bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-procedural education on anxiety levels during intravitreal injections
Authors: Beasley Rebecca 
Published: May 2014

Aim This paper aims to explore the role of pre-procedural education on the anxiety and/or pain levels of macular degeneration patients during intravitreal injections. Background The significance of pre-procedural education has been debated for many years, with many authors/clinicians alleging that informative preparation reduces pre-surgery anxiety levels and peri/post-procedural pain levels experienced by patients. Methods A comprehensive methodological analysis was employed in order to critically evaluate relevant research. A range of electronic databases and ancestry resources were searched for current contemporary articles published between January 2000 and March 2010. Search terms incorporating ‘anxiety’ ‘education’ ‘fear’ ‘discomfort’ ‘pain’ ‘ranibizumab’ and ‘macular degeneration’ were combined. The types of methodological studies were not specified in the strategy in order to prevent elimination of potentially applicable literature, therefore, both anecdotal and empirical articles were considered pertinent. Results Seven articles met the identified inclusion/exclusion criteria. Data abstraction was undertaken and all eligible studies were evaluated for quality, validity and reliability. Collectively, each of the studies reviewed placed emphasis on the importance on pre-procedural patient education and counselling. Nevertheless, individual differences exist in the amount, type and specificity of information provision provided. In general, the research articles reviewed also demonstrate the assumed existence of high anxiety levels pre-ophthalmic surgery commonly relating to patient anticipation and apprehension. Conclusion Greater understanding of the context within which educational provision impacts on patient anxiety and/or pain levels during intravitreal injections will facilitate the design of effective education and support systems for macular degeneration patients throughout the disease process.
Diabetes and diabetic retinopathy
Authors: Bentley Peter , Gibbons Helen , Mapani Adam 
Published: May 2014

It is estimated that in the UK alone there are 2.6 million people diagnosed with diabetes and a further half a million unknown people with diabetes. Although diabetes is seen across all ethnic groups it is more common in those of Afro-Caribbean populations living in the UK. One of the most common complications of diabetes is diabetic retinopathy, which features in a third of the population of those affected by the condition. This article will give a brief overview of diabetes and then it will focus on diabetic retinopathy, and will conclude with a case study.
Stereo imaging in ophthalmology
Authors: Hancock Richard 
Published: May 2014

Stereo imaging in ophthalmology is an important diagnostic modality and a task not often undertaken in many ophthalmic photography departments. Origins of retinal stereo imaging date back to over 100 years ago. Stereo imaging is recommended, for example, for all photographs of the optic nerve head and for ocular angiography intended to determine clinically significant macular oedema. It is also useful in determining sub types of wet-form age-related macular degeneration. Stereo fundus photography and angiography facilitate the diagnostic process by clearly defining retinal structure and elevation. This allows the clinician to assess the patient's retina, presenting a 3D image that does not move and is not light sensitive. Stereo imaging of the fundus is useful for follow-up management of the patient, and is used extensively in clinical trials. This article will look at the history of stereo photography, its application and rationale to ophthalmology, and the different methods of attaining stereo images of the retina.
An evaluation of dependency assessment: experiences of staff, patients and carers in a UK hospice
Authors: Quinn Helen , Allan Helen , Bryan Karen 
Published: May 2014

Aim To evaluate the experiences of health-care professionals, service users and carers of service users from a UK hospice in relation to dependency assessment. Design Qualitative evaluation. Sample Purposive, convenience sample of hospice staff, patients receiving hospice services and carers of patients receiving hospice services. Methods Focus group interviews with hospice staff and carers of hospice service users. Individual interviews with patients. Results Staff felt the tool used produced inaccurate results, in part because of omissions in content. They did not perceive the data produced affected working practice, e.g. staffing levels. Patients described unobtrusive assessment and stated their needs were met. Carers reported feelings of isolation. They also described differing information and support needs from the patients. Conclusion Further research is required to improve the validity of dependency data collection. Further investigation of carer assessment is also justified.
What influences decisions around the place of care for terminally ill cancer patients?
Authors: McCall Kathryn , Rice Ann Marie 
Published: May 2014

