Past Issues: Vol 1 Issue 1 - Summer 2011

Vol 1 Issue 1

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

The importance of recognising depression following a stroke

Published: 2012 Vol: 2 No: 1
Author(s):
Helen Brewerton
Stroke is the third most common cause of death in the UK and the single most common cause of disability. Depression following a stroke occurs in approximately one-third of stroke sufferers. It is a distressing symptom and has been found to have a significant effect on post-stroke morbidity and mortality. Various opinions exist regarding the causes of post-stroke depression (PSD), i.e. that it...
Clinical practice development

Understanding factors that influence the grieving process

Published: 2013 Vol: 3 No: 1
Author(s):
Lisa Sheehy
Grief is a universal response to loss. Despite its universality, variation exists in how it is experienced and expressed. In light of evidence from bereavement research over the last two decades, previous paradigms regarding grief and loss are changing, which has important implications for professionals, including nurses, who work in end-of-life care. Much research centres on the recognition of...
Clinical skills

Altered sense of body image in palliative and end-of-life care

Published: 2011 Vol: 1 No: 1
Author(s):
Amanda Stamper
In palliative and end-of-life care, holistic patient assessment involves considering patients'; physical, psychological, social and spiritual concerns. As part of psychological assessment, it is important to discuss with patients their perception of body image and whether it is affecting their interactions with others and their ability to live their life in the way they want. In both general...
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...
Nursing case review

Assessment of a breathless patient in end-stage heart failure in A&E

Published: 2012 Vol: 2 No: 1
Author(s):
Marie Ranson
Breathlessness is a common reason for the hospitalisation of people with chronic heart failure (CHF). It is a distressing symptom for both patients and their informal carers. Breathlessness in CHF derives from physical, psychological, social, spiritual and environmental factors. Optimal management of breathlessness in CHF requires both pharmacological and non-pharmacological interventions. This...
Clinical practice development

What is dementia? Implications for caring at the end of life

Published: 2013 Vol: 3 No: 1
Author(s):
Julie Watson
Dementia is understood in a number of different ways within different fields of practice, e.g. health and social care. In Western society, predominantly biomedical ideas of dementia influence the experiences of people who have dementia. Limitations of biomedical models of dementia have led to the development of other ways of understanding dementia. These include the social-psychology, critical...
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...
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 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...
Clinical skills

Talking about death in dementia

Published: 2013 Vol: 3 No: 1
Author(s):
Helen Scott
In this issue of the journal, Julie Watson highlights how people with dementia often become depersonalised. As dementia progresses, carers may stop seeing the human being behind the condition, attributing all behaviour to pathology. However, despite behavioural change and loss of cognitive function, people who have dementia retain their sense of uniqueness and individuality (Sabat, 2001, 2010)....
Clinical review

Assessment of depression when patients desire a hastened death

Published: 2011 Vol: 1 No: 1
Author(s):
Helen Scott
Patients’ mental health status is an important element of palliative and end-of-life care. However, depression is often under-recognised in terminally ill cancer patients. That is because symptoms of depression can mimic those of advanced cancer and clinicians often think that patients’ low mood is an understandable reaction to terminal illness. Depression has been associated with patients...
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...
Professional issues

The emotional labour of caring for patients at the end of life

Published: 2014 Vol: 4 No: 1
Author(s):
Deborah Holman
Nurses’ emotional commitment to their patients contributes to the quality and excellence of nursing care and enhances the nurse–patient relationship. Nurses are expected to manage their emotions in order to present a professional demeanour and maintain professional boundaries, while at the same time provide genuine caring behaviour to their patients. However, if not adequately educated and...
Personal narrative

A palliative holistic approach to MND using music therapy

Published: 2012 Vol: 2 No: 1
Author(s):
Dr Helen Mackinnon, Elizabeth (Liz) Upham
This article details the role of music therapy (MT) in the palliative care of a 66-year-old woman (Liz) living with severe disabilities caused by motor neurone disease. It forms part of a small but growing body of case-related evidence designed to support the use of MT in palliative care. It describes how music gave Liz a renewed sense of meaning, purpose, control and usefulness that she...
Clinical research/audit

Workplace stressors: A survey of palliative care nurses in Australia

Published: 2013 Vol: 3 No: 1
Author(s):
Dr Louise Peters, Dr Susan Lee, Professor Margaret O’Connor
Background: Working with terminally ill patients places palliative care and hospice nurses at risk of chronic stress, mental health problems and burnout. Aim: This study investigated the source and level of workplace stress experienced by palliative care nurses in Australia. Methods: Seventy-one palliative care nurses completed a self-report questionnaire based on the Nurse Stress Index and the...
Nursing case review

Maintaining dignity at the end of life in the emergency department

Published: 2013 Vol: 3 No: 1
Author(s):
Pippa Deith
The main aims of nursing care at the end of life include relieving suffering, improving sense of wellbeing and helping patients to die peacefully and with dignity. Dignity at the end of life is a subjective concept. However, there are certain fundamental principles that are deemed essential to the maintenance of a dying patient’s dignity, e.g. holistic assessment and care, privacy, symptom...
Ethics

Truth-telling, deceit and lying in cases of advanced dementia

Published: 2011 Vol: 1 No: 1
Author(s):
Rob George
Telling the truth is an integral part of every relationship. If people are not told the truth, it is hard for them to function effectively in society. In health care, if clinicians lie to patients, then patients are unable to make informed decisions. Such practice compromises patients’ autonomy. Therefore, the prevailing view in health care is that clinicians should be truthful at all times and...
Personal reflections

Barriers to effective end-of-life nursing care out-of-hours

Published: 2014 Vol: 4 No: 1
Author(s):
Nicola Hillman
The End of Life Care Strategy recommended that terminally ill patients living at home must have access to community out-of-hours end-of-life care services. The Strategy particularly emphasised that rapid-response community nursing services should be made available in all areas, 24 hours a day, 7 days a week. The lack of end-of-life care out-of-hours services can lead to terminally ill and dying...
Legal discussions

Case law on artificial nutrition and hydration since Bland

Published: 2012 Vol: 2 No: 1
Author(s):
Dr Martin JR Curtice
The legal basis and principles for the lawful withdrawal of artificial nutrition and hydration (ANH) from people in a persistent vegetative state (now termed permanent vegetative state), was laid out in the case of Anthony Bland, who sustained catastrophic and irreversible brain damage as a result of being crushed during the Hillsborough stadium disaster in 1989. Anthony Bland was medically...

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