International journal of palliative nursing最新文献

Background: Community nurses (CN), both generalist and palliative care-specific, are key to supporting the carer with their experience of grief.

Aim: To identify the grief-related needs of carers and the capacity of CNs to provide for those needs.

Methods: A convergent parallel mixed-methods study which employed i) a needs questionnaire among carers of palliative care patients who had recently died; ii) a qualitative interview study among carers and iii) a questionnaire among CNs which canvassed their confidence and skills in working with carer grief.

Findings: In the carer survey, just one-third of carers reported engagement with CNs regarding prolonged and anticipatory grief. In the CN survey, low confidence and skill regarding supporting carers with their grief was reported. CNs with palliative care training were more confident and knowledgeable than generalist CNs.

Conclusions: Despite offering high ratings for CN compassion and overall quality of support during the dying process, grief support was reported by carers to be missing from their experience of CN care. The role of CNs in providing for the grief-related needs of carers is yet to be established.

Synopses of a selection of recently published research articles of relevance to palliative care.

Background: This state-of-the-art (SOTA) review aimed to understand the historical, current and future of rural community palliative care services (PCS) with a primary focus in rural southern Minnesota communities and the United States.

Methods: This review followed the six step SOTA systematic review process described by Barry et al (2022) and examined articles from 2010-2023 regarding rural PCS.

Results: Historical and current research consistently supported the benefits of PCS and reported the top facilitators as a clear definition of palliative care and PCS. The top barriers included a lack service provision, funding/resources, national policies/regulation, and shortages of trained providers in rural communities.

Conclusions: Barriers to the provision of PCS have not improved based on this review in rural areas and must be addressed to reduce healthcare disparities for rural populations.

Background: Healthcare at home is considered a partial substitute for institutional long-term care, because patients and families with known poor prognoses prefer to stay home with their loved ones and are unable to pay for hospital care at the end of life in some countries.

Purpose: To explore patients' and family members' perspectives and experiences of receiving home-based palliative care services.

Method: This was a qualitative exploratory study conducted in Karachi, targeting patients and family members receiving home-based palliative care services. The data collection was done via interviews, and simultaneously, the interviewer recorded field notes, which were all carried out within the confines of the participants' homes. Moreover, the subjects were recruited through purposive sampling, resulting in a total of six patients and six family members. The final number of participants was determined based on data saturation. The inclusion criteria encompassed individuals of all genders, aged 18 and above, and residents of Karachi, Pakistan. Those who were not able to provide information, due to any reason, were excluded from the study. The study adhered strictly to ethical considerations.

Findings: The study uncovered several significant themes that provide valuable insights, including caregivers' availability, patients' inclusiveness, improved dietary pattern, psychological wellbeing, and rapid recovery in home-based care. Furthermore, the study identified themes on providing home-based palliative care, like family members' education and keeping back-ups for unforeseen situations. In contrast, the themes identified as home-based care preference over hospital care were: experienced compromised care, hospital anxiety, restricted to the available resources and higher hospital living expenses for patients and family members.

Conclusion: The study underscored the importance of adopting a patient-centric approach. It has become evident that the comfort and familiarity of one's home environment provide a conducive backdrop for holistic healing and wellbeing.

Background: Knowledge of and understanding the palliative care approach should be a core competency in all healthcare settings. E-learning offers the potential to deliver palliative care education and meet this challenge.

Aim: To examine hospice educator's perspectives of e-learning in palliative care education.

Methods: Semi-structured interviews were conducted with a purposeful sample of hospice educators on the island of Ireland (Republic of Ireland and Northern Ireland). These were transcribed and the data was analysed thematically.

Findings: Many factors were considered when using e-learning: objectives of the programme, learner's characteristics, topic suitability (as palliative care is very emotive) and organisational factors. Barriers to using e-learnning were the preparation time required and developing expertise in e-learning. Support mechanisms for hospice educators to share knowledge would be beneficial.

Conclusions: Educators were keen to adopt a blended approach in their teaching. While acknowledging the challenges and limitations of e-learning, educators felt that e-learning has a positive role in palliative care education.

Background: Avoiding futile treatment for patients at the end of life is among one of the care challenges of nurses in intensive care units (ICUs).

Aims: This study aimed to determine the attitude of intensive care unit nurses toward futile treatment and its relationship with missed care for patients at the end of life.

Method: This cross-sectional study was conducted on 307 ICU nurses. Eleven teaching hospitals were selected from three Iranian provinces, Zanjan Province, East Azerbaijan and West Azerbaijan, in 2021. The data were collected using The Attitudes Toward Futile Treatment Scale (ATFTS) and The Missed Nursing Care Survey (MISSCARE Survey) as self-reports.

Results: According to the obtained results, 94.8% of the nurses agreed that futile treatment should not be performed. However, 97.7% of the nurses reported that missed care occurs less for patients at the end of life. The correlation between the MISSCARE Survey's total scale and the ATFTS's total scale was positive and statistically significant (r =.11).

Conclusion: This research contributes to understanding nurses' attitudes toward futile treatment. Nurses oppose futile treatment, so obstacles to avoiding it should be eliminated. This attitude does not have a significant impact on nursing care quality or missed care for patients at the end of life, but it can lead to enduring distress for nurses. It is recommended to study the reasons for futile treatment, and its link to nurses' mental and physical health.

Synopses of a selection of recently published research articles of relevance to palliative care.

Aim: This study aimed to determine which factors improve the quality of dying and death from the point of view of patients with cancer who are nearing the end of their lives. The goal was to find out what they think are necessary conditions for a good death and how they would like to be cared for and supported at the end of their lives.

Methods: This study used an exploratory research approach. Purposive sampling was used to select 21 participants from two hospices in Bengaluru and Hyderabad (Karunashraya and Sparsh), and Karnataka Cancer Hospital in Bangalore, India. Semi-structured interviews were undertaken to obtain data from the patients. Thematic analysis was used to examine the data.

Results: Four themes were identified: 1) Spirituality and religiosity, 2) socioemotional support, 3) Breaking silence about the stage of the disease and 4) Preparation for and embracing death. There were distinct sub-themes within some of these that were highlighted using quotes from the participants.

Conclusions: The study provided a comprehensive understanding of end-of-life care, the criteria for a high-quality end of life, strategies for achieving it, and the quality of the dying process and death in advanced cancer patients. Studying patients' experiences will help inform a more robust intervention strategy and action plan to improve the quality of end-of-life care in the Indian community.

Background: Advance care planning (ACP) is an integral part of good quality end-of-life care. This study aimed to explore the role and practice of ACP among health and social care professionals (HSCPs) in a community long-term care facility.

Methods: This was a mixed-methods study. The study purposefully sampled 12 HSCPs from one community long-term care facility in Macao, China. All data were collected in November 2022.

Results: Some participants had discussed with terminally ill residents or with families in terms of end-of-life care preferences, the average correct rate of ACP knowledge was 67.4%. Interview data showed that HSCPs were primarily concerned with information-giving. The responsibility of decision-making was found to have been placed predominantly on family members of the residents.

Conclusion: Study findings raised awareness in that the execution of ACP has remained in discord with the expectations in practicing ACP. The study illuminated that the perceived sense of responsibility among HSCPs was influenced by the potential legal risks involved and consequentially impacted on the adherence to individual's decisions.