A palliative care communication simulation for undergraduate nursing and midwifery students: A pilot study.

BACKGROUND: Undergraduate nursing education prepares student for entry into the profession. Palliative care is an essential component of nursing education; however, a focus on the management of symptom burden fails to prepare the undergraduate in communication skills required for palliative or end-of-life care (EoLC). Simulation to teach acute care is well researched; however, limited studies explore simulation for palliative care or EoLC. Fewer studies combine communication with palliative care simulation. OBJECTIVES: The overarching aim is to explore the influence of a palliative care communication simulation on undergraduate nursing students. METHODS: Participants were students recruited from two campuses at a major Australian university in 2021. Students attended a compulsory simulation for all nursing or nursing and midwifery students. Pre- and post-simulation questionnaires collected qualitative and quantitative responses from participants. This paper reports that the quantitative data captured included demographic information, and the Frommelt Attitude Toward Care of the Dying (FATCOD-B) tool, to assess the attitudes. The qualitative component of the research will be reported as a separate paper. RESULTS: A statistically significant increase in FATCOD-B scores was observed between pre- and post-simulation questionnaires, as well as a statistically significant difference related to the gender of participants. Age and previous experience with death also impacted FATCOD-B results. SIGNIFICANCE OF RESULTS: The increase in FATCOD-B scores demonstrate that the positive impact of simulation suggests the importance of educational interventions such as the one conducted in this study. Education to improve the attitude toward caring for the dying and communication skills for difficult conversations are relevant and valuable. Further research is indicated.

Family-centered care and pediatric death in the emergency department: A qualitative study using framework analysis.

BACKGROUND: Family-centered care is an important concept underpinning care of children. Although much researched in some settings, little research has explored specialist settings, or areas where both children and adults are cared for, such as the emergency department. METHODS: This study sought to explore how nurses employ family-centered care in delivering care to children and families when a child dies in the emergency department. Using a descriptive, qualitative approach, semi-structured interviews were conducted with 24 emergency nurses from six Australian states. Interviews were audio-recorded and transcribed verbatim. Framework analysis was applied to examine alignment with family-centered care principles. FINDINGS: Nurses described providing support and education, and encouraged families to engage in care decisions, including about ceasing resuscitation efforts. Commonly, senior staff members were allocated during emergencies to support parents. DISCUSSION: Emergency nurses should be offered education on family-centered care, and research undertaken to explore families' experiences of their child dying in the emergency department. PRACTICE IMPLICATION: Family-centered care should be a focus for the care of children and their families in the emergency department, regardless of the pressure from rapidly occurring events.

Self-compassion training in palliative care during COVID-19: A pilot study.

OBJECTIVES: This pilot project replicated a self-compassion program to support health-care professionals in palliative care settings. We anticipated that undertaking this program would enhance participants' psychological well-being. METHODS: Participants were recruited by convenience sampling from palliative care services in an area of Melbourne, Australia. Because of the COVID-19 pandemic, the program was offered online and comprised six once-weekly gatherings. Three survey rounds with identical questions were conducted prior to, immediately after, and 3 months after the training. The surveys consisted of 6 scales: the Self-Compassion Scale, the Santa Clara Brief Compassion Scale, the Cognitive and Affective Mindfulness Scale, the Depression Anxiety Stress Scale, the Professional Quality of Life Scale, and the Interpersonal Reactivity Index Scale. Paired-sample t-test and repeated measures analysis of variance analyses were used to compare participant responses. RESULTS: Nine participants working in palliative care completed the training and 3 surveys and included qualitative responses. The experience was overwhelmingly positive. Self-compassion (F = 14.44; p < 0.05) and mindfulness (F = 18.44; p < 0.05) scores significantly increased post-training, were picked up in a short time and endured. The emotional state improved by compassion satisfaction, showing a positive improvement 3 months post-training, along with there being no changes in compassion satisfaction, burnout, and dispositional empathy. SIGNIFICANCE OF RESULTS: Participants all worked in a supportive environment, which encouraged self-care. Even against the pandemic difficulties, a short online program was effective, assisting participants to cultivate their inner resources in mindfulness and self-compassion. While a small sample size, expansion of the training may benefit the wider palliative care workforce.

Transforming their lives: post-traumatic growth experience in Chinese women with breast cancer-a grounded theory study.

Our research sought to explore post-traumatic growth experience among Chinese women with breast cancer. Constructivist grounded theory methodology was utilised to understand Chinese women's post-traumatic growth experience. 24 women with breast cancer were recruited from China. Data was collected through semi-structured, interviews. Three categories were developed from the data: renewing self-perception, encountering changes in relationships, and altering philosophical values and beliefs. The unique manifestations of post-traumatic growth highlight the need for development and adaption of the post-traumatic growth inventory to reduce cultural biases within the assessment tool and incorporate new culturally appropriate items.

