Facilitators of Palliative Care in Neonatal Nursing - Literature review Example

Critique of the Literature Student’s Name Subject Professor University/Institution Location Date Klain, V., Gardner, G., & Yates, P., 2009, Neonatal Palliative Care Attitude Scale: Development of an Instrument to Measure the Barriers to and Facilitators of Palliative Care in Neonatal Nursing. Pediatrics, 123 (2) , 207-213. Introduction This paper presents a review and critique of the literature cited above on the subject of neonatal palliative care. The article focuses on understanding the nature factors that affect the provision of neonatal palliative care. In line with this, it firsts develops an attitude scale which is verified for validity and then used as the research instrument to tackle the study objectives. The study reports three factors which are organizational, resource availability and technological factors. The article seeks to contribute to growing literature and practice needs given that nurses have had a difficulty implementing the palliative care model. It cites that in spite of there being a model of care there are persistent issues in implementation whose effect has not be previously well addressed. It suggests several factors from other literatures after which it contextually defines barriers and facilitators. This review posits that the approach of the article would have been based on the nature and importance of neonatal palliative health care. This approach gives a stronger tenet for the evaluations of why it has been successful or not to offer care. This care has been cited in literature as being important. Ferrell & Coyle (2010) refer to this care as the care of the whole person with a goal of promoting life quality “across the illness trajectory through the relief of suffering” (pp.3). This whole person care is an interaction of the patient, the family and the nurse in the patient’s experiences. In the literature reviewed by the article, the cited factors pertinent to success of care reflect the aforementioned interaction. This approach is corroborated by the reference to antenatal palliative care as being a multidisciplinary collaborative teamwork that integrates the whole person over a continuum of care whose focus is bettering the patient’s whole person (Kumar et al. 2011). Whereas the article present the ‘whole-person care’ approach, it is not emphatic on the subject. This is reflected by the conclusion over the three aforementioned factors. This review posits that such an approach limits the scope of the study and does not adequately make reference to the whole-person of the new-born. The study makes use of a scale developed as an instrument. It describes the development of the Neonatal Palliative Care Attitude scale (NiPCAS) by an expert view. This instrument had 26 attitude items and was used over a sample of 1285 neonatal nurses. It was used to have the nurses give an appraisal of factors that affect their service provision. The focus on attitudes underlines the nature of interaction between the key components of the whole-person, the state-of-art technological and medical advancement, and the role of the nurse compassion and empathy reflected by the nature of communication in this interaction (Ferrell & Coyle 2010). McMillan & Shannon (2011) point to empathetic communication as being critical in high-quality care provision and demands that the nurse plays a pivotal role in enhancing the life of the whole person. With reference to enhancing the patient care outcomes, the essence of empathy is central to determining the satisfaction of service recipients. Attitudes are critical in enabling creation of a collaborative interaction, making informed judgments on the needs of the whole-person and facilitate positive health care outcomes (McMillan & Shannon 2011). Kumar et al (2011) focus on the role of training on the attitudes of care givers lays an emphasis on the centrality of the palliative care nurse as well as the attitudes. This implies that the appropriateness of nurse attitudes affects how such a nurse integrates the whole-person to medical care and technological advancement. Additionally, the nurse is best placed to appraise service delivery from the professional point of view. Therefore, the focus on the attitudes of nurses is justifiable. The results of the study are presented from a factor analysis of the NiPCAS items from which there were six factors. Out of the six, the authors use statistical mechanisms to differentiate between the loadings of various factors. They make use of methods such as the Kaiser-Meyer-Oklin statistic and its eigenvalue and the Catell’s Scree test (Klain et al. 2009). Out of this exercise, the items lead to three factors which the study marks and explores as being at the core of influencing the organization and outcome of neonatal palliative care. A reference to organizational factors makes inference on the factors within the institutional factors. The respondents made reference to their individual experiences in respective institutions on aspects such as support for care model by the staff, extent of parent involvement, extent of teams involvement in expressing values and morals and extent of agreement with treatment options for newborns who are critical. With regard to organizational facilitators for neonatal palliative care, the respondents showed average attitude on the question of health care team involvement, agreement to offering support for a dying infant as well as the social nature of the practice. Palliative care has been described as being different from other nursing care areas (Ferrell & Coyle 2010). This is inherently because of its social nature and the involvement of the family and the centrality of the relationships. The article in review reports this as having an average score. However the need for a social system is an emphasis made in other literatures with regard to the need of the family and those of the care giver during and after the care. The relationship of the nurse, the patient and individual is crucial (Ferrell & Coyle 2010; McMillan & Shannon 2011). This system is crucial for what the article indicates as being strongly supported: that institutions show strong support for the involvement of parents in making decisions on the dying infant and that they are well informed on the pallitative care options available. In other literature, the necessity of the social system has been related to the understanding the language of pain (Craig 2009). Pain is differentiated and codified through social interactions and language. Similarly, the pathways and sensory systems get differentiated biologically and become mature. However, the study’s report on average support for its social nature is not commensurate to the support for activities and structures such family involvement and counselling which in essence are founded on the social nature. The authors should have gone further and indicated the reasons for the non-commensurate support rate. A further reference to the organization factor makes note of resources. In this regard, the respondents agreed to likelihood of there being counselling service in case of a death in their unit, time off with their families and ample guildelines for the practice. However, the responses were