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Papers by Jean-Jacques Georges
Open Journal of Nursing, 2013
Background: Caregivers experience problems when caring for people with intellectual disabilities ... more Background: Caregivers experience problems when caring for people with intellectual disabilities who are terminally ill. Aim: The aim of this study is to gain a deeper understanding of the experience of the caregiver when caring for a person with intellectual disabilities who is terminally ill and what influences this experience. Design: A qualitative research was carried out following the principles of Grounded Theory (GT) method, through fifteen interviews with caregivers in a living facility with continuous care. Results: The results show how caregivers strive to create meaningful moments for their client during the last period of his life. Since very few of the clients can clearly express their wishes and feelings, continuous observation is required of the caregivers for the interpretation of small signals of their clients. In that way, the appropriateness of their actions can be made certain. The results show that because of their involvement, caregivers are able to recognize clients' signals. When a client is dying, the special atmosphere created on the ward contributes to coping with the situation and a positive experience. Conclusion: Direct-caregivers caring for a client with an intellectual disability who is terminally ill, experience an intense period of insecurity and also a special period meaningful when caring a dying client with intellectual disabilities. Their relationship with the client makes them to be more able to strive for client's comfort. The results also show that some factors such as enough staff, clear and open communication with the physician and support of the manager contribute to the quality of palliative care on the ward.
Supportive Care in Cancer, 2005
Palliative Medicine, 2005
Palliative care, directed at improving the quality of life of terminally ill patients, is general... more Palliative care, directed at improving the quality of life of terminally ill patients, is generally not aimed at any form of postponing or hastening death. It is possible that high quality palliative care could prevent requests for euthanasia. However, empirical evidence on this issue is scarce. In a national survey of end-of-life medical decisions in The Netherlands the subject of care at the end of life has been addressed. Data on terminally ill cancer patients who died after their request was granted and euthanasia had been performed were compared with those of terminally ill cancer patients who did not request euthanasia. The results show that the prevalence and severity of symptoms e.g., pain, feeling unwell, nausea, was higher in patients who died after their request was granted and euthanasia had been performed. No differences concerning the treatment of symptoms or the care provided were found between the two groups. The results suggest that the practice of euthanasia is mai...
Nursing Ethics, 2002
This article is a review of the literature on the subject of how nurses who provide palliative ca... more This article is a review of the literature on the subject of how nurses who provide palliative care are affected by ethical issues. Few publications focus directly on the moral experience of palliative care nurses, so the review was expanded to include the moral problems experienced by nurses in the care of the terminally ill patients. The concepts are first defined, and then the moral attitudes of nurses, the threats to their moral integrity, the moral problems that are perceived by nurses, and the emotional consequences of these moral problems are considered in turn. The results show that the moral behaviour of nurses, which is theoretically grounded in commitment to care and to the patient, appears to be shaped by specific processes that lead to engagement or to mental and behavioural disengagement in morally difficult situations. Nurses often appear to fail to recognize the moral dimensions of the problems they experience and also to lack the skills they need to resolve moral pr...
Journal of Pain and Symptom Management, 2006
This study investigates the background and evolution of requests to forgo treatment and hasten de... more This study investigates the background and evolution of requests to forgo treatment and hasten death in terminally ill cancer patients. Physicians participating in a nationwide study on end-of-life decision making were asked whether they were treating a terminally ill cancer patient whose life expectancy was longer than 1 week but no longer than 3 months and who they would continue to treat until the patient's death. Of the 120 physicians who had a patient who met the inclusion criteria, 85 (70.8%) completed a questionnaire each month until the patient's death. The questionnaire provided information on the patient's symptoms, concerns, and requests involving end-of-life decisions. Most patients suffered from cancer of the gastrointestinal tract or the respiratory system, and 66% died within 2 months of the initial interview. The prevalence of requests involving end-of-life decisions increased during the last 3 months of a patient's life. The evolution of a request was especially related to an increase in the number of severe symptoms and concerns. Requests to forgo treatment were related to general weakness, whereas loss of dignity was a major reason for requests to hasten death. Physical suffering alone appeared to lead to less drastic requests than suffering blended by concerns and psychological problems leading to requests for hastened death. The results emphasize the importance of gaining insight into the patients' suffering to provide meaningful assistance.
Journal of Clinical Nursing, 2000
The original philosophy of palliative care emphasizes the importance of the integration of compas... more The original philosophy of palliative care emphasizes the importance of the integration of compassion and medical science. The meaning palliative care nurses assign to their relationships with patients has been described in several studies. This qualitative research was undertaken in order to elicit the way nurses working on a palliative care ward in an academic hospital perceive their role and gain insight into the problems they encounter. The findings present two different perceptions held by nurses about the nature of their work. The first, the more prominent, is 'striving to adopt a well-organized and purposeful approach as a nurse on an academic ward'; the second is 'striving to enhance the well-being of the patient'. Nurses should be supported in the development of their palliative care approach and be assisted in reflecting on their practice in terms of a model of 'reflective practice' and in the development of 'moral imagination'.
Journal of Clinical Nursing, 2013
To gain an insight into strategies, adopted by Dutch respiratory nurses during clinic sessions, t... more To gain an insight into strategies, adopted by Dutch respiratory nurses during clinic sessions, to improve self-management of patients with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is therefore an important consideration. By applying specific strategies, respiratory nurses can play a major role in the promotion of self-management. Research has shown that respiratory nurses, who run clinics, have insufficient knowledge of evidence-based strategies that can be adopted to promote self-management among chronic obstructive pulmonary disease patients. It appears that respiratory nurses adopt their own strategies during clinic sessions. A qualitative research study was carried out using Grounded Theory method. Data were collected during open interviews conducted by an external researcher with a nursing background. The interviews were analysed through coding after which categories were developed. Fourteen respiratory nurses were interviewed. The results show that respiratory nurses emphasise quitting smoking during the consult. Attention is also paid to inhalation medication and techniques. Other self-management strategies that respiratory nurses use are: application of specific interviewing techniques, referring to other healthcare professionals and providing tools for coping with the illness in everyday life. The main emphasis during the clinic session is directed at quitting smoking. Other self-management strategies such as providing information regarding nutrition and exercise, instilling confidence and becoming an equal discussion partner, gain less attention. During the clinic session, respiratory nurses should also focus on these self-management strategies in addition to quitting smoking. Further research should be directed at self-management strategies used by respiratory nurses in relation to different characteristics of patients. In this way, a more patient-oriented form of consultation could be developed for chronic obstructive pulmonary disease patients.
Death Studies, 2007
This study used retrospective interviews with 87 relatives to describe the experiences of patient... more This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most patients (79%) had spoken about their wishes concerning medical end-of-life decisions to be made at a later date. Hopeless suffering, loss of dignity, and no prospect of recovery were the most prevalent reasons for explicitly requesting EAS. According to the relative, in 92% of patients EAS had contributed favourably to the quality of the end of life, mainly by preventing or ending suffering.
BMJ, 2005
It has also been said that if palliative care is developed, euthanasia will not be needed. Effect... more It has also been said that if palliative care is developed, euthanasia will not be needed. Effective palliative care will keep all patients free of pain so no one will ask for euthanasia. I believe that the claim that pain can always be defeated is false (unless you sedate the patient into oblivion), but this is really not what the discussion is or should be about. Patients may request euthanasia for reasons other than pain. Some patients find that they are finished with their lives and their process of dying. They find it humiliating to have to continue living, experiencing mental and physical decay. If there are such patients, and I believe there are, it is cruel to turn down their request for euthanasia. A system for euthanasia would mean that people could approach the terminal phase of their lives without fear. They would know that, if, when their turn comes, and things turn out to be terrible, they have a way out. Contributors and sources: TT has published extensively in moral philosophy, political philosophy, and medical ethics. The three views are discussed more fully in his book Understanding Ethics (Edinburgh University Press, 2002).
… of Clinical Nursing, 2002
The original philosophy of palliative care emphasizes the importance of the integration of comp... more The original philosophy of palliative care emphasizes the importance of the integration of compassion and medical science. The meaning palliative care nurses assign to their relationships with patients has been described in several studies. ... This qualitative research was undertaken in ...
Open Journal of Nursing, 2013
Background: Caregivers experience problems when caring for people with intellectual disabilities ... more Background: Caregivers experience problems when caring for people with intellectual disabilities who are terminally ill. Aim: The aim of this study is to gain a deeper understanding of the experience of the caregiver when caring for a person with intellectual disabilities who is terminally ill and what influences this experience. Design: A qualitative research was carried out following the principles of Grounded Theory (GT) method, through fifteen interviews with caregivers in a living facility with continuous care. Results: The results show how caregivers strive to create meaningful moments for their client during the last period of his life. Since very few of the clients can clearly express their wishes and feelings, continuous observation is required of the caregivers for the interpretation of small signals of their clients. In that way, the appropriateness of their actions can be made certain. The results show that because of their involvement, caregivers are able to recognize clients' signals. When a client is dying, the special atmosphere created on the ward contributes to coping with the situation and a positive experience. Conclusion: Direct-caregivers caring for a client with an intellectual disability who is terminally ill, experience an intense period of insecurity and also a special period meaningful when caring a dying client with intellectual disabilities. Their relationship with the client makes them to be more able to strive for client's comfort. The results also show that some factors such as enough staff, clear and open communication with the physician and support of the manager contribute to the quality of palliative care on the ward.
Supportive Care in Cancer, 2005
Palliative Medicine, 2005
Palliative care, directed at improving the quality of life of terminally ill patients, is general... more Palliative care, directed at improving the quality of life of terminally ill patients, is generally not aimed at any form of postponing or hastening death. It is possible that high quality palliative care could prevent requests for euthanasia. However, empirical evidence on this issue is scarce. In a national survey of end-of-life medical decisions in The Netherlands the subject of care at the end of life has been addressed. Data on terminally ill cancer patients who died after their request was granted and euthanasia had been performed were compared with those of terminally ill cancer patients who did not request euthanasia. The results show that the prevalence and severity of symptoms e.g., pain, feeling unwell, nausea, was higher in patients who died after their request was granted and euthanasia had been performed. No differences concerning the treatment of symptoms or the care provided were found between the two groups. The results suggest that the practice of euthanasia is mai...
Nursing Ethics, 2002
This article is a review of the literature on the subject of how nurses who provide palliative ca... more This article is a review of the literature on the subject of how nurses who provide palliative care are affected by ethical issues. Few publications focus directly on the moral experience of palliative care nurses, so the review was expanded to include the moral problems experienced by nurses in the care of the terminally ill patients. The concepts are first defined, and then the moral attitudes of nurses, the threats to their moral integrity, the moral problems that are perceived by nurses, and the emotional consequences of these moral problems are considered in turn. The results show that the moral behaviour of nurses, which is theoretically grounded in commitment to care and to the patient, appears to be shaped by specific processes that lead to engagement or to mental and behavioural disengagement in morally difficult situations. Nurses often appear to fail to recognize the moral dimensions of the problems they experience and also to lack the skills they need to resolve moral pr...
Journal of Pain and Symptom Management, 2006
This study investigates the background and evolution of requests to forgo treatment and hasten de... more This study investigates the background and evolution of requests to forgo treatment and hasten death in terminally ill cancer patients. Physicians participating in a nationwide study on end-of-life decision making were asked whether they were treating a terminally ill cancer patient whose life expectancy was longer than 1 week but no longer than 3 months and who they would continue to treat until the patient's death. Of the 120 physicians who had a patient who met the inclusion criteria, 85 (70.8%) completed a questionnaire each month until the patient's death. The questionnaire provided information on the patient's symptoms, concerns, and requests involving end-of-life decisions. Most patients suffered from cancer of the gastrointestinal tract or the respiratory system, and 66% died within 2 months of the initial interview. The prevalence of requests involving end-of-life decisions increased during the last 3 months of a patient's life. The evolution of a request was especially related to an increase in the number of severe symptoms and concerns. Requests to forgo treatment were related to general weakness, whereas loss of dignity was a major reason for requests to hasten death. Physical suffering alone appeared to lead to less drastic requests than suffering blended by concerns and psychological problems leading to requests for hastened death. The results emphasize the importance of gaining insight into the patients' suffering to provide meaningful assistance.
