bluuebunny/crossref_metadata_2025 huggingface dataset:
Carotid diaphragm: an unusual and easily missed cause of internal carotid artery stenosis
Authors: Raman S , Osborn GD , Khan PY , Winter RK , Champ CS , Lewis MH
Published: May 2014

A 79-year-old retired railway worker presented to the ophthalmology department with a history of two episodes of transient loss of vision in the left eye, each lasting approximately 10 minutes, highly suggestive of amaurosis fugax. He had an extensive past medical history including a myocardial infarction, hypertension and peripheral vascular disease. In addition, he was an ex-smoker on lipid-lowering drugs and was taking regular aspirin. On physical examination, he had bilateral carotid bruits but no other cardiovascular or neurological abnormality was demonstrated. He was referred to the department of vascular surgery following duplex scanning of his carotid arteries.

Initial duplex scanning carried out by an experienced sonographer revealed increased peak systolic and end diastolic velocities in the right internal carotid artery, indicating a greater than 70% stenosis. Velocities in the left internal carotid artery were normal, excluding stenosis, although slight turbulence of flow was noted. As these results did not correlate with the clinical scenario, a repeat duplex scan was performed. It was only on the second occasion by careful scanning of the left internal carotid artery that a thin diaphragm across the carotid bulb with a small central lumen was identified (Figures 1a and b). The high velocity blood flow through this lumen associated with turbulent flow downstream correlated with a greater than 70% stenosis of the left internal carotid artery. An echolucent, eccentric plaque causing a tight stenosis of the left external carotid artery was also noted.

A left carotid endarterectomy was performed and the intraoperative findings correlated with the ultrasound findings. The excised specimen is shown in Figures 2a and b. The patient made an uneventful postoperative recovery and is now asymptomatic.

Histology confirmed that the 2.2 cm x 1.5 cm tubular, internal carotid artery atheromatous plaque contained a thin diaphragm 6 mm across with a 1 mm central hole. The diaphragm was composed of dense fibrous tissue while the central lumen was lined by endothelium (Figures 3a and b).
Training in obstetrics and gynaecology in the UK: present and future
Authors: Whitten Melissa , J Drakeley Andrew
Published: May 2014

Postgraduate medical training in obstetrics and gynaecology has changed radically over the last 10 years in the UK. It is likely that future developments will see training evolve further still.
Behind the headlines
Authors: Mynard Steve
Published: May 2014

Education seemed to fare better than most in last month's Comprehensive Spending Review, but reaction has been mixed, especially due to confusion over the pupil premium. Steve Mynard takes a look at the figures
Choosing the right path
Authors: Evans Anne
Published: May 2014

These are times of great fluidity for primary schools. For some heads, change represents opportunity; for others it is a cause of unease and confusion. Anne Evans, chief executive of leadership charity HTI, discusses the choices available to heads
Education in Wonderland
Authors: Brighouse Tim
Published: May 2014

A frustrated Sir Tim Brighouse calls for the powers that be to recognise the importance of effective CPD
Ophthalmic advanced practice nursing roles in New Zealand
Authors: Raynel Susanne , Marsden Janet
Published: May 2014

Aim: To obtain a snapshot of ophthalmic advanced practice roles and how/why they developed in New Zealand.

Methods: The survey tool used was an adaptation of one designed and utilized in the UK to gain a 'snapshot' of advanced practice roles in ophthalmic nursing in the UK. The survey consisted largely of pre-coded questions with the opportunity for free text. The survey is made up of two sections, one requesting information about what the roles are and the other about role preparation and education. Ethical approval was obtained from the Regional Ethics Committee for the survey.

Results: The findings reveal that advanced practice roles are well established in ophthalmic practice in New Zealand. The roles are predominantly part time with most combining two or more roles, with most roles expanding since implementation. Preparation for the roles was varied with some requiring no education while others were required to have post-graduate papers; several of the respondents have undertaken post-graduate education.

Discussion: The main driver for the development of advanced practice roles was policy driven with the implementation of Reduced waiting times for Public Hospitals Elective Services. The most common advanced role undertaken is that of cataract; this is not surprising with the amount of negative publicity ophthalmology services have received for long delays in treatment. Nurses who wish to hold the title of Nurse Practitioner in New Zealand must complete an approved masters degree and this may contribute to the number of nurses undertaking post-graduate study.Planning for the roles was multidisciplinary in the majority of cases.

