bluuebunny/crossref_metadata_2025 huggingface dataset:
The assessment and audit of spiritual care
Authors: Catterall RA , Cox Mark , Greet Brian , Sankey Julian , Griffiths Geoffrey
Published: May 2014

In today’s healthcare environment nurses are increasingly involved in assessing, evaluating, and auditing the care they provide. There is some evidence to suggest that spiritual care is poorly undertaken in palliative care units (Gray, 1994). This article details and discusses a scale which has been designed to assess the patient’s spiritual status. This study showed that the majority of patients including non-Christians and agnostics felt that their spirituality had positively helped them to cope with their illness. Health professionals need to ensure that patients are supported in their existing beliefs and during their spiritual journey rather than adopting a problem-solving approach to spiritual care, i.e. offering them active intervention which may often be inappropriate. Patients were given a questionnaire which included questions about prayer, religious services and the laying on of hands for healing. The majority of patients wanted all of these services and therefore further examination of such needs is warranted.
Increased medicalization within palliative care
Authors: White Kate
Published: May 2014

The specialty of palliative care has developed rapidly in the last two decades, as evidenced by the growth of specialist services, tertiary education programmes and recognition of palliative care as a specialty within professional colleges. In planning cancer services for the future, palliative care is now recognized as an integral component of these services. This acceptance of palliative care, while perhaps not complete, has been largely due to the efforts of committed health professionals from many disciplines, including nursing. The shared philosophy of what was palliative care practice enabled these individuals to argue with one voice. Recent changes in the practice of palliative care bring into question whether this shared view of palliative care remains.
Pain, the perennial problem: eased online
Authors: Sweeney John
Published: May 2014

Produced by the Cancer Centre at Michigan State University, this site serves as a taster for a CD-Rom, but is in itself worth visiting by those in need of guidance on and explanation of pain management — an area that remains problematic within palliative and cancer care. The information is presented in distinct and manageable sections. This site not only meets the information needs of those experiencing pain but also provides examples of how professionals may effectively and clearly address this issue.
Some swell sites as lymphodema goes online
Authors: Sweeney John
Published: May 2014

With lymphoedema care sustaining its nurse-led development in recent years it is good to see many of the basic concepts and approaches to the care of this condition being aired on-line. The British Lymphology Society has chosen to do so with this site in which content clearly outweighs form. In doing so, they have demonstrated that the net remains a useful medium for the dissemination of straightforward information and is not yet completely the domain of web designers and graphic artists.
A new information resource for palliative care professionals
Authors: Lynch Jay , Morgan Les , Dunbrack Janet
Published: May 2014

A challenge that the palliative care community shares with other professions is that of networking the knowledge it generates - not only among persons within the profession, but also to practitioners in other specialties, for example, primary care. While face-to-face communication and print media continue to serve well, a new means of disseminating palliative care knowledge and expertise became available in 1999.
Writing for publication
Authors: Clarke Gwen
Published: May 2014

Palliative care is a rapidly expanding and developing area within health care, which is currently undergoing many challenging and exciting changes. Recent Government initiatives in the UK seek to promote improved and integrated services across primary, secondary and tertiary care; primary care groups and trusts provide new ways of working in partnership; and the emphasis on clinical governance has contributed to a number of innovative professional developments.
Central venous catheter management in patients with cancer
Authors: Campbell Tanya
Published: May 2014

This article provides a summary on the management of central venous catheters (CVCs) in the person with cancer. The use of CVCs is becoming more commonplace with the emphasis on home-based cancer therapies and the increasing use of high-dose chemotherapy regimens and stem cell rescue. The different types of CVC are examined and the potential complications and nursing management are discussed in this article. Nurses are leading practice in this area, undertaking a holistic assessment of the patient before inserting a CVC that meets their specific medical and personal requirements. A thorough understanding of the use of CVCs, potential complications and patient issues is crucial for sensitive assessment and treatment.
Corerspondence
Authors: Hardy Janet , Mitten Trevor , Davies Andrew
Published: May 2014

1. A patient-centred approach to palliative care, 2. Suggested solutions for managing syringe drivers, 3. Xerostomia explained
The nurses’ voice is heard
Authors: Wilkinson Susie
Published: May 2014

