How Do RNs View Palliative Care for Hospitalized Older Adults? What a Study Reveals

By Sylvia Foley, AJN senior editor

“I think

[palliative care is] also for that portion of the population that falls in the crack, in terms of, they’re not quite ready for the hospice thing but they’re not really ready for new aggressive chemo or anything else. … They’re in that vague no man’s land of where they fit in terms of services.”—study participant

Timely referral to palliative care could potentially benefit many seriously ill, hospitalized older adults. Such care not only offers relief from disease symptoms, but also helps patients and families to reach personal goals, reconcile conflicts, and extract meaning from their varied experiences. Yet those who might benefit are less likely to receive such care if their providers are unclear about the concept and how it differs from hospice care.

To learn more about how staff nurses understand and manage palliative care, nurse researcher Maureen O’Shea decided to conduct an exploratory study. She reports on the findings in this month’s CE–Original Research feature, “Staff Nurses’ Perceptions Regarding Palliative Care for Hospitalized Older Adults.”

Here’s a quick overview.

Purpose: This exploratory study addressed the research question “What are the perceptions of staff nurses regarding palliative care for hospitalized older adults?”
Design: A qualitative descriptive study design using focus groups was selected.
Methods: Eighteen staff nurses participated in semistructured focus group interviews. The audio-recorded data were transcribed, sorted, and coded, then analyzed using Ritchie and Spencer’s framework approach to qualitative data analysis.
Findings: Five main thematic categories emerged concerning nurses’ perceptions: ambiguity regarding the concept of palliative care, communication challenges, a sense of informed advocacy, cognitive and emotional dissonance, and health care system constraints.
Conclusions: For many seriously ill hospitalized older patients, staff nurses can be pivotal as informed advocates for palliative care early in the course of an illness trajectory. But nurses (and other providers) often confuse palliative and hospice care; thus there is a need for increased understanding and knowledge in this area. Collaborative interdisciplinary education regarding the evolving concept of palliative care may be useful. Further research is warranted.

In closing, the author speaks to the need for “a fundamental shift in perspective” about palliative care. To learn more, read the article, which is free online.