bluuebunny/crossref_metadata_2025 huggingface dataset:
Ensuring nursing students on placement to ophthalmology have an effective placement
Authors: Tremayne Penny , Harrison Penny
Published: May 2014

Ophthalmology placements can be misintepreted by nursing students who can under estimate the many valuable learning opportunities that such placements can offer. Ophthalmology can provide a nursing student with an extensive menu of opportunities ranging from the acute and chronic. The ophthalmic nurse therefore needs to draw on a multitude of skills and expertise to ensure effective learning is facilitated and optimized.
Nutritional supplements – a way to prevent AMD?
Authors: Wanger Peter
Published: May 2014

Age-related macular degeneration (AMD) is a major cause of severe visual impairment in the elderly. The more dramatic wet form is characterized by rapid visual loss and subjective experience of image distortion from the affected eye. The dry form has a slowly progressive course, which may lead to complete loss of central vision. Consumption of fruits and vegetables containing carotenoid pigments is linked to reduced risk for AMD and recent studies indicate that administration of the macular pigments lutein and zeaxanthin may be beneficial, at least in some patients. Nutritional supplements are currently a billion dollar market, and a large number of scientific articles have been published during the last decade. This overview is intended to briefly summarize the current knowledge regarding AMD and nutritional supplements.
A novel approach to expanding the role of nurses to deliver intravitreal injections for patients with age-related macular degeneration
Authors: Varma Deepali , Lunt David , Johnson Paul , Stanley Sarah
Published: May 2014

Sunderland Eye Infirmary serves a patient population marked by a higher-than-average incidence and prevalence of wet age-related macular degeneration (AMD). Over the past years, a graduated multidisciplinary approach has been taken to maximise patient management capacity through implementation of AMD triage clinics, nurse-led wet AMD review clinics and optometrist-led OCT clinics for monitoring and assessment. This team-based approach has created added flexibility in the service to ensure efficient and effective delivery of AMD treatment. To extend capacity and flexibility, further SEI has recently introduced independent nurse-led intravitreal anti-VEGF injection lists enabling consultants to focus increasingly on complex pathology, poor responders and other high-risk patients. This article discusses this process to meet the AMD capacity challenge in a busy eye hospital.
The importance of evidence-based care
Authors: Wilkinson Susie
Published: May 2014

Palliative care patients have as much right as other patients to receive the most appropriate care. Several official bodies (World Health Organization, 1990; Department of Health, 1995) have suggested there is an urgent need to ensure that palliative care is of the highest quality and, where possible, evidence based. However, palliative care services have developed so rapidly over the last decade that meeting the clinical needs of patients and their families has not tended to take priority over the need to establish a sound evidence base.
Depression in palliative care patients: a literature review
Authors: Payne Sheila
Published: May 2014

This literature review aims to identify the prevalence of depression in patients who require palliative care. It is argued that it is possible to differentiate between three categories of depression. These are transitory feelings of sadness, long-term adjustments to loss, and persistent severe depression. This article briefly introduces a number of psychological theories of depression. A Medline search of the literature between 1992 and 1996 using the key words depression and terminal care/palliative care/hospice generated 96 articles. From these, 12 empirical studies on the prevalence of depression in palliative care patients were identified. It was concluded that depression rates ranged from 3% to 69% depending on the measures and diagnostic criteria used. The semi-structured interview was the most common method of assessment, and 75% (9) of studies used a cross-sectional design. Overall, the lack of methodological rigor and the small sample sizes used in these studies means that little is known about which factors are significant for predicting depression in palliative care.
Palliative care — ‘the Italian reality’
Authors: Ferrario Regina , Saita Luigi
Published: May 2014

Continuing care involves addressing the physical, emotional, socio-environmental and spiritual needs of terminally ill patients and providing adequate symptom relief (Ventafridda, 1989). This is undertaken through the development of scientific knowledge and evidence-based practice, and a strong commitment to improving the care of these patients.
Nurses’ perceptions of specialist palliative care in an acute hospital
Authors: Skilbeck Julie , Small Neil , Ahmedzai Sam Hjelmeland
Published: May 2014

Establishing the appropriate levels of provision for specialist palliative care, within the acute hospital setting, is a matter of importance for those seeking to purchase and provide such services. This article provides evidence from a study, commissioned by an NHS Trust, where the focus of attention was nurses’ assessment of the current need for specialist inpatient palliative care. Using a prospective questionnaire survey, on two separate days nursing staff were asked to identify patients who were either considered to be terminally ill and/or to have palliative care needs. Ninety-three patients were identified, approximately 5% of the hospital patient population. Of that population, 75 patients were suitable for referral to a specialist palliative care unit and 25 patients in this group were suitable for direct admission to a specialist unit. The study concluded that, in the view of nurses, a significant number of patients would be suitable for specialist palliative care within a dedicated unit.
Developing practice in palliative care
Authors: Corner Jessica
Published: May 2014

