Psychometric analysis of the Comfort with Communication in Palliative and End-of-Life Care (C-COPE) instrument.

BACKGROUND: Nurses must be comfortable facilitating palliative and end-of-life communication with patients and their families. AIM: A validated instrument measuring the comfort of nurses with conducting end-of-life communication is essential for meeting the goals and wishes of patient care. This study aimed to develop and conduct a psychometric evaluation of the Comfort with Communication in Palliative and End-of-Life Care (C-COPE) instrument. METHODS: Face, content, and construct validity, including test-retest reliability, were conducted. RESULTS: Four experts subjectively confirmed face content validity and the quantitative item content validity index (I-CVI) ranged from 0.67 to 1 and scale content validity index (S-CVI/Ave) was 0.98. Principal axis factoring with Promax rotation yielded a five-factor solution accounting for 66.2% of the variance. The items loading on the five factors ranged from 0.46-0.96 (factor 1), 0.67-0.93 (factor 2), 0.49-0.86 (factor 3), 0.68-0.79 (factor 4), and 0.24-0.96 (factor 5). Internal consistency reliability (coefficient a) was 0.90 for the total C-COPE, and above 0.75 for each factor. The five factors are 'cultural/spiritual considerations,' 'team considerations,' 'addressing decision-making,' 'addressing symptomatology,' and 'deliberate awareness.' Test-retest reliability yielded an intraclass correlation coefficient (ICC) of 0.87 (CI 95%, 0.82-0.91). CONCLUSIONS: The C-COPE is a reliable and valid instrument measuring nurse comfort with palliative and end of-life care communication, yet requires testing in more diverse samples.

Nurse Comfort With Palliative and End-of-Life Communication: A Rural and Urban Comparison.

Communication is a key component of palliative and end-of-life care. Little is known about comfort with palliative and end-of-life communication among nurses working in rural and urban settings. We assessed this comparison using the 28-item (including 2 ranked items) Comfort with Communication in Palliative and End-of-Life Care instrument. Descriptive analyses of the sample (N = 252) identified statistically significant results differences for age and experience; rural nurses were older and more experienced. Urban nurses reported less comfort than did rural nurses based on composite score analysis (P = .03) and reported less comfort than did rural nurses in talking with patients and families about "end-of-life decisions" (P < .05). Overall, years of experience were significant for more comfort with end-of-life communication. Our instrument could be used within academic settings to establish baseline awareness of comfort with palliative and end-of-life communication and in institutional settings to provide a continuing education bridge from prelicensure through licensure. Moreover, experienced nurses are integral in mentoring new graduates in initiating and sustaining difficult conversations.

End-of-Life Communication: Nurses Cocreating the Closing Composition With Patients and Families.

Communication is imperative for end-of-life decision-making; however, descriptions of key strategies used by nurses are missing. A phenomenological approach was used to interpret interviews from 10 hospice/palliative nurses. The overarching pattern is the closing composition. Key communication strategies/patterns include establishing context, acknowledging through attentive listening, making it safe for them to die, planning goals of care, and being honest. Essential is the awareness that nurse, patient, and family all hold expertise in the subject matter. It is imperative that pre-/postnursing licensure curriculum be expanded to include training in mutual influence communication practices and mentoring in the skill of orchestration.

A willingness to go there: Nurses and spiritual care.

AIMS AND OBJECTIVES: To describe rural and urban palliative/hospice care nurses' communication strategies while providing spiritual care for patients and families at end of life. BACKGROUND: Nurses aim to provide holistic care consisting of physical, psychological and spiritual components. However, it is well documented that spiritual care is largely missing from nursing care. Internationally, spiritual care is a growing topic of interest, yet many nurses feel unprepared to deliver spiritual care. DESIGN: This qualitative study used Braun and Clarke's thematic analysis method. METHODS: As part of a larger multimethod study, this study shares the narrative descriptions from 10 experienced palliative/hospice care nurses. Individual, face-to-face interviews were conducted and lasted 45-60 minutes. Each interview started with the same lead-in questions, was audio-recorded and was transcribed verbatim. The research team used an inductive analysis approach and met several times reviewing and analysing the detected themes until reaching consensus. RESULTS: The primary theme, sentience includes the capacity to act, a willingness to enter into the unknown and the ability to have deep meaningful conversations with patients regardless of the path it may yield. Subthemes include: (i) Willingness to Go There, (ii) Being in "A" Moment and (iii) Sagacious Insight. CONCLUSION: Nurses are integral in the provision of spiritual care for patients/families across the lifespan and at end of life. Nurses must feel confident and competent before they are willing to enter uncomfortable spaces with patients/families. Nursing curriculum must include purposeful engagement and focused debriefing in spiritual assessment and care. RELEVANCE TO CLINICAL PRACTICE: There is a dire need to prepare undergraduate and graduate students to assess and support a patient's spiritual needs. Addressing spiritual care content as a clinical and educational priority will promote a patient-centred approach for spiritual care and can further shape nursing curricula, policies, guidelines and assessment tools.

