bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospice care: A unique clinical experience for MSN students
Authors: Sorrentino Elizabeth A.
Published: May 2006

There are several preconceived notions among members of the nursing profession about hospice care. Among graduate students in nursing, there remains a belief that going to a hospice for clinical experience would be depressing and unrewarding. This paper discusses the learning experiences in the hospice setting and how consistent these are with graduate course objectives, and highlights the positive outcomes of the clinical experience unique to hospice care. This unprecedented recognition that hospice clinical experience brings a re-examination of previous knowledge, values, and concepts among Master of Science in Nursing (MSN) students underscores the importance of faculty role in this process. However, these casual observations require systematic characterization and quantification. Indeed, there is tremendous need for educational research in this area.
Family assessment and its relation to hospice care
Authors: Gulla James P.
Published: May 2006

It is proposed that a family system evaluation be added to the initial medical and social history used during a hospice assessment. The family evaluation should assess the family through a functional dysfunctional framework in addition to assessing the role structure of each of its members. This additional data, can of fer insight into the internal workings of the family while adding important information as to the compliance level of the family in accepting hospice and the services that hospice hasto of fer. This may assist in not only the quality of service implementation but in assisting hospice personnel in lessening their potential for stress and burnout as well.
Acupressure wrist bands to relieve nausea and vomiting in hospice patients: Do they work?
Authors: Brown Sonja , North David , Marvel M. Kim , Fons Roger
Published: May 2006

This study assessed the effects of acupressure wrist bands on the nausea and vomiting ofterminally ill patients. Using a single subject experimental design, six hospice patients were exposed to three conditions:

• An acupressure wrist band;

• A placebo wrist band;

• A no wrist band condition.

Patients and their caregivers rated nausea and vomiting during the treatment. Despitesome difficultyobtaining complete data, the results of this preliminary test indicate that acupressure wrist bandswere not effective in reducing nausea and vomiting in this small sample of hospice patients.
Hospice research: The importance of program participation
Authors: Raudonis Barbara , Kirschling Jane Marie
Published: May 2006

Hospice research is needed in order to understand the complex phenomena of holistic carefor terminally ill persons and their families. Hospice program participation is key to future hospice research efforts. The purpose of this article is to encourage hospice programs to participate in hospice research. The discussion includes why research is done, who undertakes a research project, the role of institutional review boards in assuring rights of human subjects and potential strategies for recruitment of research subjects. The authors use their experiences with conducting hospice research to illustrate potential recruitment strategies.
Are you caring or caretaking?
Authors: Portnoy Dennis
Published: May 2006

People in helping roles often confuse caretaking with being a caring professional. This confusion leads to burnout, self-neglect, and perpetuates destructive relating habits. This article describes the signs of caretaking, exposes some of the common family roles/dynamics that encourage caretaking, and points out ways to change.
Camp Sunrise: Supporting bereaved children
Authors: Summers Karen Haag
Published: May 2006

A four-day outdoor experience, Camp Sunrise was developed for youth who have had a family member or close friend die. During the camp, children are involved in activities which support the grieving process, and foster relationships with others who have experienced a significant loss.
The role of occupational therapy groups in an Australian hospice
Authors: Dawson Sky
Published: May 2006

The hospice philosophy plays an important role in the delivery of health services that focus on the biopsychological needs of people with a terminal illness and their environment. Occupational therapy in hospice can provide an environment which will enable people to discover and respond to their own inner needs. The occupational therapy setting creates an environment which provides people with the opportunity to carry out activities which they are interested in, to socialize with others, and to experience the philosophy of hospice. The purpose of this study was to examine the role of groups with occupational therapy in hospice. A literature search, participant observation, interviews and discussion indicate that music, massage, and beauty treatment are important aspects of care for the dying person.
Hospice care in Japan
Authors: Suzuki Shizue , Kirschling Jane Marie , Inoue Iku
Published: May 2006

Hospice care was introduced in Japan in the 1970s. There are currently an estimated 21 programs, which are primarily hospital-based. This paper provides an overview of the history, current state, and future trends of hospice care in Japan. Four programs are described, including staffing information, length of stay, and prognoses of patients. Hospice care in Japan is compared to hospice care in the United States and major differences are described. Lastly, the concept of “truth telling” is explored within the context of the Japanese culture. The discussion is based on a review of the literature and a mailed survey completed by 16 Japanese hospice programs during July 1992. The paper is in four sections:

• An overview of Japan.

• The history, current state, and future trends of hospice care in Japan.

• The major differences between hospice care in Japan and the United States.

