Palliative Care Professionals Research Articles

Understanding Family Members in the Palliative Phases of Their Loved Ones: A Qualitative Study.

Because of aging and rising rates of chronic diseases, the demand for palliative care services is increasing worldwide, and patients need family members to care for them throughout the palliative care process. This study aimed to investigate the experiences of the relatives of palliative care patients during hospitalization. This was a qualitative study conducted with 15 family members. A topic guide was used to conduct semistructured face-to-face interviews. Content analysis was used to analyze the textual data. As a result of the analysis, 3 main themes, 6 categories, and 24 subcategories emerged. The main themes were "reactions to the admission," "feeling obligated to care," and "coping processes." The interviews revealed that most participants had misconceptions and a lack of knowledge about palliative care. Almost all of the family members expressed that they experienced various emotions during this process and had trouble coping. The significant finding of our study is that culture and religious beliefs have a considerable influence on caregiving. A limited number of studies in the literature provide detailed insight into the state of patient relatives. Therefore, this study is critical in guiding palliative care professionals in understanding the requirements of this vulnerable group.

Translation and validation of the Chinese version of Palliative Care Self-Efficacy Scale.

Accurately assessing the self-efficacy levels of palliative care professionals' is crucial, as low levels of self-efficacy may contribute to the suboptimal provision of palliative care. However, there is currently lacking a reliable and valid instrument for evaluating the self-efficacy of palliative care practitioners in China. Therefore, this study aimed to translate, adapt, and validate the Palliative Care Self-Efficacy Scale (PCSS) among Chinese palliative care professionals. This study involved the translation and cross-cultural adaptation of the PCSS, and the evaluation of its psychometric properties through testing for homogeneity, content validity, construct validity, known-groups validity, and reliability. A total of 493 palliative care professionals participated in this study. The results showed the critical ratio value of each item was >3 (p < 0.01), and the corrected item-total correlation coefficients of all items ranged from 0.733 to 0.818, indicating a good homogeneity of the items with the scale. Additionally, the scale was shown to have good validity, with item-level content validity index ranged from 0.857 to 1.000, and scale-level content validity index/Ave was 0.956. The exploratory factor analysis and confirmatory factor analysis (CFA) confirmed the 2-factor structure of the Chinese version of PCSS (C-PCSS), explaining 74.19% of the variance. CFA verified that the 2-factor model had a satisfactory model fit, with χ2/df = 2.724, RMSEA = 0.084, GFI = 0.916, CFI = 0.967, and TLI = 0.952. The known-groups validity of C-PCSS was demonstrated good with its sensitive in differentiating levels of self-efficacy between professionals with less than 1 year of palliative care experience (p < 0.001) or without palliative care training (p = 0.014) and their counterparts. Furthermore, the C-PCSS also exhibited an excellent internal consistency, with the Cronbach's α for the total scale of 0.943. The findings from this study affirmed good validity and reliability of the C-PCSS. It can be emerged as a valuable and reliable instrument for assessing the self-efficacy levels of palliative care professionals in China.

Core Palliative Care Competencies for Undergraduate Nursing Education: International Multisite Research Using Online Nominal Group Technique.

Background: Nurses should have appropriate education and required competencies to provide high-quality palliative care. The aim of this international multisite study was to list and evaluate core palliative care competencies that European nurses need to achieve in their education to provide palliative care. Methods: The Nominal Group Technique (NGT) was used as a data collection method. NGT meetings were organized in four European countries. Targeted groups of palliative care professionals with diverse contextual and professional backgrounds participated in the NGTs. The research question was: "What are the core competencies in palliative care that need to be achieved during undergraduate nursing education?" Data analysis was done in two stages: grouping the top 10 answers based on similarities and thematic synthesis based on all the ideas produced during the NGTs. Results: Palliative care core competencies based on the research were (1) competence in the characteristics of palliative care; (2) competence in decision-making and enabling palliative care; (3) symptom management competence in palliative care; (4) competence in holistic support in palliative care; (5) active person- and family-centered communication competence in palliative care; (6) competence in empathy in palliative care; (7) spiritual competence in palliative care; (8) competence in ethical and legal issues in palliative care; (9) teamwork competence in palliative care; and (10) self-awareness and self-reflection competence in palliative care. Conclusions: It was possible to find differences and similarities in the top 10 palliative care core competencies from different countries. Thematic synthesis of all the data showed that there were various competencies needed for nursing students to provide quality palliative care.

Exploring the role of palliative care occupational therapists in supporting compassionate communities in end-of-life care.

The compassionate communities' movement is a public health approach to end-of-life care that emphasises the integral role of communities in supporting and caring for dying persons and their informal carers. Although occupational therapists have well-established roles in palliative care teams, little is known about their potential in assisting in the formation and maintenance of compassionate communities. Data were gathered via semi-structured interviews with nine Australian occupational therapists with experience in specialist palliative care. Interview questions were based around the British Columbia Compassionate Community Ideal framework. Key themes were derived through qualitative descriptive analysis, blending deductive, and inductive reasoning. Interviewees indicated that occupational therapists have a role in supporting compassionate communities that centres on the facilitation of networks and connections between palliative care professionals and in the promotion of informal care networks. The importance of education and awareness raising were also discussed as valuable to the development of community capacity. It was also suggested that occupational therapists have important skills to support dying persons and their caregivers to remain engaged and safe in their homes and communities, in a meaningful and sustainable way. However, many interviewees maintained a profession-centric view on control within compassionate communities, as opposed to approaches that are community led. Findings offer early insights into the promise and potential of occupational therapists in supporting the compassionate communities' movement. However, education regarding the ethos of the compassionate communities' movement so as to facilitate a shift away from professionally oriented modes of practice may be needed to maximise success.

Burnout and attachment in oncology and palliative care healthcare professionals

ObjectivesExamine the prevalence of burn-out in health professionals working in a hospital dedicated to patients with cancer. Explore the relationship between attachment style and burn-out in healthcare professionals working in...

Perceptions and experiences of onco-haematology professionals in relation to advance care planning: a qualitative study.

The objective of this study is to identify the beliefs, values, perceptions, and experiences of medical oncology, radiation oncology, and clinical haematology professionals about the advance care planning process. Qualitative exploratory study. There were four focus groups with 14 nurses and 12 physicians (eight medical oncology, one radiation oncology, three haematology). A reflexive thematic analysis of the data obtained was performed. We identified 20 thematic categories, which we grouped into four themes: lack of knowledge about advance care planning; perception of the advance care planning process: knowledge acquired from practice; barriers and facilitators for the implementation of advance care planning; and communication as a key aspect of advance care planning. The participants valued advance care planning as an early intervention tool that promotes autonomy. They perceived difficulties in approaching planning due to lack of knowledge, training, and time. They identified the therapeutic relationship with the person, the participation of the person's loved ones, teamwork, and communication skills as essential to ensuring the quality of the process. Finally, they recognised that palliative care professionals provide added value in supporting planning processes.

How palliative care professionals develop coping competence through their career: A grounded theory

Background: Palliative care professionals face emotional challenges when caring for patients with serious advanced diseases. Coping skills are essential for working in palliative care. Several types of coping strategies are mentioned in the literature as protective. However, little is known about how coping skills are developed throughout a professional career. Aim: To develop an explanatory model of coping for palliative care professionals throughout their professional career. Design: A grounded theory study. Two researchers conducted constant comparative analysis of interviews. Setting/participants: Palliative care nurses and physicians across nine services from Spain and Portugal (n = 21). Theoretical sampling included professionals who had not continued working in palliative care. Results: Professionals develop their coping mechanisms in an iterative five-stage process. Although these are successive stages, each one can be revisited later. First: commencing with a very positive outlook and emotion, characterized by contention. Second: recognizing one’s own vulnerability and experiencing the need to disconnect. Third: proactively managing emotions with the support of workmates. Fourth: cultivating an integrative approach to care and understanding one’s own limitations. Fifth: grounding care on inner balance and a transcendent perspective. This is a transformative process in which clinical cases, teamwork, and selfcare are key factors. Through this process, the sensations of feeling overwhelmed sometimes can be reversed because the professional has come to understand how to care for themselves. Conclusions: The explicative model presents a pathway for personal and professional growth, by accumulating strategies that modulate emotional responses and encourage an ongoing passion for work.

Time-oriented decisions in Palliative Care team meetings

In a wide diversity of workplaces time and temporality are an omnirelevant feature of the praxeological and material environment, as observable by the pervasiveness of chrono-metrical and chronological technologies and artifacts, and by workers’ orientation to matters of punctuality, productivity and other aspects of task dispatch and managerial organization. Professionals’ orientation to time takes an additional complexity in healthcare settings, given the multiple temporalities involved – biological, institutional, social – and the implications of timely professional intervention in the progression of patients’ health. In palliative care, we argue, a practical concern with time and temporality is a constitutive feature of the work of professionals and teams, visible in and built in their interactions. Furthermore, such orientation to time is related to the collective production of justifications for actions. Drawing on conversation analysis of a corpus of audio recordings, we examine how, in team meetings and interactions with other healthcare staff, palliative care professionals make sense of patients’ end of life trajectories in a situated and joint manner, grounding their proposals for action in terms of timeliness – or lack thereof – concerning patients’ current situation and prognoses on their more-or-less foreseeable unfolding, accomplishing a valid rationale for palliative intervention.

How can technology be used to support communication in palliative care beyond the covid-19 pandemic: a mixed-methods national survey of palliative care healthcare professionals

BackgroundDevelopments in digital health have the potential to create new opportunities for healthcare professionals support delivery of palliative care. Globally, many palliative care professionals used digital health innovations to support communication with staff, patients and caregivers, during COVID-19 pandemic. However, there is limited data about the views of palliative care professionals of using digital health to support communication during the pandemic. We aimed to describe how palliative care professionals used technology to support communication (multidisciplinary team working, education and with patients and family caregivers) during the COVID-19 pandemic.Method(s)UK based palliative care healthcare professionals completed an electronic questionnaire to describe their use of digital health, during the COVID-19 pandemic, to support (1) communication within the multidisciplinary team (MDT), (2) education and (3) to support communication with patients and carers.ResultsTwo hundred and thirty-four palliative care professionals participated. Most (n = 227, 97%) described an increase in their use of digital health, to support communication, since the start of the COVID-19 pandemic. We identified benefits and challenges for digital health communication, which we summarised into themes, including ‘a new way of working’, ‘developing a new approach to learning’ and ‘impacting care’.Conclusion(s)Since the pandemic, palliative care professionals have increased their use of digital health to support communication in clinical practice. We have identified facilitators and barriers for future practice. Further work should identify the levels of support needed for organisations to ensure that digital health interventions are meaningfully used to help palliative care professionals effectively communicate with patients, caregivers and staff.

Spiritual Care through the Lens of Portuguese Palliative Care Professionals: A Qualitative Thematic Analysis.

Providing spiritual care is paramount to patient-centered care. Despite the growing body of data and its recognized importance in palliative care, spiritual care continues to be the least advanced and most overlooked aspect. This study aims to explore the perceptions and experiences of spiritual care from the perspective of PC professionals and identify their strategies to address spiritual care issues. Data were collected through semi-structured personal interviews and managed using WebQDA software (Universidade de Aveiro, Aveiro, Portugal). All data were analyzed using thematic content analysis, as recommended by Clark and Braun. The study included 15 palliative care professionals with a mean age of 38.51 [SD = 5.71] years. Most participants identified as lacking specific training in spiritual care. Thematic analysis spawned three main themes: (1) spiritual care as key to palliative care, (2) floating between "shadows" and "light" in providing spiritual care, and (3) strategies for competent and spiritual-centered care. Spiritual care was considered challenging by its very nature and given the individual, relational, and organizational constraints lived by professionals working in palliative care. With support from healthcare institutions, spiritual care can and should become a defining feature of the type, nature, and quality of palliative care provision. Care providers should be sensitive to spiritual needs and highly skilled and capable of an in-the-moment approach to respond to these needs. Further research on educating and training in spiritual care competence is a priority.

A Survey of State Correctional Health Care Providers on Advance Care Planning: Opportunity for Collaboration With Corrections.

Prison populations are rapidly aging. Persons in prison age quicker and suffer more chronic illness and disability than their nonincarcerated peers, posing challenges to caring for prisoners who are chronically ill and dying. The goal of our study was to describe state prisons' practices and policies addressing persons in prison with advanced chronic and life limiting illness through a national web-based survey of state-level prison health care professionals. In particular, we focused on advanced care planning, use of health care directives, decision-making about goals of care, including life sustaining treatments, The response rate was 22% for a sample size 152 completed surveys. The average age of respondent was 52years; majority were female and Caucasian, and had worked in corrections more than 8years. Nearly half were registered nurses. Most reported their prison did not have a dedicated end-of-life care program and only 11% offered a peer-care program. However, two-thirds indicated their facility provided the opportunity to designate a health care agent with physicians most likely responsible for facilitating completion of a health care directive. It is evident the care of persons aging and dying in prison is complex and requires further investigation addressing staff and prison population education, ethics guidelines for care, compassionate release, and advance care planning. This study suggests that hospice and palliative care professionals could collaborate with corrections professionals and national organizations to provide innovative education and support to enhance the humane care of this vulnerable population.

The needs of healthcare personnel who provide home-based pediatric palliative care: a mixed method systematic review

BackgroundFamilies with children who have life-limiting or life-threatening illnesses often prefer to receive care at home to maintain a sense of normalcy. However, caring for children at home is different from caring for them in a hospital, and we do not know enough about the needs of healthcare personnel who provide home-based pediatric palliative care.AimThe aim of this review was to systematically summarize, appraise and synthesize available quantitative, qualitative, and mixed methods research to identify the needs of healthcare personnel in home-based pediatric palliative care.MethodsWe used the Joanna Briggs Institute methodology for mixed method systematic reviews and searched systematically in Medline, Embase, PsycINFO, CINAHL, Web of Science, AMED, and the Cochrane Library. Quantitative, qualitative and mixed methods studies from 2012 to 2021 reporting on healthcare personnel’s needs, experiences, perspectives, coping strategies, and/or challenges related to home-based pediatric palliative care were eligible for inclusion. The screening was conducted independently in pairs. The quantitative data were transformed into qualitative data and analyzed using thematic synthesis.ResultsOverall, 9285 citations were identified, and 21 studies were eligible for review. Most of the studies were qualitative and interview-based. Few studies included healthcare personnel other than doctors and nurses. Three analytical themes were developed: (1) being connected and engaged with the child and family, (2) being part of a dedicated team, and (3) ensuring the quality of home-based pediatric palliative care services. Healthcare personnel strived to deliver high-quality, home-based pediatric palliative care. Establishing a relationship with the child and their parents, collaborating within a committed team, and having sufficient resources were identified as important needs influencing healthcare personnel when providing home-based pediatric palliative care.ConclusionThe findings underscore the importance of building trusting relationships among healthcare personnel, children, and families. It also emphasizes the significance of interdisciplinary collaboration that is effective, along with the presence of enough skilled personnel to ensure high-quality home-based pediatric palliative care. Further research is necessary to include healthcare personnel beyond doctors and nurses, as palliative care requires a team of professionals from various disciplines. Addressing the needs of healthcare personnel can ensure safe and professional palliative care for children at home.

Family Caregivers’ Dilemma while Providing Palliative Care to Elderly Patients

Elderly patients receiving palliative care are terminally ill, thereby requiring an increasing amount of caregivers’time and attention. Caregivers often face diverse issues and challenges while performing caregiving tasks. Thepurpose of this paper is to systematically investigate the challenges that trigger family caregivers’ dilemmas whileproviding palliative care to their elderly patients. The sample size was 10 respondents (family caregivers) who werepurposively selected by the researchers from hospital-based palliative care settings and home-based palliative caresettings. The finding of this study presents the existing and emerging dilemmas confronted by the caregivers of theelderly receiving palliative care. The caregivers in both settings reported elderly patients’ reluctance to performdaily exercises and medication. The caregivers in the hospital-based palliative care setting mentioned the patient’sdesire to go home, while the caregivers in the home setting needed extra assistance to manage the care needs ofthe elderly patients. The paper also highlights the implications for social workers functioning in palliative caresettings. In conclusion, caregiving for an elderly patient is a very arduous and demanding task. Family caregiversgrapple with many day-to-day challenges which creates dilemma in providing quality palliative care to theirelderly patients. They try to fix their dilemmas by looking at the issue through a medical lens and discussing itwith professional palliative care providers.

Neutrosophic Personality Traits and Ethical Competencies in Palliative Care Professionals

The present study aimed to demonstrate the applicability of neutrosophic logic in investigating the relationship between the personality traits of a group of palliative care professionals and the ethical aspects inherent in their work. Neutrosophic correlation coefficients were employed to identify the most influential personality traits in the ethics of palliative care, as well as the ethical competencies with the greatest impact. The results revealed differences in personality traits, with nurses showing higher sensitivity than doctors, and doctors exhibiting greater kindness. Furthermore, varying degrees of relationships between personality traits and ethical competencies were identified. The neutrality, indeterminacy, and non-truth of the personality traits and competencies analyzed from a neutrosophic perspective allow for a more precise and nuanced evaluation of how palliative care professionals relate to patients and their families. These elements provide a solid foundation for understanding the interaction between ethical aspects and the personality traits of healthcare professionals.

Using normalization process theory to evaluate the use of patient-centred outcome measures in specialist palliative home care—a qualitative interview study

BackgroundStandardised use of patient-centred outcome measures (PCOMs) improves aspects of quality of care. Normalization Process Theory (NPT) considers the social (inter-)actions of implementation processes operationalised through four constructs: coherence-building, cognitive participation, collective action and reflexive monitoring. The aim of the study was to identify barriers and enablers for the successful use of PCOMs in specialist palliative home care (SPHC) using NPT, to collect clinically meaningful and reliable data to improve patient outcomes.MethodsQualitative study using semi-structured interviews with palliative care professionals from German SPHC teams who participated in a study using PCOMs. Data were analysed using Framework analysis, and contextualised within NPT.ResultsSeventeen interviews across five teams were conducted. Some teams already had an understanding of what PCOMs are and how to use them, based on previous experience. In other teams, this understanding developed through the perception of the benefits (coherence). Participation and engagement depended on individuals and was decisive for coherence-building. The attitude of the management level also played a major role (cognitive participation). Integration of PCOMs into everyday clinical practice varied and depended on the manifestation of the first two constructs and other already established routines (collective action). In the context of appraisal, both positive (e.g. focus on patient) and negative aspects (e.g. additional work) of using PCOMs were mentioned (reflexive monitoring).ConclusionsAlthough benefits of using PCOMs were partly recognised, not all teams continued standardised use. Here, not only the social (inter-)actions, but also the influence of the context (working environment) were decisive. Future implementation strategies should consider integrating PCOMs in existing electronic patient records, education sessions supporting coherence-building, internal facilitators/local champions, and ensuring frequent data analyses as it is beneficial and increases the readiness of using PCOMs.

"The “Amfora conversation”: reflecting on life and death when the end is near. An innovative practice empowering patients".

Death is part of life. Yet, few people are prepared for it. Many of those who are old or seriously ill, have the need to reflect on the past life, the nearing end and the things that matter. Talking about and sharing those deeper feelings and thoughts can be deeply liberating. It can create a closer connection between the ill or old person, the loved ones and the health care professionals. End-of-life conversations can stimulate the person to think about future care and, this way, contribute to advance care planning. And for loved ones it can have a preventive effect in the sense that it increases the chances of healthy grieving.&#x0D; Who am I, where do I find strength, which meaning do I give to death? How do I look back on my life? What are my fears and my hopes? What do I wish to leave for those staying behind? Thinking and talking about these questions is not easy. The non-profit organization Amfora helps people to find language and create a tangible memory for loved ones, by means of an “Amfora conversation” resulting in a precious, carefully written end-of-life story. Amfora provides training to health care professionals and volunteers from various settings (hospitals, palliative care networks, facilities for people with disabilities and elderly care), so they can integrate the practice in their daily work.  &#x0D; Integrated care reflects the whole of a person’s health needs. It means we focus on the totality of the person and his full context, beyond the disease or chronic condition. This is particularly important in palliative care and end-of-life care, where consensus exists about the four pillars of care: physical, psychological, social and spiritual/existential. This last pillar – which goes far beyond religion – is the most intimate and hidden dimension of care, yet it’s crucial because of its close connection to each of the other dimensions.&#x0D; However, it remains a challenge for many palliative care professionals how to implement this non-medical, existential pillar in practice. This is where the Amfora conversation comes in: it has proven to be an accessible and effective way to empower people in having their spiritual/existential needs fulfilled. The Amfora concept is innovative because it is based on the journalistic interview method. The interviewer captures the essence of the person and gives it back in another form, so it can be passed on. End-of-life conversations are a form of care and should therefore be fully integrated in palliative care.

Cross-Sectional Study of the Professional Quality of Life of Palliative Care Professionals during the COVID-19 Pandemic.

The display of compassionate care by palliative care professionals is of the utmost importance to the patients, their families, and even to their own professional well-being. Lately and, especially due to the emergence of the COVID-19 pandemic, palliative care professionals have been subjected to greater pressures stemming from their work environment, organizational standpoint, and emotional sense of view. Not only have these factors made it harder for professionals to deliver compassionate care to their patients, but they have also decreased their overall well-being. The aim is to study how sociodemographics, workplace characteristics, internal resources, and the COVID-19 pandemic-derived pressures have affected the professionals' capacity to perform compassionate care and their well-being while at the same time exploring the relationship between compassionate care and well-being. This study used a cross-sectional design with data gathered from Spanish palliative care professionals. The final sample was formed by 241 participants. They were surveyed about compassion, professional quality of life, well-being, sociodemographic data, working conditions, self-care, and coping with death competence, and the impact of the COVID-19 pandemic. The analyses used were descriptive statistics, bivariate tests, and the construction of a structural equation model. Compassion was predicted by the ability to control their workload and the ability to cope with death. Burnout was predicted by age, workload, workload control, self-care, material resources, and changes in teamwork. Moreover, compassion, age, workload control, and changes in teamwork and self-care were shown to significantly predict compassion satisfaction. When it comes to compassion fatigue, different variables were shown to predict it, those being compassion, control over the workload, social self-care, and the ability to cope with death. Having a healthy lifestyle and an adequate social support system is key to maintaining professional well-being in the case of palliative care professionals. Inner resources such as the ability to perform self-care and the capacity to cope with death are of vital importance to taking care of these professionals. Thus, it would be beneficial to establish training programs focused on these aspects in the myriad of sanitary centers that perform these tasks, as these abilities are necessary to withstand the work-related pressures and, at the same time, be able to provide compassionate care for patients.

Association Between Oral Health Status and Survival Time in Terminally Ill Cancer Patients

Introduction Patients with terminal cancer often experience various oral problems. Whether oral health status is associated with the survival of terminally ill cancer patients receiving palliative care remains unclear. Methods We analyzed the data of 59 Korean patients with terminal cancer receiving palliative care, including their oral health status, using a modified Korean version of the Oral Health Assessment Tool (OHAT). Patients were categorized into “Good,” “Moderate,” or “Poor” groups based on OHAT scores. The Kaplan-Meier method was used to compare the median survival time, and the prognosis between groups was estimated using Cox proportional hazard models. Results The most common oral symptoms observed were xerostomia (69.5%) and mucositis (17.0%). Significantly shorter survival times were observed in patients with hyperbilirubinemia, elevated creatinine levels, and no use of dentures. The “Poor” group had a shorter survival than the “Good” oral group ( P = .010). A multivariate Cox proportional hazards analysis revealed that the “Poor” group was significantly associated with poor survival compared to the “Good” group (hazard ratio, 2.05; P = .047). Conclusion Terminally ill cancer patients with poor oral health may have a higher risk of shorter survival. Palliative care professionals should pay attention to oral health. Further research is needed to determine the effects of oral care on survival.

Effectiveness of CURA: Healthcare professionals' moral resilience and moral competences.

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences.Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences.Design: Single group pre-/post-test design with two questionnaires.Methods: Questionnaires used were the Rushton Moral Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist.Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents.Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales.Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice.

The meaning of dignity in care during the COVID-19 pandemic: a qualitative study in acute and intensive care

BackgroundThe pandemic Era has forced palliative care professionals to use a dignity-in-care approach in different settings from the classic ones of palliative care: acute and intensive care. We explored the meanings of dignity for patients, their family members, and clinicians who have experienced COVID-19 in the acute and intensive care setting.MethodsA qualitative, prospective study by means of semi-structured interviews with patients hospitalized for COVID-19, family members, and clinicians who care for them.FindingsBetween March 2021 and October 2021, we interviewed 16 participants: five physicians, three nurses, and eight patients. None of the patients interviewed consented for family members to participate: they considered it important to protect them from bringing the painful memory back to the period of their hospitalization. Several concepts and themes arose from the interviews: humanity, reciprocity, connectedness, and relationship, as confirmed by the literature. Interestingly, both healthcare professionals and patients expressed the value of informing and being informed about clinical conditions and uncertainties to protect dignity.ConclusionsDignity should be enhanced by all healthcare professionals, not only those in palliative care or end-of-life but also in emergency departments.