Melissa Bloomer

Australians living with and managing hepatitis C

Publisher: Informa UK Limited

Date: 07-2010

DOI: 10.3109/01612841003629532

Abstract: This paper discusses the psychosocial impact of being diagnosed with hepatitis C virus (HCV). The paper clarifies some of the key misconceptions about the virus, especially the impact HCV has on people who have been recently diagnosed. An in idual's reaction to the HCV diagnosis and the subsequent lifestyle challenges to maintain health, well-being, family, and social networks are discussed, particularly the issues surrounding mental health in respect to a recent chronic illness diagnosis and how to manage the trajectory of the illness in the community and in idually. HCV disclosure and its effect on intimacy are also detailed. For people living with both a diagnosed mental illness and HCV, managing the illness can be complicated. Not only are these in iduals concerned about their mental illness, its treatment, and the social stigma and discrimination associated with it, they also may be alarmed over their future physical health. The paper is preliminary to research using the psychotherapeutic approach of Cognitive Behavioural Therapy (CBT) in groups of persons with a dual diagnosis of mental illness and HCV.

Extending boundaries: Clinical communication with culturally and linguistically diverse mental health clients and carers

Publisher: Wiley

Date: 07-2010

DOI: 10.1111/J.1447-0349.2010.00667.X

Abstract: We are often confronted with the dilemmas of interacting with people from different cultural backgrounds. How do we ensure that we meet their needs, if they have some barriers to communicating those needs? This project explores the communication mechanisms used by mental health clinicians, to explore how they modify their communication to reconcile cultural differences and promote self-disclosure. It also identifies the practical experiences that have enlightened clinicians' practice when interacting with culturally and linguistically erse (CALD) groups. Through focus groups, mental health clinicians were probed about their experiences with CALD groups and the methods used to facilitate communication. Clinicians were working in either acute adult inpatient or community settings in a large metropolitan health service. Fifty-three clinicians formed 7 focus groups. In the focus groups, clinicians were asked about their perceptions of communication with CALD clients. Guided questions were used. All focus groups were audio-taped and transcribed. Two distinct themes emerged. They were 'respect' and 'cultural understanding'. The clinicians recognized that showing and maintaining respect for the CALD client, and their families significantly impacted on the development of a therapeutic relationship. Showing cultural understanding and acceptance for difference also enhanced communication.

End-of-life care in a rehabilitation centre for older people in Australia

Publisher: Wiley

Date: 31-01-2013

DOI: 10.1111/J.1741-6612.2012.00654.X

Abstract: To investigate processes at the end of life for patients who died in a subacute evaluation and management facility for older people. A retrospective chart audit for patients (n = 55) who died in the previous 2 years was undertaken, recording a number of significant variables. Despite diagnosis of comorbid medical conditions, most participants were admitted for improved functioning or assessment for alternative accommodation. Consistent with this focus, the key contact person was most often an allied health team member. Not For Resuscitation order and/or power of attorney documents on admission were uncommon (<30%) as were referrals to palliative care specialist staff (13%), although an end-of-life discussion was recorded (90%) and often included as a new goal of care (71%). Factors likely to improve end-of-life care include advance care planning, earlier recognition of short prognosis and staff education.

A national Position Statement on adult end-of-life care in critical care

Publisher: Elsevier BV

Date: 07-2022

DOI: 10.1016/J.AUCC.2021.06.006

Abstract: Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.

World Federation of Critical Care Nurses 2019 Position Statement: Provision of a Critical Care Nursing Workforce

Publisher: Springer Publishing Company

Date: 03-2019

DOI: 10.1891/1748-6254.13.1.3

Abstract: Due to changes in critical care worldwide, the World Federation of Critical Care Nurses Board of Directors commissioned a review of its 2005 Declaration of Buenos Aires: Position Statement on the Provision of a Critical Care Nursing Workforce. To provide international recommendations to inform and assist critical care nursing associations, health services, governments, and other interested stakeholders in the development and provision of an appropriate critical care nursing workforce. An international review group was established, comprised of critical care nurse clinicians, leaders, and researchers. A literature search was undertaken, which informed the revision of the 2005 Declaration, which is contained in the 2019 Position Statement. The position is supported by six central principles, and is comprised of eight key statements: A critical care unit should have a dedicated nurse leader Each shift should have at least one registered nurse (RN) designated as the team leader The majority of RNs providing patient care should hold a recognized post-registration qualification or certification in critical care Critical care RN staffing should be assessed on a shift-by-shift basis according to patient acuity, the staffing profile, and unit need An additional critical care RN, not counted in RN-to-patient ratios or allocated a patient load, may provide additional hands-on assistance in patient care, and coordinate other patient-related activities Support staff (such as nursing and allied health assistants, nursing aides, and care assistants) should work only under the direct supervision of a critical care RN, and never in place of a critical care RN Where institutionally supported, and in accordance with local legislation, a critical care RN may provide expert critical care consultancy A critical care unit should be staffed to provide at least one senior nurse, who holds a recognized post-registration critical care qualification or certification, and ideally further qualifications in education.

Facilitating family needs and support at the end of life in hospital: A descriptive study

Publisher: SAGE Publications

Date: 30-12-2021

DOI: 10.1177/02692163211066431

Abstract: Caring for family members of dying patients is a vital component of end-of-life care, yet family members’ needs at the end of life may be unmet. To explore hospital clinician assessment and facilitation of family needs and practices to support families at the end of life. Descriptive study utilising a retrospective medical record audit. Undertaken in a large public hospital, the s le included 200 deceased patients from four specialities general medicine ( n = 50), intensive care ( n = 50), inpatient palliative care ( n = 50) and aged rehabilitation ( n = 50). Data were analysed according to age under 65-years and 65-years or over. Deceased patients’ mean age was 75-years, 60% were Christian and Next-of-Kin were documented in 96% of cases. 79% spoke English, yet interpreters were used in only 6% of cases. Formal family meetings were held in 64% of cases. An assessment of family needs was undertaken in 52% of cases, and more likely for those under 65-years ( p = 0.027). Cultural/religious practices were supported/facilitated in only 6% of all cases. Specialist palliative care involvement was more likely for those aged 65-years or over ( p = 0.040) and social work involvement more likely for those under 65-years ( p = 0.002). Pastoral care and bereavement support was low across the whole s le. Prioritising family needs should be core to end-of-life care. Anticipation of death should trigger routine referral to support personnel/services to ensure practice is guided by family needs. More research is needed to evaluate how family needs assessment can inform end-of-life care, supported by policy.

Nursing care of the family before and after a death in the ICU--an exploratory pilot study

Publisher: Elsevier BV

Date: 02-2013

DOI: 10.1016/J.AUCC.2012.01.001

Abstract: This qualitative descriptive study was undertaken in two metropolitan ICUs utilising focus groups to describe the ways in which ICU nurses care for the families of dying patients during and after the death. Participants shared their perspectives on how they care for families, their concerns about care, and detailed the strategies they use to provide timely and person-centred family care. Participants identified that their ICU training was inadequate in equipping them to address the complex care needs of families leading up to and following patient deaths, and they relied on peer mentoring and role-modelling to improve their care. Organisational constraints, practices and pressures impacting on the nurse made 'ideal' family care difficult. They also identified that a lack of access to pastoral care and social work after hours contributed to their concerns about family care. Participants reported that they valued the time nurses spent with families, and the importance of ensuring families spent time with the patient, before and after death.

Inequities of palliative care availability and access to opioids in low- and middle-income countries

Publisher: SAGE Publications

Date: 26-07-2021

DOI: 10.1177/02692163211034083

‘It’s not what they were expecting’: A systematic review and narrative synthesis of the role and experience of the hospital palliative care volunteer

Publisher: SAGE Publications

Date: 17-02-2020

DOI: 10.1177/0269216319899025

Abstract: Volunteers make a major contribution to palliative care but little is known specifically about hospital palliative care volunteers. The aim of this study was to understand the role and experience of hospital palliative care volunteers. Systematic review and narrative synthesis. CINAHL, Embase, Medline, PsycINFO, PubMed and three dissertation databases were searched from inception to June 2019. A forward and backward search of included papers in key journals was also undertaken. Records were independently assessed against inclusion criteria by authors. Included papers were assessed for quality, but none were excluded. In total, 14 papers were included. Hospital palliative care volunteers were mostly female, aged above 40 years, and training varied considerably. Volunteers faced unique challenges in supporting dying patients due to the nature of hospital care, rapid patient turnover and the once-off nature of support. Volunteer roles were erse, with some providing hands-on care, but most focused on ‘being with’ the dying patient. Volunteers were appreciated for providing psychosocial support, seen as complementary to, rather than replacing the work of health professionals. Given volunteers were often required to work across multiple wards, establishing positive work relationships with health professionals was challenging. Divergent views about whether the volunteer was part of or external to the team impacted volunteers’ experience and perceptions of the value of their contribution. Hospital palliative care volunteers face unique challenges in supporting terminally ill patients. Volunteer support in hospital settings is possible and appropriate, if sufficient support is available to mitigate the challenges associated with complex, high-acuity care.

