bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare professional education: A unique role for hospices
Authors: Fischer Stacy M. , Egan Kathy , Kassner Cordt , Kutner Jean S.
Published: May 2006

We sought to describe the educational experiences that hospices currently provide for students in health professions by using a national cross-sectional, Web-based survey of the National Hospice and Palliative Care Organization (NHPCO) and the Population-based Palliative Care Research Network (PoPCRN) hospice sites. Of the 75 responding sites, 71 (95 percent) participated in the education of health profession students, most commonly providing education for bachelor of science in nursing students (73 percent), associate’s degree nursing students (61 percent), master’s-level social work or counseling students (61 percent), registered nursing students (59 percent), medical students (58 percent), and medical residents (57 percent). Significant staff time was devoted to educating these students (averaging 11 to 30 hours/week), but less than 3 percent received any financial compensation. Therefore, we conclude that hospices provide a significant amount of uncompensated education. This conclusion provides a unique opportunity for hospices to collaborate with health-care educational institutions and to influence the work force of the future.
Radiopharmaceuticals for the palliation of painful bone metastases
Authors: Reisfield Gary M. , Silberstein Edward B. , Wilson George R.
Published: May 2006

Metastatic bone pain is prevalent in advanced cancer, and, despite a plethora of available therapies, effective palliation remains a clinical challenge. Bone-seeking radiopharmaceuticals are an often-overlooked but valuable analgesic option for select patients. These agents work by binding to hydroxyapatite at the tumor-bone interface of osteoblastic lesions, delivering therapeutic doses of radiation to closely circumscribed tissue regions. They have been shown to reduce pain and improve quality of life. Their safety, simplicity, convenience of administration, and cost-effectiveness make them suitable for hospice and palliative care settings.
Palliative care volunteerism among college students in Canada
Authors: Claxton-Oldfield Stephen , Tomes Jennifer , Brennan Michelle , Fawcett Catherine , Claxton-Oldfield Jane
Published: May 2006

The goal of Study 1 was to investigate whether young Canadian adults were interested in becoming involved in palliative care volunteer work. After reading a brief description of what volunteering in a palliative care environment typically involves, participants (undergraduate students) were asked to indicate whether they would be interested in this kind of volunteer experience and to provide a written explanation of their answer.

Of the 105 participating students, only 39 (37.1 percent) expressed an interest in volunteering, while 66 (62.9 percent) were not interested. Not surprisingly, the results revealed that significantly more females than males were interested in palliative care volunteer work (45.9 percent and 25.0 percent, respectively). The most common reason students gave for wanting to become a palliative care volunteer was to help others; the reason given most often for not wanting to volunteer was that it would be too emotionally demanding. It is important to note that prior to taking part in this study the majority of the participating students (75.9 percent) did not know what palliative care was.

The goal of Study 2 was to investigate undergraduate students’ interest in volunteering in a nursing home, in a classroom, and at a food bank. Of the 111 participating students, 74 (66.7 percent) expressed an interest in volunteering at a food bank and in a nursing home, and 89 (80.2 percent) were interested in becoming a classroom volunteer. Together, the results of Studies 1 and 2 support the view that young people in Canada (especially males) are not interested in becoming involved in the care of dying persons. However, the results also indicate that they are very interested in volunteering with other populations (e.g., the elderly, school children) and in other settings (e.g., food bank).
Exploratory study on end-of-life issues: Barriers to palliative care and advance directives
Authors: Feeg Veronica D. , Elebiary Hoda
Published: May 2006

Background. In the United States, as in most developed countries, death is rarely unexpected. It usually occurs in older persons with chronic progressive illnesses that often are complicated by infections or exacerbations. Many patients with terminal illnesses choose palliative care to relieve symptoms, improve the quality of their lives, and strive for a peaceful death. Professionals who serve dying patients need to recognize the importance of advance directives as part of a patient’s decision to forgo curative treatment for palliative care.

Objectives. SOLACE™ (Supporters of Life-Affirming Care at End of Life) is a coalition of interdisciplinary professionals in the northern Virginia community dedicated to improving end-of-life care. The objectives of the SOLACE survey were to identify and describe: 1) professionals’ perceptions about barriers related to hospice and palliative care, 2) professionals’ opinions about barriers related to dying at home, 3) professionals’ perceptions about barriers related to advance directives, and 4) relationships between professionals and their perceived barriers to advance directives and hospice and palliative care.

Methods. From several consultations with hospice experts, a survey questionnaire was developed to solicit responses from professionals on palliative care, dying at home, and advance directives. Measures that assessed obstacles to palliative care were modified from previous studies to yield composite barrier scores. From a sample of a variety of participants at a national conference on palliative care (n = 200), 101 subjects returned questionnaires (51 percent) yielding 100 usable completed forms from attendees who demonstrated an interest in palliative care and, in some cases, a high level of personal or professional experience. Survey results were analyzed on respondents’ perceptions concerning barriers related to advance directives and the delivery of palliative care.

