There is limited evidence relating to end of life care for people with a history of problematic substance use, despite a growing need for treatment related to an older opiate-using population and increased premature mortality associated with alcohol-related liver disease. This article examines several significant challenges for nurses in supporting people who have engaged in problematic substance use, often resulting in comorbidities such as kidney damage, respiratory conditions and/or chronic pain. These challenges include ensuring accurate assessment and screening and how to openly communicate with individuals to explore their problematic substance use. The author also discusses advance care planning at the end of life and the challenges of providing effective palliative care and pain management for this population.

Background: Homeless people using substances at the end-of-life face many challenges in accessing and receiving good care. These can relate to poor interdisciplinary working by health and social care practitioners, stigma and structural disadvantage. Objective: Using positioning theory, we explored the challenges of existing models of practice for practitioners supporting this population. Research design: This is a qualitative descriptive study in which data were collected via four interdisciplinary practitioner focus groups. Data sources and methods: The four online interdisciplinary focus groups were conducted within a region of North-West England. This included 24 participants from health and social care providers with experience of working with and/or supporting people experiencing homelessness and using substances. Results: The findings indicated three primary discourse positions related to (i) What constitutes a good death and where? (ii) The limitations of professional boundaries and (iii) Maintaining moral adequacy in the face of traumatic death. For practitioners, maintaining moral adequacy was often compromised by ineffective multi-disciplinary collaboration. Practitioners were often exposed to traumatic working experiences with limited resources to effect change. Conclusion: The findings support work examining the structural and environmental challenges of palliative care provision for hostel-users and unsheltered homeless people in providing care at the end of life for people experiencing homelessness.

BACKGROUND:Though randomized controlled trials of non-pharmacological palliative care interventions have shown positive outcomes, findings are often generalized with limited consideration for the impact of the influence of race, ethnicity, nationality, or religion on said outcomes. AIM:To identify trends and gaps in global reporting of racial, ethnic, nationality, and religious demographics in non-pharmacological palliative care randomized controlled trials. DESIGN:We conducted a scoping review guided by the Joanna Briggs methodology. DATA SOURCES:Global randomized controlled trials published in English, between 1999 and 2021 extracted from databases: Cochrane, PubMed, and Scopus. Inclusion criteria were non-pharmacological palliative care interventions for people with serious conditions reporting on one or more of the demographics of race, ethnicity, nationality, or religion. RESULTS:Our review included 131 (44%) articles published from 19 countries, predominantly the USA (n = 84, 64%). Most studies focused on cancer (n = 71, 54%) in inpatient settings (n = 85, 64%). Race was the most commonly reported demographic (n = 93, 70%), followed by ethnicity (n = 54, 41%), religion (n = 46, 35%), nationality (n = 20, 15%). Within racial reporting, 86 (92%) indicating a majority White/Caucasian sample. Only 14 (10%) articles provided context connecting participant demographics to intervention outcomes. Demographic data was discussed only as a limitation to generalizability in 18 cases (41%). CONCLUSIONS:Improving greater transparency in study reporting of social and historical context about population demographics, including specific demographic data collected, may better identify unmet palliative needs, facilitate cross-cultural interpretation, and improve adaptation and implementation of non-pharmacological palliative care interventions.

Harmful use of illicit drugs and/or alcohol is linked to life-limiting illness and complex health and social care needs, but people who use substances and have complex needs do not receive timely palliative care and fail to achieve quality standards for a good death. They and their families often require support from multiple health and social care services which are shown to be poorly integrated and fail to deliver interdisciplinary care. This study aimed to identify the existing barriers and facilitators within and between services in providing this population with a good death. Using a mixed methods approach of survey, focus groups and semi-structured interviews, we explored the perspectives of practitioner and management staff across a range of health and social disciplines and organisations in one combined authority in a large city in the north west of England. Our findings indicate that practitioners want to provide better care for this client group, but face structural, organisational and professional boundary barriers to delivering integrated and shared care. Differences in philosophy of care, piecemeal commissioning and funding of services, and regulatory frameworks for different services, lead to poor and inequitable access to health and social care services. Ways forward for improving care are suggested as bespoke hostel-based accommodation for palliative care for this client group, and specialist link workers who can transcend professional and organisational boundaries to support co-ordination of services and support. We conclude that it is no longer adequate to call for more training, better communication and improved joint working. Complex care at the end of life requires creative and cohesive systemic responses that enable multi-disciplinary practitioners to provide the care they wish to give and enables individuals using substances to get the respect and quality service they deserve.