Australian College of Critical Care Nurses and Australasian College for Infection Prevention and Control position statement on facilitating next-of-kin presence for patients dying from coronavirus disease 2019 (COVID-19) in the intensive care unit

Publisher: Elsevier BV

Date: 03-2020

DOI: 10.1016/J.AUCC.2020.07.002

Prevention of central venous line associated bloodstream infections in adult intensive care units

Publisher: Elsevier BV

Date: 12-2017

DOI: 10.1016/J.ICCN.2017.05.006

Abstract: In adult Intensive Care Units, the complexity of patient treatment requirements make the use of central venous lines essential. Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters. Identify and critique the best available evidence regarding interventions to prevent central venous line associated bloodstream infections in adult intensive care unit patients other than anti-microbial catheters. A systematic review of studies published from January 2007 to February 2016 was undertaken. A systematic search of seven databases was carried out: MEDLINE CINAHL Plus EMBASE PubMed Cochrane Library Scopus and Google Scholar. Studies were critically appraised by three independent reviewers prior to inclusion. Nineteen studies were included. A range of interventions were found to be used for the prevention or reduction of central venous line associated bloodstream infections. These interventions included dressings, closed infusion systems, aseptic skin preparation, central venous line bundles, quality improvement initiatives, education, an extra staff in the Intensive Care Unit and the participation in the 'On the CUSP: Stop Blood Stream Infections' national programme. Central venous line associated bloodstream infections can be reduced by a range of interventions including closed infusion systems, aseptic technique during insertion and management of the central venous line, early removal of central venous lines and appropriate site selection.

Understanding the role and deployment of volunteers within specialist palliative care services and organisations as they have adjusted to the COVID-19 pandemic: A multi-national EAPC volunteer taskfor

Publisher: SAGE Publications

Date: 25-11-2022

DOI: 10.1177/02692163221135349

Abstract: Early indications were of a major decline in specialist palliative care volunteer numbers during COVID-19. It is important that ongoing deployment and role of volunteers is understood, given the dependence of many palliative care services on volunteers for quality care provision. To understand the roles and deployment of volunteers in specialist palliative care services as they have adjusted to the impact of COVID-19. Observational multi-national study, using a cross-sectional online survey with closed and free-text option questions. Disseminated via social media, palliative care networks and key collaborators from May to July 2021. Any specialist palliative care setting in any country, including hospices, day hospices, hospital based or community teams. The person responsible for managing the deployment of volunteers was invited to complete the survey. Valid responses were received from 304 organisations (35 countries, 80.3% Europe). Most cared for adults only (60.9%), provided in-patient care (62.2%) and were non-profit (62.5%). 47.0% had cared for people with COVID-19. 47.7% changed the way they deployed volunteers the mean number of active volunteers dropped from 203 per organisation to 33, and 70.7% reported a decrease in volunteers in direct patient/family facing roles. There was a shift to younger volunteers. 50.6% said this drop impacted care provision, increasing staff workload and pressure, decreasing patient support, and increasing patient isolation and loneliness. The sustained reduction in volunteer deployment has impacted the provision of specialist palliative care. Urgent consideration must be given to the future of volunteering including virtual modes of delivery, micro-volunteering, and appealing to a younger demographic.

End-of-life care for older people in subacute care: A retrospective clinical audit

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.COLEGN.2018.02.005

Communicating end-of-life care goals and decision-making among a multidisciplinary geriatric inpatient rehabilitation team: A qualitative descriptive study

Publisher: SAGE Publications

Date: 03-08-2018

DOI: 10.1177/0269216318790353

Abstract: In geriatric inpatient rehabilitation settings, where the goal is to optimise function, providing end-of-life care can be challenging. The aim of this study is to explore how end-of-life care goals and decision-making are communicated in a geriatric inpatient rehabilitation setting. The design is a qualitative descriptive design using semi-structured in idual and group interviews. This study was conducted in a 154-bed facility in metropolitan Melbourne, Australia, providing geriatric inpatient rehabilitation for older patients medical, nursing and allied health clinicians, who had cared for an inpatient who died, were recruited. Participants were interviewed using a conversational approach, guided by an ‘aide memoire’. A total of 19 clinicians participated in this study, with 12 interviewed in idually and the remaining 7 clinicians participating in group interviews. The typical patient was described as older, frail and with complex needs. Clinicians described the challenge of identifying patients who were deteriorating towards death, with some relying on others to inform them. How patient deterioration and decision-making was communicated among the team varied. Communication with the patient/family about dying was expected but did not always occur, nor was it always documented. Some clinicians relied on documentation, such as commencement of a dying care pathway to indicate when a patient was dying. Clinicians reported difficulties recognising patient deterioration towards death. Uncertainty and inconsistent communication among clinicians about patient deterioration negatively impacted team understanding, decision-making, and patient and family communication. Further education for all members of the multidisciplinary team focusing on how to recognise and communicate impending death will aid multidisciplinary teams to provide quality end-of-life care when required.

Perspectives of family‐centred care at the end of life during the COVID‐19 pandemic: A qualitative descriptive study

Publisher: Wiley

Date: 18-01-2023

DOI: 10.1111/JOCN.16627

Abstract: To explore nurses' and family members' perspectives of family care at the end of life, during restricted visitation associated with the COVID‐19 pandemic. To minimise the transmission of COVID‐19, stringent infection prevention and control measures resulted in restricted hospital access for non‐essential workers and visitors, creating challenges for the provision of family‐centred care at the end of life. Qualitative descriptive approach based on naturalistic inquiry. At a large public hospital in Melbourne, Australia, in idual semi‐structured interviews were undertaken with 15 registered nurses who cared for patients who died during restricted visitation associated with the COVID‐19 pandemic, and 21 bereaved family members. COREQ guidelines informed analysis and reporting. Five themes developed from the data: (i) impact of visitor restrictions, which describes uncertain, ambiguous and arbitrary rules, onerous and inconsistent requirements (ii) nurse‐family communication (iii) family‐centred care and interrupted connections (iv) well‐being and negative emotions and (v) suggestions for a better way, such as moving away from the black and whiteness of the rules, prioritising communication, compassion and advocacy. Negative consequences for communication and the patient‐family connection at the end of life were felt deeply. The evolving COVID‐19 rules that were frequently revised and applied at short notice, and the subsequent consequences for clinical practices and care were felt deeply. Technology‐facilitated communication, innovation and increased resources must be prioritised to overcome the challenges described in this study. A family‐centred approach to care and emphasising the patient‐family connection at the end of life is fundamental to minimising trauma and distress associated with future public health emergencies. Bereaved family members contributed their first‐hand experience. Members of the health service's patient experience team ensured the research was conducted in accordance with health service guidelines for patient and public contribution.

The experience of family carers of people with dementia who are hospitalised

Publisher: SAGE Publications

Date: 27-07-2016

DOI: 10.1177/1471301214558308

Abstract: Hospital admission of a person with dementia can have a significant impact on the family carer, who temporarily relinquishes caring to health professionals. A descriptive qualitative design using in-depth interviews with a conversational approach was used to elicit data. Adjusting to the change in the carer’s role can be challenging and result in feelings of helplessness, loneliness, loss of control and being undervalued. Family support can assist with the transition but family conflict increases anxiety. Good communication between clinicians and the carer is vital. The carer should be included in decision-making as the ‘expert' in the care of the person with dementia. This article discusses findings of a larger study specifically related to the emotional support required for the carers of people with dementia, who are admitted to hospital. The carer and the patient must be considered as a dyad in relation to discharge planning.

