Inpatient Palliative Care Unit Research Articles

Views of admitted palliative care patients and their clinicians on corneal donation discussions: a qualitative content analysis of semi-structured interviews

BackgroundThere is a severe shortage of corneas for donation, globally, for transplantation and research purposes. One group of individuals who could potentially be donors are those who die within the inpatient palliative care unit. The aim of the study was to understand clinician and patient perceptions of corneal donations and discussion of donation in palliative care units.MethodsA qualitative design was utilised with data collected through semi-structured interviews and analysed using qualitative content analysis. A total of 46 interviews were undertaken involving inpatient palliative care unit patients (19) and clinicians (27) in three major inpatient palliative care units in South Australia.ResultsVery few patient participants reported being asked about corneal donations during their time in palliative care. Most inpatient palliative care unit clinicians did not raise the topic as they felt other areas of care took precedence. Inpatient palliative care unit patients thought if inpatient palliative care unit clinicians did not raise the topic, then it was not important. There were some differences between patient and clinician views, such as preference about who raises the possibility of donation and when the discussion might occur.ConclusionsFindings suggest that patients are receptive to discussing corneal donations, but clinicians are not initiating these. This is a missed opportunity for donors and potential recipients. We recommend that clinicians routinely discuss eye donation as part of palliative care.

Adding spontaneity to organizations – what hospice volunteers contribute to everyday life in German inpatient hospice and palliative care units: a qualitative study

BackgroundVolunteers have always been integral to hospice and palliative care. However, their roles have been left relatively undefined and broad.AimThis study aims to examine the role of hospice volunteers in German inpatient hospice and palliative care. The question we seek to answer is: What do hospice volunteers contribute to everyday life in inpatient hospice and palliative care units?MethodsWe undertook a multicenter, on-site qualitative interview study, utilizing problem-centered interviews with 16 volunteers from five inpatient hospice units and one hospital palliative care unit. Interviews were analyzed using grounded theory.ResultsAnalysis of the interviews revealed three typical characteristics of how hospice volunteers’ describe their own role: (1) performing small acts of kindness, (2) creating a family-like atmosphere, (3) expecting emotional experiences. A common theme across all categories is the emphasis on spontaneous actions and personal experiences. The process of dying becomes an experience interpreted by volunteers as enriching, as a gift, as a “teacher”.ConclusionGranting hospice volunteers freedom to act spontaneously and intuitively benefits hospice and palliative care delivery. Organizations should leave sufficient room for spontaneity in order to involve volunteers effectively. Open and unstandardized roles facilitate dynamic work practices.

A comparison of the prevalence of dry mouth and other symptoms using two different versions of the Edmonton Symptom Assessment System on an inpatient palliative care unit

BackgroundSymptom assessment is key to effective symptom management and palliative care for patients with advanced cancer. Symptom prevalence and severity estimates vary widely, possibly dependent on the assessment tool used. Are symptoms specifically asked about or must the patients add them as additional symptoms? This study compared the prevalence and severity of patient-reported symptoms in two different versions of a multi-symptom assessment tool. In one version, three symptoms dry mouth, constipation, sleep problems were among those systematically assessed, while in the other, these symptoms had to be added as an “Other problem”.MethodsThis retrospective cross-sectional study included adult patients with advanced cancer at an inpatient palliative care unit. Data were collected from two versions of the Edmonton Symptom Assessment System (ESAS): modified (ESAS-m) listed 11 symptoms and revised (ESAS-r) listed 9 and allowed patients to add one “Other problem”. Seven similar symptoms were listed in both versions.ResultsIn 2013, 184 patients completed ESAS-m, and in 2017, 156 completed ESAS-r. Prevalence and severity of symptoms listed in both versions did not differ. In ESAS-m, 83% reported dry mouth, 73% constipation, and 71% sleep problems, but on ESAS-r, these symptoms were reported by only 3%, 15% and < 1%, respectively. Although ESAS-r severity scores for these three symptoms were higher than on ESAS-m, differences did not reach statistical significance.ConclusionWe identified significant differences in patient symptom reporting based on whether symptoms like dry mouth, obstipation and sleep problems were specifically assessed or had to be added by patients as an “Other problem”.

