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Leclerc-Loiselle J, Gendron S, Daneault S. Nursing activities for health promotion in palliative home care: an integrative review. Palliat Care Soc Pract 2024; 18:26323524241235191. [PMID: 38487793 PMCID: PMC10938613 DOI: 10.1177/26323524241235191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.
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Affiliation(s)
- Jérôme Leclerc-Loiselle
- School of Nursing, Université de Sherbrooke, 150, Pl. Charles-Le Moyne, L1-7730, Longueuil, QC J4K 0A8, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - Sylvie Gendron
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Serge Daneault
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
- Research centre of Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
- Integrated University Health and Social Services Centre of Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
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Sørstrøm AK, Ludvigsen MS, Kymre IG. Home care nurses facilitating planned home deaths. A focused ethnography. BMC Palliat Care 2023; 22:175. [PMID: 37940911 PMCID: PMC10634003 DOI: 10.1186/s12904-023-01303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Home care nurses provide complex palliative care for patients who want to die in their own homes. This study aimed to explore home care nurses' facilitation of planned home death to better understand nursing practices. METHODS Data were collected between March 2019 and March 2020 using participant observations and semi-structured interviews. In addition, the number of planned home deaths was recorded. The analysis was guided by Roper and Shapira`s framework on focused ethnography. RESULTS Twenty home care nurses (three men) in eight home care areas in two Norwegian municipalities met the inclusion criteria. Eight home deaths were registered, seven participatory observations were performed, and 20 semi-structured interviews were completed. Home care nurses find facilitating planned home deaths to be rewarding work, to the point of going above and beyond. At the same time, they describe facilitating planned home deaths as demanding work due to organizational stressors such as staff shortages, heavy workloads, and time restraints. While they tend to patients' needs, they also express concern for the wellbeing of the next of kin. They find it challenging to juggle the needs of the patients with the needs of next of kin, as these are not always correlated. CONCLUSION Home care nurses are pushing the boundaries of their practice when facilitating planned home deaths while compensating for a fragile system by going above and beyond for patients and their next of kin. Providing insights into the work of home care nurses providing palliative care in patients' homes can impact recruiting and retaining nurses in the workforce and influence local practices and policies.
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Affiliation(s)
| | - Mette Spliid Ludvigsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine - Randers Regional Hospital, Aarhus University, Aarhus, Denmark
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Ferguson E, Wiseman L, Stratton F, Evans C, Linton J, McLeod L, MacArthur J. Exploring the delivery of end-of-life care by community nurses. Br J Community Nurs 2023; 28:542-548. [PMID: 37930858 DOI: 10.12968/bjcn.2023.28.11.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
AIMS To understand what aspects of care and support were important to bereaved relatives and to explore the experiences of nurses delivering end of life care. METHODS Interviews and focus groups were undertaken with 17 family members, 31 community nurses and 13 community hospital staff. A workshop was held with 6 family members, 13 community nurses and 3 hospital nurses to review findings and make recommendations for improvement. FINDINGS Four themes were identified: relationships and being treated as a whole person; being able to make choices; getting help when and where it is needed; specialist advice and care, especially at the very end of life. CONCLUSION Seeking feedback from relatives was valued both by family members and the staff and has provided an effective model to lead to focussed improvements.
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Affiliation(s)
| | - Leanne Wiseman
- District Nurse, Penicuik Health Centre, Midlothian, Scotland
| | - Fiona Stratton
- Chief Nurse Midlothian Health and Social Care Partnership, Fairfield House, Dalkeith, Scotland
| | - Catherine Evans
- Planning Officer - Older People, Midlothian Health and Social Care Partnership, Fairfield House, Dalkeith, Scotland
| | - Joanna Linton
- Student District Nurse, Bonnyrigg Health Centre, Midlothian, Scotland
| | - Laura McLeod
- Community Staff Nurse, Newbattle Medical Practice, Midlothian, Scotland
| | - Juliet MacArthur
- Chief Nurse Research and Development, NHS Lothian, Waverley Gate, Waterloo Place, Edinburgh, Scotland
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Robinson J, Frey R, Gibbs G, Hayden M, Gott M. The contribution of generalist community nursing to palliative care: a retrospective case note review. Int J Palliat Nurs 2023; 29:75-82. [PMID: 36822619 DOI: 10.12968/ijpn.2023.29.2.75] [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: 02/25/2023]
Abstract
Background: There is a paucity of evidence regarding the contribution of generalist community nursing to palliative care. Aim: The aim of this study was to identity the proportion of patients referred to a generalist community nursing service who meet the criteria for palliative care need and explore key aspects of their management. Methods: A retrospective case note review of people known to a generalist community nursing service was undertaken to identify people with palliative care needs. Results: Of the 1284 people enrolled in the community nursing service, 21.1% (n=271) were identified as having palliative care needs, of which most (82.7%; n=224) had a non-cancer illness. However, palliative care need was largely unrecognised in the referrals to community nursing and there was little evidence of a palliative approach being integrated into nursing care. Conclusions: Nursing has a significant role in the provision of generalist palliative care in the community. However, research is needed to identify the barriers community nurses experience identifying needs and providing palliative care. A focus on education and support in implementing screening tools, which may assist community nurses in recognising needs and delivering palliative in the generalist setting, is urgently needed.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, Faculty of Medical Health Sciences; School of Nursing, University of Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, Faculty of Medical Health Sciences; School of Nursing, University of Auckland, New Zealand
| | - Gillian Gibbs
- Community and Long Term Conditions Directorate, Auckland District Health Board, New Zealand
| | - Meenu Hayden
- Community and Long Term Conditions Directorate, Auckland District Health Board, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical Health Sciences; School of Nursing, University of Auckland, New Zealand
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Robinson J, Goodwin H, Williams L, Anderson N, Parr J, Irwin R, Gott M. A task service and a talking service: A qualitative exploration of bereaved family perceptions of community nursing care at the end of life. Palliat Med 2022; 36:1522-1531. [PMID: 36267044 PMCID: PMC9749007 DOI: 10.1177/02692163221127168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Greater emphasis on community-based care at the end of life is supported by the premise that most people want to be cared for and die at home. As such, it is important to understand the current state of palliative care nursing within an integrated generalist-specialist model of care in the community. AIM To explore bereaved family perceptions and experiences of community nursing at the end of life, with a particular focus on service integration. DESIGN A qualitative study design using semi-structured telephone interviews with bereaved family. A critical realist framework was used to inform the analysis of interview data and thematic analysis of data was used to identify key themes. SETTING/PARTICIPANTS Participants were the family carers of patients who had died within the catchment area of two large District Health Boards in Auckland, New Zealand. RESULTS Twenty-three participants were interviewed. Participants described their experiences of community nursing in terms of the service they provided. Hospice nursing roles were described in terms of a "talking service" and District Nursing as a "task service." There was minimal expectation of the general practice nurse in terms of palliative care support and little evidence of service integration. CONCLUSION Findings from this study support the need for a new integrated model of palliative care nursing which utilizes the unique skill set of nurses working across all community care settings including general practice, hospice and district nursing services. Accommodating different models of nursing care which can be responsive to patient need rather than limited to a defined service delivery model.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Natalie Anderson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Rebekah Irwin
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Chooha U, Chotwattanakulchai N, Sirisome J. Measurement of Midwifery Clinical Leadership Among Nursing Students: Exploratory Factor Analysis. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:1329-1339. [PMID: 36276195 PMCID: PMC9586703 DOI: 10.2147/amep.s375854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of this study was to report the development measurement of midwifery clinical leadership instruments among nursing students. METHODS Specifically, the five-component concepts defined by Katz and Standards Midwifery Practice were used to build items for midwifery clinical leadership instruments. This study also used Netemeyer's "Guidelines in Scale Development" to develop an instrument for midwifery clinical leadership among nursing students. The sample used for the research was 9 experts and 330 nursing students in the fourth year of being selected by multi-stage sampling. The instruments used in the study were an interview guide and a questionnaire. The data were analyzed by content analysis and factor analysis (exploratory factor analysis: EFA). RESULTS Three separate data collections were used for the development of these instruments. The outcome of the content validity assessment was a 60-items questionnaire, Item-Objective Congruence (IOC) 0.94. The results of EFA yielded an instrument with 58 items in four-component. The final value of the Kaiser-Meyer-Olkin (KMO) and Bartlett's Test was 0.956. CONCLUSION The instruments present a good interpretation of the data and were consistent with the personality attributes. The questionnaire was designed to measure with strong loading of measurement.
