Exploring The Role Of Nurses In Palliative Care For Terminally Ill Patients, An Essay.

Background of Palliative Care

Discuss about the Terminally Ill Patients in Palliative Care.

Each day the nurses meet and treat patients who are suffering from life-threatening diseases under all healthcare settings. The study conducted by Wiener et al. (2015) emphasised over the requirement of the skilled yet experience nurses as an important element in managing the terminally-ill patients in the palliative care unit. Palliative care is mainly erected over the modern Hospice philosophy movement and provides the basic guidelines for the care plan of the seriously ill and dying patients in order to improve the quality of life of both the patients and their family members (Sekse, Hunskår & Ellingsen, 2018). The overall approach is multidisciplinary. This multidisciplinary approach provides importance to the role of both doctors and physicians towards addressing the complex needs of patients and their concerned family members (Sekse, Hunskår & Ellingsen, 2018). According to World Health Organization (2011), there is a lack of adequate training and awareness among the nursing professionals towards managing the patients in the palliative care unit. This lack of awareness is creating a significant barrier towards improving the overall quality of care.

The main aim of this research is to explore how the nursing professionals describe their role in providing palliative care to the terminally ill patients

1. What are the main factors that are required to be taken into consideration while handling terminally-ill patients in the palliative care unit?
2. How this nurse specific roles help in the overall improvement of the quality of life of the patient’s and their family members?
3. Possible recommendations in order to improve the role of the nurses further

According to the latest reports published in the ABC News (2017), the condition of the palliative care in Australia is extremely poor. The main reason highlighted behind this lack of proper training, education and awareness among the nursing professionals. Proper definition of the nurses’ roles and responsibilities will help to generate a stringent training and awareness program for the nurses operating in the palliative care unit. This will help to change the overall quality of care and thereby improving the patient’s quality of life (Sekse, Hunskår & Ellingsen, 2018). Though the studies have been undertaken in order to highlight the role of the nursing professionals but the approach was on specific field and over specific perspective. So this study will help in framing proper roles and responsibility of the nursing professional in handling the terminally ill patients in the palliative care unit.

The research conducted by Anderson et al. (2011) was based on the investigation over what nurses perceive as they handle critically or terminally ill patients of COPD suffering from anxiety and dyspnoea. Their phenomenological hermeneutic study based on the interview of the 7 RN showed that main nursing approaches to handle critically or terminally ill patients must be a perfect amalgamation of the personal and professional approach crafted with solidarity. They also highlighted the need to availability of the nursing professionals to each patients whenever they need them. This study though helped to provide a definite focus of the nursing approach in handling the patients, but scoreless in accuracy due to its poor sample size.

Previous Studies on Nursing Roles in Palliative Care

Arbour and Wiegand (2015) conducted another study based on qualitative phenomenological analysis in order to understand the overall experience of the critical care nurses and their perception about their roles and activities in treating patients during their transition from the aggressive life saving care to the palliative or end of life care. The results of their study highlighted the co-operation from the family members as the main weapon in managing symptoms and emotions of the terminally ill patients. Though the aim of the study is extremely significant with the present aim of the study but it failed to extract the detailed insight about the nursing roles in palliative care.

Bloomer et al. (2013) conducted study with an aim to explore the nurses’ recognition or responsiveness towards the dying patients and the overall influence of the nursing professionals on the end-of-life care. They main opted from focus group, semi-structured interviews with content analysis and highlighted that nurses attitude to death has a significant impact over care process and the coping strategies. But this study also was limited in the domain of poor sample size.

Though the review of literature conducted in this study is not comprehensive, but it helped to provide a detailed insight about how the roles of nurses are important in the palliative care unit. This helped in the justification of the chosen aim and objectives of the study. Moreover, the review of literature also helped the researcher to select the best suitable approach of research.

The methodology mainly outlines the design and the approach that will be followed in order to conduct the research in a successful manner to achieve the framed objective of the research. The research methodology is guided by research onion where each layer of the opinion constitutes the each steps of the research. In this research, the researcher will undertake qualitative research via conducting a semi-structured interview with open-ended interview (Bernard, 2011).

The very first layer of the research opinion is known as research philosophy. There are different types of research philosophies and these are: positivism, interpretivism and realism. In this research, the researcher will follow interpretivism research philosophy. This will help in analysis of the data from small sample size (Bergh & Ketchen, 2011).

