Estimating Life Expectancy From Chinese Medicine Could Improve End-of-Life Care in Terminally Ill Cancer Patients.

Preparing for a good death is an important and meaningful concept in Chinese culture because people hope to know residual life to make effort for their unfinished business. However, the family of terminally ill patients with cancer may be annoyed and frustrated about unexpected bereavement if they have unresolved conflicts with the loved one, missing a chance for declaring love, untimely apologizing and saying goodbye. The study aimed to explore this difficult issue. The medical records of 121 deceased terminally ill patients with cancer at National Cheng Kung University Hospital between December 2010 and February 2012 were reviewed. The signs and awareness of dying among these patients were collected using palliative routine instruments in the hospice ward. The top 3 most prevalent dying signs were coolness and cyanosis (prevalence 98.3%, median period from the first documented dying sign to death 2 days, P = .028), mirror-like tongue (prevalence 94.2%, median period 5 days, P = .007), and earlobe crease (prevalence 93.4%, median period 4 days, P = .052). In addition, the prevalence of dying awareness was 71.1% (median period 4 days, P = .001). Furthermore, terminal agitation was identified more frequently in terminally ill patients with hepatoma and colon cancer (adjusted odds ratio = 3.240, P = .043), but turbid sclera with edema was noted more often in terminally ill patients with head and neck cancer (adjusted odds ratio = 5.698, P = .042). The results provide evidence to support clinical practice, offering knowledge and techniques to health care providers, and increasing quality of life for terminally ill patients with cancer.

[The application of hospice palliative care on discharge planning for the terminal cancer patient].

Whole person, family-centered, continued care, and multidisciplinary approach were four core values of hospice palliative care applied in this paper to assist in the difficult processes of discharging terminal cancer patients from the hospital and providing continued care until their peaceful death. Reasons underlying difficulties with discharges identified during hospitalizations between July 5th to 25th 2007 include: 1. 'whole person' aspects, including lack of confidence with the discharge on the part of the patient and his / her families due to inadequate symptoms control and loneliness due to lack of caregiver understanding and support; 2. 'family-centered' aspects, including failure to designate a key decision maker, differences of opinions, and overwhelming caregiver burdens; 3. 'continuity of care' aspects, including lack of appropriate and continuing palliative care and 4. 'multidisciplinary approach' aspects, including factitious relationships among patient, family members, and healthcare providers due to lack of trust. Furthermore, the healthcare team mapped out individual and continued care plans as follows: 1. 'whole person' aspects should focus on symptom control, enhancing comfort, and encouraging emotional expression; 2. 'family-centered' care aspects should identify the key person and significant others, decrease caregiver burdens, provide essential assistance and conduct family conferences; 3. 'continuity care' aspects should include consulting hospice home care and bereavement care professionals; 4. 'multidisciplinary approach' aspects should address comprehensive care so that team members learn from and reflect on their experiences. Ultimately, patients were successfully discharged from the hospital and peacefully passed away one week afterward. The writer hopes this nursing experience will provide a valuable reference for clinical practice to develop a family-centered approach to palliative care based on the four core values of hospice palliative care and the multidisciplinary discharge plan for terminal cancer patients.

Building a bridge for nursing education and clinical care in Taiwan--using action research and Confucian tradition to close the gap.

BACKGROUND: Nursing workplaces in Taiwan are unable to retain talent. An examination of this problem has revealed that the causes of this phenomenon are that nursing education fails to cultivate the skills that meet workplace requirements and that there are gap between nursing education and clinical practice. OBJECTIVES: This paper is an action research that aims is to design educational programs that can close the gap between nursing education and clinical practice in Taiwan. DESIGN: In this action research project, 4 action cycles were used to design educational programs including concept mapping and focused discussion strategies. SETTINGS: Participants were invited to join the research in three teaching hospitals and one university. PARTICIPANTS: Two groups of participants, student nurses (SN) and nursing staff personnel (NS), were sampled and invited to participate in the research. METHODS: Participant observation, focus groups, and qualitative interviews were used to collect data. Qualitative data were not only profiled by content analysis, but they were also compared continuously between the two groups as well as between the 4 cycles. RESULTS: The qualitative data collected for the 135 participants were analysed. The themes of an effective nursing program were summarized. CONCLUSIONS: Many fundamental values of traditional Chinese education have gradually faded due to the Westernization of education. In this study, we discovered that Western educational models may play a critical role in improving traditionally taught nursing education programs.