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Colquhoun-Flannery E, Goodwin D, Walshe C. How clinicians recognise people who are dying: An integrative review. Int J Nurs Stud 2024; 151:104666. [PMID: 38134558 DOI: 10.1016/j.ijnurstu.2023.104666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Timely recognition of dying is important for high quality end-of-life care however, little is known about how clinicians recognise dying. Late recognition is common and can lead to futile treatment that can prolong or increase suffering and prevent a change in the focus of care. AIM To explore how clinicians caring for dying people recognise that they are in the last days or hours of life, as well as the factors that influence the recognition of dying. DESIGN A systematically constructed integrative review of the literature. METHODS Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsycInfo and Allied and Complementary Medicine were searched in July 2022. Papers were included if they were original research, discussed how clinicians recognise dying, available in English language and published in 2012 or later. A constant comparison approach was applied to the analysis and synthesis of the literature. RESULTS 24 papers met the inclusion criteria. There were 3 main categories identified: 'Clues and signals' refers to prompts and signs that lead a clinician to believe a person is dying, incorporating the sub-categories 'knowing the patient over time', and 'intuition and experience'. 'Recognition by others' is where clinicians come to recognise someone is dying through others. This can be through a change in the context of care such as a tool or care plan or by communication with the team. 'Culture, system and practice' refers to the cultural beliefs of a setting that influences awareness of dying and denial of death as a possibility and avoidance of naming death and dying directly. System and practice of the setting also impact on recognition of dying. This involves work pace and intensity, shift systems and timing of senior reviews of patients. Uncertainty and its impact on recognition of dying are evident throughout the findings of this review. The seeking of certainty and the absence of the possibility of dying contributes to late recognition of dying. DISCUSSION Recognition of dying is a complex process that occurs over time, involving a combination of intuition and gathering of information, that is influenced by contextual factors. A culture where dying is not openly acknowledged or even named explicitly contributes to late recognition of dying. A shared language and consistent terminology for explicitly naming dying are needed. Uncertainty is intrinsic to the recognition of dying and therefore a shift to recognising the possibility of dying rather than seeking certainty is needed. REGISTRATION (PROSPERO) CRD42022360900. Registered September 2022.
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Affiliation(s)
- Elizabeth Colquhoun-Flannery
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
| | - Dawn Goodwin
- Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
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Soo Rui Ting M, Nashi NB, Ang Lin Elaine K, Hooi BMY. Effect of a multidisciplinary ward-based intervention on end-of-life care for general medicine patients. Palliat Support Care 2022; 20:813-817. [PMID: 34663485 DOI: 10.1017/s1478951521001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Providing good end-of-life (EOL) care for noncancer patients has been made a national priority in Singapore. A combined medical and nursing ward-based intervention known as the EOL care plan was piloted in a general medicine ward at our institution, aiming to guide key aspects of EOL care. The aim of this study is to assess the EOL care plan's effect on EOL care for general medicine patients. METHOD We conducted a retrospective cohort study on inpatients who died in a general ward under the discipline "General Medicine" from May to October 2019. We collected data around symptom management, rationalization of care and communication with families. The primary analysis compared care received by patients who died in the pilot ward with that of a control group of patients who died in other wards. RESULTS In total, 112 records were included in the analysis. Pain assessment was more common in the pilot ward compared with the control group (35.3% vs. 6.3%, p < 0.001), as were anti-psychotic prescriptions for delirium (64.7% vs. 24.4%, p = 0.001). Fewer patients received blood glucose monitoring in the last 48 h of life in the pilot ward (69.5% vs. 35.3%, p = 0.007). There were also less frequent parameters monitoring in the pilot ward (p < 0.004). SIGNIFICANCE OF RESULTS The implementation of the EOL care plan was associated with process-level indicators of better EOL care, suggesting that it could have a significant positive impact when implemented on a wider scale.