Emerging From the "Ku:" Fluctuating in Adjusting With Breast Cancer-A Post-Traumatic Growth Theory Situated Within Chinese Culture.

This purpose of the study was to construct a model (theory) to understand Chinese women's adjustment process in living with breast cancer. A constructivist grounded theory method was adopted in this study. A total of 24 women were recruited through purposive and theoretical sampling. Semi-structured, audio-recorded interviews were undertaken in Chinese and transcribed. Initial coding, focused coding, and theoretical coding approaches were used to identify subcategories and categories, and to construct the emergent theory. The basic social process these women used to deal with the breast cancer diagnosis was identified as: Emerging from the 'ku': Fluctuating in adjusting with breast cancer. Four categories were revealed following analysis: confronting challenges, orienting to reality, accommodating the illness, and transforming their lives, which encapsulated the main cognitive and emotional processes in which Chinese women engaged in their adjustment to living with their illness. The core process was influenced by a variety of contextual influences, which were identified as personal factors, social-environmental factors, and some specific cultural factors which emphasized positive changes. Chinese cultural values such as "Wuwei" coping strategies, familial primacy, and Chinese self-disclosure contribute to Chinese women's adjustment processes and post-traumatic growth experiences. Hence, there is a need to consider Chinese cultural features, in designing culturally tailored supportive programs in multi-cultural clinical settings.

Nurses' resilience and nurturance of the self.

BACKGROUND: Despite the losses experienced by nurses in their role in palliative care, they wish to continue working in this environment. This is described as resilience, which enhances coping in dealing with death and grief. AIM: To explore the nature of nurses' resilience and the way it is developed. DESIGN: A qualitative research design using grounded theory methods was employed. With theoretical sampling, 18 interviews were conducted and theoretical saturation was achieved. RESULTS: Self-nurturing was evident as the way nurses developed resilience, which included knowledge of self, coping adaptively, valuing care and accepting limitations. DISCUSSION: All participants spoke of the characteristics of resilience from the blend of individual responsibility for self and the support provided by others. However, none had educational pathways to build greater resilience. CONCLUSION: Integrating support and education to foster nurses' resilience is important to enable self-protection, as well as the provision of high quality care.

Developing relationships: A strategy for compassionate nursing care of the dying in Japan.

OBJECTIVES: The aim of this study was to explore the type of relationship and the process of developing these relationships between nurses and patients in palliative care units in Japan. The special contribution that culture makes was examined to better understand the intensity of nurses' grief after the death of their patient. METHODS: Thirteen Japanese registered nurses currently practicing in palliative care units were interviewed between July 2006 to June 2009. Theoretical sampling was utilised and the data were analysed using grounded theory methodology. Constant comparison was undertaken during coding processes until data saturation was achieved. RESULTS: Significant cultural influences emerged both in the type of relationship nurses formed with patients and in the way they developed relationships. The type of relationship was termed 'human-to-human', meaning truly interpersonal. The cultural values of 'Uchi (inside) and Soto (outside)' have particular implications for the relationship. Four actions Being open, Trying to understand, Devoting time and energy, and Applying a primary nurse role, were identified as strategies for nurses to develop such relationships. The quality of this deeply committed encounter with patients caused nurses to grieve following patients' death. SIGNIFICANCE OF RESULTS: Culture is a major influence upon the reasons, complexities, and impact that lie behind nurses' behaviours. Attention is needed to support nurses to sustain a fundamental caring quality in their relationships with patients.

Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis.

BACKGROUND: Evidence suggests that there is a gap in advance care planning (ACP) completion between vulnerable and disadvantaged populations compared with the general population. This review seeks to identify tools, guidelines or frameworks that have been used to support ACP interventions with vulnerable and disadvantaged adult populations as well as their experiences and outcomes with them. The findings will inform practice in ACP programmes. METHODS: A systematic search of six databases from 1 January 2010 to 30 March 2022 was conducted to identify original peer-reviewed research that used ACP interventions via tools, guidelines or frameworks with vulnerable and disadvantaged adult populations and reported qualitative findings. A narrative synthesis was conducted. RESULTS: Eighteen studies met the inclusion criteria. Relatives, caregivers or substitute decision-makers were included in eight studies. SETTINGS: hospital outpatient clinics (N=7), community settings (N=7), nursing homes (N=2), prison (N=1) and hospital (N=1). A variety of ACP tools, guidelines or frameworks were identified; however, the facilitator's skills and approach in delivering the intervention appeared to be as important as the intervention itself. Participants indicated mixed experiences, some positive, some negative and four themes emerged: uncertainty, trust, culture and decision-making behaviour. The most common descriptors relating to these themes were prognosis uncertainty, poor end-of-life communication and the importance of building trust. CONCLUSION: The findings indicate that ACP communication could be improved. ACP conversations should incorporate a holistic and personalised approach to optimise efficacy. Facilitators should be equipped with the necessary skills, tools and information needed to assist ACP decision-making.

