Visiting Nurses' Perspectives on Practices to Achieve End-of-Life Cancer Patients' Wishes for Death at Home: A Qualitative Study.

OBJECTIVE: This study aimed to clarify visiting nurses' perspectives on critical practices to ensure they could advocate for patients who prefer to die at home. METHODS: Sixteen nurses, working at home-visit nursing agencies in Japan, participated in this study. Data were generated by interviews with the nurses and participant observations from nursing home-visits for six end-of-life cancer patients and were analyzed using content analysis. RESULTS: Five themes emerged: (1) nursing assessment, (2) support for comfortable daily life of the patient and their family, (3) advocating for the patient's views about continuing homecare until death, (4) supporting the patient's preparedness for death, and (5) coordination with other health professionals and related facilities for a comfortable environment for the patient. In addition, the nurses sometimes used humorous responses to death-related work to change the patient's melancholy thoughts. CONCLUSION: The present study found that the participants advocated for the patient's views about continuing homecare until death while coordinating views between the patient and their family; they further supported the patient's daily life while helping them prepare for death to achieve their wish for death at home. In addition, our study uncovered the visiting nurses' unconscious practical wisdom of using humorous responses to death-related work to alleviate the patients' feelings of hopelessness. To develop practical wisdom for using humor effectively in end-of-life care, nurses need to verbalize unconscious practices, and accumulate empirical knowledge about nursing interventions using humor, including cultural attitudes, through case study analysis.

Association between Daily Life Difficulties and Acceptance of Disability in Cancer Survivors after Total Laryngectomy: a Cross-Sectional Survey.

OBJECTIVE: This study aimed to clarify the relationships between the acceptance of disability and daily life difficulties in patients after total laryngectomy. METHODS: An anonymous questionnaire was mailed to 135 patients who were participating in a self-help group after laryngectomy. The questionnaire included items on personal attributes, daily life difficulties, and acceptance of disability according to the Nottingham Adjustment Scale - Japanese Laryngectomy version (NAS-J-L). Multiple regression analysis was conducted using the NAS-J-L acceptance of disability subscale score as the dependent variable and daily life difficulties as the independent variables. RESULTS: Among the 57 respondents, 43 who provided valid answers were included in the analysis (41 men and 2 women; mean age = 67.5 ± 10.6 years). Acceptance of disability was significantly associated with difficulties in defecation (ß = -0.409, P < 0.01) and breathing (ß = -0.356, P < 0.05). CONCLUSIONS: Our findings suggested that difficulties in defecation and breathing due to airway alterations influence acceptance of disability after laryngectomy. Therefore, nurses should carefully assess daily life difficulties and patient's ability to perform self-care activities such as defecating and breathing to promote acceptance of disability and facilitate adaptation to daily life after total laryngectomy.

Anaplastic ependymoma in the cervical spinal cord of a maltese dog.

An 8-year and 6-month-old female Maltese dog showed a stoop with rigidity of her cervix and back. Neurologic examination showed loss of proprioception, and deficiency of pain response. Postmortem examination revealed the neoplastic mass replacing the central area in the cervical spinal cord at the level from 4th to 5th segments. Histologically, the mass was composed of neoplastic ependymal cells. The neoplastic cells showed marked atypism, and occasionally formed ependymal rosettes. Based on the morphologic features, the tumor was diagnosed as anaplastic ependymoma. Immunohistochemistry showed that the neoplastic cells were negative for glial fibrillary acid protein, and slightly positive for vimentin and cytokeratin.

Urination assessment after the removal of bladder catheter using a novel urination chart.

We investigated the difficulties involved in assessing post prostatectomy voiding according to 20 nurses working in urology and dermatology wards. Problems they encountered included completing a urination (frequency/volume) chart and performing an assessment. We constructed a hourly urination chart for basic nursing education in urinary incontinence. This was used for a 76-year-old male patient with hypertension and diabetes mellitus who underwent a prostatectomy. Urination was recorded for 17 consecutive days after catheter removal. Detailed pathological findings were more distinct in the hourly rather than daily recordings of voluntary micturition. Voluntary micturition appeared 12 h after catheter removal, but it was very scanty. After the onset of urination, frequency and amount of daily voluntary micturition was inversely related to incontinence during the 17 days after catheter removal. We drafted a set of urination recovery stages to enable the analysis of a patient's urination status. Nurses understood its importance and were able to reach a consensus on how to manage patients with postoperative incontinence. We have constructed a practical system for use by specialist urology nurses.