Place of death related to demographic factors for hospice patients in Wellington, Aotearoa New Zealand

BACKGROUND

Because socioeconomic and cultural factors contribute to where one dies, it is important to document place of death determinants in diverse societies.

AIM

The purpose of this study was to describe where persons in an Aotearoa New Zealand hospice die, and to identify factors that are associated with place of death.

DESIGN

A retrospective chart review was conducted.

SETTING/PARTICIPANTS

Data were extracted from the charts of all patients receiving services from one hospice (i.e. secondary care) for whom death occurred during 2006-2008; 1268 cases for whom place of death was recorded comprise this sample.

RESULTS

For close to half (47%), death occurred in the hospice inpatient unit, whereas 29% died at home, 8% died in an acute hospital setting, and 17% died in an aged/residential care facility. Bivariate analyses showed that persons who die in an aged/residential care facility are more likely to be aged 65 or older, unmarried, have a non-cancer diagnosis, and are likely poorer. Asians, those aged less than 65, those with cancer, and those admitted initially to hospice for respite care tended to die in the hospice inpatient unit. Multinominal logistic regression indicated that dying at home was only predicted by being from a Pacific Island.

CONCLUSIONS

Age, economics, diagnosis, ethnicity, marital status, and whether one enters a hospice service for (at least in part) respite were all associated to a certain extent with where one dies. These findings contribute to the growing evidence linking various factors, especially ethnic groups, with place of death.

Case series: 2q33.1 microdeletion syndrome--further delineation of the phenotype

Recurrent deletions of 2q32q33 have recently been reported as a new microdeletion syndrome, clinical features of which include significant learning difficulties, growth retardation, dysmorphic features, thin and sparse hair, feeding difficulties, and cleft or high palate. Haploinsufficiency of one gene within the deleted region, SATB2, has been suggested to be responsible for most of the features of the syndrome. This article describes seven previously unreported patients with deletions at 2q33.1, all partially overlapping the previously described critical region for the 2q33.1 microdeletion syndrome. The deletions ranged in size from 35 kb to 10.4 Mb, with the smallest deletion entirely within the SATB2 gene. Patients demonstrated significant developmental delay and challenging behaviour, a particular behavioural phenotype that seems to be emerging with more reported patients with this condition. One patient in this cohort has a deletion entirely within SATB2 and has a cleft palate, whereas several patients with larger deletions have a high arched palate. In addition, one other patient has significant orthopaedic problems with ligamentous laxity. Interestingly, this patient has a deletion that lies just distal to SATB2. The orthopaedic problems have not been reported previously and are possibly an additional feature of this syndrome. Overall, this report provides further evidence that the SATB2 gene is the critical gene in this microdeletion syndrome. In addition, because the individuals in this study range in age from 3-19 years, these patients will help define the natural progression of the phenotype in patients with this microdeletion.

Nursing Ethics in the Seventh-Day Adventist Religious Tradition

Nurses’ religious beliefs influence their motivations and perspectives, including their practice of ethics in nursing care. When the impact of these beliefs is not recognized, great potential for unethical nursing care exists. Thus, this article examines how the theology of one religious tradition, Seventh-day Adventism (SDA), could affect nurses. An overview of SDA history and beliefs is presented, which explains why ‘medical missionary’ work is central to SDAs. Theological foundations that would permeate an SDA nurse’s view of the nursing metaparadigm concepts of person, health, environment (i.e. community), and nursing (i.e. service) are presented. The ethical principles guiding SDA nurses (i.e. principled, case-based, and care ethics) and the implications of these theological foundations for nurses are noted in a case study.

Efficacy of a self-study programme to teach spiritual care

AIM AND OBJECTIVES

This study investigated the efficacy of a self study programme designed to teach nurses about how to talk with patients about spirituality, and to identify factors predicting this learning. Furthermore, the study investigated whether there were differences in learning between students and practicing clinicians, and between those in a religious or non-religious institution.

BACKGROUND

Although USA and UK accrediting bodies mandate nurses learn how to assess and support patient spiritual health, there is a paucity of evidence to guide educators regarding how to teach spiritual care to nurses. Indeed, it is unknown if aspects of spiritual care can be taught using formal approaches.

DESIGN

A pretest-posttest pre-experimental design was used to study how attitude toward spiritual care, ability to create empathic verbal responses to expressed spiritual pain, personal spiritual experience, and knowledge about communication for spiritual caregiving changed from before to after programme completion.

METHODS

Study participants, 201 nursing students and RNs, independently completed the mailed self-study programme (i.e. workbook with supplemental DVD) and self-report study instruments (i.e. Daily Spiritual Experience Scale, Spiritual Care Perspective Scale-Revised, Response Empathy Scale, Communicating for Spiritual Care Test, and Information about You form).

RESULTS

Significant differences were seen between the before and after scores measuring attitude, ability, spiritual experience, and knowledge. An interaction effect of time between students and registered nurses for both spiritual care attitude and personal spiritual experience was observed.

CONCLUSIONS

Findings suggest learning occurred for both students and RNs, regardless of whether they were at a religious institution or not. Relevance to clinical practice. These data indicate that this self-study programme was an effective approach to teach nurses about how to converse with patients about spirituality.

Promoting spiritual health in home healthcare

This article explores how clinicians can promote patient and family caregiver spiritual health. After a review of pertinent theory and research, clinical implications are identified, including appropriate goals for clinicians with regard to spiritual health promotion.

Client perspectives about nurse requisites for spiritual caregiving

Some patients welcome nurse-provided spiritual care, while others do not. This pilot study addressed the question: What characteristics does a client look for in a nurse before welcoming spiritual care from that nurse? This cross-sectional, correlational study allowed 156 cancer patients and 68 family caregivers to complete paper-and-pencil questionnaires including the 7-item Nurse Requisites Scale (NRS). Findings suggest relationship is a salient requisite, and that religiosity is directly related to how important it is to a client that these requisites be met prior to spiritual care.

Prevalence and associated factors of spiritual needs among patients with cancer and family caregivers

PURPOSE/OBJECTIVES

To measure the prevalence of spiritual needs and identify factors associated with spiritual needs among patients with cancer and family caregivers.

DESIGN

Descriptive, cross-sectional, quantitative.

SETTING

Inpatients and outpatients at a university medical center in the southwestern United States.

SAMPLE

156 patients with cancer and 68 family caregivers who were primarily white and Christian and mostly perceived their cancer as not life threatening.

METHODS

Self-report questionnaires, including the Spiritual Interests Related to Illness Tool and Information About You. Statistical analysis involved analyses of variance, correlations, and factor analysis.

MAIN RESEARCH VARIABLES

Spiritual needs and desire for nursing help with spiritual needs.

FINDINGS

The most important spiritual needs included being positive, loving others, finding meaning, and relating to God. The least important were needing to ask "why" questions and preparing for dying. Desire for nursing assistance with spiritual needs was moderate and varied. Variables correlated with spiritual needs and desire for nurse help included religiosity, being an inpatient, and perceiving the cancer as incurable. Desire for nurse help and importance of spiritual needs were directly correlated.

CONCLUSIONS

Distressing spiritual needs were reported least frequently. Certain factors appear to be associated with how much spiritual need is perceived and how much nurse help with those needs is wanted.

IMPLICATIONS FOR NURSING

Patients with cancer and family caregivers have similar spiritual needs that may require care. Spiritual assessment and therapeutics can target specific types of spiritual needs. A nurse's help with spiritual needs, however, is not always wanted.

Spiritual Complementary Therapies in Cancer Care

OBJECTIVES

To review literature documenting the frequency of use and efficacy of spiritual complementary therapies. Implications for clinical practice and research that reflect this literature are offered.

DATA SOURCES

Data based research on complementary therapy usage and clinical articles about selected mind/body therapies.

CONCLUSION

Spiritual complementary therapies are among the most frequently used. Prayer, spiritual healing, and meditation are the most frequently used spiritual therapies. Equivocal evidence supports their efficacy.

IMPLICATIONS FOR NURSING PRACTICE

Although spiritual practices may not be considered a "therapy," clinicians should assess and support these practices. Clinicians should only pray with patients when observing ethical guidelines.

A comparison of fusion, trapeziectomy and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint

This retrospective study compares three of surgical treatments for osteoarthritis of the trapeziometacarpal joint of the thumb. We assessed the outcomes of a total of 83 operations at a follow-up of between 1 and 5 years. The types of treatment were, fusion of the carpometacarpal joint (36 operations), excision of the trapezium with or without a sling ligament reconstruction (25 operations), and silastic trapezial replacement (22 operations). Assessments included patient satisfaction, pain measurement, range of movement, tip and key pinch, and complication rates. There were no significant differences between the clinical outcome of the treatments, though there was higher rate of complications and reoperation in the fusion group.

