Critical caring. Promoting good end-of-life care in the intensive care unit.

Changing the culture in the ICU to include palliative care interventions along with curative interventions is already underway. Further work is needed, however. This is a role for the critical care nurse. Critical care nurses can be involved in research and education to enhance their future practice in end-of-life care. Research to establish evidence-based protocols for use in patients who require palliative care in the ICU needs to be done. Critical care nurses can prepare themselves for carrying or dying patients by attending palliative care seminars and continuing education courses or by taking a short clinical sabbatical or internship in a local hospice to observe and help give end-of-life care. Hospice nurses can be invited to the ICU to give inservice sessions and to help nurses and other staff understand the transition to dying, including the services that need to be offered to the patient and the family. Nurses from the hospital palliative care team can consult and be available for follow-up. Promoting good end-of-life care should be a goal for all intensive care nurses and critical care units. This goal is reached one patient at a time.

Development of a teaching module for quality-of-life assessment of terminal patients. The AACE Multi-Institutional Palliative Cancer Education Section. American Association for Cancer Education.

To enhance the teaching of students to assess quality of life of patients with serious disease, the AACE Palliative Cancer Education Section has developed a teaching module. The module, which focuses on four desired learning objectives, is to be used in an hour-long small-group session. The authors describe the development of the module, as well as its objectives, teaching method, evaluation, and future challenges.

Practicing physicians' assessments of the impact of their medical-school clinical hospice experience.

BACKGROUND: The authors measured the impact of a clinical hospice experience in medical school on present medical practice by surveying former students after graduation. METHODS AND RESULTS: Of the graduates who apparently received anonymous questionnaires, 46 (71%) completed and returned them. Most were still in residency, and about a third were in private practice. Using a Likert scale, most gave the highest possible rankings in response to questions about how the experience had affected their present day-to-day communication with patients and their working knowledge of pain control, and the general question that asked about understanding quality-of-life issues. Written responses noted positive effects of the experience on the physicians' present practices, including improved knowledge of and attitudes towards dying patients, assessment of the effects of disease on patients and families, and quality-of-life. CONCLUSIONS: Although course work about death and dying is increasingly encountered in medical-school curricula, an intensive, focused clinical exposure is often lacking. This type of exposure has positive effects on physicians' self-assessments of their knowledge, attitudes, and skills in their present practices.

A historical perspective of informed consent in clinical practice and research.

OBJECTIVES: To review the historical perspective of informed consent in clinical practice and research as it pertains to human subjects. DATA SOURCES: Published professional journals, books, case law, and the internet pertaining to the historical development of informed consent. CONCLUSIONS: The history of informed consent is complex. Informed consent as a fundamental principle of clinical ethics has developed within the past 50 years. Full disclosure and shared decision making have not come naturally to clinicians. Consequently, respecting the autonomy of patients and research subjects requires a conscious, sustained effort by clinicians. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of the history of informed consent is important for practicing cancer nurses to ensure they understand the significance of preserving patient autonomy and advocate for the patient and research subject.

Integrating palliative care into daily practice: a nursing perspective.

Education of health care providers has historically been based on the traditional model of curative care. In this model, the curative care focus suddenly ends, substituted by a palliative approach to care, too often only in the last hours of life. Patient goals and wishes may never be clearly established, leaving family and care providers to guess at what the patient's wishes were. If we are to provide quality palliative care, we must equate it with health care providers establishing, acknowledging, and honoring patient and family goals. A major facilitator in accomplishing palliative care goals can arise from the nursing assessment. This article reviews the elements of a comprehensive nursing palliative care assessment (PCA). Although this article focuses on nurses, it has application for all health care professionals. Completion of the PCA provides an opportunity for reflection and evaluation of personal practices that support integrating palliative care into the care of all patients diagnosed with a life-threatening illness, beginning at the time of diagnosis and accelerating in intensity as the disease progresses.

Promoting nurses' positive attitudes toward cancer prevention/screening.

BACKGROUND: From 1991 to 1994, a special projects grant to teach nurses cancer prevention/screening theory and clinical skills was developed, implemented, and evaluated. Approximately 60 nurses in Colorado rural settings attended five two-day training sessions over a 20-month period. Attitudes, constructive or destructive, regarding specific behaviors lead to intentions to perform those behaviors and have an important impact on cancer-related nursing practice. METHODS: Two cancer-related attitude scales, Cancer Prevention/Early Detection Attitude Inventory and Fanslow Cancer Attitudes Scale, were administered prior to the first training session, following the final session, and at six-month follow-up. Data reflecting program impact on nursing practice were obtained from follow-up self-assessment of confidence in implementing new knowledge and skills. RESULTS: Significant differences in pre- and post-training attitude scores and fairly high-level confidence ratings suggest that these nurses will continue to use their cancer prevention and detection skills in practice. CONCLUSION: Documentation of practice activities to date has been impressive.

Caring theory: a framework for advanced practice nursing.

This article provides a brief review of Watson's theory of caring and demonstrates its usefulness as a framework for advanced practice nursing. Two case studies, a recently diagnosed patient who is positive for the human immunodeficiency virus and a patient terminally ill with acquired immunodeficiency syndrome, are reviewed using the carative factors as a model for providing holistic, patient-focused nursing care. The value of this exercise lies in the demonstration of the applicability of caring theory as a framework for both symptom management and palliative nursing care.

An innovative curriculum plan for advanced practice in oncology nursing.

BACKGROUND: The Advanced Practice in Oncology Nursing Program was designed to prepare graduates to manage the cancer experience through the delivery of comprehensive, holistic, oncology-focused care to individuals, families, and communities in a variety of settings. METHODS: Theoretical course work and clinical practicum are required to complete the degree plan. Students are actively recruited from urban, rural, and underserved population settings. The program is committed to fostering a teaching-learning paradigm that facilitates self-directed learning. The program's basic tenet is that all course offerings will be designed in a distributed learning/distance learning method. Clinical experiences are accomplished in or near the student's home community. RESULTS: Development and implementation of the program are in process. Shaping a curriculum and learning environment to be consonant with a health care system in a constant state of reform flux is a challenging task. CONCLUSION: This program's long-term challenge is to remain flexible, collaborative, and futuristic while promoting the expansion of advanced practice in oncology nursing.