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Affiliation(s)
- Michelle Soo Rui Ting
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Norshima Binte Nashi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kai Ang Lin Elaine
- Division of Oncology Nursing, National Cancer Institute Singapore, National University Hospital, Singapore, Singapore
| | - Benjamin M Y Hooi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
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Mathew JM, Thelly AS, Antony L. Empowering Nurses to Meet Challenges and Lead Palliative Care for Achieving Triple Billion Targets. Indian J Palliat Care 2022; 28:174-179. [PMID: 35673686 PMCID: PMC9168282 DOI: 10.25259/ijpc_56_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Nurses provide care to patients in all contexts and at all stages of their lives. Their contributions are crucial to meeting global goals like Universal Health Coverage (UHC) and the Sustainable Developmental Goals (SDG) which present challenges and opportunity to improve nursing services including rehabilitation and palliative care. This study identifies challenges for empowering nurses to lead palliative care and achieve triple billion targets'. Determine reasons for challenges to empower nurses. Recommends strategies to overcome challenges in order to empower nurses to lead palliative care and achieve triple billion targets'. Materials and methods Multiple brainstorming sessions were conducted through the Zoom platform among the three authors to 'identify challenges for empowering nurses to lead palliative care and achieve triple billion targets' and recommend strategies to overcome those challenges. Narrative literature review was conducted and experts' opinions were elicited. Identified aspects were discussed in further brainstorming sessions. Result Challenges and reasons for empowering nurses to lead palliative care and achieve triple billion targets' were identified and strategies to overcome those challenges were recommended. Conclusion Equitable, competent and compassionate palliative care is a primary tool to relieve serious health-related suffering. There is a pressing necessity to provide available, accessible, acceptable, quality, and cost-effective palliative nursing care. WHO proposed the triple billion targets to improve the health of billions where palliative care is an essential element that can be achieved only with proper identification of challenges and meticulous planning and implementation of strategies to overcome those challenges.
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Affiliation(s)
- Juby M Mathew
- Department of Obstetrical and Gynaecological Nursing, Velankanni Matha College of Nursing, Kottayam, Kerala, India
| | - Anu Savio Thelly
- Department of Palliative Medicine, Palliative Care Nursing, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Pondicherry, India
| | - Lovely Antony
- Department of Community Health Nursing, SIMET College of Nursing, Palakkad, Kerala, India
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Brickey J, Flannery M, Cuthel A, Cho J, Grudzen CR. Barriers to recruitment into emergency department-initiated palliative care: a sub-study of a multi-site, randomized controlled trial. BMC Palliat Care 2022; 21:22. [PMID: 35168622 PMCID: PMC8845365 DOI: 10.1186/s12904-021-00899-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency department (ED) visits among older adults are common near the end of life. Palliative care has been shown to reduce ED visits and to increase quality of life among patients, but recruitment into these programs is often challenging. This descriptive analysis explores the barriers to enrolling seriously ill patients scheduled for discharge from the ED into palliative care research. METHODS This descriptive sub-study aims to assess the reasons why patients with advanced illness scheduled for discharge home from 11 EDs across the United States decline to participate in Emergency Medicine Palliative Care Access (EMPallA), a Phase IV randomized controlled trial (RCT) comparing two modes of palliative care delivery. Our aim was to understand why patients decline to enroll to improve future recruitment rates and expand care for patients discharged home from the ED. Research coordinators documented reasons that patients declined to enroll in the larger EMPallA trial; reasons for refusing participation were independently analyzed by two researchers to identify overarching themes. RESULTS Enrollment rate across all sites was 45%; of the 504 eligible patients who declined participation, 47% (n = 237) declined for reasons related to illness severity. 28% of refusals (n = 143) were related to the mode of palliative care delivery, while 24% (n = 123) were due to misconceptions or stigma related to palliative care. Less commonly, patients refused due to general research barriers (16.5%), family/caregiver barriers (11.7%), and physician-related barriers (< 1%). CONCLUSIONS Patients with advanced illnesses presenting to the ED often refuse to participate in palliative care research due to the severity of their illness, the mode of care delivery, and misconceptions about palliative care. In contrast with other studies, our study found minimal physician gatekeeping, which may be the result of both changing attitudes toward palliative care and the nature of the ED setting. Robust training programs are crucial to overcome these misconceptions and to educate patients and providers about the role of palliative care. Future palliative care programs and study designs should recognize the burden this vulnerable population endures and consider alternative modes of care delivery in an effort to increase participation and enrollment. CLINICAL TRIALS REGISTRATION NCT03325985 , October 30, 2017.
