International journal of palliative nursing最新文献

Background: The AMBER care bundle facilitates earlier conversations with patients and their family about uncertain recovery and has been validated in acute hospitals. However, this tool has not been reported in a tertiary cancer setting to date.

Aim: Determine the feasibility and impact of embedding the AMBER care bundle within a tertiary cancer centre.

Method: The AMBER care bundle was launched in 2020 at a tertiary cancer centre, facilitated by a rolling education programme, digital tools and designated clinical leadership. Confidence with communicating uncertainty was collected pre- and post-training and clinical outcomes for patients supported by the AMBER care bundle were compared between baseline and 3 years post implementation.

Results: Trainees' confidence in communicating uncertainty was statistically significantly improved following training (P<0.01). Patient outcomes improved, including achievement of preferred place of death, which increased from 8 to 80% over 3 years. The AMBER care bundle is feasible and effective when implemented within a tertiary cancer setting.

Background: Many nursing students are ill-prepared to care for patients nearing the end of their lives and lack knowledge about palliative care. A focused teaching strategy could help students better understand their own feelings and conduct. It could also foster positive attitudes that make it easier to provide outstanding care.

Objective: To evaluate the efficiency of palliative education programme for nursing students caring for patients at the end of life.

Methods: A quasi-experimental study was carried out with 216 nursing students from Prince Sattam Bin Abdulaziz University in Alkharj, Saudi Arabia, using a proportionate stratified random sampling approach. The educational intervention consisted of three key modules: bereavement support, understanding the dying process and specialised palliative nursing care. Students engaged with 60 video segments through the Blackboard platform, available on a smartphone or tablet. Data collection involved four questionnaires: (a) a demographic survey, (b) the Palliative Care Quiz for Nursing, (c) the Frommelt Attitudes Towards Care of the Dying Scale, and (d) the Death Attitude Profile-Revised.

Results: Slightly over half of the nursing students (51.9%) were younger than 20 years, with a mean age of 22.8±13.5 years, and 51.4% were female. The vast majority of participants in this study (86.6%) had no prior education or training in palliative care. After participating in the palliative education programme, students showed significant improvements in their overall knowledge, Frommelt Attitudes and Death Attitude Profile-Revised scores in the post-test assessment. These results highlight the programme's effectiveness in enhancing nursing students' comprehension and attitudes toward palliative care.

Conclusion: A palliative care education programme can improve nursing students' knowledge and attitudes toward caring for patients at the end of life and supporting their families. Therefore, it is recommended that a palliative care course should be a mandatory part of nursing curricula. This course should incorporate experiential learning activities, including postmortem care, small group reflections and simulation-based training. To provide a well-rounded educational experience, these practical components should be reinforced with theoretical lectures.

Recommendations: Changing nurses' perceptions of mortality requires specialised training, and this should be prioritised in Saudi Arabia.

Background: Caregivers are fundamental to achieving effective home-based palliative care. Lack of access to after-hours visiting palliative care and non-clinical home support in rural areas increases caregiver burden, unplanned hospital admissions and impacts patients' ability to die at home. To support end-of-life care at home, the New South Wales Government endorsed partnership models between specialist community-based palliative services and non-government organisations to provide end of life support packages to enhance after-hours access and non-clinical support.

Aim: To explore bereaved rural carers' experiences of supporting dying at home within this model.

Method: Bereaved carers accessing lend of life support packages were purposively recruited. A total of 10 semi-structured interviews were conducted. Data was thematically analysed using interpretive phenomenological analysis. The COnsolidated criteria for REporting Qualitative research (COREQ) framework guided study reporting.

Findings: Collaboration, after-hours visiting access and extended non-clinical support facilitated end-of-life care at the patient's home. Participants of the study had a positive experience of this partnership.

Conclusion: This integrative model addressed existing service gaps, maximised carer support and facilitated home deaths. Further public policy, funding and research is needed to support integrated rural palliative care models.

Background: Opioids provide relief from severe cancer-related pain, but have the potential to cause significant adverse effects. They are among the top five drugs that are wrongly prescribed and can have potentially fatal consequences. This group of drugs has remained under scrutiny following the Gosport Enquiry. A lack of training and education can lead to significant prescribing errors. Education and training in end-of-life care and the prescribing of higher dose opioids than is seen in regular practice is not the norm and further work needs to be done to enhance the confidence of generalist prescribers in the community and acute setting. This incident led to changes in practice and made improvements locally with regional training, yet further work remains to be done nationally.

Background: Therapeutic intimacy is a cornerstone of palliative care nursing, requiring nurses to balance emotional connection and professional boundaries. Filipino palliative care nurses, influenced by their collectivist cultural values, offer unique perspectives on this phenomenon.

Methods: A phenomenological design employed using a adopted and validated semi-structured interviews were conducted and analysed using Colaizzi's method.

Findings: Among the 12 participating Filipino palliative care nurses, four themes emerged: (1) building therapeutic relationships, emphasising trust and holistic care; (2) navigating emotional and ethical complexities, highlighting challenges in balancing compassion and professionalism; (3) personal and professional growth, showcasing enhanced emotional resilience and fulfillment; and (4) cultural foundations in care, reflecting the role of Filipino values in caregiving. Nurses stressed the importance of trust, holistic care and familial bonds, while also confronting challenges, such as burnout and ethical conflict. The findings underscore the interplay of empathy, cultural values and reflective practice in shaping therapeutic care.

Conclusion: This study demonstrates that therapeutic intimacy-rooted in trust, holistic care and reflective practice-significantly enriches palliative care by improving patient outcomes and bolstering nurse resilience.

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

Background: The holistic approach of palliative care emphasises the importance of specialised nursing to improve the quality of life for patients and families.

Aim: To propose a theoretical model encapsulating essential aspects of palliative nursing.

Method: A review of previous literature and existing models were used to identify the key competencies essential for palliative care nurses.

Conclusions: The proposed 7C model highlights the critical skills of caring and comforting, collaboration and coordination, communication and cohesion, compassion, conflict management, competence and cultural sensitivity as foundational to effective palliative nursing practice. Formal training is essential for nurses to master palliative care skills. The proposed 7C model for palliative nursing aims to integrate holistic care principles into training, practice and thereby improving nursing efficacy and patient care standards.