Flip your classroom: Reach every student in every class every day

The first edition of this book provides a comprehensive text for nurses working within palliative care, although it would also be an interesting addition to the bookshelves of other professionals associated with this speciality. The target readership is palliative nurses working at an advanced practice level and the aim is to provide an intellectual challenge to engender critical thinking regarding clinical care of the dying rather than a ‘how to do' manual. These may be rather grand aspirations, but are ably backed by an international list of contributors. In the main, they have hit their target as the book represents a genuinely fresh approach to writing in this area and has successfully synthesised for the first time disparate information. Overall, this makes for an interesting read and certain chapters, most notably in Part One – Encountering Illness, that document the contemporary history of nursing within this speciality will become increasingly referenced and much valued.

There are four parts to the book: Encountering Illness; Transitions into the Terminal phase; Loss and Bereavement; and Contemporary Issues, each containing an overview from the editors introducing the principles and theoretical issues followed by shorter chapters that concentrate on aspects of the section. The difference is that they have avoided the rather predicable layout of physical, psychological, spiritual and so on, in favour of an integrated approach to the organisation of writing that flows more readily with the actual transitions people experience at the end of life. This approach has much to recommend as it avoids the pitfalls of making the discussions around aspects of care seem dislocated.

Part One – Encountering Illness is the strongest section. It is both illuminating and original and explores what it means for people who become ill and face death to take up the social role of patient and the implications for those that become their carers. This is examined by presenting short chapters including an excellent historical analysis followed by an account of global palliation developments and discussion of how such nurses continue to shape their approach to care. An examination of developments where patients themselves have increasingly become engaged with planning care has much relevance to recent policy imperatives and helps to put this in context, as does a review of the evidence thus far for end of life care for those without cancer and the questions it raises around organisation of the delivery of care and appropriate access. Developing palliative care in hospitals, a unique piece of writing on illness transitions, and robust overview of the communication literature all applied in a relevant way to clinical care. Lastly, there was a weaker overview on assessment in the end of life care, which is more rudimentary and missed the current emphasis that nurses are providing in areas such as pain and extending roles to include physical examination.

Part Two concentrates on the Transitions into the Terminal Phase. Again the editors have the confidence to give adequate exposure to dying, unlike other palliative care textbooks that cover this in a brief single chapter. There is valuable writing here with clinical applicability. Two particularly good examinations of the spiritual dimensions of palliative care on the excluded at the end of life is undertaken. A fundamental weakness of the book is the depth of discourse around the ethical issues at the end of life. The brevity ensured that the chapter on ethical issues was not examined in sufficient depth, leaving the sterile and remote from the clinical reality that is rather more complex. An area of great relevance is the need for palliative nurses to be articulate and fully aware of issues surrounding euthanasia. This book will not help them obtain more than a cursory examination of the argument. Although euthanasia is illegal in the UK, the authors persisted to give a neutral emphasis to the arguments. The argument against it was intellectually weak, missing an adequate exploration around how palliative nurses can engage suffering positively, an issue only partly dealt with, in the section chapters. Nurses increasingly have a major part in determining capacity and discussing issues of futility at the end of life and this omission limits the comprehensiveness of the book. This text never claimed to emphasise aspects of particular symptom control apart from a useful chapter on emotions and cognitions and pain. I suspect this will therefore be more useful for palliative nurses teaching trainees rather than challenging clinical decisions surrounding pain, which advanced practice nurses currently make. Most palliative nurses therefore will still have to use this textbook as a companion to a palliative medicine textbook.

Part Three – Loss and Bereavement will be valuable to palliative nurses and many worry that their actions are self-taught and rarely make reference to theoretical underpinnings. Organ and tissue donation are deservedly dealt with and the chapter on families and children facing loss and bereavement is especially informative and will greatly enhance how nurses approach clinical care. A nurse's role in supporting a person in exploring funeral plans would have been a useful addition here. The last section on Contemporary Issues is well balanced and introduces discourse on professional boundaries and the cost of caring, then moving onto education, research, governance and leadership.

The editors are to be congratulated in presenting a concise corpus of contemporary relevant issues of nurses' roles in palliation. Those in the speciality working at advanced practice level should certainly own a copy. Most of the material presented does indeed raise questions, however, the authors had scope for some truly visionary thinking especially in areas of clinical practice, which they did not quite harness. For this reason, I do not think that in this first edition they have quite managed to reach the claim to test the intellect, which after all was the original premise. I look forward to the second edition.

