Palliative Care Clinical Nurse Specialists Research Articles

The practice of palliative care clinical nurse specialists in the care of cancer patients in the State of Qatar

Background and objective: There is an annual increase in the number of metastatic advanced cancer patients who require palliative care; this is paralleled by the necessary increase in the workload of palliative care Clinical Nurse Specialist (CNS). Palliative care CNSs are crucial members in the palliative care multidisciplinary team. The aim of this paper is to describe the role of clinical nurse specialists by clarifying the ambiguity of their responsibilities in advanced cancer patients' care in the state of Qatar.Methods: Data used in this descriptive study were extracted from a shared Excel data registry system that has been created by palliative care CNSs. Data were retrieved from the 1st of January 2021 till the 31st of December 2021 and translated into numbers and percentages.  Results: A total of 3,571 patients' encounters were captured starting from the 1st of January 2021 till the 31st of December 2021. National Center for Cancer Care and Research (NCCCR) inpatient's encounters (33%), followed by telephone consultations (32%) were the highest two approaches to palliative care services delivered by CNSs. Pain and non-pain symptoms management, early introduction to palliative care, patient and family education and support, end-of-life care, and coordination of care with other health care professionals are few examples of the other services offered by palliative care CNSs for cancer patients at Hamad Medical Corporation (HMC).Conclusions: Palliative care CNSs’ roles are multidimensional and highly needed. Some of their clinical activities are unnoticed, especially due to the high number of patients’ encounters and the different geographic locations at HMC that CNSs cover. Future research is highly needed to describe the role of palliative care CNSs in areas, such as research, education, and leadership.

Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: a mixed methods sequential explanatory study

BackgroundSpecial palliative care is provided in a range of settings including a patient’s home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting.MethodsThis study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4).ResultsPhase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support.ConclusionsThis study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.

Managing delirium in terminally ill patients: perspective of palliative care nurse specialists.

Delirium occurs frequently at end of life. Palliative care clinical nurse specialists (CNSs) are involved in community palliative care provision. Many patients prefer being cared for at home, yet managing delirium in this setting presents unique challenges, potentially resulting in emergency hospital or hospice admission. We examined the experiences and practice of palliative care CNSs managing delirium in the community; 10 interviews were undertaken. Data were analysed using the framework approach. Challenges to delirium management in the community included limited time with patients, reliance on families and access to medications. Assessment tools were not used routinely; time limited visits and inconsistent retesting were perceived barriers. Management approaches differed depending on CNSs' previous delirium education. Strategies to prevent delirium were not used. Community delirium management presents challenges; support surrounding these could be beneficial. Routine assessment tool use and delirium prevention strategies should be included in further education and research.

Managing Do Not Attempt Cardiopulmonary Resuscitation conversations in the community.

Clear, sensitive and timely communication with palliative and end-of-life (EoL) patients and their families is important. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) conversations can help patients accept their impending death and achieve a more dignified death. This research explored the experiences and communication strategies of clinical nurse specialists (CNSs) in palliative care when managing DNACPR conversations in the community. Six semi-structured interviews were conducted with community palliative care CNSs, and the results were summarised using autoethnography. Delays in EoL discussions mean that some community palliative care CNSs are having DNACPR conversations at their first meeting with patients. Balancing being clear and sensitive is challenging, especially when patients and families have previously been informed inappropriately or insensitively about DNACPR decisions. DNACPR discussions should be initiated by exploring patient understanding and preferences while emphasising care continuation and a more dignified death.