New graduate nurses' coping with death and the relationship with death self‐efficacy and death anxiety: A multicentre cross‐sectional study

Publisher: Wiley

Date: 03-11-2020

DOI: 10.1111/JAN.14621

Factors that influence intensive care admission decisions for older people: A systematic review

Publisher: Elsevier BV

Date: 03-2023

DOI: 10.1016/J.AUCC.2021.12.006

Abstract: The population worldwide is rapidly ageing, and demand for intensive care is increasing. People aged 85 years and above, known as the oldest old, are particularly vulnerable to critical illness owing to the physiological effects of ageing. Evidence surrounding admission of the oldest old to the intensive care is limited. The objective of this study was to systematically and comprehensively review and synthesise the published research investigating factors that influence decisions to admit the oldest old to the intensive care unit. This was a systematic review and narrative synthesis. Following a comprehensive search of CINAHL, Embase, and Medline databases, peer-reviewed primary research articles examining factors associated with admission or refusal to admit the oldest old to intensive care were selected. Data were extracted into tables and narratively synthesised. Six studies met the inclusion criteria. Three studies identified factors associated with admission such as greater premorbid self-sufficiency, patient preferences, alignment between patient and physicians' goals of treatment, age less than 85 years, and absence of cancer, or previous intensive care admission. Factors associated with refusal to admit were identified in all six studies and included limited or no bed availability, level of ICU physician experience, patients being deemed too ill or too well to benefit, and older age. Published research investigating decision-making about admission or refusal to admit the oldest old to the intensive care unit is scant. The ageing population and increasing demand for intensive care unit resources has lified the need for greater understanding of factors that influence decisions to admit or refuse admission of the oldest old to the intensive care unit. Such knowledge may inform guidelines regarding complex practice decisions about admission of the oldest old to an intensive care unit. Such guidelines would ensure the specialty needs of this population are considered and would reduce admission decisions that might disadvantage older people.

Understanding consumer participation in mental health: Issues of power and change

Publisher: Wiley

Date: 18-02-2011

DOI: 10.1111/J.1447-0349.2010.00719.X

Abstract: Consumer participation occurs in all Victorian public mental health services. Area mental health services employ consumer consultants to enhance consumer participation across the network. Ongoing support of management is essential to the success of consumer participation. This project aimed to explore understandings of consumer participation from a manager's perspective. Semistructured interviews were conducted with seven participants in this qualitative, interpretive study. The thematic analysis revealed the complexities around defining consumer participation and demonstrated the difficulties and possible reasons as to why there is no real clarity between managers, service providers, and consumers as to what consumer participation should look like. Power and change were the primary themes. Power and the overwhelming consensus that the medical model and those working within it hold the most power was strongly represented in this study. Legislation and workplace settings were seen as considerable factors adding to the disempowerment of consumers within an already disempowering mental health system. Change was the other main theme that emerged, with culture and attitudes of the old 'institutionalized' thinking that still pervades some pockets of mental health services being seen as the major barriers to change. The role of the consumer consultant was a prominent subtheme, with their role in training and the education of workers seen as an essential and positive way to progress consumer participation. These findings demonstrate that managers consider there to be hope for consumers, brought about by collective action and lobbying, and through consumer participation in less-restrictive parts of the service (community settings).

Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses

Publisher: Elsevier BV

Date: 11-2016

DOI: 10.1016/J.AUCC.2016.08.006

Abstract: A core component of family-centred nursing care during the provision of end-of-life care in intensive care settings is information sharing with families. Yet little is known about information provided in these circumstances. To identify information most frequently given by critical care nurses to families in preparation for and during withdrawal of life-sustaining treatment. An online cross-sectional survey. During May 2015, critical care nurses in Australia and New Zealand were invited to complete the Preparing Families for Treatment Withdrawal questionnaire. Data analysis included descriptive statistics to identify areas of information most and least frequently shared with families. Cross tabulations with demographic data were used to explore any associations in the data. From the responses of 159 critical care nurses, information related to the emotional care and support of the family was most frequently provided to families in preparation for and during withdrawal of life-sustaining treatment. Variation was noted in the frequency of provision of information across body systems and their associated physical changes during the dying process. Significant associations (p<0.05) were identified between the variables gender, nursing experience and critical care experiences and some of the information items most and least frequently provided. The provision of information during end-of-life care reflects a family-centred care approach by critical care nurses with information pertaining to emotional care and support of the family paramount. The findings of this study provide a useful framework for the development of interventions to improve practice and support nurses in communicating with families at this time.

First and final farewells, disrupted family connections and loss: A collective case study exploring the impact of COVID-19 visitor restrictions in critical care

Publisher: Elsevier BV

Date: 02-2024

DOI: 10.1016/J.ICCN.2023.103534

Nurses' prioritization of enteral nutrition in intensive care units

Publisher: Wiley

Date: 30-01-2018

DOI: 10.1111/NICC.12284

Abstract: Enteral nutrition is important in critically ill patients to improve patient outcomes, with nurses playing a pivotal role in the delivery and ongoing care of enteral nutrition. A significant deficit in nurses' knowledge and education relating to enteral nutrition has been identified, leading to iatrogenic malnutrition and potentially compromising patient care. Enteral nutrition appears to be prioritized lower than many other aspects of care. However, there is scant research to show how nurses prioritize enteral nutrition. This study aimed to explore how nurses prioritize enteral nutrition when caring for a critically ill patient. A descriptive online questionnaire, administered in May 2014, was utilized to explore the study aim. Descriptive statistics were performed to evaluate quantitative data. Content analysis was used to evaluate qualitative data. A total of 359 responses were included in data analysis (response rate 20.8%). All respondents were registered nurses working within an Australian intensive care unit or high dependency unit. Nurses agreed that enteral nutrition was very important and should be commenced as soon as possible. However, life-saving procedures always took priority and there were often multiple barriers that hindered optimal delivery of enteral nutrition. Respondents relied on their clinical judgement to inform decisions in relation to enteral nutrition in critically ill patients. Most respondents agreed that enteral nutrition was an important aspect of patient care, but acknowledged that other aspects of care were prioritized more highly. Despite this, some delays to enteral nutrition were perceived to be avoidable, and nurses recognized a need to advocate on the patient's behalf to increase the visibility of enteral nutrition. The findings of this study demonstrate that enteral nutrition is often prioritized lower than other competing care needs in the critically ill patient. Given the importance of enteral nutrition to patient recovery, changes to clinical practice to improve enteral nutrition management are necessary.

Family-centred care at end of life in critical care: A retrospective descriptive study

Publisher: Elsevier BV

Date: 10-2022

DOI: 10.1016/J.COLEGN.2022.01.004

An integrative review of how families are prepared for, and supported during withdrawal of life‐sustaining treatment in intensive care

Publisher: Wiley

Date: 16-09-2016

DOI: 10.1111/JAN.13097

Abstract: The aim of this study was to conduct an integrative review on how nurses prepare families for and support families during withdrawal of life-sustaining treatments in intensive care. End-of-life care is widely acknowledged as integral to the practice of intensive care. However, little is known about what happens after the decision to withdraw life-sustaining treatments has been made and how families are prepared for death and the dying process. Integrative literature review. MEDLINE, CINAHL Plus, PsychINFO, PUBMED, Scopus, EMBASE and Web of Knowledge were searched for papers published between 2000-May 2015. A five stage review process, informed by Whittemore and Knafl's methodology was conducted. All papers were reviewed and quality assessment performed. Data were extracted, organized and analysed. Convergent qualitative thematic synthesis was used. From an identified 479 papers, 24 papers were included in this review with a range of research approaches: qualitative (n = 15) quantitative (n = 4) mixed methods (n = 2) case study (n = 2) and discourse analysis (n = 1). Thematic analysis revealed the nurses: equipped families for end of life through information provision and communication managed the withdrawal of life-sustaining treatments to meet family need and continued care to build memories. Greater understanding is needed of the language that can be used with families to describe death and dying in intensive care. Clearer conceptualization of the relationship between the medically focussed withdrawal of life-sustaining treatments and patient/family-centred end-of-life care is required making the nursing contribution at this time more visible.

Loss and grief in the workplace

Publisher: Emerald

Date: 29-06-2010

DOI: 10.1108/17538351011055023

Abstract: The purpose of this paper is to determine how Australian workplaces, their managers and employees respond to those who are grieving at work, as a result of chronic or terminal illness, or caring for those with chronic or terminal illness. The review draws on Australian and relevant international literature and seeks to answer this question. A literature review was undertaken in preparation for an Australian study examining workplace supports for people who are grieving – because they are carers, have experienced a death, or are balancing their own illness with their work. Using a range of search terms, the literature was searched for relevant work between 1980 and 2010. The search found ex les of workplace supports throughout the world and some developing Australian literature. Despite illness and death occurring at any stage of a person's life, there is little research that identifies workplace issues associated with grief and loss. And while workplace legislation allows for minimal supports, there was evidence that some workplaces have begun to offer flexibility for work life balance. Effective workplace supports will involve in idual and workplace responses, but also require legislative approaches in order to effect broad‐based system change. The paper compares Australian and international literature about workplace supports and provides an overview of the issues arising.

