To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Palliative psychiatry is an approach that aims to prevent and/or alleviate suffering and improve the quality of life of patients and their families through timely assessment and treatment when faced with physical, psychological, social, and spiritual problems associated with serious life-threatening mental illness. However, the need for psychiatric palliative care for individuals with serious mental illness has remained in the background and only became possible in the early 21st century. Therefore, it is essential that nurses, one of the most important actors of patient-centered care, assume the responsibility of providing palliative psychiatric care as a requirement of their patient advocacy role. The aim of this study was to determine the perception of palliative psychiatric care by psychiatric nurses in a country where palliative psychiatry has not yet emerged.
Methods
A study in qualitative descriptive design with semi-structured interviews. Fifteen psychiatric nurses participated in individual interviews. The data were analyzed using thematic analysis.
Results
Four themes (Perception of palliative psychiatric care, Palliative psychiatric care practices, Barriers to palliative psychiatric care, and Recommendations for providing palliative psychiatric care) and 14 sub-themes were identified.
Significance of results
Psychiatric nurses are not familiar with the concept of palliative psychiatric care and associate it with holistic and individualized care. Nurses stated that palliative psychiatric care targets serious psychiatric disorders, treatment-resistant conditions, comorbidities and end-of-life care. In order to overcome barriers to palliative psychiatric care, suggestions were made for reorganizing the health system, establishing palliative care centers, training professionals in this field, and efforts to combat stigma.
This study aimed to culturally adapt the Self-Blame Attributions for Cancer Scale (SBAC) into Turkish and evaluate its psychometric properties, including validity and reliability.
Method
This methodological study enrolled 161 patients from both inpatient and outpatient oncology departments of a university hospital during a 1-year observation period (March 2024–March 2025). Participant data were obtained by using 2 instruments: a demographic questionnaire and the adapted Turkish version of “the SBAC.”
Results
Confirmatory factor analysis revealed strong factor loadings ranging from 0.670 to 0.850, indicating good item reliability. Model fit statistics demonstrated excellent psychometric properties (χ2/df = 2.00; root mean square error of approximation = 0.079; Comparative Fit Index = 0.99; standardized root mean square residual = 0.042; Tucker–Lewis Index = 0.98; root mean square residual = 0.042). The scale showed high internal consistency, with a total Cronbach’s α of 0.93 and subscale α coefficients ranging from 0.85 to 0.90. The original 2-factor structure of the SBAC was supported.
Conclusion
The study confirmed the bidimensional structure (11 items) of SBAC’s Turkish version with excellent validity and reliability indices, supporting its cultural and psychometric adequacy for Turkish samples.
In the first independent study of the League of Red Cross Societies, an interdisciplinary team of leading scholars examine its history, and how it influenced twentieth-century humanitarianism. They explore how the League evolved from 1919 to 1991 as a peacetime organisation of the Red Cross in contrast to the original wartime focus of the International Committee of the Red Cross. Investigating largely unknown, but significant actors, they shed new light on the League's activities in Southeast Asia, the Horn of Africa, Latin America and Europe through case studies focussing on its global health initiatives, the complexity of its networks in war and peace, and its role in providing relief. The authors argue that it is impossible to understand today's Red Cross and Red Crescent movement and global humanitarianism without considering the structures, expertise and training provided by the League to member National Societies from 1919 to 1991.
Burnout and adverse mental health outcomes are increasingly reported by health professionals, affecting work engagement or collaboration, with negative effects on staff retention and healthcare quality. This cross-sectional study assessed the prevalence and correlates of work-related emotional exhaustion among health professionals in paediatric cardiac care.
Methods:
Health professionals (153 nurses, 37 medical doctors, 22 allied and mental health professionals, 17 research/administrative staff; 55% response rate, 85% women) at a large quaternary paediatric hospital in Australia completed validated measures within the WithCare Health Professional Survey (June 2020–February 2021). Emotional exhaustion, depersonalisation, and personal accomplishment at work were measured using the Maslach Burnout Inventory. Hierarchical linear regression was used to identify correlates of tested emotional exhaustion, with calculation of 95% confidence intervals (CI).
Results:
Two-thirds (68%) of participants endorsed feeling “used up at the end of the workday,” while 65% felt “emotionally drained from work” at least a few times a month. Correlates of emotional exhaustion included higher anxiety (ß = 1.41, CI: 0.46, 2.35), greater avoidance-based coping (ß = 4.15, CI: 0.22,8.08), greater work–family conflict (ß = 0.55, CI: 0.38, 0.71), lower compassion satisfaction (ß = −0.55, CI: −0.81, −0.30), and lower approach-based coping (e.g., positive reframing or acceptance, ß = −3.44, CI: –6.24, −0.65). Demographics, clinical role characteristics, physical health, and psychosocial factors accounted for 62% of the variance in emotional exhaustion (p < 0.0001).
Conclusions:
Health professionals providing paediatric cardiac care report emotional exhaustion, which can adversely affect both personal and professional well-being. Identification of correlates can inform the design of targeted initiatives to address mental health needs.
Palliative and end-of-life (EOL) care is gaining increasing importance in Saudi Arabia due to the rising burden of chronic and life-limiting illnesses. Nurses play a central role in delivering comprehensive, culturally appropriate palliative care; however, their practices are influenced by educational preparation, institutional support, and sociocultural and religious contexts. To date, evidence on palliative nursing care in Saudi Arabia remains fragmented and insufficiently synthesized.
Aim
This systematic review aimed to synthesize existing evidence on palliative and EOL nursing care in Saudi Arabia, with a focus on nursing practices, challenges, cultural and spiritual influences, and patient and family outcomes.
Methods
A systematic literature search was conducted in January 2025 using PubMed, Scopus, CINAHL, Web of Science, Google Scholar, and Saudi grey literature sources. Empirical qualitative, quantitative, and mixed-methods studies addressing palliative or EOL nursing care in Saudi Arabia were included. Study selection followed PRISMA guidelines, and methodological quality was appraised using appropriate critical appraisal tools. A narrative thematic synthesis was undertaken due to heterogeneity among studies.
Results
Fourteen studies met the inclusion criteria. Findings indicated that nurses are actively involved in symptom management, therapeutic communication, psychosocial support, spiritual care, and family-centered care. However, substantial barriers were identified, including gaps in knowledge and training, limited formal palliative education, emotional burden, ethical challenges related to nondisclosure, and inconsistent institutional policies. Cultural and religious norms strongly influenced communication practices and decision-making processes. Studies also showed that structured palliative care services, particularly home-based and multidisciplinary programs, were associated with improved patient comfort, dignity, and family satisfaction, although access to such services varied across regions.
Conclusion
Palliative and EOL nursing care in Saudi Arabia demonstrates commitment and potential but is constrained by educational, emotional, cultural, and systemic challenges. Strengthening nursing education, enhancing culturally sensitive communication and spiritual care training, expanding home-based palliative services, and providing institutional support for nurses’ emotional well-being are essential to improving the quality and equity of palliative care nationwide.
Beginning on a wage of £1 per week in 1934, Lesley Long was the first woman employed by the Commercial Union Insurance Company in Hobart, Tasmania. Long’s pay gradually increased to £2/10 per week and after five years of saving she was able to fulfil her dream of sailing to England in May 1939. Having found a job and a place to rent in London, Long spent one night each week and her Saturdays volunteering at Guy’s Hospital. Having been a member of a VA detachment in Hobart since 1934, Long was eager to continue as a VA in London. When war was declared in Europe only a few months after she had arrived, Long’s voluntary work became more important to her. But it also brought an end to her chance to holiday in Europe as she had planned. As the situation worsened and wartime restrictions in London began to take effect, Long said to herself, ‘What am I doing here? I might as well get home.’
At the conclusion of the war, Major General Roy Burston, the Army Director General of Medical Services and Chair of the national VAD Council, wrote, ‘The past seven years have brought about a complete change in our attitude towards the employment of women in the armed forces.’ Throughout the war Burston supported the employment and development of VAs and then the AAMWS in the military. Their indispensability had been recognised. Yet, with the end of the war, AAMWS were discharged and Burston’s suggestion to maintain a cohort of women ready to serve in the event of a future war was, as he wrote: ‘…that the [civilian] VADs provide an organisation under which this training could be most effectively carried out in peace time. In addition, it is felt that there would be many advantages in maintaining the [civilian] VADs with their tradition of service which has been built up over the past 30 years or more.’ The war had provided an environment for women to expand their job opportunities, and it gave servicewomen space in the military to demonstrate the value not only of historically female dominated duties but of women’s labour generally. But the end of the war effectively erased this recognition.
Honouring her strong character and sense of service, Alice Appleford was awarded the Florence Nightingale Medal in 1949. Administered by the International Committee of the Red Cross as the highest award for a member of the nursing profession internationally, part of Appleford’s citation reads: ‘No one who came in contact with Major Appleford could fail to recognise her as a leader of women. Her sense of duty, her sterling solidarity of character, her humanity, sincerity, and kindliness of heart set for others a very high example.’ Before her marriage to Sydney Appleford, Alice had achieved a distinguished career as a nurse. Known then as Alice Ross-King, she had trained at Melbourne’s Alfred Hospital and in November 1914 embarked for Egypt to serve with the AANS. Awarded both the Royal Red Cross and the Military Medal, Sister Ross King became one of Australia’s most highly decorated women of the First World War. The Florence Nightingale Medal in 1949 added to her deserved accolades, but this medal was awarded for her contribution during a different war and to a different service. Although a trained nurse with a dedicated career to the profession, it was Alice Appleford’s interest in training and organising VADs, those not technically part of the nursing profession, during the Second World War that saw her receive the Nightingale Medal.
Kathleen Best was a nurse to her core. Completing her training at the Western Suburbs Hospital in Sydney in 1932, Best went onto train in midwifery before holding leadership positions at several Sydney hospitals. In May 1940, she began her military career, joining the Australian Army Nursing Service (AANS) as Matron of the 2/5th Australian General Hospital (AGH). Breaking ground as the youngest matron of the AANS, Best soon demonstrated her strength of leadership and character. By 1942, she had seen service in the Middle East, had led her nurses of the 2/5th AGH through the evacuation from Greece, and had been awarded the Royal Red Cross for her courage and efficiency. Best’s service abroad with the Second Australian Imperial Force (AIF) early in the Second World War made her well versed in military organisation. Showing her understanding of the effective operation of the military medical service, in January 1943 she stated, ‘Every position in a medical unit is important for ultimate efficiency ... and every girl in this service is helping to save lives’. In this statement Best was not referring to the nurses of the AANS; the ‘life-saving’ work Best was referring to was that being undertaken by the Australian Army Medical Women’s Service (AAMWS).
The wartime priorities for Australia shifted during the summer of 1941–42 as tensions in the Pacific increased, with Japan and the United States entering and quickly mobilising for war after the bombing of Pearl Harbor on 7 December 1941. With the sinking of the HMAS Sydney off the West Australian coast in November 1941, Australia’s concern for the Indo-Pacific was already mounting. When Singapore then fell to the Japanese on 15 February 1942, and with it 18 000 Australian troops captured, Australia felt the situation worsening. With the first bombing of Darwin in February 1942, soon after the fall of Singapore, war had reached the nation’s shores, and the threat of invasion became immediate. Australia then withdrew its troops from the Middle East, where the majority had been serving, and the defence of its own territory dominated the nation’s consciousness. This sparked a change in attitude for Australia which caused a rapid growth in service enlistments, including with both the civilian and Army VAD organisations.
On 14 June 1943 the full strength of 84 civilian VAs were withdrawn from service at the Sydney Hospital. The Sun described their removal as owing to the ‘disagreeable attitude’ and protest arising from the trained nursing staff. Deputy Controller of the New South Wales civilian VAD, Dorothy Wilby, demanded that the voluntary service of these women ‘should be recognised by civilian nurses’, and threatened that if civil hospitals did not want the help of the VAs they would easily find work elsewhere. These women did not return to their voluntary duties as orderlies and hospital assistants for four days.
The AAMWS training school in Yeronga, Queensland, was established in November 1942. Set on a five-acre property, the location for the school was the former home of a Brisbane doctor. With an intake of just 27 students, the school’s first course was used as a trial to familiarise women with Army organisation. The AAMWS had only recently been established as a military service and so the newly enlisted women were drilled, taught to salute, and lectured on Army organisation and operations. Regarded as a successful exercise, the course would become known as ‘rookies’ and was continued in Queensland and implemented throughout the other states. Before the school was moved to Enoggera in August 1943, 642 AAMWS passed through Yeronga undertaking one of the eight three-week so-called rookies’ courses. A Toowoomba school teacher before the war, AAMWS officer, Lieutenant Florence Fuller established the Yeronga school as its first chief instructor. ‘Our ambition is to make recruits into good members of the AAMWS’, declared Fuller. Supported by other training staff, including AANS nurse, Patricia Chomley, Fuller explained that their objective was to train AAMWS so that, ‘when they get to their units, they know how to pull their weight’.
Jessie Laurie commenced her affiliation with nursing in 1939, joining the Dugan VA Detachment in Adelaide. Eager to volunteer for the Army when the opportunity came, Laurie was one of just 24 South Australian women to serve in the Middle East as a VA during the war. A clerk in her civilian life, Laurie was first allocated to general duties in the Middle East with the 2/1st AGH and then the 2/6th (shown in Figure 7.1). While with the 2/6th AGH, Laurie was assigned to the service of Major George Halliday. An ear, nose, and throat (ENT) specialist, Halliday ran a clinic for troops in the area and Laurie was selected to work as his assistant. After the Australian forces were withdrawn from the Middle East in 1942 and redirected to the Pacific Campaign, Laurie, now a Private in the AAMWS, joined Halliday as his assistant and helped staff his small mobile hearing clinic in Far North Queensland for troops camped on the Atherton Tableland.
It was a common assumption during the war that VAs and AAMWS servicewomen wanted to be nurses, and it was this desire that motivated them to join this service rather than take up one of the other available wartime opportunities. As Sheila Sibley confessed in 1943, before she began her work as an AAMWS, she was ‘dreaming dreams’ of becoming ‘an angel of mercy, the wounded man’s guide … the Rose of No-Man’s Land’. Sibley imagined that she would ‘float down the wards in my nifty blue uniform, and tender sighs would float right after this war’s Florence Nightingale’. Both Hitchcock and Sibley suggest there was some truth in the assumption that VAs and then AAMWS saw themselves as akin to, or aspired to be, nurses. Like Hitchcock, Sibley’s references show a clear association with the nurse in her understanding of the VAD and AAMWS. But Sibley admits that once she joined her first military hospital, she learnt the reality of the AAMWS’ work and conceded, ‘better leave that noble figure in my imagination.’
Writing encouragingly with the aim of providing constructive feedback in 1979 Mary Critch asked of Enid Herring, ‘Is ‘They wanted to be Nightingales’ a title for the finished book?’. Both were former members of the AAMWS working on their own separate compilations of the VAD/AAMWS in the Second World War. Critch, however, was alarmed by Herring’s choice of a title, and put the question to Herring, asking: ‘Is it not rather embarrassing to the hundreds of AAMW [sic.] who worked as General Duty and Mess Orderlies, as clerks, cooks etc and never saw the inside of a ward?’ Referencing Florence Nightingale, the woman noted for her humanitarian efforts during the Crimean War and cited by some as shaping modern nursing, Herring chose to perpetuate the stereotype of VAs and AAMWS. The First World War myth that all VAs either aspired to be nurses, or already saw themselves as nurses, was a common perception that tainted the VAD and AAMWS in the Second World War. While writing her own account of the VAD/AAMWS, Herring could have chosen to debunk this myth. However, she claimed its truth.
To examine the relationships between patient activation, depressive symptoms, and quality of life among older adults receiving palliative oncology care.
Methods
A cross-sectional correlational study was conducted among 145 adults aged ≥60 years receiving palliative oncology care at King Khalid Hospital, Saudi Arabia, using stratified random sampling. Data were collected via a demographic and clinical questionnaire, the Patient Activation Measure-13 (PAM-13), the Patient Health Questionnaire-9 (PHQ-9), and the McGill Quality of Life Questionnaire–Revised (MQOL-R). Descriptive statistics, Pearson correlation, independent t-tests, one-way ANOVA, and multiple linear regression were performed using SPSS version 26.
Results
All participants demonstrated Level 2 patient activation, with a mean PAM-13 score of 50.83 (SD = 1.04). Moderate depressive symptoms were prevalent (mean PHQ-9 = 13.56, SD = 3.48), and overall quality of life was moderate (mean MQOL-R = 55.21, SD = 10.14). Patient activation was weakly but significantly inversely correlated with depressive symptoms (r = −0.179, p < 0.05). No significant associations were found between patient activation and quality of life, or between depressive symptoms and quality of life. Regression analysis showed that patient activation, depressive symptoms, and demographics accounted for only 3.2% of the variance in quality of life (R2 = 0.032, p = 0.714).
