Search

Aim: The increase in the number of people with chronic obstructive pulmonary disease (COPD) and the disease burden, has prompted concerted efforts to improve healthcare, particularly outpatient services. In line with these attempts the Partnership-Based Nursing Practice Theoretical Framework for People with COPD was developed to guide outpatient nursing care. The principal approach of the framework is a ‘Dialogue’ with the patients, which has four components: ‘Establishing family involvement’, ‘Assisting living with symptoms’ and ‘Facilitating access to healthcare’, with the primary goal being ‘Enhancement of the health experience’. With new knowledge, research on the framework, and extensive experience in using it, a need arose to modify the framework to maximize its clinical utility. Design: Discursive paper. Methods: A narrative review and critical reflection was conducted to revise the nursing practice framework via selected literature search from 2012 to 2022, research on the framework, and the authors' reflections on the clinical experience of using the framework. Results: The nursing practice framework highlights capacities and possibilities that lie in the nurse–patient relationship. The overarching dialogue in the revised framework includes both patients and families. The action-related component ‘Assisting living with the disease’ was added to the framework to underscore the significance of attempting to understand what may lie ahead for patients and families. The other action-related components are as follows: ‘Assisting living with symptoms’ and ‘Facilitating access to healthcare’. The primary goal remains unchanged: enhancing the ‘Health experience’. Conclusion: Using the revised nursing practice framework in outpatient care may help to enhance the lives of people with COPD and their families, particularly at advanced stages of the disease. It may have transferability to other groups of people living with progressive diseases dealing with complicated health problems, and to reduce the usage of costly healthcare resources such as hospital care. Implications for the Profession and/or Patient Care: The partnership-based nursing practice framework assumes an extension of conventional specialized respiratory service and embraces a comprehensive account for that which may influence the patient's health problems. This guidance, which holistically attends to patient-family needs of living with complicated and progressive health predicaments, is fundamental. It contributes to strengthening the disciplinary focus of nursing, interdisciplinary collaboration, person-family-centred quality nursing care and inspires research initiatives. Critical reflections and updates on nursing practice frameworks, such as this revision, are essential to advance nursing and healthcare. [ABSTRACT FROM AUTHOR]

watts t. (2012) Initiating end-of life-care pathways: a discussion paper. Journal of Advanced Nursing 68(10), 2359-2370. Abstract Aims. To discuss the intricacies of the decision-making process about initiating end-of-life care pathways. Background. Internationally, enhancing the quality of end-of-life care has become a central concern in governments' health policies. Despite limited empirical evaluation, end-of- life care pathways have been championed and widely adopted as complex interventions to enhance end-of-life care worldwide. Data sources. A literature search of established electronic databases was conducted for published articles in English addressing decision-making and end-of-life care pathways between 1997-2010. Manual searches of relevant journals and internet sites were also undertaken. Discussion. The initiation of an end-of-life care pathway marks the transition to the terminal phase of care. Although guidance for commencing these pathways exists, this may not overcome the complexities of the decision-making process, which must be viewed in context, namely: marking the transition to terminal care, dealing with ambiguity, reaching professional consensus and engaging patients and families. Implications for nursing. Nurses in all care settings have an important role in easing the transition to end-of- life care. Accordingly, nurses need not only an appreciation of end-of-life care pathways, but the complexities surrounding the decision to commence a pathway and their role within. Conclusion. The initiation of an end-of-life care pathway is contingent on the outcome of a complex decision-making process which is rarely explored and poorly understood. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Advance care planning is a process through which people communicate their goals and preferences for future medical care. Due to the complexity of the decision‐making process, decision aids can assist individuals in balancing potential benefits and risks of treatment options. Objective: While decision aids have the potential to better promote advance care planning, their characteristics, content and application effectiveness are unclear and lack systematic review. Therefore, we aimed to explore these three aspects and establish a foundation for future research. Design: Scoping review. Methods: This scoping review adheres to the framework proposed by Arksey and O'Malley and the PRISMA‐ScR list. Six English‐language databases were systematically searched from the time of construction until 1 December 2023. Two researchers conducted the article screening and data extraction, and the extracted data was presented in written tables and narrative summaries. Results: Of the 1479 titles and abstracts, 20 studies fulfilled the inclusion criteria. Types of decision aids were employed, mainly websites and videos. Decision aid's primary components center around 11 areas, such as furnishing information, exploring treatment and care preferences. The main manifestations were a significant increase in knowledge and improved recognition of patients' target value preferences. Among the aids, websites and videos for advance care planning have relatively high content acceptability and decision‐making process satisfaction, but their feasibility has yet to be tested. Conclusions: Decision aids were varied, with content focused on describing key information and exploring treatment and care preferences. Regarding application effects, the aids successfully facilitated the advance care planning process and improved the quality of participants' decisions. Overall, decision aids are efficient in improving the decision‐making process for implementing advance care planning in cancer and geriatric populations. In the future, personalised decision aids should be developed based on continuous optimization of tools' quality and promoted for clinical application. Reporting Method: The paper has adhered to the EQUATOR guidelines and referenced the PRISMAg‐ScR checklist. No Patient or Public Contribution: This is a review without patient and public contribution. Registration: https://doi.org/10.17605/OSF.IO/YPHKF, Open Science DOI: 10.17605/OSF.IO/YPHKF. [ABSTRACT FROM AUTHOR]

Background: Dying well at home usually requires the help and assistance of an informal caregiver. This role is usually unpaid, wide‐ranging and oftentimes demanding. From diagnosis to death of a loved one, informal caregivers can experience one and frequently numerous transitions, however, little is known about this process. The purpose of this scoping review is to chart, explore and understand caregivers' experiences of transitioning when providing end‐of‐life care. A preliminary search of the literature indicated a paucity of research highlighting a notable absence of caregiver's perspectives and acknowledgements of the support they need to ensure successful transitions during this time. Consequently, this review has the potential to make a valuable contribution to the literature. Methods: Arksey and O'Malley's (2005) framework, further enhanced by Levac et al. (2010) and Peters et al. (2020) was used to conduct this scoping review. The Extension for Scoping Reviews (PRISMA‐ScR) guided reporting. A systematic search of the databases PUBMED, PsychINFO, CINAHL, EMBASE, and Web of Science and a selection of grey literature was undertaken from the year 1990 to date by two researchers. Titles and abstracts of the literature identified were screened and finally, a narrative synthesis of 11 articles was undertaken to answer the following research question: What is known from the literature about informal caregivers' transitions when caring for a dying person in the home? Conclusions: Current knowledge on this topic is limited; however, from this review, two main themes were identified: 'Challenges arising during transitioning' with subthemes of burden of care and fading away. The second theme 'Coping strategies' comprised subthemes of meaning‐making, seeking normality and hope. This evidence may support the development of transitional care interventions in the future and improve patient and caregiver outcome measures and experiences to inform a larger research study exploring this phenomenon. Patient or Public Contribution: N/A as this is a Scoping Review. What this paper contributes to the wider global community: An understanding of the experiences of transitioning when caring for a loved one dying at home could help mitigate challenges informal caregivers face when providing end‐of‐life care in the home.While informal caregivers are crucial to support people who want to die at home, the role is often invisible and family carers need support and recognition to reduce the burden of care and challenges they experience as they transition in their role. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper investigates the feasibility and the perception of the nurse's role as the palliative care coordinator. Background: Integrated care is a global imperative in all healthcare improvement processes. Due to Andrija Štampar's success in the organisation of public health services, Croatia today has more than hundred years of experience in care integration. The palliative care system has been continuously developing since 2014 as an integrated care model, with nurses as care coordinators. Methods: The study used a mixed methodology based on pragmatic research principles, including an analysis of strategic and policy documents and reports, and thematic analysis of focus group conducted with palliative care coordinators, following COREQ checklist. Results: Although a legal, professional and financial regulation of nurse coordinators has been achieved, a number of implementation challenges remain. These challenges arise as a result of long‐term fragmentation of the health and social care, and can be found in both horizontal and vertical integration of care, that is in the dimensions of functional, clinical, cultural and social integration. Conclusions: Nurses play a central role in care coordination. Coordination and integration promote professionalisation with clear roles and tasks. However, even with the legal, professional and financial implementation of the nurse coordinator model, it has to be further promoted as an equally important job in the healthcare system, with nurses as competent professionals in charge of care coordination. Relevance to clinical practice: Palliative care provides a range of individualised, coordinated services that meet the medical and non‐medical needs of seriously ill patients. Described model of palliative care in Croatia is particularly important because it was developed as an integrated part of health care (and partly social welfare) system, indicating with the nurse's role as palliative care coordinator that coordination is a continuous process that requires a dedicated professional role. [ABSTRACT FROM AUTHOR]

