Difficulties Experienced by Palliative Care Nurses in Emergency Care Practices: A Qualitative Study

Öz

Objective: This study aimed to determine the difficulties experienced by palliative care nurses during emergency care practice. Materials and Methods: This study reports the experiences of 10 nurses working in the palliative care unit of a public hospital between February 2023 and May 2023 regarding emergency care practices. A qualitative research design was used with semi-structured interviews and content analysis. Results: Four themes were identified from the analysis of the interview documents: 1) feelings in the face of emergency, 2) factors that support emergency care practices, 3) factors that hinder emergency care practices, and 4) the development of emergency care practices. Conclusions: The most important factor preventing emergency nursing practice in the palliative care service was insufficient staffing, especially during night shifts. The number of nurses was low, there was no support staff, and in case of possible cardiopulmonary resuscitation requirements, the treatment of other patients was interrupted. Identifying the factors that support and hinder emergency nursing practices will allow the development of strategies that will positively affect holistic care delivery by palliative care nurses.

Anahtar Kelimeler

• Difficulties of palliative care
• emergency care
• nursing
• qualitative research

Etik Beyan

Our study was approved by the Social and Humanities Ethics Committee of a university (Date: 27.01.2023, decision no: 2023-1216).

Teşekkür

Thank you to the nurses who participated in the study.

Palyatif Bakım Hemşirelerinin Acil Bakım Uygulamalarında Yaşadığı Zorluklar: Nitel Bir Araştırma

Öz

Amaç: Bu çalışmanın amacı, palyatif bakım hemşirelerinin acil bakım uygulamalarında yaşadığı zorlukların belirlenmesidir. Materyal ve Metot: Bu çalışma, Şubat 2023 ile Mayıs 2023 tarihleri arasında bir kamu hastanesinin palyatif bakım ünitesinde çalışan 10 hemşirenin acil bakım uygulamalarına ilişkin deneyimlerini aktarmaktadır. Yarı yapılandırılmış görüşmeler ve içerik analizi ile nitel bir araştırma deseni kullanılmıştır. Bulgular: Görüşme dokümanlarının analizi sonucunda: 1) acil durum karşısında hissedilenler, 2) acil hemşirelik uygulamalarını destekleyici faktörler, 3) acil hemşirelik uygulamalarını engelleyici faktörler, 4) acil bakım uygulamalarının geliştirilmesi olmak üzere dört tema belirlendi. Sonuç: Palyatif bakım servisinde acil hemşirelik uygulamalarına engel olan en önemli faktörün personel yetersizliği olduğu, özellikle gece mesailerinde hemşire sayısının az olduğu, destek personelinin bulunmadığı ve olası kardiyopulmoner resüsitasyon gerekliliği durumunda diğer hastaların tedavisinin aksadığı belirlendi. Acil hemşirelik uygulamalarını destekleyen ve engelleyen faktörlerin belirlenmesi, palyatif bakım hemşirelerinin bütüncül bakım sunumunu olumlu yönde etkileyecek stratejilerin geliştirilmesine olanak sağlayacaktır.

Anahtar Kelimeler

• Acil bakım
• hemşirelik
• nitel araştırma
• palyatif bakımın zorlukları

Etik Beyan

Our study was approved by the Social and Humanities Ethics Committee of a university (Date: 27.01.2023, decision no: 2023-1216).

Teşekkür

Thank you to the nurses who participated in the study.

