title: The role and significance of nurses in managing transitions to palliative care: a qualitative study.
abstract: OBJECTIVE
  Nurses are generally present, and often influential, in supporting patient and family acceptance of medical futility and in assisting doctors in negotiating referral to palliative care. Yet the specificities of the nursing role and how nurses may contribute to timely and effective referrals is not well understood. This study aimed to systematically explore hospital-based nurses' accounts of the transition to palliative care, and the potential role of nurses in facilitating more effective palliative care transitions.
  
  
  METHODS
  Qualitative study using semistructured interviews.
  
  
  METHODS
  Two health services with public as well as private clinical environments in a major metropolitan area of Australia.
  
  
  METHODS
  Hospital-based nurses (n=20) who regularly work with patients at the point of referral and in managing transitions to palliative care.
  
  
  RESULTS
  Four significant themes emerged from thematic analysis. These include: (1) professional dynamics and the roles played by nurses in initiating the transition to palliative care; (2) the value of nurses' informal interactions in timely and effective transitions; (3) the emerging challenge of managing task-oriented nursing versus intense emotional nursing work at the point of medical futility and (4) the emotional burden experienced by nurses within this clinical context. Nurses self-reported occupying critical albeit complex roles in the management of medical futility and the transition to palliative care. They reported experiencing significant emotional burden in balancing interpersonal and interprofessional relationships during this time.
  
  
  CONCLUSIONS
  The results suggest that nurses may be utilised in a more formalised and systematic fashion in the context of managing medical futility and the need to topicalise the transition, with the focus shifted away from medical referrals towards more team-based and patient-centred timely transitions. Further research focused on the experiences of doctors, allied health professionals, patients and families is required to provide a broader interdisciplinary understanding of futility and contributions to the negotiation of palliative care.
authors.affiliation: School of Social Science, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Kirby
authors.affiliation: School of Social Science, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Broom
authors.affiliation: Department of Palliative Care, St Vincent's Hospital, Brisbane, Queensland, Australia.
authors.forename: Phillip
authors.initials: P
authors.lastname: Good
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D010166:Palliative Care / Q000379:methods; D012017:Referral and Consultation; D055815:Young Adult
keywords: PALLIATIVE CARE; QUALITATIVE RESEARCH