Web-based videoconferencing for rural palliative care consultation with elderly patients at home

Providing specialized palliative care support to elderly patients in rural areas can be challenging. The purpose of this study was to gain a preliminary understanding of the experience of using mobile web-based videoconferencing (WBVC) for conducting in-home palliative care consults with elderly rural patients with life-limiting illness. This was a descriptive, exploratory, proof-of-concept study with a convenience sample of 10 WBVC visits. A palliative care clinical nurse specialist (PC-CNS), in the home with the patient/family and home care nurse (HC-N), used a laptop computer with webcam and speakerphone to connect to a distant palliative care physician consultant (PC-MD) over a secure Internet connection. Data was collected using questionnaires, interviews, and focus groups. Analysis of qualitative data revealed four themes: communication, logistics, technical issues, and trust. Participants reported they were comfortable discussing concerns by WBVC and felt it was an acceptable and convenient way to address needs. Audiovisual quality was not ideal but was adequate for communication. Use of WBVC improved access and saved time and travel. Fears were expressed about lack of security of information transmitted over the Internet. Using WBVC for in-home palliative care consults could be an acceptable, effective, feasible, and efficient way to provide timely support to elderly rural patients and their families. Having a health care provider in the home during the WBVC is beneficial. WBVC visits have advantages over telephone calls, but limitations compared to in-person visits, suggesting they be an alternative but not replacement for in-person consultations.

Breast cancer survivors concerned about preserving fertility

The palliative care clinical nurse specialist (CNS) role is a dynamic but difficult one, associated with significant and ever-changing challenges and stress, for which practitioners might not have the requisite power to effect change, according to this descriptive exploratory study. Using a purposive sample of community palliative care CNSs from a hospice in Northern Ireland, 33 staff were invited to participate and 17 ultimately contributed to semi-structured interviews. The interviews explored the learning, development and support needs of staff that would enable them to realise the main constituents of their role: clinical practice, education, research, and leadership and management. The interviews were recorded, transcribed and thematically analysed. The researchers identified and categorised three themes: the influence of organisational culture, the influence of the individual and solutions to developmental needs. In the organisational culture, stable working relationships and informal peer support were reportedly the most conspicuous forms of professional support mechanism, with more formal means such as mentoring and clinical supervision also appreciated. Nonetheless, stressful, often isolated, lone-working practices meant that the emotional effect of caring and individual self-care measures were not addressed satisfactorily. Most personal knowledge was described as obtained by practice-based ‘experiential’ learning; however, the nurses recognised the need for formal educational opportunities and qualifications. Whittaker E, Kernohan W, McLaughlin D (2014) Learning, development, and support needs of community palliative care clinical nurse specialists. International Journal of Palliative Nursing. 20, 9, 425-433.

Study finds only those who believe in energy healing receive benefits

The palliative care clinical nurse specialist (CNS) role is a dynamic but difficult one, associated with significant and ever-changing challenges and stress, for which practitioners might not have the requisite power to effect change, according to this descriptive exploratory study. Using a purposive sample of community palliative care CNSs from a hospice in Northern Ireland, 33 staff were invited to participate and 17 ultimately contributed to semi-structured interviews. The interviews explored the learning, development and support needs of staff that would enable them to realise the main constituents of their role: clinical practice, education, research, and leadership and management. The interviews were recorded, transcribed and thematically analysed. The researchers identified and categorised three themes: the influence of organisational culture, the influence of the individual and solutions to developmental needs. In the organisational culture, stable working relationships and informal peer support were reportedly the most conspicuous forms of professional support mechanism, with more formal means such as mentoring and clinical supervision also appreciated. Nonetheless, stressful, often isolated, lone-working practices meant that the emotional effect of caring and individual self-care measures were not addressed satisfactorily. Most personal knowledge was described as obtained by practice-based ‘experiential’ learning; however, the nurses recognised the need for formal educational opportunities and qualifications. Whittaker E, Kernohan W, McLaughlin D (2014) Learning, development, and support needs of community palliative care clinical nurse specialists. International Journal of Palliative Nursing. 20, 9, 425-433.