Aim To explore what factors influence decisions around the place of care for terminally ill cancer patients in a rural area in West Highland, Scotland. Design This was a descriptive, explorative, qualitative study using taped semistructured interviews. Sample A purposive sample of eight terminally ill cancer patients. Results The determinants for the desired place of care were organized into three main themes: carer resource and support; past experiences with death; and communication of wishes. The study evidenced that individuals often changed their preferred place of care at the end of life as the need for care increased. Those involved in the study found a therapeutic and emotional benefit by being able to discuss end-of-life care in a safe and secure environment. Conclusion For many, the preference for place of care at the end of life was conditional on how the process of their disease advanced. It was not a clear and positive choice, but it did include the desire to be cared for in a place other than home. Carer availability and ability were influencing factors; however, decisions reflected the patient’s perceptions of resources rather than those of the carer, even when the carer was available and able. The challenge to those who work with the terminally ill is to develop effective interventions to facilitate discourses around end-of-life care, and thereafter, where possible, to facilitate those preferences.
Identifying educational needs in end-of-life care for staff and families of residents in care facilities
Authors: Brazil Kevin , Vohra Julie Uma 
Published: May 2014

Aim The purpose of this article is to describe educational needs in end-of-life (EoL) care for staff and families of residents in long-term care (LTC) facilities in the province of Ontario, Canada. Barriers to providing end-of-life care education in LTC facilities are also identified. Design, setting and participants Cross-sectional survey of directors of care in all licensed LTC facilities in the province of Ontario, Canada. Results Directors of care from 426 (76.9% response rate) licensed LTC facilities completed a postal-survey questionnaire. Topics identified as very important for staff education included pain and symptom management and communication with family members about EoL care. Priorities for family education included respecting the residents’ expressed wishes for care and communication about EoL care. Having sufficient institutional resources was identified as a major barrier to providing continuing education to both staff and families. Conclusion Through examining educational needs in EoL care this study identified an environment of inadequate staffing and over-burdened care providers. The importance of increased staffing concomitant with education is a priority for LTC facilities.
Thinking about nursing practice and culture: syringe drivers
Authors: Shaw Susan , Meek Fraser 
Published: May 2014

We recently set up a new inpatient unit and this involved making various decisions about our philosophy and approach to nursing practice (Shaw et al, 2007). One of the clinical issues we had to deal with was how to manage syringe drivers. Syringe drivers had been used within the community for many years, and local guidelines about their use along with various policies and procedures existed. We considered all of this information and asked some critical questions about it. One of the most practical issues we explored was the volume (or length) of infusions. This single issue and our response to it caused a significant amount of reaction among colleagues. We have written this article in an attempt to explain some of the issues relating to nursing practice and culture as we perceive them and to raise questions about why and how professionals sometimes respond to changes in practice.
Intuition in clinical decision-making: a psychological penumbra
Authors: Nyatanga Brian , Vocht Hilde de 
Published: May 2014

Aim: To demonstrate the link between intuition and cognitive as well as physiological processes as a way of helping to explain how intuition plays a part in complex decision-making. Background: Over the years, numerous debates and discussions have raged about how intuition contributes to the making of complex clinical decisions. Intuition continues to be poorly understood, and in some cases, it is still considered the work of our sixth sense. Although experts make accurate intuitive decisions, they are not always able to articulate how they have arrived at a particular decision. Method: We use two scientific experiments to demonstrate how research has helped to explain the cognitive and physiological functions of intuition in relation to complex decision-making. We discuss the role of unconscious thought in intuitive decision-making. Finally, we show that intuition can be a valuable component of expert practice. Conclusion: Intuition has traceable cognitive and physiological bases that help us understand how we use it as a basis for making complex clinical decisions. Experts, especially those working in acute and palliative care, where there are difficult ethical as well as clinical patients situations, can benefit from using intuitive ideas to arrive at complex decisions.
Supporting children and families facing the death of a parent: part 1
Authors: Kennedy Catriona , McIntyre Rosemary , Worth Allison , Hogg Rhona 
Published: May 2014

Aim: To present findings from a review of key literature and from a scoping of current provision of support for children facing the death of a parent. A summary of the findings from these is reported here. Methods: To set out the background and context to the evaluation of a new service aimed at supporting children and families facing the loss of a parent from cancer, key literature was reviewed and a scoping of current bereavement support for children and families was conducted using online searching, telephone and face-to-face communications. Findings: The review processes uncovered a range of national and local bereavement services. Bereavement was reported as a normal life event and part of human experience. Health, education and social services personnel need to respond to individual needs, accepting that not all bereaved children require complex, long-term interventions. Conclusions: At national and global levels there was recognition that the needs of bereaved children require careful assessment. A complex range of initiatives have been developed across the UK aimed at supporting children facing the death of a family member. The fragmented nature of provision makes it difficult to be comprehensive or all-inclusive when describing service provision in this area.
Supporting children and families facing the death of a parent: part 2
Authors: Kennedy Catriona , McIntyre Rosemary , Worth Allison , Hogg Rhona 
Published: May 2014

