Saturday, 14 October 2017

VI Adult Palliative Care: The changing landscape of adult palliative care in the 21st Century

To coincide with Hospice Care Week (October 9th-15th) and World Hospice and Palliative Care Day on October 14th, JAN has created a virtual issue to showcase cutting edge research. The selected papers clearly demonstrate the changing landscape of palliative care in the 21st Century. Nurses still find it highly challenging to break bad news and need more support and training to do it well (Warnock et al 2017). Two conceptual papers help advance understanding on the importance of hope (Broadhurst & Harrington 2015) and autonomy and choice (Wilson et al 2015) for people at the end of life.

Many more people are living and dying with dementia and yet planning ahead and involving residents living in nursing homes and their families is not sufficiently consistent and practice varies widely (Ampe et al 2015). Hospices are broadening their services beyond the original group of people with cancer and there is also a movement towards people wanting more end of life care facilitated at home. In order for this to happen, hospices have extended their reach and specific services such as ‘hospice at home’ and community palliative nursing services have been established. Jack et al (2017) provide some insights into the experiences of people who are dying and their families who receive hospice at home services. Delivering palliative care at home involved multiple agencies and professionals, which can be difficult to coordinate efficiently. Van der Plas et al (2015) explore the benefits of palliative care case managers to coordinate between community nurses and general practitioners.
People generally fear distressing symptoms and in particular whether they will experience pain at the end of their lives. Three papers look at these important issues and offer nurses evidence to inform their decision-making and practice in these areas (Van Lancker et al 2016Hökkä et al 2014, and Bowers & Redsell 2017). Finally, many people die in intensive care settings. There is less evidence to inform optimal patient and family centred end of life care and practice in these medically dominated contexts. Three papers look at the highly sensitive issues of withdrawal of treatment (Coombs et al 2016), life after the Liverpool Care Pathway (Venkatasalu et al 2015), and implementing a new end of life care guideline in intensive care (Noome et al 2016).
Jane Noyes

Articles will be free to access until April 2018
Ampe S., Sevenants A., Smets T., Declercq A. & Van Audenhove C. (2016) Advance care planning for nursing home residents with dementia: policy vs. practiceJournal of Advanced Nursing 72(3), 569–581. doi: 10.1111/jan.12854
Bowers B, Redsell S. A qualitative study of community nurses’ decision-making around the anticipatory prescribing of end-of-life medicationsJournal of Advanced Nursing. 2017;73:2385–2394.
Broadhurst K. & Harrington A. (2016) A mixed method thematic review: the importance of hope to the dying patientJournal of Advanced Nursing 72(1), 18–32. doi: 10.1111/jan.12765
Coombs M.A., Parker R., Ranse K., Endacott R. & Bloomer M.J. (2017) An integrative review of how families are prepared for, and supported during withdrawal of life-sustaining treatment in intensive careJournal of Advanced Nursing 73(1), 39–55. doi: 10.1111/jan.13097
Hökkä M., Kaakinen P. & Pölkki T. (2014) A systematic review: non-pharmacological interventions in treating pain in patients with advanced cancerJournal of Advanced Nursing 70(9), 1954–1969. doi: 10.1111/jan.12424
Jack B.A., Mitchell T.K., Cope L.C. & O'Brien M.R. (2016) Supporting older people with cancer and life-limiting conditions dying at home: a qualitative study of patient and family caregiver experiences of Hospice at Home careJournal of Advanced Nursing 72(9), 2162–2172. doi: 10.1111/jan.12983
Noome M., Dijkstra B.M., van Leeuwen E. & Vloet L.C.M. (2017) Effectiveness of supporting intensive care units on implementing the guideline ‘End-of-life care in the intensive care unit, nursing care’: a cluster randomized controlled trialJournal of Advanced Nursing 73(6), 1339–1354. doi: 10.1111/jan.13219
Ramasamy Venkatasalu M., Whiting D. & Cairnduff K. (2015) Life after the Liverpool Care Pathway (LCP): a qualitative study of critical care practitioners delivering end-of-life careJournal of Advanced Nursing 71(9), 2108–2118. doi: 10.1111/jan.12680
van der Plas A.G.M., Onwuteaka-Philipsen B.D., Vissers K.C., Deliens L., Jansen W.J.J. & Francke A.L. (2016) Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire studyJournal of Advanced Nursing 72(1), 147–157. doi: 10.1111/jan.12818
Van Lancker A., Beeckman D., Van Den Noortgate N., Verhaeghe S. & Van Hecke A. (2017) Frequency and intensity of symptoms and treatment interventions in hospitalized older palliative cancer patients: a multicentre cross-sectional studyJournal of Advanced Nursing 73(6), 1455–1466. doi: 10.1111/jan.13230
Warnock C., Buchanan J. & TOD A.M. (2017) The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad newsJournal of Advanced Nursing 73(7), 1632–1645. doi: 10.1111/jan.13252
Wilson F., Ingleton C., Gott M. & Gardiner C. (2014) Autonomy and choice in palliative care: time for a new model? Journal of Advanced Nursing 70(5), 1020–1029.doi: 10.1111/jan.12267

Friday, 13 October 2017

Missed care in the community

Missed care in the community

Missed care in the community

Roger Watson, Editor-in-Chief

There is much greater interest these days in missed care. Defined as: 'any aspect of required patient care that is omitted (either in part or in whole) or delayed' missed care clearly leads to poor patient care up to and including avoidable death. The aim of this study from Ireland by Phelan et al. (2017) titled: 'Examining missed care in community nursing: A cross section survey design' and published in JAN was to: 'examine the prevalence of missed care in the community nursing.'

Over 450 nurses working in the community took part by completing an online questionnaire. The questioninare had over 70 items on aspects of nursing care considered to be essential. The care that was missed more than 50% of the time is presented in a table in the article and the aspect of care nost commonly missed was health promotion and next most common were aspects of care management such as liaising with other professionals. Some aspects of msised care were associated with the characteristics of the nurses. For example, younger and  less experienced nurses were more likely to miss aspects of the initial assessment of patients. In summary the study showed: 'The results of the study indicate a high prevalence of missed care in the community nurses surveyed and that preventative care was the type of care most likely to be missed.'

The authors concluded: 'This study is the first to examine the concept of missed care in a
community nursing setting. Nurses who participated in the research are struggling in the multiple and dynamic care responsibilities expected in diverse population groups' and ' levels of missed care need to be regularly monitored in governance systems to ensure a fit for practice service and to promote optimal client health outcomes.'

You can listen to this as a podcast


Phelan, A., Mccarthy, S. and Adams, E. (2017), Examining missed care in community nursing: A cross section survey design. J Adv Nurs. doi:10.1111/jan.13466