Distress In Family Members Research Articles

Family perspectives on delirium information provision in an inpatient setting.

Delirium is common in older hospitalised patients and is associated with significant distress in family members who witness it. Education-based interventions can support the family of people with delirium. This study aimed to understand the perspective of family members of people with delirium regarding the information they received and opportunities for improvement. We performed 10 semi-structured interviews of 11 family members (one mother-daughter dyad) of people with delirium greater than 65 years of age across two sub-acute Geriatric Evaluation and Management units in Victoria, Australia. Interviews were inductively analysed by the lead investigator to identify themes related to the information provided and opportunities for improvement. We identified three themes related to delirium information provision: (1) delirium knowledge is not common; (2) information should consider the broad complex of the person; and (3) lived experience of delirium was helpful. We identified five themes with regard to opportunities to improve delirium information provision: (1) Good communication skills are important; (2) Regular communication is helpful; (3) Family wish to be present and know how to be involved; (4) Information provision should include prognosis; (5) Written information can support verbal information. Information provision to family members should take into account their existing knowledge and experience and consider their family member as a whole. High quality, regular, written and oral communication from health-care professionals is likely to prove helpful.

P025 Routine Giant-cell arteritis turned Heidenhain variant of sporadic Creutzfeldt-Jakob disease: a mysterious case report!

Abstract Background/Aims Giant-cell arteritis (GCA) is a large vessel vasculitis predominantly affecting those above 50 years of age. Creutzfeldt-Jacob disease (CJD) is not a well-recognised differential diagnosis of GCA presentation. Prion diseases are progressive, currently untreatable and ultimately fatal. Methods We report the case of a 76-year-old female who had an eventful hospital stay of 37 days. She has a history of asthma, hypertension, ulcerative colitis and right-sided GCA 5 years back (normal inflammatory markers & biopsy). Results The patient presents to Harlow ED with a right temporal headache with tenderness, jaw claudication symptoms, blurred vision, diplopia, dizziness and painful right eye movements. Her CRP was <1 and ESR was 5. The plan was to treat it as a recurrence of her GCA and to continue with the high dose Prednisolone started by the ED. CT Head was normal. Owing to poor response, IV Methyl Pred was given. On day six, patient was re-admitted with worsening headache and generalised decline. Ophthalmology review noted multiple visual field defects and treated as GCA. A neurology review noted the patient to be encephalopathic. Advice was for MRI head and CSF analysis - both NAD. On day 12 she had ongoing headache, diplopia, poor vision/memory, and reduced hearing in right ear, but alert and following instructions. On day 17, ENT suggestion was to treat as Meniere’s and start on Betahistine. On day 22, the patient had a TIA episode and discussed with Stroke team. Repeat CT Head was nil acute. By day 26, the patient was unresponsive intermittently and was treated as hypoactive delirium. On day 31 a seizure activity was noticed. Neurology review on day 33 noted rapid decline- the patient being mute, seizure/atypical encephalitis. MRI-Head with contrast showed the possibility of CJD. The very next day patient was reviewed by the team from National CJD Research and Surveillance team, Edinburgh. The formal diagnosis given was: probable Sporadic CJD (visual/Heidanhain variant), rapidly progressive cognitive decline with visual signs, myoclonus, and akinetic mutism, positive MRIs, bland CSF, no clear iatrogenic or variant risk factors, and no credible alternative diagnosis. The distressed family members were updated and the patient was put on EoL pathway. She died peacefully four days later (Day 37). Conclusion The importance of this case is the conflicting inputs from at least five specialities in a rapidly deteriorating patient. A background of previous right-sided GCA did prompt initial treatment in those lines. MRI Head DWI sequence did show the classic ‘cortical ribboning’ with right caudate and lentiform hyperintensity; which clinched the mysterious diagnosis of this rare disease which requires public health surveillance. CJD is to be suspected in any undiagnosed rapidly progressive mental deterioration or dementia, often with behavioural abnormalities and myoclonus. Disclosure S. Narikkoottungal: None. K. Gunasekera: None. K. Ahmed: None.

Physician challenges and supports during the first wave of the COVID-19 pandemic: A mixed methods study.

