Introduction
In the entire world, the palliative care has become fundamental in relieving spiritual, mental, social and physical anguish in many people suffering from ailments (Catherine & Karen 2010). Numerous studies have looked at diverse ways that District Nurses effect on quality of life of their attendees. Such effects imply that compassionate care that embraces good communication and holistic approach is paramount right from the beginning of care giving. Notably, there are apparent lack of formal work based support availed to DNs that would help them to cope with emotional demands associated to this provision. Previously, then, needs to palliative address patients issues have long been known, but it is only recently that this area of abandoned distress has been acknowledged and addressed (Twycross, 2003). The aspects detailed in this work will be principally be detailing emotional challenge faced by DNs when providing palliative services to those patients who chose to die at home in the community. The purpose of this paper is to highlight why this is a pertinent issue and propose two options that could be implemented into practice in order to better protect the psychological well-being of the workforce.
Development of a peer support group and a share initiative on palliative care has recently been facilitated by many hospitals. According to Freer (2012) his move has benefited District Nurses (DNs) in different ways. Notably, there are several ways one can define the relationship of hospitals with the needs of the communities they serve, where the goal of hospice-hospital is creation of an integrated program that reflect a full spectrum of service for all its patients and their respective families from the time they are diagnosed with any chronic ailment and throughout the course of their illness. DNs may have inadequate information regarding the programs and services delivered in hospital. Freer (2012) note that accurate and up-to date information regarding relevant programs and services delivered in the hospital. Mallik et al. (2009) adds that accurate and up-to date information broadens the continuum of care and thus enhancing the ability of the district nurses in tailoring care plans that meets the needs of a patient and family. Mallik et al. (2009) argues that development of a deer support group is an instrumental bridge between hospital and district nurses palliative services. Nonetheless, every organization requires more depth information about district nurses. Every organization requires more depth in information about development of a deer support group. Notably, health care may have a narrow scope on palliative service delivery and experiences of DNs in this provision. Development of a peer support group attributes to expertise in: team care interdisciplinary management, bereavement support, facilitation of advanced care planning, end of life care and clinical services, as well as, voluntary training and integration.
Option B: Development of a supportive resource booklet
Development of a supportive resource booklet is intended for use as a tool by DNs. The purpose of the booklet is to identify key elements of peer programs for their palliative care programs to the communities. The resources in the resource booklet are helpful in offering guidance to the district nurses in their line of duty. Supportive resource booklet assists in holistic nursing care including; psychological care, education for recently diagnosed and relatively well patients and the purpose of this approach is to optimize the quality of life of a patient undergoing palliative care. Development of a supportive resource booklet in palliative care is based on the philosophy of an individual is greater than a physical being (McKinley et al. 2004). Development of a supportive resource booklet that has a unique interdependent system of attitudes, thoughts, emotions and spirituality which is a blend of mind, body and spirit is critical to boosting the spirit of district nurses.
Development of a supportive resource booklet, equips the DNs with skills on holistic management in palliative care, DNs seek to restore the patients’ sense of self and promote a sense of comfort and relaxation. As part of the strengthening the DNs, a supportive resource booklet could familiarize them on the variety of therapies available and benefits inherent in these therapies. DNs are then able to provide daily follow up on the patient while they are in their home (Freer, 2012).
Background
The need for high quality care delivery into the community including in patient’s home has risen in the contemporary times. Evidently the recent health policy aims at improving and extending services to meet the health needs of the ever increasing number of people in need of palliative care. Most of this people would have previously gotten the health care from hospital within the community setting (Jelle et al. 2013). Development of a peer support group is in itself an initiative that would help most people in this provision to cope with the stress that pertain this profession. Palliative service need to be responsive to people’s concerns and to ensure that care delivers positive experience and best outcomes.
Adoption of the person-centred approach of managing DNs emotional problems is helpful in solving the escalating emotional needs. The person-centred approach allows the DNs have great sense of flexibility, control over their condition management, choice, and design interventions for meeting their needs. Consequently, the DNs will be able to identify their roles, abilities, and establish relationships that will help them meet their emotional health needs (Debbie et al. 2007).
Whilst undertaking a clinical with a team of DNs, it became apparent through numerous conversations in the office that their intense involvement, with both palliative patients and their families, often had a significant impact on their emotional wellbeing and perceived ability to provide quality nursing care. Arguably, more care has come with development of a peer support group in the communities and people’s homes. This support groups involve long-term relationship to support people coupe with long-term conditions and co-morbidity.
