Skip to main content
Top
Published in: BMC Palliative Care 1/2018

Open Access 01-12-2018 | Research article

Striving for a balance between leading and following the patient and family – nurses’ strategies to facilitate the transition from life-prolonging care to palliative care: an interview study

Authors: Ulrika Hilding, Renée Allvin, Karin Blomberg

Published in: BMC Palliative Care | Issue 1/2018

Login to get access

Abstract

Background

The transition from life-prolonging to palliative care (PC) can be challenging often characterized by psychical, physiological, social and existential changes. Knowledge of how to support the patient and family in this specific care phase is lacking, and this area needs to be further explored. The aim of this study was to investigate strategies that registered nurses (RNs) use to ease the transition from life-prolonging care to PC for patients with incurable disease.

Methods

The study has a descriptive design. Fourteen RNs working in a specialized PC unit were interviewed. The data were analysed using content analysis.

Results

The RNs’ strategies can be described under the categories “Getting to know the patient and creating a relationship”, “Providing support”, “Adapting to individuals’ needs” and “Enabling conversations”.

Conclusion

The findings show that the RNs in this population used strategies that not only took time but also required knowledge about the transition process and required the ability to identify and meet patients’ and families’ unique needs. Patients’ difficult and exposed situation needs to be addressed through a structured follow-up after informing about the change from life-prolonging care to PC. RNs have a unique role of supporting both the patient and the family in the transition from life-prolonging care to PC for patients with incurable disease.
Literature
1.
go back to reference Lundquist G, Rasmussen BH, Axelsson B. Information of imminent death or not: does it make a difference? J Clin Oncol. 2011;29:3927–31.CrossRefPubMed Lundquist G, Rasmussen BH, Axelsson B. Information of imminent death or not: does it make a difference? J Clin Oncol. 2011;29:3927–31.CrossRefPubMed
2.
go back to reference Boston P, Bruce A, Schreiber R. Existential suffering in the palliative care setting: an integrated literature review. J Pain & Symp Manag. 2011;41:604–18.CrossRef Boston P, Bruce A, Schreiber R. Existential suffering in the palliative care setting: an integrated literature review. J Pain & Symp Manag. 2011;41:604–18.CrossRef
3.
go back to reference Carlander IDA, Ternestedt B-M, Sahlberg-Blom EVA, Hellström I, Sandberg J. Four aspects of self-image close to death at home. Int J Qual Stud Health & Well-Being. 2011;6:1–14.CrossRef Carlander IDA, Ternestedt B-M, Sahlberg-Blom EVA, Hellström I, Sandberg J. Four aspects of self-image close to death at home. Int J Qual Stud Health & Well-Being. 2011;6:1–14.CrossRef
4.
go back to reference Ek K, Sahlberg-Blom E, Andershed B, Ternestedt B-M. Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease. J Adv Nurs. 2011;67:1480–90.CrossRefPubMed Ek K, Sahlberg-Blom E, Andershed B, Ternestedt B-M. Struggling to retain living space: patients' stories about living with advanced chronic obstructive pulmonary disease. J Adv Nurs. 2011;67:1480–90.CrossRefPubMed
5.
go back to reference Van Lancker A, Velghe A, Van Hecke A, Verbrugghe M, Van Den Noortgate N, Grypdonck M, Verhaeghe S, Bekkering G, Beeckman D. Prevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis. J Pain Symp Manag. 2014;47:90–104.CrossRef Van Lancker A, Velghe A, Van Hecke A, Verbrugghe M, Van Den Noortgate N, Grypdonck M, Verhaeghe S, Bekkering G, Beeckman D. Prevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis. J Pain Symp Manag. 2014;47:90–104.CrossRef
6.
