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Be known, be available, be mutual: a qualitative ethical analysis of social values in rural palliative care.

https://arctichealth.org/en/permalink/ahliterature130916
Source
BMC Med Ethics. 2011;12:19
Publication Type
Article
Date
2011
Author
Barbara Pesut
Joan L Bottorff
Carole A Robinson
Author Affiliation
School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada. barb.pesut@ubc.ca
Source
BMC Med Ethics. 2011;12:19
Date
2011
Language
English
Publication Type
Article
Keywords
Canada
Ethical Analysis
Health Policy - trends
Health Services Accessibility - ethics - standards - trends
Health services needs and demand
Humans
Palliative Care - ethics - trends
Qualitative Research
Rural Population
Social Values - ethnology
Abstract
Although attention to healthcare ethics in rural areas has increased, specific focus on rural palliative care is still largely under-studied and under-theorized. The purpose of this study was to gain a deeper understanding of the values informing good palliative care from rural individuals' perspectives.
We conducted a qualitative ethnographic study in four rural communities in Western Canada. Each community had a population of 10, 000 or less and was located at least a three hour travelling distance by car from a specialist palliative care treatment centre. Data were collected over a 2-year period and included 95 interviews, 51 days of field work and 74 hours of direct participant observation where the researchers accompanied rural healthcare providers. Data were analyzed inductively to identify the most prevalent thematic values, and then coded using NVivo.
This study illuminated the core values of knowing and being known, being present and available, and community and mutuality that provide the foundation for ethically good rural palliative care. These values were congruent across the study communities and across the stakeholders involved in rural palliative care. Although these were highly prized values, each came with a corresponding ethical tension. Being known often resulted in a loss of privacy. Being available and present created a high degree of expectation and potential caregiver strain. The values of community and mutuality created entitlement issues, presenting daunting challenges for coordinated change.
The values identified in this study offer the opportunity to better understand common ethical tensions that arise in rural healthcare and key differences between rural and urban palliative care. In particular, these values shed light on problematic health system and health policy changes. When initiatives violate deeply held values and hard won rural capacity to address the needs of their dying members is undermined, there are long lasting negative consequences. The social fabric of rural life is frayed. These findings offer one way to re-conceptualize healthcare decision making through consideration of critical values to support ethically good palliative care in rural settings.
Notes
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Cites: Rural Remote Health. 2007 Apr-Jun;7(2):64117477793
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Cites: Int J Palliat Nurs. 2000 Feb;6(2):80-9011035627
PubMed ID
21955451 View in PubMed
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Defining and measuring a palliative approach in primary care.

https://arctichealth.org/en/permalink/ahliterature106146
Source
Can Fam Physician. 2013 Nov;59(11):1149-50
Publication Type
Article
Date
Nov-2013
Author
Joshua D Shadd
Fred Burge
Kelli I Stajduhar
S Robin Cohen
Mary Lou Kelley
Barbara Pesut
Author Affiliation
Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, London, ON N6A 3K7. joshua.shadd@schulich.uwo.ca.
Source
Can Fam Physician. 2013 Nov;59(11):1149-50
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Canada
Humans
Palliative Care - methods - organization & administration
Primary Health Care - methods - organization & administration
Notes
Cites: J Palliat Care. 2006 Summer;22(2):115-617265665
Cites: Palliat Med. 2002 Nov;16(6):457-6412465692
Cites: CMAJ. 2012 Sep 4;184(12):E643-422847965
Cites: Palliat Med. 2007 Jul;21(5):409-1517901100
Cites: Can Fam Physician. 2001 Oct;47:2009-12, 2015-611723595
PubMed ID
24235182 View in PubMed
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Experiences of rural family caregivers who assist with commuting for palliative care.

