Relationship centred outcomes focused on compassionate care for older people within in-patient care settings

This paper describes outcomes from research titled Leadership in Compassionate Care. The research adopts a participatory action research approach, utilizing appreciative inquiry and relationship centred care. Outcomes of the research are based upon relationships between patients, families and staff. This paper focuses on in-patient care for older people. A range of data generation activities were undertaken including: observation, interviews using emotional touch points and reflective accounts. To highlight outcomes in compassionate care, this paper uses case studies from two participating services. Principles of compassionate care were derived from understanding experiences of patients, relatives and staff and initiating responsive action projects. The aim was to enhance the experience of relationship centred, compassionate care. The process of emotional touch points enabled a richer understanding of experience. In terms of outcomes for patients this involved, enhanced quality of time spent with family and opening up conversations between families and staff. Outcomes for families involved enhanced access to relevant information and the opportunity to make sense of their situation. Staff outcomes were gaining experience in working alongside family to co-create the service, enhanced understanding of the experiences of patients and relatives led to direct changes in individual and team practices.     

When a hospice is not a haven

Abstract

There has been little research conducted with terminally ill patients in the UK to date. This case study describes statements made by a palliative care patient during a face-to-face interview while he was being treated in a hospice. His comments illustrate his unhappiness within the hospice environment to an extent that could compromise his holistic management in this setting. We would suggest that the important aspects of patient care include not just the major palliation issues of symptom control and good communications, but also attention to the rituals of daily living of individuals pertaining to the environment. The atmosphere of the hospice, as experienced by patients through their interactions with staff members within the care setting, is seen to be a significant factor for good holistic care. Hospices may need to be more aware of the impact that every member of staff, both clinical and non-clinical, can make at each patient contact. Becoming more alert to the likes and dislikes of each patient as regards the substance of these contacts may allow hospices to avoid institutionalized care practices and instead to individualize the care they offer to a greater number of their patients.     

Caregivers' insights on the dying trajectory in hematology oncology

It is increasingly acknowledged in the research literature that palliative care is not offered to patients with a hematologic malignancy. The evidence indicates that patients are not dying at home or in the comfort of the hospice setting but are more likely to end up in the high-tech care of an intensive care unit. The holistic, compassionate care of the hospice/palliative care philosophy is not routinely made available to either these patients or the families who care for them. However, little is known about what the end-of-life experience is for such patients and their families and how they are managing to negotiate their dying experience in a system that is designed to cure not to palliate. In particular, there is a dearth of information on what happens to the caregivers during what is characteristically a prolonged and difficult period of sustained caring within the high-tech system. This discussion presents findings from recent research that is beginning to document the experience of the dying trajectory for patients from these diagnostic groups and their families. The hope and expectation from such research is that the information will make a contribution to building multidisciplinary plans of care for hematologic malignancies during the dying trajectory, to ensure that patients and their families are appropriately referred to the palliative system or, at least, are given sensitive palliative care within the curative system.     

Appreciating and developing compassionate care in an acute hospital setting caring for older people

dewar b. & MacKay R. (2010) Appreciating and developing compassionate care in an acute hospital setting caring for older people. International Journal of Older People Nursing
5 , 299–308
doi: 10.1111/j.1748-3743.2010.00251.x Background. There is increasing emphasis in policy, research and practice on the importance of caring in health care. Indeed there is much debate about how to enhance the caring cultures within which health care is provided. This paper argues that a proper systematic analysis of caring practice that works well in care environments may help us to move towards a realistic model for the future which supports staff, patients and families to give and receive compassionate care. Aim. The aim of the project was to explore, develop and articulate strategies that enhanced compassionate relationship centred care in an acute hospital setting, caring for older people. Methods. Appreciative action research informed the development and evaluation of the project. A range of data generation activities were used to examine what worked well. Following detailed analysis key processes emerged as being central to delivery of compassionate care. Specific action projects were implemented and evaluated to enhance these processes necessary for compassionate caring. Findings. Data from the project helped to articulate the special and often hidden acts that make up compassionate care. In relation to the process of ‘knowing who I am and what matters to me’ data provided evidence of the value of this process and the potential impact to care. In addition data about the process of doing appreciative action research helped to realise its application and relevance in the health care setting. Conclusions. Findings from this work suggest that there are a number of significant processes that help people to deliver compassionate care. These need to be articulated, shared more widely across practice, policy and education so that we can build on this excellent practice. Implications for practice. Appreciative action research adopted in this project is an important methodology to supporting practitioners to identify what it is they do well and develop practice to try to make the best caring practice happen most of the time. Academics, policy makers and practitioners should consider the approach of appreciative action research as key to supporting developments in care.     

