Mexicans and care for the terminally ill: family, hospice, and the church.

The structural barriers to the use of hospice services by minority groups have been widely discussed. The attitudes of these groups are less clearly delineated. A series of focus groups with Mexicans was held in Michigan and Arizona. The participants were between the ages of 45 and 64 or over as well as providers of services to Mexicans. Regardless of length of time in the United States, participants were low on acculturation scores. These groups found important attitudes about the roles of the family, hospice services, and spirituality and the church in providing care to terminally ill individuals.     

Determinants of hospice utilization among terminally ill geriatric patients

Terminally ill geriatric patients have been found to prefer the type of care provided by home health hospices to the life-sustaining technologies received in hospitals. Nevertheless, disproportionately few dying elderly patients enroll in available hospice programs despite their preferences for, and Medicare's coverage of, hospice services. This study examines several critical factors expected to facilitate or inhibit the utilization of home-based hospice services. Seventy-six critically ill aged patients, their physicians and primary caregivers (e.g., family members) were interviewed about their attitudes and actions regarding the treatment of dying patients. The results indicate that patients who acknowledge their terminal health status, whose physicians disclose the terminal prognosis to them and do not fear malpractice, whose primary caregivers know about hospice and believe the patient would be receptive to enrollment in such a program, have a relatively high probability of home health hospice utilization.     

Hospital care for the terminally ill: a model program

While community hospitals increasingly are becoming community health care centers, evidence suggests a great need for most of these institutions to improve their care of the terminally ill. Based on a study of existing care programs and of thanatology literature, the authors have developed a model hospital program for dying patients and their families that uses a team approach to integrate resources for their care.     

Evaluation of a hospice program: effects on terminally ill patients and their families

Hospice care in the United States has grown rapidly since its introduction here from England in the mid-1970s. Surprisingly little evaluation of services has been made public, particularly with regard not merely to demographics but also the actual effect of hospice caregiving on patients and families. This article describes an attempt to identify the life dimensions that hospice addresses and the levels of discomfort or well-being of patients and families achieved in a hospice home care program. After assessing the changes in medical, psychosocial, and spiritual status for each of a group of hospice home care patients, the trend toward greater wellbeing of patients in the program can be delineated.     

Attitudes toward care of the terminally ill: an educational intervention

This quasiexperimental study examined the effect of an educational program on attitudes toward caring for terminally ill persons and their families. Participants were 115 undergraduate students: intervention group, N = 49; control group, N = 66. Pre- and post-intervention measurements were done with the Frommelt Attitude Toward Care of the Dying Scale (FATCOD, Form B). Students in the intervention group participated in a semester-long (15-week, 45-hour) educational program. Demographic variables, including age, gender, religion, major area of study, influence of religious beliefs, profession, previous education, and past or present experience with loss were evaluated. Statistical analyses (t-test, ANOVA, ANCOVA, and APVs) indicated a significant positive change in the attitude scores of the intervention group and no significant change in the attitude scores of the control group.     

A holistic nursing model for spiritual care of the terminally ill

Terms such as religion and spirituality usually imply a mature understanding of philosophical values of life principles and existence. In a holistic paradigm, nurses are ethically obligated to support spiritual aspects of care just as they do the biophysical elements. But how often is this all important step overlooked in our assessments and interventions? This essay contains a discussion of basic spiritual and religious principles, the moral obligations to alleviate spiritual suffering and the principles of altruism, beneficence, goodness, individuality, and the need for continuing spiritual education as a component of a holistically competent practice.     

Physician acceptance of home care for terminally ill children.

The study reported here explored the factors associated with the implementation of Martinson's model of home care and treatment for children in the terminal stages of illness with cancer. The model is described as an example of a health care strategy that was dramatically different from the prevalent model of care and may have conflicted with existing values. Data for the study were gathered from the hospital records of the children and from a survey of their oncologists. The findings suggest that physicians viewed the model of care as desirable and made their referral decisions on the basis of their judgment about whether the family in question was technically and emotionally capable of providing the care.     

Palliative care and hospice: one approach

The establishment of the first department of pain medicine and palliative care in a medical center in the United States is a significant marker in the development and impact of the palliative care movement. The integration of Jacob Perlow Hospice into this department is a milestone in the continued evolution of the hospice movement in the United States, and suggests that an interrelationship and interdependence between palliative care and hospice is one of the characteristics of change for the future.     

Redefining hope for the terminally ill

This paper discusses how hospice social workers assist patients and families in finding new hope and meaning in their lives as care goals turn from cure to comfort. Assessment factors important to the redefinition process and intervention strategies are explored. Hope is defined as the positive expectation for meaning attached to life events with the emphasis on meaning instead of life events. The author seeks to demonstrate the importance of meaning to the feeling of hope and the possibility of socially constructing meaning to alleviate the traditional medical perspective that hope revolves around the outcome of disease.