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The PICOT question of the proposed study can be phrased as follows: in palliative care patients being treated by an NP, does co-creation better meet the end-of-life needs as compared to current standards? The following theoretical network is suggested for the study.
Theoretical Framework
For this work, palliative care (PC) is defined after WHO as “an approach to care which improves the quality of life of patients and their families,” and which includes end-of-life (EOL) care (as cited in Coyle, 2015, p. 4). The quality of life (QoL) can be defined as the complex of “physical, social/family, emotional, and functional” well-being of a human (Dyar, Lesperance, Shannon, Sloan, & Colon-Otero, 2012). The key aim of PC is the prevention and relief of the sufferings of the patient and family, and nurse practitioners (NPs) are key figures in achieving this result due to being most often in contact with these people (Kaasalainen et al., 2014). It is well-established that NPs’ actions are capable of improving QoL of the patients (Coyle, 2015; Lukas, Foltz, & Paxton, 2013; Bookbinder et al., 2011; Vahedi Nikbakht-Van de Sande, Braat, Visser, Delnoij, & van Staa, 2014). As for the needs of the patients and their families, that should be addressed by the NP to raise QoL, they are numerous and include physical, practical, informational, spiritual, social, cultural ones along with specific needs for particular cases (Braithwaite et al., 2011; Kramer, 2013). As pointed out, for example, by Braithwaite et al. (2011) or Enguidanos, Housen, Penido, Mejia, and Miller (2013), it is not uncommon for PC and NPs to fail to meet all these needs.
PC is being increasingly accepted as a noteworthy approach to healthcare and, as a result, its practice and theory is expanding rapidly (Coyle, 2015). New intervention suggestions appear, and one of them is the Cocreation of Possibilities (CP) Framework that has been developed by Bergdahl, Benzein, Ternestedt, Elmberger, and Andershed (2013). This framework was created as a result of PC NP practice observations; it was determined that NPs tend to use CP intuitively. CP consists of the cooperative determination of the patient’s needs and wishes (goals) that are not related to healthcare directly but can be affected by the disease. The needs are assessed and formulated, analyzed in the context of the patient’s condition, and a possibility of fulfilling them is indicated. The co-creation of a feasible plan of action that can help to meet the needs and satisfy the wishes is supposed to be the end product of CP. In this approach, unmet needs and goals should be substituted by other, more feasible ones, which makes the issue less acute. Cooperation and help in decision-making are complemented by emotional support; the explanatory part of the intervention fulfills the educational function. To sum up, given the previous considerations, the intervention has the potential of improving the QoL of the patient by meeting the needs for education and support (emotional and decision-making) and by directly addressing the specific needs of a particular patient.
In this paper, it is proposed that the framework created by the authors with the help of 104 intervention cases can improve NPs’ ability to meet end-of-life needs by making their CP activities informed. The study by Bergdahl et al. (2013) shows that in 104 cases out of 110 CP activities of a kind were present; therefore, CP is a useful and used tool or skill (set of skills). Tools and skills require training for the most effective use: for example, complaint management can be done by anyone, but respective training improves the process’ efficiency and increases the probability of success (Crumbie, Justice, Brathwaite, & Cumming, 2013). Therefore, non-informed CP activities are expected to be less effective. Such non-informed activities are standard as the recent Nursing Interventions Classification by Bulechek, Butcher, McCloskey-Dochterman, and Wagner (2012) does not include the intervention of CP. As a result, by comparing the informed CP intervention to standard care, the study will determine if the former is capable of meeting end-of-life needs better.
References
Bergdahl, E., Benzein, E., Ternestedt, B., Elmberger, E., & Andershed, B. (2013). Co-Creating Possibilities for Patients in Palliative Care to Reach Vital Goals: A Multiple Case Study of Home-Care Nursing Encounters. Nursing Inquiry, 20(4), 341-351. Web.
Bookbinder, M., Glajchen, M., McHugh, M., Higgins, P., Budis, J., & Solomon, N.,… Portenoy, R. (2011). Nurse Practitioner-Based Models of Specialist Palliative Care at Home: Sustainability and Evaluation of Feasibility. Journal of Pain And Symptom Management, 41(1), 25-34. Web.
Braithwaite, M., Philip, J., Tranberg, H., Finlayson, F., Gold, M., Kotsimbos, T., & Wilson, J. (2011). End of life care in CF: Patients, families and staff experiences and unmet needs. Journal Of Cystic Fibrosis, 10(4), 253-257. Web.
Bulechek, G., Butcher, H., McCloskey-Dochterman, J., & Wagner, C. (2012). Nursing Interventions Classification (NIC) (5th ed.). St. Louis, MO: Elsevier.
Coyle, N. (2015). Introduction to palliative nursing care. In B. Ferrell, N. Coyle, & J. Paice (Eds.), Oxford Textbook of Palliative Nursing (pp. 3-10). Oxford, UK: Oxford University Press.
Crumbie, A., Justice, S., Brathwaite, B., & Cumming, S. (2013). Readers panel. When all is not going well. Nursing Standard, 28(13), 28-29. Web.
Dyar, S., Lesperance, M., Shannon, R., Sloan, J., & Colon-Otero, G. (2012). A Nurse Practitioner Directed Intervention Improves the Quality of Life of Patients with Metastatic Cancer: Results of a Randomized Pilot Study. Journal Of Palliative Medicine, 15(8), 890-895. Web.
Enguidanos, S., Housen, P., Penido, M., Mejia, B., & Miller, J. (2013). Family Members’ Perceptions of Inpatient Palliative Сare Consult Services: A Qualitative Study. Palliative Medicine, 28(1), 42-48. Web.
Kaasalainen, S., Ploeg, J., McAiney, C., Martin, L., Donald, F., & Martin-Misener, R.,… Sangster-Gormley, E. (2013). Role of the Nurse Practitioner in Providing Palliative Care in Long-Term Care Homes. International Journal of Palliative Nursing, 19(10), 477-485. Web.
Kramer, B. J. (2013). Social Workers’ Roles in Addressing the Complex End-Of-Life Care Needs of Elders with Advanced Chronic Disease. Journal Of Social Work In End-Of-Life & Palliative Care, 9(4), 308-330. Web.
Lukas, L., Foltz, C., & Paxton, H. (2013). Hospital Outcomes for a Home-Based Palliative Medicine Consulting Service. Journal Of Palliative Medicine, 16(2), 179-184. Web.
Vahedi Nikbakht-Van de Sande, C., Braat, C., Visser, A., Delnoij, D., & van Staa, A. (2014). Why a Carefully Designed, Nurse-Led Intervention Failed to Meet Expectations: The Case of the Care Programme for Palliative Radiotherapy. European Journal Of Oncology Nursing, 18(2), 151-158. Web.
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