Parish nursing: holistic nursing care in faith communities

Modern-day parish nursing is a specialized practice in professional nursing that addresses the spiritual, physical, and emotional health needs of clients within a faith community. Parish nursing care has been described as holistic care; however, few studies have focused on the holistic nature of parish nursing care. A qualitative study was conducted with the clients of parish nurses. Seventeen clients utilizing the services of 3 parish nurses in Christian faith communities participated in the study. Following the institutional review board approval, the clients were recruited with the assistance of the parish nurses. The clients completed a 7-item demographic questionnaire, followed by a face-to-face interview with the author who used a semistructured interview tool. The interview questions encompassed 6 aspects of parish nursing: education, personal counseling, health screenings, spiritual support, referrals, and health advocacy. The interviews were transcribed and analyzed by the author. The results of the study indicated that the clients in all 3 churches received holistic care from their parish nurses. The care they received addressed their spiritual, physical, and emotional health needs. Recommendations for future research and implications for the clinical practice of parish nursing, using a holistic approach, are included. The findings of future research and the holistic interventions of parish nurses could influence the funding and positions for parish nurses in the future.     

A COMPARATIVE STUDY OF THE SPIRITUAL PERSPECTIVES AND INTERVENTIONS OF MENTAL HEALTH AND PARISH NURSES

Spirituality is an integral part of holistic nursing practice. Limited research has been done that explores nurses' spirituality and the spiritual interventions they have made with patients in their practice. Much of the extant research has been done on nurses involved in terminal care such as oncology and hospice nursing. This study explores spiritual perspectives and spiritual nursing interventions in two other nursing specialties that require holistic nursing care as well: mental health and parish nurses. The findings indicate that both groups report high spiritual perspective scores and provide a variety of interventions to patients in their practices.     

Trends in mental health: implications for advanced practice nurses

PURPOSE: To examine current trends in mental health care for vulnerable populations and suggest how advanced practice nurses (APNs) can incorporate mental health care into primary care practice. DATA SOURCES: Original research and evidence-based clinical articles, government publications, and professional practice guidelines. CONCLUSIONS: Vulnerable populations, such as racial and ethnic minorities, adults with chronic mental illness, the elderly, the incarcerated, and those living in rural areas have long been ignored as recipients of quality, integrated health care services. There is a compelling need for APNs to participate in the integrated delivery of physical and mental health care to all Americans, especially to vulnerable populations. IMPLICATIONS FOR PRACTICE: Under the umbrella of advanced practice nursing, a variety of nurse practitioners (NPs) and clinical nurse specialists (CNSs) can offer a holistic approach to the provision of evidence-based health care in a wide variety of settings to an array of vulnerable and underserved people. By serving on provider panels, partnering with consumer groups, and advocating for the unmet health needs of vulnerable populations, APNs can have a positive impact on the health care delivery system.     

A comparative study of the spiritual perspectives and interventions of mental health and parish nurses

Spirituality is an integral part of holistic nursing practice. Limited research has been done that explores nurses' spirituality and the spiritual interventions they have made with patients in their practice. Much of the extant research has been done on nurses involved in terminal care such as oncology and hospice nursing. This study explores spiritual perspectives and spiritual nursing interventions in two other nursing specialties that require holistic nursing care as well: mental health and parish nurses. The findings indicate that both groups report high spiritual perspective scores and provide a variety of interventions to patients in their practices.     

United States nurse practitioner students' attitudes,perceptions, and beliefs working with the uninsured

To reduce health disparities, nurses are expected to provide compassionate and high quality care to all patients regardless of socioeconomic and insurance status. In the United States (US) nurse practitioner (NP) educators need to expose students to clinical practice settings, such as free clinics, where the vulnerable populations like the non-documented immigrants and uninsured receive care. The purpose of this mixed method study was to provide an immersion experience for (NP) students at free clinics. Then researchers evaluated the impact of a clinical immersion experience on NP students' attitudes, perceptions, and beliefs about the uninsured and determine whether the clinical experience impacted their willingness to consider working with vulnerable populations in the future. Qualitative and quantitative data suggests students challenged their own beliefs and attitudes regarding the vulnerable populations, gained insight into care provided at these free clinics, and expressed their intent to volunteer at these settings. In the era of health care reform both nationally and internationally and the need to improve primary care access globally, educational initiatives are needed to expose NP students to economically vulnerable populations. Future research needs to replicate and extend the findings of this study, focusing on teaching-learning experiences for nurse practitioners and other advanced practice nursing students.     

