Ethical problems in end-of-life decisions for elderly Norwegians

Norwegian health professionals, elderly people and family members experience ethical problems involving end-of-life decision making for elders in the context of the values of Norwegian society. This study used ethical inquiry and qualitative methodology to conduct and analyze interviews carried out with 25 health professionals, six elderly people and five family members about the ethical problems they encountered in end-of-life decision making in Norway. All three participant groups experienced ethical problems involving the adequacy of health care for elderly Norwegians. Older people were concerned about being a burden to their families at the end of their life. However, health professionals wished to protect families from the burden of difficult decisions regarding health care for elderly parents at the end of life. Strategies are suggested for dialogue about end-of-life decisions and the integration of palliative care approaches into health care services for frail elderly people.     

Barriers to Family Care in Psychiatric Settings

PURPOSE: To identify barriers to family care in psychiatric settings and to describe family and provider perspectives about what constitutes effective family care. DESIGN AND METHODS: A qualitative exploratory approach with focus groups. Seventy-eight people participated in 11 focus groups conducted with families, patients, and health professionals. FINDINGS: Families identified poor quality care, conflict with health professionals about treatment, and lack of a role for families in the treatment. African American families also identified isolation of their communities from the mental health care system. Adolescents emphasized their role as caregivers and their needs for support. Health professionals conveyed concerns about system-based barriers, professional practice-based barriers, and family-based barriers to care. Patients stated the need for their families to be better educated about mental illness. CONCLUSIONS: The lack of family care in psychiatric settings is a multifaceted problem. Current health policies do not show endorsement of a family care approach. Responses from families and health professionals indicated conflicting opinions about content of family care. Health professionals reported they often lacked training and resources to deal with complex family issues. Families believed that lengthy and intensive interventions were neither necessary nor desired to address their concerns. Family care can be improved by focusing on building rapport and communicating problems and concerns between families and health professionals.     

Factors affecting the long-term care preferences of the elderly in Taiwan

This study sets out to investigate the preferences of the elderly in northern Taiwan with regard to various types of long-term care services. Taking into consideration sociodemographics, health condition, and access to such medical care services, our study examined both economic and family factors in an attempt to gain an understanding of the knowledge of and attitudes toward, the various types of long-term care among the elderly. An interview survey was carried out by local public health nurses among a sample of 562 elderly Taiwanese residents (people aged 65 years or older) from 7 counties/cities in northern Taiwan, all of whom had been selected by means of multistage sampling. The survey was conducted using a questionnaire based on the Andersen and Newman model of health care utilization, with the intention being to gain a better understanding of the related factors. The results indicate that both ethnic background and the requirement for additional medical care services had significant effects on the long-term care preferences of the elderly in Taiwan, a finding that should help to provide a better understanding of the preferences for and availability of such long-term care services among the elderly. Such improved understanding could result in improving the quality of life for the elderly, particularly if they feel that their preferences have been taken into consideration and their needs have ultimately been met.     

对临终关怀期患者家属心理支持的探索

我国已经加速进入老龄化社会，与之相适应的医疗养老卫生服务的需求也大大增加。介于昆明市社会福利院福利医院"医养结合"的性质和"生物-心理-社会"现代医学模式理念，心理科开展了临终关怀的临床实践。对于老年患者的躯体疾病的支持治疗是主要医护服务，同时对患者家属的心理支持也是工作的重要部分。经过临床心理科医护人员长期的临床工作，总结和发展出的适合临终老年患者家属的心理支持服务，逐渐探索形成了比较成熟的模式和经验，得出如下结论：对临终关怀期患者家属的心理支持非常具有必要性、可行性和重要性，能有效的提高临床服务水平和医患沟通的满意度。同时为了促进临终关怀服务的发展，临终关怀服务需要医学、护理学、心理学、社会学、法学、伦理学、教育学等多学科的共同参与。     

Spousal caregiving following institutionalization: the experience of elderly wives

A large body of research reveals the contribution of families to the care of elderly and health-impaired community-dwelling individuals Less is known about the contribution of families to the provision of care following the admission of elderly relatives to a long-term care institution Still less is known of the experience of elderly wives following the institutionalization of their husbands The purpose of this paper is to increase nurses' awareness, through a review of the literature on family caregiving in later life, of the contribution to care made by elderly wives following the institutionalization of their husbands We also hope to provide direction for clinicians with respect to the needs and concerns of wives, particularly at the time of, and following, the admission of their husbands to long-term care institutions     

Family Nursing Practice in Public Health: Finland and Utah

Abstract This exploratory study of family nursing practice in public health care was conducted in Finland and Utah. Staff nurses were interviewed in focus groups and asked to describe their practice of family nursing, the factors promoting and restraining practice, and the impact of the changes in health care delivery on practice. Thirty-six Finnish and 30 Utah nurses participated. Pressure to do more activities with fewer nurses and resources, changes in family problems, and skill level of the nurses were common themes. However, differences were evident. Finnish public health nurses used emotional support and information to help families empower themselves to use resources and to strengthen their family unit. Utah nurses focused first on individual level goals and then family cohesion and health. Nurseinitiated referrals and direct physical care were the primary intervention strategies of Utah nurses. Unlike the U.S. health care system, access for all in maternal and child health care and school health allowed Finnish nurses to develop long-term relationships with families, thus advancing family nursing practice. This study identifies several potential variables for further study particularly related to the organization of health care and nurse-family relationships.     

Mastery, burden, and areas of concern among family caregivers of mentally ill persons

In an era of limited resources for mental health care, family interventions need to target areas where they are responsive to families' expressed needs. Although family burden has been documented, less is known about the areas of concern that families feel they need direct assistance with, to be effective caregivers. Telephone interviews were conducted with 30 family members of mentally ill relatives. Burden, sense of mastery, and contexts of caregiving were assessed. Open-ended questions elicited further understandings of caregiving concerns. The most frequently identified burden was "worry about the future." The greatest concern was "dealing with sadness and grief." Recommendations for assessing family concerns are presented.     

Working with families caring for a relative with schizophrenia: the evolving role of the community psychiatric nurse

This paper describes the effect on the role and function of the community psychiatric nurse (CPN) after training to deliver psychosocial intervention to families caring for a relative with schizophrenia living at home. The study was undertaken as part of a larger investigation, commissioned by the Department of Health, which is examining outcome in families after CPNs have received training in psychosocial intervention strategies. In the last decade four major controlled studies have shown that relapse in schizophrenia can be improved if families receive; detailed assessments of individual need, health education about schizophrenia, and family stress management programmes, often defined as "psychosocial intervention". Whilst these research programmes have been underway, CPN services have been developing closer links with Primary Health Care and individual CPN's work with clients with severe and long-term mental illness has, as a consequence, been reducing. This trend has been rightly criticized, as has the tendency for CPN work to focus on the individual rather than the family with whom the client often lives. Informal carers willingly accept the burden of care for their relatives but their own needs are all too often neglected. The pilot phase of the outcome study demonstrated that after CPNs had received experimental training in psychosocial intervention, families reported a number of positive benefits when followed up for 12 months. First, for the clients there were improvements in the symptoms of their illness and in their social functioning. Second, carers' satisfaction with the service received showed a marked improvement as did their estimates of minor psychiatric morbidity. These changes in outcome entailed a cost. Experimental CPNs reported that undertaking family intervention was more time-consuming than "traditional" CPN care of the client with schizophrenia. Further, the data reveal that the training led to CPNs extending their role in a variety of other ways even though they received only a modicum of support from colleagues within their own health authorities. This preliminary paper concludes that although family work undertaken by CPNs should be seen as an important priority, problems may arise as services attempt to juggle finite resources with ever growing demands. Guidance on the future role of the CPN from the Department of Health is essential and would greatly enable planners and managers alike to rank order service priorities.     

Psychological aspects of second pregnancy

Major psychological characteristics of the second pregnancy experience are described, including maternal tasks and sources of anxiety for secundigravidas, as a basis for improving care to expanding families. Clinical implications are suggested that meet the special needs of second-time mothers regarding time limitations to meet multiple demands, family relationship changes, and concerns about maternal health and fatigue. Strategies for enhancing care involve using childbirth and sibling classes, modifying health care and information from primary care providers, mobilizing supportive services and resources, and influencing policies to meet maternal and family needs.     

On what depends the dependence? Thoughts on the law establishing a specific subsidy of dependence in old age

The dependency of elderly persons became recently an autonomous issue beside the problem of the pensions or the disability. We can explain this late apparition in the field of social policy by a strong attention paid to problems of the pensions and the lack of interest to the new concept of disability. But the main reason is the disagreement on two main questions. There is no common vision on the resources that the community must devote to help dependent people and their family. Moreover there is no agreement on the quality assurance of the services provided. The public debate for the first law was focused on the measure of the dependency and its budget. The second, in a context of growth of the number of dependent people, must integrate the need of support for an increasing number of families, and the condition for production of care of quality.     

空巢老人的住院感受及护理需求研究

目的了解空巢老人住院感受及主要护理需求,为制订提高其护理服务质量和生活质量的干预措施提供理论依据。方法 2014年11月至2015年2月,采用方便抽样法选取上海市某三级甲等医院住院的288例空巢老人为研究对象,采用自行设计的调查问卷对其进行调查。结果空巢老人的住院感受中最强烈的是"身体的不适感"(2.86±1.37)分以及"焦虑感"(2.64±1.55)分,护理需求最大的是"迫切治好病"(4.36±1.10)分以及"获取他人关心"(4.10±1.19)分。大约88.8%的住院空巢老人对医院医护人员的工作表示满意,83.7%的患者与医护人员交流程度较高;住院空巢老人的需求较迫切的是"获取信息的需求"以及"获取关心的需求"。结论空巢老人住院期间对健康较关注,感受较强烈,获取信息及关心的需求较迫切。护理人员应加强对患者的健康宣教,主动关心空巢老年患者的健康状况并了解其需求,引导患者家属及其他社会团体更多地关注和关心患者,满足空巢老人的住院需求,从而提高住院空巢老人的生活质量。     

Access to health care resources for family caregivers of elderly persons with dementia

Concerns about the "elder care crisis" and changes in the provision of health care are fostering expectations that families should be responsible for taking care of their elderly members. The assumptions that families (1) are not providing enough care, (2) know how to provide care, and (3) have access to resources for the provision of care are embedded in the social expectation of family care for elderly persons with dementia. However, research shows that these assumptions are not based on fact.     

Nursing and health care in the twentieth century: myth, reality and dichotomy

In this Fourth Ruth Langton Memorial Lecture, the author highlights some of the major health problems in children, mentally and physically handicapped people, and in the growing numbers of elderly people in society. Nurses' roles are discussed. He identifies many major areas of concern and points out that many of the afflictions affecting people throughout the world, such as infectious diseases, blindness and malnutrition, could so easily be prevented. The author also focuses on the diseases caused by unhealthy lifestyles, in particular heart disease, cancers, drug addiction and obesity. He argues that a redirection of resources spent on arms and defense could do much to alleviate disease and suffering throughout the world. He also questions the present effectiveness of nursing education programmes and community care programmes. The paper concludes with a challenge to all nurses to explode the myth that society is becoming healthier, to face the reality of the urgent need for more primary health care and health education programmes, and to heal the dichotomy between present nursing and health care provision and the actual health needs of society.     

Interpreter services in pediatric nursing

A critical part of every encounter between a pediatric nurse and a patient is obtaining accurate patient information. Unique obstacles are encountered when patients and their families have little or no understanding of the English language. Federal and state laws require health care systems that receive governmental funds to provide full language access to services. Both legal and ethical issues can arise when caring for non-English-speaking patients. Often, obtaining accurate patient information and a fully informed consent cannot be done without the use of an interpreter. The interpreter informs the family of all the risks and benefits of a specific avenue of care. When inappropriate interpreter services are used, such as when children in the family or other family members act as interpreters, concerns about accuracy, confidentiality, cultural congruency, and other issues may arise. The purpose of this article is to: (a) explore principles related to the use of medical interpreters, (b) examine different models of interpreter services, and (c) identify available resources to assist providers in accessing interpreter services (e.g., books, online resources, articles, and videos). The case study format will be used to illustrate key points.     

CLIENTS WITH MENTAL ILLNESS AND THEIR CHILDREN: IMPLICATIONS FOR CLINICAL PRACTICE

The problem of adults with severe mental illness parenting minor children is a growing concern. These clients suffer from concerns that negatively affect them and their children. This study showed many clients seeking services at public mental health agencies are parents of minor children and have had a history of family dysfunction. Prevalence rates, demographic characteristics, types of mental illness diagnoses, family background variables, and some current issues regarding these clients were examined. The study concludes with clinical implications for clients and their families and calls for a family focused approach.     

Clients with mental illness and their children: implications for clinical practice

The problem of adults with severe mental illness parenting minor children is a growing concern. These clients suffer from concerns that negatively affect them and their children. This study showed many clients seeking services at public mental health agencies are parents of minor children and have had a history of family dysfunction. Prevalence rates, demographic characteristics, types of mental illness diagnoses, family background variables, and some current issues regarding these clients were examined. The study concludes with clinical implications for clients and their families and calls for a family focused approach.     

Evaluation of care for the aged: a multipurpose guide

There is a growing recognition of the need to evaluate quality of care. As the aged are a particularly vulnerable group, often dependent on care-givers for their remaining years, it is important to control related services. An interdisciplinary workgroup prepared a tool which lists cues to be considered in determining the quality of care for the age in ambulatory services, home care programmes, short-and long-term institutions. The cues fall into six domains: physical environment, psychosocial environment, basic personal care, health care, family involvement and manpower. The tool can be used by clients and families for selecting placement for care; by caregivers in choosing or remaining in a place of work; by those administratively responsible for care, such as supervisors, or licensing bodies for controlling performance and policy; and by other involved persons, such as educators, researchers, volunteers or funding agencies for their specific purposes.     

Nursing research in geriatric mental health

As the population of older people in the world increases, concerns about the health and delivery of health care to these elderly people become increasingly more important. Geriatric mental health arose as a nursing specialty in response to this concern over the health of older adults. This paper focuses on a review of nursing literature relevant to the mental and cognitive health of older adults. Implications for current practice and future research are explored.     

Giving Voice to Elderly People: Community-Based Long-Term Care

Abstract Information gained from elderly people regarding their needs for community-based long-term care is necessary for informed and responsive policy development. Informed policy development is essential given demographic projections and the need to develop cost-effective alternatives to institutionalization. The purpose of this study was to understand the context within which elderly people would be able to continue residing in their communities. Programs have been developed based on providers' perceptions of services that are necessary to maintain elderly people at home. There is a lack of information about elderly people's perceptions. Data were collected from 9 elderly people who represented the phenomenon of being at risk for institutionalization. Participants were interviewed serially and contingently in stages using naturalistic methodology. The interviews were tape-recorded, transcribed verbatim, and analyzed by the inquirer. Findings of the study indicated that the desire of elderly people to stay at home is motivated by their need to maintain control over their daily lives and have their individualized needs addressed. Perceptions related to nursing homes, roles of family, essential services, and future needs for assisted living emerged as major themes. The findings suggest policy implications for professional nurses related to the long-term care system, providers, and nursing homes.