Background and Significance of the Problem
Palliative care is a significant part of the healthcare system that is necessary for the improvement of the quality of life of patients. My option role is a nurse practitioner (NP), and I am interested in finding out how NP-led interventions can contribute to the improvement of the state of palliative patients.
From the literature study, it follows that NP interventions in palliative care include pain management, education activities, decision-making assistance, various types of planning, family integration, and emotional support directed at the patient as well as the family, and some others (Bergdahl, Benzein, Ternestedt, Elmberger, & Andershed, 2013; Enguidanos, Housen, Penido, Mejia, & Miller, 2013; Lukas, Foltz, & Paxton, 2013). It can also be concluded that the quality of life of palliative patients increases as a result of NPs’ work (Dyar, Lesperance, Shannon, Sloan, & Colon-Otero, 2012; Kaasalainen et al., 2013).
As stated by Dyar et al. (2012), the area of NP interventions in palliative care remains underresearched. It might be explained by the difficulties in measuring the results as well as the ethical issue of the control group that is deliberately deprived of palliative care. Therefore, research in the area is still required, but it should be designed to meet the challenges of this type of study.
With time, the sophistication of the NP’s palliative interventions and related theories advances, and new suggestions that are based on nurses’ everyday experience is proposed. A relatively new method that does not appear in the sixth edition of “Nursing Interventions Classification” by Bulechek, Butcher, McCloskey-Dochterman, and Wagner (2012) is the co-creation of possibilities as proposed by Bergdahl et al. (2013). Given the innovatory character of the intervention, investigating and testing appears to be a viable topic for a study in the field.
Statement of the Problem and Purpose of the Study
The method described by Bergdahl et al. (2013) presupposes discussing the needs and wishes of the patients and finding the ways of fulfilling or substituting them for something else if they are impossible: that is, creating the possibility of satisfying the needs together with the patient. It is similar to mutual goal-setting, but in this case, the goals are not limited to healthcare; rather, they presuppose non-healthcare-related decisions that can be affected by the patient’s state (for example, traveling). In a way, it is a course of action that NPs tend to come up with naturally, but the study by Bergdahl et al. (2013) demonstrates that they are not always successful in it. The authors propose their model of possibilities co-creation that allows theorizing and understanding the course of actions that is needed for proper possibility management. This model can be used to explain the concept and train an NP to carry out informed possibility cocreation.
Possibility cocreation is an intervention that is both educational (improves the understanding of one’s condition; facilitates decision-making) and supportive (provides emotional support, contributes to mood management). Therefore, it has the potential of improving the patients’ quality of life in several aspects, but since it is a new suggestion, it has not been researched properly. In the study of Bergdahl et al. (2013), cocreation is mostly regarded as a way of building the relationships between the NP and patients. Also, the authors did not implement their model of co-creation. In the proposed study, this model is going to be implemented as a training feature for the NP-led intervention termed “informed possibilities co-creation,” and its effectiveness is going to be considered and tested.
Research Questions, Hypothesis, and Variables with Operational Definitions
Research Question and Hypothesis
The research question can be formulated in the following way: does NP-led informed possibilities cocreation improve the health education and quality of life of palliative patients as well as their relationships with NPs? The research hypothesis states that the informed possibilities cocreation is going to affect the level of health education and the emotional aspect of patients’ quality of life along with their relationships with the NPs in a positive way. The null hypothesis consists in the claim that informed possibilities cocreation cannot affect the mentioned variables or affects them negatively.
Variables and their Operationalization
The aspects that are going to be introduced as dependent variables include the health education, quality of life, and relationship with the NP. The assessment tools (questionnaires and structured or semi-structured interviews) are likely to be developed specifically, but, for example, the quality of life tool can be created with the help of WHO’s (2016) guidelines. Apart from being included in the quality of life assessment tool, the physical state of the patient is going to be assessed via disease-specific parameters. The disease is not chosen yet; in fact, it appears logical to sample NPs rather than patients as it was done, for example, by Lukas et al. (2013) and Bergdahl et al. (2013). It is especially logical since the independent variable (the possibilities cocreation training) is meant for NPs. A clinic or program that is willing to participate in the study can be chosen, and the NPs will be divided into two groups: the one that receives the training and the control group. Since the proposed intervention is a new one and its effectiveness is to be tested, the fact that the control group will be deprived of it is not an issue. The variables will be assessed before the training; then, the work of the NPs will be studied for a year to ensure the possibility of the new knowledge implementation. The variables will be reassessed every three months. Also, the NPs’ opinion on the intervention and training will be collected through semistructured interviews at the end of their training and the year after.
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.
Bulechek, G., Butcher, H., McCloskey-Dochterman, J., & Wagner, C. (2012). Nursing Interventions Classification (NIC) (5th ed.). St. Louis, MO: Elsevier.
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.
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.
WHO. (2016). The World Health Organization Quality of Life (WHOQOL).