1
|
Shabnam J, Timm HU, Nielsen DS, Raunkiær M. Palliative Care Utilisation Among Non-Western Migrants in Denmark: A Qualitative Study Of the Experiences of Patients, Family Caregivers and Healthcare Professionals. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221111933. [PMID: 35786059 DOI: 10.1177/00302228221111933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores care experiences while utilising palliative care services of non-western migrant families from the perspectives of patients, family caregivers, and healthcare professionals in Denmark. Twenty-three semi-structured individual and group interviews were conducted among eight patients with a life-threatening disease, 11 family caregivers, and ten healthcare professionals. Thematic analysis revealed three themes: 1) Communication between families and healthcare professionals; 2) Building and lack of trusting relations, and feeling safe, and 3) Access to information and navigating in the healthcare system. Moreover, ''language and culture'' emerged as transaction themes that are not mutually exclusive, however, interconnect across the mentioned three themes. Non-western migrant families can be supported by healthcare professionals' cultural competency training, negotiating on providing services concerning information, patient preferences, family involvement, and palliative care setting. This study findings urge inter-sectoral collaboration to ensure needs-oriented and linguistically and culturally appropriate palliative care services for non-western migrant families in Denmark.
Collapse
Affiliation(s)
- Jahan Shabnam
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Helle Ussing Timm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- University Hospitals Center for Health Research (UCSF), Rigshospital, Copenhagen, Denmark
| | - Dorthe Susanne Nielsen
- Migrant Health Clinic, Department of Geriatric Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mette Raunkiær
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Fish EC, Lloyd A. Moral distress amongst palliative care doctors working during the COVID-19 pandemic: A narrative-focussed interview study. Palliat Med 2022; 36:955-963. [PMID: 35548937 PMCID: PMC9174577 DOI: 10.1177/02692163221088930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Palliative care professionals have had to adapt to rapidly changing COVID-19 restrictions with personal protective equipment and physical distancing measures impacting face-to-face communication with patients and relatives. AIM To explore the narratives of palliative care doctors working during the pandemic to understand their experiences at a personal and professional level. DESIGN In-depth narrative interviews were carried out via video call. Interviews were transcribed verbatim and analysed using a joint paradigmatic and narrative approach to elucidate common themes and closely explore individual narratives. SETTING/PARTICIPANTS Eight palliative care doctors who had worked on a hospice inpatient unit in the UK before and during the pandemic were recruited from two hospices in Scotland. RESULTS Three intersecting themes are described, the most significant being moral distress. Participants articulated a struggle to reconcile their moral convictions with the restrictions enforced, for example, wanting to provide support to patients through physical proximity but being unable to. To differing degrees, this resulted in internal conflict and emotional distress. Two further themes arose: the first concerned a loss of humanity in interaction and a striving to re-humanise communication through alternative means; the second being a change in staff morale as the pandemic progressed. CONCLUSIONS Restrictions had a considerable impact on palliative care doctors' ability to communicate with and comfort patients which led to moral distress and contributed to decreasing morale. Future research could explore moral distress in palliative care settings internationally during the pandemic with a view to compare the factors affecting how moral distress was experienced.
Collapse
Affiliation(s)
- Ellis C Fish
- College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Anna Lloyd
- St Columba's Hospice, Education and Research, Edinburgh, UK
| |
Collapse
|
3
|
Ko PY, Lien HY, Huang CM, Tsai CY, Chen CC, Woung LC, Ko MC, Huang SJ. Palliative Family Conference Reduces the Risk of Death in Intensive Care Units and Cardiopulmonary Resuscitation at End of Life. J Palliat Med 2022; 25:1050-1056. [PMID: 35349365 DOI: 10.1089/jpm.2021.0546] [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: 11/12/2022] Open
Abstract
Background: Palliative family conference (PFC) was included in the reimbursement of National Health Insurance to promote palliative care in Taiwan in 2012. Objectives: This study aimed to evaluate the impact of PFC on death in intensive care unit (ICU) and receiving cardiopulmonary resuscitation (CPR) within three days before death. Design: This is a cross-sectional study. Subjects: All patients who died in a public hospital and were admitted to ICU within 30 days before death, from 2013 to 2018, were included. Measurements: The medical records were analyzed to identify information on causes of death, receiving PFC, receiving palliative care consultation, death in ICU, and receiving CPR within three days before death. Multivariate logistic regression was used to assess the independent effects of receiving PFC on the risk of death in ICU and receiving CPR within three days before death. Results: For patients who died and those who did not die in ICU, the proportion of receiving PFC was 45.8% (1818/3973) and 55.0% (808/1468), respectively. For patients who received and those who did not receive CPR within three days before death, the proportion of receiving PFC was 23.9% (140/585) and 51.2% (2486/4856), respectively. PFC was associated with a reduced risk of death in ICU (adjusted odds ratio [AOR]: 0.842; 95% confidence interval [CI]: 0.717-0.988) and a reduced risk of receiving CPR within three days before death (AOR: 0.361; 95% CI: 0.286-0.456). Conclusion: PFC reduces the risk of receiving nonbeneficial aggressive intervention and may improve the quality of end-of-life care.