Nurses' experiences, coping and support in the death of a child in the emergency department: A qualitative descriptive study.

BACKGROUND: A child's death in the Emergency Department (ED) is usually unexpected and traumatic. Understanding nurses' experiences encountering such death is crucial in determining how they cope to provide quality nursing care to dying children and their families. PURPOSE: To report ED nurses' experiences with children's death, coping strategies and support needs. PROCEDURES: A qualitative descriptive design. Twenty-four registered nurses who had cared for a child who died in the ED took part in semi-structured interviews. Interviews were audiorecorded, and analyzed using thematic analysis. FINDINGS: Three themes were generated: 'nature of emergency department work', 'working with families' and 'coping and support'. This paper reports on the theme 'coping and support'. Although children's deaths were traumatizing and affected nurses personally and professionally, constant time pressure allowed limited reflection time. Common individual coping mechanisms used by participants included external strategies through support from other staff members including peer-support and informal supervision, and internal strategies through personal coping strategies. Participants expressed need for greater support and education/training to effectively deal with pediatric death, children's families, and their own grief. CONCLUSIONS: Children's deaths and nature of ED care affected nurses. Adequate support and deathrelated education were urged by participants to promote high-quality care provision.

Staff grief and support systems for Japanese health care professionals working in palliative care.

OBJECTIVE: This article is a literature report on grief issues for health care professionals, undertaken to identify Japanese nurses' grief experience when they work in palliative care units. Health care professionals' grief experience and its impact have not been well understood or identified as a significant issue in Japan. METHODS: Published articles relating to this study were searched using electronic catalogues such as CINAHL and PsycINFO, books, and research publications. Key words used for the search were "grief," "palliative care," "nurse," "staff support," and "Japan." Both English and Japanese were used for the literature search in order to collect information regarding nurses' grief and support systems in Japan and elsewhere. The literature search covered the period 1990-2006 inclusive. RESULTS: This article explores these issues in the literature as preparation for establishing a study that will particularly look at the influence of nurses' grief on the quality of care provided. SIGNIFICANCE OF RESULTS: Consideration of Japanese culture as it relates to death and dying and to nursing culture is a significant part of this work.

A Voice Needs to be Heard: The Meaning of "Going Home".

BACKGROUND:: This case report addresses a client from a minority cultural background in Australia and her complex cultural needs at the end of life. CASE HISTORY:: A 66-year-old Japanese female client diagnosed with renal cancer, and lung and spine metastasis shared her story. Since a left nephrectomy in 2007, she has had hemodialysis 3 days a week. She left Japan more than 30 years ago and moved to Australia 20 years ago. With the 6-month prognosis, she expressed her desire to "go home." The meaning of "going home" was explored with the author who shares the same cultural background and language and is a palliative care nurse. The meanings for wanting to go home were her nostalgia for the traditional food, language, land, and death rituals. DISCUSSION:: The client identified her preferred place to die and discussed her death wishes. Open, honest communication with health professionals about her condition and prognosis facilitated meaningful discussions. CONCLUSION:: The narrative demonstrates the complex issues and needs of clients from minority cultural backgrounds and the importance of understanding the real cultural meaning behind their stories. Exploring the meaning with compassionate curiosity as well as interpretation support was the key.

Emergency and palliative care nurses' levels of anxiety about death and coping with death: a questionnaire survey.

BACKGROUND: Caring for dying patients and their families presents many challenges, and may be negatively affected by nurses' Fear of Death. This study investigates attitudes of emergency and palliative care nurses towards death and dying. METHODS: A mixed methods design including questionnaire and interview, was utilised. This paper reports questionnaire results from the Death Attitude Profile-Revised Scale and coping skills. RESULTS: Twenty-eight emergency nurses and 28 palliative care nurses from two health services participated. Nurses held low to moderate Fear of Death (44%), Death Avoidance (34%), Escape Acceptance (47%) and Approach Acceptance (59%). Emergency nurses reported higher death avoidance and, significantly lower coping skills than palliative care nurses. Both reported high acceptance of the reality of death (Neutral Acceptance 82%), and indicated they coped better with a patient who was dying than with, the patient's family. CONCLUSIONS: Nurses generally held positive attitudes towards death and dying. Participants could cope with caring for dying patients, but were significantly less comfortable coping with patients' family members. Nurses should be aware of the impact their attitude towards death may have on providing supportive nursing care for the dying.