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"Terminally ill Psychology Case studies."
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Final gifts : understanding the special awareness, needs, and communications of the dying
\"In this moving and compassionate book, hospice nurses Maggie Callanan and Patricia Kelley share their intimate experiences with patients at the end of life, drawn from more then twenty years experience tending the terminally ill.\"--P. [4] of cover.
Book
Ultimate ambiguities
Periods of transition are often symbolically associated with death, making the latter the paradigm of liminality. Yet, many volumes on death in the social sciences and humanities do not specifically address liminality. This book investigates these \"ultimate ambiguities,\" assuming they can pose a threat to social relationships because of the disintegrating forces of death, but they are also crucial periods of creativity, change, and emergent aspects of social and religious life. Contributors explore death and liminality from an interdisciplinary perspective and present a global range of historical and contemporary case studies outlining emotional, cognitive, artistic, social, and political implications.
eBook
The challenge of patients' unmet palliative care needs in the final stages of chronic illness
Background : There is consensus in the literature that the end of life care for patients with chronic illness is suboptimal, but research on the specific needs of this population is limited. Aim : This study aimed to use a mixed methodology and case study approach to explore the palliative care needs of patients with a non-cancer diagnosis from the perspectives of the patient, their significant other and the clinical team responsible for their care. Patients (n = 18) had a diagnosis of either end-stage heart failure, renal failure or respiratory disease. Methods : The Short Form 36 and Hospital and Anxiety and Depression Questionnaire were completed by all patients. Unstructured interviews were (n = 35) were conducted separately with each patient and then their significant other. These were followed by a focus group discussion (n = 18) with the multiprofessional clinical team. Quantitative data were analysed using simple descriptive statistics and simple descriptive statistics. All qualitative data were taped, transcribed and analysed using Colaizzi's approach to qualitative analysis. Findings : Deteriorating health status was the central theme derived from this analysis. It led to decreased independence, social isolation and family burden. These problems were mitigated by the limited resources at the individual's disposal and the availability of support from hospital and community services. Generally resources and support were perceived as lacking. All participants in this study expressed concerns regarding the patients' future and some patients described feelings of depression or acceptance of the inevitability of imminent death. Conclusion : Patients dying from chronic illness in this study had many concerns and unmet clinical needs. Care teams were frustrated by the lack of resources available to them and admitted they were ill-equipped to provide for the individual's holistic needs. Some clinicians described difficulty in talking openly with the patient and family regarding the palliative nature of their treatment. An earlier and more effective implementation of the palliative care approach is necessary if the needs of patients in the final stages of chronic illness are to be adequately addressed. Palliative Medicine 2007; 21 : 313—322
Journal Article
Request for medical assistance in dying after a suicide attempt in a 75-year-old man with pancreatic adenocarcinoma
The term \"wish to hasten death\" does not have an established definition, and there is a divergence of opinion about what factors influence it. There is a consensus that this wish is a reaction to suffering in the context of a life-threatening condition, and arises when a person sees no other option than to accelerate their death. That is to say, intolerable suffering, or the anticipation of future intolerable suffering, is one of the key underlying drivers of wish to hasten death, which ultimately may manifest as a request for medical assistance in dying, or in suicidal ideation and attempts. Here, Nayyar et al examine the case of a 75-year-old man who was brought to the emergency department by his wife after he ingested an overdose of hydromorphone with the intent of ending his life.
Journal Article
Charlie Gard and the weight of parental rights to seek experimental treatment
The case of Charlie Gard, an infant with a genetic illness whose parents sought experimental treatment in the USA, brought important debates about the moral status of parents and children to the public eye. After setting out the facts of the case, this article considers some of these debates through the lens of parental rights. Parental rights are most commonly based on the promotion of a child’s welfare; however, in Charlie’s case, promotion of Charlie’s welfare cannot explain every fact of the case. Indeed, some seem most logically to extend from intrinsic parental rights, that is, parental rights that exist independent of welfare promotion. I observe that a strong claim for intrinsic parental rights can be built on arguments for genetic propriety and children’s limited personhood. Critique of these arguments suggests the scope of parental rights remains limited: property rights entail proper use; non-personhood includes only a small cohort of very young or seriously intellectually disabled children and the uniqueness of parental genetic connection is limited. Moreover, there are cogent arguments about parents’ competence to make judgements, and public interest arguments against allowing access to experimental treatment. Nevertheless, while arguments based on propriety may raise concerns about the attitude involved in envisioning children as property, I conclude that these arguments do appear to offer a prima facie case for a parental right to seek experimental treatment in certain limited circumstances.
Journal Article
Barriers and facilitators to care for the terminally ill: A cross-country case comparison study of Canada, England, Germany, and the United States
Background:
Why do many patients not die at their preferred location?