Longitudinal symptom profile of palliative care patients receiving a nurse-led end-of-life (PEACH) programme to support preference to die at home

ObjectivesTailored models of home-based palliative care aimed to support death at home, should also ensure optimal symptom control. This study aimed to explore symptom occurrence and distress over time in...

Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients

BackgroundCentral to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AimsThe purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DesignThe Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SettingsOn a six-bed adult inpatient Palliative Care Unit (PCU). Participants/SubjectsNonverbal palliative care patients. MethodsEvidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. ResultsNurses’ attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. ConclusionsMOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.

Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations.

Evidence suggests that public, and some professional, understandings of palliative care are limited to care provided immediately before death, which contrasts palliative care's scope as care provided across a range of illness stages. To examine how clinicians manage patients'understandings of palliative care during initial consultations. Initial palliative care consultations were video-recorded and analysed using conversation analytic methods. Consultations were recorded in a specialist palliative care outpatient unit within an Australian public hospital. Participants included 20 newly referred patients and their families, and three palliative care clinicians. During initial consultations, it was observed that specialist palliative care clinicians frequently managed the possibility that patients may understand palliative care as limited to care provided immediately before death. Clinicians used recurrent practices that seemed designed to pre-empt and contradict patients'possible narrow understandings. When discussing the palliative care inpatient unit, clinicians recurrently explained inpatient care could include active treatment and referred to the possibility of being discharged. These practices contradict possible understandings that future admission to the inpatient unit would be solely for care immediately before death. The findings demonstrate that palliative care clinicians are aware of possible narrow understandings of their discipline among members of the public. The practices identified show how clinicians pre-emptively manage these understandings to patients newly referred to palliative care. These findings highlight scope for greater partnership with teams referring patients to palliative care, to assist patients in understanding the range of reasons for their referral. The observational method of conversation analysis provides direct insight into matters that are relevant for patients, as raised in their consultations with clinicians. This direct evidence enables analysis of their lived experience, as it occurs, and grounds analysis in observable details of participants'conduct, rather than interpretations of subjective experiences. The patients'contributions, therefore, were to allow observation into their initial palliative care consultations.

Implementation of the Richmond Agitation-Sedation Scale (palliative version) on an inpatient palliative care unit

BackgroundThe Richmond Agitation-Sedation Scale – Palliative version (RASS-PAL) tool is a brief observational tool to quantify a patient’s level of agitation or sedation. The objective of this study was to implement the RASS-PAL tool on an inpatient palliative care unit and evaluate the implementation process.MethodsQuality improvement implementation project using a short online RASS-PAL self-learning module and point-of-care tool. Participants were staff working on a 31-bed inpatient palliative care unit who completed the RASS-PAL self-learning module and online evaluation survey.ResultsThe self-learning module was completed by 49/50 (98%) of regular palliative care unit staff (nurses, physicians, allied health, and other palliative care unit staff). The completion rate of the self-learning module by both regular and casual palliative care unit staff was 63/77 (82%). The follow-up online evaluation survey was completed by 23/50 (46%) of respondents who regularly worked on the palliative care unit. Respondents agreed (14/26; 54%) or strongly agreed (10/26; 38%) that the self-learning module was implemented successfully, with 100% agreement that it was effective for their educational needs.ConclusionUsing an online self-learning module is an effective method to engage and educate interprofessional staff on the RASS-PAL tool as part of an implementation strategy.

