The Nurses in Palliative Care - Dissertation Example

?Theme 2 – Challenges in Palliative Care Three primary research studies will be reviewed here for the relevance to the issue related to the challenges face by nurses in palliative care. Nurses here deals with various challenges in a regular basis. Among them is research by (Brajtman, Higuchi, McPherson, 2006) detailing about the issues of the nurses experiencing in caring for patients in palliative care. This type of research is ongoing. White, et al (2004) describes that impact of unrelieved patients on nurses is quite depressive. So support mechanism is very much important. So to deal with such challenges adequate training and education, peer supports are required. (Harris, Flowers, Noble, 2011) In a qualitative study by (Brajtman, Higuchi, McPherson, 2006) they looked into the matter related to the challenges the nurses face in palliative care, to explore their experiences in caring for patients with terminal delirium and their families. This qualitative research will emphasize the importance of qualitative interviews as most powerful method for understanding the experiences and meanings related to the topic. This study was conducted in a palliative care unit located in a large Canadian city hospital for 5 nurses working in an interdisciplinary palliative care unit and 4 nurses form palliative home care nursing team located in the same city. Few interview questions have been generated for the nurses to proceed with the qualitative study. Based on the questions results which has been found are like most of the participants said that they experience distress while caring for palliative care patients. They said that if they gather convenient skills and knowledge in the identification and diagnosis they can help to support the patient in better way and family during disturbed conditions. Understanding the unique nursing experience is very much important in the process of providing the nurses with required support to make them strong and help them to provide care in challenging situations. Nurses also identified their team members as most major source of support. They also mentioned that effective teamwork would help them to deal with palliative care patients and their families more efficiently. There is need for proper education and training for the nurses to face challenges with palliative care patients. Lack of education may experience in serious stress for these nurses in care of the dying people and their families. It is important to check that nurses should receive appropriate knowledge, skills and support to care for this patient (Brajtman, Higuchi, McPherson, 2006, pp.6-7). Thus from this study we can understand that proper opportunities should be provided to the nurses so that they can face challenges confidently. The support of organization, teammates and family will enhance the quality of care. The number of sample chosen here is very small. A primary research should contain minimum 20 samples to carry on with a proper research. But here amount is very small which is not very good to conduct a research. A larger sample would have been beneficial to obtain greater depth of data as there was no clear evidence to overcome the challenges. White, et al (2004) found similar trends in his study. He explored with qualitative descriptive study using semi structured interviews with nurses caring for palliative care patients. Here 9 experienced palliative care nurses were interviewed. The participants here explained about their experience and challenges they face regularly. The nurses reported that they have enormous impact on their work and personal lives. The nurses here describe about two types of sufferings, physical and emotional or psychological. Most of the nurses reported here that they try their best to relieve a patients suffering and when they cannot help the patient with such condition they get a feeling of helplessness, distress, frustration and a sense of failure. Some of the nurses also mentioned that they did not want to dwell with those things and thus tried to go back home with a fresh mind. They said they took it as their profession and so did not drag it long. In this study also the sample chosen is very small. And another needs to notice here that they have not cross checked with other hospitals. Under this circumstance it is difficult to justify that all the collected information is worth or not. To generate a validate result it is necessary at least to cross verify with some more nurses working there or in any other palliative care units in other hospitals. Next to the above a similar study by (Harris, Flowers, Noble, 2011) indicates that in most cases a significant amount of work has explored stress to in nurses in the palliative care. Among the 11 participants in this here all of them with an average of 24 years of nursing experience reported that they still remember the distressing incidents they faced during their nursing career in palliative care. Some of them explained that the conditions of the patients which they dealt with were very traumatic afterwards. So coping with this situation education and professional training is highly essential. Here the study dealt with experience nurse. Though the sample amount is small but they are experienced for many years in this unit. In such condition the research can be considered effective and measures can be taken into consideration. Overall, these studies follow a similar trend and pattern where the attempt was to combine a personal understanding through structures interview process with proper questionnaires. The study explored that to deal with the challenges which the nurses face in palliative care they need proper support and interventions. Nurses need effective education and training programs to develop their ability and confidence to deal with palliative care patients and their families. Here it is need to mention that nurses need both social and moral support to overcome their stressful working environment. But one more thing which is clear from the study that despite of all these challenges nurses face they never give up their careers. They try their best to help the patients and their families. Many positive factors can be drawn from related to the strength and positivity of the nurses. The peer group and family support thus becomes very important. So it is need to suggest here that to support the mental and physical health of the nurse the organizations should take proper care and develop a healthy and positive atmosphere. Having considered the above studies we now move on to the next theme that is Trust in Palliative Care. Theme 3- Trust in Palliative Care In Palliative Care trust plays a vital role for the nurses to deal with the patients and their families. Three primary research studies will be reviewed here consecutively to understand the need of trust in palliative care unit. Research conducted by Barnard, Hollingum and Hartfiel, (2006) enhance about the issues related to this. The care which is required for palliative care patients needs qualities and skills of the nurses that is not only task oriented but should have arise out of compassion, reciprocity, their professional commitments and ability to communicate with patients and their family. It is found that time also has contextual factor in palliative caring practices which contributes to understand the connections between time and quality of palliative care (Dalgaard