NUR272 End-of-life Care Assignment

Skilled communication by nurses is a core activity in palliative and end-of-life care. Yet for many nurses, it is a challenging and confronting task to communicate with patients about their illness trajectories, their personal experiences of dying, and the palliative care they are receiving. A key source of information to inform nursing practice are patients’ own perspectives.

In Assessment Task 1, you will prepare a 2000 word written assignment that demonstrates your ability to explore the peer-reviewed literature, your critical understanding of the key points from the peer-reviewed literature, and your insights into how nursing practice might be informed by these key points.

To do this, you will be reviewing a selected article by Collins et al. (2018) to identify three key discussion points you will then find and explore four other journal articles to review.

Follow these steps to undertake Task 1 – read them through carefully before you start:

1. Read the selected article

(there is a link on the Canvas site). Collins, A., McLachlan, S. A., & Philip, J. (2018). Communication about palliative care: a phenomenological study exploring patient views and responses to its discussion. Palliative medicine, 32(1), 133-142.

Don’t be intimidated by the research terms in the article (such as “phenomenological’, which is simply referring to an approach to research that explores phenomena of interest). Focus on the Introduction, Results, Discussion and Conclusion – these are the most relevant sections of the article for Task 1.

2. Identify three key discussion points to explore further.

Collins et al. (2018) have identified three themes and several subthemes relating to how patients understand their experience of communication in palliative care. You can select any of these, or other key points you’ve observed in reading the article. There is no right or wrong answer when it comes to identifying the three key discussion points, provided they are clearly drawn from the article itself. So read Collins et al. (2018) slowly and carefully, and identify words that might become search terms (more on that in a minute!). The three key discussion points might be a word, or several words; but the points are unlikely to be full sentences.

You’re going to create and fill out a table like the one below, where you enter your three key discussion points from Collins et al. (2018) into the row denoted as ‘0’.

3. Find the four other articles – Search for supporting literature.

Skills in searching for peer-reviewed literature can vary, so if you are unfamiliar with the process, you can find more information within the UniSC Library website. Searching the literature is a critical skill and it's important to know what you’re doing. It’s easy to waste your time searching ineffectively for relevant information, reading too much, and not effectively recording what you read for citing and referencing later on. Read this link to increase your understanding of what a journal article is.

In addition to the Collins et al. (2018) article, you must find four articles published between 2019 – 2023 to identify key discussion points (remember the table above) that inform your understanding of communication issues in palliative and end-of-life care. These other articles might cite the Collins et al. (2018) article, or they might not, but the relevance to each key discussion point should be clear.

Here are three suggested steps to take, so you can locate four articles for use in your literature review:

3.1 Create a search strategy

Use the three key discussion points from the Collins et al. (2018) article to identify your search terms – these are what you will enter into the Library Advanced Search function. They are single words or small phrases like “communication”, “dying”, or “palliative care” – these examples might be useful, but you will need to identify others.

3.2 Enter these search terms into the Advanced Search function

• In the next window, click on ‘Journal Articles’, enter the search terms you’ve identified in Step 2 (below is an example only) and click on ‘SEARCH’.

• You’ll then see a long, long list of results (that is, title and authors of journal articles) which might not quite seem like what you’re looking for. These results will need refining. The next page explains how.

• You refine your results by clicking on a range of filters, which are found in a long column on the left under ‘Refine my results’. These should include:
  • ‘Peer Reviewed’
  • ‘Publication Date’ (enter ‘2019’ and ‘2023’ – but keep an eye on this, it can default back to 1900 if you go back a window!)
  • ‘Resource Type’, tick ‘Articles’
  • There is also the ‘Subject’ filter. When you click on it, you’ll see a range of options and this is where you use your search terms and key discussion points as applies to you. For example, ‘Humans’, ‘Palliative care’, ‘Communication’ and ‘Nursing’ could broadly apply but if, for example, you have a particular interest in cancer, or aged care, or decision making, you would tick those as well.
  • ‘Language’ tab tick ‘English’
• In the bottom left-hand corner of your screen, you should see a green tab ‘APPLY FILTERS’; click on it and wait for the next page to load.
• The results you see can still be quite varied, so now you have to skimread over the titles to see if they might be relevant to your key discussion points. They may go on for a number of pages, so just briefly look at the title and the brief comments in italics to get a feel for the article.
• Once you think an article could be relevant, click on the title and you’ll be taken to the article itself. Read the abstract first to get a good idea of what the article is about. If you think it’s relevant, you can either read it online or download a pdf. If it’s relevant, follow the steps below.
• Through this process, you can select four articles for further review and save them on your device.

If you’d like to know more about how to search for, select and use literature for university studies, you could do the UniSC Library’s Research skills tutorial which you will find useful throughout your degree, and beyond!

3.3 Read the articles and organize your information

Thinking and planning for your assessment is one of the most challenging parts of the writing process. If you aren't clear in your thinking, then you won't be clear in your writing. As you are reading, you need to be doing two things:

1. Record the information needed for referencing (highlighting text is very useful and use the table too).
2. Make notes and collect the most relevant ideas that help you respond in a way that clearly shows your understanding of the key discussion points. These are the ideas that you will paraphrase, and which form the basis of the Discussion section of your review.