Conclusion: Advanced practice roles in ophthalmic nursing in New Zealand are well established with nurses, in partnership, driving change and service development to achieve targets and benefit patients.
Striving for excellence — Queensland Eye Hospital's commitment to ophthalmic nurse education
Authors: O’Sullivan Fiona
Published: May 2014

This article describes the development of our Royal College of Nursing Australia RCNA accredited Graduate Nurse Programme (GNP) at Queensland Eye Hospital. Our development team worked to produce a nationally accredited 12 month GNP which will assist us in continuing to provide the highest standard of services in the an ophthalmic day surgery environment in a time of shortage of registered nurses. Staff who take on the role of preceptor and mentor must be given appropriate education and training to make certain we provide a collaborative learning environment that supports life-long learning.
Congenital cataract: a review of the literature
Authors: McCutcheon Karen , Cooney Alyson
Published: May 2014

This article explores congenital cataract with emphasis on the effectiveness of early screening, diagnosis, pre-assessment and the timing of surgery. Congenital cataract is a rare condition. It is estimated that approximately 200 000 children worldwide are blind from cataract, and further government funding is essential to treat and reduce this treatable global cause of blindness ( World Health Organization, 1999 ).
Evaluating the effectiveness of complementary therapies
Authors: Botting Deborah , Cook Richard
Published: May 2014

The use of complementary therapies in patients with advanced cancer has increased in recent years. However, few studies have evaluated the effectiveness of complementary therapies amongst such patients. Those studies which exist have used quality of life measures namely the Rotterdam Symptom Checklist (RSCL) or the Holmes and Dickerson instrument in conjunction with psychological measures, either the State Trait Anxiety Inventory (STAI) or the Hospital Anxiety and Depression Scale (HADS). Practical and methodological issues relating to the use of such scales are considered. It is suggested that while these scales have been tested for reliability and validity and thus appear to be scientifically well constructed they were not designed to measure the effects of complementary therapies on quality of life. In particular, their ability to provide an holistic assessment is questioned and the inappropriateness of some questions is considered.
Remembering Mair Jones (the co-constituency of care giving)
Authors: Jones Alun
Published: May 2014

This short account of an episode of nursing care explains the idea of phenomenology and its relationship to professional practice. The author provides a brief overview of phenomenological thinking. A case study illustrates both Husserlian and Heideggerian ideas of phenomenology as he applies them reflexively to ease what the author describes as the ‘craft’ of nursing. The author affords a glimpse of the ‘lived experience’ of illness through this reflection on care provision and concludes with the suggestion that co-constituency forms a basis for all relationships.
The quality of life
Authors: Holmes Susan
Published: May 2014

It has been suggested that many nurses ‘push themselves to the absolute limit’ in striving to attain perfection in providing care for the dying for whom there is no ‘second chance’ to get things right (Webber, 1998). Since it is difficult to gauge the quality of dying healthcare professionals often concentrate instead on measuring the quality of life (QL). While this is laudable, and practitioners agree that the quality of living is of overriding importance, it is difficult to know whether care has successfully promoted an individual’s QL.
The problem of weakness in patients with advanced cancer
Authors: Brown Duncan JF
Published: May 2014

Weakness is a disabling symptom present in the majority of patients with advanced cancer. However, as a subject for research, it has received low priority status. Weakness and fatigue are terms that are often used synonymously and are likely to be part of a larger symptom complex and have overlapping aetiologies. This review article addresses the symptom of weakness as a physical aspect of the weakness/fatigue complex. Weakness is compared to and contrasted with fatigue, and the interaction of these two symptoms is discussed. The aetiology of weakness, including the role of cancer cachexia, intrinsic muscle dysfunction, inactivity and drug therapy, is outlined and possible management strategies examined. The role of exercise is controversial and requires further evaluation. Positive approaches to the management of weakness, even in patients without a reversible cause, may help to improve their self-esteem and quality of life.
Conceptual analysis of loneliness in dying patients
Authors: Brown Robert , McKenna Hugh P
Published: May 2014

This article presents a conceptual analysis of loneliness and highlights the importance of loneliness for dying patients. It is suggested that patient and professional avoidance of, and reluctance to address, this subject may result in part because of a lack of understanding of the concept. In analysing the concept and providing a theoretical definition, this article incorporates the methods adopted by Walker and Avant (1983) and Rodgers (1989a). The defining attributes, related concepts, antecedents and consequences of loneliness are examined and a model case is presented. The analysis concludes that loneliness is: a subjective experience which involves the social meaning of death; based on a person’s relationship with those around him/her; and is an individualized process which is characterized by loss. It is suggested that future research should concentrate on exploring the ‘living’ reality of dying people which in conjunction with nursing knowledge could improve the quality of life for dying patients.
Palliative care: a two-tier system?
Authors: Dicks Barbara
Published: May 2014