Aim: To report on the views of children, parents and key stakeholders of a new bereavement support service for families where a parent is dying from cancer. Study design: A qualitative pre- and post-intervention evaluation design was used. Case study methods allowed multiple perspectives to be accessed so broadening the scope of the evaluation. Sample and setting: A purposeful sample of six families was recruited from the community palliative care service. Each case study comprised a family, a health professional and the family support worker. Six key stakeholders also contributed data. Methods: Data gathering included individual and family group interviews, non-participant observation and interviews with nominated health professionals, key stakeholders and the family support worker. Analysis of pre- and post-intervention data were supported by QSR NVivo. Findings: Children and families with complex and/or enduring needs benefited from the specialist expertise and interventions provided by this service. Conclusions: Risk assessment procedures should be used to identify need and ensure limited resources are directed appropriately. Many children and families can be supported within the community drawing on their own social networks.
Spirituality in palliative care: what language do we need?
Authors: Byrne Marjory 
Published: May 2014

This article considers the language of spirituality in palliative care (Byrne, 2002; 2007), and focuses on the concepts of metaphor and story, demonstrated in practice by the art project and publication at The Prince & Princess of Wales Hospice (PPWH), Glasgow, UK. Metaphors have been used in everyday speech and literature throughout history. The word ‘cancer’ is a metaphor itself traced back to Hippocrates in the 5th century BC. Stanworth (2004) concluded that metaphor can draw attention to aspects of the patient’s experience that might otherwise be overlooked. In palliative care the metaphor of the journey is often used to describe the experience of illness. Cicely Saunders (2000) described it as a spiritual journey, demonstrating opportunities for growth and development, hope and discovery. As professionals we share that journey. Stories often include metaphoric images and give an understanding of the uniqueness of individual fear and inner need. Cullen and Alcock describe creative expression as the process of unraveling a story (2007). The creative arts project at PPWH bears witness to this.
Lay caregivers’ perspectives on injecting subcutaneous medications at home
Authors: Israel Fiona , Reymond Liz , Slade Georgi , Menadue Sharyn , Charles Margaret A 
Published: May 2014

Background: Most palliative care patients prefer to be cared for at home. While promoting quality of life for patients, this preference impacts on their caregivers. Lay caregivers in Australia can be required to deliver and adjust complex medication regimens. This study aimed to investigate caregivers’ perceptions concerning the injection of subcutaneous medications. Methods: Fourteen caregivers were interviewed on two occasions, once during the caregiving phase and two months after bereavement. Results: In the first interview, caregivers expressed anxieties associated with their ability to undertake the task of administering injections, including fears of overdosing their family member. In the bereavement interview caregivers reflected they were pleased they had contributed to the symptom relief of a family member and that although they would not necessarily volunteer to inject family members again, they were generally empowered by the experience. It is important for health professionals to support lay caregivers to successfully achieve their extended caregiving role.
Nurses' views of the coping and support mechanisms experienced in managing terminal haemorrhage
Authors: Harris Dylan G , Flowers Sarah , Noble Simon IR 
Published: May 2014

Introduction: Although palliative care is a rewarding specialty, it presents emotive personal challenges for the health professionals working within it. Terminal haemorrhage is arguably the most feared and distressing event in the palliative care setting, both for the patient and for the health professionals looking after them. The aim of this study was to explore and refect on the coping and support mechanisms that have helped nurses to manage these events. Method: Purposive sampling was used to recruit nurses from palliative care and oncology who had personal experience of managing terminal haemorrhage. Semi-structured interviews were used to collect qualitative data that were then analysed using interpretative phenomenological analysis. Saturation of data was reached after 11 participants had been interviewed. Results: The participants had a combined experience of managing 37 patients with a terminal haemorrhage. The key themes that emerged were the role of the ‘autopilot’, having a plan, education and training, the value of debriefing and peer support, and the importance of supporting the whole team. Education and training specifically about terminal haemorrhage and structured debriefing after such events were both identified by the participants as currently unmet needs. Conclusion: Professionals working in areas in which patients are at particular risk of terminal haemorrhage require adequate training and education prior to these events and a structure for formal debriefing and peer support afterwards.
Role of the nurse practitioner in providing palliative care in long-term care homes
Authors: Kaasalainen Sharon , Ploeg Jenny , McAiney Carrie , Martin Lori Schindel , Donald Faith , Martin-Misener Ruth , Brazil Kevin , Taniguchi Alan , Wickson-Griffiths Abigail , Carter Nancy , Sangster-Gormley Esther 
Published: May 2014

