Palliative sedation: a feasible option to improve end-of-life care in seriously ill dying patients

There is a growing imperative for nurses to be adequately trained to care for patients with serious, life-limiting illness. However, the current nursing education system requires vast content areas be taught, resulting in minimal emphasize on palliative and end-of-life care and inadequate preparation of nurses to care for dying patients upon entering practice. To address the need for enhanced palliative and end-of-life care integration within their respective programs, two universities conducted needs assessments to determine the best next steps in enhancing student preparation to care for patients with serious, life-limiting illness. One university engaged in a three-part needs assessment resulting in the formation of an ad hoc committee to guide discussions for content integration. The second university engaged in a faculty-led survey to identify areas for improvement within the program. The purpose of this paper is to describe the processes and challenges encountered by both schools to aid other programs that may be considering or preparing for a similar endeavor.

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Developing a national quality register in end-of-life care: The Swedish experience

Palliative Medicine ◽

10.1177/0269216311414758 ◽

2011 ◽

Vol 26 (4) ◽

pp. 313-321 ◽

Cited By ~ 47

Author(s):

Staffan Lundström ◽

Bertil Axelsson ◽

Per-Anders Heedman ◽

Greger Fransson ◽

Carl Johan Fürst

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Nursing Facilities ◽

Life Care ◽

Quality Register ◽

Dying Patients ◽

National Quality ◽

Hospital Wards ◽

National Quality Register

Background: The complexity of end-of-life care, represented by a large number of units caring for dying patients, different types of organizations and difficulties in identification and prognostication, signifies the importance of finding ways to measure the quality of end-of-life care. Aim: To establish, test and manage a national quality register for end-of-life care. Design: Two questionnaires were developed with an attempt to retrospectively identify important aspects of the care delivered during the last week in life. An internet-based IT platform was created, enabling the physician and/or nurse responsible for the care during the last week in life to register answers online. Setting: Units caring for dying people, such as hospital wards, home care units, palliative in-patient care units and nursing facilities. Results: The register received status as a National Quality Register in 2006. More than 30,000 deaths in nursing facilities, hospital wards, palliative in-patient units and private homes were registered during 2010, representing 34% of all deaths in Sweden and 58% of the cancer deaths. Conclusions: We have shown that it is feasible to establish a national quality register in end-of-life care and collect data through a web-based system. Ongoing data analyses will show in what way this initiative can lead to improved quality of life for patients and their families. There is an ongoing process internationally to define relevant outcome measures for quality of care at the end-of-life in different care settings; the registry has a potentially important role in this development.

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Undergraduate final year nursing students’ attitudes toward caring for dying patients: Bahrain’s experience

Clinical Nursing Studies ◽

10.5430/cns.v6n4p53 ◽

2018 ◽

Vol 6 (4) ◽

pp. 53

Author(s):

Maryam Yaqoob ◽

Husain Nasaif ◽

Hana Kadhom

Keyword(s):

Nursing Students ◽

End Of Life ◽

Curriculum Reform ◽

End Of Life Care ◽

Life Care ◽

Gulf Region ◽

Cross Sectional ◽

Convenience Sample ◽

Dying Patients ◽

Students Attitudes

Background: Nursing students are frequently exposed to dying patients during their clinical placement. Research studies that examined nursing students’ attitudes toward caring for dying patients were limited in the Gulf Region, including Bahrain.Objective: The purpose of this study is to examine the attitudes of fourth-year baccalaureate nursing students regarding caring for dying patients.Methods: A descriptive cross-sectional design was utilized to recruit a convenience sample of fifty-four nursing students. Frommelt’s Attitudes towards Caring of the Dying (FATCOD) five Likert scale was used.Results: The overall findings revealed that participants had a neutral attitude toward caring for dying patients. The overall attitudes mean score was 3.4 ± 0.3. The majority of participants were female (83%, n = 45). The difference in the mean score in relation to gender was statistically significant (p = .049). Although the majority of all participants (80%) reported having dealt with the terminally ill people in the past, the association between previous experience and reported attitudes was not statistically significant (p = .31).Conclusions and recommendations: Literature revealed that students who received end of life education where found to have positive attitudes. Therefore, it’s crucial to introduce a standalone educational module regarding end of life care early on in the undergraduate curriculum. It is recommended that future studies recruit nursing students from other baccalaureate year levels to reassess the attitudes and level of preparedness following a curriculum reform and implementation of end of life care education. Additionally, a qualitative research method is recommended to explore the lived experience of the nursing students when they are caring for dying patients.