and Delmar, 2008). If people got affected with life threatening illness, modern technology which is available can help to support their lives. If the chance of curing the disease decreases, then the treatment focuses on maximizing the quality of life in palliative care. To support this condition trust and faith in the care unit needs more importance. To build up this confidence nurses and the health professionals dealing with palliative care patients need proper support and education as well (Huijer, Abboud and Dimassi, 2009, p.346). Barnard, Hollingum, Hartfiel, (2006) conducted a qualitative research with a group of Australian nurses about their experience being a palliative care nurse. They have taken 15 nurses caring for patients in a palliative care unit in Australian region. They have been interviewed and data has been analyzed to understand their experiences. Based on the conducted qualitative research the result which has been obtained is that in most of the cases nurses works in cure oriented health care system. Their role is mainly to coordinate the patient’s care and reporting the doctors about their patients. It has been found that they create a nurse-patient dependency system according to the task performed by the nurses in their daily work. So the studies have been found that palliative care nursing is different practice than other nursing which depends on the attributes of the nurses who take care of the patients. It has been also noticed that palliative care patients with life time illness are less interested bout performance of task whereas they have more desire building close relationship. Patients often create a bonding with nurses where they want to share about their fear, hopes and expectations with them and also expect for physical and emotional demands. To avoid these conditions some nurses maintain a certain distance with the patients and just concentrate on their task and patient’s symptoms. From this study now it can be understood that trust associated with nurse in palliative care unit is very much important. It shows that nursing care along with building meaningful relationship is equally demanding in palliative care unit. It has to be understood that as the nurses provide immense care to the patients, they also need dependence on colleagues for emotional support during difficult times in their works. Thus trust is supposed to be a mutual demand among the palliative care unit. Here the amount of sample chosen was moderate. So based on that, the result which has been obtained is significant but it would have been far better if few more samples were chosen. So in this case it is difficult to justify whether the study ends with a specific conclusion or not. Similarly Dalgaard and Delmar (2008) also found certain concept about trust in palliative care in their study. The study contributes regarding understanding of connections between time and quality of palliative care practices. The two scenarios here represents in which clock time dominates over nurses personal time. This is a condition for which patient and nurse both get affected some other way. Patient gets affected as they do not get sufficient professional quality care. Nurses on the other way get strength for renewed action. In the other condition where clock time and personal time comes together, allows the nurses to concentrate on quality of palliative care practices. Then the outcome will be in a continuous positive way which will develop high level of professionalism for caring process. Barnard, Hollingum and Hartfiel, (2006) argued that there must be a role for counselors and relaxation therapies to assist staff when they feel depressed by the situations or emotionally feeling down. Here over 3 months’ field studies were carried out in several private homes and hospital ward. They observed the participant thoroughly and surveyed with both formal and informal interviews. Though the research took longer period of time but it was thoroughly progressive and result obtained was quite impressive. So the study reflects on the scenario that lack of clock time in palliative care units may effect on quality of the care. This leads to poor opportunities for professional reflection and development. So it should be keep in mind that if the clock time and personal time exist simultaneously, nurse professional ability will increase and thus it will help to build trust among the patients. Next, in order to keep connect with this study another similar research has been done by Huijer, Abboud and Dimassi (2009). They indentified about the knowledge, attitude and practices of palliative care nurses in Lebanon. The result which has been obtained through the qualitative study here indicates that non clinical nurses are more efficient and have better knowledge on the results of palliative care than any other specialists. Here 1873 nurses from 15 different hospitals were taken as sample. The finding here shows that palliative care education is very much important in Lebanon. The nurses here try to concentrate to contribute on “death without pain and suffering”. This can be attributed with increase in clinical practices on pain management in palliative care. The end of lie care thus is a very critical part to deal with. The communication techniques and palliative care knowledge interprets the educational outcomes of the nurses. So communicating with patient and their family regarding the treatment of the patient is very important part which nurses have to deal with everyday. Here cross sectional descriptive survey was conducted using self administrative questionnaire. This is a very good size of sample and as the result obtained in a cross sectional survey, it is quite effective and obvious to follow with it. From the above explained three researches it could be identified that nurses plays versatile role in their profession. They give support to the patients and their family in difficult times and thus build a mutual understanding among them. It is important to develop structured educational programs for the training of nurses in palliative care services. Proper education will help them to gather knowledge and possess skills and techniques which will help them to develop strength and handle the situation in a more mature and professional way keeping in mind the trust and care provided to the patients. References Brajtman, S. Higuchi, K. McPherson, C. (2006) Caring for patients with terminal delirium: palliative care unit and home care nurses’ experiences. International Journal of Palliative Nursing, Vol 12, No 4, 150-56 Barnard, A. Hollingum, C. Hartfiel, B. (2006) Going on a journey: understanding palliative care nursing. International Journal of Palliative Nursing, Vol 12, No 1, 6-12 Dalgaard, M. K. and Delmar, C. (2008) The relevance of time in palliative care nursing practice. International Journal of Palliative Nursing, Vol 14, No 10, 472-76 Harris, D.G. Flowers, S. Noble, S. IR. (2011) Nurses’ views of the coping and support mechanisms experienced in managing terminal haemorrhage, International Journal of Palliative Nursing, Vol 17, No 1, 7-13 Huijer H. A. S. Abboud, S. Dimassi, H. (2009) Palliative care in Lebanon: Knowledge, attitudes and practices of nurses. International Journal of Palliative Nursing, Vol 15, No 7, 346-53 White, et al (2004) The Impact of unrelieved patient suffering on palliative care nurses. International Journal of Palliative Nursing, Vol 10, No 9, 438-443 Read More