• An exploration of “truth telling” within the context of the Japanese culture.
The role of the physical therapist in hospice care
Authors: Ebel Susan , Langer Karla
Published: May 2006

The role of the physical therapist in hospice care is different from the role the therapist plays when a member of a rehabilitation team. This article will address the need for a fundamental role change and offer suggestions for ways physical therapists can contribute to the care of the hospice patient. In working with hospice patients, therapists must, for the most part, change from a controlling role to one of listener and problem-solver. In this manner; therapists can:

• Assist the patient to maintain functional abilities for as long as possible;

• Reduce the burden of care for the caregivers;

• Assist in pain control.

Physical therapists can provide hospice nurses with valuable assistance in caring for hospice patients.
COPD and hospice: Collaboration or conflict?
Authors: O’Shaughnessy Donna , Medendorp Joel R.
Published: May 2006

This article describes the struggle between the philosophies of Hospice and Respiratory Care at Saint James Hospital in Pontiac, Illinois. It presents a case study about an end-stage Chronic Obstructive Pulmonary Disease(COPD)patient in the hospice program that catalyzed change. The article shows resolution of the struggles, draws conclusions from the process, and illuminates pertinent issues.
Intermittent subcutaneous infusion of opioids in hospice home care: An effective, economical, manageable option
Authors: Crane Rebecca A.
Published: May 2006

Administration of oral opioids is not always possible for terminally-ill patients. Obstruction, emesis, or inability to swallow frequently force us to seek alternative routes of administration. When the rectal route is contraindicated, impractical, or otherwise rejected by the patient or caregivers, we must resort to the parenteral route. The purpose of this study has been to validate the effectiveness, manageability, and side effects of bolus infusions of opioids utilizing an indwelling subcutaneous butterfly needle. The retrospective chart review included a convenience sample of 50 patients enrolled in our home-based hospice program who required subcutaneous infusion of opioids at some point during their enrollment. The total number of patients served during this time was 112. In the majority of cases (88 percent), the indication was inability to swallow or difficulty swallowing, which was related to impending death. Morphine sulfate was the opiate used in 955 of the cases reviewed. The mean four-hourly dose was 14.3 mg, with a range of 5 to 60 mg. Pain ratings were recorded using a 0 - 10 scale, both prior to initiation of and during the use of subcutaneous injections. Of the 42 percent of patients able to indicate a pain rating (0 - 10 scale) all rated their pain at 2 or below while using the subcutaneous route. No objective signs of pain were noted by caregivers or hospice nurses in the 58 percent of patients who were unable to rate their pain. The mean duration of time the needle remained in place was 4.62 days, with a range of 1-26 days. It should be noted that only one patient experienced erythema at the site which necessitated an early site change; the other patients were unable to swallow because of impending death, which occurred within a few days (thus, the short duration of placement). None of the patients required hospitalization to control their pain. The opiate was administered by lay-persons in all cases.
Assessment of pain and patterns of analgesic use in hospice patients
Authors: Morgan Amy E. , Lindley Celeste M. , Berry Joni I.
Published: May 2006

The purpose of this study is to describe patterns of pain, analgesic use, barriers to pain control, and various aspects of lifestyle affected by pain in hospice patients. Seventy-six charts of deceased patients were randomly selected of patients who had received care from Hospice of Wake County between August 1990 and August 1991. All patient’s charts were reviewed from date of entry into hospice until death. Pain assessments were routinely performed at entry into hospice, then at one month intervals, and, thereafter, whenever a change in pain status occurred. The average number of pain assessments performed per patient was 2.7(range 18). Pain intensity score increased as the number of pain assessments increased. Pain was described as occasional (25.2 percent), frequent (26.6percent) or constant (24.1 percent). Most common analgesic medications were long-acting morphine sulphate (25.4 percent), acetaminophen and hydroxy/oxycodone combinations (20.1 percent) and NSAIDS (17.1 percent). Approximately 40 percent of all pain assessments reflected use of greater than one analgesic agent and pm and scheduled medications simultaneously. Eighty percent of all pain assessments prompted a recommendation to change the analgesic regimen and 62.5 percent of regimen changes were associated with improvement in pain status. Barriers to pain control and lifestyle alterations due to pain were identified. The positive findings in this report, compared to previous similar investigations, supports the use of the pain assessment document and guidelines for cancer pain management in use at the Hospice of Wake County.
What one small hospice learned from its grieving children’s program
Authors: McGlauflin Helene
Published: May 2006

Bath-Brunswick Hospice, a small hospice in Brunswick, Maine. began their Grieving Children's Program in 1991. This article discusses the unique learning experience this program has been for this hospice. An overview of the entire organization and the Grieving Children's Program is given, as well as observations about how the program has impacted this hospice. Many aspects of this Grieving Children’s Program that are different from the usual hospice work are discussed, and the topics addressed include:

