patient-centered care: the lived experiences of nurses providing hospice care rita ferguson, phd,...
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Patient-Centered Care: The Lived Experiences of Nurses
Providing Hospice Care
Rita Ferguson, PhD, RN, CHPN, CNECollege of Nursing
The University of Alabama in HuntsvilleHuntsville, AL 35899
Patient-Centered Care• Definition: Recognize the patient or designee
as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Taylor Sullivan, D., Warren, J.(2007). Quality and safety education for nurses, Nursing Outlook, 55, 122-131.DOI: http://dx.doi.org/10.1016/j.outlook.2007.02.006
Hospice Care
• Hospice nurses “promote quality of life for patients and families facing serious illness by combining the science and the art of professional nursing care” (Hospice and Palliative Nurses Association, 2011).
• Hospice nurses manage symptoms, support patient and family emotions needs, work as part of an interprofessional team, and provide indicated nursing care (Thornburg, Schim, Paige, & Grubaugh, 2008).
• Knowing about the person can enhance caring and improve the personal concerns of “dignity and quality” as defined by the patient and family (City & Labyak, 2010, p. 26).
Palliative Care Model
Background
• Work of nursing is to provide for others (Lazenby, 2013)
• Complexity is inherent in addressing the individual’s concerns and needs (Valente, 2011)
• Roles of nurses include being the patient advocate (City & Labyak, 2010)
Background
• Critical element of caring is knowing (Mayeroff, 1971)
• The caring characteristics of regard, empathy, and reassurance connect knowing by the nurse to the patient (Kelley, Docherty, & Brandon, 2013)
Review of Literature
• Nurses knowing the patient included topics relating to care, connection, and proficient practice (Zolnierek, 2014)
• Knowing the patient is characteristic of expert nurses (Radwin, 1996)
• Knowing the patient described as a reasoning and relational process (Jenny & Logan, 1992)
Purpose of the Study
Through the use of a descriptive phenomenological method, common meanings embedded in the experiences of nurses working in hospice agencies will be revealed and offer insight about the specialty of hospice nursing.
Research Question
What are the experiences of nurses working in hospice agencies in knowing about and caring
for persons receiving hospice care?
Methodology
• Design: Descriptive phenomenology
• Setting:– Individual face-to-face interviews–Multiple hospice organizations
Methodology
• Participants• Purposive sampling• < 2 years experience working in a hospice agency: 2
nurses• > 2 years but < 5 years: 4 nurses• > 5 years but < 10 years: 3 nurses• > 10 years experience in a hospice agency: 5 nurses• 14 registered nurses working in hospice
Demographic Information
•14 Registered Nurses •Time as a registered nurse: mean of 17 years•Average age: 48.5 years•Nursing education•7 currently certified in hospice and palliative
nursing•Years employed at current hospice agency:
mean 8 years
Conceptual Framework
• Boykin and Schoenhofer’s (2001) nursing as caring theory
• Liaschenko and Fisher (1999) typology of knowledge• Case knowledge• Patient knowledge• Person knowledge• Social knowledge
Theme• “SAVE THE LAST DANCE FOR ME”– connection– gift of presence– “if we listen, we can learn so much”
“Save the last dance for me”• Connection
Save the last dance for me• Gift of presence
Save the last dance for me• “if we listen, we can
learn so much”
SYNTHESIS STATEMENT
Implications and Recommendations for Nursing Education
• End-of-life care in curriculum
• Clinical management of individuals with life-limiting illness
• Inclusion of all ways of knowing
Implications and Recommendations for Nursing Practice
• Identify nurses’ educational needs
• Self-care strategies
• Experience
SIGNIFICANCE
OF THE
STUDY
Questions
Thank you-
References available
upon request via electronic mail
Acknowledgments
• Dr. Susan S. Gunby– Dissertation Committee Chair– Georgia Baptist College of Nursing, Mercer University
• Dr. Tanya Sudia – Dissertation Committee Member– Baylor University
• Dr. Susan C. McMillan– Dissertation Committee Member, External– University of South Florida
References
Boykin, A., & Schoenhofer, S. O. (2001). Nursing as caring: A model for transforming practice. Boston, MA: Jones and Bartlett.
City, K. A. E., & Labyak, M. J. (2010). Hospice palliative care for the 21st century: A model for quality end-of-life care. In B. R. Ferrell & N. Coyle (Eds.), Oxford textbook of palliative nursing (3rd ed., pp. 13-52). New York, NY: Oxford University Press.
Hospice and Palliative Nurses Position Statement. (2011). Value of the professional nurse in palliative care. Retrieved from http://www.hpna.org/DisplayPage.aspx?Title=PositionStatements
Kelley, T., Docherty, S., & Brandon, D. (2013). Information needed to support knowing the patient. Advances in Nursing Science, 36, 351-363. doi:10.1097/ANS.0000000000000006
Liashenko, J., & Fisher, A. (1999). Theorizing the knowledge that nurses use in the conduct of their work. Scholarly Inquiry for Nursing Practice: An International Journal, 13, 29-41. Retrieved from http://www.questia.com/library/1P3-1472208091/theorizing-the-knowledge-that-nurses-use-in-the-conduct
Mayeroff, M. (1971). On caring. New York, NY: Harper Perennial.
References (continued)Radwin, L. E. (1996). ‘Knowing the patient’: A review of research on an emerging concept.
Journal of Advanced Nursing, 23, 1142-1146. doi:10.1046/j.1365-2648.1996.12910.x
Rittman, M., Paige, P., Rivera, J., Sutphin, L., & Godown, I. (1997). Phenomenological study of nurses caring for dying patients. Cancer Nursing, 20, 115-119. Retrieved from http://journals.lww.com/cancernursingonline/Abstract/1997/04000/Phenomenological_study_of_nurses_caring_for_dying.6.aspx
Zolnirerek, C. D. (2014). An integrative review of knowing the patient. Journal of Nursing Scholarship, 46, 3-10. doi:10.1111/jnu.12049
Data Analysis
• Giorgi’s method
• First and second cycle coding methods as delineated by Saldaña
• Themes and subthemes are identified
• Synthesis and integration
Trustworthiness/Rigor Criteria
• Credibility• Dependability• Confirmability• Transferability (Lincoln & Guba, 1985)
• A DIFFERENT KIND– “not just little clinical
skills”– you are a nurse– “all about the care of a
person”– team approach
• KNOWING– learning about– knowing the case– knowing the patient– knowing the person– knowing the family– experience matters
• “IT’S A CALLING”– “the guide on the
journey”– rewarding– “this is where I
belong”
• “SAVE THE LAST DANCE FOR ME”– connection– gift of presence– “if we listen, we can
learn so much”
Phenomena of Knowing and Caring
• Visibility
• Outcomes
• Voice
“Save the last dance for me”
Inclusion Criteria
• Registered nurse• Currently working full time• Completed orientation to hospice agency• Minimum of 6 months work as hospice nurse• Speak and understand English
Data Collection
• Demographic information
• Semi-structured interview
• Audio recorded