Palliative care is a sphere of healthcare that is concerned with terminally ill patients (Kelley & Morrison, 2015). Medical workers play a significant role in the lives of such patients, as they provide the necessary support to people facing death. This paper will explain nurses’ functions in palliative care and describe search strategies for information seeking.
The Issue
According to Sekse, Hunskår, and Ellingsen (2018), the number of nurses in healthcare makes them one of the largest groups of medical specialists in the field. However, their roles in the lives of patients are not defined, which may affect their ability to care for patients. Sekse et al. (2018) note that nurses have to make important decisions regarding the well-being of patients and their families.
Moreover, as palliative care deals with the terminally-ill, nurses working in this sphere have to possess unique qualities to adequately accommodate the needs of their clients (Low et al., 2016). The issue of establishing nurses’ roles in palliative care is also connected to the level of awareness that nurses may possess regarding their patients’ state (Siouta et al., 2016). Nurses need to be able to recognize when their patient is dying and in need of special care (Taylor, Dowding, & Johnson, 2017).
The Search Strategy
The search for appropriate journal articles about palliative care has to follow a particular strategy to find the best available research. First of all, it is necessary to establish keywords that directly pertain to the topic of interest. In this case, the central research question is concerned with palliative care. Therefore, the words ‘palliative’ and ‘care’ should be included in the search. As can be noticed in Figure 1, the first two keywords are ‘palliative’ and ‘care’ because their presence in the article is necessary.
Figure 1. Search information for the PubMed database.
As these words have to appear together to eliminate papers discussing other spheres of healthcare, these terms are connected by a Boolean operator ‘AND.’ Other option also has these words together to ensure that they are next to each other in the title or contents of the article. Furthermore, this phrase can narrow the scope of the search.
Other keywords are synonymous with palliative care. For example, the key phrase “recognition of dying” can be used to find articles that are concerned with the topic. Thus, such key terms are used to broaden the search. The Boolean operator ‘OR’ is also used to provide one with more results, as some articles may not have palliative care in the title or substitute it with other terms. The truncation symbols, shown in Figure 2, also improve the search by including all forms of such words as ‘recognize’ and ‘recognition.’ As a result, the databases showed various articles that discussed the elements and specifics of palliative care.
Figure 2. Search information for the CINAHL database.
Conclusion
Articles about palliative care often discuss the roles of professionals in assisting patients. The search for studies in palliative care has to include relevant keywords that are directly connected to the topic. The results of a search depend on one’s knowledge of appropriate keywords, symbols, and Boolean operators.
References
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755.
Low, J., Vickerstaff, V., Davis, S., Bichard, J., Greenslade, L., Hopkins, K.,… Jones, L. (2016). Palliative care for cirrhosis: A UK survey of health professionals’ perceptions, current practice and future needs. Frontline Gastroenterology, 7(1), 4-9.
Sekse, R. J. T., Hunskår, I., & Ellingsen, S. (2018). The nurse’s role in palliative care: A qualitative meta‐synthesis. Journal of Clinical Nursing, 27(1-2), e21-e38.
Siouta, N., van Beek, K., Preston, N., Hasselaar, J., Hughes, S., Payne, S.,… Hodiamont, F. (2016). Towards integration of palliative care in patients with chronic heart failure and chronic obstructive pulmonary disease: A systematic literature review of European guidelines and pathways. BMC Palliative Care, 15(1), 18.
Taylor, P., Dowding, D., & Johnson, M. (2017). Clinical decision making in the recognition of dying: A qualitative interview study. BMC Palliative Care, 16(1), 11.
I am hoping to be an Oncology Clinical Care Nurse Specialist (CNS) at the Lee Moffit Cancer Centre Foundation at Tampa, Florida, which has been named as one of ‘America’s Best Hospitals’ for Cancer Care for the ninth time. The centre which is a National Cancer Comprehensive Cancer Center has many units for cancer care. I hope to join the psychosocial and palliative care program. The mission of the center is to strive for the prevention and cure of cancers. The main objective of the program is to provide interdisciplinary evaluation of cancer patients. Clinical research trials would be conducted. Translational linkages would be made with appropriate basic science programs. Educational programs and training would be provided for medical students, house staff physicians and fellows. The community too would benefit. (Moffit Cancer Center Foundation, 2008).
Definition of palliative care
Palliative care is defined as an approach for the improvement of the quality of life of patients and their families who have been facing the problems associated with life-threatening illness. This would be achieved through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other associated problems including physical, psychosocial and spiritual ones. (WHO, 2002).
Extended education that I would need for a successful career. Through education and research my confidence would improve delivery of palliative care. Hopefully I shall obtain my AOCN (Advanced Oncology Certified Nurse). (Langhorne 2003). I have to become an expert in the following.
Continuing education in the non- physical needs of terminal phase patients requiring end-of-life support (Parish, 2006).
Education to increase the relationship between palliative care and acute care nursing.
Issues associated with terminal illness and the dying phase (ECU, 2008).
Aim
The aim of palliative care is the provision of multi-disciplinary comprehensive care in advanced disease. (Estfan et al, 2007).
Advance Practice Role Description
An interdisciplinary multi-theory approach is to be followed. (ECU, 2008).
I must remember that emerging palliative care trends involve ethical, multicultural and political issues. (ECU, 2008). My practice should hopefully be ethical and without political or multicultural issues.
Identify the best care principles related to really sick patients and those in the terminal phase. (Parish, 2006).
Shall be readily responsive to patients and families. (Estfan et al, 2007), using my interpersonal skills.
Assist in the development of standard palliative care protocols which incorporate the holistic needs of patients in palliative care. (Parish, 2006).
Identify symptoms and provide efficient symptom control and adequate nursing care (Parish, 2006).
Become fully competent in pain and symptom management. I understand pain as a complex anatomical, physiological and psychosocial state (ECU, 2008).
Assessment and recognition of disease progression and the terminal phase. Being well equipped to provide physical care like control of pain, other symptoms like nausea, constipation or weakness. Attending to the psychosocial and emotional aspect and providing supportive care, I hope to be with the patient in all the ups and downs (Reznisky et al, 2007).
