Journal of palliative medicine
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Background: End-stage respiratory disease and compromised clinical status can hinder patients' ability to use inhalers for effective symptom management. Nebulized and oral medications offer an alternative drug delivery method that may provide therapeutic benefits and reduce medication expenditure. Objectives: Primary research objectives were to determine the cost per patient per claim per day for inhaler devices, nebulized medications, or oral corticosteroids and to estimate the monetary waste generated by using inhalers at the end of life. ⋯ Conclusions: Inhaler use near the end of life generates a significant amount of monetary waste. Using a combination of nebulized and oral medications could reduce health care costs. Nebulized medications may generate less waste since providers can tailor the dispensed supply to the patient's needs rather than using the standard one-month supply of inhaler devices.
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Background: Although the importance of intensive care unit (ICU) nurse initiative in end-of-life (EOL) decision making has been confirmed, there are few studies on the nurses' initiative in EOL situations. Objectives: To explore the role and mechanism of facilitators/barriers and perceived stress on the behavior of ICU nurses that initiate EOL decision making (i.e., initiative behavior). Design: This research adopted a cross-sectional descriptive design. ⋯ Conclusion: In the EOL context, the decision initiative of ICU nurses was at a medium level. Medical managers should implement intervention strategies based on the path that affects the initiative behavior of ICU nurses to reduce barriers and stress level in the decision-making process. That is, they should improve inter-team collaboration, nurse-patient communication, clarity of role responsibilities, and emotional support in dying situations to increase initiative and participation of ICU nurses in decision making.
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As many people with intellectual disabilities (ID) live longer, the need for access to quality palliative care (PC) rises. People with ID realize significant barriers and inequities in accessing health care and PC. ⋯ The following tips are for PC clinicians caring for people with ID, their families, caregivers, and the community. While patient-centered care is difficult to distill into "tips," this article, written by an interdisciplinary team of PC and ID specialists, offers resources and references to improve the care provided to people with ID and serious illnesses.
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Background: How children die in pediatric intensive care units (PICUs) has been poorly described, and support for parents during this traumatic experience could be improved. Better information on perceptible signs of the end of life (EOL) in children may help mitigate the trauma. Objective: To describe the most common perceptible EOL signs in PICU patients. ⋯ Gasping was noted in 12 patients. Conclusion: Perceptible signs of the EOL were different from those reported in children dying in other units or in adults. Sharing information about signs of EOL with parents may prepare them and enable them to better support their child.