In this grounded theory study, the authors analyze interviews and participant observation data related to palliative cancer nursing in hospitals. Striving for Emotional Survival emerged as the pattern of behavior through which nurses deal with their main concern, the risk of being emotionally overloaded by their work. It involved three main strategies: Emotional Shielding through Professional Shielding or Cold Shielding; Emotional Processing through Chatting, Confirmation Seeking, Self-Reflecting, or Ruminating; and Emotional Postponing through Storing or Stashing. Emotional Competence is a property of Striving for Emotional Survival that explains more or less adequate ways of dealing with emotional overload. The theory Striving for Emotional Survival can be useful in the nurses' daily work and provides a comprehensive framework for understanding how nurses deal with emotional difficulties. The authors suggest that health care organizations encourage self-care, prioritize time to talk, and offer counseling to nursing staff with emotionally difficult working conditions.
The purpose of this study was to describe perceptions of hope-fostering strategies of elderly patients with advanced cancer receiving palliative home care. Using a qualitative thematic research design, saturation was reached with 10 palliative home care patients (mean age 75 years) (five males and five females). Face-to-face audiotaped interviews were conducted in the participants' homes. Participants described hope for: "not suffering more", "living life to the fullest in the little time I have left", a peaceful death, life after death and "hope for a better life in the future" for their family. Using Lubrosky's thematic analysis, themes of fostering their hope were: leaving a legacy, achieving short-term goals, "turn your mind off", supportive family and friends, symbols of hope, positive thoughts, honest information and symptom control.
Although community health nurses have to face the increasing needs in curative and palliative care, they still engage in health promotion activities for the elderly, mainly cognitive and behavioural ones. The Quebec community health nurses who choose the McGill model of nursing, are able to integrate health promotion interventions in their daily practice with old aged people. In fact, this model helps these nurses consider the elderly, health, sickness and nursing care in a way that makes them promote self-esteem, empowerment, development and coping through most of their interventions. Moreover, the elderly population would benefit from an increased implication of nurses in ecological, environmental and community health promotion projects.
This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18-24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize.
Heart failure is a chronic, fatally progressive and incurable condition characterized by periods of apparent stability interspersed with acute exacerbations. Treatment models have historically emphasized management of acute exacerbations of cardiovascular disease, during which end-of-life issues figure frequently and prominently, though in a setting that is inappropriate to address the comprehensive needs of patients and their families. Consequently, in comparison to patients with malignancy, heart failure patients at the end of life are less likely to access palliative resources, and more likely to access in-patient care and cardiovascular procedures.
Recent reports and position statements have emphasized the following critical needs for provision of optimal heart failure care: a) Cardiovascular specialists require training to obtain basic skills for provision of palliative care to management of end-of-life issues; b) Discussion of end-of-life issues should be introduced as early as feasible in patients with heart failure and should be updated with changes in clinical status; c) Provision of palliative care should be integrated into a team approach; d) Patients with heart failure frequently suffer symptoms which are not typically considered 'cardiovascular', such as pain, social/functional and psychological. Patients should be assessed for these symptoms, which should be treated.
This report summarizes many of these suggestions and outlines future directions for the expansion and improvement of this critical need for heart failure patients.
Department of Oncology-Pathology, Karolinska Institutet and The Vårdal Institute, The Swedish Institute for Health Sciences and Research and Development Department, Stockholms Sjukhem Foundation, Stockholm, Sweden. firstname.lastname@example.org
This paper explores how bereaved relatives experienced soft tissue massage during the first four months after the death of a family member who was in palliative cancer care.
Death of a close family member or friend is recognised as being an emotional and existential turning point in life. Previous studies emphasise need for various support strategies to assist relatives while they are grieving.
Eighteen bereaved relatives (11 women and seven men) received soft tissue massage (25 minutes, hand or foot) once a week for eight weeks. In-depth interviews were conducted after the end of the eight-week periods. Interviews were analysed using a qualitative descriptive content analysis method.
Soft tissue massage proved to be helpful and to generate feelings of consolation in the first four months of grieving. The main findings were organised into four categories: (1) a helping hand at the right time, (2) something to rely on, (3) moments of rest and (4) moments of retaining energy. The categories were then conceptualised into this theme: feelings of consolation and help in learning to restructure everyday life.
Soft tissue massage was experienced as a commendable source of consolation support during the grieving process. An assumption is that massage facilitates a transition toward rebuilding identity, but more studies in this area are needed.
Soft tissue massage appears to be a worthy, early, grieving-process support option for bereaved family members whose relatives are in palliative care.
In this article I explore the importance staff and relatives give to patients' social identity at the time of dying, death, and leave-taking in a palliative medical unit in Norway. I employ Timmermans' concept of death brokering and show how various patient identities are used to broker and negotiate the timing, content, and form of leave-taking events. In their end-of-life care, nurses strive to accommodate relatives and support them in their grief process. Making patient identities relevant illustrates the close relationships between maintenance of the integrity of the material body and maintenance of the integrity of the social person; this practice aligns biomedical and physical identities with biographical and personal identities. Maintenance of patients' social identity is not a uniform process. Throughout postmortem care, nurses and relatives oscillate between poles of nearness to and distance from the deceased, who paradoxically can be experienced as both socially alive and socially dead.