Practice development combines the systematic evaluation of healthcare interventions and practices through research, using data derived from this for the ongoing improvement of services. Practice development demands a commitment to continuous review and improvement, based on evidence. The components of practice development are shown in Box 1.
The use of guided imagery as a mourning intervention
Authors: Jones Alun
Published: May 2014

Guided imagery is a useful intervention when helping people who experience difficulty in grieving and mourning. Social factors such as a lack of support or coexisting psychological factors can cause further complications for those experiencing significant loss. A model of guided imagery is described and its application demonstrated by using a case vignette. The emotional relocation of the dead person is a major determinant in the bereaved person’s ability to adapt to life following a death. It is suggested that bereaved people face a future both with and without the deceased person.
Personal illness narratives provide a valid contribution
Authors: Sweeney John
Published: May 2014

The personal illness narrative provides a powerful means of addressing cancer or life and death issues. The fact that such narratives are sometimes met with scepticism or criticism often points not to some flaw in the stories themselves but to society’s ongoing difficulty with such issues. The growth in this literary form indicates that similar to the way in which the efforts of palliative care nurses have affected the wider profession, such tales are beginning to offer people a different way of viewing the experience of cancer and its prognosis.
Research involves small steps not giant leaps
Authors: Payne Sheila
Published: May 2014

Most healthcare contexts in which palliative care services are situated, are in a perpetual state of change. There is little time in the nurses average working day to reflect on what quality means. Recent initiatives in the British National Health Service have included; clinical governance, the National Institute for Clinical Excellence, the Commission for Health Improvements and a requirement for nurses to maintain their skills. There is little evidence yet of their effectiveness in improving standards of care (Goodman, 2000).
Palliative care issues in sub-Saharan Africa
Authors: Defilippi Kath
Published: May 2014

HIV/AIDS is unquestionably the definitive health crisis currently facing the African continent. Last year it was estimated that out of the 35 million people worldwide who are HIV positive 6 in every 10 men, 8 in every 10 women and over 9 in every 10 children live in sub-Saharan Africa (South African Department of Health, (SADoH), 1999). These staggering statistics pose an enormous challenge in that the vast majority of people infected have no access to antiretrovirals or protease inhibitors, making palliative care the only ‘treatment’ available.
Issues in effective pain control 2: from assessment to management
Authors: Davies Julie , McVicar Andrew
Published: May 2014

In the first of these two articles, Davies and McVicar (2000) reviewed issues regarding pain assessment and examined the best means of providing the underpinning education. In the second article, pain management issues are considered while focusing on the factors that influence the translation of planned care into action. The literature identifies that inadequate pain control continues to be a problem and, assessment issues apart, suggests that a lack of knowledge of analgesic pharmacology, and resultant misconceptions among both health professionals and patients, are major factors. This article provides an overview of the rationale for the use of analgesics by considering their biological actions, how the drugs fit into the analgesic ‘ladder’ (World Health Organization (WHO), 1994), and how they relate to the principles of managing chronic pain. The most common misconceptions concern the use of morphine and arise as a consequence of a lack of understanding of this drug. Further issues relating to the multidimensional aspects of pain and the need for psychosocial care and sound re-evaluations of the continuing effectiveness of pain control are identified. Finally, some of the professional issues that affect the transference of assessment and knowledge are examined. Nurses have a pivotal role in pain assessment and it is suggested that education must play a role in the development of genuine interprofessional working which will allow nurses to have more influence in formulating the care strategy and subsequent action.
Family experiences of palliative care in the acute hospital setting
Authors: Dunne Kathleen , Sullivan Kate
Published: May 2014

The study described in this article sought to gain understanding and insights into the lived experience of families who journeyed with their loved one through the palliative phase of illness as inpatients in the acute hospital setting. The study was carried out in a district general hospital which did not have the services of a palliative care team. A descriptive phenomenological approach was used as the researcher wanted the participants to describe their experience of palliative care in the acute hospital setting as they experienced it. This approach is described in detail. A purposive sample of eight family members was interviewed and data were analysed using Colaizzi’s (1978) seven stages of data analysis. The results showed that the acute hospital environment had many shortcomings as a place to deliver palliative care and family members were at times left feeling isolated and helpless. The limitations of the study are discussed along with recommendations that could enhance outcomes of care for family members during this difficult period in their loved one’s illness.
Altered body image: managing social encounters
Authors: Price Bob
Published: May 2014

