Ethics in hospice care.

Discusses 4 ethical issues that arise in hospice care: (1) What are the ethical responsibilities to the patient, family, and authorities when hospice workers discover that a patient has been given incompetent and shoddy care at a previous institution? (2) Hospices that advertise themselves as offering complete care should be prepared to deal with psychological and legal issues as well as medical ones. (3) The idea of treating the entire person must include responding to the likelihood that the patient and family may raise profound philosophical and religious questions. (4) Hospice staff should periodically examine themselves on a spiritual or philosophical level. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ongoing challenges in pediatric hospice care

Reports have begun to proliferate throughout the world which describe various models of pediatric hospice care. While encouraging, these reports identify universal obstacles that continue to compromise effective care. Challenges persist in areas of pain management, medical ethics, program administration, cost analysis, staff development and bereavement follow-up. Cooperative efforts are encouraged to address these issues.     

Professional psychology's role in hospice care.

This article explores the existing and potential contributions that professional psychology brings to the growing hospice movement. It explores hospice care's unique philosophy in treating dying patients and their families and provides a psychologically based justification for this philosophy. To do so, the author draws on the literature of health psychology, behavioral medicine, and thanatology (death studies). The article ends with a discussion of recent developments in hospice care that provide expanding opportunities for professional psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A federal role in hospice care?

Discusses the advantages of hospice care for dying patients and how the federal government should support such care. Support could include the use of restricted drugs (such as heroin) to relieve pain in terminal illness, the allowance of Medicare patients to transfer their coverage from hospital to hospice if they so choose, and the initiation of a meaningful debate on the appropriate federal role in hospice funding and support. Current bills pending in Congress that concern such measures are described. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Euthanasia from the perspective of hospice care

The hospice believes in the concept of a gentle and harmonious death. In most hospice settings there is also a rejection of active euthanasia. This set of two apparently conflicting principles can be defended on the basis of two arguments. The first is that doctors should not foster the intent to kill as part of their moral and clinical character. This allows proper sensitivity to the complex and difficult situation that arises in many of the most difficult terminal care situations. The second argument turns on the seduction of technological solutions to human problems and the slippery slope that may arise in the presence of a quick and convenient way of dealing with problems of death and dying.     

End-of-life care: hospice or home?

BACKGROUND: Polar and borderline lepromatosis leprosy can be complicated by type 2 reactional states, including erythema nodosum leprosum. CASE REPORT: A 36-year-old man was treated for lepromatous leprosum. He consulted for recurrent erythema nodosum leprosum. Certain nodular lesions were bullous. Histopathology demonstrated major dermal edema causing bullous blisters. Treatment with thalidomide led to rapid regression. DISCUSSION: The bullous form of erythema nodosum leprosum is rarely described in the literature. It raises the diffential diagnosis with other bullous dermatoses, particularly Sweet's syndrome.     

Out-patient hospice services--their importance for palliative care in Germany

Morphologic and morphometric sperm characteristics of mouse epididymal extracts from animals exposed to static magnetic fields were evaluated. For this purpose, animals were exposed for 35 days to a field of 0.7 T generated by a commercial permanent magnet for either 1 or 24 h per day. The values of morphometric parameters were obtained using the morphometric module of the Sperm Class Analyzer computerized image analysis system, and percentages of abnormalities were calculated. The size of sperm heads was unaffected by exposure to static magnetic fields. Lack of hook was a sperm head abnormality found significantly more frequently in animals exposed continually than in nonexposed animals, showing a possible alteration to the spermatogenic process after exposure to static magnetic fields. The percentage of sperm with coiled tails or of sperm with abnormal midpiece or tail was not altered by exposure.     

Issues in prison hospice: toward a model for the delivery of hospice care in a correctional setting

This paper examines issues in prison hospice care based on the author's nine years experience as a prison hospice worker and trainer and on data gathered by the National Prison Hospice Association (NPHA) from a number of federal and state prison medical facilities with operational or developing hospice programs, including both scatter-bed and hospice unit models, employing inmate hospice volunteers and the services of outside community hospice agencies and volunteers. The paper discusses DNR orders and curative vs. palliative care decisions, pain management, AIDS care, interdisciplinary care teams, staff and volunteer training and supervision, and the need for compassionate early release and community placement programs. The author proposes a set of preliminary guidelines for the delivery of hospice care in the correctional setting.     

Elders' end-of-life decisions: implications for hospice care

Elders' views on various end-of-life decision options were studied to determine each option's acceptability if they were faced with the need for such decisions. 388 black and white elders aged 60 to 100 responded to 17 decision scenarios depicting situations with a low quality of life, rating acceptability of each of 7 options for each scenario. Based on factor analysis of responses over scenarios, three scores were computed: maintaining life, ending life, and letting others decide. Profile types were identified and related to demographic background and personality variables. Implications for hospice care are drawn.     

