bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceptions of the most helpful nursing behaviors in a home-care hospice setting: Caregivers and nurses
Authors: Ryan Patricia Y.
Published: May 2006

The purpose of this study was to determine those nursing behaviorsperceived as most helpful and least helpful by primary caregivers and by hospice nurses in a home-care hospice setting. A Q-sort of 60 nursing behaviors rankedfrom most to least helpful was completed by 20 caregivers, during the bereavement period and by five hospice nurses, who were currently employed by the hospice. These nursing behaviors were categorized as: • Nursing behaviors related to the patient's physical needs; • Nursing behaviors related to the patient's psychosocial needs; and • Nursing behaviors related to the psychosocial needs of the caregivers.
Prospective payment and the Medicare Hospice Benefit
Authors: Bloom Bernard S. , Amenta Madalon O’Rawe
Published: May 2006

The objective of this study was to determine the effects of very high cost patients on hospice financial status. Ten Pennsylvania hospices dually certified by Medicare were randomly selected and agreed to participate. Patient age, sex, diagnosis, length of stay and payer were fairly uniform across hospices. Payments varied by diagnosis and payer.

High cost patients were irregularly found in hospices; low cost patients were commonly and regularly distributed. Every hospice had at least one high cost patient. In one, the uncompensated payment for the 6.6 percent of patients defined as high cost ($7,300 and above) would have been 14.7 percent of total annual revenues. In another, uncompensated payments for high cost patients (9.8 percent) would have accounted for 17.2 percent of revenue. In 96.3 percent of the instances patients utilized less than the Medicare Hospice Benefit maximum allowable cost ($7,300); and, 98.8 percent of the time patients stayed less than the maximum allowable length of time of 210 days.

A logistic regression model found long length of stay (p < 0.0001), Medicare hospice benefit as primary payer (p <0.0001), any hospitalization during hospice stay (p < 0.003) and cerebrovascular disease diagnosis (p < 0.02) to be significantly related to high cost.

Between the time the study was planned and completed, Medicare instituted a reinsurance program allowing unused funds below the maximum allowable limit from one patient to be used for patients who exhausted their benefits. Thus, no study hospice was adversely affected by high cost patients. However, it should serve as an object lesson to Medicare in using prospective payment. A normal or near-normal distribution of patients by cost cannot be assumed for small institutions.
Is there congruence in hospice nurses’ view of their patients’ quality of life and their hospice patients’ view of their own quality of life?
Authors: Mueller-Marquez Barbara J.
Published: May 2006

Since the development of the hospice movement in the United States, care of the terminally ill has undergone vital change.’ This change involves the alternative of home care for the terminally ill. It allows the patients, the primary caregiver, and the rest of the family to be in control of care. As stated by Masters, 2 hospice is unique in that the patient and family controls the environment, and lifestyle, including treatment modalities, more than in any other concept in health care.

Hospice was developed to give people with a terminal illness an option to traditional medicine. Hospice is a concept of care that has been established to improve the quality of life of the terminally ill. Therefore, the ultimate goal of hospice care is to enhance the quality of life of patients with terminal illness, mainly cancer. 3

In the hospice setting, the nurse applies a holistic approach when planning and providing primary care. The nurse becomes increasingly more knowledgeable about the problems and strengths of the patient and family to whom he/she is caring for. The nurse must make the transition in her philosophy from cure-to-care in hospice, and symptom control being the nurses ‘priority in order to enhance the patients quality of life. Curtis and Fernsler4 explain that hospice care focuses on helping patients to communicate effectively and to share life agendas with their primary caregiver and the hospice nurse. These researchers continue to state that these efforts promote congruence between patient, primary caregiver, and the hospice nurses’ view of the patients quality of life. As a hospice nurse, I want to explore the relationship that the nurse has with his/her patients. Are hospice nurses and their patients viewing quality of life congruently? This paper provides a review of the literature concerning quality of life of the hospice patient and provides background information for future research.
Transcending life: The practice wisdom of nursing hospice experts
Authors: Zerwekh Joyce
Published: May 2006

In philosophy and theology, to transcend is to go beyond the limits of lived human experience. Hospice workers accompany people who are traveling beyond the limits.

“Whoever would be a companion to the dying, therefore, must enter into their darkness, go with them at least part way along their lonely and frightening road.”1

This paper explores the requisite hospice practice competencies of caring spiritually and guiding letting go, as identified in a qualitative analysis of the practice stories of 32 hospice nurse experts working with people nearing death.