Use the Table to organize your information as you read. The rows show each author/s and discussion points you have identified. The columns show the content about key discussion points from the five articles, grouping this information together, which gives you the structure of your Discussion (more explained later). You don’t need to fill every cell in the Table if the article doesn’t highlight all key discussion points that you have identified. Your completed table now maps the individual articles in rows and provides information for each key discussion point from multiple sources in the columns. This will enable you to provide a critical discussion of your search, not just a ‘shopping list’ of articles and what their authors said!

4. Follow the structure below to write your review.

The approach described below uses a particular structure to literature reviews that you would commonly find in many journal articles and books. Use these headings in your assignment.

Word counts for each section are only estimations – the final word count is the one that is measured for assessment.

Introduction

(about 100 words)

Inform the reader of the focus of the literature review. This should include why the topic is important in palliative and end-of-life care and nursing practice. You are permitted to use references here and these could include citations to the five articles and regulatory documents like NMBA Standards or NPC Standards mentioned in Week 1 of the Learning Materials.

Search strategy

(about 100 words)

Following the search strategy previously suggested, explain how you went about finding the relevant literature for this review. This should include:

• Type of resource
• Key search terms (i.e. specific words or phrases) for each key discussion point.
• Date range searched
• Subject filters used

This section of the assignment should only refer to the four journal articles you have found. Articles should be published between 2019 – 2023, unless it is earlier seminal (that is, important and influential) work. The CRAAP Framework (linked in the Resources section in Assessment Task 1 in Canvas) can help you identify whether supporting literature is relevant.

Findings

(about 800 words including text in Table)

Tell the reader what you discovered in your search – from your reading, describe in writing the four articles you’ve selected.

Insert the table you have created into this section, highlighting the issues each article raises relating to the key discussion points. Cite the authors’ names and year of publication (like you would for an in-text citation) in the second column. Note the key discussion points in the other three columns – brief, bullet point comments that show the information you’ve identified. It’s not necessary to provide lengthy explanations in the table. It’s also possible that not all articles will discuss all three key discussion points, but articles are able to be included if they are clearly relevant.

As an example, let’s pretend the key discussion points found from Collins et al. (2018) are about food – they are not, of course! This is only an example to illustrate:

So the summary of the article by Baker and Cho (2019) might look something like this:

The first article by Baker and Cho (2019) explored end-of-life care in USA hospice kitchen settings. The authors identified that there were certain foods people ate when feeling unwell and certain foods eaten to improve their health and well-being. The commonest food people ate when feeling unwell was watery soups (Baker & Cho, 2019).

Baker and Cho (2019) also highlight that the most common food eaten to improve health and well-being was white meats.

Discussion

(about 900 words)

This is the most important part of the literature review because you are ‘unpacking’ what the Findings of your literature review mean. This Discussion provides a critical analysis of the literature. So, don’t simply describe what each reference said as you’ve already done this in the Findings section. Instead, use the key discussion points in the columns of the table to provide a structure to your Discussion (that is, follow the arrows!).

Structure this Discussion as follows:

• Provide a brief introductory paragraph stating the three key discussion points.
• Use the key discussion points from your table as three subheadings (about 300 words for each).
• Under each subheading state what the key discussion point means. Explain how each key discussion point relates to the Collins et al. (2018) article and its application to the provision of palliative and end-of-life nursing care. Your discussion must draw on the references that apply to the key discussion point and use other 7 relevant references/literature to support your discussion, such as National Standards and Guidelines (see Week 1 Learning Materials) and other journal articles/books. Textbooks, policy documents and information from credible websites can be used in the Discussion section.
• This Discussion isn’t an expression of opinion, so write in academic style, using the third person voice and substantiate your points from the literature.

Using the previous example, pretending the key discussion points found from Collins et al. (2018) are about food – this subsection might look something like this:

Foods eaten when feeling unwell This key discussion point is about the types of food people eat when feeling unwell as a result of palliative and end-oflife care treatment. Four authors discuss foods eaten when feeling unwell which are: cooked spinach (Collins et al., 2018), watery soups (Baker & Cho, 2019), unseasoned chicken (D’Arcy et al., 2022), and seedless grapes (Rosenberg (2023). One common element highlighted was people who feel unwell as a result of their treatment all wanted to eat foods that were bland and not likely to make them feel even more ill. This seems to be common; patients in other end-of-life care contexts have also explained similar reasons for eating these types of foods when feeling unwell (Jones, 2012; Talman, 2009). In fact, patients in other specialities not related to end-of-life care have also been found to select these types of foods (Jupp, 2020; Zeb, 2023). In relation to Collins et al. (2018), these findings are interesting because..

Conclusion

(about 100 words)

Provide a summary of the review, stating how the three key issues address the selected topic. Do not introduce any new issues in the Conclusion. Do not cite any literature in the Conclusion – this is your opportunity to pull together all the information discussed into a summary.

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