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Today, more people are surviving cancer as a result of improved treatment and early diagnosis. In Australia, the 5-year survival rate for persons diagnosed with cancer is now approaching 50%. Although there is a growing population of cancer survivors, little is known about what surviving entails. Traditionally, a survivor has been defined as one who has been disease-free for more than 5 years. However, this definition does not take into account the experience nor the process of survival and the aim of this article is to document the process of surviving cancer as reflected in the experiences of cancer survivors. Using a method of hermeneutic phenomenology (as described by van Manen), the study draws on the stories of six women, who by their definition, are surviving cancer. A discussion of themes has been structured according to the everyday experiences of living in a body and living in time. The women describe a survival process that includes: 'feeling whole again'; 'the body as the house of suspicion'; 'the future in question'; 'changes in time'; 'lucky to be alive'; and 'sharing the journey'. [ABSTRACT FROM AUTHOR]

Objective: The integration of end of life care into emergency work is gaining momentum, especially in Australia. Emergency doctors and nurses are increasingly required to make decisions regarding the provision of end of life care. The importance of end of life care for patients and their families in the emergency department is well documented, but ethical dilemmas that arise in end of life care provision are not widely researched., Methods: A qualitative interpretative design and phenomenological approach were used to create an understanding and meaning about ethical dilemmas faced by emergency nurses and doctors in end of life care. Sixteen doctors and nurses were purposively recruited through professional organisations. Data were collected using semi-structured in-depth interviews. Interviews were audio-taped, transcribed verbatim, and thematically analysed using a qualitative seven stage thematic analysis., Results: The overarching constitutive pattern 'decision making processes' was conceptualised within the two identified major themes including: 1) Short-term (ST) versus Long-term (LT) ethical dilemmas and; 2) Individual versus community ethical dilemmas. These themes were uncovered using the phenomenological hermeneutic concepts of epoche (openness) to construct meaning and understanding for participants., Conclusions: In this study, the frequent experiences of ethical dilemmas by emergency doctors and nurses demonstrated that end of life care in the emergency department was challenging. The stated experiences were related to barriers that contributed to the complexities reported in making ethical decisions at the end of life. Therefore, an understanding of ethical principles is needed to navigate care for patients and their families for the best possible outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: An advance care directive is a legal document outlining the wishes made by a person about treatment options. However, there is increasing evidence that an advance care directive that has previously been documented may not always benefit the current prognosis of the patient. Therefore, the aim of the present study was to explore the experiences of Australian emergency doctors and nurses concerning the use of previously documented advance care directives at the point of care for patients and their families., Methods: A qualitative study guided by a phenomenological interpretive approach was employed. Semi-structured interviews were conducted with ED doctors and nurses across Australia. Data were thematically analysed using a seven-stage data analysis framework., Results: An analysis of the interview data resulted in four major themes: (i) Benefits of Advance Care Directives; (ii) Knowledge and Awareness; (iii) Communication; and (iv) Availability of Advance Care Directive Information., Conclusions: From the findings, advance care directives were believed to be beneficial in decision making when patients, families, and ED staff agreed with the decisions made. Advance care directives were often made a long time ago but were useful to start conversations around goals of care and end-of-life care relevant to the patient's current situation. Findings in the present study further reinforced that an advance care directive was beneficial when used alongside goals of care at the point of care in EDs., (© 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Nursing is the largest workforce in health care with nurses increasingly required to work with digital health technologies. However, despite the adoption of nursing informatics in Australia in the mid-1980s, nursing graduates are not being adequately equipped to use these technologies in a way that benefits the profession and improves patient care. Using a scoping review approach, this paper presents an analysis of contemporary published literature and describes the barriers to faculty engagement with digital health technologies in undergraduate nursing education. Thirty five articles were included and identified faculty lack of understanding of nursing informatics and resistance to technologies, limited infrastructure and expenditure, and limited educational resources and best practice recommendations as significant barriers to the integration of nursing informatics into undergraduate nursing curricula. Recommendations for faculty development will be explored.