go back to reference Ellingsen S, Roxberg A, Kristoffersen K, Rosland JH, Alvsvag H. Being in transit and in transition: the experience of time at the place, when living with severe incurable disease--a phenomenological study. Scand J Caring Sci. 2014;28(3):458–68.CrossRefPubMed Ellingsen S, Roxberg A, Kristoffersen K, Rosland JH, Alvsvag H. Being in transit and in transition: the experience of time at the place, when living with severe incurable disease--a phenomenological study. Scand J Caring Sci. 2014;28(3):458–68.CrossRefPubMed
7.
go back to reference Janze A, Henriksson A. Preparing for palliative caregiving as a transition in the awareness of death: family carer experiences. Int J Palliat Nurs. 2014;20:494–501.CrossRefPubMed Janze A, Henriksson A. Preparing for palliative caregiving as a transition in the awareness of death: family carer experiences. Int J Palliat Nurs. 2014;20:494–501.CrossRefPubMed
8.
go back to reference Lewis K. How nurses can help ease patient transitions to end of life care. Nurs Older people. 2013;25(8):22–6.CrossRefPubMed Lewis K. How nurses can help ease patient transitions to end of life care. Nurs Older people. 2013;25(8):22–6.CrossRefPubMed
9.
go back to reference Marsella A. Exploring the literature surrounding the transition into palliative care: a scoping review. Int J Palliat Nurs. 2009;15:186–9.CrossRefPubMed Marsella A. Exploring the literature surrounding the transition into palliative care: a scoping review. Int J Palliat Nurs. 2009;15:186–9.CrossRefPubMed
10.
go back to reference Kirby E, Broom A, Good P, Wootton J, Adams J. Families and the transition to specialist palliative care. Mortality. 2014;19(4):323–41.CrossRef Kirby E, Broom A, Good P, Wootton J, Adams J. Families and the transition to specialist palliative care. Mortality. 2014;19(4):323–41.CrossRef
12.
go back to reference Swedish National Board of Health and Welfare. National knowledge support for good palliative end-of-life care: guidance, recommendations and indicators, Support for control and management. Västerås: Edita Västra Aros; 2013. Swedish National Board of Health and Welfare. National knowledge support for good palliative end-of-life care: guidance, recommendations and indicators, Support for control and management. Västerås: Edita Västra Aros; 2013.
13.
14.
go back to reference Griffiths J, Ewing G, Wilson C, Connolly M, Grande G. Breaking bad news about transitions to dying: a qualitative exploration of the role of the district nurse. Palliat Med. 2015;29:138–46.CrossRefPubMed Griffiths J, Ewing G, Wilson C, Connolly M, Grande G. Breaking bad news about transitions to dying: a qualitative exploration of the role of the district nurse. Palliat Med. 2015;29:138–46.CrossRefPubMed
15.
go back to reference Polit D, Beck C. Nursing research: generating and assessing evidence for nursing practice. Philadelphia: Lipincott Williams & Wilkins. 2012; Polit D, Beck C. Nursing research: generating and assessing evidence for nursing practice. Philadelphia: Lipincott Williams & Wilkins. 2012;
16.
go back to reference Kvale S, Brinkmann S. InterViews: learning the craft of qualitative research interviewing. Los Angeles: Sage Publications; 2009. Kvale S, Brinkmann S. InterViews: learning the craft of qualitative research interviewing. Los Angeles: Sage Publications; 2009.
17.
go back to reference Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24:105–12.CrossRefPubMed Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24:105–12.CrossRefPubMed
18.
19.
go back to reference Reinke LF, Shannon SE, Engelberg RA, Young JP, Curtis JR. Supporting hope and prognostic information: nurses' perspectives on their role when patients have life-limiting prognoses. J Pain Symptom Manag. 2010;39:982–92.CrossRef Reinke LF, Shannon SE, Engelberg RA, Young JP, Curtis JR. Supporting hope and prognostic information: nurses' perspectives on their role when patients have life-limiting prognoses. J Pain Symptom Manag. 2010;39:982–92.CrossRef
