Appendix B Essay

Submitted By chii22
Words: 6768
Pages: 28


Spanish nurses' preparedness to care
for hospitalised terminally ill patients
and their daily approach to caring
Maria Arantzamendi, Julia Addington-Hall, Maribel Saracibar, Alison Richardson


urses have an essential part to play in
the care of terminally ill patients, and
education and training are important if
this care is to be of high quality. Shortcomings
are reported in the care that hospitalised terminally ill patients receive (Costello, 2001;
Ogasawara et al, 2003; Pincombe et al, 2003;
Rogers and Addington-Hall, 2005; London and
Lundstedt, 2007; Munárriz et al, 2007; Payne
et al, 2007a). It could be argued that since the
1980s, when studies assessed the nature and
extent of teaching about the end of life in nursing
schools (Field and Kitson, 1986; Degner and
Gow, 1988), nursing education in this regard has
improved. However, later studies continue to
highlight a lack of education in palliative care
(Kirchhoff et al, 2000; McDonnell et al, 2002;
Davidson et al, 2003; Sasahara et al, 2003;
Graham et al, 2005; Dickinson, 2007; Johnson
etal, 2009).
In a study of doctors, nurses, and other
health-care workers delivering end-of-life care in
six community hospitals, health professionals
reported that they possessed knowledge, skills,
and confidence in relation to symptom control,
but had less expertise in psychological, spiritual,
and bereavement care (Payne et al, 2007b).
Similarly, in another study, community hospital
nurses wanted more education on alternative
medicine (86%), social aspects of care (75%),
and AIDS (70%) (Jeffrey, 1994). Likewise, in a
US study involving oncology nurses in four
states, the nurses wished they had learnt in nursing school how to talk to patients and families
about dying (30%), pain control techniques
(28%), and comfort care nursing interventions
(9%) (White et al, 2001). Responses varied
according to the educational level attained:
nurses with diplomas ranked 'dealing with angry
patients' and 'legal issues' higher than did those
with Master's degrees and/or PhDs.
Thus, nurses do not seem to feel adequately
prepared to care for terminally ill patients.
However, this topic has not been* studied in

International journal of Palliative Nursing 2012, Vol 18, No 12

Objective: To describe Spanish nurses' preparedness to care for
hospitalised terminally ill patients and how this translates into care
delivery. Methods: An exploratory, sequential mixed methods study
with two stages. Stage I used unstructured observations of 22 hospital
nurses over 235 hours to understand their daily reality, followed by
semi-structured interviews with 21 nurses to elicit their perspectives.
Stage 2 was a regional survey (65% response rate) concerned with
hospital nurses' opinions of caring for terminally ill patients and their
perceived competence. Results: The nurses felt competent to provide
physical but not emotional care for terminally ill patients. They
reported that care could be improved, particularly through providing
more emotional care. This coincided v^ith an observed focus on
physical care. The nurses reported a lack of support in caring for
terminally ill patients and wanted more education on emotional issues
and dealing with their own feelings. Conclusion: There is a need for an
integrative approach in Spain that combines an educational programme
with a supportive environment, focusing on developing nurses'
competence to deliver emotional care and deal with their own
feelings. Promoting a supportive environment might enable nurses to
change their behaviour when caring for terminally ill patients and deal
with patients' emotional as well as physical needs.
Key words: Palliative care • Nursing education • Competence
• Hospital nurses • Mixed method

sufficient depth, certainly not in countries other
than the UK and USA. Moreover, studies have
considered nurses' own comments but have failed
to collect observational data about the repercussions of such inadequacies in relation to the