Characteristically, DNs are key professionals in planning and providing this care. However within this practice setting no formal support structures had been put into in order to help the DN’s seal with these feelings which, if left unresolved could potentially lead to higher levels of stress and emotional exhaustion (Freer, 2012). Therefore as a proactive measure, it is important that these nurses are adequately supervised in order to ensure that they are able to cope with their emotions and thus provide their patients with high quality nursing care (Rebecca et al. 2012). Adopting strategies that improve mental, social, and emotional wellbeing of the district nurses will help eliminate the emotional challenges the experience. This entails development of peer support group and development of supportive as well as, coming up with well-structured institutions that facilitate district nurses recovery from challenging and stressful situations provision. Additionally, strategies such as supporting the development of stress management systems, developing social, emotional, and mental well-being programs for the DNs.
Proposal
Option A
The Aim of Option A is to assist DNs is to cope with the emotional demands of providing palliative care to patients.
Development of a peer support group is integration of services which is necessary in providing joined-up care for patients at best value (Sarah 2005). Peer support group can improve quality outcomes whilst improving efficiency through better utilization of resources. According to Sarah (2005) the care and support group is committed to an ambitious, clear and measurable goal to drive further the improvements in patients’ experience of integrated care. Development of a peer support group is aimed at advancing a methodology for capturing people’s experience on integrated care and forming development of suitable outcome measures (Anne 2007). DNs are increasingly required to come up with new ways of working within teams and with other healthcare agencies and professional to support confiscated care and management more efficiently (Mallik et al. 2009). A combination of development of a peer support group to support use of technology in palliative care and enhance mobile working has evidently been supported by DNs. Arguably, meeting significant others as a DNs in palliative care means creating and maintaining a trustful relationship with significant others. DNs benefit from confidence boosts and aim to respond to the needs and desires of their patients’ ones they are guided by their peers on emerging circumstances. The DNs strive to reach a mutual understanding and co-operate to mediate support. Mallik et al. (2009) noted that being DNs is a both demanding and emotionally rewards undertaking.
Option B Development of a supportive resource / booklet
Major aims of development of supportive resource/ booklet include:
Development of a supportive booklet/resource would help to come up with new ways of utilising technology within nursing. This booklet could be availed to all the serving DNs and to the new employees as part of the induction pack. Correspondingly, the book would discuss useful strategies such as reflection that would aid the district nurses in development f greater self-awareness and boost their ability to effectively manage their emotions (Nolan & Badger, 2002). The booklet would also aid the DNs to meet future health need set within the framework of compassion practice (Nolan & Badger, 2002). According to Mallik et al. (2009) emotional intelligence, recognizing and handling ones’ own and others’ emotions has comprehensively been figured in nursing literature, with prospective to boost care, teamwork, and wellbeing.
One of the advantages of development of supportive resource is that by engaging in reflective practice through examining and analysing events that have emotionally affected them, the nurses can gain better understanding of their feelings, and thus create more effective coping strategies for the future. The main purpose of supportive resources is to assist DNs meet the 6Cs or values of care, compassion, competence, communication, courage and commitment are at the heart of district nursing service delivery (Allison et al. 2001). The priority actions from ‘Compassion in Practice’ provide a basis for the ‘call to action’ and offer direction in determining the next steps to ensure implementation of this district nursing vision.
Use of supportive resource/booklet also has some setbacks. While as use of supportive resource is helpful in various perspectives, the booklets provided to the DNs may not contain everything needed to support he emotional and psychological problems the DNs may suffering from. Jane et al. (2012) notes that meeting the end of life care needs of residents encompasses taking into consideration their religious, cultural, and spiritual well being among other life circumstances. As such, it may be hard to use booklets to adhere to these considerations (Renée et al. 2008). Patients under palliative care require person-centred care and developmental support for them to maximise their livelihood. Person-centred care involves spiritual care, time, attention and listening to support individuals to find purpose and meaning of life
Conclusion
Palliative care has many challenges to district nurses most of which are psychological, spiritual and emotional. In most cases, DNs ideals are compromised by competing practice demands. Previous researches have indicated changing health systems and philosophical views, perceived visibility/invisibility polarity, and limited resources as major job stressors (Alison et al. 2006). Notably, therapeutic use of peer support groups and supportive resources among other interpersonal communication have been noted to contribute to job satisfaction. Numerous studies on how to better protect the psychological well-being of the DNs are in progress. As suggested in this paper, DNs play a pivotal role in provision of palliative care to those patients who choose to die in the community (Samar et al. 2013.). Evidently, this paper has highlighted how managers must recognise the emotional challenges inherent within this role and looks towards developing formal channels of support within the workplace to ensure that DNs well-being is promoted and protected. As suggested in this paper, this will not only reap benefits for the organization and the staff but also for the patients under palliative care. As such, developing strategies to enhance staff support within the practice setting should be seen as an essential factor in promoting both emotional well-being and high quality care.
