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Friedrichsen M, Lythell C, Milovanovic M, Waldréus N, Thulesius H, Jaarsma T, Jaarsma P, Hedman C, Schaller AS. Nurses' experiences of ethical challenges concerning thirst in dying patients in specialist palliative care: a qualitative study. BMC Palliat Care 2024; 23:192. [PMID: 39080626 PMCID: PMC11290186 DOI: 10.1186/s12904-024-01519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024] Open
Abstract
AIM To describe nurses' experiences of ethical challenges in relation to thirst in terminally ill patients in specialist palliative care units. RESEARCH DESIGN A qualitative, reflexive thematic design with an inductive analysis was used. PARTICIPANTS AND RESEARCH CONTEXT Eighteen qualitative interviews with nurses working in six different specialist palliative care units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. RESULTS This study identified four themes that reflect ethical challenges experienced by nurses in the palliative care regarding thirst: Harmful infusions interfere with peaceful dying; conflict between tradition and personal experience; What is the right intervention to quench thirst? and; Lack of standard procedures, competence and interest among team members. CONCLUSION Palliative care nurses experience a number ethical challenges in relation to thirst in dying patients. The main challenge is the provision of fluids to dying patients via artificial infusions, which nurses struggle with, as they do not want to interfere with a peaceful dying process.
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Affiliation(s)
- Maria Friedrichsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden.
| | - Caroline Lythell
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden
| | - Micha Milovanovic
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, Vrinnevi hospital, Norrköping, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Theme Inflammation and Aging, Karolinska Institutet, Karolinska University Hospital, Huddinge, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Hans Thulesius
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Region Kronoberg, Kalmar, Växjö, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pier Jaarsma
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Anne Söderlund Schaller
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lythell C, Schaller AS, Jaarsma T, Friedrichsen M. Nurses' perception of thirst in patients within palliative home care: a qualitative study. BMC Nurs 2024; 23:516. [PMID: 39075509 PMCID: PMC11288118 DOI: 10.1186/s12912-024-01985-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/29/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Thirst is the body's natural urge to replenish fluids in response to a deficiency in hydration. Patients at the end of life gradually lose their independence and reach a point where they become unable to express their needs and can no longer drink on their own. In palliative care, the main advice is to provide regular oral care to relieve symptoms such as dry mouth and thirst. However, according to previous studies the prevalence of thirst and dry mouth remains. AIM The aim of this study was to describe palliative care, nurses' views and experiences of thirst in end-of-life care in specialist palliative care units. METHODS A qualitative interview study with an inductive approach was conducted. Eighteen nurses working in six different specialist palliative care units in different hospitals in Sweden were interviewed. The interviews were transcribed and analysed with a content analysis approach according to Graneheim and Lundman. RESULTS When nurses discuss thirst, they perceive thirst as a problem for the patient. This is attributable to various factors, including the patient breathing with an open mouth, a reduced level of awareness, and negligence on the part of the nursing staff. Signs of thirst are dry mouth, and frequently and intense sucking on the oral care stick during oral care. It also emerged that not all nurses perceived that dying patients experienced thirst. They believe that thirst is something that is reduced in the dying patient in the same way as hunger. The most important thing to them is to relieve the dry mouth by providing good oral care. Several issues, such as a lack of guidelines paired with the patient's reduced consciousness and hence his/her lack of communication, make assessing thirst problematic. CONCLUSION Nurses have different thoughts and experiences about thirst, where some perceive patients as thirsty while others perceive them as having a dry mouth. Nurses expressed that both evidence and guidelines are lacking.
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Affiliation(s)
- Caroline Lythell
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Palliative Education and Research Centre, Vrinnevi Hospital, Norrköping, Sweden.
| | | | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria Friedrichsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Palliative Education and Research Centre, Vrinnevi Hospital, Norrköping, Sweden
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Godrie F, van Zuilekom I, Onwuteaka-Philipsen B, van Os-Medendorp H, Schoonmade L, Metselaar S. Specialized expertise among healthcare professionals in palliative care - A scoping review. BMC Palliat Care 2024; 23:170. [PMID: 39003463 PMCID: PMC11245811 DOI: 10.1186/s12904-024-01498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND The generalist-plus-specialist palliative care model is endorsed worldwide. In the Netherlands, the competencies and profile of the generalist provider of palliative care has been described on all professional levels in nursing and medicine. However, there is no clear description of what specialized expertise in palliative care entails, whereas this is important in order for generalists to know who they can consult in complex palliative care situations and for timely referral of patients to palliative care specialists. OBJECTIVE To gain insight in the roles and competencies attributed to palliative care specialists as opposed to generalists. METHODS A scoping review was completed based on PRISMA-ScR guidelines to explore the international literature on the role and competence description of specialist and expert care professionals in palliative care. Databases Embase.com, Medline (Ovid), CINAHL (Ebsco) and Web of Science Core Collection were consulted. The thirty-nine included articles were independently screened, reviewed and charted. Thematic codes were attached based on two main outcomes roles and competencies. RESULTS Five roles were identified for the palliative care specialist: care provider, care consultant, educator, researcher and advocate. Leadership qualities are found to be pivotal for every role. The roles were further specified with competencies that emerged from the analysis. The title, roles and competencies attributed to the palliative care specialist can mostly be applied to both medical and nursing professionals. DISCUSSION The roles and competencies derived from this scoping review correspond well with the seven fields of competence for medical/nursing professionals in health care of the CanMEDS guide. A specialist is not only distinguished from a generalist on patient-related care activities but also on an encompassing level. Clarity on what it entails to be a specialist is important for improving education and training for specialists. CONCLUSION This scoping review adds to our understanding of what roles and competencies define the palliative care specialist. This is important to strengthen the position of the specialist and their added value to generalists in a generalist-plus-specialist model.
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Affiliation(s)
- Fleur Godrie
- AmsterdamUMC Department of Ethics, Law and Humanities, Expertise Center for Palliative Care, Amsterdam, Hoofddorp, The Netherlands.
| | - Ingrid van Zuilekom
- AmsterdamUMC, Expertise Center for Palliative Care Research group Smart Health, School of Health Saxion, University of Applied Sciences, Amsterdam, Hoofddorp, The Netherlands
| | - Bregje Onwuteaka-Philipsen
- AmsterdamUMC, Department Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam, Hoofddorp, The Netherlands
| | - Harmieke van Os-Medendorp
- Inholland University of Applied Sciences, Faculty of Health, Sports and Social Work, Amsterdam, The Netherlands & Spaarne Gasthuis Academy, Amsterdam, Hoofddorp, The Netherlands
| | - Linda Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Hoofddorp, The Netherlands
| | - Suzanne Metselaar
- AmsterdamUMC Department of Ethics, Law and Humanities, Expertise Center for Palliative Care, Amsterdam, Hoofddorp, The Netherlands
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van Zuilekom I, Metselaar S, Godrie F, Onwuteaka-Philipsen B, van Os-Medendorp H. Generalist, specialist, or expert in palliative care? A cross-sectional open survey on healthcare professionals' self-description. BMC Palliat Care 2024; 23:120. [PMID: 38755581 PMCID: PMC11097520 DOI: 10.1186/s12904-024-01449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In the Netherlands, palliative care is provided by generalist healthcare professionals (HCPs) if possible and by palliative care specialists if necessary. However, it still needs to be clarified what specialist expertise entails, what specialized care consists of, and which training or work experience is needed to become a palliative care specialist. In addition to generalists and specialists, 'experts' in palliative care are recognized within the nursing and medical professions, but it is unclear how these three roles relate. This study aims to explore how HCPs working in palliative care describe themselves in terms of generalist, specialist, and expert and how this self-description is related to their work experience and education. METHODS A cross-sectional open online survey with both pre-structured and open-ended questions among HCPs who provide palliative care. Analyses were done using descriptive statistics and by deductive thematic coding of open-ended questions. RESULTS Eight hundred fifty-four HCPs filled out the survey; 74% received additional training, and 79% had more than five years of working experience in palliative care. Based on working experience, 17% describe themselves as a generalist, 34% as a specialist, and 44% as an expert. Almost three out of four HCPs attributed their level of expertise on both their education and their working experience. Self-described specialists/experts had more working experience in palliative care, often had additional training, attended to more patients with palliative care needs, and were more often physicians as compared to generalists. A deductive analysis of the open questions revealed the similarities and distinctions between the roles of a specialist and an expert. Seventy-six percent of the respondents mentioned the importance of having both specialists and experts and wished more clarity about what defines a specialist or an expert, how to become one, and when you need them. In practice, both roles were used interchangeably. Competencies for the specialist/expert role consist of consulting, leadership, and understanding the importance of collaboration. CONCLUSIONS Although the grounds on which HCPs describe themselves as generalist, specialist, or experts differ, HCPs who describe themselves as specialists or experts mostly do so based on both their post-graduate education and their work experience. HCPs find it important to have specialists and experts in palliative care in addition to generalists and indicate more clarity about (the requirements for) these three roles is needed.
