Appendix B Essay

Research

Spanish nurses' preparedness to care for hospitalised terminally ill patients and their daily approach to caring
Maria Arantzamendi, Julia Addington-Hall, Maribel Saracibar, Alison Richardson

N

urses have an essential part to play in the care of terminally ill patients, and education and training are important if this care is to be of high quality. Shortcomings are reported in the care that hospitalised terminally ill patients receive (Costello, 2001;
Ogasawara et al, 2003; Pincombe et al, 2003;
Rogers and Addington-Hall, 2005; London and
Lundstedt, 2007; Munárriz et al, 2007; Payne et al, 2007a). It could be argued that since the
1980s, when studies assessed the nature and extent of teaching about the end of life in nursing schools (Field and Kitson, 1986; Degner and
Gow, 1988), nursing education in this regard has improved. However, later studies continue to highlight a lack of education in palliative care
(Kirchhoff et al, 2000; McDonnell et al, 2002;
Davidson et al, 2003; Sasahara et al, 2003;
Graham et al, 2005; Dickinson, 2007; Johnson etal, 2009).
In a study of doctors, nurses, and other health-care workers delivering end-of-life care in six community hospitals, health professionals reported that they possessed knowledge, skills, and confidence in relation to symptom control, but had less expertise in psychological, spiritual, and bereavement care (Payne et al, 2007b).
Similarly, in another study, community hospital nurses wanted more education on alternative medicine (86%), social aspects of care (75%), and AIDS (70%) (Jeffrey, 1994). Likewise, in a
US study involving oncology nurses in four states, the nurses wished they had learnt in nursing school how to talk to patients and families about dying (30%), pain control techniques
(28%), and comfort care nursing interventions
(9%) (White et al, 2001). Responses varied according to the educational level attained: nurses with diplomas ranked 'dealing with angry patients' and 'legal issues' higher than did those with Master's degrees and/or PhDs.
Thus, nurses do not seem to feel adequately prepared to care for terminally ill patients.
However, this topic has not been* studied in

International journal of Palliative Nursing 2012, Vol 18, No 12

Abstract
Objective: To describe Spanish nurses' preparedness to care for hospitalised terminally ill patients and how this translates into care delivery. Methods: An exploratory, sequential mixed methods study with two stages. Stage I used unstructured observations of 22 hospital nurses over 235 hours to understand their daily reality, followed by semi-structured interviews with 21 nurses to elicit their perspectives.
Stage 2 was a regional survey (65% response rate) concerned with hospital nurses' opinions of caring for terminally ill patients and their perceived competence. Results: The nurses felt competent to provide physical but not emotional care for terminally ill patients. They reported that care could be improved, particularly through providing more emotional care. This coincided v^ith an observed focus on physical care. The nurses reported a lack of support in caring for terminally ill patients and wanted more education on emotional issues and dealing with their own feelings. Conclusion: There is a need for an integrative approach in Spain that combines an educational programme with a supportive environment, focusing on developing nurses' competence to deliver emotional care and deal with their own feelings. Promoting a supportive environment might enable nurses to change their behaviour when caring for terminally ill patients and deal with patients' emotional as well as physical needs.
Key words: Palliative care • Nursing education • Competence
• Hospital nurses • Mixed method

sufficient depth, certainly not in countries other than the UK and USA. Moreover, studies have considered nurses' own comments but have failed to collect observational data about the repercussions of such inadequacies in relation to the

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