For terminally ill patients, suffering can relate to issues beyond the physical body, such as psychological and spiritual distress. The North American Nursing Diagnosis Association defines spiritual distress as a disruption in the life principle, that, when intact, suffuses a person’s entire self, integrating and transcending biological and psychosocial aspects (Mesnikoff, 2002). Patients in spiritual distress express concern about the meaning of life, death and suffering, and may state that their illness is a punishment. They may be angry, cry, be withdrawn or show apathy. This case study concerns a 45-year-old Malaysian Muslim woman with terminal breast cancer. The woman presented with spiritual distress manifested as anger and deep denial.

Although the CD rates rose exponentially with the release of the 'TBT', the mode of delivery did not impact on better PNMR in breech cases in this hospital. The need for selective vaginal births for breech, increased use of external cephalic version and the long implications of a uterine scar in future pregnancies in the 'shared antenatal care in the local context in a developing country is discussed.

No abstract

No abstract

No abstract