20.
go back to reference Stajduhar KI, Thorne SE, McGuinness L, Kim-Sing C. Patient perceptions of helpful communication in the context of advanced cancer. J Clin Nurs. 2010;19:2039–47.CrossRefPubMed Stajduhar KI, Thorne SE, McGuinness L, Kim-Sing C. Patient perceptions of helpful communication in the context of advanced cancer. J Clin Nurs. 2010;19:2039–47.CrossRefPubMed
21.
go back to reference Benzein E, Norberg A, Saveman BI. The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliat Med. 2001;5:117–26.CrossRef Benzein E, Norberg A, Saveman BI. The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliat Med. 2001;5:117–26.CrossRef
22.
go back to reference Benzein E, Saveman BI. One step towards the understanding of hope: a concept analysis. Int J Nurs Stud. 1998;35:322–9.CrossRefPubMed Benzein E, Saveman BI. One step towards the understanding of hope: a concept analysis. Int J Nurs Stud. 1998;35:322–9.CrossRefPubMed
23.
go back to reference Davis MP, Lagman R, Parala A, Patel C, Sanford T, Fielding F, Brumbaugh A, Gross J, Rao A, Majeed S, et al. Hope, symptoms, and palliative care. Am J Hosp & Palliat Med. 2017;34:223–32.CrossRef Davis MP, Lagman R, Parala A, Patel C, Sanford T, Fielding F, Brumbaugh A, Gross J, Rao A, Majeed S, et al. Hope, symptoms, and palliative care. Am J Hosp & Palliat Med. 2017;34:223–32.CrossRef
24.
go back to reference Nierop-van Baalen C, Grypdonck M, Hecke A, Verhaeghe S. Hope dies last ... A qualitative study into the meaning of hope for people with cancer in the palliative phase. Eur J Canc Care. 2016;25:570–9.CrossRef Nierop-van Baalen C, Grypdonck M, Hecke A, Verhaeghe S. Hope dies last ... A qualitative study into the meaning of hope for people with cancer in the palliative phase. Eur J Canc Care. 2016;25:570–9.CrossRef
25.
go back to reference Ellingsen S, Roxberg A, Kristoffersen K, Rosland JH, Alvsvag H. The pendulum time of life: the experience of time, when living with severe incurable disease--a phenomenological and philosophical study. Med Health Care Philos. 2015;18:203–15.CrossRefPubMed Ellingsen S, Roxberg A, Kristoffersen K, Rosland JH, Alvsvag H. The pendulum time of life: the experience of time, when living with severe incurable disease--a phenomenological and philosophical study. Med Health Care Philos. 2015;18:203–15.CrossRefPubMed
26.
go back to reference Bloomer M, Tan H, Lee S. End of life care--the importance of advance care planning. Aust Fam Physician. 2010;39:734–7.PubMed Bloomer M, Tan H, Lee S. End of life care--the importance of advance care planning. Aust Fam Physician. 2010;39:734–7.PubMed
27.
go back to reference Krawczyk M, Gallagher R. Communicating prognostic uncertainty in potential end-of-life contexts: experiences of family members. BMC Palliat Care. 2016;15:59.CrossRefPubMedPubMedCentral Krawczyk M, Gallagher R. Communicating prognostic uncertainty in potential end-of-life contexts: experiences of family members. BMC Palliat Care. 2016;15:59.CrossRefPubMedPubMedCentral
28.
go back to reference Lundberg T, Olsson M, Furst CJ. The perspectives of bereaved family members on their experiences of support in palliative care. Int J Palliat Nurs. 2013;19:282–8.CrossRefPubMed Lundberg T, Olsson M, Furst CJ. The perspectives of bereaved family members on their experiences of support in palliative care. Int J Palliat Nurs. 2013;19:282–8.CrossRefPubMed
Metadata
Title
Striving for a balance between leading and following the patient and family – nurses’ strategies to facilitate the transition from life-prolonging care to palliative care: an interview study
Authors
Ulrika Hilding
Renée Allvin
Karin Blomberg
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2018
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-018-0311-7

Other articles of this Issue 1/2018

BMC Palliative Care 1/2018 Go to the issue