Doctors’ learning experiences in end-of-life care – a focus group study from nursing homes

Fosse, Anette; Ruths, Sabine; Malterud, Kirsti; Schaufel, Margrethe Aase

doi:10.1186/s12909-017-0865-8

Cited by 21 publications

(22 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Future not being important to patients in this study may partly be a consequence of their cognitive impairment;40,43 however it could relate to patients trusting health care professionals in making the right decisions for them, a finding also found by others 44. A main reported result of ACP was better and more trustful relationships between the patient, the next of kin, and the staff,45 thus making it easier to make difficult decisions together at a later time and may save time and resources. Furthermore, talking about past and present, and more generally about hopes, worries, and preferences for the future, may provide relevant information for future decisions on life-prolonging treatment.…”

Section: Discussionmentioning

confidence: 62%

<p>Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers</p>

Sævareid¹,

Førde²,

Thoresen³

et al. 2019

CIA

View full text Add to dashboard Cite

Purpose: Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance. Patients and methods: This qualitative study is part of a mixed-method implementation study of ACP. In four nursing homes, we did qualitative interviews and audio-recordings of meetings. We completed 20 individual semistructured interviews with participants soon after ACP conversations. The interviews included patients with cognitive impairment, their next of kin, and health care personnel. We also conducted four focus group interviews with staff and managers in the nursing homes and audio-recorded four network meetings with the project teams implementing ACP. Results: All participants appreciated taking part in ACP. Patients and next of kin focused more on the past and present than future treatment preferences. Still, ACP seemed to contribute to a stronger patient focus on end-of-life conversations. More generally, ACP seemed to contribute to valuable information for future decision-making, trusting relations, improved end-of-life communication, and saving time and resources. Conclusion: Safeguarding a strong patient focus on ACP and fostering a person-centered care culture in nursing home wards seem to be achievable through implementation of ACP that includes regular staff, patients with cognitive impairment, and their next of kin.

show abstract

Section: Discussionmentioning

confidence: 62%

<p>Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers</p>

Sævareid¹,

Førde²,

Thoresen³

et al. 2019

CIA

View full text Add to dashboard Cite

show abstract

“…Regarding interactions with medical team members, the residents acknowledged the importance of better communication within a medical team, including with nurses, which was one of the most impressive themes concerning which they reflected and learned. A recent study indicated that newly qualified doctors could learn about the importance of calmness and acceptance in EOL care from interdisciplinary role models in nursing homes [ 24 ]. Our study demonstrated that residents could learn these topics in the stages of experiential learning, including concrete experiences and reflective observations, even in teaching hospital settings.…”

Section: Discussionmentioning

confidence: 99%

“…Another report suggests that dialogue with dying patients would enable residents to realize how wonderful life can be, to become aware of the importance of being a human before being a doctor, and, finally, to cultivate their humanity [ 29 ]. It has also been said that physicians value discussions about such cases with colleagues to become professional and reflective practitioners [ 24 ]. Therefore, attending physicians should utilize reflective discussions with team members, including residents, to improve the learning environment, to reduce stress on the medical team, and, ultimately, to enhance the care of patients and their families.…”

Section: Discussionmentioning

confidence: 99%

What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care

et al. 2017

View full text Add to dashboard Cite

BackgroundHow medical residents’ experiences with care for dying patients affect their emotional well-being, their learning outcomes, and the formation of their professional identities is not fully understood. We examine residents’ emotional states and learning occurring during the provision of care to dying patients and specifically discuss the impact of providing end-of-life (EOL) care on professional identity formation.MethodsSemi-structured interviews were conducted with 13 residents who had graduated in the last 3 to 5 years. Thematic theoretical analysis was applied, and key themes were developed based on Kolb’s experiential learning cycle.ResultsEight key themes emerged from the analysis. The residents experienced dilemmas in confronting the reality of medical uncertainty as well as a disruption of emotional state and self-efficacy. Although the residents felt a sense of helplessness and guilt, they were able to reflect on strategies for handling medical care that focused on patients and that required a truly sincere attitude. They also contemplated the importance of palliative care and communication with patients, patients’ family members and medical staff. Building on these experiences, the residents rebuilt a sense of awareness that allowed them to directly engage with the type of medical care that they are likely to be called upon to perform in the future as the population continues to age.ConclusionsThis study revealed Japanese residents’ perceptions, emotions and learning processes in caring for dying patients by applying Kolb’s experiential learning theory. The findings of this study may illuminate valuable pieces of knowledge for future education in EOL care.

show abstract

“…Although worldwide training on palliative care for health professionnals is often limited [35], interprofessional training (physicians and nurses) could optimize sharing expertise [36]. This is in line with the 76th World Health Assembly focusing on strengthening palliative care [37] and a recent study showed how nursing homes can become useful sites for learning about end-of-life care during internships [38]. A collective training program (undergraduate and postgraduate) for medical and nurse students would give an opportunity to learn from and about each other, which facilitate this recognition of each person's skills as well as a clarification of the individual role.…”

Section: Discussionmentioning

confidence: 77%

A phenomenological study of nurses experience about their palliative approach and their use of mobile palliative care teams in medical and surgical care units in France

et al. 2020

View full text Add to dashboard Cite

Background: Despite a broad consensus and recommendations, numerous international reports or studies have shown the difficulties of implementing palliative care within healthcare services. The objective of this study was to understand the palliative approach of registered nurses in hospital medical and surgical care units and their use of mobile palliative care teams. Methods: Qualitative study using individual in depth semi-structured interviews and focus group of registered nurses. Data were analyzed using a semiopragmatic phenomenological analysis. Expert nurses of mobile palliative care team carried out this study. 20 registered nurses from three different hospitals in France agreed to participate. Results: Nurses recognize their role as being witnesses to the patient's experience through their constant presence. This is in line with their professional values and gives them an "alert role" that can anticipate a patient-centered palliative approach. The physician's positioning on palliative care plays a key role in its implementation. The lack of recognition of the individual role of the nurse leads to a questioning of her/his professional values, causing inappropriate behavior and distress. According to nurses, "rethinking care within a team environment" allows for the anticipation of a patient-centered palliative approach. Mobile Palliative Care Team highlights the major role of physicians-nurses "balance" while providing personal and professional support.

show abstract

Doctors’ learning experiences in end-of-life care – a focus group study from nursing homes

Cited by 21 publications

References 41 publications

<p>Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers</p>

<p>Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers</p>

What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care

A phenomenological study of nurses experience about their palliative approach and their use of mobile palliative care teams in medical and surgical care units in France

Contact Info

Product

Resources

About