Specialist Palliative Care Nurses Research Articles

What influences specialist palliative care nurses working in a community setting to engage with research?

The aim of this research was to understand what influences specialist palliative care nurses working in a community setting to engage with research. Qualitative research using interviews with community based clinical nurse specialists (CNS). A total of five themes were identified: research negativity and enthusiasm, clinical focus, audits, organisational support and keeping up to date. Except for audit activity, CNS do not view the research pillar as an integral part of their clinical role. Previous research education may not give the CNS the breadth of research skills that they require. The advance professional apprenticeship may resolve these education issues. Managers and organisations need to prioritise EBP skills; supporting nurses with both education and EBP mentors to develop these skills. Nurses require ongoing time to engage with research activity and use these skills to improve both their own clinical practice and those who use them as a research resource.

Exploring the telehealth readiness and its related factors among palliative care specialist nurses: a cross-sectional study in China

BackgroundsThe majority of Chinese people who are nearing the end of their lives prefer to receive home-based palliative care. Telehealth, as a new service model, has the potential to meet the increasing demand for this service, especially in remote areas with limited resources. However, nurse-led telehealth-based palliative care services are still in the pilot implementation phase. Assessing the telehealth readiness among palliative care specialist nurses and identifying associated factors is crucial to facilitate the successful implementation of telehealth services. Therefore, this study aimed to examine TH readiness and its related factors among Chinese palliative care specialist nurses.MethodsFour hundred nine Chinese palliative care specialist nurses from 28 provinces or municipalities participated in this study between July and August 2022. The Chinese version of Telehealth Readiness Assessment Tools (TRAT-C), and Innovative Self-Efficacy Scale (ISES-C) were used to assess the degree of TH readiness and the levels of innovative self-efficacy.ResultsThe total score of the TRAT-C was 65.31 ± 9.09, and the total score of ISES was 29.27 ± 5.78. The statistically significant factors that influenced telehealth readiness were the experience of using telehealth platforms or services, the willingness to provide telehealth to patients, and the level of nurses’ innovative self-efficacy. The innovative self-efficacy is positively correlated to telehealth readiness (r = 0.482, P < 0.01). These related factors could explain 27.3% of the difference in telehealth readiness.ConclusionThe telehealth readiness of Chinese palliative care specialist nurses are at a moderate level. Measures such as providing incentives to promote nurses’ innovation self-efficacy by nurse managers, and establishing a comprehensive telehealth training system for palliative care specialist nurses should be taken to facilitate the implementation of telehealth services in the field of palliative care.

Stressors experienced by nurses providing end-of-life care in intensive care unit (ICU): A Qualitative study

Background of Study: Palliative care is unique in that the service focuses on the needs of dying patients and their families as opposed to focusing on maintaining critical bodily functions, as in critical care nursing, or on improving functional capacity, as in rehabilitation nursing (Martens, 2009). The philosophy of palliative care nursing includes providing care to patients using medical science combined with compassion and caring. Patients may be cared for in hospital wards in acute care settings, in specialist hospice or palliative care units, in aged care homes, or in their own home. Palliative care specialist nurses primarily have generalist nursing skills with various levels of specialisation and post-registration education, including palliative care certification. (International Journal of Palliative Nursing 2012).Aims and Objectives: Purpose of the study is to gain a deeper understanding of the stressors experienced by ICU nurses providing End of Life Care and to describe stressors experienced by nurses working in ICU providing End of Life Care.Materials and Methods: Phenomenological research design was used.10 nurses working in ICU and giving End of life Care were selected using purposive sampling technique as per the pre-determined inclusion criteria. Semi-structured interview schedule was used for data collection. Voice recording of the conversation was done, the transcript was then thematically analysed using Open Code Software.Results: By the findings of the study themes emerged as Emotional Stressor, Personal Stressor, Professional Stressor, Anticipatory Stressor and Experiential Stressor.Conclusion: Limited research has been undertaken on the provision of End of Life care by nurses in the Intensive care setting and thus a need arises to conduct a study in this area. Identification and development of strategies to support nurses in the provision of End Of life care is required to ensure quality care and to minimise stress and eliminate burnout.

