Nurses' willingness to perform AIDS patient care.

We evaluated nurses from hospitals with different prevalences of AIDS patients and with different levels of nursing education to measure their willingness to provide care to AIDS patients. Nurses who were most experienced in AIDS patient care, employed in high-prevalence hospitals, and who considered themselves most knowledgeable about infectious disease consistently were less willing to provide nursing care for AIDS patients. Nurses with BSN or MSN education employed in hospitals with low and moderate prevalence of AIDS were the most willing to provide AIDS patient care. The results are discussed in light of recent research on universal precautions adherence and factors that may contribute to increasingly negative attitudes for nurses who provide sustained AIDS patient care.     

A nurse-led service to provide palliative care in the community

Jersey Hospice Care, established in 1982, provides a care and support service for the community. The service includes provision of palliative care, focusing on pain assessment and control. Mainly a home-care service, it is supported by a day hospice, lymphoedema service, the provision of complementary therapies, a six-bed in-patient unit and a bereavement service.     

Nurses' attitudes to palliative care in nursing homes in Western Australia

Nursing homes are one of the care settings in Western Australia where older people may spend their final years. Residents should be able to receive palliative care where appropriate, but this type of care is not always available at some nursing homes in the state. This study investigated nurses' attitudes to palliative care in nursing homes by examining their cognitive, affective and behavioural information. A sample of 228 nurses working in nursing homes completed a questionnaire, using a free response methodology. Results showed that participants had either a positive or negative attitude to palliative care. Cognitive and affective information significantly and independently predicted the attitudes of nurse, whereas knowledge of palliative care did not contribute significantly to these attitudes. Nurses currently working in palliative care were more positively disposed towards such care, but this disappeared when they ceased working in the area. There is an emphasis on education in the literature which does not take into account the beliefs and emotions of the nurse. Therefore, there is a need to consider these in undergraduate and postgraduate training for nurses. Current experience is also important in palliative care education. The results obtained from nurses in this study should be incorporated into policy for introducing palliative care into nursing homes and used to provide support and assistance to nurses working in this field.     

Factors that influence physicians in providing palliative care in rural communities in Taiwan

Goals of work To identify the willingness, influencing factors, and educational needs of community physicians in providing palliative care in the rural areas of Taiwan.Methods A questionnaire was sent to all medical directors of the 140 government health stations assigned to the rural areas of Taiwan.Results The overall response rate was 62.8% with 85 valid questionnaires retrieved. The majority of respondents (84.7%) expressed a willingness to provide palliative care if they encountered an advanced cancer patient. However, they would limit their services to consultation and referral (93.0% and 87.5%, respectively), and were less likely to provide home visits (40.3%) or bereavement support of the family (29.2%). With respect to knowledge, the accurate answers to the philosophy/principles and clinical practice of palliative care were 93.4% and 57.3%, respectively. Regarding attitudes, the highest score item in perceiving the threat about providing palliative care was uncomfortable to meet and take care of the advanced cancer patient. The highest score item in perceiving barriers was providing palliative care may shorten patients life, just like euthanasia. The results of stepwise logistic regression analysis for the willingness to provide home visits showed that only the subjective norms remained in the model (OR=1.87, 95% CI=1.17–3.01). Educational needs expressed by the respondents were ranked as follows: emotional support to, communication skills with, and bereavement support for the advanced cancer patients and their relatives.Conclusions Effective training courses that emphasize the practical knowledge of palliative care for community physicians, incorporating palliative care into medical education particularly in terms of communication skills and ethical roles, and active health policy administration including insurance payments, are important for the enhancement of community palliative care in Taiwan.     

Nurses' knowledge of palliative care in the Australian Capital Territory

Australia has a growing number of specialist palliative care services. As they expanded in the Australian Capital Territory, a working party was established to discuss issues associated with palliative care. One activity authorized by this committee was a survey of nurses' knowledge of palliative care. The Palliative Care Quiz for Nurses (Ross et al, 1996) was adapted with permission for this survey: 455 registered and enrolled nurses were surveyed; 247 (54%) participants returned completed questionnaires. The overall mean score for the Palliative Care Quiz was 12.4 of a possible 20; the mean scores were 13.2 for registered nurses and 10.6 for enrolled nurses. Nurses with some oncology or palliative care experience scored significantly higher than others. Nurses with more work experience as measured by working years also attained significantly higher scores. Analysis and examination of correct items suggest that nurses have acquired basic knowledge through experience. However, as other studies have suggested, there is also a lack of knowledge of complex symptoms found in palliative care patients.     

