Investigation of Student Nurses’Attitudes towards End-of-Life Care and Their Influencing Factors

Background: This cross-sectional investigative study aimed to determine student nurses’ attitudes towards end-of-life care. Methods: This study used a descriptive research design with stratified sampling to survey student nurses enrolled in one of four nursing colleges in China from January 2023 to December 2023. Student nurses’ general demographic and prior related information, attitudes towards death and attitudes towards end-of-life care were determined using a general information questionnaire, the Death Attitude Profile—Revised scale and the Professional End-of-Life Attitude Scale (PEAS), respectively. Results: The total PEAS score was 122.91 ± 16.123. Significant differences were noted in the attitude towards end-of-life care scores according to sources of end-of-life care knowledge (P Conclusions: Student nurses lacked an optimistic attitude towards end-of-life care, which was influenced by differences in the sources of end-of-life care knowledge.

Individualized Aromatherapy in End-of-Life Cancer Patients Care:A Case Report

As one of the methods of palliative care,aromatherapy has been applied gradually in clinical nursing work in China in recent years.Through aromatherapy,terminal cancer patients can get not only relieves of physical symptoms,but also spiritual relaxation and peace,thus have improved quality of life at the end stage.In this paper,we report in detail about how aromatherapy was applied for symptom control in a cancer patient with unknown primary malignancy and multiple metastasis and its effects on the terminal life of this patient.

Living Conditions and Palliative Care Needs among End-of-Life Former Commercial Plasma Donors Affected with HIV/AIDS in Rural Henan of China

Objective China began providing antiretroviral therapy to people living with HIV/AIDS （PLWHA） in 2003. This study was to investigate the living conditions, including quality of life and happiness, and need for palliative care of end-of-life PLWHA in rural Henan. Methods One hundred end-of-life AIDS patients were selected from Weishi, Zhenping and Tanghe counties in Henan, using convenience sampling. The World Health Organization Quality of Life for HIV （WHOQOL-HIV） BREF Chinese Version was used to measure the quality of life and the Memorial University of Newfoundland Scale of Happiness （MUNSH） was employed to measure subjective welfare. Qualitative interviews and focus group discussions were undertaken to learn about the palliative care provided and the specific needs of the end-of-life patients. Results Patients’ overall quality of life was moderate （12.62±1.97）. Highest scores were in the spirituality/religion/personal beliefs, higher than the average scores in the Chinese population （P0.01）, while psychological （13.58±2.06） and environment （12.50±3.28） domain scores were similar to the latter （P0.05）. Both independence （12.15±2.15） and physiological （14.04±3.16） domain scores were lower than the average of the people living with HIV/AIDS in other studies （P0.01）; however, all were in the moderate range. The average MUNSH score was 21.00±6.20, which was also moderate. The in-depth interviews indicated that the Henan Provincial Government’s policy of treatment and care had a beneficial impact on end-of-life AIDS patients, although the care components could be improved. Conclusions Living conditions of the end-of-life AIDS patients were moderate, and the HIV/AIDS palliative care model used was beneficial to them. Care could be improved by assisting the family unit as a whole.

Activity coefficients of NiO and CoO in CaO–Al_2O_3–SiO_2 slag and their application to the recycling of Ni–Co–Fe-based end-of-life superalloys via remelting

To design optimal pyrometallurgical processes for nickel and cobalt recycling, and more particularly for the end-of-life process of Ni-Co-Fe-based end-of-life（EoL） superalloys, knowledge of their activity coefficients in slags is essential. In this study, the activity coefficients of NiO and CoO in CaO-Al_2O_3-SiO_2 slag, a candidate slag used for the EoL superalloy remelting process, were measured using gas/slag/metal equilibrium experiments. These activity coefficients were then used to consider the recycling efficiency of nickel and cobalt by remelting EoL superalloys using CaO-Al_2O_3-SiO_2 slag. The activity coefficients of NiO and CoO in CaO-Al_2O_3-SiO_2 slag both show a positive deviation from Raoult＇s law, with values that vary from 1 to 5 depending on the change in basicity. The activity coefficients of NiO and CoO peak in the slag with a composition near B =（%CaO）/（%SiO_2） = 1, where B is the basicity. We observed that controlling the slag composition at approximately B = 1 effectively reduces the cobalt and nickel oxidation losses and promotes the oxidation removal of iron during the remelting process of EoL superalloys.

