bluuebunny/crossref_metadata_2025_split huggingface dataset:
Providing direction for change: assessing Canadian nursing students learning needs
Authors: Brajtman Susan , Fothergill-Bourbonnais Frances , Casey Alberta , Alain Diane , Fiset Valerie 
Published: May 2014

Aim: To examine the current curriculum content and learning needs of graduating nursing students related to end-of-life care (EOLC). Design: A survey method was employed. Sample: A purposive sample of 58 Anglophone and Francophone students completed the Palliative Care Quiz for Nursing (PCQN) and Frommelt’s Attitudes Toward Care of the Dying Scale (FATCOD). Students responded to open-ended questions regarding perceptions of preparedness to care for terminally ill patients, and provided suggestions for changes to the curriculum. Key informant educators identified opportunities to include EOLC content in courses and clinical placements. Results: Results indicated that students held positive attitudes towards caring for dying patients, had modest knowledge levels, and that one third did not feel adequately prepared to care for dying patients. Although EOLC education tends to be threaded throughout the program, the emphasis is dependent upon the commitment of individual professors and clinical instructors with experience and/or expertise in this area. Conclusion: Students and educators agreed more emphasis on EOLC was needed. Recommendations include development of teaching strategies and experiential learning in EOLC throughout the curriculum.
Moral distress and providing care to dying babies in neonatal nursing
Authors: Kain Victoria J 
Published: May 2014

Moral distress in nursing is a prevalent theme in the literature. Although this issue has been investigated in other nursing disciplines, it has not been investigated by empirical research in the emotionally and ethically sensitive area of providing care to dying babies. Moral distress occurs when nurses are prevented from translating moral choices into moral action. The response to moral distress is anger, resentment, guilt, frustration, sorrow and powerlessness. If not addressed, self-worth may be jeopardised, affecting personal and professional relationships.A review of the literature was conducted to explore moral distress in neonatal nursing when providing care to dying babies. This literature review provides a basis for the direction of further research and hypothesis testing. Further focused research is necessary in this under-theorised area of nursing practice to clarify the significance of moral distress for neonatal nurses caring for dying babies.
Macmillan nurse facilitators for palliative care: evaluation of
Authors: Moriarty Deirdre , O’Hara Annette , Byron Shirley 
Published: May 2014

Aim: To describe and evaluate the implementation of two Macmillan nurse facilitator posts. Method: A case study design was adopted with data collection in two main phases. A range of data collection techniques were used, including interview, questionnaire and observation. Various sampling strategies were adopted for the different data collection methods. The use of multiple sources of data supported the triangulation of evidence in order to increase the strength and rigour of the analysis. Findings: Two Macmillan nurse facilitator posts were set up with the overall aims of enhancing the quality of palliative care to patients in the community by mobilising the existing skills and supporting the development of new competencies by community nurses. The Macmillan nurse facilitators have been active in three areas directly linked to community nurses’ clinical practice: educational programmes, establishment of a palliative resource nurse network and support of clinical guidelines in nursing and primary care teams. The model of peer facilitation whereby the Macmillan nurse facilitators continue to work as district nurses for part of the week has been highly valued by community nurses. Conclusions: The single most important factor identified in facilitating successful implementation of these posts has been the ‘dual role’ nature of the posts. This has been key to acceptance of the posts by a generic workforce. The posts provide an effective model for supporting and enhancing the palliative clinical skills and knowledge of generic community-based staff.
Artificial hydration: the role of the nurse in addressing patient and family needs
Authors: Schmidlin Esther 
Published: May 2014

When caring for terminally ill patients and their families, nurses are confronted with the subject of terminal dehydration and the question of artificial hydration at the end of life. Terminal dehydration and artificial hydration are still controversial topics of discussion and, to this day, data remain insufficient to reach a final conclusion on the benefits or harm of dehydration in terminally ill patients (Ersek, 2003; Fainsinger, 2008). Nurses, just like physicians, have different attitudes about the usefulness of artificial hydration. Personal and professional experiences, cultural influences, and the place of care, as well as education and available resources, are guiding clinical practice (Morita et al, 2002; Pasman et al, 2004). Since there is no ethically or medically based gold standard, each decision for or against hydration at the end of life needs to be taken on an individual basis. This article reflects on the meaning of dehydration for the patient and their family, and reviews the role of the nurse within the decision-making process. Arguments for or against artificial hydration are illuminated through patient situations which took place in the clinical setting of a hospice. The article further highlights the importance of recognising dehydration in frail and elderly patients, and critically assesses policies that may hinder its optimal palliation in different settings in Switzerland.
Living with terminal illness: patient and family experiences of hospital end-of-life care
Authors: Spichiger Elisabeth 
Published: May 2014

