Presence and the paradox of time for palliative care clinicians: a phenomenological study

Authors

  • Melanie Vachon Département de psychologie Université du Québec à Montréal Maison Au Diapason
  • Christine Goyette
  • Alexandra Guité-Verret

DOI:

https://doi.org/10.26443/ijwpc.v7i2.238

Keywords:

Presence, Palliative care clinicians, Meaning, Connection, Temporality, Mindfulness, Interpretative phenomenological analysis

Abstract

Background: A presence of quality is recognized as a central competence for palliative care clinicians in their mission to accompany patients and families in their end-of-life journey. However, PC clinicians’ capacity for presence may be affected by the increasing emotional, professional and organizational demands of their working environment. Those demands may, in turn, affect quality of care and clinicians’ health. To our knowledge, no previous study has aimed at a better understanding of how PC clinicians view and experience presence in their day-to-day work, although this holds the potential of generating insights to help clinicians develop and cultivate a high-quality presence towards dying patients.

Methods: We conducted in-depth qualitative semi-structured interviews with 10 PC clinicians working on a specialized PC ward, later analyzed using Interpretative Phenomenological Analysis.

Results: Results account for three essential themes describing the experience of presence; connection to the self, to the other and to the meaning of care. Results also suggest that presence was lived and experienced within a very particular relation to time, which appeared to our participants as a significant challenge in achieving high-quality presence.

Conclusion: The stressful working environment in which PC clinicians daily evolve appeared as a threat to presence for our participants. Paradoxically, cultivating presence with mindfulness may be a promising tool to better cope with the competing demands of work and to foster clinicians’ resilience to stress.

Author Biographies

Melanie Vachon, Département de psychologie Université du Québec à Montréal Maison Au Diapason

Professor

Christine Goyette

PhD in psychology

Alexandra Guité-Verret

MA

References

World Health Organization. Global Atlas of Palliative Care at the End of Life. London: The Alliance; 2014 [cited 2019 Nov 18]. 111 p. Available from: https://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf

Chalifour J. La présence est au cœur de l’accompagnement des personnes en fin de vie. Les cahiers de soins palliatifs. 2005;6(1):5-43.

Du Plessis E. Presence as a personal project in palliative care: transcending personality. Nurs Palliat Care. 2016;2(1):1-2. DOI: 10.15761/NPC.1000137

Ministère de la santé et des services sociaux du Québec. Plan directeur de développement des compétences des intervenants en soins palliatifs. Québec: Le Ministère; 2008 [cited 2019 Nov 18]. 75 p. Available from: https://publications.msss.gouv.qc.ca/msss/fichiers/2008/08-902-03.pdf

Fillion L, Saint-Laurent L, Rousseau N. Les stresseurs liés à la pratique infirmière en soins palliatifs: Les points de vue des infirmières. Les cahiers de soins palliatifs. 2003;4(1):5-40.

Vachon M, Fillion L. Development and implementation of a resilience-based intervention to support palliative care clinicians. Journal of palliative care and nursing 2(1): 111.

https://www.elynspublishing.com/journal/article/development-and-implementation-of-a-resilience-based-intervention-to-support-palliative-care-clinicians

Fillion L, Vachon M. The costs and rewards of caring in palliative care. In Walshe C, Preston N, Johnston B, editors. Palliative Care Nursing: Principles and Evidence for Practice. 3rd ed. London: Open University Press; c2018. p. 340-63.

Kavalieratos D, Siconolfi DE, Steinhauser KE, Bull J, Arnold RM, Swetz KM, et al. “It’s like heart failure. It’s chronic…and it will kill you”: A qualitative analysis of burnout among hospice and palliative care clinicians. J Pain Symptom Manage. 2017;53(5):901-10. doi: 10.1016/j.jpainsymman.2016.12.337

Toh SG, Ang E, Devi MK. Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings. Int J Evid Based Healthc. 2012;10(2):126-41. doi: 10.1111/j.1744-1609.2012.00271.x

Fillion L, Truchon M, Robitaille MA, Desbiens JF, Gélinas C, Langlois L, et al. Stress et satisfaction des infirmières et de leur équipe soignante dans le contexte des soins palliatifs: Réflexion autour du projet SATIN II. Cah fran soins palliat. 2016;16(2):21-33.

Melvin CS. Professional compassion fatigue: what is the true cost of nurses caring for the dying? Int J Palliat Nurs. 2012;18(12):606-11. doi 10.12968/ijpn.2012.18.12.606

Koh MY, Chong PH, Neo PS, Ong YJ, Yong WC, Ong WY, et al. Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: a multi-centre cross-sectional study. Palliat Med. 2015;29(7):633-42. doi: 10.1177/0269216315575850.

Kamal A, Bull J, Wolf S, Samsa G, Ast K, Swetz KM, et al. Burnout among palliative care clinicians in the United States: results of a national survey. J Clin Oncol. 2014:32. doi: 10.1200/jco.2014.32.15_suppl.e20530

Back A, Steinhauser KE, Kamal AH, Jackson VA. Building resilience for palliative care clinicians: An approach to burnout prevention based on individual skills and workplace factors. J Pain Symptom Manage. 2016;52(2):284-91. doi: 10.1016/j.jpainsymman.2016.02.002.

