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F11-C Nurses’ Clinical Judgment in Palliative Care
e54
Selected Abstracts
Home palliative care enhances the quality of life of patients and their families, increases satisfaction with the care received, and generates a positive economic impact upon healthcare systems. Voids are identified with respect to experiences in the hospital-home transition within the Latin American setting and particularly in Colombia. Objective: This work aimed to describe the experience of the patient-family caretaker dyad in palliative care during the transition process between the hospital and home at Colombia’s National Cancer Institute in Bogota. Method: This was a qualitative study, through grounded theory, with the participation of 22 informants, 8 patients in palliative care, and 14 family caretakers. Data analysis was performed through the constant comparison method. Results: Six themes emerged that reflect the experience of the dyad comprised by the person in palliative care and his or her family caretaker. The dyad confronts the prognosis and progression of the disease at home and addresses the anticipated grief to understand how to manage the symptoms, the patient’s physical discomfort e especially pain, listlessness, lack of mobility, and problems with sleeping. This combined with the economic costs of acquiring supplies are overwhelming, as are the administrative procedures to gain access to health consultations and services. Emotional and spiritual support are permanently required, considering it fundamental to have a palliative care staff that responds in a timely manner to their concerns. In many cases, these patients do not know how to have access to said staff, recognizing that they must endure the situation on their own, without the guidance they would expect from the healthcare system. Conclusions: Key aspects are identified to guide palliative care staff in dealing with users who live the experience of the transition from the hospital to the home.
F11-B Factors Associated with Burnout Among Chinese Oncology Nurses Qiaohong Guo, Susan McClement, Manitoba Palliative Care Research Unit, Winnipeg, MB, Canada Objectives: To evaluate the prevalence and associated factors for burnout among Chinese oncology nurses. Methods: A convenience sample of 279 oncology nurses from a Northern China hospital were surveyed. Participants completed the Death Attitudes Profile Scale and the Maslach Burnout Inventory (MBI), provided demographic data, and information regarding experience in caring for dying patients. Data were analyzed using descriptive statistics, t-tests, ANOVA and Spearman’s correlation.
Vol. 52 No. 6 December 2016
Results: The majority of participants were females less than 30 years of age with an average of 6 years clinical experience who cared for dying patients weekly or monthly. Less than half the sample had received education about death and dying, and 78.1% indicated the need for such training. A moderate to high level of burnout was identified in 77% of participants on the emotional exhaustion (EE), and depersonalization (DP) subscales of the MBI, and in 86.9% of participants on the reduced personal accomplishment (PA) subscale. Younger, single nurses with less than 5 years work experience scored significantly lower on the EE subscale (pLT .01), were able to discuss death openly with colleagues, and had more positive death attitudes (pLT .05). No statistically significant differences were found with respect to demographic variables for the DP and PA subscales. Fear of death, death avoidance, and perceiving death as a solution to suffering were positively correlated with EE and DP, and negatively correlated with PA. Acceptance of death as a natural part of life was positively correlated with PA, and negatively correlated with DP. Conclusion: The prevalence of burnout among Chinese oncology nurses is extremely high compared to other countries. The longer nurses work, the more burnout they tend to experience. However, nurses who are younger and who have more positive attitudes toward death tend to experience less burnout. Education about caring for dying patients was endorsed by nurses.
F11-C Nurses’ Clinical Judgment in Palliative Care
Mahvash Salsali1, Jamal Seidi2, Fatemeh Alhani3 1 Tehran University of Medical Sciences, Tehran, Iran 2 Sanandage University of Medical Sciences, Sanandage, Iran 3 Tarbiat Modares University of Medical Sciences, Tehran, Iran Nurses’ clinical judgments and decisions have the potential to help health care systems distribute resources efficiently, prevent harm, and promote health achievement and patient benefit. The core characteristics or competencies of nurses include: clinical judgment, advocacy and ethics, collaboration, professionalism, communication, cultural components, as well as facilitation of learning. Clinical judgment is one of the key attributes of professional practice. It is a prerequisite for establishing professional identity and is mainly based on nurses’ knowledge and experience as well as their reasoning, intuition, clinical thinking, and evidence-based practice skills. Evidence from healthcare systems around the world suggests that judgement made by nurses could be improved and we need to know more about nurses’
Vol. 52 No. 6 December 2016
Selected Abstracts
judgments, the interventions likely to improve their decisions, and outcomes. In this qualitative study we aimed to explore the process of Iranian nurses’ professionalization in clinical judgment. The data were collected based on semistructured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method. The study findings revealed that the participants employed different strategies for becoming professional in clinical judgment development. These strategies constituted the core category of the study, which was ‘struggling for becoming professional in clinical judgment’. To the best of our knowledge, none of the previous studies had explored the process of professionalization in clinical judgment. However, several studies have reported some of the properties and strategies of professionalization in clinical judgment. The findings provided critical information about nurses’ professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses’ clinical judgment ability especially in the field of palliative care. Keywords: Clinical Judgment, Nurse, Qualitative Research, Iran.