Aim. The study explored terminally ill patients’ and their families’ experiences of hospital end-of-life care. Design. A qualitative approach – interpretive phenomenology – was applied prospectively. Sample and setting. Ten patients and their closest family members were recruited in one Swiss university hospital. Methods. Data collection included repeated observations, conversations with patients, and interviews with family members. Findings. People led unique lives; when a terminal illness intruded and during hospital stays, they continued to live their particular life. The hospital was experienced differently, as prison, heaven, or necessary sojourn. A caring stance of the professionals was crucial to patients’ and families’ sense of being well cared for. When care providers lacked skills or did not recognize patients and family members as persons, they suffered. In contrast, adequate care interventions improved their quality of life. Conclusions. The experience of being in the hospital cannot be separated from patients’ and families’ life stories.
Perceptions of the use of a remote monitoring system in patients receiving palliative care at home
Authors: McCall Kathryn , Keen Jeremy , Farrer Keith , Maguire Roma , McCann Lisa , Johnston Bridget , McGill Maria , Sage Meurig , Kearney Nora 
Published: May 2014

In remote communities, where frequent face-to-face contact with health professionals may be difficult, the ongoing review and management of symptoms – a fundamental part of good palliative care – can be difficult to achieve. Telecare and other developments in information technology are increasingly being sought as a means of addressing shifting population demographics and rising demands on stretched health services, and may help in providing a system which allows patients to report their symptoms as they are happening. This may be one way of enhancing symptom management and improving quality of care at the end of life. A study testing the feasibility of using mobile phone-based technology (Advanced Symptom Management System in Palliative Care (ASyMSp)) to monitor and manage symptoms reported by patients being cared for at home in the advanced stages of their illness was carried out in two rural communities in the north of Scotland. The results of this study show that the system was usable and acceptable to patients and the health professionals who cared for them.
Paediatric nurses’ knowledge of palliative care in Florida: A quantitative study
Authors: A Knapp Caprice , Madden Vanessa , Wang Hua , Kassing Kristin , Curtis Charlotte , Sloyer Phyllis , A Shenkman Elizabeth 
Published: May 2014

Nurses routinely identify and suggest patients to physicians for possible referral to palliative care and discuss potential referrals with families. Knowledge of palliative care is essential for nurses, especially in paediatrics, where palliative care is less common than with adults. This study uses data from surveys from 279 paediatric nurses across Florida, USA. The palliative care quiz for nursing (PCQN) and the knowledge about hospice quiz (KHQ) were used. On the KHQ at least one-half of the nurses answered six out of seven questions correctly. On the PCQN at least one-half of the nurses answered 12 out of 20 questions correctly. Multivariate analyses show that receiving formal palliative care training and having worked at a hospice were associated with greater knowledge. Paediatric nurses in Florida have a good level of baseline knowledge of palliative care. Nurses’ training programs should be used to increase knowledge, which may subsequently lead to more referrals.
Anatomy and physiology of pain and the management of breakthrough pain in palliative care
Authors: Bass Madeline 
Published: May 2014

The aim of the study was to explore terminally ill patients’ and their families’ experiences of hospital end-of-life care. The study design was a qualitative approach using interpretive phenomenology, which was applied prospectively. Ten patients and their closest family members were recruited in one Swiss university hospital. Data collection included repeated observations, conversations with patients, and interviews with family members. It was found that people led unique lives; when a terminal illness intruded and during hospital stays, they continued to live their particular life. The hospital was experienced differently, as prison, heaven, or necessary sojourn. A caring stance of the professionals was crucial to patients’ and families’ sense of being well cared for. When care providers lacked skills or did not recognize patients and family members as persons, they suffered. In contrast, adequate care interventions improved their quality of life. The experience of being in the hospital cannot be separated from patients’ and families’ life stories.
Transition to an in-patient palliative care unit: carers share their experiences
Authors: Harrington Ann , Mitchell Patricia , Jones Jacqueline , Swetenham Kate , Currow David 
Published: May 2014

Background: For a carer, transitioning the care of a person who is dying to others may be a challenging experience. At this time, more than any other, carers’ experiences need to be understood. The emotional impact of care transitions may have clinical significance for both carers and those they care for. Aim: To explore carers’ experiences of the transition of the person they were caring for to in-patient care. Method: Carers reflected on their experiences through an explorative/descriptive research methodology. Results: Feelings of guilt and relief figured prominently in the participants’ discourses. Conclusions: Prominent feelings of guilt and relief overshadowed the participants’ experiences of transitioning care. This finding needs to be considered by care providers.
A comparison of the nurse work environment between perinatal and non-perinatal hospice providers
Authors: Lindley Lisa C , Fornehed Mary Lou , Mixer Sandra J 
Published: May 2014

