Psychological Care

Nurse Jennifer was asked to interview Mr. Folkman on his admission to the ward for minor dentalsurgery the following day. Mr. Folkman, a 32-year-old engineer, was married and had two children, agirl and a boy. He lived with his family near the hospital and in a factory in a nearby town. During theinterview, Nurse Jennifer noticed that while Mr. Folkman appeared to be in good health and to have aclear understanding of the surgery he was facing he seemed uneasy. Knowing that many patients feel ap-     

The Hospice Care

Hospiceisawordthathascomedownfrom[2 ] theMiddleAgesinEurope .Itwasusedtodescribeaway -stationwheretravelers ,pilgrims[3] ,andillpeoplecouldstopanddependonreceivinghumanecare .ThefirstpioneerofthemodernhospicemovementwasDr .CicelySaunderswithherbackgroundinmedicine ,nursing ,andsocialwork .ShefoundedSt.Christopher’shospiceinLondonin 1 96 7,whichrepresentsthebeginningoftoday’shospicesintheworld .Saundersusedthetermofhospicetomeanaway -stationwheredyingpeopleinacar ingenviromentcanliveoutth…     

Understanding Palliative Care and Hospice: A Review for Primary Care Providers

Palliative care provides invaluable clinical management and support for patients and their families. For most people, palliative care is not provided by hospice and palliative medicine specialists, but rather by their primary care providers. The recognition of hospice and palliative medicine as its own medical subspecialty in 2006 highlighted the importance of palliative care to the practice of medicine, yet many health care professionals harbor misconceptions about palliative care, which may be a barrier to ensuring that the palliative care needs of their patients are identified and met in a timely fashion. When physicians discuss end-of-life concerns proactively, many patients choose more comfort-focused care and receive care more aligned with their values and goals. This article defines palliative care, describes how it differs from hospice, debunks some common myths associated with hospice and palliative care, and offers suggestions on how primary care providers can integrate palliative care into their practice.     

词“Care”释义

随着护理事业的发展,整体护理在全国各地已经广泛开展。在新的护理模式下,护理人员不再单纯按传统方式护理病人和执行医嘱,而更多地肩负着向病人、家属以及社会提供卫生咨询健康指导等。护理观念的转变让我们必须对“护理”一词的内涵作出更深的理解。本人曾在新加坡陈...     

Do Caregiver Experiences Shape End-of-Life Care Perceptions? Burden,Benefits, and Care Quality Assessment

ContextResearchers, hospices, and government agencies administer standardized questionnaires to caregivers for assessing end-of-life care quality. Caregiving experiences may influence end-of-life care quality reports, which have implications for caregiver outcomes, and are a clinical and policy priority.ObjectivesThis study aims to determine whether and how caregivers' end-of-life care assessments depend on their burden and benefit perceptions.MethodsThis study analyzes data from 391 caregivers in the 2011 National Study of Caregiving and their Medicare beneficiary care recipients from the 2011–2016 National Health and Aging Trends Study. Caregivers assessed five end-of-life care aspects for decedents. Logistic regression was used and predicted probabilities of caregivers positively or negatively assessing end-of-life care based on their burden and benefit experiences calculated. Analyses adjusted for caregiver and care recipient demographic and health characteristics.ResultsNo or minimal caregiving burden is associated with ≥0.70 probability of caregivers reporting they were always informed about the recipient's condition and that the dying person's care needs were always met, regardless of perceived benefits. High perceived caregiving benefit is associated with ≥0.80 probability of giving such reports, even when perceiving high burden.ConclusionCaregiver burden and benefit operate alongside one another regarding two end-of-life care evaluations, even when years elapse between caregiver experience reports and care recipient death. This suggests that caregiver interventions reducing burden and bolstering benefits may have a positive and lasting impact on end-of-life care assessments.     

