Literature review: How can nurses play an integral part in Palliative care Management in aged care settings

Introduction

Palliative care management can be deemed as a complex and dynamic care intervention that requires a holistic and compassionate approach to render effective care. It is vital to manage care for the patients with quality and compassion. The idea is also based on enabling smooth facilitation of care management for family members and dear ones for ensuring a constructive effort and sustaining positive clinical outcomes (Moran et al., 2021). The literature review is about how nurses can play an integral part in palliative care management in aged care settings. It will be taking the requirement of palliative care management that is meeting the demand of aged care settings. What is the nature of palliative care and what are the management strategies by which the nurses can meet the standard & need of aged care settings. The literature review has the following sections that reflect the background and significance. Followed by personal experience of the nurses and knowledge and perception of nurses. Lastly, it will take the education and training needed for the nurses that is improving the future practices.

Background and Significance

Clinical healthcare team members are required to work in close collaboration to ensure effective care and support throughout the journey. However, out of all clinical team members, nurses can be referred to play the most crucial part in palliative care intervention and management. Caring for the patients and their family members can be life-limiting and can also be modulated as per the gravity and intensity of the symptomatic illness (Moran et al., 2021). It is also vital to know the trajectory of the illness and develop comprehensive and constant care management for the patients. It is also vital that nurses uphold the highest values for clinical practices while managing care for the patients and their family members.

Methodology

The adopted methodology for the research is secondary where the PICO questionnaire is designed. Following is the PICO question that is utilised for research:

P: Aged care population

I: Palliative care

C: No comparator

O: improvement in the nursing practices in palliative care.

For the above selected questions, the database that is selected is the Medline, PubMed central and Google scholar. It helps in the searching and collection of secondary search articles. The articles will be selected on the basis of inclusion and exclusion criteria. It is a secondary research that is compiled, gathered, organised and published by others.

Above is the table present that implies the presentation of the literature. It is implying the databases and inclusion and exclusion criteria for articles.

Personal experience of the nurses

While this can be deemed as a new conceptual framework, the issue of co-creation has been highlighted with respect to palliative care management. Co-creation has been defined as the virtue of collaboration of clinical practice with various healthcare professionals to enable positive clinical outcomes (Hemberg et al., 2019). This virtue also helps in sustaining and delivering quality care management with the core focus on ensuring smooth and effective facilitation of required dynamic clinical services for the patient and their family members. This idea also focuses on enabling holistic care management for the patient. A study conducted by Hemberg and his close associates in 2019 focused on this new concept of cocreation in palliative care management. It also varies from one individual nurse to another and their perception regarding the extent of compassion offered to the patients and the family members. The study was based on the data collected from 12 nurses and their perception regarding holistic care intervention for the patients being managed with palliative care (Hemberg et al., 2019). The study indicated on the overall relevance of being involved in the patient care on a personal as well as professional front. This is necessary for enabling positive outcomes and continuous care management required for palliative care intervention.

The role of palliative care can also become tedious and demanding when the management involves multiple clinical comorbidities. Studies have shown that it can become rather stressful and challenging for nurses to coordinate and update care on a regular and consistent basis for the patients. This challenge was further highlighted during the course of the COVID-19 pandemic, where even healthcare professionals and organizations found themselves incompetent enough to manage care. A study conducted by Bolt et al. in 2021 focused on the role of advanced care planning in the context of the healthcare limitations faced during the COVID-19 pandemic. Some of the key highlights of this study include aspects of “psychological care”, “spiritual care”, “care for the dying” and many other fundamental aspects (Bolt et al., 2021). The study highlighted the fact that a sheer focus is required on working on possible challenges which can pose a hindrance in delivering required care management for the patients. Advanced care planning generally requires a team effort and thus, an interdisciplinary approach must be followed while delivering care for the patients.

Personal experiences and belief systems of individual nurses might also affect the palliative care management and its overall outcomes. A study conducted by Pennbrant and his colleagues in 2020 focused on managing palliative care and associated challenges for patients with dementia in an aged care facility. The condition of dementia can be challenging and complex in itself, let alone managing care for cancer treatment (Pennbrant et al., 2020). This can become further challenging when the older patients are being managed in a residential care facility, as there are lack of staff clinical workforce and required amenities for treatment interventions. The study also focused on the relevance of developing robust skills and techniques for ensuring a cared and compassionate environment for such individuals (Pennbrant et al., 2020). Managing care must also be ensured with a sense of caring which will help the nurses in connecting well with the patients and their family members. This virtue is also required for delivering patient-centred care and enabling positive outcomes of engagement.

Palliative care management is awarded and delivered at different levels. Healthcare settings are rather dynamic and thus, the right level of competencies and skills are required to be ensured while managing care for the patients. A study conducted by Hokka and his close associates focused on six of these competencies dimensions (Hokka et al., 2020). This included leadership skills, communication skills, clinical virtues, ethical-legal compliance, spiritual factors and psycho-social elements. Most of these competencies are required to be reflected in palliative care nurses for ensured informed care practice and robust clinical decision-making (Hokka et al., 2020). It can be concluded that the personal experience and competence of the nurses also impact the overall quality of care and related clinical outcomes.

