Comment: Beyond the borders – where do we go?
Lukas Radbruch
pp 3-3
‘An increasing number of hospice providers would argue that, while assisted suicide and euthanasia should not be commonly performed, there may be extraordinary circumstances in which compassion compels actions to shorten life.’
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Acute akathisia in palliative care
Clare White and Neil Jackson
pp 5-7
The term akathisia (Greek, ‘not sitting still’) was used at the beginning of the 20th century by Haskovec (1909) to describe the restlessness and pacing observed in patients suffering from hysteria and neurasthenia. Later a similar syndrome was observed in post-encephalitic patients and those with idiopathic parkinsonism.
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The use of levomepromazine in palliative care
Eric Prommer
pp 8-10
Neuroleptic drugs effectively treat many symptoms such as nausea, vomiting, delirium and agitation, which are experienced by patients with advanced cancer. They are often suggested as adjuvant analgesics, despite a lack of evidence from controlled trials. Levomepromazine (methotrimeprazine) is a unique neuroleptic in that there is evidence that suggests it has dose-related analgesia comparable with opioid-mediated analgesia and an ability to control nausea, vomiting and delirium.
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Rapid opioid titration in severe cancer pain
Mellar Davis and Declan Walsh
pp 11-14
Successful management of cancer pain requires the right dose of opioid given at the right time. This is particularly true when faced with a patient who has severe or crescendo pain. Such pain emergencies need both parenteral administration and individualised dosing to response since there are large individual differences in opioid requirements. We will review dosing strategies for severe cancer pain and assessment but not breakthrough pain or transient pain due to procedures. Titration will be defined as either planned opioid dose escalation at fixed or variable intervals and/or titration by loading dose followed by maintenance opioids.
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Answering difficult questions
Jan Ablett, Lesley Dunleavy and Jane Nowlan
pp 16-17
The ability to communicate well is an essential skill for all those involved in caring professions. A workshop on communication skills, specifically answering difficult questions, was developed in response to requests from care staff in residential and nursing homes for further training in working with patients and their families. It was provided by two members of an integrated multiprofessional palliative care team and by a member of the multidisciplinary older adult team who all work across both community and hospital settings.
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End-of-life patient-controlled analgesia at home
Vianney Mourman
pp 18-21
Our palliative care support team in Le Cher, France, has been in existence for just over a year. To facilitate home care for patients at the end of life, it provides care co-ordination, advice and specialised medical and psychosocial care for patients and their relatives. The team has worked with over 160 patients, about half of whom (48%) have died at home or in an equivalent location, such as a retirement home.
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The Mercer model of paediatric palliative care
Erica Brown and Angela Mercer
pp 22-25
Although family-care practices are not new, they embrace basic healthcare, and a philosophy of holistic family-centred care has become a fundamental principle of paediatric nursing. However, despite the Department of Health and the Health Quality Service endorsing the important role of parents as carers, there is still sparse evidence for practice in paediatric palliative care. Several established nursing models support the notion of the family as a unit of care and make reference to the particular challenges of caring for people who are life-limited and life-threatened. Yet cynics argue that such practice often reflects self sufficiency rather than holistic care.
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The role of hope in serious illness and dying
Alun Charles Jones
pp 28-31
Helping individuals and their families make sense of the experience of illness is an aspect of nursing care that is fundamental to working with issues of serious illness, dying and bereavement. This article examines hope in the context of nursing relationships and in instances of serious physical illness.
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Reconnecting death and intellectual disability
Stuart Todd and Noelle Blackman
pp 32-34
One of the most remarkable changes for people with intellectual disabilities over the past 100 years has been their increasing longevity. For the majority, life expectancy has come to approximate the norm. Although many people with more profound disabilities have shorter lives, the benefits of improved medical treatments and life conditions are apparent for all.
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Intercultural experiences of training in the Maghreb
Françoise Porchet, Gisèle Schaerer, Philip Larkin and Sophie Leruth
pp 35-37
Further to our involvement in the fourth Europe–Maghreb congress on the theme of Pain and Supportive Care: Current Advances, held in Tabarka, Tunisia in late September 2004, we would like to share our experiences, which have enriched us considerably on both a personal and a professional level.
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Case study masterclass 18 answers: Aileen’s story: palliative care from a patient’s perspective
Carol Davis
pp 38-38
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