Nurses' experiences caring for patients and families dealing with malignant bowel obstruction

Abstract

Malignant bowel obstruction (MBO) is a well-recognised complication of advanced abdominal and pelvic cancers. Often surgical intervention is not feasible, resulting in complex symptoms and an unpredictable course. Although symptom management is a crucial part of nursing care, psychosocial and emotional issues frequently emerge for patients and families. This qualitative study explored the perspectives of nurses from a palliative care unit, in-patient acute care oncology units, ambulatory cancer setting, and the community on their experiences of caring for patients with MBO and their families. Six individual interviews and two focus groups were conducted. Eight overarching messages were identified related to nurses' experiences. Highlights include aspects of patients' and families' emotional distress, and the nurse-patient relationship in relieving suffering. Nurses have an important and privileged role that involves identifying MBO signs and symptoms, having knowledge of treatment and symptom management options, and helping patients transition from a curative to a palliative philosophy of care.

The nurse's role in palliative care: A qualitative meta‐synthesis

“…The nurses' availability made them natural points of contact for the patient and the family, as well as for other health professionals. Hence, the nurses described themselves as coordinators of services, aiming at providing care for the patients and their families (Austin et al., ; Daines et al., ; Hopkinson, Hallett, & Luker, ; Howell et al., ; King et al., ; Raphael et al., ; Törnquist et al., ; Wallerstedt & Andershed, ). Schaepe, Campbell, and Bolmsjo () showed that nurses, whether working in home care or hospital in Uganda, described their role as “spiders in a web.” Their work was characterised by networking with other professionals and between the patient and the family.…”

“…Hence, providing psychosocial and spiritual care to the patients went hand in hand with direct hands-on physical care (Kaasalainen et al, 2014;Schaepe et al, 2011). The study by Daines et al (2013) found that the best part of working with palliative care patients across institutions, in acute care and outpatient care as well as in a palliative care unit, was when nurses were able to find the right combination of medical and nonmedical intervention to achieve comfort. The nurse's role across continents and institutions included helping patients with the "soul pain," referring to the more psycho-existential dimension of suffering (Evans & Hallett, 2007;Howell et al, 2014;Kaasalainen et al, 2014;Zheng, Guo, Dong, & Owens, 2015).…”

“…Caring for the patient's family was reported to be a particularly important part of the nurse's role in palliative care. The role encompassed making the families feel comfortable, well supported, and not alone (Daines et al, 2013;McCallin, 2011;Zheng et al, 2015). Several studies (Espinosa et al, 2010;Johnston & Smith, 2006;Zheng et al, 2015) found that building trust with the patient's family was essential.…”

“…Austin et al, 2000;Daines et al, 2013;Hopkinson, Hallett, & Luker, 2003;Howell et al, 2014;King et al, 2010;Raphael et al, 2014;T€ ornquist et al, 2013;Wallerstedt & Andershed, 2007) Schaepe, Campbell, and Bolmsjo (2011). showed that nurses, whether working in home care or hospital in Uganda, described their role as "spiders in a web."…”

Palliative Surgery: Incidence and Outcomes

“…The goals of treatment include relieving nausea and vomiting, allowing oral intake, and alleviating pain. 13 The optimal procedure is that which is the quickest, safest, and most efficacious in alleviating the obstruction. Persistent obstructions in the face of conservative therapy (usually nasogastric decompression, hydration, and bowel rest) or evidence of complete obstructions are indications that a surgical procedure should be considered.…”