The experience of the nurse caring for families of patients at the end of life in the intensive care unit

The patient who enters at the intensive care unit (ICU) usually does because of health conditions that are sometimes irreversible and lead to death, and the care at the end of life becomes the main factor of this situation; therefore, the aim of this article was to understand the meaning of the experience of giving care to families at the end of life in an ICU. For this reason, a qualitative, hermeneutic phenomenological research was carried out. For the data collection, a semi‐structured interview was conducted to 18 participants, and the results were returned to each of the participants in order to validate each of the categories and interpretations. Among these results, two main categories were identified: emotional response of the nurse to the family and nursing care to the family of patients at the end of life. It was concluded that the nurses working at the ICU are facing aspects related to the end of life that generates emotional and psychological burden; additionally, they do not have specific training in this subject, especially in relation to the care of the families in this situation, for which they provide this care based on empiricism.     

Comparisons of the cost-effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients

AIM: This study compared the cost and effectiveness of long-term institutional care and home care for stroke patients with severe physical disabilities. BACKGROUND: Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. METHODS: From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. RESULTS: Information on family costs for caregiving, including pay for long-term services utilized, labour costs for caregiving and out-of-pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. CONCLUSIONS: The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.     

浅谈加强临终关怀中的家属护理

根据临终关怀的定义，强调对家属护理的必要性。家属是主要照护者，存在着各方面的心理应激。根据家属的生理、心理、社会和文化的需求，提出了各项护理措施，使家属的生活质量得到提高。     

Nursing home care for older people in Taiwan: a process of forced choice

Aim. To generate a substantive theory for understanding the phenomenon of nursing home care for older people in Taiwan. Background. Taiwanese culture shows great respect for older people and older people are traditionally cared for at home by their families. However, the older population in Taiwan is rapidly increasing and this demographic shift, together with various socio‐economic changes, has resulted in nursing homes becoming a new and significant care option. Design. A grounded theory approach was used to study the residents and relatives from three nursing homes in Taiwan. Methods. Formal and informal interviews and participant observation data were collected over two months in each nursing home. Forty nursing home residents and 20 of their relatives were recruited. The data were analysed using the constant comparative method and involved the use of theoretical memos and theoretical sampling procedures. Results. The study found that nursing home care for older people in Taiwan is understood to be a process of forced choice, involving three stages; namely, ‘becoming a problem’, ‘making a forced choice’ and ‘coping with the forced choice’. Conclusion. Taiwan is in a state of conflict with regard to providing care for older people, a situation in which the influence of traditional cultural and that of industrialisation exist side by side. The consequence of having to relocate older people into nursing homes means that both parties are the victims of this choice. Relevance to clinical practice. This conceptual explanation helps us to understand how the Taiwanese respond to the issue of care for older people and how they resolve their main concerns related to it. Subsequently, it is hoped that this will help health care practitioners to provide care more effectively to meet the needs of the Taiwanese with the aim of enhancing the standards of care for older people.     

A Pilot Study of the Diagnosis and Treatment of Impaired Skin Integrity: Dry Skin in Older Persons

A pilot study was conducted to isolate the clinical indicators of dry skin in the elderly, test an instrument used to measure dry skin, analyze the importance of factors thought to contribute to dry skin, test the effectiveness of an intervention for treating dry skin, and determine the feasibility of clinical implementation of the protocol. The sample included 15 elderly long-term care residents with a nursing and medical diagnosis of dry skin. Although the small sample size limits interpretation of findings, there is some evidence that scaling and flaking may be indicators of skin dryness. Subjects received the bathing intervention for 6 weeks and were assessed every 2 weeks during the 6-week periods before, during, and after intervention (nine data collection points). Analysis of the nine repeated measures of skin dryness indicated significantly reduced total dryness ( p = 031), redness ( p =.001), scaling ( p =.007), and flaking ( p =.002) over time. Post hoc comparisons, interrater agreement on the Skin Condition Data Form, and categorical variables were analyzed. Findings from this study will be used to generate further hypotheses.     

Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters

This discussion paper aims to explore potential ethical and moral implications of (patient) centredness in nursing and healthcare. Healthcare is experiencing a philosophical shift from a perspective where the health professional is positioned as the expert to one that re‐centres care and service provision central to the needs and desires of the persons served. This centred approach to healthcare delivery has gained a moral authority as the right thing to do. However, little attention has been given to its moral and ethical theoretical grounding and potential implications for nurses, persons served and the healthcare system. Based upon a review of academic and grey literature, centredness is proposed as a value‐laden concept in nursing inquiry. Potential moral and ethical implications of centredness on nurses/healthcare providers, persons served and the healthcare system are discussed. These challenges are then considered within the context of normative and relational ethical theories. These perspectives may offer guidance relative to how one should act in those circumstances as well as an understanding as to how interdependency and engagement with the other person(s) can help navigate the challenges of a centred care approach. Viewing centredness through an ethical theoretical lens provides a valuable discourse to nursing in efforts to expand the knowledge base and integrate centred approaches into practice and policy.     

Nursing staff attitudes and behaviours regarding family presence in the hospital setting

Title. Nursing staff attitudes and behaviours regarding family presence in the hospital setting. Aim. This paper is a report of a study conducted to assess the attitudes and values of nursing staff towards family presence during routine nursing care. Background. Nursing staff attitudes are an important factor in the adoption of family‐centred care for children, and for all ages in the emergency room, special care units, and anaesthesia induction and recovery. Little is documented about nurse attitudes and behaviours related to family presence during day‐to‐day routine nursing care. Method. In 2006, primary data were collected with a convenience sample of 89 nursing staff using an 18‐item questionnaire developed by the authors and based on several family‐centred care instruments in the literature. Items assessed attitude and nurse behaviours related to family presence during routine nursing care. Findings. Nurses’ attitudes and behaviours towards family presence during routine nursing care were generally favourable. There was low agreement about family members being allowed to visit whenever the patient wished. Nursing staff attitudes were consistent with their self‐reported behaviours supporting family presence. Conclusion. Nursing staff who believe family presence is important are more likely to include families in daily care. The organization plays a key role in encouraging family‐centred care by providing appropriate education and support to nursing staff.     

儿童夜惊的家庭护理有效性研究

[目的 ]探讨儿童夜惊的有效护理方法 ,减少影响儿童睡眠的不利因素。 [方法 ]将符合夜惊诊断的2 6例儿童分为干预组和对照组 ,两组同时给予药物治疗 ,干预组实施治疗的同时制定家庭护理措施并进行综合性干预。 [结果 ]干预组症状均有改善 ,且优于对照组 (P <0 .0 5 )。 [结论 ]开展家庭护理 ,对儿童的不良睡眠行为进行干预 ,能降低引起夜惊的不良因素 ,提高儿童的睡眠质量。     

Assessing quality of life of older people with dementia: a comparison of quantitative self-report and proxy accounts

moyle w., murfield j.e., griffiths s.g. & venturato l. (2012)?Assessing quality of life of older people with dementia: a comparison of quantitative self-report and proxy accounts. Journal of Advanced Nursing68(10), 2237-2246. ABSTRACT: Aims. This article reports on a study of quality of life of older people with dementia, as assessed by the person with dementia, family carer and care staff. Background. People with dementia can give meaningful assessments of their quality of life, but these often differ from proxy ratings. In understanding this discrepancy, the influence of age, extent of cognitive impairment and activity limitation has been investigated. A lack of conclusive associations between quality of life ratings and these variables indicates a need for further research. Methods. Fifty-eight triads comprising the person with dementia, family carer and member of care staff from four long-term care facilities were surveyed on the Quality of Life-Alzheimer's Disease questionnaire between August and December 2007. Results. There was an important difference in the Quality of Life-Alzheimer's Disease questionnaire total mean scores between groups, with the person with dementia providing the highest ratings. Level of impairment in Activities of Daily Living had an important effect on quality of life ratings, with proxies, particularly care staff, providing lower ratings when there was greater activity limitation. This was not replicated for assessments made by the person with dementia. Age or level of cognitive impairment did not influence any ratings. Conclusion. People with dementia can give assessments of their quality of life. However, discrepancy in ratings, with greater activity limitation affecting proxy ratings but not those made by the person with dementia, indicates the importance of including both self-report and proxy measures in research and care planning.