Collapse
Affiliation(s)
- Po-Yun Ko
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.,Teaching and Research Department, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Hsin-Yi Lien
- Taipei City Hospital, Taipei City, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | | | - Ching-Yao Tsai
- Taipei City Hospital, Taipei City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Lin-Chung Woung
- Taipei City Hospital, Taipei City, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ming-Chung Ko
- Taipei City Hospital, Taipei City, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Sheng-Jean Huang
- Taipei City Hospital, Taipei City, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, Taipei City, Taiwan
| |
Collapse
|
4
|
Lino P, Williams M. Transitioning end-of-life care from hospital to the community: case report. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1010-1014. [PMID: 34605254 DOI: 10.12968/bjon.2021.30.17.1010] [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: 06/13/2023]
Abstract
Palliative/end-of-life care is an integral part of the district nursing service. There is increasing demand for palliative care to be delivered in the community setting. Therefore, there is a need for excellent collaboration between staff in primary and secondary care settings to achieve optimum care for patients. This article critically analyses the care delivered for a palliative patient in the hospital setting and his subsequent transition to the community setting. The importance of effective communication, holistic assessment in palliative care, advance care planning, organisational structures and the socio-cultural aspects of caring for patients at the end of life are discussed. Additionally, the article highlights the impact of substandard assessment and communication and the consequent effect on patients and families.
Collapse
Affiliation(s)
- Pedro Lino
- District Nurse, The Oakridge Centre, High Wycombe
| | - Mary Williams
- Senior Lecturer in Cancer, Palliative Care and End of Life Care, School of Health Care and Social Work, Buckinghamshire New University, Uxbridge, when this article was written, and is now Macmillan Lead Nurse for Specialist Supportive and Palliative Care and Chaplaincy, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London
| |
Collapse
|
5
|
Wanko Keutchafo EL, Kerr J, Jarvis MA. Evidence of nonverbal communication between nurses and older adults: a scoping review. BMC Nurs 2020; 19:53. [PMID: 32550824 PMCID: PMC7298765 DOI: 10.1186/s12912-020-00443-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/04/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Communication is an integral part of life and of nurse-patient relationships. Effective communication with patients can improve the quality of care. However, the specific communication needs of older adults can render communication between them and nurses as less effective with negative outcomes. METHODS This scoping review aims at describing the type of nonverbal communication used by nurses to communicate with older adults. It also describes the older adults' perceptions of nurses' nonverbal communication behaviors. It followed (Int J Soc Res 8: 19-32, 2005) framework. Grey literature and 11 databases were systematically searched for studies published in English and French, using search terms synonymous with nonverbal communication between nurses and older adults for the period 2000 to 2019. RESULTS The search revealed limited published research addressing nonverbal communication between older adults and nurses. The studies eligible for quality assessment were found to be of high quality. Twenty-two studies were included and highlighted haptics, kinesics, proxemics, and vocalics as most frequently used by nurses when communicating with older adults; while studies showed limited use of artefacts and chronemics. There was no mention of nurses' use of silence as a nonverbal communication strategy. Additionally, there were both older adults' positive and negative responses to nurses' nonverbal communication behaviors. CONCLUSION Nurses should be self-aware of their nonverbal communication behaviors with older adults as well as the way in which the meanings of the messages might be misinterpreted. In addition, nurses should identify their own style of nonverbal communication and understand its modification as necessary in accordance with patient's needs.
Collapse
Affiliation(s)
- Esther L. Wanko Keutchafo
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
| | - Jane Kerr
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
| | - Mary Ann Jarvis
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, 71 Manor Drive, Manor Gardens, Durban, 4001 South Africa
| |
Collapse
|
6
|
Hammer A, Wagner A, Rieger MA, Manser T. Assessing the quality of medication documentation: development and feasibility of the MediDocQ instrument for retrospective chart review in the hospital setting. BMJ Open 2019; 9:e034609. [PMID: 31740477 PMCID: PMC6886911 DOI: 10.1136/bmjopen-2019-034609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The medication process requires clear and transparent documentation in patient records. Incomplete or incorrect medication documentation may contribute to inappropriate clinical decision-making and adverse events. To comprehensively assess the quality of in-hospital medication documentation, we developed a retrospective chart review (RCR) instrument. We report on the development process, the feasibility of the instrument and describe our application of the instrument to a sample of patient records. DESIGN Cross-sectional study using an RCR instrument to evaluate paper-based, non-standardised prescription and medication administration charts (MediDocQ). SETTING Two German university hospitals. PARTICIPANTS Records from 1361 patients admitted between April and July 2015 were evaluated. METHODS The MediDocQ development process comprised six consecutive stages: focused literature review, web-based search, initial patient record screening, review by project advisory board, focus groups with professionals and pilot testing. The final 54-item RCR instrument covers three key components of medication documentation: (1) completeness of documented information (including prescription, medication administration and pro re nata (PRN) medication), (2) quality of transcriptions and (3) compliance with chart structure, legibility, handling of deletions and chart corrections. Descriptive statistics are presented as mean values, SD, median and interquartile ranges for individual items. RESULTS Overall, 33 out of 54 items resulted in mean values above 0.75, indicating high-quality medication documentation. Documentation quality was particularly compromised for verbal and PRN orders (which involve more steps than standard orders) and when documentation was not completed at the same time as medication administration. CONCLUSIONS MediDocQ is a patient safety instrument that can be used to evaluate the quality of medication documentation and identify components of the process where intervention is required. In our setting, standardisation of medication documentation, particularly regarding medication administration and PRN medication is a priority.
Collapse
Affiliation(s)
- Antje Hammer
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
| | - Anke Wagner
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Tuebingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Tuebingen, Germany
| | - Tanja Manser
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| |
Collapse
|
7
|
Pinna MÁC, Mahtani-Chugani V, Sánchez Correas MÁ, Sanz Rubiales A. The Use of Humor in Palliative Care: A Systematic Literature Review. Am J Hosp Palliat Care 2018; 35:1342-1354. [PMID: 29587520 DOI: 10.1177/1049909118764414] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Humor has its own place in the context of medicine. Nevertheless, its acceptance by terminal stage patients and health-care professionals has not been studied in depth and is not free from controversy. OBJECTIVES To understand the significance, appropriateness, and pertinence of the use of humor in palliative care and to analyze its applicability. DESIGN A narrative systematic review was undertaken and included in PROSPERO. DATA SOURCES Online searches were carried out on PUBMED, PSYCINFO, EBSCO (CINHAL), EMBASE, SCIELO, SCOPUS, TESEO, WEB of SCIENCE, and COCHRANE between their launch date and December 31, 2015, complemented with manual searches with queries to experts. A total of 156 studies were identified, which were then filtered in pairs by means of an established hierarchy, selecting studies that discussed the use of humor specifically in palliative care from all perspectives and designs, and finally published in Spanish, English, French, or Portuguese. Critical reading of all the selected studies took place, with no exclusions due to quality evaluation. RESULTS Thirty-four studies were included. Five main topics were identified: (1) definition of humor, (2) use and functions of humor in palliative care, (3) how to use humor, (4) when not to use humor, and (5) humor before and after the diagnosis of terminal illness. CONCLUSIONS Humor plays an unquestionable role in palliative care, but its use needs training and appropriate use.
Collapse
Affiliation(s)
| | - Vinita Mahtani-Chugani
- 2 Research Unit, Hospital Universitario Nuestra Señora de la Candelaria y Gerencia de Atención Primaria de Tenerife, Tenerife, Spain
| | | | | |
Collapse
|
8
|
Silva CLME, Bertoncelo C, Barros APB, Padovani M. Characterization of the communication resources used by patients in palliative care - an integrative review. REVISTA CEFAC 2017. [DOI: 10.1590/1982-0216201719613816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The aim of this study was to integrative review of publications concerning the role of speech and language therapists in regards to communication strategies in palliative care, as well as the characterization of the types of communication used in these cases. The search was conducted in the databases SciELO, LILACS and PubMed from 2001 to 2016. The studies selected included abstracts or full articles addressing aspects of communication in palliative care, especially those related to speech and language therapy, with an emphasis on communication. Ten articles focused on communication, and published after 2004, were selected, half being literature reviews, two, case reports, two others, quantitative exploratory studies, and one, a qualitative exploratory study, with only 3 specifically describing the communication strategies used by speech and language therapists in patients in palliative care. The descriptors found were: palliative care, communication, speech and language therapy, quality of life, dysphagia, swallowing and elderly. Four of the ten articles showed the importance of patients communication in palliative care. When described, it is up to the speech and language therapist to provide family support, evaluate the patient, favore patient-family and patient-team intervention, manage and intervene in communication and swallowing. Finally, the most used communication strategies were non-verbal communication, communication board, electronic equipment, verbal communication and speech valve. The analysis of the characterization of the communication in palliative care over the past 15 years allowed concluding that the attention to communication is recent and is only described in a few reports, includes non-verbal communication in different ways as the most frequent resource, but provides oral communication as an important factor for maintaining dignity and comfort in this scenario. Speech and language therapist are the main interlocutors for the maintenance, mediation and adaptation of communication, within the multidisciplinary team as well as among patients, their family and the care team.
Collapse
|
9
|
Abreu TFKD, Amendola F, Trovo MM. Relational technologies as instruments of care in the Family Health Strategy. Rev Bras Enferm 2017; 70:981-987. [PMID: 28977224 DOI: 10.1590/0034-7167-2016-0337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/08/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: This article aims to identify the relational technologies used by Family Health Strategy nurses in their daily work when treating patients. Method: Descriptive and cross-sectional study with qualitative approach; conducted between May and July 2015, in three Basic Health Units of the Southern Region of the Municipality of São Paulo, with 19 nurses of the Family Health Strategy. Data were collected through a semi-structured interview, and the speeches were fully transcribed and analyzed according to the technique of content analysis. Results: From the speeches of the participants, three categories emerged, showing the unawareness of the concept, but the valorization of its use; which are the relational technologies used by the participating nurses (communication, listening, empathy and welcoming reception), as well as the report of barriers to the use of relational technologies. Final consideration: Although the nurses value the use of relational technologies, the participants denoted unawareness of the nomenclature and its associated concepts, suggesting superficiality in the understanding and use of these instruments in the context of care in the Family Health Strategy. Objetivo: Identificar as tecnologias relacionais utilizadas por enfermeiros de Estratégia Saúde da Família em seu cotidiano de trabalho no atendimento aos usuários. Método: Estudo descritivo, transversal, com abordagem qualitativa; desenvolvido entre maio e julho de 2015, em três Unidades Básicas de Saúde da Região Sul do Município de São Paulo, com 19 enfermeiros da Estratégia Saúde da Família. Os dados foram coletados por meio de entrevista semiestruturada, e os discursos foram transcritos na íntegra, analisados segundo a técnica de análise de conteúdo. Resultados: Das falas dos participantes, surgiram três categorias, que evidenciam o desconhecimento do conceito, mas valorização do uso; quais são as tecnologias relacionais utilizadas pelos enfermeiros participantes (comunicação, escuta, empatia e acolhimento), além do relato de barreiras para a utilização de tecnologias relacionais. Considerações finais: Embora valorizem a utilização de tecnologias relacionais, os participantes denotaram desconhecer a nomenclatura e os conceitos associados, sugerindo superficialidade na compreensão e utilização dessas ferramentas no contexto de atendimento na Estratégia Saúde da Família.