• Serving Children! The Training, Coordination and Support of Volunteers;

• The Need for Professional Consultants;

• Hospice's Mission.
Denial and terminal illness
Authors: Burgess Donna
Published: May 2006

Denial in the terminally-ill is often seen as a problem that health care professionals, particularly social workers need to fix. Rather than seeing denial as a part of acceptance, it is seen adjust the opposite. Denial surfaces to establish control in an uncontrollable situation such as terminal illness. The social worker’s challenge is to help the patient and family see their own strengths and make their own decisions. As the patient and family regain some control over their lives, denial is often replaced with other, more functional coping mechanisms.
Preliminary assessment: The Pain Inventory and the Pain Coping Tool
Authors: Arathuzik Diane
Published: May 2006

The purpose of this research study was to report the development and preliminary psychometric testing of the Pain Inventory and the Pain Coping Tool. The Pain Inventory was developed to measure cognitive factors believed to impact upon the pain experience. The Pain Coping Tool was developed to measure coping strategies and behaviors believed to be effective in dealing with the pain experience. Forty nursing doctoral students, head nurses, and clinical nurse experts rated the items to establish content validity. Initial testing for reliability found coefficient alphas to be adequate for new scales. Construct validity was established by significant correlations found between these tools and the Pain Intensity and Pain Distress Scales. These findings must be viewed as preliminary based on the small sample of 80 metastatic cancer patients interviewed for this study.
Antiemetic therapy in adults with terminal disease: A brief review
Authors: Rousseau Paul
Published: May 2006

Although nausea and vomiting (NV) are common complaints among individuals with terminal illness, there are few studies evaluating the magnitude of this disabling syndrome. Most research has emphasized chemotherapy-induced emesis, however, Reuben and Mor’ analyzed National Hospice Study data 2 and noted NV in 62 percent of patients with advanced malignancy during the last two months of life. In addition, NV was observed more frequently in women, persons younger than 65 years of age, and patients with stomach and breast cancer Lamentably, physicians were less likely to prescribe antiemetics in the elderly and inpatients with an impaired level of awareness.

With such a paucity of studies on NV in terminally-ill patients, there is frequent confusion regarding the etiology of emesis and the selection of appropriate antiemetics. This article will review the syndrome of N1 and discuss available drug regimens.
Hospice education about people with AIDS as terminally ill patients: Coping with a new epidemic of death
Authors: Dukes Carol S. , Turpin Beverly A. , Atwood Jan R.
Published: May 2006

Hospice care for patients with AIDS often differs from care provided to patients with other terminal illnesses, such as cancer. We designed a seminar series to educate regional hospice staff about these differences and subsequently determined if the educational intervention was associated with improvements in their AIDS-related knowledge, attitudes, or behaviors toward patients with AIDS. Quantitative and qualitative data were collected from seminar participants (n=63) and a similar comparison group (n=18) at several time points. Seminar participants significantly improved their AIDS-related behaviors (p.05); and there was a trend toward knowledge improvement. Qualitative data shed light on the quantitative findings. Participants verbalized better understanding of the relatively aggressive care often given to terminally ill patients with AIDS when it enhanced quality of life.
Engendering hope in the chronically and terminally ill: Nursing interventions
Authors: Herth Kaye
Published: May 2006

Nurses assume a primary role in the care of chronic and terminally ill individuals in their homes and are in a strategic position to foster or hinder hope. Using a descriptive survey design, home health care nurses and hospice nurses were asked to rate proposed hope interventions as to use and effectiveness in facilitating hope in their chronically ill and terminally ill clients. One hundred and fifty-eight registered nurses, representative of six hospice agencies and six home care agencies in a Midwestern state, completed the Hope Intervention Questionnaire. Provision of comfort and pain relief emerged as the most effective and most frequently used hope interventions by both the home health care nurses and the hospice nurses. The top 15 interventions, though ranked in slightly different order, were the same for hospice nurses and the home health care nurses and were reflective of the multidimensions of hope. The findings of this study have practical importance to nursing practice as they provide a framework for selecting strategies to foster hope in the chronically ill and terminally ill population.
A comparison of hospice programs based on Medicare certification status
Authors: Sontag Mary-Ann
Published: May 2006

This article presents results from a study of 119 hospice programs in the United States. Personal interviews and questionnaires were utilized to collect data about hospice programs, their directors, nurses, social workers, and chaplains. Specifically, this article describes reasons programs sought Medicare certification, and the perceived advantages and disadvantages to being a Medicare certified program. Characteristics of both certified and non-certified programs are presented, and examined for differences. Potential access barriers such as restrictive admission criteria are examined in this article. Finally, perceptions of staff about hospice services in certified and non-certified programs are compared. Results from this study indicate that Medicare certified programs have longer lengths of stays, were more likely to include a nurse on the first visit, and billed patients more frequently than non-certified programs. Volunteer use was lower in the Medicare certified programs. Staff in Medicare certicertified programs were much more likely to view patients' medical needs as the primary focus of their programs. Results from this study suggest that Medicare certified programs may reflect a more medical model of palliative care.
The Sacred Circle: A conceptual framework for spiritual care in hospice
Authors: Paton Lee
Published: May 2006

Hospice care has consistently recognized the need to integrate spiritual care into holistic plans of care for dying patients and their families. Designing and implementing spiritual care interventions can be potentially difficult for hospice practitioners who have not had specific training in theology or pastoral care. Matthew Fox, a theologian, has developed a model of spiritual development that utilizes an ecumenical, ethical framework that can be directly applied to the care of hospice patients and families. This model employs a Sacred Circle approach that begins with an emphasis upon the sense of awe and wonder (the Via Positiva), moves into the next cycle by recognizing problems and negative emotions (the Via Negativa), that then flows into the creative solutions to problems (the Via Creativa), which finally transforms the problem into a new level of understanding (the Via Transformativa).
Enhancing volunteer effectiveness
Authors: Hall Scott E. , Marshall Karen
Published: May 2006

The characteristics of being genuine/congruent, having an unconditional positive regard and an empathic understanding, can be integrated into the training volunteers receive prior to assignment with patients/families. Understanding and practicing these concepts may further promote the interpersonal relationships volunteers have with patients/families and other hospice professionals.
Support study results—Implications for hospice care
Authors: Greipp Mary Elizabeth
Published: May 2006

This landmark study took place over a four year period of time and included 9,105 seriously ill hospitalized clients and their physicians. Its main objective was to improve end of life decision making and reduce the frequency of painful, mechanically supported, prolonged patterns of dying. Findings indicate that despite well planned, comprehensive interventions to improve study outcomes, clients in the intervention group fared no better than their counterparts in the control group. These findings have serious implications for those working in hospice and palliative care.
The effect of an alphanumeric paging system on patient compliance with medicinal regimens
Authors: Milch Robert A. , Ziv Liora , Evans Vincent , Hillebrand Michele
Published: May 2006

There are numerous actual and potential impediments to patient compliance with medicinal regimens. The implications of poor compliance include worsening disease states or symptoms, with resultant increased costs of care. Using a population of hospice patients at high risk for noncompliance, this study evaluated the use of an alphanumeric paging system as a memory prosthetic, finding that compliance rose from a mean of 56 percent to 96 percent when the system was used. We conclude that such a program is of use in this setting, and that these findings warrant study and suggest applications in other populations.
Hospice: Humor, heartache and healing
Authors: Showalter Sherry E. , Skobel Steven
Published: May 2006

As the need for grief and loss education and interventions become more prevalent in our society, it will become increasingly important for health care professionals to be well-versed in a compilation of holistic expertise. As we bear witness to pain and suffering associated to loss, we must address these issues. This article specifically addresses the use of humor as a therapeutic mechanism for coping and surviving loss. This is an exploration of the universal and often healing effectiveness of humor.
The psychospiritual care matrix: A new paradigm for hospice care giving
Authors: Grey Richard
Published: May 2006

In a changing health care environment, Hospice is having to more carefully set forth its mission and its identity. This is causing its interdisciplinary practitioners (medical, psychosocial, spiritual) to focus on what it is they have in common, i.e. on what binds them together as a unique health care delivery system. This article suggests the common ground is that all hospice practitioners, irrespective of their clinical specialty, are psychospiritual care givers, providing basic psychological guidance and spiritual encouragement to patients and families. It sets forth a paradigm—the psychospiritual care matrix—in which all clinical practitioners can locate themselves and by which all can gain a greater clarity with respect to the individual care they provide and the character of their care with respect to that of their co-clinicians.
A personal exploration of the German hospice system
Authors: Farnon Christa
Published: May 2006

While on vacation in Germany, I explored the German hospice system and its differences from that in the United States.

I conducted an informal survey asking 10 individuals who were not associated with hospice work, about end-of-life issues. Knowledge of the hospice movement and of advance directives was found to be quite low.

Through contact with German hospice associations, I learned that the modern German hospice movement was inspired by the British example. After a difficult beginning, the German hospice system is growing steadily. Professional providers of end-of-life care are paid according to the traditional fee-for-service system. As suggested by the World Health Organization, pain management is provided according to the three-step analgesic ladder. Physician-assisted suicide is illegal as it is in the United States. A federal self-determination law has not yet been enacted.

