Past Issues

Clinical skills

Communication vignettes: She wants her misery to end, nurse!

Published: 2011 Vol: 1 No: 1
Author(s):
Dr Bruno Bubna-Kasteliz
It is a popular belief that people with terminal illness are more likely to be driven to despair and, as a result, commit suicide. In fact, only 2–4% of people with such a diagnosis actually kill themselves (Clark, 1992). The experience of hospice staff is that, if people with a terminal illness are given empathetic and structured support, the wish to end life may only be fleeting (Block, 2005...
Clinical skills

Communication Vignettes: Telling a child that her dad is dying

Published: 2012 Vol: 2 No: 1
Author(s):
Vicky Robinson and Nathalie Asmall
Traditionally, palliative care emergencies are associated with physical, often reversible, clinical signs (e.g. spinal cord compression and hypercalcaemia). However, palliative care practitioners can sometimes find themselves in a situation where there is an urgent need to communicate with a family member or friend of a terminally ill patient (Pickering and George, 2007). Nurses working in...
Complementary Therapy Vignettes

Complementary therapy: comfort for those in need of palliative care

Published: 2013 Vol: 3 No: 4
Author(s):
Marcos Viliotti
Traditionally, complementary therapies have been associated with relaxation therapies (Monti and Yang, 2005). However, the help and comfort resulting from complementary treatments go beyond what might be considered simply a ‘feel good’ factor (Pujol and Monti, 2007). Complementary therapies are now being used alongside orthodox treatments to help provide physical and emotional support for...
Clinical review

Death and dying in intensive care: emotional labour of nurses

Published: 2013 Vol: 3 No: 2
Author(s):
Lucy Ryan, Jane Seymour
Intensive care unit (ICU) nursing is associated with emotional labour. ICU nurses regularly care for dying patients. End-of-life care (EoLC) can be a major cause of stress in ICU, particularly in relation to the withdrawal of life-sustaining treatment, managing the transition from curative care to EoLC and dealing with the distress of patients, relatives/loved ones. However, ICU nurses receive...
National Association for Hospice at Home

Developing national standards for hospice-at-home services

Published: 2013 Vol: 3 No: 1
Author(s):
George Bell, Kay Greene, John Hunt, Sue Varvel
There is minimal consensus regarding what constitutes hospice home care and hospice-at-home services. Such services have developed in an ad-hoc manner since the concept of hospice care at home was originally conceived by the Sisters of Charity at St Joseph’s Hospice, Hackney, and then more formally developed by St Christopher’s Hospice, London. Lack of uniformity means no single definition or...
Clinical review

Dyspnoea in COPD: the effect on functional ability and carers

Published: 2011 Vol: 1 No: 1
Author(s):
Rebecca Jennings
Chronic obstructive pulmonary disease (COPD) is a complex, progressive, respiratory condition. The primary symptom of COPD is dyspnoea (the subjective experience of breathing discomfort). Worldwide, COPD is a leading cause of morbidity and mortality. Due to the progressive nature of COPD, limitation of functional ability increases proportionally to disease severity, becoming more pronounced as...
Clinical practice development

Eating/feeding issues in dementia: improving the dining experience

Published: 2014 Vol: 4 No: 1
Author(s):
Louisa Stone
People with dementia can have problems eating/feeding, which puts them at risk of malnutrition. There are various reasons why people with dementia find eating and/or feeding problematic, including difficulty co-ordinating movements in order to get food into their mouths, difficulty maintaining attention on eating, dysphagia, level of cognitive and physical impairment, resistance to care,...
Clinical review

Emotional distress in patients with advanced heart failure

Published: 2011 Vol: 1 No: 2
Author(s):
Christina Ramsenthaler
Chronic heart failure (CHF) is a leading cause of death, with a rising prevalence. The disease has a high symptom burden and a negative impact on patients’ quality of life. However, as a result of difficulties in prognostication in relation to CHF, palliative care services do not always become involved in the care of patients with CHF. Emotional distress is especially common in the advanced...
Clinical skills

Encouraging/supporting dying parents to talk to their children

Published: 2013 Vol: 3 No: 2
Author(s):
Steve Marshall, Julia Manning, Sally Mercer
Communicating with children about the anticipated death of a parent can be very challenging, even for experienced palliative care professionals. It can be particularly difficult for dying parents to discuss the fact that they are dying with their children. Consequently, they may adopt an overly positive stance in order to shield their children from the truth. When unable to understand what is...
Research

End-of-life care for the British Asian Hindu community: Preferences and solutions

Published: 2013 Vol: 3 No: 3
Author(s):
Sarah Frearson and Jane Henderson with Bharti Raval, Charles Daniels, Geraldine Burke, Jonathan Koffman
Abstract Background: In the UK, most people prefer to die at home but many still die in hospital. People from black, Asian and minority ethnic groups are even more likely to die in hospital. Little is known about their preferences for location of care at the end of life. Aim: To explore preferences for place of care and death among the British Hindu community and to identify barriers preventing...
Ethics

