Table 3.
Categories and codes regarding the role of the nurse in medication management at the end of life
| Relation | Category (role) | Codes |
|---|---|---|
| Nurse - patient | Inform | Instruction intake medication, (side) effects of medication, adjustments of medication, how to monitor effect, dosage form, explanation of necessity of medication |
| Signal |
Intake: Problems with intake or route of administration, adherence, aversion and motivation, medication alternatives, polypharmacy Side effects: Interactions, influence on quality of life, monitoring (e.g. defecation), diagnose overdose, common side effects, effect of reduction of medication Clinical assessment: Clinical changes, appearance of symptoms, comfort centrally, pain perception, trigger for changes in treatment plan, effect of medication, symptom assessment tools Multidimensional vision: Attention for underlying emotions of the patient, importance of medication to the patient, influence of cognitive status, psychological wellbeing, social dimension (relations, environment), contribution to personalized pharmacological therapy, take into account character of the patient |
|
| Represent | Patient discusses wishes regarding medication with or via nurse, nurse is first contact person, nurse lends an ear to patient, nurse expresses to physician how patient is doing, nurse receives more information from patient than physician, attention on the patient, nurse records in file; which role patient wants to have in medication management, motivate, put wishes and values of the patient at the centre, explore aversion towards medication, assist in decision-making and mourning, guard over the autonomy of the patient, support in quality of life, confidential advisor | |
| Support | Activities of Daily Living: order, obtain and prepare medication | |
| Intake: self-administration of ‘as needed’ medication, facilitate intake of medication | ||
| Feasibility: Propose change of route of administration, financial aspects, consultation of pharmacist as needed | ||
| Complementary care: Non-pharmacological supportive interventions | ||
| Nurse - informal caregiver | Inform | Instruction intake, (side) effects of medication, adjustments of plan, how to monitor effect, dosage form, necessity of medication |
| Support | Evaluate informal caregiver capacity, contact person for questions | |
| Involve | Involve informal caregiver in case patient cannot express wishes or complaints, link between physician and informal caregiver, asses which role informal caregiver can have in medication management, informal caregiver can substitute for nurse | |
| Nurse - physician | Inform | Report observations regarding effects, side-effects, clinical assessment and other issues to physician |
| Support |
Give input at multidisciplinary meeting/grand round/periodical meeting, think along with physician about inappropriate or lacking medication, control function, team decision-making in medication management, physician and nurse complement each other, final decision regarding medication by physician, no role for nurse in decision-making Initiative: Proposal of adjustment of medication to physician, make medication discontinuation a subject of discussion, as needed medication for symptom control, prevention of symptoms, advance care planning, support reduction of medication, check for contraindications |
|
| Represent |
Repeat information from physician to patient Continuity: Daily contact with patient, more frequent and prolonged contact than with physician, periodical evaluation, good insight into the course of the disease, 24-h availability |