Unveiling nurses' end-of-life care experiences: Moral distress and impacts.

BACKGROUND: Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding end-of-life care and its consequential impacts. RESEARCH OBJECTIVES: To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. RESEARCH DESIGN: A qualitative descriptive approach was employed. PARTICIPANTS AND RESEARCH CONTEXT: Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. ETHICAL CONSIDERATIONS: We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. FINDINGS: The moral distress-inducing factors and nurses' perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. CONCLUSIONS: End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress.

Clinical Experience of Nurses in a Consultative Hospice Palliative Care Service.

Purpose: The purpose of this qualitative study was to employ Colaizzi's phenomenological research method to elucidate and understand the essence of practical experiences among consultative hospice palliative care nurses working in hospice institutions. Methods: The participants in the study were 15 consultative hospice palliative care nurses with over 1 year of work experience in institutions located in S City, I City, and K Province in South Korea. Data were collected from 23 in-depth interviews and analyzed using Colaizzi's phenomenological qualitative method. Results: The practical experiences of consultative hospice palliative nurses were categorized into five categories, 10 theme clusters, and 25 themes. The five categories included "being aware of patients' situations at the time of transition to hospice palliative care," "empathizing with patients and their families by putting oneself in the other's shoes," "providing patient and family-centered end-of-life care," "experiencing difficulties in practical tasks," and "striving to improve hospice service quality." Conclusion: This study is significant in that it provides practical data for understanding the experiences of consultative hospice palliative care nurses caring for terminally ill patients. This could enhance our understanding of care solutions that effectively tackle the challenges consultative hospice palliative care nurses encounter while fulfilling their roles.

Art Therapy in Patients with Terminal Cancer and Their Families: A Multiple Case Study.

Purpose: The study explored the meaning of experiences within a family art therapy process among terminal cancer patients and their families. Methods: Ten participants, including four terminal cancer patients currently admitted to the hospice ward at an inpatient hospice facility in S City and four caregiving family members, engaged in four cycles of family art therapy sessions. The sessions were conducted weekly or bi-weekly, and each lasted approximately 50 minutes. Results: Nine cross-case themes emerged "feeling unfamiliar and intimidated by the idea of expressing my thoughts through art," "trying to accept the present and positively overcome sadness," "expressing hope through emotional bonds during the process of parting," "conveying and preserving personal and family beliefs," "feeling upset about family imbalances caused by deteriorating health," "valuing togetherness and striving for stability amidst the current challenges," "art as a medium of empowerment for patients and facilitator of family conversations, even amidst difficulties," "sharing a range of emotions-not just joy, but concerns and sorrow-through art," and "gratitude for art's role in improving family communication and connection through artwork. Conclusion: The findings of this study lead to several conclusions. First, patients and their families faced psychological challenges when confronted with impending death, yet they strove to remain optimistic by seeking meaning in their struggles. Second, families practiced open and expressive communication, sharing a spectrum of complex emotions with one another. Third, even as the patient's condition worsened, resulting in family fatigue, their support and cohesion strengthened.

Ethical dilemmas and care actions in nurses providing palliative sedation.

BACKGROUND: Recently, palliative care is increasingly important, with an emphasis on the process of dying with dignity. However, nurses who care for such patients experience the associated ethical dilemmas. OBJECTIVE: To explore the meaning of nurses' experiences in dealing with ethical dilemmas in relation to palliative sedation. RESEARCH DESIGN: A qualitative research design was employed with a thematic analysis approach. PARTICIPANTS AND RESEARCH CONTEXT: Using purposive sampling, 15 nurses, working at palliative care units for at least 1 year, were recruited as participants. Data were collected using unstructured in-depth interviews, and data collection and analysis was performed simultaneously. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the authors' institutional review board. All participants provided informed consent. For the face-to-face interview, the South Korean standard COVID-19 quarantine guidelines, such as mandatory masking and social distancing, were followed. RESULTS: Dilemmas raised by patients, were related to concerns about appropriate drug dose; dilemmas raised by nurses, were related to passive care, sense of guilt for failure to predict death, and colleague's disrespectful attitudes toward patients; dilemmas from patients' families were related to demands for palliative sedation and reversal of those demands. Care actions to deal with ethical dilemmas comprised evidence-based care, person-centered thinking, reflecting on the death situation, compassion, providing explanation and help to family members. CONCLUSION: Nurses' ethical dilemmas were pre-dominantly influenced by themselves, rather than by the patients or their families, especially if they felt they could not do their best for patients. The core concept of care actions to deal with the ethical dilemmas, was person-centered care and compassion. Then, how patients and their family members perceive person-centered care and compassion, should be further explored to improve palliative sedation.

Association between gastric cancer and the risk of depression among South Korean adults.

