Past Issues: Vol 1 Issue 1 - Summer 2011
Vol 1 Issue 1
Clinical practice development
Understanding factors that influence the grieving process
Published: 2013 Vol: 3 No: 1 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
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...
Clinical review
The importance of recognising depression following a stroke
Published: 2012 Vol: 2 No: 1
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
What is dementia? Implications for caring at the end of life
Published: 2013 Vol: 3 No: 1 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
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...
Nursing case review
Assessment of a breathless patient in end-stage heart failure in A&E
Published: 2012 Vol: 2 No: 1
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 skills
Talking about death in dementia
Published: 2013 Vol: 3 No: 1 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
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 skills
Communication Vignettes: Telling a child that her dad is dying
Published: 2012 Vol: 2 No: 1
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 research/audit
Workplace stressors: A survey of palliative care nurses in Australia
Published: 2013 Vol: 3 No: 1 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...
Clinical review
Dyspnoea in COPD: the effect on functional ability and carers
Published: 2011 Vol: 1 No: 1
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...
Personal narrative
A palliative holistic approach to MND using music therapy
Published: 2012 Vol: 2 No: 1
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...
Nursing case review
Maintaining dignity at the end of life in the emergency department
Published: 2013 Vol: 3 No: 1 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
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...
Legal discussions
Case law on artificial nutrition and hydration since Bland
Published: 2012 Vol: 2 No: 1
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...
Personal narrative
A daughter's experience of her mother's death in hospital
Published: 2013 Vol: 3 No: 1 Key to improving palliative and end-of-life care is recognising the end-of-life phase. Without training relating to identification of signs and symptoms indicative of the terminal phase of disease, care of dying patients and their relatives/loved ones will not improve. Analysis of individual deaths may improve systems of care provision and identify local educational and service requirements. This...
Clinical practice development
A rehabilitation training programme at the end of life
Published: 2011 Vol: 1 No: 1
Terminally ill patients face many challenges with regard to increasing physical dependence on others to meet their practical needs. Progressive weakness, profound fatigue and gradual deconditioning make daily tasks increasingly difficult to perform. Rehabilitation techniques do not lie solely within the role of physiotherapists and occupational therapists. They are an integral part of holistic...
National end of life care programme update
Achieving quality end-of-life care in the acute hospital setting: the new 'How to' guide
Published: 2012 Vol: 2 No: 1
Introduction
Since the publication of the national End of Life Care Strategy (Department of Health, 2008), a number of initiatives, tools and publications have been produced to support improvement in end-of-life care service provision. In 2010, the National End of Life Care Programme (NEoLCP) published The Route to Success in End of Life Care: Achieving Quality in Acute Hospitals to raise...
National end of life care programme update
Using information systems to better support quality care at the end of life
Published: 2013 Vol: 3 No: 1
Introduction
Quality is an important focus for every organisation involved in end-of-life care. Whether commissioning or providing services, organisations need to be able to measure progress in delivering care, demonstrate the progress in a systematic way and share best practice across their locality. Effective sharing of information is essential to the delivery of high-quality end-of-life care...
Professional issues
Problems associated with care at the end of life in acute hospitals
Published: 2011 Vol: 1 No: 1
Many more people die in acute hospitals than ever before. An integrative literature review was undertaken to explore end-of-life care (EoLC) delivered in non-palliative care settings. It showed that providing EoLC in acute hospitals is difficult, given the emphasis on life extension and cure. EoLC pathways can assist with the planning and delivery of care. According to an international report,...