Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-20T15:34:19.394Z Has data issue: false hasContentIssue false

Development of an existential support training program for healthcare professionals

Published online by Cambridge University Press:  19 June 2015

Ingela Henoch*
Affiliation:
University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden Ersta Sköndal University College and Ersta Hospital, Palliative Research Centre, Stockholm, Sweden
Susann Strang
Affiliation:
University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden Angered Local Hospital, Gothenburg, Sweden
Maria Browall
Affiliation:
Karolinska Institute, Department of Neurobiology, Care Science and Society, Division of Nursing, Solna, Sweden University of Skövde, School of Life Sciences, Skövde, Sweden
Ella Danielson
Affiliation:
University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden Mid Sweden University, Department of Health Sciences, Östersund, Sweden
Christina Melin-Johansson
Affiliation:
University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden Mid Sweden University, Department of Health Sciences, Östersund, Sweden
*
Address correspondence and reprint requests to: Ingela Henoch, Sahlgrenska Academy at the University of Gothenburg, Institute of Health and Caring Sciences, Box 457, SE-405 30 Göteborg, Sweden. E-mail: [email protected]

Abstract

Objective:

Our aim was to describe the developmental process of a training program for nurses to communicate existential issues with severely ill patients.

Method:

The Medical Research Council (MRC) framework for the development and evaluation of complex interventions was used to develop a training program for nurses to communicate about existential issues with their patients. The steps in the framework were employed to describe the development of the training intervention, and the development, feasibility and piloting, evaluation, and implementation phases. The development and feasibility phases are described in the Methods section. The evaluation and implementation phases are described in the Results section.

Results:

In the evaluation phase, the effectiveness of the intervention was shown as nurses' confidence in communication increased after training. The understanding of the change process was considered to be that the nurses could describe their way of communicating in terms of prerequisites, process, and content. Some efforts have been made to implement the training intervention, but these require further elaboration.

Significance of results:

