Palliative Care Nurses Research Articles

Psychometric properties of the Turkish version of the Palliative Nursing Care Quality Scale.

Measuring tools are essential in assessing the quality of care. This study aimed to evaluate the validity and reliability of the Turkish version of the Palliative Nursing Care Quality Scale (PNCQS-T) and the sociodemographic characteristics affecting the quality of care. This methodological study, whose linguistic equivalence was confirmed by the translation/back translation method, was carried out with the participation of 209 nurses. Personal Information Form and PNCQS-T were used as data collection tools. Construct validity was determined by confirmatory factor analysis (CFA). Reliability was tested with internal consistency and item-total correlation coefficients. Adaptation results showed that the Turkish version of the scale is adequate for linguistic and content validation. The Turkish adaptation's original scale of 20 items was reduced to 18. As in the original scale, all items were combined under a single dimension in the Turkish adaptation. Modified CFA indicated a well-fitting model. PNCQS-T explained 42.1% of the total variance. Cronbach's alpha value was 0.92. The lowest score obtained from the scale is 18; the highest score is 90. Higher scores indicated that the palliative care provided by nurses was of good quality. The Turkish version of the PNCQS-T is reliable for assessing the quality of palliative care provided by nurses in Turkey.

Palliative care nursing during the COVID-19 pandemic: reflections from Melbourne, Australia.

Nurses played a critical role in providing care for patients throughout the COVID-19 pandemic. This study aimed to explore perspectives of Australian palliative care nurses regarding the impact of COVID-19 on the provision of care for patients with advanced illness, or at the end of life. The authors conducted a survey of palliative care nurses in ward- and consultation-based roles at a metropolitan health service in Victoria, Australia. A total of 24 out of 39 nurses completed the survey. Responses included strong themes of fear of COVID-19 and sadness about separating dying patients from their families. Delivery of palliative care changed at an individual and service level. Importantly, there were strong themes of adapting to change and 'soldiering on' with the core business of palliative care.

Compassion fatigue in Nursing professionals Palliative Care Units: literature review

Today, compassion fatigue is a major problem that significantly affects healthcare professionals. Objectives: To analyze whether working in a palliative care service predisposes nursing professionals to the appearance of symptoms related to compassion fatigue. Methods: Non-systematic literature review. A literature search was carried out using different databases of primary and secondary sources and meta-search engines, mainly using the following descriptors: "Nursing", "Palliative care" and "Compassion fatigue". Inclusion and exclusion criteria were established and, finally, the scientific articles were evaluated with their corresponding quality tool (STROBE and qualitative CASPe). Results: Levels of compassion fatigue are high among palliative care nurses. According to studies, work and personal factors show a statistically significant association with compassion fatigue. Conclusions: Nursing professionals develop compassion fatigue to a large extent in the palliative care service. In addition, factors associated with increased compassion fatigue have been established in an attempt to eradicate this phenomenon. Further research is needed to investigate the effectiveness of different intervention programmes for the correct management of compassion fatigue.

Developing Community-Based Palliative Care for Children: A Community Case Study from an Urban Informal Settlement in Bangladesh.

Globally, more than 97% of children needing palliative care reside in low- and middle-income countries, where there is very limited access to palliative care. Several community-based palliative care programs focused on adults, have been described in resource limited settings, suggesting a simple and low-cost approach to providing palliative care. The implementation of community-based palliative care for children has not previously been described. This community case study describes the implementation of an innovative model of community-based palliative care program in and urban informal settlement, (Korail Slum, Bangladesh). The program is led by a local government hospital, with experience in community-based palliative care, in partnership with the local community. Children with serious conditions in an urban unformal settlement do not have access to health services which address their medical, psychosocial and spiritual needs. This gap leads to a significant burden of preventable suffering for them and their families. A community-based palliative care program was implemented, which includes home care by trained community health workers, with support and supervision from palliative care nurses and physicians. The program's objective is to provide effective symptom management, clear communication about the child's condition with parents, and psychosocial support including support for basic needs. The program was free for families including medications, medical equipment, physiotherapy, and speech therapy. The program was monitored through regular assessments of quality of life using standardized tools (PedsQL Family Impact Module), as well as interviews and focus group discussions. A model of community-based palliative care for children can be implemented in an urban informal settlement. Program effectiveness is enhanced by community health workers who share language, culture, and life-experiences with the individuals they serve. Partnerships with local health care facilities and community groups strengthen the program's sustainability. Ensuring financial sustainability remains a challenge.

