Embedding a Palliative Approach in Nursing Care Delivery
We are delighted to feature the open access article titled “Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis” authored by Richard Sawatzky, PhD; Pat Porterfield, MSN; Della Roberts, MSN; Joyce Lee, PhD; Leah Liang, MSN; Sheryl Reimer-Kirkham, PhD; Barb Pesut, PhD; Tilly Schalkwyk, MSN; Kelli Stajduhar, PhD; Carolyn Tayler, MSA; Jennifer Baumbusch, PhD; and Sally Thorne, PhD. This article not only addresses the significant challenges of palliative care, but also serves as an example of the translation of knowledge into practice. We welcome you to download and read the article at any time – it is permanently available at no cost to readers. Then return here and share your comments and ideas! This is a message from Dr. Sawatzky about the work of this team of authors:
“A palliative approach is not a service” (quote from Carolyn Tayler)
Richard Sawatzky
Although we realize that end of life care may require care from professionals who have been formally trained in palliative care, mostpeople who have life limiting illnesses receive care in settings where access to palliative care professionals is limited. To address this, our team has been studying how the notion of “a palliative approach” can help to embed general principles and practices of palliative care broadly into the healthcare system. The Initiative for a Palliative Approach in Nursing: Evidence and Leadership (www.iPANEL.ca, led by Kelli Stajduhar and Carolyn Tayler) engages nurse researchers, practitioners, and administrators in British Columbia, Canada, who share a common goal to integrate a palliative approach throughout the healthcare system. Building on our prior publication on “Conceptual Foundations of a Palliative Approach” (Sawatzky, Porterfield et al. 2016), the current article is one of the iPANEL studies that specifically seeks to synthesize across insights derived from different sources of knowledge relevant to a palliative approach as the basis for supporting nursing care teams to embed a palliative approach into their practice. In doing so, we have broadened the scope of what is
Pat Porterfield
typically considered “knowledge synthesis”, by translating general knowledge from previous studies into particular contexts of nursing practice. This knowledge synthesis process reflects the fundamental form of nursing knowledge application we articulated in a prior publication in ANS on “Particularizing the General” (Thorne and Sawatzky, 2014). We hope that, in addition to contributing to an understanding of a palliative approach, the article will spark further discourse about effective methodologies for particularizing general knowledge within local contexts of everyday nursing practice.
ANS: Advances in Nursing Science Blog 
Thank you for a comprehensive and timely article on an important subject. A palliative approach to care is so necessary in a healthcare system that often focuses more on cure that care. For persons living with chronic, debilitating and/or life-threatening illnesses, a palliative approach to nursing care recognizes the uncertainty and anticipatory grief experienced by patients and families. Acceptance of such an approach ought to support nurses as they advocate for patient’s needs, wishes and clarify goals of care. I elaborate further in the book, “The Moral Work of Nursing: Asking and living with the questions,” which integrates nurse’s experiences, nursing research and social history to inform, encourage and empower nurses in their moral work. I regret that it’s too late to reference this article in the second edition that was released in May.
Part of our health care system is Long Term Care Homes. We have residents coming in much older, most have a dementia, and much further into their diagnosed diseases. Life expectancy is 18-24 months and getting shorter every year. Staff are recognizing this fact. Yes this is their home, saying this, they deserve the best palliative care given by educated staff. I am a strong advocate for education in P/C/EOL Care. One problem I am coming across is the use of the Palliative Performance Scale. This is a wonderful tool to use for our residents. Staff are having a hard time adjusting to its descriptions. Would you know if it can be made, or has been for LTC? Our residents deserve excellent palliative care, not just end of life care.
Jackie, we appreciate your comment/question as it illustrates two of the central issues we are addressing in this paper: how to particularize general knowledge to local contexts of everyday nursing practice and how to adapt palliative care practices to provide a palliative approach for various populations and nursing contexts. Your specific question relates to the use of the Palliative Performance Scale (PPS) with persons living in residential care, many of whom have a diagnosis of dementia as well as other comorbidities. Based on our experience and the experience of other members of the iPANEL team, we have found there are challenges using the PPS to help families and staff identify the illness progression and risk of dying for this population. Victoria Hospice (which developed the PPS) has helpful information about Palliative Care Planning for dementia (https://www.victoriahospice.org/sites/default/files/forget_me_not_sample.pdf ) which illustrates how tools such as the Functional Assessment Staging of Alzheimer’s Disease (FAST) and GLOBAL DETERIORATION SCALE (GDS) can be used to understand the overall course of the illness. The Quality Palliative Care in Long Term Care Alliance (QPC-LTC) has worked with the PPS in residential care and Sharon Kaasalainen (http://nursing.mcmaster.ca/faculty/bio/sharon-kaasalainen) is a resource for this work. Work has also been done combining the PPS with the clinical frailty scale: http://www.virtualhospice.ca/Assets/CFSPPS%20Poster%20FORMAT%20APR18_20151120154653.pdf and https://www.ncbi.nlm.nih.gov/m/pubmed/24962427/. In practice contexts which use the interRAI, combining the CHESS score with frailty scales may be helpful: http://www.interrai.org/assets/files/Scales/CHESS%20Scale.pdf . The above examples of how the PPS may need to be adapted or combined with other tools illustrate the current interest in adapting palliative care practices to serve the residential care population better. iPANEL( http://www.ipanel.ca/) has recently prepared a video and infographics which you may fine helpful; they describe the shift in thinking required for nursing staff in different settings, including residential care, to adopt a palliative approach.
Pat Porterfield and Rick Sawatzky