Overall, the German hospice system has many similarities and a few interesting dissimilarities with that in the United States.
Enhancing volunteer effectiveness: A didactic and experiential workshop
Authors: Hall Scott E. , Marshall Karen
Published: May 2006

Presented is an actual workshop to enhance the personal and professional development of volunteers and their relationship with others. This workshop is a follow up to information in the article, “Enhancing volunteer effectiveness” which appeared in the May/June (1996) issue of The American Journal of Hospice & Palliative Care.
Decisions to utilize hospice—Pilot study results
Authors: Greipp Mary Elizabeth
Published: May 2006

This research included surveys and interviews with 36 hospice clients to examine their decisions to enter hospice and to identify the factors which seemed to influence these decisions. Some of the issues addressed included the time in the client’s course of illness/treatment when the decision was made to enter hospice; who seemed to make the suggestion for the client to enter hospice; use of hospice by minorities, identification of variables which may indicate higher utilization and that could be used as predictors of use; and overall evaluation of the hospice experience.

Ninety-seven percent of the study subjects stated that it was a good decision for them to have entered hospice. The one finding that is in direct contrast to the hospice literature is that 94 percent of the study subjects indicated that the timing of their referrals was appropriate and that they did not think that they should have been referred in sooner.
Debility, unspecified: A terminal diagnosis
Authors: Kinzbrunner Barry M. , Weinreb Neal J. , Merriman Melanie Pratt
Published: May 2006

Objective: To determine whether the diagnosis “debility, unspecified” (ICD-9 code 799.3) is appropriate for use with terminally ill patients and to define the criteria for assigning the diagnosis.

Design: A survey of patient charts to determine the clinical characteristics of a defined cohort.

Setting: A comprehensive hospice program with average daily census over 500 patients.

Patients: All patients who died in the hospice program during the period from January through October, 1993 and were assigned a diagnosis of “debility, unspecified” (ICD-9, 799.3).

Measurements: For each patient, the following information was recorded: demographics, level of function (ability to carry out activities of daily living), presence of major system disease, other illnesses, any other appropriate ICD-9 coded diagnosis.

Results: The diagnosis of “debility, unspecified” was confirmed in 50 out of 53 cases. All 50 patients exhibited multiple comorbid conditions. Major organ system impairment included central nervous system (96 percent of patients), cardio-pulmonary (76 percent of patients), skin integrity (42 percent of patients), and sepsis at the time of admission (30 percent of patients). The average survival for these patients was 67 days and the median survival was 20 days. In none of the 50 patients was there a single major system impairment of a degree to warrant a specific terminal diagnosis.

Conclusions: The use of the ICD-9 code 799.3 “debility, unspecified” as a terminal diagnosis was confirmed to be appropriate based on survival and hospice length of stay data and on the fact that no patients exhibited a singular major system disease sufficient to support a terminal prognosis. A decision tree for assigning the diagnosis is presented.
A hospital-based comfort care team: Consultation for seriously ill and dying patients
Authors: Bascom Paul B.
Published: May 2006

Access to hospice and palliative care services has been limited primarily to patients in the final stages of malignant terminal illness. Many have recognized the need to expand the scope of care to include other needy populations. This article describes the clinical activities of the Oregon Health Sciences University (OHSU) Comfort Care Team. This physician directed inter-disciplinary team provides consultation for any seriously ill patient with comfort care needs. There is no requirement that patients be in the final stages of a terminal illness, nor that they forego curative or life-prolonging treatments. The initial experience of this team supports the usefulness of a broader focus of care. The majority of patients referred for consultation would not have been served under a traditional palliative care model.
The hardiness of hospice nurses
Authors: Hutchings Deanna
Published: May 2006

Hardiness is a developing concept of particular relevance and interest to nursing. Hardiness is defined as a personality construct that is an amalgam of three main elements: control, challenge and commitment. Kobasa 1 asserts that an investment of committed energy serves to strengthen a person under stress or when faced with challenges.

Hospice nurses confront a myriad of challenges associated with the rapidly changing needs of dying people and their friends and families. This author suggests that the very nature of palliative care requires mobilization of the same three constituents of hardiness, i.e., control, challenge, and commitment, blended with the key hospice elements of critical competence and compassionate care.

This article considers a possible relationship between hardiness and hospice nurses, suggesting that not only are hospice nurses hardy, but that the very practice and philosophy of palliative care is predicated on a triad of control, challenge, and commitment harnessed in concert for the delivery of skilled, compassionate care to dying persons.
Bereavement: Theoretical perspectives and adaptation: Canberra, Australia
Authors: Miller Barbara , McGown Anne
Published: May 2006

This article presents an integrative model for understanding the range of individual differences arising from the bereavement process which occurs through the loss of a significant person, such as a spouse, parent or child. It is suggested that cognitive behavioral models are useful in determining stress reactions to bereavement; however, such models have certain limitations for adaptation purposes. Finally, to enhance well-being, reactions to loss are examined from a clinical perspective by using a five-phase model which outlines holistic adaptation processes, intervention strategies, and time span indicators.
A sitting/companionship service for palliative care patients: Leicestershire, England
Authors: Franks Alison L. , Geary Margaret , Smith Ida
Published: May 2006

Volunteers are vital to most UK hospices, performing wide-ranging duties. In our unit a carefully selected and trained group provides a professionally coordinated setting/companion-ship service for housebound patients. In this study we questioned their reasons for volunteering to “sit” and their evaluations of the training course. Six (of eight) completing the most recent course returned questionnaires. Five already were engaged in voluntary work, three within Leicestershire Hospice. They wanted to be “sitters” primarily to support the carers and to use their time constructively. They were aware of potential difficulties in “sitting” and considered the course had realistically acknowledged these and highlighted others that the volunteers had not contemplated, preparing them appropriately. Overall the course was valuable; all enthusiastically welcomed ongoing support and training.
Hospice care of the psychotic patient
Authors: Craun Marlys J. , Watkins Margaret , Hefty Amy
Published: May 2006

This article describes a systematic approach to understanding the needs of the terminally ill who are also subject to serious mental health problems. A compilation of potential issues that could arise is provided along with specific techniques that could be useful to staff and volunteers who encounter them. Vignettes from clinical experience are used to provide a framework for understanding the unique aspects of cognitively impaired patients and for enhancing confidence in helpers. This article will give serious consideration to dispelling some misconceptions and to detailing resources for helpful interventions in difficult cases.
Hospice support for families facing multiple deaths of children
Authors: Wolfe Jeanene J.
Published: May 2006

The hospice team can have significant impact in guiding families through the death of a second child by recognizing the additional dynamics inherent in such a grieving process. It is vital to recognize the unresolved grief these families may face when they have not been able to grieve the first child’s death adequately. The impact this unresolved grief will have on their coping abilities, anticipatory grief, and grief work when they experience the death of another child can be overwhelming. It is important to be aware of familial changes that occur when working with families who are facing the death of a second child since the addition of other children. For example, a host of additional dynamics that the family may not be familiar with or prepared to cope with may well occur, demanding specialized grief support and follow-up as provided by Hospice.
Going one step further: Skilled pain assessment and the art of adjuvant analgesia
Authors: Super Alicia
Published: May 2006

Evolving pain management practice has two phases: 1) the development of confidence and competence in prescribing opioids at whatever dose is needed to control pain; and, 2) advanced assessment skills and understanding when adjuvant analgesics must be employed with or without opioids to manage certain types of pain. A growing reliance on opioids alone is illustrated in case study by a nurse pain consultant. Dramatic improvements occur in patient function and coping when clinicians move beyond the sole utilization of opioids to understand the importance of skillful assessment of the patient’s experience and the artful use of adjuvant medications.
The family with AIDS: Multiple challenges for caregivers
Authors: Williams Ellen , Berrien Virginia , Trubey Paul
Published: May 2006

Acquired Immune Deficiency Syndrome (AIDS) continues to increase in the United States, especially among minority groups. The disease is impacting not only individuals, but entire families through multiple infections of family members. This results in simultaneous illness and multiple loss within the family system. Delivery and management of quality care for the family is often made difficult by the lack of resources experienced by families with limited income and the multiplicity of problems associated with poverty in the US. This presents numerous challenges to health care providers. Utilizing a case study, this article presents a model demonstrating the coordination of services among several providers as a means of meeting a variety of family needs and providing quality, cost-effective care.
Resuscitating and transforming hospice volunteer services
Authors: Larson Timothy James
Published: May 2006

This article is designed for hospice leaders and volunteers to explore creative ways to deal with the stagnancy that can occur in volunteer programs. Specific strategies, such as nurturing caregivers, transitioning into a gift-based program, and integrating spirituality and creativity into volunteer efforts, provide the focus of the article.
Comfort and incidence of abnormal serum sodium, Bun, creatinine and osmolality in dehydration of terminal illness
Authors: Vullo-Navich Kimberly , Smith Shirley , Andrews Maria , Levine Alan M. , Tischler James F. , Veglia Jeanne M.
Published: May 2006

