Effect-of-Life Review With Patients on Palliative Care Nurses' Practice and Views About Life and Death

Monday, 30 October 2017

Miyuki Kinoshita, MM
Miyuki Kinoshita, Ube, Japan
Noriko Watanabe, MSN
School of Medicine, Yamaguchi University, Ube, Japan
Nahoko Saita, PhD
Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
Hitomi Takemoto, MA
Department of Nursing, Tokyo Junshin University, Hachioji,Tokyo, Japan

 [Purpose] Life review is suggested to have a positive effect on end-of-life patients and family members, however, few studies have reported its effect on the nurses who conduct the reviews. We explored the effects of conducting these life reviews on nurses’ care and their views about life-and-death.

 [Methods] Following ethics review semi-structured interviews of five palliative care nurses who had experiences of providing life review therapy were conducted. The data were analyzed qualitatively by KJ Method and transcribed contents were categorized.

 [Results] The mean age of the participants was 42.6±9.7 years and the mean length of work in the palliative care ward was 7.0±4.4 years. Four categories were extracted from the interviews:

1. Desire to complete

- Clarify what they actually remained undone and assist them to complete their desires

- Forward patients’ words to the family members to promote their grief work.

- Make a timely nursing intervention

2. Differing perspectives

- Effect of life review

- Insufficient understanding of life review technique

- Different perspective towards life review therapy

3. Views about life and death

- Learn from patients how to make a medical choice and how to spend the end stage of life

- Nurses’ attitude towards their own family would not change

4. Deeper understanding

- Development of reliability leads to deeper understanding of the patients and finding better way to deal with them

 [Discussion] Nurses provided as much care as possible to assist realizing the patient and family member’s wish through life review therapy. Perhaps nurses’ knowledge that most patients are close to death influences them to strongly wish to realize patients’ wishes, and affects their nursing care. Nurses always face the death of patients, learn from patients how to make a medical choice, and how to spend the end stage of their own life. These experiences influenced their view of life-and-death, however, because they have not experienced the immediacy of death in their own family, their attitude towards their own family did not change.

Nurses recognized the positive effects of life review. These included patient and family being able to respect the patient’s way of life and being able to forget pain and suffering, while they were not confident with conducting life review therapy because they had not confirm the actual effects that patients and family felt.

Life review brought out into the open patients’ real feelings and wishes, which helped nurses develop a better understanding of patients, provide individual nursing care, and deepen the trusting relationship with patients.

 [Conclusion] Life review with patients and their family members influenced nurses’ practice and view about life-and-death. They strongly wished to assist patients and family to complete their unachieved wishes and desires, however, they were not confident with the actual effects of life review because they have not had confirmation of the benefits from patients or their families. Proving life review therapy affected nurses’ views on life-and-death and nurses had deeper understanding and developed more trusting relationships with patients and family members.