Placing Care: The Impact of the Physical Environment on Experiences of Providing and Utilizing Palliative Care

David A. AGOM ； Judith SIXSMITH ； Jude OMINYI ； Tonia C. ONYEKA ； Joy C. AGOM

《The Journal of Nursing Research》 30卷5期 (2022/10) Pp. 1-11

https://doi.org/10.1097/jnr.0000000000000508

摘要

Background: Environmental design in palliative and end-of-life care is known to improve care outcomes, service-user satisfaction, and the continuation of service uptake. No study in the literature has investigated the influence of the environment on palliative and end-of-life care in Nigeria or other African contexts. Purpose: This study was designed to explore the impact of the physical environment (i.e., place and people) on staff and service users and how these influence the experiences of providing and using palliative and end-of-life care in a Nigerian hospital context. Methods: Ethnographic methodology was employed because this approach facilitates understanding of environmental realities. This study is part of a larger ethnographic research project developed to uncover aspects of organizational complexities related to the provision and use of palliative and end-of-life care in the Nigerian context. Three hundred fifty hours of participant observation was achieved, and semistructured interviews were used to gather data from 26 participants, including 10 patients, 11 members of a palliative care team, and five hospital managers. Informal chats and photographic capture were additional methods used in data collection. Thematic analysis was conducted to identify and analyze patterns within the collected data. Results: Physical space, equipment, and placing staff were the three primary themes identified. The physical environment was untidy, and the ward layout prevented privacy, dignity, or comfort for patients and families. The equipment was old and inadequate, and the context of care was worsened by insufficient staffing and neglect of the environmental needs of the staff. Conclusions: Hospital design for palliative and end-of-life care in Nigeria is ＂autoinhibitory＂ (a negative feedback mechanism whereby hospital design detracts rather than promote quality of care), and a physical environment that supports the provision and utilization of care must be implemented to promote palliative and end-of-life care success. Urgent policy action is needed to improve environmental and staffing conditions to advance palliative and end-of-life care in Nigeria.

關鍵字

environment ； end-of-life care ； healthcare practice ； Nigeria ； palliative care

參考文獻

Agbawodikeizu, P. O., Agwu, P. C., Okoye, U. O., & Oyeoku, E. K. (2019). Perception and attitudes to end of life planning and implications for social work practice in Enugu State, Nigeria. International Social Work, 62(2), 892-904. https://doi.org/10.1177/0020872818755862

Agom, D. A., Allen, S., Neill, S., Sixsmith, J., Poole, H., Onyeka, T. C., & Ominyi, J. (2020). Social and health system complexities impacting on decision-making for utilization of oncology and palliative care in an African context: A qualitative study. Journal of Palliative Care, 35(3), 185-191. https://doi.org/10.1177/0825859719892084

Agom, D. A., Ominyi, J., Onyeka, T. C., & Anyigor, C. N. (2020). Exploring organizational culture regarding provision and utilization of palliative care in a Nigerian context: An interpretive descriptive study. Indian Journal of Palliative Care, 26(3), 358-364. https://doi.org/10.4103/IJPC.IJPC_39_20

Agom, D. A., Onyeka, T. C., Ominyi, J., Sixsmith, J., Neill, S., Allen, S., & Poole, H. (2020). An ethnographic study of palliative and end-of-life care in a Nigerian hospital: Impact of education on care provision and utilization. SAGE Open, 10(3), Article 2158244020938700. https://doi.org/10.1177/2158244020938700

Agom, D. A., Poole, H., Allen, S., Onyeka, T. C., & Ominyi, J. (2019). Understanding the organization of hospital-based palliative care in a Nigerian hospital: An ethnographic study. Indian Journal of Palliative Care, 25(2), 218-223. https://doi.org/10.4103/IJPC.IJPC_12_19