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Velaga VC, Cook A, Auret K, Jenkins T, Thomas G, Aoun SM. Palliative and End-of-Life Care for People Living with Motor Neurone Disease: Ongoing Challenges and Necessity for Shifting Directions. Brain Sci 2023; 13:920. [PMID: 37371398 DOI: 10.3390/brainsci13060920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Although the progressive clinical trajectory of motor neurone disease (MND) is widely understood, multiple challenges remain preventing optimal end-of-life care for this population with unique needs from the patient, carer and service provider perspectives. This paper reports on the experiences, gaps in service and unmet needs of MND patients and family carers and explores public health palliative care approaches that would facilitate coordinated and integrated care to respond to their changing needs. This is a qualitative study of responses to questions in an online consumer survey (353 respondents) in Western Australia (2020), focusing on a subset of 29 current and bereaved carers of people with MND who have used health services in the last five years. The analysis identified themes, highlighting the insufficient integration of services across health and social care; poor and unequal access to coordinated palliative care; significant gaps in the knowledge base of the workforce and a failure to meet the consumer expectations of person-centred care. For palliative care to be accessible to those living with MND and other under-served conditions, there needs to be a shift to more comprehensive, inclusive and sustainable options, such as the public health approach to palliative/end-of-life care that engages the assets of local communities in partnership with health services, one example being the "Compassionate Communities Connectors" model of care. Further considerations include advocacy for policy changes, fostering partnerships and developing indicators for evaluating the impact of the proposed models of care. The end result is not only better care but substantial savings for the health system.
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Affiliation(s)
- Vivek C Velaga
- Perron Institute for Neurological and Translational Science, 8 Verdun St, Nedlands, WA 6009, Australia
| | - Angus Cook
- School of Population and Global Health, University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, WA 6009, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, University of Western Australia, Building M701/31 Stirling Terrace, Albany, WA 6330, Australia
| | - Tom Jenkins
- St John of God Midland Hospital, 1 Clayton Street, Midland, WA 6056, Australia
| | - Geoff Thomas
- Thomas MND Research Group, 48 Grevillea Way, Blackwood, SA 5051, Australia
| | - Samar M Aoun
- Perron Institute for Neurological and Translational Science, 8 Verdun St, Nedlands, WA 6009, Australia
- Medical School, University of Western Australia, 8 Verdun St, Nedlands, WA 6009, Australia
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Hill TG, Langley JE, Kervin EK, Pesut B, Duggleby W, Warner G. An Integrative Review on the Feasibility and Acceptability of Delivering an Online Training and Mentoring Module to Volunteers Working in Community Organizations. Front Digit Health 2021; 3:688982. [PMID: 34723241 PMCID: PMC8551809 DOI: 10.3389/fdgth.2021.688982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Volunteer programs that support older persons can assist them in accessing healthcare in an efficient and effective manner. Community-based initiatives that train volunteers to support patients with advancing illness is an important advance for public health. As part of implementing an effective community-based volunteer-based program, volunteers need to be sufficiently trained. Online training could be an effective and safe way to provide education for volunteers in both initial training and/or continuing education throughout their involvement as a volunteer. Method: We conducted an integrative review that synthesized literature on online training programs for volunteers who support older adults. The review included both a search of existing research literature in six databases, and an online search of online training programs currently being delivered in Canada. The purpose of this review was to examine the feasibility and acceptability of community-based organizations adopting an online training format for their volunteers. Results: The database search identified 13,626 records, these went through abstract and full text screen resulting in a final 15 records. This was supplemented by 2 records identified from hand searching the references, for a total of 17 articles. In addition to identifying Volunteers Roles and Responsibilities; Elements of Training; and Evaluation of Feasibility and Acceptability; a thematic analysis of the 17 records identified the categories: (1) Feasibility Promoting Factors; (2) Barriers to Feasibility; (3) Acceptability Promoting Factors; and (4) Barriers to Acceptability. Six programs were also identified in the online search of online training programs. These programs informed our understanding of delivery of existing online volunteer training programs. Discussion: Findings suggested that feasibility and acceptability of online training were promoted by (a) topic relevant training for volunteers; (b) high engagement of volunteers to prevent attrition; (c) mentorship or leadership component. Challenges to online training included a high workload; time elapsed between training and its application; and client attitude toward volunteers. Future research on online volunteer training should consider how online delivery can be most effectively paced to support volunteers in completing training and the technical skills needed to complete the training and whether teaching these skills can be integrated into programs.
