scholarly journals A Migrant Family's Experience of Palliative Nursing Care

2021 ◽  
Author(s):  
◽  
Yvonne Mary Bray

<p><b>The focus of this research was to explore the migrant family’s experience in palliative care. In writing this thesis it became evident that cultural safety was a connection that warranted further study in relation to end-of-life nursing care as was illustrated by the intergenerational case study of this migrant family in New Zealand.</b></p> <p>The use of the case study method of qualitative research enabled the voice of the migrant to be heard and the story of the migrant family’s experience to be showcased. The uniqueness of this family’s palliative care experience was around the religious and cultural needs and migration as a process of transition from a previous society to a new one. Palliative care was defined by the family approach with strong community support and empowered by culturally safe and appropriate nursing practice.</p> <p>End-of-life illness is a time when cultural perspectives are challenged for patients and their families and religious and cultural practices take on a new priority, regardless of how they have lived life previously. As a migrant nurse living and working in the New Zealand context I identify as an important factor, the nurse-patient interaction as an encounter between two cultural perspectives, the patient’s and the nurse as bearer of her own culture. Acknowledging this factor is an important step in developing a culturally safe approach to practice, an approach that proved to be a major ingredient in planning and caring for this patient and his family in end-of-life illness. This study and thesis explores the underpinnings of culturally safe palliative nursing care and identified ‘reflexive bracketing’ as a useful practice in the process.</p>

2021 ◽  
Author(s):  
◽  
Yvonne Mary Bray

<p><b>The focus of this research was to explore the migrant family’s experience in palliative care. In writing this thesis it became evident that cultural safety was a connection that warranted further study in relation to end-of-life nursing care as was illustrated by the intergenerational case study of this migrant family in New Zealand.</b></p> <p>The use of the case study method of qualitative research enabled the voice of the migrant to be heard and the story of the migrant family’s experience to be showcased. The uniqueness of this family’s palliative care experience was around the religious and cultural needs and migration as a process of transition from a previous society to a new one. Palliative care was defined by the family approach with strong community support and empowered by culturally safe and appropriate nursing practice.</p> <p>End-of-life illness is a time when cultural perspectives are challenged for patients and their families and religious and cultural practices take on a new priority, regardless of how they have lived life previously. As a migrant nurse living and working in the New Zealand context I identify as an important factor, the nurse-patient interaction as an encounter between two cultural perspectives, the patient’s and the nurse as bearer of her own culture. Acknowledging this factor is an important step in developing a culturally safe approach to practice, an approach that proved to be a major ingredient in planning and caring for this patient and his family in end-of-life illness. This study and thesis explores the underpinnings of culturally safe palliative nursing care and identified ‘reflexive bracketing’ as a useful practice in the process.</p>


Author(s):  
Donna J. Wilson ◽  
Kathleen Michael

This chapter applies the concept of physical activity to palliative care across settings. A physical activity program for each patient should be presented at the time of diagnosis and extend to end-of-life care. Even when it is not possible to cure or reverse a disease process, or to restore a previous level of functioning and independence, a rehabilitative approach to nursing care adds quality to the experience of living until life’s completion. The language of rehabilitation nursing is a language shared with those who practice palliative care. Feelings of self-confidence, independence, hope, human dignity, and autonomy are all influenced by an individually tailored program of rehabilitation.


2021 ◽  
Vol 11 (34) ◽  
pp. 312-317
Author(s):  
Anna Rebeka Oliveira Ferreira ◽  
Wanderson Rocha Oliveira ◽  
Claudia Regina Marchiori Antunes Araújo ◽  
Brenda Melissa Barros Mota dos Santos ◽  
Camila Wohlenberg Camparoto ◽  
...  