OBJECTIVES: The diagnosis and treatment of cancer are stressful events that could trigger psychological distress in a large number of cancer patients. The aim of this study was to examine the association between gastric cancer and the risk of new onset of depression among South Korean adults. METHODS: Data from 12,664 participants aged over 40 years was derived from the National Health Service National Sample Cohort (2002-2013). The case cohort consists of patients who received a diagnosis of gastric cancer between 2002 and 2009, and the corresponding control group was selected through 1:1 propensity score matching (case: 6332, control: 6332). The new onset of depression was considered as the dependent variable. A Cox proportional hazards regression model was built to analyze the associations between variables in consideration. RESULTS: Individuals with gastric cancer had a higher risk of new onset of depression than those without cancer (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.13-1.45.) Female gastric patients had a higher risk of depression compared to male patients (Female; HR = 1.89, 95% CI = 1.66-2.16, Male; HR = 1.25, 95% CI = 1.10-1.41). Gastric cancer patients in their 60s had the highest risk of new onset of depression compared to other age groups and no cancer group (HR = 1.61, 95% CI = 1.40-1.85). Gastric cancer patients who were previously diagnosed with depression prior to their diagnosis of cancer had a higher risk of new onset of depression than gastric cancer patients without antecedent diagnosis of depression (Past Depression (Yes); HR = 5.17, 95% CI = 4.10-6.51, Past Depression (No); HR = 1.35, CI = 1.21-1.51). CONCLUSIONS: The study identified a significant relationship between gastric cancer and depression among South Korean adults, suggesting that the diagnosis and treatment of gastric cancer increases the risk of new onset of depression, especially among female patients between 60 and 69 years old of high income and living in metropolitan regions. Pre-existing health conditions also appeared to be a risk factor. Thus, in consideration of treatment efficacy and patients' quality of life, the results of the study emphasizes the need for attentive intervention, while distinguishing the most vulnerable groups.

Factors Associated with Person-Centered Care among Hospice Nurses.

Purpose: The purpose of this study was to examine person-centered care, nursing professionalism, the nursing work environment, and empathy capacity among hospice ward nurses and to identify the factors affecting person-centered care. Methods: Data were collected using a self-report questionnaire completed by 120 nurses at 30 inpatient hospice institutions in South Korea from August 24, 2020 to September 8, 2020. The independent t-test, one-way analysis of variance, and Pearson correlation analysis were conducted using SPSS version 26.0. Results: The scores were 3.76±0.45 for person-centered care, 3.58±0.47 for nursing professionalism, 3.24±0.57 for the nursing work environment, and 4.00±0.46 for empathy capacity. There were positive correlations between the variables. Factors that influenced the person-centered care of hospice nurses were being a manager (ß=0.20, P=0.002), high nursing professionalism (ß=0.20, P=0.012), a better nursing work environment (ß=0.15, P=0.033), and high empathy capacity (ß=0.51, P<0.001). The explanatory power was 65.3%. Conclusion: To reinforce the person-centered care competency of hospice nurses, it is necessary to improve nursing professionalism, the nursing work environment, and empathy competency. Opportunities for nurses to practice independently must be expanded for nurses to develop nursing professionalism. Sufficient nursing personnel and material resources must be provided to nurses to cultivate a positive work environment. Empathy should be improved by implementing integrated education programs that include nursing practice situations.

Experiences of Hospice and Palliative Nurses in Response to the COVID-19 Pandemic: A Qualitative Study.

Purpose: This study aimed to explore the experiences of hospice and palliative care (HPC) nurses at inpatient hospice centers in South Korea during the coronavirus disease 2019 pandemic. Methods: Data collection was conducted through individual interviews with 15 HPC nurses using face-to-face interviews, telephone calls, or Zoom videoconferencing. Data were analyzed using the thematic analysis method. Results: This study found that HPC nurses experienced practical and ethical dilemmas that reinforced the essential meaning and value of hospice and palliative care. The participants emphasized their practical roles related to compliance with infection prevention measures and their roles as rebuilders of hospice and palliative care. Conclusion: The findings of this study indicate that inpatient hospice centers must mitigate the practical and ethical dilemmas experienced by nurses, consider establishing explanation nursing units, and provide education to support nurses' highlighted roles during the pandemic. This study can be used to prepare inpatient hospice centers and the nurses that work there for future infectious disease outbreaks.

Current Status of Complementary Therapies Provided by Hospice Palliative Care in South Korea.