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Affiliation(s)
- Julia Brickey
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mara Flannery
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, Translational Research Building, 227 East 30th Street, Office 117, New York, NY, 10016, USA
| | - Allison Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, Translational Research Building, 227 East 30th Street, Office 117, New York, NY, 10016, USA.
| | - Jeanne Cho
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, Translational Research Building, 227 East 30th Street, Office 117, New York, NY, 10016, USA
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, Translational Research Building, 227 East 30th Street, Office 117, New York, NY, 10016, USA
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Abstract
OBJECTIVE The objective of this training project is to develop and host Interprofessional Communication courses to improve interdisciplinary communication in oncology care. The initial national course was held in a virtual format and included pre- and post-course participant data. The curriculum was developed with support from the National Cancer Institute. METHODS A virtual two-day course was held to equip nurses, social workers, and chaplains with vital communication skills in oncology practice, so that they could return to their home institutions and teach communication skills to other healthcare professionals, with the intention of making improved communication a quality improvement goal. Fifty-two participants were selected through an application process to attend the virtual course in two-person interprofessional teams (e.g., nurse and chaplain, or social worker and nurse). The Interprofessional Communication Curriculum was based on the National Consensus Project for Quality Palliative Care's eight domains of quality palliative care. The six online modules developed by the investigators were presented in lectures, supplemented by discussion groups, role plays, and other methods of experiential learning. RESULTS Pre- and post-course results identified areas of communication, which are a priority for improvement by oncology clinicians. Participant goals identified specific strategies to be implemented by participants in their settings. SIGNIFICANCE OF RESULTS The need for communication training was clearly demonstrated across professions in this national training course. Participants were able to apply course content to their goals for quality improvement in cancer settings.
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Affiliation(s)
- Haley Buller
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA 91010
| | - Betty R. Ferrell
- Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA 91010
| | - Judith A. Paice
- Feinberg School of Medicine, Division of Hematology-Oncology, Northwestern University, Chicago, IL
| | - Myra Glajchen
- MJHS Institute for Innovation in Palliative Care, New York, NY
| | - Trace Haythorn
- Association for Clinical Pastoral Education (ACPE), Atlanta, GA 30308
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Alrasheedi O, Schultz TJ, Harvey G. Factors influencing nurses' intention to work in the oncology specialty: multi-institutional cross-sectional study. BMC Palliat Care 2021; 20:72. [PMID: 34016092 PMCID: PMC8136995 DOI: 10.1186/s12904-021-00764-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nursing care for terminally ill cancer patients is routinely provided by oncology nurses in Saudi Arabia. Shortages and retention of oncology nurses is an important concern for healthcare leaders. Objectives To identify and describe predictors of nurses’ intention toward working in the oncology specialty amongst three groups: undergraduate nursing students, oncology registered nurses and postgraduate oncology nursing students. In particular, the study sought to analyse association between individual characteristics, job-related factors, palliative care knowledge, attitude toward caring for dying patients, general self-efficacy, job satisfaction and intention to work in oncology. Methods A cross-sectional study was conducted involving 477 participants in five major hospitals in Saudi Arabia. The Palliative Care Quiz for Nursing, Frommelt Attitudes Toward Care of the Dying Scale, General