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Posts tagged ‘Barbara Pesut’

Nurses Experiences with Assisted Death

In the current featured open access ANS article, the authors present the outcome of their synthesis of literature focused on nurses experiences with assisted death.  The article is titled  “Ethical, Policy, and Practice Implications of Nurses’ Experiences With Assisted Death:Synthesis” authored by Barbara Pesut, PhD, RN; Sally Thorne, PhD, RN; Madeleine Greig, MSN, RN; Adam Fulton, BScN; Robert Janke, MLIS; and Mathew Vis-Dunbar, MLIS.  Because this is an open access article, you can download and read it at any time!  As the primary author Barbara Pesut states in the video message below, we are eager to hear your responses and comments to this work.  Dr. Pesut has also invited readers to contact her for more information or to discuss this topic!  Please view the video – it is a compelling explanation of the importance of nurse presence in this situation, the important judgments that nurses form, and their role in supporting and advocating for the patient.  

Integrated Knowledge Translation: Addressing the Knowing/Doing Gap

Gweneth Hartrick Doane and Sheryl Reimer-Kirkham have been working with a team of nursing scholars for several years, exploring the philosophic underpinnings and the practice implications of translational research.  The current issue of ANS features two articles based on their work.  The current featured article is “(Re)theorizing Integrated Knowledge Translation: A Heuristic for Knowledge-As-Action” authored by Gweneth Hartrick Doane, PhD; Sheryl Reimer-Kirkham, PhD; Elisabeth Antifeau, MSN and Kelli Team600Stajduhar, PhD.  The second article which will appear as a featured article starting on September 19th, is titled “Translational Scholarship and a Palliative Approach: Enlisting the Knowledge-As-Action Framework” authored by Sheryl Reimer-Kirkham, PhD; Gweneth Hartrick Doane, PhD; Elisabeth Antifeau, MSN; Barbara Pesut, PhD; Pat Porterfield, MSN; Della Roberts, MSN; Kelli Stajduhar, PhD; and Nicole Wikjord, MSN. Dr. Doane and Dr. Reimer-Kirkham provided this message about their work for ANS readers:

We have been engaged in translational scholarship—under the umbrella of “knowledge translation” for some time, interested in its philosophic underpinnings on the one hand and its practice orientation on the other. The two papers in the ANS 38:3 issue were developed in the context of a research-practice collaborative in British Columbia (iPANEL) that shares a common goal of advancing the further integration of a palliative approach into the healthcare system. We are indebted to the many nurses engaged in this initiative as investigators, clinicians, and affiliates and to Michael Smith Foundation for Health Research (MSFHR) for their generous funding.

Within the knowledge translation (KT) literature how to actually do interactive and integrative KT has been identified as the primary question researchers are currently facing. It has become increasingly clear that something beyond instrumental, prescriptive approaches that arise out of externally-driven knowledge concerns, and impose directives for evidenced-based ‘best’ practice are needed to affect meaningful change at the practice level.

As we have conducted our various KT research projects and pondered possibilities, three key insights that offer a different KT approach (at the conceptual and practical level) have emerged. First, we have come to see the fundamental importance of KT being an inquiry process. Taking an inquiry approach involves working between the existing (what is known) and the emergent (what is not fully known and/or what might be needed). Structuring KT as a process of inquiry and working ‘in-between’ what is known/not known focuses attention on the specific features of a situation and highlights that the question “How best to proceed?” can only be answered within those particularities.

Typically KT is focused toward ‘filling a knowledge gap.’ It is assumed that ‘the problem’ is one of knowledge—people simply lack the latest research knowledge. However, that assumption has not held up in our research. As we describe in our papers, even when the latest research evidence is known there may still be a gap between the care that should be provided and the care that is offered. Subsequently a second insight we propose is that KT is not about filling a gap as much as working in the gap—the gap between the real and the ideal, between realities and possibilities— and seeing that practice gap as a fruitful site for the development of knowledge and practice capacity. It is this gap between real and ideal practice that is of utmost concern to patients, nurses and other health practitioners and that serves as the greatest impetus for practice change. Orienting KT toward a shared practice concern (i.e., the gap between real and ideal care) serves to align practitioners’ deeply felt concerns with their capacity to address those concerns. Moreover, it enables practice concerns to be heard and shared and knowledge to be enlisted to effect change. It also democratizes the knowledge process and knowledge milieu, fostering inclusivity and responsiveness to multiple forms of knowledge.

