“The actual level of palliative reasoning of nurses, in daily nursing care, a quantitative study”

Abstract

English abstract Title: The actual level of palliative reasoning of nurses, in daily nursing care, a quantitative study. Background: Nurses, although not feeling fully competent, have an important role in palliative care. Research has shown that the existing guidelines for palliative care are not sufficiently attuned to their expertise and training. Therefore, the method of palliative reasoning was developed. The method pays attention to four dimensions of suffering: physical, emotional, social and existential. A training, called Decision-making in the palliative phase, was developed to instruct nurses in palliative reasoning. Research question and aim: To what extent is the nurses opinion about their ability to apply palliative reasoning in accordance with the actual level of palliative reasoning? To determine the effect training has on the level of palliative reasoning and to point out ways in which the training can be improved. Method: An explorative observational cross-sectional design. The study took place in two hospices in the Netherlands from January to April 2013. Data of the actual level of palliative reasoning and the nurse opinion were prospectively (interdisciplinary consultation, nurses) and retrospectively (client records) collected with the aid of two measurement instruments and a questionnaire. Results: 16 nurses participated. Six interdisciplinary consultations were examined and 35 client records were analyzed. The actual level of palliative reasoning and the opinions of nurses correspond reasonably well. The focus of nurses was in particular on the physical, emotional and spiritual dimension. The social dimension received less attention. Nurses indicated that they experienced problems in the application of the method. Conclusion: The questionnaire gives a good picture of the actual level of palliative reasoning. The questionnaire cannot be used to determine the problems nurses experienced in the application of the method in daily nursing care. Recommendations: Further research is needed to examine the problems nurses experiences in applying the method in daily nursing care. Keywords: Palliative care, palliative reasoning, quality of care, nursing care.