Communicating with terminally ill cancer patients and their families

This qualitative study aimed to investigate whether 4th year undergraduate nursing students raise concerns about communication with terminally ill and dying cancer patients and their families. It focused on factors which could influence students' feelings of insecurity/security when communicating with this group of patients and their families, factors which could influence communication, and whether students felt adequately prepared for this kind of nursing. The research involved interviewing 12 student nurses in their 4th year of their undergraduate education at a Scottish university using content analysis for analyzing the data. Five themes and 13 sub-themes emerged from this analysis. The findings revealed that communicating with terminally ill and dying cancer patients in the acute setting is difficult for student nurses and issues about death and dying tended to be ignored. While it was found that university lectures about death and dying were helpful, lack of support and guidance within the clinical setting was a major concern.     

Critical times for families with a chronically ill child

Parents identified difficult times in caring for their chronically ill children. A model describing these critical times was developed through an analysis of parent interviews. Predicting these critical times enables the health care team to optimize and maximize the effectiveness of their interventions.     

Pain control in the terminally ill child at home

The seriously ill or terminally ill child with cancer has received inadequate pain control in the past, partly due to physicians' and nurses' fears and misconceptions regarding the administration of effective pain medications to a child. Advances in assessment techniques in the infant and young child, as well as increasing use of pain assessment questionnaires and VAS in the older child, have mandated changes in administration of analgesia to children. It is the responsibility of the health-care team of provide adequate pain control to the ill child, using knowledgeable assessment and monitoring skills. The goal of therapy for the dying child is to maintain comfort and support the child and the family. Providing analgesia in the hospital or the home has proven safe and effective when administered either orally or parenterally, and comfort of the child is achieved.     

Dying to know: qualitative research with terminally ill persons and their families

This article illustrates the use of qualitative research methods in the field of thanatology. The authors - a former doctoral candidate and her dissertation chair - describe their ongoing naturalistic inquiry of terminally ill persons and their family members. By describing the reasoning and decision-making informing their study, the authors provide an instructive "how to" on the following topics: finding a research question and a method; assessing risks and benefits; sampling; gaining entry/access to research informants; participant observation; interviewing; analyzing data, and establishing "relational integrity." In a final section, the first author offers reflections on the personal challenges she faced while conducting her research.     

Fathers struggling for relevance in the care of their terminally ill child

Children with terminal illness receive substantial amounts of care from their parents within their home, a palliative care facility or general hospital. Whilst there is a long history of research exploring child and family experiences and coping styles within these settings, the focus has not been on fathers' participation in care-giving. This phenomenon can be explained by traditional sex-role socialisations whereby men are ostensibly conditioned as breadwinners and mothers remain embedded as the primary carers for children, particularly when illness arises. Nevertheless, nurses report that men do provide direct care-giving or seek to be more involved in caring for their child. This literature review offers opportunities for health professionals to reflect on the significance of gender in parenting the terminally ill child and to develop empathy for men experiencing difficulties in their role as care-givers. As there is little literature available on this topic, this paper portrays men's experiences and importantly the barriers they encounter in meeting their desire to care. The approach provides a suitable basis for developing a research agenda to promote competencies and relevance for fathers in their role as care-giver.     

Concept development of family resilience: a study of Korean families with a chronically ill child

Aims. To clarify and delineate the concept of family resilience in the context of the chronic illness of a child. This study also investigated the concept of family resilience in relation to family functioning in order to compare and contrast family resilience and family functioning. Design and method. Three phases of the hybrid model of concept development were applied: theoretical, fieldwork and final analytical. In the theoretical phase, a working definition of family resilience was developed by a literature review. The fieldwork phase comprised in‐depth interviews with 11 parents with a chronically ill child, in the paediatric oncology unit of a university hospital in South Korea. The qualitative data obtained from the interviews were analysed to find attributes of family resilience. The final analytical phase compared and interpreted the findings from the theoretical and fieldwork phases in order to clarify and refine the concept of resilience. Results. The definition of family resilience was of an enduring force that leads a family to change its functioning dynamics in order to solve problems encountered. Twenty‐one conceptual attributes of family resilience emerging from this study were differentiated into four dimensions: (i) intrinsic family characteristics, (ii) family member orientation related to family characteristics, (iii) responsiveness to stress and (iv) external orientation. Conclusions. Family resilience is an enduring force that leads a family to change its dynamics of functioning in order to solve problems associated with stresses encountered. This conceptualization led to the development of a model of family coping that incorporates both family resilience and family functioning, as the property and as the process of change, respectively. Relevance to clinical practice. In order to build a family that functions better under stress, it is necessary for nurses to focus more attention on family resilience, especially in terms of the development of intervention strategies to strengthen family resilience.     

Life review interviews on the spiritual well-being of terminally ill cancer patients

Goals  The aims of this study were (1) to evaluate the treatment efficacy of life review interviews on the spiritual well-being of terminally ill cancer patients, and (2) to explore any differences in the responses of patients who obtained clinical benefits and those who did not. Materials and methods  Structured life review interviews were conducted with 12 patients in a palliative care unit in Japan. They completed the SELT-M (Skalen zur Erfassung von Lebens qualitat bei Tumorkranken–Modified Version) questionnaire before and after the interviews. The patients were classified into two groups: effective (patients who showed an increase in the SELT-M scores after the intervention) and noneffective groups. Meaningful spoken sentences from the patients’ life reviews were transcribed and correspondence analysis was conducted on the sentences using text mining software. Results  The mean overall QOL score and spirituality subscale score of the SELT-M significantly increased after the life reviews from 2.57±0.61 to 3.58±1.0 (P=0.013) and 2.57±0.61 to 3.14±2.25 (P=0.023), respectively. Three dimensions were extracted from the effective group based on the scores “Positive view of life,” “Pleasure in daily activities and good human relationships,” and “Balanced evaluation of life.” Similarly, three dimensions were extracted from the noneffective group: “Worries about future caused by disease,” “Conflicts in family relationship problems,” and “Confrontation of practical problems.” Conclusion  Life review interviews may be effective in improving the spiritual well-being of terminally ill cancer patients. The potential predictors of treatment success are “positive view of life,” “pleasure in daily activities and good human relationships,” and a “balanced evaluation of life,” while those of treatment failure are “worries about future caused by disease,” “conflicts in family relationships,” and “confrontation of practical problems.” Further intervention trials on patients with predictors of treatment success are promising.