Nursing

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24

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Relational ethics in palliative care research: Including a person-centred approach
(SAGE, 2019-12-19) Haraldsdottir, Erna; Lloyd, Anna; Dewing, Jan
The traditional approach to research ethics is to ensure that all ethical issues are adhered to through the scrutiny of research proposals by research ethics committees, themselves sitting within national research governance frameworks. The current approach implies that all potential ethical issues can be considered and mitigated prior to the research. This article is a perspective piece whereby we consider how this approach, on its own, is not enough to ensure ethical practice. We draw attention to the limitations of current ethical procedures in the inherent detachment between the researcher and research participants. We argue that applying a person-centred approach to research ethics allows for contextual and situational factors and places the relationship between research participants and researcher as central.
Barriers and facilitators perceived by registered nurses to providing person-centred care at the end of life. A scoping review
(FoNS, 2019-11-13) Carvajal, Ana; Haraldsdottir, Erna; Kroll, Thilo; McCormack, Brendan; Errasti-Ibarrondo, Begona; Larkin, Philip
Background: Registered nurses are increasingly expected to provide person-centred end-of-life care. However, there is a gap between patients’ needs and the capacity of nurses to meet the existing recommendations on provision of this care. Identifying the relevant barriers and facilitators can inform the development of strategies to support person-centred nursing.
The value of poetry therapy for people in palliative and end of life care
(Taylor & Francis, 2019-11-08) Gilmour, Fiona; Riccobono, Rossella; Haraldsdottir, Erna
Background: People in palliative and end of life care often experience issues relating to feelings of loneliness and feeling unable to connect with and express their emptions. This can lead to poorer outcomes for people, and inhibits person-centred experiences.
Mind the gap: Patients’ experiences and perceptions of goal setting in palliative care
(Taylor & Francis, 2019-10-13) Boa, Sally; Duncan, Edward; Haraldsdottir, Erna; Wyke, Sally
Background: Palliative care aims to support people to live as actively as possible until death. A rehabilitative approach which includes goal setting could be an important way of achieving this. Goal setting is well established in best practice guidelines for palliative care. However little is known about how the process of goal setting actually happens in practice, especially from patients’ points of view. We aimed to investigate patients’ expectations, experience and perceptions of goal setting in one hospice.
A systematic review examining nutrition support interventions in patients with incurable cancer
(Springer Berlin Heidelberg, 2019-07-29) Blackwood, Honor A.; Hall, Charlie C.; Balstad, Trude R.; Solheim, Tora S.; Fallon, Marie T.; Haraldsdottir, Erna; Laird, Barry J.
Purpose: Recent guidelines by the European Society for Clinical Nutrition and Metabolism (ESPEN) have advocated increased attention to nutritional support in all patients with cancer: however, little is known about the optimal type of nutritional intervention. The aim of this review was to assess the current evidence for nutrition support in patients with incurable cancer. Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. EMBASE, Medline and CINAHL were searched from 1990-2018. Evidence was appraised using a modified risk of bias table, based on guidance from the Cochrane Handbook for Systematic Reviews of Interventions. Results: Sixty studies were assessed of which twelve met the eligibility criteria. Eleven studies examined body composition, with six studies reporting improvements in weight. Six studies examined nutritional status with three studies reporting an improvement. Nine studies examined nutritional intake with six showing improvements including significant improvements in dietary and protein intake. Ten studies examined quality of life, with six studies reporting improvements following intervention. The most common nutritional interventions examined were nutrition counselling and dietary supplementation. Conclusions: There is moderate quality evidence to support the need for increased attention to nutrition support in patients with incurable cancer; however, despite some statistically significant results being reported the clinical effects of them were small. Key questions remain as to the optimal timing for these interventions to be implemented (e.g. cachexia stage, illness stage, timing with anticancer therapy) and the most appropriate endpoint measures.
Stories from people living with frailty
(Cambridge University Press, 2019-08-09) Lloyd, Anna; Haraldsdottir, Erna; Kendall, Marilyn; Murray, Scott A.; McCormack, Brendan
We describe the findings of a qualitative longitudinal interview study of a group of initially community dwelling frail older people, their informal and formal carers. We used a narrative approach to explore the role that narrative may have for people living with frailty. This has been less explored comparative to the experiences of those living with chronic illness. The frail older people told stories of their experiences that revealed three distinct shapes or typologies. These were either stable, unbalancing or overwhelmed and related to how the person managed to adapt to increasing challenges and losses and to reintegrate their sense of self into a cohesive narrative. Each is illustrated by an individual case story. Frailty is described as both biographically anticipated yet potentially biographically disruptive as older people may struggle to make sense of their circumstances without a clear single causative factor. Findings are discussed in relation to biographical disruption and reconstruction in chronic illness and the rhetoric around ‘successful ageing’. We conclude by drawing attention to the complex individual and social factors that contribute to the experience of living with frailty in later life.
A randomised, phase II, unblinded trial of an Exercise and Nutrition-based Rehabilitation programme (ENeRgy) versus standard care in patients with cancer: Feasibility trial protocol
