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.

End of Life Care Medical Education: 48 Hour Hospice Home Immersion Alters Students’ Lives

Introduction: Education and skill enhancement in palliative and end of life care is rarely part of the foundational medical education curriculum. The progress of student physicians tends to be measured by their ability to synthesize and demonstrate basic medical knowledge and clinical skills but offers little assessment of the maturation of attitudes or their values. The University of New England College of Osteopathic Medicine (UNECOM), immerses second year medical students in a hospice home for 48 hours to enhance students’ perspectives in interprofessional palliative and end of life care. Methods: This project utilized qualitative ethnographic and autobiographic research designs. Two female second year medical students (27 y/o & 26 y/o) were immersed for 48 hours into a local hospice home, sleeping in a bed where others had died, to answer the question: “What is it like for ME to live in the Hospice Home for 48 hours and how does this contribute to my future as a practitioner?” Data were collected in the form of journal notes for pre-fieldwork, fieldwork, and post-fieldwork and included subjective and objective reporting of observations, experiences, and patient/family encounters. Analyses included journal review and thematic categorization and coding through content analysis. Results: Themes common to both students that factored in the research question and their prior stated interest areas of medical humanities and person-centered care at end of life were identified. Three themes were selected for this article: 1) Person-Centered Experiences, 2) Spectrum of Communication, and 3) Introspection: Attitudes and Values. The process of living in the hospice home for 48 hours revealed students’ attitudes about various disease processes, their personal experiences with death and dying, and their assumptions about how patients approach death. Conclusion: This Hospice Home Immersion project provided both an educational approach and learning environment that was effective in advancing medical students’ attitudes, skills, and knowledge as evidenced by their self-reported life altering learning about end of life and palliative care.

Factors Relating to Nurses’ End-of-Life Care

This integrative review aimed to investigate factors relating to end-of-life care of nurses. The review was conducted according to PICo (Participant, area of Interest, and Context). Keywords identified were: “nurse” AND “end-of-life care” (“dyingcare” OR “‘deathcare”, OR “near end stage of life care” OR “palliative care” OR “hospice care” OR “comfortable care in near death” OR “quality of dying patients care”), AND “nurses”. The database searched through PubMed, ProQuest, Google Scholar, Web of Science and SCOPUS. The searching inclusion criteria were limited to English and Chinese language studies about nurses’ end-of-life care from 2010 to 2019, yielding 258 English language articles and 2Chinese language articles. Results: A total of fifteen articles were selected based on inclusion criteria. Two subjects were obtained from the results that related to nurses’ care during the process of end of life: 1) Nurses’ demographic factors;and 2) Modifiable factors. Nurses’ demographic factors were age, years of work experience, level of education and experience of the death of a family member/friend. Modifiable factors included knowledge, attitude, confidence, relationship, environment and resources, communication, nursing activities, philosophy and culture of care, skills and training. These factors were explored in various areas and majority of the studies had been conducted in public government hospitals. Conclusion: The major power ability of care was observed in nurses who acted the significant part in caring for the terminally ill during the dying process. Caring for dying patients was related to many factors which could affect the fabric of nursing care at the end stage of life. The elements found in this review could lead to recommendations with implications for nursing practice so as to improve and enhance end-of-life care. Some factors could be considered like predictors affecting nursing practice for chronical ill patients in further research. In addition, nurses’ tranquility care in community hospitals should be more focused.

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.

Life Review the Impact of Combined Watson Care Theory Intervention on Psychological Status and Quality of Life in Patients with Terminal Lung Cancer

Objective: To analyze the impact of combined Watson care theory intervention on the psychological state and quality of life in patients with terminal lung cancer. Methods: 72 patients with terminal lung cancer admitted from March 2021 to January 2024 were selected, which were divided into research group (life review combined with Watson care theory intervention) and control group (conventional intervention), with 36 cases each. Compare the nursing effect between the two groups. Results: The anxiety self-rating scale (SAS) and depression self-rating scale (SDS) scores were significantly lower than those of the control group, and the quality of life score was significantly higher than that of the control group (P < 0.05). Conclusion: Life review combined with Watson care theory intervention can improve the psychological state and improve the quality of life of patients with terminal lung cancer.

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.

