Knowledge and practices of the nursing team regarding palliative care provided to older adults
DOI:
https://doi.org/10.12957/reuerj.2024.85643Keywords:
Nursing, Palliative Care, Aged, Practice Patterns, Nurses’Abstract
Objective: to assess the knowledge and practices of the nursing team regarding palliative care provided to older adults. Method: qualitative study based on the Peaceful End of Life Theory, with 18 nurses and 28 nursing technicians. Data collection took place through semi-structured interviews between May and June 2024, in a public hospital in Fortaleza, Ceará, Brazil, with thematic-categorical content analysis. Results: the analysis resulted in three categories: 1) Emphasis on comfort and the physical dimension of care; 2) Integration of emotional, spiritual and social dimensions; 3) Eligibility criteria and ethical care. Final considerations: the participants understand palliative care as an integrated approach which involves physical, emotional, social and spiritual aspects, with an emphasis on effective communication and respect for autonomy. However, this understanding is restricted to the final phase of life, resulting in practices more focused on technical aspects of care.
References
Moura RBD, Araújo AA, Barbosa JM, Araújo R. Nutritional status and functionality in hospitalized in a University Hospital. Acta Port Nutr. 2020 [cited 2024 May 22]; 21:22-5. DOI: https://doi.org/10.21011/apn.2020.2105.
Stjernsward J. Palliative care: a global perspective. Eur J Palliat Care. 2019 [cited 2024 Sep 24]; 26(1):5-7. Available from: https://www.ejpc.eu.com.
World Health Organization. Palliative care. Geneva: WHO; 2020 [cited 2022 Mar 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care.
Radbruch L, Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, et al. Redefining palliative care - a new consensus-based definition. J Pain Symptom Manage. 2020 Oct [cited 2024 May 22]; 60(4):754-64. DOI: https://doi.org/10.1016/j.jpainsymman.2020.04.027.
Moran S, Bailey ME, Doody O. Role and contribution of the nurse in caring for patients with palliative care needs: a scoping review. PLoS One. 2024 [cited 2024 Oct 15]; 19(8):e0307188. DOI: https://doi.org/10.1371/journal.pone.0307188.
Altarawneh WM, Masa'deh R, Hamaideh SH, Saleh AM, Alhalaiqa F. Nurses' knowledge, attitudes and practices towards palliative care provided to patients diagnosed with cancer. PLoS One. 2023 [cited 2024 jul 3]; 18(10):e0289317. DOI: https://doi.org/10.1371/journal.pone.0289317.
Guo J, Dai Y, Chen Y, Liang Z, Hu Y, Xu X, Xiao Y. Core competencies among nurses engaged in palliative care: a scoping review. J Clin Nurs. 2024 [cited 2024 Oct 3]; 33(10):3905-22. DOI: https://doi.org/10.1111/jocn.17294.
Hökkä M, Martins Pereira S, Pölkki T, Kyngäs H, Hernández-Marrero P. Nursing competencies across different levels of palliative care provision: a systematic integrative review with thematic synthesis. Palliat Med. 2020 [cited 2024 may 17]; 34(7):851-70. DOI: https://doi.org/10.1177/0269216320918798.
Ruland CM, Moore SM. Theory construction based on standards of care: a proposed theory of the peaceful end of life. Nurs Outlook. 1998 [cited 2024 June 15]; 46:169-75. DOI: https://doi.org/10.1016/S0029-6554(98)90069-0.
Souza VRS, Marziale MHP, Silva GTR, Nascimento PL. Translation and validation into Brazilian Portuguese and assessment of the COREQ checklist. Acta Paul Enferm. 2021 [cited 2024 Oct 15]; 34:APE20212631. DOI: https://doi.org/10.37689/acta-ape/2021AO02631.
Camargo BV, Justo AM. Tutorial para uso do software Iramuteq (Interface de R pour les analyses multidimensionnelles de textes et de questionnaires) [Internet]. Santa Catarina: LACCOS UFSC; 2021 [citado 2024 May 30]. Available from: http://iramuteq.org/documentation/fichiers/tutorial%20iramuteq%20em%20portugues_22.11.2021.pdf.
Chaves JHB, Angelo Neto LM, Tavares VMC, Tuller LPS, Santos CT, Coelho JAPM. Palliative care: knowledge of cancer patients and their caregivers. Rev Bioét. 2021 [cited 2024 June 15]; 29(3):519–29. DOI: https://doi.org/10.1590/1983-80422021293488.