Spiritual care nursing: what cancer patients and family caregivers want

AIM

This paper presents findings from a study that was designed to understand, from the perspective of cancer patients and their family caregivers, what spiritual care is wanted from nurses.

BACKGROUND

Distressing and transformative spiritual responses to living with cancer have been documented. Although there is momentum for providing spiritual care, previous research provides scanty and conflicting evidence about what are the clients' wishes or preferences with regard to receiving spiritual care from nurses.

METHODS

A convenience sample of 156 adult cancer patients and 68 primary family caregivers, most of whom were Christians, independently completed the Spiritual Interests Related to Illness Scale and a demographic form, both of which were self-completed questionnaires.

RESULTS

A variation in responses to items about nurses providing spiritual care therapeutics was observed; means and medians for these items mostly fell between 2 (disagree) and 3 (agree) on a scale of 1-4. Generally, therapeutics that were less intimate, commonly used, and not overtly religious were most welcomed. No significant differences were found between patient and caregiver preferences. A modest, direct correlation was observed between frequency of attendance at religious services and increased preference for nurse spiritual care.

CONCLUSION

For both patients and caregivers, nurses must be sensitive to providing spiritual nurture in ways that are welcomed.

Spiritual needs of patients with cancer and family caregivers

The purpose of this descriptive, cross-sectional, qualitative study was to describe the spiritual needs experienced in living with cancer from the perspective of patients with cancer and family caregivers. The sample included 28 African American and Euro-American patients with cancer and family caregivers receiving care from inpatient and outpatient units at two metropolitan hospitals in the southwestern United States. In-depth, tape-recorded, semistructured interviews were analyzed using the process of data reduction, data display, and verification. Seven categories of identified spiritual needs included needs associated with relating to an Ultimate Other; the need for positivity, hope, and gratitude; the need to give and receive love; the need to review beliefs, the need to have meaning; and needs related to religiosity and preparation for death. Informants responded with varying levels of awareness of personal spiritual needs. Caregivers were observed to have spiritual needs similar to those of patients. The findings of this study will inform nurses as they assess and document spiritual needs.

Prayer's clinical issues and implications

Because prayer frequently sustains coping and brings comfort, it is an important resource for nurses to support or offer. How shall nurses incorporate prayer in nursing practice? This article explores practical aspects of including prayer in bedside nursing care, including suggestions for assessment, supporting patients when beliefs about prayer challenge, discussing prayer with clients for whom prayer may be harmful, overcoming nursing barriers to prayer, and more.

Nurses caring for the spirit: patients with cancer and family caregiver expectations

PURPOSE/OBJECTIVES

To determine what patients with cancer and primary family caregivers expect from nurses with regard to having their spiritual needs addressed.

RESEARCH APPROACH

Descriptive, cross-sectional, qualitative study using Miles and Huberman s approach to data reduction.

SETTING

Outpatient and inpatient settings in a county hospital and a comprehensive cancer center, both located in a large, southwestern, metropolitan area.

PARTICIPANTS

28 African American and Euro-American adult patients with cancer and primary family caregivers were purposively selected to provide variation of experiences (e.g., religious backgrounds).

METHODOLOGIC APPROACH

In-depth, semistructured, tape-recorded interviews conducted by the investigator. Analysis of transcribed interviews concurrently with data collection followed a process of data concentration, data display, and conclusion drawing.

MAIN RESEARCH VARIABLES

Spiritual needs, spiritual care.

FINDINGS

Informants identified nursing approaches for spiritual needs, including kindness and respect; talking and listening; prayer; connecting with symmetry, authenticity, and physical presence; quality temporal nursing care; and mobilizing religious or spiritual resources. To provide spiritual care, nurses must possess requisites of a personal, relational, or professional nature.

CONCLUSIONS

Although some patients or caregivers do not want overt forms of spiritual care, others are eager for them. Many recognize nonreligious actions or attitudes that nurses can practice to care for spiritual needs.

INTERPRETATION

Nurses must consider how they can address patient preconceptions and requisites for spiritual caregiving. Nurses may need to educate the public regarding their role as holistic and spiritual healthcare providers.

Use of prayer among persons with cancer

This study explored how persons use prayer to cope with cancer. Employing phenomenologic methods, 30 informants were interviewed in depth about why, when, and how they prayed, as well as what they prayed for and the outcomes expected. Findings detail how patients use prayer to ease the physical, emotional, and spiritual distresses of illness. A range of approaches to prayer and topics for prayer was observed, often determined by illness circumstances. The article provides a discussion that begins to suggest how these data can inform clinical practice and future research.