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Development and Psychometric Evaluation of a Japanese Version of Newly Graduated Nurses’ Difficulties with End-of-Life Care for Cancer Patients (NDEC Scale). NURSING REPORTS 2022; 12:637-647. [PMID: 36135982 PMCID: PMC9503130 DOI: 10.3390/nursrep12030063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: End-of-life care (EoL care) for cancer patients is stressful for nurses and can easily lead to burnout. Newly graduated nurses (NGNs) have a particularly difficult time, but no scale or inventory has been designed to evaluate their difficulties. This study developed and tested the reliability and validity of a scale to measure NGNs’ difficulties with EoL care for cancer patients (NDEC scale). (2) Methods: This study population consisted of 1000 NGNs and 1000 nurses with at least five years of clinical experience (GNs) that were working in hospitals in Japan. The initial scale consisted of six factors and 28 items. The reliability and validity of the scale were tested. (3) Results: A total of 171 NGNs and 194 GNs responded to the survey. The scale consisted of five factors and 25 items with the factors including “Feeling painful”, “Can’t deal with patients and their families”, “Don’t know the answer”, “Cannot afford”, and “Being afraid of death”. The criteria validity, known population validity, and internal consistency were confirmed. (4) Conclusions: The scale was validated to have a certain level of reliability and validity. The NDEC scale is expected to be used for self-care for NGNs and as an effectiveness indicator for educational programs.
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Ahlström G, Rosén H, Persson EI. Quality of Life among Next of Kin of Frail Older People in Nursing Homes: An Interview Study after an Educational Intervention concerning Palliative Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052648. [PMID: 35270339 PMCID: PMC8909579 DOI: 10.3390/ijerph19052648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
One cornerstone of palliative care is improving the family’s quality of life (QoL). The principles of palliative care have not been sufficiently applied in nursing homes. The aim of this study was to investigate the experiences of QoL of next of kin of frail older persons in nursing homes after an educational intervention concerning palliative care. This qualitative interview study with 37 next of kin used an abductive design with deductive and inductive content analysis. The deductive analysis confirmed the three themes of QoL from the study before the implementation: (1) orientation to the new life-situation, (2) challenges in the relationship, and (3) the significance of the quality of care in the nursing home. The inductive analysis resulted in the sub-theme “Unspoken palliative care”. Being the next of kin of an older person living in a nursing home can be distressing despite round-the-clock care, so staff need to apply a more explicitly palliative care perspective. Future research needs to evaluate the influence of meaning-focused coping on next of kin’s QoL and integrate this knowledge in psychosocial interventions. Clinical Trial Database for Clinical Research: KUPA project NCT02708498.
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Limbu T, Taylor PM. Experiences of surgical nurses in providing end-of-life care in an acute care setting: a qualitative study. ACTA ACUST UNITED AC 2021; 30:1084-1089. [PMID: 34645337 DOI: 10.12968/bjon.2021.30.18.1084] [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
BACKGROUND The number of deaths occurring in hospitals is rising, and many occur in settings other than specialist palliative care, oncology or critical care. Nurses working outside these specialist environments report end-of-life (EoL) care as a source of stress. This research aimed to explore these experiences. AIMS AND METHODS This qualitative study, using semi-structured interviews as a research technique, aimed to investigate the experiences of surgical nurses caring for dying patients. RESULTS Five themes emerged: understanding of and preference for EoL care; perceived barriers while providing EoL care; robust support from the team as a facilitator while providing EoL care; symptom management; future training and support. CONCLUSION Participants considered providing EoL care as part of their professional role and reported that they were able to provide appropriate physical care. Participants identified challenges in providing emotional and psychological support to dying patients and their families in an acute surgical setting.
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Affiliation(s)
- Teju Limbu
- Staff Nurse, Nottingham City Hospital, Nottingham University Hospitals NHS Trust
| | - Paul M Taylor
- St Luke's Senior Clinical Lecturer in Palliative Medicine, School of Health and Related Research, University of Sheffield
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Griffith S, Gelling L. How do hospice nurses prepare to give end-of-life care? A grounded theory study of nurses in one UK hospice. Int J Palliat Nurs 2021; 27:334-350. [PMID: 34569281 DOI: 10.12968/ijpn.2021.27.7.334] [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
BACKGROUND Literature for preparing hospice nurses to deliver end-of-life care is sparse. AIM To investigate how nurses in one UK hospice prepared to deliver end-of-life care in their role. METHODS A classic grounded theory approach was used to investigate the experiences of 22 registered nurses in one UK hospice, to discover how they prepared for their role. A total of 17 individual interviews and one focus group were conducted. Constant comparison of data and member checking were performed to establish validity. FINDINGS Findings were synthesised into five categories: the 'shared ideal', feeling good at the job, making a difference, experience/exposure to hospice work and the importance of role models. The shared ideal formed the core category, which explained how hospice nurses feel a sense of 'fit' with their work. CONCLUSION The feeling of a nurse feeling well-suited to the work and that there the work was a good 'fit' for them was identified as a core element to nurses' feelings of preparedness to provide end-of-life care.
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Affiliation(s)
- Sue Griffith
- Education Department, Farleigh Hospice, Chelmsford, Essex, UK
| | - Leslie Gelling
- Department of Nursing Science, Bournemouth University, Bournemouth, UK
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Rushton C, Edvardsson D. A genealogy of what nurses know about 'the good death': A socio-materialist perspective. Nurs Philos 2021; 22:e12365. [PMID: 34428347 DOI: 10.1111/nup.12365] [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: 03/05/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically 'the good death'. A genealogical approach informed by actor-network theory and appreciative inquiry were used to compose a broad socio-material account of how nurses concern themselves with the care of the dying and end-of-life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of 'the good death' were re-presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death.
