Aid when 'there is nothing left to offer': Experiences of palliative care and palliative care needs in humanitarian crises.

Access to palliative care, and more specifically the alleviation of avoidable physical and psychosocial suffering is increasingly recognized as a necessary component of humanitarian response. Palliative approaches to care can meet the needs of patients for whom curative treatment may not be the aim, not just at the very end of life but alleviation of suffering more broadly. In the past several years many organizations and sectoral initiatives have taken steps to develop guidance and policies to support integration of palliative care. However, it is still regarded by many as unfeasible or aspirational in crisis contexts; particularly where care for persons with life threatening conditions or injuries is logistically, legally, and ethically challenging. This article presents a synthesis of findings from five qualitative sub-studies within a research program on palliative care provision in humanitarian crises that sought to better understand the ethical and practical dimensions of humanitarian organizations integrating palliative care into emergency responses. Our multi-disciplinary, multi-national team held 98 in-depth semi-structured interviews with people with experiences in natural disasters, refugee camps in Rwanda and Jordan, and in Ebola Treatment Centers in Guinea. Participants included patients, family members, health care workers, and other staff of humanitarian agencies. We identified four themes from descriptions of the struggles and successes of applying palliative care in humanitarian settings: justification and integration of palliative care into humanitarian response, contextualizing palliative care approaches to crisis settings, the importance of being attentive to the 'situatedness of dying', and the need for retaining a holistic approach to care. We discuss these findings in relation to the ideals embraced in palliative care and corresponding humanitarian values, concluding that palliative care in humanitarian response is essential for responding to avoidable pain and suffering in humanitarian settings.

The Association Between Vitamin D Level and Chest Pain, Anxiety, and Fatigue in Patients With Coronary Artery Disease.

This study sought to assess the association between vitamin D deficiency (VDD) and chest pain, anxiety, and fatigue in patients with coronary artery disease (CAD). A cross-sectional study was conducted to collect data from a sample of 90 participants with CAD. Serum 25OHD3 was measured using a radioimmunoassay procedure. Chest pain was assessed using the Numeric Pain Rating Scale, anxiety using the Anxiety Subscale, and fatigue by the General Fatigue subscale. The majority of participants (80%) had VDD. Results showed that the level of vitamin D was significantly negatively associated with chest pain (r = -.43, p = .00); anxiety (r = -.466, p = .00); and fatigue (r = -.25, p = .018). Findings suggest the role of VDD in heightened central sensitivity in cardiac-related symptoms such as chest pain, anxiety, and fatigue. Patients with CAD should be monitored for VDD so that the condition can be corrected.

Nurses' Experiences of Caring for Patients with COVID-19: A Qualitative Study.

The purpose of this study was to explore nurses' experiences, abilities, and willingness to care for patients with Coronavirus Disease 2019 (COVID-19). A descriptive qualitative study was conducted among 12 nurses working with patients with COVID-19. Purposive sampling was used to recruit participants from two national hospitals in Jordan. Semi-structured interviews (45-90 minutes each) with open-ended questions were held via Zoom to collect data. Four major themes emerged from the data analysis. The first theme, uncertainty, consisted of two subthemes: new experience and lack of training. The second theme was related to social stigma by society and other staff members. The third theme of front-line fighters consisted of two subthemes: empowering the main health caregiver and community acknowledgment. The fourth theme was related to challenges and consisted of two subthemes: physical and psychological challenges. At the beginning of the outbreak of COVID-19, the nurses had experienced a lack of certainty, physical and psychological challenges, and social stigmatization, which had negatively affected their willingness and ability to fight the outbreak. However, the nurses reported growing professionally and psychologically with time and becoming more knowledgeable, skillful, powerful, and confident care providers during the pandemic. Being able to fulfill their responsibilities and being acknowledged by others gave the nurses a sense of achievement. Early education and training about COVID-19, clear infection control protocols and guidelines, psychological counseling, and adequate social support are essential steps for enhancing nurses' mental well-being and willingness and ability to fight COVID-19.

Barriers to implementing palliative care in intensive care units: perceptions of physicians and nurses in Jordan.

