Research Theme: Supportive and Palliative Care

Research Title: Ethical issues experienced by healthcare workers providing palliative care in nursing homes

Research Interests: Palliative care, ethical principles and issues, psycho-oncology and older person care, health and wellbeing in the general population

Supervisors: Professor Kevin Brazil, Dr Dorry McLaughlin, Dr Andrea Frolic

Email: dpreshaw01@qub.ac.uk

LinkedIn:  https://uk.linkedin.com/in/deborah-preshaw-8051b4ba

Twitter: @DeborahPreshaw

Personal Bio

I completed my BSc (1^st class with honours) in Psychology at QUB which I found to be a thoroughly enjoyable experience. Throughout the course of study I found statistics and research, particularly statistical modelling, to be fascinating. After graduating as the second highest performing student, I moved straight to the School of Nursing and Midwifery to pursue my research interests through a PhD. 

Project Summary

Background: Ethical issues experienced by healthcare-providers can be associated with detrimental outcomes, however, little is known about the nature of these issues within palliative care provision in nursing homes. Aim: To provide a comprehensive understanding of care-providers’ experiences of ethical issues during palliative care provision in nursing homes.

Methods: A two phase, exploratory, sequential, mixed methods design was utilised. Semi-structured interviews with 13 Registered Nurses and ten Healthcare Assistants were used to explore ethical issues during palliative care provision. An instrument was developed measuring the frequency and level of distress associated with these ethical issues and utilised in a cross-sectional survey with 69 RNs and 129 HCAs.

Results: Three themes grouped experiences of ethical issues; professional issues/ issues in practice, relational issues, and organisational issues. There were no significant differences between RNs and HCAs in the frequency (t= -.851, d.f. =196, p=.396), or level of distress the issues caused (t= -.235, d.f. =176, p=.814). Issues faced most frequently were; caring for residents refusing food/fluids (Mean = 2.71; SD= 1.19); and best interests decision making to prevent harm (Mean = 2.68; SD= 1.24). The most distressing issues included; the impact of poor communication on care (Mean = 2.48; SD= 1.39); and lack of time (Mean = 2.36; SD= 1.44). Support for the family, and increased involvement from GPs, were identified as central to reducing ethical issues.

Conclusions: Improved communication between healthcare professionals, residents, and families, and palliative care training may improve the palliative care experience.

My Perfect PhD Day

When you can go home at the end of the day knowing you have met your deadlines and achieved your planned goals 

Teaching

I am involved in teaching for the following degree programmes and modules:

BSc Nursing—Evidence Based Nursing (Year 2) 

Other Activities 

During my time at Queen’s I have worked with many charities including Action Cancer, Brain Injury Matters, and SOS NI as a volunteer, and involved myself in many extra-curricular activities such as mentoring, teaching, and student led initiatives. I have had the opportunity to share my research through publishing and presenting at national and international conferences, and I have also extended my research to Canada through the Marcia Mackie Scholarship.

When I’m not PhDing…

I love to bake, to be outdoors, and to spend time travelling with friends and family

Conferences & Publications

Publications

Preshaw, D., Brazil, K., McLaughlin, D. & Frolic, A. (2015). Ethical Issues in Nursing Homes: Literature review. Nursing Ethics Journal. Advance online publication. doi: 10.1177/0969733015576357.

Mitchell, G., McGreevy, J., Preshaw, D., Agnelli, J. & Diamond, M. (2016) ‘Care Home Managers’ Knowledge of Palliative Care: A Northern Irish Study’, International Journal of Palliative Nursing, (in press).

Selected Oral Presentations

• Invited Speaker, Ethics Grand Rounds (2016, May), Ethical issues experienced by healthcare workers providing palliative care in nursing homes: A mixed methods study, HHS Clinical Ethics Committee and McMaster University Faculty of Health Sciences, McMaster University Medical Centre, Hamilton.
• Preshaw, D., Brazil, K., McLaughlin, D. & Frolic, A. (2016, March). Ethical Issues experienced by healthcare workers providing palliative care in nursing homes. Oral Presentation at the Postdoctoral Symposium, Riddel Hall, Belfast.
• Preshaw, D., Brazil, K., & McLaughlin, D. (2014, June). Ethical Conflicts Experienced by Healthcare Workers providing Palliative Care in Nursing Homes. Oral Presentation at the Annual Student Seminars in the School of Nursing and Midwifery, Queens University Belfast.

Selected Poster Presentations

• Preshaw, D., Brazil, K., McLaughlin, D. & Frolic, A. (2015, May). Ethical Issues within the Nursing Home: A systems approach. Poster Presentation at the 14^th Word Congress of the European Association for Palliative Care, Copenhagen, Denmark.
• Preshaw, D., Brazil, K., McLaughlin, D. & Frolic, A. (2015, April). Ethical Issues within the Nursing Home: Literature Review. Poster Presentation at the International Association of Geriatrics and Gerontology European Region Congress, Dublin, Ireland.
• Preshaw, D., Brazil, K., McLaughlin, D., & Frolic, A. (2014, September). Ethical Conflict experienced by healthcare workers in nursing homes: Literature Review. Poster presentation at the NI Palliative Care Research Forum Research Showcasing event, Jordanstown Campus, University of Ulster.