Background: Education plays an important role in cancer symptom management for patients and their families. With the advancement of information and communication technology, there may be additional evidence for the use of mobile apps to support patient and family education. Purpose The purpose of this review was to explore and synthesize scientific literature about cancer symptom management mobile apps that can be used by patients and their families. Methods: This review adopted a scoping review study framework, using electronic databases including EBSCO, PubMed, ProQuest, Science Direct, and Google Scholar using search keywords: 'caregiver family', 'mobile application', 'symptom management' and 'palliative care'. Of a total of 2633 papers found, 11 papers were selected. Findings Assessment tools are a major component of mobile apps in reporting and assessing symptoms to provide appropriate education. The information in mobile apps is delivered through various mediums that include modules, videos, avatars and cultural integration features. Conclusion: Mobile apps can improve provision of palliative care in several ways, most importantly by increasing the knowledge of the patient's family to manage cancer symptoms. Nurses are expected to play an active role in finding and utilizing appropriate mobile apps to assist families in managing a patient's symptoms at home. SUMMARY STATEMENT: What is already known about this topic? Mobile apps are able to meet some healthcare information needs of patients with cancer.The use of mobile apps is proven to be a cost‐effective way to provide healthcare information to patients after discharge from hospital.What this paper adds? The assessment feature in a mobile app is a major component in reporting and assessing patient symptoms to enable provision of further appropriate education.Delivery of education in mobile apps is through various mediums including modules, videos, avatars and cultural integration features, as well as an emergency call function for managing severe symptoms.The implications of this paper: Nurses are expected to play an active role in finding and utilizing appropriate mobile apps to assist families in managing patients with cancer at home.The development of mobile apps might be extended to symptom management of other life‐limiting illness due to its benefits. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the usefulness of nonwearable actigraphy to assess changes in motor activity before and after rescue analgesic administration in terminally ill cancer patients. Background: Evaluating pain in terminally ill cancer patients is difficult; pain assessment tools are needed. Methods: This was an exploratory descriptive study conducted within a palliative care unit. A nonwearable actigraph was used to measure the activity score and movement index of terminally ill patients with weeks‐long prognosis and pain. The actigraph and medical data were integrated, and data were compared 6 h before and after rescue analgesic administration. Results: Among 10 patients (age: 75.8 ± 12.3 years; six men), we evaluated 28 pain episodes (mean activity score: 130.9 ± 180.5 counts per minute; movement index: 68.8%). When pain was relieved at night following rescue analgesic administration, activity score and movement index decreased significantly (6 h before vs. 6 h after analgesics, respectively: 113.1 to 69.7 counts per minute; 64.3% to 41.8%; both p < 0.0001). With no relief after rescue analgesic administration, activity score did not differ significantly 6 h before and after analgesics: 147.3 to 137.7 counts per minute. Conclusion: Pain in terminally ill cancer patients could be assessed using a nonwearable actigraph to capture motor activity and improve pain assessment. Summary statement: What is already known about this topic? Pain assessment in terminally ill patients with cancer relies on a subjective patient complaint as well as observations by caregivers, such as nurses and physicians. However, pain assessment can be challenging because some patients do not complain of pain, which contributes to poor pain control.Evaluating pain in terminally ill patients with cancer is difficult; therefore, developing pain assessment tools is required. What this paper adds? This is the first report to show that pain in patients who are in bed changes motor activity. Therefore, measuring motor activity could be used as an indication of pain. The implications of this paper: This study suggests that motor activity measurement with a sensing device could be used to indicate patient pain and improve pain assessment. [ABSTRACT FROM AUTHOR]

Aim: To explore the significance of culture, professional support in the community, social interactions and intrapersonal determinants of adults' preferences for life‐sustaining treatments and palliative care. Methods: A cross‐sectional design with a Social Ecological Model was used. Between 1 October 2012 and 31 December 2012, 474 adults aged ≥20 years living in a city of Southern Taiwan completed the survey. Data were analysed using hierarchical multiple regression. Results: The life‐sustaining measures model was significant with 15.3% (p < 0.0001) of the variance in the Modified Emmanuel Medical Directives being explained by variables of death of self and healthcare services' support. The palliative care model was significant with 18% (p < 0.0001) of the variance in the Modified Hospice Attitude Scale being explained by variables of palliative care knowledge, death of self and social interactions. However, cultural value adherence did not predict adults' preferences for life‐sustaining measures and community resources support did not predict palliative care preference. Conclusions: Findings enhance our understanding of the significance of different societal levels on adults' preferences for end‐of‐life care. Palliative care knowledge, fear of death, healthcare services' support and social interactions are essential factors that need to be taken into consideration when it comes to discussion about life‐sustaining treatments and palliative care. Summary statement: What is already known about this topic? End‐of‐life (EOL) preferences can be shaped not just by knowledge, values and individuals' attitudes but rather a host of social influences.Few studies with theoretical frameworks or models in the literature are available to provide a comprehensive understanding of factors contributing to responses at the EOL. What this paper adds? The findings advance the knowledge of the influence of social interactions, healthcare services' support, palliative care understanding and fear of death on adults' preferences for life‐sustaining treatments and palliative care.The identified relationships in the context of life‐sustaining treatments and palliative care provide practical guidelines, which can help to inform appropriate supportive interventions for EOL care planning. The implications of this paper: Healthcare services that provide a mediating structure where a person belongs should focus on enhancing community resources regarding EOL healthcare planning, knowledge about palliative care and reinforcing life and death education.The social support network and emotional ties with a person's significant others should also be taken into consideration to facilitate EOL healthcare planning and to promote good quality of life at EOL. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to conduct an integrative review on how nurses prepare families for and support families during withdrawal of life-sustaining treatments in intensive care. Background End-of-life care is widely acknowledged as integral to the practice of intensive care. However, little is known about what happens after the decision to withdraw life-sustaining treatments has been made and how families are prepared for death and the dying process. Design Integrative literature review. Data sources MEDLINE, CINAHL Plus, Psych INFO, PUBMED, Scopus, EMBASE and Web of Knowledge were searched for papers published between 2000-May 2015. Review methods A five stage review process, informed by Whittemore and Knafl's methodology was conducted. All papers were reviewed and quality assessment performed. Data were extracted, organized and analysed. Convergent qualitative thematic synthesis was used. Results From an identified 479 papers, 24 papers were included in this review with a range of research approaches: qualitative ( n = 15); quantitative ( n = 4); mixed methods ( n = 2); case study ( n = 2) and discourse analysis ( n = 1). Thematic analysis revealed the nurses: equipped families for end of life through information provision and communication; managed the withdrawal of life-sustaining treatments to meet family need; and continued care to build memories. Conclusion Greater understanding is needed of the language that can be used with families to describe death and dying in intensive care. Clearer conceptualization of the relationship between the medically focussed withdrawal of life-sustaining treatments and patient/family-centred end-of-life care is required making the nursing contribution at this time more visible. [ABSTRACT FROM AUTHOR]

Aims and objectives: To map existing evidence about educational interventions or strategies in nursing and allied healthcare concerning students' and staffs' spiritual care provision. Background: Spiritual care is an important part of whole person care, but healthcare staff lack competence and awareness of spiritual issues in practice. To rectify this, it is important to identify what educational approaches are most helpful in supporting them to provide spiritual care. Design: A scoping review using the PRISMA‐ScR checklist. Method: Searches in the databases CINAHL, MEDLINE, ATLA and ERIC were conducted for papers spanning January 2009–May 2020. Search terms were related to spirituality, spiritual care, education and clinical teaching. Appraisal tools were used. Results: From the 2128 potentially relevant papers, 36 were included. The studies were from 15 different countries and involved nurses, physicians and other health‐related professions, and both quantitative, qualitative and mixed methods were used. The results are presented in three themes: Understanding of spirituality, Strategies in educational settings, and Strategies in practice settings. The review points to great diversity in the content, lengths and setting of the educational interventions or strategies. Conclusions: Courses in spiritual care should be implemented in curricula in both undergraduate and postgraduate education, and several studies suggest it should be mandatory. Courses should also be available for healthcare staff to raise awareness and to encourage the integration of spiritual care into their everyday practice. There is a need for greater consensus about how spirituality and spiritual care are described in healthcare settings. Relevance to clinical practice: Spiritual care must be included both in monodisciplinary and multidisciplinary educational settings. The main result of spiritual care courses is in building awareness of spiritual issues and self‐awareness. To ensure the provision of spiritual care for patients in healthcare practices, continuing and multidisciplinary education is recommended. [ABSTRACT FROM AUTHOR]

