جستجوی مقالات مرتبط با کلیدواژه « end-of-life care » در نشریات گروه « پزشکی »

Due to the increase of chronic and incurable patients, the need for palliative care in nursing is essential. Nurses need to acquire special knowledge and skills to provide quality palliative care. The aim of this study was to investigate the relationship between palliative care knowledge and the level of anxiety, stress and depression of special care nurses in hospitals affiliated to Rafsanjan University of Medical Sciences in 1400.

This cross-sectional descriptive study was conducted with the participation of 77 nurses working in the Intensive Care Unit (ICU) of Ali Ibn Abi Talib (AS) Rafsanjan Hospital in 1400. The level of knowledge of nurses was measured using the PCNQ questionnaire and the level of anxiety and depression was measured using the DASS-21 questionnaire.s 33.34 ± 5.17; The majority of them were women (62 people, 80.88%), single (53 people, 68.78%) and with work experience of more than ten years (36 people, 46.66%). The knowledge of nurses was checked through the PCQN questionnaire, which includes 20 questions with yes or no answers, and the participant receives a score of one for a correct answer and a score of zero for a wrong answer. The range of scores of the questionnaire is from a minimum of zero to a maximum of twenty, and a score of 15 and above indicates sufficient knowledge in the field of palliative care. The questions of this questionnaire include: principles and philosophy dimension, pain management dimension and palliative care spiritual services dimension. The average score was 2.65 ± 0.40 in principles and philosophy, 3.37 ± 13.89 in pain management, and 1.86 ± 0.97 in spiritual services. The total mean score of nurses' knowledge of palliative care was 2.7 ± 0.72. Moderate to very severe anxiety, stress and depression were seen in all nurses of the ICU. So that 48.1% had moderate depression, 31.2% had very severe stress and 50.6% had very severe anxiety. According to the results of the correlation analysis, no significant correlation was observed between the overall PCQN score and anxiety, stress and depression.

The palliative care knowledge of special care nurses is insufficient, therefore, in order to fill this knowledge gap, it is suggested to develop comprehensive training programs for bedside nurses and provide palliative care topics in nursing undergraduate courses. In addition, the level of anxiety, stress and depression of nurses in special care departments is relatively high. Accordingly, no significant relationship was observed between palliative care knowledge and anxiety, stress and depression.

Providing palliative care to the elderly and dying patients is a now and the future challenge. Nurses are the first group that provided palliative care and access and identifying the pain and suffering of patients is their first professional care. Therefore, palliative care education to nursing students can help to better care of these patients. The aim of this study was to determine the elements of palliative care curriculum for nursing students.

In this narrative review study, database of Magiran, SID, PubMed, Science Direct and Springer were searched. Articles were searched from 2000 to 2017 using keywords such as education, curriculum, palliative care and nursing.

A total of 1024 articles were found. 9 papers were selected for analysis. Four elements of curriculum including goal, content, teaching methods and evaluation of palliative care curriculum were accessed. The goal of this curriculum is to educate nursing students about end of life care and palliative care. Educational content emphasizes five categories including; the principles of palliative care, physical care, communication, ethics and psychosociocultural care. This curriculum used different methods for teaching and evaluating of students.

This curriculum emphasized the various aspect of the nursing palliative care with a review of the literature. Due to the need of nurses to palliative care such educational programs is necessary.

Palliative care plays an essential role in improving the quality of life of patients suffering from chronic and incurable diseases; therefore, it seems necessary to remove barriers in improving palliative care. The present systematic review aims to describe the current status of palliative care, and determine the challenges of palliative care services.

In this systematic review study, we searched Scopus, Magiran,SID,Cochran,Embase, PubMed, Web of Science, and Google Scholar databases. Also, we retrieved articles published in English and Persian during 2000 to 2021. The keywords include "hospice care," palliative care," "health care," "terminal care," "end of life care," and palliative medicine". All retrieved articles were screened in three stages, namely review of titles, abstracts, and full texts. Meanwhile, we analyzed data based on the WHO 2018 framework and deductive-inductive approach.