Trata-se de um relato de experiência com o objetivo de descrever o processo de identificação e discussão das principais dificuldades vivenciadas durante a assistência ao paciente no fim da vida na Unidade de Terapia Intensiva. Este relato foi desenvolvido em um hospital do município de Maringá, com quatro enfermeiras, vinte e cinco técnicos de enfermagem e seis estagiários de enfermagem. Após o aprofundamento teórico, foi aplicado um questionário para a identificação das principais dificuldades da equipe na realização dos cuidados paliativos e realizado uma aula dialogada sobre o tema. Verificamos que os profissionais possuíam dúvidas principalmente sobre a classificação em cuidados paliativos, orientação a família e nutrição do paciente, o que possibilitou a padronização e classificação da assistência no setor. A aula contribuiu para que o profissional tivesse um maior embasamento na realização de uma assistência integral de qualidade para o paciente e família.Descritores: Assistência no Fim da Vida, Cuidados de Enfermagem, Sistematização da Assistência. Nursing care at the end of life: experience reportAbstract: This is an experience report with the aim of describing process of identification and discussion of the main occurrences experienced during patient care at the end of life in the Intensive Care Unit. This report was developed in a hospital in the city of Maringá, with four nurses, twenty-five nursing technicians and six nursing interns. After the theoretical deepening, a questionnaire was applied to identify the main difficulties of the team in carrying out palliative care and a lecture on the topic was held. We verified that the professionals had doubts about the classification in palliative care, family orientation and patient nutrition, what made possible the to standardize and classify assistance in the sector. The class contributes so that the professional has a greater basis in carrying to provide better quality comprehensive care for patient and family.Descriptors: End of Life Assistance, Nursing Care, Assistance Systematization. Apoyo de la enfermería al final de la vida: informe de experienciaResumen: Este es un informe de experiencia con el objetivo de describir el proceso de identificación y discusión de las principales dificultades experimentadas durante la atención pacientes que se encuentran en la fase final de su vida en la Unidad de Terapia Intensiva. Este informe fue desarrollado en un hospital de la ciudad de Maringá, con cuatro enfermeras, veinticinco técnicos de enfermería y seis pasantes de enfermería. Después de profundización teórica, se aplicó un cuestionario para identificar las principales dificultades del equipo en la realización de cuidados paliativos, y se realizó una clase dialogada sobre el tema. Comprobamos que los profesionales tenían dudas principalmente sobre la clasificación en cuidados paliativos, orientación a la familia y nutrición del paciente, lo que hizo posible lestandarizar y clasificar la asistencia el sector. El aula contribuyó para que el profesional tuviera una mayor base en la realización de una atención integral de mejor calidad para el paciente y familia.Descriptores: Asistencia al Final de la Vida, Cuidado de Enfermería, Sistematización de la Asistencia.


2021 ◽  
Author(s):  
◽  
Raewyn Anita Davidson

<p>Advance directives are just one aspect of advance care planning. According to the New Zealand Nurses Organisation, advance directives are becoming increasingly common in New Zealand. Nurses are well positioned to take on an increasing role in advance directives, particularly in view of the expected burgeoning older population to which New Zealand is no exception. The literature suggests there is a role for primary health nurses in advance directives but no literature to date is available on this role in the New Zealand context. The aim of this research was to determine primary health nurses' role in advance directives. A qualitative case study research approach was used to explore the knowledge, attitudes, experiences, and involvement of primary health nurses in advance directives. Semi-structured interviews were conducted with 13 senior primary health nurses from one New Zealand province. Two propositions informed the analysis: 1) primary health nurses currently do not have a role in advance directives; and 2) primary health nurses believe that advance directives can promote effective-end-of-life care. Watson's Theory of Human Caring was used as the theoretical framework to guide the study. Three themes were identified from the analysis: encountering challenges, facilitating patient voice, and valuing the person. The findings revealed that primary health nurses had little or no significant experience or involvement in advance directives. Participants described knowledge inconsistencies about advance directives, in particular to related legalities. Nevertheless, participants had positive attitudes towards advance directives and believed there was a role for primary health nurses in early advance directive conversations. They emphasised the importance of teamwork and envisaged their role as one of support to both the patient and doctor. Caring praxis underpinned the nurses' positive attitudes towards advance directives. These caring behaviours sustained the core values of patient autonomy and patient advocacy considered fundamental to sensitive advance directive conversations. Many challenges were identified in terms of the nurse's role in advanced directives. These included cultural considerations for Māori in order to respect The Treaty of Waitangi principles and attending to the cultural needs of the individual Pacific Island groupings. Other challenges included unclear guidelines, unclear role delineation, ethical dilemmas and fragmented or complex communication issues across the primary/secondary health sector. Results of this study may inform nurses of the need to establish nurse–patient relationships built upon trust and positive regard in order to support patients in advanced directive discussions. Implications for nurse educators include incorporating education directed at empowering nurses to participate in ethical decision making to enhance patients' end-of-life care. Given the importance of the multi-disciplinary responsibility in establishing advance directives, there is a need for further research regarding how health professionals could function together in the role of advance directive communication to best meet patients' needs.</p>


Author(s):  
Ana Aline Lacet Zaccara ◽  
Patricia Serpa de Souza Batista ◽  
Monica Ferreira de Vasconcelos ◽  
Kalina Coeli Costa de Oliveira Dias ◽  
Pamella Kelly Farias de Aguiar ◽  
...  

Objetivo:Investigar as contribuições da Teoria Final de Vida Pacífico para a assistência de enfermagem ao paciente em Cuidados Paliativos.Método: Pesquisa de campo com abordagem qualitativa, na qual participaram 12 enfermeiros. Para a coleta dos dados utilizou-se a técnica de entrevista semiestruturada. Os dados foram analisados mediante a técnica de análise de conteúdo. Resultados:Da análise do material empírico, emergiram duas categorias: Espiritualidade na promoção de paz nos momentos finais; Atender aos desejos do doente terminal como atitude de respeito à sua dignidade. Conclusão: As principais contribuições da Teoria do Final de Vida Pacífico consistem em fornecer um suporte apropriado para nortear as estratégias utilizadas por enfermeiros, especialmente no que se refere a promoção de paz mediante a atenção a dimensão espiritual e o respeito à dignidade do paciente em fase final de vida relacionada ao atendimento aos últimos desejos do paciente e a solução de situações mal resolvidas.


2021 ◽  
Author(s):  
Sima Sadat Ghaemizade Shushtari ◽  
Shahram Molavynejad ◽  
Mohammad Adineh ◽  
Mohsen Savaie ◽  
Asaad Sharhani

Abstract Background: End-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU).Materials and Methods: This quasi-experimental study was conducted with a pretest-posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected based on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), ‎and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR‎).Results: A significant difference was observed between the study groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001).Conclusions: End-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.


2020 ◽  
Vol 37 (10) ◽  
pp. 844-852
Author(s):  
Monica C. Fliedner ◽  
Monika Hagemann ◽  
Steffen Eychmüller ◽  
Cynthia King ◽  
Christa Lohrmann ◽  
...  

Background: Nurses’ end of life (EoL) care focuses on direct (eg, physical) and indirect (e,g, coordination) care. Little is known about how much time nurses actually devote to these activities and if activities change due to support by specialized palliative care (SPC) in hospitalized patients. Aims: (1) Comparing care time for EoL patients receiving SPC to usual palliative care (UPC);(2) Comparing time spent for direct/indirect care in the SPC group before and after SPC. Methods: Retrospective observational study; nursing care time for EoL patients based on tacs® data using nonparametric and parametric tests. The Swiss data method tacs measures (in)direct nursing care time for monitoring and cost analyses. Results: Analysis of tacs® data (UPC, n = 642; SPC, n = 104) during hospitalization before death in 2015. Overall, SPC patients had higher tacs® than UPC patients by 40 direct (95% confidence interval [CI]: 5.7-75, P = .023) and 14 indirect tacs® (95% CI: 6.0-23, P < .001). No difference for tacs® by day, as SPC patients were treated for a longer time (mean number of days 7.2 vs 16, P < .001).Subanalysis for SPC patients showed increased direct care time on the day of and after SPC ( P < .001), whereas indirect care time increased only on the day of SPC. Conclusions: This study gives insight into nurses’ time for (in)direct care activities with/without SPC before death. The higher (in)direct nursing care time in SPC patients compared to UPC may reflect higher complexity. Consensus-based measurements to monitor nurses’ care activities may be helpful for benchmarking or reimbursement analysis.


2021 ◽  
pp. bmjspcare-2021-003057
Author(s):  
Debasish Das ◽  
Mafas Ali ◽  
Ithsham Ali Hussain ◽  
Josh Thomas Nigel Ingram ◽  
Rachel Sarah Johnstone ◽  
...  

BackgroundLiver disease, a major cause of death worldwide, affects younger people compared with other major causes of death. Palliative and end-of-life care for these patients are often overlooked. Guidelines are emerging on what good end-of-life care in liver disease should look like, but there is a dearth of research into patients’ perspectives even though they are most affected by these guidelines.AimTo explore current knowledge and understanding of patients’ lived experiences, perspectives and expectations in relation to palliative and end-of-life care in advanced liver disease.DesignSystematic review with thematic synthesis complying to the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement.Setting and participantsDatabase searches (Ovid Medline, 1946–2021 and Web of Science, 1970–2021) to identify qualitative studies exploring patients’ perspectives of palliative and end-of-life care in advanced liver disease.FindingsOnly eight articles met all criteria. Themes demonstrated repeated hospital admissions towards the end of life, lack of coordinated care in community and barriers in discussion about palliative care in end-stage liver disease due to lack of confidence among professionals and a negative view about palliative care among patients and carers. Emotional, financial and disability-related needs of patients and their carers are often neglected.ConclusionThere is a dearth of studies exploring patients’ perspectives about care in advanced liver disease relating to palliative and end-of-life care. Lack of coordinated community support and honest conversations around palliative care leads to reduced quality of life. More primary research from diverse population is needed to improve palliative care and end-of-life care in end-stage liver disease.


Author(s):  
Sriram Yennurajalingam

For the provision of palliative care in the hospice setting in the United States, Medicare covers any care that is reasonable and necessary to manage palliative and hospice care at end of life. To be eligible for this Medicare hospice benefit, a beneficiary must be entitled to Medicare Part A and be certified by a physician to have a life expectancy of 6 months or less if the illness runs its expected course. Medicare covers medications, nursing care, and medical services including care by a physician, physical therapy, social work. This chapter briefly reviews the various aspects of the Medicare hospice benefit.


Author(s):  
Marilyn Bookbinder ◽  
Romina Arceo

This chapter provides perspectives on quality improvement (QI)-based initiatives in US healthcare organizations across settings and populations and discusses their impact on patient, professional, and system outcomes in palliative care. Principles of QI and structural, process, and outcome approaches to conducting QI studies are introduced. A case study is presented of a care-path for the end of life that the author and colleagues pilot-tested. An algorithm addressing dyspnea, a distressing symptom at end-of-life, is offered for testing, and a new approach to evaluating care at the end of life using the Joint Commission’s tracer methodology will be introduced. The chapter closes by showcasing nurses within interdisciplinary teams who are building evidence and providing leadership in the field of quality and palliative care.


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