| 1. |
- Öhlén, Joakim, 1958, et al.
(författare)
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Strategies for knowledge translation of a palliative approach outside specialized palliative care services: a scoping review.
- 2022
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Ingår i: BMC Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Research suggests palliative care to be translated and integrated in non-specialized palliative care services throughout the palliative care continuum across populations and settings. A need has been identified to build on the existing research literature in order to design strong knowledge translation strategies that can be evaluated in future research. The aim was to map strategies for knowledge translation of a palliative approach to care into non-specialized palliative care services for adult patients. The objectives were to explore the primary research activities, the specific type of knowledge translation strategies used, the research designs and study settings for such evaluations along with the major results thereof, and to identify major research gaps in this area.A scoping review was performed to map the volume and characteristics of research literature (project registered in PROSPERO #2018 CRD42018100663). The ten-year period 2010 to 2019 was searched in six major databases for original articles published in English in which the knowledge translation of a palliative approach for adult patients was evaluated in non-specialized palliative healthcare settings, and all type of empirical data-based research designs. We excluded non-English, non-empirical articles, non-evaluation of knowledge translations, specialized palliative care settings, and other types of publications (i.e. non-original articles).Most of the 183 included articles focused on patients with cancer who were dying in hospitals and in high income countries. Only 13 articles focused on early palliative care. A palette of different strategies was used to implement palliative care in non-specialist palliative settings; no strategy was identified as outstanding. The majority of the articles had unspecified essential components of the research designs.Previous suggestions for utilization of implementation science for knowledge translation of a palliative approach to care into non-specialized palliative care services are confirmed, and established knowledge translation theories can strengthen the field. To advance this specific field of knowledge, meticulously detailed reporting of studies is required as related to research designs, clarifications of contextual influences and mechanisms at work. Specific systematic reviews and meta-syntheses in the field are merited.
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| 2. |
- Hamdan Alshehri, Hanan, et al.
(författare)
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Adaptation of a Palliative Care Approach in the Context of Intensive Care: A Systematic Literature Review
- 2019
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Ingår i: 16th Word Congress of the European Association for Palliative Care (EAPC). Berlin, May 23-25, Abstract P02-385. Palliative Medicine, vol. 33, issue 1. - : SAGE Publications.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Palliative care is assumed to be an integral part of care in Intensive Care Units (ICU), yet, research still indicates lack knowledge about how to adapt, integrate and adopt palliative care in curative focused contexts such as in intensive care. Aim To identify factors influencing the integration of a palliative care approach in the context of ICU. Method A systematic review based on quantitative and qualitative studies using a thematic synthesis of the articles was performed. The following search term were used: Implementation, palliative care and ICU. In total 1843 articles were screened, and 25 articles were eligible for this review. Result: The findings show that the influencing factors for integrating a palliative care approach are multifaceted. Themes were identified; facilitators and barriers for implementation and adaptation on organizational level (facilitating policies and environmental support, care pathways, prognostication , multidisciplinary team, training and education) and interpersonal level (communication conflict, emotional and spiritual support, person-centred care and patient and family involvement). Conclusion To adopt a palliative care approach into the ICU setting, the integration process requires adaption of organizational support and personal beliefs and attitudes within the entire multi-professional team including the manager as well as patient and family.
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| 3. |
- Hamdan Alshehri, Hanan, et al.
(författare)
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Attitudes towards death and dying among intensive care professionals: A cross-sectional design evaluating culture-related differential item functioning of the frommelt attitudes toward care of the dying instrument.
- 2023
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Ingår i: Heliyon. - 2405-8440. ; 9:8
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Tidskriftsartikel (refereegranskat)abstract
- The objective is to examine whether one of the most used instruments for measuring attitudes towards caring for dying patients, the Frommelt Attitude Toward Care of the Dying (FATCOD-B) instrument, has the same meaning across different societal contexts, as exemplified by Swedish and Saudi Arabian intensive care professionals.A cross-sectional design used the 30-item FATCOD-B questionnaire. It was distributed to intensive care professionals from Sweden and Saudi Arabia, generating a total sample of 227 participants. Ordinal logistic regression models were used to examine the differential item functioning (DIF) for each item.Up to 12 of the 30 items were found to have significant DIF values related to: (a) Swedish and Saudi Arabian intensive care professionals, (b) Swedish and Saudi Arabian registered nurses (RNs), (c) RNs' levels of experience and (d) RNs and other intensive care professionals in Saudi Arabia.The results indicate that FATCOD should be used cautiously when comparing attitudes towards death and dying across different societal and healthcare contexts.
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| 4. |
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| 5. |
- Hamdan Alshehri, Hanan, et al.
(författare)
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Factors influencing the integration of a palliative approach in intensive care units: a systematic mixed-methods review.
- 2020
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Ingår i: BMC Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- While a palliative approach is generally perceived to be an integral part of the intensive care unit (ICU), the provision of palliative care in this setting is challenging. This review aims to identify factors (barriers and facilitators) influencing a palliative approach in intensive care settings, as perceived by health care professionals.A systematic mixed-methods review was conducted. Multiple electronic databases were used, and the following search terms were utilized: implementation, palliative care, and intensive care unit. In total, 1843 articles were screened, of which 24 met the research inclusion/exclusion criteria. A thematic synthesis method was used for both qualitative and quantitative studies.Four key prerequisite factors were identified: (a) organizational structure in facilitating policies, unappropriated resources, multi-disciplinary team involvement, and knowledge and skills; (b) work environment, including physical and psychosocial factors; (c) interpersonal factors/barriers, including family and patients' involvement in communication and participation; and (d) decision-making, e.g., decision and transition, goal conflict, multidisciplinary team communication, and prognostication.Factors hindering the integration of a palliative approach in an intensive care context constitute a complex interplay among organizational structure, the care environment and clinicians' perceptions and attitudes. While patient and family involvement was identified as an important facilitator of palliative care, it was also recognized as a barrier for clinicians due to challenges in shared goal setting and communication.
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| 6. |
- Hamdan Alshehri, Hanan, et al.
(författare)
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Healthcare Professionals’ Perspective on Palliative Care in Intensive Care Settings: An Interpretive Descriptive Study
- 2022
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Ingår i: Global Qualitative Nursing Research. - : SAGE Publications. - 2333-3936. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- There is a growing need to integrate palliative care into intensive care units and to develop appropriate knowledge translation strategies. However, multiple challenges persist in attempts to achieve this objective. In this study, we aimed to explore intensive care professionals’ perspectives on providing palliative and end-of-life care within an intensive care context. We used an interpretive description approach and interviewed 36 intensive care professionals at four hospitals in Saudi Arabia. Our findings reflect a discourse about end-of-life care driven by a do-not-resuscitate classification and challenges associated with family involvement in care goals. We provide key insights of importance for the development of strategies for the integration and knowledge translation of palliative care into intensive care contexts.
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| 7. |
- Hamdan Alshehri, Hanan, et al.
(författare)
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Managerial and organisational prerequisites for the integration of palliative care in the intensive care setting: A qualitative study.
- 2021
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 1365-2834 .- 0966-0429. ; 29:8, s. 2715-2723
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Tidskriftsartikel (refereegranskat)abstract
- To explore the association of organizational structures when integrating palliative care in intensive care units.Palliative care within intensive care settings has been widely recognized as an area requiring improvement when caring for patients and their families. Despite this, intensive care units continue to struggle to integrate palliative care.A qualitative descriptive methodology was used. Data were collected through research interviews with 15 managers and 36 health care professionals working in intensive care. The data were analysed adopting constant comparative analysis.This study provides insight into a diverse range of perspectives on organizational structure in the context of facilitation and the challenges posed. Three themes were identified: Do not resuscitate policy as a gateway to palliative care, facilitating family members to enable participation and support and barriers for palliative care in intensive care unit as a result of intensive care organization.In fostering a sustainable organizational culture and practice development in intensive care, the findings indicate the need for specific palliative care policies and implementation strategies tailored according to context.Management has a responsibility to facilitate dialogue within any multidisciplinary team regarding palliative care and, in particular, to focus on 'do not resuscitate' policies as a gateway into this conversation.
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| 8. |
- Hamdan Alshehri, Hanan
(författare)
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Prerequisites for palliative care provision in intensive care
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Palliative care provision is aimed at improving patients’ quality of life when cure no longer possible through healthcare systems, including intensive care. It has been ob-served that ongoing challenges exist concerning integration of palliative care into inten-sive care contexts. This necessitates an understanding of the contextual facilitators and barriers. The overall aim of this thesis therefore was to explore the prerequisites of palli-ative care provision in intensive care contexts. A multimethod approach was employed, including a systematic review, intensive care professionals and managers interviews, as well as a psychometric evaluation of an instrument with potential to be used for as-sessing intensive care professionals’ attitudes in a future evaluation of a knowledge translation strategy. Study I is a mixed-method systematic review identifying factors influencing the integration of palliative approaches in intensive care units. The review included a total of 24 qualitative and quantitative studies and the findings indicated that the prerequisite factors were (a) an organizational structure that facilitates policies and environmental dimensions, and (b) interpersonal factors/barriers, related to the patient and the patient’s family, including decision making, multidisciplinary team communi-cation, and prognostication. Study II is an interpretive description design study in-volving interviews with 36 intensive care professionals, and was designed to explore their perspectives on the provision of palliative care within intensive care settings. The findings illuminated intensive care professionals’ perceptions of palliative care within intensive care contexts, their decision-making related to goals for care strategies, and the challenges pertaining to family involvement in care goals. Study III is an interpretive description study exploring the association of organizational structures when integrating palliative care within an intensive care units. The study included interviews with 15 managers and 36 intensive care professionals. The findings show a ‘do not resuscitate’ policy as a gateway to palliative care, facilitating family members to enable to participa-tion and support, while barriers to palliative care in the intensive care units exists in the way intensive care is organized. In study IV, a cross-sectional design was applied to measure the differential item functioning of the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale. A convenience sampling method was used, recruiting partici-pants from both Sweden and Saudi Arabia professionally working in intensive care contexts. Ordinal logistic regression was undertaken to investigate potential differences in the perceptions of the items between different professional groups and in different geographical locations. The results establish that 12 out of 30 items in the FATCOD had significant differential item functioning among the groups. The conclusion derived from this thesis enhances our understanding of the facilitators and barriers of palliative care initiatives, as it illuminates the importance of acknowledging attitudes of death and dying within the professional groups in ways that go beyond the “do not resuscitate (DNR)” decision making as a gatekeeping process and considers the potential of inte-grating a palliative approach in intensive care.
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