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De Clercq E, Gamondi C. Challenges for palliative care professionals in providing spiritual care to patients from religious or cultural minority groups: a scoping review of the literature. Int J Palliat Nurs 2023; 29:6-16. [PMID: 36692483 DOI: 10.12968/ijpn.2023.29.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In light of the increasing number of people living into advanced age and the intensification of migration flows, care provision to multi-cultural and religious patient populations has become an important concern for many palliative care professionals. The current scoping review aims to explore the main barriers to spiritual care provision for minority groups and identify some strategies to overcome such obstacles. The review draws some general recommendations for researchers, policymakers and clinicians. First, more empirical research on different patient groups is needed; studies should target not only nurses, but also other healthcare providers, to ensure that practice adequately reflects the multidisciplinary nature of palliative care. Secondly, training and education should be offered in various forms and at different levels, as well as go beyond factual knowledge about the beliefs and practices of various religions.
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Affiliation(s)
- Eva De Clercq
- Doctor, University of Basel, Institute for Biomedical Ethics, Switzerland
| | - Claudia Gamondi
- Doctor, University of Basel, Institute for Biomedical Ethics, Switzerland
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Son D, Oishi A, Taniguchi S. The experience of providing
end‐of‐life
care at home: The emotional experiences of young family physicians. J Gen Fam Med 2022; 23:376-383. [DOI: 10.1002/jgf2.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/14/2022] [Accepted: 07/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Daisuke Son
- Department of Community‐based Family Medicine, Faculty of Medicine Tottori University Yonago Japan
- Department of General Medicine Hino Hospital Hino‐gun Japan
| | - Ai Oishi
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - Shin‐ichi Taniguchi
- Department of Community‐based Family Medicine, Faculty of Medicine Tottori University Yonago Japan
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Maniam R, Tan MP, Chong MC. End of life care preference among hemodialysis population: Revisit Q methodology. PATIENT EDUCATION AND COUNSELING 2022; 105:1495-1502. [PMID: 34625322 DOI: 10.1016/j.pec.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE End-of-life care is often overlooked in the dialysis unit despite high mortality rates. This study aimed to understand the diverse subjectivity of opinions on end-of-life care preferences, feelings, needs, value and goals in life among a haemodialysis population. METHODS The Q methodology was used where 37 opinion statements were ranked in order of importance in a unimodal shaped grid. Results were explored using the Centroids factor extraction and Varimax rotation. RESULTS Four-three persons living with haemodialysis, mean age± SD= 56.58 ± 10.22 years, participated in the study. Five-factors were identified: living in the present, family preference, self preservation, power vs. control and autonomy in decision making, loaded by eleven, four, four, three and three participants with 16 individuals not loading significantly and two were confounded. Preferences for remaining positive in the face of illness through a healthy lifestyle and preserving relationships and autonomy were demonstrated. CONCLUSIONS End-of-life discussions are potentially inhibited by preferences to live for the present which should be explored in future studies. PRACTICE IMPLICATION Statement sets may be used to help facilitate end-of-life discussions through identification of opinion groups. Establishing preferences may guide identification of those willing to initiate discussions.
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Affiliation(s)
- Radha Maniam
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur Malaysia.
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Penman J, Malik G, Rogerson K, Murphy J, Zhong Y, Johnson CE. It's all about the individual's right to choose: A qualitative study of Australian culturally and linguistically diverse nurses’ knowledge of and attitudes to voluntary assisted dying. Collegian 2022. [DOI: 10.1016/j.colegn.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Weber O, Semlali I, Gamondi C, Singy P. Cultural competency and sensitivity in the curriculum for palliative care professionals: a survey in Switzerland. BMC MEDICAL EDUCATION 2021; 21:318. [PMID: 34088305 PMCID: PMC8178817 DOI: 10.1186/s12909-021-02745-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cultural and linguistic diversity in patients and their relatives represents a challenge for clinical practice in palliative care around the world. Cross-cultural training for palliative care professionals is still scarce, and research can help determine and support the implementation of appropriate training. In Switzerland, health policies address diversity and equity issues, and there is a need for educational research on cross-cultural training in palliative care. The aim of this study was to investigate the clinical challenges faced by Swiss palliative care professionals when working with migrant patients and their relatives. We also documented professionals' interests in cross-cultural training. METHODS A web survey of professionals working in specialized palliative care in the French- and Italian-speaking areas of Switzerland investigated clinical challenges with migrant populations and interests in various training opportunities. RESULTS A total of 204 individuals responded to the survey, 48.5 % of whom were nurses. The major difficulties they reported were communication impediments associated with patients' linguistic and/or cultural backgrounds. In relation to educational needs, they expressed a particular interest in communication techniques that would allow them to deal with these issues autonomously. The professionals expressed less interest in training on collaborating with other professionals and examining one's own stereotypes. CONCLUSIONS Palliative care professionals' post-graduate and continuing education must address communication techniques for sensitive palliative and end-of-life topics in cross-cultural contexts. Beginning with their pre-graduate studies, health professionals should assimilate the importance of collaborating with other professionals in complex cross-cultural situations and learn to reflect on their stereotypes and pre-conceptions in clinical practice.