For terminally ill people who are still active within the community, altered body image can pose significant problems. Patients may have an obvious change in appearance or function, but be unsure how to present a positive image to others. Moreover, lay supporters are often equally unsure how to react to the changed appearance of the dying person. Changes in physical appearance and function associated with disease processes (and sometimes treatment) need to be integrated into the interaction that occurs between patients and lay carers. This is likely to be a difficult matter to facilitate, taxing the ingenuity of the palliative care nurse who hopes to assist the patient in this regard. This article uses a case study from the community-based palliative care setting to introduce steps that nurses and patients might consider as the patient sets out to manage such social encounters.
Fatigue: online resources and advice
Authors: Sweeney John
Published: May 2014

This site is a joint development by the Oncology Nursing Society and the Fatigue Coalition. Like many US sites, the content is also available in Spanish in order to reach the widest possible audience. The site allows the user to explore fatigue in detail, and includes information that patients may use to improve their ability to cope with this cancer symptom. For the professional, the site raises the challenge of considering fatigue in a new light; not just as an inevitable part of cancer, its treatment and progression but rather as a problem that needs to be addressed in a holistic fashion in much the same way as pain is.
Dying at home: evaluation of a hospice rapid-response service
Authors: King Gerry , Mackenzie Jillian , Smith Hazel , Clark David
Published: May 2014

Various studies suggest that there is a preference among patients, professionals and the public for death to occur at home (Dunlop et al, 1989; Townsend et al, 1990; Hinton, 1994). Data indicates that some patients are denied the opportunity to exercise choice in the place of death. In areas where palliative rapid-response teams have been available more people have been able to die at home. This article presents the findings of an evaluation of a hospice rapid-response service in the Highlands of Scotland, which was designed to respond to the needs of people in crisis facing death. The study was designed to produce a rigorous and comprehensive description of a newly–operational service at the pilot stage. It reflects not only the views of the professionals involved but also focuses on the views of informal carers. Seventeen patients were referred to the rapid-response service in its first year of operation between April 1998 and March 1999. The service has shown some success in enabling patients to die at home and satisfaction with the service is high among professionals and lay carers.
An audit of out-of-hours advice services provided by hospice staff
Authors: Baldry Cath , Balmer Shirley
Published: May 2014

For those giving and receiving health care there will always be problems and queries which occur outside of normal office hours. Palliative care is no exception. It was found that Queenscourt Hospice in Southport was being used as an accessible point of contact for specialist palliative care advice by patients, relatives and health professionals. In response, an audit was undertaken to monitor the frequency and substance of the many drop-in visits and telephone calls to the hospice. The results showed that almost half of the calls/visits received are outside office hours. This article describes the nature of the calls and the advice offered by the staff taking the call. As the majority of the ‘out-of-hours’ calls/visits were taken by nursing staff, it was necessary for them to draw on their specialist palliative care knowledge and communication skills to make an assessment of how best to deal with each situation. As a result of the audit, several organizational and educational initiatives have been developed to further improve the service offered.
Nurses’ knowledge of palliative care in the Australian Capital Territory
Authors: Proctor Margaret , Grealish Laurie , Coates Margaret , Sears Penny
Published: May 2014

Australia has a growing number of specialist palliative care services. As they expanded in the Australian Capital Territory, a working party was established to discuss issues associated with palliative care. One activity authorized by this committee was a survey of nurses’ knowledge of palliative care. The Palliative Care Quiz for Nurses (Ross et al, 1996) was adapted with permission for this survey: 455 registered and enrolled nurses were surveyed; 247(54%) participants returned completed questionnaires. The overall mean score for the Palliative Care Quiz was 12.4 of a possible 20; the mean scores were 13.2 for registered nurses and 10.6 for enrolled nurses. Nurses with some oncology or palliative care experience scored significantly higher than others. Nurses with more work experience as measured by working years also attained significantly higher scores. Analysis and examination of correct items suggest that nurses have acquired basic knowledge through experience. However, as other studies have suggested, there is also a lack of knowledge of complex symptoms found in palliative care patients.
Managing constipation in advanced illness
Authors: Gamlin Richard
Published: May 2014

A very troublesome symptom for patients with advanced illness is constipation. Despite our best efforts many patients will suffer the discomfort and indignity of constipation, the reasons for which are varied and complex. The internet carries a multitude of sites regarding the management of constipation. The information ranges from folklore and myth to well constructed, well presented sites that inform both professionals and patients alike. Because of the embarrassing nature of constipation we can expect patients and their carers to consult the internet for authoritative information.
Why not natural death?
Authors: Holland Christi A
Published: May 2014

