La pratique infirmière en soins palliatifs auprès de patients atteints de cancer au sein d'une équipe interdisciplinaire : une étude de cas au Liban

Authors: Saouma, Mona
Advisor: Desbiens, Jean-FrançoisGagnon, Johanne
Abstract: Background : Palliative care is a holistic approach, delivered by an interdisciplinary team, in order to improve the quality of life of people facing a serious and life-threatening illness. According to the World Health Organization and the Worldwide Palliative Care Alliance (2014), inequalities in training and lack of organization of palliative care in several countries have limited the development of nursing practice in this domain. Thus, this situation has led to disparities in the delivery of palliative care services between countries. In Lebanon, nurses are little prepared to deliver palliative care, and nursing practice in this domain is not well documented. Aim : This study aimed to understand nursing practice within an interdisciplinary team providing palliative care to end-of-life cancer patients in a Lebanese region. Framework : The study framework integrates three components that are the Plan directeur de développement des compétences des intervenants en soins palliatifs (Skill development plan for palliative care providers) (MSSS, 2008), the hindering and facilitating factors related to palliative care requirement, and Jean Watson’s Theory of Human Caring (1979). Methods : The descriptive qualitative research design chosen was a single case study with embedded levels of analysis. This study was conducted in an oncology unit of a hospital in an urban Lebanese region. Data was analyzed through a double triangulation of methods and sources, consisting of individual interview with the specialized palliative care nurse (n = 1) , with the head oncology nurse (n = 1), with oncology unit nurses (n= 9), with palliative care experts (n = 3), with family members of treated patients (n = 3) and group interview with healthcare professionals of the mobile support team (n = 3), analysis of relevant documents, direct non-participant observation of palliative nursing care, and the student’s research diary. Results : Five central themes emerged from nursing practice with cancer patients in an interdisciplinary team in Lebanon: 1) palliative care: a way to provide better quality of life; 2) nursing practice: holistic care for patient’s needs; 3) interdisciplinary: collaborative practice a main element for palliative care; 4) spirituality: a backdrop for nursing practice in palliative care and 5) family support: indispensable role of the nurse. Moreover, results have highlighted various hindering and facilitating factors of professional, organizational and emotional nature related to palliative care requirement. Nurses also demonstrated a humanistic relation marked with caring at the core of palliative care, which transcends all five central themes. Discussion : This study allowed shedding light on nursing practice in palliative care within an interdisciplinary team. Results could provide empirical foundations for informing the development of nursing practice in palliative care in Lebanon and ensure better end-of-life care for patients. Key words: Nursing practice, Palliative care, Interdisciplinarity, Caring, Facilitators, Barriers, Qualitative research, Case study.
Document Type: Thèse de doctorat
Issue Date: 2017
Open Access Date: 24 April 2018
Permalink: http://hdl.handle.net/20.500.11794/28129
Grantor: Université Laval
Collection:Thèses et mémoires

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