Dr Elizabeth (Libby) Miller1, Professor Joanne Porter1, Doctor Michael Barbagallo1
1Federation University Australia, Churchill, Australia
Biography:
Elizabeth completed her nursing PhD in 2023, where she investigated the natural, built, social, and symbolic environmental factors within the acute hospital setting where people may receive bad news about their life-limiting illness. She is a Research Fellow within the Collaborative Evaluation & Research Centre at Federation University Australia, Gippsland campus, and a casual academic at Flinders University in the College of Nursing and Health Sciences.
Abstract:
Background: In regional Victoria, many palliative and end-of-life patients are cared for in acute medical wards by nurses who are often generalists. These environments are usually clinical, busy, and curative-focused, which is at odds with the palliative approach and the wishes of patients with palliative care needs and their families. In addition, sensitive diagnostic/prognostic and end-of-life conversations occur within these environments.
Aims: The study explored how nurses in a regional hospital medical ward create a therapeutic environment for family meetings and patient and family care for people with palliative and end-of-life care needs.
Methods: A qualitative, exploratory case study, informed by the Therapeutic Landscapes framework, was designed to explore the relationship between the built, natural, social, and symbolic environments. After obtaining ethical approval, data was collected at a private regional hospital using observation, field notes, and semi-structured interviews with registered nurses. Tools were created to gather the observational data, and interviewers were analysed using reflexive thematic analysis.
Results: Observational data showed the medical ward was quiet and calm, with views and access to nature. A large double room with a bed for the family was prioritised, and personalisation was encouraged. During a family meeting, the researcher observed that home-like ambience and aesthetics changed how the family interacted with their environment. Three major and nine minor themes were developed from the interviews describing the nurses’ holistic care and how they helped to create a therapeutic environment and therapeutic family meetings.
Conclusion: While the researcher observed a difference in ambience and aesthetics between three different family meeting environments, further research is needed to understand the perception of patients and families as to whether a home-like environment impacts the receipt of bad news during a family meeting.