Identifying the concerns of terminal cancer patients and respecting their wishes is important in clinical decision-making concerning the provision of artificial nutrition and hydration (ANH). The aim of this study was to discover terminal cancer patients' wishes and determine influencing factors toward the provision of ANH. One hundred and ninety-seven patients with terminal cancer, admitted to a palliative care unit in Taiwan over a two-year period, completed a questionnaire interview, which included demographic characteristics, knowledge and attitudes on ANH, the health locus of control, subjective norms, and the wishes to use ANH. One hundred and fifty-four patients (78.2%) used ANH in the past month. A knowledge test on issues related to ANH showed the rates of accurate responses were ranked as: peripheral intravenous route can only provide hydration (48.7%), excessive artificial nutrition may increase the proliferation of cancer cells (32%), ANH can prolong life expectancy for all patients (17.3%), and ANH can prevent all patients from starving to death (5.6%). The strongest attitude of patients toward the potential benefit of ANH was "it can provide the body need with nutrition and hydration when inability to eat or drink occurs." Otherwise, the strongest attitude toward the potential burdens of ANH was "gastrostomy makes the illness worse." One hundred and twenty-two of 197 patients (62.9%) expressed their wishes to have ANH. The results of logistic regression analysis showed that the experience of using a nasogastric tube and intravenous fluids, and subjective norms were the most significant variables related to the wishes of patients to use ANH (odds ratio [OR]=11.11, 95% confidence interval [CI]=3.20-38.64; OR=2.51, 95% CI=1.22-5.15, OR=1.30, 95% CI=1.05--1.60, respectively). However, the use of artificial nutrition was negatively affected by the knowledge of ANH (OR=0.53, 95% CI=0.37-0.84). In conclusion, Taiwanese patients with terminal cancer have insufficient knowledge about AHN and still believe in the benefits of ANH, especially in avoiding dehydration or starvation. The findings of this study indicate the importance of medical professional training and decision-making in the initial consideration of using ANH. By improving the knowledge about ANH among patients, more appropriate decisions can be achieved.
Background: The COVID-19 frontline nurses' stress-reduction programme by the cooperation of manager with the nurses is not-well developed.Aim: This study aimed to examine the effect of an emergency nurse-led stressreduction project on reducing stress levels during the COVID-19 pandemic. Methods:The action research was conducted using online and person-to-person group brainstorming strategies. The online survey was used to evaluate emergency nurses' stress levels, causes of stress and needs at the 50th, 80th and 110th days of the pandemic from March to May 2020. Results:The numbers of nurses participating in three-time survey were 160, 166 and 160, respectively. There was a decrease in the nurses' work-related stress after implementing the improvement strategies. Stress from personal protective equipment (PPE), information about infection control and family's worry about being infected reduced across 2 months. Needs regarding PPE, COVID-19 information and a forum for sharing experiences of COVID-19 care decreased whereas needs of allowing more days off increased. Conclusions:The stress-reduction project targeting at nurses' views of their needs can reduce their stress during the COVID-19 pandemic.Implications for Nursing Management: The online and person-to-person group brainstorming building a good partnership between nurses and managers can be an effective nursing management.
Aims To examine the association of the working stress with posttraumatic stress disorder symptoms (PTSD), and burnout as the mediator for this association among emergency nurses during COVID‐19 pandemic. Design Longitudinal survey study. Methods Online survey was used to collect data during the period from August to November 2020 with a sample of 169 emergency nurses. They were invited to complete the following questionnaires at the 6th and 9th months after COVID‐19 outbreak: Posttraumatic Symptom Scale (PTSS‐10), the emergency nurses' COVID‐19 stress questionnaire and Chinese version of 21‐item Copenhagen Burnout Inventory (CBI). Results During the 3‐month follow‐up, there were no changes in the number of suspected PTSD cases (6 and above symptoms): 41% at the 6th month and 33.3% at the 9th month. The increases of the personal burnout levels and living apart from families were the main factors associated with the PTSD symptoms. The risk for emergency nurses suffering from PTSD is through stress levels increasing their burnout levels. Conclusions Over 30 percent of emergency nurses remained at high risk for suspected PTSD. The burnout levels mediated the relationship between the stress levels and the risks of PTSD. Impact Little as know about the impact of COVID‐19 on emergency nurses' stress. This study found emergency nurses remained to be the high risk for the suspected PTSD cases. It is urged to develop a stress‐reduction program targeting at causes of stress and improving burnout for emergency nurses during COVID‐19 pandemic.
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