Education and Mentoring of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia.

The Quality of Care Collaborative Australia (QuoCCA) builds capability in the generalist and specialist paediatric palliative care (PPC) workforce throughout Australia. It supports regional and community services to provide care close to families' homes, as well as building expertise in tertiary centers. Medical Fellows and Nurse Practitioner candidates (specialist trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia supported by an education and mentoring framework. This study explored the activity and experiences of clinicians who had occupied these roles to evaluate their effectiveness to build PPC capability. Online surveys recorded the monthly activity of Medical Fellows, with a point in time check of knowledge, skills and confidence in 2019. Discovery Interview methodology was used to collect detailed experiences of 11 trainees employed between 2018 to 2022 in Queensland. A combination of mentoring and formal and informal education, peer support and practical experience was valuable for trainees. They found the support of the whole interdisciplinary team advantageous to learning. Shadowing experienced team members gave them the opportunity to learn practical skills, especially regarding communication with families. Practicing clinical skills was beneficial, through being on call, attending home visits, supporting families, prescribing medications and developing treatment plans in collaboration with the team.The trainee experience was optimised through learning from families, personal reflection, involvement in research projects and delivering QuoCCA education. The QuoCCA trainee roles for Medical Fellows and Nurse Practitioner candidates exhibit a valuable and effective education and mentorship framework that could be applied to other specialties. The service leadership and collaborative interdisciplinary team support various modes of education and mentoring. The roles not only develop the trainees' specialised PPC clinical skills, they also improve their general clinical practice, including communication, empathy and holistic care. A structured curriculum of education is recommended to protect these positive outcomes.

Qualifications, competencies and professional liability of palliative care nurses

Qualifications, competencies and professional liability of palliative care nurses

Dimensions of good palliative nursing care: Expert panel consensus and perceptions of palliative professionals.

To analyse the dimensions of quality of palliative nursing care and to explore the perceptions of professionals for the development and validation of the Palliative Nursing Care Quality Scale. The study of palliative nursing care quality has been approached from analysis of the competencies of palliative care nurses, based on various theoretical models. However, there are fewer qualitative empirical studies that have evaluated what good palliative nursing care is and what its dimensions are. Mixed-method, Delphi approach and exploratory qualitative study. Consensus by a panel of experts using the Delphi technique and semi-structured interviews. The study was reported in a comprehensive manner following COREQ criteria. Data collection took place between January and June 2018. The eight-person expert panel reached consensus on the following dimensions of the Palliative Nursing Care Quality Scale: control and relief of symptoms, family and/or primary caregiver, therapeutic relationship, spiritual support and continuity of care. Thematic analysis of ten interviews identified four emergent themes related to good nursing care: (1) the patient and family as a whole; (2) finding meaning; (3) responsible communication; and (4) caring for the human element. The quality of palliative nursing care goes beyond providing comprehensive care; it means meticulously looking after every detail of what is important to the patient. The expectations of professionals are not as important. Instead, care should be based primarily on the needs and respect for the wishes of the patient and their family. Specifying the quality of nursing care in routine practice and reaching a consensus on its dimensions means moving towards excellence in care, as well as improving the professional profile of advanced practice palliative care nurses. Two primary caregivers participated in the panel of experts and the semi-structured interview.