The caregiver’s perspective on end-of-life inpatient palliative care: a qualitative study

Introduction Understanding patient and caregiver experience is key to providing person-centered care. The palliative care approach includes holistic assessment and whole-person care at the end of life, that also involves the patient’s family and loved ones. The aim of this study was to describe the way that family caregivers experienced patients’ deaths during their loved ones’ last hospital admission, comparing inpatient palliative care (PCU) and non-palliative care (Non-PCU) units. Methods A qualitative case study approach was implemented. Family caregivers of terminally ill patients admitted to the Infanta Elena Hospital (Madrid, Spain) between 2016 and 2018 were included using purposeful sampling. Eligible caregivers were first-degree relatives or spouses present during the patient’s last hospital admission. Data were collected via in-depth interviews and researchers’ field notes. Semi-structured interviews with a question guide were used. A thematic inductive analysis was performed. The group of caregivers of patients admitted to the PCU unit and the group of caregivers of patients admitted to Non-PCU were analyzed separately, through a matrix. Results In total 24 caregivers (12 from the PCU and 12 from Non-PCU units) were included. Two main themes were identified: caregivers’ perception of scientific and technical appropriateness of care, and perception of person-centred care. Scientific appropriateness of care was subdivided into two categories: diagnostic tests and treatment, and symptom control. Perception of person-centred care was subdivided as: communication, emotional support, and facilitating the farewell process. Caregivers of patients admitted to a PCU unit described their experience of end-of-life care as positive, while their Non-PCU unit counterparts described largely negative experiences. Conclusions PCU provides a person-centered approach to care at the end of life, optimizing treatment for patients with advanced disease, ensuring effective communication, establishing a satisfactory professional relationship with both patients and their loved ones, and facilitating the farewell process for family caregivers.

The effect of implementing the COMFORT communication model on communication skills of nursing students.

Effective communication as a key component of palliative care requires sufficient knowledge and experience to make nursing interventions successful. This quasi-experimental study was conducted to determine the effectiveness of the COMFORT communication model as an intervention to improve student nurses' communication skills while they are under clinical training in specialist palliative care inpatient units. The population sample included 86 student nurses who were randomly assigned into two groups of 40. The intervention group received training on communication skills using the COMFORT communication model. Nine lectures were delivered online or offline; the lectures lasted between 25 to 60 minutes. The control group received the conventional educational programme about communication with patients and families, according to the curriculum of the bachelor's degree in nursing. Data were collected using the Communication Skills Questionnaire and Communication Skills Attitude Scale and analysed using IBM® SPSS® Statistics 22.0. The findings showed that, after the implementation of COMFORT communication model, there was a statistically significant difference in communication skills between the intervention group (122.95±9.36) and the control group (110.1±8.92). There was also a significant difference in attitudes toward communication skills between the intervention group (90.25±8.86) and the control group (90.85±9.15) (P=0.0001). The findings of the study revealed that the COMFORT Communication model created significant statistical differences in the student's attitude, knowledge and communication skills. Novice nurses sometimes struggle with the level of communication skills needed when caring for patients with an end-stage illness. The implementation of the COMFORT communication model significantly improved communication skills and attitudes toward communication. Due to the need to establish effective communication as the core of nursing practice, the implementation of this training programme is recommended for students and qualified nurses, particularly when providing palliative care.

The Validation of the Chinese (Cantonese) Version of the Patient Dignity Inventory in a Hong Kong Palliative Care Setting.

To assess and address a patient's dignity and dignity-related distress would greatly benefit patients who have advanced stage disease. The Patient Dignity Inventory (PDI) allows clinicians to identify sources of dignity-related distress for patients. The PDI should be evaluated for use in a local Chinese setting. To validate the Patient Dignity Inventory Hong Kong-Chinese (Cantonese) version (PDI-HK) and assess the psychometric properties in patients in an inpatient palliative setting in Hong Kong. The English version of the PDI was translated and back translated, then reviewed by a panel including a clinician, clinical psychologist, and nurse clinician. Recruited patients would complete the PDI-HK, the Chinese version of Hospital Anxiety and Depression Scale (HADS), the McGill Quality of Life Questionnaire-Hong Kong (MQOL-HK), and the Edmonton Symptom Assessment Scale. Psychometric properties including internal consistency, concurrent validity, test-retest reliability, and factor analysis were tested. A total of 97 consecutive patients were recruited into the study. The mean PDI score was 51.85 (range 25-102). Cronbach's alpha was 0.953 (p < 0.001). Concurrent validity with the HADS and MQOL-HK questionnaire was established. Factor analysis showed four factors, namely Existential Distress, Physical Change and Function, Psychological Distress, and Support. These were similar to previous PDI validation studies. The PDI was translated into Chinese (Cantonese) and applied in an inpatient palliative care unit in Hong Kong, with adequate validity. The PDI-HK version can be further used in a larger Chinese population to assess and address dignity-related issues.