Aims and objectives: To conduct an integrative review of the literature to understand how the incorporation of traditional therapies affect First Nations people's utilisation of palliative care services. Background: First Nations peoples face many barriers related to accessing and utilising specialised health services such as palliative care. Whilst culturally appropriate care has been shown to improve these outcomes, there is little evidence regarding how this may be achieved. Design: Integrative review. Methods: A systematic search was conducted using electronic databases CINAHL, Joanna Briggs, Medline, Scopus, ScienceDirect InformitHealth and ProQuest between the years of 2005‐2021 databases were searched for papers with full text available and published in English. Papers were included if they were primary‐based research and focused on the topics of the use of traditional therapies in a palliative care context by First Nations persons. The Critical Appraisal Skills Programme principles were used to assess the methodological quality of the selected articles. Results: Seven studies met the inclusion criteria and were included in the review. The review included six qualitative studies and one quantitative study. From these studies, five themes were identified in the literature: supporting a holistic approach, developing culturally appropriate care, conflict within a Western medical model, regulatory issues, and geographical barriers. Conclusion: There is a dearth of current literature available discussing the utilization of traditional therapies in palliative care. From the literature analysed, the benefits of including traditional therapies are overall positive, however, there are barriers including conflict with the Western model of medicine and regulation. More research is required in the provision of traditional therapies in palliative care. Relevance to Clinical Practice: The incorporation of traditional medicines within a palliative care setting could help nurses provide holistic and culturally appropriate care, especially in rural and remote areas where they make up the majority of the healthcare force. [ABSTRACT FROM AUTHOR]

Aims and objectives To present the findings of an integrative literature review of the evidence for the clinical management of delirium in patients with advanced cancer. Background Patients with advanced cancer frequently experience delirium which can be distressing for both patients and their families. Current guidelines recommend that underlying causes of the delirium be addressed and a course of antipsychotics considered. However, the research into the effectiveness of treatments for delirium in people with advanced cancer is limited. Design Integrative literature review. Data sources Systematic searches of the MEDLINE, CINAHL, ProQuest Nursing and Allied Health and PsychInfo databases were conducted in April 2016 to include papers published in 2000 and later. The returns were screened using inclusion and exclusion criteria, and the seven studies found to be suitable were subject to review. Review methods Findings of the seven papers were extracted, appraised critically and reviewed using a narrative approach. Results A number of interventions, including the use of atypical antipsychotics, opioid rotation, methylphenidate hydrochloride and coeliac plexus block, were reported; however, there was limited evidence of their effectiveness. One study reported the use of exercise therapy as a nonpharmacological intervention. Conclusion A variety of interventions to treat delirium in patients with advanced cancer have been tested through nonblinded, nonrandomised trials which have not produced a clear evidence base for practice. Relevance to clinical practice The clinical management of delirium in patients with advanced cancer is poorly understood and remains a clinical issue which requires further research (particularity randomized control trials) in order to determine more effective treatments and management strategies. [ABSTRACT FROM AUTHOR]

Aim: To examine the experiences of internationally qualified nurses, including those from culturally and linguistically diverse backgrounds, transitioning to and working in the aged care sector of high-income countries. Design: A scoping review. Data Sources: CINAHL, MEDLINE and PSychINFO databases were searched to find eligible literature published from January 2010 onwards. Review Methods: This scoping review was based on the framework by Arksey and O'Malley and the PRISMA-ScR guidelines. The literature search was conducted by the first author, and all three authors reviewed the retrieved studies for eligibility and inclusion. Results: Fourteen articles were eligible. Data was categorized into three broad themes: stress of migration and transition; miscommunication, racism and discrimination; and aged care specific challenges which included two sub-themes ‘shock of aged care’ and ‘bottom care’. Conclusion: Internationally qualified nurses, particularly if they are culturally and linguistically diverse, face unique stresses and challenges in aged care and face barriers in the recognition of skills and qualifications. The under-utilization of skills is not only a loss in terms of patient care but is linked to fears of de-skilling, losing professional development and opportunities for career progression. Impact: Internationally qualified nurses are positioned as a solution to aged care shortages in high-income countries; however, there is a scarcity of research exploring their experiences. In the context of the global aged care staffing crisis, an understanding of the stresses and challenges faced by internationally qualified nurses will further strengthen efforts to recruit, support and retain skilled nurses in aged care. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify the mechanisms of subcutaneous fluid administration in advanced illness. Background Hydration at end of life is a fundamental issue in quality care internationally. Decision-making regarding the provision of artificial hydration in advanced illness is complicated by a paucity of evidence-based guidance. Despite considerable attention given to the topic including two recent Cochrane reviews, there has been no focus in systematically identifying papers that report the mechanisms for delivering hydration subcutaneously. Consequently, there is a need to produce guidance on the site, mode, volume and rate of infusion, based on empirical evidence. Design Systematic review of papers reporting empirical research data. Methods Key databases (CENTRAL, Medline, EMBASE, Web of Science, CINAHL) were searched in September 2015, with no date limitations. Inclusion criteria focused on hypodermoclysis in adults within an advanced illness population. Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. Results Fourteen papers were included in the analysis; most ( n = 8) were conducted in hospices with others ( n = 6) in long-stay units with a population affected by chronic conditions associated with ageing. Studies were of moderate or high quality. The site and mode of infusion were not well described in these papers, and rates of infusion varied widely allowing for little clear consensus to guide clinical practice in the administration of subcutaneous fluids. Conclusions Studies under-report the mechanisms by which artificial hydration is provided, creating a paucity of evidence-based guidance by which to practice. There is a need for evidence generated from nonmalignant populations to ensure applicability to the large number of people with other advanced illness. Relevance to clinical practice In the absence of sufficiently powered robust evidence, the mode of delivery of artificial hydration at end of life remains in the gloaming between evidence and unfounded habit. [ABSTRACT FROM AUTHOR]

Aims: To explore the nuances of theory utilization in qualitative methodologies, discuss the different relationships that applied qualitative methodologies have with theory and use the foundational underpinnings of interpretive description to challenge strongly entrenched ideas of theory that have extended into applied qualitative nursing research. Design: Methodology discussion paper. Data sources: Narrative literature review and personal observations. Conclusion: Many qualitative research traditions have viewed the use of an explicit theoretical framework as an integral grounding for qualitative research studies. Much of the discussion of theory in extant qualitative methodological literature focuses on its use in the context of traditional methodologies such as ethnography, phenomenology and grounded theory, with less attention on methodological approaches developed for applied and practice disciplines such as nursing. Uncritical adoption of ideas about theory based on traditional qualitative methodological conventions can result in findings with little utility for application to the practice context. Impact: Nursing researchers should think critically about how theory is used in research endeavours geared towards applied practice and ensure that their methodological choices are in alignment with their philosophical and disciplinary epistemological positionings. [ABSTRACT FROM AUTHOR]

Aim: To explore perspectives of Mesothelioma UK clinical nurse specialists (CNSs) on their role in providing palliative care for patients with mesothelioma and their families. Design: A qualitative descriptive approach using focus group and interview methods. Methods: Focus groups and semi‐structured interviews were conducted with 16 Mesothelioma UK clinical nurse specialists using the online software Google Meet. Data collection was carried out in Jan‐Feb 2021 and data were analysed using thematic analysis. The consolidated criteria for reporting qualitative research (COREQ) was used as the reporting guideline for this paper. Results: Four main themes were identified from the data: Mesothelioma UK clinical nurse specialist role in relation to palliative care; joint working with specialist palliative care and community services; patients and family carer's willingness to engage with palliative care services; and the impact of COVID‐19 on palliative care for mesothelioma patients. Conclusion: This study provides valuable insights into palliative care needs in mesothelioma. Patients with mesothelioma and their families have significant palliative care needs throughout the course of their illness from diagnosis to the end of life. Mesothelioma UK CNS's play a crucial role in supporting patients' and families palliative care needs, and are highly skilled in providing this care. Impact By acknowledging the role of Mesothelioma UK CNS's in palliative care provision, and supporting collaborative working between specialist and generalist palliative care providers, there is the capacity to significantly improve palliative care in mesothelioma and improve outcomes for patients and their families. [ABSTRACT FROM AUTHOR]

Aim: The present study aims to explore the research hot spots, development trends and knowledge structure of dignity in the nursing field. Design: Quantitative and co‐word biclustering analysis were used. Methods: Articles on dignity care published from 01 Jan 2011 to 31 Dec 2020, were retrieved from PubMed. The extracted Medical Subject Headings (MeSH) terms were quantitatively analysed using Bibliographic Item Co‐occurrence Matrix Builder software. To determine the hot spots, a biclustering analysis was completed using gCluto1.0 software. A strategic diagram and a social network analysis (SNA) were used to reveal trends in the theme and knowledge structure. Results: In the parameters of the retrieval strategy, a total of 1977 papers were included in the present study. Amongst all the extracted MeSH terms, 27 high‐frequency MeSH terms were identified, and the hot spots were grouped into five categories. These were namely dignity in: (1) dementia care, (2) palliative care, (3) older people care, (4) healthcare and (5) clinical nursing. In the strategic diagram, the study of dignity in clinical nursing was active and should become an emerging field of research in the near future. Conclusions: Based on the co‐word biclustering of dignity care over the past 10 years, five hot spots were identified, and it was predicted that research on dignity in clinical nursing would be the main trend in future studies. Amongst the five themes it was interesting to note that dignity in dementia and palliative care are core priorities to which scholars should pay more attention. Impact: In recent years, dignity‐conserving care has been highly valued, however, there are few relevant bibliometric articles that can be referenced on this topic. The present study was considered to offer novel insights into research on dignity in nursing and could be a reliable reference point for researchers when launching new projects. [ABSTRACT FROM AUTHOR]

