The Canadian nurse
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This portion of a study, first published last month, examines the various aspects of dying (including the dying person's needs); looks introspectively at the spiritual aspect of death; and analyzes the behavior and attitudes of care-giving staff, their values, motivations and needs. While dying people may have unpredictable attitudes and behavior, nurses need to maintain an attitude of caring and communication in their interventions. Important to consider when nursing the dying are subjects such as: establishing a helping relationship; appropriate communication; and self-knowledge and preconceived notions. Criticism most often directed at palliative care suggests that curative and palliative care should be integrated; should abandon their reserved territories (such as care units); and should develop an association that goes beyond the terminal phase.
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While the needs of dying individuals and their families have come under increasing scrutiny in the past decade, issues related to the needs of older adults (75 years or more) who are dying have not been systematically addressed. Death and dying are increasingly associated with old age, yet the conceptualization of palliative care in later life is not well developed. All too often, the philosophy and principles of palliative care are not invoked in the care of people who are both old and dying. It is an omission that must cease.
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Pakistan's health characteristics are worse than those of other Asian countries at similar stages of development. Its mortality rate for children under five is 139 per 1,000, and its maternal mortality is 60 per 10,000. Malnutrition in women and children is widespread; 50 per cent of children under five are stunted. ⋯ Partly because the training of doctors and nurses is lengthy and expensive, there is an acute shortage of health care providers, especially women. Although female health professionals are preferred for caring for women, cultural constraints inhibit women from seeking education. Such is the multifaceted dilemma in the provision of primary health care in Pakistan.