A model for end-of-life vehicles management based on green manufacturing

Like any industrial product, the vehicles also do have end of their service lives and ultimately result in end-of-life vehicle (ELV) at a certain stage of the vehicle life. The concern of this paper is to make a general review on ELV management process and present a model for ELV management on the basis of green manufacturing so as to reduce the environmental impact and minimize the resources loss due to the ELVs. The various phases of vehicle life cycle starting from design, manufacturing and utilization, occurrence of ELV and then the storage, depollution, dismantling and finally the shredding and post shredder material processing phases of ELV for the resources recovery, all of these phases need to be considered to give totality to the model, which makes end-of-life vehicles management more benign for environment, and more efficient for the usage of resources.

Investigation on end-of-life electric and electronic equipment recycling and disposal system in China: legislation, education and dissemination

The Chinese obsolete electric and electronic equipments (EEE) recycling and disposal system on the point of view of legislation, education and dissemination were discussed, because of the highly increasing volume of electric and electronic products and that of its obsoletes today in China. The legislations and responsibilities of go- vernment, industry and consumer were discussed based on the balance of benefit and responsibility depending on the realization of their benefits in the whole life cycle of products and its status in the whole value chain. Not only the legislation and establishment of the so called “compulsory discarding system” will be a possible and effective solution to the difficulty of the obsolete collection and recycling for obsolete electric and electronic reclaiming industry, but also the education and dissemination. Education and dissemination were discussed as an important role which will emphasize the adjusting of policy and law on the development of electric and electronic industry production and its reclaiming. The education of stockholders’ environmental responsibility and the advocating of responsibility sharing should be implement for industry and consumer. Chinese EEE industry should emphasize the control of natural source, and should implement the environmental benign design in their production, such as design for dismantling, no dismantling, thermal treatment and green design. The perspectives for the way to advocate a harmonic society for Chinese people were described.

End-of-life care in a cardiology department： have we improved？

Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate （DNR） order protocol. Methods ＆ Results Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet （Group A）, a conven- tional DNR order （Group B） or the absence of any DNR order （Group C）. The number of deaths was similar in both periods （n = 198 vs. n = 197）. The rate of patients dying with a DNR order increased significantly （57.1% vs. 68.5%; P = 0.02）. Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission （vs. 2.6% in the first period; P 〈 0.001）. All patients in Group A with an implantable cardioverter defibrillator （ICD） had shock therapies deactivated （vs. 25.0% in the first period; P = 0.02）. Conclusions The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation.

Economy Analysis of a Recycle Model of End-of-Life Vehicle

In order to evaluate recycle economy of end-of-life vehicles quantitatively,an economy model based on a recycle model of end-of-life vehicles and recycle cost analysis. With a practical example of recycling engines of end-of-life vehicles ,the validity of the recycle economy model and good recycle economy of the end-of-life vehicle engine were justified. It is concluded that ① remanufacture-ability of the part or component of the vehicles; ② the organization and management level of a recycle corporation; ③ policies and regulations of the government are crucial factors to raise the recycle economy of the end-of-life vehicle.

End-of-life vehicle recycling based on disassembly

The end-of-life vehicle recycling was studied based on the disassembly. The end-of-life recycling and the disassembly were reviewed and discussed. A disassembly experiment of an end-of-life engine was carried out, which strictly recorded the process of dismantling. Based on the results, a model of the end-of-life recycling was presented. In this model, the end-of-life parts were classified by three ways which included to recycle directly, to recycle after remanufacturing and to discard. By using this model, the dismantling efficiency and the recycling rate can be improved. Also, it obtains a good result after used in a dismantling factory.

End-of-life vehicles processing,towards a thermal treatment of auto shredder residue

All over the world,the management of End-of-life Vehicles(ELV) and Automobile Shredder Residue(ASR) is an increasing issue for the car industry.The setting up of several environmental directives,among others the notion of extended producer responsibility,encourage car manufacturers to find alternatives solutions to waste disposal.For 2017,China aims for the recyclability and energy recovery of 95% of total weight of used cars,and in order to reach this rate,the development of some ASR thermal processes could be envisaged.With this research,an overview of ELV management was given and the different solutions about ASR thermal treatment were presented.It is showed that in spite of its big heterogeneity,the high heating value of ASR makes pyrolysis and gasification very interesting,compared to incineration or disposal of in landfills.

