Perceptions of bereaved family members of nursing care on an inpatient hospice palliative care unit.

BACKGROUND: Understanding family members' (FMs) perceptions of the care provided by nurses is crucial to facilitating positive outcomes for FMs. AIMS: To better understand how bereaved FMs perceive the care nurses provide in an inpatient hospice palliative care unit. METHODS: An exploratory study was conducted, with an interpretive description methodology. It was guided by the question: 'How do bereaved FMs perceive nursing care in our unit, and how does this influence their bereavement experiences?' A total of 10 FMs-or close friends-who had a significant other die on a palliative care unit were interviewed. FINDINGS: Findings support the belief that positive relationships and interactions with nurses impact families' perceptions of end of life. Nurses create a therapeutic environment, building a sense of ease and meaning for patients and families. CONCLUSION: Participation of nurses in rituals and patient-honouring practices after death may help families to cope and create positive memories during their grieving process.

Home care nurses' decisions about the need for and amount of service at the end of life.

AIMS: We explore home care nurse decision-making about the need for and amount of service by clients and families at the end of life. We identify factors nurses refer to when describing these decisions, situated within contextual features of nursing practice. BACKGROUND: Home care nurses are often responsible for decisions which have an impact on the access of clients and families to services at the end of life. Understanding how these decisions, are made, factors that are considered, and contextual influences is critical for improving access and enhancing care. METHODS: Qualitative data were collected between 2006 and 2008 from two samples of home care nurses: the first group (n = 29) recorded narrative descriptions of decisions made during visits to families. The second group (n = 27) completed in-person interviews focusing on access to care and their interactions with clients and families. Data were analysed with thematic coding and constant comparison. FINDINGS: Participants described assessing client and family needs and capacity. These assessments, at times integrated with considerations about relationships with clients and families, inform predictive judgements about future visits; these judgments are integrated with workload and home health resource considerations. In describing decisions, participants referred to concepts such as expertise, practice ideals and approaches to care. CONCLUSION: Findings highlight the role of considerations of family caregiver capacity, the influence of relationships and the importance of the context of practice, as part of a complete understanding of the complexity of access to care at the end of life.

Articulating the role of relationships in access to home care nursing at the end of life.

In this article, we draw on data collected from two samples of home care nurses to examine how relationships between nurses and family caregivers intersected with access to palliative home care nursing services. Participants referred to relationships as important for their practical benefits and for access to care: good relationships enhanced the nurse's ability to assess clients and families and fostered the family's trust in the nurse's care. Although emphasizing the need to build and maintain relationships (often requiring time), participants simultaneously referred to beliefs about the need to control the personal emotions invoked in relationships so as to ensure appropriate access for clients and families. Future research should further explore how the organizational and resource context, and the culture of palliative care, shape nurses' beliefs about relationships in their practice, the nature and types of relationships that can develop, and both client and family caregivers' access to care.