Involvement Of End Research Articles

Variations in reporting of nurse involvement in end-of-life practices in intensive care units worldwide (ETHICUS-2): A prospective observational study

BackgroundICU nurses are most frequently at the patient's bedside, providing care for both patients and family members. They perform an essential role and are involved in decision-making. Despite this, research suggests that nurses have a limited role in the end-of-life decision-making process and are occasionally not involved. ObjectiveExplore global ICU nurse involvement in end of life decisions based on the physician's perceptions and sub-analyses from the ETHICUS-2 study. DesignThis is a secondary analysis of a prospective multinational, observational study of the ETHICUS-2 study. SettingEnd of life decision-making processes in ICU patients were studied during a 6-month period between Sept 1, 2015, and Sept 30, 2016, in 199 ICUs in 36 countries. InterventionNone. MethodsThe ETHICUS II study instrument contained 20 questions. This sub-analysis addressed the four questions related to nurse involvement in end-of-life decision-making: Who initiated the end-of-life discussion? Was withholding or withdrawing treatment discussed with nurses? Was a nurse involved in making the end-of-life decision? Was there agreement between physicians and nurses? These 4 questions are the basis for our analysis. Global regions were compared. ResultsPhysicians completed 91.8 % of the data entry. A statistically significant difference was found between regions (p < 0.001) with Northern Europe and Australia/New Zealand having the most discussion with nurses and Latin America, Africa, Asia and North America the least. The percentages of end-of-life decisions in which nurses were involved ranged between 3 and 44 %. These differences were statistically significant. Agreement between physicians and nurses related to decisions resulted in a wide range of responses (27–86 %) (p < 0.001). There was a wide range of those who replied “not applicable” to the question of agreement between physicians and nurses on EOL decisions (0–41 %). ConclusionThere is large variability in nurse involvement in end-of-life decision-making in the ICU. The most concerning findings were that in some regions, according to physicians, nurses were not involved in EOL decisions and did not initiate the decision-making process. There is a need to develop the collaboration between nurses and physicians. Nurses have valuable contributions for best possible patient-centered decisions and should be respected as important parts of the interdisciplinary team. Tweetable abstractWide global differences were found in nurse end of life decision involvement, with low involvement in North and South America and Africa and higher involvement in Europe and Australia/New Zealand.

End-of-life conversations when transitioning to end-of-life care in residential care: A web-based questionnaire survey of registered nurses’ expressed experiences

Older individuals within residential care (RC) may have palliative care needs that intensify along the path of their illness to death. An end-of-life (EOL) conversation follows when transitioning from one care to another, to plan for future care, to consider the patient's wishes, and to avoid unnecessary suffering for both patient and family. The aim of this study was to describe registered nurses’ (RNs) experiences of EOL conversations when transitioning to EOL care in RC. The design of this study was a survey study with questionnaire data from RNs working in RC ( n = 71), analyzed with descriptive statistics and using qualitative content analysis. This study is reported in accordance with the COREQ checklist. Three main categories and seven subcategories were identified. The first category was ‘Deficiencies in EOL conversations’ with the subcategories ‘EOL conversations at too late a stage’ and ‘Physicians’ absence in collaboration concerning EOL conversations’. The second category was ‘Nurse’s role in EOL conversations’ with the subcategories ‘Initiate EOL conversations’, ‘Cohesive link between stakeholders concerning EOL conversations’, and ‘Carry out EOL conversations’. The third category was ‘Family involvement in end of life’ with the subcategories ‘Family members’ participation in EOL conversation’ and ‘Unrealistic expectations at EOL conversation’. RNs at RC take a great responsibility regarding EOL conversations by often both initiating and carrying out the conversations. Such conversations need to be initiated at an early stage to enable patients to receive information or express their own wishes, and to have time to create good relationships with family members so they feel informed and involved.