Since 1967 when St Christopher’s Hospice, Sydenham, — the pioneer of the modern hospice movement in England — opened, numerous adults with advanced cancer have been able to benefit from the expertise of specialist palliative care services. Currently, in the UK nearly one fifth (17.5%) of cancer patients die in a hospice or palliative care unit, and a further 39% die while in the care of a domiciliary palliative care team (Eve et al, 1997).
Changes that occur in nursing when a patient is categorized as terminally ill
Authors: Wakefield AB
Published: May 2014

Death work is different from ordinary nursing care and demands the nurse’s full attention (Field, 1984; May, 1991, 1995; Wakefield, 1996a,b). This article examines the way in which nurses change the normal operational rules of the ward when a patient is dying, to create an aura of domesticity, and with it a notion of tenderness. The study adopted an ethnomethodological approach, which allows everyday taken-for-granted behaviours to be afforded an overtly observable status (Garfinkel, 1967). Although the sample size was small, consisting of 22 surgical nursing staff and 4 student nurses on one ward, it has been possible to identify some trends in clinical practice. For example, when relatives normally entered the ward they were ‘excluded’ from participating in care. Conversely, when patients were dying, the notion of mutual participation was introduced (Szaz and Hollander, 1956) enabling relatives to assist nurses in the administration of rudimentary nursing interventions.
Reflective practice: advancing quality in palliative nursing care
Authors: Howell Doris
Published: May 2014

Reflective practice has been identified by many provincial nursing regulatory agencies across Canada as an essential element for maintaining nursing competence and as a method for sustaining practitioner development. Reflective practice is a mandatory annual process incorporating five steps: self-assessment, peer review, and the creation, implementation and evaluation of a learning plan (Witmer, 1997). Reflective practice fulfils an important component of self-regulation by providing nurses with insight into the quality of their practice and an opportunity for learning.
Issues in effective pain control 1: assessment and education
Authors: Davies Julie , McVicar Andrew
Published: May 2014

Pain is a complex phenomenon to which an individual’s response is determined by the interactions of physical, psychological, cultural and social factors (Melzack and Wall, 1988; Woodward, 1995; Horn and Munafo, 1997). It cannot be measured, and self-assessment by patients is increasingly recognized as the most accurate means of evaluating their pain. However, research indicates that even self-assessment remains problematic because nurses frequently either do not use pain tools effectively, or do not always accept the self-assessment. Reasons for this seem to be rooted in the attitudes and beliefs of nurses, and inadequate communication. The latter problem could be improved by more effective use of pain tools, but attitudinal problems are more difficult to address once the barriers have become established. This article suggests that the most effective way to prevent such barriers arising is to ensure that nurses receive a focused, substantive input on pain assessment and pain control within their preregistration studies. Referring to proposals put forward several years ago by the Royal College of Nursing (Davis and Seers, 1991), the authors suggest that the process should begin very early in preregistration studies, preferably within the first 6 months, and involve teaching and learning strategies that encourage personal exploration and so are conducive to personal growth and development. In this way, postregistration studies could realistically focus on specialist aspects of pain care more appropriate to ‘continuing education’.
A longitudinal study on dying in a Norwegian hospital
Authors: Sørbye Liv Wergeland
Published: May 2014

A research project conducted at a Norwegian hospital in 1977 (n=213 deaths) was repeated in 1987 and 1997 (n=100 deaths each year). The purpose was to discover if and how terminal care had changed during these 20 years. Data sources included case records, nurses’ reports and interviews with close relatives approximately 12 weeks after death. The average stay in hospital decreased by one-third from 1977 to 1997. Active life-prolonging treatment, as defined by use of antibiotics, resuscitation and parenteral fluids, was greatly reduced from 1977 to 1987, but there was an increase in the use of such treatment in 1997. Interestingly, palliative treatments — either broadly defined as the giving of analgesics in general, or more narrowly as the giving of opiates only — have increased steadily over the years and are now offered to most patients. However, the findings demonstrated that the next-of-kin were less well informed about the patient’s impending death in 1997 than in 1977.
Palliative care nursing in rural Western Australia
Authors: McConigley Ruth , Kristjanson Linda , Morgan Adrian
Published: May 2014

This article presents the findings of a study of rural palliative care nurses in Western Australia. The number of rural centres in Western Australia offering palliative care services is increasing; however, at present there is little empirical data available about the roles of the nurses involved. This study was undertaken to begin to correct this deficit. The study examined basic social processes associated with the role of rural palliative care nurses, and identifies issues that affect the nurses’ professional practice. A modified grounded theory approach was used to form a conceptual framework that describes rural palliative care nursing. Theoretical sampling techniques were used to identify the six palliative care nurses working in rural Western Australia who participated in the study. Data were generated using in-depth interview and participant observation techniques. Constant comparative analysis of the data was employed to allow concepts to emerge from the data. The central theme that developed is the all-consuming nature of the rural palliative care nurse’s role. Three subthemes relating to multiple roles, expectations of nurses, and coping strategies are also discussed. This research explored issues that rural palliative care nurses feel are relevant to their professional practice, and it describes the basic social processes inherent in the rural palliative care nurse’s role. Recommendations for nursing research, education, administration and clinical practice are presented.
Patients with non-malignant disease deserve an equitable service
Authors: Connolly Michael
Published: May 2014