Finally our third insight is the importance of having a KT process in which nurses and other health practitioners play a central role. And this is where the KITE heuristic, the Knowledge-AS-Action Framework (see Figure below), that we describe in our papers comes in. If the goal of KT is to have the most up-to-date knowledge inform and reshape practice, is it not the practitioners who need to be supported to take the active and central role of determining the relevance and usability of any research knowledgeand, moreover, of determining the direction of the KT process itself? The KITE heuristic opens the space for practitioners to put their own expertise to work. At the same time the heuristic structure serves to identify the multiple forms of knowledge that exist, the further knowledge that might be needed as well as directions for action. The heuristic by its very nature provides an integrated way of thinking about practice development and change that is grounded in explicit and shared values and goals.

While our papers discuss the use of the KITE heuristic in integrating a palliative approach into nursing practice, we believe the heuristic may have utility across a range of practice contexts and concerns. As part of the blog discussion we invite you to consider that possibility and respond to what we have proposed—even consider trying out the heuristic in your area of nursing practice and/or with a current concern. We look forward to hearing your thoughts and experiences.

Indeed, these two articles provide compelling insights and possibilities for practice in many clinical situations. I hope you will visit the ANS web site, download these articles while they are featured, and then return here to add your responses and ideas!

Design by University Communications, Trinity Western University

Design by University Communications, Trinity Western University

Rural Nursing and Palliative Care

This “Editor’s Pick” article describes an analysis of two studies that examine nursing palliative care in rural settings.  The authors (Barbara Pesut, PhD, RN; Barbara McLeod, MSN, BSN, RN; Rachelle Hole, PhD, MSW; Miranda Dalhuisen, BSN, RN) explain how the findings of these studies inform nursing practice in palliative care, and the ways in which the rural context shapes nursing practice. Their analysis provides insight into the ways in which nursing palliative care improves quality of life.  Dr. Pesut described their project as follows:

This article was birthed out of the Initiative for a Palliative Approach in Nursing: Education and Leadership, more commonly known as iPANEL.

“Research for nurses by nurses” is the motto for iPANEL.  A population aging with multiple chronic health conditions provides some important challenges for nurses, challenges that require both evidence and leadership. Research conducted by members of this team have indicated that a failure to identify and support those who are dying may have adverse consequences including poor symptom management, lack of advance

Barbara McLeod (L) and Barbara Pesut (R)

care planning and failure to attend to important psychosocial and spiritual issues. These issues are particularly relevant for nurses working in non specialized palliative settings such as acute medical units, residential care and home health.

iPANEL is a unique team, funded by the Michael Smith Foundation for Health Research, of researchers, clinicians, administrators and policy makers whose goal it is to integrate a palliative approach into the care of those living with life limiting chronic illness.  A palliative approach takes the supportive principles of palliative care and applies them in an upstream approach, recognizing that although there is a role for specialized palliative care, a palliative approach can be used by all nurses in all contexts to improve the care of the dying. A palliative approach begins by recognizing that a person with an advancing chronic illness may indeed be on a dying trajectory and then having sensitive and ongoing conversations around the goals of care.

This particular project arose out of my (Barb Pesut’s) interest in rural palliative care. Having done extensive ethnographic work examining palliative care in rural areas I was struck by how the rural context influenced

Rachelle Hole (L), Miranda Dalhuisen (R)

nursing work at end of life. I observed how policies and programs generated in urban areas had unintended consequences for nurses. For example, nurses in rural areas work outside of hours and scopes of practice to ensure that their neighbours and friends are well cared for. And yet, this may put them in difficult situations if they are not supported by administrators, if they feel less than competent in the care they are being asked to provide, or if the burden of care becomes too great. In the context of my research I heard many nurses talk about wanting more of the benefits of specialized palliative teams. And yet, I also observed a high degree of expertise and commitment in these nurses as they cared for palliative individuals. It made me wonder about the concept of specialty practice, and where it served nursing well…and not so well. Thus, rural nursing work became an important context in which to look at a palliative approach which seeks to apply the principles of palliative care within generalist contexts – the rural context became an important “living laboratory”. It also became an opportunity to deepen understandings of what rural family caregivers need most from nurses.

Barb Pesut and Barbara McLeod are academic/practice partners leading iPANEL on how to better understand how to educate nurses for a palliative approach. Rachelle Hole is a colleague from social work who brought her expertise in qualitative analysis and social systems to help us think outside of our ‘nursing lens’ as we analyzed the data. Miranda Dalhuisen is a palliative nurse and research coordinator – those invaluable partners who make our programs of research doable.

Visit the ANS web site today to download a free copy of this very informative and interesting article!

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