International journal of palliative nursing
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This article examines the impact legislative developments in the UK have had, and are likely to have, on health care in general and how specialist palliative care providers may need to adapt to these changes. The focus of adaptation is on communication and multidisciplinary teamwork. A brief review of the previous Conservative government's reforms offers a background to understanding how the current Labour government agendas affecting health and social care have been developed. Ideas are put forward to ensure that specialist palliative care provision is maintained and developed within the current structure of the health service.
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Individuals who are involved with the death of a person with a terminal illness will often classify the death as either 'good' or 'bad'. Families and healthcare practitioners assess many factors when determining their 'success' or 'failure' in assisting someone in the terminal phase. Palliative care nurses are particularly vulnerable to self-assessments about care of the dying, because death is a daily occurrence. ⋯ This article reports the findings of a study involving interviews with 20 palliative care nurses to determine their perceptions of a good and bad death. The study also examined the expectations they hold of themselves and that they believe others hold of them in helping patients to attain a good death. Clinical implications are discussed based on these findings.
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Subcutaneous drug infusion using a portable syringe driver has had a significant impact on patient comfort in palliative care. It permits the continuous delivery of a range of drug therapies, so bypassing problems of dysphagia, weakness and the inability of many patients in the terminal phase to take oral medication. ⋯ Mechanical problems, reactions at the infusion site and difficulties with the mixing of drugs in the syringe are all widely recognized. This article reviews some general issues with the operation of portable syringe drivers, and discusses a range of potential problems and their solutions.
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Recent UK government initiatives have stressed the importance of patient choice in health care. In relation to palliative care, this involves the achievement of the best quality of life, respect for patient autonomy and choice over treatment options. Regarding selection of analgesic, the treatment options are evaluated by considering efficacy and potency, routes of delivery, titration and conversion, adverse effects and cost effectiveness. ⋯ Opioid selection should take into account quality of life issues. However the scope for opioid selection seems likely to be restricted by considerations of cost effectiveness. The challenge is to ensure that the patient voice is heard.
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Audit should be an integral part of any palliative care service. Terminal care is a continuum of palliative care. When looking for an objective measure for referrals to a new palliative care service within a specialist cancer hospital in Ireland, patient death was used as an end point. ⋯ Data from these audits were presented on several different occasions to both nursing and medical staff. This article describes these audits in detail and highlights some of the issues raised. Audit in palliative care is discussed.