Spirituality has been described as the essence of personhood, the longing for meaning in existence, experience of God, experience of ultimate values, and trust in the transcendent. Its ultimate end is union or connection with a reality more enduring than the individual self.2,3 In contrast, spiritual distress is manifested as alienation and disconnection.4 The reality of the dying process involves a progressive series of disconnections from life, which requires the process of letting go. Thus, transcending life involves both the need to detach and separate from life as it has been lived. One home visiting hospice nurse has described dying as a spiritual process of both reflecting and detaching.5

Nagai-Jacobsen and Burkhardt identify three goals of caring spiritually:

• Fostering personal integrity;

• Promoting interpersonal connection;

• Supporting personal search for meaning.6

O ‘Connor describes hospice spiritual care promoted through the practice of presence, compassion, hopefulness, and the affirmation of life as fruitful.7 Stiles has completed the only published qualitative description of hospice nursing as spiritual care.5 She asked 11 hospice nurses and 12 bereaved families to describe their hospice experiences, which were then analyzed to name dimensions of the nurse-family spiritual relationship. Many of these dimensions parallel those of the current study and will be discussed below.
Hospice are we a dumping ground?
Authors: Jonas Stanley
Published: May 2006

The enclosed article addresses a common attitude of many hospice organizations regarding the enrollment of patients still on life support systems. Many hospices refuse to take a patient unless all life sustaining apparatus has been removed prior to admission. I am attempting to create an appropriate ethical and humane attitude which will influence all hospices to willingly accept patients in the above situation, relying on a hospice physician to remove life supports.
Archetypal healing
Authors: Jones Devilen , Churchill John E.
Published: May 2006

With emphasis on healing versus curing, the authors draw from a wide assortment of treatment methods for psychospiritual relief of pain in the terminally ill. These archetypal methods include:

• Life-review therapy;

• Ministry of presence;

• Clinical hypnosis;

• Myths, symbols, rituals, and community;

• Creative therapies.

In life-review therapy, the ill per-son shares his/her life story with the provider much like the healing rituals of the ancient storyteller did in his community. In the ministry of presence, the caregiver focuses on sharing his vulnerability, not his professional skills. Clinical hypnosis emphasizes the naturalness and simplicity of accessing the unconscious along with problem areas of the hypnoclinician. Myths, symbols, rituals, and community serve as nurturing agents in the intervention of pain, while creative the rapies such as music, drama, crafts, and art continue to be powerful healing instruments.

Archetypal healing produces relief of pain in the care give, as well as the ill, with emphasis on healing versus curing.
Volunteer services
Authors: Craig Michelle
Published: May 2006

Hospice volunteers can be the link between professional staff and members of a family suffering the impending loss of a loved one. By helping with practical needs and providing emotional support, volunteers may serve a crucial role in the healing of the grieving family.
Severity index scores xscorrelate with survival of AIDS patients
Authors: Kinzbrunner Barry , Pratt Melanie M.
Published: May 2006

A major concern of hospices treating AIDS patients is survival prognosis. Patients are eligible for government hospice benefits only if they are in the last six months of life, but for AIDS patients who present at different disease stages, it is often difficult to predict survival. We have tested an index of AIDS severity developed by Alemi et al. (1991, Interfaces, 21(3), 105) for its ability to predict survival in hospice-AIDS patients. Using retrospective analysis of medical records, a severity index (SI) score was determined for 26 AIDS patients who were admitted at different disease stages to a South Florida hospice. The length of stay for each patient was also recorded. The patients fell clearly into two groups, those with stays of six months or less and those with stays of more than six months. The mean SI scores of the two groups were .9188 and. 7845, respectively. These scores were significantly different at the p=.005 level. In this preliminary study, the severity score correlated well with survival prognosis. Based on these results, it appears that the severity index may have great utility in predicting survival for AIDS patients seeking hospice admission.
Terminal dehydration: A review
Authors: Meares Candace Jans
Published: May 2006

Terminal dehydration is a naturally occurring condition which hospice nurses encounter daily. Although much has been written on this topic in recent years, a review of the literature will provide a summary of research and opinion which can form the basis for future research. This article covers the physiology, patient symptoms, and a discussion of the benefits of terminal dehydration. Ethical and legal issues have been clarified by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. A comparison of nurse and physician perceptions concludes the article. In order for nurses to provide anticipatory guidance for family/caregivers of the imminently dying, more must be known about family/caregiver perceptions of terminal dehydration.
The role of the hospice social worker in the nursing home setting
Authors: Amar Deborah F.
Published: May 2006