Background: An urgent need to improve palliative care in hospital has been identified. Moreover, service users consistently report care delivered by nurses in hospital as lacking compassion. Compassion is a fundamental component of nursing care, and promoting compassionate care has been identified as a policy priority in many countries. To help address this within the hospital context, we recently completed research exploring bereaved family experiences of good end of life care in hospital. We found that family accounts of good care aligned with Nolan and Dewar's compassionate care framework and subsequently extended the framework to the bi‐cultural context of Aotearoa, New Zealand. Aims and objectives: In this discussion paper, we explore synergies between our newly developed Kapakapa Manawa Framework: a bi‐cultural approach to providing compassionate care at the end of life and the Fundamentals of Care. We argue that our framework can be used to support the implementation of the relational component of the Fundamentals of Care and the delivery of compassionate nursing practice in hospitals in Aotearoa, New Zealand. Design: Discussion paper. Methods: Review of relevant literature and construction of two vignettes describing good end of life care from the perspectives of bereaved family—one Māori and one non‐Māori. The vignettes provide practical examples of how the values of the Kapakapa Manawa Framework can be enacted by nurses to provide compassionate care in alignment with the relationship component of the Fundamentals of Care. Conclusions: Whilst the Kapakapa Manawa bi‐cultural compassionate care framework has grown out of research conducted with people nearing the end of their lives, it has the potential to improve nursing care for all hospital inpatients. Relevance to clinical practice: Addressing the wider policy and health system factors detailed in the Fundamentals of Care will support its implementation in the clinical setting. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. Background Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. Design Naturalistic prospective repeated-measures mixed-methods approach. Methods Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. Results Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. Conclusions It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations. Relevance to clinical practice It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: In recent years, some have suggested that palliative care approaches be considered for patients diagnosed with severe, persistent mental illness.Palliative care aims to decrease the suffering related to illness rather than focusing on curing the illness.Palliative care approaches for patients diagnosed with severe, persistent mental illness are controversial: Some argue palliative care would improve quality of life while others argue it would negatively affect patients' well‐being.A recent survey found that psychiatrists from Switzerland tended to support the idea of palliative care approaches for those diagnosed with severe, persistent mental illness, but little is known about nurses' attitudes or beliefs regarding palliative psychiatry. What the paper adds to existing knowledge?: Participating nurses tended to agree that palliative care approaches may be appropriate and even important in caring for those diagnosed with severe, persistent mental illness.Participating nurses tended to prioritize quality of life and respect for patient autonomy.Participating nurses tended to agree palliative sedation may be an appropriate intervention. What the implications are for practice?: For those diagnosed with severe, persistent mental illness, care that aims to increase daily functioning and quality of life rather than care that looks to cure may be appropriate.Palliative psychiatry should be further explored and better defined. Introduction: In recent years, palliative care approaches for patients diagnosed with severe, persistent mental illness have been proposed, but remain controversial. Aim/Question: The central research question of the present study was whether nurses consider palliative psychiatry appropriate in general and for certain patient types in particular. This pilot study is designed to inform future research. Method: A quantitative survey that explored attitudes and beliefs regarding palliative care for those with severe, persistent mental illness. Results: The responding 38 nurses tended to agree that palliative care approaches are suitable (73%, n = 24) and even important (62%, n = 21) in treating patients diagnosed with severe, persistent mental illness, including interventions such as palliative sedation (73%, n = 24). Discussion: Widespread support among respondents regarding palliative care approaches for those diagnosed with severe, persistent mental illness might be an indication that palliative approaches are already implicitly understood and incorporated into patients' care. More research is needed to determine whether these findings represent nurses' views generally. Implications for practice: These finding suggest that palliative psychiatry should be further explored and developed. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross‐cultural perspective. Background: Persons with serious or life‐limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well‐being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures. Design: A quantitative, cross‐sectional, observational cross‐cultural comparison was undertaken. Methods: The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness‐related variables were also assessed using paper‐and‐pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis. Results: The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self‐reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs. Conclusions: In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently. Relevance to clinical practice: Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in‐depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs. [ABSTRACT FROM AUTHOR]

Aim: To describe a small multidisciplinary team's experience of the process of embedding nurse‐led supportive care into an existing Chronic Obstructive Pulmonary Disease outpatient service. Design: Case study methodology Methods: Data were collected from multiple sources including key documents and semi‐structured interviews with healthcare professionals (n = 6) conducted between June and July 2021. A purposive sampling strategy was used. Content analysis was applied to key documents. Interviews were transcribed verbatim and analysed using an inductive approach. Results: Subcategories under the four‐stage process were identified from the data. Assessment: evidence of needs of patients with Chronic Obstructive Pulmonary Disease; gaps in care and evidence of other models of supportive care. Planning: setting the supportive care service structure and intention; resources and funding; leadership, specialization and respiratory/palliative care roles. Implementation: relationships and trust; embedding supportive care and communication. Evaluation: benefits and positive outcomes for staff and patients, and, improvements and future considerations for supportive care in the COPD service. Conclusion: A collaboration between respiratory and palliative care services resulted in successfully embedding nurse‐led supportive care in a small outpatient service for patients with Chronic Obstructive Pulmonary Disease. Nurses are well placed to lead new models of care that aim to address unmet biopsychosocial‐spiritual needs of patients. More research is needed to evaluate nurse‐led supportive care in Chronic Obstructive Pulmonary Disease and other chronic illness settings; the effectiveness of nurse‐led supportive care from the perspective of patients and caregivers and the impact of nurse‐led supportive care on health service usage. Patient or Public Contribution: The development of the model of care is informed by ongoing discussions with patients with COPD and their caregivers. Data availability statement: Research data are not shared (due to ethical restrictions). Impact Embedding nurse‐led supportive care in an existing Chronic Obstructive Pulmonary Disease outpatient service is achievable.Nurses with clinical expertise can lead innovative models of care that address the unmet biopsychosocial‐spiritual needs of patients with conditions such as Chronic Obstructive Pulmonary Disease.Nurse‐led supportive care may have utility and relevance in other chronic disease contexts. [ABSTRACT FROM AUTHOR]

To examine the role of trained health and personal care assistants in supporting district nurses and family carers in providing palliative and end of life care in the community. In the UK, there is a policy directive to improve end of life care and to enable greater numbers of people to die at home. This places considerable demands on community nursing services and family carers. In response to this, the Complex and Palliative Continuing Care Service employing generic health and personal care assistants was developed as part of the Marie Curie Delivering Choice Programme in one city in the UK. This paper draws on findings from an independent evaluation of the scheme. The wider evaluation used a formative evaluation methodology. This paper draws on in-depth interviews with a range of stakeholders ( n = 17), in-depth interviews with bereaved carers ( n = 6) and an analysis of documentation. Stakeholders and bereaved carers perceived that the health and personal care assistants made a vital contribution to community palliative care. Careful recruitment, specific training, case management by district nursing with allocation of specific tasks and close ongoing communication were key features which stakeholders indentified. Family carers welcomed the way assistants developed relationships and became familiar and able to meet the care needs of patients. There were some problems reported which related to capacity, work flow and the need for extensive written care plans. Employing health care assistants under the supervision of district nurses appears to support patients and family at home during end of life care and contribute to good quality nursing care. The needs for community-based palliative and end of life care will increase rapidly over the course of the next 20 years, placing pressure on community nursing services and family carers. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe advance care planning (ACP) for patients with cancer in palliative care from professionals' perspective. Background: The number of patients with cancer is increasing. Palliative care should be based on timely ACP so that patients receive the care they prefer. Design: A scoping review. Methods: A systematic literature search was conducted in January 2019. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist was used. The methodological quality of the studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were analysed with content analysis. Results: Of 739 studies identified, 12 were eligible for inclusion. The settings were inpatient and outpatient facilities in special and primary care including oncology, palliative and hospice care. ACP consisted of patient‐oriented issues, current and future treatment, and end‐of‐life matters. The participants were nursing, medical or social professionals. ACP conversations rarely occurred; if they did, they took place at the onset, throughout and late in the cancer. Conclusions: Professionals could not separate day‐to‐day care planning and ACP. ACP documentation was scattered and difficult to find and use. Professionals were unfamiliar with ACP, and established practices were lacking. ACP conversations mostly occurred in late cancer. Further research clarifying concepts and exploring the significance of ACP for patients and relatives is recommended. Relevance to clinical practice: Our results support the use of ACP by a multidisciplinary team from the early stages of cancer as a discussion forum around patients' wishes and choices. We showed the need to raise professionals' awareness of ACP. Education and appropriate data tools for ACP are important as they may reduce reluctance and promote ACP use. This paper contributes to the wider global clinical community by pointing out the importance of standardising ACP contents and practices. [ABSTRACT FROM AUTHOR]