Where do I start? Introducing simulation in a hospice environment

Simulation is widely recognised as a safe, valuable learning modality [1]. However, it is greatly underutilised in End of Life (EoL) care [2] where the majority of learning has been theoretical. A plethora of challenges exist around introducing a simulation programme in a hospice environment, both organisational and psychological [3], including implementing a new idea at a time when healthcare workers are experiencing unprecedented levels of burnout following a pandemic. As part of a one-year project funded by Health Education England, we sought to create and introduce a comprehensive simulation-based programme for rollout across the Hospice with clear benefits and relevant subject matter that engages our wide range of MDTs as well as non-clinical staff. Posters were used to begin to introduce the concept of simulation. A mixture of questionnaires, interviews and online sessions were held to establish current knowledge and views of staff on simulation-based learning. Time was set aside to thoroughly outline the project and its benefits to teams throughout the Hospice, clinical and non-clinical staff. Questionnaire results from 52 respondents show that 35% of staff had no knowledge of simulation prior to the information given as part of this project. Despite this, when simulation was explained more clearly, all respondents felt that they would be able to gain something positive from introduction of a simulation-based programme as shown in Participants’ response to the question: What participants expect simulation-based learning to improve in their practice? Teams amongst the hospice recognise that simulation provides a valuable learning opportunity. By ensuring understanding of the project, encouraging involvement of all teams, and recognising their unique concerns, thoughts and pressures, it is possible to implement a successful simulation-based programme in the Hospice environment leading to quality improvement in End-of-Life care. 1. Randall DC. Pragmatic children’s nursing: A theory for children and their childhoods. Routledge; 2015. 2. Bassah N, Seymour J, Cox K. A modified systematic review of research evidence about education for pre-registration nurses in palliative care. BMC Palliative Care. 2014;13(1):1–10. 3. Patterson MD, Blike GT, Nadkarni VM. Advances in Patient Safety. Situ Simulation: Challenges and Results. In: Kerm Henriksen, James B. Battles, MA Keyes und ML Grady (Hg.): Advances in Patient Safety. New directions and alternative approaches, 3, p.4. 2008

An Innovative Academic-Practice Partnership Using Simulation to Provide End-of-Life Education for Undergraduate Nursing Students in Rural Settings.

Innovations that foster academic-practice partnerships can fill direct clinical care gaps and supplement faculty expertise, particularly in rural settings. An end-of-life simulation was cocreated by nursing faculty and regional certified hospice and palliative care nurses (CHPNs) as a course improvement project for traditional baccalaureate students who lacked direct care experience. Groups of students experienced skills-based pain management and end-of-life conversation-based scenarios using CHPNs as standardized patients. The simulation conformed to current standards in health care simulation, including prebriefing and debriefing components. Feedback from students and CHPNs supports the partnership as an effective teaching/learning strategy.

Positive Health and palliative care: an exploration among nurses

Abstract Background The current WHO definition of health seems to no longer meet the changes in the current Dutch health system. An alternative approach which puts emphasis on health, not disease, is Positive Health (Huber et al, 2011). This focus shifts the emphasis on improving resilience and well-being rather than the perspective on what is lacking in health.In this study, the attitudes towards the concept of Positive Health of palliative care nurses are examined. Methods A mixed-methods approach design was used for this study. This involved the collection of both quantitative and qualitative data. Among the nurses, 134 questionnaires were administered. SPSS was used to analyze these results. For this study, six interviews were conducted and analyzed through thematic coding. Results The quantitative analysis shows that the respondents are look positively about the Positive health description. Nurses find it important that it emphasizes that someone is more than his illness. In addition, the emphasis is on personal control. However, the question is also raised whether every patient can handle this. Nurses find the most important dimension ‘quality of life'. This is followed by the dimension ‘mental well-being’ and ‘spiritual existential'. The dimension ‘daily functioning’ is found to be the least important. The qualitative analysis also shows that the concept of Positive Health is viewed positively. The concept is considered positive, because it covers several areas of health. However, it was also indicated that the concept is still too broad. However, all respondents found that the concept can be applied in practice. Conclusions This study shows that palliative care nurses have a positive attitude towards Positive Health. Nurses consider the all the dimensions important and also embed the aspects of it in their daily practice. However, the implementation of new concept should be explored. Key messages • Palliative care nurses have a positive attitude towards Positive Health. • The implementation of Positive Health in palliative care should be explored.

Position No. 1/2022 of the Board of the Polish Palliative Care Nurses Association of 15 February 2022 on employment standards for nurses in home and inpatient palliative care

Position No. 1/2022 of the Board of the Polish Palliative Care Nurses Association of 15 February 2022 on employment standards for nurses in home and inpatient palliative care

Development of a Primary Palliative Nursing Care Competence Model and Assessment Tool: A Mixed-Methods Study.

The purpose of this study was to develop a new primary palliative nursing care (PPNC) competence model and assessment tool. Consensus guidelines, a national position statement, and new nursing program accreditation standards require nurses to be educated in providing PPNC. A means to assess PPNC competence for prelicensure nursing students and entry-level nurses is needed. The mixed-methods study utilized a three-phase design encompassing in-depth document analysis and expert workgroups; focus groups with palliative care educators, practitioners, and administrators; and stakeholder focus groups. Findings across all phases resulted in development of a PPNC competence model and assessment tool, each composed of nine domains and associated competency statements. There is a global imperative for nurses to provide high-quality PPNC. Both the model and assessment tool are vital to develop a nursing workforce with the skills to care for persons with serious illness and their families.