Background: Hospice nurses have a unique role in providing perinatal care, yet little is known about the work environment in which nurses provide care for families and infants at the end of life. Objective: To compare the nurse work environment between perinatal and non-perinatal hospices. Methods: Data from the 2007 US National Home and Hospice Care Survey was used. The sample included 526 US hospice agencies. Comparisons were calculated using the Pearson chi-square and Wald tests. Results: A majority of hospices provided perinatal care (60%). Compared with non-perinatal hospices, the perinatal nurse work environment had a significantly higher proportion of registered nurses (mean 0.87 vs mean 0.79), along with clinical nurse specialists and nurse practitioners to support them (95.6% vs 84.9%). Nurses within perinatal care providers worked in a climate of significantly greater safety (95.6% vs 84.9%) and technology (63.7% vs 47.1%). Conclusions: Understanding the unique perinatal hospice nurse work environment may be essential for advancing knowledge and compassion for mothers and babies at the end of life.
New Zealand hospice nurses' self-rated comfort in conducting spiritual assessment
Authors: Taylor Elizabeth Johnston 
Published: May 2014

Aim To measure how comfortable hospice nurses in New Zealand are in conducting spiritual assessment and explore potentially associated factors. Design Cross-sectional, mixed-methods, descriptive study. Sample and setting Sixty hospice nurses from three New Zealand hospices. Methods An investigator-designed questionnaire measured respondents' comfort with asking patients spiritual assessment questions proposed for use in the health-care literature. Other items assessed personal and work-related factors. Open questions generated data about how these nurses assess spirituality. The data was analysed using measures of central tendency, binomial non-parametric tests, and content analysis. Findings These nurses were generally comfortable with proposed spiritual assessment questions and perceived spiritual assessment to be important. Personal factors including age, years in nursing, religiosity, and spirituality were not related to this comfort; however, training was associated with comfort. Conclusion These findings underscore the importance of training and show how nurses can be comfortable with and capable of assessing patient spirituality.
Effects of patient-focused care on seclusion in a psychiatric intensive care unit
Authors: Sullivan Dan , Wallis Marianne , Lloyd Chris 
Published: May 2014

The objective of the study was to evaluate whether the introduction of patient-focused nursing care affected the number of seclusions and the length of time patients spent in seclusion, in an acute psychiatric unit. The study used a pre-intervention–post-intervention design and was conducted in an eight-bed locked unit within a large regional general hospital in Queensland, Australia. The medical records of all people who were secluded as part of their management while in hospital, during two 6-month periods, were retrospectively reviewed. Changes to the ways in which nurses conducted their daily activities were implemented during the time between the data collection periods. There were no differences between the groups with respect to the number of times a patient was secluded. However, following implementation of patient-focused care, there was a reduction in the length of time for which patients were secluded. The only change in medication administration was that post-implementation, Haloperidol was used in fewer seclusion episodes. The findings indicate that changes to nursing practice may result in closer monitoring of patients and a reduction in the time patients spend secluded in acute inpatient psychiatric settings.
Buggy-to-wheelchair progression for children with cerebral palsy: Parents’ and therapists’ opinions
Authors: Shahid Mohammad 
Published: May 2014

Some children with cerebral palsy (CP) are transported in buggies until they master the skills of ambulation. Many never learn to walk and progress from a buggy to a wheelchair as a means of maximizing their independence and improving their motor and functional skills. Therapists and parents often hold conflicting views as to why a child may not be progressed to a wheelchair from a buggy. A study was undertaken to explore the opinions of health professionals and parents concerning this problem. A questionnaire for each cohort (therapists n=17; parents n=28) was constructed containing 10 identical but general questions. Results obtained were analysed individually for each cohort and then compared to see if there was any concordance between them. Both groups believed the main factors preventing change were: transport problems making wheelchair travel difficult; inadequate housing; poorer manoeuvrability of the wheelchair compared with the buggy; and a lack of information about progressing to a wheelchair. Statistical analysis showed no correlation between how parents and therapists responded. A multilingual handbook for therapists and parents needs to be produced detailing the pros and cons of buggy-to-wheelchair progression.
A review of two workshops for occupational therapists to share clinical opinions in neuro-oncology
Authors: Tempest Stephanie , Macdonald Andrea , Holmes Claire 
Published: May 2014