Background: Early referral to palliative care has been viewed as providing opportunity for accomplishing end‐of‐life care goals of life closure, comfortable dying and effective grieving. However, previous studies have shown that palliative care referrals are being made too late. Healthcare providers play important role in helping terminally ill patients to early access and being referred to palliative care. It is necessary to understand healthcare providers' attitudes on palliative care referral and associated factors regarding referrals. Objectives: This review aimed to identify and synthesise healthcare providers' attitudes and associated factors on palliative care referrals systematically. Design: A systematic review of qualitative evidence and meta‐aggregation was conducted and guided according to PRISMA guideline. Data sources: PubMed, CINAHL, PsycINFO, EMBASE, Web of Science and Cochrane databases from inception to 24 October 2022. Results: Database searches yielded 5856 references. Twenty‐two studies met eligibility criteria and of moderate to high methodological quality were included. Studies occurred in USA, UK, Australia and France with 716 healthcare providers participants were included. A total of 378 codings were finally extracted and integrated into 41 categories, forming three synthesised findings: (1) Healthcare providers' attitudes towards palliative care referrals, (2) the influence of subjective norms on palliative care referral behaviour and (3) perceived behavioural control on palliative care referral behaviour. Conclusion: This review demonstrates a series of factors that affect the palliative care referrals, including the attitudes of healthcare providers, the participation of patients and families, the support of colleagues and supervisors, inter‐professional collaboration, the availability of hospice resource, disease trajectory and socio‐economic factors. Further research that addresses these factors and design relevant trainings on improving healthcare providers' attitudes, enhancing patient and family engagement, strengthening support networks and optimising resource allocation may aid to meet increasing demands of patients. Relevance to Clinical Practice: This review not only guides healthcare providers in making better decisions about patient referrals by identifying and addressing barriers but also aids in the development of effective interventions that facilitate the early initiation of referrals. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to estimate the proportion of acute care nurses witnessing end‐of‐life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. Design: A cross‐sectional survey study was conducted from February 2023 to May 2023. Setting/Participants: Participants were medical and surgical nurses from a 200‐bed acute care hospital in metropolitan Australia. Results: Fifty‐seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end‐of‐life dreams and visions. The nature of end‐of‐life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end‐of‐life dreams and visions but identified an unmet need for education and training on this aspect of end‐of‐life care. Conclusion: Our results suggest that nurses in acute care encounter end‐of‐life dreams and visions in a similar proportion to oncology and long‐term care but lower than in palliative care settings. Education and training regarding end‐of‐life dreams and visions are needed to ensure the provision of comprehensive, patient‐centred end‐of‐life care. Patient or Public Contribution: No patient or public contribution. Impact: Research in sub‐acute and long‐term care settings suggests that end‐of‐life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high‐income countries. This study demonstrates that acute care nurses encounter end‐of‐life dreams and visions in similar proportions to oncology and long‐term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end‐of‐life dreams and visions to enable the provision of holistic person‐centred end‐of‐life care. Reporting Method: This study was reported using the STROBE Checklist for cross‐sectional studies. [ABSTRACT FROM AUTHOR]

Aim: To describe uncertainty in surrogate decision‐making regarding end‐of‐life care for people with dementia using Mishel's reconceptualized uncertainty in illness theory. Design: Integrative literature review using Whittemore and Knafl's approach. Data Sources: PubMed, CINAHL, EMBASE, Scopus and Web of Science were searched using terms such as uncertainty/unpredictability, decision‐making/advance care planning/end‐of‐life care planning, surrogate/family/caregiver/proxy and dementia. The search was initially conducted on 28 September 2021 and updated on 31 July 2023. Review Methods: Through systematic screening, 20 research articles were included in the analysis. Content related to uncertainty in surrogate decision‐making regarding end‐of‐life care was extracted and analysed, focusing on the reconceptualized uncertainty in illness theory. Results: First, surrogate uncertainty exists in various areas of surrogate decision‐making regarding end‐of‐life care. Second, antecedents of surrogate uncertainty include numerous intrinsic and extrinsic factors. Third, surrogates exhibited some negative psychological responses to uncertainty but continually processed and structured their uncertainty through certain approaches, leading them to grow as decision‐makers. Finally, research‐based evidence on surrogates' processing of uncertainty and shifts to new life perspectives remains limited. Conclusion: Surrogates' uncertainty in decision‐making regarding end‐of‐life care for people with dementia is well characterized using the reconceptualized uncertainty in illness theory. Healthcare providers should help surrogates manage their uncertainty in surrogate decision‐making more constructively throughout the dementia trajectory. Implications for the Profession and/or Patient Care: The findings highlight the importance of assessing how surrogates process uncertainty and gauging how to help them process uncertainty and transition to new life perspectives. Impact: This review contributes to healthcare professionals' understanding of surrogates' uncertainty in end‐of‐life care planning for people with dementia, especially what they are uncertain about, what influences their uncertainty and how they process it. Reporting Method: This study adheres to the PRISMA reporting guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims This paper will examine understandings of autonomy and choice in relation to palliative and end-of-life care and identify implications for nursing practice. Background Autonomy in relation to patient-centred care and advocacy has been identified as a key component of palliative and end-of-life care provision internationally. Understandings of autonomy have emerged in an individualised framework, which may be inadequate in supporting palliative and end-of-life care. Design A critical discussion paper. Data sources Seminal texts provide a backdrop to how autonomy is understood in the context of palliative care. An overview of literature from 2001 is examined to explore how autonomy and choice are presented in clinical practice. Implications for nursing A model of autonomy based on a 'decision ecology' model may be more applicable to palliative and end-of-life care. Decision ecology aims to situate the individual in a wider social context and acknowledges the relational dimensions involved in supporting choice and autonomy. Such a model recognizes autonomy around wider care decisions but may also highlight the everyday personal aspects of care, which can mean so much to an individual in terms of personal empowerment and dignity. Conclusion A 'decision ecology' model that acknowledges the wider social context, individual narratives and emphasises trust between professionals and patients may support decision-making at end of life. Such a model must support autonomy not just at the level of wider decisions around care choice but also at the level of everyday care. [ABSTRACT FROM AUTHOR]

Aims and objectives To discuss the social context within which end-of-life nursing care takes place and to consider palliative options of last resort and the differences between societal and professional views on these. Background The distinction between life and death is not so straightforward as was once the case. Resuscitation and the increasing capability of intensive care to 'save' patients have implications for nursing practice in a society where there is an increasing demand that individuals should be able to choose the time of their death. Methods This is a discursive paper. Conclusions There are differences between the professional view on end-of-life options and the societal debates calling for a more libertarian approach. The problem for professionals is that the call for choice of the individual involves a different approach to end-of-life care, an approach that does not sit well with current professional ethics. One way forward might be a gradual reconsidering of what end-of-life care might reasonably encompass. Relevance to clinical practice Nurses are the healthcare workers who have the most prolonged and intimate contact with bodies. The way in which we conceptualise the body is central to much of the work carried out in the transition between life and death and is an important part of nursing. [ABSTRACT FROM AUTHOR]

Aims and objectives This article explores the perceptions of new graduate nurses around their readiness for practice when faced with death and dying within the workplace, particularly in rural hospital and community nursing settings. Background An essential consideration for nurses in the care of people with life-limiting illness is the extent of their preparation for this area of practice. Nurses need to be aware of a multitude of compounding factors that will influence how and where the person is cared for. Despite significant literature about how to provide end of life education to undergraduate nurses there is little in the literature that explores the experiences of new graduate nurses. Design This paper reports on a qualitative interpretative study with data collected in seven semi-structured interviews. Method Participants were invited to be interviewed with an online mail-out to Alumni who had graduated between 1-2 years earlier. A thematic analysis of the interviews was then conducted. Results Four themes emerged from the thematic analysis of the interviews. These were; the role of the new graduate in palliative care, preparation for palliative care in undergraduate nursing curricula, readiness for dealing with death and dying, and gaps in educational preparation. Conclusions While palliative care is viewed as an important aspect of undergraduate nursing education, it is recognised as an area of practice that undergraduate nurses feel they are not adequately prepared for . This study identifies the need to incorporate skills such as having conversations and communicating effectively with patients and families experiencing end of life issues. Relevance to clinical practice Graduate nurses feel they are not adequately prepared for end of life care which demonstrates the need for quality end of life care education in undergraduate nursing curricula. [ABSTRACT FROM AUTHOR]

