Hospice & Palliative Care Nursing

Background: A World Health Assembly (WHA) resolution adopted in 2014 strongly encourages member states to integrate palliative care (PC) in undergraduate training for health professionals. Objective: The study objective was to describe a consensus-based process workshop to develop PC competences for medical and nursing schools in Colombia and to present a summary of the findings. Methods: The workshop included 36 participants representing 16 medical and 6 nursing schools from 18 universities in Colombia. Participants were distributed in four thematic groups. Using the International Association for Hospice and Palliative Care (IAHPC) List of Essential Practices (LEP) as guidance, they were asked to discuss and define PC competencies at the undergraduate level. Participants provided feedback and approved each recommendation, and then were asked to complete an evaluation. Results: The resulting competences were separated into six categories: (1) Definition and Principles of PC, (2) Identification and Control of Symptoms, (3) End-of-Life Care, (4) Ethical and Legal Issues, (5) Psychosocial and Spiritual Issues, and (6) Teamwork. A comparative analysis revealed that treatment of several symptoms in the IAHPC LEP (pain, dyspnea, constipation, nausea, vomit, diarrhea, delirium, and insomnia) were included in the competencies. All of the IAHPC LEP related to psychological/emotional/spiritual care was included. The evaluation rate of return was 80%. The assessment was very positive: total score of 4.7/5.0; SD = 0.426), with 89% considering the workshop to be helpful. Conclusion: The workshop provided an opportunity for individuals from different disciplines to discuss competencies and achieve consensus. The resulting competencies will be helpful in the development of PC curricula for physicians and nurses throughout schools in Colombia and other countries.

Background: Some patients do not receive adequate pain and symptom relief at the end of life, causing distress to patients, families and healthcare professionals. It is unclear whether undertreatment of symptoms occurs, in part, because of nurses’ concerns about legal and/or disciplinary repercussions if the patient dies after medication is administered. Aim: The aim was to explore nurses’ experiences and knowledge of the law relating to the provision of end-of-life pain and symptom relief. Design: Semi-structured interviews with nurses were assessed using a six-stage hybrid thematic analysis technique. Setting/participants: Four face-to-face and 21 telephone interviews were conducted with nurses who routinely prescribed and/or administered pain and symptom relief to patients approaching the end of their lives in Queensland and New South Wales, Australia. Results: While many nurses had no personal experiences with legal or professional repercussions after a patient had died, the fea...

When a patient approaches the end of life, healthcare professionals are faced with a number of ethical
issues relating to the decision to withhold (not start) or withdraw (stop) treatment. These include
whether life should be maintained at all costs, using all available means, even if the treatment is a great
burden for the patient, or whether it is preferable to accept the imminence of death and focus on the
patient’s comfort. Ethical principles can help professionals, the patient and loved ones weigh up the
benefits, burdens and risks of a specific treatment. Today’s healthcare system considers artificial nutrition
and hydration (ANH) to be a major life-sustaining treatment, but opinions over this are divided. Research
shows that ANH is not always beneficial to patients when they have stopped oral intake. On the contrary,
it has been found that caloric deprivation and terminal dehydration provide a number of benefits for the
patient. This article will discuss the dilemmas that confront practitioners in relation to withholding and
withdrawing treatment, in particular ANH, at the end of a patient’s life.

Background: Awareness and pain during palliative sedation is typically assessed by observational scales, but the use of such scales has been put into question. Case presentation: A woman in her mid-80s was admitted to a palliative care unit, presenting with chronic lymphatic leukemia, depression, and a cerebrovascular accident, with right-sided hemiplegia and aphasia. The patient was unable to eat and was suffering from nausea and vomiting. Before admission, the patient had expressed her desire to discontinue treatment on several occasions. Case management: The decision was made to initiate palliative sedation. The patient consented to take part in a study to assess level of comfort and pain using two monitoring devices (NeuroSense monitor and Analgesia Nociception Index monitor). Case outcome: The patient died 90 h after initiation of palliative sedation. Titration of the medication was challenging and sedation was not deep enough during the first 2 days. Thirteen assessments made with the Ramsay Sedation Scale showed that the patient was considered to be in a deep sleep, while in fact the NeuroSense monitor indicated otherwise. Conclusion: This case demonstrates the feasibility and potential advantages of using monitoring devices to objectify assessments of pain and discomfort in palliatively sedated patients.

