Patient-Centered Care: The Lived Experiences of Nurses

Providing Hospice Care

Rita Ferguson, PhD, RN, CHPN, CNECollege of Nursing

The University of Alabama in HuntsvilleHuntsville, AL 35899

Patient-Centered Care• Definition: Recognize the patient or designee

as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Taylor Sullivan, D., Warren, J.(2007). Quality and safety education for nurses, Nursing Outlook, 55, 122-131.DOI: http://dx.doi.org/10.1016/j.outlook.2007.02.006

Hospice Care

• Hospice nurses “promote quality of life for patients and families facing serious illness by combining the science and the art of professional nursing care” (Hospice and Palliative Nurses Association, 2011).

• Hospice nurses manage symptoms, support patient and family emotions needs, work as part of an interprofessional team, and provide indicated nursing care (Thornburg, Schim, Paige, & Grubaugh, 2008).

• Knowing about the person can enhance caring and improve the personal concerns of “dignity and quality” as defined by the patient and family (City & Labyak, 2010, p. 26).

Palliative Care Model

Background

• Work of nursing is to provide for others (Lazenby, 2013)

• Complexity is inherent in addressing the individual’s concerns and needs (Valente, 2011)

• Roles of nurses include being the patient advocate (City & Labyak, 2010)

Background

• Critical element of caring is knowing (Mayeroff, 1971)

• The caring characteristics of regard, empathy, and reassurance connect knowing by the nurse to the patient (Kelley, Docherty, & Brandon, 2013)

Review of Literature

• Nurses knowing the patient included topics relating to care, connection, and proficient practice (Zolnierek, 2014)

• Knowing the patient is characteristic of expert nurses (Radwin, 1996)

• Knowing the patient described as a reasoning and relational process (Jenny & Logan, 1992)

Purpose of the Study

Through the use of a descriptive phenomenological method, common meanings embedded in the experiences of nurses working in hospice agencies will be revealed and offer insight about the specialty of hospice nursing.

Research Question

What are the experiences of nurses working in hospice agencies in knowing about and caring

for persons receiving hospice care?

Methodology

• Design: Descriptive phenomenology

• Setting:– Individual face-to-face interviews–Multiple hospice organizations

Methodology

• Participants• Purposive sampling• < 2 years experience working in a hospice agency: 2

nurses• > 2 years but < 5 years: 4 nurses• > 5 years but < 10 years: 3 nurses• > 10 years experience in a hospice agency: 5 nurses• 14 registered nurses working in hospice

Demographic Information

•14 Registered Nurses •Time as a registered nurse: mean of 17 years•Average age: 48.5 years•Nursing education•7 currently certified in hospice and palliative

nursing•Years employed at current hospice agency:

mean 8 years

Conceptual Framework

• Boykin and Schoenhofer’s (2001) nursing as caring theory

• Liaschenko and Fisher (1999) typology of knowledge• Case knowledge• Patient knowledge• Person knowledge• Social knowledge

Theme• “SAVE THE LAST DANCE FOR ME”– connection– gift of presence– “if we listen, we can learn so much”

“Save the last dance for me”• Connection

Save the last dance for me• Gift of presence

Save the last dance for me• “if we listen, we can

learn so much”

SYNTHESIS STATEMENT

Implications and Recommendations for Nursing Education

• End-of-life care in curriculum

• Clinical management of individuals with life-limiting illness

• Inclusion of all ways of knowing

Implications and Recommendations for Nursing Practice

• Identify nurses’ educational needs

• Self-care strategies

• Experience

SIGNIFICANCE

OF THE

STUDY

Questions

Thank you-

References available

upon request via electronic mail

Acknowledgments

• Dr. Susan S. Gunby– Dissertation Committee Chair– Georgia Baptist College of Nursing, Mercer University

• Dr. Tanya Sudia – Dissertation Committee Member– Baylor University

• Dr. Susan C. McMillan– Dissertation Committee Member, External– University of South Florida

References

Boykin, A., & Schoenhofer, S. O. (2001). Nursing as caring: A model for transforming practice. Boston, MA: Jones and Bartlett.

City, K. A. E., & Labyak, M. J. (2010). Hospice palliative care for the 21st century: A model for quality end-of-life care. In B. R. Ferrell & N. Coyle (Eds.), Oxford textbook of palliative nursing (3rd ed., pp. 13-52). New York, NY: Oxford University Press.

Hospice and Palliative Nurses Position Statement. (2011). Value of the professional nurse in palliative care. Retrieved from http://www.hpna.org/DisplayPage.aspx?Title=PositionStatements

Kelley, T., Docherty, S., & Brandon, D. (2013). Information needed to support knowing the patient. Advances in Nursing Science, 36, 351-363. doi:10.1097/ANS.0000000000000006

Liashenko, J., & Fisher, A. (1999). Theorizing the knowledge that nurses use in the conduct of their work. Scholarly Inquiry for Nursing Practice: An International Journal, 13, 29-41. Retrieved from http://www.questia.com/library/1P3-1472208091/theorizing-the-knowledge-that-nurses-use-in-the-conduct

Mayeroff, M. (1971). On caring. New York, NY: Harper Perennial.

References (continued)Radwin, L. E. (1996). ‘Knowing the patient’: A review of research on an emerging concept.

Journal of Advanced Nursing, 23, 1142-1146. doi:10.1046/j.1365-2648.1996.12910.x

Rittman, M., Paige, P., Rivera, J., Sutphin, L., & Godown, I. (1997). Phenomenological study of nurses caring for dying patients. Cancer Nursing, 20, 115-119. Retrieved from http://journals.lww.com/cancernursingonline/Abstract/1997/04000/Phenomenological_study_of_nurses_caring_for_dying.6.aspx

Zolnirerek, C. D. (2014). An integrative review of knowing the patient. Journal of Nursing Scholarship, 46, 3-10. doi:10.1111/jnu.12049

Data Analysis

• Giorgi’s method

• First and second cycle coding methods as delineated by Saldaña

• Themes and subthemes are identified

• Synthesis and integration

Trustworthiness/Rigor Criteria

• Credibility• Dependability• Confirmability• Transferability (Lincoln & Guba, 1985)

• A DIFFERENT KIND– “not just little clinical

skills”– you are a nurse– “all about the care of a

person”– team approach

• KNOWING– learning about– knowing the case– knowing the patient– knowing the person– knowing the family– experience matters

• “IT’S A CALLING”– “the guide on the

journey”– rewarding– “this is where I

belong”

• “SAVE THE LAST DANCE FOR ME”– connection– gift of presence– “if we listen, we can

learn so much”

Phenomena of Knowing and Caring

• Visibility

• Outcomes

• Voice

“Save the last dance for me”

Inclusion Criteria

• Registered nurse• Currently working full time• Completed orientation to hospice agency• Minimum of 6 months work as hospice nurse• Speak and understand English

Data Collection

• Demographic information

• Semi-structured interview

• Audio recorded