A cultural transformation model for nursing

What is important to measure in the last months and weeks of life?: A modified nominal group study

BACKGROUND

Identifying the most important issues for palliative care patients and their families, and assessing whether services address these appropriately is important. Little is known about the views of United Kingdom service users and whether, and in what ways, they differ from those in the published literature from other countries, or from health professionals.

AIMS

To investigate what is important to measure at the end of life from the perspectives of United Kingdom patients, bereaved relatives and health care professionals.

METHODS

Ten focus groups, using a modified nominal group technique, with a total of 75 participants (10 patients, 35 professionals and 30 bereaved relatives) enabled issues participants thought important to measure at the end of life to be identified and prioritised using ratings and rankings. Thematic analysis of the data was conducted to enable cross-group comparison.

FINDINGS

Seven themes were identified as most important to participants: symptom management; choice and control; dignity; quality of life; preparation; relationships; and co-ordination and continuity. Bereaved relatives and professionals emphasised symptom management, relationships and quality of life, whilst patients prioritised issues around preparation.

CONCLUSIONS

The study was successful in identifying aspects of end of life care that are important to patients, families and health professionals in the United Kingdom. Although participants were not representative of the wider population in the United Kingdom, the degree of concordance with published studies from outside the United Kingdom increases the credibility of the findings. Quality assurance initiatives need to ensure that they act on information such as this on users' priorities. Further research is needed to test out the findings in other settings in the United Kingdom, to build on the findings about different participants' views and to identify similarities and variations between countries.

Vertical systems integration

Healthcare organizations are vertically integrating into systems for operational, economic, and quality incentives. These system transformations require that the nurse executive assume new roles, responsibilities, and skills. The authors review the trends in system integration and discuss implications for nurse administrators based on literature and structured interviews with nurse executives who have experience in integrated systems or who are engaged in integrated system planing and development.

The administrative support team: specialized support

Specialization has enabled one person to develop a high level of expertise in one management function. The entire department of nursing, not just one unit, shares the benefits of this expertise. The result is efficient and effective use of resources. The lateral relationship between the administrative support team and clinical manager teams has promoted communication flow and exchange while keeping the decision-making power at the clinical level. The implementation of the administrative support team has provided the right solution to the problem: specialized support.