Purpose of Review We sought to identify current interventions, research, or non-research evidence that has direct or indirect consideration of intersectionality in the care of older adults in the emergency department (ED). An integrative review informed by Crenshaw’s Theory of Intersectionality was conducted in accordance with Whittemore and Knafl’s five-stage methodology. A rigorous review process determined appropriateness for inclusion, and articles were analyzed for areas related to direct or indirect relationship to intersectionality. Recent Findings Older adults aged 60 and above in the United States (US) account for more than 20% of ED visits annually, and half of older adults will visit the ED in their last year of life. There has been a growing focus on adapting the ED to meet the palliative care needs of older adults, but relatively little consideration has been given to older adults’ intersectional identities. Summary Six articles were identified that provided indirect insights into the status of intersectionality in ED-based palliative care for older adults. Two areas of interest were identified: (1) intersectional elements or reference to such elements embedded within the studies; and (2) the challenges of adapting quantitative methodologies to incorporate variables and approaches that would allow for intersectional analysis. This review highlights areas for future research along with recommendations for adopting an intersectional framing into commonly used methodologies.

The use of Instagram by adolescents to access deliberate self-harm content is a growing concern among scholars, mental health professionals and families, with many adolescents (10-19-year-olds) imitating offline what they have seen online. This scoping review aims to investigate the extent to which Instagram use impacts the mental health of its adolescent users, identifying whether there is a relationship between time spent on Instagram and engagement in deliberate self-harm. The databases, PubMed, Web of Science, Google scholar, APA PsycInfo, CINAHL and child development and adolescent studies were explored, and after applying the inclusion/exclusion criteria, 15 papers were included in this review. Thematic analysis indicated that there was a relationship between time spent on Instagram and deliberate self-harm; desensitization of deliberate self-harm resulting in normalization; social contagion and that Instagram provided a sense of belonging to its users who engaged in deliberate self-harm. Implications of this research is that it is quickly outdated as new social media platforms are developed and that the reliance on self-reports does not have high validity or reliability.

Background Secondary traumatic stress (STS) has been defined as the stress resulting from helping or wanting to help a traumatised or suffering person. The hyperacute nature of stroke specialist nurses’ work places them at risk of developing STS. Aims To explore the factors that are influential in stroke specialist nurses' experience of STS development within hyperacute practice. Methods This study is qualitative with a narrative design. Data were collected from a purposive sample of stroke specialist nurses (20 female and 2 male) working in hyperacute services during the years 2016 and 2017. Data were analysed using Polkinghorne’s approach. Results This research identified four themes: exposure to acute suffering and death- young presentations; moral distress; interactions with relatives and problematic healthcare systems. Conclusion The findings from this study suggest that stroke specialist nurses are exposed to multiple triggers which are commensurate with the potential for STS development. The findings contribute a new understanding of the emotional burden of hyperacute specialist stroke nursing that has implications for patient safety and satisfaction, services provision and staff well-being.

This chapter addresses a new systems level approach that takes account of the intersectional and compounded nature of the characteristics that combine to marginalise many people from palliative and end-of-life care. The delivery of care remains fragmented in spite of aspirations for integrated and shared care. Health systems are designed to be curative and social care systems are designed to safeguard and support people’s wellbeing. The new Complex case management and assertive outreach (ComCAS) service model would sit astride the other services and would seek to embed a consistency of care delivery to people with multiple needs at, or near, the end of their lives. It would not replace the other services, but it would provide an expertise in complex needs and provide a case management function for people whose access to services is currently limited and marginal.

This chapter will explore the challenges of supporting someone with a learning disability using substances at the end of life through a case study approach. The case study is based on an interview with Grace, the sister of Peter, a man with a learning disability who used substances. We will examine the wider context of health inequalities and discrimination and specifically the context and recognition of dying for people living with a learning disability using substances. We will explore the communication challenges between the person with learning disabilities, their family and social network and consider how interdisciplinary working by health and social care professionals can influence care delivery. We will further explore choice and decision-making at the end of life and how substance use can impede decision-making for people with learning disabilities.

This discussion article examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as ‘restitution’ and narratives common within the context of drug services such as ‘recovery’ can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as ‘junkies’ and associated with criminality. They are positioned as drug-seeking, and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make it challenging to generate ‘companion’ stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person’s self-identity is invested in narratives of recovery, and opioid use symbolises their addicted past because for practitioners, this population is at clinical risk with the potential for drug seeking behaviours. Whilst not requiring formal ethical review this discussion paper was constructed in accordance with good scientific practice with the work of other researchers respected and cited appropriately.

Journal of Nursing ScholarshipVolume 52, Issue 5 p. 459-461 Guest Editorial The Need for Visible Nursing Leadership During COVID-19 Elizabeth Rosser DPhil, MN, Dip N Ed, Dip RM, RN, RM, RNT, PFHEA, Corresponding Author Elizabeth Rosser DPhil, MN, Dip N Ed, Dip RM, RN, RM, RNT, PFHEA [email protected] orcid.org/0000-0002-2548-4924 Phi Mu, Emeritus Professor, Bournemouth University, Lansdowne Campus, Bournemouth, Dorset, EnglandSearch for more papers by this authorLiz Westcott DCM, MSc, Dip Man, RNT, RGN, Liz Westcott DCM, MSc, Dip Man, RNT, RGN Phi Mu, Executive Coach and Coaching Supervisor, NMC Test of Competence Assessor, Oxford Brookes University, Oxford, EnglandSearch for more papers by this authorParveen A. Ali PhD, MScN, RGN, SFHEA, FRSA, Parveen A. Ali PhD, MScN, RGN, SFHEA, FRSA orcid.org/0000-0002-7839-8130 Phi Mu, Senior Lecturer, Health Sciences School, University of Sheffield, Sheffield, EnglandSearch for more papers by this authorJoanne Bosanquet MBE, RN, RHV, Joanne Bosanquet MBE, RN, RHV Phi Mu, Chief Executive, Foundation of Nursing Studies, London, EnglandSearch for more papers by this authorEnrique Castro-Sanchez PhD, MPH, BSc, RGN, DipTropNurs, PgDip, DLSHTM, FEANS, Enrique Castro-Sanchez PhD, MPH, BSc, RGN, DipTropNurs, PgDip, DLSHTM, FEANS orcid.org/0000-0002-3351-9496 Phi Mu, Lecturer in Adult Nursing, City University of London, and NIHR 70@70 Senior Nurse Research Leader, NIHR Academy, London, EnglandSearch for more papers by this authorJan Dewing PhD, MA, MN, BSc, RN, Dip NursEd, Dip Nurs, Jan Dewing PhD, MA, MN, BSc, RN, Dip NursEd, Dip Nurs orcid.org/0000-0002-7968-2213 Omega Xi, Sue Pembrey Chair in Nursing & Director of Centre for Person-Centred Practice Research, Queen Margaret University, Edinburgh, Scotland, UKSearch for more papers by this authorBrendan McCormack D.Phil(Oxon.), BSc(Hons.) Nursing,FRCN, FEANS, FRCSI, PGCEA, RMN, RGN, FAAN, Brendan McCormack D.Phil(Oxon.), BSc(Hons.) Nursing,FRCN, FEANS, FRCSI, PGCEA, RMN, RGN, FAAN orcid.org/0000-0001-8525-8905 Omega Xi, Head of the Divisions of Nursing, Occupational Therapy and Arts Therapies and Associate Director Centre for Person-Centred Practice Research, Queen Margaret University, Edinburgh, Scotland, UKSearch for more papers by this authorJoy Merrell PhD, MSc, BSc(Hons) Nursing, RGN, RHV, RNT, HV Tut Cert, Joy Merrell PhD, MSc, BSc(Hons) Nursing, RGN, RHV, RNT, HV Tut Cert orcid.org/0000-0003-1205-2628 Upsilon Xi-at-Large, Professor of Public Health Nursing, Swansea University, Swansea, Wales, UKSearch for more papers by this authorGary Witham PhD, RN, Pg Cert Palliative Care, Pg Cert, BA(Hons), Gary Witham PhD, RN, Pg Cert Palliative Care, Pg Cert, BA(Hons) orcid.org/0000-0002-8575-7533 Phi Mu, Senior Lecturer in Nursing, Manchester Metropolitan University, Manchester, EnglandSearch for more papers by this author Elizabeth Rosser DPhil, MN, Dip N Ed, Dip