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Affiliation(s)
- Umasawan Chooha
- Department of Maternal-Newborn Nursing and Midwifery, Faculty of Nursing Rajamangala University of Technology Thanyaburi, Pathum Thani, Thailand
| | - Nadsuda Chotwattanakulchai
- Department of Maternal-Newborn Nursing and Midwifery, Srisavarindhira Thai Red Cross Institute of Nursing, Bangkok, Thailand
| | - Jirawun Sirisome
- Department of Maternal-Newborn Nursing and Midwifery, Faculty of Nursing Rajamangala University of Technology Thanyaburi, Pathum Thani, Thailand
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Leniz J, Gulliford M, Higginson IJ, Bajwah S, Yi D, Gao W, Sleeman KE. Primary care contacts, continuity, identification of palliative care needs, and hospital use: a population-based cohort study in people dying with dementia. Br J Gen Pract 2022; 72:BJGP.2021.0715. [PMID: 35817583 PMCID: PMC9282808 DOI: 10.3399/bjgp.2021.0715] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Reducing hospital admissions among people dying with dementia is a policy priority. AIM To explore associations between primary care contacts, continuity of primary care, identification of palliative care needs, and unplanned hospital admissions among people dying with dementia. DESIGN AND SETTING This was a retrospective cohort study using the Clinical Practice Research Datalink linked with hospital records and Office for National Statistics data. Adults (>18 years) who died between 2009 and 2018 with a diagnosis of dementia were included in the study. METHOD The association between GP contacts, Herfindahl-Hirschman Index continuity of care score, palliative care needs identification before the last 90 days of life, and multiple unplanned hospital admissions in the last 90 days was evaluated using random-effects Poisson regression. RESULTS In total, 33 714 decedents with dementia were identified: 64.1% (n = 21 623) female, mean age 86.6 years (SD 8.1), mean comorbidities 2.2 (SD 1.6). Of these, 1894 (5.6%) had multiple hospital admissions in the last 90 days of life (increase from 4.9%, 95% confidence interval [CI] = 4.2 to 5.6 in 2009 to 7.1%, 95% CI = 5.7 to 8.4 in 2018). Participants with more GP contacts had higher risk of multiple hospital admissions (incidence risk ratio [IRR] 1.08, 95% CI = 1.05 to 1.11). Higher continuity of care scores (IRR 0.79, 95% CI = 0.68 to 0.92) and identification of palliative care needs (IRR 0.66, 95% CI = 0.56 to 0.78) were associated with lower frequency of these admissions. CONCLUSION Multiple hospital admissions among people dying with dementia are increasing. Higher continuity of care and identification of palliative care needs are associated with a lower risk of multiple hospital admissions in this population, and might help prevent these admissions at the end of life.
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Affiliation(s)
- Javiera Leniz
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Martin Gulliford
- Department of Population Health Sciences, Faculty of Life Science & Medicine, King's College London, London
| | - Irene J Higginson
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Sabrina Bajwah
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Deokhee Yi
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Wei Gao
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
| | - Katherine E Sleeman
- NIHR clinician scientist and honorary consultant in palliative medicine, Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London
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Leniz J, Henson LA, Potter J, Gao W, Newsom-Davis T, Ul-Haq Z, Lucas A, Higginson IJ, Sleeman KE. Association of primary and community care services with emergency visits and hospital admissions at the end of life in people with cancer: a retrospective cohort study. BMJ Open 2022; 12:e054281. [PMID: 35197345 PMCID: PMC8867349 DOI: 10.1136/bmjopen-2021-054281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To examine the association between primary and community care use and measures of acute hospital use in people with cancer at the end of life. DESIGN Retrospective cohort study. SETTING We used Discover, a linked administrative and clinical data set from general practices, community and hospital records in North West London (UK). PARTICIPANTS People registered in general practices, with a diagnosis of cancer who died between 2016 and 2019. PRIMARY AND SECONDARY OUTCOME MEASURES ≥3 hospital admissions during the last 90 days, ≥1 admissions in the last 30 days and ≥1 emergency department (ED) visit in the last 2 weeks of life. RESULTS Of 3581 people, 490 (13.7%) had ≥3 admissions in last 90 days, 1640 (45.8%) had ≥1 admission in the last 30 days, 1042 (28.6%) had ≥1 ED visits in the last 2 weeks; 1069 (29.9%) had more than one of these indicators. Contacts with community nurses in the last 3 months (≥13 vs <4) were associated with fewer admissions in the last 30 days (risk ratio (RR) 0.88, 95% CI 0.90 to 0.98) and ED visits in the last 2 weeks of life (RR 0.79, 95% CI 0.68 to 0.92). Contacts with general practitioners in the last 3 months (≥11 vs <4) was associated with higher risk of ≥3 admissions in the last 90 days (RR 1.63, 95% CI 1.33 to 1.99) and ED visits in the last 2 weeks of life (RR 1.27, 95% CI 1.10 to 1.47). CONCLUSIONS Expanding community nursing could reduce acute hospital use at the end of life and improve quality of care.
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Affiliation(s)
- Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Lesley A Henson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Jean Potter
- Department of Palliative Care, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Greater London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Tom Newsom-Davis
- Oncology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Zia Ul-Haq
- Discover-Now, Imperial College Health Partners, London, UK
| | - Amanda Lucas
- Discover-Now, Imperial College Health Partners, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Robinson J, Frey R, Raphael D, Old A, Gott M. Difficulties in navigating the intersection of generalist and specialist palliative care services: A cross-sectional study of bereaved family's experiences of care at home in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:133-141. [PMID: 33894085 DOI: 10.1111/hsc.13381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
A generalist-specialist model of palliative care is well established as a framework for the provision of community care in resource-rich countries. However, evidence is lacking regarding how the model is experienced by family carers and the extent to which access to both generalist and specialist palliative care is equitable. A cross-sectional postal survey was undertaken to explore bereaved family's experiences of generalist palliative care and its intersection with hospice services in the last 3 months of life. A modified version of the Views of Informal Carers-Evaluation of Services survey was sent to 4,778 bereaved family. Data were collected between February 2017 and October 2018. Chi-square was utilised to identify factors that impacted on experiences of generalist palliative care; analysis of free text data comprising 45,823 words was undertaken using a directed content analysis approach. Eight hundred and twenty-six questionnaires were returned (response rate = 21%). Seventy per cent of people (n = 579) spent some time at home in the last 3 months prior to death. People who received support from hospice were more likely to receive support from multiple other services. Those who received no community services were less likely to feel supported by their general practitioner, less likely to spend the last 2 days of life or die at home. Feeling supported had a strong association with services working well together, being involved in decision-making and being aware of the poor prognosis. The provision of palliative care is complicated by a lack of integration with specialist palliative care and may be the basis of continuing inequities in the provision of community care at the end of life. The assumption at a policy level that "generalists" are willing and able to play a key role in palliative care provision needs to be further challenged.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Deborah Raphael
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Andrew Old
- Waitemata District Health Board, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Petrova M, Wong G, Kuhn I, Wellwood I, Barclay S. Timely community palliative and end-of-life care: a realist synthesis. BMJ Support Palliat Care 2021:bmjspcare-2021-003066. [PMID: 34887313 DOI: 10.1136/bmjspcare-2021-003066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/19/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Community-based and home-based palliative and end-of-life care (PEoLC) services, often underpinned by primary care provision, are becoming increasingly popular. One of the key challenges associated with them is their timely initiation. The latter requires an accurate enough prediction of how close to death a patient is. METHODS Using 'realist synthesis' tools, this review sought to develop explanations of how primary care and community PEoLC programmes generate their outcomes, with the explanations presented as context-mechanism-outcome configurations. Medline, Embase, CINAHL, PsycINFO, Web of Science, ASSIA, Sociological Abstracts and SCIE Social Care Online were originally searched. A multistage process of focusing the review was employed, with timely identification of the EoL stage and timely initiation of associated services representing the final review focus. Synthesised sources included 21 full-text documents and 324 coded abstracts, with 253 'core contents' abstracts generating >800 codes. RESULTS Numerous PEoLC policies and programmes are embedded in a framework of Preparation and Planning for Death and Dying, with identification of the dying stage setting in motion key systems and services. This is challenged by: (1) accumulated evidence demonstrating low accuracy of prognostic judgements; (2) many individuals' orientation towards Living and Hope; (3) expanding grey zones between palliative and curative care; (4) the complexity of referral decisions; (5) the loss of pertinent information in hierarchical relationships and (6) the ambiguous value of having 'more time'. CONCLUSION Prioritising temporal criteria in initiating PEoLC services is not sufficiently supported by current evidence and can have significant unintended consequences. PROSPERO REGISTRATION NUMBER CRD42018097218.