This study aimed to explore the experiences and perceptions of nurses caring for dying patients and their families in the acute medical admission setting. A qualitative interpretive descriptive methodology was used to explore the experiences and perceptions of 15 nurses recruited via purposive sampling from three acute medical wards of a hospital in Hong Kong. The nurses perceived insufficiency and experienced great mental and physiological strain regarding their caring roles in this setting. Four themes were derived from the findings: lack of preparedness for patients' deaths, reflecting on their own nursing roles for dying patients, reflecting on the meaning of death and their personal experiences of the death of their own family members, and coping with caring for dying patients. There are similarities between these experiences and those of nurses in similar settings in different cultures. There is a need for further research into and educational preparation of nurses in bere...

Rationale of the Study: The concept of primary health care has ignited efforts of health leaders to improve the health status of people worldwide. This impelled attempts to reduce inequities through policy changes and interagency collaborative participations. With nurses at the center of the healthcare delivery, they could contribute much to potentiate attainment of equity in health. However, little is known regarding the realization of the concept of health equity from the leaders in healthcare down to the healthcare workers. Research objectives/Problem statement: This concept analysis provides a thorough review of the concept of health equity in nursing and relatedness to healthcare and health practices. Methods: A concept analysis method described by Walker and Avant 1 was used to clarify the meaning of health equity in Nursing. The concept's attributes were determined through extensive literature search. Model, borderline, and contrary cases were constructed. Analysis was further done by identifying the antecedents, consequences, and empirical referents of health equity. Results and Conclusions: Health Equity is attributed to adequate and appropriate distribution of health services which is closely linked to an opportunity to gain access to health services that is not affected by socioeconomic status or other factors. Establishment of relevant policies and effective promoting actions of health and non-health agencies are indispensable to realize health equity. Generally, it is believed that if there is health equity, there will be improvement of the heath status of people. It will yield greatest contributions to maintaining and preserving the rights of people in terms of their health and their right to be not deprived of services from vast network of health systems. Presence of which prevents disadvantaged groups to have greater disadvantage. The concept continues to be a major concern particularly in developing countries where socially disadvantaged population groups are at its highest. Implementation of universal healthcare may continue to be a challenge among health and non-health related organizations. Clearly, more intensive efforts are needed at various levels of policy development and implementation.

El propósito de este trabajo es analizar la categoría de cuidado como valor ético. Para esto me propongo retomar un enfoque denominado ética del cuidado, exponiendo sus principales características. Considero que una de las principales críticas hechas a esta teoría tiene que ver con la indeterminación del contenido normativo de la noción de cuidado, y la posterior imposibilidad de formular una teoría ética acabada que la utilice como categoría fundamental en el direccionamiento de la acción moral de las personas. Con el fin de sortear esta limitación he buscado analizar la categoría de cuidado a partir del contexto específico en el cual se lleva a cabo. Para esto he tomado como material empírico la filosofía de cuidado hospice, utilizada en el cuidado de personas con enfermedades terminales en final de vida al interior de las instituciones pertenecientes al moderno movimiento hospice. Argumentando de qué forma esta filosofía puede ser entendida como una ética del cuidado, expondré en qué medida su estudio brinda herramientas para sortear algunas de las críticas que comúnmente se le han hecho a este enfoque, mostrando también las limitaciones que este tipo de cuidado específico tiene a la hora de extrapolarlo a una teoría ética general.

"Counselling and palliative care" is the title of the book written by Dr. Esperanza Santos and Professor José Carlos Bermejo. This book, which is easy to read and contains very practical and useful advice, presents fundamental elements for providing optimum quality accompaniment in palliative care, as well as the possibility of self-examining how caregivers provide their services and even how to avoid burnout. This book is useful both for health professionals working in palliative care units and for people who devote much of their time to caring for family members with terminal illnesses or who are going through prolonged illness processes. With examples of real-life conversations between caregivers and patients, the book is at once enjoyable, amusing and deeply reflective.



"Counselling y cuidados paliativos" es el título del libro escrito por la doctora Esperanza Santos y el profesor José Carlos Bermejo. En esta obra, de fácil lectura y con consejos muy prácticos y útiles, se presentan elementos fundamentales para brindar un acompañamiento de óptima calidad en el cuidado paliativo, así como la posibilidad de hacer un autoexamen de cómo los cuidadores de los pacientes prestan sus servicios e incluso para no caer en burnout. Este libro es de gran utilidad, tanto para los profesionales de la salud que trabajan en las unidades de cuidados paliativos, como para personas que dedican gran parte de su tiempo al cuidado de familiares con enfermedades terminales, o que pasan por procesos prolongados de enfermedad. Con ejemplos de conversaciones de la vida real entre cuidadores y pacientes, la lectura del libro se hace, a la vez, agradable, divertida y profundamente reflexiva.

