Correspondence
Developing a care model for hospice and palliative nurses Re: Dobrina R, Tenze M, Palese A (2014) An overview of hospice and palliative care nursing models and theories. Int J Palliat Nurs 20(2): 75–81
In response to the topic of palliative and hospice care discussed by Dobrina et al (2014), I believe that properly educating our primary care nurses in nursing facilities who are caring for palliative and hospice care patients each day is of the utmost importance. In 2012, the National Hospice and Palliative Care Organisaiton estimated that 1.5 to 1.6 million patients received care from hospice services in the US (NHPCO, 2013). The large number of hospice/palliative patients being served by the NHPCO is continuously rising
Dear Editor, We would like to reply to Marie Christine Magante’s letter to thank her for outlining the value of nursing education in palliative care, the need for nursing care models and the importance of considering family suffering at the end of a patient’s life. Similar to your experience, we have also witnessed several family members fearing patient death and the dying process. Anguished by the experience of their family member’s death or pain, family caregivers may neglect their basic needs (e.g. sleep, nutrition), sitting for hours on uncomfortable chairs at the patient bedside. This is even more evident in home settings where family caregivers offer care 24 hours a day. There is a deep closeness between patients and family members, especially in the last period of a patient’s life, when the complexity of their needs may also increase. In our experience, while patient needs and uncontrolled symptoms distress his/her relatives, family discomfort may, in turn, condition the beloved quality of life in their journey to death, leading the patient to feel that he or she is a burden (Chochinov et al, 2007). Family distress may also increase when their beloved become unconscious. This
96
and consquently increasing the pressure on health professionals in this area of care. As a charge nurse for almost 5 years in a nursing facility, the majority of our patients have life-limiting illnesses that often just seek comfort and peace rather than aggressive treatments. Our registered nurses are skilled and experienced in caring for hospice/palliative care patients, however, there is no standardised hospice or palliative care model that these nurses can use to provide high-quality holistic care, not only to dying patients but also to grieving families. Since the focus of palliative care is a patient-centered approach (Dobrina et al, 2014), we tend to forget that the family of the dying patient is also our patient, and as nurses we should not only care for the patients but their families as
particular bonding may lead to considering the patient and the family as a ‘dyad’, encouraging us to assess both patient and family needs to identify each patient-family dyad’s unique interrelated problems and priorities. When communication is no longer feasible and family members might feel useless, our focus of care may shift to a family-centered model of care. Literature reports how effective it is to involve the family in the care process to alleviate any family sense of uselessness and to enhance satisfaction (Azoulay and Pochard, 2003; Bee et al, 2009). However, managing patient comfort and physical care may cause some difficulties to a family member that should be addressed with appropriate communication, relational and education interventions. This process requires nurses, again, to find time. Nevertheless, family partnership in patient care may be extremely rewarding, not only for the family but also for nurses, in our process of progressive understanding of life and of dying, and increasing our professional competence. As nurses, we can prevent family problems that may have an ‘iatrogenic’ cause: for instance, family anxiety may at times be worsened when the team offers too little information. In other situations, family
well. Palliative nurses should not only focus on providing comfort to patients and controlling their symptoms at the end of life, but we should advocate for a standardised care model that will guide our nurses to provide the highest quality of care possible for both the patient and the family.
Marie Christine Magante Registered Nurse, University of Texas at Arlington, US Correspondence to: [email protected] National Hospice and Palliative Care Organisaiton (2013) NHPCO’s Facts and Figures Hospice Care in America: 2013 Edition. http://tiny.cc/ trmrsx (accessed 20 January 2015)
members may have unrealistic hopes and expectations toward the patient’s condition, and feeling that not enough is being done for their loved one. Communicating effectively with the family, sharing information, as well as involving them in decision making may help to implement personalised family-centred care. Therefore, acknowledging palliative care nursing core concepts may guide our interventions to give the necessary value and priority to planning healing interventions for the whole family. However, it should only be a starting point.