BACKGROUND: Palliative care (PC) aims to relieve a person's suffering and provide the best possible quality of life (QoL) to people with chronic illnesses. Despite the significant impact of PC services on the QoL of patients, barriers exist that prevent healthcare providers from facilitating PC in intensive care units (ICUs). AIM: The purpose of this study was to explore the perceived barriers to implementing PC in ICUs. METHODS: A qualitative approach was used to conduct 17 semi-structured interviews with clinicians across two ICUs (urban and suburban) in Jordan. Thematic analysis was used for the transcribed interviews. RESULTS: Five main themes emerged: the ICU is a demanding and complex care environment; lack of preparation to implement PC; PC is a nicety, not a necessity; healthcare system-related barriers; and lack of cultural acceptance of PC. Lack of knowledge and training was identified as a major barrier for the effective implementation of PC by both physicians and nurses. CONCLUSION: Equipping healthcare providers with the knowledge and expertise to provide PC is essential to dispel myths related to PC and facilitate PC provision. Developing an interdisciplinary care team will support the effective implementation of PC services in any setting. Establishing national PC policies will foster the ethical and legal practice of PC in Jordan.

Nurses' knowledge and practices of physical restraints in intensive care units: An observational study.

Aim: To investigate the knowledge and practice of physical restraints (PR) among Jordanian intensive care unit (ICU) nurses. Design: A descriptive, observational design was used. Methods: A convenience sampling was used to recruit participants. We examined the knowledge of PR in 301 nurses (knowledge check) and the real-time practice of PR in 81 nurses (direct observation) in ICU. A knowledge questionnaire was used to collect data on knowledge about PR use, and data on their practice of PR were observed and documented using an observation checklist. Results: The mean scores of nurses' knowledge and practices were 61.5 (SD = 12.1) and 57.4 (SD = 9.7), respectively. More than half of nurses had poor knowledge of PR use and incorrect practice of implementing PR (51.5% and 60.5%, respectively). Results indicated a positive correlation between nurses' knowledge and their use of PR.

The Effectiveness of Hologram Bracelets in Reducing Chemotherapy-Induced Nausea and Vomiting Among Adult Patients With Cancer.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) affects cancer patients' quality of life, despite the provision of antiemetic medication. OBJECTIVES: The aim of this study is to assess the clinical effectiveness of the hologram bracelet in the management of CINV among adult patients with cancer. METHODS: An experimental, double-blinded design spanning 3 courses of chemotherapy was used; 175 oncology patients were randomly assigned to 3 groups: placebo (n = 53), control (n = 54), and intervention (hologram bracelet) (n = 68). Daily diaries were used to detect the severity and the frequency of CINV and to detect the frequency of using antiemetic medications. The Functioning Living Index-Emesis was used to examine the impact of CINV on the activities of daily living. RESULTS: Significant CINV differences existed between groups. The mean total Functioning Living Index-Emesis score was significantly lower in the intervention group for total vomiting and total nausea. CONCLUSION: Hologram bracelet use among patients with cancer had a positive effect on CINV. The level of CINV decreased and activity of daily living scores increased. However, effects varied among the types of CINV. IMPLICATIONS FOR PRACTICE: Further study is recommended to explore the benefits of the bracelet.

Undergraduate nursing students' stress sources and coping behaviours during their initial period of clinical training: a Jordanian perspective.

Baccalaureate nursing students often experience high levels of stress during training that may result in psychological or emotional impairment during their professional life ultimately affecting the quality of patient care they provide. Clinical instructors provide the needed support and guidance for students to relieve stress and promote a positive clinical experience. The aim of this study was to identify the level and types of stress perceived by baccalaureate nursing students in Jordan in their initial period of clinical practice and to identify the coping strategies that students used to relieve their stress. This descriptive cross-sectional study was conducted with 181 nursing students' representative of second year undergraduate students from two universities in Jordan. Proportions and t-tests were used to analyze the data. The results showed that the source of stress for these students came mainly from assignment work and the clinical environment. The most common coping strategy used by students was problem-solving behaviour followed by staying optimistic and transference attention from the stressful situation to other things while avoidance was the least frequent used.

The practice of withholding and withdrawing life-support measures among patients with cancer in Jordan.

In Jordan, an Arabic Islamic country, decisions around withholding and/or withdrawing life support measures still present both moral and professional dilemmas. The purpose of this study was to explore the use of such measures among patients with cancer in Jordan. The medical records of 436 patients with cancer who were at least 18 years old and who died at a specialized cancer centre in Jordan in 2008 were reviewed retrospectively. Of those, 212 (48.6%) had a written decision to withhold or withdraw life support measures. Among the 436 charts reviewed, only 7 patients (1.6%) had treatment withdrawn, while 212 (48.6%) had treatment withheld. Resuscitation was the most common treatment withheld, followed by medication, and poor prognosis was the most common reason for the decision. The time period between a decision being made and the death of the patient was short, indicating that treatment plans are not being made well in advance. A cultural and religious consensus regarding such decisions is needed to help ensure that a greater proportion of terminally ill people plan their care in advance, and to aid health-care providers in advising their patients and acting in the patients' best interests.