F12-B Representations sociales de la mort des proches aidants en contexte de soins palliatifs
Sabrina Lessard1, Bernard-Simon Leclerc1,2 Centre de recherche et de partage des savoirs InterActions CIUSSS-NIM, Montre al, QC, Canada 2 Universite de Montre al, Montre al, QC, Canada 1
Cette etude avait pour objectif l’identification des repr esentations sociales de la mort des proches aidants en contexte de soins palliatifs. Les chercheurs ont analyse 23 entrevues r ealis ees aupr es de proches aidants ayant accompagne un membre de leur famille atteint d’une maladie incurable a domicile ou dans une unite sp ecialis ee en soins palliatifs, a Montr eal. Les r esultats r ev elent que les proches aidants evoquent certaines images, formes de repr esentations sociales, sp ecifiquement li ees a la mort : (1) les pertes comme diff erentes formes de mort, (2) les soins palliatifs comme un endroit pour n egocier avec la mort, (3) les derniers moments comme la confirmation d’imminence de la mort. Ces images soulignent la signification associ ee au corps en d esu etude et a la position sociale du mourant dans notre soci et e moderne occidentale. Les repr esentations des soins palliatifs
e55
revelent egalement un certain paradoxe, un lieu de grand respect et d’une bonne mort et un lieu o u la mort est presque trop omnipresente, un lieu o u la mort derange. Les resultats de la recherche montrent egalement de fortes croyances liees a l’utilisation d’antidouleur a la fin de la vie. Finalement, les images re ferent a des rituels de fin de vie personnalises en soutien au passage vers un nouveau statut. Cette etude offre une meilleure comprehension du sens commun de la mort pour les proches aidants accompagnant leur ^etre cher en soins palliatifs et aux differentes significations de ce sujet sensible.
F12-C S edation continue maintenue jusqu’au d ec es: quelle communication dans les unit es de soins palliatifs franc¸aises et polonaises ?
Martyna Tomczyk1, Sadek Beloucif1,2, Armelle Jacquet-Andrieu1,5, Maciej Sopata3, Marcel-Louis Viallard1,4 1 Laboratoire d’e thique me dicale et de me decine le gale, Universite Paris Descartes, Sorbonne Paris Cite , France 2 De partement Anesthe sie Re animation, H^o pital Universitaire Avicenne, Paris, APHP, France 3 Chaire et Clinique de me decine palliative, Universite des sciences me dicales K. Marcinkowski, Poznan, Pologne 4 UF Douleur and me decine palliative pe rinatale e pe diatrique - adulte, H^o pital Universitaire Necker Enfants Malades, Paris APHP, France 5 CNRS, UMR 7114, MoDyCo, Universite Paris OuestNanterre la De fense, Nanterre, France
Objectifs de l’etude : 1) Savoir comment « sedation continue maintenue jusqu’au deces » est nommee et conceptualisee par les soignants (medecins et infirmieres) exerc¸ant dans les USP en France metropolitaine et en Pologne, et reperer une eventuelle influence du macrocontexte du pays. 2) Comprendre si cela impacte, a son tour, le contenu de l’information delivree au malade et aux proches, et plus largement, la communication et la relation de soin. Methodes : Recherche qualitative fondee sur une approche des cas multiples ; analyse linguistique des dossiers medicaux et paramedicaux, et analyse linguistique et thematique des entretiens semi-directifs ayant ete r ealis es aupres des medecins, des infirmieres et des proches de malades sedates dans les USP franc¸aises et polonaises. Resultats : Si les representations de la « sedation continue maintenue jusqu’au deces » des soignants exerc¸ant dans ces deux pays europeens etaient semblables, il n’en allait pas de m^eme pour la fac¸on de nommer et, encore moins, pour le contenu de la delivrance de l’information. En effet, d’importantes variations ont et e
Selected Abstracts
Home palliative care enhances the quality of life of patients and their families, increases satisfaction with the care received, and generates a positive economic impact upon healthcare systems. Voids are identified with respect to experiences in the hospital-home transition within the Latin American setting and particularly in Colombia. Objective: This work aimed to describe the experience of the patient-family caretaker dyad in palliative care during the transition process between the hospital and home at Colombia’s National Cancer Institute in Bogota. Method: This was a qualitative study, through grounded theory, with the participation of 22 informants, 8 patients in palliative care, and 14 family caretakers. Data analysis was performed through the constant comparison method. Results: Six themes emerged that reflect the experience of the dyad comprised by the person in palliative care and his or her family caretaker. The dyad confronts the prognosis and progression of the disease at home and addresses the anticipated grief to understand how to manage the symptoms, the patient’s physical discomfort e especially pain, listlessness, lack of mobility, and problems with sleeping. This combined with the economic costs of acquiring supplies are overwhelming, as are the administrative procedures to gain access to health consultations and services. Emotional and spiritual support are permanently required, considering it fundamental to have a palliative care staff that responds in a timely manner to their concerns. In many cases, these patients do not know how to have access to said staff, recognizing that they must endure the situation on their own, without the guidance they would expect from the healthcare system. Conclusions: Key aspects are identified to guide palliative care staff in dealing with users who live the experience of the transition from the hospital to the home.
