...Introduction Palliative care (PC) provides a better comprehensive health care for patients with cancer and their families. Supportive care, pain management and symptom control at the end of life are valuable and common services provided by the PC team (World Health Organization [WHO], 2002). However, there are many challenges and barriers for PC in developing countries such as: health care and public literacy about PC, opioid phobia, policies and regulations to access and prescribe opioid, limited resources and adequate education and training (Bingley & Clark, 2009). The presence of these problems plays a major role in providing suitable and accessible symptom management for many oncology patients. In Saudi Arabia, between 2007 and 2011,...
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...Patients' and End of Life Care: A Multidisciplinary Concept Analysis Jennifer Thompson UTA Analysis of Theories in Nursing Nurs 5327 Ronda Mintz-Binder, RN, MSN, DNP April 19, 2014 Terminally Ill Patients' and End of Life Care: A Multidisciplinary Concept Analysis With an aging population in our country we are facing an increasing number of patients’ that are coming to the end of their lives and are presenting with terminal illness. As life expectancy increases we are seeing more and more patent that are 65 year old and older in need of end of life care. Research and medical developments have provided a vast array of treatment options available to our patients’. After patients’ have exhausted all available treatment options for their disease processes they face the reality that their life is coming to an end. Patients’ near the end choose between quality of life over quantity of life. One service available to terminal patients’ is hospice care which offers palliative care to patients’ at the end of life. Health care providers must be able to face and appropriately care for patients’ with terminal illness and end of life care. At times it may be difficult for health care providers to face or present the truth to a patient that further treatment is futile and end of life care would be appropriate. Advanced practice nurses’ will face terminal illness and it is required of them to be able to sufficiently treat, manage, and discuss end of life care with these patients. It is...
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...application in end-of-life studies. Journal of Advanced Nursing 65(12), 2719–2732. doi: 10.1111/j.1365-2648.2009.05157.x Abstract Title. The use of theory in qualitative approaches to research: application in end-of-life studies. Aim. This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end-of-life studies. Background. Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end-of-life studies is used to illustrate application of theory to study design and findings. Data sources. A review of theoretical literature was carried out, focusing on definitions and use of theory in qualitative end-of-life studies published in English between 1990 and 2008. Discussion. The term ‘theory’ continues to be used in a variety of ways by theorists and researchers. Within the reviewed end-of-life studies, the use of theory included theory creation or provision of a comparative framework for data analysis and interpretation. Implications for nursing. Nurses who...
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...Case report Cultural differences in truth-telling to cancer patients: Chinese and American approaches to the disclosure of ‘bad news’ Dong Xue1, Jane L Wheeler 2, Amy P Abernethy 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Integrated Traditional Chinese and Western Medicine, Peking University School of Oncology, Beijing Cancer Hospital, Beijing Institute for Cancer Research, Beijing, PR China, 2Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA A central challenge of the palliative care clinician, and of the oncologist who sees patients with advance disease, is that of ‘breaking bad news’. As this conversation requires that the clinician divulge extremely sensitive and personal information, and usually incurs an emotional response from the patient, truth-telling to advanced cancer patients is not only a challenging task but also one likely to be handled differently in cultures according to differing norms for interpersonal behavior and communication. China and the United States, with their deepset communitarian vs. individualistic ethics, respectively, typify divergent cultures. This paper discusses cross-cultural differences in norms of truth-telling to cancer patients, that is, the extent to which physicians inform patients themselves of their disease status when prognosis is poor; China and the US are used to illustrating potential differences in approach and consequent...
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...Enhancing end-of-life care (EoLC) is a core component of international governments’ health policies. Across the globe, nurses make significant contributions to EoLC and, at this delicate time, have the power to positively influence the health and wellbeing of those facing death. Indeed, health promotion is a core component of the nurse’s role. Originating in the UK, EoLC pathways have been adopted around the world.Their broad aim is to optimise the quality of the dying process, enabling people to ‘die well’ across care settings. This paper examines EoLC pathways in terms of promoting health and wellbeing in this discrete stage of the dying trajectory. Concepts of health and health promotion are described briefly and the idea of health-promoting palliative care and its association with a good death examined. The ensuing discussion relates to two EoLC documents. While acknowledging that much has been achieved it is argued that, despite the potential for promoting health and wellbeing, a professionally led, biomedical approach predominates, and in terms of promoting health and wellbeing at the end of life there is a pressing need for proactive advance care planning at an earlier point in the illness trajectory. Key words: End-of-life care l Care pathways l Terminal care l Health promotion Michael Allen is Staff Nurse, Chemotherapy Day Unit, Singleton Hospital, Abertawe Bro- Morgannwg University Hospital Board, Swansea, Wales; Tessa Watts is Senior Lecturer, Swansea University,...