Data and case examples from two major metropolitan hospice programs are examined in order to arrive at a definition of the hospice social worker's role in the nursing home, and how it differs from that of the hospice social worker in home care. The nursing home population tends to be older, frailer, and with poorer mental status, making them less available to “talk therapies “. The nursing home environment itself needs to be assessed as a significant part of the patient/family system. Social work interventions may focus on the patient, the family, the nursing home staff, or any combination of these elements. The hospice social worker on a nursing home team may do less counseling with patients, but the role draws on diverse other skills such as group work, negotiation, education, and advocacy.
Hospice care: Mapping the message
Authors: McCracken Scott , Colburn Kate , Pastorik Lisa
Published: May 2006

A study into the community image of Hospice of Central Iowa (HCI) was undertaken to guide the organization in making future decisions about its position in the health care market. Consumer perceptions are important if the hospice seeks steady growth in a market where potential consumers have an intense personal involvement with the service. Using a perceptual mapping technique, HCI was able to quantify and rank the importance of certain factors in influencing choice of a care setting for a terminally-ill person. It also enabled HCI to measure whether the message it had been promoting in its public relations activities was being received by consumers. The mapping techniques allowed HCI to compare how it is perceived with how other competitive health care providers, namely, hospitals, nursing homes and home health agencies are perceived by these same consumers. Finally, the technique offers information to the hospice as to the type of image development it must pursue to appeal to potential consumers making choices about care for terminally-ill people.
Factors affecting satisfaction among community-based hospice volunteer visitors
Authors: Chevrier Fiona , Steuer Roxanne , MacKenzie Jackie
Published: May 2006

Trained volunteers are an essential component in the delivery of care to clients and families facing a terminal and/or life-threatening illness. As the needfor hospice care increases, so does the need to increase the number of volunteers available for visiting. Hospice of London, which is a community based hospice, proposed that volunteers who felt satisfied would remain with the organization longer, thereby, decreasing the costs associated with training new volunteers and enhancing the ability of the agency to provide high-quality volunteer client matches. Accordingly, a survey was conducted in August 1992 to determine which factors were related to hospice volunteer satisfaction. One hundred and five volunteers were surveyed over the telephone. Results demonstrated a positive correlation between satisfaction and feeling like a team member receiving feedback from staff feeling valuable and having the volunteer’s expectations match the position. Differences in the factors related to satisfaction were noted when the groups were divided by age and gender.
Evaluation of pressure ulcer prevalence rates for hospice patients post-implementation of pressure ulcer protocols
Authors: Hanson Darlene S. , Langemo Diane , Olson Bette , Hunter Susan , Burd Christine
Published: May 2006

Hospice patients may be particularly at risk for pressure ulcer development due to several factors. Identifying populations at risk for pressure ulcer development, such as hospice patients, and providing prevention and risk protocols for these populations can substantially reduce the prevalence and incidence of pressure ulcers. However, are hospice patients prone for skin break-down despite prevention and treatment efforts? This study examines the prevalence of pressure ulcers in hospice patients following the implementation of pressure ulcer prevention and treatment protocols. Levine’s theory of conservation of structural integrity formed the theoretical frame work for this descriptive study. A midwestern hospital-based hospice agency was the site for this study. All patients 18 years of age and older were included in the study. Pressure ulcer prevalence audits were done at four, eight, 12, and 18 months after protocols were outlined by the hospice staff Results of the audits revealed prevalence rates of 14.8 percent, 8.5 percent, 13.6 percent, and 23.8 percent, at each of the aforementioned audits. 10 of15 patients who were pressure ulcer positive were males; the sacral location was most common (seven of 19 ulcers occurred sacrally) with the ischial location being the next common (six of 19 ulcers were ischially located). No ulcers occurred above the waist or in patients below 51 years of age. Recommendations from this study urge that particular prevention attention be given to protocols which address “sitting,” due to the predominance of ulcers located in the sacral and ischial regions. In addition, the author concludes that perhaps, pressure ulcers may occur in this population despite the best of efforts to prevent them.
The effect of intravenous fluid infusion on blood and urine parameters of hydration and on state of consciousness in terminal cancer patients
Authors: Wailer Alex , Hershkowitz Moshe , Adunsky Abraham
Published: May 2006

This prospective study was Undertaken to assess the state of hydration in terminal cancer patients with arid without intravenous fluids during the last 48 hours of their lives and to correlate various measures of hydration with their state of consciousness. We examined indicators of hydration in the plasma and urine of 68 consecutive patients for whom data were available at 48 hours or less before death. Thirteen of the patients were being treated with intravenous (IV) fluids. Nearly all of the patients studied were found to be dehydrated, as determined by laboratory measurements. State of consciousness correlated inversely with serum sodium (p<0.001) and urine osmolality (p<0.02). Patients receiving intravenous fluids were not better hydrated than those without IV therapy, nor was their state of consciousness improved. In light of these findings, which suggest there is no clinical benefit from intravenous infusions, decisions regarding intravenous fluid therapy during the last hours of life should be guided by the preferences of the dying patient and his family.
Midwifery to the soul while the body dies: Spiritual care among hospice nurses
Authors: Taylor Elizabeth Johnston , Amenta Madalon
Published: May 2006

Because attitudes and beliefs about spiritual care have been linked with spiritual caregiving practices in previous research among non-hospice nurses, and because little is known about hospice nurses’ attitudes and beliefs about spiritual care, this study explored such attitudes and beliefs among hospice nurses. Data were obtained from 641 Hospice Nurses Association members who completed the Spiritual Care Perspectives Survey and a demographic form. While respondents rather uniformly agreed that patients had spiritual needs and that it was appropriate for nurses to attend to such needs, attitudes about how a nurse should relate to patients’ spirituality were variable. Education and indicators reflecting personal religiosity were associated with these hospice nurses’ attitudes and beliefs about spiritual care.
High-tech pain management utilizing multiple analgesics—a case study
Authors: Pickett Rhonda R. , Secor Susan J.
Published: May 2006

Intraspinal delivery of opioids is a proven method of pain management therapy for severe cancer pain. Effective analgesiacan be achieved with spinal opioid infusions while minimizing central side effects such assedation, nausea, and severe constipation. Indications for intraspinal opioids include unmanageable side effects with increasing doses of oral or parenteral opioids or little or no pain relief with increasing dosages of strong opioids. The purpose of this case study is to illustrate the multidisciplinary approach required and multiple analgesics needed to effectively assess and manage a challenging pain management situation. This patient required the administration of intraspinal morphine, intravenous hydromorphone, and intravenous midazolam in order to effectively manage hispain. The use of spinal analgesia and multiple analgesics offers challenges to oncology and hospice nurses but is an effective modality for otherwise intractable cancer pain.
Stressors of hospice home care nurses caring for AIDS patients: A pilot study
Authors: Slone Marieann , Stephany Theresa
Published: May 2006

This exploratory study identified stressors of homecare hospice nurses caring for hospice patients with AIDS. Five hospice home care nurses provided data obtained from demographic questionnaires and semi-structured interviews. Results of this pilot study confirmed that experienced hospice nurses believe there is a difference between caring for AIDS hospice patients and non-AIDS hospice patients, and that nurses face increased stress when caring for AIDS hospice patients. Further research is needed to provide better care for the hospice patient with AIDS, and to acknowledge and respond to the increased demand on the nurses who care for them.
The benefits of beneficence: Rewards of hospice volunteering
Authors: Korda Lois J.
Published: May 2006

Hospice volunteering can provide many benefits to the volunteer as well as to the hospice program. identification of these benefits, which may be characterized as being of the body, mind, and spirit, is helpful in the recruitment of new volunteers as well as in the retention of current ones. it is important for hospice programs to find ways to assist volunteers to attain these rewards.
Children’s descriptions of their feelings and what they found helpful during bereavement
Authors: Lehna Carlee R.
Published: May 2006

Although clinicians have described the value of support groups in assisting children mourn the death of someone close, little is known about helping children with bereavement. By understanding what helps children mourn, nurses can better facilitate a healthy bereavement process. The purpose of this mini-ethnographic study, which used observation and participation procedures, was to identify what 16 children found helpful during their bereavement. Initially, the children’s expressions of feelings were demonstrated both verbally and through art work.

The patterns of the children’s emotions were labeled as affective distress, somatic complaints, and for the boys, disruptive behavior. The children then described their
Palliative care for patients with acquired immunodeficiency syndrome
Authors: Kemp Charles , Stepp Lisa
Published: May 2006

This article provides a clinically-oriented overview of palliative care for patients with AIDS. Indicators of decreased survival time are divided into categories of infections/illnesses, clinical signs and symptoms, immunological and serological markers, and psychosocial factors. Primary symptoms in AIDS are discussed according to etiology and treatment. However, treatments of opportunistic infections per se are not directly addressed in this article. Problems discussed include pain, confusion, depression and anxiety, fatigue, fever, dyspnea, nausea and vomiting, diarrhea, wasting, and dehydration. The article also briefly addresses clinical and ethical questions and challenges presented by AIDS to hospice or palliative care providers, and the various stages of HIV infection.
Developing family care plans: A systems perspective for helping hospice families
Authors: Knapp Elizabeth R. , DelCampo Robert L.
Published: May 2006