Initial exploration of training for palliative care specialist nurses in mainland China

This paper describes the initial exploration of training program for palliative care specialist nurses in mainland China. The training program included one month of theoretical learning and one month of clinical practice. The theoretical training contents were mainly set up around four modules such as clinical practice, teaching, scientific research and management. After the theoretical training, the trainees needed to practice in specific clinical practice hospitals. In total, 192 trainees from 27 provinces (municipalities) in mainland China participated in the training program. All trainees passed theoretical and clinical practice examinations. Their knowledge, attitude and behavior concerning palliative care were significantly improved after training (p < 0.001). The overall satisfaction rate of the trainees towards the theoretical courses was 95.6%, and the overall satisfaction rate of the trainees towards the clinical teaching base was 94.2%. The training program for palliative care specialist nurses can ensure the trainees to acquire basic professional knowledge and skills and improve their knowledge, attitudes and behaviors concerning palliative care. However, it is needed to explore training programs that are in part-time model, delivered online or suitable for different levels of nursing staff to improve the accessibility.

Candidates and candidacy: Patient, carer and staff perceptions of referral to a specialist palliative day unit

Background Specialist palliative day care can support palliative caregiving for those living in the community with advanced disease. However, how people access specialist palliative day care and why is unclear. This study therefore aims to explore the referral experiences of patients, carers and staff in the context of a specialist palliative day care unit. Design Qualitative study using constant comparative analysis to explore referral experiences to a UK specialist palliative day unit through one-to-one interviews with patients (n=15), family carers (n=6) and staff (n=10) including nurses, medics and managers and focus groups with (n=3 and n=7) specialist palliative care nurses. Findings The three datasets (staff, patients and carers) provide a triangulation of perspectives captured within the core category of ‘managing referral’ and presented as six sub-themes. Staff described referral as an intuitive interaction involving ‘looking for openings’ and ‘getting people through the door’. Patients familiar with the service were persistent in ‘shouting for help’ but most regarded referral with dread, only ‘giving it a go’ following crisis. For family carers referral presented ‘time out/respite’ but also the ‘end-of-the-line’. Conclusions Unclear understandings of services as well as uncertain professional, patient and carers notions of candidacy influence referral to specialist palliative day care.

The Specialist Palliative Care Nurses' in an Italian Hospital: role, competences, and activities.

Background and aim of the work:Many authors tried to clarify the palliative care nurses’ role, overall in the home care setting, but little is known in different settings of care. We aim to present a Specialist profile of palliative care (PC) nurses in an Italian hospital-based Palliative Care Unit.Methods:With an organizational case study approach, we conducted a literature review on PC nurse’s role, and we presented the Specialist PC nurses’ profile, describing competences and key related activities.Results:Our specialist profile highlights that clinical activities are similar to the experiences described in the literature (symptom assessment and management, communication, interprofessional work), while training and research activities are new fields of interest that it’s important to explore and promote, most of all in our country.Conclusions:Sustaining the flexibility of the role, being recognized by colleagues and keeping the three dimensions connected are the major challenges: drawing up a specialist palliative care nurses’ profile can help the team to better define the role framework in an interdisciplinary context.

Journey of Profound Life Lessons, Learning, Change and Self-awareness: Preparation for a Role Transition from a Senior Saudi Registered Nurse to a Specialist Palliative Care Nurse

Journey of Profound Life Lessons, Learning, Change and Self-awareness: Preparation for a Role Transition from a Senior Saudi Registered Nurse to a Specialist Palliative Care Nurse

Palliative care delivery in residential aged care: bereaved family member experiences of the Supportive Hospice Aged Residential Exchange (SHARE) intervention

