ABSTRACT
AIMS AND OBJECTIVES: To evaluate the extent to which the Davies and Oberle (1990) model of supportive nursing has currency across specialist and specialised care settings in England. BACKGROUND: The model describes attributes of palliative nursing for practice and associated educational curricula. It is influential but predates introduction of specialist/specialised care. Its applicability in contemporary care settings has not been evaluated. DESIGN: Evaluation was undertaken using sequential mixed methods, predominantly qualitative. Data collected during 2008-2009. METHODS: Four stages: (1) focus groups involving hospital and community palliative clinical nurse specialists and nurses from three hospice settings (total = 25) to identify setting-specific characteristics, (2) survey of nurses (n = 48 respondents/31%) with follow-up interviews (n = 25) to identify congruence with the model, (3) interviews with patients (n = 6) and carers (n = 13) for practice evidence and (4) reconvened focus groups (n = 19 nurses) for confirmation. RESULTS: All major dimensions were evidenced. 'Connecting' had reduced emphasis in the hospital setting where specialist nurses spend limited time with patients, but diminishing time to 'connect' with patients and carers as service develops could potentially become problematic across all settings. Two new dimensions ('Displaying expertise' and 'Influencing other professionals') with subdimensions (e.g. 'Advanced communication skills') are proposed as additions to reflect advanced practice. Further new subdimensions ('Making the assessment', 'Prioritising', 'Agreeing the plan') are suggested to be best aligned with the existing dimension 'Connecting'. CONCLUSIONS: A revised model of supportive care incorporating dimensions of advanced nursing has currency in contemporary specialist/specialised care settings, although evaluation is required as to the actual impact of the model on care outcomes. 'Connecting' is currently being affected by pace of work and lateness of referrals. IMPLICATIONS FOR PRACTICE: 'Spending time' is increasingly difficult to sustain so challenging nurses as to how they may continue to 'connect' with patients as service delivery continues to change.
Subject(s)
Models, Nursing , Nurse's Role , Palliative Care , Program Evaluation , England , Focus Groups , Humans , Nurse Clinicians , Rural Health , State Medicine , Urban HealthABSTRACT
Advanced care plans provide an opportunity for patient choice and self-determination. This article describes the process, outcome and impact of the introduction of an advanced care plan into community and inpatient settings. It demonstrates the usefulness of the tool, and the way in which it improves the chances of people dying in their preferred place of care, particularly when used in the community. It also illustrates the effect on nursing practice of improved patient, family and professional communication, and through that, patient empowerment. It confirms the benefits of integrating evaluation into new initiatives, which facilitates useful feedback to stakeholders.
Subject(s)
Advance Care Planning/organization & administration , Palliative Care/organization & administration , Attitude of Health Personnel , Choice Behavior , Diffusion of Innovation , Documentation , England , Guideline Adherence , Humans , Motivation , Nursing Evaluation Research , Nursing Staff/education , Nursing Staff/organization & administration , Nursing Staff/psychology , Outcome and Process Assessment, Health Care , Palliative Care/psychology , Patient Participation/methods , Patient Participation/psychology , Pilot Projects , Practice Guidelines as Topic , Prospective Studies , Retrospective StudiesABSTRACT
This paper reports on the management and outcome of a pilot of The Preferred Place of Care document in south Essex. This is a summary of the paper, the full version can be accessed at nursingtimes.net.