Patient-reported ability to walk 4m and to wash: New clinical endpoints and predictors of survival in patients with pre-terminal cancer.

Maintaining the ability to perform self-care is a critical goal in patients with cancer. We assessed whether the patient-reported ability to walk 4m and wash oneself predict survival in patients with pre-terminal cancer. We performed a prospective observational study on 169 consecutive hospitalized patients with cancer (52% female, 64±12years) and an estimated 1-12months prognosis at an academic, inpatient palliative care unit. Patients answered functional questions for 'today', 'last week', and 'last month', performed patient-reported outcomes (PROs), and physical function assessments. Ninety-two (54%) patients reported the ability to independently walk 4m and 100 (59%) to wash 'today'. The median number of days patients reported the ability to walk 4m and wash were 6 (IQR 0-7) and 7 (0-7) days ('last week'); and 27 (5-30) and 26 (10-30) days ('last month'). In the last week, 32% of patients were unable to walk 4m on every day and 10% could walk on 1-3days; 30% were unable to wash on every day and 10% could wash on 1-3days. In the last months, 14% of patients were unable to walk 4m on every day and 10% could only walk on 1-10days; 12% were unable to wash on every day and 11% could wash on 1-10days. In patients who could walk 'today' average 4m gait speed was 0.78±0.28m/s. Patients who reported impaired walking and washing experienced more symptoms (dyspnoea, exertion, and oedema) and decreased physical function (higher Eastern Cooperative Oncology Group Performance Status, and lower Karnofsky Performance Status and hand-grip strength [unable vs. able to walk 'today': 205±87 vs. 252±78 Newton, P=0.001; unable vs. able to wash 'today': 204±86 vs. 250±80 Newton, P=0.001]). During the 27months of observation, 152 (90%) patients died (median survival 46days). In multivariable Cox proportional hazards regression analyses, all tested parameters were independent predictors of survival: walking 4m 'today' (HR 0.63, P=0.015), 'last week' (per 1day: HR 0.93, P=0.011), 'last month' (per 1day: HR 0.98, P=0.012), 4m gait speed (per 1m/s: HR 0.45, P=0.002), and washing 'today' (HR 0.67, P=0.024), 'last week (per 1 day HR 0.94, p=0.019), and 'last month' (per 1day HR 0.99, P=0.040). Patients unable to walk and wash experienced the shortest survival and most reduced functional status. In patients with pre-terminal cancer, the self-reported ability to walk 4m and wash were independent predictors of survival and associated with decreased functional status.

Bright Light Therapy for Cancer-related Fatigue in a Palliative Care Unit: A Feasibility Study

Cancer related fatigue (CRF) is a very common symptom among palliative care patients as over 80% of them reported at least a moderate level of fatigue measured by the Brief Fatigue Inventory (BFI).1 Locally, we found that more than half of the patients in the palliative care in-patient unit (PCU) complained of fatigue,2 which continued to trouble 41% of patients in their last two weeks of life.3 Among the various treatments for fatigue, bright light therapy (BLT) emerged as a potentially useful non-pharmacological treatment.