What is Person-Centred Care? A Qualitative Inquiry into Oncology Staff and Patient and Family Experience of Person-Centred Care

IntroductionTo investigate the understanding and practice of person-centred care by health care professionals and support staff at a cancer centre and to learn how patients and family members understand and experience person-centred care.MethodsThe study was conducted in two phases. Phase 1 used large wall mounted posters and marking pens in public areas of the cancer centre to gather comments from staff, volunteers, students, patients, family members, and visitors to answer the question, “What does person-centred care mean to you?” Phase 2 used a six-question, open-ended, paper-based questionnaire for staff and patients. A manual coding technique was used to derive themes from both posters and questionnaires.ResultsWe derived 97 themes from the posters and 134 themes from 44 returned questionnaires (survey response rate of 37%). When the themes were combined and reprioritized, we learned that person-centred care is: (1) care that is caring, compassionate, and empathetic; (2) person or patient is the centre of focus; (3) care is unique to the individual's needs; and (4) person or patient is a part of their care. Furthermore, all staff should provide person-centred care.ConclusionsOur findings describe what our staff, patients, and family members believe person-centred care is, and how it should be delivered. Based on this research study, we recommend promoting additional dialogue and continuing education opportunities for health care professionals and other front-line staff who will assist them to complete the statement, “I demonstrate person-centred care by…” to their own satisfaction in the future.     

Is the Palliative Care Outcome Scale useful to staff in a day hospice unit?

AIM: this study was undertaken to elicit a day hospice team's experience of using the Palliative Care Outcome Scale (POS), with the intention of determining its usefulness to staff. An adapted version of POS was used for the purpose of the study. SAMPLE: a multiprofessional team of eight day hospice staff took part in the study. All had used POS on a weekly basis for a minimum period of 3 months. DESIGN: a focus group was conducted at the hospice. It was tape-recorded and transcribed verbatim. The data were analysed using an interpretive phenomenological approach. RESULTS: staff felt POS had limited value as an outcome measure for use in this day hospice. Other simultaneous organizational changes at the hospice may also have influenced staff negatively. Further research is needed to explore similar implementation issues in more depth, as practice developments may be abandoned for potentially the wrong reasons.     

癌症病人的临终关怀与护理

简要阐明了临终关怀护理的发展及其服务机构的形式 ,综述了癌症病人临终关怀护理的重点是控制症状、给予病人及其家属心理支持 ,提出护理人员有责任开展和宣传临终关怀的意义 ,提高临终关怀的护理质量。     

Student nurse socialisation in compassionate practice: a Grounded Theory study

Compassionate practice is expected of Registered Nurses (RNs) around the world while at the same time remaining a contested concept. Nevertheless, student nurses are expected to enact compassionate practice in order to become RNs. In order for this to happen they require professional socialisation within environments where compassion can flourish. However, there is concern that student nurse socialisation is not enabling compassion to flourish and be maintained upon professional qualification. In order to investigate this further, a glaserian Grounded Theory study was undertaken using in-depth, digitally recorded interviews with student nurses (n=19) at a university in the north of England during 2009 and 2010. Interviews were also undertaken with their nurse teachers (n=5) and data from National Health Service (NHS) patients (n=72,000) and staff (n=290,000) surveys were used to build a contextual picture of the student experience. Within the selected findings presented, analysis of the data indicates that students aspire to the professional ideal of compassionate practice although they have concerns about how compassionate practice might fit within the RN role because of constraints on RN practice. Students feel vulnerable to dissonance between professional ideals and practice reality. They experience uncertainty about their future role and about opportunities to engage in compassionate practice. Students manage their vulnerability and uncertainty by balancing between an intention to uphold professional ideals and challenge constraints, and a realisation they might need to adapt their ideals and conform to constraints. This study demonstrates that socialisation in compassionate practice is compromised by dissonance between professional idealism and practice realism. Realignment between the reality of practice and professional ideals, and fostering student resilience, are required if students are to be successfully socialised in compassionate practice and enabled to retain this professional ideal within the demands of 21st century nursing.     

安宁疗护高级实践护士核心能力指标体系的构建

目的:构建安宁疗护专业高级实践护士的核心能力指标体系.方法:通过文献回顾,根据专家协调小组意见,自行设计专家咨询问卷,对全国7个省份15所医院从事临终护理实践、护理管理、姑息医疗以及从事院校安宁疗护教育4个领域的23名资深专家进行两轮德尔菲专家咨询.结果:构建的安宁疗护高级实践护士的核心能力指标体系包括沟通及合作能力、...     

