Iranian nurses’ preparation for loss: finding a balance in end‐of‐life care

Aim. To explore the nurse–patient interaction in terminally ill situations in acute care, focusing on the nurses’ preparation for loss. Background. Caring for dying patients can be a distressing and sometimes even threatening experience for nurses. Despite the vast body of literature on nurse/patient interaction and the quality of end‐of‐life care, few studies focus specifically on nurses’ experience. Design. A grounded theory approach was used to explore nurses’ interaction with dying patients and their families and examine how nurses deal with situations in which the patient’s death is inevitable. Method. Eighteen nurses were interviewed up to three times each at three teaching hospitals in Isfahan, Iran, during autumn 2006. A shortlist of possible participants was obtained by means of theoretical sampling and those who had experienced the death of patients and were able to express their feelings verbally were selected. Results. The results clarified a core consideration: striking a balance between restorative and palliative care, information and hope, expectations and abilities and intimacy and distance. Conclusion. Attaining a balance in caring for dying patients is a major challenge to nurses: it concerns not only their interactions with patients and their families, but also their perceptions of themselves and their actions in end‐of‐life care. Relevance to clinical practice. In end‐of‐life care, it is important for nurses to be able to change the focus of their care when the patient’s condition is diagnosed as irreversible. They also need to be well equipped to maintain a balance, thereby preparing themselves for the patient’s forthcoming death.     

Religious observance and perceptions of end‐of‐life care

This study examines the impact of the level of religious observance on the attitudes toward end‐of‐life (EOL) decisions and euthanasia of Jews in Israel—where euthanasia is illegal—as compared to Jews living in the USA, in the states where euthanasia is legal. A self‐reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations.     

Delivering ‘Gold Standards’ in end‐of‐life care in care homes: a question of teamwork?

Aim. This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end‐of‐life care into care homes in England. Background. The Gold Standards Framework was developed in primary care to improve the care provided for people at the end‐of‐life. Following its successful introduction to this setting it was adapted and implemented in care homes. Design. A case study approach was appropriate for this study of a care programme into a ‘real life’ setting. Method. Fourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used. Results. It was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established. Conclusion. Effective teamwork was necessary for changes in end‐of‐life care to be achieved in the care homes. If end‐of‐life care and other improvements in practice are to continue, teamwork will need to be supported and developed. Relevance to clinical practice. Effective teamwork appears to be a pre‐requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first.     

Systematic critical realist review of interventions designed to improve end‐of‐life care in care homes

The demand for high‐quality end‐of‐life care is rising. Frequently evidenced concerns about the provision of end‐of‐life in care homes relate to inter‐disciplinary communication and engagement in advance care planning. A number of interventions employing different mechanisms have been designed to address these issues. Therefore, the aim of this systematic critical realist review was to describe and explain the effectiveness of interventions designed to improve end‐of‐life care in care homes. Electronic searches were conducted in ScienceDirect, MEDLINE, PubMed, PsychINFO, and CINAHL from January 2000 to August 2018. Forty one studies were included in the review. While most of the evidence identified in this review was not strong, there was evidence to suggest that education and inter‐professional collaboration can be effective intervention mechanisms for improving end‐of‐life care in care homes. High staff turnover was a significant contextual mechanism impacting on the sustainability of interventions. In terms of human agency, it is important to note a consistent finding related to the dedication and enthusiasm of care home staff who deliver end‐of‐life care.     

Factors influencing oncology nurses’ approaches to accommodating cultural needs in palliative care

Aims and objectives. The purpose of this study is to explore the social construction of cultural issues in palliative care amongst oncology nurses. Background. Australia is a nation composed of people from different cultural origins with diverse linguistic, spiritual, religious and social backgrounds. The challenge of working with an increasingly culturally diverse population is a common theme expressed by many healthcare professionals from a variety of countries. Design. Grounded theory was used to investigate the processes by which nurses provide nursing care to cancer patients from diverse cultural backgrounds. Methods. Semi‐structured interviews with seven Australian oncology nurses provided the data for the study; the data was analysed using grounded theory data analysis techniques. Results. The core category emerging from the study was that of accommodating cultural needs. This paper focuses on describing the series of subcategories that were identified as factors which could influence the process by which nurses would accommodate cultural needs. These factors included nurses’ views and understandings of culture and cultural mores, their philosophy of cultural care, nurses’ previous experiences with people from other cultures and organisational approaches to culture and cultural care. Conclusions. This study demonstrated that previous experiences with people from other cultures and organisational approaches to culture and cultural care often influenced nurses’ views and understandings of culture and cultural mores and their beliefs, attitudes and behaviours in providing cultural care. Relevance to clinical practice. It is imperative to appreciate how nurses’ experiences with people from other cultures can be recognised and built upon or, if necessary, challenged. Furthermore, nurses’ cultural competence and experiences with people from other cultures need to be further investigated in clinical practice.