Nursing and the Terminally Ill: Beliefs,Attitudes, and Perceptions of Practitioners

When care of the terminally ill takes place in a hospice, rather than in an acute-care setting, there is a shift in overall care from the medical staff to supportive nursing care. To better understand nurses' perceptions about providing care for the terminally ill, an investigation into the salient beliefs about providing nursing care for the terminally ill was undertaken with 97 nurses practicing in a midwestern metropolitan area. For the total sample, 13 of the 20 beliefs identified from a literature review were found to be salient. A salient belief was identified as an accurate statement by the nurses participating in the study. The 13 beliefs were analyzed according to six practice settings: adult intensive care, cardiology intensive care, pediatric intensive care, oncology, psychiatric, and hospice.     

Nursing the dying: essential elements in the care of terminally ill patients

AIM: To verify those aspects of care that nurses view as important when assisting patients beyond therapeutic possibilities and who are not under intensive care. OBJECTIVES: (1) To find out how nurses cope with daily confrontation with the death and suffering of dying patients, (2) To identify whether nurses feel it is important to have communication skills in order to assist the terminally ill patient, (3) To estimate nurses' degree of work satisfaction, and (4) To explore the humane aspects of nursing assistance to the dying. METHOD: Data were collected in January and February of 2002 by means of individual semistructured interviews with 14 nurses from the unit of haematology at a general hospital in the city of Sao Paulo, Brazil. Interviews were recorded, transcribed, and further analysed according to the qualitative method proposed by Bardin (1977). RESULTS: We found that Brazilian nurses caring for dying patients should be receiving psychological and emotional support. Results also highlighted different individual approaches in the endeavour to communicate with terminally ill patients, as well as the avoidance patterns developed by some nurses. The latter appeared to be as a result of personal difficulties in coping with the reality of human suffering and death. Finally, there is a need for better preparation in communication skills for nurses caring for terminally ill patients. CONCLUSION: Although the number of interviewed nurses in our study was small, the results corroborated the findings of other studies on the subject.     

Dying at home: Experience of the Verdun local community service centre

ObjectiveTo demonstrate that it is possible for a team of palliative care nurses in an urban centre to care for more than 50% of their terminally ill patients at home until they die, and that medical care delivered in the home is a determining factor in death at home versus death in a hospital.DesignAnalysis of place of death of terminally ill patients who died in 2012 and 2013 (N = 212) and who had been cared for by palliative care nurses, by type of medical care.SettingThe centre local de services communautaires (CLSC) in Verdun, Que, an urban neighbourhood in southwest Montreal.ParticipantsA total of 212 terminally ill patients.ResultsOf the 212 patients cared for at home by palliative care nurses, 56.6% died at home; 62.6% received medical home care from CLSC physicians, compared with 5.0% who did not receive medical home care from any physician.ConclusionCombined with a straightforward restructuring of the nursing care delivered by CLSCs, development of medical services delivered in the home would enable the more than 50% of terminally ill patients in Quebec who are cared for by CLSCs to die at home—something that most of them wish for.Many articles have been published about the factors that influence the possibility of dying at home for terminally ill patients. When brought together, these factors create a “complete” team of palliative home care professionals, with nursing and medical expertise in palliative home care, 24-hour access to nursing and medical care, access to social workers and occupational therapists able to work with palliative care patients in the home, and home supports, as needed.^1,2 The centre local de services communautaires (CLSC) in Verdun, Que, created such a team.Quebec has a vast network of CLSCs that offer general nursing care; the services of social workers, occupational therapists, and physiotherapists; and various forms of practical support in the home. Very few CLSCs offer dedicated palliative nursing care and even fewer offer medical care in the home to terminally ill patients, in spite of the fact that most of these patients want to remain at home and that access to a palliative home care team reduces hospitalizations and in-hospital deaths of terminally ill patients while providing comparable quality of care.³     

Critique of transcultural practices in end-of-life clinical nursing practice

TOPIC: Transcultural nursing practices for terminally ill patients. PURPOSE: To examine several criticisms of transcultural nursing theory in end-of-life care. SOURCES: Published literature and interviews with nurses. CONCLUSIONS: Nurses often encounter barriers that impede their ability to provide ideal end-of-life care.     

How do nurses inspire and instil hope in terminally ill HIV patients?

In this study the researcher examined how nurses inspire and instil hope in terminally ill HIV patients The study therefore focuses on the interventions, attitudes, principles and process utilized by nurses working within a liaison psychiatry unit where in-patient care for terminally ill HIV patients is available Using grounded theory methodology, the data were coded and analysed, producing an integrated theory of hope inspiration, comprised of four core variables reflection in action, affirmation of worth, creating a partnership, and the totality of the person The researcher postulates that hope is inspired in terminally ill HIV patients by means of nursing the totality of the person within the context of a formed partnership, underpinned by the affirmation of the individual's worth, which is assured by the nurse entering into the process of reflection in action The researcher further suggests that hope inspiration is inextricably linked to effective nursing practice, and is interwoven with the concepts of nursing, caring and helping     

Terminally ill patients' expectations of nurses

This exploratory study was undertaken to discover what nursing behaviours terminally ill patients desire. To rank patients' attitudes and judgements a Q-sort consisting of 70 cards was used. The statements covered three categories: physical and psycho-emotional care of patients and psycho-emotional care of significant other/s. "I would like the nurse to help me remain at home for as long as possible" was the most favoured statement and the least favoured was: "I would like the nurse to talk to me about death and dying." The overall theme was that responsive rather than directive nursing behaviours were desired. Analysis identified five Factors from which a model of responsive nursing care was developed. Interpretation of the Factors indicated patients desired responsive nursing care that enabled them and their families to bring their own resources to the dying process, rather than having imposed upon them care which nurses deemed appropriate.     

Nurses' attitudes to terminally ill patients

BACKGROUND: The care of terminally ill patients is a challenge for nurses that has raised special interest in recent years. Several studies have shown a stereotyped negative attitude in nurses towards terminally ill patients. However, all have used methods with several limitations. AIM: The aim of the study presented in this paper was to identify the nurses' attitude to the terminally ill patient in Catalonia, Spain, and the relationship of this attitude to different socio-demographic data (type of centre, shift, years of experience, age and sex) by means of a new quantitative method based on the free word-association test. METHODS: One hundred and seventy-five nurses working in 18 hospitals and hospices in Catalonia, Spain were included in the study. Data were analysed by the Associative Semantic Field Differential method by means of the computer programme CONTEXT and a quantitative evaluation of the degree of attitudes positivity was obtained. RESULTS: The study revealed a general slight negative trend in attitudes towards the terminally ill patient. A more positive attitude was observed in older caregivers and in women. The positivity in attitude decreased from morning to night shift. No differences were observed between nurses working in hospitals and those working in hospices. CONCLUSIONS: We conclude that nursing attitudes can be analysed by methods such as that used in this study. Attempts can be made to modify this attitude in caregivers by means of training programmes and stimulating awareness of an adequate professional approach.     

Long-term care nurses' knowledge of end-of-life care

Long-term care (LTC) facilities usually contract with hospice agencies to provide palliative (comfort) care to their terminally ill residents, yet only 1% of nursing home residents enroll in hospice care. Integrating hospice services with nursing home services presents many challenges. One of the most critical challenges is the lack of education in palliative care among physicians, licensed nurses, and certified nursing assistants in LTC settings. A study of 164 licensed nurses from 24 LTC facilities in north central Texas found deficiencies in their knowledge of palliative care. The mean score on the Palliative Care Quiz for Nursing was 12.3 of a possible 20 (62%, SD = 2.7). Implications for practice include a critical need for in-service education on end-of-life content for practicing LTC nurses and integration of such content in all curricula for future nurses.     

Attitudes of nurses towards euthanasia and towards their role in euthanasia: A nationwide study in Flanders,Belgium

BackgroundNurses have an important role in caring for terminally ill patients. They are also often involved in euthanasia. However, little is known about their attitudes towards it.ObjectivesTo investigate on a nationwide level nurses’ attitudes towards euthanasia and towards their role in euthanasia, and the possible relation with their socio-demographic and work-related characteristics.Design and participantsA cross-sectional design was used. In 2007, a questionnaire was mailed to a random sample of 6000 of the registered nurses in Flanders, Belgium. Response rate was 62.5% and after exclusion of nurses who had no experiences in patient care, a sample of 3321 nurses remained.MethodsAttitudes were attained by means of statements. Logistic regression models were fitted for each statement to determine the relation between socio-demographic and work-related characteristics and nurses’ attitudes.ResultsNinety-two percent of nurses accepted euthanasia for terminally ill patients with extreme uncontrollable pain or other distress, 57% accepted using lethal drugs for patients who suffer unbearably and are not capable of making decisions. Seventy percent believed that euthanasia requests would be avoided by the use of optimal palliative care. Ninety percent of nurses thought nurses should be involved in euthanasia decision-making. Although 61% did not agree that administering lethal drugs could be a task nurses are allowed to perform, 43% would be prepared to do so. Religious nurses were less accepting of euthanasia than non-religious nurses. Older nurses believed more in palliative care preventing euthanasia requests and in putting the patient into a coma until death as an alternative to euthanasia. Female and home care nurses were less inclined than male and hospital and nursing home nurses to administer lethal drugs.ConclusionsThere is broad support among nurses for euthanasia for terminally ill patients and for their involvement in consultancy in case of euthanasia requests. There is, however, uncertainty about their role in the performance of euthanasia. Guidelines could help to make their role more transparent, taking into account the differences between health care settings.     

Relational ethics of delirium care: Findings from a hospice ethnography

Delirium, a common syndrome in terminally ill people, presents specific challenges to a good death in end‐of‐life care. This paper examines the relational engagement between hospice nurses and their patients in a context of end‐of‐life delirium. Ethnographic fieldwork spanning 15 months was conducted at a freestanding residential hospice in eastern Canada. A shared value system was apparent within the nursing community of hospice; patients’ comfort and dignity were deemed most at stake and therefore commanded nurses’ primary attention. This overarching commitment to comfort and dignity shaped all of nursing practice in this hospice, including practices related to end‐of‐life delirium. The findings of this study elaborate the ways in which hospice nurses interpreted and responded to the discomfort of their patients in delirium, as well as the efforts they made to understand their patients’ subjective experiences and to connect with them in supportive ways. In addition to what is already known about clinical assessment and treatment of delirium in palliative care settings, the findings of this study offer points of reflection for nurses anywhere who are contending with the relational challenges that delirium presents in end‐of‐life care.     

Nursing In A Hospital-Based Hospice Unit

The purpose of this ethnographic study was to describe and analyze the ways in which registered nurses interacted with those terminally ill and acutely ill patients typical of a hospital-based hospice unit. Participant observation and informal interviews were used to collect data. Field notes were analyzed systematically using a constant comparative method of qualitative analysis. Data analysis revealed that patients' responsiveness rather than "acute," or "terminal" labels determined the quality of the nurses' interactions with them. Humanistic caring was found to be the unifying focus of care for both acutely ill and terminally ill patients.     

Nurse-physician collaboration in pain management for terminally ill cancer patients treated at home in Japan

Collaboration between nurses and physicians is essential for successful pain management, especially in home care settings. This study describes how physicians collaborate with nurses for the pain management of terminally ill cancer patients treated at home in Japan, and evaluates the use of standing orders in pain management. Self-administered questionnaires were sent to all 565 institutions listed in a nationwide database of home care service providers for terminally ill cancer patients; 177 responding institutions were analyzed. In general, institutions caring for fewer patients per year were less likely to make specific efforts to collaborate with nurses and less likely to use standing orders in pain management. Given that many institutions provide home palliative care services on a small scale, a standard protocol for care should be developed and applied across all institutions to ensure the availability of quality home palliative care throughout the country.     

Difficulties encountered by nurses in the care of terminally ill cancer patients in general hospitals in Japan

The aim of this study was to investigate the difficulties encountered by nurses who have cared for terminally ill cancer patients at general hospitals. To collect data, a survey by questionnaire was self-administered. The respondents were 375 nurses and the response rate was 70.2%. Factor analysis was conducted on 80 items related to the difficulties encountered by nurses who have cared for terminally ill cancer patients to allow reasonable item reduction and to explore better domains. Two items were excluded and the results revealed eight underlying domains: 'Communication with patients and families', 'Knowledge and skill of nurses', 'Treatment and informed consent (IC)', 'Personal issues', 'Collaboration as a team including patients and families', 'Environment and system', 'Collaboration among nurses', and 'Near-death issues'. Cronbach's alpha coefficients for each domain ranged from 0.77 to 0.93. The results showed that nurses working at general hospitals have experienced a high degree of difficulty overall while caring for the dying, particularly with communication with patients and families. It was concluded that this study was useful in determining the specific areas where nursing education and research should be focused.     

A model long-term care hospice unit: care, community, and compassion

The purpose of this study was to investigate the factors that influenced the quality of care of terminally ill nursing home residents on a hospice unit in a city and county long-term care facility. The findings disclosed that the hospice team had created a cultural environment in which care, community, and compassion were the predominant components of their philosophy of palliative care. Communication at all levels-among staff, family, friends, and residents-was found to be a core hospice value, essential to community development. The results of this study illustrate that exemplary palliative care can be provided when an interdisciplinary team is dedicated to creating an environment where the principles of palliative care can be fully implemented. The authors conclude that there is a developing role for geriatric nurses to participate in further defining and providing palliative care for older people in their homes, hospitals, nursing homes, and residential care.     

Nursing and public policy. What is the high ground?

To be effective in public policy formation, nurses must establish standards of care and advocate changes in financing and healthcare organization for persons who are not well served. The author delineates four areas (out-of-hospital prenatal and postnatal care; care of chronically mentally ill adults and severely emotionally disturbed youths; care for the elderly, especially in nursing homes; and care of the disabled and the chronically and terminally ill) where nurses should be the authority for much of the care provided. The author concludes that evolving dissatisfaction with the healthcare system means that nurses have the opportunity to make major contributions to the organization of all parts of the system, as it is ultimately put together, if they do the research and advocacy that is needed.     

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.