Palliative care has often challenged the status quo. With the wider health agenda focused on technology, cure and waiting lists, palliative care has strongly supported and valued quality care of the dying, the patients agenda and multidisciplinary working. Yet when faced with the new frontier of palliative care in non-malignant disease, the palliative care movement seems cautious, perhaps even daunted.
Pilocarpine for radiation-induced xerostomia in head and neck cancer
Authors: Hawthorne Mary , Sullivan Kate
Published: May 2014

This article examines the use of pilocarpine hydrochloride for radiation-induced xerostomia in patients with head and neck cancer. Four randomized controlled trials involving 401 patients met the authors’ predefined inclusion criteria and were critically appraised. Three studies used systemic pilocarpine in treatment groups, and one study used topical pilocarpine as a mouthwash. Outcome measurements were both quantitative and qualitative. The studies reported statistically significant differences in favour of pilocarpine-stimulated treatment groups. Subjective improvements in feelings of oral dryness, speaking and chewing were reported in all studies. However, sample sizes varied and in all cases sampling methods were poorly defined. The pilocarpine doses tested produced side-effects, but those reported were easily tolerated. The persistent findings of symptomatic improvement following pilocarpine use merit consideration, but there is insufficient evidence from these studies alone to generalize results to the wider population.
Palliative care nurses and mental health nurses: sharing common ground?
Authors: Black Catherine , Hanson Elizabeth , Cutcliffe John , Goward Peter
Published: May 2014

This article arose out of discussions, in a higher education setting, concerning the roles of palliative care nurses and mental health nurses; mental health nursing students frequently argue that they engage in the key principles of palliative care. This led the authors to consider the students’ arguments more fully and explore the relevant theoretical and empirical literature in palliative care and mental health nursing in order to substantiate or refute the claims put forward. This article examines the needs of palliative care patients and mental health patients and considers the core areas of similarity and difference between the roles of registered general nurses and mental health nurses. As a result, the authors urge palliative care managers to consider the arguments put forward with a view to redressing the current imbalance concerning the employment of registered mental health nurses in palliative care settings.
Tending the soul as well as the body: spiritual care in nursing and residential homes
Authors: Orchard Helen , Clark David
Published: May 2014

This article reports findings from a study in the UK which investigated the perceptions and practice of spiritual care in care homes for older people. Over 1500 homes were sent a postal questionnaire and a response rate of 42% was achieved. Home managers were found to have a broad understanding of spiritual care, according a spiritual dimension to a range of tasks that were social and emotional in nature. Most managers felt that responsibility for providing spiritual care lay with the home itself, rather than other parties, although concerns were expressed over the ability of some staff to deliver this care. Many homes had input from religious providers via regular services and visiting personnel. There was a perception of a heightened level of spiritual need for dying residents, although it is suggested that physical pain continues to dominate the focus of care at this stage.
Palliative care in Western Australia: an assessment of information and support needs
Authors: McConigley Ruth , Kristjanson Linda , Nikoletti Sue
Published: May 2014

Health professionals in rural Western Australia have embraced palliative care, however, to date no information has been available about the issues that face those providing the care. The descriptive study was undertaken to determine what palliative care education and support resources were available to rural health professionals, and to ascertain what further services would be of benefit to their practice. The findings of this study suggests that rural health professionals would welcome increased access to both education and support services when providing palliative care to patients in their communities. Recommendations are made that could enhance the delivery of palliative care education and support to rural Western Australia.
A programme of individualized and self-administration of medicines in a hospice
Authors: Shipley Valerie , Fairweather Joy
Published: May 2014

Hospice care is changing. Statistics show that people are surviving longer with cancer and many more are choosing to be cared for in the community. The hospice is no longer an institution solely for the care of people in the terminal phase of their illness but is involved in the palliation of symptoms, so allowing patients to return home to independent living. It was with this in mind that we recognized the need for the introduction of a programme of individualized and self-administration of medication at the hospice where we work. Although self-administration of medication was our first aim, the individuality of care brought about by its introduction, the adaptations required to include all palliative care patients and the resulting enhancement of holistic patient care, has become the main thrust of the project. This article will explore the term ‘self-administration of medication’; the evidence of its use in other areas of health care; the rationale for change within the hospice movement; consequences to practice; and the staged implementation of a programme of individualized and self-administration of medication.
Analysing qualitative data: examples from two studies of end-of-life care
Authors: Ingleton Christine , Seymour Jane E
Published: May 2014