Evaluation of Ovarian Cancer Care at the End of Life in a Single Tertiary Hospital

Aim: Fundamentally, aggressive care is considered to be avoided for the patients at the end of life. However, this is not always adhered in real-world practice. We attempted to determine whether, and if so how, the aggressive care is made for patients with ovarian cancer during the last month prior death. Methods: Enrolled were a total of 104 patients with ovarian cancer (including fallopian tube or primary peritoneal cancer), who were treated in Kuopio University Hospital in Finland during 2009-2014. The aggressive care was defined according to the standards outlined by the National Quality Forum;shortly, chemotherapy, emergency-room/intensive-care visit/admission, hospital admission, and death in hospital. Results: Two thirds of patients (67%) had received at least one form of aggressive care during the last month of their lives. Especially, admission in hospital in the last 30 days of life was the most common form of aggressive cancer care. Younger patients (<72 years) received significantly more often aggressive care than the older patients (80% vs 43%, p = 0.004). Those women that underwent end-of-life discussions earlier than one month prior to death had significantly less aggressive care than those women that had discussions during the last month (48% vs. 90%, p = 0.001). Conclusions: Ovarian cancer patients received commonly at least one form of aggressive care at the end of their lives. More efforts should be taken to improve the quality of palliative and end-of-life care.

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.

Association between Caregiver Quality of Life and the Care Provided to Persons with Alzheimer’s Disease: Systematic Review

We reviewed the literature to examine whether an association exists between the quality of life (QoL) of primary informal Alzheimer's disease (AD) caregivers and the level and quality of care that these caregivers provide to their loved ones with AD. We obtained studies focusing on the care that these caregivers provide for their family members with AD. Our outcome of interest was level or quality of care and the independent variable was caregiver QoL. We extracted data in tabular form and used a narrative synthesis approach to describe our findings. Only one relevant study was included in the review. Overall, the evidence was equivocal regarding the associations between caregiver QoL and the level/quality of care in AD.

The Effect of Anemia on Quality of Life and Self-Care Agency in Turkey Hemodialysis Patients

Objective: Anemia is an important complication which affects quality of life and self-care agency in hemodialysis patients. The aim of this study was to determine the effects of anemia on quality of life and self-care agency in adult patients who receive chronic hemodialysis treatment. Methods: In this cross-sectional study, the Quality of Life Scale, the Self Care Agency Scale, and a data form were administered to 136 hemodialysis patients who were receiving treatment three hospital-based dialysis units in Istanbul. Results: The health perception of cases whose hemoglobin level was 12 mg/dl and above was significantly better than those whose hemoglobin level was lower than 12 mg/dl. Hemoglobin levels were significantly and positively correlated to physical role function, general health, and health from the previous year (p < 0.05). As the hemoglobin levels of the cases increased, quality of life pertaining to the mentioned domains increased. Conclusion: It was concluded that the quality of life in chronic dialysis patients was affected by anemia.

Evaluation of Health-Related Quality of Life Associated with Provision of Healthcare to Stroke Patients Living at Home in Japan

Objective: As stroke mortality rates decline in Japan, a large proportion of disabled stroke survivors living in their homes are supported by informal caregivers or formal healthcare services. To evaluate the impact of healthcare provision on outcome of stroke patients living at home, this study investigated the associations of long-term care and health-related quality of life (HRQOL) in patients 1 year after stroke onset. Methods: Data on patient and caregiver characteristics, HRQOL of patients, and healthcare services for those living at home were prospectively collected from 426 patients with stroke at baseline and 12 months. Using general measures of HRQOL, namely, Short Form-36 (SF-36) and EuroQOL 5 dimension (EQ-5D), multivariate regression models were used to determine the contribution of variables to changes in HRQOL scores from discharge to the first year after stroke. Results: Five domains of SF-36—role-physical, vitality, social functioning, role- emotional, and mental health—were significantly improved 1 year after stroke. Factors affecting changes in the five domains of HRQOL were age, independence in activities of daily living, and cognitive function. Home care service was positively associated with role-physical, social functioning, and role-emotional. In addition, home rehabilitation and home bathing services were positively associated with social functioning. Conclusion: This study clarified that improvements of HRQOL 1 year after stroke were associated with use of home-based services involving home care service, home rehabilitation, and home bathing services. The use of home-based services contributed to the improved welfare of patients living at home.