References
Alison C, Sue Z, & Ann M. 2006. The specialist palliative care nurse: A qualitative study of the patients’ perspective Original Research Article. International Journal of Nursing Studies, Volume 43, Issue 8, Pages 1011-1022
Allison M., Michelle V., Maria M, Anne L, Noreen R, Arlete H, & John Y. 2001. An evaluation of contracted palliative care home care services in Ontario, Canada Original Research Article. Evaluation and Program Planning, Volume 24, Issue 1, Pages 23-31
Anne A. 2007. “Pain talk” in hospice and palliative care team meetings: ethnography Original Research Article. International Journal of Nursing Studies, Volume 44, Issue 6, Pages 916-926
Catherine W & Karen A. 2010. District nurses’ role in palliative care provision: A realist review Article. International Journal of Nursing Studies, Volume 47, Issue 9, September Pages 1167-1183
Debbie T, Jean M, Linda L & Paul C. 2007. Developing a managed clinical network in palliative care: a realistic evaluation Original Research Article. International Journal of Nursing Studies, Volume 44, Issue 2, Pages 183-195
Emanuel, L. & Librach, S. (2011). Palliative care core skills and clinical competencies. Philadelphia: Saunders.
Freer, M., 2012. "Involving carers makes a difference to outcomes for all." British Journal of Cardiac Nursing (BR J CARD NURS) 7(10): 500-501.
Jane L, Michael P, & Jane I. 2012. Continuing professional development programmes for rural nurses involved in palliative care delivery: An integrative review Original Research Article. Nurse Education Today, Volume 32, Issue 4, Pages 385-392
Jayln R & Nel G. 2009. An investigation of emotional wellbeing and its relationship to contemporary nursing practice Original Research Article. Collegian, Volume 16, Issue 4, Pages 185-192
Jelle van G, Jeroen H, Evert van L, Patrick H, Kris V, & Martine van S. 2013. Connecting with patients and instilling realism in an era of emerging communication possibilities: A review on palliative care communication heading to telecare practice Review Article. Patient Education and Counselling, Volume 93, Issue 3, Pages 504-514
Joanne M., Michelle D, Tim L, Patricia M. & Davidson, D. 2013. A Social Capital Framework for Palliative Care: Supporting Health and Well-Being for People with Life-Limiting Illness and Their Carers through Social Relations and Networks Original Research Article. Journal of Pain and Symptom Management, Volume 45, Issue 1, Pages 92-103
Julie B & Alison W. 2003. Decision-making in palliative and continuing care in the community: an analysis of the published literature with reference to the context of UK care provision Original Research Article. International Journal of Nursing Studies, Volume 40, Issue 8, Pages 881-888
Lugton, J. & McIntyre, R. (2005). Palliative care: the nursing role. Edinburgh: Elsevier/Churchill Livingstone.
M Lloyd-W & A Rashid. 2003. An analysis of calls to an out-of-hours palliative care advice line Original Research Article. Public Health, Vol. 117, Issue 2, Pg 125-127
Mallik, M., Hall, C. & Howard, D. 2009. Nursing knowledge and practice: foundations for decision making. Edinburgh New York: Elsevier.
Matzo, M. & Sherman, D. (2010). Palliative care nursing: quality care to the end of life. New York: Springer Pub. Co.
McKinley RK, Stokes T, Exley C, & Field D. 2004 Care of people dying with Cancer in general practice. Br J Gen Pract; 54: 909–13
Meier, D., Isaacs, S. & Hughes, R. (2010). Palliative care transforming the care of serious illness. San Francisco: Jossey-Bass.
Mitchell, G. (2008). Palliative care: a patient-cantered approach. Oxford New York: Radcliffe.
Nolan, P. & Badger, F. 2002. Promoting collaboration in primary mental health care. Cheltenham: Nelson Thornes.
Rebecca T., David C., Jane L., Tracy S, Miriam J., & Patricia M. 2012. Interventions to support a palliative care approach in patients with chronic obstructive pulmonary disease: An integrative review Article. International Journal of Nursing Studies, Vol 49, Issue 11, Pages 1443-1458
Renée M, Maggie C, & Finella C. 2008. Paediatric palliative care: Coming of age in oncology? Original Research Article. European Journal of Cancer, Volume 44, Issue 8, Pages 1139-1145
Samar M, David W, Linda J, & Shaouli S. 2013. Palliative care needs of terminally ill people living alone: A service provider perspective Original Research Article. Collegian, Volume 20, Issue 3, Pages 179-185
Sarah L (2005).Doing criticism in ‘symbiotic niceness’: a study of palliative care nurses’ talk Original Research Article. Social Science & Medicine, Volume 60, Issue 9, Pages 1949-1959
Twycross, R. (2003). Introducing palliative care. Abingdon, Oxon, U.K: Radcliffe Medical Press.