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Affiliation(s)
- Taylor G Hill
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jodi E Langley
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Emily K Kervin
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Barbara Pesut
- Nursing, University of British Columbia, Okanagan, BC, Canada
| | | | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Warner G, Baird LG, McCormack B, Urquhart R, Lawson B, Tschupruk C, Christian E, Weeks L, Kumanan K, Sampalli T. Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis. BMC Palliat Care 2021; 20:114. [PMID: 34271897 PMCID: PMC8285870 DOI: 10.1186/s12904-021-00781-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life. METHODS A realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process. RESULTS Twenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners. CONCLUSIONS Primary care practitioners' use of tools to assess patients/families' needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families' outcomes.
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Affiliation(s)
- Grace Warner
- School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lisa Garland Baird
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, PEI, C1A 4P3, Canada
| | - Brendan McCormack
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU, Scotland
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Cheryl Tschupruk
- Palliative Care Integration, Nova Scotia Health Authority, 530C Bethune Building, 1276 South Park st, Halifax, NS, Canada
| | - Erin Christian
- Primary Health Care Implementation, Nova Scotia Health Authority, 6960 Mumford Road, Suite 2068, Halifax, NS, B3L 4P1, Canada
| | - Lori Weeks
- School of Nursing, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Kothai Kumanan
- Palliative Care Integration, Nova Scotia Health Authority, Room 522 Bethune Building, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
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Warner G, Kervin E, Pesut B, Urquhart R, Duggleby W, Hill T. How do inner and outer settings affect implementation of a community-based innovation for older adults with a serious illness: a qualitative study. BMC Health Serv Res 2021; 21:42. [PMID: 33413394 PMCID: PMC7792161 DOI: 10.1186/s12913-020-06031-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Implementing community-based innovations for older adults with serious illness, who are appropriate for a palliative approach to care, requires developing partnerships between health and community. Nav-CARE is an evidence-based innovation wherein trained volunteer navigators advocate, facilitate community connections, coordinate access to resources, and promote active engagement of older adults within their communities. Acknowledging the importance of partnerships between organizations, the aim of our study was to use the Consolidated Framework for Implementation Research (CFIR) to explore organizational (Inner Setting) and community or health system level (Outer Setting) barriers and facilitators to Nav-CARE implementation. Methods Guided by CFIR, qualitative individual and group interviews were conducted to examine the implementation of Nav-CARE in a Canadian community. Participants were individuals who delivered or managed Nav-CARE research, and stakeholders who provided services in the community. The Framework Method was used to analyse the data. Particular attention was paid to the host organization’s external network and community context. Results Implementation was affected by several inter-related CFIR domains, making it difficult to meaningfully separate key findings by only inner and outer settings. Thus, findings were organized into themes informed by CFIR, that cut across other domains and incorporated inductive findings: intraorganizational perceptions of Nav-CARE; public and healthcare professionals’ perceptions of palliative care; interorganizational partnerships and relationships; community and national-level factors that should have facilitated Nav-CARE implementation; and suggested changes to Nav-CARE. Themes demonstrated barriers to implementing Nav-CARE, such as poor organizational readiness for implementation, and public and health provider perceptions palliative care was synonymous with fast-approaching death. Conclusions Implementation science frameworks and theories commonly focus on assessing implementation of innovations within facilities and changing behaviours of individuals within that organizational structure. Implementation frameworks need to be adapted to better assess Outer Setting factors that affect implementation of community-based programs. Although applying the CFIR helped uncover critical elements in the Inner and Outer Settings that affected implementation of Nav-CARE. Our study suggests that the CFIR could expand the Outer Setting to acknowledge and assess organizational structures and beliefs of individuals within organizations external to the host organization who impact successful implementation of community-based innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06031-6.
