Feasibility of a rural palliative supportive service.

INTRODUCTION: Healthcare models for the delivery of palliative care to rural populations encounter common challenges: service gaps, the cost of the service in relation to the population, sustainability, and difficulty in demonstrating improvements in outcomes. Although it is widely agreed that a community capacity-building approach to rural palliative care is essential, how that approach can be achieved, evaluated and sustained remains in question. The purpose of this community-based research project is to test the feasibility and identify potential outcomes of implementing a rural palliative supportive service (RPaSS) for older adults living with life-limiting chronic illness and their family caregiver in the community. This paper reports on the feasibility aspects of the study. METHODS: RPaSS is being conducted in two co-located rural communities with populations of approximately 10 000 and no specialized palliative services. Participants living with life-limiting chronic illness and their family caregivers are visited bi-weekly in the home by a nurse coordinator who facilitates symptom management, teaching, referrals, psychosocial and spiritual support, advance care planning, community support for practical tasks, and telephone-based support for individuals who must commute outside of the rural community for care. Mixed-method collection strategies are used to collect data on visit patterns; healthcare utilization; family caregiver needs; and participant needs, functional performance and quality of life. RESULTS: A community-based advisory committee worked with the investigative team over a 1-year period to plan RPaSS, negotiating the best fit between research methods and the needs of the community. Recruitment took longer than anticipated with service capacity being reached at 8 months. Estimated service capacity of one nurse coordinator, based on bi-weekly visits, is 25 participants and their family caregivers. A total of 393 in-person visits and 53 telephone visits were conducted between January 2013 and May 2014. Scheduled in-person visit duration showed a mean of 67 minutes. During this same time period only 19 scheduled visits were declined, and there was no study attrition except through death, indicating a high degree of acceptability of the intervention. The primary needs that were addressed during these visits have been related to chronic disease management, and the attending physical symptoms were addressed through teaching and support. The use of structured quality of life and family caregiver needs assessments has been useful in facilitating communication, although some participants experienced the nature of the questions as too personal in the early stages of the relationship with the nurse coordinator. CONCLUSIONS: Findings from this study illustrate the feasibility of providing home-based services for rural older adults living with life-limiting chronic illness. The RPaSS model has the potential to smooth transitions and enhance quality of life along the disease trajectory and across locations of care by providing a consistent source of support and education. This type of continuity has the potential to foster the patient- and family-centered approach to care that is the ideal of a palliative approach. Further, the use of a rural community capacity-building approach may contribute to sustainability, which is a particularly important part of rural health service delivery.

Strengthening transcendent meaning. A model for the spiritual nursing care of patients experiencing suffering.

The purpose of this article is to present a model for the spiritual nursing care of patients experiencing suffering. Meaningless suffering can lead to spiritual disintegration. However, the finding of transcendent meaning in the suffering experience can be a profound attenuator of how the suffering is experienced. This model outlines five categories for a comprehensive spiritual assessment: (a) authority and guidance, (b) experience and emotions, (c) community, (d) rituals and practices, and (e) vocation and consequences. For each of the five categories, interventions are identified that could strengthen transcendent meaning in the suffering.

Leadership through interdisciplinary teams: a case study of an acute pain service.

Interdisciplinary teams are rapidly becoming the standard for the organization and delivery of acute care services. Increasingly, research is showing that an interdisciplinary approach has the potential to improve patient care. Implementing a team approach, however, has challenges because of the various perspectives that different disciplines bring. In this paper we present a case study of an Acute Pain Service to illustrate how an interdisciplinary team can work to improve pain management in hospitals. The development of the Acute Pain Service will be described along with a discussion of the challenges that were faced. Key lessons will be presented that may lend direction for the implementation of an Acute Pain Service or for any other interdisciplinary team.

Evaluation of an acute pain service.

During the last two decades, knowledge has increased significantly regarding the treatment of acute pain. One of these advances has been the implementation of multidisciplinary Acute Pain Services in the hospital setting to take on accountability for acute pain management. Acute Pain Services are expanding rapidly in the Canadian health care system. Nurse administrators will be increasingly called upon to help with the establishment and evaluation of these programs. The purpose of this study was to examine the effectiveness of, and staff satisfaction with, one Canadian Acute Pain Service. Results of the study indicated that staff were generally satisfied with the Acute Pain Service and felt that the program had made a significant impact on the treatment of acute pain within the hospital; although improvements in pain outcomes were not noted. Adequate communication mechanisms and resources to allow for appropriate workload, education and clinical support are critical to the development and success of an Acute Pain Service.