Introduction: Pain is a common symptom for patients receiving palliative care, but can be relieved by effective pain management. Nurses play a critical part in implementing pain management effectively and must therefore have a solid foundation of knowledge and a positive attitude toward it. Aim: The purpose of this study was to implement and evaluate an educational pain management programme (PMP) for nurses in Kenya. Methods: The effects of the PMP were measured using a quasi-experimental pre-post test design. Twenty seven nurses from two units in a single health institution in Kenya participated in a baseline assessment using the Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP). Nine randomly selected nurses then received 7 hours of focused education. This group completed the assessment again both immediately after and 2 weeks after the PMP. Results: A deficit in knowledge and attitudes related to pain management was prominent at baseline. The nurses who received the PMP scored significantly higher on the NKASRP following the PMP: mean scores were 18.44, 28.00, and 27.56 at baseline, first follow-up, and second follow-up assessment respectively. Conclusion: The PMP appears to be effective in improving nurses' pain knowledge and attitudes.

Introduction. The influence of the environment on wellness, not only for patients themselves
but for all care-givers as well, refers to the humanisation principles of spaces of
care. Commencing with an analysis of existing paediatric hospices, the paper examines
design suggestions for prosthetic environments, considered as a fundamental component
in the healing process.
Methodology. A prosthetic environment can be created only through a specific knowledge
of the real needs of users. Therefore, some scholars have conducted research work
for defining the best practices for healing environments, supported by an assessment and
comparison of case studies. The methodology is based on two phases: the first is based
on interviews with experts in hospice design and management and the second, through
the application of a questionnaire to several users.
Discussion and Results. The output of the work is the achievement of a logical, sequential
and participatory broad-spectrum process in the design of health facilities in order to
cause a sustainable awareness in paediatric hospices.
Conclusion. Starting from the research work, it is necessary to define a scientific method
for implementing knowledge on health, psychological, perceptual and behavioural needs
to contribute towards proper planning for meeting the real requirements of users.

Communicating with patients about their spiritual and existential issues is a core element of comprehensive palliative care. Spiritual and existential issues are conceptually problematic and can be difficult to delineate from other health domains. Patients and families facing the end of life identify spiritual and existential needs as vital to their experience at the end of life and want their health care professionals to address them. This essay discusses the relevance of assessing and supporting patients as they deal with existential and spiritual issues at the end of life, while also providing clinical guidance for their health care professionals. Implicit and explicit means for communicating with patients about their existential and spiritual issues are discussed. The pneumonic SACR-D: Sself-awareness, Aassessing the patient, Ccompassionate presence, Rreferring for additional spiritual support, and Ddialogue, is presented as a clinical framework to effectively communicate with patients about their existential and spiritual needs.

Many patients suffering from cancer make use of complementary therapies, with aromatherapy being a popular choice. Quantitative studies, using questionnaire data, have shown that aromatherapy may reduce psychological distress and enhance symptom control in cancer patients. However, little is known about the personal meanings patients associate with the therapy. This study explored the patients' experiences of aromatherapy using of a focus group interview. Eight themes emerged from the analysis, six of which have been acknowledged to some extent by previous authors: de-stressing effects of aromatherapy, the counselling role of the aromatherapist, aromatherapy as a reward, patient empowerment, communication through touch, and negative aspects of the service. Two apparently new themes emerged concerned with security of context (where the aromatherapy took place) and preconceived perceptions of the value of aromatherapy as a treatment of cancer patients. The implications of the find...

During the twentieth-century, dramatic changes in the manner and location of care for the dying resulted in the conception and birth of the modern American hospice movement. Idealistic nurses, clergy, and others concerned about the plight of terminally ill cancer patients launched hospice as a necessary health care reform. As new hospice programs opened across the country, the idealism of the early leaders gave way to more pragmatic issues such as program viability. As hospice was studied and integrated into the health care system, it came to be redefined by the politics of health policy and the health care industry. As a result, there is a disarticulation between the needs of seriously ill persons and their families and the health care that is available to them. Important lessons can be learned from the history of the Medicare hospice benefit to help guide current palliative care policy initiatives. While formalized reimbursement for hospice enhanced organizational sustainability, many critical issues remain.