Alzheimer’s disease (AD) is a devastating and unforgiving disease that steals our loved ones away long before the physical body declines toward death. It robs them of their independence, their history with family and moves them into a type of existence that we can only hope is peaceful, if not content.
Fighting spirit: a psychoeducational group for younger women with breast cancer
Authors: Smeardon Kathy
Published: May 2014

Overall cancer survival rates in the United Kingdom are demonstrating a continual and progressive increase. Women diagnosed with breast cancer contribute to 28% of the 45% of all female cancers in the higher survival band (Coleman et al, 1999). As medical therapies strive to cure or extend the survival of patients diagnosed with cancer the quality of their cancer experience becomes paramount. Fighting Spirit is a support group that aims to reduce psychological morbidity in young women diagnosed with breast cancer. It promotes an optimistic attitude and a wish to participate and learn about treatment modalities while carrying on a normal life despite having cancer. The programme provides supportive therapy for both curative and palliative care. This article offers a rationale for the group intervention, describes the model used and the programme content. The facilitators’ experience of running the group is also discussed.
Silent voices, hidden practices: exploring undiscovered aspects of cancer nursing
Authors: Aranda Sanchia
Published: May 2014

This is an abridged version of the sixth annual Robert Tiffany Lecture presented on 14 March 2001 at the Royal Marsden’s National Cancer Nursing Conference in London. Robert Tiffany was the chief nurse at the Royal Marsden, London from 1976 until 1993. The lecture is named after him to commemorate his work establishing oncology nursing across the world and, more specifically, developing its practice at the Royal Marsden. This lecture examined the silences that exist in nursing practice – the things that nurses do not talk about or even understand as part of their work. Drawing on research that explored nurse–patient relationships in cancer and palliative care settings, this lecture highlighted the closeness and intimate nature of such relationships and reflected on their impact on nurses, patients and nursing practice.
The professionals and the public: on-line resources to inform all
Authors: Gamlin Richard
Published: May 2014

Although aimed at health professionals in the UK, these websites are useful the world over, for they display clarity and depth of content. They can be used as models upon which other palliative care resources can be based in order to provide an extensive information package.
Inpatient hospice triage of ‘after-hours’ calls to a community palliative care service
Authors: Aranda Sanchia , Hayman-White Karla , Devilee Linda , O’Connor Margaret , Bence Gabrielle
Published: May 2014

This article reports on a retrospective study of the provision of ‘after-hours’ telephone support by a community palliative care service during 1996 and 1997. Calls received outside of normal office hours were triaged through an inpatient hospice unit located in the same building as the community team. During the study period, 629 patient or carer calls were received, predominantly between 5pm and 11pm. The main reasons cited for using the after-hours service were medication queries, pain, seeking advice from the nurse and anxiety. The triage nurse successfully handled 30% of the calls. The remaining 70% of calls were transferred to the on-call community palliative care nurse, resulting in 251 home visits. Visits were not predicted by call reason, patient living arrangements, diagnosis or clinical problems; the patient being close to death or having died was a predominant reason for visiting. It was found, however, that call outcomes could be partly predicted by the identity of the triage nurse. It is argued that the findings of this study raise important issues related to the provision of after-hours palliative care and the training of staff providing triage of calls from patients and families at home.
Exploring the value of shiatsu in palliative care day services
Authors: Cheesman Sheliagh , Christian Rosamond , Cresswell John
Published: May 2014

This qualitative study sought to evaluate the effects of shiatsu therapy on clients attending hospice day services. Eleven clients with advanced progressive disease received five therapy sessions each at weekly intervals. Data about the effects was collected through five unstructured interviews with each client. Four of these were conducted before, during, and shortly after the therapy regime, and the fifth was undertaken four weeks after treatment ended. All the interviews were tape-recorded, transcribed and subject to content analysis. The results of the analysis revealed significant improvements in energy levels, relaxation, confidence, symptom control, clarity of thought and mobility. These benefits were of variable duration – in some instances lasting a few hours but in others extending beyond the 5-week treatment regime. Action to ensure research trustworthiness included keeping research journals to provide an audit trail, conducting member checks and using peer debriefing. The study involved three overlapping cohorts of participants in a data collection period that took approximately 6 months.
Searching successfully for on-line information
Authors: Gamlin Richard
Published: May 2014

This month, instead of reviewing specific palliative care websites I will review some of the more popular ‘search engines’. These websites offer the visitor an opportunity to search for information about a subject of their choice. It is important to realize that the search terms used will influence the quantity and type of information you receive. The search engine has no intelligence and can only look for the words you supply. Familiarity and practice enable the user to select more appropriate and useful information.
A study of family carers of people with a life-threatening illness 2: implications of the needs assessment
Authors: Scott Gill
Published: May 2014