Changes in intensive care unit nurse involvement in end of life decision making between 1999 and 2016: Descriptive comparative study

ObjectiveComparison of nurse involvement in end of life decision making in European countries participating in ETHICUS I- 1999 and ETHICUS II- 2015. MethodologyThis was a prospective observational study of 22 European ICUs included in the ETHICUS-II and I. Data were collected as per the ETHICUS-I and ETHICUS-II protocols. Four questions within the ETHICUS protocols related to nurse involvement in end of life decision making were analyzed. This is a comparison of changes in nurse involvement in end of life decisions from 1999 to 2015. SettingInternational e-based questionnaire completed by an intensive care clinician when an end of life decision was performed on any patient. SubjectsIntensive care physicians and nurses, no interventions were performed. MeasurementsA 20 question survey was used to describe the decision making process, on what basis was the decision made, who was involved in the decision making process, and what precise decisions were made. ResultsA total of 4592 cases from 22 centres are included. While there was more agreement between nurses and physicians in ETHICUS-I compared to ETHICUS-I, fewer discussions with nurses occurred in ETHICUS-II. The frequency of end of life decisions that were discussed with nurses decreased in all three regions between ETHICUS-I and ETHICUS-II. ConclusionBased on the results of the current study, nurses should be further encouraged to increase their involvement in end of life decision-making, especially those in southern Europe.

Patients’ Involvement in Decision Making at End of Life—A Systematic Review of Literature

Background: involving patient in end of life decision is important to understand their wishes and preference, which will help health care providers in improving the quality of dying and minimizing suffering. Aim: the aim of this review was to provide a detailed examination of the available literature related to patients’ involvement in decision making at end of life. Design: a systematic review following the PRISMA protocol was used, the review protocol was registered on PROSPERO: CRD42019128556. Data sources: we conducted a literature search in two electronic databases “CINAHL and Medline” during March-April 2019. The retrieved articles were included if they were: research reports or literature review; examined patient involvement in end of life discussions; full text publications, written in English and published from 2000-2019. Results: a total of (22) articles were included in the review; there was diversity in the purposes and design approach of the retrieved studies. The available literature explored patient’s involvement at end of life decision making through; describing current practices; understanding perspectives of end of life discussions; investigating the impact and identifying the barriers and facilitators of patients’ involvement in end of life discussions. Conclusion: involvement in end of life discussions improved the recognition of patients’ wishes, improved death experience, and decreased posttraumatic stress, depression, and anxiety among family members. Despite the documented benefits, some barriers against patient’s involvement in EOL decisions were recognized; lack of awareness; lack of education, training and experience; concerns about ethical and legal issues; and personal preferences of doctors or nurses were among the most commonly identified barriers.

The Role of Primary Care Physicians in Providing End-of-Life Care.

Primary care physicians (PCPs) frequently have long-term relationships with patients as well as their families. As such they are well positioned to care for their patients at the end of their lives. As the number of patients in need of end-of-life care continues to grow, it is critical to understand how PCPs can fulfill that need. The purpose of our study is to perform a narrative review of the literature and develop a theoretical model delineating the overarching roles played by PCPs in caring for patients at the end of life. For this narrative review, the authors searched Medline (PubMed), Embase, Cochrane Library, and Scopus up to March 22, 2017. Articles were not limited by geography. Review of existing literature generally supports 4 broad categories as the primary roles for PCP involvement in end of life: pain and symptom management; information management, including transmitting and clarifying information, setting care priorities, and assisting patients with treatment decisions; coordinating care and collaborating with other providers; and addressing patients' social, emotional, and spiritual needs. Based on the results of this review, PCPs provide a wide range of services to patients at the end of life. Promoting the provision of the full scope of services by PCPs will help ensure improved continuity of care while providing the highest quality of care for patients, both in the United States and around the world.

Nurse Involvement in End of Life Decision Making in the Intensive Care Unit: A Literature Review

Nurse Involvement in End of Life Decision Making in the Intensive Care Unit: A Literature Review

Paramedics and their role in end-of-life care: perceptions and confidence

Background: Studies have highlighted paramedics are inadequately prepared to care for patients who are at the end of their life, due to the historical focus of their training on acute medical management. This appears to cause conflict with paramedic perceptions of their role. Objective: To gain an understanding of paramedics' perceptions, confidence and concerns towards dealing with end of life care patients and their families. Design: An online survey comprising open and closed questions was distributed to all paramedics in a regional ambulance service in the north of England. Demographic data included: National Health Service (NHS) grade, personal experience, education and training to contextualise the data. A total population sample across differing organisational roles was used for paramedics in a regional ambulance service in the north of England. Responses were obtained from 182 staff. Results: NHS grade and length of service as a paramedic influenced the participant's confidence and concerns when dealing with end of life patients. A large number of participants (n=126, 70%) identified validity of documentation as a concern with 83 (46%) highlighting fear of litigation and 90 (50%) identifying that conflict with families was a concern. Support from other services was viewed as a contributing factor to increased paramedic involvement in end of life care. Conclusion: Most paramedics viewed end of life care as central to their role, but there was a need for further specific education to help enable paramedics to feel more confident, competent and supported in ensuring patients receive optimal care.