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Affiliation(s)
- Carole Rushton
- School of Nursing and Midwifery, College of Science, Health and Engineering, Latrobe University, Melbourne, Victoria, Australia
| | - David Edvardsson
- School of Nursing and Midwifery, College of Science, Health and Engineering, Latrobe University, Melbourne, Victoria, Australia
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Uzelli Yilmaz D, Yilmaz D, Duzgun G, Akin E. A Phenomenological Analysis of Experiences and Practices of Nurses Providing Palliative and End of Life Care. OMEGA-JOURNAL OF DEATH AND DYING 2021:302228211037506. [PMID: 34344255 DOI: 10.1177/00302228211037506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to describe the experiences and practices of nurses providing palliative and end of life care. The study was conducted in the palliative care unit of a territory hospital in Turkey. The sample consisted of 11 nurses who had been working as palliative care nurses for at least one year. The face to face interview method was used to collect data, with a semi-structured in-depth individual interview. 5 main themes and 24 sub-themes were emerged in relation to the experiences and practices of the nurses. The majority of participant nurses pointed that inadequacy in the number of nurses, secondary nursing care activities, refusal of treatment, cultural and ethical problems were barriers in the provision of nursing care. They frequently experienced ethical issues when caring for end of life patients, and for this reason they felt the need for ethics counselling which they could consult.
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Affiliation(s)
- Derya Uzelli Yilmaz
- Department of Nursing, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Dilek Yilmaz
- Department of Nursing, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Gonul Duzgun
- Department of Emergency and First Aid Services, Vocational School of Health Services, Izmir Tinaztepe University, Izmir, Turkey
| | - Esra Akin
- Department of Nursing, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
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Akay G, Aytekin Özdemir A. Validity and Reliability of the Neonatal Palliative Care Attitude Scale in Turkey. Florence Nightingale Hemsire Derg 2021; 29:212-220. [PMID: 34263240 PMCID: PMC8245023 DOI: 10.5152/fnjn.2021.20041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022] Open
Abstract
AIM This study aimed to establish the validity and reliability of the Neonatal Palliative Care Attitude Scale in Turkey. METHOD This methodological study was conducted between December, 2014, and July, 2017, in the neonatal intensive care unit of 4 hospitals (2 public, 1 university, and 1 private hospital) in the center of a city in eastern Turkey. The study population consisted of all the nurses of the hospitals. No sampling was performed, and the sample consisted of 145 nurses who agreed to participate in the study. The 26-item Neonatal Palliative Care Attitude Scale developed by Kain et al. (2009) was translated into Turkish and then back-translated into English for to determine the validity for Turkey. Experts were consulted to determine the validity of the content. Cronbach's alpha coefficient, test-retest reliability, and item-total correlation were used for reliability. Exploratory and confirmatory factor analyses were used for validity. RESULTS Content validity index ranged from .8 to 1.0. The Kaiser-Meyer-Olkin measure of sampling adequacy was .934, for which the Bartlett's test of sphericity was χ2 = 415.127, p = .000. According to the principal component analysis, the Neonatal Palliative Care Attitude Scale in Turkey. had 3 subscales as did the original Neonatal Palliative Care Attitude Scale. The items had factor loadings greater than .40, and the factors accounted for 55.51% of the total variance. The subscales "organization," "resources," and "clinician" had a Cronbach's alpha of .692, .710, and .680, respectively. CONCLUSION The Neonatal Palliative Care Attitude Scale in Turkey. has a structure similar to that of the original Neonatal Palliative Care Attitude Scale and has high validity and reliability. It is, therefore, a valid and reliable instrument that can be used to identify nurses' attitudes toward neonatal palliative care.
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Affiliation(s)
- Gamze Akay
- Department of Dentistry Services, Artvin Çoruh University, Health Services Vocational School, Artvin, Turkey
| | - Aynur Aytekin Özdemir
- Department of Child Health and Disease Nursing, İstanbul Medeniyet University, Faculty of Health Sciences, İstanbul, Turkey
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Nevin M, Hynes G, Smith V. Healthcare providers' views and experiences of non-specialist palliative care in hospitals: A qualitative systematic review and thematic synthesis. Palliat Med 2020; 34:605-618. [PMID: 32020829 DOI: 10.1177/0269216319899335] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Healthcare providers working in hospitals are frequently exposed to patients with palliative care needs. For most patients, these reflect non-specialist rather than specialist palliative care needs. Embedding palliative care principles early in patients' disease trajectories within acute care delivery in hospitals, however, is a challenge. How to best understand the experiences of those providing non-specialist palliative care in hospitals has not been systematically assessed. AIM To synthesise the evidence on healthcare providers' views and experiences of non-specialist palliative care in hospitals. DESIGN A qualitative systematic review and thematic synthesis using Thomas and Harden's thematic synthesis framework. DATA SOURCES Databases of MEDLINE, CINAHL, PsycINFO and EMBASE were searched from date of inception to March 2018. Studies were eligible for inclusion if they reported on healthcare providers' views and experiences of non-specialist palliative care in hospitals. Studies were appraised for quality but not excluded on that basis. The review was prospectively registered with the International Prospective Register of Systematic Reviews. RESULTS Thirty-nine papers of 37 studies were included, representing 985 hospital healthcare providers' views and experiences. Four major analytical themes emerged; 'Understanding of Palliative Care', 'Complexities of Communication', 'Hospital Ecosystem' and 'Doctors and Nurses - a Different Lens'. CONCLUSIONS Non-specialist palliative care in hospitals is operationalised as care in the last weeks and days of life. The organisation of acute care, inter-disciplinary working practices, clinician attitudes, poor communication structures and lack of education and training in palliative care principles exacerbates poor implementation of this care earlier for patients in hospitals.