RM, RN, RM, RNT, PFHEA, Corresponding Author Elizabeth Rosser DPhil, MN, Dip N Ed, Dip RM, RN, RM, RNT, PFHEA [email protected] orcid.org/0000-0002-2548-4924 Phi Mu, Emeritus Professor, Bournemouth University, Lansdowne Campus, Bournemouth, Dorset, EnglandSearch for more papers by this authorLiz Westcott DCM, MSc, Dip Man, RNT, RGN, Liz Westcott DCM, MSc, Dip Man, RNT, RGN Phi Mu, Executive Coach and Coaching Supervisor, NMC Test of Competence Assessor, Oxford Brookes University, Oxford, EnglandSearch for more papers by this authorParveen A. Ali PhD, MScN, RGN, SFHEA, FRSA, Parveen A. Ali PhD, MScN, RGN, SFHEA, FRSA orcid.org/0000-0002-7839-8130 Phi Mu, Senior Lecturer, Health Sciences School, University of Sheffield, Sheffield, EnglandSearch for more papers by this authorJoanne Bosanquet MBE, RN, RHV, Joanne Bosanquet MBE, RN, RHV Phi Mu, Chief Executive, Foundation of Nursing Studies, London, EnglandSearch for more papers by this authorEnrique Castro-Sanchez PhD, MPH, BSc, RGN, DipTropNurs, PgDip, DLSHTM, FEANS, Enrique Castro-Sanchez PhD, MPH, BSc, RGN, DipTropNurs, PgDip, DLSHTM, FEANS orcid.org/0000-0002-3351-9496 Phi Mu, Lecturer in Adult Nursing, City University of London, and NIHR 70@70 Senior Nurse Research Leader, NIHR Academy, London, EnglandSearch for more papers by this authorJan Dewing PhD, MA, MN, BSc, RN, Dip NursEd, Dip Nurs, Jan Dewing PhD, MA, MN, BSc, RN, Dip NursEd, Dip Nurs orcid.org/0000-0002-7968-2213 Omega Xi, Sue Pembrey Chair in Nursing & Director of Centre for Person-Centred Practice Research, Queen Margaret University, Edinburgh, Scotland, UKSearch for more papers by this authorBrendan McCormack D.Phil(Oxon.), BSc(Hons.) Nursing,FRCN, FEANS, FRCSI, PGCEA, RMN, RGN, FAAN, Brendan McCormack D.Phil(Oxon.), BSc(Hons.) Nursing,FRCN, FEANS, FRCSI, PGCEA, RMN, RGN, FAAN orcid.org/0000-0001-8525-8905 Omega Xi, Head of the Divisions of Nursing, Occupational Therapy and Arts Therapies and Associate Director Centre for Person-Centred Practice Research, Queen Margaret University, Edinburgh, Scotland, UKSearch for more papers by this authorJoy Merrell PhD, MSc, BSc(Hons) Nursing, RGN, RHV, RNT, HV Tut Cert, Joy Merrell PhD, MSc, BSc(Hons) Nursing, RGN, RHV, RNT, HV Tut Cert orcid.org/0000-0003-1205-2628 Upsilon Xi-at-Large, Professor of Public Health Nursing, Swansea University, Swansea, Wales, UKSearch for more papers by this authorGary Witham PhD, RN, Pg Cert Palliative Care, Pg Cert, BA(Hons), Gary Witham PhD, RN, Pg Cert Palliative Care, Pg Cert, BA(Hons) orcid.org/0000-0002-8575-7533 Phi Mu, Senior Lecturer in Nursing, Manchester Metropolitan University, Manchester, EnglandSearch for more papers by this author First published: 07 July 2020 https://doi.org/10.1111/jnu.12587Citations: 47Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References Shwu-Feng, T., Ching-Chiu, K., Hsiu-Hung, W., & Chia-Chin, L. (2020). Nursing's response to covid-19: Lessons learned from SARS in Taiwan. International Journal of Nursing Studies, 108, 103587. https://doi.org/10.1016/j.i.nursstu.2020.103587. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32388221/ 10.1016/j.ijnurstu.2020.103587 PubMedWeb of Science®Google Scholar World Health Organization. (2020a). State of the world's nursing 2020: Investing in education, jobs and leadership. Retrieved from file:///C:/Users/rosse/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/9789240003279-eng%20(1).pdf Google Scholar World Health Organization. (2020b). The year of the nurse and midwife. Retrieved from https://www.who.int/news-room/campaigns/year-of-the-nurse-and-the-midwife-2020 Google Scholar Citing Literature Volume52, Issue5September 2020Pages 459-461 This article also appears in:Health Policy Implications: Lessons Learned from COVID-19 ReferencesRelatedInformation