Although terminal care literature may address the importance of the family in the patient’s treatment, the family as a whole is seldom considered as the unit of care. A family system’s perspective can offer a more holistic approach to providing care to the terminally ill. In this paper, Rosen’s model of family system response to stress is adapted to provide a framework for understanding and helping hospice families. To as certain information critical to the development of a comprehensive care plan, a general format is outlined. Case examples illustrate the application of this approach.
Training volunteers and professionals to work with grieving children and their families
Authors: McGlauflin Helene
Published: May 2006

This article presents five foundational principles important for the training of professionals and volunteers who work with grieving children and their families. The principles discussed are: first, that expressing feelings is part of the healing process and requires safety and trust; second, that grieving is a process unique to each person; third, that working with grieving children and their families touches our own grief; fourth, that process is more important than content; and fifth, that working with grieving children and adults is a three-fold commitment. The importance of training and concluding remarks concerning inspiration are also included.
A qualitative evaluation of a bereavement service: An analysis of the experiences of consumers and providers of services in Australia
Authors: Marquis Ruth
Published: May 2006

This study, undertaken in 1994, involved the development of a qualitative framework to evaluate a bereavement service delivered by Silver Chain Hospice Care Service in Western Australia.

Fifty in-depth interviews were recorded with bereaved carers, nurses, and volunteers over a five-month period, and transcriptions of the interviews were analyzed. A constant cooperative analysis of the interview data revealed eight common themes related to consistent experiences of bereaved carers, nurses, and volunteers. Themes are discussed for each group separately. The manner in which themes connected to form the interactive environment of the service is subsequently demonstrated.

Service experiences, related to major themes, which were highly valued from the perspectives of the three groups of participants are identified. Experiences are then related to particular program processes and interactions consistently described by consumers and providers. Influences on, and barriers to, valued interactions occurring are discussed and elements of a valued bereavement program from the perspectives of participants in the study described.

By highlighting valued elements of the service, important areas of service delivery could be identified and safeguarded in future service development.
Carers of the terminally ill: An Australian study
Authors: Pincombe Jan , Tooth Barbara
Published: May 2006

This paper reports on the results of an Australian community-based palliative care research project which investigated and compared the effectiveness of existing support systems for paid (community nurses) and unpaid (primary carers) care givers in a regional health care center in New South Wales, Australia. In particular it looked at the needs, concerns, effects, and perceived adequacy of support system on carers.

Methodology employed in the study relied on both qualitative and quantitative methods. Qualitative data was obtained by using a questionnaire which obtained demographic data about the carers. In addition, a series of taped open-ended questions were posed to the carers on the impact and experience of caring for the terminally ill. Taped interviews were analyzed using content analysis and elicitation of themes.

Qualitative techniques utilized the Inventory of Socially Supportive Behaviors (ISSB). Examination of data collected using simple frequencies and percentages allowed cross examination of paid care givers and the questionnaire was used to assess perceived support of both sets of participants. A Wilcoxan Signed Rank non-
The hospice choice: Ethical decision making
Authors: Greipp Mary Elizabeth
Published: May 2006

Empirical research documents communication difficulties and practices which have contributed to clients’ wishes and directives regarding end of life decisions being ignored, resulting in prolonged, painful deaths in hospital intensive care costs. Hospice decisions are complex end of life ethical decisions primarily because they are centered around client autonomy and the individual’s right to choose to refuse treatment or to discontinue treatment. With documentation of the benefits of Hospice and palliative care, and overall client and family satisfaction reported in the literature, one has to question why more patients are not referred to Hospice, and why those who have been referred were done so at such a late date.

A suggested model for analyzing end of life ethical decision making and contributing factors will be presented. It is a sociological, interactional model that will assist in identifying ‘learned potential motivators’ on the part of the client and the health care professional which can influence these individuals during decision making interactions and which can contribute to the ‘rightness’ or ‘wrongness’ of end of life decisions.
Who is the chaplain anyway? Philosophy and integration of hospice chaplaincy
Authors: Harvey Ted
Published: May 2006

Hospice chaplaincy is a rather innocuous term describing a combination of duties and skills. Literature has been slow in coming and clearly defining this growing and unique role. This article looks both through the eye of the terminally ill patient and of the chaplain for further clarification of the method, philosophy, and definition of hospice chaplaincy. Through the use of brief metaphors, the author ascribes new meaning to common place terms, e.g., telephone operator, guide and teacher, and places them in context of the aforementioned perspectives. Highlighted are specific scenarios, questions, and emotional issues common to the psychosocial and psychospiritual relationship of patient and chaplain.
The dilemma of truth disclosure: Stoke-on-Trent, England
Authors: Charlton Rodger
Published: May 2006

Two case studies are used to demonstrate the continuing dilemma experienced by some doctors in the United Kingdom—whether or not to disclose to cancer patients their diagnosis. The two schools of thought concerning truth disclosure are discussed, together with the ethical implications and differences in views as a result of culture. Truth disclosure and associated communications skills are seen as an important area of medical education.
Factors contributing to late hospice admission and proposals for change
Authors: Farnon Christa , Hofmann Mary
Published: May 2006

Introduction: Hospice seeks to provide high-quality, holistic end-of-life care. Most insurances will reimburse hospice care for a period of six to seven months. However, the majority of patients are not referred to hospice until they are very close to death. The purpose of this study was to examine characteristics of an urban hospice program that may be associated with inordinately late admission to hospice care.

