Three nursing home residents speak about meaning at the end of life.
Nursing ethics, Jan 2008, vol. 15, no. 1,
p. 97-109
Dwyer-Lise-Lotte, Nordenfelt-Lennart, Ternestedt-Britt-Marie.
Abstract
This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18-24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize.
Wednesday 30 April 2008
Influence of end-of-life education on attitudes of nursing students.
The influence of end-of-life education on attitudes of nursing students.
International journal of nursing education scholarship, 2008 (epub: 15 Mar 2008), vol. 5, p. Article11
Barrere-Cynthia-C, Durkin-Anne, LaCoursiere-Sheryl
Abstract
Palliative care is an important aspect of nursing when comfort and quality of life are the patient goals. The End-of-Life Nursing Education Consortium (ELNEC) developed a comprehensive program of teaching care of the dying to nurses and nursing students. This pretest-posttest study evaluated the influence of the integration of the ELNEC curriculum into a baccalaureate nursing program on students' attitudes toward care of the dying. The Frommelt Attitudes toward Care of the Dying Scale for nurses (FATCOD) was administered to traditional and accelerated baccalaureate students before and after exposure to a nursing curriculum that integrated essential ELNEC elements. Multiple regression analyses indicated that no previous experience with death and an age of 18-22 accounted for the most variance in attitude change. The findings suggest that integrating the ELNEC curriculum throughout a baccalaureate program positively affects the attitudes of nursing students toward the care of patients who are dying.
International journal of nursing education scholarship, 2008 (epub: 15 Mar 2008), vol. 5, p. Article11
Barrere-Cynthia-C, Durkin-Anne, LaCoursiere-Sheryl
Abstract
Palliative care is an important aspect of nursing when comfort and quality of life are the patient goals. The End-of-Life Nursing Education Consortium (ELNEC) developed a comprehensive program of teaching care of the dying to nurses and nursing students. This pretest-posttest study evaluated the influence of the integration of the ELNEC curriculum into a baccalaureate nursing program on students' attitudes toward care of the dying. The Frommelt Attitudes toward Care of the Dying Scale for nurses (FATCOD) was administered to traditional and accelerated baccalaureate students before and after exposure to a nursing curriculum that integrated essential ELNEC elements. Multiple regression analyses indicated that no previous experience with death and an age of 18-22 accounted for the most variance in attitude change. The findings suggest that integrating the ELNEC curriculum throughout a baccalaureate program positively affects the attitudes of nursing students toward the care of patients who are dying.
JAMA 16 Apr 2008, vol. 299, no. 15
Management of intractable nausea and vomiting in patients at the end of life: I was feeling nauseous all of the time . . . nothing was working.
Full text available at American Medical Association
p. 1826
Markowitz-Amy-J, Rabow-Michael-W.
Comment on: JAMA. 2007 Sep 12; 298(10):1196-207.
Palliative care for patients with head and neck cancer: I would like a quick return to a normal lifestyle.
Full text available at American Medical Association
p. 1818-25
Goldstein-Nathan-E, Genden-Eric, Morrison-R-Sean.
Abstract
Head and neck cancers constitute a diverse group of diseases including malignancies of the oral cavity, oropharynx, larynx, sinuses, and skull base. Treatment of these cancers includes a combination of surgical resection, chemotherapy, and radiation. Due to both the patterns of disease recurrence and the adverse effects of treatments, patients with head and neck cancer often have a complex and prolonged course of illness that is marked by periods of freedom from disease and symptoms interspersed with bouts of serious illness, debility, and numerous physical and psychological symptoms including pain, dysphagia, weight loss, disfigurement, depression, and xerostomia. Thus, management of this disease is best provided by an interdisciplinary team that includes individuals from the disciplines of otolaryngology, palliative care, radiation oncology, oncology, nutrition, speech, and physical and occupational therapy. Using the case of Mr K, we describe the symptoms encountered by patients with head and neck cancer and suggest options for management. We discuss the psychological aspects that affect these patients, including issues such as changes in body image, quality of life, anxiety, and guilt. Finally, we discuss the importance of the interdisciplinary team in the care of these patients and outline the roles of each team member. By providing comprehensive care to patients with malignancies of the head and neck, clinicians can increase the likelihood that patients and their families will be able to obtain the best possible outcomes and quality of life.
Determining hospice benefit for patients with dementia.
Full text available at American Medical Association
p. 1774; author reply 1774-5
Cherney-Clare-L.
