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Leclerc-Loiselle J, Gendron S, Daneault S. Nursing activities for health promotion in palliative home care: an integrative review. Palliat Care Soc Pract 2024; 18:26323524241235191. [PMID: 38487793 PMCID: PMC10938613 DOI: 10.1177/26323524241235191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.
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Affiliation(s)
- Jérôme Leclerc-Loiselle
- School of Nursing, Université de Sherbrooke, 150, Pl. Charles-Le Moyne, L1-7730, Longueuil, QC J4K 0A8, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
| | - Sylvie Gendron
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Serge Daneault
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
- Research centre of Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
- Integrated University Health and Social Services Centre of Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada Réseau québécois de recherche en soins palliatifs et de fin de vie (RQSPAL), Québec, QC, Canada
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2
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Wu YH, Hsieh HY, Kuo YL, Wu CY. The experiences and needs of nurses providing home-based palliative care: A qualitative meta-synthesis. J Palliat Care 2023; 38:490-502. [PMID: 35642265 DOI: 10.1177/08258597221105167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective(s): We conducted a qualitative meta-synthesis of qualitative studies on nurses' experiences when caring for palliative patients to (1) identify the needs of nurses and (2) describe their experiences to provide more in-depth information. Methods: Qualitative articles published in English from 2000 to 2022 were identified from several databases through a searching strategy. Authors screened through the title, abstract, and full text of relevant studies. Articles were read repeatedly and discussed. The thematic analysis methodology was adopted to analyze the data. Results: Of 967 articles, 22 were included in our review. Notions reflecting community nurses providing palliative home care were clustered into four themes: (1) nature of community-based palliative nursing, (2) teamwork, (3) relationship with patient and family, and (4) resources. Findings also suggest establishing a sound support system, strengthening palliative education, and creating more decisive referral criteria and systems. Conclusions: The growing need for palliative home care has become challenging for community health care systems. Our study summarized various aspects of nurses providing home-based palliative care. The findings provide information for health care and education settings to improve home care systems and recruit more staff to meet the needs.
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Affiliation(s)
- Yu-Hsuan Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,Taiwan
| | - Hui-Ya Hsieh
- Department of Specialist Nurse and Surgical Nurse Practitioner Office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,Taiwan
| | - Yu-Ling Kuo
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,Taiwan
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,Taiwan
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung,Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung,Taiwan
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Skorpen Tarberg A, Landstad BJ, Hole T, Thronaes M, Kvangarsnes M. Nurses' experiences of compassionate care in the palliative pathway. J Clin Nurs 2020; 29:4818-4826. [PMID: 33031582 PMCID: PMC7756377 DOI: 10.1111/jocn.15528] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 01/10/2023]
Abstract
Aims and objectives The aim was to explore how nurses experience compassionate care for patients with cancer and family caregivers in different phases of the palliative pathway. Background Compassion is fundamental to palliative care and viewed as a cornerstone of high‐quality care provision. Healthcare authorities emphasize that patients should have the opportunity to stay at home for as long as possible. There are, however, care deficiencies in the palliative pathway. Design This study employed a qualitative design using focus groups and a hermeneutic approach. Methods Four focus groups with three to seven female nurses in each group were conducted in Mid‐Norway in 2018. Nurses’ ages ranged from 28–60 years (mean age = 45 years), and they were recruited through purposive sampling (N = 21). Compassionate care was chosen as the theoretical framework. Reporting followed the COREQ guidelines. Results Three themes expressing compassionate care related to different phases of the pathway were identified: (a) information and dialogue, (b) creating a space for dying and (c) family caregivers’ acceptance of death. Conclusions This study showed that it was crucial to create a space for dying, characterized by trust, collaboration, good relationships, empathy, attention, silence, caution, slowness, symptom relief and the absence of noise and conflict. Relevance to clinical practice The quality of compassion possessed by individual practitioners, as well as the overall design of the healthcare system, must be considered when creating compassionate care for patients and their family caregivers. Nursing educators and health authorities should pay attention to the development of compassion in education and practice. Further research should highlight patients’ and family caregivers’ experiences of compassionate care and determine how healthcare systems can support compassionate care.