'Finding the person the disease has'--the case for multisensory environments

Education about, and exposure to, the utilization of a multisensory environment (MSE) was provided to clinical staff as a response to findings from the problem identification stage of an action research study. Feedback was obtained about their experience and perceptions of its use. Through the auspices of focus groups and one-to-one interviews, respondents commented on the impact that using the MSE had on their perception of their clients and on subsequent care. The case is made that MSEs afford an opportunity to impact on care through their mediating influence on formal carers' perceptions of their clients and, as such represent a significant but as yet unrealized potential for improving the quality of care of older people with dementia.     

Exploring nurses' perceived benefits of utilizing holistic modalities for self and clients

The purpose of this study was to describe the experience that holistic nurses have in incorporating complementary and alternative modalities in the care of their clients, as well as gain a deeper understanding of holistic nurses and the perceived benefit of utilizing a holistic modality with their clients and themselves concurrently as providers of these modalities. Purposeful samplings of holistic nurses' who include modalities in their healing process were the participants in this exploratory research, which entailed data collection through the use of critical incident reports and open-ended interviews.     

The Supportive Hospice and Aged Residential Exchange (SHARE) programme in New Zealand

Research indicates that staff in aged residential care may be unprepared for their role in palliative care provision. In collaboration with a local hospice, the project piloted an innovative problem-based experiential learning intervention Supportive Hospice and Aged Residential Exchange (SHARE) to enhance aged residential care staff palliative care skills. The aim was to explore the impact of SHARE for staff. SHARE was implemented in two aged residential care facilities in one urban centre for six months. Measurement of the impact of the intervention consisted of 1) pre-test-post-test questionnaires (n = 27) to assess changes in staff confidence in palliative care delivery 2) Eleven post-intervention interviews to describe staff perceptions of SHARE. Results from the SHARE pilot indicate that the intervention overall is seen as a success, especially in relation to advanced care planning documentation. Relationships between hospice and facility staff, and consequently facility staff and residents are seen as the key to the success of the project. Staff survey results indicated increased confidence in palliative care delivery and decreased depression. Key lessons learnt from for the development of any palliative care intervention within aged residential care include the importance of reciprocal learning, as well as the necessity of a strong partnership with key stakeholders.     

安宁疗护研究热点的共词聚类分析

目的 分析安宁疗护研究热点,了解该领域研究现状及发展趋势。方法 以“hospice care”为主题词,采用主题检索方法对PuMed数据库中2008-2018年发表的安宁疗护相关文献进行主题检索,运用Bicomb、SPSS 24.0 软件对其进行共词聚类分析。 结果 共检索到相关文献2 968篇,截取高频关键词41个,通过共词聚类分析总结出 2008-2018年安宁疗护相关文献年发表数量虽然出现几次波动,但总体来说仍处于较高水平且趋于稳定,其中美国的相关研究论文最多,总结安宁疗护研究的共词聚类可归纳为6个热点:①安宁疗护中心标准;②安宁疗护开展现状;③安宁疗护护理实践;④安宁疗护与心理学;⑤安宁疗护的管理;⑥经济学与伦理。结论 本研究总结了安宁疗护的研究热点及其文献分布,可为今后安宁疗护的研究发展提供参考依据。     

“Goals of Care Conversations Don't Fit in a Box”: Hospice Staff Experiences and Perceptions of Advance Care Planning Quality Measurement

ContextWith rising concerns about quality of care in hospice, federal agencies recently began mandating quality measurement in hospice, including measures of advance care planning (ACP).ObjectivesTo characterize hospice providers' experiences with ACP quality measurement and their reflections on ways to improve it.MethodsSemi-structured in-depth interviews of fifty-one hospice providers from various clinical backgrounds and organizational roles in four geographically diverse non-profit, community-based hospices in the U.S. Participants were queried about their experiences with and barriers to ACP quality measurement processes in their organization, opinions about the impacts of federally mandated quality measures, and ideas for improvement. Data were analyzed using thematic analysis with an interdisciplinary team, facilitated by ATLAS.ti and Excel.ResultsFour key findings of the ACP quality measurement experience for hospice staff included variation, barriers, attitudes, and recommendations for improvement. 1) Variation: Within and across organizations, participants applied a variety of processes to measure ACP quality, and exposure to and experiences with quality measurement varied based on organizational role. 2) Barriers: ACP quality measurement was impeded by limited resources, technological problems, and measurement challenges. 3) Attitudes: Participants' opinions of recently implemented federally mandated requirements for ACP quality measurement highlighted numerous downsides, unintended consequences, and few upsides. 4) Recommendations: improvements included personalizing ACP quality measures, elevating the importance of quality measurement, and streamlining processes.ConclusionHospice staff take ACP quality measurement seriously, but insufficient organizational resources and regulatory bureaucracy create challenges. Efforts to enhance ACP quality measure nuance and assess outcomes are needed to improve care.