Raffaella Dobrina, Nurse Researcher and Alvisa Palese, Associate Professor Udine University, Italy Correspondence to: Alvisa Palese [email protected] Azoulay E, Pochard F (2003) Communication with family members of patients dying in the intensive care unit. Curr Opin Crit Care 9(6): 545–50 Bee PE, Barnes P, Luker KA (2009) A systematic review of informal caregivers’ needs in providing home-based end-of-life care to people with cancer. J Clin Nurs 18(10): 1379–3 Chochinov HM, Kristjanson LJ, Hack TF et al (2007) Burden to others and the terminally ill. J Pain Symptom Manage 34(5): 463–71
© 2015 MA Healthcare Ltd
Dear Editor,
International Journal of Palliative Nursing 2015, Vol 21, No 2
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 22, 2015. For personal use only. No other uses without permission. . All rights r
Developing a care model for hospice and palliative nurses Re: Dobrina R, Tenze M, Palese A (2014) An overview of hospice and palliative care nursing models and theories. Int J Palliat Nurs 20(2): 75–81
In response to the topic of palliative and hospice care discussed by Dobrina et al (2014), I believe that properly educating our primary care nurses in nursing facilities who are caring for palliative and hospice care patients each day is of the utmost importance. In 2012, the National Hospice and Palliative Care Organisaiton estimated that 1.5 to 1.6 million patients received care from hospice services in the US (NHPCO, 2013). The large number of hospice/palliative patients being served by the NHPCO is continuously rising
Dear Editor, We would like to reply to Marie Christine Magante’s letter to thank her for outlining the value of nursing education in palliative care, the need for nursing care models and the importance of considering family suffering at the end of a patient’s life. Similar to your experience, we have also witnessed several family members fearing patient death and the dying process. Anguished by the experience of their family member’s death or pain, family caregivers may neglect their basic needs (e.g. sleep, nutrition), sitting for hours on uncomfortable chairs at the patient bedside. This is even more evident in home settings where family caregivers offer care 24 hours a day. There is a deep closeness between patients and family members, especially in the last period of a patient’s life, when the complexity of their needs may also increase. In our experience, while patient needs and uncontrolled symptoms distress his/her relatives, family discomfort may, in turn, condition the beloved quality of life in their journey to death, leading the patient to feel that he or she is a burden (Chochinov et al, 2007). Family distress may also increase when their beloved become unconscious. This
96
and consquently increasing the pressure on health professionals in this area of care. As a charge nurse for almost 5 years in a nursing facility, the majority of our patients have life-limiting illnesses that often just seek comfort and peace rather than aggressive treatments. Our registered nurses are skilled and experienced in caring for hospice/palliative care patients, however, there is no standardised hospice or palliative care model that these nurses can use to provide high-quality holistic care, not only to dying patients but also to grieving families. Since the focus of palliative care is a patient-centered approach (Dobrina et al, 2014), we tend to forget that the family of the dying patient is also our patient, and as nurses we should not only care for the patients but their families as
particular bonding may lead to considering the patient and the family as a ‘dyad’, encouraging us to assess both patient and family needs to identify each patient-family dyad’s unique interrelated problems and priorities. When communication is no longer feasible and family members might feel useless, our focus of care may shift to a family-centered model of care. Literature reports how effective it is to involve the family in the care process to alleviate any family sense of uselessness and to enhance satisfaction (Azoulay and Pochard, 2003; Bee et al, 2009). However, managing patient comfort and physical care may cause some difficulties to a family member that should be addressed with appropriate communication, relational and education interventions. This process requires nurses, again, to find time. Nevertheless, family partnership in patient care may be extremely rewarding, not only for the family but also for nurses, in our process of progressive understanding of life and of dying, and increasing our professional competence. As nurses, we can prevent family problems that may have an ‘iatrogenic’ cause: for instance, family anxiety may at times be worsened when the team offers too little information. In other situations, family
well. Palliative nurses should not only focus on providing comfort to patients and controlling their symptoms at the end of life, but we should advocate for a standardised care model that will guide our nurses to provide the highest quality of care possible for both the patient and the family.
Marie Christine Magante Registered Nurse, University of Texas at Arlington, US Correspondence to: [email protected] National Hospice and Palliative Care Organisaiton (2013) NHPCO’s Facts and Figures Hospice Care in America: 2013 Edition. http://tiny.cc/ trmrsx (accessed 20 January 2015)
members may have unrealistic hopes and expectations toward the patient’s condition, and feeling that not enough is being done for their loved one. Communicating effectively with the family, sharing information, as well as involving them in decision making may help to implement personalised family-centred care. Therefore, acknowledging palliative care nursing core concepts may guide our interventions to give the necessary value and priority to planning healing interventions for the whole family. However, it should only be a starting point.
Raffaella Dobrina, Nurse Researcher and Alvisa Palese, Associate Professor Udine University, Italy Correspondence to: Alvisa Palese [email protected] Azoulay E, Pochard F (2003) Communication with family members of patients dying in the intensive care unit. Curr Opin Crit Care 9(6): 545–50 Bee PE, Barnes P, Luker KA (2009) A systematic review of informal caregivers’ needs in providing home-based end-of-life care to people with cancer. J Clin Nurs 18(10): 1379–3 Chochinov HM, Kristjanson LJ, Hack TF et al (2007) Burden to others and the terminally ill. J Pain Symptom Manage 34(5): 463–71
© 2015 MA Healthcare Ltd
Dear Editor,
International Journal of Palliative Nursing 2015, Vol 21, No 2
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 22, 2015. For personal use only. No other uses without permission. . All rights r