“More life and more days”—patient and care characteristics in a specialized acute pediatric palliative care inpatient unit

Only a few acute hospital inpatient units dedicated to pediatric palliative care (PPC) patients exist today. Clinical data on the patients and care provided at specialized acute PPC inpatient units (PPCUs) are scarce. This study aims at describing patient and care characteristics on our PPCU to learn about the complexity and relevance of inpatient PPC. A retrospective chart analysis was performed on the 8-bed PPCU of the Center for Pediatric Palliative Care of the Munich University Hospital, including demographic, clinical, and treatment characteristics (487 consecutive cases; 201 individual patients; 2016–2020). Data were analyzed descriptively; the chi-square test was used for comparisons. Patients’ age (1–35.5 years, median: 4.8 years) and length of stay (1–186 days, median 11 days) varied widely. Thirty-eight percent of patients were admitted repeatedly (range 2–20 times). Most patients suffered from neurological diseases (38%) or congenital abnormalities (34%); oncological diseases were rare (7%). Patients’ predominant acute symptoms were dyspnea (61%), pain (54%), and gastrointestinal symptoms (46%). Twenty percent of patients suffered from > 6 acute symptoms, 30% had respiratory support incl. invasive ventilation, 71% had a feeding tube, and 40% had full resuscitation code. In 78% of cases, patients were discharged home; 11% died on the unit.Conclusion: This study shows the heterogeneity, high symptom burden, and medical complexity of the patients on the PPCU. The high dependency on life-sustaining medical technology points to the parallelism of life-prolonging and palliative treatments that is typical for PPC. Specialized PPCUs need to offer care at the intermediate care level in order to respond to the needs of patients and families.What is Known:• Pediatric patients in outpatient PPC or hospices present with a variety of clinical syndromes and different levels of complexity and care intensity.• There are many children with life-limiting conditions (LLC) in hospitals, but specialized PPC hospital units for these patients are rare and poorly described.What is New:• Patients on a specialized PPC hospital unit show a high symptom burden and a high level of medical complexity, including dependency on medical technology and frequent full resuscitation code.• The PPC unit is mainly a place for pain and symptom management as well as crisis intervention, and needs to be able to offer treatment at the intermediate care level.

Terminally ill patients’ and their relatives’ experiences and behaviors regarding complementary and alternative medicine utilization in hospice palliative inpatient care units: a cross-sectional, multicenter survey

BackgroundTerminally ill patients often experience exacerbations of diseases that render mainstream medicine ineffective in relieving symptoms, prompting attempts at complementary and alternative medicine (CAM). This study collected data from terminally ill patients and their relatives to determine differences between CAM use, behavioral patterns, and perceptions of health information about CAM.MethodsA cross-sectional design using a self-administered questionnaire was adopted. Eight medical institutions in Taiwan with inpatient hospice palliative care units were chosen. Ninety-two terminally ill patients and 267 relatives met the inclusion criteria. The questions concerned the experience of CAM use, the kinds of products/services CAM provided, the purpose of CAM use, the source of CAM information, and the perceptions and attitudes toward CAM.ResultsBoth terminally ill patients and their relatives have a high proportion of lifetime and one-year prevalence of CAM use (88.0% vs. 88.4%; p = 0.929). CAM use for musculoskeletal and neurological discomfort is higher among terminally ill patients than among their relatives. Relatives/friends are the most frequent sources of information on CAM (53.3% vs. 62.2%; p = 0.133). The percentage of terminally ill patients who discontinued mainstream medical treatment because of CAM use was higher than that of their relatives (18.5% vs. 9.3%; p = 0.026). More than half the terminally ill patients and their relatives had never been asked about CAM by medical staff (64.1% vs. 66.7%), nor had they informed medical professionals about the use of CAM products and services (63% vs. 66.9%). Random inquiries by medical professionals may be associated with increased disclosure of CAM use (terminally ill patients: odds ratio, 9.75; 95% confidence interval, 1.97–48.35 vs. relatives: odds ratio, 5.61; 95% confidence interval, 2.66–11.83).ConclusionsThe high prevalence and concealment of CAM use in terminally ill patients should be considered. Medical professionals should establish a friendly and barrier-free communication model, encourage patients to share CAM experiences, and provide evidence-based information on the use of CAM products and services, to reduce the potential damage caused by harmful use.

