Creating comfort: Nurses’ perspectives on pressure care management in the last 48 hours of life
Christina Searle
Clinical Nursing Education Department, Austin Health, Heidelberg VIC
Fran McInerney
School of Nursing and Midwifery, Australian Catholic University, St Patrick's Campus, Melbourne VIC
PP: 147
Abstract
The aim of this paper is to report the results of a study exploring the pressure care management of patients during their last 48 hours of life, from the perspective of registered nurses caring for such patients in an acute care hospital setting.
A qualitative approach of interpretative description was used. Semi-structured interviews were conducted with twelve registered nurses working in palliative care/haematology/oncology wards in a metropolitan hospital in Melbourne, Australia. Analysis of the experiences of nurses in pressure care management of the patient in the last hours of life offered understandings into the nurse's role as a moral agent in the clinical setting.
As moral agents, nurses were motivated by a desire to 'do the best for the patient'; in this instance to provide comfort and a peaceful death. They made decisions based on their past experience, knowledge and beliefs. However, their actions could be constrained by the beliefs of their colleagues, the culture of the organisation, and respect for the wishes of both patients and family members, which contributed to moral dilemmas that could give rise to clinician distress.
Nurses need to strive for consensus in clinical practice as to what is the best care for the patient and where possible include the patient and family in these discussions. The development of policies such as advance directives and processes that highlight quality communication and conflict management may assist nurses in clinical decision making in this area.
Keywords
nursing, hospice and palliative care, moral agency, pressure ulcer, terminal care
References
Andershed B and Ternestedt B (2000) Being a close relative of a dying person, Cancer Nursing 23(2): 151-159.
Arnold M (2003) Pressure ulcer prevention and management: The current evidence for care, AACN Clinical Issues Advanced Practice in Acute Critical Care 14(4): 411-428.
Barrett S, Kristjansen LJ, Sinclair T and Hyde S (2001) Priorities for adult cancer nursing research, Cancer Nursing 24(2): 88-95.
Bergum V (2002) Relational ethics in nursing, Canadian Journal of Nursing Leadership 15(4): 7-16.
Bottoroff J, Steele R, Davies B, Porterfield P, Garossino C and Shaw M (2000) Facilitating day-to-day decision making in palliative care, International Journal of Cancer Nursing 23(2): 141-150.
Cash P (2006) Registration and practice standards, Nurses Board of Victoria. Annual Report 2002/2003, 2006.
Cullum N, McInnes E, Bell-Syer SEM and Legood R (2004) Support surfaces for pressure ulcer prevention, Cochrane Database of Systematic Reviews (3).
Doane G (ed) (2004) Toward a moral horizon: Nursing ethics for leadership and practice. Toronto, Canada: Pearson Education.
Eisenberger A and Zeleznik J (2003) Pressure ulcer prevention and treatment in hospices, Journal of Palliative Care 19(1): 9-14.
Elspeth G (2004) Austin Health Pressure Ulcer Prevention Program-PUPPS Final Results. Melbourne VIC.
Fowell A, Finlay I, Johnstone R and Minto L (2002) An integrated care pathway for the last two days of life: Wales-wide benchmarking in palliative care, International Journal of Palliative Nursing 8(12): 566-573.
Galvin J (2002) An audit of pressure ulcer incidence in a palliative care setting, International Journal of Palliative Nursing 8(5): 214-221.
George M and Apter A (2004) Gaining insight into patients' beliefs using qualitative research methodologies, Current Opinion in Allergy and Clinical Immunology 4(3): 185-189.
Goodman M (ed) (2003) Symptom control in care of the dying. New York: Oxford University Press.
Hayes C (2004) Ethics in end-of-life care, Journal of Hospice & Palliative Nursing 6(1): 36-43.
Henock I and Gustafsson M (2003) Pressure ulcers in palliative care: Development of a hospice pressure ulcer risk assessment scale, International Journal of Palliative Nursing 9(11): 474-484.
Hopkinson J, Hallett C and Luker K (2003) Issues and innovations in nursing practice. Caring for dying people in hospital, Journal of Advanced Nursing 44(5): 525-533.
Jameton A (1984) Nursing practice: The ethical issues. Engelwood Cliff, New Jersey: Prentice Hall.
Kapo J and Casarett D (2006) Prognosis in chronic diseases, Annals of Long-Term Care 14(2): 18-23.
Karim K (2000) Conducting research involving palliative patients, Nursing Standard 15(2): 34-36.
Keast D, Parslow N, Houghton P, Norton L and Fraser C (2007) Best Practice Recommendations for the Prevention and Treatment of Pressure Ulcers: Update 2006, Skin & Wound Care 20(8): 447-460.
Langemo D, K (2006) When the goal is palliative care, Advances in Skin & Wound Care 19(3): 148-154.
Liaschenko J (1996) A sense of place for patients: Living and dying, Home Care Provider 1(5): 270-272.
McCahill L, Ferrell B, R and Virani R (2001) Improving cancer care at the end of life, The Lancet 2: 103-108.
Minichiello V, Sullivan G, Greenwood K and Axford R (2004) Handbook of Research Methods in Nursing and Health Science, Malaysia: Pearson Education Australia.
Peter E (2002) The history of nursing in the home: Revealing the significance of place in the expression of moral agency, Nursing Inquiry 9(2): 65-72.
Pope C, Ziebland S and Mays N (2000) Qualitative research in health care: Analysing qualitative data, British Medical Journal 320: 114-116.
Small L and Rhodes P (2000) Too ill to talk? User involvement and palliative care, London: Routledge.
Sopata M and Luzcak J (1997) Managing pressure sores in palliative care, Journal of Wound Care 6(1): 10-11.
Strauss AL and Corbin J (1990) Basics of qualitative research: Techniques and procedures for developing grounded theory, London: Sage.
Streubert HJ and Carpenter DR (1995) Grounded theory research approach, in Streubert HJ and Carpenter DR (eds) Qualitative research in nursing: Advancing the humanistic imperative, Vol 7. Philadelphia, JB Lippincott Company.
Thorne S, Reimer Kirkham C and O' Flynn-Magee K (2004) The analytic challenge in interpretive description [Electronic Version]. International Journal of Qualitative Methods 3. Retrieved February 2008.
Vanderwee K, Grypdnock MFH, DeBaquer D and Defloor T (2007) The effectiveness of turning with unequal time intervals on the incidence of pressure ulcer lesions, Journal of Advanced Nursing 57(1): 59-68.
Whittemore R, Chase S and Mandle C (2001) Validity in qualitative research, Qualitative Health Research 11(4): 522-537.
WHO (2002) National Cancer Control Programmes: Policies and Guidelines. Geneva World Health Organisation.
Wiechula R (1997) Pressure sores-part 11: Management of pressure related tissue damage, The Joanna Briggs Institute for Evidence Based Practice 1(2): 1-6.
Wright K (2002) Caring for the terminally ill: The district nurse's perspective, British Journal of Nursing 11(18): 1180-1185.
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