Exploring in more depth issues of truth telling, deceit and lying

Published: 2011 Vol: 1 No: 2
Author(s):
Rob George
The ethics article in the last issue (George, 2011; see journal archives) discussed the case of an 80-year-old woman called Martha, with advanced multi-infarct dementia. When Martha suffered infarcts, her cognitive ability temporarily worsened and, for short periods, she forgot that her husband had died. When told that he was in fact dead, Martha would get very distressed. Therefore, during these...
Clinical review

Faecal incontinence in advanced dementia: the nursing role

Published: 2011 Vol: 1 No: 3
Author(s):
Nykki Hetherton
Faecal incontinence is one of the prognostic indicators for the terminal stages of dementia. However, there is minimal information on this distressing symptom in the context of cognitive decline. Faecal incontinence in dementia is often under-reported, under-estimated and poorly assessed and managed, despite being a potentially treatable condition. It has a profound negative impact on the...
Clinical review

Heart-failure patients' thoughts and fears concerning dying

Published: 2011 Vol: 1 No: 3
Author(s):
Kimberley Reeman, Helen Noble
Patients with heart failure experience a variety of reactions to living with a chronic yet terminal disease. These range from acceptance of death to fear of death. Heart-failure patients have a high symptom burden, which adversely affects their quality of life. Patients are very concerned about the burden that their disease places on their informal caregivers. Such concerns can influence their...
Nursing case review

Holistic assessment of a woman admitted to a hospice with anxiety

Published: 2014 Vol: 4 No: 1
Author(s):
Rebecca Newman
Many people with a terminal diagnosis experience anxiety and require emotional support. Anxiety is characterised by various symptoms, including apprehension, worry, difficulty in concentrating, irritability, panic, fear and restlessness. For some people, the anxiety becomes excessive and persistent and has a significant impact on their quality of life. In advanced disease, symptoms of anxiety can...
Clinical research/audit

Implementing stock end-of-life medication in UK nursing homes

Published: 2013 Vol: 3 No: 3
Author(s):
Kathy Morris, Jo Hockley
Background: In nursing care homes (NCHs), the use of end-of-life care (EoLC) medication has traditionally been requested and prescribed on an individual basis during each resident’s last days of life. However, some GPs are reluctant to prescribe EoLC medication in anticipation of symptoms occurring if, at the time of their visit, the resident is symptom-free. Even when prescribed, care home staff...
Clinical practice development

Incorporating spirituality in end-of-life nursing care

Published: 2011 Vol: 1 No: 3
Author(s):
Sarah Spencer-Adams
The palliative approach to care involves individual, holistic, continuous assessment of physical, psychological, spiritual and social problems. The aim is to identify adverse symptoms and associated distress and then to identify measures to help alleviate those symptoms. Spiritual distress at the end of life has the potential to impinge on physical and psychosocial wellbeing, thereby decreasing...
Research

Knowledge and skills needed by informal carers to look after terminally ill patients at home

Published: 2014 Vol: 4 No: 2
Author(s):
Josaleen Connolly, Dr Stuart Milligan
Background: The majority of terminally ill people wish to remain, and be cared for, at home by family members with the support of the community care team. However, informal carers tend to feel unprepared for the caring role, are often elderly, have varying levels of support and suffer stress and anxiety as a result of the role. Aim and objectives: The aim of this study was to explore the lived...
Legal discussions

Legal aspects of end-of-life care in severe anorexia nervosa

Published: 2014 Vol: 4 No: 1
Author(s):
Dr Martin Curtice, Dr Rhiannon Kihara
Anorexia nervosa has the highest mortality rate of any psychiatric illness. Its management can be complicated as people with the condition can resist efforts to enable them to eat and drink. Ethical, medico-legal and psychological issues need careful exploration when considering compulsory treatment. This article summarises the judgment from the High Court case of a 32-year-old woman, ‘E’, with...
Clinical review

Living with people who have dementia and faecal incontinence

Published: 2012 Vol: 2 No: 2
Author(s):
Nykki Hetherton
As the population ages, the number of people with dementia will increase. Although faecal incontinence (FI) is not always present in this patient group, its occurrence, in combination with urinary incontinence, is a prognostic indicator of advanced disease. A previous article explored the topic of FI in the context of people with dementia, highlighting associated causes and risk factors, as well...
Clinical practice development

Lymphoedema management in palliative and end-of-life care

Published: 2013 Vol: 3 No: 3
Author(s):
Catherine Kreckeler
Lymphoedema is a progressive, chronic condition that can have profound adverse effects on the physical and psychosocial wellbeing of sufferers. It tends to be ineffectively managed in palliative care clinical settings and the condition often goes unrecognised and untreated. Multi-layer, compression, decongestive therapy remains one of the cornerstones of lymphoedema management. However, minimal...

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