Influencing the Culture of Care: The Nursing Role
Repository Posting Date2012-01-11T11:04:51Z
Author(s)Baney, Brenda L.; McGhan, Gwen; Penrod, Janice
Author DetailsBrenda L. Baney, BS; Gwen McGhan RN, MN; Janice Penrod PhD, RN
(41st Biennial Convention) Operating as an organization or functional structure, specialty clinics serving patients at the end-of-life are inherent to a culture of care, a set of shared attitudes, values, goals, and practices that influence interactions between informal and formal caregivers and shape the caregiving experience. To address a major objective of the National Consensus Project for Quality Palliative Care, it is critical to shift the culture of care delivery systems toward one that embraces palliative care strategies in treatment of those with life-limiting or chronic debilitating illness. To achieve this objective, core values espoused in palliative care must be infused into settings serving those with advanced illness. One such value is the integration of informal caregivers as both co-providers and co-recipients of care. Indicative of the culture, formal caregivers signal their beliefs regarding the importance of family-centered approaches in holistic end-of-life care. These signals guide the communication at the informal/formal caregiver interface. Ethnographic methods were utilized to fully understand the culture in specialty clinics providing end-of-life care. Researchers were immersed in three distinct specialty clinics for more than 12 months observing over 350 office visits. The ethnographic inquiry produced a theoretical frame for understanding the culture of care in each clinic. Five key characteristics of the culture of care were identified: Context of the Illness, Role of the Formal Caregiver, Perception of the Patient System, Focus of the Visit, and Continuum of Care across the Trajectory. These key characteristics are interdependent, co-occurring spheres of influence which form the culture in three care delivery models. Through sustained and consistent efforts, nurses can shape these co-occurring spheres, shifting the culture of care and infusing palliative strategies into settings serving informal caregivers providing care at the end of life.