need for manpower whereas the least relevant need is the need to be comfortable physically with dying patients. Differences in job satisfaction were observed among nurses in different settings, with different opinions and satisfactory levels regarding training/education. For needs, differences were observed among nurses with different years of experience in current workplace. Both job satisfaction and needs are correlated.
Some of the most ethically challenging and emotionally demanding aspects of nursing occur in caring for patients and their family at the end of life. The aims of this study were to examine the views of acute care nurses caring for patients during transition to comfort care, to describe the personal impact on nurses, and to identify nurses’ strategies for self-support and development of competence. Using a qualitative descriptive approach, we analyzed data from 26 semistructured interviews.
Nurses experienced moral distress in situations of continuing treatment when a cure was unlikely. In managing symptoms for patients, they struggled to foster an often-tenuous balance of patient comfort and calm without oversedation. They struggled to manage the competing demands of a workload including patients receiving curative care juxtaposed with those focused on comfort care. Nurses reflected on their fears as new nurses caring for end-of-life patients, the inadequacy of their preparation for this role, and their distress when the care provided felt inadequate to them.
Nurses navigated challenges through support from nurse colleagues and effective leaders. They appealed to administrators to attend to care concerns arising from time-intensive nature of care. Mentoring and education facilitated assimilation to comfort-care nursing for novice nurses.
Both Congress and the U.S. Environmental Protection Agency (EPA) believe that treatment and recovery should be the preferred methods for managing the nation's hazardous waste to reduce the potential for harm to human health or the environment. In the 1984 amendments to RCRA, Congress mandated that land disposal of certain regulated hazardous wastes be prohibited and that treatment standards be developed for wastes banned from land disposal. In order to be able to provide current, high quality information on the treatment technologies that are available as alternatives to land disposal, EPA expanded its ongoing efforts to regulate incinerators and hazardous waste combustion by forming the Treatment, Recycling and Reduction Program in 1984. * To ban a waste from deep well injection, the Agency must reasonably determine that such disposal may not be protective of human health and the environment for as long as the waste remains hazardous.
T h e timing of metastases to the host from the AMel 4 hamster melanoma was determined by amputation of the tumor-inoculated extremity at periodic intervals after implantation. Comparisons were made with parabiotic experiments where the parabionts were separated 1 to 9 days after inoculation of the tumor into one member. Lethal metastases occurred to the host within From the
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