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Affiliation(s)
- Grace Warner
- Associate Professor School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Emily Kervin
- Mount Saint Vincent University, 166 Bedford Highway, Halifax, NS, B3M 2J6, Canada
| | - Barb Pesut
- University of British Columbia Okanagan, 1147 Research Road. Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Rm 8-032, 8th floor, Centennial Building, 1678 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Wendy Duggleby
- University of Alberta, 3-141 ECHA 11405 87th Ave., Edmonton, AB, Canada
| | - Taylor Hill
- Department of Psychology and Neuroscience, Dalhousie University, 6299 South St, Halifax, NS, B3H 4J1, Canada
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Pesut B, Duggleby W, Warner G, Bruce P, Ghosh S, Holroyd-Leduc J, Nekolaichuk C, Parmar J. A mixed-method evaluation of a volunteer navigation intervention for older persons living with chronic illness (Nav-CARE): findings from a knowledge translation study. BMC Palliat Care 2020; 19:159. [PMID: 33059655 PMCID: PMC7565322 DOI: 10.1186/s12904-020-00666-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Volunteer navigation is an innovative way to help older persons get connected to resources in their community that they may not know about or have difficulty accessing. Nav-CARE is an intervention in which volunteers, who are trained in navigation, provide services for older persons living at home with chronic illness to improve their quality of life. The goal of this study was to evaluate the impact of Nav-CARE on volunteers, older persons, and family participating across eight Canadian sites. Methods Nav-CARE was implemented using a knowledge translation approach in eight sites using a 12- or 18-month intervention period. A mixed method evaluation was used to understand the outcomes upon older person engagement; volunteer self-efficacy; and older person, family, and volunteer quality of life and satisfaction with the intervention. Results Older persons and family were highly satisfied with the intervention, citing benefits of social connection and support, help with negotiating the social aspects of healthcare, access to cost-effective resources, and family respite. They were less satisfied with the practical help available for transportation and errands. Older persons self-reported knowledge of the services available to them and confidence in making decisions about their healthcare showed statistically significant improvements (P < .05) over 12–18 months. Volunteers reported satisfaction with their role, particularly as it related to building relationships over time, and good self-efficacy. Volunteer attrition was a result of not recruiting older persons in a timely manner. There was no statistically significant improvement in quality of life for older persons, family or volunteers from baseline to study completion. Conclusions Findings from this study support a developing body of evidence showing the contributions volunteers make to enhanced older person and family well-being in the context of chronic illness. Statistically significant improvements were documented in aspects of client engagement. However, there were no statistically significant improvements in quality of life scores even though qualitative data illustrated very specific positive outcomes of the intervention. Similar findings in other volunteer-led intervention studies raise the question of whether there is a need for targeted volunteer-sensitive outcome measures. Supplementary information Supplementary information accompanies this paper at 10.1186/s12904-020-00666-2.
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Affiliation(s)
- Barbara Pesut
- University of British Columbia Okanagan, 1147 Research Road, Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada.
| | - Wendy Duggleby
- University of Alberta, 3-141 ECHA 11405 87th ave, Edmonton, Alberta, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Paxton Bruce
- University of British Columbia Okanagan, 1147 Research Road. Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada
| | - Sunita Ghosh
- University of Alberta/Alberta Health Services, 11560 University Ave, Edmonton, AB, Canada
| | | | - Cheryl Nekolaichuk
- Department of Oncology, University of Alberta, c/o Palliative Institute, Health Services Centre, DC-404, 1090 Youville Drive West, Edmonton, AB, Canada
| | - Jasneet Parmar
- Specialized Geriatrics Program, Department of Family Medicine University of AB, Medical Lead, Home Living and Transitions, AHS EZ Continuing Care, c/o Grey Nuns Community Hospital, 416 St. Marguerite Health Services Centre, 1090 Youville Drive West, Edmonton, AB, T6L 0A3, Canada
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Astle B, Reimer‐Kirkham S, Theron MJ, Lee JWK. An Innovative Online Knowledge Translation Curriculum in Graduate Education. Worldviews Evid Based Nurs 2020; 17:229-238. [DOI: 10.1111/wvn.12440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Barbara Astle
- Trinity Western University Langley British Columbia Canada
| | | | | | - Joyce W. K. Lee
- Patient Family Engagement BC Cancer Vancouver British Columbia Canada
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Implementing volunteer-navigation for older persons with advanced chronic illness (Nav-CARE): a knowledge to action study. BMC Palliat Care 2020; 19:72. [PMID: 32443979 PMCID: PMC7245025 DOI: 10.1186/s12904-020-00578-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nav-CARE is a volunteer-led intervention designed to build upon strategic directions in palliative care: a palliative approach to care, a public health/compassionate community approach to care, and enhancing the capacity of volunteerism. Nav-CARE uses specially trained volunteers to provide lay navigation for older persons and family living at home with advanced chronic illness. The goal of this study was to better understand the implementation factors that influenced the utilization of Nav-CARE in eight diverse Canadian contexts. METHODS This was a Knowledge to Action study using the planned action cycle for Nav-CARE developed through previous studies. Participants were eight community-based hospice