International Journal of Palliative Nursing最新文献

Background: Family caregivers of terminal cancer patients have reported experiencing low quality of life (QOL). Satisfaction with care has gained attention as a factor that correlates with QOL.

Aim: To examine the relationship between 'satisfaction with care' and QOL of family caregivers of patients with terminal cancer.

Methods: The study used a cross-sectional design and included family caregivers of patients with terminal cancer in general wards. The authors assessed family caregivers' QOL using the caregiver quality of life index-cancer; a multivariable regression analysis was conducted to identify the factors associated with QOL.

Findings: A total of 51 family caregivers enrolled in the study. Their satisfaction with care and the months since their initial diagnosis were positively associated with a more positive QOL.

Conclusion: Satisfaction with care is correlated with QOL among family caregivers of patients with terminal cancer in general wards. Enhancing family caregivers' satisfaction with care may contribute to improving their QOL.

Background: Understanding the frailty levels of older patients undergoing surgery and chemotherapy will contribute to timely and reliable care practices and improve care outcomes.

Aims: To determine the frailty of cancer patients who received chemotherapy treatment after surgery.

Methods: This descriptive study included 192 Turkish patients aged over 60 years who received chemotherapy after surgery for cancer. Data were collected using a patient survey and the Edmonton Frailty Scale.

Results: The average age of the participants was 66.3±5.3 years. Around 40% (40.6%) of the sample were diagnosed with breast cancer. The Edmonton Frailty Scale score of the group was 6.6 (SD±3.7). A quarter of the sample (22.9%) were at risk of frailty. Frailty levels were higher in older individuals with gastrointestinal cancers and other cancer groups compared with patients with breast cancer (p<0.001); patients with additional chronic diseases other than cancer (p=0.004); and in those with a history of falling and hospitalisation in the past year (p<0.001).

Conclusions: Older patients with gastrointestinal cancer, additional chronic disease and a history of falling and hospitalisation within the past year should be evaluated closely for frailty before and during chemotherapy. It is crucial to consider the patient's vulnerability when making care and treatment decisions for older patients with cancer. Understanding the frailty levels of older patients who undergo surgery and receive chemotherapy can help health professionals to decide on timely and reliable care practices and improve care outcomes.

Background: Delirium is common across all palliative care settings. Guidelines exist to support the care of terminally ill people who develop delirium; yet the evidence base is limited. Recent surveys of palliative care specialists have suggested clinical practice is variable. Aim: To explore delirium assessment and management in a hospice inpatient setting. Methods: A mixed-methods study comprising a retrospective case note review of 21 patients admitted to a hospice inpatient unit and semi-structured interviews with seven hospice inpatient doctors and nurses. Results: A total of 62% of patients were screened for delirium on admission using the 4 As tool (4AT). The period prevalence of delirium was 76% during the 2-week study period. The term 'delirium' was documented infrequently in case notes, compared to other more ambiguous terms. Interview data suggested that nurses were unfamiliar with delirium screening tools. Conclusion: Lack of awareness about delirium screening tools and the infrequent use of the term 'delirium' may suggest that delirium goes under-recognised and under-treated. Further education and research are required to support the care of terminally ill people with delirium.

Synopses of a selection of recently published research articles of relevance to palliative care.

Background: Childhood cancer is a stressful experience for patients and their families; it has a profound effect on families emotionally, psychologically and financially. The mother's supportive role affects the child's treatment outcomes and the health of all family members. Aims: This study was conducted to describe the experiences of mothers of children with cancer. Methods: A total of 14 mothers of children with cancer were recruited using purposive sampling. In-depth semi-structured interviews were conducted using a qualitative inductive content analysis. Data were analysed using Graneheim et al's (2004) approach. Findings: According to data analysis, the mother's supportive role can be depicted across four subthemes: 'being genuinely present with a sick child'; 'keeping the family together and strengthening its cohesion'; 'providing compassionate collaborative care for peers'; and 'empowering the self and taking charge of one's own life'. The main overarching theme extracted from this study was 'sacrifice'. Conclusion: This study results suggest that the mothers' supportive role is relying on their own personal power, in which they not only give the care to the child, family and counterparts, but also drive personal growth and empowerment of mothers. A deeper understanding of mothers' experiences of their supportive role may enhance the quality of care and promote further paediatric approaches to palliative care.

Background: Nurses in high-dependency units frequently facilitate the withdrawal of life-sustaining treatments and provide end-of-life care. Providing this care has been shown to cause distress, burnout and cumulative grief. There remains a lack of understanding of high dependency nurses' experiences of caring for patients approaching withdrawal of life-sustaining treatments. Aim: To explore experiences of high dependency nurses caring for patients approaching withdrawal of life-sustaining treatment and highlight any support or needs they may have. Methods: Interviews were conducted and analysed using qualitative thematic analysis. Findings: Nurses experienced conflict in decision making, which was reported to prolong patient distress and cause nurses moral anguish. Nurses need time to talk and further education to support them to provide withdrawal of life-sustaining treatment. Conclusion: High-dependency nurses need time to talk following caring for this patient group and more extensive education to support them to provide quality end-of-life care.

Background: It is recognised good practice to prescribe 'as required' parenteral medication (ARPM) to provide individualised symptom control in the final days of life. The decision to administer the medication and, sometimes, to decide the dose, usually lies with the nurse. Aims: To explore attitudes towards administration of ARPM at end of life (EOL) among hospital nurses. Methods: The views of registered nurses, recruited from wards with high death rates, were explored through questionnaires and semi-structured interviews. Questionnaire responses were coded and statistically analysed. Interviews were recorded, transcribed, manually coded and thematically analysed. Results: Almost 50% of questionnaire respondents (n=62) reported feeling 'very confident' in recognising symptoms at the EOL. Only 39% of respondents reported undertaking specific training. Three main themes emerged through the interviews: experience; factors influencing the decision to administer ARPM; and education. Conclusion: Wider accessibility to training may support confident decision making by hospital nurses administering ARPM at the EOL.

Background: Providing end-of-life (EOL) care in the acute care setting has been challenging, with clinicians focused on curative treatments and prolonging life, while few nurses are receiving adequate training and support in caring for the dying. Aims: To assess if the introduction of a palliative care link nurse programme (PCLNP) improved nurses' confidence in providing EOL care in the acute care setting. Methods: A total of 40 acute care nurses attended a full-day education session on core topics, followed by regular 3-monthly educational meetings. Participants were provided with ongoing support and mentoring and required to complete quality improvement activities. A mixed-research methodology was used. Findings: The PCLNP had a positive impact on nurses' attitudes towards death and dying, and increased levels of comfort in providing EOL care to patients and supporting families. Nurses completed clinical audits and provided education to their colleagues. Conclusions: EOL care in this setting must be improved for both patients and their families. This programme has shown an increase in nurses' knowledge and comfort level in providing EOL care. Further research into determining the direct impact on patient care and families is required.