During the last decade, nurses in the United Kingdom have demonstrated how visionary they can be and how they can influence the standard of care that patients with cancer and their families receive. Standards of Care for Cancer Nursing (Royal College of Nursing Cancer Nursing Society (RCN CNS), 1991) was an innovative document that encapsulated cancer nurses’ belief that cancer is a chronic or life-threatening disease that is a major health problem in our society. It emphasized the leading role that nurses play in all cancer settings, from health promotion to palliative care. It outlined the standards of care a patient should expect to receive, particularly in the areas of information, family care, psychological care, symptom control, prevention and continuity of nursing care. Furthermore, it emphasized that high standards of nursing care would only be achieved if an ongoing assessment of individuals’ needs, detailed planning and an evaluation of care and support were considered routine care.
Up and coming from Down Under
Authors: Sweeney John
Published: May 2014

The domination of the web by the US and UK is clear when seeking healthcare information. However, this effective gateway site indicates the broader horizons of the net. It provides information about palliative care, its delivery and an array of statements about standards within the field and developments across Australia. This resource is complemented by the clinical information available at www.medicineau.net.au/clinical/palliative/home.html , part of the ‘MedicineAu’ collection of guidelines and links for health professionals.
An evaluation of an interprofessional palliative care education programme
Authors: MacDougall Graham , Mathew Alison , Broadhurst Vivienne , Chamberlain Steve
Published: May 2014

Reviews of literature relating to palliative care and interprofessional working identify the need to enhance the ‘palliative approach’ among generic health and social care staff. Greater collaboration is needed in order to deliver high quality services to individuals with palliative care needs and their families. This article describes an interprofessional palliative care education course designed around these two areas. The course was developed in response to some earlier work between a health-care trust and a local authority social services department that had highlighted areas for development in both understanding the broad remit of palliative care and collaborative working. The course outline and its evaluation are described, the description of the evaluation being from the perspectives of both the individuals leading the course and those participating in it. This led to several recommendations for future courses. Interprofessional education in palliative care represents a way forward with regard to improving the understanding of professional roles and collaboration in delivering quality services.
Supportive and palliative care networks: a new model for integrated care
Authors: Travis Sara , Hunt Patricia
Published: May 2014

Cancer is one of the biggest killers in the UK, and recent Government health policy has responded to this with a number of specific developments. Foremost among these is The NHS Cancer Plan (Department of Health, 2000), which established cancer networks as a new model of integrated cancer care service provision. In response, palliative care providers have initiated the development of networks for supportive services of patients alongside the cancer networks to improve coordination of care. This article will briefly discuss the parallel development of cancer and supportive care networks and examine what form the latter will eventually take.
Hypnotherapy in a specialist palliative care unit: evaluation of a pilot service
Authors: Curtis Carole
Published: May 2014

There is evidence that hypnotherapy may have an application in the palliative care setting by relieving stress and helping patients to cope with their illness and the prospect of dying. It may also be of benefit to health professionals working in this sometimes stressful field. This article reports on the audit of a pilot hypnotherapy service for patients, carers and staff at a specialist palliative care unit. The audit explored the demand for hypnotherapy, the practicalities of providing the service and identified benefits as perceived by the clients and the therapist. Evaluation methods included questionnaires for quantifiable and qualitative data. The study was conducted over 5months and involved 11 clients (seven staff and four patients). The main findings depicted unanimous positive coping and relaxation benefits to the clients. At the end of the therapy, 82% felt it had assisted in improving the presenting problem and 91% felt it had been of benefit in general. Further issues are discussed such as the therapeutic relationship, non-attendance and the environment used during the sessions.
Palliative care in a Mediterranean culture: a review of services in the Republic of Cyprus
Authors: Costello John , Christoforou Cathryn
Published: May 2014

This article reviews the provision of palliative care services in the Republic of Cyprus, highlighting health-care resources in general and palliative care in particular. An interesting feature of palliative care in Cyprus is the extent to which community palliative care provision appears to be expanding and developing, with hospice care supplementing the work of home care nurses. The role of the home care nurse is discussed and the key role played in patient and family education highlighted. The article raises some interesting features of the relationship between bereavement and culture highlighting the influence that medicalization of health has on traditional ways of caring for patients with cancer and non-cancer conditions.
An overview of chemotherapy-induced peripheral sensory neuropathy, focusing on oxaliplatin
Authors: Gent Peter , Massey Kate
Published: May 2014

When treating patients for metastatic cancer, there is always a balance between the benefits of treatment and resulting side-effects. Peripheral sensory neuropathy (PSN) is a side-effect of many anticancer agents used in routine practice. Oxaliplatin is a relatively new agent currently licensed in over 50 countries including France, Germany and the UK for the treatment of metastatic colorectal cancer. Although it is a new agent, it is from the same family of drugs as cisplatin, an agent that has been used for many years. PSN is the most commonly discussed side-effect associated with oxaliplatin. Oxaliplatin-induced PSN is characterized by two distinct syndromes: a transient acute dysaesthesia and a cumulative distal neurotoxicity. Importantly, both are generally reversible after stopping treatment. Oxaliplatin-induced acute PSN is triggered and exacerbated by cold and can be greatly reduced in affected patients simply by avoiding cold conditions. Oxaliplatin-induced cumulative PSN may also be managed by temporary cessation of treatment.
‘Living choice’: the commitment to tissue donation in palliative care
Authors: Wells Joanne , Sque Magi
Published: May 2014

