Issues in Palliative Care Nursing - Research Proposal Example

? Issues in Palliative Care Nursing al Affiliation Research Proposal/Literature Review/Research Design Issues in Palliative Care Nursing Research Problem Description of the Problem Palliative care or caring for the dying is a stressful work especially if the caregivers have poor communication skills and cannot solve ethical dilemmas. Thus, issues can arise if the mentioned elements are not given in the proper way. Communication skills and ethical dilemmas have become major issues in palliative care nursing. For instance, conveying bad news has been the mandate of the physician but the increasing number of patients in palliative care has made it mandatory for the nurses to convey this news. However, majority of the nurses have insufficient training in communication skills, and, thus, conveying bad news has been a great issue in palliative care nursing. Research has indicated that poor communication skills may make the nurse frustrated or cause burnout. At other times, the nurses may be faced with an ethical dilemma such as euthanasia, and fail to come up with a proper decision. This is because most of them know nothing about moral sensitivity. A nurse who lacks moral sensitivity cannot use moral components or elements such as honesty and fidelity to make a proper ethical decision about a particular situation. Just like poor communication skills, inability to deal with an ethical dilemma can cause burnout and/or make the nurse frustrated. Thus, both ethical dilemmas and communication skills are key issues that can affect the quality of palliative care offered by the nurse. How the Problem Was Identified Palliative care is given to patients who are in the process of dying. These patients usually suffer from terminal diseases (diseases that have no cure or treatment). Dealing with these patients and their families is a big problem for the nurses especially if they have poor communication skills and cannot solve an ethical dilemma. Research has shown the quality of the patient and the nurse relationship has a direct impact on the quality of the care given. Thus, if these issues hamper the relationship, the quality of the care given will be very low. The patients require a holistic support from their families and the nurses. Therefore, it becomes an issue if the nurse cannot offer holistic support to the patients. Research has indicated that communications skills and ethical dilemmas are issues in palliative care nursing. Brief Overview of Why It Is a Problem in Nursing As stated before, the quality of the patient and the nurse relationship has a direct effect on the quality of care provided. If the relationship is compromised by poor communication skills and inability to deal with ethical dilemmas, then, the quality of the care given will be low based on the severity of the compromise. Good communication skills and the ability to deal with ethical dilemmas are important because the opposite may adversely affect the holistic well-being of the patient and their families. Nurses are also affected in that they can get frustrated when they are unable to communicate well and deal with ethical dilemmas. Burnout can also occur if the nurse is unable to deal with these issues. Literature Review The purpose of palliative care is to enhance the quality of life and being supportive through the management and control of the patient’s symptoms to attain the best quality of life for the patients and their families. In such a case, death should not be hastened or postponed (Hughes, Bakos, O’Mara, and Kovner, 2005). The quality of the nurse and client relationship has a direct impact on the quality of care offered, and thus, important for effective nursing practice (McWilliam, Oudshoorn, and Ward-Griffin, 2007). Communication skills are significant in effective or successful delivery of palliative care. Much emphasis has been put on physician communication and this has brought a number of issues. Less emphasis has been put on communication as an important skill for the nurses. It is important to note that communication in the nursing practice is not simple but rather a sophisticated endeavor. Like other professional nursing skills, communication needs intense practice and education. The necessity for expert communication is common in nursing care; however, it takes special significance during intense periods such as end-of-life care and serious illness (Malloy, Virani, Kelly, and Munevar, 2010). A significant portion of communication literature in palliative care is linked to physician-patient communication, with the majority of the literature associated with the breaking of bad news. Nurses are always present in most of the clinical settings, and they spend critical time with families and patients attending to their emotional reactions and assisting them to interpret bad news. The chances for nurses to positively impact patient care through successful communication reflect the stages of serious illness. Majority of the families/nurses have concerns and fears about the process of dying and death. Patients fear unrelieved symptoms, abandonment, and