Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.
Purpose: This study was done to identify observation and performance of nursing role activities by student nurses graduating from 3 year junior colleges or 4 year universities. Method: A descriptive design was used and the participants were 295 student nurses who were graduating. Data were collected using a structured questionnaire. Results: The average score for observation of nursing role activity was $2.16{\pm}0.29$, and for performance $1.61{\pm}0.29$. Among the college students, the mean item score for observation was highest for medication administrator and lowest for provider of spiritual & bereavement care, while for the university students the highest was for provider of care during surgery and lowest for provider of spiritual & bereavement care. The college students had higher scores for observation, and the university students for performance. Conclusion: It is concluded that standardized practice learning programs need to be designed in schools and in clinical practice areas, in order to further develop adaptability to nursing roles.
In the present work the knowledge of dental health as well as dental prosthesis has been studied on the basis of analysis of current dental prosthetic treatments for dental diseases prophylaxis and the final decision for dental prosthetic appliance. The results have been analyzed by the current dental health care and the subjective acknowledgement from 700 people of urban as well as rural inhabitance in our country. The results from the present work have been summarized as following: Depending dental status has been shown worse to be in the cases of divorce and bereavement, age and less educated or jobless. It is also interesting to note that the dental status has shown to be even worse than health status. It has been shown that the dental prosthetic treatments have been mainly caused by the oral disease (62.2%) and depend on the age and the educational level. According to the actual status of dental prosthetic treatments, the fixed partial denture was the most case (78.9%) that increased as divorced, bereavement and as less educated, less income, retired and jobless as well as from urban to rural. As a clinic for the dental prosthetic treatments, dental clinics have been most frequent visited as indicated by 59.6%, then the un-licensed dentist (6.5%), then the hospitals (3.7%), then the public health centers (2.2%). Most of those who are older in age, less educated and jobless have been treated by the un-licensed dentists. In point of view on the cost for dental prosthetic treatments, 93.1% have claimed to be too expensive, in as the divorced and the bereaved, the older age, the less educated and the jobless. About satisfaction of dental prosthetic treatments, 51.4% was satisfied, 39.4% was normal and 9.2% was dissatisfied. Most of people experienced increasing levels of satisfaction as their income increase. Most in the age range of 40-60 have wanted to be insured for the dental prosthetic treatments. It is also interesting to note that the older age and the less educated wanted to apply this kind of insurance.
This study has been performed to explore main reasons for staying in paid elderly residential care facilities among the residents. In this study, five males and seven females aged 65 to 82 were asked about main reasons for staying in the facilities. The answers of the qualitative interview were drawn as follows; first, some residents had suddenly decided to move into the facility due to critical life events such as bereavement, serious illness, or supporting problems. Second, some residents had taken a long period of considerations on whether staying home or in the facilities, because their health and family supports gradually diminished over the long life span. On the other hand, a few of them voluntarily chose to stay at the facilities, because they recognized supervised group activities, nutritionally well-planned meals, and health care as major inconveniences. In this study, suggestions were made as follows: first, guiding and settlement programs should be developed for the residents of the sudden events, particularly at early stage of admission. Second, intensive nursing care units should be in separation from healthy independent groups, so that the residents are relieved from stressful contacts with extremely ill patients in the residential area.
Purpose: This study was done to develop a death education program for nursing students and evaluate the effects of the program. Methods: The education program was developed based on ADDIE model. The death education program was developed on the base of educational needs, a comprehensive review of the literature and focus group interviews and then evaluated with 53 nursing students, 27 in the experimental and 26 in the control group. Measurement was done for the meaning of life using the tool by Choi et al (2005) for attitudes concerning death, the tool Thorson and Powell (1998) revised by Kim (2006) and for attitude to end-of-life patient care, the Attitudes toward Nursing Care of the Dying Scale by Frommelt (1991) translated by Cho and Kim (2005). Results: The program consisted of five sessions: Understanding of death, Family bereavement care, Communication and End-of-life patient care, Professional role, and Ethics and legal issues There was a statistically significant difference between pretest and posttest for the meaning of life in the experimental group compared to the control group. About 82% of students in the experimental group were satisfied with the program. Conclusion: The results indicate that this program can be used to educate nursing students.
Background: The main purpose of this study was to survey the education and training of certified gynecologic oncologists and fellows in Thailand. A secondary objective was to study the problems in fellowship training regarding palliative care for gynecologic cancer patients. Materials and Methods: A descriptive study was conducted by sending a questionnaire regarding palliative care education to all certified gynecologic oncologists and gynecologic oncology fellows in Thailand. The contents of the survey included fellowship training experience, caring for the dying, patient preparation, attitudes and respondent characteristics. Statistics were analyzed by percentage, mean and standard deviation and chi-square. Results: One hundred seventy completed questionnaires were returned; the response rate was 66%. Most certified gynecologic oncologists and fellows in gynecologic oncology have a positive attitude towards palliative care education, and agree that "psychological distress can result in severe physical suffering". It was found that the curriculum of gynecologic oncology fellowship training equally emphasizes three aspects, namely managing post-operative complications, managing a patient at the end of life and managing a patient with gynecologic oncology. As for experiential training during the fellowship of gynecologic oncology, education regarding breaking bad news, discussion about goals of care and procedures for symptoms control were mostly on-the-job training without explicit teaching. In addition, only 42.9 % of respondents were explicitly taught the coping skill for managing their own stress when caring for palliative patients during fellowship training. Most of respondents rated their clinical competency for palliative care in the "moderately well prepared" level, and the lowest score of the competency was the issue of spiritual care. Conclusions: Almost all certified gynecologic oncologists and fellows in gynecologic oncology have a positive attitude towards learning and teaching in palliative care. In this study, some issues were identified for improving palliative care education such as proper training under the supervision of a mentor, teaching how to deal with work stress, competency in spiritual care and attitudes on responsibility for bereavement care.
