bluuebunny/crossref_metadata_2025_split huggingface dataset:
The quality of life of hospice patients: Patient and provider perceptions
Authors: Steele Linda L. , Mills Beth , Hardin Sonya R. , Hussey Leslie C. 
Published: May 2006

The purposes of this study were to describe the quality of life (QOL) of terminally ill patients in a home-based hospice program and to examine the relationship between QOL data and patients’ symptom distress, ability to function, interpersonal communication (support from family and friends), well-being (their affairs in order), and transcendence (religious comfort/support) as recorded in their charts. QOL was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The study was conducted over a three-year period with 129 terminally ill patients enrolled in a home-based hospice program of care. The MVQOLI was administered to patients within 20 days of their admission to hospice. A retrospective chart review was conducted to determine patients’ levels of symptom distress, ability to function, social support, whether or not their affairs were in order, and religious comfort/support.The mean age of participants in this study was 67, with 54.3 percent male and 45.7 percent female. Cancer was the primary diagnosis for 92.2 percent of the sample, and 35 percent of these patients had a diagnosis of lung cancer. Of the 7.8 percent non-cancer diagnoses, five were diagnosed with AIDS, four with chronic obstructive pulmonary disease, and one with chronic heart failure.The results of this study revealed positive scores on the five dimensions of the MVQOLI QOL scale, indicating that within 20 days of admission to hospice, patients rated their QOL as good to very good. Data obtained from the chart review also indicated that patients did not experience a great deal of symptom distress (e.g., pain, nausea, shortness of breath, and restlessness). A significant correlation existed between age and QOL; number of interventions and pain levels; and marital status, well-being, interpersonal relationships, and transcendence. Shortness of breath and well-being were significantly correlated with QOL. There was no significant correlation between gender, race, or closeness to death and the five dimensions of the MVQOLI and chart review assessments.
A self-care plan for hospice workers
Authors: Jones Sally Hill 
Published: May 2006

Caring for dying patients and their families is a fulfilling, enriching, and meaningful experience. It can also be extremely stressful. Maintaining the balance between the output and input of energy in a caregiver’s professional and personal life is an ongoing process. Clinical staff members often formulate plans of care for patients. To prevent worker burnout, hospice caregivers must develop a plan of self-care to balance their own needs with the needs of their patients. The goal of this article is to provide an overview of ways for hospice care-givers to relieve stress and develop an individualized self-care plan within the context of their work.
Hyperalgesia and opioid switching
Authors: Mercadante Sebastiano , Arcuri Edoardo 
Published: May 2006

Opioids, intended to abolish pain, can unexpectedly produce hyperalgesia, particularly during rapid opioid escalation. Opioid switching could be a therapeutic option in a condition of opioid-induced tolerance or hyperalgesia, but conversion ratios between opioids are difficult to apply in this context and require strict surveillance and expertise. This situation is challenging, because the rapid escalation of opioid doses, possibly due to the development of opioid-induced tolerance, can cause hyperalgesia. To avoid this adverse effect, clinicians need to refine their assessment of pain treatment and consider opioid switching. The authors present a case report in which switching from fentanyl to methadone was effective in a patient who developed hyperalgesia as a consequence of a rapid opioid escalation. Regardless of the expected clinical improvement of opioid switching using lower doses of the second opioid, the final dose of the second opioid was exaggeratedly low, probably as a consequence of the disappearance of hyperalgesia induced by the first opioid. The results of this case and others like it may help practitioners develop a meaningful approach during opioid escalation, possibly anticipating the need for opioid switching or other alternative measures for patients with uncontrolled cancer pain.
Prospective payment and the Medicare Hospice Benefit
Authors: Bloom Bernard S. , Amenta Madalon O’Rawe 
Published: May 2006

The objective of this study was to determine the effects of very high cost patients on hospice financial status. Ten Pennsylvania hospices dually certified by Medicare were randomly selected and agreed to participate. Patient age, sex, diagnosis, length of stay and payer were fairly uniform across hospices. Payments varied by diagnosis and payer. High cost patients were irregularly found in hospices; low cost patients were commonly and regularly distributed. Every hospice had at least one high cost patient. In one, the uncompensated payment for the 6.6 percent of patients defined as high cost ($7,300 and above) would have been 14.7 percent of total annual revenues. In another, uncompensated payments for high cost patients (9.8 percent) would have accounted for 17.2 percent of revenue. In 96.3 percent of the instances patients utilized less than the Medicare Hospice Benefit maximum allowable cost ($7,300); and, 98.8 percent of the time patients stayed less than the maximum allowable length of time of 210 days. A logistic regression model found long length of stay (p < 0.0001), Medicare hospice benefit as primary payer (p <0.0001), any hospitalization during hospice stay (p < 0.003) and cerebrovascular disease diagnosis (p < 0.02) to be significantly related to high cost. Between the time the study was planned and completed, Medicare instituted a reinsurance program allowing unused funds below the maximum allowable limit from one patient to be used for patients who exhausted their benefits. Thus, no study hospice was adversely affected by high cost patients. However, it should serve as an object lesson to Medicare in using prospective payment. A normal or near-normal distribution of patients by cost cannot be assumed for small institutions.
Is there congruence in hospice nurses’ view of their patients’ quality of life and their hospice patients’ view of their own quality of life?
Authors: Mueller-Marquez Barbara J. 
Published: May 2006

