British journal of nursing (Mark Allen Publishing)
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Symptom control is an important part of maintaining a palliative patient's comfort and dignity, particularly in the end stages of their illness. Within the discipline of palliative care, the use of continuous subcutaneous syringe drivers is an important way of administering drugs at the end stages of a patient's illness to maintain symptom control. This study identified that ward staff had difficulty in obtaining the correct equipment, such as administration sets and Luer-lock syringes, leading to significant delays in patients being given drugs, affecting patient care and, when unable to obtain the correct equipment, the incorrect equipment was used. ⋯ The study aim was to identify whether the introduction of a centralized storage system of set boxes containing all the relevant equipment would resolve these issues and improve patient care and safety. The audit showed that a centralized storage system enhanced practice by ensuring that there was a standardized approach to the initiation and care of syringe drivers, including equipment when used in the palliative care setting. The system also provided easy access to the correct equipment, reducing in the delay of commencing treatment, as well as the risk of any adverse events.
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As the numbers of patients presenting with end-stage renal disease (ESRD) increases, more are opting to withdraw from dialysis, often due to increased suffering and poor prognosis related to other comorbidities. Concurrently, other renal patients are deciding to forgo dialysis, recognizing that the burden of frequent dialysis may outweigh likely survival and quality-of-life benefits. ⋯ There is a necessity for renal nurses to change from disease management through interventions of a physiological nature to that of providing support and symptom management. This article discusses the supportive and palliative nursing care needs of a population largely unheard in the literature - patients with ESRD - and highlights the need for further patient and carer-centred research in this area.
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Phantoms (painless and painful) occur following the removal of virtually all body parts. Phantoms of the limbs, including phantom limb pain (PLP), are the most studied. As yet there is no agreed theory to explain phantom limb pain but the neuromatrix and cortical reorganization theories have come to prominence over recent years. ⋯ This article explores all of these issues and identifies the implications that they have for the nursing treatment of patients with PLP and those that are expected to develop it. This involves the care of people pre-, peri- and post-amputation. All aspects of phantoms and phantom pain need to be taken into account by nurses and other healthcare workers when planning rehabilitation packages for this group.