Palliative care staff report stress from lone working practices

The palliative care clinical nurse specialist (CNS) role is a dynamic but difficult one, associated with significant and ever-changing challenges and stress, for which practitioners might not have the requisite power to effect change, according to this descriptive exploratory study. Using a purposive sample of community palliative care CNSs from a hospice in Northern Ireland, 33 staff were invited to participate and 17 ultimately contributed to semi-structured interviews. The interviews explored the learning, development and support needs of staff that would enable them to realise the main constituents of their role: clinical practice, education, research, and leadership and management. The interviews were recorded, transcribed and thematically analysed. The researchers identified and categorised three themes: the influence of organisational culture, the influence of the individual and solutions to developmental needs. In the organisational culture, stable working relationships and informal peer support were reportedly the most conspicuous forms of professional support mechanism, with more formal means such as mentoring and clinical supervision also appreciated. Nonetheless, stressful, often isolated, lone-working practices meant that the emotional effect of caring and individual self-care measures were not addressed satisfactorily. Most personal knowledge was described as obtained by practice-based ‘experiential’ learning; however, the nurses recognised the need for formal educational opportunities and qualifications. Whittaker E, Kernohan W, McLaughlin D (2014) Learning, development, and support needs of community palliative care clinical nurse specialists. International Journal of Palliative Nursing. 20, 9, 425-433.

Learning, development, and support needs of community palliative care clinical nurse specialists.

The palliative care clinical nurse specialist (PC-CNS) is a core member of the specialist palliative care team. According to professional policy, the role has four specific components: clinical practice, education, research, and leadership and management. Little is known about how to support staff in this role. The aim of this study was to explore what learning, development, and support PC-CNSs in one hospice need to enable them to fulfil all components of their role. Using a descriptive exploratory approach, semi-structured interviews were undertaken with a purposive sample of community PC-CNSs from a hospice in Northern Ireland. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Seventeen interviews were analysed and three themes identified: influence of organisational culture, influence of the individual, and learning and development solutions. Participants reported that the PC-CNS role was stressful. They identified that the organisational culture and indeed individuals themselves influenced the learning and development support available to help them fulfil the four components of the role. Working relationships and stability within teams affected how supported individuals felt and had implications for managers in meeting the needs of staff while balancing the needs of the service.

A COMMUNITY PALLIATIVE CARE NURSE SPECIALIST LED INTERVENTION TO IMPROVE PALLIATIVE CARE IN CARE HOMES: PRELIMINARY RESULTS

BackgroundApproximately 20% of people die in long term care settings. National and international policies call for care homes to provide reliably good end-of-life care. Specialist palliative care providers are well...

THE DEVELOPMENT AND INITIAL VALIDATION OF A QUESTIONNAIRE TO MEASURE THE KEY ATTRIBUTES OF THE CLINICAL NURSE SPECIALIST IN PALLIATIVE CARE

BackgroundThe Scottish Government recognises the importance of quality, person-centred healthcare, and current worldwide events have forced an examination of the nursing contribution to this agenda. This increasing requirement to demonstrate...

Clinical nurse specialists’ perspectives on advance care planning conversations: a qualitative study

The aim of the study was to identify the challenges experienced by clinical nurse specialists (CNSs) when facilitating advance care planning (ACP) conversations with terminally ill patients. This paper focuses on the factors that influence CNSs when they are deciding whether to open an ACP discussion. Semi-structured interviews were used to collect data from eight purposively selected palliative care CNSs working in two different community teams. The interviews were recorded, transcribed, and analysed to identify themes. ACP required the CNSs to 'walk a tightrope', balancing potential harm with purported benefit. The nurses identified that their decision to introduce an ACP discussion was influenced by three key factors: an assessment of the patient's readiness to discuss the topic, their physical condition, and the nurse's relationship with the patient and family. ACP involves risk-taking on the part of those initiating it, owing to the potential for unforeseen or negative consequences. Further research is required to identify the factors that facilitate nurses involving patients in ACP.

P5 The South Edinburgh care homes project: A community nurse specialist-led intervention to improve palliative care

ContextApproximately 20% of people die in long term care settings. (1) National and international policies call for care homes to provide reliably good end-of-life care. Hospices are well placed to...