Nurses' work experiences in hospital wards with single rooms: An integrative review

Publisher: Wiley

Date: 18-07-2023

DOI: 10.1111/JOCN.16824

Abstract: To evaluate evidence that examined nurses' work experiences in hospital wards with single rooms. The research question was ‘What does the research tell us about nurses’ work experiences in hospital wards with single rooms?’ In the last decades, new hospital builds have moved towards including a high proportion of single rooms. Yet, single rooms create ‘complex environments’ that impact the nurses. A structured integrative review was undertaken of empirical evidence. Original, peer‐reviewed articles, written in English, were sourced from four databases: CINAHL, PubMed, Embase and Web of Science. The initial searches were performed in April 2021 and repeated in December 2022. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was used to analyse the data. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Twelve studies, published between 2006 and 2022, with an international origin, and representing n = 826 nurses, were included in this review. The synthesis revealed mixed perspectives about nurses' work experiences in wards with single rooms. Whilst single rooms are ‘all good in theory (and) a good idea’, the reality was quite different. Synthesised findings are presented in four categories: (i) aesthetics and the physical space, (ii) privacy vs. isolation, (iii) safety, which includes situational awareness and (iv) communication and collaboration. This review describes how single rooms affects nurses' work experience. Whilst nurses shared multiple concerns about single rooms and the challenges they also acknowledged patient preference for the privacy and space afforded by single rooms. Findings from this review highlight the need for careful planning to maintain and strengthen teamwork, prevent nurses' sense of working in isolation, as well as creating opportunities for mentorship, and collaboration among nurses when working in single‐room settings.

The Acceptability and Efficacy of a Group Cognitive Behavioural Therapy Programme in a Community Mental Health Setting

Publisher: Springer Science and Business Media LLC

Date: 02-2012

DOI: 10.1007/S10597-012-9484-3

Abstract: This paper presents data on a patient evaluation of a group cognitive behavioural therapy programme in an applied setting and its efficacy for reducing generalised anxiety and or depression, and distress. Patients (n=14) participated in one of two 8-week group cognitive behavioural therapy programmes for generalised anxiety or depression, within a mental health service. Patients’ perceptions of the programme were collected via an evaluation questionnaire, and data on clinical outcomes were sourced from patients’ case notes. Most patients who were invited to participate in the programme (n=14 of 17), and their evaluations were generally favourable. Almost all participants (93%) indicated that the programme either met or exceeded their expectations. The clinical outcomes of the intervention were similar to those found in efficacy studies reported in the published literature (approximately half to threequarters of one standard deviation improvement in anxiety, depression, and distress scores).

The Environment of Inpatient Healthcare Delivery and Its Influence on the Outcome of Care

Publisher: SAGE Publications

Date: 10-2012

DOI: 10.1177/193758671200600106

Abstract: This paper addresses issues arising in the literature regarding the environmental design of inpatient healthcare settings and their impact on care. Environmental design in healthcare settings is an important feature of the holistic delivery of healthcare. The environmental influence of the delivery of care is manifested by such things as lighting, proximity to bedside, technology, family involvement, and space. The need to respond rapidly in places such as emergency and intensive care can override space needs for family support. In some settings with aging buildings, the available space is no longer appropriate to the needs—for ex le, the need for privacy in emergency departments. Many aspects of care have changed over the last three decades and the environment of care appears not to have been adapted to contemporary healthcare requirements nor involved consumers in ascertaining environmental requirements. The issues found in the literature are addressed under five themes: the design of physical space, family needs, privacy considerations, the impact of technology, and patient safety. There is a need for greater input into the design of healthcare spaces from those who use them, to incorporate dignified and expedient care delivery in the care of the person and to meet the needs of family.

Family‐centered care during a pandemic: The hidden impact of restricting family visits

Publisher: Wiley

Date: 07-10-2021

DOI: 10.1111/NHS.12748

Intensive care nurses’ enteral nutrition knowledge

Publisher: Elsevier BV

Date: 12-2016

DOI: 10.1016/J.ICCN.2016.07.001

Abstract: Nurses have an important role in the delivery and management of enteral nutrition in critically ill patients, to prevent iatrogenic malnutrition. It is not clear how nurses source enteral nutrition information. This study aimed to explore Australian nurses' enteral nutrition knowledge and sources of information. Data were collected from members of the Australian College of Critical Care Nurses in May 2014 using an online questionnaire. A combination of descriptive statistics and non-parametric analyses were undertaken to evaluate quantitative data. Content analysis was used to evaluate qualitative data. 359 responses were included in data analysis. All respondents were Registered Nurses with experience working in an Australian intensive care unit or high dependency unit. Most respondents reported their enteral nutrition knowledge was good (n=205, 60.1%) or excellent (n=35, 10.3%), but many lacked knowledge regarding the effect of malnutrition on patient outcomes. Dietitians and hospital protocols were the most valuable sources of enteral nutrition information, but were not consistently utilised. Significant knowledge deficits in relation to enteral nutrition were identified. Dietitians were the preferred source of nurses' enteral nutrition information, however their limited availability impacted their efficacy as an information resource. Educational opportunities for nurses need to be improved to enable appropriate nutritional care in critically ill patients.

Transferring from an acute hospital and settling into a subacute facility: The experience of patients with dementia

Publisher: Wiley

Date: 27-06-2012

DOI: 10.1111/J.1748-3743.2011.00282.X

Abstract: In a Melbourne metropolitan health network, patients with dementia can have difficulty settling into a subacute rehabilitation facility after transfer from the acute hospital. To understand how older patients with mild to moderate dementia experienced the transfer from acute to subacute care and settling-in period. A descriptive design was used. Eight patients with mild to moderate dementia were recruited, one to 5 days after transfer. A qualitative method using in-depth interviews was used. The data were analysed using content analysis. Four main themes were identified: 'Settling into a new environment', 'staff attitudes to people with dementia', 'loss of control' and 'family support'. Person-centred care that comes from the perspective of respect for the in idual transcends all these issues. People with dementia require more support to settle after transfer. Family involvement can assist in facilitating a smooth transition. Nurses who understand the specific needs of patients with dementia can develop ways of working with patients to ensure person-centred care. More conversations with people with dementia are needed to investigate how this can be achieved. Orientation procedures should ensure that support for people with dementia is optimized during the settling-in phase.

Palliative care for the person with a serious mental illness: The need for a partnership approach to care in Australia

Publisher: Informa UK Limited

Date: 04-2013

DOI: 10.1179/1743291X12Y.0000000033

End-of-Life Care in an Australian Rehabilitation Facility for Older People: Staff Focus Groups

Publisher: Informa UK Limited

Date: 27-08-2014

DOI: 10.1080/07481187.2012.738773

Abstract: A qualitative study of staff experiences of end-of-life care for older people in a subacute rehabilitation facility was undertaken using three focus groups with senior multidisciplinary staff (5), junior nurses (8), and junior allied health staff (7). Content analysis revealed four major themes: being a key contact person the quality of end-of-life care referring to off-site service providers and differing perspectives. These data have implications for multidisciplinary practice including staff education and capacity to change focus of care in facilities for older people dedicated to rehabilitation rather than palliation or end-of-life care.

Supporting Muslim families before and after a death in neonatal and paediatric intensive care units

Publisher: Wiley

Date: 24-05-2019

DOI: 10.1111/NICC.12434

Abstract: The death of a child is regarded as one of the most devastating events for a family. Families are reliant on nurses to not only provide end-of-life care but also to support and care for grieving families in a way that is sensitive to their cultural and religious needs and preferences. The aim of this study was to explore the perceived impact and influence of cultural ersity on how neonatal and paediatric intensive care nurses care for Muslim families before and after the death of infants/children. A qualitative descriptive approach was used in this study, conducted in Saudi Arabia. Semi-structured interviews were used to gather data from a convenience s le of registered nurses working in neonatal and paediatric intensive care, with experience in providing end-of-life care. Interviews were conducted between July and November, 2018. Interviews were audio-recorded and transcribed for analysis. Thirteen registered nurses participated all were born overseas, identified with various faiths and spoke English in the workplace. A respect for ersity and care of the family was prioritized yet impacted by communication challenges. Caring and respect was demonstrated by facilitating important cultural and religious practices important in the Muslim faith. Self-care was identified as important, transcending the culturally erse nature of the nursing workforce. Significant challenges exist for a culturally erse nursing workforce in providing care to a Saudi Muslim population of infants/children and families, before and after a death. Their overriding commitment to respect for others, and an openness to cultural ersity and difference, aided in overcoming the inherent challenges in providing culturally sensitive end-of-life care that meets the needs of Muslim families. These findings provide valuable insights for intensive care clinicians in other countries to address challenges associated with cultural ersity.

