Sairaanhoitajalta edellytetty osaaminen erityistason palliatiivisessa hoidossa

Palliatiivinen hoito on kokonaisvaltaista oireenmukaista hoitoa, jossa kuolema nähdään normaalina tapahtumana. Siinä keskitytään kivun ja muiden oireiden helpottamiseen sekä potilaan ja hänen läheistensä psykososiaaliseen tukemiseen. Suomessa palliatiivinen hoito on jaettu kolmeen portaaseen vaadittavan erityisosaamisen mukaan. Tässä työssä tutkittiin osaamista erityistason palliatiivisessa hoidossa. Palliatiivisella hoidolla tarkoitetaan tässä työssä palliatiivista- ja saattohoitoa. Tutkimuksen tarkoituksena oli kuvata sairaanhoitajilta edellytettyä osaamista ja osaamista edistäviä tekijöitä erityistason palliatiivisessa yksikössä. Tutkimuksen tavoitteena oli tuottaa tietoa, jota voidaan hyödyntää tutkintoon johtavassa- ja sen jälkeisessä täydennyskoulutuksessa, hoidon laadun ja potilasturvallisuuden parantamisessa sekä yhteisistä hoitokäytännöistä sovittaessa. Tutkimus toteutettiin laadullisena tutkimuksena. Aineisto kerättiin sähköisellä avoimista kysymyksistä muodostetulla kyselylomakkeella, joka lähetettiin kolmen Uudellamaalla toimivan erityistason saattohoidon osaston sairaanhoitajille. Vastauksia kyselyyn saatiin 21. Saatu aineisto analysoitiin induktiivisella sisällönanalyysillä. Tulosten perusteella erityistason saattohoidossa tarvitaan kliinistä-, psykososiaalista- sekä teknistä- ja työyhteisöosaamista. Kliininen osaaminen sisälsi oirehoidon, lääkehoidon, perushoidon, toimenpiteet, potilaan tarkkailun sekä lääketieteeseen liittyvän osaamisen. Psykososiaalinen osaaminen koostui kulttuuriin ja uskontoon liittyvästä osaamisesta, vuorovaikutuksesta, henkisestä tuesta sekä omaisten kohtaamisesta. Tekninen- ja työyhteisöosaaminen piti sisällään teknisen osaamisen, kirjaamisen, moniammatillisen yhteistyön sekä työn organisointitaidot. Osaamista edistävät tekijät liittyivät työyhteisöön (koulutus, työhyvinvointi, yhteistyö ja työnantajan tuki) sekä työntekijään (motivaatio, kokemus ja persoona). Saadut tulokset olivat samansuuntaisia kansainvälisten tutkimusten kanssa sekä kansallisten, että kansainvälisten osaamismäärittelyjen kanssa. Erityistason palliatiivisessa hoidossa toimiakseen sairaanhoitajalta edellytetään vahvaa osaamista useilta eri osa-alueilta.Palliative treatment is a holistic symptomatic treatment where death is seen as a normal occurrence. Palliative treatment focuses on the relief of pain and other symptoms and the psychosocial support of the patient and his / her relatives. In Finland, palliative care is recommended to be provided on a three-tier model. This thesis focuses on specialized level. In this thesis palliative care refers to both palliative and end-of-life care. The purpose of this study was to describe the competence required by the nurses working at the palliative unit and the factors that promote competencies. The aim of the study was to produce information that can be used in the graduate degree and post-graduate education, in improving the quality of care and patient safety and in agreeing common care practices. The research was carried out as a qualitative study. The data was collected through an electronic open-ended questionnaire sent to nurses working in three special palliative care units in Uusimaa, Finland. The amount of responses was 21. The data was analyzed by inductive content analysis. Based on the results, clinical, psychosocial, technical and work community competencies are required in the special palliative care treatment. Clinical competence included symptomatic treatment, medication, basic care, procedures, patient monitoring, and medical expertise. Psychosocial competence consisted of culture, religion, interaction, mental support and the encounter of relatives. Technical and work community competence included technical know-how, documentation, multi-professional collaboration and job organization skills. The promoting factors were work-related (education, well-being at work, co-operation and support from the employer) and employee-related (motivation, experience and personality). The results were similar to previous studies, both national and international. In order to work in special palliative care, the nurses need strong expertise in a number of different areas

Patient participation in shared decision-making in palliative care - an integrative review

Background Shared decision-making is a process where the decisions regarding patients' care are done in collaboration with the patient, the patient's family and a healthcare professional or an interdisciplinary team. Shared decision-making is considered to be a part of patient centred care, and it enables patient autonomy which is a cornerstone of palliative care. In the past, research on the experiences of palliative care patients' participation in shared decision-making involving a nurse has been limited as the focus has mainly been on specific medical interventions, rather than holistic palliative care. Objectives To synthesise research findings on patient participation in shared decision-making in palliative care. Research design An integrative literature review. Methods The literature search was conducted by searching computerised databases (CINAHL, PubMed, PsychINFO and COCHRANE). The search resulted in 12 articles. The quality of the included articles was evaluated with JBI checklist, and the data analysis was done using inductive content analysis. Reporting was done according to a PRISMA checklist. Findings Patients do participate in shared decision-making and desire to participate in everyday nursing care decisions, treatment-related medical decisions and end-of-life decisions. The prerequisites for patient participation in shared decision-making are interdisciplinary teamwork, open communication, good patient-healthcare professional relationship, a favourable environment and mutual information. Conclusion Palliative care patients do participate and desire to participate in decisions that cover a much broader range of topics than just medical interventions and this should be addressed in future research and in practise. The main responsibility for successful patient participation in shared decision-making lies with the healthcare professionals and the organisations providing palliative care. There is a need to conduct more research from the patient's perspective and explore the meaning of participating in shared decision-making from the patient's point of view.Peer reviewe

Patient participation in shared decision-making in palliative care - an integrative review

Background Shared decision-making is a process where the decisions regarding patients' care are done in collaboration with the patient, the patient's family and a healthcare professional or an interdisciplinary team. Shared decision-making is considered to be a part of patient centred care, and it enables patient autonomy which is a cornerstone of palliative care. In the past, research on the experiences of palliative care patients' participation in shared decision-making involving a nurse has been limited as the focus has mainly been on specific medical interventions, rather than holistic palliative care.Objectives To synthesise research findings on patient participation in shared decision-making in palliative care.Research design An integrative literature review.Methods The literature search was conducted by searching computerised databases (CINAHL, PubMed, PsychINFO and COCHRANE). The search resulted in 12 articles. The quality of the included articles was evaluated with JBI checklist, and the data analysis was done using inductive content analysis. Reporting was done according to a PRISMA checklist.Findings Patients do participate in shared decision-making and desire to participate in everyday nursing care decisions, treatment-related medical decisions and end-of-life decisions. The prerequisites for patient participation in shared decision-making are interdisciplinary teamwork, open communication, good patient-healthcare professional relationship, a favourable environment and mutual information.Conclusion Palliative care patients do participate and desire to participate in decisions that cover a much broader range of topics than just medical interventions and this should be addressed in future research and in practise. The main responsibility for successful patient participation in shared decision-making lies with the healthcare professionals and the organisations providing palliative care. There is a need to conduct more research from the patient's perspective and explore the meaning of participating in shared decision-making from the patient's point of view