UNIVERZITA KARLOVA V PRAZE FAKULTA SOCIÁLNÍCH VĚD Institut sociologických studií Katedra veřejné a sociální politiky Zdeňka Zatloukalová Paliativní péče v České republice Diplomová práce Praha 2012 Diplomová práce Název práce 4 SUMMARY The master thesis "The palliative care in the Czech Republic" is focused on the reflection of the current situation of the problem which is defined as an insufficient capacity of the specialized palliative care. A mere fraction of dying (2,7 %) receives a specialized palliative care in the Czech Republic. Only 7,5 % of cancer patients are provided with the specialized palliative care. (Sláma, 2008) Specialized palliative care has different forms. It is hospice palliative care, special palliative care in the hospital facilities or consulting teams in the hospitals. The hospice palliative care is provided in the form of the inpatient hospice, home palliative care and day care canters. In the practical part of the thesis I focused on the analysis of the state of care through the statistical data obtained mainly from the Czech Statistical Office and the Institute of Health Information and Statistics of the Czech Republic. For the comparison with other countries I used the researches Palliative care in the European Union, 2008 and Economist Inteligence Unit, 2010. The annual...

This review article addresses end-of-life care issues characterizing human immunodeficiency virus progression by delineating associated stages of medical and nursing care. The initial progression from primary medical and nursing care aimed at functional cure to palliative care is discussed. This transition is considered in accord with the major symptoms experienced, including fatigue, pain, insomnia; decreased libido, hypogonadism, memory, and concentration; depression; and distorted body image. From the stage of palliative care, progression is delineated onward through the stages of hospice care, death and dying, and the subsequent bereavement process.

Healthcare teams can implement care initiatives to promote a positive dying experience. However, there is a lack of knowledge related to how best to care for dying patients. Nurses do not receive extensive training in nursing school to care for patients at the end of life, yet most, at some point in their careers, experience the provision of this type of care. It is important to ensure that nurses caring for dying patients have been educated about end-of-life care. The purpose of the quality improvement project was to address the lack of end-of-life care education among critical care nurses in an acute care hospital by implementing and testing the effectiveness of an end-of-life care educational program. Kolcaba's theory of comfort was chosen as the theoretical framework for the project. Registered nurses (n = 34) employed on a critical care unit participated in the one-group pretest/posttest design project. The nurses completed the Healthstream online end-of-life care education, and knowledge improvement was determined through comparison of pretest and posttest scores. Descriptive tests were completed to determine the mean score. The descriptive data analysis and tests showed that participants' level of end-of-life care knowledge improved after they completed the formalized educational program. Participants' scores increased from pretest (68% to 100% correct answers) to posttest (93% to 100% correct answers). The primary populations benefiting from the project are nurses, dying patients, and family members of dying patients. The social change implication of the findings is that if nurses receive education on end-of-life nursing, increased knowledge of appropriate care for dying patients is expected.

Bereavement beliefs and practices in the modern, American culture have been well documented. However, virtually no research has been conducted on traditional and contemporary death, dying, grief, and bereavement beliefs and practices among native tribes, such as the Lakota. The present study was conducted with the Lakota, and fulfilled two goals. iii First, the contemporary and traditional death, dying, grief, and bereavement beliefs and practices of the Lakota were documented and summarized. Such documentation may help bereaved Lakota tribal members who are experiencing problems with death and bereavement, and may help preserve traditional knowledge, beliefs, and practices. Second, the consensus of opinion among Lakota tribal elders about death, dying , grief, and bereavement practices and beliefs was qualitatively evaluated and compared with that of mental health and substance abuse workers who serve the Lakota. Two main theoretical conclusions to this study were reported. First, the Lakota elders' preferred interventions for bereavement for their people included family, social, community, tribal , and ceremonial activities. These findings likely resulted from the functional aspects of these types of culturally appropriate practices not only to help the bereaved Lakota individual, but also to help "fill the hole in the circle" left by the death of a tribal member. A cultural mechanism for continued tribal unity and wholeness is provided by these tribal bereavement practices. Second, the ancient historical Lakota ceremonies used to ameliorate grief within the tribe appear to have been fragmented over time, but these rituals still exist and their derivatives are used in various contemporary forms. Two main clinical findings were reported. First, a careful clinical assessment of the bereaved Lakota client's level of acculturation is required as a prerequisite to treatment planning. Second, intervention with grieving Lakota clients should include informed attention to both "western" bereavement treatment methods and traditional Lakota family, community, and social bereavement practices. The relative value of various Lakota family, social, community, and tribal bereavement practices and a rank ordering of various Lakota ceremonies were provided. These ceremonies and Lakota tribal practices were compared to modern "western" bereavement treatment methods.