The state of critical care nursing education in Europe: an international survey

Publisher: Springer Science and Business Media LLC

Date: 10-2015

DOI: 10.1007/S00134-015-4072-Y

Navigating communication with families during withdrawal of life‐sustaining treatment in intensive care: a qualitative descriptive study in Australia and New Zealand

Publisher: Wiley

Date: 28-11-2016

DOI: 10.1111/JOCN.13585

Abstract: To explore how nurses navigate communication with families during withdrawal of life-sustaining treatment in intensive care. Death in the intensive care unit is seldom unexpected and often happens following the withdrawal of life-sustaining treatment. A family-centred approach to care relies on the development of a therapeutic relationship and understanding of what is happening to the patient. Whilst previous research has focused on the transition from cure to palliation and the nurse's role in supporting families, less is known about how nurses navigate communication with families during treatment withdrawal. A qualitative descriptive approach was used. Semi-structured focus groups were conducted with adult critical care nurses from four intensive care units, two in Australia and two in New Zealand. Twenty-one nurses participated in the study. Inductive content analysis revealed five key themes relating to how nurses navigate family communication: (1) establishing the WHO (2) working out HOW (3) judging WHEN (4) assessing the WHAT and (5) WHERE these skills were learnt. Navigating an approach to family communication during treatment withdrawal is a complex and multifaceted nursing activity that is known to contribute to family satisfaction with care. There is need for support and ongoing education opportunities that develop the art of communication in this frequently encountered aspect of end-of-life care. How nurses navigate communication with families during treatment withdrawal is just as important as what is communicated. Nurses need access to supports and education opportunities in order to be able to perform this vital role.

Single‐room usage patterns and allocation decision‐making in an Australian public hospital: a sequential exploratory study

Publisher: Wiley

Date: 06-06-2016

DOI: 10.1111/JOCN.13264

Abstract: The aims are to (1) measure occupancy rates of single and shared rooms (2) compare single room usage patterns and (3) explore the practice, rationale and decision-making processes associated with single rooms across one Australian public health service. There is a tendency in Australia and internationally to increase the proportion of single patient rooms in hospitals. To date there have been no Australian studies that investigate the use of single rooms in clinical practice. This study used a sequential exploratory design with data collected in 2014. A descriptive survey was used to measure the use of single rooms across a two-week time frame. Semi-structured interviews were undertaken with occupancy decision-makers to explore the practices, rationale decision-making process associated with single-room allocation. Total bed occupancy did not fall below 99·4% during the period of data collection. Infection control was the primary reason for patients to be allocated to a single room, however, the patterns varied according to ward type and single-room availability. For occupancy decision-makers, decisions about patient allocation was a complex and challenging process, influenced and complicated by numerous factors including occupancy rates, the infection status of the patient/s, funding and patient/family preference. Bed moves were common resulting from frequent re-evaluation of need. Apart from infection control mandates, there was little tangible evidence to guide decision-making about single-room allocation. Further work is necessary to assist nurses in their decision-making. There is a trend towards increasing the proportion of single rooms in new hospital builds. Coupled with the competing clinical demands for single room care, this study highlights the complexity of nursing decision-making about patient allocation to single rooms, an issue urgently requiring further attention.

Stability Conditions for Remote State Estimation of Multiple Systems Over Semi-Markov Fading Channels

Publisher: Institute of Electrical and Electronics Engineers (IEEE)

Date: 2022

DOI: 10.1109/LCSYS.2022.3181721

Critical care nurses’ role in family communication: Absolutely vital, but sadly hidden

Publisher: Elsevier BV

Date: 06-2023

DOI: 10.1016/J.ICCN.2023.103401

The importance of methodology to palliative care research: A new article type for Palliative Medicine

Publisher: SAGE Publications

Date: 29-12-2021

DOI: 10.1177/02692163211069566

Families and caregivers of older people: Expectations, communication and care decisions

Publisher: Elsevier BV

Date: 12-2014

DOI: 10.1016/J.COLEGN.2013.08.006

Abstract: While family caregivers may temporarily relinquish responsibility for daily care to health professionals for the period of hospitalization, new expectations and demands are placed upon them. Family caregivers can be asked to commit to new relationships with health professionals, contribute to care decisions and discharge planning. For the caregivers of older patients these new expectations may be challenging, and contribute to feelings of burden and increased stress. The aim of this qualitative descriptive study was to explore the experience of family caregivers when their relative is an inpatient in this outer Melbourne geriatric evaluation and management facility. This study found that the burden associated with the experience of caregiving continued despite the hospitalization of their relative. The challenges faced by families included communicating with health professionals, and being asked to contribute to care decisions, in particular those regarding discharge planning, and managing conflict. In conclusion, the issues and challenges faced by family caregivers needs to be acknowledged and considered as an extension of patient care planning.

Dying persons’ perspectives on, or experiences of, participating in research: An integrative review

Publisher: SAGE Publications

Date: 13-12-2018

DOI: 10.1177/0269216317744503

Abstract: Conducting research with dying persons can be controversial and challenging due to concerns for the vulnerability of the dying and the potential burden on those who participate with the possibility of little benefit. To conduct an integrative review to answer the question ‘What are dying persons’ perspectives or experiences of participating in research? A structured integrative review of the empirical literature was undertaken. Cumulative Index Nursing and Allied Health Complete, PsycINFO, MEDLINE, Informit and Embase databases were searched for the empirical literature published since inception of the databases until February 2017. From 2369 references, 10 papers were included in the review. Six were qualitative studies, and the remaining four were quantitative. Analysis revealed four themes: value of research, desire to help, expression of self and participation preferences. Dying persons value research participation, regarding their contribution as important, particularly if it provides an opportunity to help others. Participants perceived that the potential benefits of research can and should be measured in ways other than life prolongation or cure. Willingness to participate is influenced by study type or feature and degree of inconvenience. Understanding dying persons’ perspectives of research participation will enhance future care of dying persons. It is essential that researchers do not exclude dying persons from clinically relevant research due to their prognosis, fear or burden or perceived vulnerability. The dying should be afforded the opportunity to participate in research with the knowledge it may contribute to science and understanding and improve the care and treatment of others.

Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease

Publisher: Wiley

Date: 21-10-2011

DOI: 10.1111/J.1466-7657.2011.00913.X

Abstract: Taiwan has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world with 55,499 ESRD patients on long-term dialysis. Nevertheless, 90.96% of these patients are managed on maintenance haemodialysis (HD), with only 9.03% enrolled in a peritoneal dialysis (PD) programme. The study aim was to identify the factors affecting Taiwanese patient's selection of PD in preference to HD for chronic kidney disease. A cross-sectional research design was utilized with 130 chronic renal failure (CRF) patients purposively selected from outpatient nephrology clinics at four separate Taiwan hospitals. Logistic regression was used to identify the main factors affecting the patient's choice of dialysis type. Single-factor logistic regression found significant differences in opinion related to age, education level, occupation type, disease characteristics, lifestyle modifications, self-care ability, know-how of dialysis modality, security considerations and findings related to the decisions made by medical personnel (P < 0.05). Moreover, multinomial logistic regression after adjustment for interfering variables found that self-care ability and dialysis modality know-how were the two main factors affecting the person's selection of dialysis type. Self-care ability and the person's knowledge of the different types of dialysis modality and how they function were the major determinants for selection of dialysis type in Taiwan based on the results from this study. The results indicate that the education of CRF patients about the types of dialysis available is essential to enable them to understand the benefits or limitations of both types of dialysis.

Improving palliative care for people with intellectual disabilities: Communication is key

Publisher: SAGE Publications

Date: 13-09-2021

DOI: 10.1177/02692163211046445

Understanding the bereavement care roles of nurses within acute care: a systematic review

Publisher: Wiley

Date: 27-03-2017

DOI: 10.1111/JOCN.13503

Abstract: To investigate nurses' roles and responsibilities in providing bereavement care during the care of dying patients within acute care hospitals. Bereavement within acute care hospitals is often sudden, unexpected and managed by nurses who may have limited access to experts. Nurses' roles and experience in the provision of bereavement care can have a significant influence on the subsequent bereavement process for families. Identifying the roles and responsibilities, nurses have in bereavement care will enhance bereavement supports within acute care environments. Mixed-methods systematic review. The review was conducted using the databases Cumulative Index Nursing and Allied Health Literature Plus, Embase, Ovid MEDLINE, PsychINFO, CareSearch and Google Scholar. Included studies published between 2006-2015, identified nurse participants, and the studies were conducted in acute care hospitals. Seven studies met the inclusion criteria, and the research results were extracted and subjected to thematic synthesis. Nurses' role in bereavement care included patient-centred care, family-centred care, advocacy and professional development. Concerns about bereavement roles included competing clinical workload demands, limitations of physical environments in acute care hospitals and the need for further education in bereavement care. Further research is needed to enable more detailed clarification of the roles nurse undertake in bereavement care in acute care hospitals. There is also a need to evaluate the effectiveness of these nursing roles and how these provisions impact on the bereavement process of patients and families. The care provided by acute care nurses to patients and families during end-of-life care is crucial to bereavement. The bereavement roles nurses undertake are not well understood with limited evidence of how these roles are measured. Further education in bereavement care is needed for acute care nurses.