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Affiliation(s)
- Mila Petrova
- Palliative & End of Life Care in Cambridge (PELiCAM) Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffied Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Palliative & End of Life Care in Cambridge (PELiCAM) Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Understanding the Potential for Pharmacy Expertise in Palliative Care: The Value of Stakeholder Engagement in a Theoretically Driven Mapping Process for Research. PHARMACY 2021; 9:pharmacy9040192. [PMID: 34941624 PMCID: PMC8704289 DOI: 10.3390/pharmacy9040192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/21/2022] Open
Abstract
Potentially avoidable medication-related harm is an inherent risk in palliative care; medication management accounts for approximately 20% of reported serious incidents in England and Wales. Despite their expertise benefiting patient care, the routine contribution of pharmacists in addressing medication management failures is overlooked. Internationally, specialist pharmacist support for palliative care services remains under-resourced. By understanding experienced practices (‘what happens in the real world’) in palliative care medication management, compared with intended processes (‘what happens on paper’), patient safety issues can be identified and addressed. This commentary demonstrates the value of stakeholder engagement and consultation work carried out to inform a scoping review and empirical study. Our overall goal is to improve medication safety in palliative care. Informal conversations were undertaken with carers and various specialist and non-specialist professionals, including pharmacists. Themes were mapped to five steps: decision-making, prescribing, monitoring and supply, use (administration), and stopping and disposal. A visual representation of stakeholders’ understanding of intended medicines processes was produced. This work has implications for our own and others’ research by highlighting where pharmacy expertise could have a significant additional impact. Evidence is needed to support best practice and implementation, particularly with regard to supporting carers in monitoring and accessing medication, and communication between health professionals across settings.
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Mitchell S, Oliver P, Gardiner C, Chapman H, Khan D, Boyd K, Dale J, Barclay S, R Mayland C. Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey. BJGP Open 2021; 5:BJGPO.2021.0095. [PMID: 34117014 PMCID: PMC8450890 DOI: 10.3399/bjgpo.2021.0095] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. AIM To understand the views of GPs and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. DESIGN & SETTING A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks, during September and October 2020. METHOD Responses were analysed using descriptive statistics and an inductive thematic analysis. RESULTS Valid responses were received from 559 individuals (387 community nurses, 156 GPs, and 16 unspecified roles), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. CONCLUSION Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.
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Affiliation(s)
- Sarah Mitchell
- Yorkshire Cancer Research Senior Research Fellow, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Phillip Oliver
- Clinical Lecturer, Academic Unit of Medical Education, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Senior Research Fellow, Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Helen Chapman
- Queen's Nurse and Head of Integrated Community Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dena Khan
- Patient and Public Involvement Representative, University of Warwick, Warwick, UK
| | - Kirsty Boyd
- Reader in Palliative Care, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jeremy Dale
- Professor of Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Barclay
- Senior Lecturer in General Practice and Palliative Care, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Catriona R Mayland
- Yorkshire Cancer Research Senior Research Fellow, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Community end-of-life care during the COVID-19 pandemic: findings of a UK primary care survey. BJGP Open 2021. [PMID: 34117014 DOI: 10.3399/bjgpo.2021.0095.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022] Open
Abstract
BACKGROUND Thousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning. AIM To understand the views of GPs and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic. DESIGN & SETTING A web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks, during September and October 2020. METHOD Responses were analysed using descriptive statistics and an inductive thematic analysis. RESULTS Valid responses were received from 559 individuals (387 community nurses, 156 GPs, and 16 unspecified roles), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress. CONCLUSION Primary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.
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Brant JM, Fink RM, Thompson C, Li YH, Rassouli M, Majima T, Osuka T, Gafer N, Ayden A, Khader K, Lascar E, Tang L, Nestoros S, Abdullah M, Michael N, Cerruti J, Ngaho E, Kadig Y, Hablas M, Istambouli R, Muckaden MA, Ali MN, Aligolshvili B, Obeidat R, Kunirova G, Al-Omari M, Qadire M, Omran S, Mouhawej MC, Zouak M, Ghrayeb I, Manasrah N, Youssef A, Ortega PF, Tuncel Oguz G, Cajucona LA, Leaphart K, Day A, Silbermann M. Global Survey of the Roles, Satisfaction, and Barriers of Home Health Care Nurses on the Provision of Palliative Care. J Palliat Med 2020; 22:945-960. [PMID: 31380727 DOI: 10.1089/jpm.2018.0566] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: To globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: Needs assessment survey. Setting/Subjects: Five hundred thirty-two home health care nurses in 29 countries. Measurements: A needs assessment, developed through literature review and cognitive interviewing. Results: Nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: It is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity.
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Affiliation(s)
- Jeannine M Brant
- 1Collaborative Science and Innovation, Billings Clinic, Montana State University College of Nursing, Billings, Montana
| | - Regina M Fink
- 2College of Nursing and School of Medicine, University of Colorado, Aurora, Colorado
| | - Cara Thompson
- 3Palliative Care, University of Colorado Health, Aurora, Colorado
| | - Ya Huei Li
- 4Collaborative Science and Innovation, Billings Clinic, Billings, Montana
| | - Maryam Rassouli
- 5Shahid Beheshti, University of Medical Sciences Cancer Research Center, Teheran, Iran
| | - Tomoko Majima
- 6Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Tomoko Osuka
- 6Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Nahla Gafer
- 7Radiation and Isotope Center, Khartoum, Sudan
| | - Ayfer Ayden
- 8Koç University School of Nursing, Istanbul, Turkey
| | - Khaled Khader
- 9Taif University Faculty of Nursing, Taif, Saudi Arabia
| | - Eulalia Lascar
- 10Hospital de Niños "Dr. Ricardo Gutierrez," Buenos Aires, Argentina
| | - Lili Tang
- 11Department of Psychology, Peking University Cancer Hospital, Beijing, China
| | | | - Maihan Abdullah
- 13Health Promotion Department, Ministry of Public Health, Kabul, Afghanistan
| | - Natasha Michael
- 14Sydney School of Medicine, University of Notre Dame, Sydney, Australia
| | - Julie Cerruti
- 15Coordenadora Pesquisas Onco Pediátricas, Porto Alegre, Brazil
| | - Eric Ngaho
- 16Baptist Hospital Mutengene, Tiko, Cameroon
| | - Yolanda Kadig
- 17The Cyprus Association of Cancer Patients and Friends, Limassol, Cyprus
| | | | - Rana Istambouli
- 19Department of Palliative Care, Ain Wazein Medical Village University Hospital, Ain Wazein, Lebanon.,20Palliative Medicine, Paris, France
| | | | - Mushtaq Najm Ali
- 22Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | | | - Rana Obeidat
- 24Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | | | - Ma'an Al-Omari
- 26Department of Oncology, King Abdullah University Hospital, Irbid, Jordan
| | | | - Suha Omran
- 28Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Nemeh Manasrah
- 32Faculty of Nursing, Hebron University, West Bank, Palestine
| | - Alexey Youssef
- 33Faculty of Medicine, Tishrin University, Latakia, Syria
| | - Paz F Ortega
- 34Catalan Institute of Oncology, Barcelona, Spain
| | - Gonca Tuncel Oguz
- 35Dr. Abdurrahman Yurtaslan Ankara Oncology Education & Research Hospital, Ankara, Turkey
| | | | - Kassie Leaphart
- 37St. Vincent Healthcare, Montana State University College of Nursing, Billings, Montana
| | - Alexa Day
- 38Billings Clinic, Montana State University College of Nursing, Billings, Montana
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15
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Mitchell S, Maynard V, Lyons V, Jones N, Gardiner C. The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic. Palliat Med 2020; 34:1182-1192. [PMID: 32736494 PMCID: PMC7528540 DOI: 10.1177/0269216320947623] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The increased number of deaths in the community happening as a result of COVID-19 has caused primary healthcare services to change their traditional service delivery in a short timeframe. Services are quickly adapting to new challenges in the practical delivery of end-of-life care to patients in the community including through virtual consultations and in the provision of timely symptom control. AIM To synthesise existing evidence related to the delivery of palliative and end-of-life care by primary healthcare professionals in epidemics and pandemics. DESIGN Rapid systematic review using modified systematic review methods, with narrative synthesis of the evidence. DATA SOURCES Searches were carried out in Medline, Embase, PsychINFO, CINAHL and Web of Science on 7th March 2020. RESULTS Only five studies met the inclusion criteria, highlighting a striking lack of evidence base for the response of primary healthcare services in palliative care during epidemics and pandemics. All were observational studies. Findings were synthesised using a pandemic response framework according to 'systems' (community providers feeling disadvantaged in terms of receiving timely information and protocols), 'space' (recognised need for more care in the community), 'staff' (training needs and resilience) and 'stuff' (other aspects of managing care in pandemics including personal protective equipment, cleaning care settings and access to investigations). CONCLUSIONS As the COVID-19 pandemic progresses, there is an urgent need for research to provide increased understanding of the role of primary care and community nursing services in palliative care, alongside hospices and community specialist palliative care providers.
