Nursing Theory
The chosen nursing issue in palliative care. Palliative care is an approach to specialized nursing care and medical care for people who have life-limiting diseases. The main goal of this therapy is to provide people with relief from the pain, symptoms, mental and physical stress, thereby improving the quality of life for sick people and their families. The role of nurses in providing palliative and end-of-life care is crucial. They have many responsibilities that are focused on the alleviation of a patient’s suffering (Wilson et al., 2016).
Thus, the nursing theory that provides the framework for the chosen nursing issue and the identified evidence-based proposal belongs to the category of ethics. In general, the ethical nursing theory focuses on the questions of moral value and moral obligation.
Particularly, the identified proposal belongs to a subgroup of ethical nursing theories, namely the humanistic theory. The specialty of palliative and hospice care nursing comprises a holistic approach, and humanistic caring to patients care. The most appropriate nursing theory for this proposal within the category of humanistic theories is Paterson and Zderad’s Humanistic Nursing Theory, which applies the notions of Existentialism and Humanism to nursing theory (“Paterson and Zderad Theory,” 2017).
The rationale for choosing this particular theory is that it focuses on communication between a nurse and a dying patient on a deep level. In this theory, a nurse represents a helper who is always ready to help a patient. A nurse must also understand how a patient feels and do everything to alleviate their pain.
Thus, the most crucial features of the humanistic nursing dialog are openness and sympathy. Additionally, Paterson and Zderad identified the five phases in the nursing process which they called “Preparation of the Nurse Knower for Coming to Know”, “Nurse Knowing of the Other Intuitively”, “Nurse Knowing the Other Scientifically”, “Nurse Completely Synthesizing Known Others”, and “Succession Within the Nurse From the Many to the Paradoxical One”. Thus, these philosophical perspectives can be considered relevant to the practice of end-of-life care nursing (“Paterson and Zderad Theory,” 2017).
Literature Review
Dobrina, Tenze, and Palese (2014) conducted a qualitative study in which they analyzed nursing theories and practices regarding hospice and palliative care. Admittedly, among all the members of a healthcare team, nurses have the most contact with patients, especially those who suffer from life-threatening diseases. Palliative care is a multidisciplinary approach, which means that palliative and hospice care nurses need a comprehensive theoretical foundation to be confident of their role and be able to explain it.
The purpose of their research is to describe palliative and hospice care nursing theories and models and to analyze their main concepts. Thus, the authors have identified ten key concepts that are divided into three categories: nurse, patient, and therapeutic relationships. The values and themes analyzed in the end-of-life nursing theories and models correspond to the best practices in palliative care that are based on teamwork and patient-centered approach. When developing therapeutic relationships with patients, nurses gain a valuable experience, which can lead to job satisfaction and existential growth.
Wiener, Weaver, Bell, and Sansom-Daly (2015) conducted qualitative research in which they focused on the importance of a quality education for nurses and other medical providers which would help them provide comprehensive palliative care to patients with cancer. First of all, they must be trained to treat, diagnose, and investigate cancer. Their main purpose is to maximize the chances of the patients’ final recovery, or if they are terminally ill – to alleviate pain and maintain an appropriate environment until they die. Early integration of palliative care into oncology practice is a valuable approach to improving the quality of life of adolescents and young adults (AYAs). Apart from this, palliative care training must also be early integrated into trainees’ professional development.
Since the AYA age range represents subsequent transitions across all stages of development, the learning needs of trainees change during the different phases of their training. The authors review unique psychosocial, developmental, and epidemiologic factors that play a significant role in providing palliative care, especially for AYAs. Additionally, the authors analyzed different critical instructional strategies and provided guidance on how to improve the AYAs’ quality of life at the end of their lives.
Wilson et al. (2016) conducted a quantitative study in which they explored the desire for death in patients who receive palliative care for cancer. In general, the desire for death in patients with cancer that cannot be cured is connected with anxiety and depression.
However, there are cases when mentally healthy people experience the same desire. According to the results of the survey with 377 patients suffering from cancer, 70% had no craving for death, 18% admitted having such thoughts but claimed that they were transient, 12% had a strong desire for death. However, from the latter group, 52% had a mental disorder, while 48% were mentally healthy. Patients with no mental disorders and no desire for death experienced less stress in social, existential, physical, and psychological aspects, whereas mentally ill patients reported the maximum stress and desire to die.