Since the development of the hospice movement in the United States, care of the terminally ill has undergone vital change.’ This change involves the alternative of home care for the terminally ill. It allows the patients, the primary caregiver, and the rest of the family to be in control of care. As stated by Masters, 2 hospice is unique in that the patient and family controls the environment, and lifestyle, including treatment modalities, more than in any other concept in health care. Hospice was developed to give people with a terminal illness an option to traditional medicine. Hospice is a concept of care that has been established to improve the quality of life of the terminally ill. Therefore, the ultimate goal of hospice care is to enhance the quality of life of patients with terminal illness, mainly cancer. 3 In the hospice setting, the nurse applies a holistic approach when planning and providing primary care. The nurse becomes increasingly more knowledgeable about the problems and strengths of the patient and family to whom he/she is caring for. The nurse must make the transition in her philosophy from cure-to-care in hospice, and symptom control being the nurses ‘priority in order to enhance the patients quality of life. Curtis and Fernsler4 explain that hospice care focuses on helping patients to communicate effectively and to share life agendas with their primary caregiver and the hospice nurse. These researchers continue to state that these efforts promote congruence between patient, primary caregiver, and the hospice nurses’ view of the patients quality of life. As a hospice nurse, I want to explore the relationship that the nurse has with his/her patients. Are hospice nurses and their patients viewing quality of life congruently? This paper provides a review of the literature concerning quality of life of the hospice patient and provides background information for future research.
Transcending life: The practice wisdom of nursing hospice experts
Authors: Zerwekh Joyce 
Published: May 2006

In philosophy and theology, to transcend is to go beyond the limits of lived human experience. Hospice workers accompany people who are traveling beyond the limits. “Whoever would be a companion to the dying, therefore, must enter into their darkness, go with them at least part way along their lonely and frightening road.”1 This paper explores the requisite hospice practice competencies of caring spiritually and guiding letting go, as identified in a qualitative analysis of the practice stories of 32 hospice nurse experts working with people nearing death. Spirituality has been described as the essence of personhood, the longing for meaning in existence, experience of God, experience of ultimate values, and trust in the transcendent. Its ultimate end is union or connection with a reality more enduring than the individual self.2,3 In contrast, spiritual distress is manifested as alienation and disconnection.4 The reality of the dying process involves a progressive series of disconnections from life, which requires the process of letting go. Thus, transcending life involves both the need to detach and separate from life as it has been lived. One home visiting hospice nurse has described dying as a spiritual process of both reflecting and detaching.5 Nagai-Jacobsen and Burkhardt identify three goals of caring spiritually: • Fostering personal integrity; • Promoting interpersonal connection; • Supporting personal search for meaning.6 O ‘Connor describes hospice spiritual care promoted through the practice of presence, compassion, hopefulness, and the affirmation of life as fruitful.7 Stiles has completed the only published qualitative description of hospice nursing as spiritual care.5 She asked 11 hospice nurses and 12 bereaved families to describe their hospice experiences, which were then analyzed to name dimensions of the nurse-family spiritual relationship. Many of these dimensions parallel those of the current study and will be discussed below.
Archetypal healing
Authors: Jones Devilen , Churchill John E. 
Published: May 2006

With emphasis on healing versus curing, the authors draw from a wide assortment of treatment methods for psychospiritual relief of pain in the terminally ill. These archetypal methods include: • Life-review therapy; • Ministry of presence; • Clinical hypnosis; • Myths, symbols, rituals, and community; • Creative therapies. In life-review therapy, the ill per-son shares his/her life story with the provider much like the healing rituals of the ancient storyteller did in his community. In the ministry of presence, the caregiver focuses on sharing his vulnerability, not his professional skills. Clinical hypnosis emphasizes the naturalness and simplicity of accessing the unconscious along with problem areas of the hypnoclinician. Myths, symbols, rituals, and community serve as nurturing agents in the intervention of pain, while creative the rapies such as music, drama, crafts, and art continue to be powerful healing instruments. Archetypal healing produces relief of pain in the care give, as well as the ill, with emphasis on healing versus curing.
Children’s descriptions of their feelings and what they found helpful during bereavement
Authors: Lehna Carlee R. 
Published: May 2006