ANALISIS KARAKTERISTIK, PENGETAHUAN, DAN SIKAP PERAWAT TERHADAP PERAWATAN PALIATIF DI RUMAH SAKIT DAERAH KABUPATEN SUBANG

Palliative care cannot be done by just anyone, because it must involve a special team such as doctors, nurses, and other medical experts who are professionals in the field of palliative specialization. The purpose of this study is to be able to analyze the relationship between the level of knowledge and the attitude of nurses about palliative care to the characteristics in the Subang Regency Regional Hospital. The research design used is Cross Sectional. The sample in this study was 76 respondents. Univariate, bivariate data analysis using chi square and multiple logistic regression multivariates. The results showed that the variables that had a meaningful relationship with nurse actions in valiative care were variables of age, education, knowledge, and attitudes with a p value of < 0.05. Of the four variables, there is a chance of palliative care implementation of 67.5%. It is necessary to improve knowledge and attitudes in the field of palliative care for nurses who provide palliative care through special education.

Death-coping self-efficacy and its influencing factors among Chinese nurses: A cross-sectional study.

Nurses are the main caregivers of dying patients. Facing or dealing with death-related events is inevitable. Death-coping self-efficacy (DCS) is very important, as it can reduce the risk of nursing staff to adverse emotional distress, help them participate in end-of-life care and improve the quality of care of patients. Using the convenient sampling method, this study included a total of 572 nurses from a tertiary hospital in Hangzhou, China. The status and influencing factors of the DCS of nurses were explored using a general information questionnaire and DCS scale. The scores of each parameter, ranging from low to high, were in the order of coping with grief, preparation for death and hospice care. Factors influencing nurses' DCS included attendance in hospice care education courses within the previous year, experience of accompanying the family members of the deceased and attitude towards death. The overall self-efficacy of nurses in palliative care was at a medium level. Moreover, their self-efficacy in coping with grief and preparation for death should be strengthened. Managers of medical institutions can assess the death-coping ability of nurses, which helps provide corresponding support and training for nurses at an early stage. Nurses should receive guidance in grief adjustment and emotion regulation. Medical units should provide nurses with a platform for continuous training and education, use of death-related theoretical models and frameworks to guide nurses in dealing with death-related events, reduce nurses' negative mood and jointly promote their mental health.

Evaluation of the quality of palliative home care for cancer patients in Cyprus: a cross-sectional study

Home care nursing for cancer patients often involves palliative care, as it offers the potential to significantly improve the patients' quality of life. For the vast majority of patients, their home is the most preferable space for palliative care, since care in their own private space ensures they experience a feeling of meaningful existence and preserves the feeling of control over their life. The current study aims to evaluate the quality of palliative home care for cancer patients in Cyprus. This qualitative research follows the STROBE cross-sectional checklist. The study took place in the Republic of Cyprus and the study tool involved a questionnaire that was distributed by hand via convenient sampling. In the current research, a total of 80 cancer patients who participated in in-home care nursing in Cyprus were investigated. The psychological support and the communication provided by the home care nursing toward the patient appear to have a pivotal role when it comes to improving the quality of the individual's life as well as the perceived levels of respect and recognition of one's own needs. However, further research within a larger sample size of patients who receive palliative home care nursing is required in order to yield conclusions that are further representative of the wider population and which can be generalizable to a greater extent.

P17 - Group Clinical Supervision - its tops!

Clinical supervision is a supportive strategy that has been used successfully in myriad health disciplines, and is commonly used in psychology, social work, other allied health, mental health and palliative care nursing. For midwives, clinical supervision has: fostered feelings of re-energisation and invigoration; enhanced motivation for their jobs; and positively impacted interpersonal skills, situational responses, and careers. An audit of Sydney maternity units show that all organisations offer some degree of Clinical Supervision to midwives, but it is unclear how many actually attend the sessions. The presenter is currently undertaking an NHMRC-funded cluster randomised controlled trial with 12 maternity units in Sydney with Group Clinical Supervision as the intervention. It is hypothesised that midwifery burnout, as well as other health-related parameters will be lowered in relation to attendance at the sessions. As such, the presenters have a wealth of experience in running Group Clinical Supervision sessions. This workshop will demonstrate how Group Clinical Supervision is structured and run. First, background to Clinical Supervision will be outlined about what it aims to achieve for supervisees. The different models of Clinical Supervision that are used in healthcare and the research underpinning the strategy will be discussed. A Group Clinical Supervision session for willing participants will be demonstrated using the role development model. The role development model facilitates a deep reflective process on a work-related topic to unfold. Certain strategies such as using figurines (called ‘concretisation’) to enable a unique view of a situation will be used. Care will be taken to choose a demonstration topic that does not engender strong emotional responses for participants. The workshop has an overall aim to give delegates a chance to be part of a Group Clinical Supervision session and to see, firsthand, the benefits and processes involved.