Sincere effort to improve the quality of terminal care and share a special time with the patients. (Ross, 2008).
Lift the spirit, the courage and the smile of my patients.(Ross, 2008 ).
Maintain correct documentation for aspects of comfort care about assessment of physical, psychosocial and spiritual care. (Parish, 2006).
Make a correct assessment and plan the symptomatic treatment to raise the quality of the remaining life. (Parish, 2006)
Encourage support groups to use their conversation skills on the really ill.
Continuous and coordinated care is essential in attending to the needs of progressive illness (Estfan et al, 2007).
Strongly believe in the music therapy for patients. Would encourage the listening of music (Estfan et al, 2007).
Pastoral care is also instrumental in improving the quality of life at the terminal phase. (Estfan et al, 2007). Shall recommend this to the organization.
Would ensure that a 24-hour answering phone service is in place for attending calls from patients or families in distress. (Estfan et al, 2007).
Communication skills to improve the mental and physical state of the deteriorating patient
Improve on clear and honest communication with patients (Parish, 2006).
Would use good communication skills and counseling to assess the psychiatric status of the patient and respond accordingly. (ECU, 2008).
Remember that the 5 themes that dominate the last minute conversations are of love, identity, spirituality, everyday talk and difficult relationship talk. (Yingling, 2007).
Last minute communication involves more than pain, care-giving, dying and funeral arrangements. (Yingling, 2007). I must remember this.
Listen to the patients’ fears, soothe their symptoms and ease their death.
The survivor remembers these conversations for a long time.(Yingling, 2007).
Discuss hospice care and prognosis with patients as is possible (Parish, 2006).
Family theories to be adopted in my practice
I hope to cover 160000 new patients who access the Moffit Cancer Center at the National Cancer Center Network which has an alliance with 21 of the world’s leading cancer centers and this is a not-for-profit relationship. I shall be only one in a large population of the interdisciplinary teams in the center but I will do my bit well. I would provide leadership to incorporate the ‘change model’ in my activities.
Plan multidisciplinary conferences with the families in order to ensure that the family support for the patients is a part of the management in the terminal phase giving plenty of satisfaction to both patients and families.
Become a key component of the interdisciplinary healthcare team (Langhorne, 2003).
Make it important to document the patient –family relationship so that flaws can be discovered in time for retribution.
My role would be to determine how to ensure that the palliative care patient has a comfortable period with plenty of family support. Family based theories will be adopted to ensure quality care (Parish, 2006).
The communication that occurs at the end of life is extremely valuable to the surviving partner and dying alike. Survivors recall the enduring love between them, the effect the loved one had, changes in the survivor’s spirituality, solving of the issues between them and thoughts of the pleasurable moments. (Yingling, 2007). I would take care that this kind of communication persists.
Recognise the symptoms of imminent death to allow the family members to gather close. (Parish, 2006).
Funding
This excellent hospital survives on charitable funds and grant funding. At the beginning of 2008, Grant funding was more than 66million dollars. There is no dearth of funds here. So I expect my role to be supported. I consider that the Psychosocial department as a whole would benefit from my ideas and then the patients. (Moffit Cancer Center, 2008).
Moffit Cancer Center Foundation, (2008), “Adult Oncology Services”, Web.
Parish, Karen; (2006), “Dying for attention: Palliative care in the acute setting’, Australian Journal Of Advanced Nursing, Vol 24, No. 2, pg 21-25.
Reznisky, Shirli et al, (2007), “Can Family Caregivers of Terminally Ill Patients Be a Reliable Source of Information About the Severity of Patient Symptoms?”
Ross, Janice; (2008), “Lessons on the way”, Clinical Journal of Oncology Nursing, Vol 12, No. 4, Oncology Nursing Society.
World Health Organization. National Cancer Control Programmes: Policies and Managerial Guidelines. 2nd ed.Geneva, Switzerland: World Health Organization, 2002.
How important are communication skills in the performance of this person’s job in hospice/palliative care?
The nurses learn effective communication skills specifically in enhancing the practice principals in hospice/palliative care while collaborating with patients, communities, administrators, students and obviously peers. It should be mentioned that the function of a nurse it is desirable for the individual to fit into place in a sophisticated practice role and there are various objectives of this function is to enhance the compassionate practice of nursing and exhales the element of care and service that is so essential for a nurse.
How do nurses learn these effective communication skills?
Generally speaking the communication skills of a Nursing professional is to prepare that would prove to be substantially helpful once an individual faces the profession world and acquire the role of a leader under the perspective of the profession of nursing. This is why several subjects, that would otherwise appear contrasting, are included under learning program. These include subjects like education, administration and obviously the role of a nurse practitioner that deals with family nurse practitioners and acute health care. Communication skill is one of the most important aspects of this learning.
It could be easily ascertained that the Nursing Program and its objective is to make a perfect leader and nurse at the same time of a student. Another predominant objective of this program is to make a communicator out of a student who would take up the role of a nurse as the individual serves the community and the organization as a communicator within the perspective of every field. (Lamb, 2004).
What should the nurses’ approach be to communicate with the dying or her/his family?
It was needed to gather personal details for an intricate future diagnosis and treatment. For this, it was important to communicate with the patient in a warm and personal manner by introducing oneself, ensuring patient’s privacy, sitting at eye level when speaking with patient to comfort him as the patient was already in a situation of utter discomfort due to his ailment. For this, it is important to use both verbal and nonverbal communications skills. Within this approach it is also important to explain the purpose of this communicate in a heartily manner to sooth the patient telling him it is necessary to provide complete and accurate assistance as it would only help the doctors and nurses to diagnose perfectly. Then it would be possible to treat properly and thus this would help the patient to recover in a better and faster manner or comfort a dying patient. (Deb, 2006).
Who makes up the membership of the interdisciplinary team in the hospice care setting?
The administrators formulate the interdisciplinary team in the hospice care setting based on trainings. Qualified physiotherapists, psychiatrists, yoga trainers etc should be appointed to endow with spiritual heal along with physical and mental fitness to the elders. Nutritionists and center supervisors can also be appointed to administer the workings in the center, to provide proper healthy food and maintain hygiene of the center.