Palliative care is increasingly confronted with
cultural diversity. This can lead to various
problems in practice. In this perspective article,
the authors discuss in more detail which issues
play a role in culture-sensitive
palliative care, why naive culturalism will not solve such problems
and in which direction research into this aspect
of care can be further elaborated.

The purpose of this quasi-experimental study was to assess the ongoing impact of the End-of-Life Nursing Education Consortium (ELNEC) training program on registered nurses' death anxiety, concerns about dying, and knowledge of the dying process utilizing the principles of The Comfort Theory and Practice by at the institutional level. The research hypothesis was upon completion of the ELNEC training, registered nurses would have decreased death anxiety, less concerns about dying, and increased knowledge of the dying process. The Revised Death Anxiety Scale (RDAS) was used to measure death anxiety which is a 25 item self-report questionnaire. The Concerns about Dying Instrument (CAD) was used to measure death attitude or concerns about dying which includes three distinct but related areas for providers: general concern about death, spirituality, and concerns about working with dying patients. Participant's perceived knowledge of dying was measured using a self report 5-point Likert format with "0" indicating no level of knowledge to "4" reflecting complete knowledge of death and dying.

This paper by Public Health England

Prepared by: PHE Older adults team, Health and Wellbeing Directorate
Supported by: Rev Meg Burton and colleagues at the College of Health Care Chaplains
Contibuted to by: Sonia Douek, Manvir Kaur Hayer, Hannah Jacobs, Robin Jacobs, David Jones, Rashid Ali Laher, Zuliekha Laher, Brendan McCarthy, Jim McManus, Keith Munnings, Aziz Sheikh, Heema Shukla, Diviash Thakrar, Gaby Wills

This case study of 14 hospice and palliative care volunteers looked for recommendations and suggestions on how to increase cultural competency among hospice volunteers. In-depth interviews were conducted with a hospice in Toronto, Canada, and findings reveal that volunteers have very specific and diverse recommendations on how they prefer to be briefed and educated on cultural competency issues surrounding their patients. Findings also reveal hospice volunteers want more cultural competency training and acknowledge the importance of being culturally competent. This article concludes with a precis on recommendations for increasing cultural competency in hospice and palliative care for both volunteers and agencies and discusses the top four future trends in cultural competency for hospice care.

In order to provide appropriate end-of-life care, prelicensure nursing students need adequate education prior to entering professional nursing practice. This integrative literature review presents characteristics of end-of-life teaching strategies and their impact on student educational outcomes. Databases, reference lists, and related citations were explored using specific inclusion and exclusion criteria, resulting in 14 articles for review. The most commonly implemented teaching strategies were found to be in-class activities or entire courses dedicated to palliative or end-of-life care. Lecture/didactic strategies were used most often. All teaching strategies resulted in positive learning outcomes for attitude, knowledge, self-confidence/self-efficacy, and appreciation/awareness of end-of-life care. Recommendations for future research are proposed, especially for improvement of research study design, measurement of students' learning outcomes rather than attitudes and opinions, and assessment of patient outcomes within education research.

Please note that I am not permitted to disseminate this test directly, no matter who requests it. This test is officially owned by UCLA and copyright protected and distributed through Behavioral Health Innovations through a licensing agreement with UCLA's Office of Intellectual Property.

Versions of the PCBD Checklist are currently available in both English (test and administration manual) and Spanish (test only).

For fee schedule and licensing agreement (available for online purchase) see https://www.reactionindex.com. The primary author can be contacted at [email protected].

For a press release, see http://newsroom.ucla.edu/releases/new-ucla-university-of-texas-checklist-helps-identify-children-teens-with-bereavement-disorder

