Hospice Care in Nursing Homes: Does It Contribute to Higher Quality Pain Management?

Science.gov (United States)

Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.

2006-01-01

Purpose: The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods: In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication…

Supporting home care for the dying: an evaluation of healthcare professionals' perspectives of an individually tailored hospice at home service.

Science.gov (United States)

Jack, Barbara A; Baldry, Catherine R; Groves, Karen E; Whelan, Alison; Sephton, Janice; Gaunt, Kathryn

2013-10-01

To explore health care professionals' perspective of hospice at home service that has different components, individually tailored to meet the needs of patients. Over 50% of adults diagnosed with a terminal illness and the majority of people who have cancer, prefer to be cared for and to die in their own home. Despite this, most deaths occur in hospital. Increasing the options available for patients, including their place of care and death is central to current UK policy initiatives. Hospice at home services aim to support patients to remain at home, yet there are wide variations in the design of services and delivery. A hospice at home service was developed to provide various components (accompanied transfer home, crisis intervention and hospice aides) that could be tailored to meet the individual needs of patients. An evaluation study. Data were collected from 75 health care professionals. District nurses participated in one focus group (13) and 31 completed an electronic survey. Palliative care specialist nurses participated in a focus group (9). One hospital discharge co-ordinator and two general practitioners participated in semi-structured interviews and a further 19 general practitioners completed the electronic survey. Health care professionals reported the impact and value of each of the components of the service, as helping to support patients to remain at home, by individually tailoring care. They also positively reported that support for family carers appeared to enable them to continue coping, rapid access to the service was suggested to contribute to faster hospital discharges and the crisis intervention service was identified as helping patients remain in their own home, where they wanted to be. Health care professionals perceived that the additional individualised support provided by this service contributed to enabling patients to continue be cared for and to die at home in their place of choice. This service offers various components of a hospice

Cost savings and enhanced hospice enrollment with a home-based palliative care program implemented as a hospice-private payer partnership.

Science.gov (United States)

Kerr, Christopher W; Donohue, Kathleen A; Tangeman, John C; Serehali, Amin M; Knodel, Sarah M; Grant, Pei C; Luczkiewicz, Debra L; Mylotte, Kathleen; Marien, Melanie J

2014-12-01

In the United States, 5% of the population is responsible for nearly half of all health care expenditures, with a large concentration of spending driven by individuals with expensive chronic conditions in their last year of life. Outpatient palliative care under the Medicare Hospice Benefit excludes a large proportion of the chronically ill and there is widespread recognition that innovative strategies must be developed to meet the needs of the seriously ill while reducing costs. This study aimed to evaluate the impact of a home-based palliative care program, implemented through a hospice-private payer partnership, on health care costs and utilization. This was a prospective, observational database study where insurance enrollment and claims data were analyzed. The study population consisted of Home Connections (HC) program patients enrolled between January 1, 2010 and December 31, 2012 who subsequently expired (n=149) and who were also Independent Health members. A control group (n=537) was derived using propensity-score matching. The primary outcome variable was overall costs within the last year of life. Costs were also examined at six months, three months, one month, and two weeks. Inpatient, outpatient, ancillary, professional, and pharmacy costs were compared between the two groups. Medical service utilization and hospice enrollment and length of stay were also evaluated. Cost savings were apparent in the last three months of life—$6,804 per member per month (PMPM) cost for palliative care participants versus $10,712 for usual care. During the last two weeks of life, total allowed PMPM was $6,674 versus $13,846 for usual care. Enhanced hospice entry (70% versus 25%) and longer length of stay in hospice (median 34 versus 9 days) were observed. Palliative care programs partnered with community hospice providers may achieve cost savings while helping provide care across the continuum.

78 FR 68364 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date

Science.gov (United States)

2013-11-14

... providers of home health services and hospice care. The preamble of that final rule stated the effective... 17.56, applicable to non-VA home health services and hospice care. Section 17.56 provides, among... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and...

Interactional communication challenges in end-of-life care: dialectical tensions and management strategies experienced by home hospice nurses.

Science.gov (United States)

Gilstrap, Cristina M; White, Zachary M

2015-01-01

This study examines the dialectical tensions experienced by home hospice nurses in interactions with patients, families, and health care providers. In-depth, semistructured interviews were conducted with 24 home hospice nurses from a mid-size for-profit hospice organization serving approximately 230 patients on an annual basis. Interviews revealed hospice nurses experience both interpersonal and organizational dialectics during hospice interactions: authoritative-nonauthoritative, revelation-concealment, independence-collaboration, and quality of care-business of care. Dialectics often resulted as a by-product of (a) responding to expectations and care choices of patients and families particular to the emotionally charged home context, (b) obtaining authorization from health care providers who are not members of the interdisciplinary team, and (c) pressures associated with providing quality patient care while fulfilling organizational role requirements. The praxis strategies used to negotiate tensions included segmentation, balance, recalibration, and spiraling inversion. Specifically, nurses employed strategies such as ascertaining family/patient acceptance, using persuasive tactics when communicating with external health care providers, relying on effective time management, and working off the clock to provide more in-person care. Although functional for patients and hospice organizations, nurses who continually rely on these strategies may experience job stress when their interpersonal commitments repeatedly conflict with organizational role demands.