Results. Of the 13 obstacle statements, results show that respondents rated the top three barriers as 1) physician reluctance to make referrals (mean = 4.23), 2) physician lack of familiarity with availability and suitability of hospice (mean = 3.93), and 3) association of hospice with death (mean = 3.93). There was a statistically significant difference in scores for respondents from hospitals and respondents from hospices on their assessment of barriers for the association of hospice with death (t = -2.09, p < .05) and the lack of information about the severity of or irreversibility of the patient’s illness (t = -2.78, p < .01).
Patient speaking: Hospice patients discuss their care
Authors: Pevey Carolyn
Published: May 2006

Much research examines the effects of hospice assistance on the primary caregivers of hospice patients, but very little systematic research has investigated the perceptions of hospice patients themselves of the care they receive. This researcher asked 38 hospice patients whether and how hospice provided comfort, allowing the patients to guide discussion of services. Patients reported that hospice helped them by providing human contact, allowing open discussion and communication with other health professionals, providing assistance with tasks they could no longer do for themselves, and providing physical measures to alleviate discomfort.
The use of metal or plastic needles in continuous subcutaneous infusion in a hospice setting
Authors: Abbas Syed Qamar , Yeldham Margaret , Bell Suzanne
Published: May 2006

Objectives. Battery-driven portable syringe drivers are a convenient method for administering many drugs by continuous subcutaneous infusion (CSCI) to patients who cannot swallow medications. At the St. Clare Hospice, nurses usually use plastic needles to minimize needlestick injury but sometimes have patients transferred to metal needles. This study retrospectively examines this practice and its effectiveness.

Methods. The duration of audit was four months. During this period, there were 40 patients (23 women, 17 men), who required their medications delivered by CSCI. A total number of 74 sites were used. Metal or plastic needle CSCIs connected with one-hour release Graseby ® Syringe Drivers were used. The syringes were set to deliver 2 mm/hour. The maximum volume syringe used was 50 ml. The data were collected retrospectively.

Analysis and results. Sixteen patients (21.6 percent) developed minor complications (13 plastic, three metal). Among them, 16 showed inflammation. Two patients (3.5 percent) showed slight bleeding. Only one patient (1.7 percent) showed local infection (metal). In 14 patients (18.9 percent), the needle was reinserted due to various reasons, including needles pulled out by patients or needles falling out due to unknown reasons. There were no needlestick injuries reported, and the staff members reported that all problems encountered were easy to identify and resolve.

Conclusion. Plastic needle CSCI prevents needlestick injury and gives minimum distress to the patients. More research is needed to determine the local side effects of drugs used and the strategies to resolve these problems.
Central nervous system aspergillosis in an immunocompetent patient: Cure in a hospice setting with very high-dose itraconazole
Authors: Palanisamy Akilesh , Chao Stephanie D. , Fouts Michelle , Kerr Derek
Published: May 2006

Aspergillosis of the central nervous system (CNS) is a rare condition with exceedingly high mortality. This study describes the case of an immunocompetent 42-year-old man with a history of intravenous drug use and hepatitis C who developed multiple Aspergillus lesions in the cerebellum. Despite neurosurgery and antifungal therapy with amphotericin B, he had a protracted hospital course with multiple complications, eventually developing cognitive and motor impairment due to progressive cerebellar lesions. After transfer to hospice and palliative care service, oral itraconazole was escalated to 1600 mg/day with the hope of palliating headache, nausea, and cognitive impairment. Remarkably, the patient stabilized and improved over time. After 14 months, this unprecedented high-dose regimen was discontinued, and the patient was discharged home with only mild cerebellar motor impairment.
The Florida Clergy End-of-Life Education Enhancement Project: A description and evaluation
Authors: Abrams David , Albury Sonya , Crandall Lee , Doka Kenneth J. , Harris Robert
Published: May 2006

The Florida Clergy End-of-Life Education Enhancement Project was a model program developed to provide an interdenominational and statewide model of clergy education on loss, grief, dying, and death. The authors describe the project including materials and curriculum as well as present data from the project’s evaluation.

Clergy and their partners in ministry responded enthusiastically to the project. As a whole, they reported higher levels of knowledge on end-of-life (EOL) issues at the conclusion of the training. Clergy and their ministerial teams also reported that they were better informed about the technical, procedural, medical, and legal issues that arise at the end of life and expressed the desire for subsequent training. The project indicates that clergy both recognize the need for additional training and are anxious to improve their abilities to minister to the dying and bereaved. The model presented here could easily be applied to local organizations such as hospices or denominational training.
Palliation of heart failure
Authors: Davis Mellar P. , Albert Nancy M. , Young James B.
Published: May 2006