Professionals working in palliative care pride themselves on respecting patients’ views and wishes. Palliative care patients are often aware that they are going to die and so the issue of what is going to happen to them after death becomes more relevant. That they should be involved in decisions about tissue donation seems obvious, yet many palliative care units do not routinely discuss donation with patients and their families. A grounded theory approach was used to develop an explanation of the low commitment to tissue donation by palliative care units. Six registered nurses and two doctors from each of two separate palliative care units participated in semi-structured, audiotaped interviews. Several themes emerged from the interviews to form a theory of why there is a low commitment to tissue donation in palliative care units. We have called the theory ‘living choice’. The dominant theme or category was ‘patient choice’ and this pervaded and influenced ‘professional role’, ‘donation process’, ‘concerns’ and ‘knowledge’. All these categories were contained and continuously interacted in the palliative care environment.
Accessing Services
Authors: Smyth Dion
Published: May 2014

The imminent publication of the NICE clinical guidelines for supportive and palliative care (available from www.nice.org.uk from early December) provided the impetus for this month’S review.
Palliative care for Muslims and issues after death
Authors: Gatrad Rashid , Sheikh Aziz
Published: May 2014

In this, our second paper looking at issues in providing palliative care to Muslims in the UK, we focus on death customs and bereavement. We cover issues relating to the immediate handling of the body after death, washing the deceased and reasons for early burial. Muslim views on post-mortems and organ transplantation are explored. In addition to sharing information on practices common among Muslim communities, we also provide practical advice on the day-to-day issues that may arise when caring for a ‘recently deceased’ Muslim patient and his or her relatives.
Correspondence
Authors: Notta Hardev
Published: May 2014

Dear Editor

Randhawa et al’s article, Communication in the development of culturally competent palliative care services in the UK: a case study (2003) is well written and informative for professionals working in palliative and health care. It confirms the observations of Hill and Penso (1995) that communication is a major issue in providing adequate palliative care services to minority ethnic groups. However, in 1995 when the research was done, Acorns Children’s Hospice was already providing an adequate palliative care service to minority ethnic groups, which it has done since 1988, and therefore there may well be other hospices doing so.
An evaluation-based model for palliative care education: making a difference to practice
Authors: Kenny Lesley J
Published: May 2014

It has been recognized that education may be one way of improving the provision of palliative care to patients and their families. This article is the culmination of a multi-phase evaluation project that aimed to investigate the effectiveness of palliative care education provided by a hospice education network in the north west of England. Results from a study of 46 students over a 3-year period indicate that in order for education to be deemed effective, there are certain fundamental requirements. These include responding to the changing and individual needs of participants, competent teaching in theory and practice, and enabling students to make a difference to practice. This paper describes a model for providing palliative care education, which encompasses these fundamental requirements. It also meets the needs of stakeholders and provides evidence of improvements in clinical practice. In particular, it focuses on the challenges of implementing this model in the current climate of clinical effectiveness, evidence-based practice and value for money.
Intrathecal catheters: developing consistency in filter use and dressings in Perth, Australia
Authors: Cousins Kerry , Duggan Geoff , Panizza Natalie , Tinnelly Karen , Vojkovic Susie , White Kate
Published: May 2014

The use of opioids presents practitioners with many challenges, such as the variation in responses and side effects seen with traditional methods of administration. This has prompted an increase in the consideration of the intrathecal route for the management of patients with refractory cancer pain. Although this has increased the therapeutic options available to patients, it has also led to more complicated pain management strategies. In Perth, in Western Australia, it was identified that clinical variations, especially in the programming of the pump, maintenance of the filters and associated dressings, occurred between service providers, causing confusion and anxiety for patients, families and practitioners. This article discusses a review of nursing management of patients receiving intrathecal analgesia and the collaboration of all services in the development of evidence-based policy.
Correspondence
Authors: Brignall Irene
Published: May 2014

I was overjoyed to read Ann Robinson’s article on the power of poetry in palliative care (2004). It was very well researched and sensitively written. The fact that Ann is a nurse has given her special insight into patients’ needs.
Perceptions of spiritual care among nurses undertaking postregistration education
Authors: Milligan Stuart
Published: May 2014

