Palliative Care Perceptions of Palliative

Palliative Care

Perceptions of Palliative Nursing Care by Patients and Nurses

Study exploring the perceptions of palliative care nursing by nurses' and patients using a Likert-type questionnaire (DeMarrais & Lapan, 2004) and comprehensive review of present literature comparing nurses', doctors' and patients' perceptions about the quality of care, and their involvement in palliative care. The results of the study will be used to develop a more comprehensive and inclusive approach to the development of interdisciplinary teams whose goal is to provide the best care possible for patients, considering their individual preferences and needs and the ability of healthcare facilities to accommodate them.

Introduction

This study examines perceptions of palliative care nursing by nurses' and patients. The goal of the present study will be to compare nurses' and patients' attitudes and beliefs about palliative care nursing and decision-making processes. The study will also explore contradictory beliefs about palliative care held between nurses' and primary care providers. The researcher intends to explore the following research questions: (1) Are differences prominent between nurses' and patients' perceptions of palliative care? (2) What factors influence perceptions about palliative care among nurses, patients' and doctors? (3) What role do doctors' preferences have in palliative care treatments offered patients? and, (4) What criteria are used to determine patients' choices and involvement in palliative care decision-making in a hospital or other long-term care environment?

Background to Study

Studies suggest despite the importance of patient and familial input in treatment decisions, relatively little research has been conducted investigating the role families and patients have in healthcare decision-making (Coulton, 1990). Still other studies confirm that nurses views on palliative care often differ significantly from views offered and preferences stated by doctors or other primary care providers (Carmel, Werner & Ziedenberg, 2004).

Significance of the Study

Carmel, Werner & Ziedenberg (2004) are among a growing body of researchers that note often decisions about palliative care rest in the hands of doctors or other primary healthcare providers, rather than on the perceptions of patients or other care providers including social workers and nurses. This suggests a need for further exploration into palliative care (Carmel, Werner & Ziedenberg, 2004) including the need to ascertain whether assessment should also include patient and family preferences as a more significant component.

The introduction of interdisciplinary healthcare teams into medicine has introduced the potential for such inclusion (Schoefield & Amodeo, 1999; Solomon et. al, 1993).

Literature Review

Overview of Palliative Care Studies

Many studies have explored nurses and patients perceptions of palliative and life-sustaining treatment decisions (Schoefield & Amodeo, 1999; Werner & Carmel, 2001; Carmel, Werner & Ziedenberg, 2004). Many decisions about palliative and life-sustaining care are made with regard to a patient's health status, age and desires (Carmel, Werner & Ziedenberg, 2004). Helpful in assessing appropriate care is the use of palliative care teams or support care teams that work together to help decide the best course of action when treating patients; these teams may include the patient's physician, nurse, social worker and family members (Schofield & Amodeo, 1999; Carmel, Werner & Ziedenberg, 2004).

Carmel, Werner & Ziedenberg (2004) note that often decisions about palliative care are deferred to doctor's and nurses, and relate to their preferences more so than that of the patient, especially in cases of elderly patients or patients with poor health prognosis. Solomon et. al (1993) conducted a study involving over 600 physicians and 700 nurses working in five hospitals, finding that significant differences existed between the needs for palliative care and preferences between doctors, nurses and even patients (Carmel, Werner & Ziedenberg, 2004). Most notably, there is evidence suggesting more attention need be paid on "prognoses or patients' preferences" instead of the attitudes and beliefs of the healthcare providers involved in care (Carmel, Werner & Ziedenberg, 2004, p. 27).

Still other studies suggest that to involve patients more in palliative care decisions, social workers must become more involved, encouraging patients to work closer with teams of nurses and their families so proper decisions can be made about palliative treatment taking into consideration patients' needs, wishes and desires (Csikai, 1999; Coulton, 1990).

Method

Theoretical Framework

Carmel, Werner & Ziedenberg (2004) provide the framework for conducting this study, suggesting a model developed by Carmel & Multran (1997) ideal for assessing the conceptual wishes for palliative care treatment among nurses', patients and doctors. This model involves direct exploration of attitudes among health professionals and patients, suggesting attitudes are affected by many factors including: "professional self-esteem, socio-demographic characteristics, experience, fear and religion" to name a few factors (Carmel, Werner & Ziedenberg, 2004, p. 27).

Participants

This study will include a sample of 100 registered nurses working at two large medical centers including nurses working in intensive care and long-term care facilities. The study will also include a sample of 100 patients in the same settings. All participants will range in age from 40-80, and will include a random selection of male and female patients and caregivers.

Design, Setting, Instruments

Patients will be provided a questionnaire to fill out that assesses their attitudes, beliefs and feelings about the care provided to them in the past, and the care they expect from their healthcare providers. Nurses will be provided a 10 question questionnaire that will include a discussion of their roles, their attitudes and beliefs about palliative care and their involvement in palliative care decision-making processes. Nurses will also be asked to describe the level of interaction they have with patients and the education they offer patients about the palliative care treatment options available to them. Questionnaires will be scored using a Likert-type 5-point scale (Carmel, Werner & Ziedenberg, 2004) with higher numbered answers suggesting a stronger agreement with statements and lower scored questions indicating disagreement with questionnaire statements. This will provide the opportunity to conduct statistical analysis of answers and provide both internal consistency and validity (Carmel, Werner & Ziedenberg, 2004).

Ethical Implications

Patient and healthcare privacy must be protected to adhere to basic ethical and moral standards one would expect when conducting a study that includes acquisition of personal information. For purposes of this study, to protect the identities of patients and nurses or other healthcare participants, each individual participating in the study will be provided a full disclosure of the study's purpose, intent and results. Patients will be asked to provide demographic and socioeconomic information, but will not be required to provide individual identifying information such as their name, address or other personal information. Nurses will be asked to provide information about their work history and experience, but will also have the ability to answer questions anonymously so their identities are protected.