Naturally Nitrogen-Doped Biochar Made from End-of-Life Wood Panels for SO_(2) Gas Depollution

Reconstituted wood panels have several advantages in terms of ease of manufacturing,but their shorter life span results in a huge amount of reconstituted wood panels being discarded in sorting centers yearly.Currently,the most common approach for dealing with this waste is incineration.In this study,reconstituted wood panels were converted into activated biochar through a two-step thermochemical process:(i)biochar production using pilot scale fast pyrolysis at 250 kg/h and 450℃;and(ii)a physical activation at three temperatures(750℃,850℃ and 950℃)using an in-house activation furnace(1 kg/h).Results showed that the first stage removed about 66% of the nitrogen from the wood panels in the form of NO,NH3,and trimethylamine,which were detected in small amounts compared to emitted CO_(2).Compared to other types of thermochemical conversion methods(e.g.,slow pyrolysis),isocyanic acid and hydrogen cyanide were not detected in this study.The second stage produced activated biochar with a specific surface area of up to 865 m^(2)/g at 950℃.The volatile gases generated during activation were predominantly composed of toluene and benzene.This two-step process resulted in nitrogen-rich carbon in the form of pyrrolic and pyridinic nitrogen.Activated biochars were then evaluated for their SO_(2) retention performance and showed an excellent adsorption capacity of up to 2140 mg/g compared to 65 mg/g for a commercial activated carbon(889 m^(2)/g).End-of-life reconstituted wood panels and SO_(2) gas are problematic issues in Canada where the economy largely revolves around forestry and mining industries.

A conceptual analysis of the meaning of comfort at the end-of-life using the Walker and Avant(2014)Framework

Objective:The aim of the authors is to clarify the concept of comfort at the end-of-life in order to support understandings of fundamental nursing care needed at this stage of healthcare.Methods:The Walker and Avant framework was applied to develop a deeper understanding of the concept of comfort at the end of life.Results:Five defining attributes of comfort in the end-of-life were identified and they are having a peaceful home-life environment,trust and consolation,proximity and social-cultural support,alleviation of suffering,and a process of integrated intervention by nurses.Conclusions:At the end-of-life patients commonly experience physical,psychological,social-cultural,and environmental discomfort.Patients’families also encounter significant challenges.However,their comfort needs are often secondary to that of the patient.Additionally,a lack of clarity exists regarding the holistic meaning of comfort at the end-of-life,which can largely be confined to understandings of physical comfort for the patient,with a limited understanding of addressing family/caregivers’needs.Therefore,this concept analysis may provide some guidance in this regard and also provides support toward a more integrated understanding of the concept.

Palliative Care, Suffering, Death Trajectory: A View of End-of-Life Care (EOL) Related Issues in Sub-Saharan Africa (SSA)

Palliative care in the sub-Saharan Africa (SSA) region despite some progress made since the first hospice was opened in Zimbabwe in 1979, still lags far behind that of countries with developed economies, and relatively suffers from not being wholly included into mainstream public health service delivery in SSA. The situation is made worse due to relatively poor and pervasive socio-politico-economic factors and the challenge of the changing and increasing non-communicable disease epidemiology in SSA countries. This situation results in a tension between scarce resources and service needs/provision which prevails in a good number of SSA countries. In large part the situation where palliative care, end of life and the death trajectory converge in SSA countries currently portrays one of scarcity of resources and suffering for those ill SSA patients who need the services. This article is an overview of the current situation as pertains to palliative care services in the SSA region and some of the factors that contribute to or perpetuate the current state of palliative care delivery in SSA countries.