Purpose: The purpose of this study was to investigate the needs for pediatric palliative care (PPC) among parents of children with complex chronic conditions (CCCs) and to investigate differences in the needs for PPC according to their general characteristics. Methods: A cross-sectional survey was conducted between March 28 and May 18, 2018. Parents (N=96) who had a child under 18 years with a CCC were recruited. Data were analyzed using descriptive statistics, independent t-test, and one-way ANOVA. Results: The overall average need for PPC was $3.58{\pm}0.33$ out of 4.00. In terms of care for the subjects' children, the highest need was physical care, followed by psychosocial and spiritual care. In the sub-dimensions, preservation of physical function received the highest score. Of the items, the highest need was for seizure control. In terms of care for the subjects themselves, the highest need was for psychosocial care, followed by bereavement and spiritual care. In the sub-dimensions, communication received the highest score. Of the items, the highest need was for smooth communication with medical staff. Differences in needs for PPC according to participants' general characteristics were not statistically significant. Conclusion: Medical staff should provide PPC according to the priorities of parents' perceived needs.
Objectives: This study used the 2018 Korea Health Panel Survey data to analyze factors affecting employment status and income relating to unmet dental and medical care needs. Additionally it investigated measures to reduce oral health inequality among various socioeconomic classes. Methods: Descriptive statistics for the subjects' unmet dental and medical care needs were calculated through chi-square test analysis, and multivariate logistic regression analysis was applied to identify factors affecting the unmet dental and medical care needs. The odds ratio and 95% confidence interval were calculated for each level. These data were analyzed using STATA 17.0 SE (64-bit) version, and the statistical significance level was set to p<0.05. Results: As a result of unmet dental and medical care needs according to general characteristics, the lower the education level (p<0.001), the higher the age (p<0.001) and the lower the household equalization income (p<0.024) and the smoker status (p<0.003) were, respectively. Factors that have a statistically significant impact on unmet dental and medical care needs were divorce, separation and bereavement (p<0.001) in individuals than in married persons, and being smokers than non-smokers (p<0.009). The frequency of unmet dental and medical care needs were found to be lower in the cases of a high school graduate than an elementary school graduate (p<0.018), and of higher household equalization income (p<0.001) than the lowest household equalization income, respectively. Conclusions: It was found that various factors such as age, education level, household equalization income, employment status, type of working hours type, and smoking status affect unmet dental and medical care needs.
Purpose: The objective of this study was to provide an understanding of the difficulties for facing parents of children with terminal cancer. Method: The design of this study was an inductive and descriptive study. Thirty???]one parents of children with terminal cancer participated in???]depth were interviewed s. C in depth and content analysis was used for analyzing the data. Results: The main categories in the findings were 'difficulties in coping', 'physical and psychological suffering of children', 'suffering of family', 'bereavement with children', 'economic problems', 'incurable situation', 'preparation of death', 'social isolation', 'coping after a child dies', 'spiritual problems', receiving active treatment', 'informing children of their condition', 'a sense of meaninglessness', 'emotional iunstability', and 'giving up hope'. Conclusion: The main point identified from this result in this study was that parents who have a child with terminal cancer don't never give up the hope of recovery for their child even when the child is in by the terminal stage of their children, even though and they are unwillingly to prepare for their child's death. This is a unique characteristic in the attitude of the families' attitude in child hospice care and differs from that found in adult hospice care. This result can be used as an important guide for nurses to in assessing the parents' needs in the terminal care setting.
Purpose: Hospice care represents all meaningful aspects of physical, mental and economical status of the end stage patients. The purpose of this study was to estimate the cost of home-based hospice care. Method: Fifteen nurses participated in counting an hour for requirement and home visit data of 50 end stage patients were analyzed. The method of to estimate the cost of home-based hospice care was three ways. Result: In case, including traffic expense, Singles fixed fee per visit via direct inquiry was 112,970 won but in case, excluding traffic expenses, was 86,036 won and traffic expenses per visit was 26,934 won. Final cost of home-based hospice care integrated the fixed fee per the needed time for visit and fee-for services. The fixed fee per 30 minutes was 35,251 won and 60 minutes was 46,595 won and 90 minutes was 57,939 won. We included pain management and the management of emergency and bereavement care among fee-for services. Conclusion: The cost of hospice care should be establish for not only patient but the living spouse, families, and children of the dying and for anyone else affected by any patient's death.
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