How new graduate nurses experience patient death: A systematic review and qualitative meta-synthesis

Publisher: Elsevier BV

Date: 2016

DOI: 10.1016/J.IJNURSTU.2015.09.013

Abstract: Patient death is an emotional and demanding experience for nurses, especially for new graduate nurses who are unprepared to deliver end-of-life care. Understanding new graduate nurses' experience of death and dying will inform the design of training programs and interventions for improvements in the quality of care and support of new graduates. To summarize new graduate nurses' experience with patient death by examining the findings of existing qualitative studies. Systematic review methods incorporating meta-synthesis were used. A comprehensive search was conducted in 12 databases from January 1990 to December 2014. All qualitative and mixed-method studies in English and Chinese that explored new graduate nurses' experience of patient death were included. Two independent reviewers selected the studies for inclusion and assessed each study quality. Meta-aggregation was performed to synthesize the findings of the included studies. Five primary qualitative studies and one mix-method study met inclusion and quality criteria. Six key themes were identified from the original findings: emotional experiences, facilitating a good death, support for family, inadequacy on end-of-life care issues, personal and professional growth and coping strategies. New graduate nurses expressed a variety of feelings when faced with patient death, but still they tried to facilitate a good death for dying patients and provide support for their families. The nurses benefited from this challenging encounter though they lacked of coping strategies.

Smiles behind the masks: A systematic review and narrative synthesis exploring how family members of seriously ill or dying patients are supported during infectious disease outbreaks

Publisher: SAGE Publications

Date: 18-08-2021

DOI: 10.1177/02692163211029515

Abstract: Infection control measures during infectious disease outbreaks can have significant impacts on seriously ill and dying patients, their family, the patient-family connection, coping, grief and bereavement. To explore how family members of patients who are seriously ill or who die during infectious disease outbreaks are supported and cared for during serious illness, before and after patient death and the factors that influence family presence around the time of death. Systematic review and narrative synthesis. CINAHL, Medline, APA PsycInfo and Embase were searched from inception to June 2020. Forward and backward searching of included papers were also undertaken. Records were independently assessed against inclusion criteria. Included papers were assessed for quality, but none were excluded. Key findings from 14 papers include the importance of communication and information sharing, as well as new ways of using virtual communication. Restrictive visiting practices were understood, but the impact of these restrictions on family experience cannot be underestimated, causing distress and suffering. Consistent advice and information were critical, such as explaining personal protective equipment, which family found constraining and staff experienced as affecting interpersonal communication. Cultural expectations of family caregiving were challenged during infectious disease outbreaks. Learning from previous infectious disease outbreaks about how family are supported can be translated to the current COVID-19 pandemic and future infectious disease outbreaks. Consistent, culturally sensitive and tailored plans should be clearly communicated to family members, including when any restrictions may be amended or additional supports provided when someone is dying.

Ensuring cultural sensitivity for Muslim patients in the Australian ICU: Considerations for care

Publisher: Elsevier BV

Date: 11-2013

DOI: 10.1016/J.AUCC.2013.04.003

Abstract: Australia is a erse and multicultural nation, made up of a population with a predominant Christian faith. Islam, the second largest religion in the world, has demonstrated significant growth in Australia in the last decade. Coming from various countries of origin and cultural backgrounds, Muslim beliefs can range from what is considered 'traditional' to very 'liberal'. It is neither possible nor practical for every intensive care clinician to have an intimate understanding of Islam and Muslim practices, and cultural variations amongst Muslims will mean that not all beliefs ractices will be applicable to all Muslims. However, being open and flexible in the way that care is provided and respectful of the needs of Muslim patients and their families is essential to providing culturally sensitive care. This discussion paper aims to describe the Islamic faith in terms of Islamic teachings, beliefs and common practices, considering how this impacts upon the perception of illness, the family unit and how it functions, decision-making and care preferences, particularly at the end of life in the intensive care unit.

Cultural considerations at end of life in a geriatric inpatient rehabilitation setting

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.COLEGN.2018.07.004

‘Something normal in a very, very abnormal environment’ – Nursing work to honour the life of dying infants and children in neonatal and paediatric intensive care in Australia

Publisher: Elsevier BV

Date: 04-2016

DOI: 10.1016/J.ICCN.2015.09.001

Abstract: The majority of deaths of children and infants occur in paediatric and neonatal intensive care settings. For nurses, managing an infant/child's deterioration and death can be very challenging. Nurses play a vital role in how the death occurs, how families are supported leading up to and after the infant/child's death. This paper describes the nurses' endeavours to create normality amidst the sadness and grief of the death of a child in paediatric and neonatal ICU. Focus groups and in idual interviews with registered nurses from NICU and PICU settings gathered data on how neonatal and paediatric intensive care nurses care for families when a child dies and how they perceived their ability and preparedness to provide family care. Four themes emerged from thematic analysis: (1) respecting the child as a person (2) creating opportunities for family involvement/connection (3) collecting mementos and (4) planning for death. Many of the activities described in this study empowered parents to participate in the care of their child as death approached. Further work is required to ensure these principles are translated into practice.

End-of-life care and intensive care unit clinician involvement in a private acute care hospital: A retrospective descriptive medical record audit

Publisher: Elsevier BV

Date: 09-2021

DOI: 10.1016/J.AUCC.2020.10.010

The challenges of end of life care in acute hospitals

Publisher: Elsevier BV

Date: 09-2015

DOI: 10.1016/J.COLEGN.2015.07.002

Qualitative observation in a clinical setting: Challenges at end of life

Publisher: Wiley

Date: 30-01-2012

DOI: 10.1111/J.1442-2018.2011.00653.X

Abstract: This paper explores the methodological challenges associated with undertaking qualitative observation in the clinical setting at end of life. The authors reflect on their experiences of using non-participant observation to explore the nursing care delivered to dying patients in acute hospital wards. The challenges of observation as a method, clearly defining the participant group and involving vulnerable populations, such as the dying patients and their families, will be discussed. Consideration is also given to defining and working within the observational field, the researchers' dual roles, cost versus benefit, impact of culture, religion and ethnicity, and the determination of research limits/boundaries, with reflections from the authors' own experiences used to exemplify the issues.

How nurses cope with patient death: A systematic review and qualitative meta‐synthesis

Publisher: Wiley

Date: 04-12-2017

DOI: 10.1111/JOCN.13975

Abstract: To review literature on nurses' coping strategies with patient death. Dealing with the loss of a patient was viewed as one of the most demanding and challenging encounters in clinical practice. Those nurses who are not competent in coping with patient death may be inadequate in supporting dying patients and their family members, and minimise the quality of end-of-life care. To get a broader understanding of how nurses cope with patient death and to develop meaningful and effective interventions, a systematic review which would help underpin the multidimensional approaches is needed. A systematic review. Exhaustive searching in ten databases: CINAHL Plus, EMBASE, MEDLINE, AMED, PsycINFO, ProQuest Health & Medical Complete, ProQuest Dissertations & Theses Global, Google Scholar, EThOS and CareSearch. Meta-aggregation was used to synthesise the findings of the included studies. This systematic review aggregated ten categories from the sixteen qualitative studies included, and then two synthesised findings were derived: intrinsic resources and extrinsic resources. The intrinsic resources consisted of setting boundaries, reflection, crying, death beliefs, life and work experience, and daily routines and activity. The extrinsic resources were comprised of talking and being heard, spiritual practices, education and programmes, and debriefing. This systematic review synthesised the findings about what resources nurses use when coping with patient death and made recommendations on future directions. Areas which could be developed to improve deficiencies that nurses had when faced with the losses of their patients were identified. Nurses need more support resources, which better assist them in coping with patient death. The results of this systematic review could provide evidence for nurses' coping strategies when dealing with patient death, and the recommendations could be employed by nurses to cope with the losses of patients.