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Affiliation(s)
- Orest Weber
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Imane Semlali
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
- Liaison Psychiatry service, Av. de Beaumont 23, 1011, Lausanne, Switzerland.
| | - Claudia Gamondi
- Palliative and Supportive Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Pascal Singy
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Eltaybani S, Igarashi A, Yamamoto-Mitani N. Assessing the Palliative and End-of-Life Care Education-Practice-Competence Triad in Intensive Care Units: Content Validity, Feasibility, and Reliability of a New Tool. J Palliat Care 2020; 36:234-242. [PMID: 32779529 DOI: 10.1177/0825859720948972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To date, a comprehensive, psychometrically robust instrument to assess palliative and end-of-life (PEOL) care education, practice, and perceived competence among intensive care unit (ICU) nurses does not exist. OBJECTIVE To examine content validity and reliability of a proposed instrument to assess the PEOL care education-practice- competence triad among ICU nurses. METHODS An international modified e-Delphi and a cross-sectional pilot questionnaire survey. The Delphi involved 23 panelists from 11 countries. The pilot study involved 40 staff nurses and 3 nurse managers from 3 adult ICUs in a randomly selected hospital in Egypt. An instrument was developed and judged for content validity by international panelists, and then pretested in a pilot study, where data were collected at 2 time points using self-administered questionnaires, followed by cognitive interviews. Test-retest reliability was examined using intraclass correlation (ICC), standard error of measurement (SEM), and repeatability coefficient (RC). RESULTS The panelists confirmed content validity of the proposed instrument, and staff nurses confirmed its comprehensibility. At the level of the instrument's total scores, the lowest ICC was .9 (95% confidence interval: .8-.9); and the highest SEM and RC were 4.8 and 13.3, respectively. CONCLUSIONS The PEOL Care Index is a comprehensive, comprehensible, content valid, and reliable instrument to assess the PEOL care education-practice-competence triad among ICU nurses. Construct and criterion validities need to be confirmed in future studies. Applicability of the PEOL Care Index in different settings and cultures needs to be examined.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long-Term Care Nursing/Palliative Care Nursing, The University of Tokyo, Tokyo, Japan.,Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Alexandria Governorate, Egypt
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-Term Care Nursing/Palliative Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-Term Care Nursing/Palliative Care Nursing, The University of Tokyo, Tokyo, Japan
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Jahn Kassim PN, Alias F. Religious, Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making. JOURNAL OF RELIGION AND HEALTH 2016; 55:119-134. [PMID: 25576401 DOI: 10.1007/s10943-014-9995-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Religion and spirituality have always played a major and intervening role in a person's life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient's religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient's values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients' varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.
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Affiliation(s)
- Puteri Nemie Jahn Kassim
- Civil Law Department, Ahmad Ibrahim Kulliyyah of Laws, International Islamic University Malaysia, 53100, Kuala Lumpur, Malaysia.
| | - Fadhlina Alias
- Ahmad Ibrahim Kulliyyah of Laws, International Islamic University Malaysia, 53100, Kuala Lumpur, Malaysia
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Datta R, Chaturvedi R, Rudra A, Jaideep CN. End of life issues in the intensive care units. Med J Armed Forces India 2012; 69:48-53. [PMID: 24532934 DOI: 10.1016/j.mjafi.2012.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Accepted: 03/23/2012] [Indexed: 11/16/2022] Open
Abstract
A structured discussion of End-of-Life (EOL) issues is a relatively new phenomenon in India. Personal beliefs, cultural and religious influences, peer, family and societal pressures affect EOL decisions. Indian law does not provide sanction to contentious issues such as do-not-resuscitate (DNR) orders, living wills, and euthanasia. Finally, published data on EOL decisions in Indian ICUs is lacking. What is needed is a prospective determination of which patients will benefit from aggressive management and life-support. A consensus regarding the concept of Medical Futility is necessary to give impetus to further discussion on more advanced policies including ideas such as Managed Care to restrict unnecessary health care costs, euthanasia, the principle of withhold and/or withdraw, ethical and moral guidelines that would govern decisions regarding futile treatment, informed consent to EOL decisions and do-not-resuscitate orders. This review examines the above concepts as practiced worldwide and looks at some landmark judgments that have shaped current Indian policy, as well as raising talking points for possible legislative intervention in the field.