This is the second of two articles that consider the findings of a Carers’ Assessment of Difficulties Index (CADI) (Nolan et al, 1998) delivered in a palliative care context. It analyses the implications of these findings for practitioners concerned with the delivery of palliative care to such carers and their families. The development of support strategies and services addressing their needs are also presented against a backdrop of transactional stress theory. For people new to caring, recommendations for the local service include early intervention through informational support and validation of their emotional responses to caring; for longer-term carers they include assistance with cognitive reappraisal of the stressfulness of caring and regular ‘respite’ and socializing opportunities. These are taking place in a political climate that finally recognizes the contribution and value of carers (Department of Health, 1999). The research behind these carer identity and recognition initiatives aims to apply the spirit of public recognition and practical wisdom of palliative care expertise by responding sensitively to the specific needs of carers of people with a life-threatening illness.
How best to support bereaved children
Authors: Wilkinson Susie
Published: May 2014

A recommendation arising from a recent conference on child bereavement was that specific services and interventions should be developed for such children. Yet, in the current climate of evidence-based practice, it is not clear how such a recommendation can be justified.
Bridging the research-practice gap: breaking new ground in health care
Authors: Mulhall Anne
Published: May 2014

Many theorists have discussed the existence of a gap between nursing research and practice. Consequently much time and effort has been expended in trying to devise strategies to bridge this divide. This article explores what the research–practice gap is and discusses five important reasons for it. The issue is then raised as to whether or not there is a gap between evidence and practice, despite the existence of the gap between research and practice. This is explored in relation to the potential conflict between the ‘know how’ knowledge important in practice and the ‘know that’ knowledge important in academia. Finally, the concept of practitioner-centred research is described as one strategy that would effectively obliterate the research–practice gap as it is currently conceived.
Dignity and palliative care
Authors: Gamlin Richard
Published: May 2014

The word dignity is often spoken by patients, family and professionals when talking about the care of patients who are dying. Rarely is it defined yet it is a central theme running throughout the care we provide. When teaching about the philosophy of palliative care the concept of dignity is almost always raised. Some students find it relatively easy to articulate while others struggle with the concept. The literature contains many references to dignity in palliative care but again few attempts have been made to define or describe its meaning. A search using the terms ‘dignity’ + ‘palliative care’ returned 10400 sites. A selection of sites reveal very different approaches to the subject.
Containing families’ grief: therapeutic group work in a hospice setting
Authors: Kirk Kate , McManus Mick
Published: May 2014

This article explores the literature relating to the needs of bereaved children and families and describes the course of a family bereavement group run in a hospice. The interventions involved dramatherapy and other creative arts media. The group comprised of four families all of whom had had a parent die in the hospice. Their ages ranged from 6–46years. Two one-day workshops were followed by six closed-group evening sessions. The aims and interventions for each session are outlined and a short commentary on the process given. Significant aspects of containing families’ grief through the use of therapeutic group work is highlighted.
Palliative care for Muslims and issues before death
Authors: Gatrad AR , Sheikh A
Published: May 2014

National and European directives have now enshrined within European law the requirement that health-care professionals provide their patients with culturally appropriate and sensitive care. Although well intentioned, many health professionals find it difficult to translate these directives into practice. Barriers to providing culturally competent care include racism, institutional discrimination and gaps in our understanding of the interface between culture and health - this latter factor reflecting the lack of training in transcultural health care. In this paper, we concentrate on issues relating to the provision of palliative care near death to Muslims of South Asian origin in the UK, although much of what is said will equally be applicable to Muslims from other parts of the world. This is the first of two articles giving insights into the palliative care of Muslims. The second article ‘Palliative care of Muslims and issues after death’ will appear in a later issue.
An integrated care pathway for the last two days of life: Wales-wide benchmarking in palliative care
Authors: Fowell Andrew , Finlay Ilora , Johnstone Ros , Minto Lindsey
Published: May 2014

Functional benchmarking assesses performance and practice across a broad range of settings and carries the potential to effect change in practice. An integrated care pathway (ICP) can assist in the benchmarking process, defining desired outcomes for specific patient groups over a designated time frame. Any variations to the agreed course of care are documented using the ‘variance sheet’. This article describes the Wales-wide implementation of an ICP for the last two days of life. The project has enabled an ongoing centralized collection and analysis of variance sheets, which reflect the care of the dying patient in four different care settings crossing the voluntary and statutory sectors. Initial analysis of the first 500 variance sheets to be generated by the ICP for the last two days of life indicates that the management of pain, agitation, excess respiratory secretions and mouth care may be problematic. The same problems were experienced across acute, hospice, specialist inpatient units and community care. Closing the audit cycle involves incorporating the information from the variance analysis into clinical practice.
Use of quality-of-life scores in care planning in a hospice setting: the theme of revelation
Authors: Hill Nita
Published: May 2014