During the COVID-19 pandemic, physicians encountered significant COVID-19-related negative experiences and psychological distress in both their personal and professional lives. To understand the factors that negatively impact physician well-being, a number of studies have pointed to multiple work system factors such as excessive workload and workflow interruptions. In addition, studies have shown that positive interpersonal relationships that provide social support may also serve as a buffering role against psychological distress. The aim of our study explores the challenges and sources of support for physicians relative to mental health symptoms. In this study, We used a cross-sectional study design with a convergent parallel mixed method approach combining both qualitative and quantitative data collected in parallel from a self-report questionnaire immediately following the first wave of COVID-19. The aim of our study explores the challenges and sources of support for physicians relative to mental health symptoms. Of the 457 physicians in the study, the most frequently potential negative occupational experiences were, "Being at risk of contracting COVID-19 from patients/co-workers" (90.5%) and "Contact with distressed family members who cannot be with a loved one" (69.5%). We identified five common themes for main sources of social support (e.g. emotional support from family/friends) and six themes for challenges (e.g., work-related demands exacerbated by the pandemic). Our study highlights COVID-19 and other pandemic-related challenges that negatively impacted the mental health of physicians. Interventions that provide targeted organizational supports (e.g. sufficient PPE and child support), as well as specific sources of support (e.g. family and emotional), can attenuate those challenges and stressors experienced during a pandemic.

Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study

BackgroundFamily member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection. PurposeTo explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit. MethodQualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted. FindingsWe interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme ‘Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a ‘distance’ due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient’s wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance. ConclusionVisiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members’ perceptions of distance and exclusion from the intensive care unit.

Risk factors associated with post-intensive care syndrome in family members (PICS-F): A prospective observational study.

The family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future. The study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score. Emotional distress was identified in 24% of the family members 3months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment (p = .008), smoking/drinking habits (p = .036) and personal history of psychopathology (p = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09-6.93). No association was found between the patients' characteristics and emotional distress in the family members. The findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members' positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient's ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.

Psychometric Properties and Factor Analysis of Family Accommodation Scale For Obsessive Compulsive Disorder-Interviewer-Rated-Thai Version (FAS-T).

PurposeObsessive compulsive disorder (OCD) is a longstanding and debilitating psychiatric disorder which is related to a level of distress in family members of patients who suffer from it. The Family Accommodation Scale (FAS) for OCD helps medical personnel have a clearer and deeper understanding of the pattern of family accommodation. This study aimed to translate FAS into Thai and examine its psychometric properties and factor analysis.Patients and MethodsThere were fifty participants who were relatives of OCD patients. Demographic data were collected along with completion of the FAS-T, the Patient Health Questionnaire (PHQ-9), the Pictorial Thai Quality of Life (PTQL), and the Thai Florida Obsessive Compulsive Inventory (FOCI-T), and then analyzed. The severity scales of FOCI-T from 44 OCD patients who had relatives participating in this study were collected from medical records and examined. Psychometric properties and factor analysis of FAS-T were tested.ResultsThe average total score of FAS-T was 8.36±8.77 ranging between 0 to 25. The mean scores of FOCI-severity scale in relatives, PHQ-9, PTQL, and FOCI-severity scale in OCD patients, were 1.04±1.97, 4.04±3.73, 52.31±13.99, 8.95±4.36, respectively. The Cronbach’s coefficient alpha of FAS-T was 0.84, which demonstrated good internal consistency. The item-level CVI and scale-level CVI were at an excellent level. The Spearman’s rho between the FAS and FOCI symptom checklist, FOCI severity score, and PHQ-9 PTQL, were weakly correlated which implied acceptable discriminant validity. Exploratory Factor Analysis (EFA) suggested a three-factor solution as participation, modification, and facilitation.ConclusionThe Family Accommodation Scale for Obsessive–Compulsive Disorder—Interviewer-Rated - Thai version is a psychometrically reliable and valid measure for assessing accommodation in family members of OCD patients.

