In search of models of care

Most hospice programs list “spiritual support” among the characteristics of hospice care, but then avoid defining it except in ambiguous ways. The author argues that without careful definition of “spiritual,” hospice care will be little different in quality from that offered in acute and chronic care centers. The “spiritual quest” is defined as a unifying and integrating process that permits a human being to be oriented to wholeness or dignity. Also discussed is the challenge to hospice care staff to defy trends in recent health care that allow staff rather than patients to determine what dignity means, thereby making the patient an object rather than a subject.     

In search of a standard for pin site care.

To date, a standard for pin site care has yet to be identified. Pin site care recommendations are more often based upon clinician preference rather than research findings. Further, there are great variations in recommendations for pin care treatments from clinician to clinician. The nursing and medical literature were reviewed in an attempt to identify a pin site care standard based upon scientific findings. Unfortunately, the research on prophylactic treatment of pin sites is limited. The pin site care protocol recommended by this author is based on pathophysiologic processes involved in the development of pin site infections, as well as information found in the research literature. The recommended protocol includes the following: (a) using normal saline as the cleansing agent; (b) avoiding ointments for postcleansing care; (c) removing crusts; (d) using sterile technique for the hospitalized patient while clean technique is used once the patient is discharged from the hospital; (e) applying dressings to pin sites; and (f) providing pin care three times a day if drainage is present or once daily in the absence of drainage.     

In search of the sixth vital sign: cancer care in Romania

Purpose

Romania still has to adapt and develop psychosocial assessment protocols which would allow standardized screening for the sixth vital sign in cancer patients, namely distress and quality of life. The present study screens for the psychosocial and communication needs of cancer outpatients in palliative care and in rehabilitation. These data are also compared with those obtained from a sample of cancer inpatients.

Methods

Subjects for this study were recruited from cancer care services from the Transylvania region in Romania. A total of 203 persons with cancer were included in the screening. Of this number, 68 were in the hospitalized group, 71 were from the rehabilitation group, and 64 were palliative care cases. FACT-G 4.0 and BDI screening instruments were used in these clinical samples. Statistical analysis performed was: associational and comparative statistics, one-way analysis of variance.

Results

Statistically and clinically significant results were found in relation to symptoms of depression, physical and functional well-being, and overall quality of life. However, with regard to psychosocial well-being, there were no clinically relevant or significant differences among cancer patients under hospital treatment, or in rehabilitation and palliative care programs. More than 40 % of the cancer patients included in our pilot screening were not open to talk about their illness and their related needs.

Conclusions

Cancer is an unmet psychosocial challenge to patients and to the specialized services, regardless of care type. The urgency of psychosocial screening in the Romanian cancer care system is revealed. Based on these findings, there is a need for psychosocial screening and related supportive care services that need to be integrated into Romania’s cancer care programs. A recommendation is to pilot psychosocial and supportive care model within the four regional cancer care institutions.     

In search of happiness

Unlike other 'talking' therapies, psychotherapy centres on transferance. While it can be a painful experience, people feel and function better for it.     

In search of the perfect assessment

Assessment tools are essential in planning individual care for people with learning difficulties, but nurses often lack confidence in using them. This article looks at why this is, and discusses 10 commonly used tools.