies published from January 2003 until December 2018 reporting on nursing interventions to support adult family caregivers in end-of-life care at home. Data were extracted on intervention modalities, intervention components, and family caregivers' outcomes. Methodological quality of the studies was assessed with the Cochrane Risk of Bias Tool.

RESULTS

Out of 1531 titles, nine publications were included that reported on eight studies/eight interventions. Of the eight studies, three were randomised controlled trials, one a pilot randomised trial, one a non-randomised trial, and three were single-group prospective studies. Four intervention components were identified: psychoeducation, needs assessment, practical support with caregiving, and peer support. Psychoeducation was the most commonly occurring component. Nursing interventions had a positive effect on the preparedness, competence, rewards, and burden of family caregivers. Multicomponent interventions were the most effective with, potentially, the components 'needs assessment' and 'psychoeducation' being the most effective.

CONCLUSIONS

Although only eight studies are available on nursing interventions to support family caregivers in end-of-life care at home, they show that interventions can have a positive effect on family caregivers' outcomes. Multicomponent interventions proved to be the most successful, implying that nurses should combine different components when supporting family caregivers.