(BioMed Central, 2018-12-27) Hall, Charlie C.; Norris, Lucy; Dixon, Liz; Cook, Jane; Maddocks, Matthew; Graham, Catriona; Tuck, Sharon; Haraldsdottir, Erna; Brown, Duncan; Lloyd, Anna; Finucane, Anne; Hall, Peter; Diernberger, Katharina; Skipworth, Richard J. E.; Fallon, Marie T.; Laird, Barry J.
Patients are living longer with incurable cancer [1] such that in many cases, cancer is likened to a chronic disease [2, 3, 4]. This development has wide-ranging implications for both patients and wider society, with increased longevity comes increased morbidity and associated socio-economic burden [5, 6]. Primary cost drivers for patients with advanced cancer are hospitalisation, GP and domiciliary visits [7]. Rehabilitation has been advocated as one such way of optimising the function and quality of life in this group of patients [8]; however, the optimal components of a rehabilitation model for patients with incurable cancer remain to be elucidated...
Chronic pelvic pain in women: an embedded qualitative study to evaluate the perceived benefits of the meridian balance method electro-acupuncture treatment, health consultation and National Health Service standard care
(Sage Publications, 2018-11-21) Chong, Ooi Thye; Critchley, Hilary O. D.; Horne, Andrew W.; Fallon, Marie T.; Haraldsdottir, Erna
Introduction: Chronic pelvic pain (CPP) – defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy – is estimated to affect 6–27% of women worldwide. In the United Kingdom, over 1 million women suffer from CPP, which has been highlighted as a key area of unmet need. Current medical treatments for CPP are often associated with unacceptable side effects. A specific style of acupuncture, the meridian balance method electro-acupuncture (BMEA) and traditional Chinese medicine health consultation (TCM HC (BMEA + TCM HC = BMEA treatment)), may be effective for CPP in women. Aim: Three focus group discussions and semi-structured telephone interviews were embedded in a randomised controlled feasibility trial to gain in-depth description of the perceived benefits of the participants’ respective interventions. Methods: Women with CPP were randomised into the BMEA treatment, TCM HC or National Health Service standard care (NHS SC). Focus group discussions were recorded, transcribed and analysed thematically. Semi-structured telephone interviews were conducted post focus group discussions. Findings: A total of 30 women were randomised into BMEA treatment, TCM HC or NHS SC. A total of 11 participants attended the three focus group discussions. Thematic analysis of focus group discussions showed: a perceived pain reduction, enhanced sleep, energy level and sense of well-being in the BMEA treatment and TCM HC groups; a dislike for the adverse effects of medications, frustration at the lack of effective treatment, heavy reliance on medications and services that are helpful, in the NHS SC group. Semi-structured telephone interviews showed that the methodology was acceptable to the participants. Conclusion: The embedded focus group discussions captured the rich and complex narratives of the participants and provided insights into the perceived benefits of the BMEA treatment, TCM HC and NHS SC interventions.
The impact of implementing an educational intervention to enhance a family-oriented approach in specialised palliative home care: A quasi-experimental study
(Wiley, 2018-11-29) Petursdottir, Asta B.; Haraldsdottir, Erna; Svavarsdottir, Erla Kolbrun
Rationale Healthcare providers’ beliefs, attitudes, experiences and knowledge, which guide the care they deliver, are the key factors influencing the quality of palliative care. Education and coaching innovation are needed to translate research outcomes and adopt evidence‐based nursing care into practice. Objectives To evaluate the impact of an advanced educational and coaching programme in a family systems’ nursing approach for palliative care nurses in a home‐care setting. Methods A quasi‐experimental study using qualitative data from open‐ended questions to augment the quantitative outcome study that included a single‐group, pre‐ and post‐test design. A total population sample of nurses was recruited from a specialised palliative home care unit at a university hospital. The study utilised two self‐reported questionnaires. Results There was a statistically significant increase in the nurses’ critical appraisal of clinical nursing practice related to family nursing after participation in the educational programme than before. No statistical difference was found in items related to nurses’ experience of the interaction and reciprocity in the nurse–family relationship after participation in the programme than compared to before or in nurses’ cancer‐related beliefs. However, there was an overall significant positive change found in attitudes towards families in the total score of the Family Practice Scale. Nurses were also more positive about the further development of their knowledge and skills in advanced family nursing evident in the qualitative data. Conclusion An advanced educational intervention programme was successful in improving the nurses’ knowledge, skills, satisfaction and confidence in relation to applied family nursing approach within the context of caring for families affected by advanced/final stage cancer. However, further refinement of the implementation process is needed to enhance family care improvement and the nurses’ professional development in advanced family nursing in specialised palliative care.
Person centred culture in a hospice: myth or reality? (Poster presentation)
(BMJ Publishing Group Limited, 2018-03-01) Haraldsdottir, Erna; Donaldson, Kim; Barclay, Irene; Lloyd, Anna; McCormack, Brendan
Background: Person centred care is inherently integrated into palliative care as one of its cornerstones. Having developed from a pioneering grass route movement to an established organisational structure the culture of palliative care has become increasingly influenced by routine and the need for standardised practice. This has challenged the capacity to foster creative, flexible and dynamic approaches to care that put the person at the centre. McCormack and McCance’s Person Centred Practice Framework (2017) is a theoretical framework that addresses such limitations. Using this framework as an underpinning theory in our research we aimed to assess and develop a person centred culture in a hospice.

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