ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00210.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00211.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Nurses play a central role in the care of dying people, yet they may find themselves marginalized, devalued or in conflict with other health professionals. This paper examines a number of problems and issues related to nursing power and control in the workplace. The factors we consider are:• the relative effects of personal and structural influences;• the ‘medicalization’ of dying;• the demands and challenges of interdisciplinary work;• ethical issues raised by euthanasia and AIDS;• patients' rights to make informed decisions about their care;• philosophies

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00212.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

There is much controversy surrounding the issue of nurses in the role of patient advocate. Cancer patients are vulnerable due to their diagnoses, the anxiety that it generates, the nature of the disease and subsequent treatment and may have diminished autonomy as a result. It is questionable whether the nurse is able to promote the best interests of the patient in this situation. Models of advocacy and the nurse‐patient relationship are discussed. The main arguments for taking on the role of patient advocate include: reference to long periods of time spent with the patient and the chance to build a relationship; the duty to care and the duty to do no harm. Criticisms of the appropriateness of the advocacy role for nurses include: inability for the patient to choose his or her nurse; promotion of self interests; charges of paternalism; challenges from other health care professionals and multiple and/or conflicting obligations. It is concluded that perhaps the most ethical way of caring is by empowering patients and promoting selfadvocacy. This concept needs to be further explore

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00213.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Early clinical trials for new anti‐cancer drug treatments typically use patients with cancer as research subjects. This paper identifies some of the ethical and practical concerns that arise from the recruitment of a vulnerable group of patients and their exposure to a drug of unknown risk or benefit. This review discusses the ethical principles related to recruitment and informed consent in cancer trials, and indicates that there is a lack of consensus concerning the requirements, process and practice of informed consent. It is suggested that, as yet, little is know about patients' decision making framework in this situation, and the need for further work that concentrates on the patient's point of view is highlighted. The paper concludes by discussing some of the difficulties associated with obtaining patients’opinions, and suggests that the use of a qualitative approach may overcome some of these probl

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00214.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Following the rapid service development brought about by the hospice movement, specialist palliative care services are involved with up to 50% of all patients dying with cancer in the United Kingdom, although the primary health care team remains the main provider of community based palliative care. This paper discusses findings from a survey of palliative care provision in the south west of England, and describes the perceptions of the primary care team (general practitioners and district nurses) about the interface between themselves and voluntary sector specialist palliative care providers (hospice in‐patient units, hospice home care nurses and other charitably funded specialist palliative care nurses). The voluntary sector services are run with a mixture of funding from charitable sources (public donations, legacies, charitable trust moneys), and statutory funding (grants and recurrent contracts from central government, district health commissions, and local health care trusts). The interview and questionnaire data suggest that the voluntary sector services are perceived variably as substituting, supplementing, complementing and duplicating the services provided by the primary care team. Drawing attention to these dimensions and the ambivalence sometimes felt by general practitioners and district nurses could provide a means of negotiating consensus on appropriate professional tasks and facilitating interprofessional practice in what is increasingly a mixed economy of statutory and voluntary funded health car

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00215.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Social support has been claimed to have positive effects on a variety of outcomes, including physical health, mental well‐being and social functioning, and yet, its nature, meaning and measurement are still being debated in the literature. This pilot study set out to identify, within the theoretical framework of the social support literature, supportive and unsupportive nurse behaviours as perceived of by eight hospitalized patients diagnosed with a haematological malignancy. The findings of the semi‐structured interviews appear to suggest that emotionally supportive behaviour patterns are the most frequently identified helpful nurse interactions reported by individuals with cancer, followed by informationally supportive behaviour. The most frequently identified unsupportive nurse behaviours were those perceived of as being devoid of an emotional component. Tentative conclusions for practice are drawn from these findings and considerations for future research are presented.In accordance with work by Dunkel‐Schetter (1984) the terms supportive and unsupportive are operationalized throughout this paper as the more familiar terms helpful and unhe

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00216.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Fatigue is a frequently encountered symptom in cancer populations. This study aimed to describe the experience of fatigue from the perspective of cancer patients who had recently completed a course of chemotherapy. A phenomenological method was used. The themes which emerged from the data indicated both a shared and individual experience of fatigue. These incorporated: the nature of fatigue; the causes, consequences, strategies for coping with fatigue; and the trajectory of the fatigue experience. Issues arising from the nature of phenomenological inquiry and the research were also elicited from this study. An understanding of the fatigue experience for this population and the use of phenomenology have implications for the nursing profession's knowledge base and for clinical practice.

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00217.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Although sophisticated treatment of cancer requires the resources of specialist cancer treatment centres, most patients with cancer still undergo initial diagnostic investigation and treatment in district general hospitals (DGHs). The DGH frequently remains the principle site of referral for management of symptoms and terminal care. This survey was carried out at a DGH which has no palliative care services. It aimed to demonstrate the need for such services by collecting data on inpatients with cancer and interviewing members of the nursing staff. Of 63 patients studied, 76% were admitted as emergencies, 50% had newly diagnosed cancer and 27% died in hospital. The majority (85%) were cared for on general medical, surgical and care of the elderly wards. Assessment of patients' symptoms suggested thet 39 (62%) might have benefited from the services of a palliative care team. Interviews with nursing staff highlighted the need for improved communication between professionals, increased staff education and support, and highlighted the particular difficulties that exist in caring for patients with advanced cancer and their families on busy acute general hospital wards. Imaginative and flexible approaches to the design and delivery of palliative services are essential if patients with cancer in DGHs are to receive the highest standards of care at all stages of their illness.

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00218.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

The effects of cisplatin chemotherapy on the metabolism of essential trace elements were investigated in 12 patients before and after treatment with cisplatin. In serum, the mean post‐treatment concentrations of Cu (13.19 μmoll−1), Zn (9.57 μmoll−1) and Mg (0.54 mmoll−1) were significantly reduced compared with the pre‐treatment levels (19.35, 11.86 and 0.67) while Se, caeruloplasmin and C‐reactive protein concentrations were unaltered. Urinary excretion of Cu, Mg and Zn were enhanced. The urinary N‐acetyl‐β‐D‐glucosaminidase activity (a marker of proximal renal tubular dysfunction) was also increased and suggests the mechanism for decrease of certain t race elements in serum during treatment could be increased urinary excretion caused by impaired cellular metabolism. It is not clear whether the loss of trace elements via the urine has any implication for the clinical status of cancer patients

ISSN:0961-5423    

DOI:10.1111/j.1365-2354.1996.tb00219.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY