Nurse opportunities to overcome barriers to palliative care provision for patients with heart failure: an integrative review

Abstract

Background/Aims To identify opportunities for nurses to overcome barriers to the timely provision of palliative care to heart failure patients. In the UK, the burden of heart failure has increased significantly in recent years. However, despite the significant impact heart failure has on independence and quality of life, implementation of palliative care often comes too late to be of benefit. Methods An integrative literature review adopting the design methodology proposed by Whittemore and Knafl was performed. Four main themes were explored: 1) deficit of knowledge about palliative care; 2) the need for improved communication skills; 3) longer-term relationships with patients facilitate repeated opportunities sensitive conversations; and 4) the need to build confidence, advocacy and leadership skills in nursing. Results The review consistently supports wider literature in identifying a deficit in nurses' knowledge around palliative care, coupled with a lack of confidence in undertaking sensitive conversations. It highlights opportunities for individual nurses to implement change in their own practice and positively influence care provided by the multidisciplinary team to improvement quality of life for patients with heart failure. Conclusions This study highlights a number of barriers that impede the adequate assessment and delivery of palliative care to patients with heart failure. It provides a timely reminder of the importance of effective teamwork and ensuring that the patient is the driving force behind any care decisions. It is fundamentally important that nurses continue to pursue opportunities to develop confidence, leadership and advocacy skills to ensure the multidisciplinary team maintain their patient-centred focus in future care.