Research approach is the regarded as the second layer of the research onion. There are two different types of research approach, inductive and deductive approach. In this research, the researcher will follow inductive research approach. According to Crowther and Lancaster (2012), inductive research approach generally encompasses the process of generation new theories from the emerging information. Moreover, it helps to streamline the entire scope of the research in a stringent way which is appropriate for the qualitative study.

Research Methodology

The next layer of the research onion is the research design. In this layer, the researcher mainly interprets the results of the data analysis on the basis of the objectives and proposed purpose of the research. There are three basic types of research design and this includes exploratory, explanatory and descriptive. In this research, the researcher will follow descriptive style research design. Descriptive style research design is suitable for the research because it assist in exploring the elaborate description of the interview excerpts towards analysing the roles and the responsibility of the nurses in providing optimal palliative care. The descriptive style research design helps in the analysis of the data via establishing close relationship between the participants and the scope of the study (Sandelwoski 2000).

Data collection is of two types namely primary data collection and secondary data collection. Here the researcher will mainly focus over the primary data collection procedure. In this research, the research will use primary data collection process via conducting a semi-structured survey within open-ended questionnaire (10 question: provided in the appendix) among the registered nurse (RN) working in palliative care unit. The topic of the research is description of the roles of nurses in providing care to terminally ill patients in palliative care. The nurses are the best person to provide a detailed description of their roles and responsibilities in handling palliative care patients. This is the reason why the primary data is important for the research. Since the primary data is collected directly from the respondent, the research work will more reliable in valid (Galetta, 2013).

The main medium that will be used for data collection is audio recorder. The two main factors that must be taken into consideration while selecting the data collection tool are the validity and reliability of that tool. Reliability signifies the scores coming from the instrument is consistent and reliable and validity means the individual’s scores from an instrument make sense and are meaningful to the researcher to generate good conclusion. Since it is qualitative research, the validity or the reliability will not deal with the scores but with the process of data recording (Yasar & Cogenli, 2014). The response recorded through the video recorder will be transformed into a written transcript format via a professional transcriber and the generated transcript will be validated by the respondents only. This will help to secure the validity and reliability of the data collection.

The method is defines as the process of selection of proper candidate for the study. There two basic sampling method, one is probability sampling and another one is non-probability sampling (Polit, Beck & Polit, 2010). Here the researcher will use non-probability sampling. Non probability sampling with help the researcher to decrease the deviation of responses collected from the participants during the primary data collection. The main inclusion criteria that will be use to recruit the respondents include RN having experience of more than 1 year in the palliative care unit.

There are two types of research method, qualitative and quantitative (Truscott et al., 2012). The researcher here will use qualitative research method. He qualitative research method will help the researcher to carry forward the research work under natural settings with no in-corporation of the numerical data. The qualitative research method will help the researcher to analyse the response of the participants in details along with an in-depth understanding of their underlying though process (Cresswell, 2013).

According to the Data Protection Act of 1988, in case of conducting a research, it is important to abide by the ethical considerations. According to Brinkmann (2014), the ethical principles and the guidelines help the researcher to conduct the research in an authentic manner. In order to abide by the ethical consideration, the research will take the consent from the Hospital X in Australia in order to access their RN working in the palliative unit. An official letter will be drafted by the researcher and will be sent to the hospital authority. Upon receiving the permission from the hospital authority, a letter will be sent to the prospective nurses in the palliative care unit stating the details of the research. If they show interest in the researcher then 10 RN will be shortlisted based on the inclusion criteria and then will be asked to sign the consent form after reading and verifying all the contents written in the consent form. The consent form will highlight the scope of the research, will ensure the privacy and confidentiality of the participants. Upon signing the consent, form, the participants will be recruited in the research. However, they will be allowed to leave the interview process without any prior notice. The interview question will be set in such a way that it contains no personal question that might harm the sentiments of the participants. The interview will be conducted based on the convenience (time and location) of the participants. In order to ensure the safety of the patients, the research will propose to conduct the interview within the hospital premises beyond the shift timings of the RNs.

In order to protect the privacy and confidentiality of the participants, the consent form containing names other identification details of the respondents will be locked in a secured chambers in the research unit. The name of the respondents will not be disclosed in any parts of the research and moreover, the transcriptionist who will be assigned to generate the written transcript of the recorded response will be blinded about the identity of the participants. The written transcript will be stored in highly confidential manner and the soft copy of the recorded audio file will be stored in USB and that too in a highly confidential manner.