Health Literacy, Self-Care Behavior and Quality of Life in Acute Coronary Syndrome Patients: An Integrative Review

Purpose: The review aimed to find the best evidence on the relationship between health literacy, self-care behavior and perceived quality of life (QoL) among patients with acute coronary syndrome (ACS). Methods: Searching engines included Cumulative Index to Nursing Allied Health Literature (CINAHL), Pro Quest, MEDLINE, Google Scholar, SAGE Journals, Wiley on Line Library, and Science Direct electronic databases from 2010 to 2018. Fifteen research articles assessed the main variables and their associations with demographic and clinical variables. Results: Different methodologies and samples were analyzed: analytic descriptive, systematic review, a randomized control trial, retrospective cohort, a prospective Cohort, cross-sectional, and correlational designs. The fifteen studies showed that the patients with ACS have inadequate health literacy. Patients’ ability to understand basic and complex information or to accurately assess health risks was impaired and may hinder patients’ engagement in self-care. Low HL in patients having ACS is consistently associated with poor QoL. Physical domain of QoL remained the significant outcome of both self-care behavior and health literacy after adjusting for demographics and clinical variables in patients with ACS. Conclusion: The literature pointed to the importance of considering health literacy and self-care behaviors as predictors of quality of life among patients with ACS. However, there has been no previous evidence on the best process of the association between these three variables.

Relationship between Self-Care and Hand Foot Syndrome Specific Quality of Life in Cancer Patients

Purpose: The purpose of this study was to describe adherence to self-care for hand-foot syndrome (HFS) and the relationship between self-care and health-related quality of life (QOL). Methods: A cross-sectional study was conducted on 105 consecutive outpatients with HFS. To assess self-care for HFS and QOL, the participants were asked to complete self-care and HFS-14 (hand-foot syndrome specific QOL) questionnaires, respectively. Multiple regression models were used to identify the relationship between self-care and QOL. Results: Adherence to self-care for HFS was low, less than 50% for most of the items. Multivariate analysis revealed that poorer self-care (βs = -0.19;P = 0.03), depressive symptoms (βs = 0.43;P βs = 0.20;P = 0.04) were independent predictors of poorer QOL scores. Conclusions: We have identified a need for further research to develop effective programs of self-care in HFS.

Patient Quality-of-Life, Providers with Incentive Payments, Real-World Evidence, and Reducing Healthcare Costs through New Innovations

Background: Value-Based Care is a program that was created by Professor Michael E. PORTER and Elizabeth O. TEISBERG which has been modified for implementation over the last seventeen years. This new program is paid by Commercial Health Insurers (Insurance Companies) and Centers for Medicare and Medicaid Services (Medicare). This program incorporates the patients, doctors, Life Sciences Companies, Insurance Companies, Holistic practice, traditional Chinese medicine, etc. with alternative traditional treatments and therapies for Real-World Evidence based and value-based treatment customized to patients’ needs and the patients benefit. Methods: The program was proposed to achieve value for patients and an improved healthcare system which is especially needed to provide treatment for patients in Serious or Life-threatening conditions or diseases. The program will accurately measure the outcomes of patients and provide a wider choice of treatments that matter to patients, also to measure the cost that successful alternative treatments provide which may lower the cost to Medicare and Insurance Companies. Conclusion: The proposed and now implemented program is to achieve value for patients. Golden Sunrise Nutraceutical (Golden Sunrise) provides a New Medical Innovation and treatment alternative to patients suffering from Serious or Life-threatening illnesses. By using Golden Sunrise Innovation and with the incorporation of Value-based Care patients will become the drivers or it could be said the patient Ambassadors of their own health. By incorporating Golden Sunrise Innovation, the doctors will have more diversity of treatments available for their patients. Payment should reflect value not volume, and the New Medical Innovation Golden Sunrise offers will help in reducing the costs to Insurance Companies accelerating the adoption of Value-Based Care.

“Child Life”护理理念对支气管肺炎患儿的应用效果

目的观察“Child Life”护理理念应用于支气管肺炎患儿的效果。方法选择2022年6月至2023年6月就诊的支气管肺炎儿童128例,随机数字表法分为试验组和对照组,每组64例。对照组给予支气管肺炎常规护理,试验组在对照组基础上加用“Child Life”护理干预,比较2组患儿心境状态指标、治疗依从优良率、疾病控制进度指标和肺功能情况进行。结果试验组患儿焦虑抑郁评分低于对照组,治疗依从优良率高于对照组,疾病控制进度指标与肺功能指标优于对照组(P<0.05)。结论“Child Life”护理理念应用于支气管肺炎患儿,有利于该类患儿焦虑抑郁情绪的平复、治疗依从度的提升、疾病控制进度的加速与肺功能的改善,值得推广。