Establishing a culturally sensitive palliative care program in rural Alaska Native American communities

End-of-life programs that provide an option for patients to die at home are available in most U.S. communities. However, Alaska Natives living in remote Alaska villages often die alone in hospitals and nursing homes hundreds of miles away from home. The Bristol Bay Area Health Corporation (BBAHC), a tribal organization, is the sole provider of comprehensive primary care services to 34 Alaska Native villages located within a 46,000 square mile area in southwest Alaska. The closest tertiary care hospital is 329 air miles away in Anchorage. Because of the high cost of, and difficulties encountered in trying to deliver end-of-life care services to remote communities, a village-focused, culturally sensitive, volunteer and primary care program combined with a regionally based physician and home health nurse to deliver multi-disciplinary palliative care was developed. The Helping Hands Program blends cultural practices with contemporary palliative care medicine to allow Alaska Natives and others living in remote communities to be cared for at home through the end of life. Since the program was implemented in 1999, the percentage of home deaths for selected causes has changed from 33% in 1997 to 77% in 2001. The Anchorage-based Alaska Native Tribal Health Consortium (ANTHC) and the Alaska Native Medical Center (ANMC) have recognized the importance and success of the BBAHC program and are investigating expanding the program to other parts of Alaska. Centralizing the program in Anchorage will allow staff trained in palliative care to travel to regional Alaska Native hospitals to help train health care professionals.     

Nurses' and patients' perceptions of expert palliative nursing care

AIM: This paper reports a study of the perceptions of patients and nurses of palliative care and, in particular, the concept of the expert palliative nurse. BACKGROUND: Palliative care is a growing specialty and is practised globally. There is, however, limited information on patients' views about palliative care. While the idea of expertise in nursing is not new, few studies have explored the concept of the expert nurse in palliative care. Some evidence exists on palliative nurses' perceptions of their care, that it is supportive and involves maintaining therapeutic relationships with patients. Facing a terminal illness has been identified as a stressful and fearful experience that affects all aspects of life. It has also been revealed that dying patients may have unmet care needs, mainly in the areas of pain and symptom control, emotional support, and spending time alone. METHODS: A phenomenological study was carried out, using in-depth interviews and thematic content analysis. A convenience sample of 22 Registered Nurses and 22 dying patients was interviewed in 1996-1997. FINDINGS: Dying patients had a desire to maintain independence and remain in control. Palliative care nurses experienced both effective and ineffective interpersonal communication, the building of therapeutic relationships with dying patients and attempting to control patients' pain and distressing symptoms. Patients and nurses agreed that the two most important characteristics of an expert palliative nurse were interpersonal skills and qualities such as kindness, warmth, compassion and genuineness. CONCLUSION: Although the study was conducted in the United Kingdom, the findings have relevance for palliative care practice globally in terms of dependence, issues of patient choice, nurses being interpersonally skilled and building therapeutic relationships with patients.     

Medication safety challenges in the palliative care setting: Nurses' perspectives

AimTo explore medication safety issues faced by general and palliative care community nurses working in rural and remote palliative care domiciliary settings.MethodAn online survey for nurses working in rural communities was conducted across the South East region of rural Victoria, Australia. Nurses from 18 community based health care organisations across the region were invited to participate in an anonymous survey addressing medication safety issues in the palliative care settings. Qualitative data obtained from the open-ended survey questions were analysed inductively.ResultsA total of 29 nurses completed the survey (response rate 28% from potential respondents). Most of the nurses were working in a rural practice providing a mixed model of community palliative care and community nursing. Medication safety issues raised by the nurses included; errors associated with dose administration aids, frequency of medications reviews undertaken by clinical pharmacists of clients’ medications, high occurrence of medications error reporting, lack of awareness of medications initiated by nurses and cytotoxic medications handling.ConclusionTargeted interventions addressing the identified issues raised by community general and palliative care nurses have the potential to improve medication safety in the domiciliary palliative care setting.     

Nurses' use of patient notes to chart bowel care management for the palliative care patient.

Little is known about nurses' knowledge base and practice in the provision of Bowel Care Management (BCM). Recently, a study designed to investigate both factors was conducted in two hospices, one in New South Wales and the other in South Australia. Twenty-four nurses and 100 palliative care patients participated in the study. The audit of patients' medical records, one of several research methods used in the study, will be discussed here. The research identified that in all but two cases, patients' information about their BCM practices used in the home environment was not documented on their admission to the hospice. Further, the considerable number of charts used in each hospice to record BCM generally asked for information related to bowel function and the use of pharmaceutical preparations, to the exclusion of other methods of management.     