Collapse
Affiliation(s)
| | - Fernanda Amendola
- Universidade de Guarulhos, Postgraduate Program in Nursing. Guarulhos, São Paulo, Brazil
| | - Monica Martins Trovo
- Universidade de Guarulhos, Postgraduate Program in Nursing. Guarulhos, São Paulo, Brazil
| |
Collapse
|
10
|
Arrieira ICDO, Thofern MB, Porto AR, Amestoy SC, Cardoso DH. Av Enferm 2016; 34. [DOI: 10.15446/av.enferm.v34n2.38144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
Abstract
Objetivo: Compreender como a espiritualidade é incorporadapelos integrantes da equipe do Programa de Internação Domiciliar Interdisciplinar (pidi) Oncológico no cuidado paliativo.Metodologia: Estudo de abordagem qualitativa, descritivae exploratória, fundamentada na Teoria Histórico-Cultural deVygotsky. Compuseram a pesquisa todos os integrantes da equipe interdisciplinar, totalizando oito sujeitos. Os dados foram coletados por meio da técnica de grupo focal, com cinco encontros realizados durante o período de fevereiro a maio de 2009, nos quais contou-se com a participação de dois observadores. Resultados: Emergiram dois temas: Cuidados paliativos e aespiritualidade e A espiritualidade e o processo de morrer. Os profissionais relacionaram a espiritualidade como forma de promover reflexão e aceitação da morte e sua relevância nas ações paliativistas.Conclusão: Podemos perceber que esta equipe mostrou-se disposta a compreender e adotar a espiritualidade durante a execução dos cuidados paliativos das pessoas em processo de morrer.
Collapse
|
11
|
Seccareccia D, Wentlandt K, Kevork N, Workentin K, Blacker S, Gagliese L, Grossman D, Zimmermann C. Communication and Quality of Care on Palliative Care Units: A Qualitative Study. J Palliat Med 2015; 18:758-64. [PMID: 26069934 DOI: 10.1089/jpm.2014.0408] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clinician-patient communication is central in palliative care, but it has not been described qualitatively which specific elements of communication are important for high-quality palliative care, particularly in the inpatient setting. OBJECTIVE Our aim was to identify elements of communication that are central to quality of care and satisfaction with care on palliative care units (PCUs), as described by inpatients, family caregivers, and health care providers. METHODS Qualitative interviews with patients/caregivers and focus groups with staff were conducted on four PCUs. Semi-structured interviews and focus groups elicited thoughts about the characteristics of satisfaction with care and quality of care for PCU inpatients and their family caregivers. Data were analyzed using a grounded theory method with an inductive, constant comparison approach; themes were coded to saturation. RESULTS There were 46 interviews and eight focus groups. Communication was the most prevalent theme regarding satisfaction and quality of care, with five subthemes describing elements important to patients, caregivers, and staff. These included: 1) building rapport with patients and families to build trust and kinship; 2) addressing expectations and explaining goals of care; 3) keeping patients and families informed about the patient's condition; 4) listening actively to validate patients' concerns and individual needs; and 5) providing a safe space for conversations about death and dying. CONCLUSIONS Patients, family caregivers, and health care providers affirmed that communication is a central element of quality of care and family satisfaction on PCUs. The five subthemes identified may serve as a structure for education and for quality improvement tools in palliative care inpatient settings.
Collapse
Affiliation(s)
- Dori Seccareccia
- 1 Department of Psychosocial Oncology, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada .,2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- 1 Department of Psychosocial Oncology, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada
| | - Nanor Kevork
- 3 Department of Supportive Care, University Health Network , Toronto, Ontario, Canada
| | - Kevin Workentin
- 2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .,4 Department of Family Medicine, Toronto East General Hospital , Toronto, Ontario, Canada
| | - Susan Blacker
- 5 Department of Cancer Services Planning and Performance, St. Michael's Hospital , Toronto, Ontario, Canada
| | - Lucia Gagliese
- 3 Department of Supportive Care, University Health Network , Toronto, Ontario, Canada .,6 Department of Anesthesia and Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,7 School of Kinesiology and Health Sciences, York University , Toronto, Ontario, Canada .,8 Department of Anesthesia, University Health Network , Toronto, Ontario, Canada .,11 Campbell Family Cancer Research Institute, Ontario Cancer Institute , Toronto, Ontario, Canada
| | - Daphna Grossman
- 2 Department of Family and Community Medicine, University of Toronto , Toronto, Ontario, Canada .,9 Department of Family and Community Medicine , Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- 3 Department of Supportive Care, University Health Network , Toronto, Ontario, Canada .,10 Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto , Toronto, Ontario, Canada .,11 Campbell Family Cancer Research Institute, Ontario Cancer Institute , Toronto, Ontario, Canada
| |
Collapse
|
12
|
Francisco DP, Costa ICP, Andrade CGD, Santos KFOD, Brito FMD, Costa SFGD. Contributions of the chaplaincy service to the care of terminal patients. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015003180013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study aims to identify chaplains' understanding in relation to spirituality, and to analyze the chaplaincy's contribution in the care of terminal patients. It is exploratory, qualitative research undertaken with seven hospital chaplains in two public hospitals in João Pessoa in the Brazilian state of Paraíba. The data were collected through semi-structured interviews and were subjected to content analysis. The categories which emerged were: Spirituality in the view of chaplains, and Contributions of the chaplaincy in employing spirituality in the care of the terminal patient. These categories evidenced that the chaplains value the spiritual dimension in their practice, helping the patient to cope with the end-of-life process. It is hoped that this study will provide resources for further investigations, bearing in mind that studies on the chaplaincy and spirituality in the care for the terminal patient remain incipient.
Collapse
|
13
|
Patient Attitudes towards Physician Nonverbal Behaviors during Consultancy: Result from a Developing Country. ISRN FAMILY MEDICINE 2014; 2014:473654. [PMID: 24977140 PMCID: PMC4041264 DOI: 10.1155/2014/473654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022]
Abstract
Background. Nonverbal behaviors have a significant impact on patients during consultations. This study was undertaken to find out the attitudes and preferences of the patients regarding nonverbal communication during consultations with physicians, in a tertiary care hospital. Methods. A questionnaire based cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, Pakistan, during the months of January to March 2012. All patients (>18 years of age) coming for consultancy in the family medicine clinics were approached; out of 133, 120 agreed to participate. The subjects were asked questions regarding physician's comforting touch and eye contact and their responses were noted. The data were analyzed using SPSS and chi-square test was used to identify corelations. Results. Overall, 120 patients were enrolled. About 58.3% were men and 41.7% were women with a mean age of 34.9 ± 10.9 years. 95.8% were Muslims and 57.6% had more than 12 years of education. Among females 74% wanted supportive touch from doctors, used to comfort the patient (45%) or to show respect (27.5%) or as healing (30%). 86.1% of the respondents believe that establishing eye contact with the patient shows that the doctor is attentive towards his/her patient. The eye contact should be brief but regular (54.1%) and prolonged staring (36.7%) makes them uncomfortable. Conclusion. Nonverbal communication helps to strengthen the doctor-patient relation as patients do appreciate positive touch and eye contact from their physicians.
Collapse
|
14
|
Beng TS, Chin LE, Guan NC, Yee A, Wu C, Pathmawathi S, Yi KT, Kuan WS, Jane LE, Meng CBC. The experiences of stress of palliative care providers in Malaysia: a thematic analysis. Am J Hosp Palliat Care 2013; 32:15-28. [PMID: 24023263 DOI: 10.1177/1049909113503395] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A qualitative study was conducted with semistructured interviews to explore the experiences of stress in 20 palliative care providers of University Malaya Medical Centre in Malaysia. The results were thematically analyzed. Nine basic themes were generated: (1) organizational challenges, (2) care overload, (3) communication challenges, (4) differences in opinion, (5) misperceptions and misconceptions, (6) personal expectations, (7) emotional involvement, (8) death and dying thoughts, and (9) appraisal and coping. A total care model of occupational stress in palliative care was conceptualized from the analysis. This model may inform the development of interventions in the prevention and management of stress in palliative care.
Collapse
Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Cathie Wu
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Subramaniam Pathmawathi
- Department of Nursing Science, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Kweh Ting Yi
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Wong Sook Kuan
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Lim Ee Jane
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Lembah Pantai, Kuala Lumpur, Malaysia
| | | |
Collapse
|
15
|
Fernandes MA, Evangelista CB, Platel ICDS, Agra G, Lopes MDS, Rodrigues FDA. Percepção dos enfermeiros sobre o significado dos cuidados paliativos em pacientes com câncer terminal. CIENCIA & SAUDE COLETIVA 2013; 18:2589-96. [DOI: 10.1590/s1413-81232013000900013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/05/2013] [Indexed: 11/21/2022] Open
Abstract
Este estudo teve como objetivo conhecer a percepção do enfermeiro diante do paciente com câncer sob cuidados paliativos. Trata-se de um estudo exploratório com abordagem qualitativa, realizado com enfermeiros assistenciais de um hospital que atende pacientes oncológicos em regime de cuidados paliativos, situado no município de João Pessoa (PB). Participaram do estudo nove enfermeiros, que atuavam no referido hospital. O material empírico foi coletado utilizando-se a técnica de entrevista semiestruturada e analisado mediante a técnica de análise de conteúdo. A análise interpretativa das entrevistas possibilitou a construção de três categorias: Promoção da qualidade de vida através do alivio da dor e sofrimento; Cuidados Paliativos: um olhar multiprofissional para o paciente terminal e família no processo de luto; Comunicação: fonte de dignidade no processo de terminalidade. Conclui-se que o estudo possibilitou evidenciar que os enfermeiros envolvidos reconhecem a importância da equipe multiprofissional, propiciando ao enfermeiro reflexões acerca do uso da comunicação como elemento essencial do cuidar para paciente e família sob cuidados paliativos. Espera-se que os dados obtidos possam subsidiar novas investigações sobre a temática.
Collapse
Affiliation(s)
| | | | | | - Glenda Agra
- Universidade Federal de Campina Grande, Brazil
| | | | | |
Collapse
|
16
|
Andrade CGD, Costa SFGD, Lopes MEL. Cuidados paliativos: a comunicação como estratégia de cuidado para o paciente em fase terminal. CIENCIA & SAUDE COLETIVA 2013; 18:2523-30. [DOI: 10.1590/s1413-81232013000900006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/27/2013] [Indexed: 11/22/2022] Open
Abstract
Os cuidados paliativos compreendem uma abordagem de assistência ao paciente sem possibilidades de cura e sua família, com o objetivo de proporcionar-lhes uma melhor qualidade de vida, a partir, essencialmente, de uma boa comunicação, sobretudo no campo do cuidado ao paciente terminal. O estudo teve como objetivo averiguar como enfermeiros utilizam a comunicação, no âmbito dos cuidados paliativos, ao assistir o paciente em fase terminal. Trata-se de uma pesquisa exploratória, de natureza qualitativa, na qual participaram 28 enfermeiros atuantes em unidades de internação de um hospital da cidade de João Pessoa (PB), no período de agosto a outubro de 2012. Para a coleta dos dados utilizou-se um formulário. Os dados foram analisados mediante a técnica de análise de conteúdo. Da análise do material, emergiram três categorias: "cuidados paliativos e comunicação - relação interpessoal do enfermeiro com o paciente terminal"; "comunicação em cuidados paliativos como estratégia para fortalecimento do vínculo entre enfermeiro e paciente terminal"; e "importância da comunicação entre enfermeiro e família do paciente terminal sob cuidados paliativos." Conclui-se que a comunicação se configura como um elemento eficaz do cuidado com o paciente em fase terminal e é de suma importância para a promoção dos cuidados paliativos.
Collapse
|
17
|
Silva MMD, Moreira MC, Leite JL, Erdmann AL. Nursing work at night in palliative oncology care. Rev Lat Am Enfermagem 2013; 21:773-9. [DOI: 10.1590/s0104-11692013000300017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 02/14/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: to understand the meaning baccalaureate nurses and nursing technicians attribute to night work in the context of clinical palliative oncology nursing care services, as well as how nursing works to attend to clients and caregivers' needs in this period. METHOD: in this exploratory and qualitative study, grounded theory was used. Seven nurses and four nursing technicians were interviewed, who composed two sample groups. Nine categories were produced and, in their comparative content analysis, a knowledge emphasis was evidenced with implications for nighttime nursing work. In this study, these aspects were discussed in two of the categories, which are: to describe care practice in order to understand nursing care management and to point out the difficulties in care practice and nursing care management. RESULTS: The results evidence the complexity in the nighttime care context, considering the clients' clinical conditions and clients and caregivers' psychological demands, mainly because of the threat of death. CONCLUSION: The team attempts to respond to these needs through communication, but reveals a lack of assistential services and an overload. Interdisciplinarity is a palliative care premise, favoring holistic care delivery, and cannot be neglected at, which requires attention and investment to develop better practices.
Collapse
|
18
|
Beng TS, Guan NC, Jane LE, Chin LE. Health care interactional suffering in palliative care. Am J Hosp Palliat Care 2013; 31:307-14. [PMID: 23689367 DOI: 10.1177/1049909113490065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A secondary analysis of 2 qualitative studies was conducted to explore the experiences of suffering caused by interactions with health care providers in the hospital setting. Interview transcripts from 20 palliative care patients and 15 palliative care informal caregivers in University Malaya Medical Centre were thematically analyzed. The results of health care interactional suffering were associated with themes of attention, understanding, communication, competence, and limitation. These 5 themes may serve as a framework for the improvement in interaction skills of health care providers in palliative care.
Collapse
Affiliation(s)
- Tan Seng Beng
- 1Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | | | | |
Collapse
|