Developing evidence-informed decision making in a hospice: an evaluation of organisational readiness.

Science.gov (United States)

Morris, Jenny; Stewart, Amy; Richardson, Janet

2013-06-01

Multiprofessional home care and hospice teams should play a part in evidence-informed decision making. To assess organisational readiness to adopt evidence-informed decision making in a hospice in England. A mixed-methods approach was used. Clinical staff were surveyed regarding their attitudes to and skills in using evidence, and senior managers completed an organisation-based self-assessment tool recording the readiness of the organisation to embrace an evidence-informed focus. 81% of the staff completed the survey. Staff were committed to the principles of evidence-informed decision making, but overall lacked the necessary knowledge and skills. Information obtained from the management self-assessment highlighted that a priority was to develop an evidence-informed decision-making culture focusing on education, training, and policy development. The process used in this evaluation may be applicable to other areas of health care when assessing an organisation's readiness to incorporate evidence-informed decision making into policy and procedure.

Webcasting in home and hospice care services: virtual communication in home care.

Science.gov (United States)

Smith-Stoner, Marilyn

2011-06-01

The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy.

The role of hospice in the transition from hospital to home for technology-dependent children-A qualitative study.

Science.gov (United States)

Price, Jayne; McCloskey, Sharon; Brazil, Kevin

2018-01-01

To report parent and professional perspectives of step-down care in assisting the transition from hospital to home, within one children's hospice in a constituent country of the United Kingdom. In recent years, increasing numbers of children-dependent on long term assisted ventilation have been noted. Meeting the complex physical, emotional and social needs of the child and family is challenging. Many of these children spend extended periods in hospital even when medically stable. This was a qualitative study using an inductive, semantic analytic approach within a realist epistemology. Data collection was carried out in 2013. Interviews took place with parents (n = 5) and focus groups with professionals (n = 26) who had experience of step-down care. Multiple benefits of step-down in the hospice were clear. Both sets of accounts suggested that for children and families life was "on hold" in hospital. Hospice was considered a home-like environment where the child and family could "live again". Parents reflected that, in hospice they were "living, not existing" while professionals highlighted hospice as nurturing and empowering the whole family, promoting the child's development while safely meeting their clinical needs. The study highlights a number of crucial benefits to the child and family both in the immediate and longer terms. The collective perspectives therefore endorse hospice as a potential viable choice for these children and their families during the always difficult, usually protracted transition from hospital to home. © 2017 John Wiley & Sons Ltd.

[Hospice and palliative care in the outpatient department].

Science.gov (United States)

Ikenaga, M; Tsuneto, S

2000-10-01

In the medical environment, information disclosure to patients and respect of autonomy have spread rapidly. Today, many terminally-ill cancer patients wish to spend as much time at home as possible. In such situations the patient who has been informed that curative treatments are no longer expected to be beneficial can now hope to receive home care and visiting care from hospice/palliative care services. The essential concepts of hospice/palliative care are symptom management, communication, family care and a multidisciplinary approach. These concepts are also important in the outpatient department. In particular, medical staff need to understand and utilize management strategies for common symptoms from which terminally-ill cancer patients suffer (ex. cancer pain, anorexia/fatigue, dyspnea, nausea/vomiting, constipation, hypercalcemia and psychological symptoms). They also need to know how to use continuous subcutaneous infusion for symptom management in the patients last few days. The present paper explains the clinical practices of hospice/palliative care in the outpatient department. Also discussed is support of individual lives so that maximum QOL is provided for patients kept at home.

Communication of the death of a patient in hospices and nursing homes: a qualitative study.