ABSTRACT: The Persistent Complex Bereavement Disorder (PCBD) Checklist—Youth Version is a psychological test for bereaved children and adolescents aged 8-18. It is designed to assess content domains corresponding to DSM-5 proposed Persistent Complex Bereavement Disorder symptom criteria, including Separation Distress, Reactive Distress, Existential/Identity Related Distress, and Distress over Circumstances of the Death. The PCBD Checklist replaces the (now-retired) early prototype measure, the UCLA Extended Grief Inventory (Layne, Savjak, Saltzman, & Pynoos, 2001) as a more rigorously constructed, developmentally attuned, psychometrically sound, and clinically useful instrument. The 39 PCBD Checklist items were written specifically to correspond with DSM-5 proposed PCBD diagnostic criteria. Consistent with best practice test construction procedures (Haynes, Richard, & Kubany, 1995), each PCBD test item has been extensively field-tested by a team of ten masters-level clinicians and clinical child psychologists under the clinical supervision of one of the test developers (Dr. Julie Kaplow). Iterative field-testing was conducted with 237 bereaved children and adolescents aged 8-18 in various field settings including bereavement camps, grief support facilities, community clinics, and school-based health clinics. The PCBD Checklist can be used for a range of clinical applications including risk screening, treatment triage, case conceptualization and treatment planning (including assessment-driven treatment tailoring), and treatment outcome evaluation. Because Persistent Complex Bereavement Disorder (PCBD) is a proposed research diagnosis located in the appendix of DSM-5, the PCBD Checklist can only be used to assign a provisional (unofficial) discrete (present/absent) PCBD diagnosis as well as yield continuous Criterion B and C subscale scores. Administration time for the PCBD Checklist is approximately 5-8 minutes, and scoring and interpretation take between 5-10 minutes. The PCBD Checklist is typically clinician-administered but can be adapted for self-report with older children and adolescents. Training in the administration, scoring, and interpretation of the PCBD Checklist can be provided in person or online by authorized trainers. Publication Date: Nov 2014.

Initial inquiries regarding the PCBD Checklist can be directed to Christopher Layne at [email protected].

Technical questions regarding copyright and licensing of the PCBD Checklist can be directed to Dr. Alan Steinberg at [email protected]. Be sure to also CC Christopher Layne at [email protected] .

This article presents a new avenue for healthcare risk managers to drive improvement for patients and healthcare organizations alike: Working to reduce avoidable patient suffering. It briefly describes the problem of patient suffering, differentiates between avoidable and unavoidable suffering, and suggests that common risk management tools can be used to tackle the problem. It also highlights a success story from one large health system.

Communicating with patients about their spiritual and existential issues is a core element of comprehensivepalliative care. Spiritual and existential issues are conceptually problematic and can be difficult to delineatefrom other health domains. Patients and families facing the end of life identify spiritual and existential needsas vital to their experience at the end of life and want their health care professionals to address them. Thisessay discusses the relevance of assessing and supporting patients as they deal with existential andspiritual issues at the end of life, while also providing clinical guidance for their health care professionals.Implicit and explicit means for communicating with patients about their existential and spiritual issues arediscussed. The pneumonic SACR-D: S–self-awareness, A–assessing the patient, C–compassionatepresence, R–referring for additional spiritual support, and D–dialogue, is presented as a clinicalframework to effectively communicate with patients about their existential and spiritual needs.

v The need for improved nursing knowledge about end-of-life care is well documented; however, efficient measures to evaluate knowledge attainment from end-of-life training programs are lacking. The authors tested a 50-item version of an original 109-item knowledge assessment tool developed by the End-of-Life Nursing Education Consortium. Items with highest item-to-total correlations were selected to represent each of the nine domains in the original instrument. One hundred forty-one graduate and undergraduate nursing students pretested the shorter version. Thirty graduate students also completed the original version. Item analysis, equivalence, and internal consistency estimates were conducted to evaluate the validity of the 50-item version. Scores on the 109-item and 50-item versions were highly correlated (r = 0.92), and the total scale internal consistency estimate for the 50-item version surpassed the 0.80 standard (Kudar Richardson [KR] 20 = 0.84). Item difficulty and discrimination indices suggest that the revised version should discern knowledge attainment across varied achievement levels. Pretest scores were well below the 80% target for mastery among graduate students in practice and support the ongoing need for end-of-life education. The results support the utility of the shorter version to assess baseline end-of-life knowledge. Further testing is needed to demonstrate its usefulness in end-of-life program evaluation.

El dolor de los pacientes de cáncer ha sido descrito como dolor total. Tanto en la literatura científica, los libros de texto, así como en informes y directrices de la Organización Mundial de la Salud, el concepto de dolor total ha servido de trasfondo para promover la atención multidisciplinaria de pacientes cuyo dolor involucra también aspectos psicológicos, emocionales, espirituales y sociales. El objetivo de este artículo es proponer una caracterización del concepto de dolor total de manera tal que continúe jugando un papel central en la promoción de la atención multidisciplinaria propia de los cuidados paliativos. Primero, se presenta un bosquejo del concepto y de los diferentes usos en la literatura. Segundo, se hace un contraste con la definición del dolor de la Asociación Internacional para el Estudio del Dolor (IASP) para establecer la naturaleza y referente del concepto de dolor total. Tercero, se muestra cómo esta caracterización del con-cepto disuelve algunas tensiones en la literatura respecto a su uso adecuado. Se plan-tea que el concepto de dolor total hace referencia a aquellas relaciones causales entre el dolor y los estados psicológicos, emocionales, espirituales y sociales que han sido identificadas como susceptibles de ser intervenidas por el modelo de atención paliativa multidisciplinar. Como conclusión, se recomienda no vincular el concepto de dolor total con el padecimiento de una enfermedad en particular, ni con qué tan limitante para la vida es la enfermedad; tampoco para referirse a la "experiencia global" del paciente, ni como un punto muy alto de una escala.