https://arctichealth.org/en/permalink/ahliterature143994
Source
Can J Nurs Res. 2010 Mar;42(1):74-91
Publication Type
Article
Date
Mar-2010
Author
Sharon J Lockie
Joan L Bottorff
Carole A Robinson
Barbara Pesut
Author Affiliation
Okanagan College, Kalamalka, Vernon, and Salmon Arm campuses, British Columbia, Canada.
Source
Can J Nurs Res. 2010 Mar;42(1):74-91
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
British Columbia
Caregivers
Family Health
Female
Humans
Male
Medically underserved area
Middle Aged
Neoplasms - therapy
Palliative Care
Qualitative Research
Rural Health Services
Travel
Abstract
Commuting for advanced cancer care is an important option for rural patients who require palliative treatment.The purpose of this qualitative descriptive study was to investigate the experiences of rural family palliative caregivers (FPCs) who supported advanced cancer patients receiving palliative treatment at a regional cancer centre. Semi-structured interviews were conducted with 15 FPCs (27-73 years of age) who commuted with family members. Rural life, the multiple responsibilities borne by FPCs, the availability of support networks, and the culture of the regional cancer centre were all relevant contextual factors.The dedication of FPCs to making the commuting experience as positive as possible for the patient was the central theme. Subthemes were planning ahead to prepare for all possibilities, experiences on the road, the toll of commuting on FPCs, and making the best of it. The authors offer recommendations for self-care, nursing practice, and future research.
PubMed ID
20420093 View in PubMed
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Hospitable hospitals in a diverse society: from chaplains to spiritual care providers.

https://arctichealth.org/en/permalink/ahliterature140849
Source
J Relig Health. 2012 Sep;51(3):825-36
Publication Type
Article
Date
Sep-2012
Author
Barbara Pesut
Sheryl Reimer-Kirkham
Richard Sawatzky
Gloria Woodland
Perry Peverall
Author Affiliation
School of Nursing FIN 344, University of British Columbia Okanagan, 3333 University Way, Kelowna, BC, V1V 1V7, Canada. barb.pesut@ubc.ca
Source
J Relig Health. 2012 Sep;51(3):825-36
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Aged
Canada
Chaplaincy Service, Hospital
Cultural Diversity
Female
Humans
Male
Middle Aged
Professional Role
Qualitative Research
Spirituality
Volunteers
Abstract
The chaplain's role in health care services has changed profoundly within the contexts of managerial and fiscal constraints, and increasingly pluralistic and secularized societies. Drawing from a larger study that examined religious and spiritual plurality in health care, we present findings regarding the contributions of chaplains or spiritual care providers (SCPs) as they are referred to more recently, in Canadian institutional health care contexts. Qualitative analyses of interviews with 14 employed SCPs and 7 volunteers provided insights about legitimizing and crafting the role of SPCs, becoming part of the health care team, and brokering diversity. Implications are discussed in relation to role clarification and policy development for truly hospitable health care.
PubMed ID
20838896 View in PubMed
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Incorporating patients' spirituality into care using Gadow's ethical framework.

https://arctichealth.org/en/permalink/ahliterature150282
Source
Nurs Ethics. 2009 Jul;16(4):418-28
Publication Type
Article
Date
Jul-2009
Author
Barbara Pesut
Author Affiliation
University of British Columbia Okanagan, FIN 344 Faculty of Health and Social Development, Kelowna, BC, V1V 1V7, Canada. barb.pesut@ubc.ca
Source
Nurs Ethics. 2009 Jul;16(4):418-28
Date
Jul-2009
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Attitude to Death - ethnology
Attitude to Health - ethnology
Canada
Codes of Ethics
Conscious Sedation - ethics - nursing
Female
Health Knowledge, Attitudes, Practice
Humans
Models, Nursing
Moral Obligations
Negotiating
Nurse's Role
Palliative Care - ethics - organization & administration
Patient Advocacy - ethics
Philosophy, Nursing
Principle-Based Ethics
Religion and Psychology
Spirituality
Transcultural Nursing - ethics - organization & administration
Abstract
Incorporating patients' spiritual beliefs into health care decision making is essential for ethically good care. Gadow's three-level ethical framework of ethical immediacy, ethical universalism, and relational narrative is presented as a tool for enhancing nurses' ability to explore and deepen understandings of patients' spiritual beliefs, given that these and their experiences are often expressed in a language that seems foreign to nurses. The demographic and cultural shifts that lead to the necessity to understand patients who use principles and metaphors that, while commonly understood within their spiritual tradition, may seem incomprehensible to outsiders, are here set in the Canadian context. A case study on palliative sedation is used to illustrate how the ethical framework can help to reveal the spiritual certainties, principles and narratives patients bring to their health care experiences.
PubMed ID
19528099 View in PubMed
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Issues in rural palliative care: views from the countryside.

https://arctichealth.org/en/permalink/ahliterature145794
Source
J Rural Health. 2010;26(1):78-84
Publication Type
Article
Date
2010
Author
Carole A Robinson
Barbara Pesut
Joan L Bottorff
Author Affiliation
Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.
Source
J Rural Health. 2010;26(1):78-84
Date
2010
Language
English
Publication Type
Article
Keywords
Aging
British Columbia
Clinical Competence - statistics & numerical data
Focus Groups
Health Services for the Aged - statistics & numerical data
Hospice Care - statistics & numerical data
Humans
Palliative Care - statistics & numerical data
Rural Health Services - statistics & numerical data
Rural Population - statistics & numerical data
Tape Recording
Abstract
Growing concern exists among health professionals over the dilemma of providing necessary health care for Canada's aging population. Hospice palliative services are an essential need in both urban and rural settings. Rural communities, in particular, are vulnerable to receiving inadequate services due to their geographic isolation.
To better understand experiences and issues related to rural palliative care.
Focus groups were held for health professionals, family members and volunteers in 3 rural British Columbia communities. A coding schema was developed and the data were then thematically analyzed using a constant comparison technique.
Three themes in rural palliative care were established: nature of palliative health care services, nature of rural relationships, and competencies required for rural palliative care. Findings indicated that the diversity in rural communities requires tailored approaches to palliative care that consider the geographic, cultural and health aspects of residents in order to optimize care.
Tailored approaches to palliative care developed in conjunction with rural communities are needed in order to optimize care.
PubMed ID
20105272 View in PubMed
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New graduate nurse practice readiness: perspectives on the context shaping our understanding and expectations.

https://arctichealth.org/en/permalink/ahliterature148980
Source
Nurse Educ Today. 2010 Feb;30(2):187-91
Publication Type
Article
Date
Feb-2010
Author
Angela C Wolff
Barbara Pesut
Sandra Regan
Author Affiliation
Professional Practice and Integration, Fraser Health Authority, Surrey, British Columbia, Canada V3T 5X3. angela.wolff@fraserhealth.ca
Source
Nurse Educ Today. 2010 Feb;30(2):187-91
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
British Columbia
Clinical Competence
Education, Nursing, Baccalaureate
Educational Measurement
Female
Focus Groups
Humans
Male
Physician's Practice Patterns
Questionnaires
Social Perception
Students, Nursing
Young Adult
Abstract
Workforce shortages, fiscal restraint, complex healthcare organizations, increasing patient acuity, the explosion of knowledge and technology and the ever expanding role of nurses in healthcare have reinforced the importance of new graduates arriving in the work setting with the ability to move seamlessly into practice. This idea of moving seamlessly into practice is often referred to as practice readiness. Differing perspectives exist between nurses in the practice and education sector about the practice readiness of new graduates. The aim of this study was to understand the perspectives of nurses about new graduate nurse practice readiness and the underlying context shaping these perspectives. Focus groups involving 150 nurses with varying years of experience in the practice, education and regulatory sector were conducted. The findings revealed that participants' expectations and understandings of new graduate practice readiness were influenced by the historical and social context within which nursing education and professional practice is grounded. These differences centered around three main areas: the educational preparation of nurses (diploma or degree), the preparation of the technical versus the professional nurse, and the perceived responsibilities and accountabilities of the education and practice sector for the educational preparation of nurses. To shift the discourse around practice readiness, nurses from all sectors must focus on unique, innovative and cooperative solutions to ensure the seamless transition of all nursing graduates in the 21st century healthcare system.
PubMed ID
19699561 View in PubMed
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On the road again: patient perspectives on commuting for palliative care.

https://arctichealth.org/en/permalink/ahliterature144741
Source
Palliat Support Care. 2010 Jun;8(2):187-95
Publication Type
Article
Date
Jun-2010
Author
Barbara Pesut
Carole A Robinson
Joan L Bottorff
Gillian Fyles
Sandra Broughton
Author Affiliation
School of Nursing, University of British Columbia Okanagan, Kelowna British Columbia, Canada. barb.pesut@ubc.ca
Source
Palliat Support Care. 2010 Jun;8(2):187-95
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Aged
Attitude to Health
British Columbia
Cancer Care Facilities
Cost of Illness
Female
Health Care Surveys
Health services needs and demand
Hospitals, Urban
Humans
Income - statistics & numerical data
Life Style
Male
Medically underserved area
Middle Aged
Neoplasms - psychology - therapy
Palliative Care - organization & administration - psychology
Qualitative Research
Questionnaires
Rural Population - statistics & numerical data
Terminally Ill - psychology - statistics & numerical data
Transportation - economics - methods
Abstract
The aim of this research project was to gain an understanding of the experiences of rural cancer patients who commute to an urban cancer center for palliative care.
The study utilized a mixed method design. Fifteen individuals with a palliative designation participated in semi-structured interviews and filled out the Problems and Needs in Palliative Care Questionnaire.
Qualitative findings included three major themes: cultures of rural life and care, strategies for commuting, and the effects of commuting. Participants valued their rural lifestyles and gained significant support from their communities. Strategies included preparing for the trip with particular attention to pain management, making the most of time, and maintaining significant relationships. Establishing a routine helped to offset the anxiety of commuting. Commuting was costly but the quality of life and supportive relationships obtained through treatment were significant benefits. Questionnaire data suggested that participants were experiencing a number of problems but few indicated they desired more professional attention to those problems.
Rural lifestyles are often an important part of overall well-being and commuting for care is both costly and complex. Health care providers should assist individuals to weigh the relative contributions of staying in their rural locale versus commuting for care to their overall quality of life. Palliative-care individuals in this study indicated a number of ongoing problems but were not inclined to seek further assistance from health care providers in addressing those problems. Clinicians should actively inquire about problems and further research is needed to understand why patients are reluctant to seek help.
PubMed ID
20307369 View in PubMed
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Ready for what? An exploration of the meaning of new graduate nurses' readiness for practice.

https://arctichealth.org/en/permalink/ahliterature145128
Source
Int J Nurs Educ Scholarsh. 2010;7:Article7
Publication Type
Article
Date
2010
Author
Angela C Wolff
Sandra Regan
Barbara Pesut
Joyce Black
Author Affiliation
Fraser Health Authority. a.wolff@shaw.ca
Source
Int J Nurs Educ Scholarsh. 2010;7:Article7
Date
2010
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
British Columbia
Clinical Competence - standards
Education, Nursing, Continuing
Faculty, Nursing
Focus Groups
Health Knowledge, Attitudes, Practice
Health services needs and demand
Humans
Inservice training
Judgment
Licensure, Nursing
Nurse Administrators - psychology
Nurse's Role - psychology
Nursing Methodology Research
Nursing Staff - education - psychology
Preceptorship
Qualitative Research
Questionnaires
Safety
Thinking
Abstract
Dialogue continues on the "readiness" of new graduates for practice despite significant advancements in the foundational educational preparation for nurses. In this paper, the findings from an exploratory study about the meaning of new graduate "readiness" for practice are reported. Data was collected during focus group interviews with one-hundred and fifty nurses and new graduates. Themes were generated using content analysis. Our findings point to agreement about the meaning of new graduate nurses' readiness for practice as having a generalist foundation and some job specific capabilities, providing safe client care, keeping up with the current realities of nursing practice, being well equipped with the tools needed to adapt to the future needs of clients, and possessing a balance of doing, knowing, and thinking. The findings from this exploratory study have implications for policies and programs targeted towards new graduate nurses entering practice.
Notes
Erratum In: Int J Nurs Educ Scholarsh. 2010;7(1). doi: 10.2202/1548-923X.1827
PubMed ID
20196766 View in PubMed
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Rural nursing and quality end-of-life care: palliative care ... palliative approach ... or somewhere in-between?

https://arctichealth.org/en/permalink/ahliterature121246
Source
ANS Adv Nurs Sci. 2012 Oct-Dec;35(4):288-304
Publication Type
Article
Author
Barbara Pesut
Barbara McLeod
Rachelle Hole
Miranda Dalhuisen
Author Affiliation
School of Nursing, University of British Columbia, British Columbia, Canada. barb.pesut@ubc.ca
Source
ANS Adv Nurs Sci. 2012 Oct-Dec;35(4):288-304
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Canada
Caregivers - supply & distribution - utilization
Female
Health Services Accessibility
Humans
Male
Middle Aged
Nurse's Role
Nursing Care - methods - psychology
Palliative Care
Professional-Family Relations
Qualitative Research
Quality of Health Care
Rural Health Services
Terminal Care
Abstract
Secondary analysis of data from 2 studies examining palliative care in rural areas was conducted with the aim to better understand how a nursing palliative approach influences quality outcomes at end-of-life. Nurses' ways of being that brought connection and comfort at end-of-life included paying attention to time, privacy, and family support. The rural context with its geography, relationships, and unique resources influenced nurses' abilities to enact a palliative approach. Findings demonstrate that urban-centric models of palliative care do not fit well in rural nursing practice and highlight the importance of understanding the rural context.
PubMed ID
22926049 View in PubMed
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11 records – page 1 of 2.