Nurses and health support workers' views on cardiopulmonary resuscitation in a hospice setting

End-of-life care pathways as tools to promote and support a good death: a critical commentary

This paper calls into question whether and how end-of-life care pathways facilitate the accomplishment of a 'good death'. Achieving a 'good death' is a prominent social and political priority and an ideal which underpins the philosophy of hospice and palliative care. End-of-life care pathways have been devised to enhance the care of imminently dying patients and their families across care settings and thereby facilitate the accomplishment of a 'good death'. These pathways have been enthusiastically adopted and are now recommended by governments in the UK as 'best practice' templates for end-of-life care. However, the literature reveals that the 'good death' is a nebulous, fluid concept. Moreover, concerns have been articulated regarding the efficacy of care pathways in terms of their impact on patient care and close analysis of two prominent end-of-life pathways reveals how biomedical aspects of care are privileged. Nonetheless drawing on a diverse range of evidence the literature indicates that end-of-life care pathways may facilitate a certain type of 'good death' and one which is associated with the dying process and framed within biomedicine.

Should People Die a Natural Death?

In the article the concept of natural death as used in end-of-life decision contexts is explored. Reviewing some recent empirical studies on end-of-life decision-making, it is argued that the concept of natural death should not be used as an action-guiding concept in end-of-life decisions both for being too imprecise and descriptively open in its current use but mainly since it appears to be superfluous to the kind of considerations that are really at stake in these situations. Considerations in terms of the quality of life cost of the intervention in relation to the quality and length of life benefits of the same intervention. In referring to the concept of natural death we risk to blur these considerations and end up in difficult distinctions between what is a natural and non- or un-natural death, a distinction which it is argued is of no real moral interest.

Practical effects of educating nurses on the Natural Death Act

BACKGROUND

The aim of this study was to investigate a nursing staff's knowledge of the Natural Death Act before and after an educational intervention.

PATIENTS AND METHODS

This was a quasi-experimental designed study. Questionnaires were sent to 135 nurses in a medical center who volunteered to participate in the educational program. Demographic data and knowledge of the Natural Death Act were collected. The return rate was 85.37% (n=105). The educational program lasted for 6 h and included five subjects: hospice-palliative care, Natural Death Act, how to face suffering patients, nursing for agonized patients, and communicating with families. The program was a combination of lectures, case discussions, evaluation of individuals' values, and attitudes toward patient death.

MAIN RESULTS

At baseline, the average total score in the 18-item questionnaire on the Natural Death Act was 12.96, with a range of 5-18. After the educational intervention, the average total score increased from 12.9 correct answers to 17.04 (of 18). The average increase was 4.08 points, a statistically significant difference.

CONCLUSIONS

A provision of appropriate training for medical professionals appears to be a useful educational strategy, and this result shows that the Natural Death Act should be included in nursing school educational program. In the future, more effort should be made to fulfill patients' expectations and to follow medical ethics guidelines.

Staff views on cardiopulmonary resuscitation

Costello and Horne are to be congratulated on their study looking at staff views on cardiopulmonary resuscitation (CPR) (Costello and Horne, 2003), it is undoubtedly a more detailed piece of work than the study that I was involved in Liverpool (Thorns and Ellershaw, 1999). Research in this area is vital, as it remains an issue causing much professional and public concern.