Title. Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Aim. This paper is a report of an exploration of the phenomenon of existential distress in patients with advanced cancer from the perspectives of healthcare professionals. Background. Existential distress is an important concern in patients with advanced cancer; it affects their well-being and needs to be addressed in the provision of holistic care. Method. Focus groups were conducted from November 2008 to February 2009 with physicians, nurses, social workers, occupational therapists, physiotherapists, and chaplains working in a palliative care unit that served patients with advanced cancer in Hong Kong. Data collection and analysis were guided by the grounded theory approach. All categories were saturated when five focus groups had been held with a total number of 23 participants. Findings. We found three causal conditions of existential distress: anticipation of a negative future, failure to engage in meaningful activities and relationships, and having regrets. Three basic (caring, relating and knowing) and six specific (positive feedback, religious support, new experiences, task setting, exploring alternatives and relationship reconciliation) intervening strategies were identified. Whether the intervening strategies would be effective would depend on patients’ openness and readiness; healthcare professionals’ self-awareness, hopefulness, and interest in knowing the patients; and a trusting relationship between patients and healthcare professionals. A sense of peace in patients was considered a consequence of successful interventions. Conclusion. This paper acknowledges the lack of an accepted conceptual framework of existential distress in patients with advanced cancer. It is based on healthcare professionals’ views, and further studies from the perspectives of patients and their families are needed. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nurses play an important role in monitoring and supporting patients and their relatives at the end of life., To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity., The limited literature available indicates that palliative care for psychiatric patients needs to be improved., What this paper adds to existing knowledge? This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision., Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders., Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses., What are the implications for research and practice? Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group., Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored., Abstract Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2 years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored. [ABSTRACT FROM AUTHOR]

Aims and objectives To report an integrative review of evidence relating to dignity-conserving care in palliative care settings. It will also suggest avenues for future research. Background Research suggests that dignity is welcomed by those receiving palliative and end of life care. However, as dignity is a subjective term, it is not always explicit how this may be employed by nurses. Given that the preferred place of care for patients with palliative care needs is the home, the issue of dignity may be particularly important for community nurses. Therefore, synthesising evidence of dignity-conserving care for community nurses caring for people with palliative care needs provides clarity in a complex area of palliative care research. Design Integrative literature review. Method The review involved key bibliographic and review databases CINAHL, MEDLINE, EMBASE, ASSIA and PsycInfo. Medical Subject Headings and free terms were undertaken for articles published from January 2009-September 2014 and retrieved papers were assessed against inclusion criteria. Final included articles were reviewed for reported dignity-conserving care actions, which were classified under nine themes of the Dignity Model. Results Thirty-one articles were included. Nine Dignity Model themes were used to classify care actions: Level of Independence; Symptom Distress; Dignity-Conserving Perspectives; Dignity-Conserving Practices; Privacy Boundaries; Social Support; Care Tenor; Burden to Others; and Aftermath Concerns. Reported care actions included listening, conveying empathy, communication and involving patients in care. Conclusion Care actions could be classified under most of Dignity Model themes. However, there were less reported care actions related to Level of Independence and Aftermath Concerns, which meant that these had to be formulated independently. Future research should be structured around these areas to determine appropriate care actions for nurses to give dignity-conserving care that addresses these specific themes. Relevance to clinical practice Synthesising the available evidence of dignity-conserving care identifies evidence-based care actions and provides guidance to nurses in clinical practice caring for patients with palliative care needs. Future opportunities for research are identified to guide promotion of dignity in palliative care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To systematically review qualitative studies exploring families' experiences of spiritual care at the end of life in acute hospital settings. Background: Although there is a widespread belief that the consideration of spiritual and religious needs is outdated in the context of secularism, from a practical perspective patients and families appear to benefit from spiritual support at the end of life. Methods: Six key databases, CINAHL, MEDLINE, EMBASE, Global Health Library, Web of Science and Applied Social Sciences Index and Abstracts (ASSIA), were searched, and three reviewers independently extracted the data and coded them into themes and subthemes. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) was used as a reporting framework. Results: Five main themes emerged: anticipating needs; honouring the family by honouring the patient; personal connection; lack of sensitivity; and making space for religious and spiritual practices. Conclusions: Families experiencing end‐of‐life care in acute hospital settings may benefit from spiritual care. While this can also be considered as fundamental care, understanding this through the lenses of spiritual care allows for incorporation of religious and spiritual practices that many seek at this time, irrespective of their faith perspectives. Relevance to clinical practice: Although hospice care is well established internationally, many families experience end‐of‐life care in acute hospital settings. Nurses usually get to know families well during this time; however, the demands of the clinical environment place restrictions on family care and perceptions of lack of communication, limited support and/or limited sensitivity can compound families' suffering. Consideration of families' spiritual needs can help to support families during this time. Nurses are ideally placed for this and can anticipate and plan for patient and family needs in this regard, or refer to a specialist, such as the Healthcare Chaplain. [ABSTRACT FROM AUTHOR]

Aim: To develop an advance care planning intervention based on the needs of patients with chronic kidney disease, families and healthcare professionals. Background: Patients with chronic kidney disease and their families request early advance care planning that continues throughout their illness trajectory. Healthcare professionals experience barriers to initiating advance care planning. Involvement of stakeholders in development of health interventions is important, to identify priorities, understand the problem and find solutions. Method: The development was inspired by the Medical Research Council's framework, and codesign was applied. One future workshop and one design workshop were conducted with the consumers. The process was iterative, and data were analysed using the action research spiral. The Guidance for reporting intervention development studies in healthcare (GUIDED) was used. Results: Five areas were considered significant to an advance care planning intervention; a biopsychosocial approach, early palliative care, a family‐focused approach, early and continuous advance care planning and a consumer‐centred approach. Based on these, a conversation process with healthcare professionals was designed to give patients and families the opportunity to share values, preferences and wishes for treatment and their family and everyday life. Conclusion: Codesign facilitated a collaborative process that allowed the consumers to have a significant impact on the design of an advance care planning intervention. A conversation process concerning everyday life, illness and treatment was designed for patients and families. The intervention included an advance care planning tool to guide the healthcare professionals. Practice Implications: The intervention has the intention to improve the communication between healthcare professionals, patients and families. The study provides important knowledge about the significance of giving the patients and their families support in sharing their values, preferences and wishes for treatment and everyday life, thus, to improve care and treatment in their illness trajectory. Impact: What problem did the study addressPatients with chronic kidney disease and their families strongly request early initiation of advance care planning that continues throughout the illness trajectory. Healthcare professionals experience barriers to the initiation of the advance care planning and request a more systematic approach.What were the main findingsDevelopment of a conversation process about everyday life, illness and treatment for patients diagnosed with chronic kidney disease and families, including an advance care planning tool to guide the healthcare professionals.Where and on whom will the research have an impactThe study contributes an advance care planning intervention to patients in the early stages of chronic kidney disease and their families. We believe that the intervention could be included during consultations with healthcare professionals in other stages of chronic kidney disease as well as other chronic disease. Reporting Method: To strengthen the reporting of the development of the advance care planning intervention, we used the Guidance for reporting intervention development studies in healthcare (GUIDED). Patient or Public Contribution: The development of the intervention in this study was a collaborative process between patients, families, healthcare professionals and representatives from the Danish Kidney Association, the department's user council and the research team. [ABSTRACT FROM AUTHOR]

Aims: To map evidence on the nature and extent of use of nurse‐led palliative care models in low‐ and middle‐income countries serving adults with life‐limiting conditions. Design: A scoping review of the literature was undertaken. Data Sources: A systematic search was performed from database inception to March 2022 in: Medline, EMBASE, CINAHL, Wiley Cochrane Library, SCOPUS, Web of Science, SciELO and Global Health. Main search terms included: Nurse‐led AND Palliative care AND Low‐and middle‐income countries. Grey literature was searched from Proquest Dissertations and Theses Global, the World Health Organization and selected palliative care websites. We searched the reference list of included articles for additional studies. Review Methods: We used the framework by Arksey and O'Malley and the PRISMA‐ScR guidelines. Titles and abstracts were screened by one reviewer and full text by two reviewers. Thematic analysis was used to synthesize data and results are presented descriptively using themes and categories. Results: Eighteen studies were included, with majority from Sub‐Saharan Africa (10/20). Three nurse‐led palliative care models emerged: nurse‐led empowering care, nurse‐led symptom control and nurse‐led multicomponent palliative care. They served particularly cancer and HIV patients and were delivered in person or by telehealth care. Reported outcomes were adherence to therapy, improved self‐care ability, improved quality of life and increased access to palliative. Conclusions: The use of nurse‐led palliative care in low‐ and middle‐income countries is in its developing stages and seems feasible. Nursing roles in in low‐ and middle‐income countries need to be expanded by developing advanced practice nurses and nurse practitioner programmes, with palliative care content. More impact evaluation studies on the use of nurse‐led palliative care models in these countries are needed. Impact This review highlights nurse‐led care models that can enhance access and quality of life of patients with life‐limiting conditions in low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]

