A Qualitative Exploration of “Empathic Labor” in Chinese Hospice Nurses

Background: Hospice nurses may devote more emotional labor during the empathy process with patients, and this empathy can be used as a form of psychological behavior of emotional labor in the hospice care model. The aim of this study was to analyze hospice nurses’ empathy characteristics in the context of emotional labor theory, and explore the impact of empathy on patient care.Method: We conducted semi-participant observations from three hospitals and multicenter in-depth interviews with n=26 hospice nurses from eight cities. Interviews were transcribed, and directed content analysis was applied.Results: Two categories with four sub-categories were extracted from the data analysis. Category 1 described the “empathic labor” process which covers cognitive empathy (including empathic imagination, empathic consideration, and empathic perception) and affective empathy (including natural empathy, surface empathy, and deep empathy). The second category concerns the outcome of nurses’ “empathic labor” which incorporates both positive and negative effects.Conclusions: The findings indicated that hospice nurses’ empathy process should be understood as emotional labor. Nursing managers should pay more attention to raising the ability of deep empathy with hospice nurses, and explore more sufficient active empowerment strategies to alleviate the negative impact of empathy on nurses and to strengthen nurses' deep empathy with terminal patients.

How do hospice nurses prepare to give end-of-life care? A grounded theory study of nurses in one UK hospice

Background: Literature for preparing hospice nurses to deliver end-of-life care is sparse. Aim: To investigate how nurses in one UK hospice prepared to deliver end-of-life care in their role. Methods: A classic grounded theory approach was used to investigate the experiences of 22 registered nurses in one UK hospice, to discover how they prepared for their role. A total of 17 individual interviews and one focus group were conducted. Constant comparison of data and member checking were performed to establish validity. Findings: Findings were synthesised into five categories: the ‘shared ideal’, feeling good at the job, making a difference, experience/exposure to hospice work and the importance of role models. The shared ideal formed the core category, which explained how hospice nurses feel a sense of ‘fit’ with their work. Conclusion: The feeling of a nurse feeling well-suited to the work and that there the work was a good ‘fit’ for them was identified as a core element to nurses' feelings of preparedness to provide end-of-life care.

Psychometric Properties of the Chinese Version of the Brief-Mindful Self-Care Scale: A Translation and Validation Study

Objective: This study aimed to translate the Brief-Mindful Self-Care Scale (B-MSCS) into Chinese and validate its reliability and validity among hospice nurses.Methods: A total of 510 hospice nurses were recruited from three provinces in China. The reliability of the translated scale was measured by internal consistency, split-half reliability, and test-retest reliability. The validity of the translated scale was evaluated by expert consultation, exploratory factor analysis, and confirmatory factor analysis.Results: The Cronbach's α value of the Chinese version of B-MSCS was 0.920, and the Cronbach's α value of the dimensions ranged from 0.850 to 0.933. The split-half reliability and test-retest reliability were 0.770 and 0.723, respectively. Furthermore, the content validity index of the scale (S-CVI) was 0.946. The 6-factor structure, supported by the eigenvalues, total variance explained, and scree plot were obtained by using exploratory factor analysis. Moreover, as a result of the confirmatory factor analysis, the model fitting indexes were all in the acceptable range.Conclusion: The Chinese version of B-MSCS had suitable reliability and validity among hospice nurses. The developed scale will evaluate the level of mindful self-care of Chinese hospice nurses, providing an opportunity for development of targeted educational plans. Each item is a direct guide for hospice nurses to develop their mindful self-care practice.

Validation of the Simplified Palliative Prognostic Index to Predict Survival for Advanced Cancer Patients in Home Hospice Setting

Background: The simplified Palliative Prognostic Index (sPPI) substitutes a single item from the Communication Capacity Scale (CCS) for the delirium item of the original PPI. This study aimed to examine the validity of the sPPI for patients with advanced cancer in a home-based hospice care setting.Methods: This study included 75 patients with advanced cancer who received home-based hospice care. We used medical records maintained by professional hospice nurses who had visited the patients in their homes. Based on their sPPI score, patients were divided into three groups—A (<4), B (≥4 and <6), and C (≥6)—to compare survival. Further, we investigated the sPPI’s accuracy using the area under the receiver operating characteristic curve (AUC) and sensitivity and specificity for 3- and 6-week survival. We used three sPPIs including different substitutions for the delirium item (two methods using the CCS and one using the Korean Nursing Delirium Screening Scale).Results: The median survival was 60–61 days for group A, 27–30 days for group B, and 12–16 days for group C. The difference in survival was significant (P<0.05). The AUC was 0.814–0.867 for 3-week survival and 0.736–0.779 for 6-week survival. For 3- and 6-week survival, prognostic prediction showed sensitivities of 76.2%–90.9% and 76.3%–86.8%, and specificities of 64.2%–88.7% and 51.4%–70.3%, respectively.Conclusion: The sPPI, which is measured by professional hospice nurses, has acceptable validity to predict survival for patients with advanced cancer in a home hospice setting in South Korea.