being in pain. At the early periods of bad diagnosis, nurses actively take part in offering information, thoroughly explaining medical information, and listening to responses given by the family and the patient as they assess treatment options (Malloy et al., 2010). In active treatments like chemotherapy, nurses are crucial in listening to the patient’s symptoms and concerns, and training the patient to share these concerns. In late-stage or recurrent disease or for individuals approaching end of life, communication of decisions of paramount importance is essential. A number of authors have indicated that nurses need to learn communication skills in such situations, and that the addition of this content in formal curriculum is significant. Other authors have addressed special issues concerning communication with family members. Giving precise information so that the persons can make informed choices is critical. Studies have indicated that there are variations in communication necessities between the patients and the family members (Malloy et al., 2010). The patients’ communication needs entail the need for help in relief of symptoms and pain, the chance to reveal their feelings, need for information, maintenance of a sense of control, and the necessity for recognizing that their lives have meaning and purpose. Family members’ communication needs entail permission to speak, need for information, and the need to be heard as they face the waning and death of the people they love (Malloy et al., 2010). In some cases, language barrier can affect the quality of communication. Language barrier is a well-known issue in the difficulty accessing and using health care. Language barrier makes it hard for meaningful and deep communication in hospice and palliative care. Patients get frustrated as they try to, and then give up on, expressing (communicating) needs that are beyond their basic needs. In some cases, even the basic needs are difficult to communicate (Kemp, 2005). Thus, this becomes an issue for a nurse in hospice or palliative care settings. It can be very hard for a nurse to balance all the virtues of a palliative care nurse such as beneficence, fidelity, and honesty. When a nurse is faced with this situation, he or she cannot recognize what to do, thus, he is left in an ethical dilemma. Ethical dilemmas usually occur when a conflict exists between the values/virtues or rights of the individuals. A sign that the nurse is faced with an ethical dilemma is the language utilized to define the situation. Ethical dilemmas are generally defined in terms of good or bad, rights or responsibilities, duty or obligation, and right or wrong. The ability to recognize and focus on the moral issue in a certain situation is called moral sensitivity. A morally sensitive nurse can recognize moral components in a hard situation and realize that he had a purpose in the outcome (Perrin, Sheehan, Potter, and Kazanowski, 2011). Nurses usually have problems focusing on moral issues and recognizing ethical dilemmas. At times, they are unable to note the ethical components of a particular situation, and continue based on their usual mode of behavior. In other cases, they can misrepresent the issue as a legal, constitutional or a communication one, and never determine ethical element. In the past, it was usual for the nurses (and other healthcare providers) to describe only the main life-threatening circumstances, like euthanasia, as ethical and not recognizing ethical components of other everyday challenges (Perrin et al., 2011). It is now very clear that the failure to recognize and react to the ethical components of any situation may be linked to an increase in a nurse’s burnout and frustrations. For instance, moral distress has been linked to burnout in nursing. Moral distress is a common phenomenon in palliative care especially in cases where the care team does not communicate with one another. At other times, the nurse can be faced with ethical dilemmas in tragic circumstances. In such a case, the nurse can do nothing to improve the situation. Thus, a good solution or choice can lack. The sadness of the circumstances can make the nurse wish that could have been done, but in reality, there were no other alternatives for treatment (Perrin et al., 2011). The ethical dilemma may make the lower the performance of the nurse, thus, leading to frustrations and burnout. Communication and ethical dilemmas are among the major issues in palliative care nursing. Research Design The research design to be used is descriptive research method (in particular qualitative descriptive methodology). Descriptive research entails collection and analysis of data to characterize a phenomenon, concept, or a group (Fitzpatrick & Kazer, 2011). In this case, data will be collected and analyzed to characterize the phenomenon of issues in palliative care nursing. The main qualitative descriptive methodology to be used in this study includes personal interviews or questionnaires. Survey is important in the collection of data directly from the respondents concerning their perceptions, attitudes, opinions, or characteristics. The collection of data