Heart failure is the major cause of morbidity and mortality in the United States. Stage D heart failure has a greater mortality rate than many cancers and has equivalent symptom burden and severity. There has been a paradigm shift in our understanding of the pathophysiology of heart failure. Progressive heart failure is associated with ventricular remodeling and a maladaptive neurohumoral response. Drug classes have evolved that curtail ventricular remodeling, and blunt neurohumoral responses reduce morbidity and mortality. Despite combination drug and device therapies, the management of Stage D heart failure includes palliation. Both cardiology and palliative specialists need to learn from one another in order to palliate these highly symptomatic patients. Such collaboration will enhance care and are the basis for well-conceived research trials.
Methadone for cancer pain: What have we learned from clinical studies?
Authors: Soares Luiz Guilherme L.
Published: May 2006

The analgesic ladder guideline proposed by the World Health Organization has been shown to be effective in controlling cancer pain in about 80 percent of patients, but the remaining 20 percent still experience pain. Several strategies have been used to manage refractory cancer pain and opioid toxicity. Switching opioids, alternative routes of opioid administration, optimizing adjuvants, and invasive procedures are proposed treatments. Extensive medical literature corroborates each one of those treatments. Rotation from one opioid to another is a noninvasive strategy to overcome opioid side effects and refractory pain. Frequently, methadone is used during opioid rotation. However, there is a lack of consensus on how to proceed on rotation from morphine to methadone. In the current era of evidence-based medicine, the medical literature fails to answer some cancer pain-management issues. The purpose of this review is to clarify a process for transitioning from morphine to methadone.
Oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients: An overview of its pharmacological and clinical characteristics
Authors: Mystakidou Kyriaki , Katsouda Emmanuela , Parpa Efi , Tsiatas Marinos L. , Vlahos Lambros
Published: May 2006

Breakthrough pain is a transitory flare of pain occurring in most cancer patients against a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate (Actiq ® , Cephalon, Inc., West Chester, PA), a new opioid formulation with a unique delivery system, reflects the characteristics of breakthrough pain (rapid onset of action and short duration), making it an effective treatment for cancer patients who already receive opioids and experience flares of pain. This review article aims to present the role of oral transmucosal fentanyl citrate in the management of breakthrough pain in cancer patients. In particular, it is going to discuss the synthesis, clinical pharmacology, pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent.
The needs of children with life-limiting conditions: A healthcare-provider-based model
Authors: Donnelly James P. , Huff Susan M. , Lindsey Michael L. , McMahon Kathy A. , Schumacher J. Donald
Published: May 2006

Pediatric hospice and palliative care has progressed in recent years with the development of new programs and models of care. Missing from the empirical literature, however, is a model of the needs of children. The purpose of the present study was to develop an empirically based conceptual model of the needs of children with life-limiting conditions. Recognizing the value of both qualitative and quantitative data, concept mapping methodology was selected as an effective way to obtain data that reflected both the “big picture” and subtleties of pediatric endof-life needs. The seven-cluster concept map appeared best in terms of both interpretability and parsimony. This model includes the following clusters of needs: 1) pain, 2) decision making, 3) medical system access and quality, 4) dignity and respect, 5) family-oriented care, 6) spirituality, and 7) psychosocial issues. We believe that the development of a comprehensive model of the needs of such children is a step toward concrete, measurable, and effective support for children and their families.
Predictors of social service staff involvement in selected palliative care tasks in nursing homes: An exploratory model
Authors: Lacey Debra
Published: May 2006

Little research has been conducted on nursing home social service staff and end-of-life care in nursing homes. To address this gap, a cross-sectional study on end-of-life issues for people with dementia in nursing homes was conducted in New York State, in which 138 nursing home social service staff participated. This exploratory study examined issues such as perceived confidence, perceived influence, and demographic variables in relation to self-reported frequency of tasks related to palliative care of nursing home residents with dementia. Results showed that participants in this survey who discussed specific treatment issues during advance directive discussions perceived themselves to have higher degrees of influence in their respective facilities, were directors or managers of their departments, and were more likely to engage in tasks related to palliative care.
Management of constipation in palliative care patients undergoing opioid therapy: Is polyethylene glycol an option?
Authors: Wirz Stefan , Klaschik Eberhard
Published: May 2006

This study assessed the efficacy of laxative use for treatment of constipation in patients receiving opioid therapy, with special attention to polyethylene glycol 3350/electrolyte solution (PEG-ES). Computerized data from 206 patients were analyzed using descriptive statistics. Subgroups were analyzed using confirmatory statistics. Constipation occurred in 42.7 percent of patients. Laxatives were administered to 74.3 percent of these patients using a standardized step scheme, with good results in 78.4 percent. As a therapy for constipation, the combined administration of PEG-ES, sodium picosulphate, and liquid paraffin proved most effective, although statistical analysis yielded no significance. Early use of PEG-ES using a step scheme holds promise for treatment of opioid-related constipation in palliative care patients, although further investigation is warranted.
Sedation and Analgesia-Prescribing Patterns in Terminally Ill Patients at the End of Life
Authors: Vitetta Luis , Kenner David , Sali Avni
Published: May 2006

The extensive use of sedative and analgesic medication at the end of life is often controversial due to the perception that death may be hastened as a result of progressive drug escalation. Physician attitudes toward prescribing medication in this setting vary, resulting in widely differing prescribing patterns for patients with advanced cancer. This investigation attempted to identify overall prescribing patterns and variation in the use of sedation and analgesia in an inpatient hospice setting at the end of life. A retrospective case review was undertaken of 102 consecutive patients who died in a palliative care hospice. A detailed review of medication prescription, with particular attention to sedation and analgesia in the last week of life, was performed. The review revealed that regular sedation was prescribed in 68 percent of the patients. Almost two-thirds of the patients began regular sedation on admission or within seven days of admission. Although survival was higher in patients who received regular sedation (mean, 36.5 days) versus those that did not (mean, 17 days), the difference was not significant (p = 0.1). Overall, regular sedation with moderate dose increases was observed. In patients prescribed morphine from the time of admission, morphine oral equivalents increased from a mean of 111 mg on admission to a mean of 346 mg at time of death for a mean escalation of 311 percent. The mean duration of admission was 26 days with an opioid-escalation index of 12 percent per day. Survival is a multifactorial phenomenon and was unrelated to the level of analgesia in this cohort. Findings showed that sedation dose increased modestly toward the end of life, and that the increase was not associated with a significant reduction in survival. Further, there was no significant impact on survival related to an individual physician's prescribing pattern at the end of life. These results suggest that, in the institution where the review was conducted, neither sedation nor individual variation in physician prescribing habits in terminally ill patients was associated with hastening of death. Overall, the amount of sedative drugs required for adequate symptom control during terminal care was moderate.
Tactical reframing to reduce death anxiety in undergraduate nursing students
Authors: Mooney Deborah C.
Published: May 2006

The effectiveness of a death education program in reducing death anxiety in Australian undergraduate nursing students was examined. The experimental group (n = 97) participated in a death education program conducted over a 13-week period. The comparison group (n = 122) included undergraduate students at the same academic level who had enrolled in a health-science program of similar structure, design, and duration as the death education program. No subjects in the comparison group had previously participated in a death education program. All participants were pre- and post-tested using the revised Collett-Lester Fear of Death Scale. Post-test analysis indicated that the 13-week death education program was effective in decreasing death anxiety.
Control and end-of-life care: Does ethnicity matter?
Authors: Volker Deborah L.
Published: May 2006

Patient control and autonomy are core values in Western bioethics and important components of end-of-life (EOL) care. However, the centrality of the patient as decision maker may not be relevant to culturally diverse groups of people. The purpose of this article is to present results of a literature review of patient control and ethnicity within the context of EOL care. The review revealed that the interplay between control and ethnicity in EOL care is complex and unpredictable. Implications for clinical care and future research are presented.
Systemic radionuclide therapy in pain palliation
Authors: Liepe Knut , Runge Roswitha , Kotzerke Jörg
Published: May 2006

Several radiopharmaceuticals were investigated to determine their efficacy and toxicity in the palliation of painful bone metastases. Data on the influence of rhenium-188 hydroxyethylidene diphosphonate ( 188 Re-HEDP), rhenium-186 hydroxyethylidene diphosphonate ( 186 Re-HEDP), and strontium-89 ( 89 Sr) on pain symptoms, quality of life, and bone-marrow function were obtained in 64 patients with breast and prostate cancer. Thirty-one patients were treated with 188 Re-HEDP (3194 ± 387 MBq), 15 patients with 186 Re-HEDP (1358 ± 158 MBq), and 18 patients with 89 Sr (152 ± 19 MBq). The 188 Re-HEDP group included six breast cancer patients and 25 prostate cancer patients; the 186 Re-HEDP group included three breast cancer patients and 12 prostate cancer patients; and the 89 Sr group included three breast cancer patients and 15 prostate cancer patients. All subjects participated in an interview using a standardized sets of questions before and after the 12-week term of therapy. Blood counts were taken weekly for six weeks and after 12 weeks. Results showed that 77 percent of patients reported pain relief after treatment with 188 Re-HEDP, 67 percent after treatment with 186 Re-HEDP, and 72 percent after treatment with 89 Sr. Sixteen percent of patients treated with 188 Re-HEDP, 13 percent treated with 186 Re-HEDP, and 17 percent treated with 89 Sr were able to discontinue their analgesics and were pain-free. Patients described an improvement on Karnofsky performance status (KPS) from 73 ± 7 percent to 85 ± 8 percent 12 weeks after 188 Re-HEDP (p < 0.05), from 72 ± 13 percent to 79 ± 12 percent after 186 Re-HEDP (p = 0.251), and from 62 ± 14 percent to 69 ± 16 percent after 89 Sr (p = 0.415). Only three patients undergoing 188 Re-HEDP therapy, one undergoing 186 Re-HEDP therapy, and three undergoing 89 Sr therapy had thrombocytopenia (platelet count below 100 × 10(3)/µl) following treatment. The maximum nadir of platelet and leukocyte counts was observed between the second and fifth week after treatment for all radionuclides and was reversible within 12 weeks. The nadir was earlier for 188 Re-HEDP with a shorter physical half-life compared with 89 Sr. There were no significant differences in bone marrow toxicity (p = 0.123-0.421). Results of this study indicate that all evaluated radiopharmaceuticals were effective in pain palliation without induction of severe side effects. The increase in KPS after 188 Re-HEDP was the only statistically significant finding (p = 0.001).
Hispanic access to hospice services in a predominantly Hispanic community
Authors: Adams Carolyn E. , Horn Kathryn , Bader Julia
Published: May 2006