Background: End of life care in the emergency department is environmentally and culturally challenging. The aim of this study was to determine Australian emergency department doctors and nurses' perceptions of their roles in providing end of life care in this environment., Methods: Perceptions of end-of-life care roles were identified through semi-structured interviews with doctors and nurses using Dieklemann's seven interpretative stages of analysis guided by phenomenological interpretive underpinnings (hermeneutics). Nine nurses and seven doctors were recruited using purposive sampling. Organisations for emergency doctors (Australasian College for Emergency Medicine: ACEM) and emergency nurses (College of Emergency Nursing Australasia: CENA) were approached to advertise the study and recruit participants across Australia via email., Results: Results were categorised into four themes namely: role perception; the intensive nature of the role; emotional burden; and role integration. The participants stated that end of life care was provided according to their professional roles and responsibilities. Doctors and nurses had distinct tasks, some of which overlapped. The accounts of the participants in relation to their understanding of each other's roles highlighted differences in how nurses perceived the role of doctors, and vice versa. The participants spoke about aspects that had an impact on their role of practicing end of life care in the emergency department setting., Conclusions: In this study, all participants expressed concern for dying patients in the emergency department. The delivery of quality end of life care was believed to be paramount and required staff to work together to achieve the best outcome for the dying patient and their families. Regardless of the similarities and differences that were perceived within their roles, the nurses and doctors believed that their main objective was to ensure that comfort care was provided to dying patients., Competing Interests: Conflicts of interest There are no Conflict of Interest to declare for this project., (Copyright © 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.)

Aim: This scoping review aims to review contemporary published literature on Nursing Informatics education in undergraduate nursing education., Introduction: Nursing is the largest workforce in health care and nurses are increasingly required to work with digital information systems. The need for nurses to understand and embrace information technology is closely linked with the ability to function in the contemporary healthcare workplace. However, despite the early adoption of Nursing Informatics in Australia in the 1980 s, there remain barriers to Nursing Informatics engagement and proficiency, including poor computer literacy, limited professional development and a lack of undergraduate informatics education., Design: This scoping review will be developed in adherence with the JBI Manual for Evidence Synthesis: Scoping Reviews and the PRISMA-ScR Checklist., Methods: To be included in this scoping review, papers need to include Nursing Informatics education for undergraduate nursing students in a Bachelor of Nursing program. Undergraduate nursing students are defined as individuals enrolled in a recognised nursing program leading to registration as a Nurse. To meet the requirements for registration as a Registered Nurse, in Australia, individuals are required to complete a Bachelor of Nursing program at a university (Australian Qualifications Framework Level 7) For the purpose of this scoping review, undergraduate nursing students are defined as those individuals undertaking a three year Bachelor of Nursing program at a university. Equivalent international definitions will be also used in the scoping review procedure. Sources of information will be included if they were published between 2015 and 2022 and describe curriculum recommendations (including barriers to implementing Nursing Informatics education). The purpose of the identified timespan is to reflect the rapidly evolving nature of health informatics and digital technologies. The requirement for curriculum recommendations is to reflect the purpose of the scoping review as the basis for a Delphi study, where Nursing Informatics and its integration into Bachelor of Nursing curricula will be explored and described in collaboration with domain experts., Ethics and Dissemination: Ethics approval has been obtained for this scoping review (Project ID: 2156) from the Flinders University's Human Research Ethics Committee and has been determined to be low risk., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

There have been significant advancements in the fields of medicine, demography, and pathology. These disciplines have contributed to the classification and control of death and dying. People are now living longer with numerous comorbidities, and there is a significant aging population. Consequently, there have been increases in the numbers of people who present to emergency departments across Australia seeking access to care at the end of life. Emergency department staff must have the knowledge and skills required to provide end-of-life care in a setting that traditionally contradicts the goals of comfort care. With the increase in demand for end-of-life care in emergency departments, a gap exists in the experiences of how staff provide such care in this setting. As a result of this gap, it is important to understand the lived experiences of emergency department doctors and nurses who provide end-of-life care. The aim of this research is to understand the lived experiences of emergency department doctors and nurses concerning death, dying, and end-of-life care provision. Data were analyzed using Diekelmann's 7-step analysis to support Gadamer's phenomenological approach. Results indicate that challenges exist in the decision-making process of end-of-life care in emergency departments., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 by The Hospice and Palliative Nurses Association. All rights reserved.)