BackgroundThe supportive hospice aged residential exchange (SHARE) is a new model of palliative care education that has been designed for residential aged care. The goal of SHARE is to help clinical staff improve palliative care within residential aged care facilities and to improve specialist palliative care nurses’ knowledge and skill to care for frail older people.MethodThe experiences of 18 bereaved families concerning the palliative care journey (both at the start and finish of a one-year implementation of SHARE) were explored using semi-structured interviews.ResultsThree themes were important to bereaved families’ experience: communication with staff, systems of care, and hospice involvement. Sub-themes indicating changes in these three components of care between the start and finish of SHARE was identified. A fourth theme highlighted challenges (relationship with GP, staff shortages, and turnover) that continued across SHARE.ConclusionFindings indicated that SHARE benefited families (improved communication and support) through the end of life journey of their relatives, but challenges remained.

An exploration of the experiences of professionals supporting patients approaching the end of life in medicines management at home. A qualitative study

BackgroundThe management of medicines towards the end of life can place increasing burdens and responsibilities on patients and families. This has received little attention yet it can be a source of great difficulty and distress patients and families. Dose administration aids can be useful for some patients but there is no evidence for their wide spread use or the implications for their use as patients become increasing unwell. The study aimed to explore how healthcare professionals describe the support they provide for patients to manage medications at home at end of life.MethodsQualitative interview study with thematic analysis. Participants were a purposive sample of 40 community healthcare professionals (including GPs, pharmacists, and specialist palliative care and community nurses) from across two English counties.ResultsHealthcare professionals reported a variety of ways in which they tried to support patients to take medications as prescribed. While the paper presents some solutions and strategies reported by professional respondents it was clear from both professional and patient/family caregiver accounts in the wider study that rather few professionals provided this kind of support. Standard solutions offered included: rationalising the number of medications; providing different formulations; explaining what medications were for and how best to take them. Dose administration aids were also regularly provided, and while useful for some, they posed a number of practical difficulties for palliative care. More challenging circumstances such as substance misuse and memory loss required more innovative strategies such as supporting ways to record medication taking; balancing restricted access to controlled drugs and appropriate pain management and supporting patient choice in medication use.ConclusionsThe burdens and responsibilities of managing medicines at home for patients approaching the end of life has not been widely recognised or understood. This paper considers some of the strategies reported by professionals in the study, and points to the great potential for a more widely proactive stance in supporting patients and family carers to understand and take their medicines effectively. By adopting tailored, and sometimes, ‘outside the box’ thinking professionals can identify immediate, simple solutions to the problems patients and families experience with managing medicines.

Palliative care nurses' strategies when working in private homes-A photo-elicitation study.

To explore palliative care nurses' work experiences caring for patients at the end of life in private homes. The home continues to be a desired place for care and dying; however, professional competence is needed and specialist palliative care nurses play a crucial role, often highly valued by patients and their family members. The private home as a physical work environment for nurses is explored, with both positive and negative aspects being described. To ensure future high-quality end-of-life care, there is a need to describe how palliative care nurses work in private homes. Interpretative descriptive. Participant-generated photographs were used in conjunction with follow-up interviews with ten palliative home care nurses. Interpretive description was used for analysis. This study follows the COREQ checklist. The analysis process resulted in four constructed themes, presented here as strategies used by palliative care nurses: adjusting interactions and actions depending on the environment when entering each unique private home; supporting patients and family members in finding a balance between self-care, independence and safe care; guiding patients and family members towards and through environmental changes supporting end-of-life care at home; and using transitions between homes to reflect, recuperate and prepare. Working as a palliative care nurse in private homes clearly requires a variety of skills and competences, here operationalised in different strategies used to promote high-quality care. Palliative care nurses' considerations, insights and competence when performing end-of-life care in the diverse environments of private homes can contribute to the development of clinical practice. Knowledge about strategies can be used in nursing practice during everyday work, in nursing education and in the organisation of care, and can inform policy to ensure future high-quality palliative home care.

How specialist palliative care nurses identify patients with existential distress and manage their needs.

Existential distress is a term used when patients who are coming towards the end of their lives exhibit profound suffering, related particularly to their thoughts on life and existence. The clinical expression of this phenomenon has not been widely researched, and so specialist palliative care nurses were asked how they identify and manage this patient cohort. To explore how palliative-care nurses identify patients with existential distress and manage their needs. A qualitative descriptive design with thematic content analysis of transcribed interviews. Behavioural changes, agitation, social withdrawal and communication difficulties are identified as indicators of possible existential distress. Susceptible patient groups are identified. Nurses acknowledged that caring for patients with existential distress can be emotionally demanding. Being present and building relationships with patients are identified as enabling meaning-making. Sedation for refractory distress is seen as a last resort. Early identification of existential distress by carers could enable timely intervention (counselling, psychotherapy and or spiritual guidance) to improve the patients' quality of life in the terminal phase of their illness and avoid intractable or refractory existential distress that may necessitate palliative sedation.

An Exploration of How Specialist Palliative Care Nurses Identify and Manage Patients with Existential Distress

An Exploration of How Specialist Palliative Care Nurses Identify and Manage Patients with Existential Distress

Identifying and assessing the needs of carers of patients with palliative care needs: an exploratory study.

Carers of patients with palliative care needs require careful assessment and support to undertake their role effectively. The carer component of palliative care is embedded in complex situations that necessarily focus on the patient. To explore experiences of specialist palliative care nurses in identifying, assessing and planning care to support those looking after patients with palliative care needs. Findings identified gaps in identifying carers and their role, and in assessing carers' needs. This study confirmed the complexity in assessing carers' needs within the palliative care context, that practice gaps exist and positive outcomes result when routine processes were adopted. Future research should explore how to systematically make improvements in supporting carers in all palliative care contexts, including specialist and non-specialist settings.

P3.07-03 Lung Cancer Clinical Nurse Specialist and Palliative Care Nurse Specialist – A Dual Role

P3.07-03 Lung Cancer Clinical Nurse Specialist and Palliative Care Nurse Specialist – A Dual Role

What role do Death Doulas play in end-of-life care? A systematic review.

Current health and social care systems do not always meet the needs of the dying in our communities. As a result, patients and families are choosing to place their trust in those who can advocate for them or fill the gaps in care. Birth Doulas have been working with women during pregnancy and after birth for many years, and we are now seeing a new role, that of a Death Doula emerging in the end-of-life care space. How Death Doulas work within health and social care systems is not understood and we conducted a systematic review to explore the published literature to explore the role and potential implications for models of care delivery. Following the PRISMA recommendations, we searched the literature in January 2018 via bibliographic databases and the grey literature without search date parameters to capture all published literature. We looked for articles that describe the role/work of a death doula or a death midwife in the context of end-of-life care, or death and dying. Our search retrieved 162 unique records of which five papers were included. We analysed the papers in relation to relationship to health service, funding source, number and demand for services, training, licensing and ongoing support, and tasks undertaken. Death Doulas are working with people at the end of life in varied roles that are still little understood, and can be described as similar to that of "an eldest daughter" or to a role that has similarities to specialist palliative care nurses. Death doulas may represent a new direction for personalised care directly controlled by the dying person, an adjunct to existing services, or an unregulated form of care provision without governing oversight.

Feasibility of hospital-initiated non-facilitator assisted advance care planning documentation for patients with palliative care needs