ILCs recruit staffs having knowledge on public reimbursements such as Medicaid, disability insurance, etc. Additionally, some ILCs also offer support groups, workshops, or instruction. Hospice services provide palliative care for persons with terminal sickness in the last stages of life and their families. Hospice coalesce medical, emotional, social and spiritual support to ease the dying person and his family and maintain dignity at the end-of-life. Services are dispensed through the involvement of physicians, nurses, social workers, therapists and volunteers. (Dos, 2006).
What is the importance communication within the team?
A hospice team associate is on-call 24-hours to provide advice or assistance with an emergency. Hospice clients obtain services in accordance with an individualized plan of service. A social worker is usually charged with supporting the patient and family and in helping the care team in working efficiently with the family. Respite care is formed to alleviate caregivers of their everyday jobs. Some Adult Day Health Centers even organize transportation facilities. Home health agencies can also enter the field to provide assistance by introducing a homemaker or home health assistant. Moreover, home health organization can arrange for round the clock care and over night care. Thus, to maintain these complex features communication is extremely important. (King, 2006).
What would is the most important take home message about communication?
From the perspective of a nurse, it is extremely important to incur the right principals taught in the training, particularly in the context of communication. For example, nurse should concentrate on the four different components of professional practice: 1) Communicating Planning and Preparation; 2) Communicating in hospice Environment; 3) Communicating Instruction; and 4) Maintaining Professional Responsibilities through proper communication. Additionally, a nurse should always remember to follow the theories of implementation. These included:
demonstrating flexibility and responsiveness in communication;
reflecting on teaching on communication;
maintaining accurate communication means;
communicating with families;
growing and developing professionally through communication;
showing professionalism through communication.
Thus, a proper execution of all these issues should be achieved and it should be remembered that the application of theory into practice becomes vital. (Dollard, 2006).
What non-verbal communication methods are used and are most effective in the hospice care setting?
It could be stated that in this discussion most of the emphasis is centered on this aspect. So non-verbal communication in work environments like hospice care setting, it plays a definite part. Emphasizing on a particular subject and giving wrong gestures can give a different meaning to the words spoken. For instance, issuing instruction during a hospice care setting and keeping a steady eye contact gives importance to the instruction issued. And at the receiving end, a studied gesture like, nodding of head single time give the impression that the topic of the order is well understood and received.
However, there would be other side of the issue. Besides the gestures, slide shows, projector also enhances the meaning within. If a dispute arises during hospice care setting, different body gestures, voice modulation, scratching of head, indifferent mannerisms, can give an impression of showing discontent on the discussion. Often in meetings an attendee can be going on and on, on certain points or perhaps other related topics need to be discussed, to regulate the flow of conversation rather than stopping or interrupting, simple body gesture by extending hand to other attendees can be less offending and in the process inviting other attendees to continue with the hospice care. (Kar, 2006)
These small things indicate that the conversation between the two parties is not heading towards the right direction, which creates a negative impact to the attendee. Therefore, it is evident, that not only verbal but also non-verbal communication also plays a huge part in giving meaning and direction to a hospice care setting. However, the best means is the use of comforting voice and concerned behavior. (Fletcher, 2005)
References
Deb, S; (2002); Evaluation Techniques of Nursing profession; ABP Ltd.
Dos, M; (2006); Future of Thought Process: Health Care; Alliance Publications.
Dollard, John & Doob, Leonard W; (2006) Frustration and Aggression in Nursing; New Haven and London: Yale University Press.
Fletcher, R; (2005); Leadership Principals in Healthcare: Beliefs and Knowledge; Believing and Knowing; Howard & Price.
Kar, P; (2006); History of Human Resource and Related Application of Nursing; Dasgupta & Chatterjee.
The main targeted audience is the impoverished children from poor family backgrounds. There is a close relationship between the social determinants of health and social epidemiology. As a matter fact, health outcomes of any given society largely rely on factors such as disability, education, housing, job security, and the distribution of income. Medical evidence suggests that high rates of mortality and morbidity are experienced among the economically poor individuals.
In the case of pediatric palliative care and poverty, it is vivid that the two concepts closely intersect each other. There are several life-limiting illnesses among children that are aggravated by poverty. Impoverished children can hardly access quality healthcare services (McGrath, Foote, Frith & Hall, 2013). As a result, they face higher chances of morbidity and mortality than children from affluent backgrounds.
Low-income families, single-parent families and immigrant families can hardly access the best healthcare services due to economic limitations (Colby, Dahlin, Lantos, Carney & Christopher, 2010). Such families also face significant employment and housing challenges on a regular basis. Worse still, they find it cumbersome to access financial assistance from the government. Consequently, children living in such poor families are highly likely to develop stress and subsequent depression.
It is pertinent to mention that palliative care demands a holistic form of healthcare delivery. The urban poor should be catered for by their respective governments in the process of exercising pediatric palliative care.
Location
The concept of palliative pediatric care provides invaluable information to local health departments, hospitals and community agencies. For example, poverty is a major social determinant of health that the local community-based organizations can adequately address. If the economic statuses of families are improved, the negative health outcomes associated with poverty will be significantly minimized. It is vital to mention that health departments and hospitals may also find this type of information worthy because aspects of healthcare such as epidemiology, morbidity and mortality rates can be addressed. In addition, faith-based organizations can play an integral role especially in offering guidance and counseling services to the hopeless children and families. Counseling sessions can be used to reduce pain that children go through in the course of illnesses.
In several occasions, parents, guardians and caregivers also require such counseling sessions due to the tough experiences that they undergo. Hence, choosing an appropriate location is crucial in the entire process of palliative pediatric care.
In terms of the gainful employment, it is the main role of the central government to ensure that poor families are enabled to receive government assistance. It is not just enough to treat illnesses as they surface. Specific hard-hit locations should be identified by the concerned authorities so that preventive measures for human suffering are put in place.