societies located in diverse geographic contexts and with diverse capacities. Implementation data was collected at baseline, midpoint, and endpoint using qualitative individual and group interviews. Field notes of all interactions with study sites were also used as part of the data set. Data was analyzed using qualitative descriptive techniques. The study received ethical approval from three university behavioural review boards. All participants provided written consent. RESULTS At baseline, stakeholders perceived Nav-CARE to be a good fit with the strategic directions of their organization by providing early palliative support, by facilitating outreach into the community and by changing the public perception of palliative care. The contextual factors that determined the ease with which Nav-CARE was implemented included the volunteer coordinator champion, organizational capacity and connection, the ability to successfully recruit older persons, and the adequacy of volunteer preparation and mentorship. CONCLUSIONS This study highlighted the importance of community-based champions for the success of volunteer-led initiatives and the critical need for support and mentorship for both volunteers and those who lead them. Further, although the underutilization of hospice has been widely recognized, it is vital to recognize the limitations of their capacity. New initiatives such as Nav-CARE, which are designed to enhance their contributions to palliative care, need to be accompanied by adequate resources. Finally, this study illustrated the need to think carefully about the language and role of hospice societies as palliative care moves toward a public health approach to care.
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Pereira J, Chary S, Moat JB, Faulkner J, Gravelle-Ray N, Carreira O, Vincze D, Parsons G, Riordan B, Hayawi L, Tsang TWY, Ndoria L. Pallium Canada's Curriculum Development Model: A Framework to Support Large-Scale Courseware Development and Deployment. J Palliat Med 2020; 23:759-766. [PMID: 32155359 PMCID: PMC7249472 DOI: 10.1089/jpm.2019.0292] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The need to improve access to palliative care across multiple settings and disease groups has been identified. This requires equipping health care professionals from many different professions, including physicians and nurses, among others, with basic palliative care competencies to provide a palliative care approach. Pallium Canada's Curriculum Development Framework supports the development, deployment, and dissemination, on a large scale, of multiple courses targeting health care professionals across multiple settings of care and disease groups. The Framework is made up of eight phases: (1) Concept, (2) Decision, (3) Curriculum Planning, (4) Prototype Development, (5) Piloting, (6) Dissemination, (7) Language and Cultural Adaptation, and (8) Ongoing Maintenance and Updates. Several of these phases include iterative cyclical activities. The framework allows multiple courses to be developed simultaneously, staggered in a production line with each phase and their corresponding activities requiring different levels of resources and stakeholder engagement. The framework has allowed Pallium Canada to develop, launch, and maintain numerous versions of its Learning Essential Approaches to Palliative Care (LEAP) courses concurrently. It leverages existing LEAP courses and curriculum materials to produce new LEAP courses, allowing significant efficiencies and maximizing output. This article describes the framework and its various activities, which we believe could be very useful for other jurisdictions undertaking the work of developing education programs to spread the palliative care approach across multiple settings, specialties, and disease groups.
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Affiliation(s)
- José Pereira
- Pallium Canada, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; University of Navarra, Navarra, Spain
| | - Srini Chary
- Pallium Canada, Ottawa, Ontario, Canada.,Palliative Care Services, Alberta Health Services, Calgary Zone, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | | | | | | | - Tammy W Y Tsang
- Pallium Canada, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
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Abstract
BACKGROUND Building palliative care capacity among all healthcare practitioners caring for patients with chronic illnesses, who do not work in specialist palliative care services (non-specialist palliative care), is fundamental in providing more responsive and sustainable palliative care. Varying terminology such as 'generalist', 'basic' and 'a palliative approach' are used to describe this care but do not necessarily mean the same thing. Internationally, there are also variations between levels of palliative care which means that non-specialist palliative care may be applied inconsistently in practice because of this. Thus, a systematic exploration of the concept of non-specialist palliative care is warranted. AIM To advance conceptual, theoretical and operational understandings of and clarity around the concept of non-specialist palliative care. DESIGN The principle-based method of concept analysis, from the perspective of four overarching principles, such as epistemological, pragmatic, logical and linguistic, were used to analyse non-specialist palliative care. DATA SOURCES The databases of CINAHL, PubMed, PsycINFO, The Cochrane Library and Embase were searched. Additional searches of grey literature databases, key text books, national palliative care policies and websites of chronic illness and palliative care organisations were also undertaken. CONCLUSION Essential attributes of non-specialist palliative care were identified but were generally poorly measured and understood in practice. This concept is strongly associated with quality of life, holism and patient-centred care, and there was blurring of roles and boundaries particularly with specialist palliative care. Non-specialist palliative care is conceptually immature, presenting a challenge for healthcare practitioners on how this clinical care may be planned, delivered and measured.
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Affiliation(s)
- Mary Nevin
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Geralyn Hynes
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
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Friesen L, Andersen E. Outcomes of collaborative and interdisciplinary palliative education for health care assistants: A qualitative metasummary. J Nurs Manag 2018; 27:461-481. [PMID: 30194886 DOI: 10.1111/jonm.12714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore collaborative and interdisciplinary palliative educational strategies and corresponding outcomes for health care assistants. BACKGROUND Health care assistants are frontline staff who provide almost all hands-on care to seniors. Health care managers are responsible to provide ongoing support and a working environment conducive to health care assistants' abilities to provide quality, safe, evidence-based care. EVALUATION A Qualitative metasummary of collaborative and interdisciplinary teaching strategies was conducted following guidelines developed by Sandelowski et al. (). KEY ISSUES The gold standard of palliative care is interdisciplinary delivery of care, yet education is often monodisciplinary. Furthermore, evaluation of interdisciplinary continuing education is most often subjective via self-report questionnaires. CONCLUSIONS Findings from 16 articles representing 15 studies conducted between 2007 and 2017 were grouped thematically and summarized. Collaborative or interdisciplinary palliative interventions offer health care assistants opportunities to debrief, build their confidence, and critically reflect on the importance of psychosocial care for patients, family and colleagues. IMPLICATIONS FOR NURSING MANAGEMENT The metasummary provides six suggestions for managers who are considering implementing a collaborative palliative educational workshop and draws attention to the need to create contextual changes that support health care assistants to enact newly acquired knowledge and skills.
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Affiliation(s)
- Lynnelle Friesen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Elizabeth Andersen
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
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Shahid S, Taylor EV, Cheetham S, Woods JA, Aoun SM, Thompson SC. Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review. BMC Palliat Care 2018; 17:72. [PMID: 29739457 PMCID: PMC5938813 DOI: 10.1186/s12904-018-0325-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care. Methods A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research. Results Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. Electronic supplementary material The online version of this article (10.1186/s12904-018-0325-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shaouli Shahid
- Centre for Aboriginal Studies (CAS), Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia.
| | - Emma V Taylor
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
| | - Shelley Cheetham
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - John A Woods
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Australia.,Institute for Health Research, Notre Dame University, Fremantle, WA, 6160, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
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Stajduhar K, Sawatzky R, Robin Cohen S, Heyland DK, Allan D, Bidgood D, Norgrove L, Gadermann AM. Bereaved family members' perceptions of the quality of end-of-life care across four types of inpatient care settings. BMC Palliat Care 2017; 16:59. [PMID: 29178901 PMCID: PMC5702136 DOI: 10.1186/s12904-017-0237-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by additionally examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction. METHODS A cross-sectional mail-out survey was conducted of bereaved family members of patients who had died in extended care units (n = 63), intensive care units (n = 30), medical care units (n = 140) and palliative care units (n = 155). 1254 death records were screened and 712 bereaved family caregivers were identified as eligible, of which 558 (who were initially contacted by mail and then followed up by phone) agreed to receive a questionnaire and 388 returned a completed questionnaire (response rate of 70%). Measures included satisfaction with end-of-life care (CANHELP- Canadian Health Care Evaluation Project - family caregiver bereavement version; scores range from 0 = not at all satisfied to 5 = completely satisfied), grief (Texas Revised Inventory of Grief (TRIG)), optimism (Life Orientation Test - Revised) and resilience (The Resilience Scale). ANCOVA and multivariate linear regression were used to analyze the data. RESULTS Family members experienced significantly lower satisfaction in MCU (mean = 3.69) relative to other settings (means of 3.90 [MCU], 4.14 [ICU], and 4.00 [PCU]; F (3371) = 8.30, p = .000). Statistically significant differences were also observed for CANHELP subscales of "doctor and nurse care", "illness management", "health services" and "communication". The regression model explained 18.9% of the variance in the CANHELP total scale, and between 11.8% and 27.8% of the variance in the subscales. Explained variance in the CANHELP total score was attributable to the setting of care and psychological characteristics of family members (44%), in particular resilience. CONCLUSION Findings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.
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Affiliation(s)
- Kelli Stajduhar
- School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - S. Robin Cohen
- Oncology and Medicine, McGill University, Lady Davis Research Institute, Jewish General Hospital, 845 Sherbrooke Street West, Montreal, QC H3A 0G4 Canada
| | - Daren K. Heyland
- Critical Care Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
| | - Diane Allan
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SASK S7N 2Z4 Canada
| | - Darcee Bidgood
- Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Leah Norgrove
- Palliative Care, Saanich Peninsula Hospital, Island Health, 2166 Mt. Newton X Road, Saanichton, BC V8M 2B2 Canada
| | - Anne M. Gadermann
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
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Pesut B, Hooper B, Jacobsen M, Nielsen B, Falk M, O 'Connor BP. Nurse-led navigation to provide early palliative care in rural areas: a pilot study. BMC Palliat Care 2017; 16:37. [PMID: 28583176 PMCID: PMC5460511 DOI: 10.1186/s12904-017-0211-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background Few services are available to support rural older adults living at home with advancing chronic illness. The objective of this project was to pilot a nurse-led navigation service to provide early palliative support for rural older adults and their families living at home with advancing chronic illness. Methods Twenty-five older adults and 11 family members living with advancing chronic illness received bi-weekly home visits by a nurse navigator over a 2-year period. Navigation services included symptom management, education, advance care planning, advocacy, mobilization of resources, and psychosocial support. The nurse navigator collected longitudinal data on older adult and family needs, and older adult quality of life and healthcare utilization. Results Satisfaction with the service was high. There was no attrition over the 2-year period except through death, and few cancelled visits, indicating a high degree of acceptability of the intervention. The navigator addressed complex, multi-faceted needs through connecting health, social, and informal community resources. Participants who indicated a preferred place of death were able to die in that preferred place (n = 7). Emergency room use by participants was minimal and largely unpreventable by the nurse navigator. Longitudinal health-related quality of life scores for many participants were poor, lending further support to the need for more focused attention to this upstream palliative population. Conclusions Using a nurse navigator to facilitate early palliative care for rural older adults living with advanced chronic illness is a promising innovation for meeting the needs of this population. Further research is required to evaluate outcomes on a larger scale.
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Affiliation(s)
- Barbara Pesut
- School of Nursing, University of British Columbia, Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Brenda Hooper
- Greater Trail Hospice Society, 1500 Columbia Ave, Suite 7, Rossland, BC, V1R 1J9, Canada
| | - Marnie Jacobsen
- Greater Trail Hospice Society, 1500 Columbia Ave, Suite 7, Rossland, BC, V1R 1J9, Canada
| | | | - Miranda Falk
- School of Nursing, University of British Columbia, Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Brian P O 'Connor
- Department of Psychology, University of British Columbia, Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
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Sawatzky R, Porterfield P, Roberts D, Lee J, Liang L, Reimer-Kirkham S, Pesut B, Schalkwyk T, Stajduhar K, Tayler C, Baumbusch J, Thorne S. Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis. ANS Adv Nurs Sci 2016; 40:261-277. [PMID: 27930401 PMCID: PMC5555976 DOI: 10.1097/ans.0000000000000163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A palliative approach involves adapting and integrating principles and values from palliative care into the care of persons who have life-limiting conditions throughout their illness trajectories. The aim of this research was to determine what approaches to nursing care delivery support the integration of a palliative approach in hospital, residential, and home care settings. The findings substantiate the importance of embedding the values and tenets of a palliative approach into nursing care delivery, the roles that nurses have in working with interdisciplinary teams to integrate a palliative approach, and the need for practice supports to facilitate that embedding and integration.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Pat Porterfield
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Della Roberts
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Leah Liang
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Sheryl Reimer-Kirkham
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Barb Pesut
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Tilly Schalkwyk
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Kelli Stajduhar
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Carolyn Tayler
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Jennifer Baumbusch
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Sally Thorne
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
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Thorne S, Roberts D, Sawatzky R. Unravelling the Tensions Between Chronic Disease Management and End-of-Life Planning. Res Theory Nurs Pract 2016; 30:91-103. [PMID: 27333631 DOI: 10.1891/1541-6577.30.2.91] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An increasing appreciation for the burden that chronic conditions represent for people and for societies has triggered an evolving body of popular and professional conceptualizations of the nature of the chronic disease challenge. In this discussion article, we trace the trajectory of thinking about chronic illness care, surfacing underlying assumptions and drivers that have shaped current dominant models of service delivery. We note significant gaps in these conceptualizations, especially with respect to the reality that many chronic conditions are life limiting. Contrasting chronic disease theorizing with the conversations that have arisen around end-of-life care for other kinds of health conditions, we argue for a shift in our thinking to accommodate the implications of life limitation in our service delivery planning. We see significant leadership potential in optimizing the role nurses can play across the chronic disease trajectory by integrating the healthy optimism of self-care management with the profound compassion of a person-centered palliative approach.
