Compassionate end of life care

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It was great to be part of the fabulous conference organised by the International Learning Collaborative addressing the Fundamentals of Care at Middlemore Hospital earlier this week. We took the opportunity to talk about our new paper, published in the Journal of Clinical Nursing, which builds on: 1) our Pakeke study which explored the end of life circumstances of people dying in advanced age; and 2) Jackie’s PhD work around the experience of hospital at end of life. In thinking about how to apply these findings into practice, we developed the Kapakapa Manawa Framework to guide compassionate end of life care in acute hospital settings with support from Matua Rawiri Wharemate, our senior kaumatua.

‘Kapakapa’ is defined as ‘to get the heart to throb, pulsate or flutter’. The pulsating of the ‘Manawa’ (or heart) motivates the person to energise their heartfelt emotions and in turn care for the dying person and their family in a meaningful way. This aligns with current understandings of compassion where recognition of the suffering of another, identification with the suffering itself, and how the person is being affected has to occur for the observer to feel compassion towards the person suffering. This then motivates the observer to act.

We were fortunate that Jenny Parr and Julia Slark joined with us to critically consider how the Kapapa Manawa framework could be implemented in practice. They immediately thought of its fit with the relational aspect of the Fundamentals of Care (FoC). The FoC has been described as theoretical framework (Kitson, 2018)  developed to ‘explain, guide, and predict nursing interactions with patients, carers, and their families at the point‐of‐care’. Enacting the FoC therefore rests upon the ability of the clinician to connect with the patient, and through that connection, meet or help the patient meet their fundamental needs with compassion and caring. It is this integration of physical, psychosocial and relational caring forms the foundation of every care encounter.

In a nutshell we argue in the paper that:

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Whilst the Kapakapa Manawa bi‐cultural compassionate care framework has grown out of research conducted with people nearing the end of their lives, we also believe it has the potential to improve nursing care for all hospital inpatients. Ultimately, all healthcare encounters would be improved by greater attention to the relationship between the clinician and the service user. Our next steps are thinking through the practical implementation of the framework in practice and education. Watch this space!



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