Feasible criteria for enrolling end-stage dementia patients in home hospice care

Hospice care is considered appropriate for end-stage dementia patients (Luchins & Hanrahan, 1993), yet less than 1 percent of hospice patients have a primary diagnosis of dementia (Hanrahan & Luchins, 1995). This pilot study tested the feasibility of providing palliative care for dementia patients. A common eligibility requirement for admission to hospice is that the patient is likely to die within six to seven months. The uncertain survival time of dementia patients thus prevents access to hospice programs. Therefore, enrollment criteria were developed based on the characteristics of advanced dementia and a history of medical complications. With these criteria established, it was then possible to enroll 11 patients over two years. The enrollment criteria proved successful in that the median survival time was five months, with an average of seven months. Eight of the 11 patients died during the study. Hospice care was well accepted by family caregivers and appeared to meet the patient's needs.     

Advances in critical care monitoring

We report the eighteenth case of spontaneous rupture of the upper urinary tract in a pregnant woman (age = 24 years, term = 28 weeks). Sonography showed an anechogenic collection in the left perirenal area. Computed tomography confirmed the diagnosis of rupture. No cause could be determined due to the lack of an urography in post-partum. The first treatment was a double echo-guided percutaneous drainage. The pregnancy was completed to term with normal vaginal delivery of a live infant. Sonography showed complete cure.     

The assessment of need for bereavement follow-up in palliative and hospice care

This paper describes a postal survey of palliative care services and teams which were identified in the 1992 Directory of Hospice Services in the UK and Ireland. Its aims were to investigate how units assess the need for bereavement follow-up, and to determine the nature and extent of services provided for bereaved adults. We sent out 397 questionnaires, of which 187 were returned, a response rate of 47%. Results indicate that 156 respondents (84%) provided follow-up and a further 13 (7%) were planning bereavement services. Only 48 (25%) units undertook formal standardized risk assessment procedures to allocate appropriate services; in 41 units (85%) this was done by a nurse. Of the remaining 125 units, 58 (46%) reported basing their decisions on clinical impressions. Content analysis of the formal assessment instruments revealed 39 subcategories, which were broadly grouped into three areas: circumstantial factors at or near to the time of death, personal factors and social factors. Recommendations are made for further study.     

The Sacred Circle: a conceptual framework for spiritual care in hospice

Hospice care has consistently recognized the need to integrate spiritual care into holistic plans of care for dying patients and their families. Designing and implementing spiritual care interventions can be potentially difficult for hospice practitioners who have not had specific training in theology or pastoral care. Matthew Fox, a theologian, has developed a model of spiritual development that utilizes an ecumenical, ethical framework that can be directly applied to the care of hospice patients and families. This model employs a Sacred Circle approach that begins with an emphasis upon the sense of awe and wonder (the Via Positiva), moves into the next cycle by recognizing problems and negative emotions (the Via Negativa), that then flows into the creative solutions to problems (the Via Creativa), which finally transforms the problem into a new level of understanding (the Via Transformativa).     

Nurse-physician communication in home care and hospice: a physician's point of view

As economic pressure continues to mount within the medical system, more and more patient contact is shifting away from expensive inpatient care. Initially, the shift in patient visits was away from the hospital and into clinics and the physicians offices. With the growth of capitated medical groups and prepaid care, not just inpatient days are declining. With efforts to control costs, the numbers of physician office and clinic visits are declining also.     

Pharmaceutical care applied to the hospice setting: a cancer pain model

Following orthodontic treatment, the mechanical debonding of brackets often results in damage to the enamel surface of teeth. Loss of natural luster, a roughened surface, and scarring may occur. When scarring occurs, a method for re-establishing the enamel luster and surface characteristics can be instituted by either the restorative dentist or the orthodontist. One method of restoring enamel luster and natural surface characteristics following removal of orthodontic fixtures is through a sequence of enamel polishing. This article discusses logical steps for the restoration of enamel through the utilization of polishing burs and progressive pastes (Proxyt), Ivoclar Vivadent, Amherst, NY) for the final aesthetic orthodontic result.     

Differentiating recruitment strategies for direct patient care, clerical, and fundraising hospice volunteers

A survey of direct patient care and nondirect patient care volunteers in two hospice programs generated information about various aspects of their volunteer experience. This paper focuses on the effectiveness of identified recruitment strategies for direct patient care, clerical, and fundraising volunteers. People learned about the opportunity to volunteer at hospice most frequently from personal experiences, friends, and newspapers. Significantly more direct patient care volunteers learned about the volunteer opportunity through newspaper feature stories than did nondirect volunteers. Friends recruited significantly more fundraising volunteers than direct patient care or clerical volunteers. The events triggering direct care and clerical volunteers to serve were most often personal experiences, whereas friends appear to have triggered direct care and fundraising volunteers to serve.     

An alternative to traditional medical care for the terminally ill: Humanitarian, policy, and political issues in hospice care.

Indicates that hospice services to the terminally ill offer palliative care rather than curative treatment, emphasizing pain control and supportive/psychological services, and introduces a section of articles on hospice matters. Hospice care is of interest to psychologists because it is a service intervention alternative to traditional medical practice. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)