However, mentally healthy patients who expressed a considerable desire to die were under stress and experienced unpleasant symptoms that caused pain. Thus, a desire for death in terminally ill patients can be caused by mental disorders but not always. Therefore, it is crucial for nurses to provide the best end-of-life care for terminally ill patients so that they have no desire to die prematurely.
Kelley and Morrison (2015) conducted a qualitative study where they focused on palliative care for terminally ill patients in general and analyzed the core aspects of palliative care. Thus, they distinguish such aspects of palliative care as the evaluation and treatment of psychological and physical symptoms, support for and identification of spiritual distress, coordination of care, and professional communication to set goals of care and help with making medical decisions.
Ideally, a significant part of these components should be provided by high-skilled nursing teams. However, in reality, nurses have either formal or limited training in these areas. The authors also provide a chart in which they analyze the prevalence of symptoms of those diseases that most patients who require palliative care have. Thus, they mention chronic obstructive pulmonary disease (COPD), congestive heart failure, cancer, chronic kidney disease (CKD), dementia, and acquired immunodeficiency syndrome (AIDS).
Additionally, the authors compare and contrast the advantages and disadvantages of palliative and hospice care and provide recommendations for nurses on all the aspects that must be taken into account when providing palliative care for terminally ill patients.
Ciemins, Brant, Kersten, Mullette, and Dickerson (2015) conducted a qualitative study in which they explored patients’ and their families’ perceptions of the end-of-life care services or those during serious illnesses and identified barriers and facilitators of palliative care services. The authors claim that the increased understanding of experiences and perspectives of patients and their families will help improve healthcare teams’ competencies which, in their turn, will improve patient care.
The authors conducted twelve interviews and made a purposive sample of fourteen people who had been provided with palliative care services and members of their families. According to the results, the central themes connected with contentment with palliative care services were honoring choices, reassurance, and presence. The key characteristics of healthcare professionals identified with these themes are empathy, compassion, good communication, respect, timeliness, genuineness, approachability, and sensitivity. Honoring choices theme included characteristics connected with family needs, spirituality, and overall treatment.
Etkind et al. (2017) conducted a mixed methods research in which they tried to explore how many people will need palliative care in 2040. According to current studies, palliative care services are beneficial for nearly 75% of all terminally ill people. Additionally, the increasing number of older people and the rising predominance of chronic diseases in many countries may indicate that in the future, palliative care will be beneficial for more people, though there were no particular calculations on this issue.
In their study, the authors try to estimate this number of people on the basis of two countries, namely England and Wales using the mortality statistics for the last several years. They also took into account the prevalence of different life-threatening diseases such as cancer, dementia, and failure of different organs over the nine-year period. According to the results, by 2040, the annual mortality rate will rise by 25%.
If sex- and age-specific proportions of people requiring palliative care are the same as in 2016, the number of people who require palliative care will also rise by 25%. If they continue to rise, the number of people who need palliative care will increase by 42%. Additionally, the results show that cancer and dementia will be the main reason for the increase of this need.
References
Ciemins, E. L., Brant, J., Kersten, D., Mullette, E., & Dickerson, D. (2015). A qualitative analysis of patient and family perspectives of palliative care. Journal of Palliative Medicine, 18(3), 282-285.
Dobrina, R., Tenze, M., & Palese, A. (2014). An overview of hospice and palliative care nursing models and theories. International Journal of Palliative Nursing, 20(2), 75-81.
Etkind, S. N., Bone, A. E., Gomes, B., Lovell, N., Evans, C. J., Higginson, I. J., & Murtagh, F. E. M. (2017). How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Medicine, 15(1), 102-111.
Kelley, A. S., & Morrison, R. S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755.
Paterson and Zderad Theory Overview. (2017). Web.
Wiener, L., Weaver, M. S., Bell, C. J., & Sansom-Daly, U. M. (2015). Threading the cloak: Palliative care education for care providers of adolescents and young adults with cancer. Clinical Oncology in Adolescents and Young Adults, 5(1), 1-18.
Wilson, K. G., Dalgleish, T. L., Chochinov, H. M., Chary, S., Gagnon, P. R., Macmillan, K.,… & Fainsinger, R. L. (2016). Mental disorders and the desire for death in patients receiving palliative care for cancer. BMJ Supportive & Palliative Care, 6(2), 170-177.