Needs of terminally ill cancer patients in an in-patient hospice unit

In Western Australia, in-patient hospice/palliative care units are caring for increasing numbers of terminally ill cancer patients. Hospice philosophy is based on the belief that the terminally ill patient in individual needs are of paramount importance. The needs of advanced cancer patients have been researched in the home, for patients continuing or having completed curative treatment, and for patients receiving palliative care. However, there is a lack of literature about the needs of terminally ill cancer patients in in-patient hospices. Using a descriptive approach, this study investigated the needs of six terminally ill cancer patients in a 26 bed in-patient hospice unit. Semi-structured interviews based on Henderson\u27s (1964) 14 fundamental needs were used to elicit information about these patients needs’. Data was analysed using thematic analysis to determine common categories of need. Findings suggest that terminally ill cancer patients in an in-patient hospice unit have seven common need categories. These are physiological, psychological, sociological, spiritual, informational, financial and environmental categories of need. Three overriding needs are described as the need to feel safe, to maintain family contact and to reduce the impact of visitors. Implications of the findings for nurses are discussed

Staying just one step ahead: providing care for patients with motor neurone disease

Introduction: There is limited information about the experiences and educational needs of health professionals who may be required to provide care for people with Motor Neurone Disease(MND) especially in the later stages of the disease. The aim of this study was to determine the experiences of, and need for, education of these health professionals. Methods: Interviews and focus groups were conducted with 31 health professionals with some experience in providing palliative care for people with MND. Thematic content analysis was used to identify common themes. Results: A key theme, Just One Step Ahead, emerged, that describes the central capability health professionals identified as necessary to help individuals plan and prepare for disease and lifestyle changes just before they arise. Two subthemes also emerged: Expertise in MND and Bespoke Communication. Expertise in MND described the required understanding of the disease and the particular individual’s version of the disease to allow the health professional to plan, advise, support and anticipate the needs of the person living with MND. Bespoke Communication was the facility to tailor care messages sensitively and effectively to the range of people involved in care (patients, family, healthcare team members).Conclusions: Care of people with MND requires up-to-date expertise about the disease and skilled communication abilities to manage complexity and change. Timely and focused education and specialist MND support for care providers are essential to tailored and responsive care and a widely available education programme has been developed to address these needs

Working with families

Families of people receiving palliative care are profoundly affected by the challenges of the illness. They are called upon to cope with daily caregiving, alterations to their roles, and changing responsibilities within the family. Family members also confront shifts in the meaning of life and relationships as they come to recognise the terminal stage of the person\u27s illness. These demands require changes in arrangements for physical care and practical difficulties with daily living while families are attempting to handle their own emotional distress about the person\u27s care and concerns about the future (Bergen 1991; Ferrell1998)

Evaluating the Feasibility and Effect of Using a Hospital-Wide Coordinated Approach to Introduce Evidence-Based Changes for Pain Management

This action research project explored the feasibility and effect ofimplementing a hospital-wide coordinated approach to improve themanagement of pain. The project used a previously developedmodel to introduce three evidence-based changes in pain management.Part of this model included the introduction of 30 pain resourcenurses (PRNs) to act as clinical champions for pain at a locallevel. Both quantitative and qualitative measures were used to assessthe feasibility and effect of the changes introduced. Quantitativedata were gathered through a hospital-wide document review andassessment of the knowledge and attitude of the PRNs at two timepoints: time 1 before the introduction of the PRNs and time 2 nearcompletion of the project (11 months later). A statistically significantimprovement in the documentation of pain scores on admissionand each nursing shift was apparent. However, no differencewas found in the percentage of patients who had been prescribedopioids for regular pain relief that had also been prescribed anddispensed a laxative/aperient. Neither were any statistically significantdecreases in patient pain scores observed. An assessment of theknowledge and attitudes of the PRNs showed an improvement fromtime 1 to time 2 that was statistically significant. The qualitative datarevealed that despite the barriers encountered, the role was satisfyingfor the PRNs and valued by other hospital staff. Overall, theresults revealed that the new model of change incorporating PRNswas a useful and effective method for introducing and sustainingevidence-based organizational change

Frontline grief: The workplace support needs of community palliative care nurses after the death of a patient

This study describes the impact of multiple deaths on nursing staff who work exclusively with palliative care patients in the community and identifies the types of workplace support required after the death of a patient. A self-report questionnaire was mailed to community palliative care nursing staff (n = 101). Fifty-nine questionnaires were returned (58% response rate). Requesting workplace support following the death of a patient was associated with higher levels of emotional exhaustion (P =.001) and depersonalization (P =.04). Registered nurses with less than 10 years community care experience reported higher levels of depersonalization (P =.01) and lower levels of personal accomplishment (P =.03). A reported lack of training in grief responses was associated with depression (P =.02), guilt (P =.03), and physical distress (P =.02). Peer debriefing was identified as the most appropriate workplace support; however, most respondents reported they lacked debriefing skills, and this was associated with lower levels of personal accomplishment (P =.01). Staff working in this community palliative care service were not adversely affected by the deaths of their patients. It appears that training in grief responses is psychologically protective. Key recommendations for workplace support include training in debriefing, communication skills around death and dying, grief responses, and access to workplace-based complementary therapies