Mode
The mode used to deliver palliative care to impoverished children should be evaluated well before implementation. For example, it is necessary to assess the symptoms of sicknesses reported in a healthcare institution. The most common method for assessing symptoms is the dmonton Symptoms Assessment Scale. Second, the identified symptoms should be managed. Pediatric palliative patients should be provided with standard medications that have already been approved for safe use (Ward-Smith, Korphage & Hutto, 2008). For instance, nausea can be effectively treated with antipsychotic medications. As much as medication may be available for quite a number of palliative cases, the involved physicians should possess adequate knowledge on how to deal with instances of distress among children from lower socio-economic statutes.
References
Colby, W. H., Dahlin, C., Lantos, J., Carney, J., & Christopher, M. (2010). The national consensus project for quality palliative care clinical practice guidelines domain 8: Ethical and legal aspects of care. HEC Forum, 22(2), 117-1131.
McGrath, L. S., Foote, D. G., Frith, K. H., & Hall, W. M. (2013). Cost effectiveness of a palliative care program in a rural community hospital. Nursing Economics, 31(4), 176-1783.
Ward-Smith, P., Korphage, R. M., & Hutto, C. J. (2008). Where health care dollars are spent when pediatric palliative care is provided. Nursing Economics, 26(3), 175- 178.
A growing number of patients die in acute care units; nurses are not always prepared to provide the necessary end-of-life (EOL) care. Moreover, dying patients often have to compete for nursing attention with the acutely diseased. There also exists trouble in prognostication of unavoidable death, which means that patients often receive inappropriately aggressive, resuscitative care.
Purpose
To explore the ways in which nurses identify the dying patients and how they respond to their state while working with them, in order to comprehend these ways’ impact on EOL care.
Research question or hypothesis
Do nurses effectively recognize the dying state of patients? Do they provide adequate EOL care? What challenges do they face? Which factors influence the quality of EOL nursing care?
Review of the literature
The section of the article labeled “Background” provides an analysis of the current situation that dying patients and acute care nurses find themselves in; the review is based on 26 sources. The article contains references to 41 sources on the whole.
Theory or theoretical framework used in the study
The researchers utilized an adaptation of the theoretical model offered by Moretti et al. (420-428).
Population
The nursing staff of two acute wards in a hospital in Melbourne, Australia. Palliative and critical care wards were excluded from the study.
Sample population
25 nurses (11 of them were non-permanent personnel) were observed and took part in the study.
Participants
Apart from the 25 named nurses, two nursing managers of the two wards were interviewed.
Have the subjects’ rights been ensured? Confidentiality?
All the participants were given the option to quit the research at any phase, either from the phase only or from the whole research. No nurses decided to withdraw from the study. No names or personal data are given in the article, preserving the participants’ confidentiality.
Measurement tools
The reliability and validity of the utilized analysis tools are not discussed; however, a reference to Moretti et al. (420-428), whose theoretical model was used, is present.
Data collection method
Overt and non-participant observation was conducted to record what happened in acute wards. The researchers started observation when they received a phone call informing them that a patient was dying, or if there were dying patients during impromptu visits. The researchers observed the interactions that occurred between dying patients, their relatives and colleagues, and nursing staff. The observations were ceased when the state of data saturation was reached; this state was identified by researchers via personal reflection, and via consultations with colleague researchers.
Besides, interviews with nurse managers, as well as with focus groups consisting of six nurses each, were conducted to better comprehend the observations.
Data analysis
Qualitative content analysis was employed. A color coding system was utilized to sort the data into topics and sub-topics. Focus group interviews with nurses and individual interviews with nursing managers were coded in a similar way.
Statistical procedures
There are no statistical procedures explicitly mentioned in this qualitative research.
Findings – significant to nursing?
It was found that
nurses had difficulty recognizing dying patients, and when they did recognize the state, they sometimes had trouble getting the proper authorization from physicians;
nurses gave preference to single rooms for dying patients;
nurses often hesitated and showed signs of moral unpreparedness when it came to caring for dying patients.
The findings are significant in that they show the need for special preparation for EOL care during nursing education. Besides, the unequal power distribution in the nurse-physician relationship was also shown to have adverse implications in cases with dying patients.
Are there implications suggested for nursing practice, nursing education and nursing research?
No such implications are explicitly suggested.
Are there recommendations made for further research?
It is stated that further research ought to explore the influence that nurses’ attitudes towards EOL care might have on this type of care.
Limitations of the study
Some methodological limitations were uncovered retrospectively: 1) nurses rarely made phone calls to inform the researchers about the beginning of EOL care process; 2) the difference in training and education concerning EOL care between permanent and non-permanent nursing personnel was not explained; 3) a greater number of focus groups might have provided additional data.
References
Bloomer, Melissa J., Ruth Endacot, Margaret O’Connor and Wendy Cross. “The ‘Dis-Ease’ of Dying: Challenges in Nursing Care of the Dying in the Acute Hospital Setting. A Qualitative Observational Study.” Palliative Medicine 27.8 (2013): 757-764. ProQuest. Web.
Moretti, Francesca, Liesbeth van Vliet, Jozien Bensing, Giuseppe Deledda, Mariangela Mazzi, Michela Rimondini, Christa Zimmermann and Ian Fletcher. “A standardized approach to qualitative content analysis of focus group discussions from different countries.” Patient Education and Counseling 82.3 (2011): 420-428.
Complex illnesses can bring serious suffering and massive use of resources in reducing their severity or in an attempt to seek cure them. Patients with such fatal illnesses need close care and attention so as to minimize their suffering and prolong their life span (palliative care). This means providing any form of medical attention or treatments that aim at reducing the intensity of the disease symptoms or reducing the disease progression in general.
Personal relationships are very important as far as cancer patient assistance and other patient assistance are concerned. Sometimes the patients see their future as hopeless and feel so, because their situations cannot heal. Thus, personal relationships serve to restore hope and confidence in them. As mentioned, palliative care also aims to provide psychological and spiritual care to patients with fatal health complications to see them live a more active life. This could mean through guidance and counselling, where necessary.