Purpose: The aim of this study was to investigatecomplementary therapiesprovided at hospice palliative care facilities in South Koreaas designated by the Ministry of Health and Welfare. Methods: The survey was conducted via e-mail from September 2 to September 23, 2020, with responsesfrom 109 therapists and 59 managers from 55 different hospice care facilities. Results: Hospices provided an average of 3.67 different types of therapies, ranging from 1 to 7 different types. The most common types of therapies were horticultural therapy (81.4%), music therapy (79.7%), art therapy (76.3%), and aromatherapy (57.6%). The average frequency of sessions was once a week, the median duration was 60 minutes. Most therapists (96.3%) had qualifications, but the certification-issuing organizations and training intensiveness varied greatly. None of the therapists were employed on a full-time basis, and their average monthly income was KRW 270,000. Therapists and managers gave average scores of 8.90 and 8.38 out of 10, respectively, regarding the positive impact of complementary therapies on patients. Conclusion: In order for patients and their families to benefit from complementary therapiesat hospice care facilities, in addition tobetter terms of employment for therapists, evidence-based guidelines for different types of therapies are needed so that therapy sessions can be conducted according to the theoretical underpinnings and characteristics of the type of therapy. It is expected that the results of this study will be used for policy-making in support of therapy as an essential hospice service.

Nurses' experiences of providing "sensitive nursing care" for terminally-ill individuals with cancer: A qualitative study.

PURPOSE: To explore the sensitive nursing care provided by nurses who care for terminally-ill individuals with cancer. METHODS: In-depth interviews were conducted using Colaizzi's phenomenological approach. Participants were 16 hospice specialists and four non-specialist nurses with experience in caring for terminal cancer patients in hospice specialized institutions in South Korea. RESULTS: Eight theme clusters were drawn from the data and these clusters had two dimensions consisting of sensitive attitudes and sensitive nursing behaviors. The sensitive attitudes included reflecting on past experiences, developing an accepting attitude toward death, using intuition to address critical situations, and having an open mind regarding collaborating with colleagues. The sensitive nursing behaviors contained listening to patients' needs, responding to patients in a manner suitable to their conditions, quickly responding to patients' problem, and providing a moment saying farewell. CONCLUSIONS: Teamwork and role models can help hospice specialists and non-specialist nurses caring for terminally-ill individuals with cancer to improve the sensitive nursing care. The sensitive attitudes and behaviors can be used as basic data for training programs designed to enhance nurses' sensitivity.

Visually Based Characterization of the Incipient Particle Motion in Regular Substrates: From Laminar to Turbulent Conditions.

Two different experimental methods for determining the threshold of particle motion as a function of geometrical properties of the bed from laminar to turbulent flow conditions are presented. For that purpose, the incipient motion of a single bead is studied on regular substrates that consist of a monolayer of fixed spheres of uniform size that are regularly arranged in triangular and quadratic symmetries. The threshold is characterized by the critical Shields number. The criterion for the onset of motion is defined as the displacement from the original equilibrium position to the neighboring one. The displacement and the mode of motion are identified with an imaging system. The laminar flow is induced using a rotational rheometer with a parallel disk configuration. The shear Reynolds number remains below 1. The turbulent flow is induced in a low-speed wind tunnel with open jet test section. The air velocity is regulated with a frequency converter on the blower fan. The velocity profile is measured with a hot wire probe connected to a hot film anemometer. The shear Reynolds number ranges between 40 and 150. The logarithmic velocity law and the modified wall law presented by Rotta are used to infer the shear velocity from the experimental data. The latter is of special interest when the mobile bead is partially exposed to the turbulent flow in the so-called hydraulically transitional flow regime. The shear stress is estimated at onset of motion. Some illustrative results showing the strong impact of the angle of repose, and the exposure of the bead to shear flow are represented in both regimes.

Family caregivers' awareness of illness and attitude toward disclosure during chemotherapy for advanced cancer.

OBJECTIVE: We investigated family caregivers' awareness of disease status and attitude toward disclosure of disease progression compared with those of cancer patients and explored the potential association between family caregivers' attitudes and patients' quality of life (QOL). METHODS: We carried out a survey using self-administered questionnaires answered by pairs of family caregivers and patients diagnosed with advanced cancer (n = 136 pairs). To assess patients' QOL, we used the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS: More than half of family caregivers (54%) did not have full knowledge of patients' advanced stage and goal of therapy. Positive attitudes toward disclosure were less common in family caregivers than in patients (59.4% and 85.4%, respectively; p < 0.01). The family caregivers' positive attitudes toward disclosure were inversely associated with patients' low functional scores (emotion [p = 0.04] and cognition [p = 0.02]) and high symptom scores (nausea and vomiting, pain, and insomnia; p < 0.05). However, in most QOL scales, patients' attitudes were not significantly associated with functioning and symptom scores. CONCLUSIONS: A large portion of family caregivers may not know the patients' exact status. This study also suggests that the family caregivers' attitudes may differ from patients' and may be associated with patients' QOL.