Although the largest minority population in the United States, Hispanics are under-represented in hospice at the national level. The study purpose was to document Hispanic access to hospice services in an environment where Hispanics are a majority population. The framework for the study was Aday and Anderson’s model for access to medical care. In this framework, access is not defined as availability of services and resources, but whether services are actually used by the people who need them. We completed retrospective chart reviews of 500 Medicare beneficiaries who died in four hospices. Study variables were decedent characteristics and access to hospice and hospice disciplines. Results showed that Hispanics and whites differed on characteristics known to influence access to health services, e.g., preferred language and type of caregiver. Although the proportion of Hispanic elders dying in hospice was less than the proportion living in the community, the proportions of Hispanic elders who died in the community or died in their homes were not different from the proportion that died in hospice. When access to hospice disciplines was compared between Hispanic and white decedents, the results showed one difference—more whites than Hispanics had access to volunteer services. Overall, the study showed that Hispanics were not underrepresented in hospice, and they had equal access to hospice disciplines. These findings differ from national data and may be associated with Hispanics being the majority population in the community. To learn how population dominance influences minority access to services, Hispanic access to hospice could be studied in locales with varying proportions of Hispanics in the population.
Deathbed phenomena and their effect on a palliative care team: A pilot study
Authors: Brayne Sue , Farnham Chris , Fenwick Peter
Published: May 2006

Anecdotal evidence suggests that death may be heralded by deathbed phenomena (DBP) such as visions that comfort the dying and prepare them spiritually for death. Medical practitioners have been slow to recognize DBP, and there has been little research into the spiritual effect that DBP have on caregivers or on how these phenomena influence their work. A pilot study looking into the occurrence of DBP was conducted by the palliative care team at Camden Primary Care Trust. Interviews revealed that patients regularly report these phenomena as an important part of their dying process, and that DBP are far broader than the traditional image of an apparition at the end of the bed. Results of the interviews raise concerns about the lack of education or training to help palliative care teams recognize the wider implications of DBP and deal with difficult questions or situations associated with them. Many DBP may go unreported because of this. Results of this pilot study also suggest that DBP are not drug-induced, and that patients would rather talk to nurses than doctors about their experiences.
Screening the soul: Communication regarding spiritual concerns among primary care physicians and seriously ill patients approaching the end of life
Authors: Holmes Seth M. , Rabow Michael W. , Dibble Suzanne L.
Published: May 2006

The purpose of this study was to explore the spiritual concerns of seriously ill patients and the spiritual-care practices of primary care physicians (PCPs). Questionnaires were administered to outpatients (n = 65, 90 percent response rate) with end-stage illness and to PCPs (n = 67, 87 percent response rate) in a diverse general medicine practice. Most patients (62 percent) and PCPs (68 percent) considered it important that physicians attend to patients’ spiritual concerns. However, few patients reported receiving such care, and most (62 percent) did not think it was the PCP’s job to talk about spiritual concerns. Although both seriously ill outpatients and PCPs assert the importance of spiritual concerns, PCPs often do not provide spiritual care. Appropriate provision of spiritual care within a diverse population of seriously ill outpatients is complex, necessitating appropriate and attentive screening.
Urban and rural differences in end-of-life pain and treatment status on admission to a nursing facility
Authors: Bolin Jane Nelson , Phillips Charles D. , Hawes Catherine
Published: May 2006

Individuals receiving end-of-life (EOL) care may have needs that are unrecognized or treated inappropriately. Yet, very little is known about differences in pain and special-care needs of EOL patients admitted to rural nursing facilities compared with urban nursing facilities, and whether the differing payer mix in urban and rural facilities affects the treatment ordered on admission. We examine a nationally representative sample of 6,084 EOL patients upon admission to nursing homes to examine differences in diseases, pain assessments, and treatment orders. We found that rural EOL residents have higher rates of congestive heart failure, cancer, renal failure, and emphysema than urban EOL residents and are significantly more likely to report frequent pain, however, they are less likely to receive treatments such as IV medications, dialysis, and wound care.
Hospice and the family: A systems approach to assessment
Authors: Gordon Audrey , Rooney Anne
Published: May 2006

...in afew days this whole...ideal Rusanov family with two older and two younger children, with their completely well-ordered life and their spotless apartment, unstintingly furnished had receded until it had vanished on the other side of the tumor. No matter what happened to the father, they were alive and wouldgo on living. No matter how they might worly, exhibit concern, or weep now, the tumor had divided him from them like a wall, and he remained alone on this side of it.
Professional isolation in oncology and hospice care
Authors: Blanchard Christina G. , Osborn Betsy J. , Dick Edward , Kelty Thomas
Published: May 2006

Four social workers in hospice and oncology settings in Albany, New York formed a support group to deal with mutual problems of professional isolation, role definitions, relationships, and the stresses of working with dying patients and their families. The development, goals, and accomplishments of the group are described.
Helper secrets: invisible stressors in hospice work
Authors: Larson Dale G.
Published: May 2006

The demanding and emotionally complicated nature of hospice and oncology work can lead to self-doubts and other embarrassing and distressing thoughts and feelings about oneself as a helper. These troubling thoughts and feelingsfornithe core of helper secrets. This article presents an exploratory analysis of helper secrets gathered from 200 hospice workers. Factors contributing to the development, persistence, and stressful nature of helper secrets are discussed. Staff support groups and strengthened social support networks are recommendedas antidotes to these invisible stressors.
Helping parents whose child has died
Authors: Dorsel Sue J. , Dorsel Thomas N.
Published: May 2006

This literature review focuses on the reactions of parents and those around them following the death ofa child. Various coping strategies and alternatives for support are explored with a special emphasis on selfhelp groups.
Infection control at home
Authors: Lusby Grace , Martin Jeannee Parker , Schietinger Helen
Published: May 2006

By early 1986, over 16,000 people had been diagnosed with AIDS in the United States. It has been estimated that between 5percent and 15 percent of these are hospitalized at any given time. Of the 80 to 95percent who are living at home, some are experiencing few symptoms and independent in their activities of daily living. However, approximately 20 to 25 percent of those living at homeexperience chronicor acute symptoms associated with AIDS, requiring intervention by the home team. Home care agencies throughout the country have provided services to people with AIDS in the home utilizing basic, standard precautions for infection control.

This article will provide information regarding disease transmission, both to allay the anxieties of homecare personnel concerned aboutworking with AIDS patients, and to enable them to utilize appropriate precautions to prevent the transmission of AIDS and the associated opportunistic infections.
Hospital utilization of laboratory tests, procedures, and special therapies
Authors: Smith Shirley Ann Newell , Veglia Jeanne M.
Published: May 2006

One area ofhospice which would reflect both cost containment and integrity of palliative philosophy would be the volume of lab tests, procedures, and special therapies utilized. One major study found that in most areas, including utilization, there were no differences between hospice and non-hospice, and yet there is much in the literature about hospice savings due to diagnostic tests and life saving proceduresnot being done. The purpose of this study was to compare the utilization patterns betweenhospiceand non-hospice subjects in the same setting. It wasa retrospective study utilizing the medical records of hospice (n= 53) and non-hospice (n= 50) terminalcancer patients over a one year period. Though not randomized, it was found the two groups were closely matched by age, care days, number of subjects, and diagnosis. The hospice group had significantly less utilization (p .001) in all of the three categories being evaluated. The mean number of diagnostic tests for hospice patients was .94 and forthe non-hospice, 34.98. All ofthe non-hospice patients had at least one test performed while 75.5 percent of the hospice patients had no tests. Further studies are needed to define cost effectiveness, and others to compare level of utilization to quality of life.
Humor and death: you've got to be kidding
Authors: Klein Allen
Published: May 2006

The “serious business” of death is considered by many to be no laughing matter. However, humor can be an outstanding coping and communication tool in the dying process as well as a valuable asset fordealing with our own death anxieties, the death of others, and our ensuing grief. Clues for viewing deaththrough a lighter pair of spectaclescan be had by turning to the comedic arts, other ethnic cultures, and various religions. Comedian Woody Allen, the Balinese, the Tiwi, Zen, and Judaism are among the sources cited.
Volunteer Involvement in a Hospice Care Program
Authors: Seibold David R. , Rossi Sharon M. , Berteotti Carol R. , Soprych Sharon L. , McQuillan Lucas P.
Published: May 2006

This paper reviews research findings concerning: volunteers' characteristics and motives for assisting in hospice programs; selection and training of volunteers; volunteers' hospice activities and their satisfaction with involvement in hospice; volunteers' support systems; and reasons for turnover among hospice volunteers. Within the context of this review, the results of an evaluation surveying 156 former and current hospice volunteers are reported. Implications and limitations of the findings are discussed.
Hospice at the Crossroads
Authors: Sherman Lawrence M. , Finn William Edward
Published: May 2006