Methods: A retrospective chart review of 100 consecutive admissions was carried out. Patient data from the referral/intake forms were reviewed and length of stay of each patient was calculated.

Results: The average length of stay in this hospice was 34 days. Over half of the patients (51 percent) died within 14 days, and more than one-third (35 percent) died within seven days of admission. African-Americans made up nearly one-third of the patient group (32 percent). A considerable number of patients had a non-cancer diagnosis (39 percent). More than half of the patients were referred from acute care hospitals/specialists (58 percent).

Conclusion: The study shows that most patients were referred to this urban hospice program when they were very close to death. Three characteristics may contribute to this underutilization of the hospice benefit: (1) the large representation of African-Americans, (2) the high enrollment of patients with non-cancer diseases, and (3) the high number of referrals from acute care hospitals/specialists. Initiatives to overcome barriers to hospice care for minority populations, to better prognosticate terminal illnesses, and to educate physicians and patients about palliative care are needed so that more patients can benefit more fully from hospice care at the end of life.
The role of chemoradiotherapy in maintaining quality of life for advanced esophageal cancer
Authors: Tan Robert , Young Andrew
Published: May 2006

From May 1996 to July 1996, three male patients with advanced esophageal cancer with complete obstruction were treated with concurrent chemoradiotherapy. The first two courses of chemotherapy using 5-Fluorouracil (500mg/m 2 ) and Leucovorin (200mg/m 2 ) on day one through day five were given concurrently with radiotherapy. After completion of radiotherapy, four more courses of chemotherapy using the same regimen were given every four weeks. The total dose of irradiation using six MV linear accelerator given to the primary tumor was 5,000 cGy in 28 fractions. All three patients had relief of their obstruction with complete regression of the tumor after the completion of their treatment. All patients improved clinically and were able to remain symptom-free until the time of their death. The first patient survived for 12 months and died of respiratory failure because of his chronic obstructive pulmonary disease. The second patient also survived 12 months but died of liver metastasis. The third patient lived for 10 months and died of aspiration pneumonia.
Managing the pain of bone metastases in the home environment
Authors: Phillips Lisa L.
Published: May 2006

This article presents an in-depth review of the medical, pharmacological and nursing interventions needed to relieve the pain experienced with bone metastases.

Covered areas include:

• Pathophysiology

• Clinical presentation of bone pain

• Treatment options

• Therapeutic interventions

• The hospice nurse as an agent of hope

In addition, a comprehensive presentation of nonopioid medications used in managing bone pain is provided in table format.
Massage as a respite intervention for primary caregivers
Authors: MacDonald Gayle
Published: May 2006

Effective hospice care is dependent upon a caregiver who is able to withstand the physical and emotional ardors of the experience. Direct support for the family caretaker is as needed and valuable as the direct care hospice agencies provide to patients. Massage was found to be successful in addressing many of the stresses of primary caregivers. Nearly all of those who participated in an outreach project that used massage as a respite intervention reported reduced physical and emotional stress, physical pain, and fewer sleep difficulties.
Palliation of painful bone metastases: Strontium-89
Authors: Baumrucker Steven
Published: May 2006

Most patients with bony metastases experience painful symptoms. Strontium-89 isotope therapy is an alternative to traditional hemibody radiation in cases of multiple, diffuse metastases. Generally given as a single IV slow-push infusion, relief begins in one to three weeks, peaks at six weeks, and has a mean duration of 12 months. Up to 22 percent of patients are pain-free at three months.
Two hospice quality of life surveys: A comparison
Authors: Eischens Mary J. , Elliott Barbara A. , Elliott Thomas E.
Published: May 2006

This study’s objective tested the utility of two quality of life (QOL) forms in a hospice setting. The compared forms were the McGill Quality of Life Questionnaire (MQOL) and the Hospice Quality of Life Index-Revised (HQLI). Using a crossover design, hospice nurses first administered one survey to eligible patients and then, in the study’s second phase, administered the other survey to newly enrolled eligible patients. Nurses were interviewed regarding each form and possible changes in patient care that were made due to the assessment. Hospice care plans were reviewed looking for specific changes as a result of the surveys. The results showed that the QOL assessments were useful for the nurses in planning the care of the hospice patients and that the MQOL was preferred by the nurses over the HQLI.
Review of Medicare’s proposed hospice eligibility criteria for select noncancer patients
Authors: Schonwetter Ronald S. , Soendker Sandra , Perron Vince , Martin Brenda , Robinson Bruce E. , Thal Ann E.
Published: May 2006