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Affiliation(s)
- Rashmi Datta
- Senior Advisor, Anaesthesiology, Army Hospital (R&R), New Delhi, India
| | - R Chaturvedi
- Dean & Deputy Commandant, CH (AF), Bangalore 560 007, India
| | - A Rudra
- Commanding Officer, 408 Field Hospital, C/o 56 APO, India
| | - C N Jaideep
- Associate Professor, Anaesthesiology, AFMC, Pune 40, India
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Valiee S, Negarandeh R, Dehghan Nayeri N. Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study. Nurs Crit Care 2012; 17:309-15. [PMID: 23061621 DOI: 10.1111/j.1478-5153.2012.00523.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A challenge for intensive care nurses is providing the best possible care to patients in an end-of-life stage. The fact that some patients will die despite the efforts of the health care team can affect the psychological state of the nurses and families. Lack of attention to such an issue can bring about unpleasant consequences for both patients and nurses. AIM Using a qualitative design, the aim is this article explores the experiences of intensive care nurses providing care for end-of-life patients. METHODS The data were collected through in-depth interviews with a purposive sample of 10 nurses working at intensive care units (ICUs). Interviews were transcribed and finally analysed through the conventional content analysis. FINDINGS Two themes emerged out of the experience of providing care to the end-of-life patients. The findings revealed that for Iranian intensive care nurses providing care to such patients was accompanied by emotional burden and values and beliefs. CONCLUSION The results of the study have increased the current knowledge over the experience of providing care to end-of-life patients at ICUs. It also has revealed the need for providing the nurses with psychological support, accommodating the possibility for offering a complete care, attending to and managing the conditions of the patient and their families and engaging nurses in decision making about end-of-life patients. RELEVANCE TO PRACTICE Managers ought to provide specialized units for providing care to end-of-life patients. Nurses working on these units will require emotional support.
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Affiliation(s)
- Sina Valiee
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Albarran J, Scholes J. This article has been retracted and is available online only: Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study. Nurs Crit Care 2012; 17:268. [PMID: 22897813 DOI: 10.1111/j.1478-5153.2012.00505.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RETRACTION: The following article from Nursing in Critical Care, 'Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study' by Sina Valiee, Reza Negarandeh and Nahid Dehghan Nayeri, published online on 9 May 2012 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors and the journal Editors. The retraction has been agreed due to errors in the manuscript handling process which meant that an early version of the article was published that did not include all the amendments made as part of the peer review process. John Albarran and Julie Scholes Editors Nursing in Critical Care REFERENCE Valiee, S., Negarandeh, R. and Dehghan Nayeri, N. (2012), Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study. Nursing in Critical Care. doi: 10.1111/j.1478-5153.2012.00505.x.
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Abstract
AIM This paper discusses end-of-life care (EoLC) in critical care through exploration of what is known from the international literature and what is currently presented within UK policy. BACKGROUND AND CONTEXT EoLC is an important international critical care issue, and currently provides a key focus for health care policy in the UK. While society holds that critical care is delivered in a highly technical area with a strong focus on cure and recovery, mortality rates in this speciality remain at approximately 20%. When patient recovery is not an outcome, discussions with patient, family and extended care teams turn towards futility of treatment and end-of-life management. However, there are specific barriers to overcome in EoLC for the critically ill. CONCLUSION A key issue for EoLC in critical care is a lack of robust systems to prospectively identify individuals who are most at risk of dying. A further challenge is divergent perspectives within and across clinical teams on treatment withdrawal and limitation practices. To streamline patient management and underpin a hospice approach to care, EoLC policies are currently being used within the UK. While this provides a national framework to address some key critical care clinical issues in the UK, there is a need for further refinement of the tool to reflect the reality of EoLC for the critically ill. It is important that international best practice exemplars are examined and clinicians actively engage and contribute to ensure that any local EoLC frameworks are fit for purpose.
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Affiliation(s)
- Maureen Coombs
- Critical Care, Southampton University Hospitals Trust, Southampton, UK.
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