Death does not deal – nurses' experiences of transition to terminal care

Ökad ålder innebär att livet närmar sig sitt slut och har ett starkt samband med sjuklighet. Palliativ vård syftar till att lindra lidande och främja livskvalitet för patienter som har en livshotande sjukdom eller skada. Alla som är i behov av palliativ vård ska erbjudas den, oavsett ålder och sjukdom. Startpunkten för palliativ vård är ett brytpunktssamtal. Hos den äldre patienten är det palliativa stadiet längre och identifikation av brytpunkt kan därmed försvåras. En teori om vårdens övergångar kan ge en ökad förståelse för sjuksköterskors upplevelser av övergången till vård i livets slutskede SYFTE: Att beskriva sjuksköterskors upplevelser av övergången från kurativ eller palliativ vård till vård i livets slutskede. METOD: En kvalitativ studie med semistrukturerade intervjuer av fyra sjuksköterskor med erfarenhet av geriatrisk akutsjukvård. RESULTAT: Resultatet presenteras i fyra kategorier: 1.ingen delaktighet, 2.symtomlindring och omvårdnad, 3.kunskap, tid, rutiner, direktiv och reflektion samt 4.närståendes betydelse. Studiens resultat belyser sjuksköterskors upplevelser och erfarenheter av att vårda äldre sköra patienter i livets slut. De ansåg sig ha för lite kunskaper och tid för att ge en god palliativ vård. Samtliga sjuksköterskor upplevde att bristen på brytpunktssamtal och sent beslut om övergång till vård i livets slut var en central del i problematiken kring vården av den äldre patienten. KONKLUSION: Resultatet visar att sjuksköterskor upplever att de har för lite kunskap i att ge palliativ vård till äldre personer. Bristen på brytpunktssamtal gör att patientens och dennes närståendes delaktighet i vården minskar och ibland uteblir helt. Dessutom tas beslutet om vård i livets slut ofta under patientens sista levnadsdygn, vilket inte ger denne möjlighet till delaktighet i beslut kring sin egen död. Increased age means life is coming to an end and is highly connected with illness. Palliative care aims to relieve suffering and to promote quality of life to patients who suffers from a life threatening disease or injury. All who is in need of palliative care shall be offered it, regardless of age or disease. Palliative care comprises multidisciplinary teamwork and the starting point of this work is the palliative turning point. The dying processes of older patients are usually longer than that of younger patients, making the identification of the palliative turning point difficult. A theory about health transition could be useful when describing nurses’ experiences of the transition to end of life care in older patients. AIM: To describe nurses’ experiences of the transition to end of life care. METHOD: A qualitative approach with semi structured interviews with four nurses who had experience of geriatric acute care. RESULTS: The result is summarized in four categories; no participation, symptomatic relief and nursing, knowledge, time, routines, directions & reflection and relatives. The nurses felt they had too little knowledge and time to provide good palliative care, and that the lack of a documented palliative turning point and late decisions on the transition to terminal care was a central part of the problems surrounding the care of the older patient. DISCUSSION: The study highlights the nurse's perceptions of the shortcomings of the current terminal care for the elderly frail patients. Where the lack of breakpoint call causes the patient and his related parties' participation in care reduces or sometimes absent. Moreover the decision about terminal care often during the patient's last days of life, which does not give him an opportunity to make decisions about his death