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Affiliation(s)
- Mary Nevin
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Geralyn Hynes
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Valerie Smith
- School of Nursing & Midwifery, Trinity College Dublin, The University of Dublin, Ireland
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Yıldırım D, YILDIRIM D, Özçiftçi S, TOKEM Y. Hemşirelik Birinci Sınıf Öğrencilerinin Palyatif Bakımda İlk Klinik Uygulama Deneyimleri. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.568973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bökberg C, Behm L, Wallerstedt B, Ahlström G. Evaluation of person-centeredness in nursing homes after a palliative care intervention: pre- and post-test experimental design. BMC Palliat Care 2019; 18:44. [PMID: 31151438 PMCID: PMC6543575 DOI: 10.1186/s12904-019-0431-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The needs of care based on palliative principles are stressed for all people with progressive and/or life-limiting conditions, regardless of age and the place in which care is provided. Person-centred palliative care strives to make the whole person visible and prioritizes the satisfaction of spiritual, existential, social, and psychological needs to the same extent as physical needs. However, person-centred palliative care for older persons in nursing homes seems to be sparse, possibly because staff in nursing homes do not have sufficient knowledge, skills, and training in managing symptoms and other aspects of palliative care. METHODS This study aimed to evaluate whether an educational intervention had any effect on the staff's perception of providing person-centred palliative care for older persons in nursing homes. METHODS A knowledge-based palliative care intervention consisting of five 2-h seminars during a 6-month period was implemented at 20 nursing homes in Sweden. In total, 365 staff members were participated, 167 in the intervention group and 198 in the control group. Data were collected using two questionnaires, the Person-centred Care Assessment Tool (P-CAT) and the Person-Centred Climate Questionnaire (PCQ-S), answered before (baseline) and 3 months after (follow-up) the educational intervention was completed. Descriptive, comparative, and univariate logistical regression analyses were performed. RESULTS Both the intervention group and the control group revealed high median scores in all subscales at baseline, except for the subscale amount of organizational and environmental support in the P-CAT. The staff's high rating level of person-centred care before the intervention provides limited space for further improvements at follow-up. CONCLUSION This study shows that staff perceived that managers' and the organization's amount of support to them in their everyday work was the only area for improvement in order to maintain person-centred care. The experiences among staff are crucial knowledge in understanding how palliative care can be made person-centred in spite of often limited resources in nursing homes. The dose and intensity of education activities of the intervention model need to be tested in future research to develop the most effective implementation model. TRIAL REGISTRATION NCT02708498 . Date of registration 26 February 2016.
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Affiliation(s)
- Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
| | - Lina Behm
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Birgitta Wallerstedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Centre for Collaborative Palliative Care Linnaeus University, Växjö, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
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Chan LS, Macdonald ME, Cohen SR. Moving Culture beyond Ethnicity: Examining Dying in Hospital through a Cultural Lens. J Palliat Care 2018. [DOI: 10.1177/082585970902500207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lisa S. Chan
- School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Mary Ellen Macdonald
- School of Nursing and Departments of Pediatrics and Oncology, McGill University, and Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
| | - S. Robin Cohen
- Departments of Oncology and Medicine, McGill University, and Lady Davis Institute for Research, Montreal, Quebec, Canada
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Karbasi C, Pacheco E, Bull C, Evanson A, Chaboyer W. Registered nurses' provision of end-of-life care to hospitalised adults: A mixed studies review. NURSE EDUCATION TODAY 2018; 71:60-74. [PMID: 30245257 DOI: 10.1016/j.nedt.2018.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/04/2018] [Accepted: 09/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe, critically appraise and synthesise research regarding nurses' perceptions of their knowledge, skills or experiences in providing end-of-life care to hospitalised adults to help inform both future educational and practice initiatives. DESIGN Mixed studies review. DATA SOURCES MEDLINE, CINAHL, Cochrane Library, Web of Science and SCOPUS databases were searched for the years 2004-June 2018, along with journal hand-searching and reference list searching. REVIEW METHODS Two independent reviewers screened the titles and abstracts of studies. Data extraction and quality assessment using the Mixed Methods Appraisal Tool was conducted independently by two reviewers. Disagreements were adjudicated by a third reviewer. Study findings were synthesised thematically. RESULTS Nineteen studies met the inclusion criteria. Of them, ten were quantitative, eight qualitative and one mixed-method. All but one quantitative study were conducted in the United States and all but one used some form of survey. The qualitative studies were conducted in a variety of countries and all but one used some form of interview for data collection. Five themes were identified including nurse as a protecting provider, nurse as an advocate, nurse as a reflective practitioner, obstacles to providing quality end-of-life care and aids to providing quality end-of-life care. CONCLUSIONS Registered Nurses have aligned their end-of-life care with practice with the profession's expectations and are enacting a patient centred approach to their practice. They rely on reflective practices and on the support of others to overcome organisational, educational and emotional the challenges they to providing quality end-of-life care.
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Affiliation(s)
- C Karbasi
- Nursing, Physiotherapy and Podiatry Faculty of the Complutense University of Madrid, 28040 Madrid, Spain.
| | - E Pacheco
- Nursing, Physiotherapy and Podiatry Faculty of the Complutense University of Madrid, 28040 Madrid, Spain.
| | - C Bull
- Centre for Applied Health Economics (CAHE), Griffith University, Nathan Campus, 4111 QLD, Australia.
| | - A Evanson
- North West Hospital and Health Service, Mount Isa Hospital, 30 Camooweal Street, QLD 4825, Australia.
| | - W Chaboyer
- Menzies Health Institute Queensland, Griffith University, 4215 QLD, Australia.
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Donnelly S, Prizeman G, Coimín DÓ, Korn B, Hynes G. Voices that matter: end-of-life care in two acute hospitals from the perspective of bereaved relatives. BMC Palliat Care 2018; 17:117. [PMID: 30340568 PMCID: PMC6195738 DOI: 10.1186/s12904-018-0365-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland. Methods This was a quantitative descriptive post-bereavement postal survey, gathering data retrospectively from relatives or friends of patients who died, utilising an adapted version of the VOICES (Views of Informal Carers - Evaluation of Services) questionnaire. VOICES MaJam has 29 core questions, seven questions requesting personal demographic information and four open-ended questions gathering descriptive data about the care experience during the patient’s last admission to hospital. A total of 356 valid questionnaires were returned. Qualitative data were managed, coded and analysed with NVivo 10, using a template analysis framework approach. Results Three quarters (75%: n = 268) responded to at least one of the open-ended questions. Several key themes emerged, indicating areas that require particular attention in EoLC. Two themes relate to how care needs are met and how the hospital environment has a critical influence on EoLC experiences. The remaining three themes relate more to the interpersonal context including whether patients are treated with dignity and respect, the psychological, emotional and spiritual needs of patients and their family members and communication. Conclusions Acute hospitals need to ensure that patients and their relatives receive high quality EoLC. Seeking the views of bereaved relatives should be considered by all hospitals and healthcare settings to ascertain the quality of care at end of life. This study contributes to our understanding and knowledge of what good EoLC looks like and where care can be improved, thus enabling hospitals to direct and inform quality improvement.
