Conectar
To establish cultural considerations for people from culturally or linguistically diverse backgrounds at the end-of-life in Australia.
Globally, there is a rapidly increasing proportion of the ageing population, and high levels of migration to Australia, the Australian healthcare community must recognise individualised and cultural needs when approaching death and end-of-life care. Many people from culturally and linguistically diverse backgrounds do not traditionally practice the palliative care approaches that have been developed and practised in Australia.
A Critical Interpretive Synthesis.
A review protocol was established using PRISMA 2020 guidelines and the literature searched using CINAHL, PubMed, Psych INFO and Medline from January 2011 to 27th February 2021. This search protocol results in 19 peer-reviewed results for inclusion in critical analysis.
Included studies were qualitative (14), quantitative (4) and mixed methods (1). Four themes were identified from the literature: (i) communication and health literacy; (ii) access to end-of-life care services; (iii) cultural norms, traditions and rituals; and (iv) cultural competence of healthcare workers.
Healthcare workers have an essential role in providing care to people with life-limiting illnesses. Cultural considerations during end-of-life care are imperative for the advancement of nursing practice. To achieve effective care for people of culturally and linguistically diverse backgrounds during end-of-life care, healthcare workers need to increase their education and cultural competency. There is inadequate research conducted within specific cultural groups, rural and remote Australian communities and individual cultural competence of healthcare workers.
Continuing advancement within nursing practice relies on health professionals adopting a person-centred and culturally appropriate approach to care. To ensure individualised person-centred care is provided in a culturally appropriate way, healthcare workers must learn to reflect on their practice and actively advocate for people with culturally and linguistically diverse backgrounds during end-of-life care.
What are care workers' lived experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care?
Interpretative phenomenological analysis
The lived experiences of 11 care workers within the Australian Capital Territory and region who have cared for someone of a culturally and linguistically diverse background during end-of-life care were captured. Each care worker was interviewed individually and answered a series of semi-structured open-ended questions.
Using interpretative phenomenological analysis, three group experiential themes were derived: (i) navigating cultural shock and death, (ii) the hard work of communication and (iii) searching for deeper connections with client and self. Within these were key elements: Care workers worked hard to embrace cultural diversity, but struggled to meet cultural needs, particularly in relation to the unpredictable timeline of dying. Care workers relied on themselves and their improvisation, but experienced self-blame for inadequate care and unexpected challenges in communication. Blurred boundaries in relation to therapeutic relationships were apparent, and care workers felt alone with emotional burden, but also found belonging and joy in their work.
Care workers' experiences are vital to understanding the barriers and challenges in providing culturally appropriate end-of-life care. Care workers repeatedly experienced an emotional burden and vicarious trauma throughout their work in this field. Care workers were self-reliant in all aspects of care including communication and consistently desired education, training, resources and support. There remains inadequate research on care workers and their role within the Australian healthcare context.
Care workers need access to support and resources including professional translators to provide culturally appropriate end-of-life care. Workplaces and registered nurses should facilitate training and provide guidance to care workers. A person-centred approach is required during all client encounters while maintaining appropriate therapeutic relationships including therapeutic use of self and professional boundaries.
COREQ Checklist.
During this study, care workers were interviewed on their experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care. Patients were not directly involved within this study, but their views may have been expressed through the care workers' experience.
To explore how the Cognitive Continuum Theory has been used in qualitative nursing research and to what extent it has been integrated in the research process using the Qualitative Network for Theory Use and Methodology (QUANTUM).
Theory, research and nursing are intrinsically linked, as are decision-making and nursing practice. With increasing pressure on nurses to improve patient outcomes, systematic knowledge regarding decision-making is critical and urgent.
A meta-aggregative systematic review.
CINAHL, Medline, PsycINFO, Embase and PubMed were searched from inception until May 2022 for peer-reviewed research published in English.
Seven studies were included and assessed for methodological quality using the Joanna Briggs Institute checklist for qualitative research. A meta-aggregative synthesis was conducted using Joanna Briggs methodology. The QUANTUM typology was used to evaluate the visibility of the Cognitive Continuum Theory in the research process.
The review identified five synthesised findings, namely: 1. the decision-making capacity of the individual nurse, 2. nurses’ level of experience, 3. availability of decision support tools, 4. the availability of resources and 5. access to senior staff and peers. Only two of seven studies rigorously applied the theory. The included studies were mainly descriptive-exploratory in nature.
The transferability of the Cognitive Continuum Theory was demonstrated; however, evolution or critique was absent. A gap in the provision of a patient-centric approach to decision-making was identified. Education, support and research is needed to assist decision-making.
A new Person-Centred Nursing Model of the Cognitive Continuum Theory has been proposed to guide future research in clinical decision-making.
Nurses make numerous decisions every day that directly impact patient care, therefore development and testing of new theories, modification and revision of older theories to reflect advances in knowledge and technology in contemporary health care are essential.
FreshRSS 