Caring for Dying Patients and those Facing Death in an Acute-Care Hospital in Singapore: A Nurse’s Perspective

Mixed-methods systematic review: Cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care in the context of cancer

AIM

To identify and analyse the cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care in the context of cancer.

BACKGROUND

Cultural heritage shape beliefs and practices about cancer and end of life, which complicates nursing care delivery. While previous studies centred on diverse patients' perspectives and cultural competence of healthcare professionals, little analysis available focusing on the cultural attitudes and beliefs of care providers from diverse backgrounds.

DESIGN

Mixed methods systematic review.

DATA SOURCES

CINAHL, MEDLINE, Embase, PsychINFO and Scopus were searched between January and March 2020. No date limit was applied.

REVIEW METHODS

Quality appraisal was conducted using the mixed-method appraisal tool. Convergent segregated synthesis was undertaken. Findings were thematically synthesised with the final synthesis presented narratively.

RESULTS

Seven studies were included: three qualitative, two quantitative and two mixed methods. None of the studies focused on the end-of-life care experiences of IENs in the context of cancer. One study reported views on cancer, with all studies analysing the cultural attitudes, beliefs and practices of internationally educated nurses towards end-of-life care. Three main themes were identified: the philosophy of care, approaches to care and perceptions of death and dying.

CONCLUSION

The distinct gap in research on understanding the cultural attitudes and beliefs of internationally educated nurses in end-of-life care in the context of cancer demands further research. Several aspects of end-of-life care were in conflict with internationally educated nurses' cultural attitudes, beliefs and practices. As these nurses are integral in achieving culturally competent care, further understanding of this phenomenon is required to advance the delivery of culturally sensitive care to patients.

IMPACT

Stakeholders, including the nursing workforce, need to play an active role in providing a culturally inclusive workplace. Support measures are necessary to reduce the impact of cultural conflicts experienced by internationally educated nurses.

To be involved - A qualitative study of nurses' experiences of caring for dying patients

OBJECTIVE

The aim of this study was to describe nurses' experiences (>two years) of caring for dying patients in surgical wards.

BACKGROUND

Palliative care is included in education for nurses. However, the training content varies, and nurse educators need to be committed to the curriculum regarding end-of-life situations. A lack of preparation among newly graduated nurses regarding dying and death could lead to anxiety, stress and burnout. Therefore, it is important to improve knowledge regarding end-of-life situations.

SETTING, PARTICIPANTS AND METHOD

A qualitative descriptive study was carried out in two surgical wards in the southern part of Sweden. The study comprised six interviews with registered nurses and was analysed using manifest qualitative content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nurses' perspectives and thoughts regarding dying patients.

RESULTS

The results formed one category (caring-to be involved) and three subcategories (being supportive, being frustrated and being sensitive in the caring processes). Nurses were personally affected and felt unprepared to face dying patients due to a lack of knowledge about the field of palliative care. Their experiences could be described as processes of transition from theory to practice by trial and error.

CONCLUSION

Supervision is a valuable tool for bridging the gap between theory and practice in nursing during the transition from novice to expert. Improved knowledge about palliative care during nursing education and committed nursing leadership at the ward level facilitate preparation for end-of-life situations.

Palliative and Hospice Care: Educational Needs of Inpatient Registered Nurses

Hospice and palliative care aim to improve the quality of life for patients and families impacted by chronic, serious, and life-threatening illnesses. Patients and families benefit from earlier integration of palliative care and seamless transitions to hospice care. Nurses are an integral part of the care team, and their understanding of these services is critical. However, many nurses do not receive formal education in hospice and palliative care. This leads to lack of skills that nurses need to provide and discuss hospice and palliative care across care settings. Nurses in an acute care setting of a large health system were invited to participate in a survey, Attitudes Towards Care at the End-of-Life. The results of this survey revealed that nurses believe that patients and families need to be communicated with honestly regarding their disease, but nurses lack the knowledge of how to facilitate these discussions. Another key finding is that nurses feel less confident with non-pharmacologic interventions to relieve patients’ suffering. Education is urgently needed in these areas.