Aim: The purpose of this study, which was part of a large national case study of nurse practitioner (NP) integration in long-term care (LTC), was to explore the NP role in providing palliative care in LTC. Methods: Using a qualitative descriptive design, data was collected from five LTC homes across Canada using 35 focus groups and 25 individual interviews. In total, 143 individuals working in LTC participated, including 9 physicians, 20 licensed nurses, 15 personal support workers, 19 managers, 10 registered nurse team managers or leaders, 31 allied health care providers, 4 NPs, 14 residents, and 21 family members. The data was coded and analysed using thematic analysis. Findings: NPs provide palliative care for residents and their family members, collaborate with other health-care providers by providing consultation and education to optimise palliative care practices, work within the organisation to build capacity and help others learn about the NP role in palliative care to better integrate it within the team, and improve system outcomes such as accessibility of care and number of hospital visits. Conclusions: NPs contribute to palliative care in LTC settings through multifaceted collaborative processes that ultimately promote the experience of a positive death for residents, their family members, and formal caregivers.
Family members' perceptions and expectations of the use of syringe drivers: a South African study
Authors: Wilkinson Margaret , Vember Hilda 
Published: May 2014

Aim: This study aimed to explore and gain insight into the perceptions and expectations of family members of terminally ill patients pertaining to the use of syringe drivers. Background: There is a lack of research regarding the use of syringe drivers in Africa and, more specifically, South Africa. However, syringe drivers have been in use for around two decades in some South African settings. Some family members’ ambivalence about the use of syringe drivers and the lack of research prompted this study. Method: A qualitative exploratory research design was used. Data was collected using semi-structured interviews, diaries, observation, and documentation. Thematic analysis and coding were used to analyse the data. Results: Four main themes were identified: the rationale for the need for the syringe driver, positive perceptions pertaining to the use of the syringe driver, negative perceptions, and concerns/anxieties. The study also highlighted the challenges of drug addiction in some households when caring for terminally ill patients. Conclusion: The need for more continuous education and written information and support for immediate and extended family members was evident.
Advance care planning in care homes: the experience of staff, residents, and family members
Authors: Stone Louisa , Kinley Julie , Hockley Jo 
Published: May 2014

Background: In the UK, implementation of the Gold Standards Framework in Care Homes (GSFCH) programme is being promoted to develop the quality of end-of-life care for frail older people living and dying in care homes. Advance care planning (ACP) discussions are an integral part of this. This study explored experiences of initiating and completing these discussions in homes undertaking the GSFCH. Methods: A qualitative descriptive study was carried out in three nursing care homes implementing the GSFCH programme. Following an ACP discussion, 28 semi-structured interviews were conducted with the resident, a family member, and the staff member who undertook the ACP. Content analysis was then conducted. Findings: Three main categories of findings emerged: understanding ACP, undertaking ACP discussions, and impact of and reactions to ACP discussions. Staff understanding of ACP varied, affecting the depth of their discussions. Documentation was either a useful prompt or limited the discussion, blocking opportunistic cues and encouraging a ‘tick-box’ exercise. Residents were open to ACP, although the way it was introduced could affect the results. Families were comforted that the resident's future care had been considered. Education was identified as being important, and role modelling ACP enabled a member of staff to develop their skills and confidence in it. Conclusions: Care home staff need to develop the knowledge, skills, and confidence to engage in discussions around end-of-life care. The assistance of a trained facilitator who role-models this process should be explored.
Essential knowledge for family caregivers: a qualitative study
Authors: Angelo Jennifer K , Egan Richard , Reid Kate 
Published: May 2014

Background: Family caregivers are the backbone of the social care delivery system. With cancer and other life-limiting diseases on the rise, the need for well-informed informal/family caregivers has never been greater. Aim: To uncover the information that palliative care teams routinely provide to family caregivers. Design: The methodology used was the nominal group technique, a type of focus group. Participants: A total of 17 community palliative care health professionals participated in one of three focus groups. Results: Three themes emerged as dominant priorities for the education of family caregivers: caring for oneself physically, emotionally, and spiritually; learning practical skills; and knowing what to expect and plan for as the family member's health declines. Conclusions: The participants encourage caregivers to meet their own needs as well as care for family members. They help to empower family caregivers by encouraging them to take time for themselves, providing practical information for individual situations, and educating them on the signs and symptoms of approaching death. Successful terminal home care is possible through family caregiver support and empowerment.