Although there is a growing movement to conceptualize palliative care as an integral part of comprehensive cancer care, access to coordinated palliative care services is often limited to end-of-life when efforts to control the disease have failed. Little was known about how this phenomenon is experienced in oncology nursing practice. A phenomenological approach was used to explore oncology nurses experience providing non-curative care in one of six outpatient cancer settings within an urban health region in Western Canada. Emerging understandings suggest that oncology nurses support patients‟ hopes for prolonged survival with non-curative treatment while revisiting treatment decisions in the context of witnessed suffering. In the context of mounting symptoms, oncology nurses strive to construct a „safety net‟ of community supports to rescue patients from crisis. Inherent tensions within this experience are shaped by how cancer care and palliative care are understood, how treatment decisions are framed within their care team, and organizational constraints in the provision of services in the community. These understandings invite further discussion about strategies to support oncology nursing practice in the provision of non-curative care. / Graduate

The neonatal intensive care unit (NICU) is frequently occupied by newborns who are marginally viable, or critically unwell, and could be considered terminally ill. It is a busy, highly technical environment with an arsenal of life-saving medical equipment at its disposal, and advances in technology used in this field stretch the boundaries of viability. Despite technological advances, increases in the margins of viability and highly skilled healthcare delivery, some newborns will still die in the NICU. In recent years, palliative care for the neonatal population has become increasingly topical and part of the lexicon of contemporary neonatal practice. Evidence-based protocols are available to inform this model of care, yet in reality, provision of palliative care to newborns is ad hoc. The reasons why implementing a palliative model of care have been problematic are unclear. The purpose of this study was to identify the barriers and facilitators to palliative care practice in neonatal nursing, and to develop policy recommendations to improve this area of practice. This exploratory research was conducted to answer two research questions: 1) What are the barriers and facilitators to palliative care practice in neonatal nursing? 2) How can the identified issues be addressed to inform policy and clinical guidelines in the practice environment? Phase one of this investigation developed, pilot tested, and administered an instrument to identify the barriers and facilitators to practice. Data analysis identified three subscales that indicated facilitators and barriers to palliative care practice. The second phase of this study used a translational research approach, utilizing interpretive methods to explore and contextualise the population study findings to inform policy development to improve palliative care practice in neonatal nursing. This research has identified that the facilitators that do exist for palliative care practice are subject to caveats that impinge markedly upon these facilitators. Furthermore, the barriers that were identified pose threats to the integration of a palliative model of care into Australian neonatal nursing practice. Thus, the overall results from this research have lead to a composite understanding of the barriers and facilitators to palliative care practice in Australian neonatal nursing, which may account for the gap between support of palliative care for marginally viable and critically ill newborns, and the application of this model of care in clinical practice. Translating the survey findings into policy directives that are applicable to the clinical environment has resulted in the development of recommendations that are aimed at improving palliative care practice in the NICU.

Thesis (M.S.H.S.A.)--Regis University, Denver, Colo., 2008. / Title from PDF title page (viewed on May 27, 2009). Includes bibliographical references.

Thesis (M.S.H.S.A.)--Regis University, Denver, Colo., 2008. / Title from PDF title page (viewed on May 28, 2009). Includes bibliographical references.

Background: Palliative care means improving quality of life along a spectrum of illnesses including cancer. Cancer is one of the leading causes of death. Having the discussion of goals of care including palliative care is important to have with individuals who have advanced cancer. There were limited studies that identify the providers’ attitudes, subjective norms, and perceived behavioral control on discussion of goals of care including palliative care. Purpose/Aim: This Doctoral Project consisted of identifying factors (i.e., attitudes, behaviors and subjective norms) in discussion of goals of care with their terminal cancer patients in the outpatient oncology clinic. Multiple studies have demonstrated the lack of knowledge providers have about palliative care. Through this study, the attitudes, subjective norms, and behaviors of providers were evaluated regarding goals of care for palliative care. Methods: An investigator developed questionnaire with six-point Likert-type scaling was used to measure each dimension (attitudes, subjective norms, and perceived behavioral control) regarding discussion of goals regarding care. These questionnaires were sent electronically to the oncology providers at Arizona Center for Cancer Care in Phoenix, Arizona. The data were collected through Qualtrics. Outcomes: Six providers participated in the survey. Results on the Attitude subscale indicated that the providers regarded discussing goals of care including palliative as very important and beneficial to patients. In comparison to this subscale score, the results on the Subjective Norms and Perceived Behavioral Control subscales were somewhat lower, though still above the mean, indicating that providers regarded the norm and level of resources available for discussing goals of care as somewhat lacking in their work setting. Further research is needed in this area of inquiry, including a quality improvement project to promote quality care in discussing goals of care including palliative care with patients who are diagnosed with advanced cancer.

Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and crosssectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources, and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.

Yes / The role of non-medical prescribers working in palliative care has been expanding in recent years and prescribers report improvements in patient care, patient safety, better use of health professionals’ skills and more flexible team working. Despite this, there is a lack of empirical evidence to demonstrate its clinical and economic impact, limiting our understanding of the future role of non-medical prescribers within a healthcare system serving an increasing number of people with palliative care needs. We developed a unique methodology to establish the level of non-medical prescribers’ activity in palliative care across England and consider the likely overall contribution these prescribers are making at a national level in this context in relation to medical prescribing. All prescriptions for 10 core palliative care drugs prescribed by general practitioners, nurses and pharmacists in England and dispensed in the community between April 2011 and April 2015 were extracted from the Prescribing Analysis Cost Tool system. The data were broken down by prescriber and basic descriptive analysis of prescription frequencies by opioid, non-opioids and total prescriptions by year were undertaken. To evaluate the yearly growth of non-medical prescribers, the total number of prescriptions was compared by year for each prescribing group. Non-medical prescribers issued prescriptions rose by 28% per year compared to 9% in those issued by medical prescribers. Despite this, the annual growth in non-medical prescribers prescriptions was less than 1% a year in relation to total community palliative care prescribing activity in England. Impact on medical prescribing is therefore minimal.

Background: The End of Life Care Strategy stated that there should be a reduction of expected deaths in the acute setting. In order to achieve this goal, when it has been identified that where the patient's preferred place of care is home, clinicians need to be able to recognise when a patient is dying in order to achieve their preferred place of death. The aims of this study were to identify any factors that help or hinder a clinician when they are determining when irreversible dying begins and to seek consensus on which of these topics would be useful to include in an education programme. Method: A 3 stage mixed methods study was developed. Phase 1was a Systematic Review of current primary research in order to provide an evidence base for the study. Phase 2 involved unstructured interviews with clinicians in the acute setting utilising the Grounded Theory approach to the analysis identify potential factors. Phase 3 was a Delphi study used to identify which of these factors would be useful in an education programme. Conclusions: The Systematic Review identified four themes "Patient Observation", "Knowledge of the Patient", "Communication" and "Attitudes of the Clinician". These were confirmed by the interviews and a further theme "Experience" identified. The over-arching theme emerging from the findings of the interviews was that clinicians have a fear of getting the timing of the recognition of irreversible dying wrong because the decision making process is so complex and this is exacerbated by fear of missing the treatable. Many factors identified in the interviews were acknowledged as factors that could be included in an education package. It was also identified that there is the need for a culture shift in society regarding death and dying and a change in the philosophy of care for health care professionals.

Palliativa vårdens ändamål är att öka livskvalitén och stödja både patienten och dennes familj genom ett obotligt sjukdomsförlopp. Palliativa vårdens målgrupp är inte enbart de med en cancerdiagnos utan alla med en obotlig sjukdom. Förförståelsen kring begreppet palliativ är stor och kan innebära en risk för sämre vård för patienten. Studiens syfte har varit att beskriva förförståelsen i palliativ vård utifrån sjuksköterskans perspektiv. Metoden i studien är en litteraturöversikt som utgår från Fribergs litteraturöversiktsmetod (2017, ss. 141–148). En kvantitativ och nio kvalitativa artiklar analyserades. Resultatet av litteraturöversikten lyfter fram tre huvudteman följt av tre underteman. Huvudtemat kunskapsproblem tar upp riskerna när sjuksköterskans påverkas av sin förförståelse i kommunikation, utbildning och strategier. Huvudtemat vårdkonsekvenser belyser hur fördomar och förförståelse utifrån definitioner, möten och hinder i vården kan skapas. Huvudtemat lidande tar upp det lidande som förförståelsen kan leda till utifrån sjuksköterskans självbild, sjuksköterskans/patientens delaktighet och skapandet av patientrelationer. Förförståelse leder till att patientrelationen påverkas och innebär ett ökat lidande för patienten. Sjuksköterskans förförståelse kan skapa vård som inte tillför något till patientens egentliga behov. Den palliativa vården innebär utmaningar för sjuksköterskan. I den palliativa vården har författarna identifierat brister i förförståelsen hos sjuksköterskor i framför allt hur kommunikation och information framförs till patienten. En kontinuerlig vård med självreflektioner utifrån evidensbaserade utbildningar är en grundförutsättning för en mer fördomsfri palliativ vård.

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