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...practice nurse is employed as a British Heart Foundation (BHF) Heart Failure (HF) nurse and is based in secondary care. Along with networking with a wide range of health care practitioners providing a seamless service between primary and secondary care her role also involves evidence-based care to clients with chronic heart failure (CHF). CHF is a complex syndrome that results from a structural or functional cardiac disorder that impairs the ability of the heart to function as a pump. This results in the heart not being able to pump enough blood to meet metabolic demands of the body (Clinical Resource Efficiency Support Team (CREST), 2005). The most common cause of HF is coronary artery disease, hypertension and valvular disease. It is a chronic condition, which may fluctuate, and result in repeated hospital admissions. The incidence and prevalence of heart failure is on the increase and with the current ageing population it is likely to continue along this trend. It is currently the most common cause of hospital admission in clients over the age of 65 years and accounts for 1 - 3 % of the National Health Service’ expenditure, the majority of which is associated with inpatient care (CREST, 2005). The Nursing and Midwifery Council (NMC, 2010) defined specialist practice as “...the exercising of higher levels of judgement, discretion and decision making in clinical care” and requires that specialist practice nurse is competent in clinical assessment and diagnosis in their area...
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...us to do critical analysis, case study and to prepare a plan of palliative care for her. Miss. Rewini has been suffering with this disease since three years. Cervical cancer is special type of cancer which is caused by human papillomavirus (HPV) that affect cells of the cervix- lower part of the uterus which connects vagina (Bosch, Manos, Munoz, Sherman, Jansen, Peto, & Shan, 1995). It is caused when abnormal cells grow out of control on cervix (Stewart, & Kleihues, 2003). The care plan is discussed in following part of essay. As Miss Rewini is Maori women,...
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...Strengths and Weaknesses……………………………………………………………….11 Timeline and Cost Considerations……………………………………………………….12 Conclusion……………………………………………………………………………….13 Concept Model………………………………………………………………..Appendix A Sample Questions……………………………………………………………..Appendix B References……………………………………………………………………………….18 Research Proposal Research Proposal Introduction Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However, as more patients become “chronically critically ill”, critical care nurses are being asked more often to provide care to patients on their deathbeds (Puntillo et al., 2001). Deciding which ICU patients are actually dying remains an extremely inexact science, and the transition to palliative care is not one easily made. ICU mortality rates are as high as 69% (Puntillo et al., 2001);...
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... Disclaimer: This document represents part of the author’s study programme while at the Institute of Social Studies. The views stated therein are those of the author and not necessarily those of the Institute. Research papers are not made available for circulation outside of the Institute. Inquiries: Postal address: Institute of Social Studies P.O. Box 29776 2502 LT The Hague The Netherlands Location: Kortenaerkade 12 2518 AX The Hague The Netherlands Telephone: +31 70 426 0460 Fax: +31 70 426 0799 Acknowledgements I give my sincere gratitude to Jehovah God for his love and care throughout my life and the fifteen months I have been here. With much honour I sincerely thank my Supervisor, Prof M.Grimm, truth be told it was a blessing to have a supervisor like him, I am short of words to describe him, I would simply say he has been tremendously wonderful. Always there for me and giving me feedback in less than I expect, all I can say is that, ‘thank you very much’. I am equally humbled and grateful to my reader Dr Bridget O’Laughlin for her guidance and wonderful suggestions which largely contributed to the progress of this paper. Thank you To the NZP+ women, I feel indebted to you for your wonderful...
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...and change. Thus, the purpose of this literature review is to establish the current perspectives of patients, family and nurses on the factors that improve dignity in the end of life. Resultantly, this literature review will explore the role of nurses’ based on the findings of the perspectives that patients, family and health professionals have concerning the issue of dignity in the end of life care. In that regard, the paper follows a systematic approach which involves an introduction that explains the concept of end of life and the types of end of life care available. The paper then proceeds to explore the concept of dignity as viewed from several perspectives through the use of literature on the models of dignity means of measuring dignity and the themes associated with this conception. Consequently, the factors that improve dignity are laid out and discussed at length. Eventually, the paper will achieve its secondary goal which is to determine and expound on the topic of the roles that a nurse plays in end of life care not only for the patient but also for their family. End of life care Before the discussion of the main topic of this literature review which is determining the factors that promote dignity in the end of life in order to determine the role of nurses in the end of life, there is need to understand the meaning of the concepts of end of life and dignity. It is imperative...
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...Cancer Control Knowledge into Action WHO Guide for Effective Programmes Diagnosis and Treatment Cancer Control Knowledge into Action WHO Guide for Effective Programmes Diagnosis and Treatment WHO Library Cataloguing-in-Publication Data Diagnosis and Treatment. (Cancer control : knowledge into action : WHO guide for effective programmes ; module 4.) 1. Neoplasms – diagnosis. 2. Neoplasms – therapy. 3. Early detection. 4. National health programs. 5. Guidelines. I.World Health Organization. II.Series. ISBN 978 92 4 154740 6 (NLM classification: QZ 241) © World Health Organization 2008 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may...