Existential and spiritual issues are very important to severely ill patients, and healthcare professionals need to be attentive to such questions. It is important that professionals be properly prepared when patients need this communication. An evidence-based training intervention could provide such preparation. Healthcare staff were able to identify situations where existential issues were apparent, and they reported that their confidence in communication about existential issues increased after attending a short-term training program that included reflection. In order to design a program that should be permanently implemented, more knowledge is needed of patients' perceptions of the quality of the healthcare staff's existential support.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Balboni, M.J., Sullivan, A., Amobi, A., et al. (2013). Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. Journal of Clinical Oncology, 31(4), 461467.Google Scholar
Bradbury-Jones, C. & Tranter, S. (2008). Inconsistent use of the critical incident technique in nursing research. Journal of Advanced Nursing, 64(4), 399407.Google Scholar
Browall, M., Melin-Johansson, C., Strang, S., et al. (2010). Healthcare staff's opinions about existential issues among patients with cancer. Palliative & Supportive Care, 8(1), 5968.CrossRefGoogle ScholarPubMed
Browall, M., Henoch, I., Melin-Johansson, C., et al. (2014). Existential encounters: Nurses' descriptions of critical incidents in end-of-life cancer care. European Journal of Oncology Nursing, 18(6), 636644.CrossRefGoogle ScholarPubMed
Campbell, M., Fitzpatrick, R., Haines, A., et al. (2000). Framework for design and evaluation of complex interventions to improve health. BMJ, 321(7262), 694696.CrossRefGoogle ScholarPubMed
Chochinov, H.M., Hack, T., Hassard, T., et al. (2005). Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology, 23(24), 55205525.Google Scholar
Craig, P., Dieppe, P., Macintyre, S., et al. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ, 337, a1655.CrossRefGoogle ScholarPubMed
Flanagan, J.C. (1954). The critical incident technique. Psychological Bulletin, 51(4), 327358.Google Scholar
Frommelt, K.H. (1991). The effects of death education on nurses' attitudes toward caring for terminally ill persons and their families. The American Journal of Hospice & Palliative Care, 8(5), 3743.CrossRefGoogle ScholarPubMed
Henoch, I. & Danielson, E. (2009). Existential concerns among patients with cancer and interventions to meet them: An integrative literature review. Psycho-Oncology, 18(3), 225236.Google Scholar
Henoch, I., Browall, M., Melin-Johansson, C., et al. (2013 a). The Swedish version of the Frommelt Attitude Toward Care of the Dying Scale: Aspects of validity and factors influencing nurses' and nursing students' attitudes. Cancer Nursing, 37(1), E1E11.CrossRefGoogle Scholar
Henoch, I., Danielson, E., Strang, S., et al. (2013 b). Training intervention for healthcare staff in the provision of existential support to patients with cancer: A randomized, controlled study. Journal of Pain and Symptom Management, 46(6), 785794.CrossRefGoogle Scholar
Hirsch, A. & Röen, I. (2007). Me and the death: A thoughtful dialogue [Norwegian: Jag og döden: en langsom samtale]. Omsorg, 24(4), 5762.Google Scholar
Hogsnes, L., Melin-Johansson, C., Norbergh, K.G., et al. (2014). The existential life situations of spouses of persons with dementia before and after relocating to a nursing home. Aging & Mental Health, 18(2), 152160.Google Scholar
la Cour, P. & Hvidt, N.C. (2010). Research on meaning-making and health in secular society: Secular, spiritual and religious existential orientations. Social Science & Medicine, 71(7), 12921299.CrossRefGoogle ScholarPubMed
Mallory, J.L. (2003). The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students. Journal of Professional Nursing, 19(5), 305312.CrossRefGoogle ScholarPubMed
Maneesriwongul, W. & Dixon, J.K. (2004). Instrument translation process: A methods review. Journal of Advanced Nursing, 48(2), 175186.Google Scholar
McSherry, W. & Cash, K. (2004). The language of spirituality: An emerging taxonomy. International Journal of Nursing Studies, 41(2), 151161.CrossRefGoogle ScholarPubMed
Melin-Johansson, C., Henoch, I., Strang, S., et al. (2012). Living in the presence of death: An integrative literature review of relatives' important existential concerns when caring for a severely ill family member. The Open Nursing Journal, 6, 112.Google Scholar
Moore, P.M., Rivera Mercado, S., Grez Artigues, M., et al. (2013). Communication skills training for healthcare professionals working with people who have cancer. The Cochrane Database of Systematic Reviews, 3, CD003751.Google Scholar
Morita, T., Murata, H., Kishi, E., et al. (2009). Meaninglessness in terminally ill cancer patients: A randomized controlled study. Journal of Pain and Symptom Management, 37(4), 649658.Google Scholar
Mutto, E.M., Errazquin, A., Rabhansl, M.M., et al. (2010). Nursing education: The experience, attitudes, and impact of caring for dying patients by undergraduate Argentinian nursing students. Journal of Palliative Medicine, 13(12), 14451450.CrossRefGoogle ScholarPubMed
National Board of Health and Welfare (2004). Good care at the end of life: A knowledge overview about care for elderly. [Swedish: God vård i livets slut: En kunskapsöversikt om vård och omsorg om äldre]. Stockholm, Sweden.Google Scholar
Österlind, J., Hansebo, G., Andersson, J., et al. (2011). A discourse of silence: Professional carers reasoning about death and dying in nursing homes. Ageing and Society, 31(4), 529544.CrossRefGoogle Scholar
Pearce, M.J., Coan, A.D., Herndon, J.E. 2nd, et al. (2012). Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients. Supportive Care in Cancer, 20(10), 22692276.CrossRefGoogle ScholarPubMed
Phelps, A.C., Lauderdale, K.E., Alcorn, S., et al. (2012). Addressing spirituality within the care of patients at the end of life: Perspectives of patients with advanced cancer, oncologists, and oncology nurses. Journal of Clinical Oncology, 30(20), 25382544.Google Scholar
Puchalski, C.M., Vitillo, R., Hull, S.K., et al. (2014). Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine, 17(6), 642656.Google Scholar
Schön, D. (1987). Educating the reflective practitioner: Toward a new design for teaching and learning in the professions. San Francisco: Jossey Bass.Google Scholar
Selman, L., Young, T., Vermandere, M., et al. (2014). Research priorities in spiritual care: An international survey of palliative care researchers and clinicians. Journal of Pain and Symptom Management, 48(4), 518531.CrossRefGoogle ScholarPubMed
Sessanna, L., Finnell, D. & Jezewski, M.A. (2007). Spirituality in nursing and health-related literature: A concept analysis. Journal of Holistic Nursing, 25(4), 252262; discussion 263–254.CrossRefGoogle ScholarPubMed
Sloan, J.A., Cella, D. & Hays, R.D. (2005). Clinical significance of patient-reported questionnaire data: Another step toward consensus. Journal of Clinical Epidemiology, 58(12), 12171219.Google Scholar
Strang, S. (2001). Spiritual/existential issues in palliative care, with special reference to patients with brain tumours and their spouses . Doctoral dissertation, Gothenburg, Sweden: Department of Oncology, University of Gothenburg.Google Scholar
Strang, S., Ekberg-Jansson, A. & Henoch, I. (2013). Experience of anxiety among patients with severe COPD: A qualitative, in-depth interview study. Palliative & Supportive Care, 6, 18.Google Scholar
Strang, S., Bergh, I., Ek, K., et al. (2014 a). Swedish nursing students' reasoning about emotionally demanding issues in caring for dying patients. International Journal of Palliative Nursing, 20(4), 194200.Google Scholar
Strang, S., Farrell, M., Larsson, L.O., et al. (2014 b). Experience of guilt and strategies for coping with guilt in patients with severe COPD: A qualitative interview study. Journal of Palliative Care, 30(2), 108115.Google Scholar
Strang, S., Henoch, I., Danielson, E., et al. (2014 c). Communication about existential issues with patients close to death: Nurses' reflections on content, process and meaning. Psycho-Oncology, 23(5), 562568.Google Scholar
Udo, C., Melin-Johansson, C. & Danielson, E. (2011). Existential issues among health care staff in surgical cancer care: Discussions in supervision sessions. European Journal of Oncology Nursing, 15(5), 447453.Google Scholar
Udo, C., Danielson, E. & Melin-Johansson, C. (2013 a). Existential issues among nurses in surgical care: A hermeneutical study of critical incidents. Journal of Advanced Nursing, 69(3), 569577.CrossRefGoogle Scholar
Udo, C., Danielson, E., Henoch, I., et al. (2013 b). Surgical nurses' work-related stress when caring for severely ill and dying patients in cancer after participating in an educational intervention on existential issues. European Journal of Oncology Nursing, 17(5), 546553.CrossRefGoogle Scholar
Udo, C., Melin-Johansson, C., Henoch, I., et al. (2014). Surgical nurses' attitudes towards caring for patients dying of cancer: A pilot study of an educational intervention on existential issues. European Journal of Cancer Care, 23(4), 426440.Google Scholar
van Leeuwen, R., Tiesinga, L.J., Post, D., et al. (2006). Spiritual care: Implications for nurses' professional responsibility. Journal of Clinical Nursing, 15(7), 875884.Google Scholar
White, M. & Elander, G. (1992). Translation of an instrument: The US–Nordic Family Dynamics Nursing Research Project. Scandinavian Journal of Caring Sciences, 6(3), 161164.Google Scholar
Wong, F.K., Loke, A.Y., Wong, M., et al. (1997). An action research study into the development of nurses as reflective practitioners. Journal of Nursing Education, 36(10), 476481.CrossRefGoogle ScholarPubMed
Yalom, I. (1980). Existential psychotherapy. Basic Books.Google Scholar