Observation of Emergency Room Nurses Managing Pediatric Pain: Care to Be Given… Care Given…

BackgroundAlthough pain undeniably has negative consequences, pain management often remains suboptimal, particularly in the pediatric population in the emergency room (ER).AimIn this observational study using qualitative and quantitative methods, we investigated everyday adherence to current nursing best-practice pediatric guidelines in the ER paying particular attention to the interaction between children, parents, and nurses.MethodsAn adapted version of the nursing observation tool for pain management was used to describe pediatric pain management provided by nurses caring for children (0-14 years old) admitted to the ER. We also assessed child–parent–nurse interactions. (The aim of the study was presented to the nurses as part of the survey on interactions without specifying the focus on pain management.)ResultsForty-seven children were included (91 painful episodes) during the observation period (112 hours). There was a screening for pain in 55% of cases, and pain scales were used in 10% of cases. Analgesic treatments were administered in 75% of cases (procedural or disease-related pain). Follow-up evaluations were performed in 19% of cases. Nonpharmacologic approaches were scarcely used. The use of both helpful and nonhelpful languages were noted during interactions with children and parents. Parents' collaboration was rarely requested to help relieve their child's pain.ConclusionsOur results show that pediatric pain management in the ER could be optimized. Parents are still not considerably involved in their child's pain management. Parents' involvement could contribute to improving pediatric pain management.     

Care for dying patients – German legislation

Caring for dying patients appears to be one of the most difficult challenges in modern medicine. Apart from respective medical standards, such care is influenced by legal stipulations, economic resources, societal values, and ethical principles. In Germany, legal provisions prohibit actively hastening a patient's death. Although passive and indirect means of assistance to die are permitted for terminally ill patients, they appear to be implemented only with hesitation. Probably, the authority of advance directives needs further clarification. More importantly, however, physicians' deficits in knowledge as well as their conceptual and psycho-emotional barriers need comprehensive improvement in order to foster end-of-life care.     

What's So Special About Home Care?

No other setting offers more opportunity for impacting patients' level of wellness than their own homes. At home, patients feel they are in control of their environment, rather than experiencing the vulnerability felt in other settings. With the home becoming a new focal point for care, we need to prepare those who are interested in leadership in this setting. Historically, home care experience has been required for management and leadership positions because of the complexity of the “uncontrolled” setting and industry-specific processes and standards. An in-depth knowledge of the financial model and its interface with clinical modeling is essential for leadership success. As technology evolves and reimbursement changes, the future will mandate that home care embraces new leaders into its domain. There is an exciting future for this nursing specialty and opportunities for those who choose to lead.     

Intensive Care Physiotherapy — Medical Staff Perceptions

A questionnaire was sent to directors of intensive care units (ICUs) in the United Kingdom, Australia, Canada, South Africa and Hong Kong, to gather regional perceptions of each ICU's physiotherapy service. A second questionnaire was sent to the ICU physiotherapist-in-charge to profile their experience and any demarcation disputes. Fifty-four of 101 ICU directors and 100% of the physiotherapists returned a completed questionnaire. While 79% of the directors rated the service provided by their physiotherapists as either ‘outstanding’ or ‘very good’, nearly 60% of them also considered that the physiotherapist's work could be performed by other disciplines. It is suggested that ICU physiotherapists broaden their research base to promote evidence-based practice, and develop a precise marketing strategy to preserve customer (ICU director) reliance on their product and to maintain ‘market share’, especially where ‘doctor-referrals’ impacts on their practice.     

Nurse Leaders’ Influence: Implementing a New Model of Care Involving Geographic Clustering of Patient Care Assignments

The purpose of this article is to describe the nurse leader’s role in implementing a new evidence-based nursing care delivery model utilizing geographic clustering of patient care assignments to improve patient safety and patient experience. Nurse leaders on 2 inpatient units from an academic medical center supported and encouraged staff to develop and initiate similar care models; one unit focused on fall reduction, the other focused on improving patient experience. The transformational nurse leaders empowered key stake holders to implement a new and creative care model that resulted in favorable outcomes for both patients and staff, while fostering accountability for the practice change.     

Achieving Equilibrium within a Culture of Stability—Cultural Knowing in Nursing Care on Psychiatric Intensive Care Units

This article presents intensive psychiatric nurses' work and nursing care. The aim of the study was to describe expressions of cultural knowing in nursing care in psychiatric intensive care units (PICU). Spradley's ethnographic methodology was applied. Six themes emerged as frames for nursing care in psychiatric intensive care: providing surveillance, soothing, being present, trading information, maintaining security and reducing. These themes are used to strike a balance between turbulence and stability and to achieve equilibrium. As the nursing care intervenes when turbulence emerges, the PICU becomes a sanctuary that offers tranquility, peace and rest.