Expression of FOXO3a and Correlation With Histopathologic Features in Retinoblastoma.

Forkhead box (FOX) transcription factors are a class of highly conserved proteins, which serve critical cellular functions including cell cycle regulation. The downstream mechanisms of cell cycle regulation involve preservation of retinoblastoma protein function. Its deactivation by phosphorylation and translocation from nucleus to cytoplasm leads to cell proliferation. FOXO3a has been found to be dysregulated in few cancers. However, no study has been reported on role of FOXO3a in retinoblastoma. We assessed the expression of FOXO3a in sections of archived tissue blocks of enucleated/exenterated specimens of retinoblastoma by immunohistochemistry. The histopathologic features were reviewed and correlated with its expression. Effect of FOXO3a expression on survival was assessed. FOXO3a expression was assessed in 100 sections. Six samples did not contain any viable tissue. Retrospective data of 94 patients revealed that median age at presentation was 36 months with male:female ratio of 1.9:1. Fifty-one percent of patients were International Retinoblastoma Staging System stage 1. Of the 94 sections, 68 (72%) showed cytoplasmic expression. Choroidal invasion was associated with cytoplasmic FOXO3a (P=0.04). A trend was also noted in optic nerve cut end involvement (P=0.07). No other histopathologic features were found to be associated with FOXO3a expression. The overall survival and progression-free survival were not found to be affected by FOXO3a expression. Cytoplasmic expression of FOXO3a is frequently found in retinoblastoma and may be involved in pathogenesis. Activation by relocation of FOXO3a to nucleus may activate nonmutated retinoblastoma and may be a potential target of treatment in retinoblastoma.

Ethical Dilemmas, Needs and Unmet Needs in European Psychiatry – A Survey Made by the European Psychiatric Association (EPA)

During the present decade matters of ethics have been increasingly the focus of European National Psychiatric Associations and on the agenda of the European Psychiatric Association (EPA). Discussions in the association’s ethical committee have scrutinized the problems and elucidated the range of ethical dilemmas. A questionnaire sent by the Committee in 2011 to the National European Psychiatric Associations has given a panorama of the ethical problems in European Psychiatry and shown their diversity and even communalities. This overview has been presented at different meetings of the EPA and has recently been reviewed, updated and additionally commented by all committed European national associations. Hereby, new problems in European psychiatry have emerged or became again underlined e.g. the demand on psychiatry’s ethical involvement in end of life issues as well as the consequences of financing routines in times of resource limitations and changed prioritizations within medical care and mental health support systems implied by an ever more predominant market economy. Other re-emerged problems are questions and problems in contact with private sectors of users’ organizations, care providers or pharmaceutical industries and the need and strategies for multidisciplinary involvement in psychiatric education and research support. In this article these newly emerged ethical challenges will be elucidated and some positions of national psychiatric associations and their recently updated priorities regarding ethical challenges will be reviewed. Activities and structures regarding a continuous ethical sensitization as well as needs of a sustainable ethical agenda in European psychiatry are addressed.

PA19 'closing the gap': a community engagement project.

Dove House Hospice serves a population of about 600,000 covering Hull and East Riding. About 42% of people in Hull and East Riding die in their usual residence. Dove House Hospice's vision is to provide excellent specialist palliative care and support to patients, their families and carers in the locality. Despite excellent services provided, there was evidence of lack of awareness. A project, using a community engagement approaches, was therefore developed to close this gap. Raise awareness about death, dying, loss and care; and services provided by Dove House Hospice Improve partnerships between Dove House Hospice and the community. Increase social supports to those who experiences death, dying, loss and caregiving. Two postcode areas, namely Cottingham and Bransholme, were initially selected for two-week community engagement activities. The key approaches used were: direct engagement with the public, participation in community activities, engagement with local primary health care services and distribution of information leaflets. Evaluation approach: Use of pre and post activities questionnaire and feedback meetings with key community members. Leaflets were distributed to a total of about 18,000 addresses. Immediate result include: Increased donation, increased application for volunteering and increased referrals. Community involvement in end of life care waits to be evaluated. This is an on-going project. Early indications are that there has been improved awareness of the hospice services and interest in the hospice's activities. The project has also contributed to the hospice being included in the pathfinder charter community.

