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1
Greaves, Judith M. „Understanding palliative care: An ethnographic study of three Australian palliative care services“. Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2005. https://ro.ecu.edu.au/theses/1553.
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Palliative care commenced in Australia in the early 1980s. Although the value of palliative care has become more widely recognised by the public and other health care professionals, there is still a lack of understanding about what palliative care is and the depth and scope of this specialty area of health care. The research that I present in this thesis is based on examination of palliative care practice in a selection of Australian services, undertaken with the aim of enhancing understanding of Palliative Care. The significance of the research arises from the notion that members of the Australian community should be well informed about health care options available to them. Understanding palliative care and the ability to differentiate palliative care from other end-of-life care is important if people are to make informed decisions about supporting, accessing, and using services appropriate to their needs. An interpretive ethnographic study from a symbolic interactionist perspective was undertaken in three palliative care services, one in each of the major Australian cities of Sydney. Melbourne, and Perth. Each palliative care service had been established for at least ten years, and was part of a larger health care facility. A fourth service, a purpose-built three-year-old unit, was added during the course of the research to provide contrast to the emerging analyses. As an experienced palliative care nurse, I assumed the role of marginal native as the primary research instrument. Data collection was by means of participant observation, formal and informal interviews, and examination of supplementary data sources, with two months spent in each of the three study sites. Interpretations made from ethnographic observation of these Australian palliative care services showed a diversity of practice, best understood within the context of the particular service. The major findings are presented under the headings of Politics, Place, People, and Practice of Palliative Care. Common approaches to provision of care were found in creating an appropriate physical environment for patients, with an underlying mission to "make the best of things." Patients cared for in the settings were a similar cohort of middle aged to elderly cancer patients. In general, staff shared expectations of appropriate types of patients and showed discomfort or lack of understanding in caring for non-cancer patients, or patients from non-Australian, non-Christian, and non-English speaking backgrounds. Practice diversity was highlighted by the range of technology used and variations in the availability of social activities for patients in the services. These two: areas in particular warrant further research to examine the outcomes associated with these variations, in terms of survival time, quality of life, and service costs.
These findings are particularly relevant at this time when the Australian Government is attempting to enhance access to palliative care. The diversity of practice uncovered in this study suggests that discussions and decisions about allocation of resources and development of services must take into consideration the various interpretations of palliative care services that may exist. The findings also reinforce the need for sound evidence-based studies to examine the impact of variations and the types of populations that might be best served by different types of palliative care support.
2
Chandrasekhara, Seetha. „Palliative Treatment and Euthanasia for Psychiatric Illnesses“. Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/425660.
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Urban BioethicsM.A.
When looking at the natural course of life, death is the natural conclusion. Majority of the time, people do not choose when and how they die. Death and dying are topics that are difficult to discuss for many individuals. However, when one decides to choose the context of their death, it raises many ethical considerations. Psychiatry, as a field, looks at the psychodynamics of death and dying for individuals. It is also poised to comment on the growing use of physician-assisted suicide and euthanasia for psychiatric disorders. Through a review of the literature, theories in psychiatry regarding the dying process are used to better understand an individual's choice for choosing euthanasia as a medical intervention to end their suffering from a long-standing psychiatric illness. The use of palliative care in conjunction with psychiatry is also explored.
Temple University--Theses
3
Bradley, Sarah Elizabeth. „Specialist palliative day care : patients' perspectives“. Thesis, University of Hull, 2009. http://hydra.hull.ac.uk/resources/hull:3970.
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This portfolio has three parts. Part one is a systematic literature review entitled ‘Patients' Psychosocial Experiences of Attending Specialist Palliative Day Care: A Systematic Literature Review’. Recent reviews conclude that the benefits of attending Specialist Palliative Day Care are likely to be in the social, psychological and spiritual domains. However these areas are not easily identified, leaving researchers and practitioners unclear as to what aspects of these domains patients most need and desire. The objective of this review was to systematically evaluate literature on patient perceived psychosocial experiences of attendance at SPDC. Twelve studies were included. Evidence showed that patients value a person-centred approach which reduces isolation, increases social support, encourages communication and provides activities. Future research could focus on investigating why patients value the psychosocial experiences reported in this review and how these experiences can be defined in a way that would be meaningful to clinical service commissioners. Once this has been done, clinicians can start to measure clinical effectiveness and devise justifiable interventions for this patient group. Part two is a qualitative study, using Interpretative Phenomenological Analysis (IPA) to explore patients’ perspective of attending SPDC. The importance of services helping patients cope with terminal illness has been emphasised throughout Department of Health (2000) and NICE (2004) cancer guidance. However, whether or not services are achieving this aim has been sparsely researched to date; particularly in relation to Specialist Palliative Day Care (SPDC). Eleven semi-structured interviews were carried out and analysed utilising qualitative methodology (Interpretative Phenomenological Analysis – IPA) to allow for an in depth investigation of SPDC. Emerging themes suggest that SPDC provides an environment in which patients are helped to cope by facilitation of acceptance of the reality of death, thereby freeing them to focus on 'life'. The study does not claim to provide the definitive answer to what processes may underpin attendance at SPDC, however in such an under researched area it provides a much needed exploration which can be built upon or challenged by future research. Part three comprises appendices relating to the research. This includes a reflective statement on the process of conducting the research, the challenges faced and the lessons learnt.
4
Fourie, Linda. „Pain control in palliative care : a South African nursing perspective“. Thesis, [S.l. : s.n.], 2008. http://dk.cput.ac.za/cgi/viewcontent.cgi?article=1029&context=td_cput.
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5
Ramadge, Joanne, University of Western Sydney, College of Social and Health Sciences und of Nursing Family and Community Health School. „Ways of knowing cancer pain in a palliative care setting“. THESIS_CSHS_NFC_Ramadage_J.xml, 2001. http://handle.uws.edu.au:8081/1959.7/428.
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Very little work has been undertaken that explores pain as a part of human existence and the inherent knowledge that accompanies it. What pain means to people and how they know their own pain is the subject of this research study.The research sought to identify ways of knowing cancer pain of six participants, each receiving palliative care at the time of this study. The themes of, balancing conflict, living with threat, always there and making sense are identified and examined to provide understanding of the ways these people know their pain. A new model of pain assessment is offered that incorporates an ontological way of knowing, and the meaning that the findings have for nursing practice is explored. Implications for nursing practice and education that are derived from the study are offered. The rigour of the study is promoted through an audit processDoctor of Philosophy (PhD)
6
Mitchell, Geoffrey Keith. „The effect of case conferences between general practitioners and palliative care specialist teams on the quality of life of dying people /“. [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18557.pdf.
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7
Bergquist, Adam. „Evaluation of the pathways palliative care program at the Denver hospice“. [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/ABergquist2008.pdf.
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8
Uwimana, Jeannine. „Met and unmet palliative care needs for people living with HIV/AIDS in selected areas in Rwanda“. Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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The aim of this study was to investigate met and unmet palliative care needs for people living with HIV/AIDS in selected areas in Rwanda. The achieve this aim, the study, firstly, identified the palliative care needs of people living with HIV/AIDS, secondly, it identified the health care services available to meet these needs, and thirdly, it determined the extent to which palliative care needs were met.
