Nurse Practitioner’s Palliative Care Interventions

Introduction

Consistent with the role of nurse practitioner (NP), the current literature review is devoted to NP interventions for palliative care (PC), in particular, the cocreation of possibilities (CP) as defined by Bergdahl, Benzein, Ternestedt, Elmberger, and Andershed (2013). The literature review includes the answers to the following questions.

  1. What is palliative care? Why is it important nowadays?
  2. What is the role of NPs in PC? What are the interventions of NPs in PC?
  3. What is CP? How does it contribute to nursing PC?

Through the search of the South University Library, it was concluded that the role of NPs in palliative care is a relatively underresearched area of study; a similar conclusion was made by Dyar, Lesperance, Shannon, Sloan, and Colon-Otero (2012) and Bergdahl et al. (2013). Besides, qualitative studies (primarily interview-based ones) appear to dominate the field, which was also pointed out by Bergdahl et al. (2013). These studies are most often devoted to the perceptions and ideas of the people involved, which is practically useful but has limited scholarly applicability. Still, the subject is being studied, and a few recent articles have been devoted to distinct NP-led PC programs and the role of NPs in PC for cancer, stroke, and advanced diseases patients. The present literature review is based primarily on these peer-reviewed articles and two recent scholarly nursing books.

Palliative Care and Nursing

According to WHO, palliative care (PC) is “an approach to care which improves the quality of life of patients and their families facing life-threatening illness through the prevention, assessment and treatment of pain and other physical, psychological and spiritual problems” (as cited in Coyle, 2015, p. 4). Coyle (2015) suggests that the significance of PC grows together with the increasing lifespan, which raises the occurrence of age-related issues, and the development of medical research and practice, which makes formerly lethal diseases incurable but treatable. PC is an interdisciplinary approach, and a PC team is likely to include a number of specialists from different fields of practice. However, as shown by Bookbinder et al., (2011), Coyle (2015), and Bergdahl et al. (2013), the role of NP in PC is distinct and needs to be specifically described.

Nurse Practitioner in Palliative Care

The specific role of NP consists in facilitating the work of the entire PC team and ensuring its contact with patients and families (Kaasalainen et al., 2014). Moreover, NP has the closest proximity to the patient, which defines the scope of the palliative practice of this specialist. From the works of Bergdahl et al. (2013), Coyle (2015), and Lukas, Foltz, and Paxton (2013), it can be concluded that NPs are capable of contributing to PC through pain and symptom management, health education, assistance planning and decision making, family integration, emotional support, spiritual growth, and many other aspects, all of which are aimed at preventing pain and sufferings and improving the quality of life (QoL) of the patient.

The central role of NPs in PC is also demonstrated by the effectiveness of their actions. The studies by Bookbinder et al. (2011) and Vahedi Nikbakht-Van de Sande, Braat, Visser, Delnoij, and van Staa (2014) provide direct quantitative and qualitative evidence to the fact that NPs are capable of improving the QoL of palliative patients.

As the PC practice develops, new interventions are suggested by NPs and researchers. CP is one of such suggestions.

Co-Creation of Possibilities

CP is a new suggestion in the field of nursing: it does not appear in the latest Nursing Interventions Classification by Bulechek, Butcher, McCloskey-Dochterman, and Wagner (2012). It seems that Bergdahl et al. (2013) were the first to propose the term, even though NPS has been using the intervention intuitively. In fact, Bergdahl et al. (2013) use the experience and case studies of numerous interactions of NPs with their patients to deduce a model for CP that can be used in the future.

CP presupposes the discussion and planning of patient’s needs and wishes fulfilling. It is different from mutual goal setting as can be seen in Bulechek et al. (2012) since it is not concerned with healthcare goals; instead, it is aimed at improving the patient’s QoL by helping them to learn to manage their disease in daily settings or with respect to particular “vital goals” (Bergdahl et al., 2013, p. 350). The authors used the example of traveling, which is likely to be difficult for palliative patients.

Bergdahl et al. (2013) studied 110 cases of NP-patient interaction and discovered certain patterns and difficulties, which allowed them to construct a model for CP and NP-patient relationship building. The model includes three complex steps, the last of which is the PC. The first consists in the creation of “warm and caring atmosphere,” for which the authors propose different approaches including joy and humor in some cases and seriousness in others; apart from that, it requires closeness and trust. The second step consists of “interplay and cocreation:” the NP engages in a dialogue with the patient, being supportive and helpful, and leads the conversation to facilitate the planning of opportunities. As a result, the co-creative process begins. It consists of five components: the identification of the need or wish; the creation of the intention to fulfill them; knowledge sharing (concerning the patient’s abilities and possibilities); opportunity identification; possibility planning. The practically applicable plan is the last stage of CP (Bergdahl et al. 348). The elements of stages also correspond to each other: closeness and support from the first step are helpful in CP identification of needs; joy and humor facilitate the dialogue that helps intention forming and knowledge sharing; seriousness is significant for the leadership component that enhances planning process. In general, all the components form a coherent system.

It logically follows that the proposed solution is aimed at educating and supporting the patient. According to Enguidanos, Housen, Penido, Mejia, and Miller (2013), the educational function of NP appears to be the most difficult one. The supportive function is among the most significant ones for NP as it corresponds to the agenda of preventing and minimizing sufferings (Coyle, 2015). Moreover, Bulechek et al. (2012) conclude that CP is very common among nurses: of the 110 scenes studies, 104 contained it in one way or another. As a result, the CP intervention appears to be of importance for NP palliative practice, and studying it and training for it may improve the effectiveness of NP-led PC, the QoL of the patients, and NP-patient relationships.

Conclusion

PC is becoming more acknowledged by modern medical practice. Apart from that, the role of NPs in PC is central, and the functions that the specialists perform are numerous and complex. At the same time, the area appears to be underresearched, and it lacks quantitative studies that could demonstrate the effectiveness of particular interventions, which explains the need for further development of the topic.

The newly proposed CP model that is based on a popular intuitive but unregistered intervention is the result of the research in the field of NP palliative practice. The model can be used for the study and training for this intervention, which may lead to the improvement of the patients’ QoL, NP performance, and NP-patient relationships. The presented study will test the effectiveness of the said model that can be termed “informed creation of possibilities.”

References

Bergdahl, E., Benzein, E., Ternestedt, B., Elmberger, E., & Andershed, B. (2013). Co-Creating Possibilities for Patients in Palliative Care to Reach Vital Goals: A Multiple Case Study of Home-Care Nursing Encounters. Nursing Inquiry, 20(4), 341-351. Web.

Bookbinder, M., Glajchen, M., McHugh, M., Higgins, P., Budis, J., & Solomon, N.,… Portenoy, R. (2011). Nurse Practitioner-Based Models of Specialist Palliative Care at Home: Sustainability and Evaluation of Feasibility. Journal of Pain And Symptom Management, 41(1), 25-34. Web.

Bulechek, G., Butcher, H., McCloskey-Dochterman, J., & Wagner, C. (2012). Nursing Interventions Classification (NIC) (5th ed.). St. Louis, MO: Elsevier.

Coyle, N. (2015). Introduction to palliative nursing care. In B. Ferrell, N. Coyle, & J. Paice (Eds.), Oxford Textbook of Palliative Nursing (pp. 3-10). Oxford, UK: Oxford University Press.

Dyar, S., Lesperance, M., Shannon, R., Sloan, J., & Colon-Otero, G. (2012). A Nurse Practitioner Directed Intervention Improves the Quality of Life of Patients with Metastatic Cancer: Results of a Randomized Pilot Study. Journal Of Palliative Medicine, 15(8), 890-895. Web.

Enguidanos, S., Housen, P., Penido, M., Mejia, B., & Miller, J. (2013). Family Members’ Perceptions of Inpatient Palliative Сare Consult Services: A Qualitative Study. Palliative Medicine, 28(1), 42-48. Web.

Kaasalainen, S., Ploeg, J., McAiney, C., Martin, L., Donald, F., & Martin-Misener, R.,… Sangster-Gormley, E. (2013). Role of the Nurse Practitioner in Providing Palliative Care in Long-Term Care Homes. International Journal of Palliative Nursing, 19(10), 477-485. Web.

Lukas, L., Foltz, C., & Paxton, H. (2013). Hospital Outcomes for a Home-Based Palliative Medicine Consulting Service. Journal Of Palliative Medicine, 16(2), 179-184. Web.

Vahedi Nikbakht-Van de Sande, C., Braat, C., Visser, A., Delnoij, D., & van Staa, A. (2014). Why a Carefully Designed, Nurse-Led Intervention Failed to Meet Expectations: The Case of the Care Programme for Palliative Radiotherapy. European Journal Of Oncology Nursing, 18(2), 151-158. Web.

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