Nurses towards End-of-Life Situations: Sympathy vs. Empathy

Background: Nurses providing end-of-life care play an important role in providing support to both the patient and his/her family during one of their most difficult time. Patients in this stage do not only require physical care but emotional support as well. Aside from being a care provider, nurses should be able to utilize their knowledge in therapeutic communication in order for the patients and his/her family members to verbalize their feelings and concerns. Objective: The purpose of this study is to identify whether nurses project sympathy or empathy while providing end-of-life care. It also aims to determine their lived experiences while proving care at this stage. Methodology: This study utilized the mixed convergent parallel design wherein both the quantitative research and qualitative research were employed. Result and Discussion: A factor analysis was conducted on 12 items with maximum likelihood extraction method and oblique (Promax) rotation method. The Kaiser-Meyer-Olkin (KMO) measure verified the sampling adequacy for the analysis, KMO = 0.792 (“meritorious” according to Kaiser (1974)). Bartlett’s Test of Sphericity (χ2 (66) = 1007.294, p α = 0.881, sympathy α = 0.804, and cognitive empathy α = 0.728). Correlations among the factors were r = 0.315 for affective empathy and sympathy, r = 0.295 for sympathy and cognitive empathy, and r = 0.356 for affective empathy and cognitive empathy. Emergent key themes and subthemes are based on participants’ responses. The key themes are heart-touching moments of nurses in providing end-of-life care, challenges encountered by nurses in providing end-of-life care and adaptive strategies used by nurses to the challenges they face in providing end-of-life care. Conclusion: Most nurses during end-of-life care express affective empathy, followed by sympathy and lastly cognitive empathy. Nurses are encouraged to show and practice affective and cognitive empathy rather than using sympathy in caring patient and dealing with family member in the end-of-life situations. Despite the challenges that nurses faced, they are able to provide quality care by utilizing several adaptive strategies such as listening and understanding, showing empathy, providing holistic care, being spiritual and being aware of the role as caregiver.

Prediction and recovery of end-of-life vehicles of China

With the rapid development of automobile industry,car ownership of China continuously increases end-of-life vehicles(ELVs)as well.This paper analyzes the current situation of car production,car ownership and ELVs in China based on the data in the past ten years,also forecasts the number in a decade with the help of the grey system model GM(1,1)and the Matlab software.Then it reviews the recovery methods and modes of ELVs recycling.Then based on the problems existed in the ELVs recycling industry,it gives out some suggestions which are conductive to the development of ELVs recycling industry in China.

Nurses’ Experiences of Using the Liverpool Care Pathway Plan in Hospitalized Patients with Heart Failure in the End-of-Life Stage: A Qualitative Content Analysis

Background: The introduction of care pathway plans for end-of-life cares such as the Liverpool Care Pathway (LCP) reveals a unique possibility for inter professional collaboration. Knowledge of symptom relief and how to meet the patients’ needs at the last stage of the palliative phase are essential for the nurses’ approach and care actions, but the documentation of such implementations is still rare and sometimes criticized. Aim: To explore and describe nurses’ experiences of using the LCP plan with patients hospitalized with heart failure at the end-of-life stage. An explorative design was applied, using qualitative content analysis of 20 interviews with nurses practicing the LCP plan in two district hospitals in Norway. Results: The nurses found the LCP plan as quality assurance for treatment and care in patients with heart failure in the last hours and days of life. The use of the LCP plan implied: 1) individualized adjustment, 2) symptom relief and 3) a holistic approach. Conclusion: Nurses experienced that using the LCP plan as a comprehensive action plan contributed in the decision making process and improved inter professional communication. Using the LCP plan should be seen as a tool to practice individualized and holistic nursing to patients at the end-of-life and their families, as well as a purposeful relief of symptoms associated with heart failure.

Learning from the Film “Mitorishi (Transition Doula)”—Application to Understanding the End-of-Life in a Gerontological Nursing Practice Course in Japan

Purpose: This study aims to detail what nursing students learned from watching the film “Mitorishi”, which was used among the teaching materials in a gerontological nursing practice course in nursing education in Japan, and demonstrate the applicability of using the film as an element relevant to the teaching of end-of-life care in Japan. Methods: The participants were fourth-year nursing students at University A who had watched the film “Mitorishi” during the course, had submitted a report on what they learned, and provided informed consent to the study participation. The reports submitted by the participants were used as data and analyzed qualitatively using the content analysis approach. Results: The analysis identified the following five categories (number of codes): Characteristics of life during the final days (9), Importance of views on life and death (3), Importance of end-of-life care (3), Assistance in preparation for the final days of life (13), and Understanding the profession of transition doula (9). Discussion: The five categories show that the students have learned about the “role of nurses at the time of end-of-life care” while “visualizing end-of-life care” and learning “preparedness for end-of-life care”. These findings suggest that using the film “Mitorishi” in the teaching curriculum is effective for learning about end-of-life care for older people.