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Affiliation(s)
- Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Geraldine Prizeman
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
| | - Diarmuid Ó Coimín
- Mater Misericordiae University Hospital, Quality and Patient Safety Directorate, Eccles Street, Dublin 7, Ireland
| | - Bettina Korn
- 1st Floor CEO Building, St. James's Hospital, James Street, Dublin 8, Ireland
| | - Geralyn Hynes
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
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Oliveira I, Fothergill-Bourbonnais F, McPherson C, Vanderspank-Wright B. Battling a Tangled Web: The Lived Experience of Nurses Providing End-of-Life Care on an Acute Medical Unit. Res Theory Nurs Pract 2018; 30:353-378. [PMID: 28304263 DOI: 10.1891/1541-6577.30.4.353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Meeting the heath care needs of patients at the end of life is becoming more complex. In Canada, most patients with life-limiting illness will die in hospitals, many on medical units. Yet, few studies have qualitatively investigated end-of-life care (EOLC) in this context, or from the perspectives of nurses providing EOLC. The purpose of this study was to seek to understand the lived experience of nurses on a medical unit providing EOLC to patients. Interpretive phenomenology guided the method and analysis. Individual face-to-face interviews were conducted with 10 nurses from 2 hospital medical units. The underlying essence of these nurses' experiences was that of "battling a tangled web." Battling a tangled web represented their struggles in attempting to provide EOLC in an environment that was not always conducive to it. Seven themes were generated from the analysis: caring in complexity, caught in a tangled web, bearing witness to suffering, weaving a way to get there: struggling through the process, creating comfort for the patient, working through the dying process with the family, and finding a way through the web. The findings contribute to an understanding of the experiences of nurses in providing EOLC on a medical unit including perceived facilitators and barriers.
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Coelho A, Parola V, Cardoso D, Bravo ME, Apóstolo J. Use of non-pharmacological interventions for comforting patients in palliative care: a scoping review. ACTA ACUST UNITED AC 2018; 15:1867-1904. [PMID: 28708751 DOI: 10.11124/jbisrir-2016-003204] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Palliative care aims to provide the maximum possible comfort to people with advanced and incurable diseases. The use of non-pharmacological interventions to promote comfort in palliative care settings has been increasing.However, information on implemented and evaluated interventions, their characteristics, contexts of application, and population is scattered in the literature, hampering the formulation of accurate questions on the effectiveness of those interventions and, consequently, the development of a systematic review. OBJECTIVE The objective of this scoping review is to examine and map the non-pharmacological interventions implemented and evaluated to provide comfort in palliative care. INCLUSION CRITERIA TYPES OF PARTICIPANTS This scoping review considered all studies that focused on patients with advanced and incurable diseases, aged 18 years or older, assisted by palliative care teams. CONCEPT This scoping review considered all studies that addressed non-pharmacological interventions implemented and evaluated to provide comfort for patients with advanced and incurable diseases.It considered non-pharmacological interventions implemented to provide not only comfort but also well-being, and relief of pain, suffering, anxiety, depression, stress and fatigue which are comfort-related concepts. CONTEXT This scoping review considered all non-pharmacological interventions implemented and evaluated in the context of palliative care. This included home care, hospices or palliative care units (PCUs). TYPES OF SOURCES This scoping review considered quantitative and qualitative studies, and systematic reviews. SEARCH STRATEGY A three-step search strategy was undertaken: 1) an initial limited search of CINAHL and MEDLINE; 2) an extensive search using all identified keywords and index terms across all included databases; and 3) a hand search of the reference lists of included articles.This review was limited to studies published in English, Spanish and Portuguese in any year. EXTRACTION OF RESULTS A data extraction instrument was developed. Two reviewers extracted data independently. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. When necessary, primary authors were contacted for further information/clarification of data. PRESENTATION OF RESULTS Eighteen studies were included covering 10 non-pharmacological interventions implemented and evaluated to provide comfort. The interventions included one to 14 sessions. The interventions lasted between five and 60 minutes. Most of the interventions were implemented in PCUs and hospice settings. Ten of the 18 interventions were implemented and evaluated exclusively in cancer patients. CONCLUSIONS Ten non-pharmacological interventions were identified, of which the most common were music therapy and massage therapy. Their characteristics differed significantly across interventions and even in the same intervention. They were mostly implemented in palliative care units and hospices, and in patients with a cancer diagnosis. These data raise questions for future primary studies and systematic reviews. IMPLICATIONS FOR RESEARCH Future research should focus on the implementation of interventions not only with cancer patients but also with non-cancer patients and patients receiving palliative care at home. Systematic reviews on the effect of massage therapy and music therapy should be conducted.
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Affiliation(s)
- Adriana Coelho
- 1Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal 2Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal 3Department of Nursing, University of Lleida, Lleida, Spain; GRECS Research Group, Institute of Biomedical Research of Lleida, Lledia, Spain 4Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
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Reorienting Esthetic Knowing as an Appropriate "Object" of Scientific Inquiry to Advance Understanding of a Critical Pattern of Nursing Knowledge in Practice. ANS Adv Nurs Sci 2018; 40:24-36. [PMID: 27798436 DOI: 10.1097/ans.0000000000000160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The esthetic pattern of knowing is critical for nursing practice, yet remains weakly defined and understood. This gap has arguably relegated esthetic knowing to an "ineffable" creativity that resists transparency and understanding, which is a barrier to articulating its value for nursing and its importance in producing beneficial health outcomes. Current philosophy of science developments are synthesized to argue that esthetic knowing is an appropriate "object" of scientific inquiry. Examples of empirical scholarship that can be conceived as scientific inquiry into manifestations of esthetic knowing are highlighted. A program of research is outlined to advance a science of esthetic knowing.
