Bringing comfort and care to end-of-life
18 July 2012
When most of us think of palliative care, we think of people with an illness, such as terminal cancer and the work that nurses and other health care providers do in a hospital, home, or hospice setting to ensure an individual is comfortable, as pain-free as possible, and surrounded by loved ones in his or her final days.
However, a recent study by the Canadian Institute for Health Information found that 70 percent of British Columbians who die are not identified as people who could benefit from services associated with palliative care.
Dr. Kelli Stajduhar and her research colleagues want to change that. Their program, Initiative for a Palliative Approach in Nursing: Evidence and Leadership (iPANEL) is designed to look at what needs to happen from a policy, nursing practice and patient/family perspective to ensure that a palliative approach is integrated into every care setting.
“A palliative approach involves taking the principles of palliative care and moving them upstream so that nurses are better able to identify those patients with chronic life-limiting illnesses, such as chronic obstructive pulmonary disorder, heart failure or dementia who are at risk of dying in the next year,” said Stajduhar. “We want to equip nurses to work with these patients and their loved ones to ensure that patients have the opportunity to express their wishes for end-of-life care so that the quality of care is improved.”
Funded through MSFHR’s BC Nursing Research Initiative in December 2010, the four-year research program consists of several projects aimed at determining how and in which contexts a palliative approach can be integrated into the care of people with chronic life-limiting conditions. In the first 18 months, the team has been gathering data, and reviewing and synthesizing existing literature.
For example, iPANEL investigators Stajduhar and Dr. Gweneth Hartrick Doane have examined how nurses in acute and long term care incorporate evidence about end-of-life care into their day-to-day clinical practice. While the study results are still being analyzed, initial findings indicate that while nurses want to apply evidence to their practice, there are systemic barriers that make this process difficult.
Later this year, iPANEL will formally report on the results of a provincial survey of nursing care providers, led by iPANEL investigators Dr. Richard Sawatzky and Della Roberts, investigating nurses’ self-perceived competence in providing a palliative approach in various nursing care settings across the province; as well as on another project currently underway to better understand how the family empowerment is interpreted, enacted and experienced by home care nurses and how it is experienced by family caregivers, and how that differs between various care settings.