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Caring for families of the terminally ill in Malaysia from palliative care nurses' perspectives.

AIMS AND OBJECTIVES
To describe the process that nurses experienced in engaging with families in Malaysian palliative care settings and the challenges they faced.


BACKGROUND
In palliative care settings, nurses and the terminally ill person's family members interact very closely with each other. It is important for nurses to work with families to ensure that the care of the terminally ill person is optimised.


RESEARCH DESIGN
A qualitative design using grounded theory methods was used to describe how nurses engaged with families and the challenges they faced.


METHODS
Twenty-two nurses from home care and inpatient palliative care settings across Malaysia participated in this study. Data were collected through seven interviews and eight focus group discussions conducted between 2007-2009.


RESULTS
The main problem identified by nurses was the different expectations to patient care with families. The participants used the core process of Engaging with families to resolve these differences and implemented strategies described as Preparing families for palliative care, Modifying care and Staying engaged to promote greater consistency and quality of care. When participants were able to resolve their different expectations with families, these resulted in positive outcomes, described as Harmony. However, negative outcomes of participants not being able to resolve their different expectations with families were Disharmony.


CONCLUSIONS
This study highlights the importance of engaging and supporting families of the terminally ill as well as providing a guide that may be used by nurses and carers to better respond to families' needs and concerns.


RELEVANCE TO CLINICAL PRACTICE
The study draws attention to the need for formal palliative care education, inclusive of family care, to enable nurses to provide the terminally ill person and their family effective and appropriate care.