'Close to' a palliative approach: nurses' and care aides' descriptions of caring for people with advancing chronic life-limiting conditions.

AIMS AND OBJECTIVES: The purpose of the study was to examine nurses' and nursing assistants' perspectives of a palliative approach in a variety of nursing care settings that do not specialise in palliative care. BACKGROUND: Ageing populations worldwide are drawing increasing attention to palliative care. In particular, people with advancing chronic life-limiting conditions often have unmet needs and may die in acute medical, residential care and home health settings without access to palliative care. A palliative approach offers an upstream orientation to adopt palliative care principles to meet the needs of people with life-limiting chronic conditions, adapt palliative care knowledge to other chronic illness conditions, and integrate and contextualise this knowledge within the healthcare system (Sawatzky et al. 2016). DESIGN: A qualitative study using the method of interpretive description carried out by a nursing research-practice collaborative, Initiative for a Palliative Approach: Evidence and Leadership (iPANEL). METHODS: Twenty-five nurses and five nursing assistants from across British Columbia, Canada participated in interviews and focus groups. Thematic analysis was used to analyse the data. RESULTS: The overarching theme was that of participants close to a palliative approach in that they cared for people who would benefit from a palliative approach, they were committed to providing better end-of-life care, and they understood palliative approach as an extension of specialised palliative care services. Participants varied in their self-reported capacity to integrate a palliative approach, as they were influenced by role clarity, interprofessional collaboration and knowledge. CONCLUSIONS: Integration of a palliative approach requires a conceptual shift and can be enhanced through interpersonal relationships and communication, role clarification and education. RELEVANCE TO CLINICAL PRACTICE: Nurses care for people with advancing chronic life-limiting conditions in a variety of settings who would benefit from a palliative approach.

Discourses of spirituality and leadership in nursing: a mixed methods analysis.

AIM: To explore nursing discourses of spirituality and leadership. BACKGROUND: Global migration has brought unprecedented plurality to modern societies, and spirituality and religion into the purview of nurse leaders. METHOD: An innovative mixed methods approach, including a literature review, qualitative research and philosophic analysis, was utilized to examine discourses of spirituality in contexts of nursing leadership. After a literature synthesis protocol, 38 nursing literature sources were reviewed. Two qualitative studies examining plurality in hospital and home health settings provided data from 13 nurse leaders. Philosophic inquiry added further depth and uncovered important underlying assumptions. RESULTS: Integrated analysis revealed a heterogeneous discourse in the nursing literature. Nurse leaders in the qualitative study evidenced awareness of the influence of spirituality and concern for inclusive health services, yet were cautious in integrating spirituality into leadership practices because of organisational and social influences. Assumptions regarding the role of leaders' spiritual values and the integration of spirituality into the workplace were revealed. CONCLUSION: Spirituality in nursing leadership is a relatively understudied field that is influenced by many contextual factors. IMPLICATIONS FOR NURSING MANAGEMENT: Scholarly engagement and research are needed to analyse the grounds for and appropriate approaches to the integration of spirituality in nursing leadership. Nurse managers are positioned to facilitate this process in their organisations.

Sacred spaces in public places: religious and spiritual plurality in health care.

Several intriguing developments mark the role and expression of religion and spirituality in society in recent years. In what were deemed secular societies, flows of increased sacralization (variously referred to as 'new', 'alternative', 'emergent' and 'progressive' spiritualities) and resurgent globalizing religions (sometimes with fundamentalist expressions) are resulting in unprecedented plurality. These shifts are occurring in conjunction with increasing ethnic diversity associated with global migration, as well as other axes of difference within contemporary society. Democratic secular nations such as Canada are challenged to achieve social cohesion in the face of growing religious, spiritual and ethnic diversity. These challenges are evident in the high-paced, demanding arena of Health care. Here, religious and spiritual plurality enter in, sometimes resulting in conflict between medical services and patients' beliefs, other times provoking uncertainties on the part of healthcare professionals about what to do with their own religiously or spiritually grounded values and beliefs. In this paper, we present selected findings from a 3-year study that examined the negotiation of religious and spiritual pluralism in Health care. Our focus is on the themes of 'sacred' and 'place', exploring how the sacred - that which is attributed as special and set apart as it pertains to the divine, transcendence, God or higher power - takes form in social and material spaces in hospitals.

Practicing the awareness of embodiment in qualitative health research: methodological reflections.

Although the importance of the researcher's embodiment has been noted in health and social sciences research, in many instances, more attention has been paid to the embodiment of the researched. Thus, more in-depth analysis of the embodied researcher can illuminate qualitative inquiry. The influence of the embodied researcher became visible in a recent critical ethnographic study examining the negotiation of religious, spiritual, and cultural plurality in health care. In this article, we do not present research findings per se, but rather methodological reflections. As researchers, we highlight emotional and bodily ways of knowing and experiences of difference such as culture, race, and religion as embodied and a part of researcher-participant encounters. We aim to elucidate the awareness of being embodied researchers, and with this elucidation, we consider implications for knowledge generation for health and social sciences.