Developing Family Satisfaction with Care in Adult Critical Care Public Hospital Terengganu, Malaysia

In admissions to the intensive care unit (ICU), there is a high possibility of a life-threatening condition and possible emotional distress for family members. When the family is distressed and hospitalized, a significant level of stress and anxiety will be generated among family members, thereby decreasing their ability to make responsible decisions. As a result, the family members need full and up-to-date details, helping them to retain hope, and this contributes to lower stress levels. While there is growing evidence of the effectiveness of shared decision-making for family members who are directly involved in decisions, particularly regarding shared decision-making in the Malaysian context, there is less evidence that supported decisions help overall outcome. This study aims to developing the family satisfaction with decision making in the Intensive Care Unit (FS-ICU)-33 Malay language version of family member’s satisfaction with care and decision making during their stay at the intensive care units. A quantitative, cross-sectional validation study and purposive sampling was conducted from 1st November 2017 and 10 October 2018 to January 2020 among 208 of family members. The family members of the ICU patients involved in this study had an excellent satisfaction level with service care. Higher satisfaction in ICU care resulting in higher decision-making satisfaction and vice versa.

Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model

BackgroundAdverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients.MethodsWe conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other’s ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures.ResultsA total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress.ConclusionsOur results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.

FAMILY ACCOMMODATION, CAREGIVER BURDEN AND PSYCHOLOGICAL DISTRESS IN FAMILY MEMBERS OF PATIENTS WITH OBSESSIVE COMPULSIVE DISORDER

Psychological disorders affect the life of both patients and their family members. Family members of psychological patients play a vital part in treatment and intervention of patients suffering from psychological problems. Their support may facilitate the patient in treatment as well as on the other hand may contribute to exacerbation. However, such family members also suffer while dealing with their relatives who suffer from psychological disorders. Therefore, this study is intended to find out how family accommodation causes impairment in treatment of obsessive-compulsive disorder (OCD) patients, to measure the burden of care (in terms of six dimensions i.e., financial burden, disruption of family routine, disruption of family leisure, disruption of family interaction, effect on physical health of others and effect on mental health of others) and to determine the level of psychological distress in family members of OCD patients. The present correlational research was consisted of 120 family members (42 men, 78 women), who were the primary caregivers. Result of Pearson Product Moment Correlation showed a highly significant positive relationship between family accommodation, caregiver burden and psychological distress. Mediation analysis was done using PROCESS which showed that caregiver burden mediated the relationship between family accommodation and psychological distress. Family interventions regarding accommodation by family members can be provided in order to improve the patient treatment and research findings can also be implied to teach coping strategies to family members in order to deal the burden they experienced.

Früherkennung und -behandlung der Borderline-Persönlichkeitsstörung

Early detection of and intervention for borderline personal-ity disorderBorderline personality disorder is a severe mental disorderthat typically appears in adolescence and early adulthood,and interferes with important developmental tasks in thisphase of life. If left untreated, it can lead to much sufferingand persistent psychosocial impairment for those affected,distress for family members and significant economiccosts. Contrary to continuing scepticism, the researchfindings of the last 20 years show that borderline per-sonality disorder is a valid and reliable diagnosis in ado-lescence. In addition, the findings of the first randomisedcontrolled trials on the psychotherapeutic treatment ofadolescents with subsyndromal or syndromal borderlinepersonality disorder indicate that clinically relevant im-provements can be achieved. In the present study, the ra-tionale and evidence for early detection of and interventionfor borderline personality disorder in adolescence is pre-sented and compared with the current reality of care.

Helpful Approaches for Older Adults Living in a Retirement Community to Move Forward After the Death of a Significant Other

The loss of a significant other often creates emotional distress for family members that can hamper the ability to meet everyday challenges and pursue wellness. The aim of this qualitative study was to understand the challenge of losing a significant other for older adult family members and the approaches identified as most helpful to promote their own well-being after this person dies. Story inquiry method guided the interview process with 15 older adult bereaved family members residing in a continuing care retirement community. Theory-guided content analysis was used for data analysis. Two themes described the challenges: uneasiness that permeates everyday living and precious memories and patterns of disconnect that breed discontent. Appreciating the rhythmic flow of everyday connecting and separating and embracing reality as situated in one’s lifelong journey are the themes that encompass the helpful approaches used by participants. This study provided insights about the benefits of living in this community such as social networking and a possible drawback such as the frequency of death among residents. Future research should continue to investigate social service resources that older adults find most helpful after a significant other dies and the use of reminiscence groups as a form of bereavement support.

