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.

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.

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.

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.

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.

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.

Beyond statistical significance:Embracing minimal clinically important difference for better patient care

The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.

End-of-life home care of an interstitial pneumonia patient supported by high-flow nasal cannula therapy:A case report

BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.

Concept Development and Implementation of Family Care/Caring Theory in Concentric Sphere Family Environment Theory

Caring is directed toward a variety of things. One of them is thought to be the concept of “family caring” aimed at families. This study attempts to clarify family caring and develop Family Care/ Caring Theory (FCCT), with the aim of implementing it in conjunction with an existing family nursing theory, the Concentric Sphere Family Environment Theory (CSFET). In Japan and in Hong Kong, family ethnography (including formal interviews) was conducted. As a result, the item “family health care nurses and their colleagues” was added to the family external environment of the CSFET. In the family environment, evidence was obtained to the effect that the family system unit is cared for by the nursing professional, and conversely the family system unit cares for the nursing professional, in a circular transaction. Observing the two-dimensional plane formed by the structural distance and functional distance, family caring assumes a structure of concentric circles, and according to transactions, the structural distance and functional distance between the nursing professional and family system unit are gradually approached, and through deepening of mutual trust maintain an appropriate distance. Moreover observing the three-dimensional space-time continuum which is created through addition of the temporal distance, family caring forms a helical structure. As transactions are repeated along the temporal axis, the family system unit’s self-actualization of other individuals and the self-actualization of the nursing professional are realized. Through these processes, a family care/caring relationship is reinforced and established. This is the concept of FCCT. Through future utilization in clinical settings this will be empirically substantiated, and it will be necessary to continue making creative corrections and revisions.

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.

Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses'caring ability

Objective： To understand the effect of humanistic nursing care model wards in Children Caring Ward School （CCWS） on the nurses＇ caring ability. Methods： Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory （CAI） before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses＇ caring ability. Results： The nurses＇ caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered （p 〈 0.05）. Conclusions： The humanistic nursing care model wards in CCWS has a positive effect on the nurses＇ caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients＇ satisfaction.

Healthcare interprofessional team members' perspectives on human caring: A directed content analysis study

Objectives:As Watson's Human Caring Theory continues to evolve and guide the discipline of nursing,the challenge is to find ways to integrate it into practice.The purpose of this study is to describe interprofessional team members'perspectives on human caring based on the Ten Caritas Processes(R)/Caritas-Veritas Literacy of Watson's Human Caring Theory within the Unitary Caring Science.Methods:This is a qualitative directed content analysis study,taking place in a Children's Hospital in the United States between November 2017 and April 2018.Information redundancy was utilized to guide the recruitment.Data were collected via a one-time face-to-face individual interview.A qualitative directed content analysis was conducted using Watson's Ten Caritas Processes(R)/Caritas-Veritas Literacy as a coding framework.Results:Twenty-seven healthcare professionals participated in the study.Interprofessional human caring,based on the Ten Caritas Processes(R)/Caritas-Veritas Literacy,was referred to as performing lovingkindness to patients,each other,and self;maintaining faith-hope in teamwork;valuing intersubjective interactions and building trust among team members;cultivating heart-centered-caring relations;acknowledging and processing positive and negative feelings non-judgmentally;applying all ways of knowing in caring;encouraging reciprocal teaching-learning;developing caring-healing environments collaboratively;respecting human dignity of patients and each other;and being open-minded to the unknowns and believing in miracles.Conclusions:Watson's Human Caring Theory can be an underlying guide to enrich human-to-human relations and create a caring-healing environment.When human caring is applied in interprofessional teams,healthcare professionals find a caring consciousness to care for oneself and each other and promote patient care.

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.

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.

个性化护理联合CICARE沟通模式在耳鼻喉门诊患者中的应用

目的:探讨个性化护理联合CICARE沟通模式在耳鼻喉门诊患者中的应用效果。方法:采用便利取样法将2022年6月1日~2023年12月31日就诊于耳鼻喉门诊的256例患者作为研究对象,将2022年6月1日~2023年1月31日就诊的128例作为对照组,将2023年2月1日~12月31日就诊的128例作为实验组;对照组给予常规耳鼻喉门诊护理,实验组给予个性化护理联合CICARE沟通模式;比较两组护理前后护理质量、护理满意度。结果:护理后,实验组有形性感知、可靠性感知、响应性感知、保证性感知评分均高于对照组(P<0.05,P<0.01),两组移情性感知比较差异无统计学意义(P>0.05);护理后,实验组服务态度、沟通能力、就诊秩序、专业素质、护理安全、护理满意度总分均高于对照组(P<0.05,P<0.01)。结论:将个性化护理联合CICARE沟通模式应用于耳鼻喉门诊患者中,能够提高护理质量和护理满意度。

Mothers’ Knowledge of Health Caring for Premature Infants after Discharge from Neonatal Intensive Care Units in the Gaza Strip, Palestine

Background: Preterm labor is one of the most public health problems related to neonates admitted to Neonatal Intensive Care Unit (NICU). Poor knowledge among mothers about the care requirements of a preterm neonate is immediate cause for post-discharge medical problems in premature and neonates readmission to NICU. Hence, this study aims to evaluate mothers’ knowledge of caring for premature infants post-discharge from Neonatal Intensive Care Units in the Gaza strip. Methods: A Quantitative-based cross-sectional designs study was used to survey 120 mothers of preterm neonates at the time of preterm neonates discharge by face-to-face interview at Al-Shifa medical complex and Nasser hospital between February and June 2018. Results: The results showed that only about 58.4% of mothers of premature babies had good knowledge about health care needed for premature infants after discharge from NICU. Furthermore, there was no statistically significant difference between the level of knowledge and mother’s sociodemographic characteristics (P-values > 0.05). Conclusion: Mothers’ knowledge of premature infants care was not at the optimal level, which might put the newborns at risk. Therefore, the study emphasizes the necessity of thoughtful exchange of health information between team members and mothers and establishing pre- and post-discharge plans with mothers to start their healthy transition of preterm neonate to home and to ameliorate family concerns.

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.

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.

The development and implementation of a model to facilitate self-care of the professional nurses caring for critically ill patients

Objectives This article aimed to describe the development,implementation,and evaluation of the model’s effectiveness to facilitate self-care of professional nurses caring for critically ill patients in ICUs.Methods The methods of Chinn and Kramer,Walker and Avant were utilized to generate this model.The study included four steps to develop,implement and evaluate the model:Step 1-concept analysis;Step 2-placing the concept in relationship statements;Step 3-description and evaluation of the model;and Step 4-implementation and evaluation of the model.The implementation and evaluation of the model included two phases:a one-day workshop to present the model,and three months of model implementation.The study was conducted in a specific tertiary hospital in Gauteng Province,South Africa.Twenty-five participants were identified amongst the five ICUs,and only eight participants accepted the invitation.Out of the eight participants,only six professional nurses working in different ICUs in the public sector were interviewed.Results The model was divided into three stages:relationship,working,and termination;it comprised the primary and secondary contexts in which the facilitation of self-care occurs.The model process occurred in a spiral form.The registered nurses benefitted holistically from the three presenters at the workshop,and the social worker contributed to their emotional self-care activities.Three themes emerged:The model brought positive experiences,change,and self-awareness;the model benefitted the registered nurses holistically;role modeling self-care practices motivated and benefitted others.Conclusion The model implementation assisted the registered nurses’in developing self-awareness and resilience.They gained more knowledge regarding self-care,and the model encouraged them to implement improved self-care practices.They became role models of self-care and motivated their friends and families.