BackgroundAdvance Care Planning (ACP) and its documentation, accessible to healthcare professionals regardless of where patients are staying, can improve palliative care. ACP is usually performed by trained facilitators. However, ACP conversations would be more tailored to a patient’s specific situation if held by a patient’s clinical healthcare team. This study assesses the feasibility of ACP by a patient’s clinical healthcare team, and analyses the documented information including current and future problems within the palliative care domains.MethodsThis multicentre study was conducted at the three Groningen Palliative Care Network hospitals in the Netherlands. Patients discharged from hospital with a terminal care indication received an ACP document from clinical staff (non-palliative care trained staff at hospitals I and II; specialist palliative care nurses at hospital III) after they had held ACP conversations. An anonymised copy of this ACP document was analysed. Documentation rates of patient and contact details were investigated, and documentation of current and future problems were analysed both quantitatively and qualitatively.ResultsOne hundred sixty ACP documents were received between April 2013 and December 2014, with numbers increasing for each consecutive 3-month time period. Advance directives were frequently documented (82%). Documentation rates of current problems in the social (24%), psychological (27%) and spiritual (16%) domains were low compared to physical problems (85%) at hospital I and II, but consistently high (> 85%) at hospital III. Of 545 documented anticipated problems, 92% were physical or care related in nature, 2% social, 5% psychological, and < 1% spiritual. Half of the anticipated non-physical problems originated from hospital III.ConclusionsHospital-initiated ACP documentation by a patient’s clinical healthcare team is feasible: the number of documents received per time period increased throughout the study period, and overall, documentation rates were high. Nonetheless, symptom documentation predominantly regards physical symptoms. With the involvement of specialist palliative care nurses, psychological and spiritual problems are addressed more frequently. Whether palliative care education for non-palliative care experts will improve identification and documentation of non-physical problems remains to be investigated.

How do patients with cancer pain view community pharmacy services? An interview study

Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi-structured interview which was audio-recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, and unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in person and by telephone, and the latter was perceived to be of particular benefit to patients less able to leave the house.

Readiness for providing primary palliative care in regional Aged Residential Care: Partnering with SEQUAL specialist palliative care nurses

Readiness for providing primary palliative care in regional Aged Residential Care: Partnering with SEQUAL specialist palliative care nurses

Specialist palliative care nursing and the philosophy of palliative care: a critical discussion.

Nursing is the largest regulated health professional workforce providing palliative care across a range of clinical settings. Historically, palliative care nursing has been informed by a strong philosophy of care which is soundly articulated in palliative care policy, research and practice. Indeed, palliative care is now considered to be an integral component of nursing practice regardless of the specialty or clinical setting. However, there has been a change in the way palliative care is provided. Upstreaming and mainstreaming of palliative care and the dominance of a biomedical model with increasing medicalisation and specialisation are key factors in the evolution of contemporary palliative care and are likely to impact on nursing practice. Using a critical reflection of the authors own experiences and supported by literature and theory from seminal texts and contemporary academic, policy and clinical literature, this discussion paper will explore the influence of philosophy on nursing knowledge and theory in the context of an evolving model of palliative care.

Specialist palliative care nurses' management of the needs of patients with depression.

Depression is an important condition to consider if we are to optimise the care outcomes for patients with palliative care needs. Depression has a high incidence in palliative patients, with up to 15% diagnosed with major depression and 37% expressing some form of depressive symptoms ( O'Connor et al, 2010 ). The challenge is to ensure that palliative care patients with depression are identified in a timely manner and that their depression is effectively managed. To examine how Australian specialist inpatient palliative care nurses perceive, assess and respond to depression in a patient case study. This descriptive pilot study is a replication of a United States study by Little et al (2005) , exploring contemporary Australian specialist palliative care nurses' screening, assessment and management of depression in people with a progressive life-limiting illness. A survey titled 'Specialist palliative care nurses managing patients with complex care needs' questioned the nursing assessment, knowledge and clinical care priorities related to a case vignette of a patient demonstrating signs of depression. A total of 33 nurses completed this survey. Less than half (39.4%) of the participants identified depression as a major issue arising from the case vignette. Depression screening tools were not widely known. Functionality assessments measuring activities of daily living were the most recognised and widely used tools by participants. This small sample pilot study demonstrated that specialist palliative care nurses are still not confident in their screening and responding to a patient with depression. The available evidenced based depression screening tools were unfamiliar to these nurses and not widely used which can result in depression remaining undetected and undermanaged. The connections between physical health and mental health need stronger recognition and response within nursing care of palliative patients.