This prospective clinical study was undertaken to evaluate the effect of spontaneous food/fluid intake on serum sodium and comfort levels in a population of terminal patients (n = 31) receiving clysis or intravenous hydration. The median and mode of serum sodiums were within normal limits and 56 percent of the patients were eunatremic. There was no statistically significant difference in comfort scores between predehydration and dehydration phases, and 85 percent had an optimal comfort score. A statistically significant difference was found (p < 0.5) between mean daily comfort scores of those with normal sodiums versus those with abnormal sodiums; those with hypernatremia were lower but still in the top third comfort levels. Because the sodium was tested using a Chem7, we also were able to calculate the BUN, creatinine, and osmolality. These are presented and compared to other study results. The findings of this study reinforce the belief that fluid depletion in dying patients results in relatively benign symptoms, that serum sodium levels are not always altered with limited intake and that comfort levels can be maintained when the serum sodium is abnormal.
Spiritual terrorism
Authors: Purcell Boyd C.
Published: May 2006

Spiritual abuse is the act of making people believe—whether by stating or merely implying—that they are going to be punished in this life and/or tormented in hell-fire forever for failure to live a good enough life to earn admission to heaven. Spiritual terrorism is the most extreme form of spiritual abuse, which in itself is a serious mental health problem. The 12 steps of Alcoholics Anonymous can be a useful therapeutic modality for countering this problem, provided steps two and three are reworded to facilitate cognitive restructuring, therefore enabling victims to develop a positive conception of God. Biblical symbolism can be cognitively helpful if interpreted metaphorically rather than literally. Thus, victims will be able to trust God to restore them to sanity and empower them to be survivors who experience peace of mind, joy of living and freedom from fear.
Communicating with metaphor: A dance with many veils
Authors: Hutchings Deanna
Published: May 2006

Health practitioners face many challenges when caring for and communicating with dying persons. As truth-tellers, we search for ways to communicate with honesty, sensitivity, and compassion. Creative use of language is one aspect of caring. Metaphorical communication can be a healing modality, one consistent with communication as an art. This article suggests that metaphor is a powerful and sensitive form of language that offers a range of characteristics particularly suitable for the art and the challenge of communicating with dying people. Metaphor, as figurative language, provides a permissible way of saying one thing and meaning another. It allows us to share a truth without the glare of reality. This author contends that metaphor is mysterious, creative, invitational, safe, open to interpretation, respectful and playful. The creative and judicious use of metaphor provides health care practitioners with many veils—veils that shield the dying from the glare of their prognosis, veils particularly valuable and suited in communicating with our palliative patient population.
Hospice research: Challenges, opportunities and rewards
Authors: Kovacs Pamela J.
Published: May 2006

Hospice and research have had a long-standing and, at times, strained relationship. Early studies, most notably the National Hospice Study, were instrumental in the passage and ongoing support of the hospice Medicare benefit and the growth and development of the hospice movement in the United States. Increasingly, hospices are involved in research as a result of managed care and other demands for outcome measures. Yet, it is often difficult to define and measure much of what hospice is about—quality of life, social support, interdisciplinary intervention. This article discusses some of the ethical, organizational, psychosocial, and physical challenges inherent in hospice research; identifies research opportunities through collaborative efforts with team members, other hospices, and university researchers; and illustrates some of the rewards associated with hospice research.
Part one: Introduction, bladder cancer, and brain cancer
Authors: Kemp Charles
Published: May 2006

This is the first of a multi-part series detailing the metastatic spread and natural history of 18 common tumors. The introduction summarizes (1) the concept of symptom/problem anticipation and early identification; (2) the process of cancer metastasis; and (3) the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder cancer is discussed, with information included on tumor types, metastatic spread and invasion, and common symptoms. Obstructive uropathy is the oncologic emergency most commonly associated with bladder cancer. Sites of spread, resulting problems, and assessment parameters are presented as a table. Brain cancer (and brain metastasis) is discussed, with information included on tumor types, invasion (the primary means of spread in primary brain cancer), and common symptoms. Increased intracranial pressure and, to a lesser extent, spinal cord compression are the oncologic emergencies most commonly associated with brain cancer. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as a table.
Criteria for enrolling dementia patients in hospice: A replication
Authors: Hanrahan Patricia , Raymond Michael , McGowan Elizabeth , Luchins Daniel J.
Published: May 2006

Because survival time varies greatly in dementia, it is difficult for dementia patients to meet a key criterion for the Medicare Hospice Benefit, a six-month survival time. In a previous study, the authors examined guidelines for admitting dementia patients to hospice; the National Hospice Organization (NHO) guidelines were found to work well in identifying appropriate candidates for hospice among dementia patients. This was especially true for those patients whose deficits had progressed in an ordinal fashion consistent with Functional Assessment Staging (FAST) and who had reached stage 7C. The purpose of this study was to examine the utility of the NHO guidelines in identifying dementia patients who are appropriate for hospice; the limitations of these guidelines regarding non-ordinal patients; and the importance of the actual care plans used—as opposed to our previous study, which only examined initial treatment plans.