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Experiences of a Group of Senior Nursing Students with End of Life Care and Death in Turkey

OMEGA - Journal of Death and Dying ◽

10.1177/0030222820961232 ◽

2020 ◽

pp. 003022282096123

Author(s):

Deniz Sanli ◽

Fatma Iltus

Keyword(s):

Nursing Students ◽

End Of Life ◽

End Of Life Care ◽

Quality Care ◽

Death And Dying ◽

Life Care ◽

Death Attitudes ◽

Positive Attitudes ◽

Dying Patients ◽

And Behaviors

Nursing students may feel unprepared to manage the care of dying individuals and may experience anxiety and fear related to death and dying. Preparing nursing students for this situation can help them provide quality care to dying patients. This study aimed to examine the end-of-life care values and behaviors and death attitudes of senior nursing students. In examining these variables, the Values and Behaviors of Intensive Care Nurses for End-of-Life Instrument and the Death Attitude Profile-Revised Scale were used. It was found that the students developed positive attitudes and behavior towards end-of-life care, and that they believed death to be a natural part of life and there is life after death. Students who felt that the information they received during their education was partially sufficient were more likely to have negative death attitudes. It can be recommended that teaching strategies in the education of the nursing students be developed.

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Palliative Sedation in End-of-Life Care and Survival: A Systematic Review

Journal of Clinical Oncology ◽

10.1200/jco.2011.37.3795 ◽

2012 ◽

Vol 30 (12) ◽

pp. 1378-1383 ◽

Cited By ~ 177

Author(s):

Marco Maltoni ◽

Emanuela Scarpi ◽

Marta Rosati ◽

Stefania Derni ◽

Laura Fabbri ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

End Of Life ◽

End Of Life Care ◽

Randomized Clinical Trials ◽

Palliative Sedation ◽

Life Care ◽

Review Of Literature ◽

Refractory Symptoms ◽

Manual Search

Purpose Palliative sedation is a clinical procedure aimed at relieving refractory symptoms in patients with advanced cancer. It has been suggested that sedative drugs may shorten life, but few studies exist comparing the survival of sedated and nonsedated patients. We present a systematic review of literature on the clinical practice of palliative sedation to assess the effect, if any, on survival. Methods A systematic review of literature published between January 1980 and December 2010 was performed using MEDLINE and EMBASE databases. Search terms included palliative sedation, terminal sedation, refractory symptoms, cancer, neoplasm, palliative care, terminally ill, end-of-life care, and survival. A manual search of the bibliographies of electronically identified articles was also performed. Results Eleven published articles were identified describing 1,807 consecutive patients in 10 retrospective or prospective nonrandomized studies, 621 (34.4%) of whom were sedated. One case-control study was excluded from prevalence analysis. The most frequent reason for sedation was delirium in the terminal stages of illness (median, 57.1%; range, 13.8% to 91.3%). Benzodiazepines were the most common drug category prescribed. Comparing survival of sedated and nonsedated patients, the sedation approach was not shown to be associated with worse survival. Conclusion Even if there is no direct evidence from randomized clinical trials, palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not seem to have any detrimental effect on survival of patients with terminal cancer. In this setting, palliative sedation is a medical intervention that must be considered as part of a continuum of palliative care.

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Dignified end-of-life care in the patients’ own homes

Nursing Ethics ◽

10.1177/0969733011398100 ◽

2011 ◽

Vol 18 (3) ◽

pp. 374-385 ◽

Cited By ~ 16

Author(s):

Christina Karlsson ◽

Ingela Berggren

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Life Care ◽

Human Beings ◽

Life World ◽

Life Phase ◽

Dying Patients ◽

Nurses Perceptions ◽

Significant Factors

Nowadays it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Therefore it is vital to identify significant factors in order to prevent unnecessary suffering for dying patients and their families in end-of-life homecare. This study aimed to describe 10 nurses’ perceptions of significant factors that contribute to good end-of-life care in the patients own home. The transcribed texts from the interviews’ were analyzed using phenomenological hermeneutical method, which focuses on the life-world of human beings. The results demonstrate that good end-of-life care presupposes that the aim of the caring staff is to provide safety, autonomy and integrity for the patient and family in order to create the respect required for as good and dignified a death as possible.

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Proxy, Health, and Personal Care Preferences: Implications for End-of-Life Care

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180199802096 ◽

1999 ◽

Vol 8 (2) ◽

pp. 200-210 ◽

Cited By ~ 8

Author(s):

PETER J. AIKMAN ◽

ELAINE C. THIEL ◽

DOUGLAS K. MARTIN ◽

PETER A. SINGER

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Robert Wood Johnson Foundation ◽

Focused Attention ◽

Life Care ◽

Personal Care ◽

Dying Patients ◽

Care Project ◽

Life Sustaining Treatment ◽

Advance Care

The Institute of Medicine's report, “Approaching Death: Improving Care at the End of Life,” the American Medical Association's “Education for Physicians on End-of-Life Care” project, the Open Society Institute's “Project on Death in America,” and the “Last Acts” initiative sponsored by the Robert Wood Johnson Foundation have focused attention on improving the care of dying patients. These efforts include advance care planning and the use of written advance directives (ADs). Although previous studies have provided quantitative descriptions of patient preferences for life-sustaining treatment, including those documented in written ADs, to our knowledge open-ended written preferences have not been studied. Studies of these open-ended preferences could highlight issues with respect to quality end-of-life care. The purpose of this study was to explore the open-ended proxy, health, and personal care preferences of people with HIV as expressed in a written AD form.

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