Ingela Beck

Senior Lecturer in Nursing Care, Faculty of Health Science
Member of the Board of the Faculty of Health Science
Head of specialisation, programmes and courses in caring for older people

Research

Palliative care is essentially a person-centred care aimed at maximising the level of well-being for people facing the end of their lives due to illness or age. The palliative care identifies and addresses problems of a physical, mental, social and/or existential nature in addition to which, support is given to the family.

The study on which my thesis is based, i.e. To focus on 'being' in a world of doing: Support to nurse assistants in applying a palliative care approach in residential care for older people (2013), looked at the level of palliative care experience among nursing staff. The aim of the study was also to investigate the level of impact of a palliative care approach intervention on the nursing staff and their work.

The reasoning behind the study was that even if a palliative approach may be appropriate for patients in a residential care facility over a longer period of time than end of life care– it is often only available to a limited number of patients.

According to the study result, nursing staff often find it difficult to focus on the relational aspects of their work, and as a result palliative care is mostly given in the final week of life. The result formed the basis for the development of an intervention in the form of study circles and workshops with focus on a palliative approach in the care of older people. A subsequent evaluation of the intervention showed that the nursing staff felt more focused on the personal circumstances of the older person, their life stories and what brought meaning to their lives.

It also gave the nursing staff a greater insight into how important they themselves were for the well-being of the older person. In addition, the evaluation results showed the nursing staff to be more critical of the leadership and the care provided than prior to the intervention, most likely as a result of being more aware of the needs of the older person, at the same time, not having the capacity to provide the person with the palliative care needed.

My research work today is centred on the following: 1) Identifying and meeting palliative care needs, 2) Existential loneliness among older people 3) Effective measures for recovery and increased well-being.

Identifying and meeting palliative care needs

The research, centred on identifying and meeting the palliative care needs of individual people, is based on using the questionnaire Integrated Patient care Outcome Scale (IPOS) in a meaningful way that will make a positive difference to the person facing a life threatening situation, the family and/or staff. The IPOS contains questions about the existence of common symptoms as well as issues of an emotional and existential nature. So as to be applicable to the Swedish healthcare context, a translation and adaptation of the IPOS questionnaire was required. The study result showed the IPOS questionnaire to have a satisfactory content validity and to be of relevance and usefulness to both general and specialised palliative care patients and staff. Research on the use of the IPOS questionnaire in acute care setting involved studying factors that contribute to nursing staff using the IPOS in their assessment of patient related symptoms and problems as well as their own experience of using the measurement tool. Research on the introduction of the IPOS in specialised palliative care is ongoing and implemented within the framework of the project 'A meaningful assessment of care needs' , a project for which I am responsible and conduct together with the Institute for Palliative Care at Lund University and Region Skåne.

Existential loneliness among older people

Existential loneliness among older people involves studying the impact of loneliness among frail older people and what could be done, in their experience, to help ease the loneliness. Further studies in this area relate to the way in which and to what extent existential loneliness is mentioned in the medical records of older patients. These studies are carried out within the framework of the project Existential loneliness at the end of life - challenges for nursing staff.

Effective measures for recovery and increased well-being

Measures for recovery and increased well-being include empirical and literature studies. The experience of having soft touch massage as an established and integrated part of the care given was studied among participants at a specialised palliative care unit.

The soft touch massage was perceived by the patients as a way of finding inner peace, dignity, relief from discomfort and a sense of hope. In addition, a systematic literature research review of existing evidence on various interventions contributing to the recovery in women following breast cancer surgery was carried out. Other studies relate to the rehabilitative palliative care provided by physiotherapists as well as the nursing staff's perceptions of their own involvement in the recovery process of women having undergone breast cancer surgery.

Project

A meaningful assessment of care needs

One primary objective of the project A meaningful assessment of care needs is to optimise the care and support offered to individuals and their family when life itself is threatened by illness or age. In order for the care to be as beneficial as possible, it is important for the individual to be able to describe his/her circumstances and needs. It also helps the nursing staff to pay better attention to and meet the needs of the individual in question.The project is based on the IPOS (Integrated Patient care Outcome Scale) questionnaire. IPOS is used as a basis for talks with the patient and/or someone close to the patient. This helps to better understand the patient's circumstances and needs.
It is also a prerequisite for the care team to make informed decisions, together with the patient and/or the patient's family, about appropriate care measures. The model for the introduction of IPOS and training initiatives for nursing staff, as used in this project, have been developed by the Institute for Palliative Care and Kristianstad University and are based on implementation guidelines and research on Person-Centred Outcome Measures (PCOM) in palliative care. Specific project objectives include: I) To evaluate whether the implementation strategies developed promote a meaningful systematic use of IPOS questionnaires as PCOM, II) to examine the experience of nursing staff, patients and immediate family of using IPOS as PCOM, and III) to review long term needs, problems and symptoms of patients in palliative care using the IPOS tool.
Project Manager is Ingela Beck

Link 

Existential loneliness at the end of life - challenges for nursing staff

Link 

Collaborations

Researcher at the Institute of Palliative Care at Lund University and Region Skåne with long-term collaborations with various projects.
Contributing member of the International Palliative Care Measurement Collaborative, Person-Centred Perspective, Canadian Partnership Against Cancer, Canada – a collaborative partnership aimed at improving patient care through the use of person-centred and family-report results.

Member of the Board the Swedish Association of Nurses in Palliative Care (SFPO) since 2017 and has together with the Board's working group revised and in 2019, published Description of Key Skills in Palliative Care.

A representative of the research and development network of Palliative Care, Northeast Skåne since 2016 – a network of palliative representatives from district municipalities, hospitals, specialised palliative care units and Kristianstad University who meet regularly to promote increased collaboration and knowledge sharing.

Publications