Exploring the Dilemma of Ethical Issues Using the Lens of Seedhouse Can Help Oncology Nurses to Gain a Different Perspective on Caring for Older Adults with Cancer.

OBJECTIVE: To explore ethical issues associated with older adults with cancer and the people who matter to them. DATA SOURCES: A scoping review of the literature was conducted to inform the article using CINAHL, Medline, and Google Scholar databases using broad terms, older adults, geriatrics, cancer, and ethics. CONCLUSION: Older adults with cancer experience ageism, which stems from a range of uncertainties on best practice in care and treatment. By employing an ethical lens, decision-making by oncology nurses can be aided by creating and promoting autonomy through impeccable communication. Best interests for individual older adults with cancer can also be served by oncology nurses working in a way that serves needs first and acts in the best interests of the person and their family. IMPLICATIONS FOR NURSING PRACTICE: The article is of relevance to practicing oncology globally nurses because the framework can be easily used in clinical practice.

A qualitative insight into time-poor/grade-hungry health studies students' perceptions of using assessment criteria and feedback in assignment writing.

BACKGROUND: Grade-led study and surface-learning approaches compromise student success at undergraduate level. However, encouraging students to adopt deeper approaches to learning can feel like an endless challenge for staff in the current consumerist university climate. OBJECTIVE: This study explored undergraduate health studies students' current use, experiences and perceptions of assessment criteria in relation to their assignment writing and feedback. DESIGN: Using a qualitative research design, data were collected via focus groups with 18 students then analysed using thematic analysis. RESULTS: Findings revealed three key themes: Grades as the driver; The dependent learner; and Time-poor sacrifices. Ultimately, students are primarily motivated by grades and this has been reflected in the way they use assessment criteria and feedback. A general lack of autonomy was evident among students' attitudes towards assessment criteria and feedback and in the way these resources were utilised. Time restrictions for studying were a fundamental issue raised by this study. Students felt they should be offered greater flexibility with meeting deadlines due to balancing competing demands outside of university life. CONCLUSION: These findings hope to trigger initiatives that aim to shift time-poor/grade-hungry students' towards a deeper understanding of what it means to be an effective learner in higher education.

Participating in the personal care of a person living with a life-limiting illness in a hospice inpatient setting: the informal caregiver's perspective.

METHODS: Using semi-structured interviews, this descriptive qualitative research study examined informal caregivers' perspectives of participating in the personal care of a person living with a life-limiting illness within one hospice inpatient setting. Some 10 principal, informal caregivers of hospice inpatients were recruited by means of purposive sampling, using posters displayed in the hospice inpatient unit. Thus, participation was entirely 'opt-in'. A flash card was displayed at the beginning of each interview to determine a definition of personal care. Field notes and digital audio recording were used to capture data collected. RESULTS: Data were thematically analysed and demonstrated that informal caregivers' perceptions of personal care included everything that allowed the patient to remain the person they were. Informal caregivers reported an acceptable balance between being able to carry out personal care and hospice nursing staff involvement, despite no discussions being carried out to establish their wishes. Prior experiences of informal caregiving, and individual caregiver preparedness, contributed to negative and positive feelings about participating in personal care. Informal caregivers reported additional support and education needs associated with being able to participate in the personal care of patients on discharge and in the future. CONCLUSIONS: The emergent themes provide palliative care practitioners with direction for professional practice and research around supporting informal caregivers participating in personal care. Healthcare professionals need to clarify terminology of personal care by having dialogues with informal caregivers and acting on these accordingly. However, not all informal caregivers want such conversations. Consequently, healthcare professionals should approach this topic sensitively. Healthcare professionals ought to be asking informal caregivers if they wish to participate in personal care. Hospice nurses need to engage, support and educate informal caregivers about personal care. Furthermore, they should help to maintain and develop the skills of those informal caregivers who want to continue to play this role and not allow them to become deskilled.

A retrospective medical records review of risk factors for the development of respiratory tract secretions (death rattle) in the dying patient.

AIM: Identification of risk factors predicting the development of death rattle. BACKGROUND: Respiratory tract secretions, often called death rattle, are among the most common symptoms in dying patients around the world. It is unknown whether death rattle causes distress in patients, but it has been globally reported that distress levels can be high in family members. Although there is a poor evidence base, treatment with antimuscarinic medication is standard practice worldwide and prompt intervention is recognized as crucial for effectiveness. The identification of risk factors for the development of death rattle would allow for targeted interventions. DESIGN: A case-control study was designed to retrospectively review two hundred consecutive medical records of mainly cancer patients who died in a hospice inpatient setting between 2009-2011. Fifteen potential risk factors including the original factors weight, smoking, final opioid dose and final midazolam dose were investigated. METHODS: Binary logistic regression to identify risk factors for death rattle development. RESULTS: Univariate analysis showed death rattle was significantly associated with final Midazolam doses and final opioid doses, length of dying phase and anticholinergic drug load in the pre-terminal phase. In the final logistic regression model only Midazolam was statistically significant and only at final doses of 20 mg/24 hrs or over (OR 3.81 CI 1.41-10.34). CONCLUSIONS: Dying patients with a requirement for a high dose of Midazolam have an increased likelihood of developing death rattle.