Формы семьи и семейные отношения лезгин-карчагцев в XIX–XX вв..

The article considers the forms of family and family relations of Lezgin-korchag people in the 19th–20th centuries. The economic component of this ethnic group, such as agricultural and cattle breeding, household crafts, low land, as well as observance of the customs and traditions of ancestors and other factors, contributed to the partial preservation until the beginning of the 20th century of undivided families numbering 20–25 people. Special attention is paid to the principles of kinship of the older generation in the face of grandparents, as well as father and mother, who determined the leadership and educational role in families. The novelty of the work lies in the fact that family relations in the patronymic and after the division into small families, since the second half of the 20th century, to the present time remain strong and stable, in particular the provision of moral, moral, material support and assistance to impoverished or distressed family members. And therefore, according to the traditions and customs, Lezgins-korchagas families remained close closely related to communication.

Spiritual Distress in Family Members of Critically Ill Patients: Perceptions and Experiences.

Background: Spiritual distress among family members of patients in the intensive care unit (ICU) has not been well characterized. This limits clinicians' understanding of how to best offer support. Objective: To explore how family members experience spiritual distress, and how it is recognized and support offered within the ICU context. Design: A qualitative study involving interviews and focus groups between May 2016 and April 2017. Setting/Subjects: Family members of ICU patients (n = 18), spiritual health practitioners (n = 10), and an interprofessional group of clinicians who work in the ICU (n = 32). Measurements: Transcribed data were analyzed using interpretive description. Results: The experience of spiritual distress was variably described by all three groups through concepts, modulators, expressions and manifestations, and ways in which spiritual distress was addressed. Concepts included loss of meaning, purpose and connection, tension in beliefs, and interconnected distress. Modulators were related to the patient and family context, the ICU context, and the relational context. Expressions and manifestations were unique and individual, involving verbal expressions of thoughts and emotions, as well as behavioral manifestations of coping. Clinical strategies for addressing spiritual distress were described through general principles, specific strategies for discussing spiritual distress, and ways in which spiritual support can be offered. Conclusions: Our study provides a rich description of how spiritual distress is experienced by family members of ICU patients, and how spiritual health practitioners and clinicians recognize spiritual distress and offer support. These findings will help inform clinician education and initiatives to better support families of critically ill patients.

Development of a Clinical Guide for Identifying Spiritual Distress in Family Members of Patients in the Intensive Care Unit.

Background: Spirituality is important for many family members of patients in the intensive care unit (ICU). Clinicians without training in spiritual care experience difficulty identifying when family members are experiencing distress of a spiritual nature. Objective: The purpose of this study was to develop a guide to help clinicians working in the ICU identify family members who may benefit from specialized spiritual support. Design: Cross-sectional study. Setting/Subjects: A national sample of spiritual health practitioners, family members, and ICU clinicians. Subjects: A panel of 21 spiritual health practitioners participated in a modified Delphi process to achieve consensus on items that suggest spiritual distress among family members of patients in the ICU through three rounds of remote review followed by an in-person conference and a final round of panelist feedback. Feedback on the final set of items was obtained from an end-user group of four family members and six ICU clinicians. Measurements: Quantitative data were summarized with descriptive statistics. Content analysis was used to analyze written comments. Results: A total of 220 items were iteratively reviewed and rated by panelists. Forty-six items were identified as essential for inclusion and developed into a clinical guide, including an introduction (n = 1), definitions (n = 2), risk factors (n = 10), expressed concerns (n = 12), emotions (n = 7) and behaviors (n = 7) that may suggest spiritual distress, questions to identify spiritual needs (n = 6), and introducing spiritual support (n = 1). Conclusions: We have developed an evidence-informed clinical guide that may help clinicians in the ICU identify family members experiencing spiritual distress.

