Latest Australian research

Hungerford C.

Abstract: Grief is a highly personal, idiosyncratic experience involving deep sorrow and emotional distress in response to significant loss. Family carers of people with dementia report high levels of grief after diagnosis, during the progressive deterioration in the person’s cognition, and after the person’s death, with many family carers experiencing complicated grief. Factors contributing to the complexity of a family carer’s grief journey include the protracted and evolving nature of the loss, together with the burden of care carried by family carers as the dementia progresses.

This column explores the grief journey of family carers of people with dementia and identifies how health professionals, including mental health nurses, can better support them to process their grief. Such support includes helping to reduce the burden of care, listening to the carer express their grief, enhancing their problem-solving skills, and addressing their personal needs. Family carers assisted in this way are less likely to develop mental health issues, such as anxiety, depression, or complicated grief.

Adi Pranoto E, Wong ABO.

Abstract: 

Delirium occurs frequently near the end of life and is highly prevalent in palliative care settings. This case report describes how purposeful examination supported a diagnosis of serotonin syndrome (SS) as a contributor to the patient's delirium and how deliberate interventions resulted in the resolution of symptoms and delirium. Given its impact on prognostication and management, we strive to raise awareness about SS in palliative care.

Bloomer MJ, Brooks LA, Coventry A, Ranse K, Rowe J, Thomas S.

Background: The death of a child can have a profound impact on critical care nurses, shaping their professional practice and personal lives in diverse, enduring ways. Whilst end-of-life care is recognised as a core component of critical care nursing practice and a research priority, evidence about nurses' experiences after death in neonatal and paediatric intensive care is poorly understood.

Research question: What is the experience of the nurse after death of a patient in neonatal and/or paediatric intensive care?

Method: Following registration with Open Science Framework, an integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings was used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Medline, APA PsycInfo, Scopus, and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All included papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.

Findings: From 13,018 records screened, 32 papers reporting primary research, representing more than 1850 nurses from 15 countries, were included. Three themes were identified: (i) postmortem care; (ii) caring for bereaved families; and (iii) nurses' emotional response, which includes support for nurses. Nurses simultaneously cared for the deceased child and family, honouring the child and child-family relationship. Nurses were expected to provide immediate grief and bereavement support to families. In response to their own emotions and grief, nurses described a range of strategies and supports to aid coping.

Conclusion: Recognising neonatal and paediatric critical care nurses' experience after death is key to comprehensively understanding the professional and personal impacts, including the shared grief of a young life lost. Enabling nurses to acknowledge and reflect upon their experiences of death and seek their preferred supports is critically important. Thus, ensuring organisational and system processes similarly align with nurses' preferences is key.

Gaviola MA, Pedzisi S, Inder KJ, Johnson A.

Introduction: Worldwide in the population of older people, ethnic diversity is prevalent and therefore warrants culturally sensitive advanced care planning. This study aimed to explore advanced care planning documentation related to the cultural needs of residents of Chinese ethnicity in Australian aged care facilities.

Methods: A retrospective review of advanced care plan documentation was undertaken among 31 older Chinese residents with life-limiting illnesses across two residential aged care facilities in New South Wales, Australia. Data were analyzed using descriptive statistics.

Results: 90% of residents had advanced care planning documentation. The presence of the resident and their representative and medical care directives were well documented. Specific details on the provision of palliative care that considers the person's cultural needs and preferences were limited.

Discussion: Findings suggest the need for further research that explores an optimal way of embedding culture-specific information and the development of a culturally sensitive advanced care plan for people of Chinese ethnicity.

Gofton C, Bartolomeo AD, Wijekulasuriya S, Cai S, Boutros R, Stafford-Bell F, et al.

Background: Integration of palliative and supportive care in cancer treatment pathways is becoming standardised. While there has been significant qualitative research in oncology on palliative and supportive care integration into clinical care, there is little evidence that focusses on clinicians who manage hepatocellular carcinoma (HCC) and their perceptions on palliative and supportive care.

Aim: To investigate the attitudes and perceptions regarding palliative and supportive care of healthcare professionals managing patients with HCC.

Design: Qualitative study involving semi-structured individual interviews transcribed verbatim and analysed thematically.

Settings/ participants: A total of 25 healthcare professionals including hepatologists, gastroenterology trainees, hepatology clinical nurse consultants, social workers, and palliative care specialists providing care to patients with HCC recruited at 4 tertiary hospitals via purposive sampling.

Results: The following themes emerged: (1) availability of palliative care services, (2) need for clear referral pathways and processes, (3) patients' limited understanding of palliative care, (4) recognition of benefits of palliative care, and (5) the lack of training in hepatology services for palliative care provision.

Conclusion: Health professionals' perceptions of integration of palliative and supportive care in liver cancer care are hampered by multiple barriers. Opportunities to establish a more cohesive approach to care integration for patients with liver cancer have been identified. TRIAL REGISTRATION: ACTRN12623000010695 (date of registration 9/01/2023). What is already known about the topic? • Integration of palliative and supportive care for cancer can have profound benefits for patients' symptom burden and quality of life. • There is a lack of empirical studies examining the perspectives of health professionals who manage liver cancer on the integration of palliative and supportive care into the treatment pathways for patients. What this paper adds • This study identifies a number of barriers to the implementation of palliative and supportive care into liver cancer treatment algorithms. • The absence of sufficient evidence in clinical guidelines impairs the capacity of health professionals to improve the integration of palliative and supportive care for liver cancer patients. Implications for practice, theory, or policy. • As liver cancer prevalence increases, further effort is required to develop appropriate evidence-based clinical guidelines and referral pathways to support the integration of palliative and supportive care within existing liver cancer services.