Healthcare has experienced rapid transformation with the development of digital technologies which aim to make healthcare safer and more efficient. In response, health informatics has evolved, including nursing informatics, which integrates nursing, information and communication technologies (ICT) and professional knowledge to improve patient outcomes. New language has developed to describe informatics and its processes; however, this has generally been poorly understood. This paper will describe current definitions of nursing informatics from three different healthcare contexts: Australia, the United States of America and Canada, to identify the similarities and differences between these definitions and to summarise the distinct bodies of knowledge described by each country. These countries have amongst the oldest definition attempts in the literature. A pragmatic approach was taken in this narrative review, working forward from historic references and backwards from recent references extracted from published health and nursing informatics literature.

Aims: The aim of the study is to explore the experiences of nurses providing home-based palliative care for patients who live in country settings., Methods: This study is an integrated literature review. Electronic databases, specific journals of interest, and reference lists were searched using key words and Boolean operators. Descriptive thematic analysis was undertaken to identify main themes and subthemes. Critical appraisal of the articles was conducted using the qualitative Critical Appraisal Skills Program guidelines. Primary research articles published in English, in peer-reviewed journals from 1990 to 2017, were included., Results: Twelve articles were included in this review. Two main themes emerged including the nature of nursing in country communities and nurses' emotional responses. The first main theme had the subthemes of community connections, geographical distance and isolation, organizational deficits, lack of education, and resources. The second main theme consisted on five subthemes including feeling rewarded, autonomy and professional isolation, hope and hopelessness, frustration, and fear., Conclusion: Literature is sparse reporting the lived experience of nurses providing palliative care in country areas for patients wanting to die at home. An increase in demand for a home-based palliative nursing service will require additional funding globally to meet this increase in the future., (© 2019 John Wiley & Sons Australia, Ltd.)