in surveys is usually facilitated by questionnaires or personal interviews. Personal interviews or questionnaires will be used to gather information about a particular population. This research design will be able to answer questions concerning issues in palliative care nursing. The significance of asking questions is to know what is happening in the minds of the respondents, that is, their motives, past events, feelings, perceptions, and attitudes (Houser, 2011). In this case, it will be important to focus on the feelings or the perceptions of the respondents regarding issues in palliative care nursing. Selection of an Appropriate Sample The size of the sample will be 200 respondents: 150 nurses in palliative care and 50 patients undergoing palliative care. It is important to note that some of the patients may not be able to fully take part in the research. Thus, in cases where the patient is not fit in participating in the research, the family or close relative will represent the patient. This is crucial because responses will be obtained from other people apart from the nurses and the patients. The sample will be selected randomly within the health care setting. It is important that the selection of the respondents be done randomly since it will reduce errors related to bias. Planning and Developing Instrumentation After selecting the appropriate sample, the researcher will plan and develop the instrument to be used in the collection of data. In this case, two instruments will be used and they are personal interviews and questionnaires. In personal interviews, open-ended questions will be used. This is because much data is required about the issues in palliative care nursing. Apart from collecting enough and diverse data, the respondent will not be restricted in answering the questions. Thus, he or she will be free to give what he perceives, or feels about the issues in palliative care nursing. The questions will be structured in a manner that will not restrict the respondents in answering the questions. Personal interviews will be mostly used in patients under palliative care. In questionnaires, open-ended questions will also be used. The questionnaires will be used to gather information from the nurses since most of them may not have the time to participate in personal interviews. The questionnaires will be distributed to the nurses and collected after three days. This will make sure that they offer enough information about the issues they face in palliative care. Thus, in both cases (personal interviews and questionnaires), questions will be structured in a way that they offer information about the issues nurses face in palliative care. Emphasis will be on communication issues and ethical dilemmas. Data Collection As stated before, the data will be collected using personal interviews and questionnaires. Personal interviews will be used to collect data from the patients or family members of the patient. In this case, the patients or the family members will be asked questions (open-ended questions) prepared by the researcher prior to data collection. On the other hand, questionnaires will be used to collect data from the nurses. The questionnaires will be posted to their various working stations and collected after three days. Data Analysis SPSS (Statistical Package for the Social Sciences) will be used to analyze the data. In this case, descriptive statistics will be obtained. It is worth noting that different approaches will be taken in both personal interviews and questionnaires. In personal interviews, the notes taken have to be analyzed at the end of each day of interviewing. This is referred to as Daily Interpretive Analysis. This has to be done on a daily basis because the integrity of the data is threatened by the passage of time. All the data collected will have to be analyzed and compiled for the final data analysis at the end of the research. In questionnaires, each question can be coded using SPPS software and analyzed at the end of the research. Thus, ambiguity will be low and the integrity of the data will not be threatened. References Fitzpatrick, J. J., & Kazer, M. W. (2011). Encyclopedia of nursing research. New York, NY: Springer Publishing Company. Houser, J. (2011). Nursing research: Reading, using, and creating evidence. Sudbury, MA: Jones & Bartlett Learning. Hughes, R. G., Bakos, A. D., O’Mara, A., Kovner, C. T. (2005). Palliative wound care at the end of life. Home Health Care Management & Practice, 17(3), 196-202. Kemp, C. (2005). Cultural issues in palliative care. Seminars in Oncology Nursing, 21(1), 44-52. Malloy, P., Virani, R., Kelly, K., & Munvar, C. (2010). Beyond bad news: Communication skills of nurses in palliative care. Journal of Hospice and Palliative Nursing, 12(3), 166-174. McWilliam, C., Oudshoorn, A., & Ward-Griffin, C. (2007). Client-nurse relationships in home-based palliative care: A critical analysis of power relations. Journal of Clinical Nursing, 16, 1435-1443. Perrin, K. O., Sheehan, C. A., Potter, M. L., & Kazanowski, M. K. (2011). Palliative care nursing: Caring for suffering patients. Sudbury, MA: Jones & Bartlett Publishers. Read More