Palabras Clave: Dolor; dolor en cáncer; cuidados paliativos; medicina paliativa; manejo del dolor (fuente: DeCS, BIREME).

ABSTRACT The pain suffering in cancer patients has been described as "total pain". The concept of "total pain" plays a key role in the promotion of the multidisciplinary nature of palliative care. In palliative attention, suffering is conceptualized as an addition of physical, psychological , emotional, spiritual and social aspects. In this paper, I offer a characterization of the concept of "total pain", one which preserves its key role in palliative care promotion. First, I sketch the concept and some different usages found in the literature. Second, I establish the nature and referent of the "total pain" concept by means of showing the contrast between it and the pain definition provided by the International Association for the Study of Pain (IASP). Third, I propose that the concept of "total pain" refers to the relevant causal chains identified by the palliative care research as elements susceptible of intervention for the purpose of alleviating patient's suffering. These causal chains feature and link physical, psychological, emotional, spiritual and social aspects of the patient's suffering. As conclusion, I add the recommendation to not associate the concept of "total pain" with any particular diagnostic or disease or any particular prognosis, neither to the global experience of the patient, nor treat it as a high point on a scale.

Around 1-3% of the world's population has intellectual disabilities (Mash and Wolfe, 2004). Communication difficulties are a major obstacle in providing effective palliative care to this group. Problems may arise due to a lack of comprehension and a lack of verbal skills, affecting assessment and the provision of psychosocial support. This paper maps the communication difficulties experienced by people with intellectual disabilities within a palliative care setting, drawing on several research studies carried out by the authors. These include the time-consuming nature of effective communication, and difficulties around breaking bad news. The paper explores the ways in which people with intellectual disabilities may (mis)understand verbal information. Strategies for managing communication difficulties are outlined, including ways to use clear, unambiguous language. The authors conclude that the ability to communicate effectively with people with intellectual disabilities is a use...

Palliative care (PC) is defined by the World Health Organization as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness..." In Lebanon, PC is new to the health care field and as such very little is known about type of services offered and the preparedness of health care professionals to provide PC. The purpose of this study is to determine the knowledge, attitudes, and practices of physicians and nurses towards PC in Lebanon, and to assess the need and model for service delivery. A cross-sectional descriptive survey using self-administered questionnaire sent to 15 hospitals in Lebanon was used; 1873 nurses and 1884 physicians participated in the study. The response rate was 32%; 51% for nurses and 13% for physicians. Around 93% of nurses and 96% of physicians were able to identify the goals of PC. The majority (94% to 99%) believes terminally ill patients and their families should be inf...

Background: Thailand has few hospices and a limited range of palliative care services. Aims: To explore palliative care models in Thailand. Methods: A convergent mixed-methods study design using purposive sampling to select three levels of healthcare services and one religious organisation. Findings: The quantitative data revealed that the structures of palliative care accessibility, referral systems, and continuity of care were in place at all levels of healthcare services. The qualitative data revealed the themes of the structure of palliative care, processes and outcomes. Conclusion: The variety of palliative care structures identified in Thailand are suitable for the context in which palliative care is provided. The problems that need solving are referral systems, patient access to opioids, inequitites in care distribution and medicine dispensing and palliative care outcome evaluation.

Loss is a common life experience including death of a loved one, breakup of a relationship, loss of health, loss of employment, loss of one's home and financial wealth, infertility, and many more.

The types of loss are reviewed as well as the goals of grief counseling and helpful things to say for healing painful feelings around loss and grief, the unfinished business of loss, and the behaviour decisions of grief. Therapeutic interventions and statements for helping the healing of grief, are described and discussed in detail.