A total of 3497 articles were found. After reviewing these articles, we were able to selecte 48 articles. Data were extracted and categorized according to four functions, namely service delivery, stewardship, resources generation, and financing. Service delivery had four themes, and nine sub-themes; stewardship had two themes and five sub-themes; resource generation had three themes and nine sub-themes; and financing had one themes and three sub-themes.

Findings of the present study can help policymakers improve the infrastructure and resources, as well as processes of palliative care that can consequently lead to an improvement in the outcomes of palliative care. Also, solving the challenges of palliative care requires strengthening the health systems so that they will be able to design and implement appropriate policies

Nurses are among the members of the treatment team who have the most contact with Corona Virus Disease- 2019 (COVID-19) patients and their ethical decision-making is inevitable during patient care. On the other hand, nurses' motivation to implement end-of-life care is influenced by their attitude, awareness, and moral reasoning. The aim of this study was to investigate the level of ethical decision making of nurses and its relationship with the attitudes of end-of-life care of patients with COVID-19 in hospitals affiliated to Hamadan University of Medical Sciences in 2021. In this study, 180 nurses working in hospitals affiliated to Hamadan University of Medical Sciences were selected by convenience sampling method. Data collection tools included: demographic Information questionnaire, Nursing Dilemma Test (NDT) questionnaire, and Frommelt Attitudes towards End-of-Life Care questionnaire. According to the results, there is a direct relationship between nurses' ethical decisions and the attitude of end-of-life care (<0.05, r=0.819). The mean score of nurses' ethical decision-making indicates the low level of ethical decision-making (39.19 (5.3)) and the mean score of nurses' practical considerations (20.62(4.2)) showed that the process of nurses' ethical decision-making is relatively influenced by environmental factors. Also, the average score of nurses' exposure to moral challenges indicates that nurses are familiar with similar situations. The mean score of nurses' attitudes toward end-of-life care was reported at an undesirable level (81.58(7.8)). According to the results, by identifying the factors affecting nurses' ethical decision-making and educational planning to improve their decision-making level, it is possible to improve the quality of patients care while improving nurses' attitudes toward end-of-life care.

Palliative care is one of the most important aspects of neonatal intensive care. Providing palliative care for infants faces many obstacles and challenges. The aim of this study was to determine the attitude to palliative care and the barriers for delivering palliative care practices among nurses in the Neonatal Intensive Care Unit (NICU).

In the present descriptive cross-sectional study, 128 nurses working in NICUs of hospitals affiliated to the Shahid Beheshti University of Medical Sciences, Tehran, Iran were selected by census method in 2018. Data were collected with "Fromelt Attitude Towards Caring   for Dying Patient" (FATCOD) and "Neonatal Palliative Care Attitude Scale" (NPCAS). 

Nurseschr('39') attitude toward palliative care was positive (102.17±4.81) and a statistically significant association was observed between shift work and nurseschr('39') attitudes (p<0.001). A strong barrier to providing palliative care was the presence of insufficient resources (10.93±2.66). Improper application of technology (5.90±1.59), organizational culture (18.69±5.25) and professional competence of nurses (18.09±4.82) were classified as intermediate barriers. The weak barrier to the implementation of palliative care was the individual and social attitude of the nurse (18.67±2.60).

Nurses have a positive attitude to providing palliative care, and it is necessary to strengthen their positive attitude by providing clinical and theoretical training. It is also important to pay more attention to eliminating other factors that can affect the implementation of palliative care. Insufficient resources are a strong obstacle to providing palliative care in neonates. So equipping the resources in terms of a suitable physical environment, adequate skilled manpower, providing counseling services and developing guidelines and policies for the nurses,   are important in order to improve the implementation of neonatal palliative care.

End-of-life care providers to patients in the later stages of the disease are potentially exposed to a variety of judicial, legal and professional problems. This study was to review and analyze these challenges and ways to deal with them.

In this systematic review study, some aspects of end-of-life care such as patient decision-making competence, discontinuation of life support treatments and useless or ineffective treatments and requesting death assistance with targeted search in 8 databases and reviewing 44 sources, from a legal point of view. An analysis was made.

The biggest challenges in the field of assisting in the death of patients, choosing the right person to decide in the final stages and ending the treatment were seen as useless or ineffective. In many countries, laws were enacted to discontinue life-sustaining treatments, and the process of judicial proceedings was to accept the requests of patients or their alternative representatives. Gradually, more and more countries have legalized end-of-life assistance in terms of conditional assistance.