This article follows an earlier one in which measurement of quality of life (QOL) was used in developing patient-care plans and to identify differences in QOL assessment between nurses and patients as an aid to reflective practice. The present article discusses how the theme of revelation emerged from the insights of those in the study. The process of measuring, and subsequent use of, QOL scores increased understanding between nurses and patients. Some nurses were surprised at how different their perception of a patient’S QOL was from that of the patient. Completing QOL questionnaires also gave some patients new insights. How such revelations might be used to improve QOL are discussed.
A commentary on ‘Joe’s story: reflections on a difficult interaction between a nurse and a patient’s wife’
Authors: Seber Pat
Published: May 2014

In this article Pat Seber gives her viewpoint on a nurse’S reflections on a difficult interaction and discusses the possible role of clinical supervision.
Palliative care in district general hospitals: the nurse’S perspective
Authors: McDonnell Mary , Johnston Gail , Gallagher Anthony G , McGlade Kieran
Published: May 2014

Most patients with a terminal illness die in hospital, yet the opinions of their prime carers are largely ignored. This study investigated registered nurses’ perceptions of palliative care in district general hospitals. A random sample of 263 nurses was surveyed, using a pre-piloted questionnaire, and results showed that 70% of general ward nurses believe that managing care of the dying is an integral part of hospital care. However, their dissatisfaction with the care they give is reflected in the mere 8% who consider hospital an ideal setting for patients who are dying. Although nurses are confident in their physical/clinical role, dealing with psychosocial issues is more problematic. A minority feel confident in discussing death and dying with the patient. Barriers to optimal palliative care on general wards were perceived as lack of appropriate education and training, work pressures, and lack of support from medical colleagues and managers.
An overview of chemotherapy-induced emesis highlighting the role of lorazepam as adjuvant therapy
Authors: Cooper Ruth , Gent Peter
Published: May 2014

By preventing and optimizing emesis control in patients receiving chemotherapy, clinicians may significantly improve patients’ functional status and quality of life. Improved tolerability may lead to greater patient acceptance of chemotherapy and prevent premature withdrawal or cessation of treatment. Controlling chemotherapy-induced emesis also helps to decrease the direct and indirect costs of managing cancer. This article reviews improvements made in antiemetic therapy and considers how the addition of lorazepam may further optimize the prevention and management of emesis at various stages of manifestation.
In search of a common language
Authors: Larkin Philip
Published: May 2014

Perhaps one major achievement of international conferences in palliative care is to highlight the common language that unites us in our vision and resolve to develop the speciality. Criticism could be levelled at those of us who speak English as a first language because of our failure to fully explore European collaboration, in the fear that we won’t understand each others language. However, the language of palliative care evidently causes problems for our European counterparts too, as highlighted in a national report on the development of palliative care (National Advisory Committee on Palliative Care, 2000).
Looking to the future
Authors: Aranda Sanchia , Cooley Candy
Published: May 2014

The start of a new year is a time for resolutions, good intentions and change. At the International Journal of Palliative Nursing there have been a number of changes since it’s conception in 1995. The journal has developed in terms of the diversity of writers and editorial board members and in the breadth and scope of the subjects presented. Many of these changes result from the stewardship of Susie Wilkinson as Editor-in-Chief, a position Susie resigned from at the end of 2002. We would like to thank Susie for her significant contribution to the journal over the past 4 years and wish her well on behalf of all the IJPN editorial board and readers.
Using a model for structured reflection on palliative care nursing: exploring the challenges raised
Authors: Souter Jill
Published: May 2014

Reflection on palliative care nursing practice has to encompass every dimension of the holistic care we offer. In this article a possible structured model for reflection on palliative care nursing is discussed and used to reflect on the care given during a community Macmillan nurse visit. The reflection revealed a number of challenges. These included the possible conflict between patient autonomy and quality of life for carers, the role of intuition in palliative nursing and spiritual care. The article concludes that reflection has a role to play in exploring the innate tensions in palliative care, voicing the often silent intuitive knowledge and promoting expertise in spiritual care.
Phenomenology: learning from our patients and ourselves
Authors: Coyle Nessa
Published: May 2014

The suffering of the dying and the suffering of their families is most often told in the words of others. But suffering is something that happens within a person. It may be deduced, inferred, and theorized by others but only direct testimony communicates the suffering felt by an individual (Coyle, 1996).
General nurses: palliative care needs You!
Authors: Glide Julian
Published: May 2014