Knowledge and perception of nurses

Given the dynamic nature of palliative care, it is vital the nurses have a piece of a strong subject knowledge and possess a sound perception of their respective roles and responsibilities. Every nurse can have a different perspective and perception regarding palliative care and its related elements for delivering required care for the patients (Alshammari et al., 2022). While there have been studies reflecting on the strong evidence of nurses of palliative care specialists, to have a strong set of skills for enabling quality care, there is less known for nurses who are from other clinical expertise. To further analyse this concern, a study was conducted amongst registered nurse practitioners from a non-specialists palliative care setting. This study focused on analysing the nurse’s knowledge of pain symptoms and management and sustaining a positive attitude towards caring for patients dying from a terminal illness (Alshammari et al., 2022). While the nurses were found to have a prolific competence in managing care for pain regarding terminal cancer, they lacked the required competence for having a positive attitude to render quality and compassionate care. The psychological and spiritual aspects of end-of-life care management were reported to be lacking for these nurses. The study also suggested a chance of fostering negative relationships with the patients due to a lack of compassion and communication, which can eventually lead to negative clinical outcomes (Alshammari et al., 2022). It is rather vital that nurses must have good knowledge and positive belief regarding palliative care management. There is a dire need of educating young and novice nurses and also professional nurses for ensuring a sense of compassion and expansion of their belief system for palliative care delivery with competence.

A similar study was conducted focusing on the issue of severe pain and grief management for patients being treated for palliative care. The idea was to highlight various factors which can attribute to the overall challenge of knowledge and comprehension of palliative care and its dynamic elements. The idea is to integrate clinical practices and personal beliefs of the nurses for the amalgamation of robust clinical services offered to patients being managed with palliative care (Xue et al., 2023). The study reflected on various scores and elements to be analysed with respect to this concern. The attitude score collected for nurses was based on elements such as gender, educational level, religious preferences, previous level of education and personal perception (Xue et al., 2023). The findings were suggestive of the inclusion of nurse education and the promotion of constructive training modules to develop such levels of skills and competence for the nurses, especially those who are aligned in palliative care management.

While some factors are personally driven, there are certain factors that can be organisation-oriented. These factors can be deemed as barriers and facilitators in the process of end-of-life care management. These elements can also compromise the overall understanding of enabling comprehensive nursing care for patients requiring palliative care and enabling positive clinical outcomes. A study conducted by Rhee and his close associates in 2020 focused on highlighting these contributory factors which can impair the overall quality of palliative care management (Rhee et al., 2020). Four different clinical settings were identified and the factors were analysed through effective data collection. There were significant structural and functional barriers identified that posed an evident hindrance to effective care management for end-of-life care with quality and competence (Rhee et al., 2020). Most of these barriers were highlighted with rural and primary healthcare facilities where there was a significant lack of required amenities and sources for rendering required care and support. The study recommended on narrowing down these barriers of functionality and enabling sustainable positive clinical outcomes of the engagement.

Studies have also identified a significant barrier to effective pain management, especially for palliative care. Pain management is a key factor in ensuring compassionate and quality palliative care management. This is rather significant in end-of-life care as this is inclusive of a cultural perspective. There is also a significant barrier to the acceptance of families for availing care due to the compromised clinical health status of the individual (Gerber et al., 2022). This can be further complimented by institutional barriers which can challenge the end-of-life care management and endanger the health of the individual. To provide better end-of-life care, services should acknowledge nurses’ unique insights. Particular attention should be on supporting nurses in aged care facilities, community settings and remote areas.

Educational training for nurses

One of the focused issues in palliative care management is the lack of acceptance of cultural differences (Thrane et al., 2020). This concern is mainly faced by novice nurses who fail to comprehend the relevance and importance of the same in palliative care management. It, therefore, becomes vital to impart education to nurses for ensuring culturally competent care and management (Karacsony et al., 2019). For managing palliative care, this factor further becomes rather significant as the dynamics can shift completely. Studies have shown that nurse-led interventions are required to ensure a culturally competent and relevant clinical environment (Xiao et al., 2020). Palliative care management further becomes a concerning issue with respect to individual cultural and spiritual preferences. This will also help in enhancing clinical practices and improving clinical outcomes for palliative care.

Training and development are an integral part of any professional practice, let alone nursing care and management. It is vital that nurses are provided with specialised and specific training skills for handling patients that are being managed for end-of-life care (Cheng et al.,2021). The clinical care specifications usually change with all specialties. This might also directly affect the dynamics of handling patients and their family members and breaking news to them. Cheng et al. conducted a study in 2021 that provided nurses with a one-month specialized training for managing palliative care. The teaching was based on theoretical learning and knowledge enhancement for nurses posted in palliative care. The training also focused on enhancing the current aptitude and attitudes of nurses regarding palliative care and its related dynamics (Cheng et al.,2021). The study was able to reflect on positive clinical outcomes from the perspective of delivering constructive and effective palliative care for the patients and thus, leading to positive clinical outcomes.

Training and education of nurses for palliative care management can also help in enhancing their efficacy in enabling quality clinical care (Dehghani et al., 2020). This is required as an effective and imperative part of every step of the professional development. Dehghani and his close associates conducted a study in 2020, which helped in focusing on the effect of palliative care training on the perceived self-efficacy of the nurses. The study included a random sampling of 40 individuals with a focused training of 45 minutes of duration (Dehghani et al., 2020). The questionnaire data was collected for perceived self-efficacy. The results were indicative of a positive contribution of training in enhancing self-efficacy and clinical outcomes for the patients. It is also the role of nurse managers in ensuring regular updates for the team members ad ensure their timely training and support throughout the process.

Ethical decision-making in palliative care

Ethical considerations are also an integral part of palliative care management. End-of-life care management for the patients is required to be focused on an ethically driven purpose. This is a rather sensitive issue and must be dealt with a great competence and excellence. Various studies have shown that there is a significant gap in practice when it comes to managing ethical care for palliative patients (Lim et al., 2021). There are multiple factors that are need to be pondered upon and must be considered for ensuring safe and informed decision-making. It is the duty of the nurses to be sensitive and considerate of palliative care and coordination. The virtue of compassion and care go hand in hand and must be strictly adhered to while handling end-of-life care for patients and their family members. Ethics and values are also a vital components of patient care and these virtues also define the standard of professional nursing practice.

Ethics also help in defining the scope of roles and responsibilities of nurses for managing patient care. Palliative care mainly focuses on managing care based on complex clinical symptoms. This will also help in defining the advancing care for the patients and the extended support required for their family members (Munkombwe et al., 2020). Studies have shown that ethical and legal decision-making in palliative care is rather necessary for avoiding any potential state of conflict (Fliedner et al., 2021). Nurses also play a vital role as patient advocates and help them get the required support with quality and competence. Etically competent channels and organizational structure can assist in marginalising the care gap and rendering care through a constructive approach. This can also be relevant in enhancing existing interprofessional relations and promoting collaborative care management.

In the future, clarifying the contribution of staff nurses and APRNs in the ACP process in relation to other members of the interprofessional team can lay the groundwork for improved interprofessional collaboration.

Future recommendations

There is a dire need of reforming future clinical palliative clinical practice with a holistic perspective of well-being in the best interest of the patients. Some of the core ideas must focus on enabling care through an ethically and legally driven method which further highlights the significance of enabling positive care. Another core recommendation is the process of constructive follow-ups (Khalil et al., 2020). This is in relation to the patient and also in relation to keeping a track of the clinical progress. With the help of improved knowledge and clinical information, there can be a robust constructive general practice reforms. There is also a need of identifying the required screening tools for patients requiring palliative care. This will also allow adjustment of care management as per the patient’s specifications and dynamic needs of care.

It is also vital to prepare the novice and professional nurses to face the possible challenges that they might face while managing palliative care for patients and their family members. It must also be an essential part of the curriculum so that the insights are provided from an early onset of clinical care provision for the patients. Nurses play a vital role in patient care and coordination, let alone managing care for patients struggling with terminal conditions (Rosa et al., 2022). The students and professional nurses must be empowered with comprehensive assessment and knowledge regarding each paradigm and aspect of palliative care. This is necessary for enabling quality care management, with a focus on ensuring informed decision-making and ensuring positive clinical outcomes. This will also help in identifying the barriers and facilitators which will might hinder with the process of well-coordinated and effective care management for the patients and their family members (Rosa et al., 2022). The further application will help in reforming the existing attitudes and beliefs of the individual nurses and empowering them with the true capacity to render ethically and legally competent care deliverance with exemplary professionalism.

Reference list

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Bolt, S. R., van der Steen, J. T., Mujezinović, I., Janssen, D. J., Schols, J. M., Zwakhalen, S. M., ... & Meijers, J. M. (2021). Practical nursing recommendations for palliative care for people with dementia living in long-term care facilities during the COVID-19 pandemic: A rapid scoping review. International Journal of Nursing Studies, 113, 103781.https://doi.org/10.1016/j.ijnurstu.2020.103781

Cheng, Q., Zhang, Q., Liu, X., & Chen, Y. (2021). Initial exploration of training for palliative care specialist nurses in mainland China. Nurse Education Today, 101, 104869. https://doi.org/10.1016/j.nedt.2021.104869

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Fliedner, M., Halfens, R. J., King, C. R., Eychmueller, S., Lohrmann, C., & Schols, J. M. (2021). Roles and responsibilities of nurses in advance care planning in palliative care in the acute care setting: A scoping review. Journal of Hospice & Palliative Nursing, 23(1), 59-68. 10.1097/NJH.0000000000000715

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