Introduction: The number of people dying in emergency departments (EDs) is increasing. However, EDs are not well designed or resourced for safe and effective End-Of-Life (EOL) care encounters, and there is little evidence regarding clinicians' perceptions and experiences of providing such care when the death is sudden and unexpected., Aim: This study explored nurses' perceptions and experiences of caring for patients who die suddenly and unexpectedly in the ED., Methods: Open-end responses were collected as part of a larger descriptive survey design. The qualitative data were analysed thematically., Results: 211 ED nurse completed the online survey. Within the qualitative data, five themes were identified during analysis: 1) key elements of EOL care, 2) systemic and environmental barriers, 3) educational deficits, 4) role ambiguity, and 5) emotional impact. Participants identified communication, a standardised approach, and better educational preparedness as the most important elements of EOL care when the death was sudden and unexpected., Conclusions: ED nurses want to provide high quality care to dying patients and their families. However, their efforts are hampered by systemic and environmental barriers outside their control. There is a need for a culture shift to overcome the barriers that currently obstruct ED nurses from providing meaningful and effective EOL care in the ED., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Context: Despite limited clinical evidence, long-term oxygen therapy (LTOT) is used for the management of refractory breathlessness in people with life-limiting illnesses who are not necessarily hypoxemic., Objectives: The aim of this study was to understand caregiver factors associated with caring for someone with LTOT from the perspectives and experiences of caregivers themselves., Methods: The qualitative study used semistructured interviews. The study was conducted in two states in Australia. Participants (n = 20) were self-nominated caregivers of people receiving LTOT for refractory breathlessness in the palliative setting., Results: Data analyses established one overarching theme titled: "Oxygen giveth (something to help caregivers relieve breathlessness) and oxygen taketh away (from patients who lose some autonomy)." The theme captured caregivers' feelings of extreme distress in response to witnessing refractory breathlessness, and oxygen fulfilling several critical and beneficial roles in this context. In parallel, caregivers also explicitly and implicitly articulated several downsides to the use of LTOT., Conclusion: Caregivers find caring for someone with refractory breathlessness extremely distressing. The benefits of LTOT are often overestimated, whereas its potential harms are underestimated. As significant stakeholders of people receiving LTOT, caregivers should be provided with opportunities to collaborate with clinicians in evidence-based decision making, efforts should be made to provide them with information and education about the most effective pharmacological and nonpharmacological strategies to manage refractory breathlessness in a palliative care setting including the appropriate use of LTOT to enable them to do so., (Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: The ability of patients to finalise their affairs at the end of life is an often neglected aspect of quality of life (QOL) measurement in palliative care effectiveness research despite compelling evidence of the high value patients place on this domain., Objective: This paper describes the preliminary development and evaluation of a new, single-item, end-of-life patient-reported outcome measure (EOLPRO) designed to capture changes in the ability of patients to finalise their affairs at the end of life., Methods: Cognitive interviews with purposively sampled Australian palliative care patients (N = 9) were analysed thematically to explore content validity. Simultaneously, secondary analysis of data from a randomised controlled trial comparing ketamine and placebo for the management of cancer pain (N = 185) evaluated: construct validity; test-retest reliability; and responsiveness., Results: Preliminary findings suggest patients interpret the new measure consistently. The EOLPRO captures the ability to complete physical tasks and finalise practical matters although it is unclear whether emotional tasks or resolution of relationship issues are considered. Personal and financial affairs should be separated to allow for differences in ability for these two types of affairs. The significant correlation between performance status and EOLPRO scores (r = 0.41, p<0.01, n = 137) and expected relationships between EOLPRO and proximity to death and constipation demonstrated construct validity. Pre- and post-treatment EOLPRO scores moderately agreed (n = 14, κ = 0.52 [95% CI 0.19, 0.84]) supporting reliability. The measure's apparent lack of sensitivity to discriminate between treatment responders and non-responders may be confounded., Conclusion: Based on the preliminary findings, the EOLPRO should be separated into 'personal' and 'financial' affairs with further testing suggested, particularly to verify coverage and responsiveness. Initial evaluation suggests that the single-item EOLPRO is a useful addition to QOL outcome measurement in palliative care effectiveness research because common palliative care specific QOL questionnaires do not include or explicitly capture this domain.

Background: Chronic breathlessness is a significant problem in palliative care and oxygen is often prescribed in an attempt to ameliorate it. Often, this prescription falls outside the current funding guidelines for long-term home oxygen use. The aim of this qualitative study was to understand the factors that most influence Australian specialist palliative care nurses' initiation of home oxygen for their patients., Methods: A series of focus groups were held across three states in Australia in 2011 involving specialist palliative care nurses. The invitation to the nurses was sent by e-mail through their national association. Recorded and transcribed data were coded for themes and subthemes. A summary, which included quotes, was provided to participants to confirm., Results: Fifty-one experienced palliative care nurses participated in seven focus groups held in three capital cities. Two major themes were identified: 1) logistic/health service issues (not reported in this paper as specific to the Australian context) involving the local context of prescribing and, 2) clinical care issues that involved assessing the patient's need for home oxygen and ongoing monitoring concerns. Palliative care nurses involved in initiating or prescribing oxygen often reported using oxygen as a second-line treatment after other interventions had been trialed and these had not provided sufficient symptomatic benefit. Safety issues were a universal concern and a person living alone did not emerge as a specific issue among the nurses interviewed., Conclusion: The role of oxygen is currently seen as a second-line therapy in refractory dyspnea by specialist palliative care nurses.

