Spiritual support for terminally ill patients: nursing staff assessments.

This study is part of a larger questionnaire survey concerned with the views of nursing staff on physical, emotional and spiritual support for terminally ill patients and decision making on the transition to the terminal phase of treatment. This article discusses the results concerning the spiritual support offered to terminally ill patients. The results describe the readiness and willingness of nursing staff to provide spiritual support, the expression of spiritual needs by patients, the provision of spiritual support, and problems occurring in providing this support. A total of 328 nurses working on the in-patient wards of 32 community health centres took part. Data were collected with a questionnaire including both multiple choice items and open-ended questions. The data were processed with SPSS software and the responses to the open-ended questions were interpreted using content analysis. The results revealed shortcomings in nurses' readiness and willingness to provide spiritual support and clearly highlighted the need for further training. Half of the nurses said they only rarely offered spiritual support to their patients. The nurses drew attention to problems within themselves, their patients and with the availability of the chaplain's services. The results also pointed to factors related to the health centre and nursing staff.

Attitudes of cancer patients, their family members and health professionals toward active euthanasia.

This qualitative study describes the attitudes of four groups of people in cancer care toward active euthanasia. Patients (32) with incurable cancer, their family members (13), nurses (13) and physicians (13) participated in the study which was carried out in two central hospitals and in four health centres in Finland. The data was collected by means of focused interviews which were taped, transcribed and then analysed by content analysis. More than half of the participants said that they could ethically justify active euthanasia. Most of these were family members and nurses. The main reasons for their ethical justification were the terminal illness of the patient, the presence of suffering and pain and the patient's own request. Those who could not justify active euthanasia said that one human being has no right to decide death of another. Potential abuse, uncertainty about the finality of the situation, the possibility of effective alleviation of symptoms and the effects which the practice might have on medical staff were also mentioned by this group. The results of this study support the assumption given in the earlier literature that attitudes toward active euthanasia are most positive where terminally ill cancer patients are concerned.

Cancer patients', family members' and professional helpers' conceptions and beliefs concerning death.

The purpose of this study was to examine the attitudes of different groups of people towards death, as well as their opinions and beliefs concerning life after death. The study is part of a larger research project in which cancer patients' suffering and coping were under examination. Data were collected in semi-structured focused interviews with 32 patients with incurable cancer, 13 family members, 13 nurses and 13 doctors from two central hospitals and four community health centres. The interviews were tape-recorded and transcribed verbatim. Data were analysed by content analysis. Most of the interviewees were not afraid of death. The professionals were slightly more often afraid of death than the patients and the family members. The participants gave many reasons for their opinions. The interviewees were not very interested in reading death-related literature. Only nurses had read a great deal of literature on death. Most of the participants believed in the existence of God and in life after death. The participants had different kinds of conceptions of the events after death. The doctors differed from the other groups in that they read less literature on death and had less faith in God and in life after death.

Cancer patients' reported experiences of suffering.

This study describes the nature and content of experiences of suffering by patients with incurable cancer. The main body of data was collected in interviews. A structured questionnaire was administered for additional information. Three different dimensions were identified in patient experiences of suffering: physical, psychologic, and social. Suffering has a physical foundation, which was divided into two categories: that caused by the illness itself and that caused by treatment of the illness. The primary sources of physical suffering were fatigue, pain, and the side effects of chemotherapy. The causes of psychologic suffering lie in the physiologic changes associated with the disease and in the imminence of death. Psychologic suffering was most typically manifested in depression, which most of the patients suffered during the initial stages of the disease, when the disease metastasized, and when they were in a particularly poor condition. General deterioration and fear of infections very much restrict the social life of cancer patients, causing them to withdraw into their home or the hospital.

Ethical dilemmas in the care of patients with incurable cancer.

This article aims to identify and describe the ethical dilemmas that are involved in the care of patients with incurable cancer. The data were collected in semistructured focused interviews with 32 patients, 13 nurses and 13 doctors from two central hospitals and four community health centres. The interviews were tape-recorded and transcribed verbatim. Interpretation was based on the method of content analysis. Ethical dilemmas occurred at the time of diagnosis, in connection with telling the truth, in providing information, in the treatment of pain, and in decision-making situations concerning active treatment. Dilemmas of active treatment concerned chemotherapy, intravenous infusions, blood transfusions and antibiotics. There were also problems in relationships between nursing staff and next of kin, as well as a lack of co-operation between nurses and doctors.

[Attitude of cancer patients, their relatives, nurses and doctors to active euthanasia]. / Syöpää sairastavien potilaiden, omaisten ja ammattiauttajien suhtautuminen aktiiviseen eutanasiaan.

In this qualitative study the attitudes of the different groups of people to active euthanasia are described. 32 persons having incurable cancer, 13 relatives, 13 nurses and 13 doctors participated in the study. The study was carried out in two central hospitals and in four local hospitals. The data was collected by theme-interviews. The interviews were taped and transcribed. The interview-texts were analysed by content analysis. More than half of the participants in the study approved of active euthanasia. Among the relatives and the nurses the approval was most common. Also the attitudes of the doctors were more positive that it has been reported in the earlier studies. In the decision making concerning active euthanasia the persons with positive attitude emphasized the meaning of terminal illness, the existence of suffering and pain and the self-determination of the person. The persons with negative attitude said that a human being has no right to decide on the death of an other human being. The misuses, the uncertainty of the finality of the situation and the effective possibilities to the symptom control came out too. The doctors mentioned also the arguments concerning their own profession.

Ethical decision making on starting terminal care in different health-care units.

Set in the context of a major research project on terminal care for cancer patients, this paper examines the process in which the ethical decision is taken to proceed to the stage of terminal care. The sample consisted of 191 nurses from three different health-care units in Finland: a health centre, a central hospital and a radiotherapy clinic. The data were collected in August and September 1989 by means of a postal questionnaire, and they were analysed by cross-tabulation and chi-squared tests. According to the nurses in all three units, there is often no definite and explicit decision to commence terminal care with elderly cancer patients. It was felt that patients and relatives have only very little say in the decision-making process. The nurses themselves would also have wanted to be more closely involved. Most of them said that the decision is usually taken by the doctor alone, especially in the central hospital. The nurses at the radiotherapy clinic said that almost all of their patients are informed of the decision to start terminal care. At the health centre and central hospital, only less than half of the patients are informed.

[Ethical decision making of nurses associated with the feeding of demented patients and terminally ill elderly cancer patients in 7 countries]. / Dementiapotilaiden ja terminaalivaiheessa olevien iäkkäiden syöpäpotilaiden syöttämiseen liittyvä hoitotyön eettinen päätöksenteko eri maissa.

This article clarify the results of the international study, carried out in seven countries. The purpose of the study was to clarify the ethical decision making of the nurses working with demented patients and with elderly cancer patients in terminal state, who refused to eat. In the structured interview a different kind of case study was presented to the nurses (N = 300) working with demented patients and to the nurses working with cancer patients. Nurses were asked to make a decision to feed or not to feed the patient. Justifications to the decision were also demanded. The subjects were also asked under what conditions they would change their decision. The most part of the nurses working with cancer patients made a decision not to feed the patient. Nurses from China and quite many from Israel chose however to feed the patient. The half of the nurses working with demented patients made a decision to feed the patient and an other half prefer not to feed the patient. Nurses from China, Israel, Finland and Kalifornia did prefer feeding and nurses from Australian, Sweden and Canada chose mostly not to feed the patient. The majority who chose not to feed the patient used the principle of autonomy as justification. Nurses who made a decision to feed the patient stressed mostly the principle of sanctity of life. Nurses changed their decision mostly when a doctor, nursing staff or patient's husband had different kind of opinion of the strategy to nurse the patient. Nurses from Sweden and China changed mostly their attitude because of the order of the doctor. The opinion of the staff was most important to australian nurses and the opinion of the husband had most influence to finnish nurses.

[Ethical decision making and the beginning of terminal care in various nursing units]. / Eettinen päätöksenteko ja terminaalihoidon aloittaminen eri hoitoyksiköissä.

This article reviews the ethical decision making in moving to terminal care in different nursing unites from viewpoint of nurses. The research results presented in this article are part of the larger study, which dealt with the terminal care of an elderly patient (Kuuppelomaki 1991). Nurses, special nurses and head nurses (N = 191) working in local hospitals, in central hospitals and in radiotherapy clinics participated in the study. The research material was collected by questionnaires during august and september in year 1989. In the processing of the research material cross-tabulations were used. The statistical significance of the differences in results of groups was tested by the Chi-Square. It was found out that the decision of terminal care is often left unmade both in local hospitals, in central hospitals and in radiotherapy clinics. According to the nurses patients and relatives didn't take part very much in decision making process. The participation of nurses were also more less than the willingness of them. Most often the decision was made by the doctor alone, especially in central hospital. Almost every patient in radiotherapy clinics knew about the decision of terminal care but in local hospitals and in central hospitals less than half of them knew about the thing.

[Ethical problems concerning the feeding of aged patients and of patients in the terminal stage]. / Eettiset ongelmat iäkkäiden terminaalivaiheessa olevien potilaiden syöttämisessä.

The purpose of this study was to explain the nurses' and the special nurses' decision making and the facts with it in connection to eating problems with the old, seriously demented patients and with the old cancer patients in terminal stage. The study was carried out by interviewing 40 nurses and special nurses. Twenty of them was working with dementia patients in the wards of two health centers and twenty nurses had experience by caring cancer patients in terminal stage in one central hospital. The structural interview schedule was used and the interviews were recorded. It was found in the study, that the most nurses in cancer care didn't want to feed a patient against his will. In dementia care most of the nurses were ready to feed a patient. The opinion of relatives, order given by a physician, the attitudes of the other medical staff and the suffering caused by feeding the patient were the facts, which effected to the decision making of the nurses, especially in dementia care.