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Affiliation(s)
- Sarah Mitchell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | | | - Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Clare Gardiner
- Division of Nursing and Midwifery, Health Sciences School, Sheffield, UK
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16
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Walshe C. Aims, actions and advance care planning by district nurses providing palliative care: an ethnographic observational study. Br J Community Nurs 2020; 25:276-286. [PMID: 32496856 DOI: 10.12968/bjcn.2020.25.6.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
District nurses are core providers of palliative care, yet little is known about the way that they provide care to people at home. This study aimed to investigate the role and practice of the district nurse in palliative care provision. This was an ethnographic study, with non-participant observation of district nurse-palliative care patient encounters, and post-observation interviews. District nurse teams from three geographical areas in northwest England participated. Data were analysed iteratively, facilitated by the use of NVivo, using techniques of constant comparison. Some 17 encounters were observed, with 23 post-observation interviews (11 with district nurses, 12 with patients/carers). Core themes were 'planning for the future' and 'caring in the moment'. District nurses described how they provided and planned future care, but observations showed that this care focused on physical symptom management. District nurses engaged in friendly relationship building, which allows detailed management of symptomatology, but with little evidence of advance care planning.
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Affiliation(s)
- Catherine Walshe
- Professor of Palliative Care, International Observatory on End of Life Care, Lancaster University, Bailrigg, Lancaster
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17
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Sukcharoen P, Sakunpong N, Sripa K. Spiritual dimension in palliative care from the perspective of Thai palliative caregivers. Int J Palliat Nurs 2020; 26:70-74. [DOI: 10.12968/ijpn.2020.26.2.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: In Thailand, most terminally ill patients die in hospital and are looked after by health professionals. Terminally ill patients tend to receive physical care only, while in the main, spiritual care is neglected. This study aimed to explore spirituality in palliative care health professionals and spiritual leaders in the Thai Buddhist context. Method: In this qualitative case study, seven experienced palliative caregivers took part in in-depth interviews. Thematic analysis and a trustworthiness process were used to analyse the data. Findings: Three themes emerged: (1) the ability for self-awareness and faith; (2) acceptance and compassion for others; and (3) spiritual behaviour while nursing. Conclusion: The results revealed the meaning of spirituality and the necessary characteristics for spirituality in palliative care for the participants, which could serve as a basis for further development.
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Affiliation(s)
- Pilaiporn Sukcharoen
- Doctoral student, Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Nanchatsan Sakunpong
- Lecturer, Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Kantita Sripa
- Assistant Professor, Faculty of Social Sciences, Royal Police Cadet Academy, Bangkok, Thailand
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18
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Nasu K, Konno R, Fukahori H. End-of-life nursing care practice in long-term care settings for older adults: A qualitative systematic review. Int J Nurs Pract 2019; 26:e12771. [PMID: 31364244 DOI: 10.1111/ijn.12771] [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: 07/23/2018] [Revised: 02/03/2019] [Accepted: 06/15/2019] [Indexed: 12/19/2022]
Abstract
AIM To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults. BACKGROUND Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically. DESIGN Qualitative systematic review. DATA SOURCES Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. METHODS The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation. RESULTS Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. CONCLUSION Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.
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Affiliation(s)
- Katsumi Nasu
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rie Konno
- School of Nursing, Hyogo University of Health Sciences, Hyogo, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
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19
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Mertens F, De Gendt A, Deveugele M, Van Hecke A, Pype P. Interprofessional collaboration within fluid teams: Community nurses' experiences with palliative home care. J Clin Nurs 2019; 28:3680-3690. [PMID: 31216390 DOI: 10.1111/jocn.14969] [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: 10/30/2018] [Revised: 04/13/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore how community nurses experience the collaboration with general practitioners and specialist palliative home care team nurses in palliative home care and the perceived factors influencing this collaboration. BACKGROUND The complexity of, and the demand for, palliative home care is increasing. Primary palliative care is provided by community nurses and general practitioners, often in collaboration with palliative home care team nurses. Although these professionals may each individually be part of a fixed team, a new temporary team is often composed for every new palliative patient. These membership changes, referred to as team membership fluidity, challenge professionals to work effectively. DESIGN AND METHODS A qualitative research design, using semi-structured interviews with community nurses. Participant selection happened through regional palliative care networks in Belgium. The network's palliative home care team nurses selected community nurses with whom they recently collaborated. Twenty interviews were conducted. A constant comparative analysis approach was used. Consolidated criteria for reporting qualitative research guidelines were followed. RESULTS Formal interprofessional team meetings were not common practice. The other's approachability and knowing each other positively influenced the collaboration. Time constraints, the general practitioners' lack of expertise, communication style, hierarchy perception and income dependency negatively influenced the collaboration with general practitioners and determined palliative home care team nurses' involvement. The coping strategies of community nurses balanced between a behaviour focused to the patient and to the professional relationship. Specialist palliative home care team nurses were relied upon for their expertise but also to mediate when community nurses disagreed with general practitioners. CONCLUSION Community nurses showed to be highly adaptable within the fluid team. Strikingly, dynamics described in the doctor-nurse game 50 years ago are still present today and affect the interprofessional communication. Interprofessional education interventions can contribute to improved interprofessional collaboration. RELEVANCE TO CLINICAL PRACTICE The study findings uncovered critical knowledge gaps in interprofessional collaboration in palliative home care. Insights are relevant for and related to professional well-being and workplace learning.
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Affiliation(s)
- Fien Mertens
- Department of Public Health and Primary Care, Ghent University, Belgium.,End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Anneleen De Gendt
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Myriam Deveugele
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Belgium.,End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
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20
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Ward-Griffin C, McWilliam C, Oudshoorn A. Negotiating Relational Practice Patterns in Palliative Home Care. J Palliat Care 2018. [DOI: 10.1177/082585971202800206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Providing palliative care in the home presents a variety of challenges for nurses and other care providers. As part of a focused ethnographic study examining client/caregiver/care-provider relationships within the socio-cultural context of home-based palliative care, this paper describes the provision of palliative care to Canadian seniors with advanced cancer from the perspective of nurses. Data were collected through in-depth interviews (n=19) with three palliative care nurses and participant observations in four households over a six-to-eight-month period. Home-based palliative care nursing was depicted in this study as a dialectical experience, revealing three relational practice patterns: making time-forfeiting time, connecting-withdrawing, and enabling-disabling. Nurses attempted to negotiate the tensions between these opposing approaches to palliative care. Study findings suggest that the socio-cultural context of palliative care is not conducive to high-quality palliative care and provide several insights related to future directions for practice, policy, and research.
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Affiliation(s)
- Catherine Ward-Griffin
- C Ward-Griffin (corresponding author): Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada N6A 5C1
| | - Carol McWilliam
- C McWilliam, A Oudshoorn: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Abram Oudshoorn
- C McWilliam, A Oudshoorn: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
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21
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Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Prim Health Care Res Dev 2018; 20:e6. [PMID: 30068402 PMCID: PMC6476399 DOI: 10.1017/s1463423618000488] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim To appraise and synthesize empirical literature on implementation of evidence within community nursing. To explore the use of implementation theory and identify the strategies required for, and the barriers and facilitators to, successful implementation within this context. Background There is an international consensus that evidence-based practice can improve outcomes for people using health and social care services. However, these practices are not always translated into care delivery. Community nursing is a relatively understudied area; little is known about how innovations in practice are implemented within this setting. Methods Systematic mixed-studies review, synthesizing quantitative and qualitative research. The electronic databases AMED, PsycINFO, Ovid Medline, CINAHL Plus, ASSIA, British Nursing Index and EMBASE were used. Two grey literature databases were also searched: OpenGrey and EThOS. English language, peer-reviewed papers published between January 2010 and July 2017 were considered. Criteria included implementation of an innovation and change to practice within adult community nursing. An approach called Critical Interpretive Synthesis was used to integrate the evidence from across the studies into a comprehensible theoretical framework. Results In total, 22 papers were reviewed. Few studies discussed the use of theory when planning, guiding and evaluating the implementation of the innovation (n=6). A number of implementation strategies, facilitators and barriers were identified across the included studies, highlighting the interplay of both service context and individual factors in successful implementation. Conclusion Implementation is an expanding area of research; yet is challenged by a lack of consistency in terminology and limited use of theory. Implementation within community nursing is a complex process, requiring both individual and organizational adoption, and managerial support. Successful adoption of evidence-based practice however, is only possible if community nurses themselves deem it useful and there is evidence that it could have a positive impact on the patient and/or their primary carer.