Rego F, Gonçalves F, Moutinho S, Castro L, Nunes R. The influence of spirituality on decision-making in palliative care outpatients: a cross-sectional study. BMC Palliat Care. 2020 [cited 2024 June 29]; 19:22. DOI: https://doi.org/10.1186/s12904-020-0525-3.
Jenkins L, Parry R, Faull C. A direct observation of pain scale use in five video-recorded palliative care consultations: Using conversation analysis to show how practitioners support patients to describe pain. Patient Educ Couns. 2022 [cited 2024 May 15]; 105(7):2603-6. DOI: https://doi.org/10.1016/j.pec.2021.10.027.
Willems AAJM, Kudrashou AF, Theunissen M, Hoeben A, Van den Beuken-Van Everdingen MHJ. Measuring pain in oncology outpatients: Numeric Rating Scale versus acceptable/nonacceptable pain. A prospective single center study. Pain Pract. 2021 [cited 2024 jul 1]; 21(8):871-6. DOI: https://doi.org/10.1111/papr.13053.
Castro A, Testoni I, Zamperini A, Ronconi L, Galantin LP, Caraceni A. The implicit soul: factors between the representation of death and dehumanization of patients. Health Psychol Open. 2019 [cited 2024 July 1]; 6(1):2055102919854666. DOI: https://doi.org/10.1177/2055102919854666.
Wachholz P, Giacomin K. Dignity in the care of older adults living in nursing homes and long-term care facilities. F1000Res. 2023 [cited 2024 May 15] 11:1208. DOI: https://doi.org/10.12688/f1000research.126144.3.
Oliveira SG, Pacheco STA, Nunes MDR, Caldas CP, Cunha AL, Peres PLP. Bioethical aspects of the health care provided to older adults at the end of their lives. Rev Enferm UERJ. 2020 [cited 2024 May 18]; 28:e47321. DOI: https://doi.org/10.12957/reuerj.2020.47321.
Delgado-Guay MO, Palma A, Duarte E, Grez M, Tupper L, Liu DD, Bruera E. Association between spirituality, religiosity, spiritual pain, symptom distress, and quality of life among Latin American patients with advanced cancer: a multicenter study. J Palliat Med. 2021 [cited 2024 July 1]; 24(11):1606-15. DOI: https://doi.org/10.1089/jpm.2020.0776.
Austin PD, Lee W, Keall R, Lovell MR. Efficacy of spiritual interventions in palliative care: An umbrella review of systematic reviews. Palliat Med. 2024 [cited 2024 Oct 31]; 2692163241287650. DOI: https://doi.org/10.1177/02692163241287650 1.
Mendes NS, Malaguti C, Dos Anjos Sena L, Lucchetti G, de Jesus LAS, Vitorino LM, Mesquita R, Lee AL, Oliveira CC. Spirituality and religiosity are associated with physical and psychological status in patients with chronic obstructive pulmonary disease. J Clin Nurs. 2022 [cited 2024 July 1]; 31(5-6):669-78. DOI: https://doi.org/10.1111/jocn.15926.
Gonçalves RG, Oliveira LPBA, Silva CJA, Elias TMN, Nogueira ILA, Menezes RMP. Palliative care in nursing training: Higher education course coordinators' perception. Rev Bras Enferm. 2023 [cited 2024 July 3]; 76(3):e20220222. DOI: https://doi.org/10.1590/0034-7167-2022-0222.
Dominguez RGS, Freire ASV, Lima CFM, Campos NAS. Palliative care: challenges for teaching in the perception of nursing and medical students. Rev Baian Enferm. 2021 [cited 2024 May 7]; 35:e38750. DOI: http://dx.doi.org/10.18471/rbe.v35.38750.
Batstone E, Bailey C, Hallett N. Spiritual care provision to end-of-life patients: a systematic literature review. J Clin Nurs. 2020 [cited 2024 May 15]; 29(19-20):3609-24. DOI: https://doi.org/10.1111/jocn.15411.
Santos FC, Macieira TGR, Yao Y, Hunter S, Madandola OO, Cho H, et al. Spiritual interventions delivered by nurses to address patients' needs in hospitals or long-term care facilities: a systematic review. J Palliat Med. 2022 [cited 2024 Apr 25]; 25(4):66277. DOI: https://doi.org/10.1089/jpm.2021.0578.
van Meurs J, Wichmann AB, van Mierlo P, van Dongen R, van de Geer J, Vissers K, et al. Identifying, exploring and integrating the spiritual dimension in proactive care planning: a mixed methods evaluation of a communication training intervention for multidisciplinary palliative care teams. Palliat Med. 2022 [cited 2024 May 15]; 36(10):1493-503. DOI: https://doi.org/10.1177/02692163221122367.
Freitas RA, Menezes TMO, Santos LB, Moura HCGB, Sales MG, Moreira FA. Spirituality and religiosity in the experience of suffering, guilt, and death of the elderly with cancer. Rev Bras Enferm. 2020 [cited 2024 July 3]; 73(Suppl 3):e20190034. DOI: https://doi.org/10.1590/0034-7167-2019-0034.
Mendes BV, Donato SCT, Silva TL, Penha RM, Jaman-Mewes P, Salvetti MG. Spiritual well-being, symptoms and functionality of patients under palliative care. Rev Bras Enferm. 2023 [cited 2024 July 3]; 76(2):e20220007. DOI: https://doi.org/10.1590/0034-7167-2022-0007.
Pun J, Chow JCH, Fok L, Cheung KM. Role of patients' family members in end-of-life communication: an integrative review. BMJ Open. 2023 [cited 2024 July 1]; 13(2):e067304. DOI: https://doi.org/10.1136/bmjopen-2022-067304.
Mroz EL, McDarby M, Kutner JS, Arnold RM, Bylund CL, Pollak KI. Empathic communication between clinicians, patients, and care partners in palliative care encounters. Patient Educ Couns. 2023 [cited 2024 May 15]; 114:107811. DOI: https://doi.org/10.1016/j.pec.2023.107811.
Cesar FCR, Oliveira LMAC, Galvão MC, Lacerda ALA. How do healthcare professionals develop the communication process to promote patients' health literacy? Int J Environ Res Public Health. 2024 [cited 2024 Oct 2]; 21(5):536. DOI: https://doi.org/10.3390/ijerph21050536.
Araujo MMT, Silva MJP. Communication with dying patients--perception of intensive care units nurses in Brazil. J Clin Nurs. 2024 [cited 2024 July 1]; 13(2):143-9. DOI: https://doi.org/10.1046/j.1365-2702.2003.00862.x.
Lima SF, Lamy ZC, Motta VBRD, Roma TM, Gomes CMRP, Souza TP. The dynamic of the supply of pediatric palliative care: a multiple case study. Cad Saude Publica. 2020 [cited 2024 Oct 02]; 36(9):e00164319. DOI: https://doi.org/10.1590/0102-311X00164319.
Saretta M, Doñate-Martínez A, Alhambra-Borrás T. Barriers and facilitators for an effective palliative care communication with older people: a systematic review. Patient Educ Couns. 2022 [cited 2024 Aug 17]; 105(8):2671-82. DOI: https://doi.org/10.1016/j.pec.2022.04.003.
Kerr D, Milnes S, Ammentorp J, McKie C, Dunning T, Ostaszkiewicz J, Wolderslund M, et al. Challenges for nurses when communicating with people who have life-limiting illness and their families: a focus group study. J Clin Nurs. 2020 [cited 2024 May 15]; 29(3-4):416-28. DOI: https://doi.org/10.1111/jocn.15099.
Ioshimoto T, Shitara DI, Prado GF, Pizzoni R, Sassi RH, Gois AFT. Education is an important factor in end-of-life care: results from a survey of Brazilian physicians' attitudes and knowledge in end-of-life medicine. BMC Med Educ. 2020 [cited 2024 July 2]; 20(1):339. DOI: https://doi.org/10.1186/s12909-020-02253-8.
Sarmento WM, Araújo PC, Silva BN, Silva CR, Dantas RC, Véres GC, et al. Academic education and professional qualification of nurses for practice in palliative care. Enferm Foco. 2021 [cited 2024 May 7]; 12(1):33-9. DOI: https://doi.org/10.21675/2357-707X.2021.V12.N1.3805.
Oliveira SG, Pacheco STA, Nunes MDR, Caldas CP, Cunha AL, Peres PLP. Bioethical aspects of the health care provided to older adults at the end of their lives. Rev Enferm UERJ. 2020 [cited 2024 May 22]; 28:e47321. DOI: https://doi.org/10.12957/reuerj.2020.47321
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Copyright (c) 2024 Ana Luiza Almeida de Lima, Hanna Gadelha Silva, José Lima de Sousa Junior, Gabriel de Jesus Aprígio, Manuela Bastos Alves, Lúcia de Fátima da Silva, Vera Lúcia Mendes de Paula Pessoa, Maria Célia de Freitas

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