The legal challenges to end-of-life and how to deal with it vary in different societies and legal intervention in end-of-life lawsuits be avoided as much as possible.

End of Life Care (EOL) and End-Stage Patients Care (ED) is usually presented in an environment full of a variety of emotional and moral challenges, the recognition of them can improve the quality of EOL services.

In this narrative review, ethical aspects of EOL sucs as diagnosing the time of death or the final stage of the disease, patient's autonomy, the use of life sustaining treatments, and assisted dying were reviewed in 8 databases and 45 sources.

Uncertainty is a principle in determining the proximity of the death or the final stage of a disease. In EOL, autonomy is limited, and some consider other moral principles, such as beneficence and justice, to be more important. Withholding of life sustaining treatments, especially in our country, is more moral and religious acceptance than withdrawing it. Approach different medically assisted dying varies in nations, and there are various moral justifications for accepting or denying it.

Ethical issues in EOL are complex in nature, and are intertwined with individual attitudes, religious beliefs, and social conditions. Proper communication between the patient, family members, and clinicians is the most important factor in preventing and resolving EOL challenges.

Moral distress is one of the major sources of stress for nurses who provide end-of-life care to infants. The purpose of this study was to evaluate the effect of end-of-life care education on the Moral distress of nurses in neonatal intensive care units. In a clinical trial study with 66 nurses (33 control and 33 intervention groups), neonatal intensive care units in two hospitals affiliated to Iran University of Medical Sciences in 1396, At first, the control group in both centers was included in the study and completed Hamric's MDS-R questionnaires in three stages,pre-test, two weeks after the pre-test and one month after the pre-test. After collecting the questionnaires, the intervention group entered the study and after completing a pre-test questionnaire, participated in the End-of-Life Workshop, which was held in two consecutive sessions of two consecutive weeks. Their Moral distress were compared with the control group in the pre-test, immediately after intervention and 2 weeks after intervention (one month after the pre-test). The research units in the two groups of test and control were homogeneous for all demographic variables. There was no significant difference between the two groups in terms of moral distress before training (P = 0.226). After implementing the educational program, the morphology of the intervention group decreased to two weeks after the intervention (P = 0.013). Covariance test was performed to remove the effect of pre-test score. The results of this study indicate the effect of the end-of-life care program on decreasing the moral distress of NICU nurses. Use of this training program is recommended to managers and planners of educational programs.

  Cancer is an important cause of mortality worldwide. Many cancer patients are hospitalized at the end of their life, requiring end-of-life care. The perception of nurses toward end-of-life care could correct inappropriate care behaviors and enhance the quality of care. The present study aimed to assess the understanding of nurses regarding the end-of-life care of cancer patients. This qualitative study was conducted using the conventional content analysis method in 2017. Sample size included 16 nurses employed in oncology wards, who were selected via purposive sampling. Data were collected via semi-structured interviews. All the interviews were transcribed and reviewed, and data analysis was performed using content analysis. The nurses perceived end-of-life care as the main category of ‘comprehensive care’ and three subcategories of ‘value-based care’, ‘support-based care’, and factors in care’. According to the results, the comprehensive perception of the nurses toward end-of-life care, which arises from their perception toward the care of these patients, could help them provide high-quality care that is value-based, nursing-based, and support-based. Such care services seem to bring about a sense of proper care provision for the nurses, as well as peaceful death for the patients.