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22
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Mertens F, de Groot E, Meijer L, Wens J, Gemma Cherry M, Deveugele M, Damoiseaux R, Stes A, Pype P. Workplace learning through collaboration in primary healthcare: A BEME realist review of what works, for whom and in what circumstances: BEME Guide No. 46. MEDICAL TEACHER 2018; 40:117-134. [PMID: 29094626 DOI: 10.1080/0142159x.2017.1390216] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Changes in healthcare practice toward more proactive clinical, organizational and interprofessional working require primary healthcare professionals to learn continuously from each other through collaboration. This systematic review uses realist methodology to consolidate knowledge on the characteristics of workplace learning (WPL) through collaboration by primary healthcare professionals. METHODS Following several scoping searches, five electronic bibliographic databases were searched from January 1990 to December 2015 for relevant gray and published literature written in English, French, German and Dutch. Reviewers worked in pairs to identify relevant articles. A set of statements, based on the findings of our scoping searches, was used as a coding tree to analyze the papers. Interpretation of the results was done in alternating pairs, discussed within the author group and triangulated with stakeholders' views. RESULTS Out of 6930 references, we included 42 publications that elucidated who, when, how and what primary healthcare professionals learn through collaboration. Papers were both qualitative and quantitative in design, and focused largely on WPL of collaborating general practitioners and nurses. No striking differences between different professionals within primary healthcare were noted. Professionals were often unaware of the learning that occurs through collaboration. WPL happened predominantly through informal discussions about patient cases and modeling for other professionals. Any professionals could both learn and facilitate others' learning. Outcomes were diverse, but contextualized knowledge seemed to be important. DISCUSSION/CONCLUSIONS Primary care professionals' WPL is multifaceted. Existing social constructivist and social cognitivist learning theories form a framework from which to interpret these findings. Primary care policy makers and managers should ensure that professionals have access to protected time, earmarked for learning. Time is required for reflection, to learn new ways of interaction and to develop new habits within clinical practice.
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Affiliation(s)
- Fien Mertens
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| | - Esther de Groot
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Loes Meijer
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Johan Wens
- c Department of Primary and Interdisciplinary Care Antwerp , University of Antwerp , Antwerp , Belgium
| | - Mary Gemma Cherry
- d Psychology of Healthcare Research Group, Department of Psychological Sciences , Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK
| | - Myriam Deveugele
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
| | - Roger Damoiseaux
- b The Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Ann Stes
- e Antwerp School of Education, Centre for Excellence in Higher Education , University of Antwerp , Antwerp , Belgium
| | - Peter Pype
- a Department of Family Medicine and Primary Health Care , Ghent University , Gent , Belgium
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23
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Sekse RJT, Hunskår I, Ellingsen S. The nurse's role in palliative care: A qualitative meta-synthesis. J Clin Nurs 2017; 27:e21-e38. [DOI: 10.1111/jocn.13912] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ragnhild Johanne Tveit Sekse
- VID Specialized University; Faculty of Health Studies; Bergen Norway
- Department of Obstetrics and Gynaecology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Science; University of Bergen; Bergen Norway
| | - Irene Hunskår
- VID Specialized University; Faculty of Health Studies; Bergen Norway
| | - Sidsel Ellingsen
- VID Specialized University; Faculty of Health Studies; Bergen Norway
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24
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Lessons for Responsible Innovation in the Business Context: A Systematic Literature Review of Responsible, Social and Sustainable Innovation Practices. SUSTAINABILITY 2017. [DOI: 10.3390/su9050721] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Grimshaw P, McGowan L, McNichol E. An extra care community's perceived priorities for 'whole system' relationships: a Q-methodological study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1169-1180. [PMID: 28052482 DOI: 10.1111/hsc.12417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 06/06/2023]
Abstract
Health and social care settings worldwide need to sustainably improve the quality of relationships across communities or 'whole systems'. This research informs the development of a relational framework based on stakeholder perspectives. It is grounded in an action research project with practitioners, and draws on a previous literature review, to present the underpinning elements of quality relationships as statements, organised under the headings of integrity, respect, fairness, compassion and trust. Using Q methodology, 27 participants, comprising a range of stakeholders (staff, residents, family and service providers), rank-ordered 48 statements based on perceptions of the importance of differing aspects of relationships. By-person factor analysis was used to create five factors or viewpoints by comparing and contrasting using the composite rankings alongside interview data collected for each participant. The first view 'Altogether now' prioritises compassionate engagement. Second, 'Respect is a two-way street' emphasises the need for reciprocal respect and recognition of history. The factor labelled 'Free spirits' posits the dominant view of freedom. The fourth view 'Families … strengths and challenges' focuses on the necessary and complex involvement of families and finally, 'Helping hands' emphasises the role of relationships in increasing previously low expectations of social integration for previously isolated residents. The different views that exist on the composition of quality relationships can be used to help extra care communities to understand and utilise relationships as a powerful and effective resource.
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Affiliation(s)
- Paul Grimshaw
- School of Healthcare, University of Leeds, Leeds, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds, Leeds, UK
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26
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McIlfatrick S, Connolly M, Collins R, Murphy T, Johnston B, Larkin P. Evaluating a dignity care intervention for palliative care in the community setting: community nurses’ perspectives. J Clin Nurs 2017; 26:4300-4312. [DOI: 10.1111/jocn.13757] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sonja McIlfatrick
- Institute of Nursing and Health Research; Ulster University; Newtownabbey UK
- All Ireland Institute of Hospice and Palliative Care; Dublin Ireland
| | - Michael Connolly
- School of Nursing, Midwifery & Health Sciences Centre; University College Dublin; Dublin Ireland
| | - Rita Collins
- All Ireland Institute of Hospice and Palliative Care; c/o Our Lady's Hospice & Care Services; Dublin Ireland
| | - Tara Murphy
- All Ireland Institute of Hospice and Palliative Care; c/o Our Lady's Hospice & Care Services; Dublin Ireland
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing; University of Glasgow; Glasgow UK
| | - Philip Larkin
- School of Nursing, Midwifery & Health Sciences Centre; University College Dublin; Dublin Ireland
- Education and Research; Our Lady's Hospice & Care Services; Dublin Ireland
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Johnston B, Papadopoulou C, Östlund U, Hunter K, Andrew J, Buchanan D. What’s Dignity Got To Do With It? Patient Experience of the Dignity Care Intervention. SAGE Open Nurs 2017. [DOI: 10.1177/2377960817699839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bridget Johnston
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow and NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | | | - Ulrika Östlund
- Department of Health and Caring Sciences, Linnaeus University, Sweden
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Fujita J, Fukui S, Ikezaki S, Otoguro C, Tsujimura M. Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care. Geriatr Gerontol Int 2017; 17:1943-1950. [DOI: 10.1111/ggi.12998] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 11/12/2016] [Accepted: 12/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Junko Fujita
- Department of Community Health Nursing; Japanese Red Cross College of Nursing; Tokyo Japan
| | - Sakiko Fukui
- Department of Community Health Nursing; Japanese Red Cross College of Nursing; Tokyo Japan
| | - Sumie Ikezaki
- Health Administration in Nursing; Chiba University; Chiba Japan
| | - Chizuru Otoguro
- Department of Community Health Nursing; Japanese Red Cross College of Nursing; Tokyo Japan
| | - Mayuko Tsujimura
- Department of Visiting Nursing, Graduate School of Nursing; Chiba University; Chiba Japan
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Zhang XY, Zhang PY. Hospital information technology in home care. Exp Ther Med 2016; 12:2408-2410. [PMID: 27698741 PMCID: PMC5038446 DOI: 10.3892/etm.2016.3664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/26/2016] [Indexed: 11/11/2022] Open
Abstract
The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.
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Affiliation(s)
- Xiao-Ying Zhang
- Nanjing University of Chinese Medicine, Information Institute, Nanjing, Jiangsu 210029, P.R. China
| | - Pei-Ying Zhang
- Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, Jiangsu 221009, P.R. China
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Cook J, Horrocks S. Community nursing quality indicators for end-of-life care in England: identification, preparation, and coordination. Br J Community Nurs 2016; 21:118-23. [PMID: 26940613 DOI: 10.12968/bjcn.2016.21.3.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jane Cook
- Clinical Community Nurse Advisor (QuICN Project), at University of the West of England, Bristol, England
| | - Susan Horrocks
- Senior Lecturer, at University of the West of England, Bristol, England
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Karasouli E, Munday D, Bailey C, Staniszewska S, Hewison A, Griffiths F. Qualitative critical incident study of patients' experiences leading to emergency hospital admission with advanced respiratory illness. BMJ Open 2016; 6:e009030. [PMID: 26916687 PMCID: PMC4769410 DOI: 10.1136/bmjopen-2015-009030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences, particularly in relation to the decision-making process prior to emergency admission. We sought to explore patient and carer experiences and those of their healthcare professionals in the period leading up to emergency admission to hospital. SETTING 3 UK hospitals located in different urban and rural settings. DESIGN Qualitative critical incident study. PARTICIPANTS 24 patients with advanced lung cancer and 15 with advanced COPD admitted to hospital as emergencies, 20 of their carers and 50 of the health professionals involved in the patients' care. RESULTS The analysis of patient, carer and professionals' interviews revealed a detailed picture of the complex processes involved leading to emergency admission to hospital. 3 phases were apparent in this period: self-management of deteriorating symptoms, negotiated decision-making and letting go. These were dynamic processes, characterised by an often rapidly changing clinical condition, uncertainty and anxiety. Patients considered their options drawing on experience, current and earlier advice. Patients tried to avoid admission, reluctantly accepting it, albeit often with a sense of relief, as anxiety increased with worsening symptoms. CONCLUSIONS Patients with advanced respiratory illness, and their carers, try to avoid emergency admission, and use logical and complex decision-making before reluctantly accepting it. Clinicians and policy-makers need to understand this complex process when considering how to reduce emergency hospital admissions rather than focusing on identifying and labelling admissions as 'inappropriate'.