Caring for children and families in the community: experiences of Irish palliative care clinical nurse specialists

An increasing number of children require care at home owing to life-limiting illness. In addition, there is growing recognition of the specific care needs of such children and their families, and it is anticipated that recent developments in children's palliative care will result in more people accessing these services. In the Republic of Ireland (ROI), community palliative care clinical nurse specialists (CNSs), who are not registered children's nurses, contribute significantly to the support of these children and families. This study aimed to obtain a picture of the current nursing service that would help to determine whether the needs of these patients are being met. Seven community palliative care CNSs from across one health region in the ROI participated in a focus group. Four key themes emerged: gaining access to the child and family, role complexities, pressures of caring, and support strategies. Provision of community children's palliative care by the CNS is complex. The participants demonstrated their commitment to consult, coordinate, negotiate, and ultimately deliver the care required by children and families, but against a background of issues relating to accessing the patient and family, the complexity of the CNS role, and the pressures that such work incurs.

Seamless service on the isle of man

The hospice movement has engendered a multi-disciplinary team (MDT) approach to the delivery of palliative care and the evolvement of the Palliative Care Clinical Nurse Specialist (PCCNS). Advancements in palliative...

Is a triage system of referrals to a community palliative care nurse specialist team workable?

AimTo provide an insight into the workability of a triage system for patient referrals to a team of Community Palliative Care Clinical Nurse Specialists (CPCT).BackgroundThe community team were concerned about...

Impact of the palliative care clinical nurse specialist on patients and relatives: a stakeholder evaluation

Within the last decade, there has been a rapid expansion in the United Kingdom of clinical nurse specialists (CNSs), yet there has been limited evidence of their effectiveness. The clinical area of palliative care has one of the largest numbers of CNSs which has particularly started to escalate in the acute hospital setting. Following the Calman-Hine Report and the more recent NHS Cancer Plan, it is anticipated that the number of CNSs in palliative and cancer care is likely to grow. In light of the current policy emphasis of Clinical Governance and Clinical Effectiveness, there is an urgent need to demonstrate the contribution that CNSs make. This paper presents the qualitative findings of an evaluation study on the impact of the CNS within a palliative care team in a large acute hospital in the North-West of England. A stakeholder evaluation that encompassed tape-recorded semi-structured interviews to explore how the stakeholders saw the impact of the CNS within palliative care was performed. Twenty-seven interviews were conducted with stakeholders across the hospital setting including senior nurses, consultants, junior doctors and nurses representing the different grades. Data were analysed for emerging themes utilizing a case and cross-case analysis. The results indicated that the CNSs within palliative care in an acute hospital are seen to be potentially beneficial for both patients and relatives. This paper will focus on exploring these perceived benefits, which included symptom control, psychological care and being an advocate for patients and relatives.

Palliative care nursing in France: a personal perspective.

This article gives an account of a visit to palliative care services in France and identifies the benefits to be gained from the cross-fertilisation of ideas from a different European culture. Most of the challenging issues around terminal illness and death are experienced by the French, but palliative care provision has not been developed and established within the health-care system to the extent that it has in Britain. The role of the clinical nurse specialist (CNS) in palliative care in France closely matches the role of the palliative care CNS in Britain. Nurse-led community teams in France have the potential to develop specialist care practice in a way that will maximise the nursing role, enhance patient care and disseminate the principles of good practice.

Primary sarcoma of the pericardium.

<h3>Objective</h3> To provide insight into the prescribing practices of three independent nurse prescribers (INPs)/clinical nurse specialists (CNSs) working in a supportive and palliative care team (SPCT) in a district general hospital and a specialist tertiary cancer centre in the UK. <h3>Methods</h3> A prospective review of all consultations and the prescribing activity arising from the consultations (and reasons for non-prescribing following a consultation) of 3 INPs/CNSs between 1 August 2018 and 31 October 2018. <h3>Results</h3> Four hundred ninety-three consultations were undertaken on 186 individual patients. Two hundred forty-seven consultations representing 50% resulted in changes to a prescription, and 123 of those consultations representing 50% of prescriptions written resulted in the prescribing of an opioid for moderate-to-severe pain. <h3>Conclusions</h3> This service evaluation demonstrates the potential for INPs in SPCTs to provide comprehensive symptom control while enabling CNSs to practice with a greater degree of autonomy leading to enhanced job satisfaction. On the basis of our experience, we would encourage all palliative care CNSs to undergo training to become INPs (if available).