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Palliative Care Nursing: Principles and Evidence for Practice

Strategies to improve the care of elderly, multimorbid patients frequently focus on implementing evidence-based knowledge by structured assessments and standardization of care. In Germany, disease management programs (DMPs), for example, are run by general practitioners (GPs) for this purpose. While the importance of such measures is undeniable, there is a risk of ignoring other dimensions of care which are essential, especially for elderly patients: their spiritual needs and personal resources, loneliness and social integration, and self-care (i.e., the ability of patients to do something on their own except taking medications to increase their well-being). The aim of this study is to explore whether combining DMPs with interventions to address these dimensions is feasible and has any impact on relevant outcomes in elderly patients with polypharmacy. An explorative, cluster-randomized controlled trial with general practices as the unit of randomization will be conducted and accompanied by a process evaluation. Patients aged 70 years or older with at least three chronic conditions receiving at least three medications participating in at least one DMP will be included. The control group will receive DMP as usual. In the intervention group, GPs will conduct a spiritual needs assessment during the routinely planned DMP appointments and explore whether the patient has a need for more social contact or self-care. To enable GPs to react to such needs, several aids will be provided by the study: a) training of GPs in spiritual needs assessment and training of medical assistants in patient counseling regarding self-care and social activity; b) access to a summary of regional social offers for seniors; and c) information leaflets on nonpharmacological interventions (e.g., home remedies) to be applied by patients themselves to reduce frequent symptoms in old age. The primary outcome is health-related self-efficacy (using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES-6G)). Secondary outcomes are general self-efficacy (using the General Self-Efficacy Scale (GSES)), physical and mental health (using the Short-Form Health Survey (SF-12)), patient activation (using the Patient Activation Measure (PAM)), medication adherence (using the Medication Adherence Report Scale (MARS)), beliefs in medicine (using the Beliefs About Medicines Questionnaire (BMQ)), satisfaction with GP care (using selected items of the European Project on Patient Evaluation of General Practice (EUROPEP)), social contacts (using the 6-item Lubben Social Network Scale (LSNS-6)), and loneliness (using the 11-item De-Jong-Gierveld Loneliness Scale (DJGS-11)). Interviews will be conducted to assess the mechanisms, feasibility, and acceptability of the interventions. If the interventions prove to be effective and feasible, large-scale implementation should be sought and evaluated by a confirmatory design. German Clinical Trials Register (DRKS), DRKS00015696
 . Registered on 22 January 2019.

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Holistic care program for elderly patients to integrate spiritual needs, social activity, and self-care into disease management in primary care (HoPES3): study protocol for a cluster-randomized trial.

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The Merck Manual Of Geriatrics

Learning experiences of game-based educational intervention in nursing students: A systematic mixed-studies review

Self-care model application to improve self-care agency, self-care activities, and quality of life in patients with systemic lupus erythematosus

Background: Cervical cancer and breast cancer are the two top leading cases of female cancer in Indonesia. Being the 2nd largest city in Indonesia, Surabaya is being populated by more than 1.5 million females in 2017. This study aimed to describe the demographic characteristic of women living with cervical and breast cancer in order to show the current picture of female cancer situation in Surabayan communities nowadays. Substantial to it, the correlation between time of first diagnosis and type of therapy with current stage of cancer were analyzed to evaluate the cancer management effectiveness in community context. Methods: This cross-sectional study involved six (9.68%) Public Health Centers (PHCs) among 62 PHCs in Surabaya, Indonesia, which were selected by one stage cluster random sampling. There were 140 and 139 women living with cervical and breast cancer participated in this study respectively (n=279). Self-developed demographic questionnaire was used to collect the data. Descriptive statistic, Spearman Rank correlation test, and Mann-Whitney U test were used in data analysis (α<.05). Results: Overall, most respondents were married (77.06%) and were housewives (59.14%). They were high school graduated at majority (44.44%). Family support came from spouse and children (70.25%). Those with breast cancer mostly aged middle-up adulthood (56.12%), while older aged were found in respondents with cervical cancer (72.86%). The majority had been diagnosed with cancer for less than five years (81.36%), but there was a tendency that the longer life expectancy was found in those with cervical cancer. More cervical cancer respondents with advanced stage were found to be long-term survivors (25%). The first time of diagnosis and the type of therapy were significantly different between cases (p=.039 and p=.000 respectively), but the current stage of cancer was not significantly different (p=.239). There was a quite strong correlation between time of first diagnosis and current stage of cancer (ρ = -.409; p=.000), but there was no significant correlation between type of therapy and current stage of cancer (p=.147). Conclusions: The demographic characteristic of women living with cervical and breast cancer has been slowly shifting from elderly or late adulthood, to middle and early adulthood. The first time of diagnosis and the type of therapy were significantly different between cases, but the current stage of cancer was not significantly different. There was a strong significant correlation between time of first diagnosis and current stage of cancer in cervical and breast cancer.

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Women Living with Breast and Cervical Cancer in the Community: the Face of Surabaya Nowadays

Introduction : Learning method of Team Game Tournament (TGT) has student-centered learning characteristic focuses on students’ knowledge construction in which they could find important information useful for constructing their own knowledge. The continuous weak comprehension of neurology system anatomy and physiology resulted in the application of TGT for constructing students’ knowledge in this study. This study aimed to analyze the efficacy of TGT application for improving learning motivation and achievement in studying neurology system anatomy and physiology among nursing students. Method s : This pre-experimental study used the one group pretest post-test design approach. Target population was all nursing students in two institutions around Surabaya in the even semester of 2016/2017 academic year. Inclusion criteria were passed the course of Biomedical II or Nursing Basics I. Sample size was 143 chose by total sampling. Independent variable was TGT application and dependent variables were learning motivation and achievement. Study instruments were motivation questionnaire and objective test. Data analysis used paired t-test and Mann-Whitney test with α ≤ 0.05. Ethical clearance was issued (number: 449-KEPK). Results: Most respondents were 19 years old single female who chose nursing major because of their dream, and the majority still live with parents in their own house. Only learning motivation data that were normally distributed. TGT application could increase learning motivation and achievement of nursing students significantly (p=0.000 and p=0.028 respectively). Conclusion s : TGT application could increase learning motivation and achievement in studying neurology system anatomy and physiology among nursing students. Further implementation could be broad, other subjects in nursing could be the target in which difficult subject would be underlined.

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The Effect of Team Game Tournament (TGT) Cooperative Learning Method Application Towards Learning Motivation and Achievement

The effects of meditation-healing exercise among elderly who lives with non-communicable disease.
The purposes of the study were to determine the effects of meditation-healing exercise on non-communicable
disease, blood glucose, blood pressure level, quality of life, psychological support, and attitude of elderly.
The study utilized a one group pretest-posttest quasi-experimental research design among 196 elderly in
selected communities in Bangkok, Thailand and Surabaya, Indonesia. Descriptive analysis and repeated measure ANOVA were utilized for data analysis of the study. In Bangkok, the effects of meditation-healing
exercise on stress found that the elderly had moderate stress level (at 36.9 and decrease to 31.75), the blood
pressure and blood sugar level were significantly different effect in the each measurement of every month. In Surabaya, the elderly reported a change from high to moderate mean scores (at 47.31 and decrease to 33.86)
in the stress level. The result of the blood pressure showed significant effect, but the blood sugar level was
not significant. Both Bangkok and Surabaya reported to have a moderate quality of life (QOL) level. In general,
meditation-healing exercise affected the overall quality of life on psychological support, attitude and blood
pressure level of the elderly in community. Thus, meditation-healing exercise is safe and effective method in health care.

The Effects of Meditation-Healing Exercise in Elderly Who are Living with Non-Communicable Disease in Bangkok and Surabaya

Background: Cervical and breast cancer are the two top leading cases of female cancer worldwide. Both cases share some similar clinical manifestations as specific symptoms of cancer. Physical wellbeing often decreased as frequent symptoms appear. This study aimed to compare and analyze the physical wellbeing among cervical cancer and breast cancer survivors (CCS and BCS). Methods: This cross-sectional study involved 47 CCS and 58 BCS in the district of Rangkah, Gading, and Pacarkeling, Surabaya, Indonesia. Instrument of Quality of Life – Cancer Survivors (QOL-CS) was used for data collection. Independent sample T test and Mann-Whitney U test were used in data analysis (α< .05).  Results: More severe fatigue, appetite changes, pain, sleep disturbance, constipation, nausea-vomiting, and menstrual changes were found in CCS. More poor perceived health status and optimal physical wellbeing were found in BCS. Overall, most sufficient physical wellbeing was found in both groups. There were significant differences of fatigue, pain, sleep disturbance, appetite changes, constipation, health status (p<.001 for each), nausea-vomiting (p= .004), and menstrual changes (p= .001) were found between groups. Overall, physical wellbeing was significantly different between groups (p< .001). Sleep disturbance (84.7% of influence) and appetite changes (75.7% of influence) were the best predictors for determining physical wellbeing in CCS and BCS respectively. Conclusion: More severe cancer symptoms were found in CCS, but more poor perceived health status was found in BCS. There was a significant difference of physical wellbeing found between CCS and BCS.

Ni Putu Wulan Purnama Sari

Papers

Self-care model application to improve self-care agency, self-care activities, and quality of life in patients with systemic lupus erythematosus

Women Living with Breast and Cervical Cancer in the Community: the Face of Surabaya Nowadays

The Effect of Team Game Tournament (TGT) Cooperative Learning Method Application Towards Learning Motivation and Achievement

The Effects of Meditation-Healing Exercise in Elderly Who are Living with Non-Communicable Disease in Bangkok and Surabaya

Physical Wellbeing in Cervical and Breast Cancer Survivors: A Cross-sectional Study in Surabaya, Indonesia