Science.gov (United States)

Rivolta, Maria Marcella; Rivolta, Licia; Garrino, Lorenza; Di Giulio, Paola

2014-02-01

Announcing the death of a patient to another in hospices and nursing homes (NH) requires special skills, especially when the recipient is another resident. The aim of this study is to describe how hospice and NH staff deal with the communication regarding a patient's death, if this communication is perceived as a problem, and strategies implemented. The 55 health care workers (HCWs, 26 nurses and 29 auxiliary nurses) of two NHs and two hospices in Turin (Italy) were interviewed with a semi-structured interview exploring the residents' perception of need to receiving information on another patient's death, the experiences of having given this information in the last 6 months, and the strategies implemented. The interviews were analyzed using Colaizzi's method and researchers looked for the main themes and related subthemes. Six themes were identified and grouped into 2 main themes: a. the choice to tell the truth or not, which may be influenced by: the patients' request for confirmation of the fate of the other resident, by patients' fear of death ("I will be next"), the relationships among the guests, and personal and group experiences; b. the need to share own feelings and the burden of deciding whether or not to inform the other residents and how to go about this. If a structured discussion of experiences and reflection on cases is not implemented, HCWs may limit communication to bare information, lies, and adopt behaviors of avoidance and concealment. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Nationwide Survey of Quality of End-of-Life Cancer Care in Designated Cancer Centers, Inpatient Palliative Care Units, and Home Hospices in Japan: The J-HOPE Study.

Science.gov (United States)

Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Tsuneto, Satoru; Shima, Yasuo

2015-07-01

End-of-life (EOL) cancer care in general hospitals and home care has not previously been evaluated in Japan. This study aimed to evaluate EOL cancer care from the perspective of bereaved family members in nationwide designated cancer centers, inpatient palliative care units (PCUs), and home hospices in Japan. We conducted a cross-sectional, anonymous, self-report questionnaire survey for bereaved family members of cancer patients in March 2008 for 56 designated cancer centers and in June 2007 for 100 PCUs and 14 home hospices. Outcomes were overall care satisfaction, structure and process of care (Care Evaluation Scale), and achievement of a good death (Good Death Inventory). In designated cancer centers, PCUs, and home hospices, 2794 (response rate 59%), 5312 (response rate 69%), and 292 (response rate 67%) bereaved family members participated, respectively. Mean scores for overall care satisfaction were high for all places of death, at 4.3 ± 1.2 for designated cancer centers, 5.0 ± 1.2 for PCUs, and 5.0 ± 1.0 for home hospices. Designated cancer centers showed significantly lower ratings than PCUs and home hospices for structure and process of care and achievement of a good death (P = 0.0001 each). Home hospices were rated significantly higher than PCUs for achievement of a good death (P = 0.0001). The main findings of this study were: (1) overall, bereaved family members were satisfied with end-of-life care in all three places of death; (2) designated cancer centers were inferior to PCUs and home hospices and had more room for improvement; and 3) home hospices were rated higher than PCUs for achieving a good death, although home hospices remain uncommon in Japan. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Length of home hospice care, family-perceived timing of referrals, perceived quality of care, and quality of death and dying in terminally ill cancer patients who died at home.

Science.gov (United States)

Yamagishi, Akemi; Morita, Tatsuya; Kawagoe, Shohei; Shimizu, Megumi; Ozawa, Taketoshi; An, Emi; Kobayakawa, Makoto; Tsuneto, Satoru; Shima, Yasuo; Miyashita, Mitsunori

2015-02-01

This study aims to clarify the length of home hospice care, family-perceived timing of referrals, and their effects on the family-perceived quality of care and quality of death and dying of terminally ill cancer patients who died at home and identify the determinants of perceived late referrals. A multicenter questionnaire survey was conducted involving 1,052 family members of cancer patients who died at home supported by 15 home-based hospice services throughout Japan. A total of 693 responses were analyzed (effective response rate, 66 %). Patients received home-based hospice care for a median of 35.0 days, and 8.0 % received home hospice care for less than 1 week. While 1.5 % of the families reported the timing of referrals as early, 42 % reported the timing as late or too late. The families of patients with a length of care of less than 4 weeks were more likely to regard the timing of referrals as late or too late. The patients of family members who regarded the timing of referrals as late or too late had a significantly lower perceived quality of care (effect size, 0.18; P = 0.039) and lower quality of death and dying (effect size, 0.15, P = 0.063). Independent determinants of higher likelihoods of perceived late referrals included: frequent visits to emergency departments, patient being unprepared for worsening condition, and patient having concerns about relationship with new doctor. Discharge nurse availability was independently associated with lower likelihoods of perceived late referrals. A significant number of bereaved families regarded the timing of referrals to home hospices as late, and the perceived timing was associated with the family-perceived quality of care and quality of death and dying. Systematic strategies to overcome the barriers related to perceived late referrals are necessary.

Racial Differences in Hospice Use and In-Hospital Death among Medicare and Medicaid Dual-Eligible Nursing Home Residents

Science.gov (United States)

Kwak, Jung; Haley, William E.; Chiriboga, David A.