Due to their job nature, nurses are the first group whose time is mostly associated with dying patients and their families. The aim of this study was to determine the role of attitude to the care of a dying patient in prediction of clinical anxiety and sleep quality of nurses in Zahedan city. This is a descriptive-correlational study. The statistical population of the study included all nurses working in medical sciences hospitals of Zahedan. 130 nurses were selected by available sampling method; they completed the Clinical Anxiety Scale of Thyer & Westhuis (1989), Scale for the End of Life Caregiving Appraisal of Lee, Yoo & Kim (2009) and the Pittsburgh Sleep Quality Questionnaire (1989). Data were analyzed using Pearson correlation and stepwise regression and SPSS19. Findings showed that in components of attitude to patient care there was a positive correlation between physical suffering and burden with clinical anxiety (P<0.01); there was also a negative correlation between maturation with clinical anxiety (P<0.01) and social support pursuit with clinical anxiety (P<0.01). There was a positive correlation between physical suffering and burden with quality of sleep (P<0.01), and there was a negative correlation between maturation and sleep quality (P<0.01). Also, in stepwise regression analysis, two components of burden and maturation of 0.165 variance of clinical anxiety and components of physical suffering and burden a 0.254 predicted the variance of sleep quality.   Due to their job nature, nurses are the first group whose time is mostly associated with dying patients and their families. The aim of this study was to determine the role of attitude to the care of a dying patient in prediction of clinical anxiety and sleep quality of nurses in Zahedan city. This is a descriptive-correlational study. The statistical population of the study included all nurses working in medical sciences hospitals of Zahedan. 130 nurses were selected by available sampling method; they completed the Clinical Anxiety Scale of Thyer & Westhuis (1989), Scale for the End of Life Caregiving Appraisal of Lee, Yoo & Kim (2009) and the Pittsburgh Sleep Quality Questionnaire (1989). Data were analyzed using Pearson correlation and stepwise regression and SPSS19. Findings showed that in components of attitude to patient care there was a positive correlation between physical suffering and burden with clinical anxiety (P<0.01); there was also a negative correlation between maturation with clinical anxiety (P<0.01) and social support pursuit with clinical anxiety (P<0.01). There was a positive correlation between physical suffering and burden with quality of sleep (P<0.01), and there was a negative correlation between maturation and sleep quality (P<0.01). Also, in stepwise regression analysis, two components of burden and maturation of 0.165 variance of clinical anxiety and components of physical suffering and burden a 0.254 predicted the variance of sleep quality. According to the results, the positive attitude to the care of a dying patient can help to reduce the level of clinical anxiety and increase the quality of sleep in nurses

Aim: This study aimed to evaluate the perceptions of nurses working in intensive care units about obstacles and supportive behaviors of end of life care. Background: End of life care is an important part of nursing duties in intensive care units. Exploring supportive behaviors of end of life care from the perspective of nurses may lead to better understanding of supportive behaviors and obstacles of end of life care. Method: This study was a descriptive cross-sectional study in which 160 staff nurses, working in intensive care units in Rajaei Cardiovascular Medical and Research Center, were recruited by random sampling in 2016. Data were collected using demographic form and the questionnaire “National Survey of Critical-Care Nurses Regarding End-of-Life Care” (NSCCNR-EOL) and analyzed in SPSS version 22 software using descriptive statistics. Findings: The most important obstacle in end-of-life care was "family and friends who continually call the nurse wanting an update on the patient's". In the field of supportive care, "After the patient's death, having support staff compile all the necessary paper work for you" received the highest score. Conclusion: Based on the findings, in critical care nurses views, appropriate training on end-of-life care and palliative care for staff, educating families about issues of death and dying, and the holistic care of patients and their families improve end-of-life care of dying patients

Nurses are involved in providing end of life care for end stage individuals. Thus knowledge and attitude of them can be used as a key factor in planning and implementing programs for such care. The purpose of this study was to determine the knowledge and attitude of nurses Toward Caring for End of Life Patients.
In this cross-sectional study the stratified non-random sampling method was used to select the 240 participant nurses from the teaching hospitals of Tabriz, Iran. Data collection tools were the knowledge test and the Frommelt Attitude Toward Caring For Dying Patients questionnaire. Data analysis was done by descriptive statistics, independent samples T-test, ANOVA, and Pearson correlation.
Mean score of nurse's knowledge of end-of-life care was 14.26 (SD=4.37) out of 29. Fifty-five percent of the nurses stated that they have not received sufficient training on providing end of life care. With a score of 100.32 (11.79) of a maximum score of 150, Participant's attitudes toward patient care were positive. The attitude level was higher in staff with an experience of care in home care centers (P Considering the low level of nurse's knowledge about providing end-of-life care, educational programs should be developed to improve the knowledge of nurses. Regarding the positive attitude of the nurses toward such care, training programs can contribute to developing professional end of life care in Iran.