Lung cancer exhibits such symptoms as breathing difficulty, continual fatigue and intensive cough. As it progresses, the disease passes to the terminal stage exhibiting severe conditions which lead to a patient’s death. The treatment depends on the type of cancer cells, the extent of its spread, and the intensity of the progress of the disease. When undergoing a course of treatment, a patient may feel distressed, lose the interest to the course of his/her life; his/her eating habits and social life may be also affected. Palliative care services help a patient and his/her family cope with the treatment process from the moment the disease has been diagnosed to its advanced stages.
Palliative care is applied to clients who are not responding to medical treatment. it gives them opportunity to life their life with dignity and comfort at that stage when the disease is threatening their lives (Doyle, Hanks, & MacDonald, 1998). It provides guidance for both a client and the family in making decisions regarding optional pain management and treatment that may be inconsistent with their will and wishes before the clients’ end of life (Lynch, 2003; Buckley, 2008).
Case Management
This paper is devoted to study of the case of a 65 year old woman with lung cancer. Clare lives with her husband in their home and has two grown children who are married. The disease exhibits such symptoms as breathlessness, cough and fatigue: Clare gets distressed by her inability to breathe, and as she sometimes has trouble sleeping at night; she is often sleepy during the day. Clare feels her powerlessness in managing the symptoms of the disease and considers that her condition challenges fulfilling her usual activities. Besides, she lacks close communication with her children: despite being in constant touch with her children by the phone, she misses them very much.
Clare feels uncomfortable about a big number of people who come to visit her. Her husband, Andrew, retired two years ago and helps her with shopping, cooking, and other household tasks.
He still feels that he would be more helpful if he could do more and seeks help in this regard. Palliative care services provide support for the family and the patient during the illness and treatment procedure, which includes social, spiritual and emotional support. Since the disease is life threatening, both the patient and the family need exceptional help in dealing with the ailment.
Clare’s condition is one of those that need palliative care. That is,, lung cancer is a chronic condition that worsens with time and needs appropriate palliative care so that Clare lives a better life with minimized suffering from the condition. The nurse has to provide all the support for Clare’s coping to ensure that she lives with the hope of a better future. Clare’s wish for personal relationships with the people around her has to be taken care of in addition to medical and other health support for her condition. The nurse has to see that Clare’s lack of strategies to manage her life-threatening illness is complemented and that numerous alternatives and strategies are provided.
Though Clare’s disease is a big sorrow for her family, their task is to support her and provide psychologically comfortable environment. At this stage, health education which is the part of palliative care is crucial for Clare and the family members: it is the source of emotional, spiritual and physical support for them. The family needs to go through counselling to get the holistic notion of care they should provide to Clare, not the issues of pharmacological management only.
It is multiple style behaviour to adopt more than one mechanism of treating patients as described, and it can be beneficial, according to Byers (2002) (cited in Pierce, et al., 2007).
Physical support
Physical support is evidenced to have benefit to patients with cancer, for instance, sleeping well, relaxing, and maintaining a weight that is reasonable as has been featured in Pierce et al. (2007) and Chlebowski et al. (2006) (cited in Rutledge & Robinson, 2009). It is possible to advise patients to join a professional program aimed at improving their health. These health-related programs are available after organizations have lobbied the government for their development. The nurse has to provide physical support to the client such physical exercises, which can be done by preparing an exercise program that combines a range of activities that Clare will have to perform each day.
The physical exercise will be of great importance, especially in reducing fatigue and promoting her general physical performance and well-being. The exercise will also be useful in relieving other symptoms such as lack of breath and coughing, since they will enhance air circulation within the lungs and throughout the other body parts. Physical therapy will also be vital in case Clare has to undergo surgery as this will help her to regain physical vigour (movements) as soon as possible.
Other physical support in terms of occupational therapy is also vital. The nurse can help Clare in what she does like dressing, showering and other major daily tasks. Some studies have linked survival after breast cancer with physical activity level and dietary patterns, as can be supported by Rock et al. (2005), Zhang, et al. (1995), Holmes, et al. (2005), Bastarrachea, et al. (1994) and Obermair, et al. (2002) (cited in Pierce, et al., 2007) while others have not supported the idea e.g. Rohan, Fu, & Hiller et al. (1994), and Kroenke, et al. (2005) (cited in Pierce, et al., 2007). These relate to diets that are linked with hormones, featured also in discussions by Rock & Demark-Wahnefried (2002) and Broocks et al. (1990) (cited in Pierce, et al., 2007), as well as other diets such as food vegetables (Pierce, et al., 2002, cited in Pierce, et al., 2007).
This means that the nurse may at times have to administer oxygen to Clare’s respiratory system when she cannot breathe normally to increase this supply to the lungs and thereby enhance its availability to the body tissues. Oxygen therapy results in more comfort and this can help Clare sleep at night and be more attentive during the day.
Depending on the effect of drugs, the nurse can choose the best combination to be administered at different times. When Clare is experiencing pain, regular massage will give her a great deal of relief. Other non-pharmacological therapies that will be important in Clare’s case are music, laughter, good aromas and regular happiness.
Psychological Support
According to literature, the distress level of the patient needs to be addressed effectively. Trained professionals can be assigned to people if they are experiencing high levels of stress and anxiety according to Thomas & Bultz (2008) (cited in Rutledge & Robinson, 2009). Otherwise, there are “psych-educational support groups” which can be helpful in supporting those with less psychological stress (Rutledge & Robinson, 2009).
It is possible to implement self-help skills to patients so as to help them cope with their psychological problems. Many medical systems have programs which help patients in this manner, although some are dogged with poor financing according to McMurtry & Bultz (2005) (cited in Rutledge & Robinson, 2009). Usually, the level of stress will increase with the extent of the illness, and a chronic cancer patient will experience high level of stress due to their suffering and because they are worried about how they will get well (and how long this will take). Psychological support involves guidance and counselling, advice and other related care, which means an interpersonal relationship with trained personnel (psychotherapy).
The nurse needs to be in constant communication with Clare as this will provide her with a personal relationship and company that she requires most. Those newly diagnosed patients need to be taken care of so as to impart emotional experience in them. A care for cancer, which is completely therapeutic, can be facilitated where people find a purpose for engaging in the cancer experience. Trained volunteer programs have been proven to be helpful and successful through practical experience, hence it would be expected that Clare would experience positive outcomes according to the Centre for Behavioural Research and Program Evaluation (n.d.) (cited in Rutledge & Robinson, 2009).
