Page 539 - Encyclopedia of Nursing Research

506 n TERMINAL ILLNESS

applications involving human touch have cure. Furthermore, unlike hospice or end-of-
occurred using robotic technology (DeKastle, life care, palliative medicine is recognized as
T 2009; Eckberg, 1998; peck, 1992). The ability a medical specialty. As such, the likelihood
to touch patients, change dressings, perform that this service will be incorporated into
wound care, or hug an elderly patient remain treatment is enhanced.
a distant possibility. Research in the area of terminal illness
Telepresence is a new and challenging has focused on the individual (patient needs,
aspect being added to the nursing practice. symptom management, and holistic care),
Nurses are expected to take an active role, family needs (meaning-making, empower-
embrace this technology, and work to max- ment, anticipatory grief, managing time, and
imize its potential for patient care. the impact of terminal illness on the family),
and system issues (adequacy of care, ethical
Josette Jones issues, impact of ethnicity on care, terminally
ill patients and research, transfer to hospice
and palliative are, and incarcerated termi-
nally ill patients).
Terminal illness A continuing question in the care of
those with a terminal illness is the role of
food and hydration. For relatives and signif-
What is a terminal illness? The term gener- icant others, food has a symbolic value, con-
ally is applied to a person with a degenerative noting nurturing and life and the hope that
process rather than an episode engendered death will be forestalled. “What if my loved
by trauma sustained as a result of some exter- one stops eating/Will my loved one starve”
nal force. “A person may be regarded as hav- was one of a number of questions that fam-
ing a terminal illness when broad agreement ily caregivers wanted to discuss with health
has been reached among health professionals care professionals in a study of 33 current and
that there is no longer the possibility of cure bereaved health caregivers (Herbert, Schulz,
and that life-expectancy is limited” (Hughes Copeland, & Arnold, 2008). Nurses in Taiwan
& Neal, 2000, p. 4). also were influenced by the cultural maxim
“When is an illness terminal?” is still of “food comes first for people” and thus con-
a question that both providers and patients sidered artificial nutrition and hydration as
may be reluctant to discuss. The emphasis basic care for terminally ill persons (Ke, Chui,
on curative treatment, no matter the dimin- Lo, & Hu, 2008). plonk and Arnold (2005) dis-
ishing chances for prolonged life, abets the aggregate nutrition and hydration, noting
reluctance to label a condition as terminal. that the consensus is that the former is not
Failure to do so, however, may result in dying beneficial to dying persons whereas the lat-
persons not having the time to attend to the ter is controversial. Also controversial is the
tasks they would wish to, were the reality use of palliative sedation when other means
of their condition openly shared (gawande, of pain relief are ineffective to relieve intrac-
2010). Interestingly, nurses were more likely to table suffering (De graeff & Dean, 2007).
be willing to disclose “bad” news to patients Although the previous studies focus on the
than were physicians (Ben Natan, Shahar, & needs of the dying person, the needs of the
garfunkel, 2009). At the same time, with the families of those who are terminally ill also
new emphasis on palliative care at the diag- have been of concern to health care practitio-
nosis of a life-threatening illness, the poten- ners and of interest to researchers.
tial for such discussions may be enhanced. The quality of life of the informal care-
And unlike hospice care, there is no require- giver is predicted by their physical health
ment to forego aggressive treatment aimed at and spirituality (Tang, 2009). Consequently,