2008-01-01

Purpose: We investigated the role of race in predicting the likelihood of using hospice and dying in a hospital among dual-eligible (Medicare and Medicaid) nursing home residents. Design and Methods: This follow-back cohort study examined factors associated with hospice use and in-hospital death among non-Hispanic Black and non-Hispanic White…

Characteristics of workplace violence prevention training and violent events among home health and hospice care providers.

Science.gov (United States)

Vladutiu, Catherine J; Casteel, Carri; Nocera, Maryalice; Harrison, Robert; Peek-Asa, Corinne

2016-01-01

In the rapidly growing home health and hospice industry, little is known about workplace violence prevention (WVP) training and violent events. We examined the characteristics of WVP training and estimated violent event rates among 191 home health and hospice care providers from six agencies in California. Training characteristics were identified from the Occupational Safety and Health Administration guidelines. Rates were estimated as the number of violent events divided by the total number of home visit hours. Between 2008 and 2009, 66.5% (n = 127) of providers reported receiving WVP training when newly hired or as recurrent training. On average, providers rated the quality of their training as 5.7 (1 = poor to 10 = excellent). Among all providers, there was an overall rate of 17.1 violent events per 1,000 visit-hours. Efforts to increase the number of home health care workers who receive WVP training and to improve training quality are needed. © 2015 Wiley Periodicals, Inc.

Medicare Hospice Benefits

Science.gov (United States)

CENTERS for MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who’s eligible for hospice care What services are included in hospice care How ...

The Hospice Information System and its association with the congruence between the preferred and actual place of death.

Science.gov (United States)

Lin, Huang-Ren; Wang, Jen-Hung; Hsieh, Jyh-Gang; Wang, Ying-Wei; Kao, Sheng-Lun

2017-01-01

A Hospice Information System (HIS) developed in eastern Taiwan in 2012 aimed to improve the quality of hospice care through an integrated system that provided telemetry-based vital sign records, online 24/7 consultations, online video interviews, and online health educations. The purpose of this study was to explore the congruence between the preferred and actual place of death (POD) among patients who received HIS services. A retrospective study was performed from January 2012 to August 2016. Data from patients enrolled in the HIS who died during this period were included. Data on basic characteristics and the actual and preferred POD were obtained from the HIS database. The primary outcome was the congruence between the preferred and actual POD. Secondary outcomes were comparisons between patients who did and did not achieve their preferred POD. Further comparisons between patients who did and did not achieve home death were also performed. In total, we enrolled 481 patients who received HIS services and died. Of them, 444 (92.3%) died at their preferred POD. Patients who preferred an inpatient hospice as their POD had higher achievement rate than those who wanted a home death. High-intensity HIS utilization was associated with a higher likelihood of home death than low-intensity HIS utilization. Patients living in areas distant from the medical center had lower achievement of home death than those living in local areas. This study suggested that patients enrolled in the HIS had high congruence between the actual and preferred POD.

Supporting home hospice family caregivers: Insights from different perspectives.

Science.gov (United States)

Ellington, Lee; Cloyes, Kristin G; Xu, Jiayun; Bellury, Lanell; Berry, Patricia H; Reblin, Maija; Clayton, Margaret F

2018-04-01

ABSTRACTObjective:Our intention was to describe and compare the perspectives of national hospice thought leaders, hospice nurses, and former family caregivers on factors that promote or threaten family caregiver perceptions of support. Nationally recognized hospice thought leaders (n = 11), hospice nurses (n = 13), and former family caregivers (n = 14) participated. Interviews and focus groups were audiotaped and transcribed. Data were coded inductively, and codes were hierarchically grouped by topic. Emergent categories were summarized descriptively and compared across groups. Four categories linked responses from the three participant groups (95%, 366/384 codes): (1) essentials of skilled communication (30.6%), (2) importance of building authentic relationships (28%), (3) value of expert teaching (22.4%), and (4) critical role of teamwork (18.3%). The thought leaders emphasized communication (44.6%), caregivers stressed expert teaching (51%), and nurses highlighted teamwork (35.8%). Nurses discussed teamwork significantly more than caregivers (z = 2.2786), thought leaders discussed communication more than caregivers (z = 2.8551), and caregivers discussed expert teaching more than thought leaders (z = 2.1693) and nurses (z = 2.4718; all values of p nurses, and thought leaders. Hospice teams may benefit from further education and training to help cross the schism of family-centered hospice care as a clinical ideal to one where hospice team members can fully support and empower family caregivers as a hospice team member.

"We Take Care of People; What Happens to Us Afterwards?": Home Health Aides and Bereavement Care in Hospice.

Science.gov (United States)

Ghesquiere, Angela; Bagaajav, Ariunsanaa

2018-01-01

After a hospice patient dies, hospice providers can experience a variety of emotional responses. While work has been done on social workers' and nurses' reactions to patient death, home health aides (HHAs) have been overlooked. To address this gap, we conducted focus groups and individual qualitative interviews with 14 hospice HHAs. Questions covered HHAs' grief responses and how they coped with grief. We found a high burden of grief reactions; many HHAs often developed very close patient relationships. HHAs also noted that they often started working with new patients almost immediately after a death, leaving little time to process the loss. However, HHAs found support from other HHAs, their supervisors, as well as family, friends, and spiritual practices to be helpful in coping with their grief. Future work should enhance support to HHAs around patient loss; for example, grief support may be embedded into hospice team activities.

Hospice utilization of Medicare beneficiaries in Hawai‘i compared to other states

Directory of Open Access Journals (Sweden)

Deborah Taira

2017-11-01

Full Text Available The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian (57% vs. 1%, p < .001 and “other race” (10% vs. 0.1%, p < .001, and less likely to be White (28% vs. 84%, p < .001. Hawai‘i beneficiaries were also more likely to have Medicare Advantage (55% vs. 30%, p = .05. Regarding primary diagnoses, hospice users in Hawai‘i were significantly more likely to have a primary diagnosis of stroke (11% vs. 8%, p = .03 and less likely to have respiratory disease (5% vs. 11%, p = .003. In addition, hospice users in Hawai‘i were more likely to use services in their homes (74% vs. 52%, p = .03. Hawai‘i hospice users were also less likely to die while in hospice (42% vs. 47%, p = .002. Characteristics of Medicare beneficiaries in Hawai‘i differ from those in other states, regarding demographic characteristics, type of coverage, primary diagnoses, likelihood of using services in their homes, and death rates. Further research is needed to better understand factors affecting these differences and whether these differences warrant changes in policy or practice.

Physical function in hospice patients and physiotherapy interventions: a profile of hospice physiotherapy.

Science.gov (United States)

Cobbe, Sinead; Kennedy, Norelee

2012-07-01

There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. The study design consisted of a retrospective chart audit over 6 months. The study took place at a specialist palliative care inpatient unit (hospice) in Limerick, Ireland. All patients were discharged (through death or discharge onwards) from January to June 2010. The Edmonton Functional Assessment Tool (EFAT-2) was used as an outcome measure. Sixty-five percent were referred for physiotherapy; 58% (n=144) were assessed and treated. A wide range of patients was referred (mean functional score 11, range 1-23, SD 5). Rehabilitation activities were widespread: 48% with more than one functional score recorded made improvements; 53% of physiotherapy patients were eventually discharged home; 47% of physiotherapy patients died, of whom 52% received physiotherapy in the last week of life. The median physiotherapy program lasted 11 days (range 1-186, SD 22) whereas the median number of treatments was four (range 1-99, SD 10). The most common interventions were gait re-education (67%), transfer training (58%), and exercises (53%). One third of treatment attempts were unsuccessful because of the unavailability/unsuitability of patients. Challenges for physiotherapists included frequent suspension of treatment and large functional fluctuations in patients. There was a high referral rate to physiotherapy in this hospice. Functional changes in hospice patients were mapped, showing that physiotherapy involved both rehabilitative and quality of life/supportive measures. The most common treatments were physical activity interventions.

Information Framing Reduces Initial Negative Attitudes in Cancer Patients' Decisions About Hospice Care.

Science.gov (United States)

Fridman, Ilona; Glare, Paul A; Stabler, Stacy M; Epstein, Andrew S; Wiesenthal, Alison; Leblanc, Thomas W; Higgins, E Tory

2018-06-01

Negative attitudes toward hospice care might prevent patients with cancer from discussing and choosing hospice as they approach end of life. When making a decision, people often naturally focus on either expected benefits or the avoidance of harm. Behavioral research has demonstrated that framing information in an incongruent manner with patients' underlying motivational focus reduces their negative attitudes toward a disliked option. Our study tests this communication technique with cancer patients, aiming to reduce negative attitudes toward a potentially beneficial but often-disliked option, that is, hospice care. Patients (n = 42) with active cancer of different types and/or stages completed a paper survey. Participants read a vignette about a patient with advanced cancer and a limited prognosis. In the vignette, the physician's advice to enroll in a hospice program was randomized, creating a congruent message or an incongruent message with patients' underlying motivational focus (e.g., a congruent message for someone most interested in benefits focuses on the benefits of hospice, whereas an incongruent message for this patient focuses on avoiding harm). Patients' attitudes toward hospice were measured before and after receiving the physician's advice. Regression analyses indicated that information framing significantly influenced patients with strong initial negative attitudes. Patients were more likely to reduce intensity of their initial negative attitude about hospice when receiving an incongruent message (b = -0.23; P negative reactions toward hospice care. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Physical function in hospice patients and physiotherapy interventions: a profile of hospice physiotherapy.