Because patients suffering from the illness may experience stressful and isolating feelings, they would be more appreciative if they have someone to discuss their personal experience with, and therapeutic effects may be achieved by listening to the patients as well as their family members, according to Maguire (1999) (cited in Rutledge & Robinson, 2009)
The nurse can also organize other visitors to ensure that Clare is not lonely and bored, because she likes company and is surprised by the number of people who have come to visit her. Therefore, the nurse should not restrict such people from seeing Clare, but organize appropriate times for them to do so.
The nurse should let Clare’s husband be close as this makes her more motivated in life. It may be possible to ease anxiety, improve the quality her interaction with the medical practitioners and the system, as well as assist her to prepare for meeting medical professionals whenever psychological help is offered to make her understand what is happening as can be seen in Mayer et al. (2007) (cited in Rutledge & Robinson, 2009). Nevertheless, where many people pay attention to treatment and neglect the relational aspects of patients, they are doing harm, because illness affects the emotions.
This can be done by setting goal-oriented systematic procedures to be practised regularly in minimizing the symptoms and other effects of the illness. The nurse will need to provide Clare with necessary information to better her state and provide ways that will boost her understanding and learning, especially in matters related to her condition. Intensive interaction and active engagement of the brain will be useful in administering this therapy. There are programs which are offered through telephone numbers and which avail opportunities for the cancer patients to get support and healing according to Canadian Cancer Society (2008) (cited in Rutledge & Robinson, 2009).
Social Support
Palliative care seeks to help the family of the patient with information about the needs of the patients. Using a team approach to provide support for both the patient and family helps to deal with the life-threatening ailment in a positive way and understand the progress the disease takes. This is a further course of therapy for the patient other than the medication given for treatment as the patient may also be dealing with depression: the fear of losing his/her social position, job prestige, income and role in the family aggravated by insomnia affects his/her psychological condition and makes him/her feel dispirited; hence, medicine alone cannot help them instantly in their illnesses. Sometimes, the patient is depressed due to feeling like a burden to the family, the pain they are going through and the deterioration of their health.
Their social support will ensure that she gets various therapies and other requirements. The support will also ensure that Clare’s change of condition is noticed so that necessary action can be taken in time. Clare should also be given time to interact with other community members, as this will make her have a sense of belonging and attachment. Clare’s husband, Andrew, wishes to be more helpful during her illness. He is helping with the jobs around the house, cooking and shopping which is a step forward in caring for the patient. However, it would be important for him to understand that care is needed to help Clare deal with her physical and psychological suffering.
The family, as Clare’s closest unit of interaction, is better placed to provide this care. Andrew would provide support by attending the treatment together with his wife so that he can understand more about Clare’s condition and progress and thus be of better help. Palliative care centres seek to provide health education to the family as well as counselling since they also go through some trauma. Clare appreciates relations with her children and needs their psychological support; phone contact is not enough for her to satisfy her needs in communicating with children.
Being affected by a disease, many people are isolated from the day-to-day activities that they took part in before the illness due to their physical condition, and sometimes isolated from conversations or the responsibilities they handled.
This isolation and the thought that they will not be in a position they had before may cause their stress. As Clare goes through treatment, she needs emotional support and the opportunity to be listened to in order to accept her condition and feel appreciated. Open discussion of the changes that are happening in her life may help her to accept the situation; Andrew’s task is to listen to Clare’s concerns and support her psychologically. As Clare does not have opportunity to manage her symptoms, Andrew should be more attentive to her and get ready to provide the necessary help.
Patients suffering from lung cancer are required to follow the fat-free diet. It is highly recommended to increase the intake of fruits and vegetables, as well as taking foods and drinks containing minerals, vitamins, proteins, and carbohydrates; lack of sufficient nutrients can cause a patient’s exhaustion and the inability to fight infection. Thus, providing a balanced diet for Clare during this time is vital for her health.
She and her husband need to learn nutritional requirements that assist in fighting infections and rebuilding tissues; to create opportunity for Clare to follow the healthy diet, Andrew should take the responsibility of providing her with the necessary health foods.
Palliative care centres provide support groups where cancer patients share their experiences. These activity may become an encouragement factor for Clare: at the moment, she is dispirited by impact the illness is having on her; hearing other people’s experiences can help her identify with her symptoms. Attending social events together with Andrew will also become a significant factor of support for Clare.
Spiritual Support
Illnesses and diseases touch and affect emotions; hence, the importance of emotional support for the patient cannot be ignored for wholesome healing. The spiritual care includes emotional support from families, friends and society (Jeffrey, 2003). The families of patients with life threatening diseases find great solace in this, too. However, this area is less addressed by many physicians.
Since the essence of palliative care is to provide holistic care for the family and the patient, their spiritual well-being is an aspect not to be ignored. One of the most burning questions is how and when it is appropriate to bring up the topic of spirituality to the patient; in many cases, this concern is raised later in the illness when the patient is on the advanced stages.
Being aware of Clare’s religious background, Andrew may provide valuable support to his wife by praying with her or reading scriptures together with her: it is a good way to give Clare opportunity to feel their psychological unity.
Study of Townsend, Kladder and Ayele, et al. (2002), showed that religious practice such as prayer improved health outcomes. This idea can be a source of inspiration and hope for Clare: it may reduce her concerns and encourage resisting to the disease. Being psychologically close with his wife, Andrew may find an appropriate moment to touch upon this idea in the conversation with her and make her interested in it. Besides, love and support of Clare’s family may give her energy to live her life with psychological comfort and accept death as a natural process.
Spiritual support will enable Clare to be connected to a transcendental force according to her belief system and this may as well provide support, protection, guidance, hope and general well-being. The relationship between Clare and the spiritual powers she believes in should be promoted. The nurse can also be part of her spiritual support by joining Clare in spiritual practices such as prayers, meditation, or singing. In this way, Clare’s spirituality will be expanded by increased hope, peace and faith. With this spiritual support, the importance of love will also be manifested. Furthermore, experiencing love from spiritual leaders will also do Clare a great deal of good.
