Confronting behaviour in palliative care: a qualitative study of the lived experience of nursing staff.

BACKGROUND: Little research examines the extent and impact of aggressive or uncomfortable 'confronting behaviour' experienced by palliative care nurses, despite palliative wards being an emotionally labile environment. METHODS: Qualitative data on nurses' experiences of confrontation were collected from 17 palliative care nurses at a major metropolitan hospital via a focus group and individual interviews. Data were analysed using inductive thematic analysis. FINDINGS: Results indicated that family members were the main perpetrators and tolerance of confrontation varied dependent on the characteristics of the aggressor. Confrontation was described as arising in response to grief, and because of misunderstandings of palliative care goals. Nurses reported a perceived lack of appreciation for their work from some patients' families and feelings of discontent with the nature and amount of structured support available following a confrontation. Informal workplace support helped nurses to deal with these incidents and, despite bad experiences, nurses affirmed their commitment to working in this area. CONCLUSION: The findings demonstrate the demands placed on nurses working in palliative care, and the importance of compassion in moderating the impact of a challenging environment.

Identifying and prioritising unanswered research questions for people with hyperacusis: James Lind Alliance Hyperacusis Priority Setting Partnership.

OBJECTIVE: To determine research priorities in hyperacusis that key stakeholders agree are the most important. DESIGN/SETTING: A priority setting partnership using two international surveys, and a UK prioritisation workshop, adhering to the six-staged methodology outlined by the James Lind Alliance. PARTICIPANTS: People with lived experience of hyperacusis, parents/carers, family and friends, educational professionals and healthcare professionals who support and/or treat adults and children who experience hyperacusis, including but not limited to surgeons, audiologists, psychologists and hearing therapists. METHODS: The priority setting partnership was conducted from August 2017 to July 2018. An international identification survey asked respondents to submit any questions/uncertainties about hyperacusis. Uncertainties were categorised, refined and rephrased into representative indicative questions using thematic analysis techniques. These questions were verified as 'unanswered' through searches of current evidence. A second international survey asked respondents to vote for their top 10 priority questions. A shortlist of questions that represented votes from all stakeholder groups was prioritised into a top 10 at the final prioritisation workshop (UK). RESULTS: In the identification survey, 312 respondents submitted 2730 uncertainties. Of those uncertainties, 593 were removed as out of scope, and the remaining were refined into 85 indicative questions. None of the indicative questions had already been answered in research. The second survey collected votes from 327 respondents, which resulted in a shortlist of 28 representative questions for the final workshop. Consensus was reached on the top 10 priorities for future research, including identifying causes and underlying mechanisms, effective management and training for healthcare professionals. CONCLUSIONS: These priorities were identified and shaped by people with lived experience, parents/carers and healthcare professionals, and as such are an essential resource for directing future research in hyperacusis. Researchers and funders should focus on addressing these priorities.