This article will outline the use of continuous subcutaneous infusion pumps, known as syringe drivers, including their benefits and drawbacks in a palliative care context. There have been over 5 000 articles published globally describing syringe drivers in the medical and nursing literature within the last decade. Many provide guidance on their use, although much of the data are repetitious, disease or age-group specific, and focused on pragmatic issues to do with clinical application. Several trusts and hospices across the UK are carrying out trials of the recently launched McKinley T34 syringe driver. Therefore, it seems timely to consider their wider use internationally. Globally, practitioners in palliative care are very familiar with their use, although the literature lacks specific guidance and, at times, the information is ambiguous. Having briefly reviewed their benefits, the article considers the limitations of using syringe drivers and comments on some of the lesser known/reported practical and patientfocused drawbacks associated with their use. We conclude by considering why, when so much education and training exists to help practitioners use these devices effectively, so many human errors occur.

The most important role in a family is of parents. They are the most precious gift to us from God.Each time when children get stuck in some problem they seek help from their parents. In contrast, when children observe conflicts, fighting, abusive languages among parents resulting divorce they are disturbed mentally, socially, emotionally and psychologically and it really impacts child’s overall development. This paper will benefit the readers to identify developmental problems i.e. social, psychological, emotional and physiological in their children, identifies some psychological theories applicable to them and helping the children who are the victims to cope with the situation in a positive way.

Children with life-threatening conditions may encounter significant spiritual suffering as they anticipate and prepare for their impending deaths. This pediatric palliative care case study illustrates symptom management challenges related to spiritual suffering of a dying adolescent. The nurse plays a critical role in identifying the pediatric patient's verbal and nonverbal cues that may denote spiritual problems, as well as patient, family, and environmental factors. Evidence-based clinical practice guidelines are available to facilitate symptom management of spiritual suffering in pediatric patients across disciplines and within the community. This article highlights the nursing role in assessing and managing symptoms of spiritual suffering in children living with life-threatening conditions. The complexity of spiritual suffering in the pediatric palliative care population emphasizes the need for an interdisciplinary team approach and the integral role of the nurse in providing spiritual support at end of life.

Summary: Textbook suggestions for a student library on Health-Medicine-Pharmacy, alphabetically listed by First Author. Each textbook has been checked (see -c after book title) for Author Names, Publication Year, Book Title, Publisher, and for Book Cover, Title Page, Copyright Page, Table of Contents, and Subject Index. If missing, such pages have been added where available. All textbooks are .pdf, unless marked by djvu,  epub,  or  chm  after the title. To find books with a particular key word/subject in the book title, please use the Search Function of your computer on this document.

All of us have some preferences about how we will die. We care about such things as what will cause our death, when and where it will happen, who will be with us, how much warning we will have, and how we will experience death. While such preferences are sometimes grounded in a concern for the well-being of others or a desire to promote some social or spiritual cause, preferences regarding one's own death are commonly self-interested or, as philosophers say, prudential. In other words, they are grounded in a concern for one's own well-being. Accordingly, they provide insight into an individual's substantive normative view about what makes a death go better or worse for the one who dies. This is commonly referred to as the theme of the good death. 1 Despite its obvious significance to self-conscious mortal beings like ourselves, It might be thought that there is nothing problematic about the silence surrounding the good death. After all, the silence is only apparent. Most theories of the good life are understood to be comprehensive and pertain to all portions of a life, from beginning to end. So, even if well-being theorists have not explicitly addressed the theme of the good death, they have been implicitly addressing it. For instance, those who defend hedonism (which identifies well-being with pleasure and the absence of pain, broadly construed) are thereby defending the idea that the best death for an individual is the most pleasant, or least unpleasant, death. 4 Likewise, desire-fulfillment theory, perfectionism, and objective list theories each provide their own distinctive picture of the good death. The purpose of this essay is to highlight some commonly held views about what makes for a better or worse death and examine how these views might fit into the existing theoretical landscape. In particular, I explore whether the four leading theories of well-being are able to fully accommodate these popular views about the good death. The findings of my preliminary investigation into this matter are that, by and large, they cannot. If these views about the good death happen to be true, the most popular and widely discussed theories of well-being appear to be inadequate in this domain. Moreover, even if these views are not true, it seems both odd and problematic that commonsense views about the good death have no representation among the dominant theories of well-being.

