‘When a patient chooses to die at home, that’s what they want… comfort, home’ : brilliance in community-based palliative care nursing

Introduction: To redress the scholarly preoccupation with gaps, issues, and problems in palliative care, this article extends previous findings on what constitutes brilliant palliative care to ask what brilliant nursing practices are supported and promoted. Methods: This study involved the methodology of POSH-VRE, which combines positive organisational scholarship in healthcare (POSH) with video-reflexive ethnography (VRE). From August 2015 to May 2017, inclusive, nurses affiliated with a community health service who delivered palliative care, contributed to this study as co-researchers (n = 4) or participants (n = 20). Patients who received palliative care (n = 30) and carers (n = 16) contributed as secondary participants, as they were part of observed instances of palliative care. With a particular focus on the practices and experiences that exceeded expectations and brought joy and delight, the study involved capturing video-recordings of community-based palliative care in situ; reflexively analysing the recordings with the nurses; as well as ethnography to witness, experience, and understand practices and experiences. Data were analysed, teleologically, to clarify what brilliant practices were supported and promoted. Results: Brilliant community-based palliative care nursing largely involved maintaining normality in patients' and carers' lives. The nurses demonstrated this by masking the clinical aspects of their role, normalising these aspects, and appreciating alternative 'normals'. Conclusion: Redressing the scholarly preoccupation with gaps, issues, and problems in palliative care, this article demonstrates how what is ordinary is extraordinary. Specifically, given the intrusiveness and abnormalising effects of technical clinical interventions, brilliant community-based palliative care can be realised when nurses enact practices that serve to promote a patient or carer to normality. Patient or public contribution: Patients and carers contributed to this study as participants, while nurses contributed to this study as co-researchers in the conduct of the study, the analysis and interpretation of the data, and the preparation of the article

POMSNAME: an aide-mémoire to improve the assessment and documentation of palliative care – a longitudinal project

Abstract Background Evidence-based palliative care requires comprehensive assessment and documentation. However, palliative care is not always systemically documented – this can have implications for team communication and patient wellbeing. The aim of this project was to determine the effectiveness of an aide-mémoire – POMSNAME – to prompt the comprehensive assessment of the following domains by clinicians: pain, orientation and oral health, mobility, social situation, nausea and vomiting, appetite, medication, and elimination. Methods A placard depicting the aide-mémoire was distributed to community-based nurses who received training and support. The case notes of palliative care patients were evaluated one month before the intervention, and was repeated at one month, eight months, and fifty months following the intervention. The 235 case notes pertained to patients who received palliative care from a team of 13 registered nurses at one community health service. Results The documented assessment of palliative care patients improved across all nine domains. The most significant improvements pertained to patients’ social situation, orientation, and nausea, eight months after the aide-mémoire was introduced (170.1%, 116.9%, and 105.6%, respectively, all at p < .001). Although oral health and medication assessment declined one-month after the aide-mémoire was introduced (-41.7% and-2.1%, respectively), both subsequently improved, thereafter, at both 8 months and 50 months after the aide-mémoire was introduced. Conclusions The improvement of palliative care documentation across all nine domains demonstrates the potential of the POMSNAME aide-mémoire to prompt the comprehensive assessment of patients by clinicians with generalist expertise. Research is required to determine whether other domains warrant inclusion and how

Using the consolidated framework for implementation research to understand clinicians' innovations

Implementation research aims to understand how and why innovations are successfully implemented in particular healthcare settings. However, much of the research has focused on assessing the implementation of externally-developed, if not superimposed innovations in different settings. There has been little examination – empirical or theoretical – beyond this linear and/or topdown understanding of implementation research. This begs the question of how innovations created by clinicians at the coalface can be understood, ex post facto. This conceptual paper explores the value of the consolidated framework for implementation research (CFIR) and argues its capacity to retrospectively understand the effect of innovations created by clinicians, in situ

‘When a patient chooses to die at home, that's what they want… comfort, home’: Brilliance in community‐based palliative care nursing

Abstract Introduction To redress the scholarly preoccupation with gaps, issues, and problems in palliative care, this article extends previous findings on what constitutes brilliant palliative care to ask what brilliant nursing practices are supported and promoted. Methods This study involved the methodology of POSH‐VRE, which combines positive organisational scholarship in healthcare (POSH) with video‐reflexive ethnography (VRE). From August 2015 to May 2017, inclusive, nurses affiliated with a community health service who delivered palliative care, contributed to this study as co‐researchers (n = 4) or participants (n = 20). Patients who received palliative care (n = 30) and carers (n = 16) contributed as secondary participants, as they were part of observed instances of palliative care. With a particular focus on the practices and experiences that exceeded expectations and brought joy and delight, the study involved capturing video‐recordings of community‐based palliative care in situ; reflexively analysing the recordings with the nurses; as well as ethnography to witness, experience, and understand practices and experiences. Data were analysed, teleologically, to clarify what brilliant practices were supported and promoted. Results Brilliant community‐based palliative care nursing largely involved maintaining normality in patients’ and carers’ lives. The nurses demonstrated this by masking the clinical aspects of their role, normalising these aspects, and appreciating alternative ‘normals’. Conclusion Redressing the scholarly preoccupation with gaps, issues, and problems in palliative care, this article demonstrates how what is ordinary is extraordinary. Specifically, given the intrusiveness and abnormalising effects of technical clinical interventions, brilliant community‐based palliative care can be realised when nurses enact practices that serve to promote a patient or carer to normality. Patient or Public Contribution Patients and carers contributed to this study as participants, while nurses contributed to this study as co‐researchers in the conduct of the study, the analysis and interpretation of the data, and the preparation of the article