Death does not deal – nurses' experiences of transition to terminal care

BAKGRUND: Ökad ålder innebär att livet närmar sig sitt slut och har ett starkt samband med sjuklighet. Palliativ vård syftar till att lindra lidande och främja livskvalitet för patienter som har en livshotande sjukdom eller skada. Alla som är i behov av palliativ vård ska erbjudas den, oavsett ålder och sjukdom. Startpunkten för palliativ vård är ett brytpunktssamtal. Hos den äldre patienten är det palliativa stadiet längre och identifikation av brytpunkt kan därmed försvåras. En teori om vårdens övergångar kan ge en ökad förståelse för sjuksköterskors upplevelser av övergången till vård i livets slutskede SYFTE: Att beskriva sjuksköterskors upplevelser av övergången från kurativ eller palliativ vård till vård i livets slutskede. METOD: En kvalitativ studie med semistrukturerade intervjuer av fyra sjuksköterskor med erfarenhet av geriatrisk akutsjukvård. RESULTAT: Resultatet presenteras i fyra kategorier: 1.ingen delaktighet, 2.symtomlindring och omvårdnad, 3.kunskap, tid, rutiner, direktiv och reflektion samt 4.närståendes betydelse. Studiens resultat belyser sjuksköterskors upplevelser och erfarenheter av att vårda äldre sköra patienter i livets slut. De ansåg sig ha för lite kunskaper och tid för att ge en god palliativ vård. Samtliga sjuksköterskor upplevde att bristen på brytpunktssamtal och sent beslut om övergång till vård i livets slut var en central del i problematiken kring vården av den äldre patienten. KONKLUSION: Resultatet visar att sjuksköterskor upplever att de har för lite kunskap i att ge palliativ vård till äldre personer. Bristen på brytpunktssamtal gör att patientens och dennes närståendes delaktighet i vården minskar och ibland uteblir helt. Dessutom tas beslutet om vård i livets slut ofta under patientens sista levnadsdygn, vilket inte ger denne möjlighet till delaktighet i beslut kring sin egen död.BACKGROUND: Increased age means life is coming to an end and is highly connected with illness. Palliative care aims to relieve suffering and to promote quality of life to patients who suffers from a life threatening disease or injury. All who is in need of palliative care shall be offered it, regardless of age or disease. Palliative care comprises multidisciplinary teamwork and the starting point of this work is the palliative turning point. The dying processes of older patients are usually longer than that of younger patients, making the identification of the palliative turning point difficult. A theory about health transition could be useful when describing nurses’ experiences of the transition to end of life care in older patients. AIM: To describe nurses’ experiences of the transition to end of life care. METHOD: A qualitative approach with semi structured interviews with four nurses who had experience of geriatric acute care. RESULTS: The result is summarized in four categories; no participation, symptomatic relief and nursing, knowledge, time, routines, directions & reflection and relatives. The nurses felt they had too little knowledge and time to provide good palliative care, and that the lack of a documented palliative turning point and late decisions on the transition to terminal care was a central part of the problems surrounding the care of the older patient. DISCUSSION: The study highlights the nurse's perceptions of the shortcomings of the current terminal care for the elderly frail patients. Where the lack of breakpoint call causes the patient and his related parties' participation in care reduces or sometimes absent. Moreover the decision about terminal care often during the patient's last days of life, which does not give him an opportunity to make decisions about his death

Scaffolding for learning and establishing a professional identity : A qualitative descriptive study of nursing students’ experiences of learning with a student-centered supervision model based on patient-oriented care during clinical placement

The nursing profession is close to clinical practice and vital to the student’s professional development. Innovative learning activities and models are sought to improve clinical placements. A student-centered supervision model based on patient-oriented care was introduced in a medical ward. The aim of this study was to describe nursing students’ experiences of learning with a student-centered supervision model based on patient-oriented care during their clinical placement. A qualitative descriptive study involving interviews with 12 nursing students analyzed through inductive qualitative content analysis was conducted in accordance with COREQ. The findings revealed that the nursing students viewed learning as personal, knowledge, and professional development. Their learning experiences can be seen as a process in which the scaffolding is gradually reduced in line with each student’s ability to act independently and establish a professional identity. The model can enhance structure and support in the practice setting to maximize learning.CC BY 4.0</p

Scaffolding for learning and establishing a professional identity : A qualitative descriptive study of nursing students’ experiences of learning with a student-centered supervision model based on patient-oriented care during clinical placement

The nursing profession is close to clinical practice and vital to the student’s professional development. Innovative learning activities and models are sought to improve clinical placements. A student-centered supervision model based on patient-oriented care was introduced in a medical ward. The aim of this study was to describe nursing students’ experiences of learning with a student-centered supervision model based on patient-oriented care during their clinical placement. A qualitative descriptive study involving interviews with 12 nursing students analyzed through inductive qualitative content analysis was conducted in accordance with COREQ. The findings revealed that the nursing students viewed learning as personal, knowledge, and professional development. Their learning experiences can be seen as a process in which the scaffolding is gradually reduced in line with each student’s ability to act independently and establish a professional identity. The model can enhance structure and support in the practice setting to maximize learning.CC BY 4.0</p