Prayer and the Registered Nurse (PRN): nurses' reports of ease and dis-ease with patient-initiated prayer request.

AIMS: To explore nurse comfort with patient-initiated prayer request scenarios. BACKGROUND: Spiritual care is fundamental to patient care evidenced by Joint Commission requirement of a spiritual assessment on a patient's hospital admission. Prayer is an assessment component. Patients may seek solace and support by requesting prayer from the bedside nurse, the nurse may lack confidence in responding. Absent in the literature are reports specific to nurses' comfort when patients initiate prayer requests. DESIGN: Cross-sectional mixed methods study. METHODS: Data were collected in early 2014 from 134 nurses in the USA via an online survey using QuestionPro. The qualitative results reported here were collated by scenario and analysed using thematic analysis. RESULTS/FINDINGS: The scenario responses revealed patterns of ease and dis-ease in response to patient requests for prayer. The pattern of ease of prayer with patients revealed three themes: open to voice of calm or silence; physical or spiritual; can I call the chaplain. For these nurses, prayer is a natural component of nursing care, as the majority of responses to all scenarios demonstrated an overwhelming ease in response and capacity to pray with patients on request. The pattern of dis-ease of prayer with patients distinguished two themes: cautious hesitancy and whose God. These nurses experienced dis-ease with the patient's request no matter the situation. CONCLUSION: Educators and administrators must nurture opportunities for students and nurses to learn about and engage in the reflective preparation needed to respond to patient prayer requests.

Palliative and end-of-life care in South Dakota.

BACKGROUND: Geographical disparities play a significant role in palliative and end-of-life care access. This study assessed availability of palliative and end of life (hospice) care in South Dakota. METHODS: Grounded in a conceptual model of advance care planning, this assessment explored whether South Dakota health care facilities had contact persons for palliative care, hospice services, and advance directives; health care providers with specialized training in palliative and hospice care; and a process for advance directives and advance care planning. Trained research assistants conducted a brief telephone survey. RESULTS: Of 668 health care eligible facilities, 455 completed the survey for a response rate of 68 percent (455 out of 668). Over one-half of facilities had no specific contact person for palliative care, hospice services and advance directives. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives. Despite a lack of a specific contact person, nearly 75 percent of facilities reported having a process in place for addressing advance directives with patients; slightly over one-half (53 percent) reported having a process in place for advance care planning. Of participating facilities, 80 percent had no staff members with palliative care training, and 73 percent identified lack of staff members with end-of-life care training. Palliative care training was most commonly reported among hospice/home health facilities (45 percent). CONCLUSIONS: The results of this study demonstrate a clear need for a health care and allied health care workforce with specialized training in palliative and end-of-life care.

Carrying the pain: the journey from suffering to transformation-perspectives from Shakespearean tragedy and pastoral care.

This paper proposes an admittedly difficult thesis that emotional pain and suffering can be good news. Rather than denying and running from emotional pain and suffering, we suggest embracing and carrying the pain. Through academic and spiritual writings, an observation of Hamlet's tragic suffering, an examination of pastoral care case study data, and a B.L.E.S.S. acronym, this paper proposes that within the experience of suffering lies the transformative potential for meaning and fullness.

The first anniversary: stress, well-being, and optimism in older widows.

The first anniversary for older widows (n = 47) has been explored during Months 11, 12, and 13. Concurrent correlations show that optimism inversely correlates with psychological (intrusion and avoidance) stress as measured with the Impact of Event Scale (r = -.52 to -.66, p < .005) and positively correlates with well-being (physical: r = .36 to .46, p < .025; psychosocial: r = .58 to .72, p < .005; spiritual: r = .50 to .69, p < .005). Lagged correlation patterns suggest that higher levels of optimism at a given time are associated with higher life satisfaction and spiritual well-being at later times. Psychological stress is higher at Month 12 when compared to Month 13, t(43) = 2.54, p = .01, but not when compared to Month 11, t(43) = 1.49, p > .10. There are no significant differences in physiologic stress (salivary cortisol) or well-being during the first anniversary of spousal bereavement.

Spousal bereavement assessment: a review of bereavement-specific measures.

The death of a spouse represents a common form of bereavement among adults and is associated with significant distress and adaptation. This 10-year review of the bereavement literature highlights 12 tools used to assess bereavement in spousally bereaved samples. Pertinent measurement foci and psychometric properties of each tool are presented. Applicability of each tool within the spousal bereavement process is discussed, and aspects of the spousal bereavement process not currently addressed or under-addressed provide direction for future tool development.