This research is an examination of job satisfaction and turnover among nursing assistants employed in nursing homes. Using a statewide sample with 550 nursing assistants responding, the results indicated that 60% were satisfied with their jobs and 30% planned to quit. The nursing assistants participating in this study identified the relationship with the resident as the most important work issue, and their major reason for staying in the job. They were most dissatisfied with pay, benefits, and recognition and appreciation. Although the respondents were dissatisfied with benefits and salary, these work issues could not explain overall satisfaction or turnover. The multivariate analysis confirmed that professional growth and involvement in work-related decisions, supervision, and management keeping employees informed were significantly related to both turnover and overall satisfaction.
The palliation of cancer-related breathlessness is challenging and complex. An open pilot study was conducted, exploring the safety and efficacy of acupuncture in 20 patients who were breathless at rest and whose breathlessness was directly related to primary or secondary malignancy. Sternal and LI4 acupuncture points were used. Outcome measures included pulse, respiratory rate, oxygen saturation and patient-rated visual analogue scales of breathlessness, pain, anxiety and relaxation. At each time point the mean values of the variables were calculated and compared to their pretreatment levels (Student's t-test). Seventy per cent (14/20) of patients reported marked symptomatic benefit from treatment; there were significant changes in VAS scores of breathlessness, relaxation and anxiety at least up to 6 hours post acupuncture which were measured to be maximal at 90 minutes (p < 0.005, p < 0.001, respectively). There was a significant reduction in respiratory rate, which was sustained for 90 minutes post acupuncture (p < 0.02). The therapeutic value of acupuncture in the management of breathlessness requires further evaluation.
Advocacy is a contentious and topical issue and there is continued debate as to whether a nurse can ever truly represent patients' views and interests. This article will address this argument with particular reference to palliative care.
Passive euthanasia is invariably practised in palliative care. This article aims to address the legal, moral and ethical implications of not hydrating dying patients and presents the results of a questionnaire assessing doctors' attitudes.
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