Palliative care: a challenge for nurses

There is an ever-growing number of cancer patients in the world today. Of the estimated nine million new cancer cases diagnosed in 1997 worldwide, 52% occurred in developing countries (WHO, 1998). The mortality from cancer is expected to rise around the globe. About 7 million deaths per year occur in the world due to cancer, of which, approximately 0.8 million occur in India (WHO, 1994). There is no cure to date for this disease but definitely a lot can be done to make the lives of these people meaningful and productive. With this idea the concept of hospice and palliative care was initiated.     

Palliative care: a challenge for orthopaedic nursing care

Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.     

Palliative care education for pediatric nurses

Of all the various healthcare professionals that provide care to children and their families facing life's end, no one spends more time at the bedside observing, critically thinking, consulting, and providing direct care than the pediatric nurse. Previous research, however, demonstrates that undergraduate education has not prepared nurses to provide optimum end-of-life (EOL) care (Ferrell, Grant, & Virani, 1999; Ferrell, Virani, & Grant, 1999). Although many reasons have been cited in the literature for this inadequacy, the fact remains that when nurses complete their basic education and enter practice, they often are grossly unprepared to care for children and families in need of end-of-life care (Field & Behrman, 2003).     

Palliative care for breathless patients in the community

Breathlessness is one of the commonest symptoms experienced by people receiving palliative care. However, misunderstanding of the nature of palliative care may hinder assessment, management and evaluation of care and may contribute to the fear associated with living with breathlessness in the community. Knowledge of related anatomy and physiology of breathlessness is vital in informing nursing care and interventions. Pharmacological interventions have their place, but the focus of nursing care should be on systematic holistic assessment. Using this, nurses should adopt a proactive role in supporting and helping patients to adapt to change by maximizing coping strategies.     

Cultural diversity: a challenge for community nurses

Cultural diversity is a challenge for community nurses and can present many difficulties in the provision of quality nursing care and in achieving optimal health outcomes. In this paper seven enabling principles are identified and their application to diverse groups discussed. These include: willingness to recognize expert family skills and knowledge, acknowledging own and other nurses' strengths and weakness, taking time to establish rapport and acceptance, assessing influences on health and health care, providing care that is culturally appropriate, developing cultural competent practice and advocating for CLD appropriate resources and expertise. The aim of this paper is to assist community nurses to provide nursing care congruent with the many lifeway practices encountered in the community. Diverse cultural groups with distinguishing dominant characteristics of ethnic orientation, aboriginality, and disability are selected as examples to demonstrate the application of the principles.     

Palliative care nursing education: opportunities for gerontological nurses

Approximately 80% of Americans who die each year are 65 or older. Increasingly, gerontological nurses are asked to deliver high quality end-of-life care. Studies, however, have identified deficiencies in the delivery of care to older adults who are dying-particularly those who die in nursing homes. Enhancing nursing education and training in end-of-life care is one strategy proposed as a remedy for inadequate care for nursing home residents who are dying. This article reviews the current status of end-of-life nursing home care, describes the philosophy and components of quality palliative care, and provides information about opportunities and resources for educating gerontological nurses in end-of-life care.     

Palliative care update for gastroenterology nurses.

Changing demographics, specifically an aging population associated with an increase of chronic and terminal illness, have highlighted the need for palliative or comfort care in nursing from the time of diagnosis through the dying process. Palliative or comfort care is now on the national healthcare agenda. The purpose of this article is to provide an update on selected palliative care and end-of-life issues and resources related to practice, education, research, and policy for gastroenterology nurses. In addition, selecting one of the suggested resources to review on a regular basis will provide the reader with a strategy for keeping up-to-date in palliative and end-of-life care.     

Palliative care in district general hospitals: the nurse's perspective

Most patients with a terminal illness die in hospital, yet the opinions of their prime carers are largely ignored. This study investigated registered nurses' perceptions of palliative care in district general hospitals. A random sample of 263 nurses was surveyed, using a pre-piloted questionnaire, and results showed that 70% of general ward nurses believe that managing care of the dying is an integral part of hospital care. However, their dissatisfaction with the care they give is reflected in the mere 8% who consider hospital an ideal setting for patients who are dying. Although nurses are confident in their physical/clinical role, dealing with psychosocial issues is more problematic. A minority feel confident in discussing death and dying with the patient. Barriers to optical palliative care on general wards were perceived as lack of appropriate education and training, work pressures, and lack of support from medical colleagues and managers.     

Palliative care for patients with cancer: district nurses' experiences

AIM: This paper reports a study exploring district nurses' experiences of providing palliative care for patients with cancer and their families. BACKGROUND: There is an increasing demand for palliative care in the community, as many patients wish to die at home. District nurses are central to providing palliative care in the community, but there is a dearth of literature on district nurses' experiences in palliative care. METHOD: A Husserlian phenomenological approach was adopted with a purposive sample of 25 female district nurses. Data were collected using unstructured, tape-recorded interviews and analysed using Colaizzi's seven stages of data analysis. FINDINGS: Four themes were identified: the communication web; the family as an element of care; challenges for the district nurse in symptom management and the personal cost of caring. CONCLUSIONS: District nurses' experiences of providing palliative care to family units was challenging but rewarding. The emotive nature of the experience cannot be under-estimated, as many district nurses were touched by the varying situations. Whilst acknowledging the need to maintain an integrated approach to care, district nurses should be identified as the key workers in the complex situation of palliative care.     

Palliative care crises in the community: a survey

With the rising age of the population, hospital cutbacks, and increased attention to home-based care for the dying, the community can expect to experience more intense care situations and a greater potential for palliative care crises developing in the home setting. Whether the crisis is precipitated by hemorrhage, severe uncontrolled pain, or agitation, the demands placed on the family unit and careprovider can be phenomenal. Only with a greater awareness of the difficulties encountered in the home setting can the community begin to respond to the needs of the family in crisis. An open-question survey regarding palliative care crises in the community was conducted among community visiting RNs, home care case managers, and palliative outreach clinicians in southwestern Ontario, The objectives were: 1) to determine the pattern of events that precipitated a crisis; 2) to understand how crises were managed; 3) to identify barriers to effective crisis management; 4) to investigate the impact on the family unit and careprovider. Participants were also asked to list the essential resources they needed to deal effectively with a crisis situation. This paper highlights the results of the survey and suggests implications for the future direction of palliative care in the home.     

End-of-life care in the intensive care unit: a challenge for nurses.

Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. This article explores cultural issues influencing end-of-life care in intensive care units, explores factors surrounding the limited involvement of critical care nurses in end-of-life decision making and care planning, and offers recommendations for changing nursing practice. Because improving end-of-life care will require cultural changes, an understanding of the cultural issues involved is needed. Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.