Journal of Clinical Nursing, 2000
The original philosophy of palliative care emphasizes the importance of the integration of compas... more The original philosophy of palliative care emphasizes the importance of the integration of compassion and medical science. The meaning palliative care nurses assign to their relationships with patients has been described in several studies. This qualitative research was undertaken in order to elicit the way nurses working on a palliative care ward in an academic hospital perceive their role and gain insight into the problems they encounter. The findings present two different perceptions held by nurses about the nature of their work. The first, the more prominent, is 'striving to adopt a well-organized and purposeful approach as a nurse on an academic ward'; the second is 'striving to enhance the well-being of the patient'. Nurses should be supported in the development of their palliative care approach and be assisted in reflecting on their practice in terms of a model of 'reflective practice' and in the development of 'moral imagination'.
Journal of Clinical Nursing, 2013
To gain an insight into strategies, adopted by Dutch respiratory nurses during clinic sessions, t... more To gain an insight into strategies, adopted by Dutch respiratory nurses during clinic sessions, to improve self-management of patients with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is therefore an important consideration. By applying specific strategies, respiratory nurses can play a major role in the promotion of self-management. Research has shown that respiratory nurses, who run clinics, have insufficient knowledge of evidence-based strategies that can be adopted to promote self-management among chronic obstructive pulmonary disease patients. It appears that respiratory nurses adopt their own strategies during clinic sessions. A qualitative research study was carried out using Grounded Theory method. Data were collected during open interviews conducted by an external researcher with a nursing background. The interviews were analysed through coding after which categories were developed. Fourteen respiratory nurses were interviewed. The results show that respiratory nurses emphasise quitting smoking during the consult. Attention is also paid to inhalation medication and techniques. Other self-management strategies that respiratory nurses use are: application of specific interviewing techniques, referring to other healthcare professionals and providing tools for coping with the illness in everyday life. The main emphasis during the clinic session is directed at quitting smoking. Other self-management strategies such as providing information regarding nutrition and exercise, instilling confidence and becoming an equal discussion partner, gain less attention. During the clinic session, respiratory nurses should also focus on these self-management strategies in addition to quitting smoking. Further research should be directed at self-management strategies used by respiratory nurses in relation to different characteristics of patients. In this way, a more patient-oriented form of consultation could be developed for chronic obstructive pulmonary disease patients.
Death Studies, 2007
This study used retrospective interviews with 87 relatives to describe the experiences of patient... more This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most patients (79%) had spoken about their wishes concerning medical end-of-life decisions to be made at a later date. Hopeless suffering, loss of dignity, and no prospect of recovery were the most prevalent reasons for explicitly requesting EAS. According to the relative, in 92% of patients EAS had contributed favourably to the quality of the end of life, mainly by preventing or ending suffering.
BMJ, 2005
It has also been said that if palliative care is developed, euthanasia will not be needed. Effect... more It has also been said that if palliative care is developed, euthanasia will not be needed. Effective palliative care will keep all patients free of pain so no one will ask for euthanasia. I believe that the claim that pain can always be defeated is false (unless you sedate the patient into oblivion), but this is really not what the discussion is or should be about. Patients may request euthanasia for reasons other than pain. Some patients find that they are finished with their lives and their process of dying. They find it humiliating to have to continue living, experiencing mental and physical decay. If there are such patients, and I believe there are, it is cruel to turn down their request for euthanasia. A system for euthanasia would mean that people could approach the terminal phase of their lives without fear. They would know that, if, when their turn comes, and things turn out to be terrible, they have a way out. Contributors and sources: TT has published extensively in moral philosophy, political philosophy, and medical ethics. The three views are discussed more fully in his book Understanding Ethics (Edinburgh University Press, 2002).
… of Clinical Nursing, 2002
The original philosophy of palliative care emphasizes the importance of the integration of comp... more The original philosophy of palliative care emphasizes the importance of the integration of compassion and medical science. The meaning palliative care nurses assign to their relationships with patients has been described in several studies. ... This qualitative research was undertaken in ...