'Close to' a palliative approach: nurses' and care aides' descriptions of caring for people with advancing chronic life-limiting conditions

J Clin Nurs. 2016 Aug;25(15-16):2189-99. doi: 10.1111/jocn.13256. Epub 2016 Jun 17.

Abstract

Aims and objectives: The purpose of the study was to examine nurses' and nursing assistants' perspectives of a palliative approach in a variety of nursing care settings that do not specialise in palliative care.

Background: Ageing populations worldwide are drawing increasing attention to palliative care. In particular, people with advancing chronic life-limiting conditions often have unmet needs and may die in acute medical, residential care and home health settings without access to palliative care. A palliative approach offers an upstream orientation to adopt palliative care principles to meet the needs of people with life-limiting chronic conditions, adapt palliative care knowledge to other chronic illness conditions, and integrate and contextualise this knowledge within the healthcare system (Sawatzky et al. 2016).

Design: A qualitative study using the method of interpretive description carried out by a nursing research-practice collaborative, Initiative for a Palliative Approach: Evidence and Leadership (iPANEL).

Methods: Twenty-five nurses and five nursing assistants from across British Columbia, Canada participated in interviews and focus groups. Thematic analysis was used to analyse the data.

Results: The overarching theme was that of participants close to a palliative approach in that they cared for people who would benefit from a palliative approach, they were committed to providing better end-of-life care, and they understood palliative approach as an extension of specialised palliative care services. Participants varied in their self-reported capacity to integrate a palliative approach, as they were influenced by role clarity, interprofessional collaboration and knowledge.

Conclusions: Integration of a palliative approach requires a conceptual shift and can be enhanced through interpersonal relationships and communication, role clarification and education.

Relevance to clinical practice: Nurses care for people with advancing chronic life-limiting conditions in a variety of settings who would benefit from a palliative approach.

Keywords: advance care planning; chronic conditions; chronic illness; dying; end-of-life care; nursing; nursing assistant; palliative approach; palliative care; qualitative research.

MeSH terms

  • Adult
  • Aged
  • Canada
  • Communication
  • Empathy*
  • Female
  • Focus Groups
  • Humans
  • Leadership
  • Male
  • Middle Aged
  • Nurse's Role*
  • Nursing Assistants
  • Nursing Staff
  • Palliative Care*
  • Qualitative Research
  • Terminal Care*