Kaynakça

1. Center to Advance Palliative Care. What is palliative care? https://www.capc.org/about/ palliative-care/. Accessed May 20, 2023.
2. Australian Institute of Health and Welfare. Palliative care services in Australia. https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia/ contents/summary. Accessed May 25, 2023.
3. Sekse RJT, Hunskår I, Ellingsen S. The nurse's role in palliative care: A qualitative meta‐synthesis. Journal of Clinical Nursing. 2018;27(1-2):e21-e38. doi:10.1111/jocn.13912
4. Üzen Cura Ş, Ateş E. The difficulties that palliative care unit nurses have while caring the dying patients. Journal of Academic Research in Nursing. 2020;6(3):483-490. doi:10.5222/jaren.2020.43760
5. Güngördü ND, Akbal Y, Üstün Ç, Başaran A. Palyatif bakım ünitesinde ölüm sürecindeki müdahale ve bakımda hemşireleri etkileyen faktörler: Fenomenolojik çalışma. Ege Tıp Dergisi. 2024;63(2):282-291. doi:10.19161/etd.1360184
6. Tertemiz OF, Tüylüoğlu E. Are signs of burnout and stress in palliative care workers different from other clinic workers? Ağrı. 2020;32(2):79-84. doi:10.14744/agri.2019.14880
7. Tekindal M, Uğuz Arsu Ş. Nitel araştırma yöntemi olarak fenomenolojik yaklaşımın kapsamı ve sürecine yönelik bir derleme. Ufkun Ötesi Bilim Dergisi. 2020;20(1):153-172.
8. Lindseth A, Norberg A. Elucidating the meaning of life world phenomena. A phenomenological hermeneutical method for re searching lived experience. Scandinavian Journal of Caring Sciences. 2022;36(3):883–890. doi:10.1111/scs.13039

9. Zeilinger EL, Gabal A, Adamidis F, et al. Challenges in palliative care nursing at a university hospital: A qualitative interview study. Journal of Hospice & Palliative Nursing. 2022;24(5):E219–E225. doi:10.1097/NJH.000000000000886
10. Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: A discussion paper. Nurse Education Today. 2017;56:29-34. doi:10.1016/j.nedt.2017.06.002
11. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2):105–112. doi:10.1016/j.nedt.2003.10.001.
12. Lincoln YS, Guba EG. Naturalistic inquiry. Beverley Hills: Sage Publications; 1985. Hussain FA. Psychological challenges for nurses working in palliative care and recommendations for self-care. British Journal of Nursing. 2021;30(8):484-489. doi:10.12968/bjon.2021.30.8.484
13. American Nurses Association. Position statement: Nurses’ roles and responsibilities in providing care and support at the end of life. https://www.nursingworld.org/~4af078/ globalassets/docs/ana/ethics/endoflife-positionstatement.pdf. Accessed Nov 10, 2023.
14. Forrest J, Napier M. Emergencies in palliative care. In: Cooper J, ed. Stepping Into Palliative Care 2: Care And Practice. 2nd ed. Seattle: Radcliffe Publishing; 2006:130-148.
15. Hagarty AM, Bush SH, Talarico R, Lapenskie J, Tanuseputro P. Severe pain at the end of life: A population-level observational study. BMC Palliative Care. 2020;19(1):1-13. doi:10.1186/s12904-020-00569-2
16. Coyne P, Mulvenon C, Paice JA. American society for pain management nursing and hospice and palliative nurses association position statement: Pain management at the end of life. Pain Management Nursing. 2018;19(1):3-7. doi:10.1016/j.pmn.2017.10.019
17. Noble S. Emergencies in palliative care. Medicine. 2020;48(1):33-36.
18. Landstad BJ, Kvangarsnes M. Physicians’ narratives of communication with patients and their relatives in different phases of the palliative pathway. BMJ Open. 2023;13(6):e065681. doi:10.1136/bmjopen-2022-065681
19. Tanrıverdi Ö, Kömürcü Ş. Palyatif bakım ünitelerinde yapılanma. İçinde: Gülhan M, Yılmaz Ü, eds. Akciğer Kanserinde Destek Tedavisi. İstanbul: TUSAD yayıncılık; 2016:391-407.
20. Menekli T. Problems experienced by healthcare professionals caring for palliative care patients and solution suggestions. Journal of Health Profession Research. 2023;5(1):81-88. doi:10.57224/jhpr.1073872
21. Kıyak S, Altuntuğ K, Ege E. Views of nurses on working in the palliative care unit: Qualitative study. Ordu University Journal of Nursing Studies. 2022;5(2):191-199. doi:10.38108/ouhcd.896557
22. Arslanoğlu A. Sağlık hizmetlerinde kalite yönetimi: Hastane-yoğun bakımlar ve palyatif bakım kliniklerinde kalite yönetimi. Ankara: Nobel Akademik Yayıncılık; 2021.
23. Sarıhan M, Öztürk D, Yurdakoş K. Scale development for evaluation of palliative care services in terms of healthcare employees. Journal of Health Sciences. 2022;31(2):219-228. doi:10.34108/eujhs.944146