In palliative care, the witnessing of unrelieved (refractory) suffering takes its toll on all concerned; however, the effect on experienced palliative clinicians of witnessing such suffering has largely been unexplored. The aim of this study was to examine health care professionals' (nurses, doctors, and allied health workers) experiences of working with a patient's refractory suffering, together with their clinical management strategies. A qualitative research design involving semistructured interviews and an online questionnaire was used to collect the data. Seventeen experienced palliative care clinicians participated; 13 with face-to-face interviews and a further 4 by an online questionnaire. The overarching theme of negotiating uncertain terrain was common across all clinician narratives. In order for them to work successfully with a patient's refractory suffering, the clinicians had to negotiate areas of practice characterized by uncertainty, with no clear directions and with few expert guides. In reviewing their experiences, they identified within an overarching theme of negotiating uncertain terrain four subthemes: Changing Approach from "Fixing" to "Being With," Maintaining Perspective, Negotiating and Maintaining Boundaries, and Living the Paradoxes. This study highlights that dealing with patients' refractory suffering involves clinicians moving into uncertain and unexplored territory. For them to work effectively in this terrain the clinicians need wisdom, courage, and a commitment to journeying alongside the suffering person.

Managing dyspnea at home is a challenging task. Although a competent palliative home care team can assist a patient to live at home with better pain control, dyspnea is usually not as well managed. In the Asian context, there are few research studies in dyspnea management in palliative home care. This paper aims to illustrate the cultural context that has an impact on dyspnea management at home and the assessment and management of dyspnea in a community palliative care setting in Malaysia. This paper reports on a study of 5 dyspneic patients suffering from both cancer-related and non-cancer-related dyspnea. Its focus is on a unique Asian cultural belief system that affects communication about prognosis and the role of family in palliative home care. In addition, this paper also describes dyspnea assessment, the barriers to morphine use, benzodiazepine prescription, oxygen therapy, and nonpharmacologic intervention in this center.

Objective: This qualitative study aimed to describe the skill sets that experienced palliative care clinicians possess when managing refractory suffering., Method: Thirteen tape recorded semi-structured interviews and four online questionnaires were completed by participants with at least two years clinical palliative care experience. The research team undertook cross sectional thematic analysis of the transcribed interviews., Results: In the face of refractory suffering, team cohesion was identified as a key requirement to support the interdisciplinary team. However, team cohesion was found to be undermined by philosophical differences between team members, a paradigm shift concerning cure versus care and individual opinions regarding the chosen approach and levels of respect between the individual disciplines involved in the care of a person with a life limiting illness., Significance of Results: The findings of this study highlight the precarious nature of the interdisciplinary team when significant challenges are faced. As a result of witnessing refractory suffering the division and fracturing of teams can easily occur; often team members are completely unaware of its cause. The findings of this study contribute to the limited literature on the nature of refractory suffering from the perspective of the interdisciplinary team.

Breathlessness is a frightening symptom to both witness and experience. It is common in many conditions, especially in the palliative setting, profoundly affecting the quality of the person's life. The purpose of this article is to provide an overview of the recent advances in the management of breathlessness in the areas of, knowledge of disease trajectories, assessment, pharmacological and non-pharmacological interventions and the use of oxygen.

Palliative care is a growing area of practice throughout the world and its promotion relies on adequately trained health care professionals. However, there are only a limited number of postgraduate academic courses or clinical training opportunities available, especially in resource challenged areas of the Asia Pacific region. This article outlines a creative endeavour between Flinders University, Adelaide Australia, the Singapore National Cancer Centre and the Asia Pacific Hospice and Palliative Care Network to provide an educational opportunity for students from the region. The strengths of the programme include its strong theoretical and evidenced-based framework, its multidisciplinary inclusiveness and its innovative and interactive teaching style. The main teaching challenge for the teaching team is to deliver culturally appropriate curricula to students from diverse cultural and linguistic backgrounds. This postgraduate programme is an important initiative for the region and for the development of future leaders and pioneers in the discipline.