Culturally sensitive communication at the end-of-life in the intensive care unit: A systematic review

Publisher: Elsevier BV

Date: 11-2019

DOI: 10.1016/J.AUCC.2018.07.003

Abstract: The objectives of this systematic review were the following: (i) to describe whether culturally sensitive communication is used by clinicians (nurses and physicians) when communicating with patients and families at the end-of-life in the intensive care unit and (ii) to evaluate the impact of culturally sensitive communication at the end-of-life. The systematic review question was how is culturally sensitive communication used by clinicians when communicating with patients and families at the end-of-life in the intensive care unit? A search of CINAHL, MEDLINE, Embase, and PsycINFO databases identified all peer-reviewed research evidence published in English between January 1994 and November 2017. Two authors independently assessed articles for inclusion. From the 124 articles resulting from the search, nine were included in this systematic review. Articles were independently assessed for quality by two authors using Caldwell et al.'s framework to critique health research. The data available in this systematic review were heterogeneous, with varied study designs and outcome measures, making the data unsuitable for meta-analysis. The most appropriate method for data synthesis for this systematic review was narrative synthesis. From the narrative synthesis, two major themes emerged: communication barriers and cultural and personal influences on culturally sensitive communication. Communication barriers were identified in eight studies, influencing the timing and quality of culturally sensitive communication at the end-of-life. Cultural and personal influences on communication at the end-of-life was present in eight studies. The findings of this systematic review show that clinicians lack the knowledge to enable effective interaction with culturally erse patients and families at the end-of-life.

The 'dis-ease' of dying: challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study

Publisher: SAGE Publications

Date: 26-02-2013

DOI: 10.1177/0269216313477176

Abstract: Changes in health care and an ageing population have meant that more people are dying in the acute hospital setting. While palliative care principles have resulted in quality care for the dying, many patients die in an acute care, still receiving aggressive/resuscitative care. The aims were to explore nurses’ ‘recognition of’ and ‘responsiveness to’ dying patients and to understand the nurses’ influence on end-of-life care. A qualitative approach was taken utilising non-participant observation to elicit rich data, followed by focus groups and in idual semi-structured interviews for clarification. This study was conducted in two acute medical wards in one health service, identified as having the highest rates of death, once palliative care and critical care areas were excluded. Twenty-five nurses consented to participate, and 20 episodes of observation were conducted. Nurses took a passive role in recognising dying, providing active care until a medical officer’s declaration of dying. Ward design, nurse allocation and nurses’ attitude to death impacts patient care. End-of-life care in a single room can have negative consequences for the dying. Nurses demonstrated varying degrees of discomfort, indicating that they were underprepared for this role. When patients are terminally ill, acknowledgement of dying is essential in providing appropriate care. It should not be assumed that all nurses are adequately prepared to provide dying care. Further work is necessary to investigate how the attitudes of nurses towards caring for dying patients in the acute hospital setting may impact care of the dying patient.

How the observed create ethical dilemmas for the observers: experiences from studies conducted in clinical settings in the UK and Australi

Publisher: Wiley

Date: 09-05-2013

DOI: 10.1111/NHS.12052

Abstract: Observational research has a history of controversy, particularly when the research is conducted in a clinical setting. Existing ethical approval processes focus on protecting participants and the researcher's responsibilities, in particular where vulnerable populations are concerned. In this study, the authors explored the less overt and often understated ethical challenges that can arise when conducting observational research in a clinical setting. Reflecting on two recent studies conducted in different clinical settings, the authors described the challenges of blurring role boundaries, the risk of collecting redundant data, and the impact of reverse power relationships between researchers, clinicians, and managers. From their experiences, the authors suggested that the preparatory work undertaken with clinicians and managers onsite, which typically focuses on how the researchers will maintain the ethical robustness of the research and protect the rights of participants and the vulnerable, should also highlight the sometimes overlooked ethical issues associated with participatory research. This can help ensure that participants and managers understand the scope and limitations of the research, and consider the ways in which the observed can influence the researcher and the findings.

How to prepare Chinese-born nurses to care for patients at the end-of-life in Western settings: A discussion paper

Publisher: Elsevier BV

Date: 10-2022

DOI: 10.1016/J.COLEGN.2022.05.003

A retrospective descriptive study of medical record documentation of how treatment limitations are communicated with family members of patients from culturally diverse backgrounds

Publisher: Elsevier BV

Date: 06-2023

DOI: 10.1016/J.AUCC.2023.04.007

People with dementia and the hospital environment: The view of patients and family carers

Publisher: Wiley

Date: 16-01-2014

DOI: 10.1111/OPN.12014

Abstract: A metropolitan geriatric evaluation and management (GEM) facility in Australia was undergoing expansion, and consideration for the needs of in iduals with dementia and their family carers was identified as important in planning the new facility. Existing literature revealed that people in hospital value privacy, minimal noise, family amenities and homeliness, but these findings did not consider the perspectives of the person with dementia specifically. The aim was to elicit the perspectives of current inpatients with dementia, and their family carers, about the environment/design features that they believe are necessary for people with dementia, and their family carers. This qualitative study utilised in-depth semi-structured interviews to obtain information from current inpatients with dementia and their family carers. Participants described how the care received was more important than the physical environment however, participants also valued homeliness, privacy for the patient and for conversations, a shared space without a television and a connection to the outside. Participants described how accommodating carers, providing quiet spaces and appropriate amenities were also important. While participants valued care over the physical surroundings, they also offered valuable information about their experience in the ward environment. Despite cognitive difficulties, people with dementia were able to provide useful information about the environment within which they were being cared. Consumer opinions about hospital design/environment should be considered as an important source of data. Privacy and personal space for people with dementia and their family carers, a connection with the outside environment , and the needs of carers and visitors are all important considerations when designing healthcare environments.

Culturally sensitive communication in healthcare: A concept analysis

Publisher: Elsevier BV

Date: 06-2019

DOI: 10.1016/J.COLEGN.2018.09.007

Vulnerability at the End of Life

Publisher: SAGE Publications

Date: 26-12-2013

DOI: 10.1177/1084822313514978

Abstract: In Australia, veterans are a vulnerable group, because of ageing, and high rates of chronic or life-threatening illnesses and poor mental health .This retrospective pilot study explored the home-based palliative care needs of veterans as they face the end of their life, compared to non-veterans. Medical records of ten deceased veterans and ten non-veterans in a home-based palliative care service were analyzed both for demographic data, and qualitative content. Veterans had significantly more comorbidities and were older at death. Qualitative data indicated common concerns, including the role of families and practical aspects of care. Some differences were found between veterans and non-veterans in their end-of-life care requirements. More awareness of veterans’ status may assist in care more tailored to their specific needs.

Transitioning from caregiver to visitor in a long-term care facility: The experience of caregivers of people with dementia

Publisher: Informa UK Limited

Date: 30-09-2015

DOI: 10.1080/13607863.2014.962008

Abstract: Transitioning from the primary caregiver to the visitor in a long-term care facility may be challenging for the caregiver they are required to surrender their caring duties to the medical and nursing staff. The aim of this study was to explore the experiences of caregivers during their transition from day-to-day caregiver of a person with dementia to a visitor in a long-term care facility. This study utilised a qualitative descriptive design. Twenty caregivers of people with dementia were recruited from the one Aged Rehabilitation and Geriatric Evaluation and Management facility, located in Victoria, Australia. Semi-structured interviews were used to explore the caregiver's experiences. Interviews were analysed using thematic analysis. The interview data revealed that the participants were undergoing similar experiences. The findings revealed that it was difficult for the caregiver to transition to their new role of visitor negative reactions of grief, loss of motivation and loneliness were also coupled with positive feelings of relief and the reassurance that their relative or friend would be well cared for and safe within the long-term care facility. The findings offer insight into the experiences felt by caregivers when their relative or friend with dementia is admitted to hospital. Implications of this study include the need to improve the transition process for the caregiver by allowing them to be involved in the decision-making process, keeping them informed of care decisions, and importantly, providing emotional support to help the caregiver positively adapt to this transition.