Desired Lifestyle of Older Adults with Dementia Living at Home from Their Perspective and That of Their Families with Support from Care Providers

Objective: This study aimed to determine the lifestyle of older adults with dementia living at home, how their families perceive them, and how care providers support their desired lifestyle. Methods: Semi-structured interviews were conducted with 12 pairs of older adults with dementia, their families, and care providers followed by a qualitative descriptive study. Results: Older adults with dementia described their lifestyle as follows: “I continue to take pride in the way I have lived so far,” “I want to do what I can now even if I cannot do it well,” “I live peacefully with my family,” “I go out and interact with people,” and “I live this time today with care.” Families regarded the lifestyle of older adults with dementia as a desire “to continue living at home peacefully,” “to live on their own,” and that they “probably do not want anything.” Care providers’ support was based on “respect (for an older adult with dementia) as a person,” “drawing out and making use of what they can do with their current abilities through providing care,” “supporting families and confirming their sense of satisfaction with life,” and “predicting the future course and supporting decision-making.” Conclusions: To support the lifestyle of older adults with dementia, it is important to ensure that they continue to have dignity and are comfortable living with their families and in their communities without intimidation.

Great Care for Life——New-type of Beijing's rural medical care system

Shi Lianzhen, a 79-year-old villager from rural Beijing, has been suffering from coronary heart disease and myocardial irffarction. On October 15, 2003, she unexpectedly received 10,064 yuan (US$1,215) in subsidies for her diseases from the local government department in charge of rural co-operative medical care. This old female farmer, without any income source, was so excited that she couldn’t put her feeling into words. For the first time in their life, Chinese farmers can enjoy medical care insurance like those wage workers in dries, when their health fails them and their lives are in the menace of death.

Application of Palliative Care in Improving the Quality of Life of Patients with Cancer Pain

Objective: To explore the effect of palliative care on the quality of life of patients with cancer pain. Methods: For May 2015 to May 2016 hospitalized 57 patients with advanced cancer pain carry out palliative care. At the same time, the quality of life questionnaire, including physical function, role function, emotional function, cognitive function and social function, were investigated at the time of admission and 6 weeks after admission. Results: Patients with various functions have significantly improved after palliative care (P Conclusions: Palliative care can effectively improve the quality of life of patients with cancer pain. It is worth in clinical promotion.

Art Therapy to Improve Quality of Life of Cancer Patients and Their Carers in Bangladesh

Objective: Art as a therapy helps in reparation and recovery. The aim of this study was to see the response of the cancer patients and their carers residing in Bangladesh towards art therapy and the perceived effect of art therapy on their physical and psychological condition. Method: The study was a record review study conducted through a cross-sectional descriptive method from July to November 2018. Along with the cancer patients, their immediate carers were enrolled in this study since patients and their carers both suffer from the distress that comes with the diagnosis of cancer. In-depth interviews and focused group discussions of art therapy were conducted with our study population at BPSCF and BSMMU. Findings: After art therapy, there was an improvement in sensory perception and self-perception, physical and psychological condition, communication and social skills and helped in more personal integration and built stronger insight among the patients and carers. Majority of the participants of art therapy felt good and wanted to continue art therapy. Significance of results: The results of this study will help to create awareness among the community about the importance of psychotherapies like art therapy in the life of the cancer patients and their carers. Introducing the concept of art therapy will also help the public health practitioners to improvise palliative care services in Bangladesh in a very cost-effective approach.

Critical care nurses＇ attitude towards life-sustaining treatments in South East Iran

BACKGROUND:Life-sustaining treatments(LSTs)may prolong life but greatly decrease the quality of death.One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses.This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran.METHODS:In this cross-sectional study,"Ethnicity and Attitudes towards Advance Care Directives Questionnaire"was used to investigate the attitude of 104 critical care nurses towards lifesustaining treatments in three hospitals affiliated to Kerman University of Medical Sciences.RESULTS:The findings of this study indicated that although a majority of critical care nurses(77%)did not have personal desire for use of LSTs including CPR and mechanical ventilation,they had moderately negative to neutral attitude towards general use of LSTs(2.95 of 5).CONCLUSIONS:These findings suggest that nurses'attitude towards LSTs can be changed by inclusion of specific courses about death,palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula.Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes.