Tesi: "Palliative care"

1

Perun, O., e V. Klimenko. "Palliative care". Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/27488.

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Perun, O., e V. Klimenko. "Palliative care". Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/27492.

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3

Ortenmo, Andreas. "Efter utbildning av palliativa ombud : En utvärdering av möjligheter och hinder i arbetet med palliativa frågor". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-192506.

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Syfte: Syftet med denna studie var att utvärdera om de palliativa ombud som utbildats av Palliativt Kompetenscentrum mellan hösten 2008 och våren 2012 anser att de kan arbeta med palliativa frågor på sin arbetsplats. Metod: En icke experimentell empirisk tvärsnittsstudie med mixad metod i form av en enkätundersökning riktad till samtliga som gått utbildningen till palliativt ombud och som lämnat sin e-postadress vid kursregistreringen. Resultat: Både medarbetare och överordnade ger ett bra stöd i arbetet med palliativa frågor och i ambitionen att arbeta enligt ett palliativt förhållningssätt. Stödet upplevs starkare från medarbetare än från överordnade. Det palliativa förhållningssättet fungerar bra bland personalen på arbetsplatsen. Tidsbrist, att palliativa frågor inte prioriteras och ett ointresse från överordnade upplevs som de största hindren i arbetet som palliativt ombud. Medarbetarna är intresserade av att arbeta enligt ett palliativt förhållningssätt, men mer tid behövs för utbildning. Grundutbildningen till palliativt ombud ger ett gott stöd i arbetet med palliativa frågor. Slutsats: Grundutbildningen till palliativa ombud ger ett gott stöd i arbetet med palliativa frågor. Tidsbrist är det främsta hindret i arbetet med palliativa frågor och mer utrymme att utveckla vården och utbilda personal efterfrågas. Den palliativa vården bör få högre prioritet.
Objective: The aim of this study was to evaluate if the palliative agents trained by Palliativt Kompetenscentrum between autumn 2008 and spring 2012 believe that they can work with palliative care issues in their workplace. Methods: A non-experimental empirical cross-sectional study with a mixed method in the form of a survey directed to all palliative agents who left their email address at course registration. Results: Both the employee and the supervisor gives good support in palliative care issues and in the ambition to work according to a palliative approach. Stronger support is experienced from employees than from superiors. The palliative approach works well among staff in the workplace. Lack of time, low priority of palliative care issues and disinterest from superiors is perceived as the main obstacles. Employees are interested in working according to a palliative approach, but more time is needed for training. Basic training for palliative agents provides good support in palliative care issues. Conclusion: Basic Training for palliative agent gives a good support in the work with palliative care issues. Lack of time is the main obstacle and more time to develop the care and training of staff is required. Palliative care should be given higher priority.

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Ngowi, Epiphania. "Assessing palliative care policies in Africa: Implication for paediatric palliative care". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32956.

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Around the world, there are millions of children who need palliative care from the moment they are diagnosed with life-threatening and life-limiting illnesses, yet very few children have access to palliative care services. In many African countries, where palliative care is still new, many children with chronic illnesses continue to experience needless pain and suffering. The World Health Assembly Resolution 67.19 made a clear call for governments around the world to implement palliative care policies. Such policies should support the “comprehensive strengthening of health systems to integrate evidence-based, costeffective and equitable palliative care services in the continuum of care, across all levels of care”. However, despite these frequent calls, no specific policies target the provision of paediatric palliative care in Africa. This dissertation consists of three parts. Part A is the study protocol, which consists of the introduction and the study methodology. The study is qualitative in nature and it adopted the Walt and Gilson framework for extraction of data and analysis of palliative care policies in Africa. The study used publicly available policy documents, which were identified and obtained from government websites, international agencies' websites and through communication with palliative care experts. An excel spreadsheet was used to extract data, which was analysed thematically. Part B is a literature review of available published and unpublished work pertaining to paediatric palliative care in Africa. It provides the historical background of palliative care and defines palliative care and paediatric palliative care as well as exploring the general literature on paediatric palliative care, and the evidence on the existence of palliative care policies in Africa. Part C is a journal manuscript. It follows the structure and guidelines of the journal of the Health Policy and Planning. The manuscript begins with introduction and the study methods. Further, the study used publicly available policy documents on palliative care in Africa published from 2002 until 2018. An appropriate conceptual framework was chosen, and the results of the policy analysis are provided and followed by the discussion section and conclusions. The study findings indicate that few palliative care policies exist in Africa, and children's palliative care needs are not adequately included and addressed. The findings further show that there was no single policy targeting paediatric palliative care, and children were included among the larger population. As such, palliative care needs were not sufficiently addressed. Only three policies (South Africa, Zimbabwe, and Malawi) clearly address paediatric palliative care needs. The study, therefore, argues that for children with life threatening and life-limiting conditions to be free from pain, African governments need to formulate specific policies that will guide the provision of paediatric palliative care. This study is likely contribute to policy making processes, acts as a reference document for academics and students and provides an advocacy tool for activists, nongovernmental organizations (NGOs), and civil society organizations (CSOs) working on children's welfare and human rights issues more broadly. Further, the findings of the study may contribute to formulating specific palliative care policies for children, particularly in African countries that lack such policies.

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Spaar-Huber, Silvia. "Sozialarbeit unterwegs zu Palliative Care?! zur Funktion der Sozialarbeit in Palliative Care". Zunzgen Rubigen Bern Ed. Soziothek, 2006. http://www.soziothek.ch/?978-3-03796-154-4.

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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.

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Täckström, Linda, Annette Johansson e Lundholm Anne Björkegren. "Relations in palliative care". Thesis, Kristianstad University College, Department of Health Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-3601.

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Abstract

Background: Relation means the relationship between two parts. By creating a good relation between nurse and patient you can conduce a better caring. Aim: The aim of the study was to illustrate the relation within palliative care from nurse- patient perspective. Method: The study is a literature review where ten articles were analysed with qualitative content analysis. Results: The findings showed that knowledge, communication, continuity, silence and availability were the most important thing for the nurse in the relationship. Energy, regular contacts, having time and the nurse being able to listen was most important for the patient. In the encounter between the nurse and patient, communication is fundamental for understanding in the conversation where the patient tried to find information about treatment, medicament and the illness. The most valuable was being able to talk about feelings. You must get to know the patient as the person he is to be able to know his interests and what he considers important. Continuity is a prerequisite to make the patient feel safe and secure. Conclusion: Being able to pay attention to unspoken needs and understanding why the patient reacts the way he does is a proof that knowledge has appeared.

Keywords: Relationship, relation nurse – patient, communication, palliative care.

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Buttry, Nancy Kyle. "Palliative Care: Viewpoints from Nurses". OpenSIUC, 2016. https://opensiuc.lib.siu.edu/dissertations/1300.

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TITLE: Palliative Care: Viewpoints from Nurses Palliative Care has been described as care that includes the physical, intellectual, emotional, social, and spiritual needs of an individual when they are diagnosed with a serious or life-limiting illness. The ultimate goal of palliative care is to promote the best quality of life possible. Palliative care should be implemented across the lifespan and across different health care settings. The purpose of this study was to describe the perceptions, impact, and meaning of palliative care from the viewpoint of nurses who provide basic palliative care to patients and their families. This study used a qualitative design to investigate the meaning, experiences, and feelings of nurses who provide palliative care in small or critical access hospitals and other agencies in this rural area. Three focus groups and eleven interviews were conducted with nurses working in a variety of agencies from October 2015 to February 2016. The four themes that emerged from the data included inconsistencies, knowledge deficits, communication issues, and emotional responses and rewards to providing palliative care. The themes focused on the need for clarification of the meaning of palliative care, more education on the topic and better communication. The nurses shared that it was rewarding to provide palliative care but identified barriers that they felt should be addressed. Nurses participating in the study did not perceive that they had palliative care at their agencies. Recommendations included that more health education about palliative care be provided to healthcare professionals, the community, and individuals with life-limiting illnesses and their families. Key words: palliative care, quality of life, life-limiting illness, nursing

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Goldsborough, Jennifer. "Palliative Care Integration in the Intensive Care Unit". ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4787.

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Palliative health care is offered to any patient experiencing a life limiting or life changing illness. The palliative approach includes goals of care, expert symptom management, and advance care planning in order to reduce patient suffering. Complex care can be provided by palliative care specialists while primary palliative care can be given by educated staff nurses. However, according to the literature, intensive care unit (ICU) nurses have demonstrated a lack of knowledge in the provision of primary care as well as experiencing moral distress from that lack of knowledge. In this doctor of nursing practice staff education project, the problem of ICU nurses' lack of knowledge was addressed. Framed within Rosswurm and Larrabee's model for evidence-based practice, the purpose of this project was to develop an evidence-based staff education plan. The outcomes included a literature review matrix, an educational curriculum plan, and a pretest and posttest of questions based on the evidence in the curriculum plan. A physician and a master's prepared social worker, both certified in palliative care, and a hospital nurse educator served as content experts. They evaluated the curriculum plan using a dichotomous 6-item format and concluded that the items met the intent of the objectives. They also conducted content validation on each of the pretest/posttest items using a Likert-type scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was 0.82 indicating that test items were relevant to the educational curriculum objectives. Primary palliative care by educated ICU nurses can result in positive social change by facilitating empowerment of patients and their families in personal goal-directed care and reduction of suffering.

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Daniels, Alexandra. "Paediatric Palliative Care - describing patient needs and the experiences of caregivers and health care workers in a Cape Town Paediatric Intermediate Care Facility". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33603.

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Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and crosssectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources, and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.

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Haynes, Liana Iris, e Liana Iris Haynes. "Palliative Care: Attitudes and Practices of Trauma Care Providers". Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624549.

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Background: Palliative care focuses on improving quality of life for patients and their families by providing relief from the stress, pain, and other symptoms of a serious disease or injury. Trauma care has a heavy focus on improving resuscitation efforts, which has left little room in the literature for studies on utilization of palliative care in this population. Objective: The purpose of this DNP project was to better understand the use of palliative care for trauma patients at a Level 1 trauma center in southern Arizona to inform a future quality improvement (QI) project. Project Design: A survey was completed to determine 1) how palliative care is utilized for trauma patients at this institution; 2) what barriers exist for the use of palliative care in this population; 3) what is the culture of the trauma team regarding palliative care; and 4) whether there are differences in palliative care use between physicians and advanced practice providers (APPs) on the trauma service. Participants and Setting: Eleven trauma APPs and attending physicians at a Level 1 trauma center in southern Arizona. Measurements: APPs and physicians were surveyed using a survey tool created by the author to answer the project questions. This survey assessed barriers to the use of palliative care, situations and patient characteristics prompting palliative consults, previous education in palliative care, comfort with difficult topics and symptoms, and suggestions for improving palliative care use at this facility. Results: As a team, there was agreement between APPs and attending physicians that lack of timely availability of palliative care staff was a barrier to initiating consults, in addition resistance from families regarding palliative care. Both groups were also likely to consult palliative care for assistance with transitions of care and when there is family conflict in decision making. Both groups felt that increased availability of palliative staff to cover nights and weekends, as well as provider education on palliative concepts would improve utilization of palliative care. Conclusion: Future QI projects should focus on provider-identified interventions to improve palliative care use, such as continuing education on palliative care and increased availability of palliative care staff.

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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.

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Westerberg, Susan. "Palliative Care : The role of Counsellors". Thesis, Ersta Sköndal högskola, Institutionen för socialvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-2237.

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The following article is a study about counsellors working with terminally ill patients receiving Palliative care. In an effort to understand their role in the Palliative team and how they participate in the care of dying individuals, four counsellors working in four different Palliative hospices in Stockholm were interviewed by using structured interviews. The key questions concern the methods and interventions counsellors use, the risk factors that the job entails, the support they receive and finally their reflections about life and death The literature on the topic was accessed via Ersta Sköndal Högskola College library and Internet database. The results of the study reveal that Palliative Care Approach takes into consideration all aspects of an individual (physical, psychological, social and spiritual). Counsellors are part of a multidisciplinary team and their role is to focus on the social and psychological aspects. They undertake comprehensive assessments of the patient’s context and their coping strategies through the use of psychosocial theories such as Sense of Coherence and Logo therapy. Via their skilled use of core counselling skills they establish close relationships with patients and families. At the same time they are always mindful of keeping the right distance. Counsellors are the receivers of a lot of emotional pain and suffering of patients and families and as such this transference can lead to emotional exhaustion. Access to good support is an essential prerequisite for avoiding burnout. Close encounters with death leads to reflections of life and death. Counsellors need to be well developed and experienced in order to provide good quality palliative care.

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Kennedy, Owen. "Valuing caregiver burden in palliative care". Thesis, City University London, 2014. https://kclpure.kcl.ac.uk/portal/en/theses/valuing-caregiver-burden-in-palliative-care(582190ea-6bbd-4ebf-8e0a-98eee7832753).html.

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There is a clear need to account for caregiver burden in economic evaluations of healthcare interventions, since omitting it has the potential to produce skewed cost-effectiveness estimates. This is particularly important in palliative care, as interventions in this field are often explicitly intended to help patients’ families and informal caregivers as well as the patients themselves. However, caregiver burden is a complex concept with a number of different dimensions, so valuation can be a challenging task. This paper describes the different dimensions of caregiver burden and provides suggestions as to how those dimensions might be valued for inclusion in economic evaluations. Outcomes are found to be far more complex to value than costs, with considerable controversy over the appropriateness of quality adjusted life years (QALYs) as a unit of outcome both for palliative care and for informal care more generally. The results of a cost-effectiveness analysis of a palliative care intervention are also presented. This analysis was conducted both to demonstrate how to apply the valuation techniques discussed in the first section in practice, and to illustrate how accounting for caregiver burden can significantly affect the estimated cost-effectiveness of palliative care interventions. A simple two-state Markov model was used, with results reported both with and without caregiver burden taken into account. The intervention in question was a multidisciplinary service in southeast London for patients prone to breathlessness. Including both caregiver costs and outcomes in cost-effectiveness calculations was found to reduce the estimated incremental cost-effectiveness ratio (ICER) for the intervention from £103,744 to £26,194 per QALY. Sensitivity analyses revealed substantial uncertainty around these results due to the small sample size in the primary dataset. It is concluded that while accounting for caregiver burden when assessing the cost-effectiveness of palliative care interventions is vital and has the potential to significantly alter ICER estimates, further research on how best to value caregiver outcomes is required, since consensus in this area is necessary to ensure the consistency and comparability of cost-effectiveness estimates.

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Shekera, N., e M. Kobylchenko. "Provision of servies in palliative care". Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/25975.

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Oruč, Mirza. "Comparative Analysis in Palliative Care Competencies". Doctoral thesis, Universidad de Alicante, 2020. http://hdl.handle.net/10045/110519.

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According to the WHO cancer is one of the leading causes of morbidity and mortality in the world. In 2012 there was 14 million of new cases worldwide. A number of new cases is expected to rise in future. An increasing number of cases demanding a new approach from health care systems regarding the staff education, hospital equipment and interprofessional cooperation in order to give full service to the customers (patients). For several years palliative care education is a top priority in the education of nurses due to the fact that there are serious deficiencies in that area (Komaromy et al. 2000, Miller et al. 2004, Goodridge et al. 2005, Hasson et al. 2008). Nurses are the forefront of caring for terminally ill patients and their families approaching the end of life, which does not minimize role of other healthcare professionals, but nurses have main role in this process. Definition and competencies of nurses involved in this process must be precisely identified and measured from time to time in order to improve the process of end of life care and palliative care nursing. Continuous development of guidelines and protocols for palliative care nursing is particularly relevant (Watts, 2013; Gambles et al 2009, Hockey et al 2005, Jack et all 2003). Development of competencies is one of key issues in contemporary education it and can be achieved with development of proper curriculum and education schedule, especially development of a proper instrument for measurement of competencies. This research has identified most important 10 competencies in accordance with WHITE paper for EAPC and WHO. General objective. This research has one general objective and it is creation and validation of new questionnaire about competencies in field of palliative care nursing with aspect of realization of core competences in developed and under developing systems. This questionnaire is a new instrument in field of competence measurement in palliative care nursing. Specific objectives of the research are based on evaluation and comparison of competences among nurses from Bosnia and Herzegovina and Spain (Valencia area). Methodology. Methodology comprises research, cross – section, analytical method of research. Actions taken in this process were literature review, analysis of data available curricula of nursing schools, literature research, development of new instruments for measurement of competences in palliative care nursing, interviews with nurses in Bosnia and Herzegovina, development of online platform for nurses in Spain, translation of instruments to Spain language, data processing, Comparison of results from both group were done by every single item of instrument and by every competences. Results. Results are presented in two different parts: Part I (one) of results is about development of instrument PALCOM and part II (two) is about the data collected from Bosnia and Herzegovina and Spain. All results are shown in proper table and graphs that are reflecting research process. Results show the significant statistical difference between groups in Bosnia and Herzegovina and Spain (Valencia area) in some aspects, while in several aspect there is no difference. Working experience and level of education are in directly linked with self-competence measurement. There is a high statistical difference between groups with different level of education, and working experience, which has a direct impact on development of competence of nurses. Conclusion. Need for measurement of competencies is expressed in the daily development of palliative care, community palliative care, hospice care and subspecialty palliative care. Questionnaire that can measure all competencies does not exist but using general competencies in PALCOM questionnaire can cover this entire field with measurement of various domains and competencies specific to that domains. PALCOM as an instrument for evaluation of competencies in the field of palliative care, is, for the time being, a reliable instrument. With the development of palliative care, improvement can be done in the area of competencies in palliative care nursing. PALCOM is applicable in various health care systems and educational systems and it does not depended on external factors. PALCOM as instrument measures the competence level of nurses and preparedness for work in palliative care settings. First scale measure knowledge, while second scale is self-measurement of competences in accordance with the level of education and work experience. Need for the appropriate instrument for measuring competences in palliative care nursing leads us to this instrument following most economical and reasonable way of developing.

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Parrington, Diane J. "Responsible nutrition therapy in palliative care". Diss., The University of Arizona, 2003. http://hdl.handle.net/10150/298731.

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The purpose of this study was to begin to fill the void regarding nutriologic status in patients with Congestive Heart Failure (CHF) and or Chronic Obstructive Pulmonary Disease (COPD) receiving palliative care, and to bring the quality of palliative care to a more appropriate level as related to nutritional injury. Objectives: The objectives were: 1) to determine the prevalence of patients with a stage of nutritional injury at or above the clinical horizon; 2) to determine the response, specifically changes in biochemical parameters and physical manifestations of nutrient based lesions, after micronutrient intervention; 3) to determine if there is a relationship between micronutrient intervention and macronutrient intake; 4) to determine if there is a positive relationship between micronutrient intervention and stage of nutritional injury regardless of the percent of estimated non-protein calorie and protein needs consumed and 5) to ascertain what characteristics identify patients without resiliency / response to treatment. Design: The design was a prospective theory-based effectiveness trial exploring nutriologic status and response to micronutrient intervention utilizing a quasi-experimental design. Twenty-six Veterans with CHF / COPD admitted to the Nursing Home Care Unit for palliative care or designated as Advanced Disease were enrolled; nineteen completed the study. Subjects were recruited consecutively and comparisons were made between baseline and post-treatment values. Methods: A Minimum Data Set structured nine-step nutritional care process including evidence, diagnoses, etiologies, goals / predicted outcomes, interventions and actual outcomes was utilized. Results: All subjects presented at or above the clinical horizon of nutritional injury at baseline representing acquired nutritional loss; 84% had lesions suggestive of nutrient imbalance. Prevalence of pyridoxine, thiamin and zinc deficits were 63%, 11% and 21% respectively. Pyridoxine status following treatment improved significantly, p = .000. Fifty-three percent of subjects had improved outcomes indicating nutritional resiliency, and change within stage of injury. Factors observed in suboptimal nutritional resiliency included drug-nutrient interactions and acute infection. Conclusions: The nutritional cost from lack of responsible nutrition therapy is likely to be significant in veterans with CHF/COPD receiving palliative care. Drug-nutrient interactions and acute infections are most likely the offending factors interacting with the resiliency state.

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Maarschalk, Therese. "Palliative care : needs and expectations in a HIV Care Centre". Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/12135.

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Includes abstract.
Includes bibliographical references (leaves 62-68).
To determine the demographics and the physical, psychosocial and spiritual needs and expectations for the palliative care of a homeless community in an HIV Care Centre, located in the inner city of Johannesburg.

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19

Bark, Malin, e Annelie Kilersjö. "Närståendes upplevelse av inskrivningssamtal till palliativt team". Thesis, Sophiahemmet Högskola, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2725.

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Inom palliativ vård är stödet till närstående en av fyra hörnstenar som möjliggör god livskvalitet för patient och närstående. Förutom att stödja patienten behöver närstående även hantera sin egen sorg vilket gör att närstående både ger och behöver stöd. Familjefokuserad omvårdnad är ett förhållningssätt som utgår ifrån familjens betydelse för patientens upplevelse av sjukdom och ohälsa. Vid palliativa teams första möte, inskrivningssamtal, kartläggs patientens och närståendes situation och behov samt, är tänkt att skapa förutsättning för en trygg och tillitsfull vårdrelation. Syftet med studien var att undersöka närståendes upplevelse av inskrivningssamtalet i palliativt team då det inom berörda team inte har skett någon utvärdering av inskrivningssamtalet. Metoden som användes var semistrukturerade intervjuer av närstående som nyligen varit med på inskrivningssamtal i palliativt team. Studien utfördes på de två författarnas respektive arbetsplatser och åtta närstående deltog. Genom analys och tolkning av det insamlade datamaterialet framkom ett resultat med tre kategorier under två teman; Frihet utan ansvar och Befinna sig i en trygg och tillitsfull vårdrelation. Frihet utan ansvar innebar att närstående upplevde en delaktighet utan att vara ansvarig. Att befinna sig i en trygg och tillits vårdrelation innebar att närstående upplevde en känsla av tillit till teamet som hade en empatisk förmåga och svarade för en bekräftande kommunikation. Slutsatsen var att närstående var nöjda och såg mötet som mycket positivt. Det framkom faktorer som påverkade mötet negativt såsom otydlighet kring mötets struktur, språksvårigheter och stressig bemötande.
In palliative care, supporting the family is one of the four cornerstones that enable quality of life for the patient and family. In addition to supporting the patient, the family also need to handle their own grief which means that the family both provide and need support. Palliative care teams have a first meeting, a sign-up call, to identify the patient and family's situation and needs and to create the conditions for a safe and confident care relationship. The aim of this study was to investigate familymembers experience of the first meeting with the palliative care team, because it previously has been no evaluation of the enrollment call. The method used was semi-structured interviews with family members recently been taking part in enrollment call to the palliative care team. The study was conducted at the two authors' respective workplaces and eight family members attended. Through analysis and interpretation of the collected data revealed a result of three categories within two themes; Freedom without responsibility and Being in a safe and confident care relationship. Freedom without responsibility meant that family members experienced a participation without being responsible. Being in a safe and confident care relationship meant that the family members experienced a sense of confidence in the team that had a capacity for empathy and accounted for a confirmatory communication. The conclusion was that the family members were satisfied and saw the meeting as very positive. It emerged factors that negatively impacted the meeting such ambiguity about the meeting, language difficulties and a stressful approach.

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Beynon, Teresa Anne. "Developing education in palliative care for primary health care professionals". Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.408772.

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Krause, S. R. "An evaluation to asses [i.e. assess] the holistic care of tuberculosis patients with palliative care needs in the Western Cape, South Africa". Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/13441.

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Ardegård, Anna. "Sjuksköterskors upplevelser av att vårda personer i behov av palliativ vård på två medicinska vårdavdelningar : en kvalitativ intervjustudie". Thesis, Sophiahemmet Högskola, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1895.

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SAMMANFATTNING Många av de som avlider i Sverige idag, avlider på sjukhus, eller tillbringar dagar på sjukhus sitt sista år i livet. På en medicinavdelning vårdas personer med många olika diagnoser och multisjuka äldre. Sjuksköterskor som arbetar på medicinavdelning möter därför många personer som är i behov av palliativ vård. Vården på en medicinavdelning är oftast kurativt och akut inriktad, och den palliativa vården kan därför lätt hamna i skymundan. Värdegrunden i den palliativa vården innefattar närhet, helhet, kunskap och empati. Allmän palliativ vård ska kunna ges till alla patienter som är i behov av det. För att skapa en god palliativ vård krävs att vårdpersonal arbetar förebyggande och åtgärdar symtom i ett tidigt skede. När god omvårdnad, empati, trygghet och medicinska kunskaper finns att tillgå kan den palliativa vården bli en naturlig fortsättning på den vård personen fått innan. På medicinavdelning får sjuksköterskan ta ett stort ansvar gällande den palliativa vården, då de är närmast patienten och träffar dem ofta. Syftet med studien var att beskriva sjuksköterskors upplevelser av att vårda personer i behov av palliativ vård på medicinska vårdavdelningar. Metoden för studien var en kvalitativ intervjustudie och sju stycken sjuksköterskor på medicinavdelning intervjuades. För analysen av den insamlade datan användes en kvalitativ innehållsanalys. I resultatet framkom tre kategorier; Det komplexa i att vara professionell i vården av personer i behov av palliativ vård, Förutsättningar för att kunna ge en god palliativ vård och Hinder för att kunna ge en god palliativ vård. I studien framkommer att det finns en vilja att vara nära personen men även ett behov av att hålla distans för att själv behålla hälsan och balans. Sjuksköterskan upplever att hon har ett stort ansvar gällande den palliativa vården på avdelning. Bekräftelse från patient och närstående upplevs som viktigt för att veta att arbetet är utfört på ett bra sätt. Sjuksköterskorna beskrev tiden som viktig för att kunna ge en god palliativ vård. När personen i behov av palliativ vård fick kontinuitet, en plan och helhetssyn gav det sjuksköterskorna en känsla av att ha kunnat ge en god palliativ vård. Det är även viktigt att ha kunskap och erfarenhet inom palliativ vård för att ge sjuksköterskan, patient och närstående trygghet. Stöd från kollegor och specialiserat team var också en förutsättning. Organisationen gällande exempelvis resursbrist, och en miljö som inte var anpassad efter behoven, var något som många av sjuksköterskorna upplevde som ett hinder. Kunskapsbrist och erfarenhet saknades ibland och upplevdes som ett hinder i att ge en god vård. Detta kunde även leda till en upplevelse av att fel beslut togs gällande patientens fortsatta behandling. Studien visade att det finns förutsättningar för en god palliativ vård på medicinavdelningarna men att den behöver utvecklas. Detta för att personen i behov av palliativ vård ska få bästa möjliga vård. Det finns en önskan och vilja hos sjuksköterskor att göra annorlunda gällande till exempel omfördelning av resurser och vara mer närvarande i vården. Behov av utbildning och handledning både hos sjuksköterskor och hos läkare framkommer i studien. Organisatoriskt behövs mer resurser, tid och anpassad miljö för att kunna ge en helhetsvård till personen i behov av palliativ vård och dess närstående.
ABSTRACT Many of those who dies in Sweden today, dies in hospital or spend days in hospital their last year of life. In a medical ward people with many different diagnoses and multi-ill elderly is being cared for. Nurses' who works in a medical ward meets many people who are in need of palliative care. The care in a medical ward is usually curative and emergency-oriented and palliative care may be left aside. The values in palliative care includes; closeness, holism, knowledge and empathy. General palliative care should be given to all patients who are in need of it. To create a good palliative care requires that health professionals work to prevent and resolve symptoms in the early stages. With good care, empathy, security and medical knowledge available, the palliative care can be a natural continuation of the care the person had before. In medicine wards the nurses take a big responsibility regarding palliative care, since they are closest to the patient and meet them often. The aim of the study was to describe nurses' experiences of caring for people in need of palliative care in medical wards. The methodology for this study was a qualitative interview in which seven nurses in medical wards were interviewed. A qualitative content analysis was used for the analysis of the collected data. The results revealed three main categories; The complexity of being a professional in the care of people in need of palliative care, Conditions order to provide good palliative care and Obstacles in order to provide good palliative care. There is a desire to be close to the person, but also a need to keep the distance to maintain your health and balance. The nurse feels that she has a great responsibility regarding palliative care in the wards. Confirmation from the patient and family are perceived as important to know that the work is carried out in a good way. To provide a good palliative care, time was described as important. When the person in need of palliative care got continuity, a plan and a holistic approach the nurses got a sense of having been able to give a good palliative care. It also revealed how important it is to have knowledge and experience in palliative care to give the nurse, patient and family security. Support from colleagues and specialized team was also a prerequisite. Many of the nurses experienced the organization with lack of resources and environmental problems as an obstacle. Lack of knowledge and experience was perceived as an obstacle in providing good care. This could also lead to an experience of wrong decisions were taken regarding the patients continued treatment. The study showed that there are conditions for good palliative care medicine departments but it needs to be developed. This is to make the person in need of palliative care receive the best possible care. There is a desire and willingness of nurses to do differently and be more present in care. Need for training and supervision of both the nurses and the doctor emerges in the result. Organizationally are more resources, time and adapted environment needed, in order to provide a holistic care to the person in need of palliative care and their family members.

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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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Westergren, Maja, e Oscar Södergren. "Spiritual and Existential needs in palliative care". Thesis, Kristianstad University College, Department of Health Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-3677.

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Background: Previous research has shown that the understanding and knowledge about the spiritual needs is not given high priority among nursing staff. During the latest years the body and its functions has controlled the healthcare and the spiritual needs has been placed in the background. All humans have spiritual needs that must be satisfied irrespective of religious background. Aim: The aim of this study was to in a caring perspective illustrate patients’ spiritual and existential needs in palliative care. Method: The study is a literature review where 12 articles has been analyzed and summarized to give an overview of rescent research. The approach for the work of the analysis of the articles was qualitative content analysis. Results: The spiritual needs increase in palliative care. To handle the increased needs coping strategies are needed. Nursing staff, relatives and religion are considered by the patient to be important resourses in order to handle the situation. The spiritual needs are not always payed attention to because of lack of knowledge among health care personal. Discussion: The older generation are most likely more spiritual and religious convinced. The sum of this becomes that most of the palliative care patients have a religious belief, that might explain the meaning of spirituality in palliative care. Conclusion: The spiritual needs increase in palliative care and the most important as a nurse is to pay attention to and answer these needs. Through education and increased awareness of spiritual needs, the palliative care could improve considerably.

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Bashir, Kifah, e Yvonne Bengtsson. "Palliative care for pancreatic cancer - patients´ experiences". Thesis, Kristianstad University College, Department of Teacher Education, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-4609.

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To receive a diagnosis of pancreatic cancer can lead to a tremendous change in a person’s life. Thoughts regarding death may cause a personal crisis which can have negative influences on the patient’s social, mental and spiritual state. Most people with pancreatic cancer are diagnosed in a late stage of the disease. Therefore, palliative care is often one of the options that are offered to patients. Moreover, to be able to provide patients with nursing care and tend to their needs, it is very important to see them as unique individuals. The purpose with the literature review was to illustrate the experiences of palliative nursing care of patients with pancreatic cancer. A systematic literature review of scientific articles was performed. The study showed that patients’ experiences of need for information, patients’ need for time, support and personal relations, patients’ experiences of hope as well as patients’ need for symptom control were of importance in palliative nursing care.

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Milberg, Anna. "Family members' experience of palliative home care /". Linköping : Univ, 2003. http://www.bibl.liu.se/liupubl/disp/disp2003/med821s.pdf.

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Aarons, Derrick. "Palliative care, ethics, and the Jamaican paradigm". Thesis, McGill University, 1996. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23764.

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Palliative care provides symptom control, social, psychological and spiritual care for terminally ill patients, and psycho-social support and bereavement care for their families. Ethics is the study of rational processes for determining the best course of action between conflicting values and choices. All medicine is practiced within a defined cultural setting and local beliefs about health and illness may determine particular solutions to ethical problems.
Culturo-religious beliefs and practices in Jamaica are linked historically to its people's African ancestry and to the syncretism of Euro-British values during slavery. The resulting socio-cultural and medical pluralism has presented an ethical dilemma concerning respect for the beliefs and wishes of terminally ill patients to seek care from magico-religious practitioners versus what is in the society's best interest.

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Burge, Frederick. "Dehydration symptoms of palliative care cancer patients". Thesis, McGill University, 1990. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=60446.

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Controversy exists among clinicians and caregivers as to whether reduced fluid intake contributes to the suffering of those dying of advanced cancer. This study explored the distribution of proposed "dehydration state" symptoms among inpatient palliative care cancer patients. Fifty-two subjects responded to a seven item self-report questionnaire using visual analogue scales. Associations were determined between the symptom self-reports and the possible predictor variables fluid intake, serum sodium, urea and osmolality. Confounding variables considered were age, oral disease and mouth care regime. Mean symptom ratings (range 0-100 mm) were: thirst 53.8, dry mouth 60.0, bad taste 46.6, nausea 24.0, pleasure to drink 61.6, fatigue 61.8, and pain 33.5. No significant association was determined between symptom ratings and the predictor or confounding variables. Although the symptoms appear to be rated moderately severe, there was no demonstrable association between severity and fluid intake, the key concern of clinicians and families.

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Dixon, Elizabeth May. "Examining clinical supervison with palliative care nurses". Thesis, University of Hertfordshire, 2009. http://hdl.handle.net/2299/3029.

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This study focuses on the current issues regarding the provision of clinical supervision for palliative care nurses. NICE (2004) recommendations stated that the task of supervision should be undertaken by „Level 4‟ practitioners such as clinical psychologists or psychiatrists. Palliative care nurses are recognised to experience high levels of stress due to the emotionality of their role. However there appears to be little understanding of how they cope with this aspect of their role. Self care is promoted as a useful strategy; however this is thought to have limitations due to the questionable ability for an individual to objectively and accurately assess their own mental and emotional state. Clinical supervision has been attempted with palliative care nurses but this appears to focus on the internal world of the nurse rather than the interaction between nurse and patient. This study employed a staff survey, including a demographic questionnaire, the Copenhagen Burnout Inventory and the General Health Questionnaire, followed by individual interviews and focus groups analysed using thematic content analysis. Participants were recruited from two teams within one cancer network. Results showed that there was an incidence of both high stress and psychiatric morbidity within the sample. Provision of clinical supervision was shown to be inconsistent across the two teams. Although there was recognition that clinical supervision would be beneficial, there was a certain amount of confusion regarding the concept as well as suspicion about the „real‟ agenda. These factors appeared to work together to produce a situation in which clinical supervision was not being provided or accepted in a way that would maximise its efficacy as its application was inconsistent with the theoretical basis. In conclusion, in order to better support palliative care nurses with the difficult aspects of their role, it was suggested that a more structured and consistent picture of clinical supervision was provided. This would enhance their practice, support their emotional needs and protect the patients under their care.

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Randall, Fiona Maria. "The philosophy of palliative care : a critique". Thesis, University of Glasgow, 2000. http://theses.gla.ac.uk/3481/.

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Palliative care is unusual as a specialty within health care in that it has its own philosophy, which is summarised in the WHO definition of palliative care. This philosophy has influenced clinical practice so that specialist palliative care differs significantly from other aspects of health care. The thesis is a critique of that philosophy. It examines the moral problems inherent in implementing the philosophy in clinical practice. It concludes with suggestions for improvements which could be made to the philosophy statement so as to influence clinical care for the better. Thesis 1 is that decisions regarding the use of treatment to control symptoms or prolong life did not need to depend on complex doctrines such as double effect, but instead ought to be based on weighing up the benefits, harms and risks of treatment. Thesis 2 is that the relatives should not be an equal part of the remit of care. It is argued that whilst there is a special relationship, founded on an implicit promise and associated with specific obligations, between patients and health care professionals, this special relationship should not be extended to relatives of the patient. Thesis 3 is that quality of life as a global concept should not be used. Since quality of life depends on many incommensurable factors, and it is not possible to construct a coherent account of quality of life from our everyday notions of what it means, it is not possible to construct a quality of life scale. Thesis 4 is that there are constraints of expertise and propriety on attempts to influence the patient’s psychological, social and spiritual well-being. Thesis 5 is that within health care there ought to be a just distribution of resources to specialist palliative care, and then among terminally ill patients regardless of their illness.

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Perone, Jennifer A., Taylor S. Riall e Kelly Olino. "Palliative Care for Pancreatic and Periampullary Cancer". W B SAUNDERS CO-ELSEVIER INC, 2016. http://hdl.handle.net/10150/622658.

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Most patients with pancreatic cancer will present with metastatic or locally advanced disease. Unfortunately, most patients with localized disease will experience recurrence even after multimodality therapy. As such, pancreatic cancer patients arrive at a common endpoint where decisions pertaining to palliative care come to the forefront. This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient's and family's goals to guide decision making.

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Mwangi, Samuel M. "Development of Palliative Care around the World". Miami University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=miami1312041936.

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Slusher, Kimberlee B. "Early Palliative Care in Advanced Gastrointestinal Cancer". Mount St. Joseph University Dept. of Nursing / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=msjdn1588952929366227.

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Iannacone, Stephen Mark. "Systemic and Racial Barriers to Palliative Care". Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/433062.

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Urban Bioethics
M.A.
Those who have known an individual with a chronic medical condition or someone that has been diagnosed with a terminal illness have experienced the physical and emotional toll these diagnoses have on both patients and their loved ones. Medical providers encounter these situations daily and are often responsible for assisting the patient and their family in the decision-making process. The specialty of Hospice and Palliative Medicine was created specifically with these difficult, but very common, situations in mind. Even though the concept of palliative care has become mainstream and its practice is considered standard of care in many situations, it continues to be misunderstood, misrepresented, and underutilized, despite providing measurable benefits to patients, families and the healthcare system. This paper explores two systemic barriers to palliative care that contribute to this problem and highlights how race, cultural mistrust, and a long history of racial disparities in health care work together to undermine the effective delivery of palliative care.
Temple University--Theses

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Dearing, Kristen R. "A Model for Developing an Outpatient Palliative Care Clinic within an Accountable Care Organization". Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/299123.

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The purpose of this practice inquiry project is to create a model for implementing an outpatient palliative care clinic within an organization of healthcare providers who participate in shared savings for Medicare patients, also known as, an accountable care organization (ACO). The goal of this project is that it can be used by future health care administrators to successfully create and implement an outpatient palliative care clinic. The philosophical nursing foundation for palliative care is discussed to set the groundwork for the model proposed. The benefits of palliative care nursing for patients, families and the ACO are discussed to support the importance of opening an outpatient palliative care clinic. A step by step model has been developed and presented on how to plan and implement an outpatient palliative care program. Tools have been proposed to help successfully and effectively create, implement and evaluate outpatient palliative care clinics within an ACO.

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Crockett, Lisa. "Palliative care needs of pediatric patients & their families : a phenomenological study of multidisciplinary pediatric palliative care team experiences". Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2008831/.

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In the United States, more than 1 million children may be suffering from a life-limiting condition (Ruston and Catlin, 2002, p. 57) for which there is no reasonable hope for cure or long-term survival (Fraser et al, 2012, p. 923). However, less than one percent of these children and their families benefit from the provision of pediatric palliative care (Stayer, 2012, p. 350), which is an innovative health care model designed to address their physical, emotional, psychosocial and spiritual needs from diagnosis through end-of-life. During the last decade, pediatric palliative care has begun to secure a foothold as an emerging health care specialty (Crozier and Hancock, 2012, p. 198), but a dearth of literature has left the lived experience of children and their families poorly understood. Therefore, the Pediatric Palliative Care Study is a qualitative research study that utilizes interpretative phenomenological analysis to address two objectives: (1) understand and articulate the comprehensive lived experience of caring for children with life-limiting conditions and their families and (2) delineate how the collective experiences provide insights into needs that can be addressed by pediatric palliative care. The study was conducted at four research sites within Providence Health & Services. In total, nine major themes emerged from the experiences of 27 multidisciplinary care team providers who participated in the study. The themes have been framed from the perspective of the child and family: 1) Develop an innovative approach to caring for me, (2) Place me at the center of care, (3) Care for me as a whole person, (4) Be my guide, (5) Educate and prepare me for what I need to know, (6) Come alongside me, (7) Cultivate the plan and purpose for my life, (8) Be my voice and help me find my own and (9) Help me thrive. The analysis also contributed to an overarching statement about the experience that articulates the interconnectedness between the themes and creates a story of the phenomenon. The study presents seven implications for future practice related to (1) balancing matters of health care design with the human experience, (2) addressing the aims of health care reform legislation, (3) developing care models for home-based settings, (4) customizing care and developing solutions from the perspective of families, (5) educating about palliative care, (6) understanding the skills needed for palliative care providers and (7) improving data reporting for palliative care. Moreover, the study offers three contributions to extant literature, including: (1) validating and refining the WHO definition of palliative care, (2) completing an assessment of the adult versus pediatric palliative care literature from 2011-2014 and (3) addressing a known gap in the literature by offering the first IPA study to articulate the comprehensive lived experience. Limitations of the study and implications for future research are delineated as a research agenda for those seeking to build upon the study findings.

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Sargeant, Anita R. "Exploring the complex and dynamic construction of care within palliative care : an ethnographic study of care within and across a specialist palliative care service in England". Thesis, University of Southampton, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.415243.

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Edström, Malin, e Charlotte Forsgren. "Närståendes upplevelser av stöd vid palliativ vård i hemmet : En litteraturöversikt". Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-5138.

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Bakgrund: Närstående har en viktig roll i den palliativa vården då många svårt sjuka personer i livets slutskede har en önskan om att vårdas och dö i hemmet. I och med att de närstående får ett stort ansvar kan deras hälsa påverkas och det är därför viktigt att de får stöd i den situation som de befinner sig i. Den palliativa vården består av fyra hörnstenar där närståendestöd är en av dem. Syfte: Syftet var att beskriva vad närstående upplever som stöd när de vårdar en person i livets slutskede. Metod: Metoden var en litteraturöversikt. 14 artiklar hämtades i databaserna Cinahl Complete, MEDLINE with Full Text och Nursing and Allied Health Source. Artiklarna analyserades och likheter och skillnader identifierades för att få fram olika teman. Resultat: Fyra huvudteman identifierades utifrån analysen: Upplevelse av stöd från den palliativa hemsjukvårdens organisation, Upplevelse av stöd från vårdpersonal, Upplevelse av stöd i grupp och Upplevelse av stöd från familj och vänner. I huvudtemat Upplevelse av stöd från vårdpersonal identifierades fem underteman: Att skapa relationer, Delat ansvar och avlastning, Att bli sedd och bekräftad, Behov av information för upplevelsen av stöd och Vikten av kontinuitet. Resultatet redovisar vad de närstående upplever som stöd. Diskussion: Med Meleis transitionsteori som teoretisk referensram har resultatet diskuterats mot litteraturöversiktens bakgrund och annan relevant litteratur. Det är viktigt att sjuksköterskan uppmärksammar de närståendes individuella behov och därefter utformar ett lämpligt stöd. Sjuksköterskan har en viktig roll i att skapa förtroendefulla relationer. Hon ska också vägleda och stötta de närstående så att de kan hantera situationen som de befinner sig i.
Background: Relatives play an important role in the palliative care when many people with severe illness have a desire to be cared for and die at home. The relatives’ health may be affected and it is important that they receive support in this situation. Palliative care consists of four cornerstones and support for relatives is one of them. Aim: The aim was to describe what relatives experience as support when they care for a person in end of life. Method: The method was a literature review. 14 articles were retrieved in the databases Cinahl Complete, MEDLINE with Full Text and Nursing and Allied Health Source. The articles were analyzed and similarities and differences were identified in order to form different themes. Results: Four main themes were identified from the analysis: Experience of support from the palliative home care organisation, Experience of support from care staff, Experience of support in a group and Experience of support from family and friends. In the main theme Experience of support from care staff five sub-themes were identified: To create relationships, Shared responsibility and relief of burden, To be seen and affirmed, The need of information for the experience of support and The importance of continuity. The result reports what the relatives experience as support. Discussion: With Meleis transition theory as a theoretical framework the result has been discussed towards the background of the literature review and other relevant literature. It is important that the nurse observes the relatives’ individual needs and creates the appropriate support. The nurse has an important role in creating trusting relationships. She should also guide and support the relatives to handle their situation.

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Narto, Linda, e Therese Persson. "Upplevelser av palliativ vård i hemmet under livets slutskede – ur ett anhörigperspektiv : En litteraturöversikt". Thesis, Högskolan Dalarna, Omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:du-20934.

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Bakgrund: Palliativ vård handlar om att ge stöd till patienten och anhöriga under och efter vårdtiden. De ”6 s:n” är en arbetsmodell inom palliativ vård där patienten har rätt till självbestämmande och att upprätthålla sina sociala relationer, även stöd till anhöriga ingår. Anhöriga har en betydelsefull roll i den palliativa vården, deras närvaro skapar möjlighet för den döende att vara hemma i livets slutskede. Syfte: Syftet var att beskriva anhörigas upplevelse av palliativ vård i hemmet under livets slutskede. Metod: Litteraturöversikt baserad på 15 vetenskapliga artiklar från fem olika länder med kvalitativ ansats. Resultat: Fem kategorier identifierades kopplade till anhörigas upplevelser: Palliativa teamets inträde i hemmet, anhörigas vårdansvar, den medicintekniska utrusningens inverkan på vardagslivet, känslor och konsekvenser för anhöriga samt förbättringsmöjligheter och anhörigas uppfattning om palliativ vård. Slutsats: Anledningen till anhörigas vårdansvar var löftet att få dö hemma, uppgiften upplevdes krävande och gav konsekvenser på sömnen och deras fysiska och psykiska mående. Detta var genomgående i hela litteraturöversikten. Vården i hemmet sågs som den rätta platsen att dö på för alla parter, endast en anhörig uttryckte avsky för situationen. Enligt anhöriga var stödet bra dock fanns det ett ökat behov av mer resurser för fullständig trygghet.
Background: Palliative care is about providing support to both the patient and family during and after the time of care. The “6 s:n” is a working model in palliative care where the patient has the right to self-determination and to maintain their social relationships, which includes support to relatives. Relatives have an important role in palliative care, their present creates opportunity for the dying person to be at home in the final stages of life. Aim: The aim of this study was to describe relative’s experiences of palliative home care during the final stage of life. Methods: A literature review based on 15 scientific articles from five different countries with a qualitative approach. Results: Five categories were identified related to relatives experiences: The entry of palliative home care, relatives caring role, the impact of medical technology on everyday life, feelings and consequences for relatives and also improvement opportunities and relatives comprehend about palliative home care. Conclusions: The promise was the reason for relatives caring role, the caring role was an demanding task and gave impacts on their sleep and their physical and mental needs. This was consistently throughout the whole literature review. For all parties the home was seen as the right place to die, only one relative expressed disgust for the situation. According to relatives the support was good, but to complete full security for them it was an increased need for more resources.

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Torres, Nicole Marie, e Nicole Marie Torres. "Palliative Care Utilization in the Intensive Care Unit: A Descriptive Study". Diss., The University of Arizona, 2018. http://hdl.handle.net/10150/626674.

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Objective: The Patient Self-Determination Act of 1990 (PSDA) protects a patient’s right to predetermine the level of life-supporting care they are willing to receive (U.S. Department of Health and Human Services, 1993). In Arizona, the advance directive (AD) complies with the PSDA and is used to guide care in the event of cardiopulmonary failure. The AD may indicate “do not resuscitate” (DNR), which prohibits cardiopulmonary resuscitation in the event of cardiac arrest. In the institution used for this project, a palliative care team assists with identifying goals of care and helps guide interventions consistent with the AD. The purpose of this Doctor of Nursing Practice (DNP) project was to complete a retrospective chart review and identify patients admitted to the medical intensive care unit (ICU) with a DNR as indicated by a copy of the AD in the electronic health record (EHR) and determine if they received a palliative care consultation. This information could support a quality improvement project led by the DNP-prepared AGACNP focused on ensuring a palliative care consultation within 48 hours of admission for patients admitted to the ICU with a DNR. Methods: A search of the EHR identified patients admitted to the medical ICU over a 12-month period. The EHR of patients admitted with a DNR were reviewed to determine if they received a palliative care consultation during the ICU stay and the patient’s final disposition. Findings: A total of 38 patients had an AD indicating DNR status on admission to the medical ICU. Of those patients, 26 (68.4%) received a palliative care consultation. Twelve patients (31.6%) with a DNR status on admission did not receive a palliative care consultation. Additionally, five patients with a DNR (13.16%) died in the ICU without receiving a palliative care consultation. Conclusion: Twelve patients with an AD indicating a DNR did not receive a palliative care consultation, and five of those patients died in the ICU. The findings from this project support a quality improvement project to implement palliative care consults to review goals of care for patients with a pre-existing AD indicating a DNR code status.

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Li, Sarah. "Symbiotic niceness : a study of psychosocial care in palliative care settings". Thesis, Goldsmiths College (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275638.

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Almobarak, Fhaied Khalaf. "Exploring the perspectives of nurses, physicians, and healthcare administrators in Saudi Arabian hospitals on palliative care and palliative care nursing". Thesis, Manchester Metropolitan University, 2016. http://e-space.mmu.ac.uk/621247/.

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This thesis presents a qualitative research study, which identifies issues regarding the development of palliative care in the Kingdom of Saudi Arabia (KSA) hospital setting, from the perceptions of healthcare professionals working in Saudi Arabian hospitals. The literature suggests that challenges to palliative care in KSA exist on various levels. At the professional level, they exist where healthcare practitioners may neither be sufficiently equipped nor sufficiently oriented to deal with palliative care concerns. Saudi practitioners may have misconceptions that lead them to recommend or carry out activities that may be detrimental to the palliative care of their patient. Issues also exist at institutional levels, where palliative care systems in place in Saudi hospitals are insufficient for addressing the needs of its patients. There are also issues found at the cultural and legal levels, where pain and individual choice are not considered sufficiently important in Islamic law especially when weighed against matters about prolonging and preserving life and preparing the individual for the afterlife. The aims of this study were to determine the perceptions of KSA hospital healthcare professionals regarding palliative care, identify issues regarding the development of palliative care in the KSA hospital setting and to develop recommendations for strengthening the value of palliative care among healthcare professionals in KSA. To this end, semi-structured qualitative interviews were carried out with members of staff working in hospitals in KSA, with terminally ill patients. The findings suggest that while some participants define palliative care in a way which is in keeping with internationally recognised definitions, others had not heard of the term, or defined it in a way which was incomplete. Insights are provided in to doctors and nurses experiences of palliative care, an example of which is that the personality of the healthcare provided was a significant factor in the quality of palliative care. The findings suggested that as a specialism, palliative care is seen as unique and growing, and participants understood the need and importance of this area. Issues and problems with palliative care were identified, including issues with communication and lack of material and human resources. Various opinions were offered as to the role of the media in promoting palliative care in KSA, issues with medication, including access and procedures, were discussed, and finally the participants spoke about their vision of the future of palliative care in KSA, and what would be needed to achieve this vision. The contribution of the present study to the understanding of the perceptions of healthcare workers in KSA towards palliative care is significant considering the scarcity of research in this area, particularly qualitative research. It supports the findings of previous research into palliative care in KSA and the wider research on palliative care. It also provides a unique insight into the views of healthcare workers in an Islamic culture, expanding upon current literature.

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Stewart, Tiffany Nicole, e Tiffany Nicole Stewart. "Palliative Care Education to Increase Outpatient Provider Knowledge and Palliative Care Referral Intent Within Veterans Healthcare System of the Ozarks". Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624300.

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Purpose: Examine outpatient providers' perceptions of palliative care education in increasing their understanding, knowledge of resources, and intent to refer. Research questions/goals: 1) Increase provider understanding about palliative care and the benefits that patients can receive as a result of early referral; 2) Increase provider knowledge of palliative care facilities and resources within VHSO; 3) Increase provider intent to use the referral process for patients in need of palliative care. Setting: Veterans Healthcare System of the Ozarks, Fayetteville, Arkansas. Participants: 14 outpatient providers within VHSO; 8 MDs, 4 NPs, and 2 PAs. Methods: Descriptive research study consisting of an education session, discussion, and completion of a demographics form and evaluation questionnaire. Results: Questionnaire scores: Goal 1) 4.9 (SD=1.27)/6; Goal 2) 5.07 (SD=1.1)/6; Goal 3) 5.1 (SD=1.1)/6. Open ended question themes: 1) 21.4%: palliative care was an "umbrella"; 35.7%: early referral improves outcomes; 21.4%: treatment plan can include curative therapies; 2) 28.6%: open group discussion; 14.3%: training opportunities; 21.4%: multidisciplinary team approach. 3) 35.7%: screenshots of the referral process; 14.3%: individual comments for the care plan; 21.4%: open discussion regarding referrals. 4) 14.3%: more about how to accommodate homebound Veterans; 28.6%: more about telehealth opportunities; 21.4%: more information on communication tactics. Conclusions: There is a knowledge deficit among outpatient care providers in regards to palliative care. The providers found this education session informative, beneficial, and increased their intent to initiate palliative care referrals.

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Denton, Anne Paton. "Corticosteroid Prescribing in New Zealand Palliative Care Settings". Thesis, University of Auckland, 2012. http://hdl.handle.net/2292/18013.

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Background Modern palliative care developed in the 1960s in response to the perceived overmedicalisation and lack of recognition of the plight of the terminally ill patient. The development of evidence-based practice for palliative care has been slow and not without its difficulties because clinical trials involving vulnerable dying patients have been problematic. Prescribing in palliative care does appear to be different from other medical specialities; an example of this is the prescribing of corticosteroids. Corticosteroids are a potent group of medicines, with many adverse effects, that are widely prescribed as adjuvant drugs in palliative care for both specific and non-specific indications. On initial impression, little of their prescribing appears to be supported by rigorous evidence. This study was commenced with a desire to find out more about these medicines and what influences their prescribing in the palliative care setting. Aim and objectives The aim of this study was to explore and clarify the reasons for the prescribing of corticosteroids in New Zealand palliative care settings. Objectives included the identification of which corticosteroids were prescribed, as well as their indications, doses, use of guidelines, and processes for their reviewing and monitoring. The perceptions of those involved in the prescribing of corticosteroids were also sought. Methods A mixed methods approach was undertaken to include a quantitative phase (Phase One) and qualitative phase (Phase Two). Phase One was a retrospective review of inpatient use of corticosteroids in a sample of six New Zealand hospices. These hospices were chosen to give a representation of corticosteroid prescribing during the chosen year of 2007. Phase Two consisted of semistructured interviews with key informants (prescribers and senior nurses) from the six hospices and was intended to elicit information on factors influencing the use of corticosteroids in those hospices. Results In Phase One, the case notes of 1179 inpatients in the six hospices were reviewed and data was recorded of those who had been prescribed corticosteroids. There was a marked consistency of between 61% and 69% in the proportion of patients prescribed corticosteroids in the sample hospices. Corticosteroids were prescribed most commonly for non-specific reasons, and despite prescribing being similar in dose range and choice of corticosteroid, it varied in course length, method of stopping, recording of monitoring and reviewing, and recording of adverse effects. In Phase Two, 18 key informants were interviewed (12 medical practitioners and six senior nurses). Interviewees were shown the data pertaining to their hospice from Phase One of the study. Interviewees agreed that there were a number of challenges associated with these frequently prescribed medicines. They suggested that there was lack of formal evidence behind their corticosteroid prescribing and voiced surprise and disappointment over the amount of nonspecific prescribing, methods of stopping corticosteroids, monitoring and reviewing, and lack of recording of adverse effects. Discussion As evidenced in this study, corticosteroids are widely prescribed as adjuvant drugs in palliative care, most commonly for non-specific indications. The corticosteroid of choice in this study was dexamethasone. Monitoring and reviewing of these medicines was under-recorded and adverse effects, if recognised, were generally not recorded. By exploring clinicians�� practice and perceptions of prescribing and comparing this with existing articles and guidelines, it was found that these potent commonly prescribed medicines tended to be used experientially and intuitively. Corticosteroid prescribing appeared not to be supported by rigorous evidence. These findings seem to be consistent with the limited international literature in this area and suggest that it is timely for a reappraisal of their use in palliative care.

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Nasrullah, Ghany. "Caregivers’ experiences of unmet needs during palliative care". Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för omvårdnad, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-38616.

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Caregivers while, the biggest providers of palliative care for terminally sick patients, are often neglected in the process of providing care, which inadvertently affects their overall health and well-being. This study aims to explore the experiences of the unmet needs of the caregivers in palliative care. The literature review is based on seven quantitative, four qualitative and one mixed methodology approach studies. Results show a shortage of information given to caregivers regarding disease progression, symptomatology, support services and financial services. Furthermore the themes of unmet needs that emerged are physical, psychological, emotional, social and spiritual needs. Caregivers also reported the shortage of standard services provided by healthcare sector. A healthy relationship scenario, where caregivers are supported to look after themselves as well as their loved ones, would boost the support they render to the patients. The provision of needed services to caregivers, nurses, and healthcare personnel is required to fulfill a healthy relationship and further develop it by learning from the caregivers’ experiences. In conclusion, effective communication between caregivers and care providers is found to be a prerequisite for building trust and could contribute to satisfy the informational, medical, social and spiritual needs while helping to decrease health strains of caregivers.

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Belchamber, Caroline Anne. "Physiotherapy palliative cancer care : a case study approach". Thesis, Bournemouth University, 2016. http://eprints.bournemouth.ac.uk/24774/.

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There is evidence to suggest that the role of the allied health professional continues to evolve in the delivery of palliative cancer care services. Whilst it appears that there is an increasing need for physiotherapists, there is a lack of understanding about the nature of their role, their educational needs and their place within the rehabilitation team. The aim of my work was to explore a local palliative cancer care physiotherapy service provision in the light of best practice recommendations, using both my own practice development and a research study. For my research a qualitative approach using a single case study design was chosen as it provided a framework to facilitate the inclusion of multiple perspectives in a complex context within an area of healthcare where little research has been undertaken. Multiple methods of data collection were used from numerous perspectives, which included four data sets: interviews (healthcare professionals [10]); interviews (service users [10]); observations (physiotherapists [2] treating service users [5]); and policy document collection (NICE guidelines; white papers [12]). Detailed data analysis was then carried out using a thematic approach within a framework, comparing and contrasting patterns within and across the four data sets. Emergent themes highlighted a number of important aspects relating to physiotherapists including: new ways of working, shift in mindset and treatment planning, emotional adjustment and integration of professional boundaries. My primary research and practice development project combined to evidence the metamorphosis of both the physiotherapist profession and service provision where competencies around mentorship, entrepreneurship, leadership, policy championship, integrated teamwork, humanisation and self-reflection embodied within the psycho-social-cultural-spiritual model of healthcare enabled them to meet key policy recommendations of service quality and innovation. A debate is necessary around the need for profession specific or service specific outcomes in this area, and how physiotherapists ‘prove their worth’ now that they are an integral part of palliative cancer care provision.

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Jacknicke-Prochnau, Catherine A. "Personal-professional connections in palliative care occupational therapy". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0001/MQ34378.pdf.

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48

Cameron, Barbara. "Palliative Care Services Utilization and Location of Death". Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/22907.

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In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.

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White, Nicola Gayle. "Clinician estimates of survival in palliative care patients". Thesis, University College London (University of London), 2017. http://discovery.ucl.ac.uk/10022703/.

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Doctors need to identify when palliative care patients are imminently dying so they can adjust their goals of care and treatment accordingly. The systematic review of the literature, completed as part of this thesis, showed that these decisions are very inaccurate. The aim of this thesis was to determine the judgement policies of expert prognosticators (i.e. those clinicians with a proven ability to identify patients in the last 72 hours of life). This information is needed to help the development of training programmes for less expert clinicians. In order to understand decision-making judgements, it was first necessary to identify an “expert” group of clinicians. Previous studies suggested that expertise is not defined by years of experience or seniority. Therefore to identify an expert group with proven prognostic abilities, palliative care doctors (n = 99) completed a prognostic “test”. The test was developed by compiling case histories from the direct observation of 50 seriously ill patients in a hospice and an acute hospital. In order to complete the test, doctors were asked to review 20 case summaries and to provide a percentage likelihood that each patient would die within the next three days. The top 20% of doctors who performed most accurately on this test were deemed to be “expert prognosticators” and were invited to participate in the next phase of the research. The expert group (n = 19) were asked to complete a further prognostic task so that the decision-making policy of each individual (and the expert group as a whole) could be determined using Judgement Analysis. Through statistical modelling, experts had weighted Cheyne-Stoke breathing (β=15.44), the standardised palliative performance score (β=12.35) and the rapidity of decline in the previous 24 hours (β=11.512) as the most important factors. They gave lower weighting to the standardised level of agitation and sedation (β=5.97), the presence of audible secretions (β=5.95) and the presence of cyanosis (β=5.38).

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Maree, JE, e SCD Wright. "Palliative care: A positive outcome for cancer patients?" Curationis, 2008. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1000680.

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The development of palliative care in terms of recognizing the needs of the dying, palliative care becoming a nursing and medical speciality, the involvement of the World Health Organization in palliative care and the continuous development of treatment modalities available to cancer patients creates the expectation that the outcomes for the patient should also be positively influenced. The purpose of the study was to determine the most common symptoms of advanced cancer patients treated in a public and private hospital in Tshwane, and whether advances in palliative care improved the outcomes for these patients by decreasing the prevalence of symptoms experienced. The design of the study was a quantitative survey. The population consisted of patients with advanced cancer receiving palliative treatment as out patients in radiation and medical oncology clinics in a public and private hospital the Tshwane Metropolitan area. The sampling method was convenient and the sample size was 148 participants (n=148). Data was gathered by means of an interview and self report. Data analysis was done by means of descriptive statistics. The results of the study indicated that a high number of patients still experience problems that could have been prevented. Pain was found to be the biggest problem for patients (76.4%) followed by weakness and fatigue (65.5%), nausea and vomiting (65.5%) and a dry mouth (46.6%). Thirst was reported by 41.2% of the sample. The study provides evidence that the development of palliative care did not have a positive outcome for patients by reducing the prevalence of symptoms experienced.

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