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In this dissertation I explore the cultures of death and dying in medical institutions, hospices and funeral work. I argue that not only are there competing cultures of death and dying in American society, but within these institutions that produce tension and conflict, sometimes among the workers, other times between the workers and those they serve, and other times between the institution and outside organizations. Medical institutions, by medicalizing death and dying, constructed a "death as enemy" orientation in which doctors fight death with the use of medical technology, practice detached concern from their patients, and marginalize religion and spirituality. On the other hand, a "suffering as enemy" orientation has also emerged, primarily in the form of palliative medicine, in which needless suffering is considered worse than death, therefore life-saving technology is removed, doctors empathize with patients and families, and spirituality is incorporated. Hospice started as a social movement to change how dying patients were treated at the end of life, addressing patients' physical, spiritual and emotional pain. However, the bureaucratization of hospice, particularly the Medicare Hospice Benefit, has led to a compromise of the social movement's ideals and these competing orientations shape how hospice workers, particularly nurses and social workers, express frustrations with their work. Funeral directors assert their jurisdictional claims of the right to handle the corpse and assuage the grief of the bereaved, through embalming, informal grief counseling and the funeral performance, but funeral directors encounter resistance from large funeral corporations and the funeral societies. Large corporations centralize embalming, turning the corpse from a craft to a product, recruit other professionals to practice grief counseling, and sell standardized funeral packages. Funeral societies challenge the necessity of embalming, funeral directors' expertise in grief counseling, and focusing on the value of simple, dignified and affordable funerals. I conclude this dissertation by showing how orientations toward death and dying vary in American society and these institutions because of tension between experts who espouse a particular orientation and activists who resist the claims of the experts.

All nurses must be adequately prepared to care for individuals requesting Medical Assistance in Dying (MAiD) due to the practical, ethical, personal, and legal ramifications associated with MAiD. Nurses are both professionally and legally obligated to be knowledgeable and skilled in navigating the care of individuals requesting MAiD. This qualitative systematic review explored the knowledge and education needs identified by nurses regarding MAiD. This qualitative systematic review was conducted following the JBI methodology for systematic reviews of qualitative evidence, including critical appraisal, study selection, data extraction and data synthesis. Four themes were identified: 1) ethical and moral challenges, 2) legislation and standards, 3) communication, and 4) mandatory MAiD education. The information and practice recommendations found within this review can be used to support the knowledge and education needs of all nursing students and practicing nurses throughout Canada.

Medical Assistance in Dying (MAID) was legalized in Canada in 2016. In 2021, an update in legislation included changes to MAID eligibility and procedural safeguards. Guided by the Ottawa Decision Support Framework (ODSF), the overall aim was to describe how Canadian patients considering MAID are being supported in making the decision about end-of-life care. Eleven articles were included in the literature review. ODSF themes are evident in MAID literature. Nurses play key roles in end-of-life decision-making. Environmental scan of publicly available MAID resources identified 58 eligible resources. Sixty-nine percent of MAID resources were updated with 2021 legislation. None met the International Patient Decision Aid Standards criteria. Thirty met Patient Education Materials Assessment standard for adequate understandability and 11 for actionability. Although patient decision aids are effective for supporting health care decisions, none exist for MAID and current resources are inadequate for supporting people of lower health literacy.

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