Conclusion
In this paper, the case of a 65 old woman suffering from lung cancer has been discussed. Palliative care is the kind of treatment given to patients ailing from terminal diseases such as cancer, and the aim is to reduce the severity of the disease rather than stop the disease. Moreover, palliative care helps to care for social, emotional, spiritual and physical needs as the patients go through the treatment regimen.
Clare gets distressed by her inability to breath, and she sometimes has trouble sleeping at night and is often sleepy during the day. She feels unable to manage the symptoms of the disease and considers her disease an obstacle on the way to living her usual life. Furthermore, Clare suffers from insufficient psychological contact with her children and misses them, though she is in constant communication with them by phone.
Palliative care is important, because it aims at providing a support system for the family so that they can understand how well to handle the patient during this time of the illness. Since the disease is life threatening, the patient is taken through a process where they can view death as a natural process rather than only considering the outcome of the disease. A palliative care for Clare in enduring this life-threatening illness will help reduce her suffering and improve her quality of life. Palliative care will also be important in choosing and administering various therapies and treatments for this fatal condition.
The care will also help in Clare’s communication and determine her welfare by disclosing factors leading to the progress or deterioration of her condition. Palliative care is a commendable approach in caring for people with a life-threatening condition, and the nurse plays a major role to play in this care as they know when and how various therapies, treatments and other requirements of palliative care have to be administered. The family, friends and the community have also a role to play in the care as they make the world complete for such patients with chronic and fatal conditions like lung cancer.
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The research is devoted to testing a palliative care (PC) nurse practitioner-led (NP) intervention method “the Co Creation of Possibilities” (CP) described by Bergdahl, Benzein, Ternestedt, Elmberger, and Andershed (2013). CP includes the discussion of the needs and goals (wishes) of the patients that are not connected to healthcare but may be affected by the state of health, approving them or substituting them with more attainable ones, and co-creating a plan for fulfilling them. Bergdahl et al. (2013) have found out that NPs use CP with PC patients suffering from various illnesses instinctively, but they are not always successful. The model of CP proposed by the authors may assist in understanding the intervention and provide a ground for informed CP activities that can fulfill the functions of health-related education and support. Apart from that, the authors expect CP to improve NP-patient relationships. In other words, informed CP is likely to help NPs improve the quality of life (QoL) of patients in palliative care (PC) in several ways, but this method has not been researched yet. The presented study is aimed at changing this fact.
The PICOT research question will be formulated as follows: in PC patients being treated by an NP, does co-creation better meet the end-of-life needs as compared to current standards (Melnyk & Fineout-Overholt, 2011)?
Sampling
The independent variable (CP training) is meant for NPs, and the PICOT question targets an NP intervention, which is why the sampling will be aimed at contacting PC NPs (possibly in a PC clinic). Some NP characteristics (especially experience) will be taken into account, but they will not be used to stratify the sample. The findings, therefore, are intended to be generalized to PC NPs in general, which corresponds to the problem statement. At least 10 NPs would be required for each of the groups (the intervention and control group). The number is explained by feasibility: a smaller sample is unlikely to provide sufficient generalizability, but since each of the NPs is supposed to have a number of patients, the qualitative and quantitative data to be analyzed will increase significantly with every new NP. Tracing the work of NP with multiple patients is needed to define how likely the intervention is to change the practice of each of them. To improve the population representation and sample generalizability, the number of NPs can be increased if it is deemed feasible. The NPs from the final sample will be assigned to the control or intervention group randomly to improve the validity of the experiment (Coryn & Hobson, 2011). Thus, the sample will correspond to the research design as described below.
Research design
Since the sampling is randomized, the research can be considered an experiment (Polit & Beck, 2014). Still, it is a field experiment with a correspondent possibility of contamination (Johnson & Christensen, 2014). The study will be longitudinal (one year) to ensure that there is a “temporal relationship between the exposure and the outcome” (El-Masri, 2014, p. 16). The variables will be assessed before and repeatedly after the NP training (pretest-posttest) to trace the changes in NPs’ work.
To evaluate the proposed intervention as suggested by the research problem, the mixed methods will be used: both quantitative and qualitative data will be gathered. In general, the mixed methods research is believed to be more comprehensive as it is not limited to using only one type of data, which has been leading to its increasing popularity in various fields of study, including nursing, business, and human resources (Cameron & Molina-Azorín, 2014; Polit & Beck, 2014).
The necessity for both types of data in this research is explained by the expected outcomes (the expectations are based on the theoretical framework and literature review). The QoL is going to be assessed with the help of specifically developed questionnaires, and the physical state of the patient will be defined through disease-specific parameters. The educational needs fulfillment and the NP-patient relationship will be assessed with the help of closed and open question questionnaires.
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.
Coryn, C. L., & Hobson, K. A. (2011). Using nonequivalent dependent variables to reduce internal validity threats in quasi-experiments: Rationale, history, and examples from practice. New Directions For Evaluation, (131), 31-39. Web.
El-Masri, M. M. (2014). Prospective cohort study design. Canadian Nurse, 110(2), 16. Web.
Johnson, B., & Christensen, L. (2014). Educational research. Los Angeles, CA: SAGE.
Melnyk, B., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Polit, D., & Beck, C. (2014). Essentials of nursing research. Philadelphia: Lippincott Williams & Wilkins.
The settings of a longitudinal field experiment are likely to be multiple, but a palliative clinic may be considered a central setting. The patients’ conditions and health will define the rest of the settings. The clinic (or several clinics) will provide the sample: at least 20 NPs. The sample size is explained by the aim of the research and feasibility considerations. In order to test the co-creation of possibilities (CP) introduced by Bergdahl, Benzein, Ternestedt, Elmberger, and Andershed (2013), the number of NPs in both groups (CP and control) needs to be roughly equal and sufficient to make a generalization possible. However, since the NPs are going to use CP with a number of patients, every new NP increases the amount of data to be processed significantly. Therefore, if it is feasible to increase the sample size (given the funding), it should be done. Still, the proposed sample should be enough to make generalizations about the effectiveness of CP within the practice of one NP (due to the number of the patients involved) and NPs in general.
