ARTICLESWhen All Else Has Failed: Nurses' Perception of Factors Influencing Palliative Care for Patients With End-Stage Heart FailureWotton, Karen RN, RM, IW, DipEd, BNg MEdM; Borbasi, Sally PhD, MA(Educ), RN; Redden, Maurine BNg(Hons), RNAuthor Information Senior Lecturer, School of Nursing & Midwifery, Flinders University, Adelaide, South Australia. (Wotton) Associate Professor, School of Nursing & Midwifery, Flinders University, Adelaide, South Australia. (Borbasi) School of Nursing & Midwifery, Flinders University, Adelaide, South Australia. (Redden) Corresponding author Sally Borbasi, PhD, MA(Educ), RN, School of Nursing & Midwifery, Flinders University, GPO Box 2100, Adelaide, SA 5001 (e-mail: [email protected]). This project was funded by a Flinders Medical Centre Foundation grant (Flinders University of Adelaide Small). The research team acknowledges the contribution of Dr Ysanne Chapman, David Stephenson, James Dunne, Kathy Read, and Mette Groenkjaer (Research Assistant), and all nurse participants. The Journal of Cardiovascular Nursing: January-February 2005 - Volume 20 - Issue 1 - p 18-25 Buy Abstract The purpose of this study was to describe registered nurses' (RNs') perceptions of factors influencing care for patients in the palliative phase of end-stage heart failure (ESHF). Seventeen senior RNs across 3 acute care and 5 community centres in metropolitan Adelaide, Australia, participated in the study. In this descriptive, exploratory research project, we analyzed audiotaped indepth, semistructured interviews, using a computer-assisted (NVIVO) thematic procedure. According to participants, the care of patients with ESHF is dominated by a focus on symptom management and optimal pharmacologic therapies, with a perceived deficit in other aspects of palliative management. Key mitigating factors against quality palliative care for this population included the difficulty in recognising ESHF and reluctance by physicians to negotiate end-of-life decisions. In the acute care sector, nurses believed ESHF was medicalized and characterized by paternalistic care, with treatment generally curative to the last breath. Nursing care and patient advocacy were also negatively influenced by a lack of awareness in patients and families concerning the inevitability of death in ESHF until the last few days or hours before death. Involvement of the palliative care team was often an afterthought rather than an integral component of care. Nurses in acute care settings embraced the concept of a multidisciplinary team approach, but stressed the need for the cardiac team to be the overall coordinator of care for the ESHF population. Care of patients with ESHF should promote the amalgamation of technological and pharmaceutical advances in the treatment of heart failure with more timely end-of-life care. All involved parties must work toward advancing a common middle ground for appropriate end-of-life care for patients with ESHF. Recommendations for practice include the need for greater education for patients and their families and greater collaboration between the members of the multidisciplinary healthcare team to assist patients with ESHF and their families prepare more timely for the final trajectory of the illness. © 2005 Lippincott Williams & Wilkins, Inc.