Forty-five dementia patients enrolled in Hospice of the Great Lakes in Illinois were studied longitudinally over two years; this included a follow-up period of at least six months for all patients. Measures included: survival time; FAST; a medical complications checklist, which consisted of common complications of end-stage dementia; and co-morbid medical conditions and aggressive care, which consisted of feeding tubes, antibiotics, and Foley catheters used during the course of the study. Patients who had reached Stage 7C at intake had a mean survival time of 4.1 months; and the majority (71 percent) died within six months. Non-ordinal patients lived significantly longer at a mean of 10.9 months (p < .01), and and the minority (30 percent) died within six months. Foley catheters decreased survival time; and the use of antibiotics did not make a difference. This study echoed our previous findings regarding the usefulness of NHO guidelines in identifying dementia patients with a survival time of six months or less, specifically those at stage 7C or greater. The findings also suggest that the nature of the palliative care plan influences survival time.
A holistic nursing model for spiritual care of the terminally ill
Authors: Kendall Marion L.
Published: May 2006

Terms such as religion and spirituality usually imply a mature understanding of philosophical values of life principles and existence. In a holistic paradigm, nurses are ethically obligated to support spiritual aspects of care just as they do the biophysical elements. But how often is this all important step overlooked in our assessments and interventions? This essay contains a discussion of basic spiritual and religious principles, the moral obligations to alleviate spiritual suffering and the principles of altruism, beneficence, goodness, individuality, and the need for continuing spiritual education as a component of a holistically competent practice.
Part three: Kidney cancer, leukemia, and liver cancer
Authors: Kemp Charles
Published: May 2006

This is the third of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancers were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charted the natural histories, problems, and assessment parameters of advanced breast, colon and rectum (colorectal), and esophageal cancers.

Part three presents the natural histories, problems, and assessment parameters of advanced kidney cancer, leukemia, and liver cancer. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and can thus identify problems early in their development so that that they are more easily managed.
The Minimum Data Set 2.0: A functional assessment to predict mortality in nursing home residents
Authors: Abicht-Swensen Lisa M. , Debner Linda K.
Published: May 2006

Measures of functional assessment, such as the Karnofsky Scale, the Modified ADL Scale, and the Descriptive Scale, have been used to predict appropriateness for hospice care. A tool is needed to assess functional status across all treatment settings, including acute care, long-term care, and hospice. The objective of this paper is to determine whether the Minimum Data Set, when utilized in conjunction with physical assessment tools to determine prognosis, is accurate in predicting short-term mortality in nursing home residents.

The paper has been designed as a retrospective study of residents in 24 Minnesota nursing homes who were referred to a hospice program. The study included 199 patients from 30 to 107 years of age.

Functional variables, as triggered by the Minimum Data Set, have a direct correlation to patient mortality within three months of the documented observation of the triggered variable, and are the main outcome measure.

Of a total of 199 patients, 147 patients (74 percent) died within 15 days of a documented significant decline in the Minimum Data Set in areas of cognitive function, communication, activities of daily living, incontinence, and nutrition. Age, gender, diagnosis, and significant medical data received from the nursing home staff at the time of referral to hospice were applied to the Karnofsky Scale, the Modified ADL Scale, the Descriptive Scale, and the Minimum Data Set to determine if a resident assessment protocol (RAP) would be triggered by these data. The data were then analyzed to determine whether there existed a correlation between a significant change, as documented on the Minimum Data Set, and subsequent death of the patient. If there existed a correlation, the data were further studied to determine consistency in the categories of change that might demonstrate predictors of short-term mortality in nursing home residents.

A decline in functional status, as documented on the Minimum Data Set 2.0 in the areas of cognitive functioning, communication, activities of daily living, incontinence, and nutrition, are strong predictors of short-term mortality in nursing home residents, independent of age, gender, and diagnosis.
Practice patterns of hospice medical directors in a Midwestern state
Authors: Parker-Oliver Debra
Published: May 2006

This study of hospice medical directors was conducted in a Midwestern state with the help of the state hospice organization in the summer of 1998. The hospice programs in this state were young and relatively small. While having practiced medicine for many years, the majority of hospice medical directors had been affiliated with a hospice program for less than five years. The programs reported little orientation or continuing education for their physician leaders. Pain management practices were analyzed and compared with practice standards in the hospice pain management literature. Attitudes on the scheduled dosing of opioids, use of adjuvant medications for bone pain, the assessment of pain by the patient, and physician comfort with high doses of morphine are consistent with suggested standards and attitudes in the literature. Practice patterns that differed with the literature included choice of drugs, routes of administration, and dosing issues. Opportunities exist to improve care and lower cost.