Comment
Comment on: JAMA. 2007 Dec 5; 298(21):2527-36.
Full text available at American Medical Association
p. 1826
Markowitz-Amy-J, Rabow-Michael-W.
Comment on: JAMA. 2007 Sep 12; 298(10):1196-207.
Palliative care for patients with head and neck cancer: I would like a quick return to a normal lifestyle.
Full text available at American Medical Association
p. 1818-25
Goldstein-Nathan-E, Genden-Eric, Morrison-R-Sean.
Abstract
Head and neck cancers constitute a diverse group of diseases including malignancies of the oral cavity, oropharynx, larynx, sinuses, and skull base. Treatment of these cancers includes a combination of surgical resection, chemotherapy, and radiation. Due to both the patterns of disease recurrence and the adverse effects of treatments, patients with head and neck cancer often have a complex and prolonged course of illness that is marked by periods of freedom from disease and symptoms interspersed with bouts of serious illness, debility, and numerous physical and psychological symptoms including pain, dysphagia, weight loss, disfigurement, depression, and xerostomia. Thus, management of this disease is best provided by an interdisciplinary team that includes individuals from the disciplines of otolaryngology, palliative care, radiation oncology, oncology, nutrition, speech, and physical and occupational therapy. Using the case of Mr K, we describe the symptoms encountered by patients with head and neck cancer and suggest options for management. We discuss the psychological aspects that affect these patients, including issues such as changes in body image, quality of life, anxiety, and guilt. Finally, we discuss the importance of the interdisciplinary team in the care of these patients and outline the roles of each team member. By providing comprehensive care to patients with malignancies of the head and neck, clinicians can increase the likelihood that patients and their families will be able to obtain the best possible outcomes and quality of life.
Determining hospice benefit for patients with dementia.
Full text available at American Medical Association
p. 1774; author reply 1774-5
Cherney-Clare-L.
Comment
Comment on: JAMA. 2007 Dec 5; 298(21):2527-36.
Survey of bereavement support provided by Australian palliative care services.
Survey of bereavement support provided by Australian palliative care services.
Full text available at ProQuest
The Medical journal of Australia, 18 Feb 2008, vol. 188, no. 4
p. 228-30
Mather-Mark-A, Good-Phillip-D, Cavenagh-John-D, Ravenscroft-Peter-J.
Abstract
OBJECTIVE: To determine the prevalence, staffing, methods, timing and allocation of bereavement programs in Australian palliative care services. DESIGN: Questionnaire-based postal survey. SETTING AND PARTICIPANTS: The questionnaire was mailed in January 2007 to all 324 palliative care centres identified from the Australian Palliative care national directory 2004. RESULTS: 236 of the 324 centres responded (73%), and 95% of these undertook bereavement follow-up, with similar prevalence in metropolitan and regional areas. Staff from a range of disciplines were involved in coordinating and delivering these services, with nurses taking on these roles in most regional centres. Common types of bereavement follow-up included individual sessions and visits, telephone contact, letters, anniversary cards and memorial services. Most centres (74%) approached the bereaved within 2 weeks of the death, and 83% of centres offered bereavement support to families or significant others of all patients who died under their care. Some form of risk assessment for complicated grief was performed by 69% of participating centres. CONCLUSION: Bereavement care is an integral part of Australian palliative care services. Given the multidisciplinary staffing demonstrated, it is important that those coordinating and delivering these programs are adequately trained and supported. There is a need for further research to guide the development of bereavement support practice.
Full text available at ProQuest
The Medical journal of Australia, 18 Feb 2008, vol. 188, no. 4
p. 228-30
Mather-Mark-A, Good-Phillip-D, Cavenagh-John-D, Ravenscroft-Peter-J.
Abstract
OBJECTIVE: To determine the prevalence, staffing, methods, timing and allocation of bereavement programs in Australian palliative care services. DESIGN: Questionnaire-based postal survey. SETTING AND PARTICIPANTS: The questionnaire was mailed in January 2007 to all 324 palliative care centres identified from the Australian Palliative care national directory 2004. RESULTS: 236 of the 324 centres responded (73%), and 95% of these undertook bereavement follow-up, with similar prevalence in metropolitan and regional areas. Staff from a range of disciplines were involved in coordinating and delivering these services, with nurses taking on these roles in most regional centres. Common types of bereavement follow-up included individual sessions and visits, telephone contact, letters, anniversary cards and memorial services. Most centres (74%) approached the bereaved within 2 weeks of the death, and 83% of centres offered bereavement support to families or significant others of all patients who died under their care. Some form of risk assessment for complicated grief was performed by 69% of participating centres. CONCLUSION: Bereavement care is an integral part of Australian palliative care services. Given the multidisciplinary staffing demonstrated, it is important that those coordinating and delivering these programs are adequately trained and supported. There is a need for further research to guide the development of bereavement support practice.