Conclusion

The main limitation of the study is its poor sample size (10). But due to the lack of adequate time and proper funding the researcher was forced to restrict the sample size. This poor sample size must led to the generation of biased results (Marshall et al., 2013).

The scope of the study and the designed objectives is extremely beneficial for the wider community of terminally ill patients and their family members. The elucidation of the proper nursing roles in handling terminally ill patients in palliative care will help in framing proper nursing training plans and thereby helping to improve the overall quality of life of the patients and their family members.

Thus from the above discussion, it can be concluded that there is a significant gap in nursing knowledge and training in handling patients in the palliative care section. Moreover, the research conducted so fare also failed to provide a detailed in-sight over the generation of comprehensive nursing training module in palliative care. The aim of the research will help understand the nursing role in palliative care and thereby helping to frame proper nursing education and awareness program.

References

ABC News (2017). Palliative care expert shocked at poor country services for the dying. Access date: 21^st June 2018. Retrieved from: https://www.abc.net.au/news/2017-10-18/former-doctor-slams-palliative-care-in-new-england/9061972

Andersen, I. H., Ytrehus, S., & Grov, E. K. (2011). Palliativ sykepleie til pasienter med kronisk obstruktiv lungesykdom (KOLS). Klinisk Sygepleje, 25(01), 48-56.

Arbour, R. B., & Wiegand, D. L. (2015). Self-described nursing roles experienced during care of dying patients and their families: A phenomenological study. Journal of Critical Care, 30, 857–858. https:// doi.org/10.1016/j.jcrc.2015.04.112

Bergh, D., & Ketchen, D. J. (2011). Research methodology in Strategy and Management, 1^st ed. Bingley: Emerald Group Publishing Ltd

Bernard, H. R. (2011) Research Methods in Anthropology: Qualitative and Quantitative Approaches. 5th ed. Plymouth: London. Alta Mira Press.

Bloomer, M. J., Endacott, R., O’Connor, M., & Cross, W. (2013). The ‘dis-ease’of dying: Challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study. Palliative medicine, 27(8), 757-764.

Brinkmann, S., 2014. Interview. In Encyclopedia of critical psychology (pp. 1008-1010). Springer New York.

Creswell, J. W. (2013). Qualitative Inquiry and Research: Choosing Among Five Approaches. 3rd editions.

Crowther, D., & Lancaster, G. (2012). Research Methods, 2nd ed. London: Routledge

Marshall, B., Cardon, P., Poddar, A., & Fontenot, R. (2013). Does sample size matter in qualitative research?: A review of qualitative interviews in IS research. Journal of Computer Information Systems, 54(1), 11-22.

 Polit, D., Beck, C. & Polit, D. (2012). Resource manual for Nursing research. Philadelphia: Wolters Kluwer Health/lippincott Williams & Wilkins

Sandelowski, M. (2000). Focus on research methods-whatever happened to qualitative description?. Research in nursing and health, 23(4), 334-340.

Saunders, M., Lewis, P., & Thornhill, A. (2009). Research Onion. Research methods for business students, 136-162.

Sekse, R. J. T., Hunskår, I., & Ellingsen, S. (2018). The nurse's role in palliative care: A qualitative meta?synthesis. Journal of clinical nursing, 27(1-2), e21-e38.

Truscott, D. M., Swars, S., Smith, S., Thornton?Reid, F., Zhao, Y., Dooley, C., ... & Matthews, M. (2010). A cross?disciplinary examination of the prevalence of mixed methods in educational research: 1995–2005. International Journal of Social Research Methodology, 13(4), 317-328.

Wiener, L., Weaver, M. S., Bell, C. J., & Sansom-Daly, U. M. (2015). Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. Clinical oncology in adolescents and young adults, 5, 1.

World Health Organization (2011). Definition of palliative care. Retrieved from https://www.who.int/cancer/palliative/definition/en/ (accessed 21^st June 2018)

Yasar, S., & Cogenli, A. G. (2014). Determining Validity and Reliability of Data Gathering Instruments Used by Program Evaluation Studies in Turkey. Procedia-Social and Behavioral Sciences, 131, 504-509.