Challenges in Palliative Care Nursing at a University Hospital: A Qualitative Interview Study

A Qualitative Interview Study

Elisabeth L. Zeilinger, PhD, MSc; Ablah Gabal, MD; Feroniki Adamidis, MD; Petar Popov, MD; Karin Jaeger, MD; Miriam Hufgard-Leitner, MD, MSc; Robert Brettner, MSc; Harald Titzer, MSc, RN; Eva Katharina Masel, MD, PhD, MSc; Matthias Unseld, MD, PhD

Disclosures

Journal of Hospice and Palliative Nursing. 2022;24(5):E219-E225. 

In This Article

Abstract and Introduction

Abstract

We examined the perception of palliative care nurses regarding challenges, coping strategies, resources, and needs when working in a university hospital in Austria. A qualitative descriptive design was applied, using semistructured interviews with 8 female and 2 male nurses. All interviews were recorded as digital audio and transcribed verbatim. We used thematic analysis and MAXQDA. In our analysis, 6 themes emerged: Four themes related to challenges: (a) lack of a supporting structural framework, (b) conflict in interdisciplinary work, (c) conflict with caregivers, and (d) dealing with death in a highly specialized university environment. One theme related to (e) individual solutions and coping strategies, and 1 theme comprised (f) needs and suggestions for improvements. Taking care of the family of a dying person, handling threatening situation, and working with inexperienced physicians were among the most important challenges reported by nurses. A supportive team, professional counseling, and training related to communication skills and to culturally specific needs of families are perceived to be necessary to provide high-quality palliative care. Addressing the needs of nurses can substantially improve their working condition and has an impact not only on the nurses themselves but also on the quality of patient care.

Introduction

Palliative care (PC) provides medical care for people with life-limiting diseases and emphasizes well-being at all points of the disease trajectory. The International Association for Hospice and Palliative Care recently established a consensus-based definition of PC as the "…active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life."[1] (p755) The purpose of PC is not only to improve the quality of life for patients, but also for their families and caregivers.[1] In the next decades, the number of people needing PC will rise,[2] as will the demand for hospital-based PC.[3]

Palliative care nurses (PCNs) play a central role in PC. They are constantly available, coordinating patients care and acting as a link between different professional groups, as well as between patients and their families.[4] Working in a PC unit (PCU), nurses face both physical and psychological challenges as they seek to provide high-quality support to patients in the last phase of life. Palliative care nurses face exhausting and challenging as well as rewarding experiences in their work.[5,6] Across different countries, the working conditions of PCNs are in need of improvement.[7–9] However, burnout levels of health professionals working in PC have been found to be lower than in other settings, which might be a result of the relationship-based work with patients and their caregivers.[5,10]

In Austria, a concept of graduated hospice and palliative care has been in place since 2004, which provides basic hospice and PC and care through specialized hospice and palliative facilities.[11] Palliative care units in hospitals are part of specialized PC facilities and provide specialized PC for acute cases for a limited period of time. Long-term palliative and hospice care is provided primarily by hospice facilities and nursing homes. The hospital where the study was conducted, the General Hospital in Vienna, has an internal web-based platform on which certain care standards and processes are noted. The care standards are closely aligned with the PC guidelines of the German Association for Palliative Medicine.[12] Challenges PCNs face and the kind of support they need to be able to cope with those challenges are highly dependent on the working environment.[13] In the working environment of a highly specialized university hospital, nurses can feel pressured to be in line with the academic context of the clinic, which means that nurses may consider it of upmost importance to use a "scientific" reasoning and classification system in their nursing practice and that their role is defined by being a coordinator and by providing information to physicians.[14] These tasks can even be perceived as more important than the relationship with patients and influence self-perception of PCNs.[14] The lack of knowledge on challenges and needs of PCNs in a university hospital hinders the improvement of working conditions for nurses in this working environment.

The aims of the present study were to explore (1) the greatest challenges in everyday working life for PCNs from their point of view, (2) individual solutions of the nurses and their coping strategies, and (3) nurses' needs to improve their daily work on a PCU of a highly specialized university hospital.

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