Article of the Month
Margaret O'Connor, RN, PhD, DN, A.M.
(Australia)
Therapeutic relationships in specialist
palliative care nursing practice
Author(s):Canning, D., Rosenberg, J.P.& Yates, P
Journal: International Journal of Palliative Nursing 2007; 13 (5) 222-22
This Australian study highlights the complexity of specialist palliative care nursing practice in responding to the range of care needs of people receiving palliative care, their family and caregivers. The researchers note that there is a dearth of research that describes the scope of practice of specialist palliative care nurses. This study developed a competency framework.
The study:
A large qualitative study, involving palliative care nurses throughout Australia, developed 5 core domains of specialist nursing practice: therapeutic relationships, complex supportive care, collaborative practice, leadership and improving care. This particular article is a description of the domain of therapeutic relationships.
Design:
The researchers undertook an extensive literature review from which they developed an issues paper. Specialist palliative care nurses were asked to read the issues paper, then fill out a survey using a Likert scale to rate the frequency and importance of aspects of their role. In addition they were invited to provide a written exemplar illustrating aspects of their role.
238 surveys were disseminated throughout Australia, with a 31% return rate.
Some respondents were then interviewed to gain further detailed information. Data were analysed using SPSS, to identify frequent cues. Thematic analysis of the exemplars and the interview data provided additional material for identifying convergence and divergence from the cues.
Based on findings from all these activities, a competency framework was developed. Importantly, the framework was mapped against the Standards for Providing Quality Palliative Care for all Australians (2005) and Australian standards for advanced nursing practice.
The major findings were:
The most important of the core domains of specialist nursing practice was considered to be the therapeutic relationships established with those for whom the nurses care as well as their families. This finding is also supported in the literature, which suggests that such relationships empower the person requiring care and their family, and lead to improved outcomes of care. In addition, the nurse’s skills in clinical care and patient management count for nothing if not contextualized within the therapeutic relationship.
Another aspect of this domain is respect for the individual’s illness experience. This requires great sensitivity on the part of the specialist palliative care nurse when having “tough” conversations about aspects of disease and the person’s responses to their anticipated death. Information needs to be “honest and genuine” and imparted in a timely, sensitive manner and includes listening to the person’s own desires and choices within the context of other aspects of their life.
Specialist palliative care nurses are required to be very knowledgeable, but this study suggests there is also “tacit knowledge” that comes from being very experienced.
The authors conclude the article with a caution about the role of the specialist palliative care nurse. They suggest that these nurses are at risk of becoming stressed from their highly individualised and concentrated work, particularly if they are working in roles that are either geographically isolated or where they are the sole practitioner. While supervision is noted as a key support strategy in many places in the world, it has varying uptake.
Why I chose this article.
This research is a demonstration of excellent qualitative research. It has assisted in articulating and developing the competencies required of the specialist palliative care nurse, providing a framework for both educational preparation and assessment of the role. This Australian project makes a valuable addition to the international literature on nursing competencies.
The complete framework is available at: www.cpcre.com
Reviewer:
Margaret O'Connor, RN, PhD, DN, A.M.
Vivian Bullwinkel Chair in Nursing, Palliative Care
Palliative Care Research Team
School of Nursing & Midwifery, Monash University, Frankston, Australia
Please visit the following link to read past Articles Of The Month:
http://www.hospicecare.com/AOM/
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