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Zheng R, Lee SF, Bloomer MJ. How nurses cope with patient death: A systematic review and qualitative meta-synthesis. J Clin Nurs 2017; 27:e39-e49. [DOI: 10.1111/jocn.13975] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Ruishuang Zheng
- School of Nursing and Midwifery; Monash University; Melbourne Vic Australia
| | - Susan Fiona Lee
- School of Nursing and Midwifery; Monash University; Melbourne Vic Australia
| | - Melissa Jane Bloomer
- School of Nursing and Midwifery; Faculty of Health; Deakin University; Geelong Vic Australia
- Centre for Quality and Patient Safety Research; Deakin University; Geelong Vic Australia
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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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19
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The experiences of undergraduate nursing students and self-reflective accounts of first clinical rotation in pediatric oncology. Nurse Educ Pract 2017; 25:22-28. [DOI: 10.1016/j.nepr.2017.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 10/24/2016] [Accepted: 04/07/2017] [Indexed: 11/19/2022]
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Chan LS, Macdonald ME, Carnevale FA, Cohen SR. 'I'm only dealing with the acute issues': How medical ward 'busyness' constrains care of the dying. Health (London) 2017; 22:451-468. [PMID: 28552003 DOI: 10.1177/1363459317708822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute hospital units are a common location of death. Curative characteristics of the acute medical setting make it difficult to provide adequate palliative care; these characteristics include an orientation to life-prolonging treatment, an emphasis on routine or task-oriented care and a lack of priority on emotional engagement with patients. Indeed, research shows that dying patients in acute medical units often experience unmet needs at the end of life, including uncontrolled symptoms (e.g. pain, breathlessness), inadequate emotional support and poor communication. A focused ethnography was conducted on an acute medical ward in Canada to better understand how this curative/life-prolonging care environment shapes the care of dying patients. Fieldwork was conducted over a period of 10 months and included participant-observation and interviews with patients, family members and staff. On the acute medical ward, a 'logic of care' driven by discourses of limited resources and the demanding medical unit created a context of busyness. Staff experienced an overwhelming workload and felt compelled to create priorities, which reflected taken-for-granted values regarding the importance of curative/life-prolonging care over palliative care. This could be seen through the way staff prioritized life-prolonging practices and rationalized inconsistent and less attentive care for dying patients. These values influenced care of the dying through delaying a palliative approach to care, limiting palliative care to those with cancer and providing highly interventive end-of-life care. Awareness of these taken-for-granted values compels a reflective and critical approach to current practice and how to stimulate change.
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Affiliation(s)
- Lisa S Chan
- McGill University, Canada; Lady Davis Institute for Medical Research, Canada
| | - Mary Ellen Macdonald
- McGill University, Canada; Montreal Children's Hospital and McGill University Health Centre, Canada
| | - Franco A Carnevale
- McGill University, Canada; Montreal Children's Hospital and McGill University Health Centre, Canada
| | - S Robin Cohen
- McGill University, Canada; Lady Davis Institute for Medical Research, Canada
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Elmore J, Wright DK, Paradis M. Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research. Nurs Ethics 2016; 25:955-972. [DOI: 10.1177/0969733016679468] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.
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Affiliation(s)
- James Elmore
- St. Mary’s Research Centre, Canada; McGill University, Canada
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Abu-Ghori IK, Bodrick MM, Hussain R, Rassool GH. Nurses’ involvement in end-of-life care of patients after a do not resuscitate decision on general medical units in Saudi Arabia. Intensive Crit Care Nurs 2016; 33:21-9. [DOI: 10.1016/j.iccn.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/26/2022]
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Andersson E, Salickiene Z, Rosengren K. To be involved - A qualitative study of nurses' experiences of caring for dying patients. NURSE EDUCATION TODAY 2016; 38:144-149. [PMID: 26689734 DOI: 10.1016/j.nedt.2015.11.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to describe nurses' experiences (>two years) of caring for dying patients in surgical wards. BACKGROUND Palliative care is included in education for nurses. However, the training content varies, and nurse educators need to be committed to the curriculum regarding end-of-life situations. A lack of preparation among newly graduated nurses regarding dying and death could lead to anxiety, stress and burnout. Therefore, it is important to improve knowledge regarding end-of-life situations. SETTING, PARTICIPANTS AND METHOD A qualitative descriptive study was carried out in two surgical wards in the southern part of Sweden. The study comprised six interviews with registered nurses and was analysed using manifest qualitative content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nurses' perspectives and thoughts regarding dying patients. RESULTS The results formed one category (caring-to be involved) and three subcategories (being supportive, being frustrated and being sensitive in the caring processes). Nurses were personally affected and felt unprepared to face dying patients due to a lack of knowledge about the field of palliative care. Their experiences could be described as processes of transition from theory to practice by trial and error. CONCLUSION Supervision is a valuable tool for bridging the gap between theory and practice in nursing during the transition from novice to expert. Improved knowledge about palliative care during nursing education and committed nursing leadership at the ward level facilitate preparation for end-of-life situations.
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Affiliation(s)
- Erika Andersson
- Department of Surgery, Norra Älvsborg County Hospital, SE-461 85 Trollhättan, Sweden.
| | - Zivile Salickiene
- Department of Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.
| | - Kristina Rosengren
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, SE-405 30 Gothenburg, Sweden.
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Zheng R, Lee SF, Bloomer MJ. How new graduate nurses experience patient death: A systematic review and qualitative meta-synthesis. Int J Nurs Stud 2016; 53:320-30. [DOI: 10.1016/j.ijnurstu.2015.09.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/04/2015] [Accepted: 09/25/2015] [Indexed: 11/16/2022]
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25
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Karlou C, Papathanassoglou E, Patiraki E. Caring behaviours in cancer care in Greece. Comparison of patients', their caregivers' and nurses' perceptions. Eur J Oncol Nurs 2015; 19:244-50. [DOI: 10.1016/j.ejon.2014.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 11/15/2014] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
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Bergenholtz H, Hølge-Hazelton B, Jarlbaek L. Organization and evaluation of generalist palliative care in a Danish hospital. BMC Palliat Care 2015; 14:23. [PMID: 25943367 PMCID: PMC4431605 DOI: 10.1186/s12904-015-0022-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hospitals have a responsibility to ensure that palliative care is provided to all patients with life-threatening illnesses. Generalist palliative care should therefore be acknowledged and organized as a part of the clinical tasks. However, little is known about the organization and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. METHODS Results from three different data sets, all aiming to evaluate generalist palliative care, were compared retrospectively. The data-sets derived from; 1. a national accreditation of the hospital, 2. a national survey and 3. an internal self-evaluation performed in the hospital. The data were triangulated to investigate the organization and evaluation of palliative care in order to identify concordances and/or discrepancies. RESULTS The triangulation indicated poor validity of the results from existing methods used to evaluate palliative care in hospitals. When the datasets were compared, several discrepancies occurred with regard to the organization and the performance of generalist palliative care. Five types of discrepancies were found in 35 out of 56 sections in the fulfilment of the national accreditation standard for palliative care. Responses from the hospital management and the department managements indicated that generalist palliative care was organized locally--if at all--within the various departments and with no overall structure or policy. CONCLUSIONS This study demonstrates weaknesses in the existing evaluation methods for generalist palliative care and highlights the lack of an overall policy, organization and goals for the provision of palliative care in the hospital. More research is needed to focus on the organization of palliative care and to establish indicators for high quality palliative care provided by the hospital. The lack of valid indicators, both for the hospital's and the departments' provision of palliative care, calls for more qualitative insight in the clinical staff's daily work including their culture and acceptance of the provision of palliative care.