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Affiliation(s)
- Anett Skorpen Tarberg
- Medical department, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, European Palliative Care Centre (PRC), Norwegian University of science and Technology (NTNU, Trondheim, Norway
| | - Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torstein Hole
- Medical department, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Thronaes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, European Palliative Care Centre (PRC), Norwegian University of science and Technology (NTNU, Trondheim, Norway.,Cancer Clinic, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Ålesund, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
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4
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Yeh T, Huang H, Yeh T, Huang W, Huang H, Chang Y, Chen W. Family members' concerns about relatives in long‐term care facilities: Acceptance of visiting restriction policy amid the
COVID
‐19 pandemic. Geriatr Gerontol Int 2020; 20:938-942. [DOI: 10.1111/ggi.14022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/03/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ting‐Chun Yeh
- Department of Community Health Ditmanson Medical Foundation Chiayi Christian Hospital Chiayi Taiwan
| | | | - Ting‐Yu Yeh
- Department of Community Service Ditmanson Medical Foundation Chiayi Christian Hospital Chiayi Taiwan
| | - Wan‐Ting Huang
- Clinical Medicine Research Center Ditmanson Medical Foundation Chiayi Christian Hospital Chiayi Taiwan
| | - Hsiu‐Chen Huang
- Department of Community Health Ditmanson Medical Foundation Chiayi Christian Hospital Chiayi Taiwan
| | | | - Wei Chen
- Department of Community Health Ditmanson Medical Foundation Chiayi Christian Hospital Chiayi Taiwan
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5
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Baik D, Russell D, Jordan L, Matlock DD, Dooley F, Masterson Creber R. Building trust and facilitating goals of care conversations: A qualitative study in people with heart failure receiving home hospice care. Palliat Med 2020; 34:925-933. [PMID: 32374659 PMCID: PMC7339047 DOI: 10.1177/0269216320917873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite a majority of persons receiving hospice care in their homes, there are gaps in understanding how to facilitate goals of care conversations between persons with heart failure and healthcare providers. AIM To identify barriers and facilitators which shape goals of care conversations for persons with heart failure in the context of home hospice. DESIGN A qualitative descriptive study design was used with semi-structured interviews. SETTING/PARTICIPANTS We conducted qualitative interviews with persons with heart failure, family caregivers, and interprofessional healthcare team members at a large not-for-profit hospice agency in New York City between March 2018 and February 2019. RESULTS A total of 39 qualitative interviews were conducted, including with healthcare team members (e.g. nurses, physicians, social workers, spiritual counselors), persons with heart failure, and family caregivers. Three themes emerged from the qualitative interviews regarding facilitators and barriers in goals of care conversations for better decision-making: (1) trust is key to building and maintaining goals of care conversations; (2) lack of understanding and acceptance of hospice inhibits goals of care conversations; and (3) family support and engagement promote goals of care conversations. CONCLUSION Findings from this study suggest that interventions designed to improve goals of care conversations in the home hospice setting should focus on promoting understanding and acceptance of hospice, family support and engagement, and building trusting relationships with interprofessional healthcare teams.
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Affiliation(s)
- Dawon Baik
- College of Nursing, University of Colorado, Aurora, CO, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Visiting Nurse Service of New York, New York, NY, USA
| | | | | | | | - Ruth Masterson Creber
- Division of Health Informatics, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
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6
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Abstract
A new concept in palliative care, cocreation, appears to be a part of caring in nursing but has not yet been explored as a caring phenomenon. The aim was to, from a caring science perspective, explore how cocreation can be experienced as a phenomenon by nurses working in palliative home care. A hermeneutical approach and thematic analysis were used. The material consisted of texts from in-depth interviews with 12 nurses in a home care context. Informed consent regarding study participation and the storage and handling of data for research purposes were sought from participants. One main theme and 4 subthemes emerged. Cocreation can be viewed as an essential part of caring and being involved in patients' health and holistic care is a profound endeavor. Further research should focus on illuminating cocreation from patients' perspectives.