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Affiliation(s)
- Eleni Karasouli
- Warwick Manufacturing Group (WMG), University of Warwick, Coventry, UK
| | - Daniel Munday
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Cara Bailey
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Sophie Staniszewska
- Division of Health Sciences, Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alistair Hewison
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Johnson A. Role of district and community nurses in bereavement care: a qualitative study. Br J Community Nurs 2016; 20:494-501. [PMID: 26418402 DOI: 10.12968/bjcn.2015.20.10.494] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The district nurse is one of the main providers of palliative care, which includes bereavement care. However, previous evidence shows a lack of education and training, as well as time management, as important factors in the delivery of bereavement care. AIM This qualitative study aimed to explore the provision of bereavement care from a district nurse's perspective. METHOD Data were collected from five participants using semi-structured interviews, and thematically analysed to produce the findings. The interviews were conducted within the author's and participants' working environments to maintain a professional stance between both parties. FINDINGS The results suggest an awareness of bereavement care, but a lack of training and education into the theoretical aspects of the care. Knowing the types and stages of bereavement would be beneficial, both in the delivery and the identification of the most effective time to refer on. CONCLUSION Bereavement care was understood to be part of the district nurse role, but the findings suggest that some nurses get too involved and no end date could be standardised, as each case is dependent on need. More experience of bereavement care and exposure increased awareness to its importance and improved confidence toward its delivery.
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Affiliation(s)
- Anna Johnson
- Adult Nurse Lecturer, Department of Clinical Health Care, Faculty of Health and Life Sciences, Oxford Brookes University
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Azami-Aghdash S, Ghojazadeh M, Aghaei MH, Naghavi-Behzad M, Asgarlo Z. Perspective of patients, patients' families, and healthcare providers towards designing and delivering hospice care services in a middle income Country. Indian J Palliat Care 2015; 21:341-8. [PMID: 26600704 PMCID: PMC4617043 DOI: 10.4103/0973-1075.164898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: In view of the recent surge in chronic disease rates and elderly population in the developing countries, there is an urgent felt need for palliative and hospice care services. The present study investigates the views and attitudes of patients and their families, physicians, nurses, healthcare administrators, and insurers regarding designing and delivering hospice care service in a middle income country. Materials and Methods: In this qualitative study, the required data was collected using semi structured interviews and was analyzed using thematic analysis. Totally 65 participants from hospitals and Tabriz University of Medical Sciences were selected purposively to achieve data saturation. Results: Analyzing the data, five main themes (barriers, facilitators, strategies, attitudes, and service provider) were extracted. Barriers included financial issues, cultural-religious beliefs, patient and family-related obstacles, and barriers related to healthcare system. Facilitators included family-related issues, cultural-religious beliefs, as well as facilitators associated with patients, healthcare status, and benefits of hospice service. Most participants (79%) had positive attitude towards hospice care service. Participant suggested 10 ways to design and deliver effective and efficient hospice care service. They thought the presence of physicians, nurses, and psychologists and other specialists and clergy were necessary in the hospice care team. Conclusion: Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system.
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Affiliation(s)
- Saber Azami-Aghdash
- Department of Health Services Management, Health Management and Economics Research Center, University of Medical Sciences, Tehran, Iran
| | - Morteza Ghojazadeh
- Department of Physiology, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mir Hossein Aghaei
- Department of Medical-Surgical Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naghavi-Behzad
- Department of Cardiology, Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zoleikha Asgarlo
- Department of Midwifery, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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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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Devik SA, Hellzen O, Enmarker I. "Picking up the pieces" - Meanings of receiving home nursing care when being old and living with advanced cancer in a rural area. Int J Qual Stud Health Well-being 2015; 10:28382. [PMID: 26362533 PMCID: PMC4567585 DOI: 10.3402/qhw.v10.28382] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/22/2022] Open
Abstract
Rural home nursing care is a neglected area in the research of palliative care offered to older cancer patients. Because access to specialized services is hampered by long distances and fragmented infrastructure, palliative care is often provided through standard home nursing services and delivered by general district nurses. This study aimed to illuminate the lived experience and to interpret the meaning of receiving home nursing care when being old and living with advanced cancer in a rural area in Norway. Narrative interviews were conducted with nine older persons, and a phenomenological hermeneutic approach was used to interpret the meaning of the lived experience. The analysis revealed three themes, each with subthemes: being content with what one gets, falling into place, and losing one's place. The phrase picking up the pieces was found useful to sum up the meaning of this lived experience. The three respective themes refer to how the pieces symbolize the remaining parts of life or available services in their environment, and how the older persons may see themselves as pieces or bricks in a puzzle. A strong place attachment (physical insideness, social insideness, and autobiographical insideness) is demonstrated by the informants in this study and suggests that the rural context may provide an advantageous healthcare environment. Its potential to be a source of comfort, security, and identity concurs with cancer patients' strong desire for being seen as unique persons. The study shows that district nurses play an essential role in the provision of palliative care for older rural patients. However, the therapeutic value of being in one's familiar landscape seems to depend on how homecare nurses manage to locate it and use it in a more or less person-centred manner. Communication skills and attentiveness to psychosocial aspects of patient care stand out as important attributes for nursing in this context.
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Affiliation(s)
- Siri Andreassen Devik
- Centre of Care Research, Mid-Norway, Steinkjer, Norway
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden;
| | - Ove Hellzen
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden
| | - Ingela Enmarker
- Centre of Care Research, Mid-Norway, Steinkjer, Norway
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden
- Department of Health Sciences, Nord-Trøndelag University College, Stjørdal, Norway
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Nagington M, Walshe C, Luker KA. Quality care as ethical care: a poststructural analysis of palliative and supportive district nursing care. Nurs Inq 2015; 23:12-23. [PMID: 26189362 PMCID: PMC5034813 DOI: 10.1111/nin.12109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2015] [Indexed: 11/29/2022]
Abstract
Quality of care is a prominent discourse in modern health‐care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse–patient–carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi‐structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health‐care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved.
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Abstract
This article explores bereavement support as one of the roles of the district nurse (DN) and community nurse (CN). Bereavement support is considered part of palliative care, which is a major role for all nurses. There is, however, a constant move to increase acute care in the home, questionably placing greater demand on DNs/CNs and primary care provision. Discussion in this article is framed around research into bereavement care in the community, existing guidelines, and policy drivers stressing its importance. Bereavement can result in depression, stress-related disorders, and high mortality; it is therefore imperative to understand the complexities, theoretical aspects, and implications of poor service provision. Palliative care is one of the primary roles of a DN, and it largely involves emotional support. It has been shown that DNs lack confidence and the skills to provide bereavement support to families and carers of palliative care patients. Education, training, and time management are the main determinants of effective bereavement support. The need is to develop a standard collaborative approach to bereavement support and incorporate it into the palliative care role of DNs.
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Affiliation(s)
- Anna Johnson
- Adult Nurse Lecturer, Department of Clinical Health Care, Faculty of Health and Life Sciences, Oxford Brookes University
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Oishi A, Murtagh FEM. The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals. Palliat Med 2014; 28:1081-98. [PMID: 24821710 PMCID: PMC4232314 DOI: 10.1177/0269216314531999] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary care has the potential to play significant roles in providing effective palliative care for non-cancer patients. AIM To identify, critically appraise and synthesise the existing evidence on views on the provision of palliative care for non-cancer patients by primary care providers and reveal any gaps in the evidence. DESIGN Standard systematic review and narrative synthesis. DATA SOURCES MEDLINE, Embase, CINAHL, PsycINFO, Applied Social Science Abstract and the Cochrane library were searched in 2012. Reference searching, hand searching, expert consultations and grey literature searches complemented these. Papers with the views of patients/carers or professionals on primary palliative care provision to non-cancer patients in the community were included. The amended Hawker's criteria were used for quality assessment of included studies. RESULTS A total of 30 studies were included and represent the views of 719 patients, 605 carers and over 400 professionals. In all, 27 studies are from the United Kingdom. Patients and carers expect primary care physicians to provide compassionate care, have appropriate knowledge and play central roles in providing care. The roles of professionals are unclear to patients, carers and professionals themselves. Uncertainty of illness trajectory and lack of collaboration between health-care professionals were identified as barriers to effective care. CONCLUSIONS Effective interprofessional work to deal with uncertainty and maintain coordinated care is needed for better palliative care provision to non-cancer patients in the community. Research into and development of a best model for effective interdisciplinary work are needed.
