Participation in inpatient care from the perspective of family members of palliative care patients.

BACKGROUND: The participation of family members in inpatient palliative care has been shown to be meaningful; it contributes to the wellbeing of the patient. Even so, little is known about the perspectives of family members regarding their participation in this type of care. AIM: The aim of this study was to describe participation in inpatient care from the perspective of family members of palliative care patients. METHOD: This study involved semi-structured individual interviews with family members (n=19) of patients receiving inpatient palliative care, as well as inductive thematic analysis. FINDINGS: Four main themes describing the family members' perspectives of their participation in inpatient palliative care were identified: family members attending to everyday activities, importance of participation to family members, family members providing emotional support to patients and the role of family members in discussions and decision-making processes concerning patient care. CONCLUSION: Family members participate in inpatient palliative care in different ways. Participation was experienced as important to patients and family members, and some family members felt that participation may have supported their coping process.

Healthcare professionals' perceptions of psychosocial support for family members in palliative care inpatient units-A qualitative descriptive study.

AIM: This study aimed to describe the psychosocial support healthcare professionals in specialist palliative inpatient units provide to family members of palliative care patients. DESIGN: A qualitative descriptive design. METHOD: The data were collected with focus group interviews and analysed with inductive content analysis. RESULTS: Altogether, 48 healthcare professionals, including physicians, registered nurses and practical nurses, participated in the study. Information sharing was recognised as an essential element of support. Methods to improve support of family members included an opportunity to allocate recourses to the families, systematic support and strengthening healthcare professionals' competence in family care. The healthcare professionals describe their perceptions of psychosocial support for family members primarily through patient care and the patient's situation rather than family needs. Direct support for the family members is realised principally by information sharing and conversations. Healthcare professionals express their opportunities to implement support focusing on family members' needs restricted by reason of organisational resources. The information can be used when developing and improving family care in palliative care context to recognise the most relevant needs from healthcare professionals' perspective and also when implementing healthcare professionals' education and training.

Family members' participation in palliative inpatient care: An integrative review.

AIM: To analyse how family members participate in hospital inpatient palliative care, and how their participation could be supported. METHODS: This review followed a methodology outlined in the literature for integrative reviews. A literature search supplemented by a manual search was conducted on four electronic databases during 2020 to 2021: PubMed, CINAHL, PsycINFO, and Cochrane Library. A critical appraisal of the included studies was performed, and data were analysed using inductive content analysis. RESULTS: The literature search resulted in 4990 articles, of which 14 articles were included in this review. Four main categories were identified concerning the participation of family members in hospital inpatient palliative care: participation in the physical care, provision of emotional support, promoting good patient care, and support provided by healthcare professionals for family members' participation. Family members' participation can be supported in different ways, including active communication and adequate information. CONCLUSION: Family members' participation in hospital inpatient palliative care has been an important part of palliative care in hospital settings. Family members should be offered the opportunity to participate in patient care, and their presence in the hospital should be accommodated. Research on the topic is still scarce, and future research is needed from different perspectives, including intervention research.

Supportive interventions for family members of very seriously ill patients in inpatient care: A systematic review.

AIMS AND OBJECTIVES: To systematically review existing literature exploring supportive interventions for family members of very seriously ill patients in inpatient care. BACKGROUND: Being around a patient with a very serious illness in inpatient care setting is stressful and burdensome for family members. There is little information available on interventions that support family members of very seriously ill patients in inpatient care. DESIGN: A systematic review. METHODS: The literature review was conducted in May 2020 using four databases: PubMed (Medline), CINAHL, PsycINFO and Cochrane. A quality assessment was performed using the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group by the National Heart, Lung, and Blood Institute. The PRISMA checklist was used to support specific reporting and the TIDieR checklist to form detailed descriptions of the interventions. RESULTS: Of the 7165 identified studies, 11 studies were included in the review based on predetermined criteria. Interventions were based on meetings with family members, education or therapy. Mindfulness- and therapy-based interventions and multiple-session tailored interventions showed beneficial outcomes for psychological symptoms and educational interventions on preparedness and self-efficacy. Several different measuring instruments to evaluate similar outcomes, such as psychological symptoms and coping, were used. CONCLUSIONS: Only a few supportive interventions for family members of very seriously ill patients in inpatient care were found, which made comparing the differences in the varying study methods and outcomes difficult. More studies on supportive interventions and their feasibility and effectiveness are essential. Further evaluation of instruments is necessary to identify the most valid and reliable ways of measuring symptoms and coping. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be used in clinical practice when selecting effective interventions or assessing family members' need for support. Additionally, the results can be used for guidance when developing new, effective interventions.

Nurses' required end-of-life care competence in health centres inpatient ward - a qualitative descriptive study.

BACKGROUND: Studies of nurses' required competence in EOL care in health centres are rare. It is important to produce information about experienced nurses' perceptions of the competence they consider important in their practical work. AIM: The aim of this study was to describe nurses' required competence in EOL care in health centre inpatient wards as experienced by nurses. METHOD: A descriptive qualitative study using four semi-structured group interviews (20 nurses) and inductive descriptive content analysis. RESULTS: Five categories describing nurses' required competence in EOL care in a health centre inpatient ward were identified: (1) ethics and courage in action, (2) support for the patient, (3) support for the family, (4) care planning and (5) physical care. Factors promoting nurses' competence in EOL care comprised two categories: (1) professional development in EOL care and (2) an organisation that supports EOL care. CONCLUSIONS: End-of-life care in health centre inpatient wards requires wide and complex competence from nurses. Nurses' experiences of required competence are associated with holistic care of the patient, encountering the family and multiprofessional cooperation. Nurses' competence in EOL care could be enhanced with postgraduate education, and educational planning should be given more attention in the future.

Instruments for assessing nurses' palliative care knowledge and skills in specialised care setting: An integrative review.

AIMS AND OBJECTIVES: To examine the content and reported psychometric properties of instruments for assessing nurses' palliative care knowledge and skills in specialised healthcare units. BACKGROUND: Knowledge of palliative care, and competence in the delivery of care, is essential. Assessment of competence is an important means of evaluating the knowledge and skills of practitioners in order to improve the quality of care provided for patients and their families. DESIGN: An integrative review. METHODS: A systematic literature search was conducted in November 2018 in five databases: CINAHL, PubMed (Medline), Cochrane, Scopus and Web of Science. The quality assessment was conducted using the Joanna Briggs Institute's (JBI) Checklist for Analytical Cross-Sectional Studies. The data were analysed using content analysis. PRISMA guidelines were followed to ensure explicit reporting. RESULTS: Overall, 5,413 studies were identified and 23 met the inclusion criteria. Nurses' knowledge and skills, as assessed by the instruments, were as follows: (a) care for the patient, (b) care for the patient's family and (c) professional requirements. Ten instruments were identified assessing nurses' knowledge and skills through knowledge tests and skill evaluation self-tests. The psychometric properties of the instruments were reported to varying degrees, mainly focusing on internal consistency and content validation. CONCLUSIONS: Nurses' knowledge and skills were seen to contribute to the holistic care of the patient and his or her family, and the possession of adequate information and skills is essential when dealing with death and dying. The instruments are commonly available and potentially reliable, although reliability must be determined with caution, so validation studies in other cultures are recommended. RELEVANCE TO CLINICAL PRACTICE: These results could be utilised to improve the quality of palliative care by evaluating the knowledge and skills of nursing staff or when considering the needs of palliative care education.