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7
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Bergdahl E, Ternestedt B, Berterö C, Andershed B. The theory of a co-creative process in advanced palliative home care nursing encounters: A qualitative deductive approach over time. Nurs Open 2019; 6:175-188. [PMID: 30534407 PMCID: PMC6279716 DOI: 10.1002/nop2.203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/02/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022] Open
Abstract
AIMS AND OBJECTIVES The aim of this study was to test the theoretical conceptualization of the co-creative process in home care nursing encounters over time. METHOD AND DESIGN This was a multiple case study with a deductive analysis of qualitative data over time, using interviews and observations collected from three cases. RESULTS The co-creative process was complex and contained main, sub- and micro-processes. Time was important and valuable, giving the patient and relatives space to adjust the process to their own pace. Some processes were worked on more intensively in accordance with the patients' and relatives' needs, and these are considered the main-process. The further developed theory of the co-creative process and its main, sub- and microprocesses can be understood as a concretization of how good nursing care can be performed within caring relationships in the context of advanced palliative home care.
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Affiliation(s)
| | - Britt‐Marie Ternestedt
- Department of Health Care Science/Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
| | - Carina Berterö
- Division of Nursing Science, Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Birgitta Andershed
- Department of Health Care Science/Palliative Research CentreErsta Sköndal Bräcke University CollegeStockholmSweden
- Faculty of Health, Care and NursingNorwegian University of Science and TechnologyGjøvikNorway
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8
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Ward-Griffin C, McWilliam C, Oudshoorn A. Negotiating Relational Practice Patterns in Palliative Home Care. J Palliat Care 2018. [DOI: 10.1177/082585971202800206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Providing palliative care in the home presents a variety of challenges for nurses and other care providers. As part of a focused ethnographic study examining client/caregiver/care-provider relationships within the socio-cultural context of home-based palliative care, this paper describes the provision of palliative care to Canadian seniors with advanced cancer from the perspective of nurses. Data were collected through in-depth interviews (n=19) with three palliative care nurses and participant observations in four households over a six-to-eight-month period. Home-based palliative care nursing was depicted in this study as a dialectical experience, revealing three relational practice patterns: making time-forfeiting time, connecting-withdrawing, and enabling-disabling. Nurses attempted to negotiate the tensions between these opposing approaches to palliative care. Study findings suggest that the socio-cultural context of palliative care is not conducive to high-quality palliative care and provide several insights related to future directions for practice, policy, and research.
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Affiliation(s)
- Catherine Ward-Griffin
- C Ward-Griffin (corresponding author): Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada N6A 5C1
| | - Carol McWilliam
- C McWilliam, A Oudshoorn: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Abram Oudshoorn
- C McWilliam, A Oudshoorn: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
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9
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Iwasaki T, Yamamoto-Mitani N, Sato K, Yumoto Y, Noguchi-Watanabe M, Ogata Y. A purposeful Yet Nonimposing Approach: How Japanese Home Care Nurses Establish Relationships With Older Clients and Their Families. JOURNAL OF FAMILY NURSING 2017; 23:534-561. [PMID: 29199533 DOI: 10.1177/1074840717743247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Relationship development is crucial to nursing practice with families. However, little is known about the process of building relationships with multiple family members in home care settings and in various cultures. The objective of this study was to explore the experiences of home care nurses about how they established relationships with older clients and their families in Japan. Grounded theory was used to guide the research. Twenty-three expert home care nurses participated in semistructured interviews concerning their family nursing practice. The establishment of relationships with clients/family members was based on a purposeful yet nonimposing approach composed of four aspects: keeping a mindful distance from the family, not being a threat to family life, being a comfortable neighbor, and gaining trust as a competent nurse. Through a purposeful nonimposing approach, Japanese home care nurses promoted and nurtured nurse-family relationships and became involved in the life of the family. These findings provide a useful foundation to guide practice with families and grow knowledge about the process of establishing relationships with multiple family members in home settings.