Significance of results
Patient activation may modestly reduce depressive symptoms but is not sufficient to improve quality of life in older adults receiving palliative oncology care. Quality of life appears influenced by broader multidimensional factors beyond activation and mood, highlighting the need for comprehensive interventions in palliative care settings.
Nursing Aids at War: The Australian Army Medical Women's Service in the Second World War explores the chronological history of the Australian Army Medical Women's Service (AAMWS) and challenges our understanding of servicewomen and gendered work in the Australian Army. Arranged in three parts, the book first introduces the nursing aid and how the Voluntary Aid Detachments (VADs) became intertwined with the nursing service in the First and Second World Wars. It then investigates disruptions, tensions and controversies faced by the VAD as they transitioned into the AAMWS; in particular, the training schemes for AAMWS to become professionally trained nurses in military hospitals. Lastly, the book explores and challenges representations and reflections of the VAD and AAMWS, including building a national identity separate to practising nurses, and acknowledging their history as largely being forgotten amongst discussion of Australia's wider military history.
The aim of this study was to determine the health problems of individuals who survived the 2023 Kahramanmaraş earthquake according to the Omaha System.
Methods
This descriptive cross-sectional study was conducted in Adıyaman, Türkiye, and included 297 earthquake survivors. Data were collected using the Problem Classification Scheme of the Omaha System.
Results
The majority of individuals who survived the earthquake were women and had at least one chronic disease. Of the 42 problems listed in the Omaha Problem Classification Scheme, 38 were identified. Most of the identified problems were actual and individual-level issues. Income, Sanitation, Residence, Living/workplace safety, Communication with community resources, Communicable/infectious condition, and Nutrition problems were identified in all earthquake survivors.
Conclusions
The Omaha System provides nurses with pertinent data to organize health services and prioritize interventions in the post-disaster period. The problems identified highlight the urgent need to improve health and living conditions in temporary shelters.
This chapter considers conformation of communal sharing by means of consubstantial assimilation: making essential substances or surfaces of bodies alike, or contact between bodies, or engaging in synchronous rhythmic movement of the torso and limbs; blood sacrifice; classic anthropological theories of commensalism; and milk kinship. In a number of cultures, drinking alcohol together creates strong commitments. Among North American Indians, smoking the sacred pipe together is a way to make peace or cement bonds. In Homeric Greece and in other Bronze Age and early Iron Age societies around the Mediterranean, men created host–guest bonds by hospitably welcoming and feeding a travelling stranger, and exchanging gifts. In Africa and elsewhere, there are practices in which two men each cut themselves and bleed into a vessel in which they mix the blood, and then drink it. This creates extremely strong commitments to mutual aid in blood brotherhood.
Diabetes mellitus is a prevalent chronic illness worldwide and largely impacts migrants who have settled in developed countries. In diabetes care, patients play a central role and are natural partners in self-care education for improving health. Upon reviewing the literature, no studies were found that evaluated culturally adapted education models led by a nurse and delivered by a multi-professional team from the perspective of migrants in a group setting. Therefore, this study aims to explore patients’ evaluation of the content and implementation of a person-centred, group-based diabetes education model for migrants with type 2 diabetes led by a nurse and delivered by a multi-professional team.
Method:
Qualitative exploratory study, using semi-structured interviews in focus groups and individually to collect data. Eleven migrants who had participated in an intervention testing the education model aged 45–70, who had been living in Sweden between 4–32 years participated. Inductive qualitative content analysis of data was undertaken.
Results:
Participants gave a positive picture of their experiences concerning the content and organisation of the person-centred, group-based, culturally adapted diabetes education model. The education sessions were described as providing new and evidence-based knowledge. The multi-professional education staff and the interpreter were perceived as having a professional and familiar approach. They wanted to recommend the education model to others.
Conclusions:
The study revealed a well-functioning diabetes education model tailored to individual beliefs and cultural aspects. It improved perceived knowledge about type 2 diabetes among migrants, thus increasing self-care behaviour and health. In today’s multicultural society, the study offers insights into migrants’ feelings, ideas, concerns, knowledge, and experience regarding the content, structure, and outcome of a group-based, culturally adapted diabetes education model that can improve self-care behaviour to promote health and prevent illness. As a result, the education model can be used in primary healthcare as a central and natural partner in self-care education to improve health.