Healthcare professionals' perceptions of psychosocial support for family members in palliative care inpatient units-A qualitative descriptive study.

This study aimed to describe the psychosocial support healthcare professionals in specialist palliative inpatient units provide to family members of palliative care patients. A qualitative descriptive design. The data were collected with focus group interviews and analysed with inductive content analysis. Altogether, 48 healthcare professionals, including physicians, registered nurses and practical nurses, participated in the study. Information sharing was recognised as an essential element of support. Methods to improve support of family members included an opportunity to allocate recourses to the families, systematic support and strengthening healthcare professionals' competence in family care. The healthcare professionals describe their perceptions of psychosocial support for family members primarily through patient care and the patient's situation rather than family needs. Direct support for the family members is realised principally by information sharing and conversations. Healthcare professionals express their opportunities to implement support focusing on family members' needs restricted by reason of organisational resources. The information can be used when developing and improving family care in palliative care context to recognise the most relevant needs from healthcare professionals' perspective and also when implementing healthcare professionals' education and training.

Family members' experiences of psychosocial support in palliative care inpatient units: A descriptive qualitative study.

The support for family members (FMs) during a patient's palliative hospital care has been rarely studied, creating a gap in how FMs can be better supported. Psychosocial support answers widely to FMs' needs. Therefore, this study aims to describe FMs' experiences of psychosocial support in specialist palliative care inpatient units from the perspective of the FMs themselves. A qualitative descriptive study with individual semi-structured interviews and inductive content analysis was conducted. Data were collected in four specialist palliative care inpatient units in two large hospital districts in Finland. The 32-item checklist Consolidated Criteria for Reporting Qualitative Studies was used to ensure detailed reporting. A total of 19 FMs of cancer patients receiving palliative care participated in the study. Their experiences of psychosocial support focused on Support FMs hoped for, Support practices in the care unit, and Informational support for FMs. According to FMs' experiences, support focusing particularly on the FMs, safe quality patient care, proper access to information regarding the patient's care and condition, and genuine encounters with HCPs were the aspects that seemed to be the most important to the FMs. Systematic provision of support and information should be a routine model in palliative care. Additionally, a care environment that promotes FMs' presence, participation, and family-centred care is essential in FMs' support and should be considered when developing family involvement in palliative care. Furthermore, the importance of FMs receiving sufficient information, and FMs' dependence on HCPs to share the needed information, should be acknowledged. Hence, more attention should be paid to successful information sharing between the HCPs and FMs in palliative hospital care.

The Impact of ASCITIC Paracentesis on Symptomatic Outcomes in Palliative Patients: 3-Year Experience of a Melbourne Inpatient Palliative Care Unit Using Palliative Care Outcomes Collaboration Assessments

Background Ascites formation is a common occurrence in patients receiving palliative care. This is associated with symptoms that may respond to drainage. Aim To review and quantify ascites-related symptoms pre- and post-paracentesis to evaluate its benefit in an inpatient palliative care setting. Methods A retrospective audit of patients admitted to an inpatient palliative care unit who underwent paracentesis between November 2016 to June 2020 was performed. The primary outcome was a symptomatic benefit of paracentesis. Secondary outcomes assessed the associated complications as well as the alterations to functional status. Data were analysed using a paired T-test. Results 43 instances of ascitic paracentesis were performed on a total of 26 patients. Three patients were excluded from the study due to the technical failure of their paracentesis procedure. There was a mean 0.16-point reduction in pain (95% confidence interval (CI) −0.33 to 0.65), a mean 0.03-point increase in dyspnoea (95% CI −0.51 to 0.46), and a mean 0.32-point reduction in nausea (95% CI −0.09 to 0.74). Conclusions Ascitic paracentesis in the palliative setting may demonstrate some benefit in managing symptoms associated with ascites. Although the findings of this study did not achieve statistical significance, these results may be substantiated by future studies with larger sample size.

Caregiver delivered massage therapy options in inpatient palliative care: A mixed methods exploratory study

Backgroundand purpose: Massage therapy can benefit palliative care inpatients and this intervention could be provided by trained caregivers in this setting. This study aimed to determine the feasibility and acceptance of caregiver massage therapy, to explore patients' and caregivers’ experience of massage therapy, and examine staff perspectives about caregiver massage therapy in palliative care. Materials and methodsThis was a mixed methods, convergent, study design. Inpatient palliative care patients were offered massage provided by a caregiver, following training. Caregiver massage therapy was provided up to five days post training. Patients and caregivers completed self-report measures of satisfaction for the five-day intervention, while caregivers rated massage-related burden and confidence. Healthcare professionals working in inpatient palliative care participated in a focus group, during which enablers and barriers to caregiver massage therapy were explored. ResultsOver the three-month recruitment period, 62 participants were available for recruitment. Of these, 23 (37%) consented to caregiver massage. Caregiver burden was highest on day 2 (mean 2.9/5) while confidence was highest on day 4 (mean 4.1/5). Caregivers and patients were satisfied with the massage training sessions, and patients reported perceptions of comfort during subsequent sessions. Staff-identified enablers to caregiver massage therapy included patient symptom improvement and caregiver empowerment but considered caregiver massage potentially burdensome for caregivers. ConclusionCaregiver massage training is feasible, with a modest acceptance within an inpatient palliative care unit. Enablers of massage therapy in inpatient palliative care were caregiver empowerment, but this model was perceived as potentially burdensome for caregivers by healthcare professionals.

Perceptions of bereaved family members of nursing care on an inpatient hospice palliative care unit.

Understanding family members' (FMs) perceptions of the care provided by nurses is crucial to facilitating positive outcomes for FMs. To better understand how bereaved FMs perceive the care nurses provide in an inpatient hospice palliative care unit. An exploratory study was conducted, with an interpretive description methodology. It was guided by the question: 'How do bereaved FMs perceive nursing care in our unit, and how does this influence their bereavement experiences?' A total of 10 FMs-or close friends-who had a significant other die on a palliative care unit were interviewed. Findings support the belief that positive relationships and interactions with nurses impact families' perceptions of end of life. Nurses create a therapeutic environment, building a sense of ease and meaning for patients and families. Participation of nurses in rituals and patient-honouring practices after death may help families to cope and create positive memories during their grieving process.

Adaptation, implementation, and mixed methods evaluation of an interprofessional modular clinical practice guideline for delirium management on an inpatient palliative care unit

BackgroundUsing delirium clinical guidelines may align interprofessional clinical practice and improve the care of delirious patients and their families. The aim of this project was to adapt, implement and evaluate an interprofessional modular delirium clinical practice guideline for an inpatient palliative care unit.MethodsThe setting was a 31-bed adult inpatient palliative care unit within a university-affiliated teaching hospital. Participants for the evaluation were interprofessional team members. Using integration of guideline adaptation and an education initiative, an interprofessional guideline adaptation group developed a face-to-face ‘starter kit’ module and four online self-learning modules. The mixed methods evaluation comprised pre-and post-implementation review of electronic patient records, an online survey, and analysis of focus groups/ interviews using an iterative, inductive thematic analysis approach.ResultsGuideline implementation took 12 months. All palliative care unit staff attended a ‘starter kit’ session. Overall completion rate of the four e-Learning modules was 80.4%. After guideline implementation, nursing documentation of non-pharmacological interventions occurring before medication administration was observed. There was 60% less scheduled antipsychotic use and an increase in ‘as needed’ midazolam use. The online survey response rate was 32% (25/77). Most participants viewed the guideline’s implementation favourably. Six key themes emerged from the qualitative analysis of interviews and focus groups with ten participants: prior delirium knowledge or experiences, challenges of facilitating change, impacts on practice, collaborative effort of change, importance of standardized guidelines, and utility of guideline elements.ConclusionsGuideline implementation warrants concerted effort, time, and management support. Interprofessional team support facilitates the modular approach of guideline adaptation and implementation, leading to a change in clinical practice.