The Medicare regulations for hospice haveallowedthe development of two types of programs. The physician-supervised model, in which the hospice provides a physician to oversee a general program with no requirement of his direct involvement with patient care. The second model is physician-directed, where the care of the patient is assumed by the hospice physician. This report reviews the implications of each model with an examination of their benefits and disadvantages. It is our feeling that the physiciandirected modelof hospice care has so many advantagesto this movement that it should be favored.
Compassion, conviction, commitment
Authors: Korda Lois
Published: May 2006

Burnout in hospice personnel may result in a significantly impaired quality of care. A search of the literature has been cornbined-with the results of clinical observations to identify a number of factors conducive to the development of burnout. It is suggested that consideration be given to examining the concepts of compassion, conviction, and commitment, and that appropriate interventions be implemented to prevent these requisites for quality caregiving from paradoxically becoming key contributors to burnout.
Hospice administration
Authors: Olson Sharon L.
Published: May 2006

Hospices can be said to be evolving through their own life cycle. This involves four stages with indicators within each stage that include motivation, leadership, and community involvement. Effective leadership in hospice requires that individuals assuming an administrative role also be aware that caution is needed at both the administrative and self-care levels in each stage. To remain viable, hospice programs must keep pace with and anticipate the “inevitable change” that will occur in the hospice life cycle.
Spirituality and the caregiver
Authors: Millison Martin B.
Published: May 2006

Spiritual aspects of care with the terminally ill has been rarely discussed in professional literature. To many caregivers, the notion of anything spiritual signals a referral to a chaplain rather than an exploration between caregiver and patient.

In order to examine the role that spirituality plays for caregivers, eight professionals working with the terminally ill were interviewed. The common thread found in all the interviews was the heightened spirituality experienced by the caregivers as a result of their work with the terminally ill, and the impact that it has upon the patient. All caregivers felt they received more from their patients than they were able to give.
Perceptions and services of hospice volunteers
Authors: Hughes Marsha Magnusen
Published: May 2006

This study was conducted to determine how hospice volunteers perceived the needs of the patients and caregivers they served and to identify what services the volunteer provided. This study also explored families willingness to utilize volunteers, how the volunteers felt about various issues, and demographic and personal variables. A total of 185 questionnaires were distributed to four hospice sites in northeastern Wisconsin and 70 percent were returned.
Hospice volunteer turnover
Authors: Brichacek Glenn B.
Published: May 2006

Descriptive data on volunteer turnover were collected from inactive volunteersat afull hospiceprogram in the Midwest. Twenty-four inactive volunteers (85 percent female, mean age45.25) responded to a checklist of reasons for volunteer turnover developedfrom literature on volunteer turnover. Reasons were coded according to two categories: administratively uncontrollable and controllable. Frequency distributions and percentages were tabulatedfor the data. Volunteers reported 46 reasons that were coded administratively uncontrollable (74.3 percent) and 16 reasons that were potentially controllable (25.7percent). Fifteen volunteers (62.5percent) considered themselves temporarily inactive with plans to return to active service. The use of turnover data in the evaluation of the volunteerprogram is discussed.
Contribution of occupational therapy to pain management in cancer patient with metastatic breast disease
Authors: Lloyd Chris , Coggles Laura
Published: May 2006

Many patients with advanced cancer experience pain. Successful pain managementcan be achieved through the coordinated efforts ofthe members of the cancer care team. Multiple methods of treatment need to be employed. Occupational therapy is a vital service in pain management. Its focus is both on modifying the perception of pain and on modifying the individual's lifestyle.
The rectal administration of MS Contin®: Clinical implications of use in end stage cancer
Authors: Maloney Catherine M. , Kesner R. Kaye , Klein Gloria , Bockenstette Judith
Published: May 2006

Mercy Hospice in Nampa, Idahoadministered unmodified MS Contin 30 mg tablets rectally to 39 terminally ill patients. All patients hadpain controlled on oral MS Contin but were switched to the rectal route of administration because of intractable nausea, inability to swallow or both. Pain control was maintained on all patients receiving rectal MS Contin. In 11 patients, the dosage of MS Contin was decreased. No local or systemic adverse reactions developed. The rectal administration is a safe, effective and simple means ofmaintaining pain control in terminally ill patients.
The attitudes and experiences of families with death determination in the home
Authors: Critz Susan H.
Published: May 2006

The purpose of this study is to describe the attitudes and experiences of family members with respect to death determination practices for the terminally iii clients of home care agencies. A sample of family 53 members in Southeast Michigan returned survey questionnaires. The findings indicate that police and emergency medical technicians most frequently respond to the call when a person with a terminal illness has died. Fifty percent of the family members reported feeling sad, 35 percent reported feeling relieved and 18 percent of the respondents felt angry about the arrival of multiple personnel. Feelings of anger were signficantly associated with the absence of a nurse at the time of death, the use of lights and sirens, disrespectful personnel and the arrival of multiple personnel. Feelings of anger were also significantly associated with continuing thoughts of the day of death by family members. Results suggest the need to rethink state and local laws in regard to death determination and to educate those most likely to respond to families sensitively. Home care agencies and hospices should also encourage attendance by nurses at the time of death.
Trusting the hospice nurse
Authors: Eberhardt Gary , Duldt Bonnie Weaver
Published: May 2006

