Chair: Jenny Jones
a. The moments we meet: Lived experiences of rapport for nurses, patients and families in palliative care
Background: Nurses are charged with making rapport and connection with every patient, every shift, every day. Rapport and relationship are considered foundational to palliative nursing with its focus on the patient and their family. Yet the meaning and understanding of this rapport has received little research attention in palliative care.
Aim: To describe the lived experience of rapport and connection with nurses, patients and their families in palliative care.
Design/Approach: This is a phenomenology study informed by Max van Manen’s approach to research. Twelve in-depth interviews with nurses, patients and families were transcribed and thematically analysed and interpreted.
Results/Findings: In-depth descriptions of rapport and connection come under two main themes of “Being Connected” and “Being Disconnected”. Being connected has sub-themes of connection to self and connection to other. While being disconnected has sub-themes of disconnection from self or disconnection from other. Links are made with rapport and nursing care, and rapport and the concepts of between-ness and separate-ness.
Conclusions and application to PHPC: Rapport is important and gives meaning and fulfillment in palliative care nursing. There are different levels of care given, related to the quality of connection created. Rapport and connection are linked to holistic care. An absence of rapport is linked to holistic care being unlikely. Rapport is the preferred way of connecting for all participants and a lack of rapport was considered unsafe and uncomfortable. There are implications for practice relating to kindness, safety and belittlement and rethinking rapport. This study has potential implications for all nursing where the nurse-patient-family relationships are a cornerstone of care.
b. Building community capacity: Supporting students to understand bereavement
A compassionate community approach to public health end of life care encourages communities to be resilient and enabled to support people and their families who are dying or have been bereaved (Kellehear, 2005). Recognising that locally there was no opportunity for students to gain confidence and an understanding of bereavement, we partnered with schools and colleges to develop workshops and peer mentor sessions, enabling students to support each other in school and their wider social circles.
Through delivery of a workshop to
• enable students to have a basic understanding of the effects of bereavement
• enable students to understand the importance of their own wellbeing
• improve the knowledge of tutor’s and how grief affects people, thus helping identification of bereaved students
• evaluate these sessions from a student, tutor and facilitator perspective
• relationships were made with schools and colleges, delivery content discussed
• facilitators were arranged for each session, using staff and volunteers
• we ensured tutors were aware that any student who became emotional could step outside and someone would follow to check on their wellbeing
• evaluation from the students was gathered collecting narrative during the session and a post-it note evaluation at the end
• Whilst some students found the subject matter difficult, all engaged. The feedback received reflected a wide range of thoughts and emotions which included indicators of increased resilience
• The sessions facilitated conversations and highlighted students whose grief was unknown to others
• The workshop was valued by the tutors
• The sessions have strengthened relationships between the hospice and the schools and colleges
• Further sessions have been requested
Working in partnership with schools and colleges is a positive way to equip young people with the basic skills to support bereaved people and is essential if we are to continue our commitment to create compassionate communities
c. Putting your nurse face on: How nurses manage their own grief after the death of a patient within the clinical setting
Introduction - Current literature explores nurse’s grief experiences in palliative care, paediatric nursing or oncology settings, but to date, there is limited research identifying or exploring grief experiences of nurses working in other clinical areas in a hospital setting after the death of a patient in their care.
Objectives – The purpose of this study is to understand how nurses working in acute hospital settings experience grief after the death of a patient in their care, and how they manage their grief within the context of the workplace.
Approach – A constructivist grounded theory methodology is being used for this study. This presentation presents the emerging category of “Putting your nurse face on”. This category explores how nurses manage their clinical practice whilst grappling with the emotional toll of dealing with a patient death.
Practice Implications – The findings may present an opportunity for changes in best practice and individual self-care strategies for nurses who may be grieving after the death of a patient.
Conclusions - When a patient has died nurses cope with the intensity of these emotive clinical situations by putting their nurse face on. This is a temporary state of being. Nurses reframe their thinking becoming task focused and clinically practical at the time of a patient death, describing acts of emotional control to suppress their grief reactions.
d. Shifting the culture of academic Palliative care with PHPC: our teaching imperative!
Dr Denise Marshall
In 2013, a year long sabbatical from an academic Division of Palliative Care at a major Health Sciences University in Canada provided an opportunity for a mid career faculty member to explore the emerging international movement whose focus is attending to Palliative Care as a public health issue. During this time, the faculty member was able to dive deeply into the literature, seek mentorship from founding architects of the health promoting palliative care movement and attend international meetings. Prior to this year, little formal application of the PHPC approach was evident in Canada either at the academic level or at the community level. Knowledge translation from this sabbatical was expected as the key output from this protected academic time.
The purpose of this oral presentation is to outline the process of knowledge translation post sabbatical and describe the known impacts on both the academic community in Canada and in the communities served by the academies
This presentation will be descriptive- outlining the organizational approach taken to KT of the PHPC approach in Canada at an academic institution.Approaches to academic mission, faculty projects, faculty roles and leadership will be detailed.
The sabbatical focus and subsequent KT through an academic Division of Palliative care has had wide and far reaching impact on individual academic careers and culture, as well as community partners and institutions. These impacts will be highlighted .
Conclusion/application to PHPC
The decision of an academic department in a health sciences university to support this sabbatical focus proved to itself be an effective ecological strategy to help undertake a culture shift towards a Public health Palliative Care approach .