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Respiratory therapists (RTs) frequently encounter death in their work with critically ill patients. Healthcare providers' attitudes toward death significantly affect their approach to caring for dying patients; however, there is a lack of knowledge on RTs' attitudes toward death. This study examines how the work environment and personal characteristics of RTs influence their attitudes toward death. Utilizing the Death Attitude Profile-Revised-Chinese questionnaire, a cross-sectional survey compared non-critical care RTs (non-CCRTs, N = 86) to critical care RTs (CCRTs, N = 85). Non-CCRTs displayed significantly lower scores in overall acceptance of death compared to CCRTs (p = 0.015) and a tendency to actively avoid thoughts about death (p = 0.005). CCRTs scored higher in "neutral acceptance" (p = 0.015), and non-CCRTs exhibited higher scores on items reflecting a negative attitude toward death. RTs with shorter professional tenures showed heightened fear of death and avoidance tendencies. Perception of life and death education correlated with higher "fear of death" and "death avoidance" scores (p = 0.001). The findings indicate that CCRTs demonstrate a more neutral acceptance of death. Additionally, experience, sex, mental health status, and life-death education exposure significantly influence RTs' attitudes toward death.
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BACKGROUND: The prevalence of end-stage renal disease in Taiwan is the highest in the world. The rate of signing advance directives in Taiwan is lower than in Western countries, and most of the barriers that have been identified relate to initiating advance care planning (ACP). PURPOSE: This study was designed to explore the barriers to discussing ACP with patients with chronic kidney disease faced by nephrology nurses. METHODS: A descriptive qualitative study design was adopted. The Consolidated Criteria for Reporting Qualitative Research was used to report the findings of this study. Data were collected using purposive sampling. A total of 34 nephrology nurses were recruited from hospitals in northern (2 groups, 10 participants), central (1 group, 4 participants), and southern (5 groups, 20 participants) Taiwan. A qualitative content analysis was conducted to analyze the transcripts of the eight focus groups. RESULTS: Five themes were identified, including (a) lacking the confidence to discuss ACP, (b) difficulty in finding an appropriate opportunity to initiate ACP discussion, (c) personally lacking the characteristics to discuss ACP, (d) conflicting perspectives between doctors and nurses over ACP, and (e) culture and belief-based barriers to discussing ACP. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings obtained from the interviews revealed that nurses must enhance their ACP-related knowledge and communication skills and foster personal confidence in initiating ACP discussions. Furthermore, nurses must be empowered to work with other healthcare professionals. To implement the initial process of discussing ACP in clinical settings, clinical guidelines should be developed for healthcare professionals on initiating ACP. These measures may facilitate improved collaboration in healthcare settings and further encourage patients and their families to participate in shared decision-making that may help patients complete advance directives and thereby achieve better care quality at the end of life.
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Planificación Anticipada de Atención , Nefrología , Enfermeras y Enfermeros , Insuficiencia Renal Crónica , Grupos Focales , Humanos , Investigación Cualitativa , Insuficiencia Renal Crónica/terapiaRESUMEN
The lack of knowledge of advance care planning and training of communication skills among nurses in Taiwan is one of the main reasons for the low rate of advance directive signing. However, there is no specific and effective solution to this problem. The purposes of this study were (1) to develop and pilot testing of an advance care planning simulation-based communication training program and (2) to evaluate the feasibility and acceptability of the program. This study was conducted in three phases. Phase 1: Developing an advance care planning simulation-based communication training program; Phase 2: Conducting a pilot test; Phase 3: Evaluating the feasibility and acceptability of the program. Twelve convenient participants from a medical center in central Taiwan were selected. The participants believed that team-based learning was beneficial for several reasons. First, it helped to clarify the participants' understanding of advance care planning and improve their communication skills. Second, role-playing, as one of the components, was helpful for discovering their own shortcomings in communication skills while debriefing enabled them to identify their blind spots in the communication process. Finally, the reflection log documented their weekly performance so they were able to reflect upon their weekly performance, improve their performance, and become more confident. All twelve participants signed the consent form and completed the whole training program. The participants were satisfied with the program, affirming that the timing and content of the program were appropriate and that the expected learning outcomes could be achieved. According to participant feedback, the program was beneficial in improving their knowledge of advance care planning and confidence in communication. Thus, it is feasible and acceptable to introduce communication of advance care planning programs into the staff training protocols of healthcare organizations. Clinical trial registration: NCT04312295.
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Planificación Anticipada de Atención , Entrenamiento Simulado , Adulto , Comunicación , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos PilotoRESUMEN
OBJECTIVE: To compare the postoperative outcomes of inspiratory muscle training and aerobic exercise, along with standard care, on lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS). DESIGN: A parallel-group, single-blind randomized clinical trial. SETTING: Thoracic surgery ward and outpatient clinic in a teaching hospital. SUBJECTS: Overall 63 patients underwent VATS were randomly assigned to a triaging (TG, n = 32) or control group (CG, n = 31). A total of 54 patients (TG, n = 26; CG, n = 28) completed the study. INTERVENTION: TG: six-week threshold inspiratory muscle training and aerobic exercise. CG: standard care. MAIN MEASURES: Maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) lung expansion volume, and 6-min walking test (6MWT) were performed on the day of chest tube removal (baseline), and 2, 6, and 12 weeks postoperatively. RESULTS: The TG showed significant improvement in PImax at week 6 (71.6 ± 34.9 vs. 94.3 ± 32.8 cmH2O, P = 0.018), PEmax at week 2 (70.9 ± 24.3 vs. 90.9 ± 28.2 cmH2O, P = 0.015) and week 12 (76.1 ± 20.2 vs. 98.6 ± 35.3 cmH2O, P = 0.012), the lung expansion volume at week 2 (1080 ± 433 vs 1457 ± 624 mL, P = 0.02) and week 12 (1200 ± 387 vs 1885 ± 678 mL, P < 0.001), in addition to the 6MWT at week 2 (332 ± 78 vs 412 ± 74 m, P = 0.002), week 6 (360 ± 70 vs 419 ± 60 m, P = 0.007) and week 12 (360 ± 58 vs 402 ± 65 m, P = 0.036). CONCLUSION: A six weeks of inspiratory muscle training and aerobic exercise had improved respiratory muscle strength and aerobic exercise postoperatively in lung cancer patients after VATS as early as 2 weeks.
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Ejercicios Respiratorios/métodos , Ejercicio Físico/fisiología , Entrenamiento de Fuerza/métodos , Cirugía Torácica Asistida por Video/rehabilitación , Anciano , Femenino , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Fuerza Muscular/fisiología , Periodo Posoperatorio , Músculos Respiratorios/fisiología , Método Simple CiegoRESUMEN
OBJECTIVE: Multimorbidity in elderly patients increases complications and retards the recovery of pulmonary function after coronary artery bypass grafting (CABG) surgery. We aimed to evaluate the impact of multiple-intervention pulmonary rehabilitation (PR) on respiratory muscle strength and dyspnea scores after CABG in adult patients aged ≥65 years who had multimorbidity. METHODS: A cohort study was retrospectively conducted with 95 adults aged ≥65 years who underwent CABG surgery and completed a multiple-intervention PR program. RESULTS: Patients in the non-multimorbidity (n = 56) and multimorbidity groups (n = 39) were evaluated on the basis of their muscle strength, degree of dyspnea, and pulmonary function. Postoperative complications were compared after the completion of PR. Between extubation days 1 and 14, the multimorbidity group showed significant improvements in maximal inspiratory pressure (16.91 vs. 24.95 cmH2O, P < 0.001), Borg Scale score (0.99 vs. 2.3, P < 0.001), and the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC ratio) of 7.02% vs. 13.4% (P = 0.01). The incidence rates of pulmonary complications were similar between the two groups. CONCLUSIONS: Multi-interventional PR program significantly improved the maximal inspiratory pressure, Borg scale score, and FEV1/FVC ratio in the adult patients aged ≥65 years who had multimorbidity after undergoing CABG surgery.