Recent events have challenged our health system to increase access to and provide high quality care for patients near the end of life. Simultaneously, Medicare is developing review policies to determine eligibility for hospice patients with select noncancer diagnoses. The purpose of this study was to determine whether the proposed policies met one of their chief goals: accurate identification of patients with a less-than-six-months prognosis. Only 35 percent of 104 patients who died within six months of admission to the hospice used for this study, LifePath Hospice, met the Medicare proposed criteria for hospice eligibility. The median and mean survival time of the sample was 14 and 30 days respectively. Based on this review, it is recommended that Medicare alter their proposed review policies and not limit access to hospice eligible patients who desire and are in need of such services.
Fluconazole sensitivities of Candida species isolated from the mouths of terminally ill cancer patients
Authors: Ball Karen , Sweeney M. Petrina , Baxter Wendy P. , Bagg Jeremy
Published: May 2006

Oral candidosis is common in advanced cancer and is often treated with the systemic triazole antifungal drug fluconazole. This study examined the species of yeast present in the mouths of 30 patients with advanced cancer and determined their sensitivity to fluconazole. Thirty-five yeast isolates were collected from a total of 25 (83 percent) of the patients sampled. The two most common species were Candida albicans (15 isolates) and C. glabrata (11 isolates)—with smaller numbers of C. tropicalis, C. parapsilosis, C. guilliermondii, C. inconspicua, and Saccharomyces cerevisiae. The minimal inhibitory concentrations (MIC) of fluconazole for the strains of C. albicans were generally low (median 0.19µg/ml) but were considerably higher for C. glabrata (median 2µg/ml). The remaining species demonstrated MICs similar to those for C. albicans, with the exceptions of C. inconspicua and Saccharomyces cerevisiae, which were relatively insensitive. In conclusion, non-albicans yeasts are common in the mouths of patients with advanced cancer and these may have reduced sensitivity to fluconazole. Mycological diagnosis is a valuable aid to management.
Development of an outcome measure to document pain relief for home hospice patients: A collaboration between nursing education and practice
Authors: Lehna Carlee , Seck Linda , Churches Sheri
Published: May 2006

In the spring of 1997, an Eastern Michigan University nursing educator, a master’s nursing student, and a hospice clinical nursing director collaborated to develop a pain outcome instrument as a part of the student’s clinical practicum. The instrument was designed to describe and measure pain control of home hospice patients in preparation for fall accreditation of a home hospice program by the Joint Commission on Accreditation of Health-care Organizations. A chart audit of all on-call communications (n = 63 charts) by the educator and student supported the organization’s need to improve patients’ pain control. The collaborators reviewed the pain instrument literature, developed measurement instruments, and presented information to nurses at staff meetings for input and instrument revisions. A pilot study of the Home Hospice Patient Pain Assessment Instrument (HHPPAI) was conducted, the instrument was revised, and a second pilot was performed (n = 51 pain episodes). A description of those findings is presented. Further research needs to be conducted to examine instrument reliability and validity. The use of a pain outcome instrument, such as the HHPPAI, can improve patients’ pain control and, therefore, promote their quality of life.
Minority access to hospice
Authors: Haber David
Published: May 2006

In recent decades, the hospice movement in America has experienced substantial growth, but there are still impediments preventing the majority of Americans from utilizing this type of care. Moreover, minority Americans experience greater barriers to the utilization of hospice care. Although there are positive trends to suggest utilization of hospice care by minorities may increase in the future, these factors need to be supported through strategies implemented by hospice administrators, providers, and volunteers.
Factors in hospice patients’ length of stay
Authors: Frantz Thomas T. , Lawrence Jenifer C. , Somov Pavel G. , Somova Marla J.
Published: May 2006

Many hospice patients are referred comparatively late in the course of their disease progression, therefore minimizing the time of services to the patient, caregivers, and families. Untimely referrals can create organizational, clinical, and emotional problems for all involved; a better understanding of the factors related to length of stay (LOS) in hospice is necessary. This study investigated the relationship between LOS and selected variables. There were significant differences in LOS by diagnosis, physician type, and referral source. No significant differences were found in LOS by gender or insurance type. Factors related to LOS can assist hospices in identifying those particular patients more likely to have longer stays. Additionally, administrators may tailor their programs to meet the needs of the individual hospice.
A qualitative study of self-transcendence in caregivers of terminally ill patients
Authors: Enyert Gail , Burman Mary E.
Published: May 2006