This article describes how a group of senior occupational therapists identified a gap in evidence-based practice within neuro-oncology and how they sought to address this by organizing two workshops, to seek opinions from like-minded peers. It also includes a summary of the process involved in organizing the workshops and the resulting opinions from 95 occupational therapists on the personal, clinical and environmental factors affecting their work with neuro-oncology patients. The process of gathering the information and the issues discussed are relevant to all disciplines working in all specialist areas where there is limited evidence or service frameworks. The results from this study are used to raise awareness of the needs of this specialist client group and of the occupational therapists working in this clinical area. They demonstrate an effective way to reflect on practice and lay the foundations for the continued development of evidence-based practice.
The use of mime therapy as a rehabilitation method for patients with facial nerve paresis
Authors: Beurskens Carien HG , Devriese Pieter P , Van Heiningen Ide , Oostendorp Rob AB 
Published: May 2014

Since 1980, patients with sequelae of peripheral facial nerve paresis have been treated with mime therapy at the physiotherapy department of the University Medical Centre in Nijmegen, which aims to rehabilitate facial expression. Mime therapy was developed by Jan Bronk (a mime actor) and Pieter Devriese (an otolaryngologist) in the 1970s, using the principles of mime for patients suffering from either lack of facial movement or uncontrolled movements. Both therapists and patients reported benefits of mime therapy; most importantly, an improved symmetry of the face. There is a belief within the profession that evidence-based treatment is required to scientifically substantiate physiotherapy. A detailed description of the mime therapy treatment is essential for performing a randomized controlled trial, which is currently underway. This article aims to comprehensively describe the historical development and clinical characteristics of mime therapy and to give insight into its usefulness as a tool in the treatment of patients with facial nerve paresis.
Efficacy of botulinum toxin for spasticity management in neurorehabilitation
Authors: Kulkarni Jai 
Published: May 2014

This article aimed to assess the effect of botulinum toxin type A (BTX-A), when used in conjunction with physiotherapy, in spasticity management. Patients were assessed before and after BTX-A injection using the following outcome measures: the Medical Research Council (MRC) scale for motor testing; the Modified Ashworth Scale (MAS) for spasticity; the Global Pain Scale (GPS); the modified Barthel score for activities of daily living; spasm frequency; and adductor tone rating. In total, 72 patients (aged 13–81 years; 43% male) received BTX-A treatment. MAS scores were reduced by a median of 1 point (P <0.001) and 56% of patients had a 30% or greater reduction in GPS scores after injection. Mean spasm frequency (per hour) was reduced by 3.1 (P <0.001) and improvements were detected in adductor tone and activities of daily living scores (P <0.001 and P=0.046 respectively) after injection, while MRC scale scores showed statistically significant improvements, particularly in severely impacted categories (P=0.007). Reported improvements in affected joints were made by patients and carers, with benefits lasting an average of 6 months. BTX-A injections were well tolerated. These findings suggest that BTX-A injections have a key role to play in spasticity management.
Evaluating the Community Dependency Index in a social services context
Authors: Stubbs Rachel , Atwal Anita , Mckay Elizabeth 
Published: May 2014

In the UK, current health-care policy has outlined the importance of evidence-based practice. Within social services, the need for evidence of efficacy of occupational therapists’ practice in social services is often raised. This article discusses the use of the Community Dependency Index (CDI), reporting an initial evaluation undertaken by occupational therapists in an inner London social services department. This was undertaken in order to enhance practice. The results of this pilot study suggest that the measure is not sensitive enough to reflect the complexity of the client’s presenting problems. However, it can be a useful measure to determine whether a client could benefit from rehabilitation. In using this measure, careful consideration should be given to the criteria for its use within practice. The CDI, unfortunately, did not fully meet the expectations of the social services, but its usefulness may be enhanced by the use of a quality-of-life measure.
Wheelchair postural support for young people with progressive neuromuscular disorders
Authors: Clark Janice , Morrow Marina , Michael Shona 
Published: May 2014

This study aimed to measure the effects of postural support within the wheelchair on posture, respiration and upper limb function for young people with progressive neuromuscular disorders. A prospective two-period randomized crossover study was used. Participants were 19 people (aged 6–21years) with a diagnosis of Duchenne muscular dystrophy or Friedreich's ataxia, who required the use of a wheelchair. Participants were assessed for wheelchair seating with a standardized in-depth protocol. The new wheelchair seating was then fitted. Sitting posture, respiration and upper limb function when sitting in a standard wheelchair and also when sitting in the adaptive seating were measured. In the adaptive seating there was a significant improvement in many of the postural measures. No such improvement was found in respiratory function. Participants were able to complete one of the six upper limb function tests more quickly in the adaptive seating. Adaptive seating within the wheelchair can instantaneously improve sitting posture for this client group. There is, however, potential for the person's position to be over-corrected with inappropriately configured seating. There are no immediate differences in respiratory function and only small differences in upper limb function between the two chairs with the protocol of this study.