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Purpose: It is unclear whether the effectiveness of pulmonary rehabilitation program (PRP) after cardiac surgery differs between patients with and without COPD. This study aimed to compare the effectiveness of PRP between patients with and without COPD undergoing coronary artery bypass graft (CABG) surgery. Patients and methods: We retrospectively included patients who underwent CABG surgery and received 3-week PRP from January 2009 to December 2013. We excluded patients who underwent emergency surgery, had an unstable hemodynamic status, were ventilator dependent or did not complete the PRP. Demographics, muscle strength, degree of dyspnea, pulmonary function and postoperative complications were compared. Results: Seventy-eight patients were enrolled (COPD group, n=40; non-COPD group, n=38). Maximal inspiratory pressure (MIP; -34.52 cmH2O vs -43.25 cmH2O, P<0.01; -34.67 cmH2O vs -48.18 cmH2O, P<0.01), maximal expiratory pressure (MEP; 32.15 cmH2O vs 46.05 cmH2O, P<0.01; 37.78 cmH2O vs 45.72 cmH2O, P<0.01) and respiratory rate (RR; 20.65 breath/minute vs 17.02 breath/minute, P<0.01; 20.65 breath/minute vs 17.34 breath/minute, P<0.01) in COPD and non-COPD groups, respectively, showed significant improvement, but were not significantly different between the two groups. Forced vital capacity (FVC; 0.85 L vs 1.25 L, P<0.01), forced expiratory volume in 1 second (FEV1; 0.75 L vs 1.08 L, P<0.01), peak expiratory flow (PEF; 0.99 L vs 1.79 L, P<0.01) and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75; 0.68 L vs 1.15 L, P<0.01) showed significant improvement between postoperative Days 1 and 14 in the COPD group. FVC (1.11 L vs 1.36 L, P<0.05), FEV1 (96 L vs 1.09 L, P<0.05) and FEF25-75 (1.03 L vs 1.26 L, P<0.05) were significantly improved in the non-COPD group. However, only PEF (80.8% vs 10.1%, P<0.01) and FEF25-75 (67.6% vs 22.3%, P<0.05) were more significantly improved in the COPD group than in the non-COPD group. Conclusion: PRP significantly improved respiratory muscle strength and lung function in patients with and without COPD who underwent CABG surgery. However, PRP is more effective in improving PEF and FEF25-75 in COPD patients.
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Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Pulmón/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Terapia Respiratoria , Anciano , Investigación sobre la Eficacia Comparativa , Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Flujo Espiratorio Medio Máximo , Persona de Mediana Edad , Fuerza Muscular , Ápice del Flujo Espiratorio , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Recuperación de la Función , Músculos Respiratorios/fisiopatología , Terapia Respiratoria/efectos adversos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Capacidad VitalRESUMEN
The aging population and changing lifestyles have lead to the increased general risk of chronic kidney disease. Taiwan currently has the highest incidence and prevalence of end-stage renal disease (ESRD) of any country or region in the world. Hemodialysis patients must endure comorbidities and face the uncertainties of death. The best way to achieve a good death is for patients to sign advance care planning (ACP). However, the key factors contributing to low ACP signature rates have been the lack of communication skills and related training among medical staffs. This article explores the dilemma of ACP using an example of chronic kidney disease (CKD) and proposes a theory-based approach to develop a theoretical framework for an ACP simulation-situation communication training program that integrates the simulation situation model, PREPARED model, and scaffolding theory. Readers may use this framework to design ACP simulation-situation communication training programs that conform to their own conditions and then test the effectiveness and feasibility of these programs in clinical settings.
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Planificación Anticipada de Atención , Comunicación , Insuficiencia Renal Crónica/terapia , Entrenamiento Simulado , Conocimientos, Actitudes y Práctica en Salud , Humanos , Diálisis RenalRESUMEN
In the context of holistic care, the definition of "unitary human being" incorporates the physical, psychological, social and spiritual. However, patient spiritual well-being is often neglected by nurses. Part of the reason for this is that a majority of clinical nurses have not had adequate training or practical guidance on spiritual caring methods. This paper applied the methodology outlined by Walker and Avant (2005) to analyze the concept of spiritual well-being. Analytical procedures used included a literature review of conceptual definitions of spiritual well-being and identification of defining attributes. We then developed a concept of spiritual well-being by referencing borderline and contrary cases identified in the constructed model and identified antecedents and consequences. Empirical referents were also outlined. Results show the defining attributes of spiritual well-being to be: (1) having a subjective feeling of happiness; (2) Affirming the self worth; (3) managing interpersonal relationships with an open, accepting attitude; and (4) possessing an internal "energy". This analysis is hoped to enhance nurse understanding of spiritual well-being in order to utilize the concept in their professional practice.