Self-Efficacy Scale and Minnesota Satisfaction Questionnaire short form were used for data collection. Multilevel logistic regression analysis was used to identify predictors associated with intention to work in oncology. Results 43.9% (n = 208) of the sample reported an intention to work in oncology. Only one variable was a significant predictor of intention to work in oncology across all three groups studied: a more positive attitude toward caring for dying patients (Odds ratio (OR) = 1.09 [95% confidence interval (CI) 1.04–1.16]), (OR = 1.08 [95% CI 1.04–1.12]), (OR = 1.078 [95% CI 1.053–1.103] with P ≤ 0.001 for undergraduate, registered and postgraduate groups respectively. At post-graduate level, higher levels of palliative care knowledge and general self-efficacy were significantly associated with increased intention, whilst at undergraduate level, general self-efficacy was a significant predictor. Job satisfaction was a significant predictor of intention amongst registered nurses. Conclusions Attitude toward caring for dying patients and general self-efficacy appear to be the most important predictors of intention to work in the oncology nursing specialty. However, the significance of influencing factors varied between the different groups of nurses studied. Perhaps surprisingly, palliative care knowledge was an influential factor amongst the postgraduate group only. The study results provide important insights for nursing leaders and policymakers in Saudi Arabia to inform the future planning of nursing workforce strategies to address shortages and retention of oncology nurses.
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Affiliation(s)
- Omar Alrasheedi
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5000, Australia. .,College of Nursing, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Timothy John Schultz
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5000, Australia.,Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Gillian Harvey
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, 5000, Australia.,College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
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Bryniarski P, Bryniarska M, Jezioro M, Andrysiak D, Filipczak-Bryniarska I. Prognostic factors, symptoms and consequences of dehydration and dyselectrolytemia in patients with terminal stomach cancer. Int J Palliat Nurs 2021; 27:46-52. [PMID: 33629907 DOI: 10.12968/ijpn.2021.27.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dyselectrolytaemia and dehydration are common symptoms in people with terminal stomach cancer. AIMS To determine factors related to dyselectrolytemia and dehydration in patients with terminal stomach cancer. METHODS An analysis of 134 patients with terminal stomach cancer admitted to the palliative care unit was conducted, through an audit of the patients' medical records. The average age of women was 63.1 years and that of men was 64.9 years. FINDINGS Dehydrated patients were more likely to: have dyselectrolytaemia; have a higher PS scale score; be taking opioids as an analgesic; have a high sodium concentration; experience dyspnoea, constipation, nausea and vomiting during hospitalisation; and require glucocorticoids administration both during and before hospitalisation. Patients with dyselectrolytaemia were more likely to: be admitted to the palliative care unit from the emergency department; experience cachexia and dehydration during hospitalisation and constipation at discharge; have a lower albumin level; and have a higher glucose level. Patients with dyselectrolytaemia also had a shorter duration of treatment and a 2.48 greater chance for death compared with those who did not have it. CONCLUSIONS Knowledge of the adverse factors connected with dehydration and dyselectrolytaemia will allow health professionals to avoid dangerous clinical symptoms and prolong the life of those with terminal stomach cancer, as they might be able to foresee the occurrence of these conditions based on the medication the patient has been taking and symptoms they have been experiencing. Nurses will have a greater understanding of the importance of fluid therapy to resolve ionic disturbances and the need to address dehydration and dyselectrolytemia as a means to prolong and improve quality of life.
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Affiliation(s)
| | | | - Maciej Jezioro
- Jagiellonian University Medical, College, Cracow, Poland
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Simmons SW, Jacobs S, McKillop A. Developing clinical leadership in New Zealand hospice staff nurses. Int J Palliat Nurs 2020; 26:200-205. [PMID: 32584689 DOI: 10.12968/ijpn.2020.26.5.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Staff nurse clinical leadership is a relatively new concept that includes the elements of collaboration, coordination, patient advocacy, and often quite autonomous decision-making required of palliative care nurses. Staff nurses need structural and psychological empowerment to develop as clinical leaders. AIMS The aim of this study was to establish baseline data regarding the self-perceived structural and psychological empowerment experienced by New Zealand hospice staff nurses and their ability to practise as clinical leaders. METHODS An explanatory sequential mixed-methods design was used, which included questionnaires measuring structural and psychological empowerment and clinical leadership behaviours and focus group discussions. FINDINGS Survey respondents reported that they were moderately psychologically and sometimes or rarely structurally empowered and felt that they can practise as clinical leaders most of the time. Two themes were identified from the focus groups. CONCLUSION New Zealand staff hospice nurses felt that-despite feeling only moderately psychologically empowered, and only sometimes or rarely structurally empowered-they practise as clinical leaders most of the time.
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Sullivan KA, Kingi N, Good P, Vayne-Bossert P, Hardy JR. Castrate-resistant prostate cancer: lessons learnt from a pilot study in the palliative care research population. Int J Palliat Nurs 2019; 24:96-98. [PMID: 29469641 DOI: 10.12968/ijpn.2018.24.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Palliative care patients are inherently difficult to recruit to and retain on studies. Even when patients are recruited, it is hard to complete studies with sufficient data. There is a dearth of literature specific to men with castrate resistant prostate cancer (CRPC) and the clinical trials coordinator/research nurse's perspective in improving trial outcomes in palliative care. Objectives To describe the lessons learnt (by the nursing research team) from a prospective cohort study of men with CRPC and the practical implications for future research in this area. METHODS A pilot feasibility cohort study that followed patients with CRPC from referral until death. The participants completed questionnaires while the researcher documented treatments, disease status and symptom burden. The recruitment methods, data quality and results were analysed. RESULTS AND DISCUSSION Several lessons have been learnt with regard to facilitating trial recruitment and design. These lessons are: the importance of building relationships with local urology teams, including all men with the diagnosis of CRPC as documented by a medical oncologist or urologist, reducing questionnaire burden, capturing symptom scores in clinic, actively following up patients by phone, and recording all reasons for drop-out or lost to follow-up. These lessons can now be implemented to improve future studies involving this demographic.
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Affiliation(s)
- Karyn A Sullivan
- Clinical Trials Coordinator, Department of Palliative and Supportive Care, Mater Health Services, South Brisbane, Queensland, Australia
| | - Ngaire Kingi
- Research Nurse Department of Palliative and Supportive Care, Mater Health Services, South Brisbane, Queensland, Australia
| | - Phillip Good
- Palliative Care Specialist, St Vincent's Private Hospital Brisbane; Mater Research Institute, Department of Palliative and Supportive Care, University of Queensland Australia, Mater Health Services, South Brisbane, Queensland, Australia
| | - Petra Vayne-Bossert
- Palliative Care Specialist, University Hospitals of Geneva, Department of Readaptation and Palliative Medicine; Hopital de Bellerive, Collonge-Bellerive, Switzerland
| | - Janet R Hardy
- Medical Director of Cancer Services Director of Palliative Care, Department of Palliative and Supportive Care, Mater Health Services University of Queensland South Brisbane Australia
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Abstract
BACKGROUND Recent worldwide economic events have forced an examination of the nurse's contribution to high-quality, effective, person-centred care. Since the role of specialist nurses is considered one of the least understood or valued developments in nursing, specialist nurses must demonstrate their contribution to quality, person-centred health care. AIM To develop a questionnaire which aims to measure the quality of care provided by palliative care specialist nurses from the patients' perspective and to undertake initial validation. METHOD The process of questionnaire development involved six phases including systematic literature reviews, patient advisory groups and expert panel reviews, each of which contributed to the questionnaire face and content validity. Johnston's Expert Palliative Care Nurse Model (2002; 2005) provided an evidence-based framework for the development of the questionnaire, and enabled the identification of the key attributes of the palliative care specialist nurse role, thereby providing the themes on which to base the questionnaire. RESULTS The Quality Measure for Palliative Nursing, a questionnaire, was developed. The themes identified in the questionnaire--personal characteristics, communication skills, knowledge, relationship with patient and providing comfort--aim to facilitate measurement of the quality of care provided by palliative care specialist nurses. Designed for use by palliative patients the Quality Measure for Palliative Nursing is a one-page questionnaire comprising of 15 questions. CONCLUSIONS The Quality Measure for Palliative Nursing is unique since it aims to measure the quality of care provided by community palliative care specialist nurses, and could also be used to measure patient satisfaction with the quality of care provided. Further testing is recommended to ensure that this questionnaire can provide reliable and valid results.
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Affiliation(s)
- Dee Cameron
- Team Leader, Community Macmillan Nurses and the Hospital Palliative Care Team, Cornhill Macmillan Centre, Perth Royal Infirmary, Perth, Scotland UK
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Abstract
This paper presents the development and implementation of a recurrently funded, rolling, 6-month palliative care secondment programme for NHS community staff nurses based in a rural health economy in Southwest England. The programme is a key tool in a wider development plan for improving access to, and the quality of, palliative and end-of-life care for a dispersed rural population. This is part of a much bigger programme of integration to meet the shared challenges of service capacity, equity, and sustainability that are presented by the geographical and demographical profile of the locality. The 'bigger picture' is defined and set in the context of the national drive and evidence base for integration in order to explain the reasons behind the secondment programme. This is followed by outlining the iterative process of design and implementation--the 'what?' and 'how?'--and key learning points to date are shared.
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Affiliation(s)
- Kay Kelsall
- Assistant Director of Patient Services, Weldmar Hospicecare Trust, Dorset, England
| | - Ebony Brennan
- Community Staff Nurse, Shaftesbury District Nurse Team, Dorset Health Care University NHS Foundation Trust, England
| | - Teresa Cole
- Locality Manager (North Dorset), Blandford Community Hospital, Dorset Health Care University NHS Foundation Trust, England
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Abstract
This article explores bereavement support as one of the roles of the district nurse (DN) and community nurse (CN). Bereavement support is considered part of palliative care, which is a major role for all nurses. There is, however, a constant move to increase acute care in the home, questionably placing greater demand on DNs/CNs and primary care provision. Discussion in this article is framed around research into bereavement care in the community, existing guidelines, and policy drivers stressing its importance. Bereavement can result in depression, stress-related disorders, and high mortality; it is therefore imperative to understand the complexities, theoretical aspects, and implications of poor service provision. Palliative care is one of the primary roles of a DN, and it largely involves emotional support. It has been shown that DNs lack confidence and the skills to provide bereavement support to families and carers of palliative care patients. Education, training, and time management are the main determinants of effective bereavement support. The need is to develop a standard collaborative approach to bereavement support and incorporate it into the palliative care role of DNs.
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Affiliation(s)
- Anna Johnson
- Adult Nurse Lecturer, Department of Clinical Health Care, Faculty of Health and Life Sciences, Oxford Brookes University
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Abstract
Cancer is a long-term, life-limiting condition, and its end-of-life stage is complex. This study aimed to understand the lived experience of patients with progressive advanced oncological disease. Seven women in an acute hospital in Portugal were interviewed and the results analysed using a phenomenological approach to understand their lived experience. The analysis indicated that lived experience of these patients has six essential constituents: information about one's own health; perception of the disease; emotional reactions; aid strategies by nurses; imitations imposed by the disease; and changes in life perspective. The experience of advanced progressive cancer is very powerful and complex. The authors believe that this study has contributed to the understanding of this situation, particularly in terms of helping to improve palliative care practices.
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Affiliation(s)
- Amélia Esteves
- Specialist Nurse, Gynecological ward, Coimbra Hospital and Universitary Centre
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