Although clinicians have described the value of support groups in assisting children mourn the death of someone close, little is known about helping children with bereavement. By understanding what helps children mourn, nurses can better facilitate a healthy bereavement process. The purpose of this mini-ethnographic study, which used observation and participation procedures, was to identify what 16 children found helpful during their bereavement. Initially, the children’s expressions of feelings were demonstrated both verbally and through art work. The patterns of the children’s emotions were labeled as affective distress, somatic complaints, and for the boys, disruptive behavior. The children then described their
A qualitative evaluation of a bereavement service: An analysis of the experiences of consumers and providers of services in Australia
Authors: Marquis Ruth 
Published: May 2006

This study, undertaken in 1994, involved the development of a qualitative framework to evaluate a bereavement service delivered by Silver Chain Hospice Care Service in Western Australia. Fifty in-depth interviews were recorded with bereaved carers, nurses, and volunteers over a five-month period, and transcriptions of the interviews were analyzed. A constant cooperative analysis of the interview data revealed eight common themes related to consistent experiences of bereaved carers, nurses, and volunteers. Themes are discussed for each group separately. The manner in which themes connected to form the interactive environment of the service is subsequently demonstrated. Service experiences, related to major themes, which were highly valued from the perspectives of the three groups of participants are identified. Experiences are then related to particular program processes and interactions consistently described by consumers and providers. Influences on, and barriers to, valued interactions occurring are discussed and elements of a valued bereavement program from the perspectives of participants in the study described. By highlighting valued elements of the service, important areas of service delivery could be identified and safeguarded in future service development.
Carers of the terminally ill: An Australian study
Authors: Pincombe Jan , Tooth Barbara 
Published: May 2006

This paper reports on the results of an Australian community-based palliative care research project which investigated and compared the effectiveness of existing support systems for paid (community nurses) and unpaid (primary carers) care givers in a regional health care center in New South Wales, Australia. In particular it looked at the needs, concerns, effects, and perceived adequacy of support system on carers. Methodology employed in the study relied on both qualitative and quantitative methods. Qualitative data was obtained by using a questionnaire which obtained demographic data about the carers. In addition, a series of taped open-ended questions were posed to the carers on the impact and experience of caring for the terminally ill. Taped interviews were analyzed using content analysis and elicitation of themes. Qualitative techniques utilized the Inventory of Socially Supportive Behaviors (ISSB). Examination of data collected using simple frequencies and percentages allowed cross examination of paid care givers and the questionnaire was used to assess perceived support of both sets of participants. A Wilcoxan Signed Rank non-
The hospice choice: Ethical decision making
Authors: Greipp Mary Elizabeth 
Published: May 2006

Empirical research documents communication difficulties and practices which have contributed to clients’ wishes and directives regarding end of life decisions being ignored, resulting in prolonged, painful deaths in hospital intensive care costs. Hospice decisions are complex end of life ethical decisions primarily because they are centered around client autonomy and the individual’s right to choose to refuse treatment or to discontinue treatment. With documentation of the benefits of Hospice and palliative care, and overall client and family satisfaction reported in the literature, one has to question why more patients are not referred to Hospice, and why those who have been referred were done so at such a late date. A suggested model for analyzing end of life ethical decision making and contributing factors will be presented. It is a sociological, interactional model that will assist in identifying ‘learned potential motivators’ on the part of the client and the health care professional which can influence these individuals during decision making interactions and which can contribute to the ‘rightness’ or ‘wrongness’ of end of life decisions.
Factors contributing to late hospice admission and proposals for change
Authors: Farnon Christa , Hofmann Mary 
Published: May 2006

Introduction: Hospice seeks to provide high-quality, holistic end-of-life care. Most insurances will reimburse hospice care for a period of six to seven months. However, the majority of patients are not referred to hospice until they are very close to death. The purpose of this study was to examine characteristics of an urban hospice program that may be associated with inordinately late admission to hospice care. Methods: A retrospective chart review of 100 consecutive admissions was carried out. Patient data from the referral/intake forms were reviewed and length of stay of each patient was calculated. Results: The average length of stay in this hospice was 34 days. Over half of the patients (51 percent) died within 14 days, and more than one-third (35 percent) died within seven days of admission. African-Americans made up nearly one-third of the patient group (32 percent). A considerable number of patients had a non-cancer diagnosis (39 percent). More than half of the patients were referred from acute care hospitals/specialists (58 percent). Conclusion: The study shows that most patients were referred to this urban hospice program when they were very close to death. Three characteristics may contribute to this underutilization of the hospice benefit: (1) the large representation of African-Americans, (2) the high enrollment of patients with non-cancer diseases, and (3) the high number of referrals from acute care hospitals/specialists. Initiatives to overcome barriers to hospice care for minority populations, to better prognosticate terminal illnesses, and to educate physicians and patients about palliative care are needed so that more patients can benefit more fully from hospice care at the end of life.
Managing the pain of bone metastases in the home environment
Authors: Phillips Lisa L. 
Published: May 2006

