Judith M. Saunders

Diagnosis and treatment of major depression among people with cancer.

Although depressive disorders are common among 20-25% of people with cancer, they are frequently unrecognized. Untreated depression in the presence of comorbid conditions may result in more frequent clinic visits, increased costs, extended hospitalization, and reduced compliance and quality-of-life. Oncology clinicians need not have psychiatric expertise to play a major role in the detection and treatment of depression and in the prevention of suicide. Using early detection and screening tools, the nurse can identify depressed patients and can collaborate in their treatment. Approximately 80-90% of depressed patients are effectively treated with psychotherapy, and/or pharmacologic, or somatic, interventions. Failure to diagnose or reluctance to treat depression among patients with cancer is a common error and can increase morbidity and mortality.

A process of bereavement resolution: uncoupled identity.

This clinical study explored the bereavement process in a small number of young widows whose husbands died from one of the four modes of death: natural, accidental, suicidal or homicidal. All the deaths were sudden; occurring within three days from the onset of the illness or the emergence of symptoms following an injury. Similarities and differences in bereavement among the widows were examined to formulate concepts related to the experiences and responses of the widows as they moved through the bereavement process. Data were obtained through serial, unstructured interviews over 13 months directed toward understanding the widows’ definitions of their situations. One concept of bereavement resolution that emerged among the respondents is presented in this paper; this concept is Uncoupled Identity.

Managing depression among people with HIV disease

Many people with HIV suffer from depression, which responds to antidepressants, counseling, education, and cognitive strategies. Untreated depression hinders treatment compliance and increases risk of suicide. Management and complications of major depression are described. The evaluation of rational suicide is examined. Clinicians who treat this population need to respond therapeutically to patients with depression and suicidal ideas.

Psychiatric Nurses’ Expertise, Interest in End-of-Life Care, and Requests for Continuing Education on End of Life:

Background: The time before dying can be extremely challenging and stressful. Gaps in end-of-life care include inadequate communication, education about end-of-life options, symptom control, and management of common mental illnesses (eg, mood disorders, dementia), and death anxiety. Psychiatric nurses are in a pivotal position to help address these gaps and improve end-of-life care. Psychiatric nurses can facilitate communication about end of life, educate patients about options, and provide consultation, assessment, and management of common psychosocial needs (eg, mood disorders, grief, and loss). Objective: This survey examined psychiatric nurses’ perspectives of their skills, knowledge, expertise, continuing education needs, and recommendations for the role of the psychiatric nurse. Study design: Using a descriptive design, we surveyed a convenience sample of psychiatric nurses from the American Psychiatric Nurses Association. Results: Psychiatric nurses reported they were skilled in discussions of difficult topics, evaluation of mental status, and assessment and management of mood disorders, grief, and suicide risk. However, nurses asked for continuing education in focusing these skills for end of life, knowing the needs of the dying patient, and differentiating depression and dementia at end of life. Requests for continuing education on end-of-life care included issues about how to apply these psychiatric skills and knowledge to the dying patient and their families. Conclusions: Psychiatric nurses have skills and knowledge to reduce the gaps in end-of-life care. Many request continuing education to assist them to expand and focus their knowledge to use their psychosocial skills and to develop a specialty area in end-of-life care.

Exploring a life history of HIV disease and self-caring: Alfredo's story

Alfredos story is part of a larger phenomenological study of nursing, self care, and HIV disease that incorporated the anthropological tradition of reconstructing a life-story in the persons own words. This exemplar emphasizes Alfredos shifts perspective organized around three turnings, or shifts in perspective, which are illustrated with narrative text and discussed. The three turnings include becoming HIV-infected, becoming a positive force, and reclaiming self. Implications for nursing include the importance of story telling in life history, the value of knowing the patient as a person, the positive impact of negative events, and the educational impact of a paradigm case.

Nurses and assisted dying: Taking our roles to heart and mind

and impersonal circumstances versus trying to determine your own practices and underlying values in a particular situation. Benedict et al. deftly guide our journey through the ethical, legal, and sometimes political issues that have played such an important role in shaping current practices. In understanding where we have been, we can be better prepared to examine where we are to determine where we should and should not journey in the future. In November 1994, the members of the Association of Nurses in AIDS Care adopted a resolution to form a task force to examine these complex issues and to draft a position paper on the role of the nurses in assisted suicide. Given the complexity of these issues, the task force is continuing its work. A report will be forthcoming.

AIDS, Nursing, and Physician-Assisted Suicide: Part 2

Nurses who work in HIV/AIDS care often hold conflicting views about appropriate nursing roles in relation to physician-assisted suicide. Regardless of whether the individual nurse supports or opposes physician-assisted suicide, nurses in HIV/AIDS care need to have a broad knowledge base of the legal and ethical issues related to physician-assisted suicide. This articles main purpose is to provide nurses with the knowledge base they need to assist them in their work in clinical practice, education, policy development, and research.

American academy of nursing's HIV/AIDS nursing care summit: The final synthesis

The American Academy of Nursing HIV/AIDS Nursing Care Summit convened nurse leaders from across the United States to discuss nursing responses to the HIV/AIDS epidemic. This final synthesis of the Summit includes recommendations regarding clinical practice, administration and policy, education, and research in the area of HIV/AIDS.

Commentary by Saunders

With this article, the authors contribute to an expanding body of knowledge on end-of-life care in general and to the specific end-of-life issue of communicating end-of-life preferences—certainly, a relevant endeavor. The authors point out the dearth of successful efforts to increase advance directives use. For this study, investigators approached adults in the community who had experience with communicating their end-of-life preferences to their significant others and to their health care providers. The purpose was to describe how they communicated these preferences. The authors developed a semistructured interview schedule from a review of end-of-life research literature and the attuning strategies from communication accommodation theory. They made minor changes in the interview after pilot testing their instrument. Using a descriptive survey design, the investigators recruited a convenience sample of 119 adults from a variety of community settings; the authors did not make clear how they verified that these adults had met the inclusion criterion of having had a previous discussion about their own end-of-life preferences. This research endeavor was rooted in the premise that people who had experienced these discussions might shed some light on how to hold meaningful end-of-life discussions with significant others and with health care providers. Although the findings do shed some light, the issue of how to engage patients, their families, and their health care providers in meaningful discussions remains a largely unsolved challenge. A major challenge with tools (interview schedules or questionnaires) that limit response choices is choosing which items to include or exclude. One of the interview questions for the semistructured interview in this study addressed treatment preferences, and they included the following treatments as choices: cardiopulmonary resuscitation, defibrillation, intubation or tracheostomy and mechanical breathing assistance, dialysis, intravenous fluids, artificial nutrition, antibiotics, preferred setting, and persons you would like present. Absent were any of the following: palliative care, pain management, terminal sedation, or legal measures to hasten death. These items did not appear in the interview schedule and are important omissions in meaningful end-of-life preference discussions.