Level 2 clinical supervision for community practitioners working with palliative and end-of-life care patients.

BACKGROUND: Little has been written on the availability of specialist level 2 supervision groups to support community practitioners regarding the emotional components of their palliative and end-of-life caseload. Adapted level 2 groups (AL2Gs) have been piloted in three community teams in the NHS to address this. AIMS: This study aimed to evaluate whether access to AL2Gs benefited community palliative and end-of-life practitioners at three sites. The outcomes for those who attended and those unable to attend were considered. FINDINGS: Attendees found AL2Gs beneficial, reporting better confidence and wellbeing, plus a sense of containment through group cohesion and trust in the facilitators and fellow AL2G members. Most would recommend the groups to all staff working in community palliative care. Practitioners who were not able to attend relied on informal and ad-hoc peer support, and had concerns about their skills in managing patients' psychological needs. CONCLUSION: Community nurses benefit from attending AL2Gs to support them with their palliative care/end-of-life caseloads. It is recommended that all community staff involved in this type of care have access to regular clinical supervision, especially in a group format.

Psychological challenges for nurses working in palliative care and recommendations for self-care.

Working in palliative care services has an impact on the personal and professional lives of healthcare staff. The complex practicalities of the role and additional factors such as moral distress, burnout, compassion fatigue and death anxiety all impact on the overall quality of services and patient care. This article aims to highlight what is known of the practical and emotional challenges for palliative nursing care and offers recommendations to services to support staff at an organisational as well as individual level, to help create a more supportive workplace for staff and patients alike. It follows previous research on working in palliative and end-of-life care.

Through the looking glass: Highlighting the challenges facing healthcare professionals who have cancer.

BACKGROUND: Little is known directly about the experiences of health professionals with cancer. Current studies mainly employ pathographies as the information source and focus on doctors experiences only. OBJECTIVE: This paper aims to build upon our understanding of healthcare professionals who have cancer and considers practical management of barriers and gaps in care. METHOD: It uses conductive research to analyse and critique available studies, highlighting the experiences of health professionals throughout their diagnosis and treatment. It additionally presents thematic clinical observations, reflecting additional experiences noted by the author during her own therapeutic practice. RESULTS: The findings reflect a disparity between treatment of healthcare professionals suffering from cancer as compared to the general patient population. CONCLUSIONS: A number of recommendations are made to support healthcare colleagues to facilitate the care offered to this group of patients.

Managing conversations with patients about death and dying.

Caring for patients who are dying is both a challenging and demanding role. This is further intensified by the expectation that in addition to attending to physical issues, nurses are expected to manage the emotional and psychological aspects of the situation. The inconsistent nature of the care pathways between differing specialist services can often mean that open access to specialist services is not possible. As such, staff may find themselves inadvertently supplementing and often reinforcing interventions offered by specialist (psychological) services with little consideration given to capacity, experience and resources. As the most 'consistently present' professionals in such settings, it is important for nursing colleagues to be aware of the emotional and psychological themes common to patients who are dying. Thus, allowing patients access to supportive conversation with professionals as and when required, ameliorating unnecessary distress.

I beg your pardon?! using conditionals theory to understand doctor-patient communication problems.

BACKGROUND: Little attention is given to the process and impact of poor communicaton on the doctor-patent relationship. OBJECTIVE: The paper aims to employ Theory of Conditionals to help shed light on the experience from a patient perspective. METHODS: Doesnt really apply as this was inductive research i.e. based on other research in the area. RESULTS: Doesnt really apply except that The Theory of Conditionals enables us to understand the points of mis-communication as well as reasons behind misunderstandings across the medical consultation. CONCLUSIONS: A number of recommmednations are made to support GPs to reduce the impact of this problem on the medical consultation.

Using a frame of reference for talking to patients about death and dying.

Recent years have seen a recognition of the importance of talking openly to patients at the end of life about death and dying. This article aims to add to the existing body of literature on this subject. Conversations at the end of life can be difficult, particularly if the patient is experiencing mental distress alongside their terminal illness. A number of factors can disrupt a constructive and supportive conversation around death and dying. This article offers a frame of reference for nurses to consider when having such conversations.

COPD: a proposed multidisciplinary approach to psychological issues.

Patients with chronic obstructive pulmonary disease (COPD) form a sizeable part of the ill-health demographic, both internationally and nationally, impacting markedly on hospital admissions. While prevalence rates of psychological comorbidity vary, there appears to be a consistent presence of depression and anxiety, and additional COPD symptom-related psychological distress. The research evidence base is limited, with seemingly little potential for expansion. Based on the available evidence, this study proposes a multidisciplinary team working model to support the integration of psychological input into the care of inpatients with COPD.

'Heart-talk:' considering the role of the heart in therapy as evidenced in the Quran and medical research.

The emphasis on scientific approaches and evidence-based therapy has been a key force in developing and refining existing models of therapy. While this has been unquestioningly invaluable, it has similarly restricted the development and so implementation of those models that do not lend themselves easily to current research methodology, since the lack of evidence-practice research means they are not considered as 'legitimate' therapeutic practice. That the mind and body have an inter-dependent relationship is readily evidenced in numerous religious texts, but the lack of acknowledgement of that relationship in contemporary therapeutic approaches means that patients are not able to benefit from its use in sessions. Ironically, it is current developments in medical research that have discovered the reality around this relationship that have enabled such models to be further explore within an accepted context of evidence-based practice. This paper highlights the relationship between the heart and brain function as evidenced with brief reference to Quranic verses and medical (namely, neurocardiological) research. Further, it raises questions around the implications of this information for therapists working in both physical and mental health. The concept of 'heart talk' is an extension of the term 'heart brain' coined by Dr Armour (Professor of Pharmacology) in 1991 and is suggestive of its use in the world of psychological therapy. It relates to those cognitions which patients suggest come 'from the heart' which though previously dismissed are now suggestive of having some scientific basis and are potentially a legitimate source of information in understanding patients experiences.

Multidisciplinary work to provide cardiac rehabilitation for patients.

Cardiac rehabilitation is an important aspect of cardiac care strategies. This article outlines the importance of such care using a case-study approach to highlight the impact that rehabilitation programmes can have on individual patients.

Depression in South Asian women living in the UK: a review of the literature with implications for service provision.

Research has shown that South Asian people in the UK underutilize health services compared with White people. Also, where services are accessed, they may not adequately meet cultural and religious needs. In exploring the relationship between the cultural and religious beliefs of South Asian service users about perceptions, beliefs about aetiology, cause and treatment of mental illness, past studies have illustrated a wide range of expectations, experiences, beliefs and attitudes. This article reviews research on depression in South Asian women in the UK, highlighting implications for services.

A multidisciplinary approach to cardiac rehabilitation care.

In reviewing our rehabilitation service in line with the national service framework a number of issues were identified to be addressed by the nursing and psychology team. It was decided that a group should be set up to help address and contain anxieties in line with patient needs and provide practical information during this interim period of treatment. Patient feedback has shown the sessions meet their needs and staff have found that less time is taken up during individual appointments answering commonly asked questions and repeating information that is frequently asked for.