LENUS (Irish Health Repository)

Cobbe, Sinead

2012-07-01

Abstract Objective: There is a dearth of international research on hospice physiotherapy. This study aims to profile hospice physiotherapy in an Irish setting in order to inform practice internationally. Design: The study design consisted of a retrospective chart audit over 6 months. Setting: The study took place at a specialist palliative care inpatient unit (hospice) in Limerick, Ireland. Participants: All patients were discharged (through death or discharge onwards) from January to June 2010. Outcome measure: The Edmonton Functional Assessment Tool (EFAT-2) was used as an outcome measure. Results: Sixty-five percent were referred for physiotherapy; 58% (n=144) were assessed and treated. A wide range of patients was referred (mean functional score 11, range 1-23, SD 5). Rehabilitation activities were widespread: 48% with more than one functional score recorded made improvements; 53% of physiotherapy patients were eventually discharged home; 47% of physiotherapy patients died, of whom 52% received physiotherapy in the last week of life. The median physiotherapy program lasted 11 days (range 1-186, SD 22) whereas the median number of treatments was four (range 1-99, SD 10). The most common interventions were gait re-education (67%), transfer training (58%), and exercises (53%). One third of treatment attempts were unsuccessful because of the unavailability\\/unsuitability of patients. Challenges for physiotherapists included frequent suspension of treatment and large functional fluctuations in patients. Conclusion: There was a high referral rate to physiotherapy in this hospice. Functional changes in hospice patients were mapped, showing that physiotherapy involved both rehabilitative and quality of life\\/supportive measures. The most common treatments were physical activity interventions.

Medicare Provider Data - Hospice Providers

Data.gov (United States)

U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

Optimum hospice at home services for end-of-life care: protocol of a mixed-methods study employing realist evaluation.

Science.gov (United States)

Butler, Claire; Brigden, Charlotte; Gage, Heather; Williams, Peter; Holdsworth, Laura; Greene, Kay; Wee, Bee; Barclay, Stephen; Wilson, Patricia

2018-05-16

Hospice at home (HAH) services aim to enable patients to be cared for and die in their place of choice, if that is at home, and to achieve a 'good death'. There is a considerable range of HAH services operating in England. The published evidence focuses on evaluations of individual services which vary considerably, and there is a lack of consistency in terms of the outcome measures reported. The evidence, therefore, does not provide generalisable information, so the question 'What are the features of hospice at home service models that work, for whom, and under what circumstances?' remains unanswered. The study aims to answer this question. This is a mixed-methods study in three phases informed by realist evaluation methodology. All HAH services in England will be invited to participate in a telephone survey to enable the development of a typology of services. In the second phase, case study sites representing the different service types will collect patient data and recruit carers, service managers and commissioners to gather quantitative and qualitative data about service provision and outcomes. A third phase will synthesise and refine the results through consensus workshops. The first survey phase has university ethics approval and the second phase, Integrated Research Application System (IRAS) and Health Research Authority (HRA) approval (IRAS ID:205986, REC:17/LO/0880); the third phase does not require ethics approval. Dissemination will be facilitated by project coapplicants with established connections to national policy-making forums, in addition to publications, conference presentations and reports targeted to service providers and commissioners. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Workplace violence prevention policies in home health and hospice care agencies.

Science.gov (United States)

Gross, Nathan; Peek-Asa, Corinne; Nocera, Maryalice; Casteel, Carri

2013-01-31

Workplace violence in the home health industry is a growing concern, but little is known about the content of existing workplace violence prevention programs. The authors present the methods for this study that examined workplace violence prevention programs in a sample of 40 California home health and hospice agencies. Data was collected through surveys that were completed by the branch managers of participating facilities. Programs were scored in six different areas, including general workplace violence prevention components; management commitment and employee involvement; worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation. The results and discussion sections consider these six areas and the important gaps that were found in existing programs. For example, although most agencies offered workplace violence training, not every worker performing patient care was required to receive the training. Similarly, not all programs were written or reviewed and updated regularly. Few program differences were observed between agency characteristics, but nonetheless several striking gaps were found.

Comparison of the Hospice Systems in the United States, Japan and Taiwan

Directory of Open Access Journals (Sweden)

Chung Yul Lee, RN, PhD

2010-12-01

Conclusions: Based on the comparison of three countries, the most interesting thing was that home hospice care accounted for more than 90% of all hospice services in the United States and Taiwan. The results of this study will aid the countries that are in the process of developing a hospice system including Korea, which has been implementing a pilot project only for hospital hospice services.

Online resources for culturally and linguistically appropriate services in home healthcare and hospice, part 2: resources for Asian patients.

Science.gov (United States)

Young, Judith S

2012-04-01

Home care and hospice clinicians are increasingly working with patients for whom English is not their primary language. Provision of culturally respectful and acceptable patient-centered care includes both an awareness of cultural beliefs that influence the patient's health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. This article identifies resources for understanding the cultural norms of Asian-born patients and appropriate patient education materials in the many languages spoken by this population. The resources have been made available free on the Web by healthcare professionals and government agencies from around the world.

Strategies to support spirituality in health care communication: a home hospice cancer caregiver case study.

Science.gov (United States)

Reblin, Maija; Otis-Green, Shirley; Ellington, Lee; Clayton, Margaret F

2014-12-01

Although there is growing recognition of the importance of integrating spirituality within health care, there is little evidence to guide clinicians in how to best communicate with patients and family about their spiritual or existential concerns. Using an audio-recorded home hospice nurse visit immediately following the death of a patient as a case-study, we identify spiritually-sensitive communication strategies. The nurse incorporates spirituality in her support of the family by 1) creating space to allow for the expression of emotions and spiritual beliefs and 2) encouraging meaning-based coping, including emphasizing the caregivers' strengths and reframing negative experiences. Hospice provides an excellent venue for modeling successful examples of spiritual communication. Health care professionals can learn these techniques to support patients and families in their own holistic practice. All health care professionals benefit from proficiency in spiritual communication skills. Attention to spiritual concerns ultimately improves care. © The Author(s) 2014.

Work and health conditions of nursing staff in palliative care and hospices in Germany

Science.gov (United States)

Schröder, Christina; Bänsch, Alexander; Schröder, Harry

2004-01-01

Aims of this representative study were to assess the relevant differences between the work and organisational characteristics as well as the subjective resources and health status of nurses occupied in hospice care, compared to nurses from palliative stations. Further, the assessment of the predictive correlations between the work situation of this nurses as a factor influencing their health and perceived strains was also a leading intention. Method: In a written survey conducted in Germany in 2001, 820 nursing staff of 113 palliative stations and stationary hospices were included. A qualified diagnostic procedure for the assessment of health promoting work was implemented. In order of obtaining a secure comparison, a sample of 320 nurses working in 12 homes for old people in Saxony was also considered. Results: The nurses referred generally to favourable working conditions, still they informed about deficiencies in the perceived participation, organizational benefits and experienced gratification. Hospice nurses experienced overall more favourable work conditions than palliative nurses or than the staff of homes for old people (regarding identification with the institution, organizational benefits, accurate gratification and little time pressure during work). Hospice personnel were psychologically and physically healthier than the staff of palliative stations. Important predictors for health stability that could be assessed by multiple regression analysis were: positively evaluated work contents, the identification with the institution, little time pressure and a positive working atmosphere. Conclusions: The assessed organisational framework is generally more favourable in the institutions of professional terminal care than in common hospitals and homes for old people. Therefore, the conditions in hospices could have a modelling function for the inner-institutional work organisation and for the anchorage of the intrinsic motivation of nurses in the health care

The effects of hospice-shared care for gastric cancer patients.

Directory of Open Access Journals (Sweden)

Kun-Siang Huang

Full Text Available Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients.A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93 and a control group (n = 81.Among the 174 patients, 84% had advanced stage (stage III or stage IV cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001 and those cared by other physicians (63% vs 41%, p = 0.004. Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, p<0.001, intubation (1% vs 27%, p<0.001, cardiopulmonary-cerebral resuscitation (0% vs 11%, p = 0.001, ventilator use (1% vs 27%, p<0.001, inotropic agent use (8% vs 46%, p<0.001, total or partial parenteral nutrition use (38% vs. 58%, p = 0.029, and blood transfusion (45% vs 74%, p<0.001. Besides, the hospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR orders (95% vs 37%, p<0.001, receiving home hospice care (16% vs 1%, p<0.001, and indicating home as the realistically preferred place of death (41% vs 19%, p = 0.001. The hospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014.The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.

Hospice-assisted death? A study of Oregon hospices on death with dignity.