F11-B Factors Associated with Burnout Among Chinese Oncology Nurses Qiaohong Guo, Susan McClement, Manitoba Palliative Care Research Unit, Winnipeg, MB, Canada Objectives: To evaluate the prevalence and associated factors for burnout among Chinese oncology nurses. Methods: A convenience sample of 279 oncology nurses from a Northern China hospital were surveyed. Participants completed the Death Attitudes Profile Scale and the Maslach Burnout Inventory (MBI), provided demographic data, and information regarding experience in caring for dying patients. Data were analyzed using descriptive statistics, t-tests, ANOVA and Spearman’s correlation.
Vol. 52 No. 6 December 2016
Results: The majority of participants were females less than 30 years of age with an average of 6 years clinical experience who cared for dying patients weekly or monthly. Less than half the sample had received education about death and dying, and 78.1% indicated the need for such training. A moderate to high level of burnout was identified in 77% of participants on the emotional exhaustion (EE), and depersonalization (DP) subscales of the MBI, and in 86.9% of participants on the reduced personal accomplishment (PA) subscale. Younger, single nurses with less than 5 years work experience scored significantly lower on the EE subscale (pLT .01), were able to discuss death openly with colleagues, and had more positive death attitudes (pLT .05). No statistically significant differences were found with respect to demographic variables for the DP and PA subscales. Fear of death, death avoidance, and perceiving death as a solution to suffering were positively correlated with EE and DP, and negatively correlated with PA. Acceptance of death as a natural part of life was positively correlated with PA, and negatively correlated with DP. Conclusion: The prevalence of burnout among Chinese oncology nurses is extremely high compared to other countries. The longer nurses work, the more burnout they tend to experience. However, nurses who are younger and who have more positive attitudes toward death tend to experience less burnout. Education about caring for dying patients was endorsed by nurses.
F11-C Nurses’ Clinical Judgment in Palliative Care
Mahvash Salsali1, Jamal Seidi2, Fatemeh Alhani3 1 Tehran University of Medical Sciences, Tehran, Iran 2 Sanandage University of Medical Sciences, Sanandage, Iran 3 Tarbiat Modares University of Medical Sciences, Tehran, Iran Nurses’ clinical judgments and decisions have the potential to help health care systems distribute resources efficiently, prevent harm, and promote health achievement and patient benefit. The core characteristics or competencies of nurses include: clinical judgment, advocacy and ethics, collaboration, professionalism, communication, cultural components, as well as facilitation of learning. Clinical judgment is one of the key attributes of professional practice. It is a prerequisite for establishing professional identity and is mainly based on nurses’ knowledge and experience as well as their reasoning, intuition, clinical thinking, and evidence-based practice skills. Evidence from healthcare systems around the world suggests that judgement made by nurses could be improved and we need to know more about nurses’
Vol. 52 No. 6 December 2016
Selected Abstracts
judgments, the interventions likely to improve their decisions, and outcomes. In this qualitative study we aimed to explore the process of Iranian nurses’ professionalization in clinical judgment. The data were collected based on semistructured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method. The study findings revealed that the participants employed different strategies for becoming professional in clinical judgment development. These strategies constituted the core category of the study, which was ‘struggling for becoming professional in clinical judgment’. To the best of our knowledge, none of the previous studies had explored the process of professionalization in clinical judgment. However, several studies have reported some of the properties and strategies of professionalization in clinical judgment. The findings provided critical information about nurses’ professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses’ clinical judgment ability especially in the field of palliative care. Keywords: Clinical Judgment, Nurse, Qualitative Research, Iran.
