Palliative Care Nursing Theories

Introduction

Quality health care is an essential aspect of any treatment phase of patients. Palliative care is a common term in nursing practice. It is an approach that entails the prevention of suffering and treatment in patients suffering from severe injuries and progressive diseases but not necessarily in the dying stage. Palliative care is provided during the patient’s entire life beginning from the diagnosis point extending into the bereavement period for the friends and family members after the patient’s death.  Palliative care for the terminally ill patients requires extra care, commitment, and attention from the nurses involved and this call for the need to equip them with more skills and knowledge. The shared theory is one of the essential midrange theories adopted in palliative care because of its ability to incorporate the core concepts of the nursing metaparadigm as well as obvious significant benefits in its current application in nursing practices.

Shared Theory

The shared theory is one of the middle range theories that have had a considerable contribution to the nursing practice. Mid-range arguments are essential in the nursing profession because they facilitate the application of research into practice. According to Kirkpatrick et al., this theory resulted from Desbins et al., combining the social cognitive theory by Bandura’s and self-care theory by Orem. According to Dobrina, Tenze, and Palese, this theoretical development aimed at providing a framework that would guide nurses in developing high levels of competence with the aim of giving quality health care to individuals with life-limiting illnesses.

The shared theory adopts the basic nursing metaparadigm in its practice. These essential components include nursing, health, patient and environment. Nursing intervention, palliative self-care behaviour, nursing competence, quality of life, nursing self-competence and emotional symptoms are the core values that define the relationship between the patient and the palliative care nurse. According to Kirkpatrick et al., theorists who came up with this theory argued that the self-competence and nursing concepts in the shared theory contributed significantly in providing quality health care as required in the palliative nursing care. The previously mentioned elements of the shared theory and their application in the concepts of the nursing metaparadigm will be discussed in the frame work below.

Nursing Metaparadigm

Nursing

Different palliative care nurses possess varying proficiency levels that range from competent to expert. Higher levels of self- competence and nurse competence result in higher quality palliative care. Nursing competence, nursing intervention and nursing self-competence are the basics of the nursing concept. Thus Nursing competence entails a set of specific capabilities that all nurses must get through clinical experiences and specialized training. It includes knowledge of the broad areas of nursing intervention which are interpersonal, social and professional as well as the practical skills. According to Kirkpatrick et al., competence involves the integration of skills, knowledge, attitude and values and it is closely related to performance. Theorists employ this concept in ensuring that the nursing providing palliative care possesses the skills and knowledge required. As for the nursing intervention partly compensatory and palliative care systems are used together to help the patients meet self-care deficits while still implementing supportive educative systems to them. For those in the final stages of their illnesses, wholly compensatory care systems are appropriate. These inteventions are tailored to identifying self-care deficits. Lastly, nursing self –competence focuses on the capability of judging the ability of nurses in treating suffering patients. Nurses with high competence levels are believed to offer quality palliative care. To measure the palliative care nurses self-competence, theorists Desbian et al., developed a Nursing Self-care Competence Scale.  Kirkpatrick et al., views self-competence (self-efficacy) as a determinant of improved clinical performance and nurse’s confidence. It ensures that nurses with high competence levels get appointed to offer palliative care.

Patient

According to Kirkpatrick et al., provision of palliative care to the patient also includes care of his or her entire significant family. Patients and their families are regarded a unit during the provision of palliative care.  Palliative self-care behaviour is a subcomponent of the patient concept of nursing metaparadigm. Therefore palliative self -care behavior entails the patient’s ability to cope with the complexity of his or her life-limiting illness. Palliative care nurses in the context of the shared theory concept equip the patient with self-management skills through educative sessions to help improve their symptom management and quality of life.

Health

The general body condition of the patient receiving palliative care is mainly determined by the concept of quality of life and emotional and physical symptoms. Thus quality of life of the patient at the end of the palliative care period corresponds with the wellbeing as per one of the models of this shared theory, the Orem’s self -care theory. Theorists apply this concept to determine the effectiveness of the palliative care provided to the patient.  On the other hand emotional and physical symptoms such as fatigue, emotional distress and pain are the main symptoms in patients seeking palliative care. These are used to measure the intensity of the signs and symptoms of the patients before determining the type of palliative care to be offered to them.

Environment

Environment concept in nursing metapadigm is characterised by natural factors. According to Kirkpatrick, certain system factors may be present in the working environment of the nurse that may affect the ability of the nurse to provide quality palliative care, for example, shortage of medications, congestion at work and work tension among others.

Importance of the Shared Theory

The shared theory is important since it  According to Kirkpatrick et al., palliative care nursing interventions in the shared theory benefits patients by improving the quality of life and the overall symptom management. Provision of quality palliative care also creates a beneficial therapeutic nurse-patient/ family relationship.

Applications

Shared theory has been put into practice by the palliative care nurses in different cases such as: it has been applied in  creating a therapeutic patient/ family/ nurse relationship through quality palliative care which benefits all the parties. The patient benefits from improved symptom management and better quality of life. The family benefits from grief coping strategies and the nurses benefit from improved self-awareness, self-competence and knowledge and skills. Another example of the application of the shared theory is in the identifying the anticipated emotional reactions of family members and friends. in this case, care providers should assess the grieving and coping mechanisms of families and come up with mechanisms that will help the affected families offer them the emotional support they need to cope with the health condition of their love one.

Conclusion

The shared theory is one of the primarily adopted concepts in palliative nursing care. Its adoption of the components of nursing metaparadigm that is nurse, patient, health and the environment has made the nurses using it achieve significant benefits. Caring for patients with life-limiting conditions using palliative care practices has helped increase the life expectancy of many of them. The shared theory has been identified as a strong framework for use in palliative nursing care due to the nursing intervention, nursing self-competence, palliative self-care behaviour, nursing competence and quality of life concepts that are attributed to it. Nurses in clinical practices may adopt this concept to help better the lives of their patients, their close family members, and friends while still maintaining the set standards and guidelines for clinical operations.