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Affiliation(s)
| | - Bibi Hølge-Hazelton
- Roskilde/Køge Hospitals, Region Zealand, Denmark.
- The Research Unit for General Practice and Section of General Practice Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Lene Jarlbaek
- PAVI, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Edo-Gual M, Monforte-Royo C, Aradilla-Herrero A, Tomás-Sábado J. Death attitudes and positive coping in Spanish nursing undergraduates: a cross-sectional and correlational study. J Clin Nurs 2015; 24:2429-38. [DOI: 10.1111/jocn.12813] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Montserrat Edo-Gual
- Escola Universitària d'Infermeria Gimbernat; Universitat Autònoma de Barcelona; Sant Cugat del Vallès Barcelona Spain
| | - Cristina Monforte-Royo
- Department of Nursing; School of Medicine and Health Sciences; Universitat Internacional de Catalunya; Sant Cugat del Vallès Barcelona Spain
- WeCare Chair: End-of-life Care; Universitat Internacional de Catalunya; Sant Cugat del Vallès Barcelona Spain
| | - Amor Aradilla-Herrero
- Escola Universitària d'Infermeria Gimbernat; Universitat Autònoma de Barcelona; Sant Cugat del Vallès Barcelona Spain
| | - Joaquín Tomás-Sábado
- Escola Universitària d'Infermeria Gimbernat; Universitat Autònoma de Barcelona; Sant Cugat del Vallès Barcelona Spain
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Bergenholtz H, Jarlbaek L, Hølge-Hazelton B. The culture of general palliative nursing care in medical departments: an ethnographic study. Int J Palliat Nurs 2015; 21:193-201. [DOI: 10.12968/ijpn.2015.21.4.193] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Heidi Bergenholtz
- PhD student, The Regional Research Unit, Region Zealand, Roskilde/Koege Hospitals, Denmark
| | - Lene Jarlbaek
- Consultant in Oncology, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Denmark
| | - Bibi Hølge-Hazelton
- Associate Research Professor at Roskilde/Koege Hospitals and The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
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29
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Searle C, Mcinerney F. Creating comfort: Nurses’ perspectives on pressure care management in the last 48 hours of life. Contemp Nurse 2014; 29:147-58. [DOI: 10.5172/conu.673.29.2.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Haishan H, Hongjuan L, Tieying Z, Xuemei P. Preference of Chinese general public and healthcare providers for a good death. Nurs Ethics 2014; 22:217-27. [PMID: 24878575 DOI: 10.1177/0969733014524760] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The aim of this study is to find and compare the current situation between common people and healthcare providers’ preferences for a good death in the context of Chinese culture. Methods: A cross-sectional anonymous questionnaire survey covering 190 ordinary Chinese people and 323 healthcare providers was conducted. An inventory of the good death was translated and the subjects were surveyed about their attitude toward it. Ethical considerations: Permission to conduct the study was granted by department chiefs, nurse managers and the participants themselves. The participants were informed that they took part on a voluntary and anonymous basis, that they could withdraw at any time, that they had the right to ignore questions they did not wish to answer, and that whatever they chose to do would not jeopardize their employment conditions. Results: The attributes that were perceived as important by major respondents for a good death were maintaining hope and pleasure, good relationship with medical staff, good relationship with family, independence, environment comfort, being respected as an individual, preparation for death, physical and psychological comfort, dying in a favorite place, and not being a burden to others. And some relatively less important characteristics were life completion, receiving enough treatment, natural death, controlling over the future, unawareness of death, pride and beauty, feeling that one’s life is worth living, and religious and spiritual comfort. We also found that healthcare providers were more likely than general out-patients to perceive “physical and psychological comfort,” “dying in a favorite place,” “good relationship with medical staff,” and “natural death” as important for a good death. Conclusion: This study offers healthcare providers in China a fundamental understanding of the normal expectations of the general public for a good death. It is believed that these findings in our study are valuable to improve palliative care in China. We compared the attitudes of Chinese and Westerners and found some differences, which suggested that cultural difference should be an important consideration to achieve a good death in China. We also found that healthcare providers see good death differently from general public, indicating that the criteria for good death warrant further study.
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Affiliation(s)
- Huang Haishan
- Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, P.R. ChinaNusing Department, Tongji Medical College, Huazhong University of Science and Technology, P.R. China
| | - Liu Hongjuan
- Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, P.R. ChinaNusing Department, Tongji Medical College, Huazhong University of Science and Technology, P.R. ChinaTongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, P.R. ChinaFirst Affiliated Hospital, Medical College of Shihezi University, P.R. China
| | - Zeng Tieying
- Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, P.R. China
| | - Pu Xuemei
- First Affiliated Hospital, Medical College of Shihezi University, P.R. China
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McCourt R, James Power J, Glackin M. General nurses' experiences of end-of-life care in the acute hospital setting: a literature review. Int J Palliat Nurs 2013; 19:510-6. [PMID: 24162282 DOI: 10.12968/ijpn.2013.19.10.510] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Approximately 90% of the UK population spend some time in hospital in their final year of life, and more than half of the population die in hospital. This review aims to explore the experiences of general nurses when providing end-of-life care to patients in the acute hospital setting. Nine studies were identified through a literature search, and each was then analysed and evaluated until themes emerged. Six themes were drawn from the literature: lack of education and knowledge, lack of time with patients, barriers arising in the culture of the health-care setting, communication barriers, symptom management, and nurses' personal issues. The themes cause concern about the quality of end-of-life care being provided in the acute care setting. The literature appears to be consistent in the view that terminally ill patients are best cared for in specialised care settings, such as palliative care units and hospices. However, increasing demands on health services will result in greater numbers of dying patients being admitted to the acute hospital setting. It is therefore paramount that general nurses' educational needs are met to ensure they develop clinical competence to provide high-quality holistic end-of-life care.