This article presents an in-depth review of the medical, pharmacological and nursing interventions needed to relieve the pain experienced with bone metastases. Covered areas include: • Pathophysiology • Clinical presentation of bone pain • Treatment options • Therapeutic interventions • The hospice nurse as an agent of hope In addition, a comprehensive presentation of nonopioid medications used in managing bone pain is provided in table format.
Restoring dressing independence in persons with Alzheimer's disease: A pilot study
Authors: Engelman Kimberly K. , Mathews R. Mark , Altus Deborah E. 
Published: May 2006

Purpose: Well meaning nursing facility staff may compromise the independence of older adults with dementia by performing activities of daily living for residents. We assessed the impact of teaching certified nursing assistants (CNAs) to use a graduated prompting procedure to increase dressing independence of persons with dementia. Design and methods: This study was conducted in a seven-bed dementia care unit. Three residents and two CNAs participated in the study. We used a repeatedmeasures experimental design to evaluate the effect of a training workshop for CNAs on a strategy for increasing resident engagement in self-care activities. Results: During a series of baseline observations, we found that CNAs typically dressed residents with minimal resident involvement. Results showed that, following the training workshop for CNAs, resident independence in dressing increased and range of motion improved. Implications: CNAs can provide restorative care that increases dressing independence and range of motion of older adults with dementia.
Alzheimer's disease and other dementias: A review
Authors: Rogan Shannon , Lippa Carol F. 
Published: May 2006

Dementia and its associated diseases are important causes of disability and morbidity in developed countries, especially in the aged population. As the babyboomers arrive at retirement and individuals over 100 are one of the fastest growing segments of our nation's population, we may realize the substantial cost these diseases bring to society. Dementia is characterized by a significant loss of cognitive function and should be clinically distinguished from an acute delirium or decreased arousal. Its manifestations cause anguish to millions of caregivers and family members, who are pressed to cope with their loved one's unfortunate decline in multiple cognitive domains, functioning, and behavior. Early detection and management may prevent overuse of costly medical resources and allow patients and family members time to prepare for future medical, financial, and emotional challenges. Diagnostic clues to the etiology of the patient's dementia can be found in a medical workup in which the neurologic history and examination (including mental status examination) are essential and neuroimaging is indicated. Herein, the concept of central nervous system (CNS) degenerative diseases as disorders of specific proteins is introduced. This review is intended to summarize clinical, biological, and genetic features of the common subtypes of dementia, and bring light to potential benefits of early and accurate diagnoses to optimize treatment. Details of the various diseases remain only partially uncovered, raising extensive prospects for future research and therapy for patients with dementia.
The underdetection of pain of dental etiology in persons with dementia
Authors: Cohen-Mansfield Jiska , Lipson Steven 
Published: May 2006

Background. The detection of dental pain in persons suffering from dementia has not yet been investigated. Subjects and methods. Twenty-one nursing home residents with a mean age of 88 participated in this study. Nine rotating volunteer dentists came to the nursing home to conduct dental evaluations. Two outside geriatricians performed a second assessment, and additional information concerning dental status was obtained from the minimum data set (MDS). Results. Over 60 percent of assessed participants were considered to have a pain-causing condition. Less than half of these were rated by the geriatricians as having dentalrelated pain. Only one participant was rated to have dental or mouth pain on the MDS. Only one of the 18 persons with either a full or partial evaluation had no dental problems. Conclusions. Dental problems are underdetected and undertreated in the nursing home. Better training for nondentists in detection of such problems and better reimbursement for dental care are needed to improve care of residents.
Addressing psychological trauma in dementia sufferers
Authors: Flannery Raymond B. 
Published: May 2006

Research has demonstrated that dementia sufferers may be victims of recent physical assault by family caregivers and other patients and staff in long-term care facilities. Some dementia sufferers have also been victims of violence at other points in their lives from events such as combat, physical and sexual abuse, natural and manmade disasters, and the like. These violent events may result in psychological trauma and the psychological aftermath of these violent incidents may last until death, if it is not treated. The purpose of this paper is to outline some intervention strategies regarding restraints for dementia sufferers who have a history of violence and for whom little or no treatment has been provided. This paper is not intended to train trauma counseling specialists but to present common intervention strategies that may be fielded by long-term care staff to relieve unnecessary suffering.