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...Providing Culturally Competent Care to a Native American Patient Introduction When caring for a Native American patient, it is imperative that the nurse provide culturally competent care. In this scenario, there are two main dimensions along which cultural tensions between the patient and the nurse can arise. The first pertains to the actual practices and values of Native American culture, which may be at odds with the practices and values of dominant healthcare institutions. The second is both broader and more subtle: it pertains to the historical relationship of the Native Americans peoples vis-à-vis mainstream U.S. society. After addressing both of these dimensions, suggestions will be made with respect to how a nurse could bridge this gap and provide culturally competent care for the Native American patient. To start with, it is important for the nurse to acknowledge that the Native American perspective on health may simply diverge from the default culture's perspective in some significant ways. For example, BigFoot and Funderburk (2011) have discussed how Native American conceptions of family are different from the contemporary norm, and how this results in the need to adapt nursing interventions in this sphere to the cultural context of Native Americans. Further, these alternative conceptions are often supported by a whole alternate philosophy of life: for example, while Native American culture certainly doesn't advocate passivity "in the face of grave potential...
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...Bilal_badrnaga@yahoo.com Case scenario Abstract Euthanasia is one of the issues that has been the subject of intense debate over time. It has been a pertinent issue in human rights discourse as it also affects ethical and legal issues pertaining to patients and health care providers. This paper discusses the legal and ethical debates concerning both types of euthanasia. It focuses on both the supporter of euthanasia and the opponent of euthanasia. Several statements for the Euthanasia argument arediscussed: a merciful response that alleviates the suffering of patients which is sometimes wrongly perceived to be otherwise unrelievable; the autonomy in which the patient has the right to make his own choices; the regulation and legislation of existing practices of euthanasia to protect health care providers and patients. In this heated debate religious, political, ethical, legal and personal views are also included. Among all these, those who desperately want to end their lives because they simply cannot go on in any way, are the ones who suffer. Every individual or group has a different viewpoint regarding euthanasia. Euthanasia is considered a practical, emotional, and religious debate. Key words: euthanasia, palliative care, type of euthanasia. A 56 year old female patient, divorced 5 years ago, a mother of one daughter, lives with her 20 year old daughter. She was working as a maths teacher, was well and very active until six months ago; she started to complain of...
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...The Difference in competencies between Nurses prepared at the Associate Degree level versus the Baccalaureate Degree level. Name: Jason Nordstrom Grand Canyon University, Phoenix Arizona: NRS-430V-0500 November 07th, 2012 Introduction: Recent studies have shown that nursing practices and quality of overall patient care, have a direct link to the quality and level of nursing education. Today’s nursing education must be able to meet the demands, challenges and needs of a modern healthcare. According to the (AACN) Facts Sheets: It approaches today’s nursing workforce with researches, relating education to outcomes, and also outline the capacity and preparedness of four year college, as means of improving the level of education in the United States. The definition, history and competencies of BSN and ADN degrees are discussed below: Associate Degree in Nursing (ADN): An associate degree in nursing, on average requires from two to three years of formal education. ADN predominately prepares nurses for bedside patient care, in a healthcare facilities such as hospitals and long-term care. It is usually offered by community and junior colleges, and some nursing schools. Students with an ADN, meet academic requirement for NCLEX-RN exam, and are eligible for license as R.N. The ADN was started by Dr. Mildred Montag in 1951, as WWII was ending. This was an important and necessary step, in order to deal...
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...Running head: ANALYSIS OF AN ETHICAL DILEMMA Analysis of an Ethical Dilemma NRS 437V December 11, 2011 Analysis of an Ethical Dilemma Euthanasia, sometimes referred to as mercy killing, is an act by a third party that causes a patient’s death. Such acts include administering a lethal dose of medication by way of injection or mask, usually to a seriously ill patient. This analysis will discuss the ethics of euthanasia as it relates to nursing, laws, society, and the stakeholders involved in the scenario. The American Nurses Association (ANA) believes that the nurse should not participate in Active euthanasia because such an act is in direct violation of the Code for Nurses with Interpretive Statements, the ethical traditions and goals of the profession, and its covenant with society. (Task Force on the Nurse's Role in End-of-Life Decisions, 2011) While patient advocates should be vigilant for providing diligent care, they should perform their tasks with respect, support and due commitment towards their care. In healthcare practice, in order to relieve pain and suffering, there is an obligation to promote dignity and autonomy of patients. Euthanasia is a complex issue in which nurses are uncomfortable determining the life and death of a patient. Nurses have to practice ethical principles of beneficence, which maximize benefit and reduce potential risk and harm to the patient. Non-malfeasance is another ethical issue in which a nurse should do no harm. A competent...
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