Synergising acute care and palliative care philosophies to optimise nursing care in cardiorespiratory disease

Advances in the practice of acute care medicine and nursing science have created more favourable mortality outcomes for patients with chronic cardiorespiratory disease. However, in the chronic disease illness experience, the inevitability of death is raising a dilemma, more than ever before, for the health care professional involved in delivering appropriate care to patients and their families. The appropriate time for broaching of this issue with patients and their families and determining when related intervention is required is problematic. This may be attributed to the perceived dissonance between acute and palliative care and difficulties in determining prognosis. Focus groups were conducted to assess the needs and attitudes of nurses working in acute care areas in respect of palliative care. Within these focus groups frustration was expressed by acute care nurses as to what appears to be the tensions between acute and palliative care nursing philosophies. A lack of understanding of palliative care principles was also evident. It was the concern of many clinicians that patients were often denied a good death, and that palliative care was viewed as a discrete entity in the last days of life rather than a phenomenon entrenched within the health continuum. Qualitative thematic analysis identified lack of planning and communication between patients, relatives and health care professionals as a major theme. This poster identifies the issues in the care of patients with chronic diseases within acute care environments as provided by focus groups and review of the extant literature. Issues for refinement of acute nursing practice and research priorities are identified to create a synergy between acute care and palliative care nursing philosophies.