This paper examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as “restitution” and narratives common within the context of drug services such as “recovery” can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as “junkies” and associated with criminality. They are positioned as drug-seeking and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make is it challenging to generate “companion” stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person’s self-identity is invested in narratives of recovery and opioid use symbolises their addicted past or because for practitioners, this population is a clinical risk with the potential for drug seeking behaviours.

People who use alcohol and other drugs(hereafter "substances") and who are over the age of 40 are now more likely to die of a non-drug related cause than people who use substances under the age of 40. This population will therefore potentially need greater access to palliative and end of life care services. Initially, the purpose of this rapid evidence assessment (REA), conducted August 2016-August 2017, was to explore the peer-reviewed evidence base in relation to end of life care for people with problematic substance use. The following databases were searched using date parameters of 1 January 2004-1 August 2016: Amed, Psycharticles, Ovid, Ageinfo, Medline, Ebscohost, ASSIA, Social Care Online, Web of Knowledge, Web of Science, SSCI, Samsha, NIAAA. Data were extracted using a predefined protocol incorporating inclusion and exclusion criteria. Given the dearth of evidence emerging on interventions and practice responses to problematic substance use, the inclusion criteria were broadened to include any peer-reviewed literature focussing on substance use specifically and end of life care. There were 60 papers that met the inclusion criteria. These were quality assessed. Using a textual thematic approach to categorise findings, papers fell into three broad groups (a) pain management, (b) homeless and marginalised groups, and (c) alcohol-related papers. In general, this small and diverse literature lacked depth and quality. The papers suggest there are challenges for health and social care professionals in meeting the end of life needs of people who use substances. Addressing issues like safe prescribing for pain management becomes more challenging in the presence of substance use and requires flexible service provision from both alcohol/drug services and end of life care providers. Work is needed to develop models of good practice in working with co-existing substance use and end of life conditions as well as prevalence studies to provide a wider context for policy development.

Purpose: The experiences of cancer care can be mediated by many different factors and this narrative literature review aims to explore the experiences of cancer care in relation to people with intellectual disabilities receiving cancer treatment. Method We undertook a search for articles in English from (Jan) 2000-(Feb) 2018 using Medline, CINAHL, ScienceDirect, ASSIA and Wiley. The inclusion criteria are 2000-2018, English language and focussing on experiences of cancer journey. We used a narrative approach and thematically analysed the data. Results: There were 10 papers that met our inclusion/exclusion criteria. The themes generated included communication issues, information giving and decision-making. The literature suggests that communication and decision-making within cancer care are often mediated through support workers or family carers with minimal involvement of the person with intellectual disabilities. Information-giving by health professionals and support workers to people with intellectual disabilities was limited. This was often justified by the perceived distress this may cause. Conclusion: Training for health professionals and support workers in supporting people with intellectual difficulties is required for more effective communication in cancer care.

In this article, we examine the challenges of informal carers supporting someone with dementia and cancer within the United Kingdom. Interviews were conducted with seven informal carers using a narrative approach to examine the construction of their experiences. Our findings demonstrate how informal carers navigate a path through complex cancer treatments and support their relative. A cancer diagnosis often requires multiple treatment visits to an oncology center, and this can be challenging for carers. They find that they need to coordinate and manage both health professionals and their relative in terms of getting access to appropriate services and support. This process can be particularly challenging in the presence of a cognitive impairment that often demands effective communication with different agencies. Carers frequently experienced multiple challenges including dealing with the stigma that is characteristic of the dementia experience and the added complexity of negotiating this within a cancer care context.