CP is not supposed to depend on the disease or the NP’s qualities, which is why no stratification is suggested (Bergdahl et al., 2013, p. 343). It is proposed to take into account the experience of NPs, but it is not going to affect their eligibility. All the NPs who currently work in palliative care and have not studied the intervention proposed by Bergdahl et al. (2013) will be eligible.
Sampling Strategy
The sampling strategy will begin with contacting palliative clinics or clinics and their NPs. The research design and aim will be explained to them; they will be provided with a copy of informed consent and encouraged to inquire their patients, who will also need to provide consent, about their intent or lack of intent to participate. The final sample will be randomly split into two groups: control and CP. Such a strategy corresponds to the type of the research; apart from that, randomization is “the most effective approach” to improving the validity of a study (Polit & Beck, 2014, p. 166)
Research Design
The type of the research design is a randomized controlled trial (RCT), which is a subtype of the experiment proper. The specifics of RCT include the random assignment of the people from the sample to either the intervention or control group (Polit & Beck, 2014). The NPs from one group will receive the CP training; those from the other one will not. Both groups will be followed for a year, which makes the study longitudinal (El-Masri, 2014). The baseline data will be gathered before the intervention; apart from that, it will be collected throughout the year, which makes the study a pretest-posttest one (Johnson & Christensen, 2014). It is a field experiment since is it going to be “conducted in real-life setting” (Johnson & Christensen, 2014, p. 321).
Rationale
RCT is one of “the most powerful designs for testing hypotheses and cause-and-effect relationships” (Polit & Beck, 2014, p. 156). The usage of RCT provides the opportunity of comparing the results of the trained group, and the randomization ensures the validity of the study. The longitudinal aspect is necessary to guarantee the “temporal relationship between the exposure and the outcome” (El-Masri, 2014, p. 16). It also might indicate the effect of practicing CP on NPs’ success. The pretest provides the baseline; the repeated posttests supply the results and their development. As for the field experiment aspect, it is mostly a necessity: such a longitudinal study cannot be carried out in a laboratory. This aspect of the research ensures that CP will be tested in real-world settings, but it also has the disadvantage of the lack of control over the extraneous variables (Johnson & Christensen, 2014, p. 321).
The research will employ mixed methods of data gathering since the measurement of variables needs both qualitative and quantitative information. The study will mostly use questionnaires (quality of life, relationships, NPs’ opinions concerning CP) and also measure disease-specific parameters.
References
Bergdahl, E., Benzein, E., Ternstedt, 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.
El-Masri, M. M. (2014). Prospective cohort study design. Canadian Nurse, 110(2), 16. Web.
Johnson, B., & Christensen, L. (2014). Educational research. Los Angeles, CA: SAGE.
Polit, D., & Beck, C. (2014). Essentials of nursing research. Philadelphia: Lippincott Williams & Wilkins.
The presented proposal includes an approximate plan for data analysis in the research devoted to the Cocreation of Possibilities: a new intervention that can be used by nurse practitioners (NPs) in palliative care and has been defined by Bergdahl, Benzein, Ternestedt, Elmberger, and Andershed (2013).
Data Analysis Plan: Demographic Variables
As it was mentioned before, the specific data that will be gathered from the NPs and especially patients may change, but some demographic variables are sure to be used. For NPs, the information concerning their age, sex, years of experience, and education will be collected since they may influence the outcomes. The patients’ demographic variables will mostly include their age, gender, and marital status along with the family size. The socioeconomic variables are not supposed to influence the outcome, and they will not be included to avoid testing too many aspects. The data will be coded to make its processing easier and summarized with the help of the frequency tables. According to Wetcher-Hendricks (2011), this approach is probably the only one that is properly-suited for the analysis of such information (p. 50). Specific software (SPSS Statistics) will be used to facilitate the process. The data will also be depicted with the help of graphs (most definite histograms), which ensures improved display (Wetcher-Hendricks, 2011).
Data Analysis Plan: Study Variables
The study variables include the patients’ quality of life defined by the WHO (2016) preexisting tool and the relationships with the NPs defined with the help of the instrument created by Cossette (2006); also, the diagnosis and the disease-specific aspects of the quality of life are likely to need to be measured. Since the latter is not defined yet and depends on the final sample, there can be variations.
Both tools provide ordinal data that will be descriptively analyzed for every patient, NP, and group, thus demonstrating the changes in the states of the former and the performance of the latter. As a result, the information will be presented as ratio data, which indicates that if the rest of the conditions for a parametric test (PT) are met (in particular, the normal distribution), a PT will be chosen. However, the requirements for PTs are not too likely to occur, which is why we expect and plan to use a non-parametric test (NPT) as it is usually done if a PT is not an option (Rubin & Bellamy, 2012, p. 157). The reporting measure of central tendency depends on the final data, but it is unlikely that the mean will be used since normal distribution is not expected.
NPTs can be applied to a broader scope of conditions and, even though the results of PTs have a lower probability of error, NPTs are also very reliable and often considered equivalent to PTs (Anastas, 2012). For this plan, the Mann–Whitney U test is suggested since it is meant to deal with the data that we are going to have and is suited for the aim of testing the null and research hypothesis. In other words, the instrument is meant for the comparison of two groups, which is why it can be used to find out if there are differences in the performance of the experimental and control groups. Apart from that, it is an NPT, which is why it can be used for any type of data and skew distribution (Rubin & Bellamy, 2012, p. 172).
References
Anastas, J. (2012). The research design for social work and human services. New York: Columbia University Press.
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.
Cossette, S. (2006). CNPI User Guide and Related Articles. Web.
Rubin, A., & Bellamy, J. (2012). Practitioner’s guide to using research for evidence-based practice. Hoboken, N.J.: Wiley.
Wetcher-Hendricks, D. (2011). Analyzing quantitative data. New York, BY: John Wiley & Sons.
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.