Aim: To examine the multidimensional properties of caregiver burden among family caregivers of patients with advanced cancer in a palliative context. Design: A sequential, explanatory, mixed‐method study was performed. Methods: Family caregivers of patients diagnosed with advanced cancer were recruited from a palliative care department of a third‐level hospital in Sichuan Province, China. The Caregiver Burden Inventory, Social Support Rating Scale and Connor–Davidson Resilience Scale were used to collect quantitative data, and a total of 150 caregivers were recruited from January 2022 to September 2022. Qualitative data were collected through semi‐structured interviews, and a total of 22 caregivers were interviewed from October 2022 to November 2022. Survey data were analysed using descriptive statistics, and the factors of caregiver burden were identified using the Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations. Interpretative phenomenological analysis was performed to analyse the interview data to initially explore the multidimensions of caregiver burden. The following‐a‐thread method and convergence coding matrix were used for triangulation to examine the multidimensional properties of caregiver burden. Results: The participants experienced a moderate level of caregiver burden (32.97 ± 13.09). Through triangulation, six meta‐themes and nine meta‐subthemes were identified as multidimensional properties of caregiver burden, including physical (too many caring tasks and poor health condition), emotional (strong negative emotions resulting from patients' suffering and insufficient and ineffective family communication), social (less social interaction and social role conflict) and economic burdens, factors that aggravate burden (prevention and control of COVID‐19 and spousal relationship with patients) and factors that mitigate burden (social support). Conclusion: Multiple dimensions of caregiver burden were experienced by family caregivers of patients with advanced cancer in the palliative context. Family‐centred palliative care must be further developed. Implications for the profession: It is important to develop family‐centred palliative care. Therefore, the focus must be on developing a rational understanding of palliative care in public and a culture‐oriented death education in palliative units. Impact: This study adopted a mixed‐method approach to comprehensively understand the phenomenon of and factors in caregiver burden in the Chinese palliative oncology context.Our findings suggest that family caregivers in palliative oncology experience a moderate level of caregiver burden, with dimensions including physical, emotional, social and economic burdens, among which emotional burden is the most prominent.The findings of this study provide policy makers and nurse practitioners with targets to be addressed in family‐centred care in Chinese palliative units. Reporting Method: The results of this study are reported based on the guidelines of the Mixed‐Methods Article Reporting Standards. Patient or Public Contribution: Eligible caregivers were invited to participate in the study and semi‐structured interviews. Nurse managers of the palliative unit helped us access the patient‐management system. [ABSTRACT FROM AUTHOR]

Aim: To gain insight into the perceived emotional impact of providing palliative care among nursing assistants in Dutch nursing homes, their strategies in coping with this impact and associated needs. Design: Exploratory qualitative study. Methods: In 2022, 17 semistructured interviews with nursing assistants working in Dutch nursing homes were conducted. Participants were recruited via personal networks and social media. Interviews were open‐coded by three independent researchers following the thematic analysis approach. Results: Three themes emerged regarding the elements that contribute to the emotional impact of providing palliative care in nursing homes: impactful situations (e.g. witnessing suffering and sudden deaths), interactions (e.g. close relationship and receiving gratitude) and reflection on provided care (e.g. feeling fulfilment or feeling inadequate in caring). Nursing assistants used different strategies to cope, including emotional processing activities, their attitude towards death and work and gaining experience. Participants experienced a need for more education in palliative care and organized peer group meetings. Conclusion: Elements that play a role in how the emotional impact of providing palliative care is perceived by nursing assistants can have a positive or negative impact. Implications for the Profession and/or Patient Care: Nursing assistants should be better supported in coping with the emotional impact of providing palliative care. Impact: In nursing homes, nursing assistants are most involved in providing daily care to residents and have a signalling role in recognizing the deteriorating conditions of residents. Despite their prominent role, little is known about the emotional impact of providing palliative care among these professionals. This study shows that although nursing assistants already undertake various activities to reduce the emotional impact, employers should be aware of the unmet needs in this area and the responsibility they have in this regard. Reporting Method: The QOREQ checklist was used for reporting. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims To assess and synthesize the evidence of the effects and safety of non-pharmacological interventions in treating pain in patients with advanced cancer. Background Pain is a common symptom experienced by patients with advanced cancer; the treatment of such pain is often suboptimal. To manage it, non-pharmacological interventions are recommended after pharmacological treatments have been re-evaluated and modified. However, there remains a lack of knowledge about the effects and safety of such interventions. Design A systematic review was conducted based on the procedure of the Centre of Reviews and Dissemination. Data Sources Research papers published between 2000-2013 were identified from the following databases: CINAHL, MEDIC, MEDLINE (Ovid) and Psyc INFO. The references in the selected studies were searched manually. Review Methods The studies selected were reviewed for quality, using Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria. Results There was limited evidence that some of the non-pharmacological interventions were promising with respect to reducing cancer pain. Relatively, few adverse events were reported as a result of using such interventions. Conclusion It was not possible to draw conclusions about the effects and safety of the non-pharmacological interventions in reducing cancer pain. Some interventions showed promising short-term effects, but there is a need for more rigorous trials. Qualitative studies are required to collect information about patients' perceptions. There are several research gaps: we found no studies about music, spiritual care, hypnosis, active coping training, cold or ultrasonic stimulation. [ABSTRACT FROM AUTHOR]

This paper aims to explicate the essence of spiritual engagement from the perspective of palliative care clients and their caregivers. Van Manen's hermeneutic phenomenological approach guided this study. In-depth interviews of 14 rural Australian participants with experience of a life-limiting condition provided rich discourse of the lived experience of spiritual engagement. This research highlights spiritual engagement represented in a relational model developed from a creative synthesis of the emerging themes. Spiritual engagement is associated with 'personal transformation', 'human values of love, compassion and altruism', 'maintaining relationships', 'participating in religious practices' and 'culture'. The findings of this research are supported by Mayes' observations on spirituality, that is, the 'pursuit of a trans-personal and trans-temporal reality that serves as the ontological ground for an ethic of compassion and service'. [ABSTRACT FROM AUTHOR]

Aim and objectives. This paper explores how bereaved relatives experienced soft tissue massage during the first four months after the death of a family member who was in palliative cancer care. Background. Death of a close family member or friend is recognised as being an emotional and existential turning point in life. Previous studies emphasise need for various support strategies to assist relatives while they are grieving. Design. Qualitative design. Method. Eighteen bereaved relatives (11 women and seven men) received soft tissue massage (25 minutes, hand or foot) once a week for eight weeks. In-depth interviews were conducted after the end of the eight-week periods. Interviews were analysed using a qualitative descriptive content analysis method. Results. Soft tissue massage proved to be helpful and to generate feelings of consolation in the first four months of grieving. The main findings were organised into four categories: (1) a helping hand at the right time, (2) something to rely on, (3) moments of rest and (4) moments of retaining energy. The categories were then conceptualised into this theme: feelings of consolation and help in learning to restructure everyday life. Conclusions. Soft tissue massage was experienced as a commendable source of consolation support during the grieving process. An assumption is that massage facilitates a transition toward rebuilding identity, but more studies in this area are needed. Relevance to clinical practice. Soft tissue massage appears to be a worthy, early, grieving-process support option for bereaved family members whose relatives are in palliative care. [ABSTRACT FROM AUTHOR]

Background: During the COVID‐19 epidemic, palliative care has become even more indispensable for cancer patients. Aim: To identify the changes in palliative care for cancer patients and improvements in palliative care quality during the COVID‐19 pandemic. Design: A systematic review and narrative synthesis was conducted in PubMed, Embase and Web of Science. An evaluation tool using mixed methods was used to assess the quality of the study. The main relevant themes identified were used to group qualitative and quantitative findings. Results: A total of 36 studies were identified, primarily from different countries, with a total of 14,427 patients, 238 caregivers and 354 health care providers. Cancer palliative care has been experiencing several difficulties following the COVID‐19 pandemic, including increased mortality and infection rates as well as delays in patient treatment that have resulted in poorer prognoses. Treatment providers are seeking solutions such as electronic management of patients and integration of resources to care for the mental health of patients and staff. Telemedicine plays an important role in many ways but cannot completely replace traditional treatment. Clinicians strive to meet patients' palliative care needs during special times and improve their quality of life. Conclusions: Palliative care faces unique challenges during the COVID‐19 epidemic. With adequate support to alleviate care‐related challenges, patients in the home versus hospital setting will be able to receive better palliative care. In addition, this review highlights the importance of multiparty collaboration to achieve personal and societal benefits of palliative care. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aim: This review sought to discover how community nurses globally provide palliative care, with specific focus on how they manage the personal and professional stressors associated with caring for dying clients in the home. Design: An integrative review methodology was used to gain insight into how community palliative care is delivered worldwide. Background: The provision of home palliative care by community nurses gives clients the ability to spend their final days in familiar surroundings. Research has focussed on the provision of palliative care in the inpatient setting, with little known about the community setting. Methods: Data were collected through a literature search, then a critical analysis approach was used to evaluate the strengths of palliative care literature by analysing recurrent themes to stimulate further research on the topic. Data Sources: The following databases were used to conduct the literature search: CINAHL, Medline, Pubmed, Scopus, Ovid. Results: The results highlighted the importance of building a skilled palliative community nursing workforce and the need to offer specialised palliative care training to nurses, particularly around difficult conversations and service coordination. Conclusion: The literature identified the challenges implicit within the community nursing role in delivering palliative care, but it did not identify the factors that enhance the nurses' ability to manage the stressors associated with this role. The input of nurses must be sought to understand the development of resilience. Implications for the profession: Community palliative care nursing requires time spent with clients and family members who are suffering, therefore predisposing nurses to stress. Effort must be made to provide palliative care nurses with support to enhance professional resilience. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the longitudinal experiences using an application named remote home care for remote palliative care among patients with cancer living at home. Background: Introducing welfare technology in home‐based care for patients with cancer in the palliative phase is internationally suggested as a measure to remotely support palliative care needs. However, little is known about the experiences of patients utilising welfare technology applications to receive home‐based care from healthcare professionals in a community care context. Although living with cancer in the palliative phase often presents rapidly changing ailments, emotions and challenges with patients' needs changing accordingly, no studies exploring the longitudinal experiences of patients were found. Design: A qualitative study with a longitudinal, exploratory design. Methods: Data were collected through individual interviews with 11 patients over 16 weeks. The data were analysed using qualitative content analysis. The COREQ checklist guided the reporting of the study. Results: Three themes were identified: (1) potential to facilitate self‐governance of life‐limiting illness in daily life, (2) need for interpersonal relationships and connections, and (3) experiences of increased responsibility and unclear utility of the Remote Home Care. Conclusion: The results showed that remote home care facilitated patients' daily routines, symptom control and improved illness‐management at home. Interpersonal relationships with healthcare professionals were considered pivotal for satisfactory follow‐up. Infrastructural glitches regarding data access, information sharing and lack of continuous adjustments of the application represented major challenges, with the potential to impose a burden on patients with cancer in the palliative phase. Relevance to Clinical Practice: By exploring the experiences of patients in palliative care over time as the disease progresses, this study provides constructive insights for the design and development of welfare technology applications and optimal care strategies. Patient or Public Contribution: The remote home care was developed by interdisciplinary healthcare professionals. [ABSTRACT FROM AUTHOR]