This article examines the analysis of qualitative data, identifying and explaining some key approaches which researchers may wish to use to contribute to the developing knowledge base of palliative nursing. Drawing on the work of Grbich (1999), practical examples from the authors’ own studies of end-of-life care are used to illustrate some of the possibilities for analysing interview and observational data. The article concludes with an examination of the concept of ‘rigour’ in qualitative inquiry and suggests some practical ways of helping nurses who are new to palliative care research.
An audit of oral care practice and staff knowledge in hospital palliative care
Authors: Lee Louise , White Val , Ball Jane , Gill Karen , Smart Lynn , McEwan Karen , Chilton Pauline , Pickering Penny
Published: May 2014

Mouth care is considered one of the most basic of nursing activities, and palliative care patients are especially vulnerable to oral problems (Macmillan Practice Development Unit, 1995). This article describes a project on developing oral care practice and staff knowledge, by nursing staff and Macmillan nurses at a hospital in central England. A baseline audit (audit I) was carried out to examine all aspects of current oral care practice and nursing knowledge, including assessment, implementation, prescribing and evaluation of care. Oral care guidelines and a programme of ward-based teaching were then introduced. Several months later a follow-up audit (audit II) was conducted. Results showed an improvement in all aspects of oral care and staff knowledge. Additional benefits of this process included improved professional relationships and the promotion of further audits in hospital palliative care. Recommendations include the need for further nursing research into oral care to build the evidence base further. Additionally, it is suggested that nurses must recognize their important and central role in improving this aspect of palliative care. Education and training is pivotal to this process.
Oral care for people with advanced cancer: an evidence-based protocol
Authors: Milligan Stuart , McGill Maria , Sweeney M Petrina , Malarkey Carol
Published: May 2014

Poor oral health is an extremely common problem in patients with advanced cancer and, because of its impact on quality of life, promoting oral care should be regarded as a priority by every hospice and palliative care team. At Accord Hospice, Paisley, UK a protocol for oral care has been developed which is simple, inexpensive and evidence-based. Evaluation of the protocol has shown that it can lead to significant and consistent improvements in oral health and comfort. A survey of mouth-care practices in other Scottish hospice units reveals that although much agreement exists, certain practices that are unsupported by research evidence are still undertaken.
Giving voice to the less articulated knowledge of palliative nursing: an interpretative study
Authors: Dunniece Una , Slevin Eamonn
Published: May 2014

This article details a study that was undertaken in order to give voice and thereby increase understanding of the less articulated knowledge used in practice by palliative care nurses. An additional aim was to explore perceived influences on the development of these nurses. A hermeneutic approach was used to explore the lived experiences of seven nurses who had worked in the field for more than 2years. The themes that emerged from analysis of the data were: knowing the bigger picture, time (movement and measure), ethical dimensions, knowing and minding yourself, the ‘just’ and ‘simply’ of practice, the embodiment of being with, unseen tutors. Recommendations relating to the need for further research, practice setting and palliative education are suggested from the findings of the study.
Perception of empowerment by family caregivers of patients with a terminal illness in Hong Kong
Authors: Mok Esther , Chan Faye , Chan Vivian , Yeung Ellen
Published: May 2014

The purpose of this study is to provide an in-depth description of the nurse-facilitated empowering experiences of family caregivers of terminally ill patients in Hong Kong. Data were collected through in-depth interviews with 24 family caregivers of patients with terminal cancer. Grounded theory strategies served as the basis for data collection and analysis. Data were analysed in terms of the strategies, consequences, and interactions involved in the empowering experience. Themes included establishing an engaged relationship; providing information, knowledge and skills; affirming self-worth; and giving reassurance that the patient is under good care. The consequences of empowerment included a trusting relationship, having confidence to carry out caregiving tasks, acceptance of patient’S death, sustained self-worth and feeling peace at heart. The focus of empowering experiences was related to the quality of life of the dying patients. Family caregivers require information, education, encouragement and support, and nurses are in an ideal position to meet this need. Fundamental in the empowering process is the formation of a trusting relationship and as a result the caregivers feeling they are not being abandoned or left alone in the caring process. The results of this study can help nurses interact more effectively with family caregivers, giving them direction for effective nursing practice when caring for patients with a terminal illness.
A patient-held record for cancer patients from diagnosis onwards
Authors: Johnson Sylvia , Mayor Paul
Published: May 2014

