Ethical sensitivity and perceptiveness in palliative home care through co-creation

Abstract

Background: In research on co-creation in nursing, a caring manner can be used to create opportunities whereby the patient’s quality of life can be increased in palliative home care. This can be described as an ethical cornerstone and the goal of palliative care. To promote quality of life, nurses must be sensitive to patients’ and their relatives’ needs in care encounters. Co-creation can be defined as the joint creation of vital goals for patients through the process of shared knowledge between nurses, patients and their relatives. Aim: The aim of this study was to explore nurses’ experiences of caring encounters and co-creation in palliative home care from an ethical perspective. Research design, participants, and research context: A hermeneutical approach was used. The material consisted of texts from interviews with 12 nurses in a home care context. The method was inspired by thematic analysis. Ethical considerations: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Findings: An overall theme, a main theme and four sub-themes emerged. Through ethical sensitivity and perceptivity, nurses can balance their actions in the moment and change their nursing care actions according to the patient’s wishes through co-creation in encounters. Here the time is crucial, as the time needed is unique to each patient. Discussion: The themes together can be considered prerequisites for good palliative home care. If nurses fail to be sensitive and perceptive in encounters with dying patients, good palliative home care cannot be achieved. Ethical sensitivity and perceptiveness can also be considered a part of nurses’ ethical competence. Conclusion: Patients’ dignity can be preserved through ethical sensitivity and perceptiveness, which is fundamental for good palliative care. Co-creation from patients’ perspectives should be the focus of future research.

The theory of caritative caring: Katie Eriksson’s theory of caritative caring presented from a human science point of view

“…This fundamental focus on alleviating (or avoiding unnecessary) suffering is on an ontological level, thus applicable to various models of nursing and nursing care. Hemberg and Bergdahl (2020), for example, have applied the theory of caritative caring with a person‐centred approach in palliative care.…”

Compassion fatigue as bruises in the soul: A qualitative study on nurses

“…4 In order to be caring and compassionate, Newham et al 4 have found that it is necessary to see other persons as they truly are, which resonates with the ideas of nurses being morally perceptive and sensitive to patients. [8][9][10] Gallagher 11 stresses that it is admirable if health professionals are able to find opportunities to demonstrate kindness and compassion even in busy care contexts.…”

Dealing with ethical and existential issues at end of life through co-creation

“…49 Time has been found to play a particularly important role in co-creation. 49,63 Many patients wish to receive comprehensive information about their health status, but as patients come closer to the end of life, this may decrease. 69,70 Research shows that existential issues are more profoundly present in end-of-life and palliative care than in any other care context.…”

“…60 In nursing, the concept of co-creation is defined as deep nursing: a solicitous and considerate co-created nursing process that entails a personal nursing practice enabled through perceptiveness and attention to patients, spending time with patients, and reflecting on nursing encounters. 49,[61][62][63] According to Palumbo, 64 co-creation relates to that patients should be involved in honest and comfortable relationships with their healthcare providers because patients are effective members of the healthcare team. Co-creation in nursing care is more than simple collaboration with patients.…”

“…100 Building on previous research, the co-creation of vital goals for the patient in home care is important, 61 and time is considered to be highly important. 49,63 Previous research shows that co-creation can also be seen as an aspect of caring 101 or compliance and that nurses' role is to create conditions for co-creation as well as provide patients with the space to enjoy the freedom to choose. 63,101 Therefore, we seek to explore cocreation as a means for dealing with ethical and existential issues at the end of life in palliative home care from a qualitative perspective.…”