Development and measurement of palliative care cultural standards using clinical indicators

Publisher: Wiley

Date: 28-02-2011

DOI: 10.1111/J.1743-7563.2011.01510.X

End of life management of adult patients in an Australian metropolitan intensive care unit: A retrospective observational study

Publisher: Elsevier BV

Date: 02-2010

DOI: 10.1016/J.AUCC.2009.10.002

Abstract: Death in the intensive care unit is often predictable. End of life management is often discussed and initiated when futility of care appears evident. Respect for patients wishes, dignity in death, and family involvement in the decision-making process is optimal. This goal may often be elusive. Our purpose was to review the end of life processes and family involvement within our Unit. We conducted a chart audit of all deaths in our 10 bed Unit over a 12-month period, reviewing patient demographics, diagnosis on admission, patient acuity, expectation of death and not-for-resuscitation status. Discussions with the family, treatments withheld and withdrawn and extubation practices were documented. The presence of family or next-of-kin at the time of death, the time to death after withdrawal of therapy and family concerns were recorded. There were 70 patients with a mean age of 69 years. Death was expected in 60 patients (86%) and not-for-resuscitation was documented in 58 cases (85%). Family discussions were held in 63 cases (90%) and treatment was withdrawn in 34 deaths (49%). After withdrawal of therapies, 31 patients (44%) died within 6h. Ventilatory support was withdrawn in 24 cases (36%). Family members were present at the time of death in 46 cases (66%). Family concerns were documented about the end of life care in only 1 case (1.4%). Our data suggests that death in our Unit was often predictable and that end of life management was a consultative process.

Research involving dying persons: Time to reconsider?

Publisher: Elsevier BV

Date: 02-2018

DOI: 10.1016/J.COLEGN.2018.01.003

Nursing care for the families of the dying child/infant in paediatric and neonatal ICU: Nurses’ emotional talk and sources of discomfort. A mixed methods study

Publisher: Elsevier BV

Date: 05-2015

DOI: 10.1016/J.AUCC.2015.01.002

Abstract: The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure. The objectives of this study were to explore how NICU/PICU nurses care for families before and after death to explore the nurses' perspectives on their preparedness/ability to provide family care and to determine the emotional content of language used by nurse participants. Focus group and in idual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content. Four core themes were identified: preparing for death communication challenges the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses. This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.

End-of-life care in hospital: an audit of care against Australian national guidelines

Publisher: CSIRO Publishing

Date: 05-03-2019

DOI: 10.1071/AH18215

Abstract: Objective The aim of this study was to map end-of-life care in acute hospital settings against Elements 1–5 of the Australian Commission on Safety and Quality in Health Care’s (ACSQHC) Essential Elements for Safe and High-Quality End-of-Life Care. Methods A retrospective medical record audit of deceased in-patients was conducted from 2016 at one public (n = 320) and one private (n = 132) hospital in Melbourne, Australia. Ten variables, key to end-of-life care according to the ACSQHC’s Elements 1–5 were used to evaluate end-of-life care. Results Most patients (87.2%) had a limitation of medical treatment. In 91.97% (P 0.0001) of cases, a written entry indicating poor prognosis preceded a documented decision to provide end-of-life care, with a documented decision noted in 81.1% of cases (P 0.0001). Evidence of pastoral care involvement was found in 41.6% of cases (P 0.0001), with only 33.1% of non-palliative care patients referred to specialist palliative care personnel (P = 0.059). An end-of-life care pathway was used in 51.1% of cases (P 0.0001). Conclusion There is clear scope for improvement in end-of-life care provision. Health services need to mandate and operationalise Elements 1–5 of the ACSQHC’s Essential Elements into care systems and processes, and ensure nationally consistent, high-quality end-of-life care. What is known about the topic? Acute care settings provide the majority of end-of-life care. Despite the ACSQHC’s Ten Essential Elements, little is known about whether current end-of-life care practices align with recommendations. What does this paper add? There is room for improvement in providing patient-centred care, increasing family involvement and teamwork, describing and enacting goals of care and using triggers to prompt care. Differences between public and private hospitals may be the result of differences in standard practice or policy and differences in cultural ersity. What are the implications for practitioners? The Essential Elements need to be mandated and operationalised into mainstream care systems and processes as a way of ensuring safe and high-quality end-of-life care.

Facing uncertainty - Pilot testing of a palliative prognostic index training with hospital aged care assessment teams

Publisher: Elsevier BV

Date: 11-2023

DOI: 10.1016/J.GERINURSE.2023.09.014

“Time and life is fragile”: An integrative review of nurses’ experiences after patient death in adult critical care

Publisher: Elsevier BV

Date: 09-2023

DOI: 10.1016/J.AUCC.2022.09.008

Abstract: Providing bereavement support and care to families is an aspect of critical care nursing practice that can be rewarding, yet emotionally and psychologically challenging. Whilst significant research has focused on end-of-life care in critical care, less is known about nurses' experiences after patient death. The aim of this study was to synthesise research evidence on the experience of registered nurses after patient death in adult critical care. A structured integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings were used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Ovid Medline, PsycInfo, Embase, and Emcare databases. Records were independently assessed against inclusion and exclusion criteria. A process of forward and backward chaining was used to identify additional papers. All papers were assessed for quality. Narrative synthesis was used to analyse and present the findings. From the 4643 records eligible for screening, 36 papers reporting 35 studies were included in this review, representing the voices of 1687 nurses from more than 20 countries. Narrative synthesis revealed three themes: (i) postmortem care, which encompassed demonstrating respect and dignity for the deceased, preparation of the deceased, and the concurrent death rituals performed by nurses (ii) critical care nurses' support of bereaved families, including families of potential organ donors and the system pressures that impeded family support and (iii) nurses' emotional response to patient death including coping mechanisms. Whilst a focus on the provision of high-quality end-of-life care should always remain a priority in critical care nursing, recognising the importance of after-death care for the patient, family and self is equally important. Acknowledging their experience, access to formal education and experiential learning and formal and informal supports to aid self-care are imperative.

An exploration of the role and scope of the Clinical nurse consultant (CNC) in a metropolitan health service

Publisher: Elsevier BV

Date: 06-2011

DOI: 10.1016/J.COLEGN.2010.09.002

Abstract: Clinical nurse consultants have been a part of the nursing workforce for some time however a lack of clarity regarding this role has led to significant variations in health service expectations, workloads and scope for the Clinical nurse consultants working within this metropolitan health service. The aim of this study was to explore the role of the CNC as it is perceived by them, in the context of this health service. A qualitative approach was used for this study. Following ethics approval a single audio-taped focus group was undertaken to gather data. Guiding questions were used to elicit responses from the group, moderated by the co-investigators. The focus group was transcribed verbatim. Each researcher independently analysed the narrative data, using coding and clustering the data to develop primary and sub-themes. Whilst each participant experiences their role in idually, there were four themes derived from comments expressed by the participants: 'Diversity and conflict', 'Leaders but powerless', 'Support systems' and 'The portfolio holder role'. The role of the Clinical nurse consultant is complex and erse. The variability in the role suggests that organisational consensus of the role, scope and purpose of the CNC position has not been actualised, resulting in a lack of support systems, and an underutilisation of the Clinical nurse consultants as leaders, where they can challenge existing practice and guide future directions in care delivery.

Nurses' roles and responsibilities in cardiac advanced life support: A single‐site eDelphi study

Publisher: Wiley

Date: 20-03-2023

DOI: 10.1111/NICC.12897

Abstract: Nurses are often the first responders to in‐hospital cardiac arrest in postoperative cardiac surgical patients. Poor clarity about role expectations and responsibilities can hinder nurses' performance during cardiac advanced life support (CALS) procedures. To seek expert consensus on nurses' roles and responsibilities in CALS for patients in postoperative cardiac surgical patients. A two‐round modified eDelphi survey. Delphi items were informed by guideline literature, an audit of resuscitation records and expert interviews. Panellists, drawn from a single site of a large tertiary health service in metropolitan Melbourne, included nurses, doctors and surgeons familiar with the management of cardiac arrest in post‐operative cardiac surgical patients. The two rounds of the modified eDelphi generated 55 responses. A consensus of % agreement was reached for 24 of the 41 statements in Round 2. All items related to nurses' roles and responsibilities during nurses pre‐ and post‐arrest phases reached consensus. In contrast, only 29% ( n = 4/14) of items related to peri‐arrest, and 36% of those related to nurse scope of practise in CALS arrest ( n = 4/11) reached consensus. The study's aim was only partially achieved. Findings indicate high agreement about nurses' roles and responsibilities before and immediately after a cardiac arrest, but limited clarity about nurses' roles when implementing the CALS protocol, such as resternotomy and internal cardiac massage. There is an urgent need to address uncertainty about nurses' roles and scope of practice in CALS, which is essential to the recognition of nurses' contribution to the cardiac specialty workforce. Uncertainty about nurses ‘roles and responsibilities when implementing the CALS protocol may hinder their performance to their full scope of practice, leading to poor patient outcomes.

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