This article presents the findings of a qualitative study looking at the content and use of a personally-held record for cancer patients. The study was conducted in the York area of the UK over a 1-year period and the record was introduced to patients as near to diagnosis as possible. The record had three main sections: general information, communication sheets and a health diary. Users were invited to complete questionnaires and volunteer patients took part in independently facilitated focus group discussions. Patients liked the record and placed importance on access to information early in their treatment process. They valued the health diary as a means of therapy and personal reflection and shared information in their records with family and friends. The steering group coordinating the study believed there was sufficient positive feedback to warrant further work. However, the findings of regional and national working groups must be assessed before progressing to the next stage of development.
The contribution of psychologists to specialist palliative care
Authors: Payne S , Haines R
Published: May 2014

Current approaches to multidisciplinary working in specialist palliative care generally acknowledge the need for psychological care and the contribution of specialist psychological services. Embedded within an integrated approach to care, there has long been a recognition of the psychological needs of patients and their informal caregivers, although there has been less consensus on how these needs should be addressed. Confusion appears to exist regarding the boundaries between psychological support and psychological interventions, and which members of the multidisciplinary team are best qualified to provide them. This article aims to explore the contribution of psychologists and psychological services to specialist palliative care. It offers a conceptual model to help categorise psychological care in hospices and specialist palliative care services. It seeks to help define the boundaries between general psychological support and care which may be offered by nurses and other health care professionals, and the specialist expertise of psychologists.
Exploring documentation of end-of-life care of children with cancer
Authors: De Graves Sharon , Aranda Sanchia
Published: May 2014

This article presents the findings of a study that explored documentation surrounding the end-of-life care of children with cancer. An in-depth history audit of 18 children with cancer, who died from disease progression at a single tertiary paediatric centre during 1999, was performed to explore the extent and the ways in which the shift from cure to palliation was reflected in the child’S medical record. The study found that while physical aspects of care were documented there was little evidence of the human-to-human aspects of care or processes of decision making when cure was no longer a possibility. Relapse and disease progression were identified as critical junctures for families and health professionals and an important area for future research. Further, the medical records documented ill-defined periods of palliation, with the child’S approaching death appearing as a gradual awareness rather than a distinct shift in goals of care from cure to palliation.
Palliative care for Sikhs
Authors: Gatrad Rashid , Panesar Sukhmeet Singh , Brown Erica , Notta Hardev , Sheikh Aziz
Published: May 2014

This article provides an overview of the palliative care needs of Sikh patients. It describes the basis of Sikh beliefs and practices and discusses practical aspects of caring for terminally ill Sikh patients and their families. Issues before and after death are considered and the importance of an individual approach is highlighted.
A Greek perspective on concepts of death and expression of grief, with implications for practice
Authors: Mystakidou Kyriaki , Tsilika Eleni , Parpa Efi , Katsouda Emmanuela , Vlahos Lambros
Published: May 2014

Death has been conceptualized in different ways by different cultures and civilizations. It is increasingly entering into the public consciousness and society is now more ready to discuss and lessen the fear of dying and grief than it has been in the last few decades. In Greece, by Classical times there was an increase in burial rituals and commemorative practices compared to earlier periods. When Christianity was introduced into Greece it attempted to change the way the dead were mourned, preaching immortality of the soul and resurrection of the dead. Nevertheless, the way people grieve and bury their dead in Greece has not changed greatly since before the introduction of Christianity, except for the difficulty experienced in witnessing burial procedures observed in the large cities. Burial and bereavement traditions were introduced to help Greeks cope with death and bereavement. In Greece today beliefs about grief and death are based both on the ancient and the Christian Orthodox traditions. Health-care professionals need to develop cultural competence to improve nursing and future health care. If care is culturally informed and tailored its quality is improved.
Models of lymphoedema service provision across Europe:
Authors: MacLaren Julie-Ann
Published: May 2014

Lymphoedema treatment has long been associated with large lymphology clinics in Austria and Germany, where many therapists and patients have made pilgrimages to experience or learn techniques for managing the condition. Although these clinics have undoubtedly played an important part in introducing effective treatment techniques, several models of care and service provision have emerged over the past 20 years and a variety of health-care professionals are now involved in lymphoedema treatment across Europe.
Breaking bad news revisited: the push for negotiated disclosure and changing practice implications
Authors: Arber Anne , Gallagher Ann
Published: May 2014

This article revisits the ethical, legal, professional and emotional issues involved with disclosing bad news. The authors examine the push for disclosure that has come from a number of quarters in the UK, including ethical and legal challenges, in particular the Bristol Royal Inquiry Report, professional codes of conduct, health policy and the expectations of the public. The contribution of nurses to breaking bad news is not widely discussed in the literature. With the development of new nursing roles and evidence-based practice it is timely to consider the role of nurses in this process. The article highlights some limitations with current guidelines for breaking bad news, in particular, that these guidelines tend to be constructed from a professional standpoint and lack patient-centred evidence. The issue of emotional labour and how it relates to giving bad news is discussed with respect to professional staff and patients. The article concludes by raising some practice implications, including: the importance of context and continuity; the significance of information and support; the desirable qualities of the professional; and issues to consider in determining patient preferences.
Non-pharmacological management of breathlessness: a collaborative nurse-physiotherapist approach
Authors: Syrett Elaine , Taylor Jenny
Published: May 2014

Breathlessness is a common and challenging symptom in palliative care. A simple audit of 470 patients under the St Christopher’s Hospice Homecare team found that 43% complained of breathlessness. Research has indicated that non-pharmacological management can be of benefit to terminally ill patients with breathlessness. Knowing that both nurses and physiotherapists each have core skills to offer these patients, the authors aimed to integrate and consolidate their approach to enhance best practice. The supportive care and advice of the clinical nurse specialist was combined with physiotherapy sessions. The aim of this collaborative approach was to reduce patient anxiety, maximize respiratory function and provide information to help patients understand, adapt and regain some control of their breathing. A leaflet containing simple written information for patients was developed and found to be useful. It was found that supportive professional relationships strengthened links between the multiprofessional team. Positive feedback has been received from patients and health-care professionals about the sessions and breathlessness leaflet. By establishing this combined approach the authors have contributed to significant practice development at St Christopher’s Hospice.
Nurses and health support workers’ views on cardiopulmonary resuscitation in a hospice setting
Authors: Costello John , Horne Maria
Published: May 2014

This paper reports on a study which took place in a 15-bed hospice and provides an account of the views of registered nurses (n=12) and health support workers (n=10) in relation to cardiopulmonary resuscitation (CPR) within a hospice setting. The study was part of a larger ethnographic research project being conducted in the hospice when the British Medical Association/Royal College of Nursing and the Resuscitation Council UK (Resuscitation Council UK, 2001) published guidelines urging all establishments that face decisions about attempting CPR to develop local policies. The guidelines provided the impetus for the present study, the aim of which was to explore staff responses to the introduction of a CPR policy in the hospice. Semi-structured interviews were conducted on a purposive sample of hospice staff. The findings raise issues about the implementation of CPR in a context where it was felt that the patient should be allowed to die a natural death.
Administration of as required subcutaneous medications by lay carers: developing a procedure and leaflet
Authors: Lee Louise , Headland Cheryl
Published: May 2014

Good symptom control is considered one of the factors that determines whether patients are able to die at home. This article describes a practice development project to enable carers to administer as required (PRN) subcutaneous medication, via a subcutaneous butterfly device in a community setting. Medications were mainly analgesic injections, although others, such as midazolam, were also given. The article highlights the lack of literature on the topic, reviews relevant background information and presents two successful case histories. It outlines the development of a procedure and accompanying leaflet to support community nurses in teaching relatives how to carry out this task, and the implementation of the process.
Audit on discharging patients from community specialist palliative care nursing services
Authors: Newbury Jenny , Hatherell Claire A
Published: May 2014

Discharging patients from community specialist palliative care services is a contentious issue. Although some specialist nursing teams discharge patients at the earliest opportunity and are open to re-referral, others retain patients as ‘pending’, i.e. patients do not receive regular contact or intervention but remain on the caseload until a need arises. This anomaly is not surprising given the lack of evidence of good practice in the discharge of patients who no longer have specialist needs. This article describes an audit by a community specialist palliative care nursing team of patients discharged from their caseloads over a 6-month period from January to June 2002. The aims of the audit were to compare the reasons for discharge given by the nurse specialists with existing discharge criteria and to provide data for guidelines for good practice in discharging patients. The rate of re-referral for the discharged cohort was also measured. There were 199 patient discharges in the audit period with 23 being re-referred within 6 months of discharge. The reasons for discharge were generally broader than the discharge criteria and the nurses frequently emphasized to the patient, the family and primary carers that re-referral was welcomed as needs arise. The need for multicentre discharge audits was also highlighted.
Breaking bad news: part 1
Authors: Smythe Dion
Published: May 2014

Breaking bad news is one of the most difficult duties to befall a health-care professional and yet surprisingly little time is spent on preparing and properly training staff. The results of numerous studies have shown that the effective and empathetic disclosure of bad news is desirable, and the delivery and discussion needs to acknowledge the psychosocial and emotional distress. This month’s Web Words examines sites that support the practice of compassionate communication on this topic.
The experiences of district nurses caring for people receiving palliative chemotherapy
Authors: Andrew Jane , Whyte Fiona
Published: May 2014