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Affiliation(s)
- Takako Iwasaki
- 1 Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
- 2 Tokyo Medical and Dental University, Japan
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10
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Rosemond C, Hanson LC, Zimmerman S. Goals of Care or Goals of Trust? How Family Members Perceive Goals for Dying Nursing Home Residents. J Palliat Med 2017; 20:360-365. [PMID: 27898281 PMCID: PMC5385445 DOI: 10.1089/jpm.2016.0271] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF STUDY Dementia affects more than 5 million Americans, and is a leading cause of death. Family members of nursing home (NH) residents with advanced dementia report difficulty making decisions about care toward the end of life. As part of a randomized trial testing an intervention to improve decision making, this qualitative study aimed to understand how family decision makers experienced goal-based decision making in advance of the death of their relative. DESIGN AND METHODS This qualitative study was conducted as part of the goals of care clinical trial. Study participants (n = 16) were family decision makers in North Carolina whose relative with advanced dementia died after participating in the goals of care intervention. Semi-structured interviews were analyzed using a qualitative description approach. RESULTS Family members' experience of decision making and death differed based on the presence or absence of trusting relationships with NH staff. Family members who reported trust described a positive end-of-life experience and less need for prescribed goals of care discussions. In the absence of trust, family members reported that goals of care discussions were ignored by staff or created confusion. IMPLICATIONS Among family members of persons who recently died from dementia in NHs, expressions of trust in staff were strongly related to perceptions of decision making about goals of care. Although goals of care discussions may potentially promote communication to earn trust, the presence of pre-existing trust ultimately influenced the decision making and end-of-life experiences of residents and families.
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Affiliation(s)
- Cherie Rosemond
- Partnerships in Aging Program, University of North Carolina, Chapel Hill, North Carolina
| | - Laura C. Hanson
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
- Division of Geriatric Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina
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Sutherland N, Ward-Griffin C, McWilliam C, Stajduhar K. Gendered Processes in Hospice Palliative Home Care for Seniors With Cancer and Their Family Caregivers. QUALITATIVE HEALTH RESEARCH 2016; 26:907-920. [PMID: 26489710 DOI: 10.1177/1049732315609571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There has been limited investigation into the processes that shape gender (in)equities in hospice palliative home care. As part of a larger critical ethnographic study, we examined how and why gender relations occur in this context. Using a critical feminist lens, we conducted in-depth interviews with clients living with terminal cancer, their family caregivers and primary nurses; observations of agency home visits; and review of institutional documents. A gender-based analysis revealed that gender enactments of Regulating Gender Relations were legitimized through ideological processes of Normalizing Gender Relations and Equalizing Gender Relations (Re)produced through institutional discourses of individualism and egalitarianism, these gendered processes both advantaged and disadvantaged men and women in hospice palliative home care. Findings suggest that to promote equity, health care providers and policy makers must attend to gender as a prevalent social determinant of health and health care. Implications for policy, practice, education, and research are discussed.
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Applying research into practice: a guide to determine the next palliative home care nurse visit. ACTA ACUST UNITED AC 2015; 32:88-95; quiz 95-7. [PMID: 24492266 DOI: 10.1097/nhh.0000000000000018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Beyond their own family caregivers, home healthcare nurses play a pivotal role in caring for those dying at home. However, deciding the timing of the next visit for these patients and their families is not straightforward. The Palliative Care: Determining Next Home Care Nurse Visit decision guide supports clinicians in their decision-making process of planning visits to most effectively meet the needs and goals of patients and families during the final months of life.
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Stajduhar KI, Funk L, Outcalt L. Family caregiver learning--how family caregivers learn to provide care at the end of life: a qualitative secondary analysis of four datasets. Palliat Med 2013; 27:657-64. [PMID: 23695826 DOI: 10.1177/0269216313487765] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family caregivers are assuming growing responsibilities in providing care to dying family members. Supporting them is fundamental to ensure quality end-of-life care and to buffer potentially negative outcomes, although family caregivers frequently acknowledge a deficiency of information, knowledge, and skills necessary to assume the tasks involved in this care. AIM The aim of this inquiry was to explore how family caregivers describe learning to provide care to palliative patients. DESIGN Secondary analysis of data from four qualitative studies (n = 156) with family caregivers of dying people. DATA SOURCES Data included qualitative interviews with 156 family caregivers of dying people. RESULTS Family caregivers learn through the following processes: trial and error, actively seeking needed information and guidance, applying knowledge and skills from previous experience, and reflecting on their current experiences. Caregivers generally preferred and appreciated a supported or guided learning process that involved being shown or told by others, usually learning reactively after a crisis. CONCLUSIONS Findings inform areas for future research to identify effective, individualized programs and interventions to support positive learning experiences for family caregivers of dying people.
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Affiliation(s)
- Kelli I Stajduhar
- School of Nursing, University of Victoria, Victoria, BC V8W 2Y2, Canada.
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14
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Silva L, Poles K, Baliza MF, Silva MCLDSR, Santos MRD, Bousso RS. The process of end-of-life care delivery to the families of elderly patients according to the Family Health Strategy. Rev Lat Am Enfermagem 2013; 21:380-7. [DOI: 10.1590/s0104-11692013000100013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 12/03/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To understand the process of end-of-life care delivery to the families of elderly patients according to a Family Health Strategy (FHS) team, to identify the meanings the team attributes to the experience and to build a theoretical model. METHOD: Symbolic Interactionism and Grounded Theory were applied. Fourteen professionals working in an FHS located in a country town in the state of São Paulo were interviewed. RESULTS: Through comparative analysis, the core category overcoming challenges to assist the family and the elderly during the dying process was identified, and it was composed of the following sub-processes: Identifying situational problems, Planning a new care strategy, Managing the care and Evaluating the care process. CONCLUSION: the team faces difficulties to achieve better performance in attending to the biological and emotional needs of families, seeking to ensure dignity to the elderly at the end of their lives and expand access to healthcare.
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15
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Bergdahl E, Benzein E, Ternestedt BM, Elmberger E, Andershed B. Co-creating possibilities for patients in palliative care to reach vital goals--a multiple case study of home-care nursing encounters. Nurs Inq 2013; 20:341-51. [PMID: 23336338 DOI: 10.1111/nin.12022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The patient's home is a common setting for palliative care. This means that we need to understand current palliative care philosophy and how its goals can be realized in home-care nursing encounters (HCNEs) between the nurse, patient and patient's relatives. The existing research on this topic describes both a negative and a positive perspective. There has, however, been a reliance on interview and descriptive methods in this context. The aim of this study was to explore planned HCNEs in palliative care. The design was a multiple case study based on observations. The analysis includes a descriptive and an explanation building phase. The results show that planned palliative HCNEs can be described as a process of co-creating possibilities for the patient to reach vital goals through shared knowledge in a warm and caring atmosphere, based on good caring relations. However, in some HCNEs, co-creation did not occur: Wishes and needs were discouraged or made impossible and vital goals were not reached for the patients or their relatives. Further research is needed to understand why. The co-creative process presented in this article can be seen as a concretization of the palliative care ideal of working with a person-centered approach.
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Affiliation(s)
- Elisabeth Bergdahl
- FOU nu, Research and Development Centre, Jakobsbergs sjukhus, Järfälla, SwedenDepartment of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, SwedenDepartment of Palliative Care Research, Ersta Sköndal University College, Stockholm, SwedenSchool of Health and Caring Sciences, Linnaeus University, Kalmar, SwedenDepartment of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, SwedenDepartment of Health Care Sciences, Ersta Sköndal University College, Stockholm, SwedenDepartment of Nursing, Gjøvik University College, Gjøvik, NorwayStockholms Sjukhem Foundation, Research and Development Department, Stockhom, Sweden
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16
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Fukui S, Yoshiuchi K. Associations with the Japanese population's preferences for the place of end-of-life care and their need for receiving health care services. J Palliat Med 2012; 15:1106-12. [PMID: 22788951 DOI: 10.1089/jpm.2012.0034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aims of this study were to identify the associations with the Japanese population's preferences for the place of end-of-life care and their need for receiving health care services. METHODS A secondary analysis of a cross-sectional nationwide survey was conducted for 2000 randomly selected Japanese people aged 40-79 years. RESULTS A total of 1042 people (55%) responded. Regarding preferred place of care, we set the place within the choices of "Home" (preferred by 44% of respondents), "Acute Hospital" (15%), "Palliative Care Unit" (19%), "Public Nursing Home" (10%), and "Private Nursing Home" (2%). Multinomial logistic regression analysis revealed that the people who preferred "Acute Hospital" tended to have the following need compared to those who preferred "Home," "Palliative Care Unit," or "Nursing Home": higher need for receiving end-of-life care not from its experienced professionals but from the same staff; higher need for using health care services in highly supported environment such as the need for being near health care staff whenever and for receiving treatment possibly until the end; and higher need for consulting nurses whenever. They had lower need for using home care services and daycare services and also lower need for instructing families about how to use insurance/public health services. CONCLUSIONS The present findings may help to develop an effective end-of-life care system in Japan considering Japanese people's need for health care services. Also, the results of this study may underscore the importance of education on receiving home care services especially for the people who presently prefer the hospital for end-of-life care.
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Affiliation(s)
- Sakiko Fukui
- Department of Community Health Nursing, Graduate School of Nursing, The Japanese Red Cross University, Shibuya-ku, Tokyo, Japan.
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Ward-Griffin C, Hall J, Deforge R, St-Amant O, McWilliam C, Oudshoorn A, Forbes D, Klosek M. Dementia home care resources: how are we managing? J Aging Res 2011; 2012:590724. [PMID: 22132332 PMCID: PMC3205668 DOI: 10.1155/2012/590724] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/05/2011] [Indexed: 11/18/2022] Open
Abstract
With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future.
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Affiliation(s)
- Catherine Ward-Griffin
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario (UWO), London, ON, Canada N6A 5C1
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Funk L, Stajduhar K. Analysis and Proposed Model of Family Caregivers’ Relationships With Home Health Providers and Perceptions of the Quality of Formal Services. J Appl Gerontol 2011; 32:188-206. [DOI: 10.1177/0733464811408699] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Relationships between families and home health nurses promote effective care and service access for those at end of life, positive caregiver experiences, and satisfaction with care. This study explores family caregivers’ accounts of relationships with home care nurses; findings inform a model of relationships and satisfaction with home health services. Ethnographic, qualitative interviews were conducted with 26 bereaved caregivers in one Western Canadian regional health agency. Data analysis was informed by symbolic interactionism. Participants described their relationships with home care nurses and spoke about their assessments of the care provided. Findings highlighted the importance of the length, frequency, and continuity of contact, conversation, socializing, and sharing information. Participants were cognizant of their own and care recipients’ roles in building relationship. Nurse behaviors demonstrating affection, acknowledgment, commitment, and understanding were appreciated. A model links relationship preconditions, relational demonstrations, and perceived care quality and may be used to identify points of intervention.
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Affiliation(s)
- Laura Funk
- University of Victoria, British Columbia, Canada
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