Nursing activities for health promotion in palliative home care: an integrative review.

Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.

Levels of Medical Intervention and End-of-Life Practices in Long-Term Care Centres.

Background: Levels of medical intervention (LMI) are legal documents in which physicians record patient preferences, or those of their designated substitute decision-makers, concerning end-of-life care. Studies suggest that, although LMI are intended to orient clinical practice, their function tends to be limited to logistical aspects of care. How LMI shapes or guides patient-centred, end-of-life care remains unclear. The aim of this study was to examine possible associations between LMI and certain aspects of end-of-life care practices in LTCC, such as nurse-documented patient experiences of pain, and prescription and administration of medication. Methods: A retrospective descriptive study of 100 files retrieved from a clinical database of deceased patients in LTCCs located in an urban integrated health and social service organization in Québec, Canada, was conducted. Results: Significant associations between last documented LMI and frequency of narcotic prescription and administration, at either regular intervals or PRN, are highlighted. The time delay between last LMI assessment and patient death was one week or less for 39.4% of cases. Conclusion: These results suggest that LMI assessment practices may not correspond to their intended use. A short time frame between last LMI (L-LMI) assessment and patient death may suggest less-than-optimal patient comfort in end-of-life care.

Effect of yoga on patients with cancer: our current understanding.

OBJECTIVE: To determine whether therapeutic yoga improves the quality of life of patients with cancer. DATA SOURCES: Search of MEDLINE database (1950-2010) using key words yoga, cancer, and quality of life. STUDY SELECTION: Priority was given to randomized controlled clinical studies conducted to determine the effect of yoga on typical symptoms of patients with cancer in North America. SYNTHESIS: Initially, 4 randomized controlled clinical studies were analyzed, then 2 studies without control groups were analyzed. Three studies conducted in India and the Near East provided interesting information on methodologies. The interventions included yoga sessions of varying length and frequency. The parameters measured also varied among studies. Several symptoms improved substantially with yoga (higher quality of sleep, decrease in symptoms of anxiety and depression, improvement in spiritual well-being, etc). It would appear that quality of life, or some aspects thereof, also improved. CONCLUSION: The variety of benefits derived, the absence of side effects, and the cost-benefit ratio of therapeutic yoga make it an interesting alternative for family physicians to suggest to their patients with cancer. Certain methodologic shortcomings, including the limited size of the samples and varying levels of attendance on the part of the subjects, might have reduced the statistical strength of the studies presented. It is also possible that the measurement scales used did not suit this type of situation and patient population, making it impossible to see a significant effect. However, favourable comments by participants during the studies and their level of appreciation and well-being suggest that further research is called for to fully understand the mechanisms of these effects.

[Does meditation improve the quality of life for patients living with cancer?]. / La méditation améliore-t-elle la qualité de vie des patients vivant avec un cancer?

OBJECTIVE: To determine whether interventions that promote meditation improve quality of life in cancer patients. DATA SOURCES: MEDLINE data bank (1966 to 2004) using the terms "spiritual well-being" and the MeSH terms "meditation", "neoplasm", "cancer", and "spiritual therapies". STUDY SELECTION: Clinical trials evaluating the effect of meditation on cancer patients. SYNTHESIS Five studies were retained; none were designed in a way that made it possible to evaluate the effect of meditation exclusively or its effect on quality of life compared with a neutral intervention. Only 1 evaluated spiritual well-being. Four reported a significant improvement in symptoms of depression and anxiety when the study group's preintervention and post-intervention scores were compared. In the 2 studies that included a control intervention, participants preferred the meditation intervention. CONCLUSION: The design of studies to evaluate the effect of meditation on cancer patients did not make it possible to clearly identify the effect of meditation alone. These studies did show, however, that mood and anxiety parameters tend to improve--something that has been documented in other populations--and that spiritual well-being tends to improve as well. The main biases preventing a generalization of the effects of meditation are simultaneous evaluation of several interventions, "diluting" the effect of meditation; the lack of control groups receiving a comparable intervention; and the selection of study populations favourable to the intervention. There is increasing recognition of the effect of improved spiritual well-being on quality of life, even though most tools for measuring quality of life do not have a section for measuring spiritual well-being. Failing to take this aspect into account could be causing us to miss certain effects of meditation. In order to determine whether meditation should be offered to terminally ill patients, we need studies that do not contain these biases--studies designed to measure spiritual well-being.