‘Close to’ a palliative approach: nurses' and care aides' descriptions of caring for people with advancing chronic life‐limiting conditions

Abstract

Nurses care for people with advancing chronic life-limiting conditions in a variety of settings who would benefit from a palliative approach.

The role of unregulated care providers in Canada—A scoping review

“…The scoping review demonstrates a perceived lack of respect for the role of UCPs by other healthcare providers and a lack of authority for decision‐making in patient care. This theme was consistent across Canada, with studies from British Columbia (Reimer‐Kirkham, Sawatzky, Roberts, Cochrane, & Stajduhar, ), Alberta (Dahlke & Baumbusch, ; White, Jackson, Besner, & Norris, ), Ontario (Giosa et al., ; Heckman et al., ; Kaasalainen et al., ; Kontos, Miller, & Mitchell, ; McGilton, Guruge, Librado, Bloch, & Boscart, ; Tayab & Narushima, ; Wagner et al., ; Zeytinoglu et al., ) and New Brunswick (McCloskey, Donovan, Stewart, & Donovan, ; Rheaume, ) reporting minimal UCP contribution to interprofessional care teams and highlighting important challenges. Such challenges included vertical power hierarchies within the teams (Heckman et al., ; McGilton et al., ), isolation from teams or lack of communication and collaboration between UCPs and other members of the team (Dahlke & Baumbusch, ; Heckman et al., ; Tayab & Narushima, ), lack of role clarity and perceived differences in knowledge among team members (Heckman et al., ; Reimer‐Kirkham et al., ) and a limited role in documentation in patient charts (Kontos et al., ; McCloskey et al., ; White et al., ).…”

“…Such challenges included vertical power hierarchies within the teams (Heckman et al., ; McGilton et al., ), isolation from teams or lack of communication and collaboration between UCPs and other members of the team (Dahlke & Baumbusch, ; Heckman et al., ; Tayab & Narushima, ), lack of role clarity and perceived differences in knowledge among team members (Heckman et al., ; Reimer‐Kirkham et al., ) and a limited role in documentation in patient charts (Kontos et al., ; McCloskey et al., ; White et al., ). Such challenges lead to a lack of confidence among UCPs as they provide care for patients (Reimer‐Kirkham et al., ).…”

A qualitative study of assistant nurses' experiences of palliative care in residential care

“…Thus, the consultant structure had the potential to affect the palliative care practices at an interpersonal level that may have had negative patient consequences, such as reduced quality of life during patients' last days. In fact, the practices of the consultant organization may directly contradict palliative care guidelines, especially when ANs' roles and relationships with RNs are varied and nonstandardized (Juthberg & Sundin, ; Reimer‐Kirkham et al., ). Previous studies have shown that ANs in RCFs are especially dependent on RN support in palliative care situations (Juthberg & Sundin, ; Karlsson, Ekman, & Fagerberg, ).…”

“…Often, RNs delegate the responsibility of giving medication to ANs when needed, such as when older patients are in pain. Several studies have underlined the need to improve the education of ANs in palliative care, particularly in the RCF setting (Eriksson, Bergstedt, & Melin-Johansson, 2015;Reimer-Kirkham, Sawatzky, Roberts, Cochrane, & Stajduhar, 2016;Ronaldson, Hayes, Carey, & Aggar, 2008), as one way to strengthen the professional care given by ANs (Daly & Szebehely, 2012). The National Board of Health and Welfare (2011) emphasized that staff involved in elderly care must be skilled and experienced.…”

“…To achieve high qualitative palliative care, it is necessary to develop strategies for communication between the staff and to clarify the roles of those involved in care (Reimer‐Kirkham et al., ). Implementing and integrating palliative care must be context‐sensitive and supported by the leadership to succeed (Pesut et al., ; Reimer‐Kirkham et al., , ). In a survey conducted among RNs and ANs in British Columbia (Sawatzky, Roberts, Reimer‐Kirkham, & Stajduhar, ), the authors emphasized the importance of integration and contextualization in the specific healthcare system when identifying and bridging gaps in palliative care.…”