Enhancing palliative care in nursing practice

19 August 2015

Three quarters of British Columbians who die are not identified as people who could benefit from services associated with palliative care. iPANEL, a BC Nursing Research Initiative research project, is working to change that by studying how a palliative approach can be integrated into every care setting.

Two recently completed iPANEL research projects explored educational and knowledge-sharing techniques to support greater use of palliative care in nursing practice. Summary reports from these MSFHR-funded studies are now available for download.

One study, co-led by UBC Okanagan nursing associate professor Barbara Pesut and Selkirk College nursing instructor Gail Potter, investigated  how to best prepare nurses and health care assistants in rural areas to provide palliative care. In rural areas, health care practitioners are often called on to provide chronic illness palliative care as expert generalists without the benefit of specialized teams or resources. Supporting rural nurses to become confident and competent in palliative approaches is an important factor in ensuring the best care for people living with advanced chronic illnesses.

The research project aimed to use research evidence to develop, offer, and evaluate a palliative educational curriculum that meets the needs of rural nurses. This curriculum, developed by a rural nurse educator with expertise in palliative care, was successful in improving self-perceived knowledge and confidence in providing a palliative approach. Nurses and health care assistants who participated in the collaborative education reported an improved understanding of one another’s roles and enhanced communication with each other about care.

The research project also piloted an innovative clinical experience in which student nurses and health care assistants visited adults living in the home with advanced chronic life-limiting illness, and who were not currently receiving nursing services. The trial was successful and has the dual benefit of providing service to an under-served population while teaching students about relational practice and chronic disease management.

The second study was led by Trinity Western University nursing professor Richard Sawatzky and UBC adjunct nursing professor Patricia Porterfield. It sought to synthesize knowledge from the nursing literature about how palliative care can be integrated into practice. The study also aimed to apply these findings to the BC health context to inform care delivery for patients with life-limiting illnesses and their families.

In its synthesis of the existing literature, the study did not find any particular nursing care delivery model for a palliative approach. Rather, the researchers suggest, a palliative approach needs to be integrated at all levels – the system, the care delivery of each setting and the roles of providers.

Evidence from the literature synthesis also indicated that nurses feel a lack of training and experience in providing quality palliative care to patients with life-limiting conditions. A system with supportive management, clear communication, effective interdisciplinary team work, and appropriate clinical tools will greatly assist nurses to integrate a palliative approach into their practice.

The research project also included two integrated knowledge translation activities:  (i) engagement of stakeholders through a province-wide symposium and (ii) two pilot demonstration projects

iPANEL (which stands for Initiative for a Palliative Approach in Nursing: Evidence and Leadership) has been funded through MSFHR’s BC Nursing Research Initiative since 2010. The initiative consists of nurse researchers, practitioners, and administrators who share a common goal of advancing the further integration of a palliative approach into the health care system. The program of research is strongly practice-oriented, meant to inform, and be informed by clinical practice.