Systematic review and narrative summary: Treatments for and risk factors associated with respiratory tract secretions (death rattle) in the dying adult.

AIM: To identify effective treatments and risk factors associated with death rattle in adults at the end of life. BACKGROUND: The presence of noisy, pooled respiratory tract secretions is among the most common symptoms in dying patients around the world. It is unknown if "death rattle" distresses patients, but it can distress relatives and clinicians. Treatments appear unsatisfactory, so prophylaxis would be ideal if possible. DESIGN: Quantitative systematic review and narrative summary following Cochrane Collaboration guidelines. DATA SOURCES: CINAHL, MEDLINE, Health Source Nursing and Web of Science were searched for international literature in any language published from 1993 - 2016 using MeSH headings and iterative interchangeable terms for "death rattle". REVIEW METHODS: Randomized controlled trials were appraised using the Cochrane Collaboration's tool for assessing risk of bias. Non-randomized studies were assessed using ROBINS-I tool for assessing risk of bias in non-randomized studies of interventions. Instances of treatment and risk were extracted and relevant key findings extracted in line with Cochrane methods. RESULTS: Five randomized trials and 23 non-randomized studies were analysed. No pharmacological or non-pharmacological treatment was found superior to placebo. There was a weak association between lung or brain metastases and presence of death rattle, but otherwise inconsistent empirical support for a range of potential risk factors. CONCLUSIONS: Clinicians have no clear evidence to follow in either treating death rattle or preventing it occurring. However, several risk factors look promising candidates for prospective analysis, so this review concludes with clear recommendations for further research.

Advance care planning in a community setting.

AIM: To evaluate the effects of implementing an advance care planning process within pilot sites in North Ayrshire in 2010, focusing on people with palliative care needs. METHOD: Data were collected from participants in advance care planning training using a questionnaire. Semi-structured interviews were conducted and an audit of documentation was undertaken. RESULTS: Thirty nine questionnaires were returned, a response rate of 16%. Twenty four out of 25 (96%) participants rated the training as having improved their understanding of the advance care planning process. The general consensus in interviews was that advance care planning is a worthwhile process. Participants reported patients achieving their preferred place of end of life care and greater consultation regarding hospitalisation. CONCLUSION: Within the pilot sites, advance care planning training enhanced the ability of professionals to implement the advance care planning process and record the wishes of patients and residents.

The outcomes of palliative care day services: a systematic review.

This systematic review evaluates the evidence underpinning the provision of palliative day care services (PDS) to determine whether such services have a measurable effect on attendees' wellbeing. The majority of studies reviewed were qualitative and elicited individual perceptions of the benefits PDS. Although it was difficult to determine the quality of many studies, it would appear that attendance at PDS had a positive impact on attendees' quality of life. Fewer studies utilized validated outcome measures to determine the effect of PDS on attendees' wellbeing and small sample sizes combined with high attrition rates influenced the significance of some the results. However little quantitative evidence was offered to prove that PDS had an impact on attendees' quality of life or wellbeing. The review concludes that dying people find attending PDS a valuable experience that allows them to engage with others and to be supported in a restorative environment. However, further well-powered empirical studies are required to provide quality evidence to determine whether or not attendance at PDS does indeed have a positive impact on the wellbeing of attendees.

Reflexology audit: patient satisfaction, impact on quality of life and availability in Scottish hospices.

Complementary therapies are being accessed increasingly by cancer patients. The aims of this audit were to investigate the impact of reflexology on the quality of life of 20 cancer patients, to determine their satisfaction with the service provided and to investigate the availability of this therapy within Scottish hospices. The audit findings suggest that the clients were satisfied with the service received. Respondents noted that their quality of life was improved through a reduction in physical and emotional symptoms. It was found that the provision of reflexology within Scottish hospices varied, with less than half providing this service. The results of this audit suggest that reflexology may be a worthwhile treatment for other cancer patients and requires further research to evaluate the benefits.

Group therapy for bulimic adults.

Eating disorders are increasingly coming to the attention of mental health practitioners, and effective treatment approaches are a matter of growing concern. This paper describes the structure, process, and outcome of a group therapy project involving eight bulimic women.