The treatment options being offered to people with advanced cancer are increasing with growing use of palliative chemotherapy. As people are experiencing shorter hospital stays and receiving treatment on an outpatient basis, this has implications for primary health-care provision. This study aimed to explore the experiences of district nurses caring for patients receiving palliative chemotherapy: how they viewed their role, factors that influenced their role and their attitudes to palliative chemotherapy. Data were collected using qualitative interviews that incorporated critical incident technique (n=10). Themes that emerged from the content analysis included the role of the district nurse, knowing the patient and family, the interface between hospital and primary care, and uncertain ground. District nurses saw their role as having relevance at all stages of the patient’s cancer journey and the provision of holistic care based on good interpersonal relationships was valued. However, difficulties were perceived at the interface between hospital and primary care. District nurses had ambivalent attitudes to palliative chemotherapy but had positive attitudes towards optimizing quality of life and care in the palliative stages of illness.
Multicomponent psychosocial support for newly diagnosed cancer patients: participants’ views
Authors: Taylor Elizabeth , Ismail Sabana , Hills Helen , Ainsworth Sue
Published: May 2014

The diagnosis and treatment of cancer carries a heavy psychological burden, particularly in the first year after diagnosis. The purpose of this study was to investigate and report qualitatively on patients who had completed a 10-session programme consisting of education, social interaction, psychological support, exercise and complementary therapies for newly diagnosed cancer patients. A thematic analysis of data obtained from purposefully selected focus groups revealed that peer support was the most highly valued aspect of the service and that a variety of needs were being met. The relaxed atmosphere, sensitivity of staff and complementary therapies were particularly appreciated. The findings also indicated that patients would like the option of diversional activities and a period of structured group therapy in addition to the services offered and that the revision of information-giving procedures would enhance psychological support. Opportunities for staff development are identified.
Evaluation of the Bereavement Risk Index (BRI): a community hospice care protocol
Authors: Kristjanson Linda J , Cousins Kerry , Smith Joanna , Lewin Gill
Published: May 2014

Aim To test the validity, reliability and feasibility of using a modified version of Parkes’ (1993) Bereavement Risk Index (BRI) and bereavement support protocol in an Australian home hospice care setting. In addition, the study aimed to explore what types of family members are most likely to experience a more difficult grief reaction.

Design A prospective, descriptive study was used. One hundred and fifty bereaved family members participated. Bereaved family members were classified as high, medium or low risk and received a structured bereavement support protocol based on their level of risk as measured by the BRI.

Findings Results indicated that a shorter 4-item version of the BRI was more internally consistent than the longer version and demonstrated good predictive validity when correlated with outcome measures at 3 months following the patient’s death.

Conclusion The modified 4-item BRI demonstrated acceptable reliability and validity and was brief and simple to use. Nurses were able to use the instrument with minimal training and were able to adhere to a matched bereavement support protocol.
Towards a culturally acceptable end-of-life survey questionnaire: a Bengali translation of VOICES
Authors: Hughes Rhidian , Saleem Tariq , Addington-Hall Julia
Published: May 2014

Aim To assess the cultural acceptability and appropriateness of an English end-of-life survey questionnaire translated into Bengali for use in east London.

Study design Group discussions with informal carers (n=3 groups) and professionals (n=1 group).

Sample and setting Informal carers within a Bengali-speaking community (n=26) in east London participated in three groups discussions led by three community workers trained in interviewing procedures. These data were followed up with one group discussion with bilingual health and social care professionals (n=6).

Analysis Data subject to content analysis.

Results Participants were supportive of the development of the translated questionnaire. However, attention should be paid to vocabulary, shared meanings, cultural equivalence and the ways people conceptualize health and illness, and death and dying.

Conclusions These findings, together with participants’ views on the administration of the questionnaire, will prompt revisions to the research approach when targeting ethnic and cultural groups in the future.
Palliative care in Irish nursing homes: the work of community clinical nurse specialists
Authors: Ling Julie
Published: May 2014

Aim To assess the current level of input from community-based clinical nurse specialists in palliative care into nursing homes in the Republic of Ireland.

Method A national survey was undertaken with questionnaires distributed via the National Council for the Professional Development of Nursing and Midwifery database. The total population was 114 community-based clinical nurse specialists in palliative care.

Findings Sixty-three completed questionnaires were returned achieving a 55% response rate. All respondents had undertaken work with nursing homes. The main focus of interactions with nursing homes was on pain and symptom management and this was often provided by telephone. The majority of nurses were involved exclusively in care of patients with cancer, although 40% of respondents cared for patients with non-malignant diseases.

Conclusions As populations age and more people end their lives in residential care settings, this area of care has increasing relevance. The dissemination of palliative care best practice would ensure that all patients, regardless of their diagnosis, receive the benefits of palliative care at the end of life. Clinical nurse specialists are ideally placed to provide education and support to nursing homes and other residential care settings for older people.