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    Palliative care in Lebanon: where are we now? Where are we going?
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    Currently, there are many changes taking place in the area of paediatric palliative care. These include the role of the nurse, development of national policies, and recommendations for the future of paediatric palliative care. This article discusses palliative care for children with life-limiting conditions in the UK and Ireland, highlights national and international developments in this area, describes current services, and makes recommendations for future developments. Paediatric palliative care should be holistic, family centred and tailored to meet the needs of each child and family. Palliative care should promote autonomy and allow informed choices regarding end-of-life care. Palliative care should begin at the time of diagnosis and continue beyond illness, through the bereavement process. It should be adaptable to allow care delivery in any setting; home, hospice or hospital. Health professionals providing paediatric palliative care should be appropriately trained in this specialist field and the best interests of the child should always be at the forefront of care.
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    Specialist palliative care providers are seeking to transfer the principles of palliative care to more general care settings in order to meet the needs of people with diseases other than cancer. To prepare nursing home staff to provide palliative care increasing numbers of educational initiatives are now being offered. This paper explores some of the assumptions that underpin these initiatives. Recommendations are made that recognize the expertise already held within nursing homes and propose a collaborative approach to promote the appropriate integration of palliative care with nursing home practice.
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    Nursing research in palliative care is becoming more important as cost effectiveness and evidence‐based practice are becoming mandatory. Fifty‐nine published and unpublished projects relating to nursing research on palliative care in Australia between 1990 and 1996 were reviewed. Findings indicated that nurses working in palliative care in Australia are interested in researching a range of topics using varied methods. The nurses’ primary interests appear to be their own professional issues and management of the patient’s pain. Little research on families/carers of palliative care patients was evident. There is a need for future research to focus on projects that justify the nurse’s role in the palliative care team, show that nursing interventions for symptom control affect patient outcomes and prove nurses are integral to the psychosocial and spiritual wellbeing of the patient and family during the palliative care journey.
    Community palliative care nurses provide a range of services for patients who have complex needs and their carers in the midst of terminal illness. Patients often prefer to be looked after at home when they are terminally ill because home represents a place where they feel safe and where they have most control over decisions. The author works as a clinical nurse specialist within a community palliative care team. Her professional experience led her to be interested in identifying the aspects of palliative care patients and their families value most. Consequently, a literature search was carried out to identify those aspects of care provided by community specialist palliative care nurses deemed invaluable to patients and their families. The two most important elements of care, as identified by patients and carers, were found to be the provision of emotional support and having expertise in the management of symptoms. This article discusses these elements with regard to the community specialist palliative care nurse’s role, highlighting where the community palliative care service fails to meet the needs of patients and families. Conflicts of interest: none
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    Family carers play a central role in community-based palliative care. However, caring for a terminally ill person puts the carer at increased risk of physical and mental morbidity. The Carer Support Needs Assessment Tool (CSNAT) enables comprehensive assessment of carer support needs. The present study aimed to identify barriers and facilitators to implementing the CSNAT in a community specialist palliative care service. Semi-structured interviews with 12 palliative care nurse specialists from two community nursing teams in Lothian, Scotland, June 2017. Data was audio-recorded, transcribed and analysed. Palliative care nurse specialists acknowledge the importance of carers in palliative care and encourage carer support practices. Nurses perceived the CSNAT as useful, but used it as an 'add-on' to current practice, rather than as a new approach to carer-led assessment. Further training is recommended to ensure community palliative care nurses are familiar with the broader CSNAT approach.
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    A massive demand for palliative care has developed in Vietnam because of the burden of cancer, with more than 70% of patients diagnosed in the terminal stage. Despite the recommended guidelines, palliative nursing in Vietnam has focused mainly on pain management and the treatment of complications. Research is needed to explore the reality of nursing practice and difficulties in palliative nursing. A cross-sectional study was conducted at 6 hospitals in 2 central cities of Vietnam by using the Palliative Care Difficulties Scale and the Palliative Care Self-Reported Practices Scale. All 143 registered nurses reported difficulties providing palliative care, with community coordination being the most difficult aspect and the alleviation of symptoms being the least difficult. The most common practice in palliative nursing was dyspnea management; the least common practice was patient- and family-centered care. The longer nurses had practiced, the less difficulty they experienced in palliative care. The improvement of nursing practice could help minimize the difficulties that nurses encounter when providing palliative care. Palliative nursing could be enhanced through training programs, especially for community coordination and patient- and family-centered care. Further longitudinal studies are recommended for multidimensional perspectives in palliative nursing.
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    Recently there has been a rapid, if somewhat haphazard, proliferation of specialist roles in palliative care. The need to define levels of nursing practice in palliative care and the appropriate educational input for each level has been acknowledged. This paper discusses how one education team has described levels of practice in the form of performance standards as a basis for developing the curriculum of a postregistration degree course for the specialist nurse in palliative care.
    The provision of end-of-life care through a multidisciplinary integrated palliative-care approach is dependent on effective communication between professional groups and services. We did a qualitative study, using semi-structured individual and focus group interviews, in Melbourne, Australia. The research aim was to explore the experiences and strategies used by palliative care nurses to communicate with general practitioners. We found that palliative care nurse consultants in acute hospitals not only provided inpatient consultation, but also played an important part in facilitating continuity of care across healthcare services by improving existing communication strategies and establishing further communication networks. However, there were several issues that had the potential to disrupt communication, and this article reports on the role of the palliative care nurse consultant in addressing these issues.
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