Previous research has suggested that qualified nurses recognize that patients have spiritual needs and consider meeting those needs to be important. However, there is also evidence suggesting that nurses feel ill prepared for, and uncertain about, their role as spiritual care providers. A questionnaire on spiritual care and the nurse’s role was distributed to a group of 59 registered nurses (of varying ages and levels of experience) undertaking a palliative care module as part of a postregistration degree programme in Scotland. The findings demonstrated that respondents regarded spiritual care as important, especially for certain patient groups. They also thought nurses had a significant responsibility in spiritual caregiving. Individuals varied in how difficult they found identifying patients in need of spiritual care and in meeting those needs. However, analysis of responses revealed considerable insight into possible signs of patient need, examples of nursing interventions and potential barriers to effective spiritual care. Some areas of relative lack of knowledge were identified and may indicate where future efforts to raise awareness of spiritual care among similar groups of nurses should be concentrated.
Attitudes towards end-of-life care in a geriatric hospital in Japan
Authors: Schreiner Andrea S , Hara Naoko , Terakado Tomoko , Ikegami Naoki
Published: May 2014

Nursing and medical staff attitudes toward end-of-life care at a private, not-for-profit geriatric hospital in Japan were measured as part of a larger intervention study to develop a palliative care programme. The intervention consisted of focus groups, education with pre- and post-testing, and attitude/belief surveys. All the medical staff (n=8) and 99% (n=97) of the nursing staff participated. Nursing staff overwhelmingly agreed that a palliative care programme would improve end-of-life care (94.6%) and that nurses should be more involved in discussing treatment options with families (85.7%). Of the nursing staff 88.7% did not agree that doctors currently spend enough time discussing care plans with patients/families. The main barriers to improving end-of-life care perceived by the nursing staff were the treatment-oriented attitude of the doctors and their limited communication skills. The main barriers perceived by doctors were the lack of alternatives to their medical approach and legal concerns. The findings suggest that improving doctor/nurse communication would facilitate the development of a palliative care programme at this hospital.
Reflections on the contribution of Frances Sheldon
Authors: Payne Sheila , Speck Peter
Published: May 2014

Frances Sheldon died on 26 February 2004 at the age of 64 years. In this short article, we will offer some reflections on her contribution to palliative care and consider what we can learn from her legacy.
Euthanasia - mercy or murder?
Authors: Mitchell Kay
Published: May 2014

Research indicates that patients suffering from life-threatening conditions would like the option of physician-assisted death (Ogden, 1994; Emanuel et al, 1996; Ganzini et al, 1998). Moreover, the provision of such a death by physicians is occurring even when there are no legal sanctions for such actions (Kuhse et al, 1997; Emanuel et al, 1998; Deliens et al, 2000; Mitchell and Owens, 2003). Some use this information to argue that justice may only be served if such a death is legalized – why should the option only be available to a few? Others argue that legalization is unnecessary given modern palliative care that successfully addresses suffering in almost all cases. Is it worth adopting such a hugely divisive freedom into a society to benefit those few who may arguably be well served by such actions?
Playing the endgame: reflections on waiting
Authors: Lunghi Martin
Published: May 2014

In working with those in long-term care, within a skills-oriented culture, we understandably experience a need to be active in meeting the challenge of another’s suffering, loss and decline. Inactively waiting is not considered a viable option. This article offers a re-evaluation of the concept of ‘waiting’ through a broad conceptual analysis of its implications, together with anecdotal illustrations of its potential value in caring both for others and for oneself.
Barriers to effective uptake of cancer screening among black and minority ethnic groups
Authors: Thomas Veronica Nicky , Saleem Tariq , Abraham Rachel
Published: May 2014

Aim To describe some of the factors that act as barriers to effective uptake of breast and cervical cancer screening services among black minority ethnic (BME) groups living in Brent and Harrow in the UK.

Design A series of focus groups among African Caribbean, African, Gujarati, Pakistani, Greek and Arabic groups were held to discover their perceptions of cancer screening, the barriers to effective uptake and some strategies for intervention.

Sample This consisted of 135 participants: 85 women and 50 men.

Results Analysis of focus group data has revealed poor knowledge, underlying health and cultural beliefs, attitudes, language and unhelpful attitudes of health professionals to be important barriers. In terms of strategies for effective intervention, the most popular strategy for improving uptake of screening services was community-based cancer awareness education that is sensitive to religious and cultural needs.

