The Goals of Palliative Care: Beyond Symptom Control

My father died a basically “good death.” He died, comfortably, at home, in his own bed, clean shaven, surrounded and embraced by his family. My father lived with widely metastatic prostate cancer for 5 years. In those 5 years, he had minimal pain and no episodes of infection or hospitalizations. He did extremely well for 4 years and 6 months, even working. The last 6 months were marked by progressive weight loss and weakness, requiring him to slow down. But up until the day before he died, he was ambulatory, showered and dressed himself, argued with my mother, and was pain free. On a Tuesday morning, for the first time in his long illness, he did not get out of bed. He was drowsy and not completely responsive. My mother called to tell me of the change. I left morning rounds at the hospital, collected a few essential medications, and went straight to their home (the home I grew up in). I spent the next and last 24 hours of his life sitting in a chair at the side of his bed, feeding him drops of liquid morphine and haloperidol to keep him comfortable, free of pain, free of confusion and agitation. My mother slept beside him that entire night. When the hospice nursing aide arrived on Wednesday morning it was clear that my father was very near death. We both bathed my father, and I insisted on shaving him. He had about 4 days worth of beard growth, and I knew he would want to die clean shaven. After shaving the left side of his face, he stopped breathing. I kissed him, thanked him for giving me life, and then I completed shaving the right side of his face.

Sudden Loading During a Dynamic Lifting Task: A Simulation Study

It is believed that nurses risk the development of back pain as a consequence of sudden loadings during tasks in which they are handling patients. Forward dynamics simulations of sudden loads (applied to the arms) during dynamic lifting tasks were performed on a two-dimensional whole-body model. Loads were in the range of −80kg to 80 kg, with the initial load being 20 kg. Loading the arm downwards with less than that which equals a mass of 20 kg did not change the compressive forces on the spine when compared to a normal lifting motion with a 20 kg mass in the hands. However, when larger loads (40 kg to 80 kg extra in the hands) were simulated, the compressive forces exceeded 13 000 N (above 3 400 N is generally considered a risk factor). Loading upwards led to a decrease in the compressive forces but to a larger backwards velocity at the end of the movement. In the present study, it was possible to simulate a fast lifting motion. The results showed that when loading the arms downwards with a force that equals 40 kg or more, the spine was severely compressed. When loading in the opposite direction (unloading), the spine was not compressed more than during a normal lifting motion. In practical terms, this indicates that if a nursing aide tries to catch a patient who is falling, large compressive forces are applied to the spine.

Discussion 4

Although the Nurses' Observation Scale for Inpatient Evaluation is a commonly used tool in nursing home studies of behavioral disturbances of dementia, Dr. Luxenberg noted that this instrument is relatively weak compared with other rating scales. In most nursing homes in the United States, as well as in other countries, nursing aides are the primary caregivers and therefore the primary informants. These aides often have a cultural background different from that of other nursing staff members and may be less likely to accurately report on behavioral problems. Dr. Luxenberg provided an example of a nursing aide who reported that a patient chanted every morning and then refused assistance with bathing and dressing. When the investigator observed this behavior, he found that the patient was praying and refused to bathe until he had completed his prayers.

A Training Programme for Homemakers

The term Homemaker has been used to describe roles which range from a friendly visitor, to a teaching role, to that of a domestic or nursing aide (Canadian Council of Social Development, 1971). To avoid any confusion the Homemakers referred to in this article are essentially support workers with a teaching orientation. Their role is to prevent breakdown in the family unit by acting as a resource to the parent in a range of problem areas, but with a specific focus on child rearing. They aim to protect, restore or improve family functioning in the area of physical, social and emotional health. In some situations they may perform practical tasks to help improve the quality of life in the home, but generally their main task is to assist the parent to acquire the necessary skills.