Aim: To synthesise the evidence regarding older adults' perception of advance care planning in preparation for end‐of‐life care. Background: Advance care planning involves continuous communication of end‐of‐life care goals involving an individual's medical treatment preferences. However, its uptake among older adults remains low. Design: The meta‐synthesis was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative research (ENTREQ) guidelines and thematic synthesis was employed to synthesise the qualitative findings in an inductive manner. Data Source: A search was completed on six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus), for publications from 1 January 2000 to 4 December 2021. Review Method: The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation and Confidence (GRADE‐CERQual) in the Evidence from Reviews of Qualitative research. Two independent reviewers conducted this process, and disagreements were resolved through discussions. Results: Fourteen studies were analysed. Four major themes and eleven subthemes emerged from the thematic synthesis: (1) psychosocial preparedness, (2) medical preparedness, (3) psychological barriers towards advance care planning and (4) extrinsic barriers towards advance care planning. Discussion These themes consolidated older adults' views of advance care planning and how engagement in this planning affected their end‐of‐life preparedness. Conclusion: This review suggested psychological and extrinsic factors were barriers to the uptake of advance care planning and provided directions for future research to achieve a holistic understanding of the impact of advance care planning on end‐of‐life preparedness. Relevance to Clinical Practice: Healthcare professionals could maintain close communication with older adults and families periodically to evaluate their readiness to discuss advance care planning to improve their preparedness. Healthcare professionals could also provide psychological support during the discussion of clinical decision‐making to enhance readiness and confidence among older adults and their families. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To enhance the practice of a person‐centred palliative approach in long‐term care. Background: Implementing a person‐centred palliative approach in long‐term care entails placing residents at the centre of care planning that attends to the 'whole' person, rather than prioritising biomedical needs. Design: We conducted a four‐stage directed content analysis of long‐term care progress notes to meet our study aims and applied the EQUATOR guidelines for qualitative research publication (COREQ). Methods: We qualitatively analysed 78 resident charts across three long‐term care homes in southern Ontario to capture the extent to which person‐centred care was absent, initiated or implemented in different types of documented care interactions. Results: Most residents had interactions related to daily care activities (65/78, 83%), social concerns (65/78, 83%) and treatment decisions (53/78, 68%). By contrast, interactions around pain and discomfort (34/78, 44%) and spirituality (27/78, 35%) were documented for less than half of the residents. Almost all (92%) residents had at least one progress note where staff initiated person‐centred care by documenting their preference for a certain type of care, but only a third had at least one progress note that suggested their preference was implemented (35%). Conclusions: While person‐centred care is often initiated by nurses and other allied health professionals, changes to care plans to address resident preferences are implemented less often. Nurses and other allied health professionals should be encouraged to elicit care preferences crucial for holistic care planning and equipped with the skills and support to enact collaborative care planning. Relevance to Clinical Practice: Collaborative care planning appears relatively absent in charted progress notes, constraining the full implementation of a person‐centred palliative approach to care. Patient or Public Contribution: An advisory group consisting of long‐term care resident and staff representatives informed the overall study design and dissemination of the results. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe the quality of information coming from previous care units to palliative care. Background: Information quality is an interconnected concept that includes different dimensions and can be viewed from different perspectives. More knowledge is needed from a multi‐professional perspective on the information quality coming to palliative care. Design: Descriptive qualitative study. Methods: Altogether 33 registered nurses, practical nurses, social workers and physicians working in palliative care were purposively selected to participate in thematic interviews. The research was carried out in six palliative care units in three hospital districts. The data were analysed by using deductive and inductive content analysis. The COREQ checklist was used. Results: Three main categories with thirteen categories were identified in connection with the deductive analysis based on the Clinical Information Quality framework: (1). Informativeness of information coming from previous care units to palliative care included accuracy, completeness, interpretability, plausibility, provenance and relevance. (2). Availability of information coming from previous care units to palliative care included accessibility, portability, security and timeliness. (3). Usability of information coming from previous care units to palliative care included conformance, consistency and maintainability. Each category is divided into sub‐categories followed by narratives of their content. Conclusions: This study provides new knowledge on the quality of information coming to palliative care from a multi‐professional perspective. Professionals working in palliative care units highlight issues describing good information quality, but also point out quality issues and areas for improvement. Relevance to clinical practice: The results can guide the development of documentation practices and Health Information System development as well as be used in the generation of a new audit instrument of information quality. [ABSTRACT FROM AUTHOR]

Aim and objectives: To present our experience of a nursing telephone consultation service, describing patient and caregiver requests, and outlining ensuing nursing or medical interventions. Background: Recently, there has been an increase in the use of telephone consultation for cancer patients. However, there is still limited data on the characteristics of this type of service and on the nature of the interventions carried out. Design and methods: In this observational retrospective study, we evaluated the phone calls made over a 6‐month period by patients or caregivers to the early palliative care team of a cancer institute. Information regarding telephone calls (frequency, reason and management) was systematically collected by a nursing case manager. The study complies with the STROBE checklist File S1. Results: 171 patients used the service, for a total of 323 phone calls. The majority (80.8%) were from patients followed at the outpatient clinic and the most common requests were for pain management (38.4%) and for updates on the clinical situation (23.8%). Other frequent requests were for medication management (18.9%) and scheduling (18.3%). 210 of the 323 phone calls were handled by the nurse, while 22 were managed in collaboration with a physician. An 87.6% effectiveness in telephone management was observed. Conclusion: The overall use of the phone service was higher for early palliative care patients. The majority of phone calls were effectively handled by the nursing case manager. Relevance to clinical practice: An effective and feasible nurse‐led telephone follow‐up of early palliative care patients with advanced cancer could improve their care experience. Specifically, it could impact on patients and families improving quality of life and symptom control securing access to timely care without travel or additional cost.It can also improve continuity of care, adherence to oncological treatments and minimise acute care visits. [ABSTRACT FROM AUTHOR]

Background: Hope is an integral part of a dying person's needs and an important phenomenon that has not been satisfactorily explored. The tension between hope for a cure and the reality of being terminally ill is a paradox, which in the context of palliative cancer care, nurses and health care professionals must take into consideration. Objective: The purpose of this study was to elucidate the phenomenon of hope and to investigate the lived experiences of hope among newly diagnosed patients with advanced cancer. Method: The study used a phenomenological‐visual method where drawings and post‐drawing interviews were used. The participants were six patients who recently had been offered specialised palliative care treatment. They were five women and one man with different cancer diagnoses and between 30 and 82 years of age (median 65 years). The data consisted of six drawings and individual post‐drawing interviews with the participants. The study was reported using the COREQ checklist. Results: The study revealed one main concern 'Being in hope' and hope appeared in four different dimensions; internal, external, relational and transcendental. Hopelessness was present at all times. Conclusion: Hope pictured in drawings was expressed through colour, shape, lines, symbols and metaphors, and hope incorporated internal, external, relational and transcendental aspects. Hope was constantly fighting against hopelessness and hope integrated with past, present and future. Relevance to clinical practice: Drawings, as well as other visual representations, are suitable tools when trying to understand an ineffable phenomenon such as hope experienced by people newly diagnosed with cancer. [ABSTRACT FROM AUTHOR]