Shigeko Izumi

Defining end-of-life care from perspectives of nursing ethics

Despite increasing interests and urgent needs for quality end-of-life care, there is no exact definition of what is the interval referred to as end of life or what end-of-life care is. The purpose of this article is to report our examination of terms related to end-of-life care and define end-of-life care from nursing ethics perspectives. Current terms related to end-of-life care, such as terminal care, hospice care, and palliative care, are based on a medical model and are restrictive in terms of diagnosis and prognosis. Using codes of ethics for nurses as a framework, we attempt to identify people to whom nurses are responsible to provide end-of-life care and develop a definition of end-of-life care that is more inclusive and applicable to a broader range of people who would benefit from end-of-life care by nurses and other health-care providers.

Predictors of Patient Satisfaction With Telephone Nursing Services

Patient satisfaction has been shown to be a factor in clinical outcomes, health care quality, and patient follow-through. Thus, a high level of satisfaction is a desired outcome of patient care. This article examines predictors of patient satisfaction with telephone nursing services among a sample of 1,939 respondents, using a conceptual model derived from the literature and preliminary work. The study was conducted in medical offices and call centers of a large national health maintenance organization. Calls were taped and content coded and then matched with caller questionnaire data. In the final multivariate predictive models, patient health status; caller ratings of expectations met by the nurse for listening, clarity, and collaboration; and nurse competence were the strongest predictors of satisfaction. Consistent with the literature, findings suggest that nurses should expand interpersonal communication skills, and systems should reduce barriers to effective listening, clarity, and collaboration with callers.

Quality nursing care for hospitalized patients with advanced illness: Concept development

The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability.

A model for examining predictors of outcomes of telephone nursing advice

Although telephone advice nursing is the fastest-growing nursing specialty, useful information to guide managers’ decisions about how best to structure and support advice services to achieve desired outcomes is unavailable. We identified issues and variables relevant to outcomes of telephone advice from the perspectives of callers, nurses, and the system. Subsequently, we derived a model for studying factors affecting nursing advice outcomes that will help managers identify modifiable factors to improve outcomes of care.

Bridging Western Ethics and Japanese Local Ethics by Listening to Nurses’ Concerns

Among Japanese nurses ethics is perceived as being distant and unrelated to their practice, although this is filled with ethical concerns and the making of ethical decisions. The reasons for this dissociation are the primacy of western values in modern Japanese health care systems and the suppression of Japanese nurses’ indigenous ethical values because of domination by western ethics. A hermeneutic study was conducted to listen to the ethical voices of Japanese nurses. Seven ethical concerns were revealed. Although some of these concerns may seem to share similar values with western ethical principles, the basis for the concerns was unique and rooted in the Japanese cultural value system. The meanings of each concern are explicated in conjunction with related background meanings. Listening and trying to understand these nurses’ voices in their own context suggests a way of bridging the gap between abstract and universal ethics and practical and local ethics.

Telephone advice nursing services in a US health maintenance organization

We studied telephone advice nursing (TAN) in the US. We recorded 4269 TAN calls in four regions served by Kaiser Permanente, a health maintenance organization. A call description form was used to record information regarding both calls and callers. The mean call length was 5.9 min (SD 3.6, range 0.3-35.8); 300 calls lasted less than 2 min. The mean call length differed significantly across regions, from 4.4 min in Hawaii to 8.7 min in Southern California. Calls to call centres lasted an average of 6.5 min (SD 3.8), compared with 4.2 min (SD 2.9) for those to medical offices. These differences were significant. Although 42% of calls required some further medical management, only 18% (n = 754) resulted in an urgent disposition, and only 16% (n = 121; 3% of all calls) of the urgent dispositions involved referral to emergency services. The likelihood of urgent disposition varied significantly by region. Callers generally used the TAN services for the right reasons, that is, with questions or concerns that could be reasonably handled by telephone advice nurses.

Relief of Suffering and Regard for Personhood: nurses’ ethical concerns in Japan and the USA

The ethical concerns of Japanese nurses are compared with those of previously described nurses from the USA. Patient comfort was a primary concern of nurses from both countries. Participants described an ethical imperative to provide adequate pain medication for patients and prevent unnecessary and uncomfortable invasive tests and procedures, especially at the end of life as the focus changed from ‘cure’ to ‘care’. The notion of regard for personhood varied, based on the communication styles and definition of the self inherent in the different cultures of the nurses. A common meaning centred around knowing patients as persons, listening to their needs and preferences, supporting their everyday choices through advocacy, and maintaining their dignity. Despite background cultural differences, there are common ethical concerns between nurses in Japan and the USA. This article invites readers to reflect on everyday nursing practices that exemplify ethical expertise, and the significance of this expertise in uncovering and articulating nursing ethics across cultures.

Advance care planning: The nurse's role

: This series on palliative care is developed in collaboration with the Hospice and Palliative Nurses Association (HPNA; http://hpna.advancingexpertcare.org). The HPNA aims to guide nurses in preventing and relieving suffering and in giving the best possible care to patients and families, regardless of the stage of disease or the need for other therapies. The HPNA offers education, certification, advocacy, leadership, and research.

Ethical practice in end-of-life care in Japan:

Nurses are obliged to provide quality nursing care that meets the ethical standards of their profession. However, clear descriptions of ethical practice are largely missing in the literature. Qualitative research using a phenomenological approach was conducted to explicate ethical nursing practice in Japanese end-of-life care settings and to discover how ethical practices unfold in clinical situations. Two paradigm cases and contrasting narratives of memorable end-of-life care from 32 Japanese nurses were used to reveal four levels of ethical practice: ethical, distressed, uncertain, and unethical. Having the ability to actualize, justify, and recognize what is the good and/or right differentiated between these levels of ethical practice, empirical descriptions of which are given, followed by discussion of how nurses gain the skilled knowledge necessary for ethical practice.

“I Didn’t Know He Was Dying”: Missed Opportunities for Making End-of-Life Care Decisions for Older Family Members

Research is limited on end-of-life care decision-making for older adults with chronic conditions whose end-of-life trajectory is difficult to predict because of their complex and frail condition. Semistructured interviews were conducted with family members of 22 deceased older adults to explore their experiences with end-of-life decision-making with/for their loved ones. Participants did not identify a specific time they made an end-of-life care decision as they did not know the older adult was at the end of life, health care providers did not ask them to make a decision, or they had to make forced decisions, and subsequently they experienced regret about the end-of-life care their family member received. End-of-life care decisions were dependent on the awareness of approaching death by participants, their loved ones, and health care providers. Health care providers being aware of the possibility of approaching death and assisting family members to make decisions that would honor the older adult’s preference by explaining possible care options and what each care options would mean to them are key to providing quality end-of-life care for these individuals.