Transformation of Tribals through MGNREGA in Attappady Block of Palakkad District, Kerala Some Case studies

MGNREGS is a mammoth employment programme, launched more than a decade ago in the rural diaspora of the Indian sub-continent, with a massive annual budget of Rs.60,000crore, aimed at eradicating rural poverty and unemployment in one stroke, targeting a multitude of mainstream rural workers, as well as vulnerable categories such as the adivasis, the aged, the differently abled and disabled persons. Acclaimed as a model by most other countries, MGNREGS entitles every worker with wage employment for 100 days, augments their income and forms the base for a sustainable rural livelihood. With a plethora of studies made on the impact of this scheme on poverty eradication, the present study conducted in early 2019, concentrates on its impact on the primitive and nomadic tribal groups in Attappadi , a tribal- prominent block in Palakkad district of Kerala State. Conducted primarily thro’ Case studies, the present research highlights the role of the scheme in achieving not only the intended outcome, but also its unintended outcome. The study has profiled the role of the scheme in not only providing livelihood to all the workers, but also in restoring the normal life of persons with disabilities such as mental depression, speech and visual impairment.The mentally and physically challenged workers, who were hitherto confined to their homes or settlements and were a frustrated lot, are now able to ease their depression, while working, and interacting with fellow workers, and find cheer and solace in their company.
 Besides, it has provided physical safety, economic security, and social status to the deserted women, divorcees, and children with disabilities. Though living in poverty, the fellow workers have proved that they have concern and commitment for not only their distraught co-workers but also for their distressed family members. By sharing the work of the weak and the vulnerable at the worksite, they have demonstrated that “humanitarianism” exists amidst destitution and deprivation and “compassion and camaraderie” are the primary assets of the workers, than poverty and backwardness.

Family-clinician communication in the ICU and its relationship to psychological distress of family members: A cross-sectional study

BackgroundEffective communication between family and clinicians has been identified as one of the most important factors in end-of-life care. Family members’ perception of communication quality with clinicians may be associated with their psychological symptoms. ObjectivesTo examine the association between family-clinician (physicians or nurses) communication quality and symptoms of anxiety, depression, and stress among family members of chronically critically ill patients in intensive care units (ICUs). DesignA cross-sectional study. Settings and participantsThe participants were 71 adult family members of 71 patients who required prolonged mechanical ventilation in ten ICUs at three medical centres in Korea. MethodsParticipants completed the Quality of Communication (QOC) questionnaire, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale-Revised (IES-R). The data were analysed using correlation, bivariate regression, and multiple regression analysis. ResultsThe mean (SD) QOC score for physicians and nurses was 50.3 (15.2) and 42.9 (14.2), respectively. Forty-six participants (64.8%) were identified as being at risk for having anxiety symptoms; 22 (31%) had a mild risk and 24 (33.8%) had a moderate or severe risk. More family members (76.1%) were at risk for having depressive symptoms; 15 (21.1%) had a mild risk and 39 (54.9%) had a moderate or severe risk. For post-traumatic stress symptoms, 48 (67.6%) were at risk. While the QOC scores for nurses were negatively associated with participants’ HADS-depression scores (β = −.01, p = .03), the QOC scores for physicians were not associated with the HADS or IES-R scores. This conclusion held after consideration of covariates. ConclusionsThe findings suggest that communication between family members and ICU nurses may be more influential than that with ICU physicians on psychological distress of family members in Korea. However, further research is warranted to confirm this relationship. Future interventions to reduce psychological distress in family members of chronically critically ill patients may need to target ICU nurses for improving communication skills.

Perceptions by Families of Emergency Medical Service Interventions During Imminent Pediatric Out-of-Hospital Death

Objective: To understand how family members view the ways Emergency Medical Services (EMS) and other first responders interact with distressed family members during an intervention involving a recent or impending pediatric death.Methods: In depth interviews with 11 grieving parents of young children and survey results from 4 additional grieving parents of adult children were conducted as part of a larger study on effective ways for EMS providers to interact with distressed family members during a pediatric death in the field. The responses were analyzed using qualitative content analyses.Results: Family reactions to the crisis and the professional response by first responders were critical to family coping and getting necessary support. There were several critical competencies identified to help the family cope including: (1) that first responders provide excellent and expeditious care with seamless coordination, (2) allowing family to witness the resuscitation including the attempts to save the child’s life, and (3) providing ongoing communication. Whether the child is removed from the scene or not, keeping the family apprised of what is happening and why is critical. Giving tangible forms of support by calling friends, family, and clergy, along with allowing the family time with the child after death, giving emotional support, and follow-up gestures all help families cope.Conclusion: The study generated hypothetical ways for first responders to interact with distressed family members during an OOH pediatric death.