Implementation and evaluation of a palliative and end-of-life care peer-learning initiative

Background: Palliative and end-of-life care skills for nurses in acute care are dependent on the level of training received. Hospices are seen as fountains of knowledge in end-of-life and complex care issues. Aim: This study evaluated peer learning between registered nurses (RNs) at West Suffolk Foundation Trust and St Nicholas Hospice Care. Six acute and six hospice nurses spent 1 week each, over a 6-month period, shadowing in the opposite of their usual acute or hospice setting. Method: The study used an action research approach. Reflective diaries, questionnaires and evaluation forms provided feedback, giving nursing practice perspectives on learning gained during the shadowing process. Findings: Key features were improved knowledge in medications for symptom management in end of life; understanding holistic assessments to enhance patient care; key competencies completed. Conclusion: This study led to the development of the West Suffolk Foundation Trust 2-day shadowing model offering access to end-of-life care learning.

COVID-19 Pandemic Impacts on U.S. Hospice Agencies: A National Survey of Hospice Nurses and Physicians

Background: Hospice agencies face unique challenges during times of widespread public health emergencies. The pandemic of novel coronavirus disease COVID-19 is widely affecting global healthcare systems. Aim: This study assesses effects of the COVID-19 pandemic on U.S. hospice agencies, staff, and patients as reported by hospice agency staff. Design: An anonymous electronic survey was developed. Free-text comments were assessed for impacts on hospice agencies, staff, and patients and their families. Setting/Participants: The target audience was members of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association who self-identified as being active with hospice agencies in the United States. Results: Reported impacts include inadequate supplies of personal protective equipment, changes in hospice services, and decreased access by hospice personnel to patients in long term care facilities. Flow of patients through hospice care settings was impeded. Agencies experienced changes in workforce availability and increased emotional support needs of staff. Patient and families experienced increased bereavement needs. Nearly one-third of respondents reported negative effects on patient outcomes, such as inadequate symptom management and negative psychosocial effects. Conclusion: Respondents indicate that the COVID-19 pandemic had negative effects on both hospice patient care and hospice agency functioning. Hospice agencies appear to face challenges unique among U.S. healthcare agencies due to their service delivery model and focus on interdisciplinary care. There is need for further exploration of the effects that the COVID-19 pandemic has on hospice agencies in order to improve care for their patient population during public health emergencies.

Live Discharge From Hospice: Experiences of Patients, Families, and Staff

Hospice services can provide patient stabilization and improved quality of life, making the patient ineligible for continued hospice. Using focus groups and in-depth interviews, we explored how patients, families, and hospice staff experience, anticipate, and cope with “live discharge” from hospice. Nurses and administrators tried to prepare families for the possibility and unsettling reality of live discharge, yet the aides who worked most closely with families remained unaware of regulations dictating an impending live discharge. Reactions of families ranged from excitement, when patient was selected for clinical trial, to more common expressions of frustration, as they lost access to the staff, coordinated services, and medications only covered under the Medicare hospice benefit. Families also reported relationship stressors and decisional uncertainty associated with longer than expected patient life. Families still needed and wanted hospice services, with most agreeing they would return to hospice after the patient declined and became eligible again.

The Integral Role of Hospice Nurse Educators in a Palliative Care Education Program for Nurses in Assisted Living

Persons with dementia (PWD) are increasingly cared for in assisted living (AL) settings with an annual mortality rate of close to 20%. Palliative care (PC) for PWD in ALs can improve end-of-life care. From May, 2019 to February, 2020 a 4-week PC education in AL (PCEAL) program for nurses who provide care to PWD, facilitated by hospice nurses in Florida, was tested in a sample of nurses (N=20) in a cluster randomized trial (9 ALs, 4 treatment/5 control). We examined if PC knowledge increased from pre to post-intervention using a validated measure (Thompson, 2011). All intervention nurses (N=10) completed all four sessions of the PCEAL. While the baseline score was lower for the intervention group compared to the control group, the intervention group improved (M=2.20 to 2.37) compared to the control group (M=2.83 to 2.75) post-intervention. Two-month booster sessions indicate nurses have integrated PC care learned in the PCEAL program.