Eco-friendly regeneration of end-of-life PVDF membrane with triethyl phosphate:Efficiency and mechanism

Membrane will inevitably reach the end of its lifespan due to the irrecoverable fouling accumulation in membrane bioreactors(MBRs)during long-term operation.Herein,we developed an eco-friendly membrane regeneration strategy with triethyl phosphate(TEP),which successfully prolonged the lifespan of end-of-life(EOL)polyvinylidene fluoride(PVDF)membranes in a large-scale MBR.The regenerated(Rg)membrane exhibited a water permeance of 534.8±45.7 L m^(-2)h^(-1)bar-1,along with stable rejection rate,which was comparable with that of the new membrane.Furthermore,compared to the membrane subjected solely to preliminary cleaning,the Rg membrane presented a more hydrophilic surface due to the combination of preliminary cleaning and solvent-based processing.Besides,the Rg membrane presented less fouling propensity with the critical flux of 15.2 L m^(-2)h^(-1),significantly higher than that of the EOL membrane(4.0 L m^(-2)h^(-1)).Importantly,the membrane regeneration strategy was capable of guaranteeing the effluent quality in MBR systems for treating real municipal wastewater.This study provides an eco-friendly membrane regeneration strategy for effectively removing the irrecoverable foulants,thereby promoting the advancement of sustainable membrane-based wastewater treatment technology.

Recycling of reclaimed fibers from end-of-life tires in hot mix asphalt

Nowadays, the disposal of end-of-life tires(ELT) is worldwide one of the major concerns for the environment as well as for public health. Crumb rubber and steel wires, the main byproducts(in terms of weight) deriving from the ELT processing, can be recycled in several ways. However, the textile fiber, representing about 10% of the waste by weight, is typically not reused and ends up in landfills or incinerators. The present paper deals with the use of reclaimed fibers from ELT in hot mix asphalt(HMA), with the aim to improve its performance. The study included the preliminary characterization of the fiber through microscope observation and Fourier trans form infrared(FTIR) spectroscopy and then the investigation of the mechanical properties of HMA containing ELT fibers, in comparison with an ordinary HMA with no fibers. In particular, indirect tensile strength(ITS), indirect tensile stiffness modulus(ITSM), semi-circular bending(SCB), three point bending(3PB)and indirect tensile fatigue(ITF) tests were carried out. The results showed that the use of ELT fibers does not reflect in a significant improvement in terms of strength and stiffness properties. However, the ELT fibers determine a noticeable increase of the HMA resistance to fatigue, probably related to the ability of the fibers in sewing the micro-crack edges and contrasting the macro-crack opening.

Comparison on End-of-Life strategies of WEEE in China based on LCA

As the Electrical and Electronic Equipment （EEE） are upgraded more frequently in China, a large quantity of Waste Electrical and Electronic Equipment （WEEE） was and will be generated. It becomes an urgent issue to develop and adopt an effective End-of-Life （EoL） strategy for EEE in order to balance the resource recovery and environmental impacts. In an EoL strategy hierarchy for EEE, reuse strategy is usually deemed to be prior to materials recovery and other strategies. But in practice, the advantages and disadvantages of different strategies are always context-dependent. Therefore, main EoL strategies for EEE in China need to be evaluated in environment and resources aspects from the life cycle perspective. In this study, the obsolete refrigerator and Power Supply Unit （PSU） ofdesktop PC are both taken as the target products. Life Cycle Assessment （LCA） is applied to assess the environmental impacts of different EoL scenarios in China： Unit Reuse Scenario （URS）, Component Reuse Scenario （CRS） and Materials Recovery Scenario （MRS）. The LCA results show that the EoL strategies hierarchy is reasonable for the part＇of computer, bui not necessarily suitable for obsolete refrigerators. When the policy makers promote or demote one EoL strategy especially reuse, it is necessary to take subsequent impacts into consideration.