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Watts T. The media critique of the Liverpool Care Pathway: some implications for nursing education. Int J Palliat Nurs 2013; 19:275-80. [PMID: 24151738 DOI: 10.12968/ijpn.2013.19.6.275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
End-of-life care pathways are championed around the globe as tools that might be used to enhance the quality of care at the very end of a person's life. This paper examines recent negative media discourse in the UK about the Liverpool Care Pathway for the Dying Patient (LCP). This media coverage may have had damaging effects, but it has also served to highlight inappropriate and even suboptimal end-of-life care. While recognising the pervading influence of organisational structures and cultures, some implications for initial and ongoing education of nurses are identified.
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Affiliation(s)
- Tessa Watts
- College of Human and Health Sciences, Swansea University, SA2 8PP, Wales.
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The provision of end-of-life care by medical-surgical nurses working in acute care: a literature review. Palliat Support Care 2013; 12:393-408. [PMID: 24477088 DOI: 10.1017/s1478951513000965] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Caring for terminally ill patients is complex, stressful, and at times distressing for nurses. Acute care hospitals continue to be the predominant place of death for terminally ill patients in most Western countries. The objective of the present literature review was to explore and gain an in-depth understanding of the experience of providing end-of-life (EOL) care by medical-surgical RNs working in acute care hospitals, to identify knowledge gaps, and to recommend future research. METHOD A comprehensive literature review was conducted using the following electronic databases: CINAHL, MEDLINE, and PsyInfo (from 1992 to October 2012). RESULTS The findings from the 16 reviewed studies suggest that nurses felt a strong commitment to help terminally ill patients experience a good death. Nurses reported feeling deeply rewarded and privileged to share the EOL experience with patients/families. Organizational and individual factors influenced nurses' experience. Important challenges were associated with managing the divergent needs of a mixed patient load (i.e., curative and palliative care patients) in a biomedical culture of care that is heavily oriented toward cure and recovery. In this culture, nurses' emotional work and ideals of good EOL care are often not recognized and supported. SIGNIFICANCE OF RESULTS Managerial and organizational support that recognize the centrality of emotional work nurses provide to dying patients is needed. More research exploring ways to improve communication among nurses and medical colleagues is essential. Finally, a critical examination of the ideological assumptions guiding nurses' practice of EOL care within the context of acute care is recommended to help reveal their powerful influence in shaping nurses' overall understanding and experience of EOL care.
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Mak YW, Lim Chiang VC, Chui WT. Experiences and perceptions of nurses caring for dying patients and families in the acute medical admission setting. Int J Palliat Nurs 2013; 19:423-31. [DOI: 10.12968/ijpn.2013.19.9.423] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Vico Chung Lim Chiang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Wai To Chui
- Department of Psychiatry, Kowloon Hospital, Hong Kong
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36
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van Brummen B, Griffiths L. Working in a medicalised world: the experiences of palliative care nurse specialists and midwives. Int J Palliat Nurs 2013; 19:85-91. [PMID: 23435537 DOI: 10.12968/ijpn.2013.19.2.85] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM This paper reports a study that explored birth and death care experiences from the perspectives of midwives and palliative care clinical nurse specialists (CNSs). METHODS A grounded theory approach illuminated the social processes associated with caring during birth and death. Data was collected during 2011 through in-depth semi-structured interviews with eight participants: four midwives and four CNSs from UK NHS Trusts. FINDINGS Four categories were identified through thematic analysis: memories, one act, advocate, and medical event. These integrated to create a core category: working to counter the pathologisation of birth and death. CONCLUSION The participants illustrate the impact of medicalisation on the experience of birth and death and struggle with the negative effects of this. Health professionals should work toward practice that emphasises the importance of holistic care.
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Aradilla-Herrero A, Tomás-Sábado J, Gómez-Benito J. Death Attitudes and Emotional Intelligence in Nursing Students. OMEGA-JOURNAL OF DEATH AND DYING 2013; 66:39-55. [DOI: 10.2190/om.66.1.c] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aims of this study were to analyze the relationships between death attitudes and perceived emotional intelligence in a sample of nursing students, and to determine whether there are differences between different academic years with regard to both emotional intelligence and death attitudes. The participants were 243 nursing students. They all responded voluntarily and anonymously to a questionnaire that assessed the following constructs: Fear of death, Death anxiety, Death depression, Death obsession, and Emotional intelligence (Attention, Clarity, and Mood Repair). Students' scores on Fear of Death of Others subscale ( p < .05) decreased significantly across the 3 years of the nursing degree program and increased significantly on emotional Clarity ( p < .05), a dimension of emotional intelligence. The multiple linear regression analyses confirmed the predictive value of Attention, Clarity, and Mood Repair regarding levels of Fear of Death of Others. The importance of including emotional skills training and death-education programs as part of professional nursing curricula are discussed.
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Affiliation(s)
- Amor Aradilla-Herrero
- Escola Universitària d'Infermeria Gimbernat, Universitat Autònoma de Barcelona, Spain
| | - Joaquín Tomás-Sábado
- Escola Universitària d'Infermeria Gimbernat, Universitat Autònoma de Barcelona, Spain
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McCallum A, McConigley R. Nurses’ perceptions of caring for dying patients in an open critical care unit: a descriptive exploratory study. Int J Palliat Nurs 2013; 19:25-30. [DOI: 10.12968/ijpn.2013.19.1.25] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amanda McCallum
- High Dependency Area, Royal Perth Hospital, East Perth, Western Australia 6001, Australia
| | - Ruth McConigley
- School of Nursing and Midwifery, Curtin University, GPO Box U 1987, Perth, Western Australia 6845, Australia
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Arantzamendi M, Addington-Hall J, Saracibar M, Richardson A. Spanish nurses’ preparedness to care for hospitalised terminally ill patients and their daily approach to caring. Int J Palliat Nurs 2012; 18:597-605. [DOI: 10.12968/ijpn.2012.18.12.597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Maria Arantzamendi
- School of Nursing, University of Navarra, C/Irunlarrea, 1 31.008, Pamplona, Spain
| | | | | | - Alison Richardson
- Cancer Nursing and End of Life Care, University of Southampton & Southampton University Hospitals NHS Trust
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Bridges J, Nicholson C, Maben J, Pope C, Flatley M, Wilkinson C, Meyer J, Tziggili M. Capacity for care: meta-ethnography of acute care nurses' experiences of the nurse-patient relationship. J Adv Nurs 2012; 69:760-72. [PMID: 23163719 PMCID: PMC3617468 DOI: 10.1111/jan.12050] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2012] [Indexed: 11/30/2022]
Abstract
Aims To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings. Background While primary research on nurses' experiences has been reported, it has not been previously synthesized. Design Meta-ethnography. Data sources Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO. Review methods Qualitative studies describing nurses' experiences of the nurse-patient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method. Results Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients. Conclusion The findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.
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Karlsson M, Karlsson C, Barbosa da Silva A, Berggren I, Söderlund M. Community nurses' experiences of ethical problems in end-of-life care in the patient's own home. Scand J Caring Sci 2012; 27:831-8. [DOI: 10.1111/j.1471-6712.2012.01087.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/13/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Margareta Karlsson
- Department of Caring Science; Åbo Academy University; Vasa Finland
- Department of Nursing; Health and Culture, University West; Trollhättan Sweden
| | | | | | - Ingela Berggren
- Department of Nursing; Health and Culture, University West; Trollhättan Sweden
| | - Maud Söderlund
- Department of Caring Science; Åbo Academy University; Vasa Finland
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Thurston J, Waterworth S. ‘Making sense’: nurses' experiences of changing practice in caring for dying patients in New Zealand. Int J Palliat Nurs 2012; 18:500-7. [DOI: 10.12968/ijpn.2012.18.10.500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jenny Thurston
- Auckland City Hospital, Private Bag 92-024, Auckland, 1023, New Zealand
| | - Susan Waterworth
- School of Nursing, The University of Auckland, Private Bag 92019, Auckland, New Zealand
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Cook KA, Mott S, Lawrence P, Jablonski J, Grady MR, Norton D, Liner KP, Cioffi J, Hickey P, Reidy S, Connor JA. Coping while caring for the dying child: nurses' experiences in an acute care setting. J Pediatr Nurs 2012; 27:e11-21. [PMID: 22703689 DOI: 10.1016/j.pedn.2011.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 05/17/2011] [Accepted: 05/24/2011] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe and understand behavior and coping strategies used by pediatric nurses caring for dying children on an inpatient acute care cardiology unit. Qualitative descriptive methods consisting of semistructured questions were presented to acute care nurses participating in focus groups. The nurses who participated in the focus groups had cared for an acutely ill child who died. Conventional content analysis was used to analyze data and organize results. The categories that emerged included the following: boundaries, memories, disconnecting, and labeling. Colleague support, institutional resources, and nurses' experience level were critical to the process of coping. Coping and grieving are facilitated by colleague and unit resources. Studies exploring job dissatisfaction, stress, and burnout from an inadequate grieving process are required.
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Affiliation(s)
- Katherine A Cook
- Nursing/Patient Services, Children's Hospital Boston, Boston, MA, USA.
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Affiliation(s)
- Maria Parry
- Faculty of Health, Sport … Science, University Of Glamorgan, Pontypridd, CF37 1DL, Wales
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Abstract
Nowadays it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Therefore it is vital to identify significant factors in order to prevent unnecessary suffering for dying patients and their families in end-of-life homecare. This study aimed to describe 10 nurses’ perceptions of significant factors that contribute to good end-of-life care in the patients own home. The transcribed texts from the interviews’ were analyzed using phenomenological hermeneutical method, which focuses on the life-world of human beings. The results demonstrate that good end-of-life care presupposes that the aim of the caring staff is to provide safety, autonomy and integrity for the patient and family in order to create the respect required for as good and dignified a death as possible.
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Staff Perceptions of End-of-Life Care in the Acute Care Setting: A New Zealand Perspective. J Palliat Med 2011; 14:623-30. [DOI: 10.1089/jpm.2010.0470] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Casey D, Murphy K, Ni Leime A, Larkin P, Payne S, Froggatt KA, O’Shea E. Dying well: factors that influence the provision of good end-of-life care for older people in acute and long-stay care settings in Ireland. J Clin Nurs 2011; 20:1824-33. [DOI: 10.1111/j.1365-2702.2010.03628.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Cavaye J, Watts JH. End-of-life education in the pre-registration nursing curriculum: Patient, carer, nurse and student perspectives. J Res Nurs 2010. [DOI: 10.1177/1744987110379531] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Providing good quality care for dying patients has been highlighted as a national priority in the UK. The Department of Health’s end-of-life (EOL) care strategy outlines how patients should be cared for to ensure that they experience a ‘good death’. Nurses have an important role to play in the delivery of EOL care and need to be knowledgeable about the palliation of symptoms and the social context of death and dying. Traditionally, the pre-registration nursing curriculum has had a limited emphasis on EOL care. While there have been significant developments in nurse education in the last decade, the amount of EOL content in nurse education remains inadequate. Drawing on literature mainly from the UK and USA, this review explores from the perspectives of students, newly qualified nurses, patients and carers the outcomes of EOL education. It reviews the evidence to determine whether newly qualified nurses are adequately prepared to deliver quality care to patients at the end of their lives. The evidence suggests that despite a greater emphasis on EOL care in nurse training, adequately preparing nurses remains a challenge to educators.
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Affiliation(s)
- Joyce Cavaye
- Senior Lecturer, Faculty of Health and Social Care, The Open University, Edinburgh, UK
| | - Jacqueline H. Watts
- Senior Lecturer, Faculty of Health and Social Care, The Open University, London, UK
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Karlsson M, Roxberg A, da Silva AB, Berggren I. Community nurses' experiences of ethical dilemmas in palliative care: a Swedish study. Int J Palliat Nurs 2010; 16:224-31. [PMID: 20679970 DOI: 10.12968/ijpn.2010.16.5.48143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The aim of this study was to highlight community nurses' experiences of ethical dilemmas in palliative care. BACKGROUND There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence. METHOD Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis. FINDINGS The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients' end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals. CONCLUSION The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues' experience and deal with such issues.
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Affiliation(s)
- Margareta Karlsson
- Department of Nursing, Health and Culture, University West,Trollhättan, Sweden
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Abstract
AIM This paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies. BACKGROUND The goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief. METHOD This study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework. FINDINGS Participants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients. CONCLUSION There are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.
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