Home-Care Nurses’ Experience With Medication Kit in Palliative Care

Abstract

Home-care nurses assist many advanced cancer patients desiring to live in the familiar surroundings of their own home until the day they die. The purpose of this study was to increase the understanding concerning home-care nurse experience with the Norwegian version of the medication kit as a tool in symptom management for the terminally ill. The study had a qualitative, descriptive, and explorative design, based on hermeneutic methodology. Two focus group interviews with 4 subsequent in-depth interviews helped generate data. The nurses reported how thorough planning and clear instructions on medication kit usage gave security and facilitated proper application. Good collaboration with primaryphysicians, including accessibility and clarifying meetings in particular, was necessary. In the past, infrequent use of the medication kit hindered its relevance for symptom management. Home-care nurses were often alone with the responsibility for assessing the patient and administering medications, leading to unjustifiable professional conditions, particularly during night shifts. Thus, clear guidelines, planning and clarifying meetings with primary physicians, helped to facilitate the use of the medication kit.

Mapping end-of-life and anticipatory medications in palliative care patients using a longitudinal general practice database

“…Almost a third of all nurses surveyed did not have specific guidance regarding the use of AM for their patients. These results are also consistent with a qualitive study by Staats et al (2018) where home care nurses felt unsupported with the responsibility for assessing patients and their medications which often led to decisions being made at night shifts. Bowers and Redsell et al (2017) have also explored the issue of prescribing these medications using interviews.…”

Unwelcome memento mori or best clinical practice? Community end of life anticipatory medication prescribing practice: A mixed methods observational study

“…[1][2][3][4][5][6] In the UK, Australia, Canada, Norway and New Zealand, the individualised prescribing of injectable anticipatory medications, ahead of potentual need, for people approaching the end of life in the community is widely promoted to optimise symptom control in the last days of life at home and prevent unwanted hospital admissions. [7][8][9][10][11][12][13] Anticipatory medications are kept in the home, where they are available to be administered by visiting nurses or doctors if the patient is unable to take oral medications and develops symptoms of pain, breathlessness, nausea and vomiting, agitation or respiratory secretions at the end of life. 7,14,15 Although anticipatory prescribing is recommended practice in several countries 8,9,12,13 there is inadequate evidence of its clinical effectiveness and limited research into the incidence and timing of prescriptions.…”

“…15,23,24 Nurses find some GPs to be resistant to prescribing anticipatory medications 18,23,25 while other GPs act on their requests to prescribe. 13,23,24 Some GPs prefer to independently judge when to prescribe anticipatory medications, 10,20,22 or to discuss intended care with patients themselves and prescribe drugs whilst their condition is stable. 13,22 Prescribing decisions involve assessing patient and family willingness to have end-of-life care discussions, safety risks associated with prescribing strong opioids and how soon medications may be needed.…”

Hjemmedød: Dette får sykepleiere til å bruke medikamentskrinet

“…Tverrfaglig møte kaller de det. Den avklaringen synes jeg er veldig viktig å få, og når vi får det, så er jo det en trygghet for hjemmetjenesten.» (7) Andre ressurspersoner som blant andre primaersykepleier og kreftkoordinator ble også beskrevet som viktige samarbeidspartnere. Sykepleierne fra landkommunene fremhevet spesielt tryggheten de opplevde når de hadde en ressursperson i tjenesten som påtok seg ansvaret ved oppstarten av medikamentskrinet hos den enkelte pasient.…”