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Affiliation(s)
- Ai Oishi
- Cicely Saunders Institute, King's College London, London, UK
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Jackson LA, Buxton JA, Dingwell J, Dykeman M, Gahagan J, Gallant K, Karabanow J, Kirkland S, LeVangie D, Sketris I, Gossop M, Davison C. Improving psychosocial health and employment outcomes for individuals receiving methadone treatment: a realist synthesis of what makes interventions work. BMC Psychol 2014; 2:26. [PMID: 25566385 PMCID: PMC4269989 DOI: 10.1186/s40359-014-0026-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For over 50 years, methadone has been prescribed to opioid-dependent individuals as a pharmacological approach for alleviating the symptoms of opioid withdrawal. However, individuals prescribed methadone sometimes require additional interventions (e.g., counseling) to further improve their health. This study undertook a realist synthesis of evaluations of interventions aimed at improving the psychosocial and employment outcomes of individuals on methadone treatment, to determine what interventions work (or not) and why. METHODS The realist synthesis method was utilized because it uncovers the processes (or mechanisms) that lead to particular outcomes, and the contexts within which this occurs. A comprehensive search process resulted in 31 articles for review. Data were extracted from the articles, and placed in four templates to assist with analysis. Data analysis was an iterative process and involved comparing and contrasting data within and across each template, and cross checking with original articles to determine key patterns in the data. RESULTS For individuals on methadone, engagement with an intervention appears to be important for improved psychosocial and/or employment outcomes. The engagement process involves attendance at interventions as well as an investment in what is offered. Three intervention contexts (often in some combination) support the engagement process: a) client-centered contexts (or those where clients' psychosocial and/or employment needs/issues/skills are recognized and/or addressed); b) contexts which address clients' socio-economic conditions and needs; and, c) contexts where there are positive client-counselor and/or peer relationships. There is some evidence that sometimes ongoing engagement is necessary to maintain positive outcomes. There is also some evidence that complete abstinence from drugs (e.g., cocaine, heroin) is not necessary for engagement. CONCLUSIONS It is important to consider how the contexts of interventions might elicit and/or support clients' engagement. Further research is needed to explore how an individual's background (e.g., involvement with different interventions over an extended period) may influence engagement. Long-term engagement may be necessary to sustain some positive outcomes although how long is unclear and requires further research. Engagement can occur without complete abstinence from such drugs as cocaine or heroin, but additional research is required as engagement may be influenced by the extent and type of drug use.
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Affiliation(s)
- Lois A Jackson
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Jane A Buxton
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Julie Dingwell
- AIDS Saint John, 62 Waterloo St, Saint John, NB E2L 3P3 Canada
| | - Margaret Dykeman
- University of New Brunswick, 2140 Hanwell Rd, Hanwell, NB B3C 1 M8 Canada
| | - Jacqueline Gahagan
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Karen Gallant
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada
| | - Jeff Karabanow
- School of Social Work, Dalhousie University, Suite 3201-1459 LeMarchant Street, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Susan Kirkland
- Community Health & Epidemiology, Dalhousie University, 5790 University Ave., 4th Floor, Halifax, NS B3H 1 V7 Canada
| | - Dolores LeVangie
- School of Health and Human Performance, Dalhousie University, 6230 South Street, P.O. Box 15000, Halifax, NS B3H 4R2 Canada ; Atlantic Health Promotion Research Centre, Dalhousie University, 1318 Robie Street, Halifax, NS B3H 3E2 Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, 5968 College St, Halifax, NS B3H 4R2 Canada
| | - Michael Gossop
- National Addiction Centre, King's College London, PO48, 4 Windsor Walk, Denmark Hill, London, SE5 8BB UK
| | - Carolyn Davison
- Mental Health, Children's Services, and Addictions Branch, Nova Scotia Department of Health and Wellness, PO Box 488, Halifax, NS B3J 2R8 Canada
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Wong G, Greenhalgh T, Westhorp G, Pawson R. Development of methodological guidance, publication standards and training materials for realist and meta-narrative reviews: the RAMESES (Realist And Meta-narrative Evidence Syntheses – Evolving Standards) project. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02300] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BackgroundThere is growing interest in theory-driven, qualitative and mixed-method approaches to systematic review, such as realist and meta-narrative review. These approaches offer the potential to expand the knowledge base in policy-relevant areas. However, the quality of such reviews can be difficult to assess.ObjectivesThe aim of this project was to produce methodological guidance, publication standards and training resources for those seeking to undertake realist and/or meta-narrative reviews.Methods/designWe (1) collated and summarised existing literature on the principles of good practice in realist and meta-narrative systematic reviews; (2) considered the extent to which these principles had been followed by published and in-progress reviews, thereby identifying how rigour may have been lost and how existing methods could be improved; (3) used an online Delphi method with an interdisciplinary panel of experts from academia and policy, to produce a draft set of methodological steps and publication standards; (4) produced training materials with learning objectives linked to these steps; (5) refined these standards and training materials prospectively on real reviews in progress, capturing methodological and other challenges as they arose; (6) synthesised expert input, evidence review and real-time problem analysis into more definitive guidance and standards; and (7) disseminated outputs to audiences in academia and policy.ResultsAn important element of this study was the establishment of an e-mail mailing list to bring together researches in the field (www.jiscmail.ac.uk/RAMESES). Our literature review identified 35 and nine realist and meta-narrative reviews respectively. Analysis and discussion within the project team produced a summary of the published literature, and common questions and challenges into briefing materials for the Delphi panel, comprising 37 and 33 members (for realist and meta-narrative reviews respectively). Within three rounds this panel had reached a consensus on 19 (realist) and 20 (meta-narrative) key publication standards, with an overall response rate of 90% and 91% respectively. The Realist And Meta-narrative Evidence Syntheses – Evolving Standards (RAMESES) publication standards for realist syntheses and meta-narrative reviews were published in open-access journals and quickly became highly accessed. The RAMESES quality standards and training materials drew together the following sources of data: (1) personal expertise as researchers and trainers; (2) data from the Delphi panels; (3) feedback from participants at training sessions we ran; and (4) comments made on RAMESES mailing list. The quality standards and training materials are freely available online (www.ramesesproject.org).DiscussionThe production of these standards and guidance drew on multiple sources of knowledge and expertise, and a high degree of a consensus was achieved despite ongoing debate among researchers about the overall place of these methodologies in the secondary research toolkit. As with all secondary research methods, guidance on quality assurance and uniform reporting is an important step towards improving quality and consistency of studies. We anticipate that as more reviews are undertaken, further refinement will be needed to the publication and quality standards and training materials.LimitationsThe project’s outputs are not definitive and in the future updating and further development is likely to be needed.ConclusionAn initial set of publication standards, quality standards and training materials have been produced for researchers, users and funders of realist or meta-narrative reviews. As realist and meta-narrative reviews are relatively new approaches to evidence synthesis, methodological development is needed for both review approaches.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Geoff Wong
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Trish Greenhalgh
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Watts T. Final-year nursing undergraduates' understandings of palliative care: a qualitative study in Wales, UK. Int J Palliat Nurs 2014; 20:285-93. [PMID: 25040864 DOI: 10.12968/ijpn.2014.20.6.285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND With worldwide population ageing and the increasing prevalence of chronic conditions, government policies promoting palliative care, and evidence of disparate or even blurred conceptions of palliative care, it is important for educators and practitioners who support undergraduate nurses to establish how these students conceptualise palliative care. Today's students are tomorrow's nurses, and their understanding will shape the ways in which palliative care is integrated into their professional practice. AIM The aim of this work was to explore nursing undergraduates' understandings of palliative care. METHODS As part of a larger qualitative study of palliative care for people with advanced dementia, 11 final-year adult-field nursing undergraduates' understandings of palliative care were explored through in-depth individual interviews. The data was subject to thematic content analysis. FINDINGS The analysis revealed that the participants were cognisant of the broad scope of palliative care. Moreover, they valued and appreciated compassionate comfort care and emotional support. However, their understanding was rather superficial and focused on the imminently dying phase. CONCLUSION The findings are positive as they indicate that the participants appreciated and valued compassionate person- and family-centred care. However, they also illuminate where undergraduate nurse education could be further enhanced.