Ethical issues arising from the requirement to provide written information in palliative care

French Healthcare Networks aim to help healthcare workers take care of patients by improving co-operation, co-ordination and the continuity of care. When applied to palliative care in the home, they facilitate overall care, including medical, social and psychological aspects. French legislation in 2002 required that an information document explaining the functioning of the Network should be given to patients when they enter a Healthcare Network. Ethical problems arise from this legislation with regard to providing terminal patients with explicit information upon their entry into the palliative phase of the disease, and requiring them to sign the document. It highlights the limitations of this practice, and the gap between the legislation and the nature of the physician-patient relationship in palliative care.     

Nurses' ability and willingness to work during pandemic flu

martin s.d. (2011) Journal of Nursing Management 19, 98–108
Nurses’ ability and willingness to work during pandemic flu Aim The present study reports factors affecting nurses’ ability and willingness to work during pandemic flu (PF). Background Previous studies suggest some nurses may be unable or unwilling to work during PF. Method A questionnaire was mailed to nurses during October to December 2009, the second wave of the 2009 A/H1N1 flu pandemic. Results Most (90.1%) reported they would work. Willingness decreased primarily as personal protective equipment (PPE) dwindled, family or nurse were perceived to be at risk and when vaccine or antiviral medication was not provided to both nurse and family although many other factors also affected willingness to work. Ability decreased primarily when the nurse was sick, a loved one needed care at home or transportation problems existed although many other factors also affected ability to work. Conclusion Certain factors can decrease willingness and ability of nurses to work during a flu pandemic. Implications for nursing management Managers can anticipate factors that may decrease nurse’s ability and willingness to work during pandemic flu. Preparing for staffing during emergencies can retain the health care workforce when it is needed most.     

Nurses' moral experience of administering PRN anti-seizure medications in pediatric palliative care

This article explores nurses' decision-making related to the administration of PRN anti-seizure medications to children with long-term seizure disorders in palliative care. Hermeneutic phenomenological inquiry guided by van Manen's approach was the method used. Six nurses participated in interviews. Data analysis revealed that not on my watch was the overarching theme in which nurses engaged in bearing witness, being attentive, creating connectedness, and finding the right thing to do. Four themes emerged: being in the know--what to know and ways of knowing; marking time--waiting and timekeeping; seeking a sense of personal comfort--developing a sense of comfort, experiencing distress, and responding to distress; and making the decision--recognizing a seizure, identifying options, weighing the options, and rethinking the decision. This study reveals the moral dilemmas and resulting moral distress that may be experienced in making this type of decision and advances our thinking about the corresponding tensions and rewards.     

Predictors of rural critical care nurses' willingness to care for people with AIDS.

The purpose of this study was to examine the relationship between rural critical care nurses' attitudes about acquired immunedeficiency syndrome (AIDS) and people with AIDS (PWAs), and their willingness to provide care to AIDS patients. Sixty-one critical care nurses in nine rural counties in the northeastern USA completed a mailed questionnaire as part of a larger study of 957 rural nurses. A bivariate logistic regression analysis revealed a relationship between willingness to provide care and positive attitudes about homosexuality, nursing care concerns, and professional-societal concerns. However, a multivariate logistic regression indicated that the most significant factors influencing rural critical care nurses' willingness to care were their feelings of not being prepared to care for people with AIDS, and their anxiety and fears about contracting the disease from their patients. These findings add insight into the care of critically ill AIDS patients and support the need for continuing educational efforts in rural areas of the USA to address critical care nurses' concerns.     

Evaluation of a scheme to enhance palliative cancer care in rural Wales

Since the early 1990s, the United Kingdom has seen several initiatives designed to improve the quality of cancer palliative care in the community. We report on the evaluation of a project that took place in the rural county of Powys in Wales in which a group of general practitioner clinical facilitators (GPCFs) sought to raise the overall standard of palliative care among primary health care teams (PHCTs). The evaluation was conducted over 3 years and made use of several methods: interviews with facilitators and other key stakeholders at regular intervals throughout the project; a survey of PHCT members at two time points; an analysis of patterns of opioid prescribing in the county before and during the project; monitoring of referrals to specialist palliative care services out of county; and an analysis of place of death of those dying from cancer. The evaluation found that local general practitioners (GPs) were willing to work as facilitators and that they made contact with over two thirds of those in the PHCTs. Facilitators undertook a variety of clinical, educational and service development initiatives but did report on problems of role definition and time management. There were no marked changes in patterns of referral to specialist palliative care or in place of death, but there was some evidence to suggest that the facilitators had an influence on their colleagues opioid prescribing patterns.