Language and the built, natural, social, and symbolic environments during bad news conversations for people with a life-limiting illness : a case study methodology
- Authors: Miller, Elizabeth
- Date: 2023
- Type: Text , Thesis , PhD
- Full Text: false
- Description: Background Bad news of a life-limiting illness is devastating to receive and remains a difficult conversation for healthcare professionals to undertake, despite education and training. Bad news conversations occur anywhere along an illness trajectory and often take place with the acute ward that is busy, sterile, and unfamiliar to patients and family members. Method A qualitative case study research methodology was used to explore the case, being the phenomenon of receiving bad news of a life-limiting illness for people living in regional Victoria, Australia. The literature was examined to understand the physical hospital environment and truth disclosure within bad news delivery. Data was collected between November 2021 and August 2022, through 14 semi-structured interviews with patients and family members, 13 semi-structured interviews with registered nurses, a three week observation period at a private regional hospital. The theoretical framework of Therapeutic Landscapes enabled the built, nature, social, and symbolic environments to be examined. Data was analysed using reflexive thematic analysis and qualitative content analysis. Results A review of the literature resulted in the development of the "SSAFER place approach" concept model and found that patients need to feel safe in the hospital environment and that safety is equated with space for family and familiar notions of home. Nurses aimed to provide holistic person-centred through therapeutic relationships with patients and family members and create a home-life environment. It was found that a calm and quiet environment was essential for absorbing bad news, and patients and family members believed the way bad news was delivered, and the language used often needed to be improved. The audit of 17 family meeting s highlighted that death and dying language was rarely documented, and late referrals to palliative care services often occurred. The "Breaking bad news model," created from a second literature review supported the results of the thesis. Due to the COVID-19 pandemic, patients, family members and nurses were negatively affected, creating a non-therapeutic social environment. Conclusion For patients and family members, a therapeutic landscape comprised of therapeutic relationship, open, honest and empathetic language delivered within holistic person-centred care. In addition, care needed to be provided within a calm and quiet environment to allow absorption and processing of bad news. Nurses providing palliative care aimed to meet patients and family needs holistically within an environment aesthetically tuned to be more home-like than clinical.
- Description: Doctor of Philosophy
- Authors: Miller, Elizabeth
- Date: 2023
- Type: Text , Thesis , PhD
- Full Text: false
- Description: Background Bad news of a life-limiting illness is devastating to receive and remains a difficult conversation for healthcare professionals to undertake, despite education and training. Bad news conversations occur anywhere along an illness trajectory and often take place with the acute ward that is busy, sterile, and unfamiliar to patients and family members. Method A qualitative case study research methodology was used to explore the case, being the phenomenon of receiving bad news of a life-limiting illness for people living in regional Victoria, Australia. The literature was examined to understand the physical hospital environment and truth disclosure within bad news delivery. Data was collected between November 2021 and August 2022, through 14 semi-structured interviews with patients and family members, 13 semi-structured interviews with registered nurses, a three week observation period at a private regional hospital. The theoretical framework of Therapeutic Landscapes enabled the built, nature, social, and symbolic environments to be examined. Data was analysed using reflexive thematic analysis and qualitative content analysis. Results A review of the literature resulted in the development of the "SSAFER place approach" concept model and found that patients need to feel safe in the hospital environment and that safety is equated with space for family and familiar notions of home. Nurses aimed to provide holistic person-centred through therapeutic relationships with patients and family members and create a home-life environment. It was found that a calm and quiet environment was essential for absorbing bad news, and patients and family members believed the way bad news was delivered, and the language used often needed to be improved. The audit of 17 family meeting s highlighted that death and dying language was rarely documented, and late referrals to palliative care services often occurred. The "Breaking bad news model," created from a second literature review supported the results of the thesis. Due to the COVID-19 pandemic, patients, family members and nurses were negatively affected, creating a non-therapeutic social environment. Conclusion For patients and family members, a therapeutic landscape comprised of therapeutic relationship, open, honest and empathetic language delivered within holistic person-centred care. In addition, care needed to be provided within a calm and quiet environment to allow absorption and processing of bad news. Nurses providing palliative care aimed to meet patients and family needs holistically within an environment aesthetically tuned to be more home-like than clinical.
- Description: Doctor of Philosophy
The effects of the ward environment and language in palliative care : a qualitative exploratory study of Victorian nurses’ perspectives
- Miller, Elizabeth, Porter, Joanne, Barbagallo, Michael
- Authors: Miller, Elizabeth , Porter, Joanne , Barbagallo, Michael
- Date: 2023
- Type: Text , Journal article
- Relation: Health Environments Research and Design Journal Vol. 16, no. 4 (2023), p. 146-158
- Full Text:
- Reviewed:
- Description: Objectives: The current study aimed to explore regional nurses’ perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. Background: In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. Method: Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. Results: Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: “conducting family meetings,” “palliative care practice,” and “the environment matters.” Conclusions: A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards. © The Author(s) 2023.
- Authors: Miller, Elizabeth , Porter, Joanne , Barbagallo, Michael
- Date: 2023
- Type: Text , Journal article
- Relation: Health Environments Research and Design Journal Vol. 16, no. 4 (2023), p. 146-158
- Full Text:
- Reviewed:
- Description: Objectives: The current study aimed to explore regional nurses’ perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. Background: In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. Method: Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. Results: Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: “conducting family meetings,” “palliative care practice,” and “the environment matters.” Conclusions: A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards. © The Author(s) 2023.
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