Despite changes in social and cultural structure, the family has remained a consistent provider of in-home care needs for the chronically and terminally ill. The experience of a terminal illness is not limited to the individual patient and creates a myriad of challenges for the family, including the struggle to adjust and respond to the demands of the situation. The purpose of this study was to assess the caregivers’ sense of emotional well being and their ability to transcend and find meaning in the caregiving experience. The participants in this study were all caregivers of a family member who had died six to 12 months prior to the interview. They were able to find meaning as a result of their caregiving experience within the context of supportive networks, caregiving actions, grief and loss, fatigue, financial burdens and multiple challenges. Finding meaning involved “being with” or “doing for” their loved one as death approached. Finding meaning had positive consequences for the caregivers. They described a new life view and were able to reach out to help others as a result of their caregiving.
An EPEC weekend
Authors: Cole Barry Eliot
Published: May 2006

Education for Physicians on End-of-Life Care (EPEC) is the American Medical Association’s project to train physicians about care at the end of life. This new curriculum is initially being taught to 250 physician-trainers, who, in turn, will teach physicians throughout the United States. This article discusses one physician-trainer’s reaction to the January 1999, EPEC Regional Conference in Phoenix, AZ.
Part four: Lung cancer, malignant melanoma, multiple myeloma
Authors: Kemp Charles
Published: May 2006

This is the fourth of a six-part series on the metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Parts two and three charted the natural histories, problems, and assessment parameters of advanced cancers of the breast, colon and rectum, esophagus, kidney, and liver; and leukemia. Part four provides corresponding information on lung cancer, malignant melanoma, and multiple myeloma. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncology emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able anticipate the spread of these cancers and can thus identify problems early in their development so that the problems are more easily managed.
Investigating the educational needs of licensed nursing staff and certified nursing assistants in nursing homes regarding end-of-life care
Authors: Ersek Mary , Kraybill Beth Miller , Hansberry Jennifer
Published: May 2006

Nursing homes care for people at the end of life (EOL). There is evidence to suggest, however, that nursing staff in these settings is often unprepared to provide a high level of EOL care. This article reports the findings from three preliminary studies that investigated the needs of licensed staff and certified nursing assistants in nursing homes regarding EOL care. The studies involved needs assessment surveys, focus group interviews with staff members, and telephone interviews with nursing home administrators. Data show that the major needs included a lack of knowledge and skills in symptom management; communication difficulties; conflicts with families and physicians; and emotional distress in dealing with time constraints and attachment to residents. Implications for nursing home staff education are described.
Part five: Non-Hodgkin’s lymphoma, oral cavity and pharynx, and ovary
Authors: Kemp Charles
Published: May 2006

This is the fifth of a six-part series on metastatic spread and natural history of 18 common tumors. Part 1 summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6000 deaths/year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Parts two, three, and four charted the natural histories, problems, and assessment parameters of advanced cancers of the breast, colon and rectum, esophagus, kidney, liver, and lung; and leukemia, melanoma, and multiple myeloma. Part five provides corresponding information on non-Hodgkin’s lymphoma and cancers of the oral cavity (and pharynx) and ovary. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and can thus identify problems early in their development so that the problems are more easily managed.
Diversity among hospice volunteers: A challenge for the development of a responsive volunteer program
Authors: Roessler Amira , Carter Helen , Campbell Laurel , MacLeod Roderick
Published: May 2006

Voluntary organizations such as hospices are increasingly being called upon to substitute for state health and social welfare delivery at a time when volunteer contributions are threatened because of organizational and demographic changes. These changes include: the adoption by the nonprofit sector of market strategies in response to health and social welfare reforms, increases in the size and complexity of hospices, increasing professionalization of staff, and the move of women away from voluntary work in the health and welfare services to paid employment. With these changes, hospices must be knowledgeable about their volunteer workforce and resourceful if they are to continue to attract and retain volunteers. A survey of volunteers conducted at the Mary Potter Hospice, Wellington, New Zealand, examined differences in volunteers’ characteristics, motivations for joining hospice, and factors affecting work satisfaction according to age, gender, and the length of time volunteers had worked. Those findings of particular relevance to program development were: (1) the tendency for the recently recruited volunteers to be in paid employment; (2) the mixed motivations of the younger volunteers, reflecting both altruistic and personal gain needs; and (3) the rewards commonly identified by volunteers, such as feeling their work is of value, being accepted by hospice staff, and feeling like important team members. Practical outcomes of the study are described.