Questo libro è una raccolta di saggi che hanno in comune l'intento di mettere al centro della cura e dell'assistenza la persona, intesa non come puro corpo o organismo biologico ma come costrutto culturale, con un bagaglio storico, emotivo ed esperienziale da cui ogni professionista (sociale e sanitario in particolar modo) non può prescindere. I diversi contributi propongono l'analisi di un contesto di assistenza in cui un professionista sanitario, nella maggior parte dei casi un infermiere, si pone a contatto con una persona bisognosa di cura, intesa quest'ultima non esclusivamente come somministrazione di una terapia quanto piuttosto come predisposizione a osservare, ascoltare, interpretare la narrazione della malattia, la dichiarazione di bisogni fisici, sociali e psicologici, ad aiutare e assistere la persona a preservare la sua autonomia. I primi contributi si collocano in questo ambito di humanities cares, mentre i successivi rientrano nell'ambito dell'infermieristica transculturale, ovvero in quel dominio dell'assistenza che oggi si pone di fronte a culture differenti da quella italiana, occidentale ed europea, constatata l'evidente presenza sul territorio nazionale di una sempre crescente popolazione immigrata.

Ce mémoire vise à s’inscrire dans le débat sur l’euthanasie et sur la fin de vie qui secoue présentement le Québec et de nombreuses sociétés contemporaines, en cherchant à fournir des données anthropologiques sur le domaine des soins palliatifs, un champ de la santé apparemment méconnu d’une grande partie de la population selon certains commentateurs. Cette recherche a donc d’abord voulu documenter, par l’entremise d’un terrain ethnographique, les normes, valeurs et pratiques d’une équipe soignante en soins palliatif, dans le quotidien d’une institution québécoise. Les rapports empiriques des représentations d’une mort paisible, douce, réalisée dans le confort et l’harmonie furent également investigués. En trame de fond, ce mémoire adresse une question centrale de l’anthropologie, soit le domaine des transitions entre la vie et la mort : ainsi, l’accompagnement palliatif est-il un rite de passage en bonne et due forme ? Cette recherche indique que la mort paisible est une trajectoire du mourir normative, institutionnelle, davantage imbriquée dans un passage de statuts que dans un contexte rituel per se. La mort paisible est un cheminement qui invite la personne mourante à dévoiler, par le partage d’une parole narrative, l’essence d’elle- même. En ce sens, les institutions de soins palliatifs se retrouvent au front de changements majeurs dans la façon de concevoir la spiritualité en Occident, en opérant notamment un passage majeur de la transcendance à l’immanence.

This thesis was conducted amidst a growing debate in Quebec and elsewhere about end-of-life options, namely euthanasia and palliative care. Apparently, the public is not well informed about the philosophy and goals of palliative care. This research first aimed to document the norms, values and practices of a team of carers in an independant institution of the province of Quebec. Then, it tried to understand what the representations of a peaceful, harmonious and comfortable death refer to empirically. Finally, this thesis addresses a fundamental anthropological problematic, mainly the transition between life and death : is palliative care, then, a rite of passage ? My data shows that the peaceful death, a version of the good death, is a normative death trajectory, more of a status passage than a ritual per se. It consists for the dying person of showing the very essence of themselves, through the exchange of narrative speech acts. In inviting the dying to do so, palliative care institutions are on the forefront of massive changes in the way of thinking and experiencing spirituality, which is currently shifting from a transcendantal scale to individual immanent experiences.

A description of new architectural directions in health care program facilities and assisted living residences, identifying the core changes in health care delivery expected in the future and the design needs which those changes will require. The 16 essays written by architects, doctors, and facilities managers target the impacts of healthcare reform, technology, community care in the UK, and the more particular issue of creating buildings which humanely and efficiently accommodate requirements for long term care, senior day care, assisted living, nursing homes, dementia care, and hospice care. The design descriptions and outlines are patient focused, and sometimes involve reusing existing buildings. Includes illustrations and some photographs. Annotation c. by Book News, Inc., Portland, Oregon.

Esta tesis tiene como objetivo fundamental analizar antropológicamente cómo se construye la noción de persona en el cuidado de personas con enfermedades amenazantes para su vida que se encuentran en el final de su vida. La investigación se sustenta empíricamente en un trabajo etnográfico llevado a cabo dentro de una institución hospice ubicada en Buenos Aires, Argentina, entre 2014 y 2020. La práctica de cuidado analizada, por tanto, corresponde a aquella perteneciente al moderno movimiento hospice, y que sigue los fundamentos de su filosofía (cuyas características son presentadas en el desarrollo del escrito): el cuidado hospice. Este tipo de establecimientos se dedica, de forma gratuita y voluntaria, al cuidado de personas que se encuentran en el final de su vida, y que no disponen de recursos, sea económicos o humanos, para ser cuidados en sus hogares.