I was recently left pondering a disquieting encounter between a staff nurse and myself, variations of which are, in my experience, all too common. Responding to an urgent referral from one of the wards, I was informed by the staff nurse that the patient to be seen had been in pain all weekend. When I enquired why nothing had been done about the pain, I was told that they were waiting for me to assess and make recommendations.
Professionals’ perceptions of maintaining personhood in hospice care
Authors: Kabel Allison , Roberts Dai
Published: May 2014

This qualitative study examines the attempts made by hospice staff to support and maintain the personhood of hospice patients. The study was conducted over a 6-month period at two hospice facilities in northwest England. Thirty staff members were interviewed about their interpretation of the hospice philosophy and how this influences their work with regard to patient personhood. Staff employed methods of normalizing the often-distressing symptoms that accompany serious illness, with the aim of maintaining personhood and dignity. Related to the support of personhood, is the concept of the ‘special’ patient. Staff members discussed feelings of attachment towards particular patients that had developed out of the care-giving relationship. There was no suggestion that staff perceived special patients as receiving preferential treatment at the expense of other patients. However, experiences with ‘special’ patients positively impacted staff members by reinforcing occupational choice and the inherent rewards of the profession.
Skin cancer resources
Authors: Smyth Dion
Published: May 2014

The diagnosis and treatment of cancer can have an overwhelming influence upon the quality of patients’ lives, and that of their families and carers. It has long been established that access to knowledgeable and skilled staff who are able to provide adequate information, advice, and support from the time of diagnosis through to death is an essential requirement for the provision of quality services.
Listening, advocacy and commitment: common threads that unite us all
Authors: Drew Donna
Published: May 2014

Regardless of where we work, the cultural and religious aspects we encounter and whether our patient is young or old, we as palliative care nurses have common qualities that unite us all. In my day-to-day work, it is not uncommon to share the care of a dying child, and of his or her family, with an adult-focused palliative care team. Sometimes these referrals may be an emotional or confronting experience for a nurse who is not familiar with the world of paediatrics or who chooses not to work specifically with children or adolescents.
The experience of manual lymph drainage as an aspect of treatment for lymphoedema
Authors: Woods Mary
Published: May 2014

The aim of this study was to develop an understanding of the patient’s experience of a course of manual lymph drainage (MLD) for cancer-related lymphoedema. The study used an interpretative approach. Six patients took part in unstructured interviews with the researcher 1 month after a 3-week course of daily MLD, provided by a trained MLD therapist. The researcher also recorded personal observations and thoughts throughout the study period. A number of themes emerged from the data illustrating patients’ hopes and expectations regarding MLD. These were often linked with a desired response to treatment. Feelings of relaxation and calm during and after daily MLD were described and the treatment was also found to allow patients time-out to sleep, think or reflect. This small study adds to the limited body of knowledge about MLD and will help lymphoedema therapists identify how this treatment may influence the care of their patients and how resources could be allocated in its future provision.
Nurses’ perceptions of the Liverpool Care Pathway for the dying patient in the acute hospital setting
Authors: Jack Barbara A , Gambles Maureen , Murphy Deborah , Ellershaw John E
Published: May 2014

The Liverpool Care Pathway for the dying patient (LCP) was developed to transfer the hospice model of care into other care settings. It is a multiprofessional document that provides an evidence-based framework for the dying phase. It provides guidance on the different aspects of care required including comfort measures, anticipatory prescribing of medication, and discontinuation of inappropriate interventions. Additionally, psychological and spiritual care and family support is included. This article presents the findings of a study to explore hospital nurses’ perceptions of the impact of the LCP using focus group interviews. Data were analysed for emerging themes using thematic analysis. The results suggest that the nurses have generally found that the LCP had a positive impact on patients, their families and also on nurses and doctors. This article will explore these benefits, as well as potential barriers to its use.
Have you heard the one about…
Authors: Becker Bob
Published: May 2014

Few of us have the talent and timing to tell a joke successfully and raise a hearty laugh. As a teacher, telling a joke in the classroom is even more fraught with danger. Even the most experienced and charismatic have fallen foul of the mistimed punch line that leaves a previously rapturous audience totally bemused.
The experience of uncertainty for individuals with HIV/AIDS and the palliative care paradigm
Authors: Cochrane Jackie
Published: May 2014

This small qualitative study investigated the lived experience of individuals with HIV/AIDS, exploring the uncertainty related to episodes of life-threatening illness followed by recovery, ‘revival’. The themes that emerged related to the unpredictability of when death would occur. The participants described the dilemma of living with a chronic illness with a totally unpredictable disease trajectory. Following periods of being extremely unwell, individuals would then recover and experience periods of relative wellbeing, only to succumb to another infection later. The findings highlighted the uncertainty that pervades all aspects of HIV-positive individuals’ lives as they face death. An awareness of this may be important in those offering palliative care to those with HIV/AIDS.
Lung cancer resources
Authors: Smyth Dion
Published: May 2014