Conclusion There is a need to provide community-based education to increase the uptake of screening services among BME groups. It is essential to plan concurrently to educate GPs and other health professionals in cultural beliefs and customs, language needs, racial awareness and communication skills.
Bereavement and palliative care in China
Authors: Chan Cecilia LW
Published: May 2014

The traditional Confucius Chinese rituals promote prolonged mourning, e.g. if a child’s parent dies he/she expected to mourn for 3 years. A widow would be called ‘the unlucky one’ for the rest of her life as she had brought bad luck to the husband who died before her. There are indeed rich and colourful rituals and cultural myths that can actually be oppressive for bereaved family members, who are robbed of the right to live a happy life after bereavement. Grieving is tightly ‘policed’ in our collective culture (Chan and Chow, 2006).
Evaluation of a pilot nurse-led, community-based treatment programme for lymphoedema
Authors: Howell Doris , Watson Marcia
Published: May 2014

Aim To evaluate the effect of this treatment programme on lymphoedema specific fluid volume, pain, discomfort, limb function and quality of life outcomes.

Design Prospective, descriptive study.

Sample and Setting A convenience sample of four women with breast-cancer related lymphoedema referred to a community-based specialist oncology nurse consultant programme in Canada that involved manual lymph drainage combined with compression bandaging.

Measures Circumferential arm measurements to assess fluid volume, visual analogue scales to assess the impact of lymphoedema on specific practical, physical and psychosocial problems known to be affected by lymphoedema and field notes.

Results Although a reduction in arm volume was observed, quality-of-life outcomes worsened for most of the women as they realized that this symptom would require life-long management, serving as a reminder of their breast cancer experience.

Conclusions Lymphoedema treatment programmes must ensure that the multidimensional impact of this symptom on women’s lives is recognized and addressed as part of the treatment process.
Resources for paediatric patients and their families
Authors: Smyth Dion
Published: May 2014

The palliative care needs of paediatric patients and their families are, in relation to adult and adolescent services, in their infancy. The development of services suitable and appropriate to the individual and idiosyncratic needs of infants is imperative, if members of society are to have access to equitable and expert care. This months web words examines sites that expand our knowledge of this interesting aspect of palliative care provision.
Exploring students’ experience of training for counselling skills and the impact on practice
Authors: Johnston Bridget , Smith Val
Published: May 2014

Aim The aim of this study was to explore participants’ experience of an accredited counselling skills course and their perception of its impact on practice.

Design A qualitative design was used utilizing a mixed-method approach. Data were collected using semistructured interviews and the repertory-grid technique. Data were analysed using thematic content analysis (interviews) and the repertory grids were analysed qualitatively using a four-stage procedure.

Sample A convenience sample of six healthcare professionals undertaking a counselling skills course completed both interviews.

Results The biggest impact of the course was in the area of self-awareness and skill development. The development of attentive listening, both in terms of objective and subjective findings, was evident. Students perceived that personal qualities, such as warmth and caring, were essential. All participants identified that the group were supportive and that this enhanced learning. The students changed their practice by improving their skills, increasing their awareness and by developing deeper therapeutic relationships with patients and their carers.

Conclusion This research adds to the body of knowledge in palliative care. It identifies key elements in the learning of counselling skills and recognizes the impact of these skills on improving the care of palliative care patients and families.
Skeletal complications and the use of bisphosphonates in metastatic prostate cancer
Authors: Drudge-Coates Lawrence
Published: May 2014

Metastatic prostate cancer represents an incurable progression of the disease that accounts for the vast majority of disease related mortality and is associated with significant skeletal morbidity, With events including bone pain, fractures and spinal cord compression. This article provides an overview of the bone disease in this patient group, with a specific focus on the role of bisphosphonate use, in addressing quality of life issues. Key clinical trial data relating to bisphosphonates is presented and discussed, culminating in key management guidelines.
The hospice model in Sierra Leone
Authors: Kwakwa Jennifer
Published: May 2014

I have worked in very different hospices across the world; however, I faced a steep learning curve and experienced a humbling appreciation of the pressures on the sole hospice in Sierra Leone.
Exploring the role of spiritual care in post-death nursing
Authors: Ronaldson Susan M
Published: May 2014

Traditionally nurses have performed the act of laying out of the body of a person following death, referred to here as post-death nursing care. This article provides a reflective account of the experience of expert nurses during post-death care. Over the preceding weeks to a woman’s death, two expert nurses had cared for her; she was elderly and had just died from multiple causes including metastatic cancer. The observations of a novice nurse during the post-death care led to the understanding that this final act of caring is not only a procedure, but also has a deeper spiritual dimension that can be modelled and described as a continuation of the depth of care given when the person was alive.
Caring for life-limited children: web resources
Authors: Smyth Dion
Published: May 2014

