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Yildiz B, Korfage IJ, Witkamp EF, Goossensen A, van Lent LG, Pasman HR, Onwuteaka-Philipsen BD, Zee M, van der Heide A. Dying in times of COVID-19: Experiences in different care settings - An online questionnaire study among bereaved relatives (the CO-LIVE study). Palliat Med 2022; 36:751-761. [PMID: 35264024 PMCID: PMC9006387 DOI: 10.1177/02692163221079698] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic and restricting measures have affected end-of-life care across different settings. AIM To compare experiences of bereaved relatives with end-of-life care for a family member or friend who died at home, in a hospital, nursing home or hospice during the pandemic. DESIGN An open observational online survey was developed and disseminated via social media and public fora (March-July 2020). Data were analyzed using descriptive statistics and logistic regression analyses. PARTICIPANTS Individuals who lost a family member or friend in the Netherlands during the COVID-19 pandemic. RESULTS The questionnaire was filled out by 393 bereaved relatives who lost a family member or friend at home (n = 68), in a hospital (n = 114), nursing home (n = 176) or hospice (n = 35). Bereaved relatives of patients who died in a hospital most often evaluated medical care (79%) as sufficient, whereas medical care (54.5%) was least often evaluated as sufficient in nursing homes. Emotional support for relatives was most often evaluated as sufficient at home (67.7%) and least often in nursing homes (40.3%). Sufficient emotional support for relatives was associated with a higher likelihood to rate the place of death as appropriate. Bereaved relatives of patients who died at a place other than home and whose care was restricted due to COVID-19 were less likely to evaluate the place of death as appropriate. CONCLUSION End-of-life care during the COVID-19 pandemic was evaluated least favourably in nursing homes. The quality of emotional support for relatives and whether care was restricted or not were important for assessing the place of death as appropriate.
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Affiliation(s)
- Berivan Yildiz
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Fe Witkamp
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Research Centre Innovations in Care, University of Applied Sciences, Rotterdam, The Netherlands
| | | | - Liza Gg van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - H Roeline Pasman
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Masha Zee
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
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2
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"We are to be like machines…fill the bed before it gets cold": Exploring the emotional geographies of healthcare providers caring for dying residents in long-term care facilities. Soc Sci Med 2021; 272:113749. [PMID: 33588203 DOI: 10.1016/j.socscimed.2021.113749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/19/2020] [Accepted: 02/03/2021] [Indexed: 11/20/2022]
Abstract
The end-of-life context is imbued with emotions, with death and dying transforming everyday places, like long-term care facilities, into entirely new emotional topographies that can evoke profound effects on those who live and work within these settings. Despite their significant role, healthcare providers' emotions and their interconnections with 'place' have received relatively little attention from researchers, including geographers of care and caregiving. This secondary thematic analysis attempts to address this notable gap by exploring the emotional geographies of healthcare providers caring for dying residents in four long-term care facilities in western Canada. By drawing upon interview and focus group data with administrators (n = 12) and direct care provider (n = 80) participants, findings reveal that experiences of caring for dying residents were often charged with negative emotions (e.g., distress, frustration, grief). These emotions were not only influenced by social and physical aspects of 'place', but the temporal process of caring for a dying resident, which included: (1) Identifying a resident as in need of a palliative approach to care; (2) Actively dying; and (3) Following a resident's death. Findings indicate that providers' emotions shifted in scale at each of these temporal phases, ranging from association with the facility as a whole to the micro-scale of the body. Broader structural forces that influence the physical and social place of long-term care facilities were also found to shape experiences of emotional labor among staff. With an increasing number of deaths occurring within long-term care facilities throughout the Global North, such findings contribute critical experiential knowledge that can inform policy and programs on ways to help combat staff burnout, facilitate worker satisfaction, and foster resilience among long-term care providers, ensuring they receive the necessary supports to continue fulfilling this valuable caring role.
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3
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Just DT, O'Rourke HM, Berta WB, Variath C, Cranley LA. Expanding the Concept of End-of-life Care in Long-term Care: A Scoping Review Exploring the Role of Healthcare Assistants. Int J Older People Nurs 2020; 16:e12353. [PMID: 33124160 DOI: 10.1111/opn.12353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The context of care provided in long-term care homes is changing, as an increasing number of older adults are entering long-term care with advance stages of illness and higher care needs. Long-term care homes are quickly becoming the place of death for an increasing number of older adults, despite recent literature identifying inadequate and suboptimal levels of end-of-life care. Within long-term care, healthcare assistants represent 60%-70% of the unregulated workforce and provide 70%-90% of the direct care to residents. Research indicates that a high level of uncertainty exists surrounding the role of healthcare assistants in end-of-life care, with numerous studies reporting the role of healthcare assistants to be 'unclear' with varying levels of responsibilities and autonomy. OBJECTIVE The purpose of this scoping review was to explore healthcare assistants' experiences and perspectives of their role in end-of-life care in long-term care. METHODS We applied Arksey and O'Malley's methodological framework, with recommendations from Levac and colleagues' guiding principles. Electronic databases and the grey literature were searched for relevant articles. Search concepts included end-of-life care and healthcare assistants. Articles were included in this review if they explored healthcare assistants' experiences or perspectives of providing end-of-life care in long-term care. The peaceful end of life theory by Ruland and Moore (1998) was used to organise data extraction and analysis. RESULTS A total of n = 15 articles met the inclusion criteria. The most predominant role-required behaviours reported by healthcare assistants were as follows: psychosocial support to significant others, knows the resident's care wishes and physical care with respect and dignity. The most predominant extra-role behaviours reported by healthcare assistants were as follows: becoming emotionally involved, acting as extended family and ensuring residents do not die alone. CONCLUSIONS Findings from this review expanded the concept of end-of-life care by illustrating the role-required and extra-role behaviours healthcare assistants perform when providing end-of-life care in long-term care. IMPLICATIONS FOR PRACTICE Findings from this scoping review highlight the numerous behaviours healthcare assistants perform outside their role description in order to provide end-of-life care to dying residents in long-term care. These findings could inform policymakers and managers of long-term care homes.
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Affiliation(s)
- Danielle T Just
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Whitney B Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Caroline Variath
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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4
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Foster S, Balmer D, Gott M, Frey R, Robinson J, Boyd M. Patient-centred care training needs of health care assistants who provide care for people with dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:917-925. [PMID: 30729629 DOI: 10.1111/hsc.12709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
It is well documented that Health care assistants (HCAs) provide the most hands-on care to residents in aged care facilities, and play a critical role in the provision of care to dementia residents. Over the last 25 years, a philosophy of person-centred care has become the preferred approach to care and this has meant that HCAs are encouraged to get to know the resident very well. This paper reports the experiences of HCAs in caring for people at end-of-life, identifies the skills required for their work and examines the education provided against these skills. Semi-structured interviews were conducted in 49 facilities (n = 34) across New Zealand and data analysed thematically, with the aim of critically examining the adequacy of education for health care assistants which meets their needs within a person-centred environment. The results confirm that the skills include traditional tasks of care (showering, feeding, toileting, and dressing) but the increasingly important communication and de-escalation skills, both verbal and non-verbal, have become central to their care skills. Education provided has not sufficiently shifted focus to include these more complex skills. Provision of educations that acknowledges the increased complexities of their role needs to be provided. As well, facilities need to be challenged to reconsider the HCA's position in the facility care tem.
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Affiliation(s)
- Susan Foster
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Deborah Balmer
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Freemasons' Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
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Castro A, Testoni I, Zamperini A, Ronconi L, Galantin LP, Caraceni A. The implicit soul: Factors between the representation of death and dehumanization of patients. Health Psychol Open 2019; 6:2055102919854666. [PMID: 31245019 PMCID: PMC6580724 DOI: 10.1177/2055102919854666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Spiritual approaches in healthcare settings proved effective in reducing the
negative outcomes of dehumanization processes impacting health professionals and
patients. Although previous literature focused on explicit measures of
spirituality, the present research explored the role of implicit components of
spirituality and their effects on the humanization of patients in two healthcare
contexts. Professionals from hospices and nursing homes completed an implicit
task to assess whether the diverse representation of death as physical or
spiritual led to perceive patients with more uniquely human traits. Results
showed that only for hospice participants, implicit and explicit spirituality
predicts more humanness attribution to patients. This article discusses
palliative care models and death education as a resource for reducing
dehumanization.
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Affiliation(s)
- Aurelio Castro
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Adriano Zamperini
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Lucia Ronconi
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy
| | - Laura Padmah Galantin
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, Padova, Italy.,Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
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6
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Brazil K, Krueger P, Bedard M, Kelley ML, Mcainey C, Justice C, Taniguchi A. Quality of Care for Residents Dying in Ontario Long-Term Care Facilities: Findings from a Survey of Directors of Care. J Palliat Care 2019. [DOI: 10.1177/082585970602200104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to collect information on the practice of end-of-life (EOL) care in long-term care (LTC) facilities in the Province of Ontario, Canada. A cross-sectional survey of directors of care in all licensed LTC facilities in the province was conducted between September 2003 and April 2004. Directors of care from 426 (76% response rate) facilities completed the postal survey questionnaire. The survey results identified communication problems between service providers and families, inadequate staffing levels to provide quality care to dying residents, and the need for training to improve staff skills in providing EOL care. Directors of care endorsed the use of a number of strategies that would improve the care of dying residents. Logistic regression analysis identified the eight most important items predictive of facility staff having the ability to provide quality EOL care. The findings contribute to the current discussion on policies for meeting the care needs of residents in LTC facilities until life's end.
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Affiliation(s)
- Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University, and St. Joseph's Health System Research Network, Hamilton
| | - Paul Krueger
- Department of Clinical Epidemiology and Biostatistics, McMaster University, and St. Joseph's Health System Research Network, Hamilton
| | - Michel Bedard
- Public Health Program, Lakehead University & Division of Human Sciences, Northern Ontario School of Medicine, Thunder Bay
| | | | - Carrie Mcainey
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton
| | | | - Alan Taniguchi
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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7
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Gill C, Hillier LM, Crandall JM, Johnston J. Nursing Guidelines for End-Of-Life Care in Long-Term Care Settings: Sustainable Improvements to Care. J Palliat Care 2018. [DOI: 10.1177/082585971102700308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carole Gill
- LM Hillier (corresponding author) Specialized Geriatric Services, St. Joseph's Health Care London, and Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, 801 Commissioners Road East, London, Ontario, Canada, N6C 5J1
| | - Loretta M. Hillier
- Palliative Pain and Symptom Management Consultation Program—Southwestern Ontario, Windsor, Ontario, Canada
| | - Jacqueline M. Crandall
- London Health Sciences Centre; Faculty of Nursing, University of Western Ontario; and Department of Interdisciplinary Studies, King's University College, London, Ontario, Canada
| | - Julie Johnston
- Palliative Pain and Symptom Management Consultation Program— Southwestern Ontario, London, Ontario, Canada
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8
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Cresp SJ, Lee SF, Moss C. Substitute decision makers' experiences of making decisions at end of life for older persons with dementia: A systematic review and qualitative meta-synthesis. DEMENTIA 2018; 19:1532-1559. [PMID: 30253658 DOI: 10.1177/1471301218802127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Substitute decision makers are important for people with advanced dementia, particularly at the end of life. Substitute decision makers report issues in providing support, and physical and psychological consequences from the role. However, there is no synthesised evidence about how substitute decision makers are affected by and experience making decisions for older persons diagnosed with dementia at end of life. Methodology: A protocol for a qualitative systematic review was developed. Seven articles met both inclusion and research quality criteria following a comprehensive search for published and unpublished studies (January 2007-2017, English language). Meta-synthesis was achieved through meta-aggregation of the results from included studies. RESULTS Meta-aggregation of 20 themes into eight categories resulted in five synthesised findings. The findings were: 'trust'; 'guilt, mistrust and confusion'; 'translating quality of life'; 'negotiating families'; and 'uncertainty and reactivity'. Trust in healthcare personnel positively affected substitute decision makers and supported their adaptability. Substitute decision makers experienced guilt, mistrust, and confusion as they encountered increased complexity in care and health interventions as social needs changed. Substitute decision makers experienced complexities and struggles as they interpreted quality of life and negotiated end of life treatment decisions. Substitute decision makers experienced practical needs to negotiate family as they fulfilled their support roles. Ambiguity in advance care plans, limited knowledge of dementia, end of life uncertainties, and communication issues reduced substitute decision makers' proactivity. Implications: Being a substitute decision maker for people with advanced dementia at end of life is stressful. Health professionals need to be cognizant of substitute decision makers experiences and needs, and identify mechanisms to achieve support and education. The findings generate need for further investigation of interventions to meet the needs of substitute decision makers.
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Affiliation(s)
- Sarah Jane Cresp
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Susan Fiona Lee
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Cheryle Moss
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Shinall MC, Wilson JE, Karlekar M, Ely EW. Facility Placement as a Barrier to Hospice for Older Adult Patients Discharged From a Palliative Care Unit. Am J Hosp Palliat Care 2018; 36:93-96. [PMID: 30064237 DOI: 10.1177/1049909118791149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT: Many older adults discharged from an inpatient stay require postacute facility placement, which can be a barrier to hospice enrollment since the Medicare hospice benefit does not cover facility costs for patients under routine hospice care. OBJECTIVES: To evaluate the extent to which need for postdischarge facility care was a barrier to hospice enrollment for older patients with short life expectancy discharged from a palliative care unit. METHODS: Retrospective cohort using a prospectively collected database of patients 65 and older with a life expectancy of <6 months admitted to a palliative care unit in an urban, academic medical center and discharged alive from 2012 to 2017. Primary outcome was hospice enrollment at hospital discharge. Exposure of interest was need for facility placement at discharge. RESULTS: Of 817 included patients, 649 (79%) were discharged with hospice. Patients discharged home had a significantly higher rate of hospice enrollment than patients discharged to a facility-92% versus 71% ( P < .0001). On multivariate logistic regression analysis, discharge to home versus facility remained a strong predictor of hospice enrollment, with an odds ratio for hospice enrollment of 6.04 (95% confidence interval: 3.73-9.79). CONCLUSION: Need for postdischarge facility placement represents a barrier for hospice enrollment among older patients who are otherwise hospice appropriate. The structure of the hospice benefit may require modification so that these hospice appropriate patients can utilize the benefit.
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Affiliation(s)
- Myrick C Shinall
- 1 Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA.,2 Division of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jo Ellen Wilson
- 3 Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohana Karlekar
- 1 Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wesley Ely
- 4 Division of Allergy, Pulmonology, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,5 Tennessee Valley Veteran's Affairs Geriatrics Research Education Clinical Center (GRECC), Nashville, TN, USA
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Funk LM, Peters S, Roger KS. Caring about dying persons and their families: Interpretation, practice and emotional labour. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:519-526. [PMID: 29462841 DOI: 10.1111/hsc.12559] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 06/08/2023]
Abstract
The importance of emotional support for dying persons and their families has been well established, yet we know less about how care workers understand emotional processes related to death and dying, or how these understandings are connected to care practices and emotional labour at the end of life. The aim of this study was to explore how healthcare workers interpret and respond to emotional needs of dying persons and their families. Qualitative data were collected between 2013 and 2014 through in-depth, in-person interviews with 14 nurses and 12 healthcare aides in one Western Canadian city. Transcripts were analysed using an inductive, interpretive thematic coding approach and the analytic lens of emotional labour. Dominant interpretive frames of a "good death" informed participants' emotionally supportive practice. This included guiding patients and families to "open up" about their emotions to activate the grief process. There was concern that incomplete grieving would result in anger being directed towards care staff. The goal of promoting emotional sharing informed the work of "caring about." Although palliative philosophies opened up moral and professional space for "caring about" in the context of organisational norms which often discouraged these practices, the tension between the two, and the lack of time for this work, may encourage surface expressions rather than authentic emotional care.
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Affiliation(s)
- Laura M Funk
- Department of Sociology, University of Manitoba, Winnipeg, MB, Canada
| | - Sheryl Peters
- School of Nursing, University of Manitoba, Winnipeg, MB, Canada
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11
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Funk LM, Peters S, Roger KS. The Emotional Labor of Personal Grief in Palliative Care: Balancing Caring and Professional Identities. QUALITATIVE HEALTH RESEARCH 2017; 27:2211-2221. [PMID: 28891373 DOI: 10.1177/1049732317729139] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The paid provision of care for dying persons and their families blends commodified emotion work and attachments to two often-conflicting role identities: the caring person and the professional. We explore how health care employees interpret personal grief related to patient death, drawing on interviews with 12 health care aides and 13 nurses. Data were analyzed collaboratively using an interpretively embedded thematic coding approach and constant comparison. Participant accounts of preventing, postponing, suppressing, and coping with grief revealed implicit meanings about the nature of grief and the appropriateness of grief display. Employees often struggled to find the time and space to deal with grief, and faced normative constraints on grief expression at work. Findings illustrate the complex ways health care employees negotiate and maintain both caring and professional identities in the context of cultural and material constraints. Implications of emotional labor for discourse and practice in health care settings are discussed.
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Affiliation(s)
- Laura M Funk
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheryl Peters
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Thompson GN, Doupe M, Reid RC, Baumbusch J, Estabrooks CA. Pain Trajectories of Nursing Home Residents Nearing Death. J Am Med Dir Assoc 2017; 18:700-706. [DOI: 10.1016/j.jamda.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 01/08/2023]
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13
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Measuring Family Members' Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4621592. [PMID: 28706945 PMCID: PMC5494554 DOI: 10.1155/2017/4621592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/28/2017] [Accepted: 04/20/2017] [Indexed: 11/17/2022]
Abstract
RATIONALE Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. METHODS AND RESULTS Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. PHASE 2 The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. PHASE 3 The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88-.94) indicated internal consistency. CONCLUSION This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.
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14
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Cagle JG, Unroe KT, Bunting M, Bernard BL, Miller SC. Caring for Dying Patients in the Nursing Home: Voices From Frontline Nursing Home Staff. J Pain Symptom Manage 2017; 53:198-207. [PMID: 27815169 PMCID: PMC5463275 DOI: 10.1016/j.jpainsymman.2016.08.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 12/18/2022]
Abstract
CONTEXT Nursing homes are an important site for end-of-life care, yet little is known about the perspectives of the frontline staff who provide a majority of this care. OBJECTIVE To describe, from the staff perspective, positive/negative experiences related to caring for dying residents. METHODS Qualitative analysis using survey data from staff working in 52 Indiana nursing homes. RESULTS A total of 707 frontline staff who provide nursing, nurse aide, and social work services responded to open-ended prompts. Study data included responses to open-ended prompts asking participants to describe one positive experience and one negative experience caring for a dying patient. A thematic content analysis was conducted using the constant-comparative method. Respondents were largely female (93%), white (78%), 31-50 years (42%), and 53% had >5 years of nursing home work experience. Experiences were described from three perspectives: 1) first-hand experiences, 2) observed experiences of dying patients, and 3) observed experiences of family members. Selected themes for positive experiences include the following: creating close bonds; good patient care; involvement of hospice; being prepared; and good communication. Selected themes for negative experiences consisted of the following: challenging aspects of care; unacknowledged death; feeling helpless; uncertainty; absent family; painful emotions; and family discord. CONCLUSION Findings reveal the richness and many complexities of providing end-of-life care in nursing homes and have implications for improving staff knowledge, coordination of care with hospice, and social support for patients.
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Affiliation(s)
- John G Cagle
- University of Maryland, Baltimore, Maryland, USA.
| | - Kathleen T Unroe
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | | | - Brittany L Bernard
- Indiana University Center for Aging Research, Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Susan C Miller
- Brown University School of Public Health, Providence, Rhode Island, USA
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15
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Aldridge MD, Hasselaar J, Garralda E, van der Eerden M, Stevenson D, McKendrick K, Centeno C, Meier DE. Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliat Med 2016; 30:224-39. [PMID: 26405109 DOI: 10.1177/0269216315606645] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. AIM To provide an overview of the barriers to more widespread palliative care integration in the United States. DESIGN AND DATA SOURCES A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. RESULTS We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. CONCLUSION We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness.
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Affiliation(s)
- Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eduardo Garralda
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain and Palliative Medicine Group, Area of Oncology and Haematology, Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | | | - David Stevenson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Karen McKendrick
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Centeno
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain and Palliative Medicine Group, Area of Oncology and Haematology, Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Center to Advance Palliative Care, New York, NY, USA
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Stephens C, Halifax E, Bui N, Lee SJ, Harrington C, Shim J, Ritchie C. Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life. Curr Gerontol Geriatr Res 2015; 2015:893062. [PMID: 26379704 PMCID: PMC4561315 DOI: 10.1155/2015/893062] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/16/2015] [Indexed: 11/29/2022] Open
Abstract
Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers.
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Affiliation(s)
- Caroline Stephens
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, N531E, UCSF Box 0608, San Francisco, CA 94143-0608, USA
| | - Elizabeth Halifax
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, N531E, UCSF Box 0608, San Francisco, CA 94143-0608, USA
| | - Nhat Bui
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, N531E, UCSF Box 0608, San Francisco, CA 94143-0608, USA
| | - Sei J. Lee
- Department of Geriatrics, Palliative & Extended Care, San Francisco VA Medical Center, Division of Geriatrics, School of Medicine, University of California, San Francisco, 4150 Clement Street, Building 1, Room 220F, San Francisco, CA 94121, USA
| | - Charlene Harrington
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, 3333 California Street, Suite 455, UCSF Box 0612, San Francisco, CA 94118, USA
| | - Janet Shim
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, 3333 California Street, Suite 455, UCSF Box 0612, San Francisco, CA 94118, USA
| | - Christine Ritchie
- Division of Geriatrics, School of Medicine, University of California, San Francisco, 3333 California Street, Suite 380, San Francisco, CA 94143-1265, USA
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17
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Ho AHY, Dai AAN, Lam SH, Wong SWP, Tsui ALM, Tang JCS, Lou VWQ. Development and Pilot Evaluation of a Novel Dignity-Conserving End-of-Life (EoL) Care Model for Nursing Homes in Chinese Societies. THE GERONTOLOGIST 2015; 56:578-89. [DOI: 10.1093/geront/gnv037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/07/2015] [Indexed: 11/12/2022] Open
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Towsley GL, Hirschman KB, Madden C. Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff. J Palliat Med 2015; 18:421-8. [PMID: 25658608 DOI: 10.1089/jpm.2014.0316] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Care in nursing homes (NHs) often overlooks individual values and preferences. Residents' voices are critical to discussions about preferences, yet there remains limited research on conversations about the end of life (EOL) from the perspective of older adults who reside in NHs. OBJECTIVE The aim of this study was to describe the communication, content and process, related to EOL conversations among residents, family, and staff. METHODS We used semistructured interviews in this qualitative, descriptive study to describe conversations about EOL preferences. We examined participants' conversation, when it occurred, and what was discussed. We queried about barriers to and facilitators in discussing EOL care in the NH setting. We interviewed residents (n=16), family (n=12), and interdisciplinary staff (n=10) from four NHs. RESULTS The overarching theme—missed conversations—describes EOL-related communication. Residents, families, and staff rarely talked about EOL care preferences, nor did they pass along information about preferences or initiate conversations about EOL care with each other. Three categories explained missed conversations: inquiry ("No one asked"); assumptions (presence of an advance directive [AD], "They know me"); and conveying (lack of conveying information or wishes). Existing barriers and lacking facilitators resulted in missed opportunities to hold conversations about EOL preferences. CONCLUSIONS Not all residents wanted to have conversations, but many wanted to be asked about their preferences. Missed conversations may adversely affect the quality of EOL care. Conversations with residents can be initiated by asking residents who they would like involved in the conversation and drawing upon the experience of others.
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Affiliation(s)
- Gail L Towsley
- 1 University of Utah College of Nursing , Salt Lake City, Utah
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19
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Temkin-Greener H, Ladwig S, Caprio T, Norton S, Quill T, Olsan T, Cai X, Mukamel DB. Developing palliative care practice guidelines and standards for nursing home-based palliative care teams: a Delphi study. J Am Med Dir Assoc 2015; 16:86.e1-7. [PMID: 25481748 DOI: 10.1016/j.jamda.2014.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 11/19/2022]
Abstract
CONTEXT Lack of nursing home (NH)-specific palliative care practice guidelines has been identified as a barrier to improving palliative and end-of-life (EOL) quality of care. OBJECTIVES The objectives of this study were to (1) assess which of the guidelines developed by the National Consensus Project, and the corresponding preferred care practices endorsed by the National Quality Forum, are important and feasible to implement in NHs; and (2) identify the operational standards for palliative care teams in NHs. METHODS Two-round mail Delphi study. Based on the existing literature, a set of 7 domains with associated 22 palliative practice guidelines was drafted. We invited 48 NH leaders, including clinicians, to review the importance (10-point Likert scale) and the feasibility (5-point Likert scale) of these guidelines. Participants were also asked about palliative care team composition rounding frequency. RESULTS The response rate to both rounds was 85%. With regard to importance, the mean rating for all guidelines was 8 or higher (ie, highly important), but there was variability in agreement with regard to 5 of the guidelines. The same 5 guidelines were also considered more difficult to implement (eg, costly, unrealistic). Overall, 17 palliative care guidelines were identified for use by NH palliative care teams. Five disciplines (social work, certified nurse assistant, nurse, physician, and nurse practitioner or physician assistant) were identified as comprising a core team and 3 were proposed as extended or ad hoc members. CONCLUSION The palliative care guidelines and team standards identified in this study may be helpful in providing practical direction to NH administrators and staff looking to improve palliative care practice for their residents.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY.
| | - Susan Ladwig
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY
| | - Tom Caprio
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY
| | - Sally Norton
- University of Rochester, School of Nursing, Rochester, NY
| | - Timothy Quill
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY
| | - Tobie Olsan
- University of Rochester, School of Nursing, Rochester, NY
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, NY
| | - Dana B Mukamel
- Department of Medicine, Health Policy and Research Center, University of California, Irvine, Irvine, CA
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20
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Barooah A, Boerner K, van Riesenbeck I, Burack OR. Nursing home practices following resident death: the experience of Certified Nursing Assistants. Geriatr Nurs 2014; 36:120-5. [PMID: 25554351 DOI: 10.1016/j.gerinurse.2014.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/15/2014] [Accepted: 11/24/2014] [Indexed: 11/26/2022]
Abstract
This study examined certified nursing assistants' (CNAs) experiences of nursing home practices following resident death. Participants were 140 CNAs who had experienced recent resident death. In semi-structured, in-person interviews, CNAs were asked about their experiences with the removal of the resident's body, filling the bed with a new resident, and how they were notified about the death. The facilities' practice of filling the bed quickly was most often experienced as negative. Responses to body removal and staff notification varied, but negative experiences were reported by a substantial minority. Being notified prior to returning to work was associated with a more positive experience. Learning about the death by walking into a room to find the bed empty or already filled was the most negative experience. Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience.
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Affiliation(s)
- Adrita Barooah
- Jewish Home Lifecare, Research Institute on Aging, 120 West 106th Street, New York, NY 10025, USA
| | - Kathrin Boerner
- University of Massachusetts Boston, Department of Gerontology, 100 Morrissey Boulevard, Boston, MA 02125, USA.
| | - Isabelle van Riesenbeck
- University of Osnabrück, FB 8/Institut für Psychologie Seminarstraße 20, 49074 Osnabrück, Germany
| | - Orah R Burack
- Jewish Home Lifecare, Research Institute on Aging, 120 West 106th Street, New York, NY 10025, USA
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21
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Funk LM, Waskiewich S, Stajduhar KI. Meaning-Making and Managing Difficult Feelings: Providing Front-Line End-of-Life Care. OMEGA-JOURNAL OF DEATH AND DYING 2014; 68:23-43. [DOI: 10.2190/om.68.1.b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Managing grief and difficult emotions related to end-of-life (EOL) care is an often under-recognized part of the work of resident care aides (RCAs). In this interpretive analysis we explore the shared and socially constructed ideas that 11 RCAs in 1 Canadian city employ to make sense of death and the provision of EOL care. RCAs spoke of personal challenges involved in witnessing death and experiencing loss, as well as helplessness and frustration when they could not provide quality EOL care. RCAs invoked “consoling refrains” to manage grief, including “such is life,” “they are better off,” and “they had a full life.” To manage guilt and moral distress, RCAs reminded themselves “I did my best” and “I experience rewards.” Though these ideas help RCAs, some may need to be reframed through coaching and mentorship, to prevent unintended negative effects on care or the reproduction of ageist beliefs more broadly.
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22
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Supiano KP, Cloyes KG, Berry PH. The grief experience of prison inmate hospice volunteer caregivers. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2014; 10:80-94. [PMID: 24628143 DOI: 10.1080/15524256.2013.877866] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Correctional institutions are obligated to provide end-of-life care to a population with complex medical needs. Prison hospices are increasingly being formed to address this demand. Few empirical studies have examined the impact of caring for dying inmates on the hospice inmate volunteers, who, in several prison health care systems, provide direct care. In this study, experiences of the inmate hospice volunteers with death were investigated to illuminate their grief processes. Understanding the bereavement needs of hospice volunteers and how prison hospice volunteers navigate grief and remain committed to providing excellent hospice care can inform the grief processes and practices of hospice care professionals.
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23
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Lee PC, Lo C, Ko WJ, Huang SJ, Lee PH. When and how should physicians determine the need for palliative and hospice care for patients with end-stage liver disease?: an experience in Taiwan. Am J Hosp Palliat Care 2013; 31:454-8. [PMID: 23861543 DOI: 10.1177/1049909113495707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We analyzed one case of end-stage liver disease and discussed whether the palliative care should be considered for this case. The medical record of a 56-year-old woman with alcoholic liver cirrhosis admitted to our hospital due to hypovolemic shock and esophageal varices (EV) was reviewed. The EV with active bleeding were arrested by panendoscopic intervention. However, repeat surgery revealed transmural laceration over the cardia, and immediate surgery and splenectomy were needed. The patient died postoperatively in the surgical intensive care unit due to bleeding tendency and hypovolemic shock. We suggest that palliative care and/or hospice care should have been considered for this patient before the crisis developed and that physicians require education about timely palliative and hospice care for patients with end-stage nonmalignant disease.
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Affiliation(s)
- Po-Chu Lee
- 1Department of Trauma, National Taiwan University Hospital, Taipei, Taiwan
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24
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Aragon K, Covinsky K, Miao Y, Boscardin WJ, Flint L, Smith AK. Use of the Medicare posthospitalization skilled nursing benefit in the last 6 months of life. ACTA ACUST UNITED AC 2013; 172:1573-9. [PMID: 23026981 DOI: 10.1001/archinternmed.2012.4451] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND In the last 6 months of life, many older adults will experience a hospitalization, followed by a transfer to a skilled nursing facility (SNF) for additional care. We sought to examine patterns of Medicare posthospitalization SNF use in the last 6 months of life. METHODS We used data from the Health and Retirement Study, a longitudinal survey of older adults, linked to Medicare claims (January 1994 through December 2007). We determined the number of individuals 65 years or older at death who had used the SNF benefit in the last 6 months of life. We report demographic, social, and clinical correlates of SNF use. We examined the relationship between place of death and hospice use for those residing in nursing homes and the community before the last 6 months of life. RESULTS The mean age at death among 5163 individuals was 82.8 years; 54.5% of the cohort were female, and 23.2% had resided in a nursing home. In total, 30.5% had used the SNF benefit in the last 6 months of life, and 9.2% had died while enrolled in the SNF benefit. The use of the SNF benefit was greater among patients who were 85 years or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services, and were expected to die soon (P < .01 for all). Of community dwellers who had used the SNF benefit, 42.5% died in a nursing home, 10.7% died at home, 38.8% died in the hospital, and 8.0% died elsewhere. In contrast, of community dwellers who did not use the SNF benefit, 5.3% died in a nursing home, 40.6% died at home, 44.3% died in the hospital, and 9.8% died elsewhere. CONCLUSIONS Almost one-third of older adults receive care in a SNF in the last 6 months of life under the Medicare posthospitalization benefit, and 1 in 11 elders will die while enrolled in the SNF benefit. Palliative care services should be incorporated into SNF-level care.
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Affiliation(s)
- Katherine Aragon
- Division of Palliative Care, Department of Medicine, University of California, San Francisco, CA 94121, USA
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25
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Sources of stress for family members of nursing home residents with advanced dementia. Alzheimer Dis Assoc Disord 2013; 26:254-9. [PMID: 22037596 DOI: 10.1097/wad.0b013e31823899e4] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The sources of stress for families of nursing home (NH) residents with advanced dementia have not been well described. Semistructured interviews were conducted with 16 family members previously enrolled in the Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life study, a prospective cohort of 323 NH residents with advanced dementia and their family members. Questions were asked pertaining to the experience of having a family member in the NH, communication with health-care professionals, surrogate decision making, emotional distress, and recommendations for improvement in care. Transcripts were analyzed using the constant comparative method. The majority of the participants were women (63%), children of the resident (94%), and white (94%). The average age was 62 years. Four themes emerged: (1) inadequate resident personal care, resulting in family member vigilance and participation in care; (2) stress at the time of NH admission; (3) lack of communication with NH physicians; and (4) challenges of surrogate decision making, including the need for education to support advance care planning and end-of-life decisions. Our results support the provision of emotional support to families upon resident admission, education regarding prognosis to guide decision making, improved resident care, and greater communication with health care professionals.
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Johnston B, Östlund U, Brown H. Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life. Int J Palliat Nurs 2012; 18:483-9. [PMID: 23123951 DOI: 10.12968/ijpn.2012.18.10.483] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND People nearing the end of life fear loss of dignity, and a central tenet of palliative care is to help people die with dignity. The Dignity Care Pathway (DCP) is an intervention based on the Chochinov theoretical model of dignity care. It has four sections: a manual, a Patient Dignity Inventory, reflective questions, and care actions. METHOD The feasibility and acceptability of the DCP were evaluated using a qualitative design with a purposive sample of community nurses. Data was collected from April to October 2010 using in-depth interviews, reflective diaries, and case studies and then analysed using framework analysis. RESULTS The DCP was acceptable to the community nurses, helped them identify when patients were at the end of life, identified patients' key concerns, and aided nurses in providing holistic end-of-life care. It requires the nurse to have excellent communication skills. Some of the nurses found it hard to initiate a conversation on dignity-conserving care. CONCLUSION The DCP helps nurses to deliver individualised care and psychological care, which has previously been identified as a difficult area for community nurses. All of the nurses wished to continue to use the DCP and would recommend it to others.
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Affiliation(s)
- Bridget Johnston
- School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, Scotland.
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27
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Abstract
RÉSUMÉNous avons examiné les caractéristiques contextuelles qui façonnent les soins de fin de vie (SFV) dans les établissements de soins pour bénéficiaires, en s’appuyant sur les perspectives de 11 aidants résidents (AR) dans un centre urbain canadien de l’Ouest. ARs décrivent les soins de fin de vie comme “offrant un confort,” y compris le bien-être physique et émotionnel. Les inquiétudes au sujet des défis posés par le temps et la charge de travail ont dominé les comptes et ont généré la culpabilité, la tristesse et de la frustration. ARs ont essayé de “trouver le temps” en le prenant d’eux-mêmes ou les autres résidents, et en s’appuyant sur l’engagement des collègues et sur les familles. Les résultats soulignent l’importance du rôle d’AR (en particulier en offrant un confort émotionnel), mais faire appel à l’attention à l’interprétation de ce qui est impliqué dans ce travail, et à la définition du portée de la pratique et de la formation. Les résultats également réitère l’importance, entre aidants résidents canadiens, des charges de travail adéquates pour faciliter les soins de fin de vie de qualité, et soulève des préoccupations au sujet des contraintes et comment elles forment la pratique de soins de fin de vie et les significations qui infusent une telle pratique.
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Thompson GN, McClement SE, Menec VH, Chochinov HM. Understanding bereaved family members' dissatisfaction with end-of-life care in nursing homes. J Gerontol Nurs 2012; 38:49-60. [PMID: 22998093 DOI: 10.3928/00989134-20120906-94] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 04/03/2012] [Indexed: 12/31/2022]
Abstract
With increasing numbers of older adults identifying a nursing home (NH) as their final place of care, it is important to assess the quality of dying in this setting and understand factors that impact family members' dissatisfaction with end-of-life care. A retrospective bereaved family member survey (N = 208) was conducted in 21 NHs located in urban areas of central Canada. Bereaved family members who were dissatisfied with care identified significantly more concerns in all domains assessed and were more likely to have problems with: (a) receiving confusing information from nursing staff about the resident's care, including medical treatments; (b) receiving inadequate information from nursing staff; and (c) feeling that end-of-life care was different than they had expected. Since the quality of communication between nurses, residents, and family members is the main factor that determines families' dissatisfaction with care, strategies and interventions aimed at reducing unmet information needs will be vital to improving end-of-life care in NHs.
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Frahm KA, Brown LM, Gibson M. The importance of end-of-life care in nursing home settings is not diminished by a disaster. OMEGA-JOURNAL OF DEATH AND DYING 2012; 64:143-55. [PMID: 22375349 DOI: 10.2190/om.64.2.c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The emphasis in disaster situations is on preserving life, and this goal is both appropriate and laudable. There is a risk, however, that the needs of people who are dying can become lost when there is a sudden surge of people needing acute intervention. There are significant ethical considerations inherent in society's prioritization of care needs across the acute, rehabilitative, and palliative spectrum in general, let alone in a disaster situation. These ethical conundrums are not the focus of this article. Rather, we anchor our discussion on the assumption that care needs are equally valid, and our purpose is to explore the issues that impact the provision of quality end-of-life care in nursing home settings for those who require this care when a disaster occurs. Nursing home residents, in particular, are at heightened risk for experiencing negative disaster-related outcomes due to compromised physical or mental health that requires skilled nursing care. Moreover, within the already vulnerable nursing home population are many people who are receiving palliative end-of-life services when a disaster strikes. Education and training in end-of-life services for nursing home staff, disaster emergency responders, and other lay people is vital to build capacity for adapting the delivery of these services in disaster situations in the interest of equity and human rights. Given the present lack of guidance in the literature as to what end-of-life care looks like when adapted to the context of disaster response, there is also a pressing need for research to inform this discussion. The purpose of this article is to draw attention to this topic and highlight some of the critical issues, gaps, and opportunities.
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Affiliation(s)
- Kathryn A Frahm
- Department of Aging and Mental Health Disparities, University of South Florida, Tampa 33612, USA.
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Brazil K, Kaasalainen S, McAiney C, Brink P, Kelly ML. Knowledge and perceived competence among nurses caring for the dying in long-term care homes. Int J Palliat Nurs 2012; 18:77-83. [DOI: 10.12968/ijpn.2012.18.2.77] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics
| | | | - Carrie McAiney
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Mary Lou Kelly
- School of Social Work, Lakehead University, Thunder Bay, Ontario
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Kuhn DR, Forrest JM. Palliative care for advanced dementia: a pilot project in 2 nursing homes. Am J Alzheimers Dis Other Demen 2012; 27:33-40. [PMID: 22296910 PMCID: PMC10697225 DOI: 10.1177/1533317511432732] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
This article describes a pilot project involving training, case consultations, and administrative coaching over a period of 1 year aimed at introducing palliative care in 2 nursing homes among 31 residents with advanced dementia. Resident outcomes that examined numerous clinical measures were assessed at 3 points in time. Changes in the knowledge and attitudes of 80 staff members and 33 family members who participated in the multimodal intervention were also assessed at 3 points in time. Limited improvements were demonstrated on measures for residents, staff members, and family members at the first nursing home (site 1) and significant improvements were demonstrated at the other nursing home (site 2). Top leadership turned over 3 times at site 1 which limited the integration of palliative care, whereas leadership of site 2 remained stable. Implications for implementing a program of palliative care in nursing homes are discussed.
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Affiliation(s)
- Daniel R Kuhn
- Rainbow Hospice and Palliative Care, Mount Prospect, IL 60056, USA.
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Liu LM, Guarino AJ, Lopez RP. Family Satisfaction With Care Provided by Nurse Practitioners to Nursing Home Residents With Dementia at the End of Life. Clin Nurs Res 2011; 21:350-67. [DOI: 10.1177/1054773811431883] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine family satisfaction with care provided by nurse practitioners (NP) to nursing home (NH) residents with dementia. A survey was mailed to 239 family members of nursing home residents who died with dementia. One open-ended question was added to provide comment about the care provided by the NP. A total of 131 surveys were returned (response rate 55%). The study revealed that 98% of family members agreed that they were satisfied with the end-of-life care provided by the NP. Survey responses were used to analyze the associations of communication, comfort, and satisfaction with NPs to total satisfaction with end-of-life care. Pearson’s correlations demonstrated that overall satisfaction was significantly associated with NP–family communication, resident comfort, and satisfaction with NP care. Findings suggested that NPs using a model of care that emphasizes advance care planning, communication, and comfort results in high satisfaction of family members.
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Affiliation(s)
| | - A. J. Guarino
- MGH Institute of Health Professions, Boston, MA, USA
| | - Ruth Palan Lopez
- MGH Institute of Health Professions School of Nursing, Boston, MA, USA
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Huskamp HA, Kaufmann C, Stevenson DG. The Intersection of Long-Term Care and End-of-Life Care. Med Care Res Rev 2011; 69:3-44. [DOI: 10.1177/1077558711418518] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High-quality end-of-life care is an important component of high-quality long-term care, yet many elderly individuals receiving long-term care services do not obtain good care as they approach death. This study provides a systematic review of articles that describe care received at the nexus of long-term care and end-of-life care. The articles identified three primary types of barriers to high-quality end-of-life care in long-term care settings: delivery system barriers intrinsic to long-term care settings, barriers related to features of coverage and reimbursement, and barriers resulting from the current regulatory approach for long-term care providers. The authors recommend areas for future research that would help to support progress on public policy that governs the provision of care at this important intersection.
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Kelly K, Thrane S, Virani R, Ferrell B, Malloy P. Expanding palliative care nursing education in California: the ELNEC Geriatric project. Int J Palliat Nurs 2011; 17:188-94. [DOI: 10.12968/ijpn.2011.17.4.188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kathe Kelly
- Division of Nursing Research & Education, City of Hope, 1500 East Duarte Road, Duarte, California 91010-3000, USA
| | - Susan Thrane
- Division of Nursing Research & Education, City of Hope, 1500 East Duarte Road, Duarte, California 91010-3000, USA
| | - Rose Virani
- Division of Nursing Research & Education, City of Hope, 1500 East Duarte Road, Duarte, California 91010-3000, USA
| | - Betty Ferrell
- Division of Nursing Research & Education, City of Hope, 1500 East Duarte Road, Duarte, California 91010-3000, USA
| | - Pam Malloy
- American Association of Colleges of Nursing (AACN), USA
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35
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Davidson KM. Evidence-Based Practice Guideline Family Preparedness and End-Of-Life Support Before the Death of a Nursing Home Resident. J Gerontol Nurs 2011; 37:11-6. [DOI: 10.3928/00989134-20110106-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Carlson MDA, Lim B, Meier DE. Strategies and innovative models for delivering palliative care in nursing homes. J Am Med Dir Assoc 2010; 12:91-8. [PMID: 21266284 DOI: 10.1016/j.jamda.2010.07.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 07/29/2010] [Accepted: 07/29/2010] [Indexed: 11/17/2022]
Abstract
The goals of palliative care address critical issues for individuals with complex and serious illness residing in nursing homes, including pain and symptom management, communication, preparation for death, decisions about treatment preferences, and caregiver support. Because of the uncertain prognosis associated with chronic nonmalignant diseases such as dementia, many nursing home residents are either not referred to hospice or have very short or very long hospice stays. The integration of palliative care into nursing homes offers a potential solution to the challenges relating to hospice eligibility, staffing, training, and obtaining adequate reimbursement for care that aligns with resident and surrogate's preferences and needs. However, the delivery of palliative care in nursing homes is hindered by both regulatory and staffing barriers and, as a result, is rare. In this article, we draw on interviews with nursing home executives, practitioners, and researchers to describe the barriers to nursing home palliative care. We then describe 3 existing and successful models for providing nonhospice palliative care to nursing home residents and discuss their ongoing strengths and challenges. We conclude with specific policy proposals to expedite the integration of palliative care into the nursing home setting.
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Affiliation(s)
- Melissa D A Carlson
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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37
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Gibson M, Gorman E. Contextualizing end-of-life care for ageing veterans: family members’ thoughts. Int J Palliat Nurs 2010. [DOI: 10.12968/ijpn.2010.16.7.49062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maggie Gibson
- Veterans Care Program, St. Joseph’s Health Care London and Aging, Rehabilitation and Geriatric Care Research Program, Lawson Health Research Institute
| | - Eunice Gorman
- Department of Interdisciplinary Programs (Thanatology), King’s University College, University of Western Ontario, Canada
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Abstract
The ethical implications of telehealth go well beyond providers' obligations to ensure privacy and confidentiality. The ethical conundrum of telehealth realizes the uniquely positive impact that telehealth can have on patients, providers, and clinical outcomes, as well as the potential for harm and abuse that may ensue. This article explores telehealth as one of many evolving information technologies that have ethical questions extending well beyond the confines of privacy and confidentiality. Providers and systems who utilize telehealth should also consider how it influences relationships with patients, access to healthcare, capacity for equitable treatment, cost, and quality of life. The ability to respond to these concerns will be important to the future development and deployment of this important technology as one means by which to improve access and quality of healthcare for all members of our society.
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Affiliation(s)
- David A Fleming
- MU Center for Health Ethics, University of Missouri School of Medicine, Columbia, Missouri 65211, USA.
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Lo RSK, Kwan BHF, Lau KPK, Kwan CWM, Lam LM, Woo J. The needs, current knowledge, and attitudes of care staff toward the implementation of palliative care in old age homes. Am J Hosp Palliat Care 2009; 27:266-71. [PMID: 19959840 DOI: 10.1177/1049909109354993] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aims to explore in depth the needs, current knowledge, and attitudes of all ranks of old age home staff. A large-scale qualitative study with 13 semistructured focus groups was conducted in Hong Kong. Key themes were extracted by framework analysis. Three major themes were extracted, including role as a service provider, current knowledge, and attitude toward palliative care. There was a marked difference in familiarity with the concept of ''palliative care'' between different groups of staff, yet both shared the motivation for enhancement. The biggest concerns for the staff were elderly residents' readiness to accept palliative care, manpower, and resources. Care staff, regardless of rank, seemed to welcome and be ready to adopt a palliative care approach in caring for old age home residents, though not without worries and concerns.
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Affiliation(s)
- Raymond S K Lo
- Department of Medicine and Geriatrics, Shatin Hospital, New Territories, Hong Kong.
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40
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McInerney F, Ford R, Simpson A, Willison M. Residential Aged-Care Workers and the Palliative Approach. J Hosp Palliat Nurs 2009. [DOI: 10.1097/njh.0b013e3181bd03df] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Woo J, Lo RSK, Lee J, Cheng JOY, Lum CM, Hui E, Wong F, Yeung F, Or KKH. Improving end-of-life care for non-cancer patients in hospitals: description of a continuous quality improvement initiative. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1752-9824.2009.01026.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McDonnell MM, McGuigan E, McElhinney J, McTeggart M, McClure D. An analysis of the palliative care education needs of RGNs and HCAs in nursing homes in Ireland. Int J Palliat Nurs 2009; 15:446, 448-55. [DOI: 10.12968/ijpn.2009.15.9.44257] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary M McDonnell
- Health Service Executive, Dublin North East, Louth, Meath, Cavan/Monaghan, Dóchas Centre, Drogheda, Co. Louth
| | - Eileen McGuigan
- SPCS, School of Nursing, Midwifery, Health Studies and Applied Science, Dundalk Institute of Technology, Dundalk
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Temkin-Greener H, Zheng NT, Norton SA, Quill T, Ladwig S, Veazie P. Measuring end-of-life care processes in nursing homes. THE GERONTOLOGIST 2009; 49:803-15. [PMID: 19574538 DOI: 10.1093/geront/gnp092] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The objectives of this study were to develop measures of end-of-life (EOL) care processes in nursing homes and to validate the instrument for measuring them. DESIGN AND METHODS A survey of directors of nursing was conducted in 608 eligible nursing homes in New York State. Responses were obtained from 313 (51.5% response rate) facilities. Secondary data on structural characteristics of the nursing homes were obtained from the Online Survey Certification and Reporting System. Exploratory factor analyses and internal consistency reliability analyses were performed. Multivariate regression models with fixed and random effects were estimated. RESULTS Four EOL process domains were identified-assessment, delivery, communication and coordination of care among providers, and communication with residents and families. The scales measuring these EOL process domains demonstrated acceptable to high internal consistency reliability and face, content, and construct validity. Facilities with more EOL quality assurance or monitoring mechanisms in place and greater emphasis on EOL staff education had better scores on EOL care processes of assessment, communication and coordination among providers, and care delivery. Facilities with better registered nurse and certified nurse aide staffing ratios and those with religious affiliation also scored higher on selected care process measures. IMPLICATIONS This study offers a new validated tool for measuring EOL care processes in nursing homes. Our findings suggest wide variations in care processes across facilities, which in part may stem from lack of gold standards for EOL practice in nursing homes.
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Affiliation(s)
- Helena Temkin-Greener
- Department of Community and Preventive Medicine, Center for Ethics, Humanities and Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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44
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Gibson MC, Gutmanis I, Clarke H, Wiltshire D, Feron A, Gorman E. Staff opinions about the components of a good death in long-term care. Int J Palliat Nurs 2009; 14:374-81. [PMID: 19023953 DOI: 10.12968/ijpn.2008.14.7.30772] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The aim of this study was to identify differences of opinion about the relative importance of different components of a good death among care providers in a long-term care home serving Canadian war veterans. METHODS The Concept of a Good Death scale (Swartz et al, 2003), with slight adaptations to fit the long-term care context, was made available to all staff. Responses were accepted for a one-month period. FINDINGS Survey return rate was 30.4%. There was a majority (greater than 50%) opinion that 12 of the 20 items were essential or important to a good death, and that three items were not necessary: 'that death is sudden and unexpected' (64.5%), 'that there be control of bodily functions to the end' (61.8%) and 'that there be mental alertness to the end' (55.3%). There was not a majority opinion on the five remaining items: 'that the dying period be short', 'that death occurs naturally without technical equipment', 'that the person lived until a key event', 'that the ability to communicate be present until death', and 'that death occurs during sleep'. CONCLUSIONS Detailed analysis of survey results identified differences of opinion that could have implications for consistency and quality of care. The findings suggest ways in which the unique characteristics of the long-term care environment and population influence opinions about the components of a good death.
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45
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Thompson GN, Menec VH, Chochinov HM, McClement SE. Family Satisfaction with Care of a Dying Loved One in Nursing Homes: What Makes the Difference? J Gerontol Nurs 2008; 34:37-44. [DOI: 10.3928/00989134-20081201-10] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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46
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Thompson S, Oliver DP. A New Model for Long-Term Care: Balancing Palliative and Restorative Care Delivery. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/02763890802232014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hasson F, Kernohan WG, Waldron M, Whittaker E, McLaughlin D. The palliative care link nurse role in nursing homes: barriers and facilitators. J Adv Nurs 2008; 64:233-42. [PMID: 18785884 DOI: 10.1111/j.1365-2648.2008.04803.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study to explore link nurses' views and experiences regarding the development, barriers and facilitators to the implementation of the role in palliative care in the nursing home. BACKGROUND The delivery of palliative care in nursing homes is widely advocated; one approach is to develop the link nurse role to cascade good practice and training to nurses and other care staff to enhance patient care. METHOD A descriptive qualitative study was conducted with a purposive sample of 14 link nurses from 10 nursing homes in Northern Ireland during 2006. Three focus groups, composed of all Registered Nurses currently acting as link nurses in their nursing homes participated, and the data were audio recorded, fully transcribed and content analysed. FINDINGS The link nurse system shows potential to enhance palliative care within nursing homes. However, link nurses experienced a number of difficulties in implementing education programmes. Facilitators of the role included external support, monthly meetings, access to a resource file and peer support among link nurses themselves. Lack of management support, a transient workforce and lack of adequate preparation for link nurses were barriers to fulfilling this role. CONCLUSION Whilst palliative care link nurses can improve care for residents in nursing homes, consideration must be given to overcome the types of barriers identified in order to enable the link nurse system to function effectively.
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Affiliation(s)
- Felicity Hasson
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey, UK.
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48
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Waldron M, Hasson F, Kernohan WG, Whittaker E, McClaughlin D. Evaluating education in palliative care with link nurses in nursing homes. ACTA ACUST UNITED AC 2008; 17:1078-83. [DOI: 10.12968/bjon.2008.17.17.31104] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Waldron
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey
| | - F Hasson
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey
| | - WG Kernohan
- Institute of Nursing Research and School of Nursing, University of Ulster, Newtownabbey
| | - E Whittaker
- Northern Ireland Hospice Care, Northern Ireland Hospice, Belfast
| | - D McClaughlin
- Northern Ireland Hospice Care, Northern Ireland Hospice, Belfast
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49
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Kelly K, Ersek M, Virani R, Malloy P, Ferrell B. End-of-Life Nursing Education Consortium. Geriatric Training Program: improving palliative care in community geriatric care settings. J Gerontol Nurs 2008; 34:28-35. [PMID: 18512631 DOI: 10.3928/00989134-20080501-06] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)-Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC-Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC-Geriatric Training Program and follow-up evaluation of the "train-the-trainer" model to disseminate comprehensive palliative care education in geriatric settings.
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Affiliation(s)
- Kathe Kelly
- ELNEC-Geriatric Training Program, Nursing Research and Education Department, City of Hope, Duarte, CA 91010, USA.
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50
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Hodgson NA, Lehning AJ. Palliative care in nursing homes: a comparison of high- and low-level providers. Int J Palliat Nurs 2008; 14:38-44. [DOI: 10.12968/ijpn.2008.14.1.28152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nancy A Hodgson
- Polisher Research Institute, Abramson Center for Jewish Life, North Wales, Pa, USA
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