Nurses' perceptions of barriers and facilitators and their associations with the quality of end-of-life care.

To examine nurses' perceptions of barriers to and facilitators of end-of-life care, as well as their association with the quality of end-of-life care. Often, dying patients and their families receive their care from general nurses. The quality of end-of-life care in hospital wards is inadequate. A self-administered questionnaire was completed by 553 nurses working in a tertiary teaching hospital in Malaysia. The barrier with the highest mean score was "dealing with distressed family members." The facilitator with the highest mean score was "providing a peaceful and dignified bedside scene for the family once the patient has died." With regard to barrier and facilitator categories, the barrier category with the highest total mean score was patient-related barriers and the facilitator category with the highest totalmean score concerned facilitators related to healthcare professionals. In themultivariate analysis, age, patient family-related barriers and healthcare professional-related facilitators significantly predict the quality of end-of-life care. The results of this study suggest that there is an urgent need to overcome barriers related to the patient and family members that hinder the quality of care provided for dying patients, as well as to enhance and implement the facilitators related to healthcare providers. In addition, there is also a need to enhance the quality of end-of-life care provided by younger nurses through end-of-life care courses and training. Helping nurses overcome barriers and implement facilitators may lead to enhanced quality of care provided for dying patients.

Care Providers’ Integration of Family Requests in End-of-life Communication: Understanding What to Do and Why to Do It

ABSTRACTEnd-of-life situations are fraught with challenges for patients, family members, and individuals working at the patient’s bedside. Care workers must address needs of the patient, as well as his or her distressed family members. This article is an inductive investigation of care workers’ (nurses, patient advocates, and clergy) experiences with end-of-life discussions when the family asks to “do everything.” Participants also noted resistance to hospice in some of these encounters based on pre-existing connotations of hospice held by the family members. The article concludes with a discussion about how identifying end-of-life terms may be transformed to be more accessible for family members.

Risk factors of chronic obstructive pulmonary disease among rural women, Chittagong, Bangladesh

BackgroundThere are different risk factors for chronic obstructive pulmonary disease (COPD). Village women of developing countries such as Bangladesh are at a risk of COPD.AimThe present study was aimed to find risk factors of COPD among rural women of Bangladesh.Patients and methodsThis observational study was conducted in different villages of Chittagong, Bangladesh, among 250 women who were exposed to different risk factors of COPDWomen aged over 40 years were given a questionnaire adopted from a previous prevalence study of COPD in Bangladesh. Spirometry was performed in all subjects. A postbronchodilator ratio of the forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was calculated among all women who had FEV1/FVC ratio less than 0.70. Women having postbronchodilator FEV1/FVC ratio less than 0.70 were diagnosed to have COPD (GOLD criteria). After collection, all data were analyzed by SPSS-20.ResultsOverall prevalence of COPD in rural women aged over 40 years was 20.4%. Most (76.9%) of them who did not have COPD were in the age group of 40–49 years and those who had COPD were in the age group of 60–69 years (51.0%). A majority (60%) of the women were poorly educated or not educated. Most women were housewives (86.4%). FEV1/FVC ratio significantly reduced in relation with different risk factors of COPD. Multinomial logistic regression analysis showed that respiratory distress in family members [odds ratio (OR)=0.633], nature of kitchen (1.206), seasonal variation in cooking (OR=1.245), cough in childhood (OR=0.336), tobacco chewing habit (OR=12.491), type of stove (OR=0.191), history of cough (OR=0.130), and life-time smoking history (OR=0.376) influenced the development of COPD. Lung function also was significantly reduced (P<0.05) among women who were using biomass compared with those using cleaner fuels such as natural gas/liquid petroleum gas.ConclusionIn the living conditions existing in the rural areas of Chittagong, Bangladesh, biomass smoke pollution, smoking, and cooking habits are some important risk factors of COPD in rural Bangladesh.