Older Age: A Protective Factor Against Perceived Dignity-Related Distress in Patients With Advanced Cancer?

ContextMost older adults will face threats to loss of health and social support, which can affect their perceived dignity. Although problems with perceived dignity increase in the context of cancer, the specific experience for those older compared with younger patients with advanced cancer has not been described despite its contributions to the wish to hasten death (WTHD).ObjectivesTo understand the influence of age group to the perception of dignity, considering changes in quality of life and the WTHD in patients with advanced cancer.MethodsThe Patient Dignity Inventory was administered to 194 patients with advanced cancer. The data were analyzed by separating the sample into age groups younger than 65 years (N = 106) or 65 years and older (N = 88). Linear regression models were adjusted with the explanatory variables of WTHD, quality of life, as well as functional status, physical dependence, depression, anxiety, and sociodemographic variables.ResultsOlder patients showed a 2.6% decrease in the total scores of perceived dignity-related distress compared to younger patients.ConclusionOlder age could be a protective factor against the perception of loss of dignity in patients with advanced cancer, a more positive perspective of the aging experience.     

晚期肝癌住院患者尊严感状况及影响因素

目的进行晚期肝癌住院患者尊严感现状的横断面调查。方法选择医院2019年1月—2020年1月共90例晚期肝癌患者为研究对象,采用中文版患者尊严量表(PDI)进行尊严感调查,通过单因素及多元线性逐步回归分析,调查晚期肝癌住院患者尊严感的影响因素。结果90例晚期肝癌患者PDI总评分为68.44±4.84分,尊严明显受损者(>50分)62例,受损率68.89%,其中生存困境评分最高,社会支持评分最低;不同经济情况、学历、治疗方式、居住方式PDI评分差异具有统计学意义(P<0.05);不同性别、婚姻状况比较差异无统计学意义(P>0.05);多元线性逐步回归分析法进行多因素分析显示,ECOG评分、NRS评分、LINK评分、经济情况、治疗方式、年龄是晚期肝癌住院患者尊严感的影响因素(P<0.05)。结论晚期肝癌住院患者普遍存在尊严感下降现象,受到活动能力、疼痛、年龄以及病耻感等多种因素的影响,应开展针对性护理措施以提升患者尊严感。     

The body's dignity in integrative understanding of health in IBD – A hermeneutic approach to holistic care

Background and purposeThis article will convey a new understanding of health and disease as a coherent dimension where the whole body interacts with its natural environment. This understanding is linked to a theoretical framework and illustrated by reference to research with patient experiences with inflammatory bowel disease (IBD), with the disorders Crohn's disease and ulcerative colitis. Creating ecological sustainability towards a greener health service where the body has a higher intrinsic value is a growing concern.Material and methodsThe methodological approach is hermeneutic, whereby the results of one's own research are interpreted and reconceived through reflection towards a new understanding. Themes from patients' experiences are interpreted in light of the theoretical frame of reference of this article in order to achieve a new understanding.ResultsThe further interpretation of the state-of-the-art article and empirical articles resulted in the following themes: 1. The lived body is understood as a coherent whole and a place of inner freedom. 2. The body in a lowered state of stress helps the patient to experience dignity and vitality. 3. An integrative understanding of health in terms of IBD brings dignity and wholeness to the body.ConclusionThis article sheds light on the connections between body knowledge, nutrition, dignity, and integrative understanding of health in acute and chronic IBD. In clinical practice, the connections may happen when giving the patient the opportunity for recovery by learning to listen to the body. Dignity is linked to both coping and expert help from clinically competent health professionals.     

尊严疗法对临终患者焦虑、抑郁及希望水平影响的Meta分析

目的系统评价尊严疗法对临终患者焦虑、抑郁及希望水平的影响。方法计算机检索PubMed、WebofScience、CochraneLibrary、Scopus、EMBASE、EBSCO、OVID、中国生物医学文献数据库（CBM）、中国知网（CNKI）及万方数据知识服务平台等，收集有关尊严疗法对终末期患者干预效果的原始研究，检索时间均为建库至2017年3月，由2位评价人员按照标准独立筛选文献、提取资料、评价文献质量。采用RevMan5.3分析软件对资料进行统计分析。结果共纳入7个随机对照试验（RCTs），543例患者。Meta分析结果显示，尊严疗法在干预＞1周时能改善临终患者焦虑[SMD=-0.95，95%CI：（-1.86，-0.05），P＜0.01]，抑郁[SMD=-0.85，95%CI：（-1.61，-0.09），P＜0.01],希望水平[SMD=3.74，95%CI：（0.89，6.59），P=0.01]；而干预不足1周时，尊严疗法组和对照组相比，焦虑、抑郁及希望水平改善均无统计学差异(均P＞0.05)。结论尊严疗法干预＞1周时对改善临终患者的焦虑、抑郁及希望水平具有较好的效果，但干预≤1周时效果不明显。受纳入研究数量和质量限制，上述结论尚需要更多高质量研究予以验证。     

Disability and dignity-enabling home environments

In Canada where long-term care is primarily oriented to elderly persons and affordable accessible housing is limited, younger disabled adults may be living in circumstances that do not meet their health needs and contribute to their social exclusion. The purpose of this study was to undertake an ethical analysis of what constitute an 'adequate' home environment for adults with significant mobility disabilities. An integrated design was used that combined qualitative interviews with normative ethical analysis in an iterative process. Twenty interviews with 19 participants were conducted in Ontario, Canada with two groups: younger adults (ages 18-55) with mobility disabilities and 'decision-makers' who consisted of policy makers, program administrators and discharge planners. Data were analyzed using a critical disability ethics approach and processes of reflective equilibrium. Drawing on Nora Jacobson's (Jacobson, 2009) taxonomy of dignity and pluralistic approaches to social justice, the concept of 'social dignity' provides a lens for exploring the adequacy of home environments for disabled people. Analyses suggested seven threshold conditions necessary for a dignity-enabling home: the ability to form and sustain meaningful relationships; access to community and civic life; access to control and flexibility of daily activities; access to opportunities for self-expression and identity affirmation; access to respectful relationships with attendants; access to opportunities to participate in school, work or leisure; access to physical, psychological and ontological security. The results have implications for housing, health and social care policies, and political reform. Social dignity provides a normative ethical grounding for assessing the adequacy of home environments. The threshold elements outline specific dignity-enabling conditions that are open to further specification or elaboration in different contexts.     

Back to basics—Essential nursing care in the ED, Part 2

Emergency nurses are expected to work under pressure to many standards, guidelines and protocols related to patient care, and often in an advanced practice role. These expectations can sometimes take priority over basic nursing care once emergency/resuscitative intervention has occurred. However posing the question ‘How would I want this patient to be cared for if they were my grandmother/father/child?’ sets a benchmark for nursing practice [Fulbrook P, Grealy B. Essential nursing care of the critically ill patient. In: Elliot D, Aitken L, Cheboyer W, editors. ACCCN Critical Care Nursing. Sydney: Elsevier; 2006.]. How well patients are cared for has a direct effect on their sense of wellbeing and their recovery. Effective communication is essential to good nursing care and patient outcomes. The length of stay of the patient in the ED may be extended, and the use of “holding” wards while waiting for investigation results of patients for probable discharge necessitates the ED nurse to consider basic but essential aspects of nursing care that will be discussed.