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Håkanson C, Sandberg J, Ekstedt M, Kenne Sarenmalm E, Christiansen M, Öhlén J. Providing Palliative Care in a Swedish Support Home for People Who Are Homeless. QUALITATIVE HEALTH RESEARCH 2016; 26:1252-1262. [PMID: 25994318 DOI: 10.1177/1049732315588500] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite high frequencies of multiple, life-limiting conditions relating to palliative care needs, people who are homeless are one of the most underserved and rarely encountered groups in palliative care settings. Instead, they often die in care places where palliative competence is not available. In this qualitative single-case study, we explored the conditions and practices of palliative care from the perspective of staff at a Swedish support home for homeless people. Interpretive description guided the research process, and data were generated from repeated reflective conversations with staff in groups, individually, and in pairs. The findings disclose a person-centered approach to palliative care, grounded in the understanding of the person's health/illness and health literacy, and how this is related to and determinant on life as a homeless individual. Four patterns shape this approach: building trustful and family-like relationships, re-dignifying the person, re-considering communication about illness and dying, and re-defining flexible and pragmatic care solutions.
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Affiliation(s)
| | | | | | | | | | - Joakim Öhlén
- Ersta Sköndal University College, Stockholm, Sweden
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Reimer-Kirkham S, Sawatzky R, Roberts D, Cochrane M, Stajduhar K. ‘Close to’ a palliative approach: nurses' and care aides' descriptions of caring for people with advancing chronic life-limiting conditions. J Clin Nurs 2016; 25:2189-99. [DOI: 10.1111/jocn.13256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Richard Sawatzky
- School of Nursing; Trinity Western University; Langley BC Canada
| | | | | | - Kelli Stajduhar
- School of Nursing and Centre on Aging; University of Victoria; Victoria BC Canada
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18
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Sawatzky R, Porterfield P, Lee J, Dixon D, Lounsbury K, Pesut B, Roberts D, Tayler C, Voth J, Stajduhar K. Conceptual foundations of a palliative approach: a knowledge synthesis. BMC Palliat Care 2016; 15:5. [PMID: 26772180 PMCID: PMC4715271 DOI: 10.1186/s12904-016-0076-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background Much of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A “palliative approach” has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care. The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity. Methods We conducted a knowledge synthesis of empirical peer-reviewed literature. Search terms pertaining to “palliative care” and “chronic life-limiting conditions” were identified. A comprehensive database search of 11 research databases for the intersection of these terms yielded 190,204 documents. A subsequent computer-assisted approach using statistical predictive classification methods was used to identify relevant documents, resulting in a final yield of 91 studies. Narrative synthesis methods and thematic analysis were used to then identify and conceptualize key characteristics of a palliative approach. Results The following three overarching themes were conceptualized to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care. Conclusion Our findings provide much needed conceptual clarity regarding a palliative approach. Such clarity is of fundamental importance for the development of healthcare systems that facilitate the integration of a palliative approach in the care of people who have chronic life-limiting conditions.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
| | - Pat Porterfield
- School of Nursing, University of British Columbia, T-201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Duncan Dixon
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Kathleen Lounsbury
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Barbara Pesut
- School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Della Roberts
- Fraser Health, Delta Hospital, Hospice Palliative Care, 5800 Mountain View Blvd, Delta, BC, V4K 3V6, Canada
| | - Carolyn Tayler
- Fraser Health, Suite 400-Central City Tower, 13450 102nd Avenue, Surrey, BC, V3T 0H1, Canada
| | - James Voth