Challenges, Needs and Unmet Needs – an EPa Overview of European Codes of Ethics

Since 3 years matters of ethics are in an increasing way on the agenda of the European Psychiatric Association. Intensive discussions in the associations ethical committee have scrutinized the problems and elucidated the range of ethical dilemmas. A questionnaire sent by the Committee to European Psychiatric Associations has given a panorama of the ethical problems in European Psychiatry and shown their diversity and even communalities. This overview has been presented at different meetings of the EPA and has recently been reviewed, updated and additionally commented by all committed European national associations. Hereby, new problems in European psychiatry have emerged or became intensified, e.g. the demand on psychiatry’s involvement in end of life issues as well consequences of the limitation of resources, specificities of financing routines in times of resource limitations and ways of prioritizations within medical care and mental health support implied by an all more predominant market economical system. Other re-emerged problems are questions and problems in contact with private sectors of users organizations, care providers or pharmaceutical industries and the need and strategies for multisectorial involvement in psychiatric education and research support. Here, again a need of ethical guidelines in psychiatrists contact has become actualized, especially regarding the needs of young psychiatrists and is one of the focuses in this symposium. In this contribution, these newly emerged ethical challenges will be elucidated, the positions of national psychiatric associations and their recently updated priorities regarding ethical challenges will be reviewed and the activities and structures of EPAs further activities on ethics will be presented for discussion.

Promoting Neonatal Staff Nurses' Comfort and Involvement in End of Life and Bereavement Care

Background. Nurses who provide end of life and bereavement care to neonates and their families are potentially at risk for developing stress-related health problems. These health problems can negatively affect nurses' ability to care for their patients. Purpose. Nurses need to be knowledgeable about end of life and bereavement issues to provide quality care. This study sought to evaluate the effect of a bereavement seminar on the attitudes of nurses regarding end of life and palliative care of neonates. Design. A convenience sample of fourteen neonatal nurses completed a Bereavement/End of Life Attitudes about Care of Neonatal Nurses Scale after a bereavement seminar designed to provide information on end of life care. A pre- and posttest design with an intervention and control group was used to assess changes in nurse bereavement attitudes in relationship to comfort, role, and involvement. Results. After bereavement seminar, the seminar attendees had higher levels of comfort in providing end of life care than nurses in the control group (t = −0.214; P = 0.04). Discussion. Nurses' comfort levels can be improved by attending continuing education on end of life care and having their thoughts on ethical issues in end of life care acknowledged by their peers.

Bringing the nurse to the patient (plenary)

Consider how a change in culture can enhance end of life care in an acute hospital setting. Reflect on how using an evidenced based care pathway can facilitate dignified end of life care. Recognise the importance of multidisciplinary involvement in end of life care for patients and their families. Recognition of the importance of effective communication, interdisciplinary teamwork and comprehensive documentation in end-of-life care.

An unusual presentation of a rare chest wall tumour: Giant cell tumour of bone

Giant cell tumour of bone is an aggressive benign bone tumour. It rarely affects the ribs. It usually involves the posterior end of the ribs and literature regarding anterior end involvement is scanty. We report a case of giant cell tumour of the anterior end of the rib masquerading as a sub-mammary abscess in lactating women.

Social Work Involvement in End of Life Planning

This cross sectional study examined the factors associated with social workers' involvement in end-of-life (EOL) planning using a random sample of NAS W members in health and aging. Of the 390 social workers who worked in EOL planning, the majority were involved in health care proxy discussions and counseling with patients. Respondents tended to see barriers to proxy completion as client-related. However, some system barriers were correlated with overall involvement. Factors that predicted social workers' involvement with the health care proxy included age, attitudes, perceptions of barriers, and perceived physician support. Social workers need to attend to the systems in which they operate as well as to client concerns.

A Future Vision of Innovative and Expanded Community Involvement in End of Life Care

Research has clearly identified that Americans do not die well. Many die alone, isolated and in pain in hospitals. Improvements will come only with greater individual and societal commitment. One way to ensure change is through expanded community involvement in end of life care reform. The Community-State Partnerships to Improve End-of-Life Care are serving as a model for building community awareness and involvement. Home health is in an opportune position to take a leadership role in reform by convening community coalitions and by bringing the home health philosophy and perspective to these coalitions.