Lung cancer is the second most common form of cancer in the UK after breast cancer and there are over 38 000 new cases of lung cancer in the UK each year. Worldwide, lung cancer incidence and mortality continue to rise – it is, reportedly, the ninth most common cause of death in the world.
The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia
Authors: Abbey Jennifer , Piller Neil , Bellis Anita De , Esterman Adrian , Parker Deborah , Giles Lynne , Lowcay Belinda
Published: May 2014

The need for a specialized clinical regimen for patients with dementia who require palliative care has only recently been recognized. Structured approaches to palliative care are not well developed. The recognition and treatment of pain is an important part of this management task. However, pain is consistently underdiagnosed and undertreated in this population. A factor contributing to this has been a lack of appropriate tools to help recognize and document pain. This study sought to develop and validate an easy-to-use pain scale for use in residential aged care homes. The tool was developed with residents with end- or late-stage dementia who were unable to articulate their needs, identified by the registered nurses who knew them. Results showed that following pain-relief intervention the average pain score recorded using the scale fell by more than half. A paired Student’s t-test showed the reduction to be highly significant (P<0.001). Validity and internal reliability, assessed by calculating Gamma and Cronbach’s alpha, were found to be satisfactory. Qualitative evidence gathered from users of the scale indicated that it was considered a useful clinical device that could be completed within 1 minute. Further analysis of the use of the scale in clinical settings, testing of inter-rater reliability and examination of the limitations found in this study will commence early in 2004.
Patients should choose where they want to die
Authors: Cooley Candy
Published: May 2014

Happy New Year! The purpose of this new section of IJPN is to stimulate some discussion and debate that reflects international experiences around a specific issue. I’m going to start with a discussion around government-led initiatives and whether they always achieve their stated aim.
Role of a clinical facilitator in introducing an integrated care pathway for the care of the dying
Authors: Mellor Frances , Foley Tina , Connolly Michael , Mercer Vicky , Spanswick Maryam
Published: May 2014

Integrated care pathways (ICPs) have been developed as a tool for improving end-of-life care. The Liverpool Care Pathway for the Dying (LCP) is a multidisciplinary and evidence-based approach to caring for the dying person. At Wythenshawe hospital a clinical facilitator was appointed to facilitate the introduction of the LCP. This full time post, which existed for 18 months, involved supporting and educating staff about the pathway. The LCP is now used throughout the general surgical and medical wards and acute and regional coronary care units. This article reflects on the different aspects of the role and the development of the project.
Handling spiritual questions of terminally ill patients
Authors: Loh Keng Yin
Published: May 2014

In caring for terminally ill patients, we may sometimes be asked difficult questions by our patients. The hardest questions may not be medically related but rather relate to doubts about patients’ own cultural and religion practices.
Friends and family caregivers in palliative care
Authors: Smyth Dion
Published: May 2014

Although the definition and description of palliative care may change, one constant in the principles and practice of this developing specialty is the recognition of the core involvement of family and friends as contributing carers, or recipients of our support.
Forgotten voices: lessons from bereaved caregivers of persons with a brain tumour
Authors: Sherwood Paula R , Given Barbara A , Doorenbos Ardith Z , Given Charles W
Published: May 2014

Although investigators have identified rewards and difficulties from assuming the role of caregiver for persons with cancer and persons with Alzheimer’s disease, few studies have examined factors that lead to role strain for caregivers of persons with both oncological and neurological symptoms. In this study qualitative methods were used to analyze data from self-report questionnaires from 43 caregivers of adults with a primary malignant brain tumour (PMBT) in the USA. Six themes emerged from the analysis: the work of caring, informal support, formal support, information, dealing with symptoms, and end of life. The data suggest that health-care providers (HCPs) may decrease role strain by helping to identify competing demands, clarifying expectations of the role, providing information to caregivers on how to use formal and informal support systems to delegate care tasks, and by teaching caregivers how and when to ask for help. HCPs may also assist caregivers by providing information on managing cognitive and neuropsychiatric problems at home, what to expect at the end of life, and by following up to determine the caregiver’s ability to integrate information into providing care.
An interview with Lesley Martin
Authors: Mitchell Kay
Published: May 2014

In December 1998, Lesley Martin, a registered nurse, relocated from her home in Australia to New Zealand, to care for her mother who was receiving treatment for bowel cancer. In May 1999, after surgery and multiple interventions to address postoperative complications interspersed with periods of relative wellness, Joy Martin’s condition had deteriorated until it was clear she was dying. Joy discussed with Lesley her fear of a long drawn-out death, asking Lesley to promise that she would intervene to spare her such a death. Lesley promised.