- Intogrey Research and Development Inc., 300-34334 Forrest Terrace, Abbotsford, BC, V2S 1G7, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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Pesut B, McLean T, Reimer-Kirkham S, Hartrick-Doane G, Hutchings D, Russell LB. Educating registered nursing and healthcare assistant students in community-based supportive care of older adults: A mixed methods study. NURSE EDUCATION TODAY 2015; 35:e90-e96. [PMID: 26249645 DOI: 10.1016/j.nedt.2015.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/07/2015] [Accepted: 07/17/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Collaborative education that prepares nursing and healthcare assistant students in supportive care for older adults living at home with advanced chronic illness is an important innovation to prepare the nursing workforce to meet the needs of this growing population. OBJECTIVES To explore whether a collaborative educational intervention could develop registered nursing and healthcare assistant students' capabilities in supportive care while enhancing care of clients with advanced chronic illness in the community. DESIGN Mixed method study design. SETTING A rural college in Canada. PARTICIPANTS Twenty-one registered nursing and 21 healthcare assistant students completed the collaborative workshop. Eight registered nursing students and 13 healthcare assistant students completed an innovative clinical experience with fifteen clients living with advanced chronic illness. METHODS Pre and post-test measures of self-perceived competence and knowledge in supportive care were collected at three time points. Semi-structured interviews were conducted to evaluate the innovative clinical placement. RESULTS Application of Friedman's test indicated statistically significant changes on all self-perceived competence scores for RN and HCA students with two exceptions: the ethical and legal as well as personal and professional issues domains for HCA students. Application of Friedman's test to self-perceived knowledge scores showed statistically significant changes in all but one domain (interprofessional collaboration and communication) for RN students and all but three domains for HCA students (spiritual needs, ethical and legal issues, and inter-professional collaboration and communication). Not all gains were sustained until T-3. The innovative community placement was evaluated positively by clients and students. CONCLUSIONS Collaborative education for nursing and healthcare assistant students can enhance self-perceived knowledge and competence in supportive care of adults with advanced chronic illness. An innovative clinical experience can maximize reciprocal learning while providing nursing services to a population that is not receiving home-based care.
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Affiliation(s)
- Barbara Pesut
- University of British Columbia School of Nursing, 1147 Research Rd., Kelowna, BC, Canada V1V 1V7.
| | - Tammy McLean
- Selkirk College, A-22 301 Frank Beinder Way, Castlegar, BC, Canada V1N 4L3
| | - Sheryl Reimer-Kirkham
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, Canada V2Y 1Y1
| | - Gweneth Hartrick-Doane
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8W 2Y2
| | - Deanna Hutchings
- End of Life Care, Vancouver Island Health Authority, Room 309N, Aberdeen Hospital, Third Floor-1450 Hillside Avenue, Victoria, BC, Canada V8T 2B7
| | - Lara B Russell
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8W 2Y2
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Abstract
Approaches to knowledge translation (KT) have undergone substantial transformation in an effort to find more effective strategies to ensure the best available knowledge informs nursing practice. However, the fundamental epistemology underpinning KT itself has gone largely unquestioned. Of particular concern is the inadequacy of current representational models to depict the complex, social process of KT. To address the limitations of representational models we propose an inquiry heuristic that conceptualizes KT as a knowledge-as-action process. Developed through a series of KT research projects, the heuristic is intended to guide the KT process and support effective navigation in the complexities of contemporary health care milieus.
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Translational Scholarship and a Palliative Approach: Enlisting the Knowledge-As-Action Framework. ANS Adv Nurs Sci 2015; 38:187-202. [PMID: 26244476 DOI: 10.1097/ans.0000000000000077] [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
Based on a retheorized epistemology for knowledge translation (KT) that problematizes the "know-do gap" and conceptualizes the knower, knowledge, and action as inseparable, this paper describes the application of the Knowledge-As-Action Framework. When applied as a heuristic device to support an inquiry process, the framework with the metaphor of a kite facilitates a responsiveness to the complexities that characterize KT. Examples from a KT demonstration project on the integration of a palliative approach at 3 clinical sites illustrate the interrelatedness of 6 dimensions-the local context, processes, people, knowledge, fluctuating realities, and values.
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