Being a Palliative Nurse for Persons with Severe Congestive Heart Failure in Advanced Homecare

Abstract

Advanced homecare for persons with congestive heart failure is a 'new' challenge for palliative nurses. The aim of this study is to illuminate the meaning of being a palliative nurse for persons with severe congestive heart failure in advanced homecare. Narrative interviews with 11 nurses were conducted, tape-recorded, and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. One meaning of being a palliative nurse is being firmly rooted and guided by the values of palliative culture. Being adaptable to the patient's way of life carries great weight. On one hand nurses live out this value, facilitating for the patients to live their everyday life as good as possible. Being a facilitator is revealed as difficult, challenging, but overall positive. On the other hand nurses get into a tight corner when values of palliative culture clash and do not correspond with the nurses interpretation of what is good for the person with congestive heart failure. Being in such a tight corner is revealed as frustrating and giving rise to feelings of inadequacy. Thus, it seems important to reflect critical on the values of palliative culture.

End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis

“…53 They see prognostication in heart failure as very difficult given the uncertain disease trajectory, 51,55,56,62,64 and that comorbid conditions may be a more probable cause of death; 51 in light of the potential for a catastrophic event such as sudden death, some feel unable to discuss future plans. 53 failure, 54 or believe that patients rarely acknowledge this.…”

“…51 The ethical balance between beneficence and non-malificence can be hard to find. Discomfort with breaking bad news, 53,56,62 or with broader issues of death and dying hinders communication. 61,62,64,68 Clinicians believe some heart failure patients do not wish to know they are dying, 68 or are unsure whether patients wish to talk about death, recognising that they may be uncertain how to show to their doctors that they want to talk.…”

“…61,62,64,68 Clinicians believe some heart failure patients do not wish to know they are dying, 68 or are unsure whether patients wish to talk about death, recognising that they may be uncertain how to show to their doctors that they want to talk. 62 Some see it as inappropriate for the doctor to initiate EOLC discussions, 51,56 and 'use their own judgement' about what information patients may or may not want to hear and when; 51 in practice this commonly means waiting for patients to initiate a conversation, although they recognise that some, especially older people, may be reluctant to raise such issues with their doctors. 51 Rather than a one-off conversation, this is seen as a process over time, based on an established and trusting relationship between doctor and patient.…”

“…53 failure, 54 or believe that patients rarely acknowledge this. 56,62 Doctors tend to focus on current aspects of medical management rather than the future, 51,68 approaching heart failure as a problem to be fixed instead of a terminal illness; 51 …”

Participation in heart failure home-care : Patients’ and partners’ perspectives

“…The importance of trustful relationships with health care professionals has been described by patients receiving home-care (Brännström et al 2006, Skär & Söderberg 2011, Holmberg et al 2012. Health care professionals have also described seeing themselves as a guest in the patient's home (Öhman & Söderberg 2004, Brännström et al 2005. This might lead to a more equal relationship between the patient and health care professional, which probably facilitate participation.…”