Physical, psychological, social, spiritual and cultural issues and concerns need to be addressed in end-of-life care. Yet the evidence suggests that health care professionals have concerns about adequately managing the needs and concerns of life-limited children and their families. This may be because of a lack of training, a more aggressive focus and intent on cure, or as one of the websites below suggests, because it is a scenario that everyone finds difficult to think about and address.
Intercultural palliative care: online information and resources
Authors: Smyth Dion
Published: May 2014

The provision of care that is culturally sensitive and sympathetically considerate is a vital component of our working roles and responsibility. As the demographics of many of our societies alter, reflecting the varying patterns of immigration and settlement to our countries and communities, the need to face the challenges and force the changes in the ethnic and racial palliative care needs of these persons becomes more and more apparent. This month’s Web Words follows on from Yasmin Gunaratnam’s article on page 470 with a review of sites that develop our understanding of this matter.
Remembrance Day: lest we forget
Authors: Smyth Dion
Published: May 2014

‘At the going down of the sun and in the morning / We will remember them’. When the poet Laurence Binyon wrote these words that now adorn many a war memorial and monument, a simple, solemn promise was being made to those who had fallen ‘in the cause of the free’; their immeasurable sacrifice would not be forgotten. Now, each year across the Commonwealth of Nations, Remembrance Sunday is commemorated. We honour ‘the Glorious Dead’ with poignant gestures of respect and thanksgiving and, for at least two minutes of thoughtful silence, we can publicly or privately reflect upon matters of life and death, mourn our own loss and grief and, as an individual or as a community, share that sense of sadness and sorrow for the generations of men and women blighted by conflict and war.
Authentic performance appraisal: when home is the workplace
Authors: O’Connor Margaret , Lee Susan
Published: May 2014

Home care services have characteristics that are distinctive from other health care settings. Thus, they require different management systems to those traditionally used in institutional settings. Typical management models often require adaptation for home care services in areas such as staffing, education and support. This includes performance appraisal, where traditional models may be inappropriate when clinicians work alone, with little supervision.

This article describes an experience of adapting a performance appraisal tool, in order to be more relevant for staff working in home-based care. The project arose from staff frustration with the expectation of management that a tool developed for institutional settings would be appropriate for the home setting. This frustration gave the impetus for developing a successful appraisal system, and because of staff involvement, the model was wholeheartedly embraced. The process of development is discussed, and the model explained, with commentary about its implementation in a home care service.
Palliative care provison throughout the world
Authors: Smyth Dion
Published: May 2014

Last month Web Words focused on finding out about the various conferences, courses and seminars that are held around the world. Before you fly off to other countries you may want to find out about the level and location of local service provision
The relevance of time in palliative care nursing practice
Authors: Dalgaard Karen Marie , Delmar Charlotte
Published: May 2014

This article describes time as a contextual factor in palliative caring practices and contributes to an understanding of the connections between time and the quality of palliative care. The article is based on an explorative and qualitative research study inspired by grounded theory. The empirical data of the study were obtained through field studies and interview. The interpretation is indebted to a philosophical interpretation that assumes time to be consciously organised into two categories: an objective clock time and a subjective personal time. Two scenarios are presented: one in which clock time is insufficient and another in which clock time is sufficient. Each scenario outlines how nurses relate to time in different ways according to whether clock time is insufficient or sufficient, respectively. It is found that the two scenarios have different implications for palliative care, nurses’ personal time, and nurses’ opportunities for reflection and professional development.
An inner struggle for hope: insights from the diaries of bereaved family caregivers
Authors: Holtslander Lorraine , Duggleby Wendy
Published: May 2014

Aim: To explore the experience of hope for bereaved palliative caregivers through participant hope diaries.

Design: A secondary analysis of hope diaries collected as part of a grounded theory study of hope and bereavement.

Sample and setting: Twelve older women from a small Canadian city completed a hope diary.

Data analysis: Content analysis (Patton, 2002) was applied to describe and interpret the data.

Findings: Hope was a feeling of peace, courage, strength, and self-confidence that enabled them to face each day and look to the future with a positive outlook. Hindrances to hope were multiple losses, loneliness, and physical health concerns, which created an inner struggle for hope. Hope was fostered through positive thoughts, connections, and taking care. Writing in the diary affected their experience of hope.