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Affiliation(s)
- Ingrid van Zuilekom
- Saxion, University of Applied Science, School of Health, research group Smart Health, Postbus 70.000, 7500 KB, Enschede, The Netherlands.
- Amsterdam UMC Location VUmc, De Boelelaan 1117 1081 HV Amsterdam Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Suzanne Metselaar
- Amsterdam UMC Location VUmc, Department of Ethics, Law and Humanities, De Boelelaan 1117 1081 HV Amsterdam Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Fleur Godrie
- Amsterdam UMC Location VUmc, Department of Ethics, Law and Humanities, De Boelelaan 1117 1081 HV Amsterdam Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC Location VUmc, Chair Amsterdam UMC Expertise Center for Palliative Care, Department of Public and Occupational Health, Locatie VUmc | MF D349 | van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
| | - Harmieke van Os-Medendorp
- Domain of Health, Sports and Welfare, Inholland, University of Applied Sciences, De Boelelaan, 1109, 1081 HV, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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Li WY, Fang Y, Liang YQ, Zhu SQ, Yuan L, Xu Q, Li Y, Chen YL, Sun CX, Zhi XX, Li XY, Zhou R, Du M. Building bridges of excellence: a comprehensive competence framework for nurses in hospice and palliative care-a mixed method study. BMC Palliat Care 2023; 22:197. [PMID: 38087276 PMCID: PMC10714629 DOI: 10.1186/s12904-023-01318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Hospice and Palliative Care (HPC) is in high demand in China; however, the country is facing the shortage of qualified HPC nurses. A well-suited competence framework is needed to promote HPC human resource development. Nevertheless, existing unstandardized single-structured frameworks may not be sufficient to meet this need. This study aimed at constructing a comprehensive multi-structured HPC competence framework for nurses. METHODS This study employed a mixed-method approach, including a systematic review and qualitative interview for HPC competence profile extraction, a two-round Delphi survey to determine the competences for the framework, and a cross-sectional study for framework structure exploration. The competence profiles were extracted from publications from academic databases and interviews recruiting nurses working in the HPC field. The research team synthesized profiles and transferred them to competences utilizing existing competence dictionaries. These synthesized competences were then subjected to Delphi expert panels to determine the framework elements. The study analyzed theoretical structure of the framework through exploratory factor analysis (EFA) based on a cross-sectional study receiving 491 valid questionnaires. RESULTS The systematic review involved 30 publications from 10 countries between 1995 and 2021, while 13 nurses from three hospitals were interviewed. In total, 87 and 48 competence profiles were respectively extracted from systematic review and interview and later synthesized into 32 competences. After the Delphi survey, 25 competences were incorporated into the HPC competence framework for nurses. The EFA found a two-factor structure, with factor 1 comprising 18 competences namely Basic Competences; factor 2 concluding 7 competences namely Developmental Competences. CONCLUSIONS The two-factor HPC competence framework provided valuable insights into the need and directions of Chinese HPC nurses' development.
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Affiliation(s)
- Wei-Ying Li
- School of Nursing, Nanjing Medical University, Nanjing, 211166, P. R. China
| | - Ying Fang
- School of Nursing, Nanjing Medical University, Nanjing, 211166, P. R. China
| | - Yi-Qing Liang
- School of Medicine, Jiangsu University, Zhenjiang, 212000, China
| | - Shu-Qin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, P. R. China.
| | - Ling Yuan
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, 210008, P. R. China.
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, P. R. China.
| | - Yue Li
- Jiangsu Institute of Quality and Standardization, Nanjing, 210029, China
| | - Yin-Long Chen
- Jiangsu Institute of Quality and Standardization, Nanjing, 210029, China
| | - Chang-Xian Sun
- School of Health Sciences, Jiangsu Vocational Institute of Commerce, Nanjing, 211168, China
| | - Xiao-Xu Zhi
- Nursing Department, Jiangsu Cancer Hospital and Nanjing Medical University Affiliated Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, 210009, China
| | - Xiao-Yan Li
- Hospice Unit, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Rong Zhou
- School of Nursing, Nanjing Medical University, Nanjing, 211166, P. R. China
| | - Mai Du
- School of Nursing, Nanjing Medical University, Nanjing, 211166, P. R. China
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