Comfort-Supporting Nursing Activities for End-of-Life Patients in an Institutionalized Environment

Applying Comfort Theory to Improve Outcomes for People in Sickle Cell Crisis

When people with sickle cell disease in vaso-occlusive crisis need hospitalization, they often experience fragmented and disparate treatment. Racial, gender, and socioeconomic treatment bias by providers, including nurses, is complicated by the current reactionary United States (US) controlled substance policies. To provide high-quality and respectful care, nurses can use Kolcaba's Comfort Theory as the framework for a holistic plan to assess, deliver individualized interventions, and evaluate outcomes for people experiencing vaso-occlusive crisis. Once in the electronic medical record, it can guide care during future hospitalizations. By refocusing on the nursing value of providing comfort care to individuals in distress, nurses can change treatment outcomes for clients.

Factors influencing nurse spiritual care practices at the end of life: A systematic review

OBJECTIVES

The aim was to identify determinants of nurse spiritual/existential care practices toward end-of-life patients. Nurses can play a significant role in providing spiritual/existential care, but they actually provide this care less frequently than desired by patients.

METHODS

A systematic search was performed for peer-reviewed articles that reported factors that influenced nurses' spiritual/existential care practices toward adult end-of-life patients.

RESULTS

The review identified 42 studies and included the views of 4,712 nurses across a range of hospital and community settings. The most frequently reported factors/domains that influenced nurse practice were patient-related social influence, skills, social/professional role and identity, intentions and goals, and environmental context and resources.

SIGNIFICANCE OF RESULTS

A range of personal, organizational, and patient-related factors influence nurse provision of spiritual/existential care to end-of-life patients. This complete list of factors can be used to gauge a unit's conduciveness to nurse provision of spiritual/existential care and can be used as inputs to nurse competency frameworks.

A conceptual analysis of the meaning of comfort at the end-of-life using the Walker and Avant (2014) Framework

Objective

The aim of the authors is to clarify the concept of comfort at the end-of-life in order to support understandings of fundamental nursing care needed at this stage of healthcare.

Methods

The Walker and Avant framework was applied to develop a deeper understanding of the concept of comfort at the end of life.

Results

Five defining attributes of comfort in the end-of-life were identified and they are having a peaceful home-life environment, trust and consolation, proximity and social-cultural support, alleviation of suffering, and a process of integrated intervention by nurses.

Conclusions

At the end-of-life patients commonly experience physical, psychological, social-cultural, and environmental discomfort. Patients’ families also encounter significant challenges. However, their comfort needs are often secondary to that of the patient. Additionally, a lack of clarity exists regarding the holistic meaning of comfort at the end-of-life, which can largely be confined to understandings of physical comfort for the patient, with a limited understanding of addressing family/caregivers’ needs. Therefore, this concept analysis may provide some guidance in this regard and also provides support toward a more integrated understanding of the concept.

Predictors of quality of life and attitude to ageing in older adults with and without dementia

OBJECTIVES

This study explored the quality of life (QoL) and attitudes to aging in older adults with and without dementia, and ascertained the main factors that predict QoL and attitude to ageing.

METHODS

A cross-sectional study involving 563 community-dwelling adults with (PwD) and without dementia (PwoD) >60 years of age was conducted in three Czech regions. A tools battery including the Quality of Life-Alzheimer's Disease Scale, Geriatric Depression Scale, Patient Dignity Inventory, Attitude to Aging Questionnaire (AAQ), Short Physical Performance Battery, and Barthel Index, were administered.

RESULTS

PwD had worse scores in QoL and AAQ (both p = 0.0001). Less depression (p < 0.001), better sense of dignity (p < 0.05), and lower pain (p < 0.05) in PwoD predicted better scoring for QoL and AAQ. Physical ability in PwoD (p < 0.05), living alone (p < 0.05) and self-sufficiency (p < 0.001) in PwDwere predictors influencing QoL.Age (p < 0.01) in PwoD, gender (p < 0.05) and physical ability (p < 0.001) in PwD influenced AAQ.

CONCLUSIONS

This research is the first study to show that dignity can influence the QoL and attitude to aging in community-dwelling older adults. Our findings suggest that depression and dignity are common predictors of QoL and AAQ in older adults with and without dementia.

Psychometric Properties of the Czech Version of the Falls Efficacy Scale-International in Patients with Early-Stage Dementia

Introduction

A fear of falling marks an important psychological factor connected with a reduction in the life space of people with dementia. The Czech version of the Falls Efficacy Scale-International (FES-I) has not been validated in patients with early-stage dementia.

Methods

The tests were administered to 282 patients with early-stage dementia. The test battery included the following: the FES-I, the Short Physical Performance Battery, the Geriatric Depression Scale, the Bristol Activity Daily Living Scale, and the Quality of Life-Alzheimer's Disease Scale. Internal reliability (Cronbach's α and intraclass correlation [ICC]), Pearson's and Spearman's correlations, exploratory factor analysis, and a t test for independent samples were used for statistical analyses.

Results

The Czech version of the FES-I had excellent internal and test-retest reliability (Cronbach's α = 0.98, ICC = 0.90; 95′ CI 0.82–0.94). Factor analysis suggested 2 relevant factors. A significantly higher FES-I score was associated with patients with early-stage dementia who were older (p = 0.003) or female (p = 0.001), lived alone (p = 0.0001), spent >8 h a day alone (p = 0.032), used mobility aids (p < 0.0001), or had severe hearing (p = 0.004) or vision impairment (p < 0.0001) or a lower education (r = −0.16, p = 0.007).

Conclusion

The Czech version of the FES-I had very good reliability and validity and may be useful in future cross-cultural comparisons in research among patients with early-stage dementia.

Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature

Many studies on spiritual care in palliative care are performed in the US, leaving other continents unexplored. The objective of this systematic review is to map the recent studies on spiritual care in palliative care in Europe. PubMed, CINAHL, ATLA, PsycINFO, ERIC, IBSS, Web of Science, EMBASE, and other databases were searched. Included were European studies published in a peer-reviewed journal in 2015, 2016, or 2017. The characteristics of the included studies were analyzed and a narrative synthesis of the extracted data was performed. 53 articles were included. Spiritual care was seen as attention for spirituality, presence, empowerment, and bringing peace. It implied creative, narrative, and ritual work. Though several studies reported positive effects of spiritual care, like the easing of discomfort, the evidence for spiritual care is low. Requirements for implementation of spiritual care in (palliative) care were: Developing spiritual competency, including self-reflection, and visibility of spirituality and spiritual care, which are required from spiritual counselors that they participated in existing organizational structures. This study has provided insight into spiritual care in palliative care in Europe. Future studies are necessary to develop appropriate patient outcomes and to investigate the effects of spiritual care more fully.