Conclusion: The diaries provide unique insight into their experience, suggesting practical ways to foster hope in bereavement.
Children affected by genetic conditions in end-of-life care. Part 1: development of a study
Authors: Metcalfe Alison , Pumphrey Rachel , Clifford Collette
Published: May 2014

Background: Many children receiving hospice care are affected by inherited genetic conditions. To provide appropriate care, children’s hospice nurses require knowledge and awareness of the issues faced by the child and their family along with the implications of having, or being at risk from, an inherited genetic condition. Little is currently known about the competence levels of children’s hospice nurses to support these children and their families. Aim: This study aims to explore how important children’s hospice nurses perceived genetics to be within children’s hospice care provision, and their level of confidence in meeting the care needs of children and their families with a genetic predisposition to disease. Method: This study involved two stages: a single-page survey to children’s hospice directors of nursing designed to determine the nature of children’s hospice care provision in England and Wales. Second, a postal survey using a structured, self-administered questionnaire was sent to nursing staff in a sample of children’s hospices in England and Wales. A total of 277 packs were sent to the hospices for distribution to children’s nurses working in their employment. Likert scales were used to rate the importance of genetic activities relevant to children’s hospices, and nurses’ confidence in performing them. Demographic data were also collected. The results, the discussion of the findings and implications for practice will be discussed in part 2.
The lived experience of patients with pleural mesothelioma
Authors: Hughes Nicola , Arber Anne
Published: May 2014

This paper reports on a research study of five patients diagnosed with mesothelioma. The study used a phenomenological approach to explore patients’ lived experience using in-depth interviews. The findings identify that patients have many unmet psychosocial and emotional needs and that there was a lack of information provided to patients about specialist supportive and palliative care services. A number of the patients found specialist supportive care by chance rather than by referral. In addition, patients were involved in complex medico-legal matters in relation to asbestos exposure, and this was an additional burden for them and their spouse or carer. A feeling of social isolation was also reported and a number of patients would welcome the opportunity to meet with other people in the same situation as themselves. In conclusion, there is a lack of attention to the emotional needs of this group of patients, which means that supportive care resources are not being accessed in a timely and flexible manner.
Supervision needs of nurses working in the community
Authors: Fletcher Susan
Published: May 2014

The aim of this research was to develop and evaluate a programme comprising a series of supervision sessions (based on a social work model) to meet the needs of nurses working in the community. Nurses are now working in programmes such as drug and alcohol withdrawal and community-based palliative care where they are increasingly assuming more of a counselling role with their clients. This is typified by an increase in the emotional intensity of the relational engagement. In this new environment, the old skills, strategies and support frameworks are no longer sufficient. Nurses in the project were asked to evaluate their experience of the programme in relation to self-regulated learning, developing self-awareness, skills competence and increase in counselling knowledge. The small sample size means that there are important restrictions on generalising the findings. Nevertheless, the findings show that the programme has been evaluated positively by the participants and should encourage further research.
‘A voyage of grief and beauty’: supporting a dying family member with an intellectual disability
Authors: Marlow Susan , Martin Margi
Published: May 2014

This article reports on a small research project designed to reveal what it is like to support a dying family member with an intellectual disability in a community setting. Five open-ended interviews were conducted with individuals who had experienced this phenomenon. Three thematic elements which lay within the experience of being a family support person were elucidated through hermeneutic phenomenological analysis of interview audio-recordings, verbatim transcripts and field notes. Collectively, these themes (Interlocked Companionship, Search for New Balance and Permeable Interaction) created a metaphorical understanding that participants had navigated ‘a voyage of grief and beauty’. Rhetorical consideration of the research findings generated recommendations for tertiary, palliative care and intellectual disability support services. These are presented along with suggestions for future research.
Active carers: living with chronic obstructive pulmonary disease
Authors: Spence Allison , Hasson Felicity , Waldron Mary , Kernohan George , McLaughlin Dorry , Cochrane Barbara , Watson Barbara
Published: May 2014

It has long been recognised that the majority of care provided in chronic illness comes not from health and social care professionals, but from family and friends. One such illness is chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality in the developed world. To explore the specific care needs of informal caregivers of patients with advanced COPD, interviews were conducted with seven active family caregivers. Interviews were taped, transcribed and content analysed to obtain the caregivers’ needs. Results confirm that family caregivers provide direct care with little support and assistance. Participants reported restricted activities of daily living and some emotional distress. There were knowledge deficiencies among caregivers relating to the COPD illness trajectory and little awareness of the potential of palliative care. Family caregivers need social and professional support while caring for a patient at home. This would help to ensure that their physical and emotional health does not suffer. There is a need to devise interventions to ensure family caregivers are supported.
Spirituality: What do we mean?
Authors: Costello John
Published: May 2014

Despite the plethora of published articles on the concept of spirituality, it seems we are no further forward in understanding it. I do not agree with others who argue that spirituality is a mysterious, transcendental and invisible force (McSherry, 2006).
Understanding the influence of palliative care nursing: A global perspective
Authors: O’Connor Margaret
Published: May 2014

