Palliative nurses' experiences of alleviating suffering and preserving dignity

BackgroundMost patients in need of palliative care remain in their homes, thus great focus should be placed on the creation of functional palliative homecare. Suffering through an often multifaceted illness and contemplating one's death can contribute to the loss of one's sense of dignity, and the preservation of patient dignity is a major challenge for health professionals worldwide.AimThe aim of the study was to explore and describe nurses' experiences of caring qualities alleviating suffering and preserving the dignity of patients in need of palliative homecare.Research designA qualitative exploratory study. In-depth semi-structured interviews as data collection method, and the qualitative content analysis of Graneheim and Lundman for data analysis. The theoretical perspective was based on Eriksson's caritative caring theory.Participants and research contextA total of nine nurses with extensive work experience from a palliative homecare context participated in the study.Ethical considerationsThe study was conducted in accordance with the criteria set forth by the Finnish National Board on Research Integrity TENK. Research permission was granted and participants gave their written informed consent to participate in the study.FindingsOne main theme and three subthemes were found. The main theme was: Being there for the other alleviates suffering while shaping and reshaping dignity preservation in a process. The three subthemes were: (1) Being a sensitive and compassionate witness who becomes responsible, (2) Having compliance, courage, and perception in a deep presence, (3) Being calm and patient while having time for conducting skilled practical knowledge.ConclusionsCertain caring qualities are important in the dignity-preserving care of people in need of palliative homecare, and person-centeredness plays a central role in alleviating suffering. Deep and trusting caring relationships and nurses' ability to customize the care being provided are significant in alleviating patient suffering and preserving dignity.

Nursing activities for health promotion in palliative home care: an integrative review

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.

Relational practice in health, education, criminal justice, and social care: a scoping review

BACKGROUND

Establishing and maintaining relationships and ways of connecting and being with others is an important component of health and wellbeing. Harnessing the relational within caring, supportive, educational, or carceral settings as a systems response has been referred to as relational practice. Practitioners, people with lived experience, academics and policy makers, do not yet share a well-defined common understanding of relational practice. Consequently, there is potential for interdisciplinary and interagency miscommunication, as well as the risk of policy and practice being increasingly disconnected. Comprehensive reviews are needed to support the development of a coherent shared understanding of relational practice.

METHOD

This study uses a scoping review design providing a scope and synthesis of extant literature relating to relational practice focussing on organisational and systemic practice. The review aimed to map how relational practice is used, defined and understood across health, criminal justice, education and social work, noting any impacts and benefits reported. Searches were conducted on 8 bibliographic databases on 27 October 2021. English language articles were included that involve/discuss practice and/or intervention/s that prioritise interpersonal relationships in service provision, in both external (organisational contexts) and internal (how this is received by workers and service users) aspects.

RESULTS

A total of 8010 relevant articles were identified, of which 158 met the eligibility criteria and were included in the synthesis. Most were opinion-based or theoretical argument papers (n = 61, 38.60%), with 6 (3.80%) critical or narrative reviews. A further 27 (17.09%) were categorised as case studies, focussing on explaining relational practice being used in an organisation or a specific intervention and its components, rather than conducting an evaluation or examination of the effectiveness of the service, with only 11 including any empirical data. Of the included empirical studies, 45 were qualitative, 6 were quantitative, and 9 mixed methods studies. There were differences in the use of terminology and definitions of relational practice within and across sectors.

CONCLUSION

Although there may be implicit knowledge of what relational practice is the research field lacks coherent and comprehensive models. Despite definitional ambiguities, a number of benefits are attributed to relational practices.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021295958.

Exploring interface design to support caregivers' needs and feelings of trust in online content

INTRODUCTION

Family caregivers of people living with dementia require a range of accurate, current, and reliable information throughout the care trajectory. Much of this information is available online, however it can be difficult for caregivers to identify and decide what content is relevant to them. Little is known about how online design cues impact family caregivers' decision to assess how trustworthy information is and whether to engage with it.

METHODS

Our exploratory research focused on the interface design of CARE-RATE, an online search tool intended to support more effective information searches for family caregivers seeking dementia care-related resources. Data from focus groups were coupled with design literature to inform the development of three mockups that were evaluated by seven dementia caregiver experts.

RESULTS

Participants preferred a search bar design because of its simplicity, familiarity, and functionality. Design elements that impact trust included logos from reputable organizations, transparency of content author, and ratings from other caregivers.

CONCLUSION

Feelings of trust regarding information, including the ability to ascertain trustworthiness, is a major aspect of caregivers' willingness to engage with online content. Transparency and familiarity appear to be key elements that impact caregivers' trust in online information, which agrees with current web design research.

The nurse's role in palliative care: A qualitative meta-synthesis

AIMS AND OBJECTIVES

To explore how nurses, across various health systems, describe their role in providing palliative care for patients with life-threatening illnesses.

BACKGROUND

Despite the fact that nurses make up the largest group of healthcare professionals, little is known about their role in palliative care, across health services.

DESIGN

A qualitative systematic review of studies.

METHODS

A search was made for relevant articles, published between January 2000-June 2016. Twenty-eight articles were selected and analysed using thematic synthesis.

RESULTS

The themes that emerged from the analysis were as follows: Being available, which gave nurses a pivotal role in palliative care and paved the way for Being a coordinator of care for patients and relatives, as well as for other health personnel. Doing what's needed was to handle an enormous breadth of activities, always in a holistic framework of understanding. Being attentively present and dedicated as well as using flexible and nontraditional methods was essential in the role. Standing in demanding situations dealt with lack of time and resources, limited legitimacy, handling ethical dilemmas and being in need of support and knowledge.

CONCLUSION

Being available as well as a coordinator characterises the nurse's role across healthcare systems. The nurse acts as a link between different levels of health care, between different professions and between patient and family, which contribute to ensuring the quality of care to the individual patient. The review illuminates that the basic tenets of care in nursing are also fundamental to the nurse's role in palliative care. To be able to give individually tailored palliative care to patients with life-threatening illnesses and their relatives, the nurses need all their knowledge of basic nursing. Situations challenge nurses in practical, relational and moral dimensions of care and make demands on their role in a comprehensive way.

RELEVANCE TO CLINICAL PRACTICE

Nurses need knowledge and training, guidance and support to fulfil their role.

Atuação do enfermeiro na atenção domiciliar: uma revisão integrativa da literatura

RESUMO Objetivo: analisar a produção científica acerca da atuação do enfermeiro na atenção domiciliar em saúde. Método: realizou-se uma revisão integrativa da literatura por meio de consulta às bases de dados LILACS, BDENF, IBECS e MEDLINE. Foram incluídos estudos em espanhol, inglês e português, não delimitando data de publicação. Resultados: analisados 48 artigos, identificou-se que a atuação do enfermeiro na atenção domiciliar possui complexidade e diversidade de ações com uso de tecnologias leves, leve-duras especialmente, e duras. Destaca-se que desafios relacionados ao processo formativo para a atenção domiciliar estão relatados na literatura. O enfermeiro utiliza conhecimento experiencial e recomendações científicas aliados à reflexão na prática. Conclusão: a atuação do enfermeiro no espaço domiciliar é fundamental e ampla. As ações relacionais e educacionais se destacam, sendo necessárias inclusive nos cuidados técnicos, predominando a necessidade de formação para a atenção domiciliar.

Development of a questionnaire to measure the key attributes of the community palliative care specialist nurse role

BACKGROUND

Recent worldwide economic events have forced an examination of the nurse's contribution to high-quality, effective, person-centred care. Since the role of specialist nurses is considered one of the least understood or valued developments in nursing, specialist nurses must demonstrate their contribution to quality, person-centred health care.

AIM

To develop a questionnaire which aims to measure the quality of care provided by palliative care specialist nurses from the patients' perspective and to undertake initial validation.

METHOD

The process of questionnaire development involved six phases including systematic literature reviews, patient advisory groups and expert panel reviews, each of which contributed to the questionnaire face and content validity. Johnston's Expert Palliative Care Nurse Model (2002; 2005) provided an evidence-based framework for the development of the questionnaire, and enabled the identification of the key attributes of the palliative care specialist nurse role, thereby providing the themes on which to base the questionnaire.

RESULTS

The Quality Measure for Palliative Nursing, a questionnaire, was developed. The themes identified in the questionnaire--personal characteristics, communication skills, knowledge, relationship with patient and providing comfort--aim to facilitate measurement of the quality of care provided by palliative care specialist nurses. Designed for use by palliative patients the Quality Measure for Palliative Nursing is a one-page questionnaire comprising of 15 questions.

CONCLUSIONS

The Quality Measure for Palliative Nursing is unique since it aims to measure the quality of care provided by community palliative care specialist nurses, and could also be used to measure patient satisfaction with the quality of care provided. Further testing is recommended to ensure that this questionnaire can provide reliable and valid results.

District nurse advocacy for choice to live and die at home in rural Australia: a scoping study

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.

Relational experiences of family caregivers providing home-based end-of-life care

The multiple relationships involved in home-based end-of-life care have received little systematic analysis. As part of a focused ethnographic study examining client-caregiver-provider relational care experiences within the sociocultural context of home-based end-of-life care, this article describes the provision of end-of-life care to older adults with advanced cancer from the perspective of family caregivers. Data were collected through in-depth interviews (n = 16) with 4 family caregivers and participant observations in each of the 4 households over a 6- to 8-month period. Family caregiving in home-based end-of-life care was portrayed in this study as 3 dialectical relational care experiences: (1) prioritizing care recipient needs-ignoring own needs, (2) feeling connected-feeling isolated, and (3) juggling to manage-struggling to survive. Study findings suggest that the sociocultural context of end-of-life care is not conducive to quality care and provide several insights for future directions in nursing practice, policy, and research.