The purpose of this study was to determine what it is about nurses that elicits trust in the perception of primary care-givers. Participants (N = 32) responded to a questionnaire, “Patient Trust and Nursing Behaviors,” that identifies a variety of descriptors about trust promoting behaviors of nurses. The behaviors identified can readily be learned by nurses and are believed characteristic of humanistic communication patterns of interaction or skills and attitudes as proposedby Humanistic Nursing Communication Theory.
The dental hygienist as a hospice care provider
Authors: Brown Jessie O. , Hoffman Lois A.
Published: May 2006

The hospice concept focuses on the interdisciplinary team approach to providing palliative care for the terminally ill patient. Although oral conditions resulting from the patient's disease and treatment are frequently encountered in hospice patients, dental personnel have not traditionally been recognized as members of the interdisciplinary hospice team. This paper presents a model which incorporates a dental hygienist into the hospice team. We suggest that the roles of the dental hygienist are educator, dental consultant, and primary care provider.
Care-givers' support group: One hospice's approach
Authors: Bylewski Christine M. , Beardi Linda Y. , O'Brien-McKenna Ann M. , Thomas Shirley L.
Published: May 2006

The Care-givers' Support Group has been a successful intervention in helping hospice family members work through the numerous emotional tasks with which they are faced in the dying process and in bereavement. This paper focuses on the significance of a support group setting as illustrated through case studies of hospice families.
Recognizing the role of the physical body in palliative care
Authors: Bilderback Barbara
Published: May 2006

A goal ofhospice care is to help the terminally ill live most fully while dying. Health care professionals must appreciate the role ofthephysical body inpalliative care. This article identifies reasons we may hold mixed views about the body's worth and discusses relationships between the body and the human symbols of earth, air, fire, and water. These relationships suggest interventions which support the mind! body/spirit integrationwhich is beneficialfor dying persons.
A profile of Canadian hospital-based palliative care
Authors: Hudson J. Edward
Published: May 2006

This article describes the characteristics of hospice-based palliative care programs in Canada, based on a sampling of respondents, teams, programs, and hospitals. This report is an outgrowth of a study of social services in Canadian, hospital Based palliative care programs. One hundred eighty-five hospitals were polled between December 1987 and March 1988, using a mailed-out questionnaire. One hundred sixty programs replied, a response rate of 86.5 percent. Replies from 81 persons working in 79 programs were chosen for data analysis. Calculation of percentages and correlations for certain independent (sub)variables, along with consideration of some replies to open ended questions, yields a limited sketch of Canadian hospital based palliative care in the late 1980s. Funding of hospital-based palliative care in Canada, as elsewhere, remains an on-going and limiting concern.
Grief has no color
Authors: Kuntz Barbara B.
Published: May 2006

A black adolescent from the inner city explores his grief after his father's death through a bereavement group facilitated by a white middle class female nurse therapist.
AIDS and hospice
Authors: von Gunten Charles F. , Martinez Jeanne , Weitzman Sigmund A. , Von Roenn Jamie
Published: May 2006

Which AIDS patients should be admmited to hospice programs? Many health care professionals feel that any anti-viral drug or treatment directed against the opportunistic infections characteristic of AIDS to be incompatible with hospice philosophy. Others argue that inclusion of AIDS patients blurs the distinction between hospice and community service programs. We argue that achieving consensus on this issue is best served by focusing on the defining characteristic of hospice programs — the care of the dying. Consensus is not served by dwelling on the specific palliative or supportive measures used to achieve the hospice goal. We suggest a framework by which AIDS patients may be accommodated in existing hospice programs while maintaining hospice program integrity. It is further suggested that these may be used for the consideration of any patient for hospice care.
Using a community networking approach in a bereavement program
Authors: Harding Deborah Jean , Southern John
Published: May 2006

This paper reviews the history of St. Anthony's Hospice and Life Enrichment Program. St. Anthony's provides bereavement counseling and death education to the community using a networking approach involving the educational, religious, social, and mental health organizations in the area. At present, this model features a church satellite program, grief recovery and anticipatory grief seminars, on-going bereavement support and social support groups, volunteer speakers' bureau, a volunteer staffed bereavement team, and training of psychology, nursing, and medical students.
A qualitative retrospective study of coping strategies of newly widowed elderly
Authors: Hegge Marge
Published: May 2006

Findings of a qualitative retrospective study ofcopingstrategies ofnewly widowed elderly are presented. The focus is on effects ofanticipatory grieving on the caregiver before the spouse's death as reported by the widowed partnerfollowing the death. Mostfrequent and troubling problems were reportedasloneliness, social isolation, disruption in eating and sleeping patterns and independent decision making. Changes in health status following the death were not asdetrimental as expected. Caregivers' health actually improved when those responsibilities were over. Recommendations for hospice care for the caregiver are suggested.