International journal of palliative nursing
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Review Comparative Study
A description and comparison of palliative care services in the United Kingdom and Czech Republic.
National and international comparative studies on provision of palliative care are lacking and further research would be beneficial for the development of national policies and effective service frameworks in different countries. This literature review focuses on a comparison of the development, structure and provision of the palliative care services in the United Kingdom (UK) and the Czech Republic (CZ). ⋯ The challenges and constraints within the Czech and UK health-care systems preventing delivery of palliative care to all patients with palliative care needs will be identified. The aim is to provide the reader with a simple, but comprehensive picture of palliative care services within the UK and the CZ as they currently exist, offering a building block for possible future research.
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Transdermal fentanyl patches first became available in the early 1990s and provided an innovative treatment for the management of cancer pain. Since then, they have become a familiar and convenient method for providing analgesia for patients with stable levels of cancer pain. Transdermal delivery is more complex than oral administration and some specific factors need to be taken into consideration for the patches to be used appropriately and to their best advantage. This article will review the use of transdermal fentanyl, looking at their place in the overall therapy plan, the use of appropriate adjunctive prescribing and some specific practical and safety issues.
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Review Case Reports
Dire deadlines: coping with dysfunctional family dynamics in an end-of-life care setting.
Working in a hospice and being able to focus on individualized, specialized end-of-life care is a privilege for the hospice staff member. However, it also presents the hospice staff with unique challenges. This descriptive study is based upon two cases from an end-of-life care setting in Denmark, where dysfunctional family dynamics presented added challenges to the staff members in their efforts to provide optimal palliative care. ⋯ Higher expectations and demands of younger, more well-informed patients and family members challenge hospice staff in terms of information and communication when planning for care. The inherent risk factors of working with patients in the terminal phase of life become a focal point in the prevention of the development of compassion fatigue among staff members. A series of coping strategies to more optimally manage dysfunctional families in a setting where time is of the essence are then presented in an effort to empower the hospice team, to prevent splitting among staff members, and to improve quality of care.
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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. ⋯ 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.