Embedding a Palliative Approach in Nursing Care Delivery

Abstract

A palliative approach involves adapting and integrating principles and values from palliative care into the care of persons who have life-limiting conditions throughout their illness trajectories. The aim of this research was to determine what approaches to nursing care delivery support the integration of a palliative approach in hospital, residential, and home care settings. The findings substantiate the importance of embedding the values and tenets of a palliative approach into nursing care delivery, the roles that nurses have in working with interdisciplinary teams to integrate a palliative approach, and the need for practice supports to facilitate that embedding and integration.

Living with dying: A narrative inquiry of people with chronic kidney disease and their family members

“…Genuine presence and partnership in setting goals of care can help people with life‐threatening illnesses and their family members navigate the difficult existential questions relating to living and dying. Creating space for conversation about EOL also aligns with values inherent in a palliative approach (Sawatzky et al., ) and holistic care (Noble, Brown, Shields, Fogarty, & Maxwell, ).…”

“…Palliative care is an approach that focuses on improving “the quality of life of people and their families facing the problem associated with life‐threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual” (WHO, ). A palliative approach, that uses “principles of palliative care [that] are adapted and integrated into contexts of care that do not give specialized palliative care services, regardless of the healthcare sector where the service is provided” (Sawatzky et al., , p. 1), seems particularly appropriate given the organization of renal care services. “Supportive care” is a term recently used in the literature relating to EOL with CKD that offers language that is preferred by people and health professionals in this setting (Davison et al., ).…”

“…These are important initiatives that will need further and their family members navigate the difficult existential questions relating to living and dying. Creating space for conversation about EOL also aligns with values inherent in a palliative approach (Sawatzky et al, 2016) and holistic care (Noble, Brown, Shields, Fogarty, & Maxwell, 2015). Although we asked participants what would have been helpful to them, we were struck that we heard no stories where nurses or other professionals engaged in discussion about death and dying with the participants.…”

Barriers to Staff Involvement in End-of-Life Decision-Making for Long-Term Care Residents with Dementia

“…Research examining staff perspectives of their involvement in end-of-life decision-making has indicated that LTC home staff tends to be excluded, and exclude themselves, from decision-making. Studies have found that nurses perceive a lack of power and knowledge and are ambiguous regarding their role related to endof-life conversations (Laging, Ford, Bauer, & Nay, 2015;Lopez, 2007Lopez, , 2009Reimer-Kirkham, Sawatzky, Roberts, Cochrane, & Stajduhar, 2016;Sawatzky et al, 2017). Nurses have characterized their role as playing the middle person between family members and physicians (Bryon, Gastmans, & de Casterle, 2008;Lopez, 2007Lopez, , 2009.…”

A Stakeholder Analysis of the Strengthening a Palliative Approach in Long-Term Care Model

“…In recent years, several programs or strategies have been developed within longterm care (LTC) contexts to improve the delivery of a palliative approach to care and build capacity to support sustainable change (Hockley and Froggatt 2006;Kaasalainen et al 2019;Palliative Alliance 2017;Parker et al 2010). As defined by Sawatzky et al (2016Sawatzky et al ( , 2017, a palliative approach to care consists of an upstream orientation toward the needs of people living with life-limiting conditions and their families, adaptation of palliative care knowledge and expertise and operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care. Importantly, a focus on advance care planning (ACP) helps to ensure early discussions about wishes and values that will contribute to goals of care and treatment decisions at end of life.…”