No abstract

Objectives: Palliative care research is relatively diverse and prioritizing research in this field is dependent on multiple factors such as complex ethical decisions in designing and conducting the research; access to participants who may be deemed "vulnerable" and an increasingly medically focused approach to care. The aim of this study was to inform organizational decision-making and policy development regarding future research priorities for a hospice service in New Zealand.Methods: A modified three-round Delphi technique was employed. Participants were drawn from one dedicated specialist palliative care service that delivers care in the community, daycare, hospice inpatient, aged residential care, and acute hospital palliative care service. A purposive sample included palliative care staff (n ¼ 10, 18, 9, for rounds 1-3, respectively) volunteers (n ¼ 10, 12, 11); and patients and family carers (n ¼ 6, 8, for rounds 1 and 2). Patients and family carers were not involved in the third round.Results: At final ranking of six research themes encompassing 23 research topics were identified by staff and volunteers. These were: symptom management; aged care; education; community; patient and family; and bereavement support and young people. Patients and family carers agreed on four themes, made up of 10 research topics. These were: decision-making, bereavement and loss, symptom management; and recognition of need and response of service.Significance of results : The study generated a rich set of research themes and specific research topics. The perspectives of staff and volunteers are significantly different from those of patients and family members, in spite of the recognition by all concerned that palliative care services work within a philosophy of patient-centered care. Open discussion of ideas has the potential to engage both staff and patients and carers in quality improvement initiatives, and to reinforce the value of research for patient care.

The incidence of chronic pain amongst elderly people in nursing homes is very high, making pain in this population a serious problem for aged care facilities. Research studies reveal a pattern of poor pain management in this setting despite the high incidence of pain suggesting that the management of pain in nursing homes is limited in scope and only partially effective. What is not fully appreciated by health professionals is the impact pain has on the lives of elderly people who live in nursing homes. In the study reported here a phenomenological method was used involving several in depth interviews with elderly people over a period of 9 months. Field notes of observations were also recorded as the participants went about their everyday lives in the nursing home. The discussion focuses on some of the themes drawn from the study with an emphasis on a key theme 'being constantly pained'. The findings of the study highlight what it is like to experience pain and how this impacts on everyday lives of elderly people. The paper concludes with some suggestions for health professional for improving care in this area.

No abstract

Demoralization and remoralization: a review of these constructs in the healthcare literature Development of the constructs of demoralization and remoralization began in the psychiatric literature in the 1970s when a psychiatrist in the USA observed a pattern of characteristics in people referred to him for depression, which he believed, was not depression. These characteristics included hopelessness, helplessness, isolation, low self-esteem and despair. Such characteristics are often termed existential distress. Distinguishing between depression and the existential distress of demoralization is still central in the literature. This is important as successful responses to each condition differ. Research into these constructs has broadened and contributions now come from many different countries and multiple health disciplines, including nursing. This study presents a review and exploration of these constructs in the healthcare literature in an attempt to bring them to the attention of greater numbers of nurses. Facilitating remoralization requires time and sensitivity to people's personal narratives. Difficulty in achieving such a response in the present efficiency climate of many health institutions can lead to moral distress.