Aim:
Analyze system-level characteristics influencing the ability to implement best practices in delivering care for terminally ill adults (barriers and facilitators).
Design:
Cross-country comparison study from a “most similar—most different” perspective, triangulating evidence from a scoping review of the literature, document analyses, and semi-structured key informant interviews.
Setting:
Case study of Canada, England, Germany, and the United States.
Results:
While similar with regard to leading causes of death, patient needs, and potential avenues to care, different models of service provision were employed in the four countries studied. Although hospice and palliative care services were generally offered with standard care along the disease continuum and in various settings, and featured common elements such as physical, psycho-social, and spiritual care, outcomes (access, utilization, etc.) varied across jurisdictions. Barriers to best practice service provision included legislative (including jurisdictional), regulatory (e.g. education and training), and financial issues as well as public knowledge and perception (“giving up hope”) challenges. Advance care planning, dedicated and stable funding toward hospice and palliative care, including caregiver benefits, population aging, and standards of practice and guidelines to hospice and palliative care, were identified as facilitators.
Conclusion:
Successful implementation of effective and efficient best practice approaches to care for the terminally ill, such as shared care, requires concerted action to align these system-level characteristics; many factors were identified as being essential but not sufficient. Policy implementation needs to be tailored to the respective health-care system(s), monitored, and fine-tuned.
Journal Article
Physical Symptoms of Children Receiving Pediatric Hospice Care at Home During the Last Week of Life
To identify symptoms of greatest parental concern on the last day and during the last week of their children's lives, the five most common symptoms of parental concern, and symptom-management strategies used during the last week of the children's lives.
Descriptive, exploratory, and retrospective.
A pediatric hospice program in St. Louis, MO.
Convenience sampling of 28 bereaved parents.
The Krippendorff method for semantical content analysis of data collected from semistructured telephone interviews with parents.
Parents' perceptions of their children's symptoms and symptom-management strategies.
On the last day of life, change in the children's breathing was the most frequent symptom of concern. During the last week of life, loss of motor function was the most frequent symptom of concern. Physical comfort actions and use of pharmaceutical agents were the strategies perceived as most helpful in managing symptoms.
The study is the first to document parents' perceptions of their children's symptoms and of symptom-management strategies during the last week of life while receiving care in the home from staff of the pediatric hospice program.
Symptoms experienced by dying children during the last week of life and symptom-management strategies used by pediatric hospice programs to support dying children and their families have not been well described. Additional research is warranted to further identify pediatric symptoms at the end of life and effective symptom-management strategies.
Journal Article
Legalized Physician-Assisted Suicide in Oregon — The First Year's Experience
On October 27, 1997, Oregon legalized physician-assisted suicide.
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Although there have been many studies of physician-assisted suicide, there are no data on the experiences of patients and physicians when the practice is legal.
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Physician-assisted suicide is practiced in the Netherlands but is subject to criminal prosecution, even though such prosecutions are rare. We report on the first year of experience with legalized physician-assisted suicide in Oregon.
The Oregon Death with Dignity Act allows terminally ill state residents to receive prescriptions for self-administered lethal medications from their physicians.
1
It does not permit euthanasia, in which a physician or other person . . .
Journal Article
Meaning-centered dream work with hospice patients: A pilot study
Hospice patients often struggle with loss of meaning, while many experience meaningful dreams. The purpose of this study was to conduct a preliminary exploration into the process and therapeutic outcomes of meaning-centered dream work with hospice patients.
A meaning-centered variation of the cognitive-experiential model of dream work (Hill, 1996; 2004) was tested with participants. This variation was influenced by the tenets of meaning-centered psychotherapy (Breitbart et al., 2012). A total of 12 dream-work sessions were conducted with 7 hospice patients (5 women), and session transcripts were analyzed using the consensual qualitative research (CQR) method (Hill, 2012). Participants also completed measures of gains from dream interpretation in terms of existential well-being and quality of life.
Participants' dreams generally featured familiar settings and living family and friends. Reported images from dreams were usually connected to feelings, relationships, and the concerns of waking life. Participants typically interpreted their dreams as meaning that they needed to change their way of thinking, address legacy concerns, or complete unfinished business. Generally, participants developed and implemented action plans based on these interpretations, despite their physical limitations. Participants described dream-work sessions as meaningful, comforting, and helpful. High scores on a measure of gains from dream interpretation were reported, consistent with qualitative findings. No adverse effects were reported or indicated by assessments.
Our results provided initial support for the feasibility and helpfulness of dream work in this population. Implications for counseling with the dying and directions for future research were also explored.
Journal Article