F12-B Representations sociales de la mort des proches aidants en contexte de soins palliatifs
Sabrina Lessard1, Bernard-Simon Leclerc1,2 Centre de recherche et de partage des savoirs InterActions CIUSSS-NIM, Montre al, QC, Canada 2 Universite de Montre al, Montre al, QC, Canada 1
Cette etude avait pour objectif l’identification des repr esentations sociales de la mort des proches aidants en contexte de soins palliatifs. Les chercheurs ont analyse 23 entrevues r ealis ees aupr es de proches aidants ayant accompagne un membre de leur famille atteint d’une maladie incurable a domicile ou dans une unite sp ecialis ee en soins palliatifs, a Montr eal. Les r esultats r ev elent que les proches aidants evoquent certaines images, formes de repr esentations sociales, sp ecifiquement li ees a la mort : (1) les pertes comme diff erentes formes de mort, (2) les soins palliatifs comme un endroit pour n egocier avec la mort, (3) les derniers moments comme la confirmation d’imminence de la mort. Ces images soulignent la signification associ ee au corps en d esu etude et a la position sociale du mourant dans notre soci et e moderne occidentale. Les repr esentations des soins palliatifs
e55
revelent egalement un certain paradoxe, un lieu de grand respect et d’une bonne mort et un lieu o u la mort est presque trop omnipresente, un lieu o u la mort derange. Les resultats de la recherche montrent egalement de fortes croyances liees a l’utilisation d’antidouleur a la fin de la vie. Finalement, les images re ferent a des rituels de fin de vie personnalises en soutien au passage vers un nouveau statut. Cette etude offre une meilleure comprehension du sens commun de la mort pour les proches aidants accompagnant leur ^etre cher en soins palliatifs et aux differentes significations de ce sujet sensible.
F12-C S edation continue maintenue jusqu’au d ec es: quelle communication dans les unit es de soins palliatifs franc¸aises et polonaises ?
Martyna Tomczyk1, Sadek Beloucif1,2, Armelle Jacquet-Andrieu1,5, Maciej Sopata3, Marcel-Louis Viallard1,4 1 Laboratoire d’e thique me dicale et de me decine le gale, Universite Paris Descartes, Sorbonne Paris Cite , France 2 De partement Anesthe sie Re animation, H^o pital Universitaire Avicenne, Paris, APHP, France 3 Chaire et Clinique de me decine palliative, Universite des sciences me dicales K. Marcinkowski, Poznan, Pologne 4 UF Douleur and me decine palliative pe rinatale e pe diatrique - adulte, H^o pital Universitaire Necker Enfants Malades, Paris APHP, France 5 CNRS, UMR 7114, MoDyCo, Universite Paris OuestNanterre la De fense, Nanterre, France
Objectifs de l’etude : 1) Savoir comment « sedation continue maintenue jusqu’au deces » est nommee et conceptualisee par les soignants (medecins et infirmieres) exerc¸ant dans les USP en France metropolitaine et en Pologne, et reperer une eventuelle influence du macrocontexte du pays. 2) Comprendre si cela impacte, a son tour, le contenu de l’information delivree au malade et aux proches, et plus largement, la communication et la relation de soin. Methodes : Recherche qualitative fondee sur une approche des cas multiples ; analyse linguistique des dossiers medicaux et paramedicaux, et analyse linguistique et thematique des entretiens semi-directifs ayant ete r ealis es aupres des medecins, des infirmieres et des proches de malades sedates dans les USP franc¸aises et polonaises. Resultats : Si les representations de la « sedation continue maintenue jusqu’au deces » des soignants exerc¸ant dans ces deux pays europeens etaient semblables, il n’en allait pas de m^eme pour la fac¸on de nommer et, encore moins, pour le contenu de la delivrance de l’information. En effet, d’importantes variations ont et e