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Affiliation(s)
- Tessa Watts
- Associate Professor in Nursing, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, Wales
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Waterworth S, Gott M, Raphael D, Parsons J, Arroll B. Working with older people with multiple long-term conditions: a qualitative exploration of nurses' experiences. J Adv Nurs 2014; 71:90-9. [DOI: 10.1111/jan.12474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Susan Waterworth
- School of Nursing; Department of Medical and Health Sciences; University of Auckland; New Zealand
| | - Merryn Gott
- School of Nursing; University of Auckland; New Zealand
| | | | - John Parsons
- School of Nursing; University of Auckland; New Zealand
| | - Bruce Arroll
- School of Population Health; University of Auckland; New Zealand
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Reed FM, Fitzgerald L, Bish MR. District nurse advocacy for choice to live and die at home in rural Australia: a scoping study. Nurs Ethics 2014; 22:479-92. [PMID: 24981253 DOI: 10.1177/0969733014538889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. OBJECTIVES The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. METHOD Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. RESULTS 34 international studies revealed themes of 'the nursing relationship', 'environment', 'communication', 'support' and 'the holistic client centred district nursing role. DISCUSSION Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. CONCLUSION It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.
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Pusa S, Hägglund K, Nilsson M, Sundin K. District nurses' lived experiences of meeting significant others in advanced home care. Scand J Caring Sci 2014; 29:93-100. [DOI: 10.1111/scs.12134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Susanna Pusa
- Department of Nursing; Umeå University; Örnsköldsvik Sweden
| | | | | | - Karin Sundin
- Department of Nursing; Umeå University; Örnsköldsvik Sweden
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Hollman D, Lennartsson S, Rosengren K. District nurses' experiences with the free-choice system in Swedish primary care. Br J Community Nurs 2014; 19:30-35. [PMID: 24800324 DOI: 10.12968/bjcn.2014.19.1.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article aims to describe the experiences of district nurses regarding their work situation after the free-choice system in primary care in Sweden was implemented. The study comprised a total of 17 semi-structured narratives with district nurses. The narratives were analysed using manifest qualitative content analysis. One category,'being an underused resource', and three subcategories, 'being financially aware','being flexible' and 'being appealing', were identified. A focus on economic benefit can limit the cooperation and exchange of experiences within and between different care units, which could have a negative impact on the quality of care due to competition between different care providers. Underused resources and restrictions in terms of improvement skills have an impact on job satisfaction and the working environment, and affect the quality of care as a result.
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Andrew J, Johnston B, Papadopoulou C. Community nurses' participation in palliative care research: the Dignity Care Pathway. Br J Community Nurs 2013; 18:326, 328-31. [PMID: 24156194 DOI: 10.12968/bjcn.2013.18.7.326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Evidence-based practice is a cornerstone of modern health care. Ongoing challenges have been identified in the strength of the evidence base in community palliative care nursing (Walshe and Luker, 2010). This paper discusses the participation of community nurses in a palliative care research project. The Dignity Care Pathway (DCP) is an evidence-based framework developed using a collaborative research approach with community nurses in Scotland. Collaborative research has been advocated as one way to facilitate integrated knowledge transfer and to address the research-practice gap. The aim of this paper is to discuss the participation of community nurses in a collaborative research project to implement a palliative care intervention in practice. The discussion will draw on findings from the third phase of the DCP multiphase research project.
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Affiliation(s)
- Jane Andrew
- Palliative Care Services, Dundee, NHS Tayside, UK.
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Newton J, McVicar A. Evaluation of the currency of the Davies and Oberle (1990) model of supportive care in specialist and specialised palliative care settings in England. J Clin Nurs 2013; 23:1662-76. [PMID: 23875691 DOI: 10.1111/jocn.12301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2013] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the extent to which the Davies and Oberle (1990) model of supportive nursing has currency across specialist and specialised care settings in England. BACKGROUND The model describes attributes of palliative nursing for practice and associated educational curricula. It is influential but predates introduction of specialist/specialised care. Its applicability in contemporary care settings has not been evaluated. DESIGN Evaluation was undertaken using sequential mixed methods, predominantly qualitative. Data collected during 2008-2009. METHODS Four stages: (1) focus groups involving hospital and community palliative clinical nurse specialists and nurses from three hospice settings (total = 25) to identify setting-specific characteristics, (2) survey of nurses (n = 48 respondents/31%) with follow-up interviews (n = 25) to identify congruence with the model, (3) interviews with patients (n = 6) and carers (n = 13) for practice evidence and (4) reconvened focus groups (n = 19 nurses) for confirmation. RESULTS All major dimensions were evidenced. 'Connecting' had reduced emphasis in the hospital setting where specialist nurses spend limited time with patients, but diminishing time to 'connect' with patients and carers as service develops could potentially become problematic across all settings. Two new dimensions ('Displaying expertise' and 'Influencing other professionals') with subdimensions (e.g. 'Advanced communication skills') are proposed as additions to reflect advanced practice. Further new subdimensions ('Making the assessment', 'Prioritising', 'Agreeing the plan') are suggested to be best aligned with the existing dimension 'Connecting'. CONCLUSIONS A revised model of supportive care incorporating dimensions of advanced nursing has currency in contemporary specialist/specialised care settings, although evaluation is required as to the actual impact of the model on care outcomes. 'Connecting' is currently being affected by pace of work and lateness of referrals. IMPLICATIONS FOR PRACTICE 'Spending time' is increasingly difficult to sustain so challenging nurses as to how they may continue to 'connect' with patients as service delivery continues to change.
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Affiliation(s)
- Jenni Newton
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, Essex, UK
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Wälivaara BM, Sävenstedt S, Axelsson K. Caring relationships in home-based nursing care - registered nurses' experiences. Open Nurs J 2013; 7:89-95. [PMID: 23894261 PMCID: PMC3722540 DOI: 10.2174/1874434620130516003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 12/02/2022] Open
Abstract
The caring relationship between the nurse and the person in need of nursing care has been described as a key concept in nursing and could facilitate health and healing by involving the person’s genuine needs. The aim of this study was to explore registered nurses’ experiences of their relationships with persons in need of home-based nursing care. Individual interviews with nurses (n=13 registered nurses and 11 district nurses) working in home-based nursing care were performed. A thematic content analysis was used to analyze the transcribed interviews and resulted in the main theme Good nursing care is built on trusting relationship and five sub-themes, Establishing the relationship in home-based nursing care, Conscious efforts maintains the relationship, Reciprocity is a requirement in the relationship, Working in different levels of relationships and Limitations and boundaries in the relationship. A trusting relationship between the nurse and the person in need of healthcare is a prerequisite for good home-based nursing care whether it is based on face-to-face encounters or remote encounters through distance-spanning technology. A trusting relationship could reduce the asymmetry of the caring relationship which could strengthen the person’s position. The relationship requires conscious efforts from the nurse and a choice of level of the relationship. The trusting relationship was reciprocal and meant that the nurse had to communicate something about themself as the person needs to know who is entering the home and who is communicating through distance-spanning technology.
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Affiliation(s)
- Britt-Marie Wälivaara
- Division of Nursing, Department of Health Science, Luleå University of Technology, SE-971 87 Luleå, Sweden
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Herber OR, Johnston BM. The role of healthcare support workers in providing palliative and end-of-life care in the community: a systematic literature review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:225-35. [PMID: 22974295 DOI: 10.1111/j.1365-2524.2012.01092.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Despite the widespread use of Health Care Support Workers (HCSWs) in providing palliative and end-of-life care, there is little information available about their contributions towards supporting patients who want to be cared for at home or to die at home. Between January and April 2011, a systematic review was conducted to address two questions: (i) What particular tasks/roles do HCSWs perform when caring for people at the end of life and their families to comply with their desire to remain at home?; (ii) What are the challenges and supporting factors that influence HCSWs' ability to provide palliative and end-of-life care in the community? Databases searched for relevant articles published between 1990 until April 2011 included CINAHL, EMBASE, PsychINFO, British Nursing Index, Web of Science, Medline and ASSIA. In total, 1695 papers were identified and their titles and abstracts were read. Ten papers met the eligibility criteria of the study. After the methodological quality of the studies was appraised, nine papers were included in the review. Judgements regarding eligibility and quality were undertaken independently by the authors. The findings indicate that HCSWs invest a great deal of their time on emotional and social support as well as on assisting in the provision of personal care. They are also involved in providing care for the dying, respite care for family members and offer domestic support. Although it is important to acknowledge the many positive aspects that HCSWs provide, the findings suggest three challenges in the HCSWs role: emotional attachment, role ambiguity and inadequate training. Support factors such as informal peer grief-support groups, sense of cohesiveness among HCSWs and task orientation enabled HCSWs to overcome these challenges. To conclude, induction and training programmes, a defined period of preceptorship, appropriate support, supervision and clearly defined role boundaries may be helpful in reducing the challenges identified in HCSWs' roles.
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Affiliation(s)
- Oliver R Herber
- School of Nursing & Midwifery, University of Dundee, Dundee, UK.
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