Bergdahl, E., Benzein, E., Ternestedt, B., Elmberger, E., & Andershed, B. (2013). Co-Creating Possibilities for Patients in Palliative Care to Reach Vital Goals: A Multiple Case Study of Home-Care Nursing Encounters. Nursing Inquiry, 20(4), 341-351. doi:10.1111/nin.12022
The study is devoted to the relationships of home-care palliative teams (primarily nurse practitioners, NPs), patients, and their families. It is a multiple case study that involved the observation and analysis of nursing encounters of 120 patients. The study was conducted for a year; the measures of the success included the co-creation of possibilities (planning) and their achievement. The references appear to be appropriate. The authors emphasized the atmosphere of support and caring, the importance of dialogue, planning, and knowledge sharing. They developed a model of possibilities co-creating that included these elements and demonstrated the relationship between NP actions and achievements in the field of planning. The result is of noticeable importance for the proposed project: in the latter, the role option is NP, and the potential problem is the effectiveness of NPs in palliative care. The described study provides an example of the results of NPs’ actions and demonstrates how to improve their practice. To avoid personal bias, the researchers invited two observers to every case study. However, the NPs and their patients were volunteers and had a positive prior relationship. The NPs could have avoided more difficult cases, which is a bias of selection. The authors conclude by describing their model as a valid way of building the relationships between an NP and patient; also, they regard their article as a source of documented experiences for study. They do not insist that this is a superior way; they only demonstrate that co-planning reduces the feeling of uncertainty. In general, the study is relevant for the proposed project since it demonstrates a way of improving the effectiveness of an NP’s work.
Enguidanos, S., Housen, P., Penido, M., Mejia, B., & Miller, J. (2013). Family Members’ Perceptions of Inpatient Palliative Сare Consult Services: A Qualitative Study. Palliative Medicine, 28(1), 42-48. doi:10.1177/0269216313491620
The aim of the study consists in defining the role of palliative care teams (including NP) in working with the family of the patients. The study involved semistructured interviews; 23 family members dwelled on the understanding of the situation and the perceived quality of life of the patient as affected by the work of the palliative team. The data was deductively analyzed. Besides, the research involved using numerous references, all of which appear to be appropriate. The results indicated that the team managed to create a comfortable environment due to their communication choices. The educational function was performed with a varied level of success (some of the participants indicated conflicting messages). Some of the participants also insisted that the consultation helped them to accept the situation and make decisions. Finally, patients appreciated the holistic approach employed by the palliative team. The study emphasizes the significance of family aspects, which are not the focus of the NPs’ palliative practice but tend to have a significant impact it. This aspect of palliative care is typically overlooked. Unfortunately, the study does not focus on NPs, but the results are applicable. It is an obvious fact that the presented paper has the shortcomings of low statistical power and non-generalizable settings. The authors realize it and avoid making generalizations, instead emphasizing the perceptions of family members as indicators of the areas of palliative care that should be paid attention (especially concerning clarifications since the clarity of messages received negative feedback). To sum up, the research is a relatively weak reference with respect to the problem and role option, but the unique point of view makes it noteworthy.
Gardiner, C., Harrison, M., Ryan, T., & Jones, A. (2013). Provision of Palliative and End-Of-Life Care in Stroke Units: A Qualitative Study. Palliative Medicine, 27(9), 855-860. doi:10.1177/0269216313483846
The article is aimed at discovering the directions and applicability of health professionals’ actions (including NPs) with respect to stroke units palliative care. Its references are recent and come from reputable journals or websites. The study involved 66 health professionals (focus groups and individual interviews). The work provides evidence to the fact that the professionals concerned with various aspects of stroke care consider palliative medicine necessary, but find certain issues controversial (for example, its integration with stroke care). They also expressed their opinion on the significant aspects of palliative care The study provides evidence to the significance of palliative care for stroke care, but the information on NPs in it is very limited (one interview). Also, it is not described how NPs can contribute to palliative care (mostly because the ways of providing it are not described at all). Still, the study demonstrates the palliative care from the point of view of various medical workers including NPs. The limitations of the study are concerned with the sampling: it is of relatively low statistical power and diversity: it belongs to one region in the UK. The authors conclude that their study demonstrates the adoption of palliative care in the UK and provides the information about the suggestions and concerns of the people practicing it in the field of stroke care. The issues mentioned by the participants can be proposed for the attention of practitioners and policy makers. To sum up, the study can contribute the perceptions of NPs concerning palliative care to the study, but the information is concerned with a particular setting (stroke care in the UK) and is has a limited generalizability.
Vahedi Nikbakht-Van de Sande, C., Braat, C., Visser, A., Delnoij, D., & van Staa, A. (2014). Why a Carefully Designed, Nurse-Led Intervention Failed to Meet Expectations: The Case of the Care Programme for Palliative Radiotherapy. European Journal Of Oncology Nursing, 18(2), 151-158. doi:10.1016/j.ejon.2013.11.005
The study is devoted to the evaluation of a particular NP-led program (the Care Programme for Palliative Radiotherapy) that was implemented in the Netherlands. The list of references is mostly recent and consists of reputable sources (primarily journals). The methods were qualitative and included document analysis, observation, semi-structured interviews (both professionals including NPs and patients), and focus groups. The authors conclude that the implementation of the NP-led program was a right decision for patient care: it was a reaction to the shift from inpatient to outpatient treatment (that happened due to technological advancements in the field) and was successful in improving the care that patients received. However, the program did not succeed in the terms of managerial and institutional support. This study is of great importance for the proposed project. First of all, it demonstrates that NPs are capable of contributing to palliative care. Secondly, it includes the description of NP care; it is specific, but it has generalizable features (support and information supply, for example). Finally, the study provides a detailed analysis of why NP care can be ineffective, and it is a significant contribution to the project. The authors do not discuss shortcoming and bias, but they point out that the funding is unlikely to produce bias. The samples were not too big (eight people on average), but the studied environment was also very limited. The authors finish by providing recommendations concerning the improvement of the program and insist that more attention is paid to the organizational aspects of an NP-led program. The presented study contributes to the proposed project in several ways and presents a holistic view of NP programs.