1268P Associations between psycho-social-spiritual interventions, reduced aggressive end-of-life measures, and increased time after final oncologic treatment

Though the positive impact of palliative care physicians and nurses on end of life medical outcomes is increasingly well-established, little is known about the impact of spiritual caregivers, psychologists, and social workers on desired end of life medical outcomes. In particular, on reduced use of aggressive care in the final two weeks of life, having more time after the last active oncological treatment and before death, and increased hospice use.

Symptom frequency in patients with advanced cancer admitted to a palliative care unit in the Islamic Republic of Iran

Background: Symptoms and their severity are among the main causes of suffering in patients with advanced cancer. Although knowledge of symptom prevalence is important for clinical practice, little is known about the frequency of symptoms in advanced cancer patients. Aims: To identify the most frequent cancer-related symptoms in a palliative care unit in the Islamic Republic of Iran. Methods: A cross-sectional study was conducted on patients with advanced cancer admitted to the Palliative Care Unit at Imam Khomeini Hospital, Tehran, between March 2019 and March 2020. We collected data from 387 patients’ records, including age, sex, cancer type, reported symptoms, and pain intensity. Pain intensity was measured using a numeric rating scale of no pain (0), mild (1 or 2), moderate (3–6), and severe (7–10). Results: Gastric (16.02%), breast (13.95%), colon (11.60%), ovarian (8.79%), and lung (5.94%) were the most frequent cancers. Patients reported 2582 symptoms. The most frequent symptoms were pain (91.2%), anorexia (86.7%), oral thrush (69.3%), nausea (55.6%), constipation (53.7%), fatigue (45.5%), and vomiting (40.1%). Based on pain intensity measurement, 72.2% of patients reported severe, 17.0% moderate, and 10.8% mild pain. Pain intensity and symptom frequency did not differ significantly by age, sex, and type of cancer. Conclusion: Cancer patients reported multiple symptoms. In the Islamic Republic of Iran, with limited palliative care services, these findings can guide palliative care centre doctors and nurses in symptom management

Factors associated with attitudes toward advance directives in nurses and comparisons of the levels between emergency nurses and palliative care nurses.

Little is known about attitudes toward advance directives and factors associated with them among emergency and palliative care nurses who often or daily face end-of-life circumstances. Thus, we aimed to compare the levels of attitudes toward advance directives, communication skills, knowledge about end-of-life care (knowledge), and awareness of the concept of a good death (good death awareness) between emergency and palliative care nurses, and to examine factors associated with attitudes toward advance directives in the total sample. In this cross-sectional, correlational study, data were collected from 153 nurses (59 emergency and 94 palliative care nurses) at three tertiary hospitals using online or offline surveys and were analyzed using t-tests and multiple linear regression analysis. The levels of attitudes, communication skills, knowledge, and good death awareness were moderate in both groups. Attitudes in emergency compared to palliative care nurses were less positive (46.78 vs. 48.38; p=.044), and knowledge was significantly lower (13.64 vs. 15.00; p=.004). Communication skills and good death awareness between the two groups were similar. In the total sample, emergency practice (B=-1.59, p=.024), and lower levels of good death awareness (B=0.30, p < .001), communication skills (B=0.18, p=.001), and education (B=-2.84, p=.015) were associated with less positive attitudes (F=9.52, p < .001; R2 =0.35). The findings demonstrate the need for improvements in attitudes, knowledge, communication skills, and good death awareness in both groups, especially emergency nurses. Two modifiable targets of interventions to improve nurses' attitudes were also noted.

Frequency of nurse-provided spiritual care: An international comparison.

To compare the frequency of nurse-provided spiritual care across diverse cultures. Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement. This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument. Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n=4062). STROBE guidelines for cross-sectional observational studies were observed. Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics. In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care. Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.