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      The 6S‐model for person‐centred palliative care: A theoretical framework

      research-article
      , RN 1 , , , RN, PhD 2 , 3
      Nursing Philosophy
      John Wiley and Sons Inc.
      nursing, nursing theory, palliative care, philosophy of nursing, practice, theory

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          Abstract

          Palliative care is provided at a certain timepoint, both in a person's life and in a societal context. What is considered to be a good death can therefore vary over time depending on prevailing social values and norms, and the person's own view and interpretation of life. This means that there are many interpretations of what a good death can actually mean for an individual. On a more general level, research in palliative care shows that individuals have basic common needs, for example physical, mental, social and spiritual well‐being. Therefore, in today's pluralistic Western society, it becomes important that palliative care is person centred to enable individuals to receive, as far as can be achieved, care that promotes as good a life as possible based on the person's own needs and preferences, and in accordance with evidence and current laws. For many years a research group, consisting nurse researchers together with nurses working in palliative care, has developed a model for person‐centred palliative care, the 6S‐model. The model's central concept is Self‐image, where the starting point is the patient as a person and their own experience of the situation. The other concepts: Self‐determination, Symptom relief, Social relationships, Synthesis and Strategies are all related to the patient's self‐image, and often to each other. The model's development, value base and starting assumptions are reported here, as are examples of how the model is applied in palliative care in Sweden. The model has been, and still is, constantly evolving in a collaboration between researchers and clinically active nurses, and in recent years also with patients and close relatives.

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          Person-centered care--ready for prime time.

          Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the focus and mainstay of care in long-term illness. Copyright © 2011 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
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            Experiencing transitions: an emerging middle-range theory.

            Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. Uncovering these risks may be enhanced by understanding the transition process. As a central concept of nursing, transition has been analyzed, its components identified, and a framework to articulate and to reflect the relationship between these components has been defined. In this article, the previous conceptual analysis of transitions is extended and refined by drawing on the results of five different research studies that have examined transitions using an integrative approach to theory development. The emerging middle-range theory of transitions consists of types and patterns of transitions, properties of transition experiences, facilitating and inhibiting conditions, process indicators, outcome indicators, and nursing therapeutics. The diversity, complexity, and multiple dimensionality of transition experiences need to be further explored and incorporated in future research and nursing practice related to transitions.
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              Redefining Palliative Care—A New Consensus-Based Definition

              Context. The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. Objective. The main objective of this article is to present the research behind the new definition. Methods. The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition. Results. The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC. Conclusion. Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span.
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                Author and article information

                Contributors
                Role: Senior Lecturer, Associate Professorjane.osterlind@esh.se
                Role: Senior Lecturer, Associate Professor
                Journal
                Nurs Philos
                Nurs Philos
                10.1111/(ISSN)1466-769X
                NUP
                Nursing Philosophy
                John Wiley and Sons Inc. (Hoboken )
                1466-7681
                1466-769X
                22 October 2020
                April 2021
                : 22
                : 2 , Philosophy at the intersection of thinking and doing in nursing ( doiID: 10.1111/nup.v22.2 )
                : e12334
                Affiliations
                [ 1 ] Department of Health Care Sciences Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
                [ 2 ] The Sahlgrenska Academy Institute of Health and Care Sciences University of Gothenburg Gothenburg Sweden
                [ 3 ] Angered Local Hospital Gothenburg Sweden
                Author notes
                [*] [* ] Correspondence

                Jane Österlind, Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Box 11189, SE‐100 61 Stockholm, Sweden.

                Email: jane.osterlind@ 123456esh.se

                Author information
                https://orcid.org/0000-0001-9559-1939
                Article
                NUP12334
                10.1111/nup.12334
                8243997
                33089912
                f1e58e0d-b32a-4693-b51f-c801e819384d
                © 2020 The Authors. Nursing Philosophy published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 September 2020
                : 17 May 2020
                : 01 October 2020
                Page count
                Figures: 2, Tables: 0, Pages: 10, Words: 8291
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                April 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:30.06.2021

                Nursing
                nursing,nursing theory,palliative care,philosophy of nursing,practice,theory
                Nursing
                nursing, nursing theory, palliative care, philosophy of nursing, practice, theory

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