scholarly journals CURA—An Ethics Support Instrument for Nurses in Palliative Care. Feasibility and First Perceived Outcomes

HEC Forum ◽  
2021 ◽  
Author(s):  
Malene Vera van Schaik ◽  
H. Roeline Pasman ◽  
Guy Widdershoven ◽  
Bert Molewijk ◽  
Suzanne Metselaar
Keyword(s):  
Palliative Care ◽  
Moral Distress ◽  
Daily Practice ◽  
Evaluation Study ◽  
Cross Sectional ◽  
Ethics Support ◽  
Organizational Barriers ◽  
Moral Competences ◽  
Perceived Outcomes ◽  
Moral Resilience

AbstractEvaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience.

scholarly journals Current status of integrating oncology and palliative care in Japan: A nationwide survey

2019 ◽  
Author(s):  
Yu Uneno ◽  
Kazuki Sato ◽  
Tatsuya Morita ◽  
Mayumi Nishimura ◽  
Satoko Ito ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Control ◽  
Nationwide Survey ◽  
Daily Practice ◽  
Current Status ◽  
Full Time ◽  
International Consensus ◽  
Cross Sectional ◽  
Symptom Screening ◽  
The Government

Abstract Background: Palliative care (PC) is increasingly recognized as essential for oncology care, and several academic societies strongly recommend integrating oncology and palliative care (IOP) in daily practice. Similarly, the Japanese government encouraged the implementation of IOP through the Cancer Control Act of 2007; however, its detailed progress remains unclear. Therefore, this cross-sectional nationwide survey was conducted to investigate the current status and hospital executive physicians’ perception of IOP. Methods: The questionnaire was developed based on IOP indicators with international consensus. It was distributed to executive physicians at all government-designated cancer hospitals (DCHs, n = 399) and matched non-DCHs (n = 478) in November 2017 and the results were compared. Results: In total, 269 (67.4%) DCHs and 259 (54.2%) non-DCHs responded. The number of PC resources in DCHs was significantly higher than those in non-DCHs (e.g., full-time PC physicians and nurses, 52.8% vs. 14.0%, p < 0.001; availability of outpatient PC service ≥3 days per week, 47.6% vs. 20.7%, p < 0.001). Routine symptom screening was more frequently performed in DCHs than in non-DCHs (65.1% vs. 34.7%, p < 0.001). Automatic trigger for PC referral availability was limited (e.g., referral using time trigger, 14.9% vs. 15.3%, p = 0.700). Education and research opportunities were seriously limited in both types of hospitals. Most executive physicians regarded IOP as beneficial for their patients (95.9% vs. 94.7%, p = 0.163) and were willing to facilitate an early referral to PC services (54.7% vs. 60.0%, p < 0.569); however, the majority faced challenges to increase the number of full-time PC staff, and <30% were planning to increase the staff members. Conclusions: This survey highlighted a considerable number of IOP indicators met, particularly in DCHs probably due to the government policy. Further investigation is warranted whether those indicators effectively work in real clinical situations.

Barriers to and Facilitators of Neonatal Palliative Care Among Neonatal Professionals in China

2021 ◽  
pp. 104990912110462
Author(s):  
Lin Gu ◽  
Zhen-Zhen Li ◽  
Niang-Huei Peng ◽  
Jian-Fu Zhou ◽  
Bi-Rong Wei ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Education ◽  
Neonatal Intensive Care ◽  
Moral Distress ◽  
Attitude Scale ◽  
Neonatal Intensive Care Units ◽  
Cultural Issues ◽  
Cross Sectional ◽  
Medical Centers ◽  
Care Training

Objectives: This study investigated institutional and personal barriers to and facilitators of neonatal palliative care facing neonatal professionals in China. Methods: A cross-sectional questionnaire surveyed 231 neonatal clinicians employed in 5 neonatal intensive care units from 2 children’s hospitals and 3 medical centers in China. Measurements: The translated modified version of the Neonatal Palliative Care Attitude Scale was used to survey neonatal clinicians’ attitudes and beliefs regarding neonatal palliative care. Results: Findings highlight 4 facilitators and 5 barriers among participating clinicians. Participants gave contradictory responses regarding the relative importance of curative treatment versus palliative care in the NICU. Negatively traumatic feelings, cultural issues and moral distress may impact this contradictory response and discourage clinicians from providing neonatal palliative care. Additionally, neonatologists and nurses held differing attitudes on several topics (p < 0.05). Conclusion: Further research should address strategies to improve knowledge and attitudes and relieve moral distress in NICU clinicians. Neonatal clinicians providing neonatal palliative care should receive regular palliative care training addressing culture-specific issues and communication skills. Practice Implications: Study findings will be beneficial to inform clinical education and practice. Regular interdisciplinary team training is needed to enhance support for palliative care and decrease clinicians’ moral distress during end-of-life care.

Moral distress and professors of nursing: A cluster analysis

2020 ◽  
Vol 27 (4) ◽  
pp. 1157-1167
Author(s):  
Aline Marcelino Ramos Toescher ◽  
Edison Luiz Devos Barlem ◽  
Valéria Lerch Lunardi ◽  
Aline Neutzling Brum ◽  
Jamila Geri Tomaschewski Barlem ◽  
...  
Keyword(s):  
Higher Education ◽  
Cluster Analysis ◽  
Graduate Program ◽  
Moral Distress ◽  
Education Institution ◽  
Daily Practice ◽  
Moderate Intensity ◽  
Cross Sectional ◽  
Daily Work ◽  
Distress Scale

Background Professors of nursing sometimes experience specific situations in their daily practice that conflict with their values and ethical principles and may culminate in moral distress. Moral distress occurs when one is prevented from acting according to his or her knowledge or values, or what one considers to be ethically sound. Objectives To identify the profile of professors of nursing through grouping sociodemographic characteristics and intensity of moral distress. Method Cross-sectional and exploratory study addressing 373 nurses teaching in Brazilian federal public higher education institutions. Data were collected from June to December 2018 through email, using the Google Docs tool. A moral distress scale directed to nurse educators was used. Data were analyzed using descriptive statistics, variance analysis, and cluster analysis. Ethical considerations The Institutional Review Board at the Federal University of Rio Grande approved this study. Findings Initially, four clusters emerged for each variable predicting the profile of Brazilian professors of nursing: sex; whether the individual worked in a graduate program; age; experience in years in their respective higher education institution; and intensity of moral distress. The profile of Brazilian professors of nursing was represented by the largest cluster, 36.5% (n = 136), composed of women working in graduate programs, aged 37 years old on average, having worked in their respective institutions for approximately 5 years, and presenting a moderate intensity of moral distress. Conclusion Assigning individuals into groups facilitates seeing similarities among the predictors that compose the profile of Brazilian professors of nursing, thus recognizing those workers experiencing moral distress in their daily work routine. In addition, this study’s results are expected to encourage reflection on the planning of efficacious interventions directed to the context of education and health.

scholarly journals Current status of integrating oncology and palliative care in Japan: A nationwide survey

2020 ◽  
Author(s):  
Yu Uneno ◽  
Kazuki Sato ◽  
Tatsuya Morita ◽  
Mayumi Nishimura ◽  
Satoko Ito ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Control ◽  
Nationwide Survey ◽  
Daily Practice ◽  
Current Status ◽  
Full Time ◽  
International Consensus ◽  
Cross Sectional ◽  
Symptom Screening ◽  
The Government

Abstract Background: Palliative care (PC) is increasingly recognized as essential for oncology care, and several academic societies strongly recommend integrating oncology and palliative care (IOP) in daily practice. Similarly, the Japanese government encouraged the implementation of IOP through the Cancer Control Act of 2007; however, its detailed progress remains unclear. Therefore, this cross-sectional nationwide survey was conducted to investigate the current status and hospital executive physicians’ perception of IOP. Methods: The questionnaire was developed based on IOP indicators with international consensus. It was distributed to executive physicians at all government-designated cancer hospitals (DCHs, n = 399) and matched non-DCHs (n = 478) in November 2017 and the results were compared. Results: In total, 269 (67.4%) DCHs and 259 (54.2%) non-DCHs responded. The number of PC resources in DCHs was significantly higher than those in non-DCHs (e.g., full-time PC physicians and nurses, 52.8% vs. 14.0%, p < 0.001; availability of outpatient PC service ≥3 days per week, 47.6% vs. 20.7%, p < 0.001). Routine symptom screening was more frequently performed in DCHs than in non-DCHs (65.1% vs. 34.7%, p < 0.001). Automatic trigger for PC referral availability was limited (e.g., referral using time trigger, 14.9% vs. 15.3%, p = 0.700). Education and research opportunities were seriously limited in both types of hospitals. Most executive physicians regarded IOP as beneficial for their patients (95.9% vs. 94.7%, p = 0.163) and were willing to facilitate an early referral to PC services (54.7% vs. 60.0%, p < 0.569); however, the majority faced challenges to increase the number of full-time PC staff, and <30% were planning to increase the staff members. Conclusions: This survey highlighted a considerable number of IOP indicators met, particularly in DCHs probably due to the government policy. Further efforts are needed to address the serious research/educational gaps.

scholarly journals Clinical ethics support services during the COVID-19 pandemic in the UK: a cross-sectional survey

2021 ◽  
pp. medethics-2021-107818
Author(s):  
Mariana Dittborn ◽  
Emma Cave ◽  
David Archard
Keyword(s):  
Support Services ◽  
Clinical Ethics ◽  
Research Team ◽  
Moral Distress ◽  
Clinical Staff ◽  
Cross Sectional ◽  
Clinical Ethics Support ◽  
Ethics Support ◽  
Advisory Boards ◽  
The Uk

BackgroundThe COVID-19 pandemic highlighted the need for clinical ethics support provision to ensure as far as possible fair decision making and to address healthcare workers’ moral distress.PurposeTo describe the availability, characteristics and role of clinical ethics support services (CESSs) in the UK during the COVID-19 pandemic.MethodA descriptive cross-sectional online survey was developed by the research team. The survey included questions on CESSs characteristics (model, types of support, guidance development, membership, parent and patient involvement) and changes in response to the pandemic. Invitations to participate were widely circulated via National Health Service institutional emails and relevant clinical ethics groups known to the research team.ResultsBetween October 2020 and June 2021, a total of 53 responses were received. In response to the pandemic, new CESSs were established, and existing provision changed. Most took the form of clinical ethics committees, groups and advisory boards, which varied in size and membership and the body of clinicians and patient populations they served. Some services provided moral distress support and educational provision for clinical staff. During the pandemic, services became more responsive to clinicians’ requests for ethics support and advice. More than half of respondents developed local guidance and around three quarters formed links with regional or other local services. Patient and/or family members’ involvement in ethics discussions is infrequent.ConclusionsThe pandemic has resulted in an expansion in the number of CESSs. Though some may disband as the pandemic eases, the reliance on CESSs during the pandemic demonstrates the need for additional research to better understand the effectiveness of their various forms, connections, guidance, services and modes of working and for better support to enhance consistency, transparency, communication with patients and availability to clinical staff.

Theoretical and Methodological Problems of a 10-Year Follow-Up Program Evaluation Study

2002 ◽  
Vol 18 (3) ◽  
pp. 229-241 ◽  
Author(s):  
Kurt A. Heller ◽  
Ralph Reimann
Keyword(s):  
Program Evaluation ◽  
Evaluation Studies ◽  
Evaluation Study ◽  
Control Groups ◽  
Cross Sectional ◽  
Long Term Study ◽  
Partial Inclusion ◽  
Methodological Problems

Summary In this paper, conceptual and methodological problems of school program evaluation are discussed. The data were collected in conjunction with a 10 year cross-sectional/longitudinal investigation with partial inclusion of control groups. The experiences and conclusions resulting from this long-term study are revealing not only from the vantage point of the scientific evaluation of new scholastic models, but are also valuable for program evaluation studies in general, particularly in the field of gifted education.

scholarly journals Burnout Determinants among Nurses Working in Palliative Care during the Coronavirus Disease 2019 Pandemic

2021 ◽  
Vol 18 (7) ◽  
pp. 3358
Author(s):  
José Vítor Gonçalves ◽  
Luísa Castro ◽  
Guilhermina Rêgo ◽  
Rui Nunes
Keyword(s):  
Palliative Care ◽  
Health Care Professionals ◽  
Online Survey ◽  
Three Dimensions ◽  
Linear Regression Models ◽  
Perceived Health Status ◽  
Cross Sectional ◽  
National Network ◽  
Work Related ◽  
High Level

Nurses working in palliative care are at risk of burnout. The Copenhagen Burnout Inventory was used to determine burnout levels of nurses working in the Portuguese national network of palliative care. We evaluated the contribution of personal, work, and COVID-19 variables in three burnout subclasses: personal, work, and patient-related. A cross-sectional, exploratory, and quantitative design was employed and participants were sampled using convenience and snowball technique. An online survey was conducted and 153 nurses participated in our study. Socio-demographic characterization was conducted, levels of burnout and determinants were explored through multiple linear regression models for its three dimensions. High levels of personal, working, and patient burnout were present in 71 (46%), 68 (44%), and 33 nurses (22%), respectively. Most of them agreed that COVID-19 had an impact on their activities. Significant personal and work related burnout factors found were specialization in palliative care, self-perceived health status, unit type, weekly hours of work, and allocation to COVID-19 units. Gender was found to be a significant factor in patient-related burnout. There is a high level of burnout among nurses working in the Portuguese national network of palliative care. Measures for identification and mitigation of burnout are necessary to protect health care professionals.

scholarly journals Barriers and facilitators to e-learning in palliative care

2020 ◽  
Vol 26 (8) ◽  
pp. 394-402
Author(s):  
Joanne Callinan
Keyword(s):  
Palliative Care ◽  
Administrative Support ◽  
Healthcare Professionals ◽  
Computer Training ◽  
Barriers And Facilitators ◽  
Cross Sectional ◽  
Face To Face ◽  
Course Work ◽  
E Learning ◽  
Prior Experiences

Background: E-learning provides opportunities for flexible learning to those who cannot access palliative education in the traditional classroom setting, but it also presents learners with challenges. The study aims to identify the barriers and facilitators to accessing e-learning courses in palliative care. Methods: Cross-sectional surveys were developed, piloted and disseminated to healthcare professionals (HCPs) working in palliative care on the island of Ireland (Republic of Ireland and Northern Ireland). Results: Important factors that motivated HCPs to participate in e-learning are: dedicated time; quick technical and administrative support; computer training before completing an e-learning course; and regular contact with the tutor in online course work. Some 50% indicated face-to-face assistance and hands-on training sessions as the type of support that they would like to receive. Conclusions: Healthcare professionals' prior experiences and attitudes towards e-learning will guide educators developing programmes. This study indicates the prerequisite for organisational supports and practical considerations to facilitate the uptake of e-learning.

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