The Nursing clinics of North America
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Nurs. Clin. North Am. · Jun 1985
Implications of the new hospice legislation and the accompanying regulations.
Recent government intervention into hospice care resulted from legislation designed to provide payment for care for Medicare recipients. The new regulations are reviewed, financial ramifications are investigated, and the possible implications of this reimbursement system are addressed.
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This article has reviewed the effects on the family system of the experience of living with a dying child. The importance of facilitating open channels of communication between the child who is dying, the mother, father, and the caregivers are discussed with examples of parents' and childrens' concerns and questions about the dying process. Finally, it is suggested that research conducted by a nurse researcher on families of children who are dying may itself be considered an intervention.
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The experience of terminal illness can best be viewed as a situation of multiple losses involving the dying person, family members and friends, and the health care providers engaged in offering services to them. It is a major transition during which the central participants must cope with the personal meanings of the forthcoming death as well as other losses brought about by the disease process, medical treatments, and the need to provide care for the dying person. How families adapt to the stresses and changes imposed by the experience of living with dying depends on their previous experiences with death, their established patterns of communication about serious matters, and their decision-making practices. ⋯ The delivery of nursing care in terminal illness requires an orientation to assessment as an ongoing process that makes use of knowledge about disease processes, medical treatments, individual and group adaptations to loss, risk factors suggestive of maladaptive responses, and family dynamics in relation to crisis and change. Although nurses bring expert knowledge about available treatments and resources, the process of assessment and decision-making about what needs to be done can be best accomplished through a process of contracting with the patient and family. These mutual agreements need to be concerned with the establishment of specific goals, plans for achieving them, available resources within the family, division of responsibility, time limits on the achievement of objectives, and mutual evaluation of the process and the outcomes.(ABSTRACT TRUNCATED AT 400 WORDS)
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Nurs. Clin. North Am. · Jun 1985
Symposium on compassionate care and the dying experience. Hope: its spheres and dimensions.
The phenomenon of hope has been described according to spheres and dimensions. The two spheres and six dimensions of hope, deduced from interviews and observations of elderly patients with cancer and tested on another population, serve as a theoretical model for understanding the complex nature of hope. ⋯ Therefore, there is always hope. The nursing challenge is to understand how hope may be operative, in order to facilitate and support this indispensable resource throughout the illness experience, but perhaps most importantly, during the last phase of a person's life.