Family member satisfaction with end-of-life decision making in the ICU.
Family member satisfaction with end-of-life decision making in the ICU.
Chest, Mar 2008 (epub: 15 Jan 2008), vol. 133, no. 3,
p. 704-12,
Gries-Cynthia-J, Curtis-J-Randall, Wall-Richard-J, Engelberg-Ruth-A.
Abstract
RATIONALE: Families of ICU patients may be at risk for increased psychological morbidity due to end-of-life decision making. The identification of chart-based quality indicators of palliative care that predict family satisfaction with decision making may help to guide interventions to improve decision making and family outcomes. OBJECTIVE: To determine patient and family characteristics and chart the documentation of processes of care that are associated with increased family satisfaction with end-of-life decision making for ICU patients. METHODS: We conducted a cohort study of ICU patients dying in 10 medical centers in the Seattle-Tacoma area. Measurement: Outcomes from family surveys included summary scores for family satisfaction with decision making and a single-item score that indicated feeling supported during decision making. Predictor variables were obtained from surveys and chart abstraction. Main results: The survey response rate was 41% (442 of 1,074 families responded). Analyses were conducted of 356 families with questionnaire and chart abstraction data. Family satisfaction with decision making was associated with the withdrawal of life support, and chart documentation of physician recommendations to withdraw life support, discussions of patients' wishes, and discussions of families' spiritual needs. Feeling supported during decision making was associated with the withdrawal of life support, spiritual care involvement, and chart documentation of physician recommendations to withdraw life support, expressions of families' wishes to withdraw life support, and discussions of families' spiritual needs. CONCLUSIONS: Increased family satisfaction with decision making is associated with withdrawing life support and the documentation of palliative care indicators including the following: physician recommendations to withdraw life support; expressions of patients' wishes; and discussions of families' spiritual needs. These findings provide direction for future studies to investigate approaches to improving family satisfaction in end-of-life decision making. In addition, because there were few nonwhites in this study, these results may not be generalizable to more diverse populations. Future studies should target diverse populations in order to test whether similar factors are similarly important for end-of-life decision making.
Chest, Mar 2008 (epub: 15 Jan 2008), vol. 133, no. 3,
p. 704-12,
Gries-Cynthia-J, Curtis-J-Randall, Wall-Richard-J, Engelberg-Ruth-A.
Abstract
RATIONALE: Families of ICU patients may be at risk for increased psychological morbidity due to end-of-life decision making. The identification of chart-based quality indicators of palliative care that predict family satisfaction with decision making may help to guide interventions to improve decision making and family outcomes. OBJECTIVE: To determine patient and family characteristics and chart the documentation of processes of care that are associated with increased family satisfaction with end-of-life decision making for ICU patients. METHODS: We conducted a cohort study of ICU patients dying in 10 medical centers in the Seattle-Tacoma area. Measurement: Outcomes from family surveys included summary scores for family satisfaction with decision making and a single-item score that indicated feeling supported during decision making. Predictor variables were obtained from surveys and chart abstraction. Main results: The survey response rate was 41% (442 of 1,074 families responded). Analyses were conducted of 356 families with questionnaire and chart abstraction data. Family satisfaction with decision making was associated with the withdrawal of life support, and chart documentation of physician recommendations to withdraw life support, discussions of patients' wishes, and discussions of families' spiritual needs. Feeling supported during decision making was associated with the withdrawal of life support, spiritual care involvement, and chart documentation of physician recommendations to withdraw life support, expressions of families' wishes to withdraw life support, and discussions of families' spiritual needs. CONCLUSIONS: Increased family satisfaction with decision making is associated with withdrawing life support and the documentation of palliative care indicators including the following: physician recommendations to withdraw life support; expressions of patients' wishes; and discussions of families' spiritual needs. These findings provide direction for future studies to investigate approaches to improving family satisfaction in end-of-life decision making. In addition, because there were few nonwhites in this study, these results may not be generalizable to more diverse populations. Future studies should target diverse populations in order to test whether similar factors are similarly important for end-of-life decision making.
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