not uniform indicating the likelihood of differences in palliative care experiences for the nurses. The results of this further indicate the centrality of the nurse in the effectiveness of the care and the need for institutions to provide maximum support to the nurses. In Ferrell & Coyle (2010), there are remarks on the formulation of teams in view of establishing a collaborative practice. This team is made up of a medical team, patient and family. Essentially, the nurse is at the core making and bringing the care plan to the bed. Additionally, there is a deep personal contact with the family and patient. Care givers are at a risk of stressful situations and guilt having given all their best and the infant dies. This is because of societal view of the deaths as being as a result of professional failure. At worse still, there are indications that many hospitals reflect the nature of the society it is in (Carter et al. 2011). As such, there is pressure from within and without. There are cited difficulties in offering support after the death. This necessitates support for the the nurse and this should be provided by well trained co-workers (Carter et al. 2011) in order to deal with their issues. From the results of the study, the authors report three barriers to effective palliative care practice: staff inadequacy, inadequacy of palliative care environment and technological imperatives (Klain et al. 2009). The reported barriers were more with reference to health care organization. The inadequacy of palliative care givers in Australia seems a global problem recorded in other areas. Ferrell & Coyle (2010) make note if the same with regard to inadequacy of the nurses as well as their training in the American health care system. This denotes the labor intensiveness of the care. Carter et al (2011) suggests the need for organizations to estimate the number of staff required in order to meet the health care need and provision gap. It is essential that there are appropriate staff-patient ratios in order to accommodate the nature of palliative health care. Secondly, the study reports barriers of lacking an optimal environment for effective palliative care with a majority of the respondents citing physical environment inadequacy. This was in reference to design of facilities, noise and lighting. While acknowledging this barrier, Carter et al (2011) indicate that adequacy of the physical environment has two importances: promoting effectiveness and demonstrating the attitude of an institution towards palliative care. The environment is vital for conducive discussions, family consideration and quality of the palliative experience for the both the patient and family. However, the article does not take lengths into the effects of the inadequacies of the environment. Additionally, it does not provide solutions to the barriers. However, it does make note of implications to policy makers especially with regard to environment. Such implications include having separate areas for various ages of patients as well as with regard to condition criticality. Finally, the study reports on the impact of technology in determining the effectiveness of palliative health care. Together with the demands of parents, technological imperatives are separated into the ‘clinician’ construct. Technological imperatives sorround the issue of values and morals with regard to the extent of the use of technology. In the survey, majority of the nurses sampled agreed to having used technology beyond what they appraised as comfortable. This has been refered to as the judicious use of technology (Klain et al 2009). According to Kain (2008) the concern is about the ethical expectations on the nurse especially in neonatal intensive care unit with regard to the extent of technological life support. The nurses are entangled in the need to respond to fast paced and highly technical environment (Kain 2008, 131) that is characterizing todays palliative environments. The challenge of technological judiciousness is heightened by the parents’ demand that life be prolonged, beyond what the nurse feels is professionally right. In the study reviewed 75.7% of all respondents reported finding themselves in this moral and ethical dilemma in the interaction of the nurse, technology, the patient’s needs and the demands of the parents. To this regard, Matzo & Sherman (2010) suggests that the participants of this social process, aforementioned, consider the following: existence of a reasonable survival chances, acceptability of life beyond survival, future medical implications of such technological intervention and the availabilty of resources. This will help this social process determine the balance between consequentialism and deontology. Consequentialism refers to deciding course of action with respect to outcomes whereas deontology is making decisions with regard to ethics and moral duty only. Given the nature of the results presented in the study and what other reviewed literatures have indicated,the impact of the survey on policy makers, in the opinion of this review, may not be impactful. The survey has only delineated barriers and facilitators. This is a relatively narrow scope and would have been more impactful on policy development and palliative care practice with addition of solutions to barriers and recommendations on how to enhance the facilitators. In conclusion, this paper has reviewed an article which uses NiPCAS to measure the facilitators and barriers in effective provision and outcomes of palliative care. The survey of 1285 neonatal nurses only delineates the barriers and facilitators, to the scope of the objectives. It purposed to contribute to policy implications and practice. However, the effectivess of the study to impact goes only to the extent of pointing out the parameters in planning and delivering palliative care and scores, but does not address recommendations and solutions. References Carter, B., Levetown, M., & Friebert, S, 2011, Palliative Care for Infants, Children, and Adolescents: A Practical Handbook (2nd Ed). Baltimore: John Hopkins University press . Craig, K, 2009, The Social communication model of pain. Canadian Psychology, 50 (1) , 22-32. Ferrell, B., & Coyle, N, 2010, Oxford Text of palliative nursing 3rd Ed. New York: Oxford . Kain, V, 2008, Developing Palliative care models in neonatal nursing: an investigation of barriers and parameters for practice. Queensland : Queensland University of Technology. Klain, V., Gardner, G., & Yates, P, 2009, Neonatal Palliative Care Attitude Scale: Development of an Instrument to Measure the Barriers to and Facilitators of Palliative Care in Neonatal Nursing. Pediatrics, 123 (2) , 207-213. Kumar, S., Jim, A., & Sisodia, V., 2011, Effects of Palliative Care Training Program on Knowledge, Attitudes, Beliefs and Experiences Among Student Physiotherapists: A Preliminary Quasi-experimental Study. Indian Journal of Palliative Care, 17 (1) , 45-53. Matzo, M., & Sherman, D., 2010, Palliative care nursing : quality care to the end of life. New York : Springer Publisher. McMillan, L., & Shannon, D., 2011, Psychometric Analysis of the JSPE Nursing Student Version R: Comparison of Senior BSN Students and Medical Students Attitudes toward Empathy in Patient Care. ISRN Nursing, 2011 , 1-7. Read More