International journal of palliative nursing
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Multicenter Study
Anticipating emotion: a qualitative study of advance care planning in the community setting.
Advance care planning at the end of life is high on the political agenda across the UK. The aim is to deliver patient-centred care for all patients, whenever possible in their preferred place of care. It is widely acknowledged that discussions about the end of life are sensitive and often difficult for health professionals, particularly those in the community setting. ⋯ The findings clearly depict two of the challenges faced by the GPs and DNs in the community: emotional labour, and balancing patients' and families' expectations about care provision in the community with the limited resources available. This study contributes to the knowledge base of advance care planning by providing insight into the experiences of the GPs and DNs who care for patients at the end of life. Further research is required to more fully understand the emotional impact on the health professionals having these sensitive discussions.
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In the past decade, the Robert Wood Johnson Foundation's 2002 report Means to a Better End: A Report on Dying in America Today and other studies brought attention to deficiencies in care of the dying in the USA. Palliative care's mandate is to promote a 'good death' through expert symptom management and compassionate care that addresses the psychosocial needs and dignity of persons at the end of life. ⋯ From 2007 through 2009, 351 California-based nurses and nursing home staff attended one of four ELNEC Geriatric courses. This paper describes programme development, implementation, follow-up evaluations, and examples of participants' use of the ELNEC Geriatric curriculum.
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At Leeds Paediatric Intensive Care Unit (PICU), whenever possible, patients are offered the opportunity to have mechanical ventilation withdrawn at a children's hospice or in the home. The aims of this study were to examine the views of the PICU staff regarding this choice, to understand their emotional and practical considerations, and to gain insight into the perceived effect on parents. ⋯ The PICU seems to fit neither the 'consultative model' nor the 'integrative model' of previous literature, but rather a 'facilitative model' not previously described.
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In December 2010 the National Patient Safety Agency released a Rapid Response Report citing evidence of harm and death necessitating the need to immediately address safety issues affecting ambulatory syringe drivers with rate settings in millimetres of travel. These devices are widely used in palliative care in the UK, both in the community and in the hospital setting. ⋯ This article outlines the experiences of one acute hospital trust in identifying and trialling ambulatory syringe drivers to potentially adopt, and in implementing the selected driver and training staff in its use. It is hoped that it will provide insight into the challenges of undertaking such a change in practice.