Throughout the world, nurses are involved across all levels in establishing services and shaping palliative care practice, including clinical bedside care, clinical leadership, sole practitioner roles, management, education, research and policy development. In all these roles, many models of palliative care nursing exist, with nurses working alone or in teams. While this contribution to palliative care is laudable, we must remember that nursing is not universally respected as its own profession and in many countries, nursing is regarded as lowly, with no status and power and lacking its own autonomous professionalism and accountability.
Core attitudes of professionals in palliative care: A qualitative study
Authors: Simon Steffen T , Ramsenthaler Christina , Bausewein Claudia , Krischke Norbert , Geiss Gerlinde
Published: May 2014

Introduction: Self-awareness of one’s own reactions towards patients and their relatives is of paramount importance for all professionals in palliative care. ‘Core attitude’ describes the way in which a person perceives himself and the world, and forms the basis for his actions and thoughts. Objective: The aim of this study is to explore what core attitude means for palliative care professionals and whether there is a specific core attitude in palliative care. Methods: Qualitative study with 10 face-to-face in-depth interviews with experts in palliative care (nurses, physicians, social workers, psychologists, chaplain) in Germany. Results: Core attitude in palliative care can be best described with the following three domains: 1) personal characteristics; 2) experience of care; and 3) competence in care. Authenticity is the most important characteristic of professionals, along with honesty and mindfulness. Core attitude primarily becomes apparent in the relationship with the patient. Perception and listening are key competences. The experts emphasized the universality of the core attitude in the care of ill people. They stressed the importance and relevance of teaching core attitudes in palliative care education. Conclusion: In the field of palliative care, core attitude consists predominately of authenticity, manifests itself in relationships, and requires a high degree of perceptiveness.
Getting it right: oncology nurses’ understanding of spirituality
Authors: Noble Agnes , Jones Colin
Published: May 2014

Aim: To explore oncology nurses’ understanding of spirituality in order to shed some light on this complex area. Method: The study used a qualitative cross-sectional design, inspired by a grounded theory approach. A non-probability sample of seven nurses took part in a focus group and individual semi-structured interviews. Inspired by the framework analysis technique, the data were displayed and reduced to underlying themes. Findings: Five major themes were identified: understanding of spirituality, the nurses’ own spirituality, skills required, constraints and barriers to providing spiritual care, and education and support needs. The study found diverse definitions of spirituality, which was viewed as a vague and ambiguous concept, with some participants finding it difficult to differentiate between spirituality and religion. The impact of nurses’ own spirituality was also uncovered, with unique findings of guilt, inadequacy, and stress in attempting to address patients’ spiritual needs. Lack of time was seen as the main barrier to addressing spiritual needs, along with the emotional demands on the nurse, and a lack of training and education. Conclusion: The study finds a need for improved education in spirituality and spiritual care.
Study skills—part two
Authors: Smyth Dion
Published: May 2014

The method or practice of learning about a subject, such as palliative nursing care, by reading or conducting literature-based research, can be made more enjoyable and effective by the application of skills that allow the reader to better assimilate the information. This month’s Web Words continues the series of articles pertinent to education and learning (but relevant to all aspects of personal and professional life) with a topic that may be of particular interest to practitioners that have recently enrolled on a course of further or higher study or those contemplating doing so.
A literature review of the role of the specialist palliative care community nurse
Authors: Mulvihill Claire , Harrington Ann , Robertson Amanda
Published: May 2014

This article reviewed international research to obtain an improved understanding of the role defined in the literature as the specialist palliative care community nurse (SPCCN). Developments in cancer treatment and palliative care have lead to improved symptom control and increased prognosis for palliative care patients. In response, there has been a change to the role of the SPCCN indicating a move from a generalized, to specialist, community nurse who provides a consultancy service, thus causing role ambiguity. Within the literature, three themes emerged in defining the role of the community palliative care nurse: communication and collaboration; a clarification of the role; and the role of referral. This review found that there was a blurring of professional boundaries amongst the palliative care team and that the SPCCN has a capacity to coordinate and provide expertise in delivering complex symptom control to patients and their families
What are the key challenges facing palliative care internationally in the next 10 years?
Authors: Murray Scott A , Mason Bruce , Donaldson Anne
Published: May 2014

Five key areas ripe for development in palliative care were highlighted at the UK Palliative Care Congress in Bournemouth in March 2010 by members of the Primary Palliative Care Research Group at Edinburgh University. The presentation generated substantial interest, and hence we have invited this comment for the journal.
Employability skills: maximizing knowledge and enthusiasm
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing