Barriers and facilitators to early initiation of palliative care as perceived by nurses working on pneumology and nephrology, a descriptive qualitative study.

IF 1.9 4区 医学 Q2 NURSING
Kristel Paque, Lars Baudry, Frank Van Fraeyenhove, Bert Heyrman
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引用次数: 0

Abstract

Aims and objectives: Initiation of palliative care early in the disease trajectory is beneficial for patients with a life-limiting disease. However, palliative care is still introduced rather late or not at all. Therefore, this study aims to explore barriers and facilitators to early initiation of palliative care as perceived by nurses working on pneumology and nephrology.

Methods: A descriptive interview-based study was conducted from a critical realist perspective until data sufficiency was reached. Fifteen nurses presented and discussed a patient for whom palliative care was initiated too late. Template analysis was conducted to develop themes and subthemes.

Results: Five key themes were extracted: (1) communication, (2) fear, (3) personal beliefs about life and death, (4) ambiguity in terminology and (5) workload and time pressure. Barriers related to poor interdisciplinary communication were therapeutic obstinance, hierarchy, unawareness of the patient's wishes and fear of saying something inappropriate. Other barriers were patients' religious beliefs which often hindered the use of sedatives or morphine and led to discomfort and time restraints. A palliative support team in hospital and advance care planning (ACP) were enablers for early palliative care.

Study limitations: This study started from a negative experience, leading to identification of a lot of barriers and only a few facilitators. The limited sample size and the restriction to two wards within one single hospital limit the diversity of perspectives and the generalisability of the findings.

Conclusion: More attention is needed for ACP and interdisciplinary communication. Palliative care, including ACP, and interdisciplinary communication should be included in the basic curricula of all healthcare professional courses. Further research is needed to explore barriers and facilitators to early initiation of palliative care in other healthcare settings and patient populations. This is crucial in order to develop and implement sustainable interventions for specific groups of patients.

一项描述性定性研究:从事肺病学和肾病学工作的护士对早期启动姑息关怀的障碍和促进因素的看法。
目的和目标:在疾病发展轨迹的早期启动姑息关怀对患有局限生命疾病的病人是有益的。然而,姑息关怀的引入仍然较晚或根本没有引入。因此,本研究旨在探讨从事肺病学和肾病学工作的护士所认为的早期启动姑息关怀的障碍和促进因素:方法:从批判现实主义的角度出发,进行了一项以访谈为基础的描述性研究,直到数据充分为止。15 名护士介绍并讨论了一名姑息关怀启动过晚的患者。研究采用模板分析法来确定主题和次主题:提取了五个关键主题:(1) 沟通;(2) 恐惧;(3) 对生死的个人信念;(4) 术语含糊不清;(5) 工作量和时间压力。与跨学科沟通不畅有关的障碍包括治疗障碍、等级制度、不了解病人的意愿以及害怕说出不恰当的话。其他障碍还包括病人的宗教信仰,这通常会阻碍镇静剂或吗啡的使用,并导致不适和时间限制。医院的姑息支持团队和预先护理计划(ACP)是早期姑息关怀的促进因素:研究局限性:本研究从患者的负面经历入手,发现了许多障碍,而只有少数促进因素。样本数量有限,且仅限于一家医院的两个病房,这限制了观点的多样性和研究结果的普遍性:结论:ACP 和跨学科交流需要得到更多关注。姑息关怀(包括 ACP)和跨学科交流应纳入所有医疗保健专业课程的基础课程中。需要进一步开展研究,探索在其他医疗环境和患者群体中早期启动姑息关怀的障碍和促进因素。这对于为特定患者群体制定和实施可持续的干预措施至关重要。
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来源期刊
CiteScore
4.60
自引率
5.30%
发文量
71
期刊介绍: Scandinavian Journal of Caring Sciences is an established quarterly, peer reviewed Journal with an outstanding international reputation. As the official publication of the Nordic College of Caring Science, the Journal shares their mission to contribute to the development and advancement of scientific knowledge on caring related to health, well-being, illness and the alleviation of human suffering. The emphasis is on research that has a patient, family and community focus and which promotes an interdisciplinary team approach. Of special interest are scholarly articles addressing and initiating dialogue on theoretical, empirical and methodological concerns related to critical issues. All articles are expected to demonstrate respect for human dignity and accountability to society. In addition to original research the Journal also publishes reviews, meta-syntheses and meta-analyses.
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