Evaluation of the currency of the Davies and Oberle (1990) model of supportive care in specialist and specialised palliative care settings in England

Abstract

To evaluate the extent to which the Davies and Oberle (1990) model of supportive nursing has currency across specialist and specialised care settings in England. The model describes attributes of palliative nursing for practice and associated educational curricula. It is influential but predates introduction of specialist/specialised care. Its applicability in contemporary care settings has not been evaluated. Evaluation was undertaken using sequential mixed methods, predominantly qualitative. Data collected during 2008-2009. Four stages: (1) focus groups involving hospital and community palliative clinical nurse specialists and nurses from three hospice settings (total = 25) to identify setting-specific characteristics, (2) survey of nurses (n = 48 respondents/31%) with follow-up interviews (n = 25) to identify congruence with the model, (3) interviews with patients (n = 6) and carers (n = 13) for practice evidence and (4) reconvened focus groups (n = 19 nurses) for confirmation. All major dimensions were evidenced. 'Connecting' had reduced emphasis in the hospital setting where specialist nurses spend limited time with patients, but diminishing time to 'connect' with patients and carers as service develops could potentially become problematic across all settings. Two new dimensions ('Displaying expertise' and 'Influencing other professionals') with subdimensions (e.g. 'Advanced communication skills') are proposed as additions to reflect advanced practice. Further new subdimensions ('Making the assessment', 'Prioritising', 'Agreeing the plan') are suggested to be best aligned with the existing dimension 'Connecting'. A revised model of supportive care incorporating dimensions of advanced nursing has currency in contemporary specialist/specialised care settings, although evaluation is required as to the actual impact of the model on care outcomes. 'Connecting' is currently being affected by pace of work and lateness of referrals. 'Spending time' is increasingly difficult to sustain so challenging nurses as to how they may continue to 'connect' with patients as service delivery continues to change.