9
Liu, Chang-Han. „Effectiveness of palliative measures in treatment of dysphagia of cancer of the oesophagus“. Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/11191.
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Includes bibliographical references (leaves 34-35).Cancer of the oesophagus,one of the most common cancers amongst the black population in South Africa with "cure" in this condition often considered as a "fortunate accident" by many experts in the field of oncology due to its late presentation and common occurrence of metastasis at presentation. The palliative care team focused their attention on measures to solve the cardinal symptom of this disease, which in most cases was dysphagia. This was also the main determinant of quality of life for these patients. Therefore, the primary objective of the study was to determine the effectiveness of the palliative measures in improving the cardinal symptom of oesophageal carcinoma - dysphagia. Accurate staging in most, if not all of the cancers is paramount, as it determines which options and sequences of treatment are appropriate. Oesophageal carcinoma is no exception. For patients stage III/IV, surgical resection of the tumour was attempted if possible. For advanced stage oesophageal carcinoma, that is stage III/IV, surgical resection with curative intent was not performed. The cardinal symptom of oesophageal carcinoma was then treated mainly with palliative radiotherapy, dilatation of the oesophagus with flexible bougie and oesophageal intubations.
10
Painter, Mark Llewellyn. „Outcome after palliative cardiac surgery in a developing country“. Master's thesis, University of Cape Town, 1990. http://hdl.handle.net/11427/25963.
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The outcome of 121 children who underwent palliative cardiac surgery at the Red Cross War Memorial Children's Hospital over a 5 year period, 1980 1984, was retrospectively examined. 79 children had systemic artery to pulmonary artery shunt operations (SPS), 40 had pulmonary artery bands (PAB) and 2 had surgical septectomies. SPS was most often done for children with Tetralogy of Fallot (TOF, 26 cases) or complex univentricular hearts with right ventricular outflow tract obstruction (27 cases). PAB was done chiefly for ventricular septa! defects, alone (VSD, 8 cases) or with coarctation of the aorta (9 cases). Children were referred from a wide area with 63 cases being referred from other major centres and foreign countries. Overall, 36 children died (30 % mortality): 5 died at surgery, 6 within 48 hours of surgery, a further 5 within 31 days; and 20 died after 31 days. SPS and PAB had the same early mortality rates ( 13 % ) • SPS had higher late and overall mortality rates (20 and 33 %) than PAB (10 and 23 %). Age at operation was found to be the most significant determinant of the overall mortality rate: children less than six months had a mortality of 42 % and those over 6 months, 13 % • The children were grouped into those with lesions which were probably correctable and those that were unlikely to be so, based on diagnosis and age at surgery: those with correctable lesions had a lower overall mortality (22 %) than those with uncorrectable lesions (43 %). Where the surgery was performed as an emergency, there was a higher overall and early mortality (55 and 35 respectively), compared to those operations which were performed electively ( 25 and 9 % ) • The presence of other medical conditions, for example congenital abnormalities and infections, was also a determinant of death (44 % mortality if other medical condition present, 26 % if absent). sex, population group, home address and type of surgery performed did not significantly affect mortality when examined by multivariate analysis. Using routine methods of follow up, it was initially thought that 17 % of all patients (22 % of survivors) were lost to follow up. An important determinant of this was the referral centre. 31 % of cases from other major centres and 20 % of foreign cases were lost, as compared to 8 % of cases from smaller towns near Cape Town and 2 % of children from Cape Town. Population group (35 % Blacks, 14 % Coloureds and 7 % Whites were lost), and palliative operation (23 % SPS, and 5 % PAB lost) were also significant determinants. It was possible to trace 12 of the 20 children who were thought to be lost to follow. 8 had died, 3 were still awaiting correction and 1 was traced and received corrective surgery. The records of the children who underwent cardiac surgery in 1987 were also analysed. There was no difference in the demographic characteristics of either group, and the early mortality was the same. This study shows that the outcome after palliative cardiac surgery is poor, with a high mortality rate and children often being lost to follow up. The decision to palliate rather than to correct a congenital heart defect must be made after balancing these risks with those of early correction for the particular surgical team. Should palliative surgery be undertaken, careful follow up is essential to ensure that complications of palliation do not set in and that corrective surgery is done at the optimal time.
11
Davison, Graydon, University of Western Sydney, College of Law and Business und School of Management. „Innovative practice in the process of patient management in palliative care“. THESIS_CLAB_MAN_Davison_G.xml, 2005. http://handle.uws.edu.au:8081/1959.7/498.
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This thesis examines the management of multidisciplinary teams in a highly innovative environment through a study of multidisciplinary patient care teams in palliative care. It investigates management that enables spontaneous innovation where necessary, yet maintains discipline and compliance with legislation, regulation and policy. To assist the explanation a model of palliative care multidisciplinary team management and operation is developed, building on work described in the continuous innovation and organisational configuration literatures. This thesis describes innovative practices as focusing on changing the organisation’s social potential, when necessary, in order to match changes in an individual patient’s situation. A definition of innovation suitable to this environment is developed here, adapted from the innovation literature. A definition of social potential suitable to this environment is also developed, based primarily in the literature of the socialisation of organisations. In palliative care organisations, care is delivered to the patient and any group of people supporting the patient during the end of life process. Care provided to these supporters, referred to in this thesis as patient-based carers, can extend beyond the death of the patient. Palliative care is more than symptom management during the dying process and can involve an interaction lasting weeks or months between the organisation and patients and patient-based carers. A patient’s situation is described at many levels and involves a number of aspects of the patient’s condition and life; for example medical, social, psychosocial, spiritual and physical. In palliative care, patients and patient-based carers are the major sources of information about their situation and changes to it. This makes them active participants in the care team, although some patients and patient-based carers choose not to take this role. Every patient and every group of patient-based carers creates individualised situations when progressing through their end of life processes, requiring individualised care from teams that can change the membership mix to suit the situation. Palliative care professionals can be members of multiple individual patient care teams simultaneously and teams can include heads of discipline (managers). Multidisciplinary palliative care teams can be managed from inside or outside the team, as the situation requires. Uncertainty pervades this environment and the response is flexibility based in learning and understanding. From the model developed of the management of innovation in the palliative care environment implications for the management of multidisciplinary teams in a highly innovative environment are drawn.Doctor of Philosophy (PhD)
12
Garanganga, Eunice. „Palliative care needs of children suffering from AIDS, Zimbabwe“. Thesis, [S.l. : s.n.], 2009. http://dk.cput.ac.za/cgi/viewcontent.cgi?article=1030&context=td_cput.
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13
Dawson, Patricia Shelagh Jean. „An exploration of bereavement intervention in palliative/hospice care programming“. Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28712.
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Bereavement intervention is subsumed within palliative programme philosophy which encompasses the family as the unit of care and provides a continuum of care that extends beyond the death of a family member. There is no available research on the effect of post-bereavement intervention within palliative programming, and very limited research exists that evaluates the effect of intervention on bereavement outcome. This exploratory study endeavors to differentiate bereavement outcome between two populations having palliative/hospice program support but only one choosing to participate in bereavement follow-up. A mixed strategy of quantitative and grounded theory approaches provided an expanded analysis through which meaning structures and time/process parameters for grieving individuals were explored. The study extended from idiosyncratic data into the realm of larger systemic interactions. An important finding was that the amount of time for preparation for the death of a family member is crucial. Other mitigating factors influencing the grief outcome were social support, network viability, and age.Arts, Faculty of
Social Work, School of
Graduate
14
Law, Chi-ching. „Can integrated palliative care services enhance the quality of end-of-life cancer care?“ Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42994949.
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15
Davison, Graydon. „Innovative practice in the process of patient management in palliative care“. Thesis, View Thesis, 2005. http://handle.uws.edu.au:8081/1959.7/498.
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This thesis examines the management of multidisciplinary teams in a highly innovative environment through a study of multidisciplinary patient care teams in palliative care. It investigates management that enables spontaneous innovation where necessary, yet maintains discipline and compliance with legislation, regulation and policy. To assist the explanation a model of palliative care multidisciplinary team management and operation is developed, building on work described in the continuous innovation and organisational configuration literatures. This thesis describes innovative practices as focusing on changing the organisation’s social potential, when necessary, in order to match changes in an individual patient’s situation. A definition of innovation suitable to this environment is developed here, adapted from the innovation literature. A definition of social potential suitable to this environment is also developed, based primarily in the literature of the socialisation of organisations. In palliative care organisations, care is delivered to the patient and any group of people supporting the patient during the end of life process. Care provided to these supporters, referred to in this thesis as patient-based carers, can extend beyond the death of the patient. Palliative care is more than symptom management during the dying process and can involve an interaction lasting weeks or months between the organisation and patients and patient-based carers. A patient’s situation is described at many levels and involves a number of aspects of the patient’s condition and life; for example medical, social, psychosocial, spiritual and physical. In palliative care, patients and patient-based carers are the major sources of information about their situation and changes to it. This makes them active participants in the care team, although some patients and patient-based carers choose not to take this role. Every patient and every group of patient-based carers creates individualised situations when progressing through their end of life processes, requiring individualised care from teams that can change the membership mix to suit the situation. Palliative care professionals can be members of multiple individual patient care teams simultaneously and teams can include heads of discipline (managers). Multidisciplinary palliative care teams can be managed from inside or outside the team, as the situation requires. Uncertainty pervades this environment and the response is flexibility based in learning and understanding. From the model developed of the management of innovation in the palliative care environment implications for the management of multidisciplinary teams in a highly innovative environment are drawn.
16
Ramadge, Joanne. „Ways of knowing cancer pain in a palliative care setting“. Thesis, View thesis View thesis, 2001. http://handle.uws.edu.au:8081/1959.7/428.
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Very little work has been undertaken that explores pain as a part of human existence and the inherent knowledge that accompanies it. What pain means to people and how they know their own pain is the subject of this research study.The research sought to identify ways of knowing cancer pain of six participants, each receiving palliative care at the time of this study. The themes of, balancing conflict, living with threat, always there and making sense are identified and examined to provide understanding of the ways these people know their pain. A new model of pain assessment is offered that incorporates an ontological way of knowing, and the meaning that the findings have for nursing practice is explored. Implications for nursing practice and education that are derived from the study are offered. The rigour of the study is promoted through an audit process
17
Watts, Tessa Elisabeth. „Educating undergraduate pre-registration nursing students for complexity in contemporary palliative nursing“. Thesis, Swansea University, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678375.
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18
Ali, Murtaza Najabat. „Development of auxetic polymeric stent-graft for the palliative treatment of oesophageal cancer“. Thesis, University of Sheffield, 2012. http://etheses.whiterose.ac.uk/2862/.
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Oesophageal cancer is the ninth leading cause of malignant cancer death and its prognosis remains poor, ranking as the sixth frequent cause of death in the world. This research work is aimed to use Auxetic (rotating-squares) geometry, only theoretically predicted and analysed by (Grima and Evans 2000), for the production of a novel Auxetic oesophageal stents and stent-grafts relevant to the palliative treatment of oesophageal cancer and also for the prevention of dysphagia. This study also endeavoured to manufacture a significantly small diameter Auxetic oesophageal stent and stent-graft. In order to easily deploy the Auxetic stent orally using a commercial balloon dilatational catheter, and hence it also obviates the need of an expensive dedicated delivery system. A novel manufacturing route was employed in this research to develop both Auxetic films and Auxetic oesophageal stents, which ranged from conventional subtractive techniques to new generative manufacturing methods. Polyurethane was selected as a material for the fabrication of Auxetic films and Auxetic oesophageal stents because of its good biocompatibility and non-toxicological properties. The Auxetic films were later used for the fabrication of seamed Auxetic oesophageal stents. The flexible polyurethane tubular grafts were also attached to the inner luminal side of the seamless Auxetic oesophageal stents, in order to prevent tumour in-growth. The scanning electron microscopy (SEM) was used to conduct surface morphology study by using different Auxetic specimens developed from different conventional and new additive manufacturing techniques. Tensile testing of the Auxetic films was performed to characterise their mechanical properties. The stent expansion tests of the Auxetic stents were done to analyse the longitudinal extension and radial expansion of the Auxetic stent at a range of radial pressures applied from the balloon catheter, and to also identify the pressure values where the Auxetic stent fails. Finite element models of both Auxetic film and Auxetic stent were developed, and the results were compared with experimental results with reasonably good agreement. The tensile testing of the Auxetic polyurethane films revealed that the Poisson’s ratio of the sample ranged between -0.87 to -0.963 at different uniaxial tensile load values. From the stent expansion test, it was found that the Auxetic oesophageal stent radially expanded from 0.5 to 5.73mm and longitudinally extended from 0.15 to 1.83mm at a range of applied pressure increments (0.5 to 2.7 bar) from the balloon catheter.
19
Chauhan, Jyoti. „The experiences of primary caregivers providing palliative care to women living with advanced breast cancer“. Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3534_1194347235.
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The aim of this explorative study was to understand the experiences and challenges of primary caregivers providing palliative care to women with advanced breast cancer. This study was conducted within a qualitative research design framework underpinned by phenomenology. The significance of this study was to contribute to the knowledge that would help care professionals understand the experiences and challenges that primary caregivers face whilst providing palliative care to women with advanced breast cancer.
20
Munene, Grace N. „An Assessment of a Hospice and Palliative Care Partnership Program“. Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc699969/.
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This project attempts to describe how a hospice and palliative care partnership program works. Through the assessment of one such program, the researcher sought to find out the essential components of the partnership including how the two partner organizations interact and work together. Data was collected using various methods: document review of organization documents such as newsletters, annual or quarterly reports, brochures and other available literature e.g. materials on organizations’ website and on social media; in-depth interviews with stakeholders of both organizations that included staff and board members; observation of staff working; and participant observation during organization events. The findings of the research shows that in order for organizations to have an effective partnership program in place, both partners need to have strong leadership in place, possess a willingness to learn from each other, maintain regular communication, and visit each other regularly. With this in place, several outcomes of the program are likely such as: increasing advocacy for hospice and palliative care, increasing visibility of the organizations both nationally and internationally, and provides an opportunity for organizations to network with other organizations in their locality in order to achieve partnership objectives. The study further reveals that global collaborations in the field of hospice and palliative care began with the advent of the international hospice movement. The assessment of this hospice partnership demonstrates how organizations can establish working relationships and the results likely to come out of such an initiative.
21
Milone, Mary Anne. „The Level of Hope in Patients Receiving Treatment for the Diagnosis of Lung Cancer“. Scholarly Repository, 2010. http://scholarlyrepository.miami.edu/oa_dissertations/409.
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Lung cancer is the most common cause of cancer deaths worldwide. Hope is considered essential to life and has been positively associated with coping. The purpose of this study was to describe the level of hope in patients receiving medical treatment for lung cancer. The study was guided by Dufault and Martocchio's multidimensional theoretical model of hope. A total of 167 patients were recruited for this cross sectional descriptive study from oncology clinics in the Southeast United States. Each participant completed a nine-item demographic self-survey questionnaire and a twelve-item, four point Likert-type Herth Hope Index (possible scores 12-48, higher score = higher hope) to measure the level of hope. Clinical information included lung cancer type, stage of lung cancer, and time since diagnosis. The overall total mean hope score was 41.48 (SD = 5.10). This finding suggests that although lung cancer patients may be at risk for lower hope scores, this study demonstrated that lung cancer patients continue to hope throughout their disease trajectory. The other major findings demonstrated that widow/widowers (n = 14, 8%), were more hopeful (M = 42.57) than divorced (n = 36, 22%), (M = 39.29) and Blacks/African Americans (n = 22, 13.2%) had higher levels of hope (M = 43.22) than Whites/Caucasians (n = 140, 83%) (M = 41.26). Participants undergoing second line of chemotherapy treatment n = 30 (18%), were more hopeful 43.63(4.99) compared to all others. Future studies may include measuring hope at the time of diagnosis and throughout the disease trajectory, as well as at multiple data points during different lines of chemotherapy treatment.
22
何孝恩 und Hau-yan Andy Ho. „Living and dying with dignity : an interpretive-systemic framework in Hong Kong“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193427.
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Protecting and promoting patients’ and families’ sense of dignity at end-of-life is an indispensable goal, one that palliative care professionals have pursued unceasingly in the modern era. While researchers have made several attempts to uncover the intricate meaning and constitution of dignity and dignified end-of-life care in recent years, their works are solely based upon a Western individualistic paradigm that may not be applicable in Eastern collective societies. This limitation underscores that the existing body of knowledge is missing an important articulation on the Chinese experience. Thus, to fill this important knowledge gap, this study has applied ‘micro’, ‘meso’ and ‘macro’ levels of inquiries to attain a holistic understanding of dignity and dignified end-of-life care in the Hong Kong Chinese context.
Through meaning-oriented interviews with 18 Chinese palliative terminal cancer patients and 18 of their family caregivers, as well as four interpretive-systemic focus groups with 30 key informants involved in a novel end-of-life care pathway programme (N=66), a total of 31 themes that elucidate dignity and dignified end-of-life care have been generated. These 31 themes are carefully organized into 9 categories that reflect the Individual, Familial and Institutional dimensions of dignity at end-of-life.
First, the Individual dimension includes: 1) “Personal Autonomy”, which consists of Regain Control, Self-Sufficiency, Informed Care Decisions and Future Planning; 2) “Family Connectedness”, which consists of Express Appreciation, Achieve Reconciliation, Fulfill Family Obligations and Strengthen Family Bond; and 3) “Spiritual Plasticity”, which consists of Enduring pain, Spiritual Surrender, Moral Transcendence and Transgenerational Unity.
Second, the Familial dimension involves: 1) “Social Agency”, which comprises of Caregiving Resources, Caregiver Assertiveness and Communicative Action; 2) “Family Integrity”, which comprises of Mutual Support, Kinship Involvement and Family Adaptability; and 3) “Filial Compassion”, which comprises of Compassionate Duty, Reciprocal Relationship and Emotional Connection.
Third, the Institutional dimension entails: 1) “Regulatory Empowerment”, which encompasses Interdisciplinary Teamwork, Resource Allocation, Culture Building and Collaborative Policymaking; 2) “Family-Centered Care”, which encompasses Continuity of Care, Family Conference and Care Partnership; and 3) “Collective Compassion”, which encompasses Devotion in Care, Empathic Understanding, and Compassionate Action.
These 9 categories and their respected 31 themes are clearly interrelated and embedded within the political, cultural, and spiritual contexts of society, highlighting the intricate interplay of systemic structure and social discourse for promoting dignity at end-of-life. These findings have further led to the development of the ‘Patient-Family Model of Dignified Care’ and the ‘Interpretive-Systemic Framework of Dignity at End-of-Life’. The former provides a new clinical protocol for identifying and evaluating the strengths and weaknesses within the personal, interpersonal and transpersonal functioning of the patient-family dyads in Chinese end-of-life care. The latter offers a public health roadmap for social change that accentuates the necessity for a collective consciousness of compassion in pushing forth the ultimate ideal of living and dying with dignity in Hong Kong.
Based on this body of work, recommendations for patient-family care at end-of-life, expansion of community-based palliative care, and development of palliative long-term-care for ensuring quality and equality in the care of dying patients and their families are discussed.published_or_final_version
Social Work and Social Administration
Doctoral
Doctor of Philosophy
23
Dignan, Debra L. „Palliative care patients and their quality of life as perceived by the patient and their caregiver“. [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/DDignan2008.pdf.
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Mondejar, Pont Meritxell. „An Integrated Palliative Care System in Osona“. Doctoral thesis, Universitat de Vic - Universitat Central de Catalunya, 2020. http://hdl.handle.net/10803/670065.
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L’envellida població del segle XXI pateix malalties cròniques, malalties terminals i multimorbiditat. Les cures pal·liatives han estat tradicionalment la resposta a aquestes afeccions i han evolucionat al que anomenem cures pal·liatives integrades. L’objectiu d’aquest estudi és descriure el sistema de cures pal·liatives d’Osona i identificar els elements que inclou i els que li falten com a sistema integrat en relació als elements essencials descrits a la bibliografia. Aquesta investigació ha seguit una metodologia qualitativa amb una tècnica d’estudis de cas. En conclusió els principals elements descrits a la bibliografia sobre un sistema integrat de cures pal·liativa (SICP) es van trobar en els resultats d'aquest estudi, confirmant que són essencials. També es va trobar que el sistema d’Osona inclou la majoria d'elements integradors per a un SICP indicats en la documentació revisada. Tot i això, alguns dels elements necessiten canvis i millores per a una millor atenció al pacient.The aging population of the 21st century suffers from chronic diseases, terminal illnesses and multimorbidity. Palliative care has traditionally been the answer to these conditions and it has evolved into what we call integrated palliative care. The goal of this study is to describe the Osona palliative care system and identify the elements it includes and those that it lacks as an integrated system in relation to the essential elements described in the bibliography. This research has followed a qualitative methodology with a case study technique. In conclusion the main elements described in the literature on an integrated palliative care system (IPCS) were found in the results of this study, confirming that they are essential. It was also found that the Osona system includes most of the integrative elements for an IPCS as indicated in the revised documentation. However, some of the elements need changes and improvements for better patient care.
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Miti, Elvis Joseph. „An evaluation of a psychosocial intervention for orphans on HIV treatment: A phase II RCT of memory work therapy at PASADA, Tanzania“. Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16603.
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Includes bibliographical referencesAim: Evidence shows high burden of psychosocial problems among orphaned children with HIV. Intervention studies have generally been conducted in developed countries. This mixed methods study aimed to determine whether Memory Work (MWT) Therapy 1 week group intervention improves outcomes for this complex population, in terms of their self-esteem, coping and psychological wellbeing compared to standard care, and to establish mechanisms of action. Method/Issue: An RCT Phase II of 48 Adolescents aged 14-18, full-orphaned AIDS on ART in Tanzania, with a waitlist control. Following (T0) baseline interviews, random allocation was for either intervention experimental condition (EC), or Control Condition (CC). All participated in second round of data collection (T1) at two weeks, and a final (T2) a month later. The EC children and caregivers participated in a focus group at T2. The CC then received the intervention 4 months later. Four questionnaires used, Brief Symptom Inventory (BSI), Rosenberg Self Esteem Scale (SES), Strengths and Difficulties Questionnaire (SDQ), and Self Efficacy Questionnaire (SEQ). Groups were compared at each time-point using multivariable linear regression controlling for baseline characteristics and group as independent variable, with change score as dependent variable. Qualitative data were subjected to thematic analysis to describe the experience of the intervention and how to refine it. Results/Comments: Significant differences favoured the EC at T1: BSI P<0.001, B=44.985, CI=25.5, 64.4), SDQ P=0.010, B=4.811, % CI 1.226, 8.396), SEQ both social scale P=0.015, B=-4.539, % CI-8.161,-0.918) and emotional scale P=0.002, B=-5.803 % CI-9.434, 2.171) (no effect for SES). At T2 we found these effects persisted: BSI P=0.001, B=46.668 %CI=21.541, 71.835), SDQ P=0.002, B=5.218 % CI 1.960, 8.476), SEQ both social scale P=<0.001, B=-7.791, % CI-11.320,-4.262) and emotional scale (P=<0.001, B=-9.007, % CI-12.032,-5.983). Additionally, at T2 found an EC effect for SES P<0.001, B=-4.392, %CI=-6.738,-2.046). The children recalled and described enjoying specific tasks within the intervention memory book, (such as "hero book" and the "tree of life") and described becoming "resilient" people. Discussion: The trial demonstrates improved outcomes in all measures for a complex population, i.e., bereaved children on treatment. Importantly, the effect did not attenuate and indeed self-esteem improved over time. The intervention should now be replicated in a fully powered trial.
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Chapman, Ysanne. „Dimensions of sadness - expanding awareness of community nurses' practice in palliative care /“. Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09PH/09phc4663.pdf.
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Davison, Graydon. „Innovative practice in the process of patient management in palliative care“. View Thesis, 2005. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20051025.104715/index.html.
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Dobies, Pamela A. Roffol Herman Robert D. „Organizational design issues of establishing palliative care services in an acute care hospital“. Diss., UMK access, 2005.
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Thesis (Ph. D.)--Henry W. Bloch School of Business and Public Administration and Dept. of Sociology. University of Missouri--Kansas City, 2005."A dissertation in public affairs and administration and sociology." Advisor: Robert D. Herman. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed June 23, 2006. Includes bibliographical references (leaves 194-204 ). Online version of the print edition.
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Law, Chi-ching, und 羅志清. „Can integrated palliative care services enhance the quality of end-of-life cancer care?“ Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42994949.
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Held, Mareike [Verfasser], und Olivier [Akademischer Betreuer] Morin. „A new on-board imaging treatment technique for palliative and emergency treatments in radiation oncology / Mareike Held. Betreuer: Olivier Morin“. Hamburg : Staats- und Universitätsbibliothek Hamburg, 2016. http://d-nb.info/1095766643/34.
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Held, Mareike Verfasser], und Olivier [Akademischer Betreuer] [Morin. „A new on-board imaging treatment technique for palliative and emergency treatments in radiation oncology / Mareike Held. Betreuer: Olivier Morin“. Hamburg : Staats- und Universitätsbibliothek Hamburg, 2016. http://nbn-resolving.de/urn:nbn:de:gbv:18-78319.
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Byström, Per. „Colorectal cancer treatment and early response evaluation how do we best evaluate treatment response? /“. Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-766-5/.
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Akhiwu, Patrick. „Home Based Care (HBC) providers knowledge attitude and perception of identification treatment and referrals of common symptoms of Acquired Immune Deficiency Syndrome (AIDS) in Botswana“. Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20352.
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Home based care is a major intervention in the management of HIV/AIDS and other illnesses in need of palliative care, especially in situations where resources are limited. The challenges associated with HIV/AIDS infection in Botswana resulted in the training of home based care volunteers (HBCV) to assist in the fight against HIV/AIDS. The HBCV regularly visit and assist ill patients at home. They provided support with home activities and basic health care. They are to note changes in their clients' condition, and, if necessary, report to the home based team at the clinics f or further action. The purpose of this study was to explore their knowledge, attitude, and perception in the identification, management, and referral of common symptoms of HIV/AIDS. METHODOLOGY: A cross sectional study of thirty three HBCV participants using a semi - structured interview guide was carried out. Closed and open ended questions were used to collect sociodemographic data and explore their knowledge, attitudes, and perception in relation to the identification, management, and referral of common symptoms of HIV /AIDS. A 5 point Likert scale was used to access their confidence with caring for different symptoms. The response to the open - minded ended question were coded and analysed qualitatively using thematic analysis. RESULTS AND CONCLUSION: Most of the participants were women. The study revealed that fatigue, weakness and pain were the symptoms most identified by HBCV. Other symptoms like diarrhoea were also identified with HBCV demonstrating satisfactory basic knowledge and management of these symptoms. They were aware of common symptoms of opportunistic diseases like tuberculosis and the need to refer such patients. Majority of HBCV were "comfortable" or "very comfortable" with their role of referring patients for symptom management. This study exposed the negative experiences of HBCV, which included stress, fatigue, helplessness, dealing with difficult families, fear of HIV infection, and death of clients. It also highlighted their positive experiences of community appreciation, financial reward, providing symptom relief, spiritual development, increased knowledge, and having a sense of "Botho" (humanness and community responsibility). This study showed the knowledge of the HBCV in relation to HIV/AIDS and associated symptoms. It also presented their attitude and perceptions with the management and referral of these symptoms.
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McConigley, Ruth. „Rural palliative care nursing: A modified grounded theory study“. Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1998. https://ro.ecu.edu.au/theses/986.
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This paper presents the findings of a study of rural palliative care nurses in Western Australia. The numbers of rural centres in Western Australia offering palliative care services are increasing; however at present there is little empirical data available about the roles of the nurses involved. This study was undertaken to begin to correct this deficit. The study examines basic social processes associated with the role of rural palliative care nurses and identities issues that affect the nurses’ professional practice. A modified grounded theory approach was used to form a conceptual framework that describes rural palliative care nursing. Theoretical sampling techniques were used to identify the six palliative care nurses working in rural Western Australia who participated in this study. Data was generated using in depth interview and participant observation techniques. Constant comparative analysis of the data was employed to allow concepts to emerge from the data. The central theme that developed from the data Living Palliative Care describes the all-consuming nature of the rural palliative care nurses’ role. Three related categories, Wearing Many Huts, Being the Expert and Surviving in Palliative Care are also discussed. This research has explored issues that rural palliative care nurses feel are relevant to their professional practice and it describes the basic social processes inherent in the rural palliative care nurse’s role. Recommendations for nursing research, education, administration and clinical practice are presented.
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MacLeod, Roderick D. „Changing the way that doctors learn to care for people who are dying“. Thesis, University of South Wales, 2001. https://pure.southwales.ac.uk/en/studentthesis/changing-the-way-that-doctors-learn-to-care-for-people-who-are-dying(a13ed38e-49a2-42de-a112-180e68e4339d).html.
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This collection of work represents an interest in education in palliative care over the last ten years. These papers are written either by myself or in collaboration with colleagues in Britain and New Zealand. During those years the way in which palliative care is taught and learned has changed and continues to change. The overview of the work submitted here describes the rationale behind the development of new approaches to the teaching and learning of care at the end of life. In many ways this collection represents a personal journey - one that involves investigation, growth, research and evaluation. By publishing these papers and promoting discussion in this area of education I have made an original contribution to the changing way in which doctors are taught and learn to care for people who are dying and into our understanding of the nature of learning to care for those people. The papers are listed here in chronological order. Throughout the text of the overview they are referenced along with other relevant papers but appear in the reference list in bold. I declare that I am the author of the papers contained in thesis unless otherwise stated. All references documented have been consulted in the writing of these papers. References appear in the texts in the form required for each individual journal. The papers have all been published in peer reviewed journals. MacLeod, R.D., Nash, A.: 1991 : Teaching palliative care in General Practice - a survey of education needs and preferences. Journal of Palliative Care 7: 4, 9-12. (reference 6) (RDM 70% - AN 30%) MacLeod, R.D., Nash, A.: 1992 : "Taking the lid off1 -observations of the process of palliative care education for General Practitioners. Postgraduate Education for General Practice 3, 28-3 (reference 9) (RDM 60% - AN 40%) James, C., and MacLeod, R.D.: 1993 : The problematic nature of education in palliative care. Journal of Palliative Care 9:4, 5-10 (reference 10) (RDM60%-CRJ-40%) MacLeod, R.D.: 1993 : Education in palliative medicine : a review. Journal of Cancer Education 8: 4, 309-312 (reference 11) MacLeod, R.D., Nash, A.: 1994 : Multidisciplinary palliative care education. Journal of Interprofessional Care 8:3.283-288 (reference 12) (RDM 70% - AN 30%) MacLeod, R.D., Nash, A. and Charny, M.: 1994 : Evaluating education in palliative medicine. European Journal of Cancer Care 3: 163-168 (reference 14) (RDM 60% - AN 30% - MC 10%) MacLeod, R.D.: 1997 : Teaching holism in palliative care and hospice. American Journal of Hospice & Palliative Care 14:1, 12-16 (reference 36) MacLeod, R.D., James, C.R.: 1997 : Improving the effectiveness of palliative care education. Palliative Medicine 11:5, 375-380 (reference 38) (RDM 60% - CRJ 40%) MacLeod, R.D., Robertson, G.: 1999: Teaching about living and dying. Education for Health 12:2,185-192 (reference 65) (RDM 80% - GR 20%) MacLeod, R.D.: 2000 : Learning to care: a medical perspective. Palliative Medicine 14:3, 209-216 (reference 66) MacLeod, R.D.: 2001 : On reflection: how doctors learn to care for people who are dying. Social Science & Medicine 52,1719-1727 (reference 67).
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Hill, Hazel Catherine. „Psychosocial support within the everyday work of hospice ward nurses : an observational study“. Thesis, University of Stirling, 2016. http://hdl.handle.net/1893/24356.
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Psychosocial support is said to be an inherent component of nursing care and a major focus of palliative care. Literature exists which outlines perceptions of the psychosocial needs of patients and how psychosocial support should be provided. However, there is a lack of empirical evidence on how psychosocial support is operationalised in practice. This study provides a valuable and substantial new contribution to the evidence on the psychosocial needs expressed by patients in a hospice ward and how nurses immediately respond to these needs within their everyday practice. A study gathering data via observations with matched interviews of patients and nurses, organisational, documentary, and demographic variables, was conducted over an eight month period. Thirty-eight nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data was analysed using constant comparative qualitative techniques. Patients expressed a wide variety of psychosocial needs, often only signalling them whilst receiving care for other reasons. Considering these needs in relation to Maslow’s (1943) hierarchy of needs suggests that in-patients more commonly express prerequisites to physiological care and ‘lower level’ safety needs rather than the more thoroughly researched and espoused ‘higher’ level psychosocial needs. The nurses reacted to these psychosocial needs with a range of responses which indicated a diminishing level of immediate support: ‘dealing’, ‘deferring’, ‘diverting’ and ‘ducking’. The majority of the nurses were observed using each of these responses at some point during data collection. A variety of the responses were used for each type and context of psychosocial need. These responses were influenced by the ward’s workplace culture. This study demonstrates a requirement for more thorough consideration of the true psychosocial needs of patients, which appear to vary dependent on the context of care. Consideration should be v given to workplace culture and its influence over psychosocial support, with nurses being supported to expand their response repertoire so that patients’ psychosocial needs are acknowledged more. Increasing nurses’ knowledge of the reality of psychosocial support through education and research will encourage formalisation of the place of psychosocial support in the planning, documentation and provision of care. This study shows that ward nurses can offer psychosocial support as an inherent component of their everyday work. Findings derived from this research indicate that developing an understanding of how patients express psychosocial needs in practice, through a consideration of Maslow’s (1943) hierarchy of needs, may increase recognition and support of psychosocial needs and enable nurses to respond more comprehensively.
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Farrant, Lindsay Georgina. „A survey of the prevalence and burden of pain and symptoms amongst HIV positive patients attending HIV treatment clinics in the University of the Witwatersrand Academic Hospital clinics“. Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10472.
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This study was designed to measure the symptom prevalence and symptom burden amongst patients attending three HIV treatment clinics in greater Johannesburg, and to assess the relationship of these to CD4 count, viral load, WHO stage, functional status and HAART. Patients at the three clinics were invited, using convenience sampling, to participate in completing the interviewer administered Memorial Symptom Assessment Scale-Short Form (MSAS-SF) which assesses the 7 day prevalence and distress for 28 physical symptoms and prevalence and frequency of four psychological symptoms. Demographic and clinical data, including initial and latest CD4 counts, initial and latest viral loads and information on HAART use, were collected from the participants and from their clinic files.
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Cohen, Lynne. „Attitudes of nurses to palliative care in nursing homes in the Perth metropolitan region“. Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1995. https://ro.ecu.edu.au/theses/1179.
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Zanna and Rempel (1988) have proposed that attitudes are a summary evaluation of an attitude object based on three classes of information, namely: cognitive information, affective information and behavioural information. This model has mainly been tested in the social groups and social policies area investigating two classes of information: cognitive and affective, and therefore there is a need for research to test the validity of this model in other areas. The present study applies the model to the area of palliative care in nursing homes. 76 directors of nursing, 76 clinical nurse specialists, and 76 nursing assistants working in nursing homes, completed a questionnaire in which they were asked (a) to make an evaluation of their overall attitude on a 7-point semantic differential scale, (b) to write down their own beliefs and (c) affects in response to the attitude object "palliative care in nursing homes" and then rate these beliefs and affects on a 7-point Likert Scale (d) to answer 18 factual knowledge questions about palliative care, and (e) to supply some demographic information. The results indicated that cognitive and affective information significantly and independently predicted the attitudes of nurses to palliative care in nursing homes.
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Reid, Noreen. „An action research study to investigate the strategies that can be used by health care professionals, during video consultations with palliative care patients, to enhance the therapeutic alliance“. Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27690.
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Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts.
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Tanner, Carolyn A. „Perception of palliative care practice of health care professionals in a mental institution : a descriptive study“. Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/29703.
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The purpose of this descriptive study is to investigate the perception of practice of health care professionals at a mental institution, as it pertains to their work with dying patients, and also to identify areas of change. The conceptual framework is constructed of six factors important to palliative care that have been identified from the literature. These are personal death anxiety, organizational structure of the hospital system, role expectations of professionals, teamwork, education and training for care of the dying, and conveyance and exchange of diagnostic information. The sample surveyed by a written questionnaire included physicians, psychiatrists, health care workers, social workers and pastoral care workers from the Geriatric Division of Riverview Hospital, Port Coquitlam. The findings indicate that age, sex, marital status and length of working experience at Riverview Hospital had no significant association with personal death anxiety. Informal education such as workshops and in-services had a significant correlation with personal death anxiety, as did perception of being competent and/or confident about working with the dying. The study also raised concerns that not all was being done for the dying patients and their families at this institution. Suggestions such as education and training, support mechanisms, and less stereotyping of professional roles were
offered to improve this situation. As well, findings indicated that there was a need for palliative care service either in the form of a team or separate unit, or simply the practicing of the palliative care philosophy.Arts, Faculty of
Social Work, School of
Graduate
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Ferrel, Cynthia Lynn. „The experience of critical care nurses in initiating hospice care“. abstract and full text PDF (free order & download UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1453534.
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Velupillai, Yoganathan. „A comparison of palliative care needs and palliative care services for community based patients with cancer and non-cancer illnesses in the Greater Glasgow NHS Board area“. Thesis, Connect to e-thesis, 2004. http://theses.gla.ac.uk/1022/.
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Thesis (Ph.D.) - University of Glasgow, 2004.Ph.D thesis submitted to the Departments of Public Health and Palliative Medicine, Faculty of Medicine, University of Glasgow, 2004. Includes bibliographical references (p. 272-293). Print version also available. Mode of access : World Wide Web. System requirements : Adobe Acrobat reader required to view PDF document.
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Phillips, Jane Louise. „Navigating a palliative approach in residential aged care using a population based focus“. View thesis, 2008. http://handle.uws.edu.au:8081/1959.7/33324.
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Thesis (Ph.D.)--University of Western Sydney, 2008.A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy to the College of Health and Science, School of Nursing, University of Western Sydney. Includes bibliography.
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Carolan, Clare. „The experience of emotional distress and help-seeking for distress in families living with advanced cancer and receiving palliative care : a multi-perspective case study approach“. Thesis, University of Stirling, 2018. http://hdl.handle.net/1893/28047.
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The emotional impact of serious illness in families is recognised. To enhance well-being in families living we must understand how distress is experienced within families; from this, evidenced-based systemic distress interventions can be derived. However, the success of systemic intervention programmes is reliant on whether families will seek help (or not) for distress. This PhD by publication explores emotional distress and help-seeking in families living with advanced cancer. Papers one and two used systematic review techniques. Paper one evidenced distress as a systemic construct and proposes the tiered model of distress to convey current understandings. Paper two offers the attaining normality model to convey why some people seek help for distress to achieve a new normality whereas some choose not to seek help to maintain normality. Together, these papers evidence gaps in systemic understandings of distress and help-seeking; from this an exploratory cross-sectional multiple case study of families was proposed. Papers three and four provided methodological underpinning to this research through the development of the DESCARTE model: The Design of Case Study Research in Healthcare (paper three) used in the case study design; paper four reflects on multi-perspective interviewing methods used. Distress and help-seeking are conceived as systemic relational phenomena, occurring within the family system and arising from relational interaction with healthcare. Distress is conveyed through four themes: interdependent distress, living in uncertainty, unnecessary distress and oscillatory distress; from this, possible systemic intervention designs are offered (paper five). Non-help-seeking for distress was the predominant response in families. The mutuality model of help-seeking is proposed to synthesise current understandings (paper six). Families describe how healthcare interactions cause unnecessary distress and shapes families’ help-seeking behaviours. Findings indicate significant gaps between the rhetoric of palliative care policy and families’ experience. To improve families’ wellbeing, relational care must be embedded in policy and practice.
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Grove, Jan. „An evaluation of the current practices followed by oncologists in private practice in Cape Town, South Africa, in the management of patients with advanced cancer which no longer responds to anticancer treatment and the identification of the needs associated with such management“. Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/12646.
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Includes abstract.~Includes bibliographical references.Managing patients whose disease has become unresponsive to anticancer treatment confronts oncologists with major stressors which may range from the management of distressing physical symptoms to complex psychosocial issues. These sets of circumstances prompted the undertaking of this study: An evaluation of the current practices followed by oncologists in private practice in Cape Town, South Africa, in the management of patients with advanced cancer which no longer responds to anticancer treatment and the identification of the needs associated with such management. A descriptive qualitative study was selected for data collection. Cross-sectional, in-depth semi structured face to face interviews were conducted with fifteen radio-oncologists working in five satellite units of a private oncology company in Cape Town. The interviews were conducted with the aid of a topic guide. The process of coding was employed to organise and manage the collected data. The following six themes which had a bearing on the main topic were distilled from the data: Oncologists' experiences pertaining to the management of patients with advanced disease; the difficult discussion necessary when a patient's disease became incurable and when it had to be decided whether anticancer treatment should be stopped; the decision to stop anticancer treatment; advance directives; oncologists’ burnout and the palliative care team approach. A description of challenging aspects associated with the management of terminally ill cancer patients is given. Identified needs include training of staff in palliative care; guidance for oncologists regarding the discussion of and the decision to stop anticancer treatment; implementation of advance directives; the development and employment of a multidisciplinary approach to provide palliative care; and support for oncologists facing burnout. Recommendations were made pertaining to appropriate training in the field of palliative care; the development of guidelines to aid oncologists in the discussion of and decision to stop anticancer treatment and the implementation of advance directives; the provision of palliative care through employment of a multidisciplinary approach led by a palliative care physician; and external support which should be provided by the oncologists' company to prevent and treat burnout.
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Day, Michele Oliver Debra. „Team communication and collaboration in hospice pain management“. Diss., Columbia, Mo. : University of Missouri--Columbia, 2008. http://hdl.handle.net/10355/6632.
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Title from PDF of title page (University of Missouri--Columbia, viewed on Feb 25, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Dissertation advisor: Dr. Debra Oliver. Vita. Includes bibliographical references.
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Magnusson, Carlsson Therése, und Elin Larsson. „Smärta och dess olika samband i livets slutskede“. Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-270536.
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Bakgrund: Palliativ vård syftar bland annat till att lindra lidande och symtom som smärta och ångest. För att kunna bedöma, utvärdera samt lindra symtomen behövs smärtskattningsinstument användas. Att lindra dessa symtom främjar livskvaliteten hos patienter i en palliativ fas. Genom det Svenska palliativregistret finns möjlighet att sammanställa och utvärdera information som kan främja forskning och därmed bidra till ett minskat lidande. Syfte: Syftet är att undersöka förekomst av smärta och smärtlindring i livets slutskede samt se i vilken utsträckning validerade instrument används. Syftet är också att undersöka om det finns någon skillnad mellan smärta och olika bakgrundsvariabler. Metod: Denna studie är en deskriptiv studie av kvantitativ design och är utformad med hjälp av retrospektiv registerdata. Datan insamlades genom det Svenska palliativregistrets dödsfallsenkät. 1435 patienter inkluderades som hade vårdats på olika palliativa vårdformer inom Uppsala och Enköping. Resultat: Resultatet visar att smärtskattningsinstrument används i en bristande utsträckning inom den palliativa vården, då endast 56 % utav de som hade smärta också smärtskattades. När det gäller smärtlindring så blev 69 % utav patienterna helt och 30 % delvis smärtlindrade. Vid analysen utav samband mellan smärtlindring och vissa dödsplatser så visade resultatet att det fanns en signifikant skillnad. Samma resultat framkom även gällande analysen utav samband mellan vissa grundsjukdomar och upplevelsen utav smärta. Upplevelsen utav smärta samtidigt som upplevd ångest visade sig ha ett samband. Slutsats: Detta område är relativt outforskat, vilket gör att mer forskning behövs. Resultatet från denna studie kan användas som ett underlag för framtida forskning.Background: Palliative care is intended to alleviate suffering such as pain and anxiety. By using pain measurements instruments these symptoms can be assessed, evaluated and alleviated. The patients life quality is promoted by alleviating these symptoms. Through the Swedish Register of palliative care there is a possibility to compile and evaluate information that can promote research and thereby contribute to a reduced suffering. Aim: The aim is to investigate the presence of pain and pain treatment in end of life care and also to learn in which extent validated pain measurements instruments are used. The aim is also to investigate whether there is a difference between pain and different background variables. Method: This is a descriptive study of a quantitative design and is shaped with retrospective registry data. The data was collected through the Swedish register of palliative cares’ death questionnaire. 1435 patients were included who had been cared in different forms of palliative care in Uppsala and Enköping. Result: The result shows that pain measurement instruments are used in a lacking extent in palliative care, where 56 % of those who experienced pain were pain estimated. When it comes to pain estimation this study shows that 69 % of the patients were completely relieved of their pain and 30 % were partly relieved. The analysis of the connection between pain treatment and some death places showed that there is a significant difference. The same result also appeared in the analyze of the connection between some background diseases and the experience of pain. The experience of pain was shown to have a connection with the experience of anxiety. Conclusion: This area is relatively unexplored, which means more research is required. The results of this study could be used as a basis for future research.
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Jumah, Anne Mukeli. „The nature and extent of palliative care in the Nairobi Hospice“. Diss., Pretoria : [s.n.], 2008. http://upetd.up.ac.za/thesis/available/etd-11202008-163831.
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Gentry, W. Michael. „A comparison of two palliative methods of intervention for the treatment of mathematics anxiety among female college students“. Diss., Virginia Polytechnic Institute and State University, 1986. http://hdl.handle.net/10919/53620.
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Bandura’s (1978) self-efficacy theory provided the conceptual basis for two math-anxiety interventions: cognitive restructuring (CR) and modified progressive relaxation (MPR). These two palliative techniques were chosen since considerable evidence exists which indicates that both intrapsychic and symptom-directed methods are effective as therapeutic interventions for a wide range of stress-related problems. In addition to the treatment variable, there were two other independent variables: level of achievement in mathematics (SAT), and level of participation in mathematics (remedial, intermediate, or advanced). The sample consisted of sixty—two female subjects enrolled in a small private liberal arts college for women. Four research questions were investigated (1) When administered over a six-week treatment period, are CR and MPR equally effective in reducing mathematics anxiety among female college students? (2) Are any combinations of treatment and level of achievement in mathematics characterized by lower levels of anxiety than other combinations? (3) Are any combinations of treatment and level of participation in mathematics characterized by lower levels of anxiety than other combinations? (4) To what extent do physiological indicators of mathematics anxiety and paper-and-pencil assessments measure the same construct?
Data were collected in two stages. The first stage occurred at the end of a six-week treatment period, at which time Sandman’s (1973) Mathematics Attitude Inventory (MAI) and an electromyograph (EMG) were used to obtain self-report and physiological measures of mathematics anxiety, respectively. The second stage occurred eight weeks later, at which time the MAI was re-administered. Inferential methods revealed that: (1) when mathematics anxiety was measured with Sandman’s MAI, for both the immediate and delayed posttests, the difference between the mean levels of self-reported anxiety for CR and MPR subjects was not statistically discernible; (2) when anxiety was operationally defined as skeletal muscle tension and measured with an electromyograph, CR led to significantly greater reductions in anxiety than MPR (F=2.81, p=.036); (3) there was no interaction between type of intervention and level of achievement in mathematics; (4) when anxiety was operationally defined as skeletal muscle tension and measured with an electromyograph, a statistically discernible (F=3.925, p=.O27) synergistic effect was detected between type of intervention and level of participation in mathematics, indicating that CR is superior to MPR for subjects at advanced levels of participation in mathematics; (5) there was insufficient evidence to indicate that a linear relationship exists between paper-and-pencil (MAI) and physiological (EMG) measures of mathematics anxiety, implying that the two instruments may be tapping different dimensions of the mathematics anxiety construct.Ed. D.
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Fan, HaiYan (LingLing), und University of Lethbridge Faculty of Arts and Science. „Medical encounters in "closed religious communities" : palliative care for Low German-Speaking Mennonite people“. Thesis, Lethbridge, Alta. : University of Lethbridge, Dept. of Anthropology and Health Sciences, 2011, 2011. http://hdl.handle.net/10133/3079.
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This multi-sited ethnography focuses on beliefs and practices associated with death,
dying, and palliative care among the Low German-Speaking (LGS) Mennonites. The
qualitative data, collected through participant-observation fieldwork and interviews
conducted in three LGS Mennonite communities in Mexico and Canada, show a gap
between official definitions of palliative care and its practice in real life. The LGS
Mennonites’ care for their dying members, in reality, is integrated into their community
lives that emphasize or reinforce discipleship by promoting the practices of mutual aid,
social networks, and brotherhood/sisterhood among community members. This study
also offers ethnographic insights into some difficulties that healthcare providers face
while delivering the “holistic” palliative care services to their patients in general, and to
the LGS Mennonites in particular. Finally, it provides some suggestions that may aid
healthcare providers in developing culturally safe and competent health care services
for the LGS Mennonite people living in Canada.xi, 231 leaves ; 29 cm