Hill RC, Dempster M, Donnelly M, McCorry NK. Improving the wellbeing of staff who work in palliative care settings: a systematic review of psychosocial interventions Palliat Med. 2016;30(9):825-33. doi: 10.1177/0269216316637237.

Jacono B, Cable-Williams B, Foster C, Mitchell M, Lavoie M, Richardson H, et al. Principes et pratiques des soins infirmiers palliatifs et compétences en soins palliatifs à l'intention du personnel infirmier au Canada. Ottawa: Canadian Association of Schools of Nursing/Association canadienne des écoles de sciences infirmières; 2009 [cited 2019 Nov 18]. 16 p. Available from: https://casn.ca/wp-content/uploads/2014/12/MicrosoftWordCompetenciesDocumentFinalFR.pdf

Covington H. Caring presence. Delineation of a concept for holistic nursing. J Holist Nurs. 2003;21(3):301-17. DOI: 10.1177/0898010103254915

Easter A. Construct Analysis of Four Modes of Being Present. J Holist Nurs. 2000;18(4):362-77. doi: 10.1177/089801010001800407

Finfgeld‐Connett D. Qualitative Comparison and Synthesis of Nursing Presence and Caring. Int J Nurs Terminol Classif. 2008;19(3):111-9. doi: 10.1111/j.1744-618X.2008.00090.x.

Hain A. How expert professional nurses practice and develop nurse presence in a critical care unit: A grounded theory study [doctoral thesis]. [Ottawa (ON)]: University of Ottawa; 2007. 150 p. doi.org/10.20381/ruor-18720

Ponterotto JG. Qualitative Research in Counseling Psychology: A Primer on Research Paradigms and Philosophy of Science. J Couns Psycho. 2005;52(2):126-36.

Smith JA, Osborn M. Interpretative phenomenological analysis. In: Smith JA, editor. Qualitative psychology: A practical guide to research methods. London: Sage; c2003. p. 51-80.

Tracy SJ. Qualitative Quality: Eight “Big-Tent” Criteria for Excellent Qualitative Research. Qualitative Inquiry. 2010;16(10):837-51. doi/10.1177/1077800410383121

Favetta V, Feuillebois-Martinez B. « Prendre soin et formation infirmière ». Rech Soins Infirm. 2011;107(4):60-75. doi:10.3917/rsi.107.0060.

Sansó N, Galiana L, Oliver A, Pascual A, Sinclair S, Benito E. Palliative care professionals’ inner life: exploring the relationships among awareness, self-care and compassion satisfaction and fatigue, burn out, and coping with death. J Pain Symptom Manage. 2015;50(2):200-7. doi: 10.1016/j.jpainsymman.2015.02.013.

Epstein RM, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Acad Med. 2013;88(3):3013. doi: 10.1097/ACM.0b013e318280cff0.

Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med. 2013;88(3):382-9. doi: 10.1097/ACM.0b013e318281696b.

Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol. 2003;10(2):144-56. https://doi.org/10.1093/clipsy.bpg016

Irving JA, Dobkin PL, Park J. Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR). Complement Ther Clin Prac. 2009;15(2):61-6. doi: 10.1016/j.ctcp.2009.01.002

Quintin J. L’art de la rencontre. In Quintin J, editor. Cheminer vers soi. Hommage à Jean-François Malherbe pour son soixantième anniversaire. Montréal: Liber; c2010. p. 231-49.

Fillion L, Duval S, Dumont S, Gagnon P, Tremblay, Bairati I, et al. Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses. Psychoonc. 2009;18(12):1300-10. doi: 10.1002/pon.1513

Fillion L, Vachon M, Gagnon P. Enhancing meaning at work and preventing burnout: The meaning-centered intervention for palliative care clinicians. In Breitbart WS, editor. Meaning-Centered Psychotherapy in the Cancer Setting: Finding Meaning and Hope in the Face of Suffering. New York: Oxford University Press; c2016. p. 168-81.

Vachon M, Fillion L, Achille M. Death confrontation, spiritual-existential experience and caring attitudes in palliative care nurses: An interpretative phenomenological analysis. Qual Res Psychol 2012;9(2):151-72. doi.org/10.1080/14780881003663424

Fawcett TN, Rhynas SJ. Re-finding the ‘human side’ of human factors in nursing: Helping student nurses to combine person-centred care with the rigours of patient safety. Nurse Educ Today. 2014;34(9):1238-41. doi: 10.1016/j.nedt.2014.01.008.

Downloads

Published

2020-07-15

How to Cite

Vachon, M., Goyette, C., & Guité-Verret, A. (2020). Presence and the paradox of time for palliative care clinicians: a phenomenological study. The International Journal of Whole Person Care, 7(2), 13-25. https://doi.org/10.26443/ijwpc.v7i2.238