Science.gov (United States)

Campbell, Courtney S; Cox, Jessica C

2012-05-01

Nearly 90% of terminally ill patients who have used Oregon's distinctive death with dignity law to receive a medication to end their lives are enrolled in hospice care programs. In 2009-2010, we conducted a study of the policies developed by Oregon hospices to address patient inquiries and requests for death with dignity. The study examined the stated hospice values and positions and identified the boundaries to participation drawn by the hospice programs to protect personal and programmatic integrity. The boundaries were drawn around 6 key caregiving considerations: (1) language regarding physician-assisted death (PAD); (2) informed decision making by patients; (3) collaboration with physicians; (4) provision of lethal medication; (5) assistance in the patient's act of taking the medication; and (6) staff presence at the time of medication ingestion.

A cost-benefit analysis of music therapy in a home hospice.

Science.gov (United States)

Romo, Rafael; Gifford, Lisa

2007-01-01

Medicare's fixed daily rates create an absolute cost constraint on hospices; consequently, the growth in hospice brings financial pressures. The patient efficacy of music therapy has been demonstrated in the literature and includes improving pain, agitation, disruptive behaviors, communication, depression, and quality of life. Music therapy is well suited to hospice as it addresses the four domains of palliative care (physiological, emotional, social, and spiritual care). In this small study, the total cost of patients in music therapy was $10,659 and $13,643 for standard care patients, resulting in a cost savings of $2984. The music therapy program cost $3615, yielding a cost benefit ratio of 0.83. When using cost per patient day, the cost benefit ratio is 0.95.

Increasing Information Dissemination in Cancer Communication: Effects of Using "Palliative," "Supportive," or "Hospice" Care Terminology.

Science.gov (United States)

Fishman, Jessica M; Greenberg, Patricia; Bagga, Margy Barbieri; Casarett, David; Propert, Kathleen

2018-04-20

When attempting to share information about comfort-oriented care, many use "palliative," "supportive," and "hospice" care terminology interchangeably, but we lack evidence about the effects of using these different terms. This study was designed to test whether the use of "palliative," "supportive," or "hospice" terminology can improve the dissemination of information among breast cancer patients-a large and growing oncology population. Design, Setting, and Measurement: This experimental study was conducted at a major U.S. hospital serving a diverse population. Patients visiting a cancer clinic encountered opportunities to learn more about cancer care. They were offered health materials that were described as reporting on "palliative," "supportive," or "hospice" care and the primary outcome was whether a patient decided to select or reject each. As a secondary outcome, the study measured the patient's level of interest in receiving each. Compared with alternatives, materials labeled as "supportive" care were most likely to be selected and considered valuable (p value information labeled as being about "supportive" care was significantly more likely to be selected. If these effects are supported by additional research, there may be low-cost, highly feasible changes in language choice that increase the dissemination of relevant health information.

Rapid EHR development and implementation using web and cloud-based architecture in a large home health and hospice organization.

Science.gov (United States)

Weaver, Charlotte A; Teenier, Pamela

2014-01-01

Health care organizations have long been limited to a small number of major vendors in their selection of an electronic health record (EHR) system in the national and international marketplace. These major EHR vendors have in common base systems that are decades old, are built in antiquated programming languages, use outdated server architecture, and are based on inflexible data models [1,2]. The option to upgrade their technology to keep pace with the power of new web-based architecture, programming tools and cloud servers is not easily undertaken due to large client bases, development costs and risk [3]. This paper presents the decade-long efforts of a large national provider of home health and hospice care to select an EHR product, failing that to build their own and failing that initiative to go back into the market in 2012. The decade time delay had allowed new technologies and more nimble vendors to enter the market. Partnering with a new start-up company doing web and cloud based architecture for the home health and hospice market, made it possible to build, test and implement an operational and point of care system in 264 home health locations across 40 states and three time zones in the United States. This option of "starting over" with the new web and cloud technologies may be posing a next generation of new EHR vendors that retells the Blackberry replacement by iPhone story in healthcare.

A Theoretical Model of Resource-Oriented Music Therapy with Informal Hospice Caregivers during Pre-Bereavement.

Science.gov (United States)

Potvin, Noah; Bradt, Joke; Ghetti, Claire

2018-03-09

Over the past decade, caregiver pre-bereavement has received increased scholarly and clinical attention across multiple healthcare fields. Pre-bereavement represents a nascent area for music therapy to develop best practices in and an opportunity to establish clinical relevancy in the interdisciplinary team. This study was an exploratory inquiry into the role of music therapy with pre-bereaved informal hospice caregivers. This study intended to articulate (a) what pre-bereavement needs are present for informal hospice caregivers, (b) which of those needs were addressed in music, and (c) the process by which music therapy addressed those needs. A constructivist grounded theory methodology using situational analysis was used. We interviewed 14 currently bereaved informal hospice caregivers who had participated in music therapy with the care recipient. Analysis resulted in a theoretical model of resource-oriented music therapy promoting caregiver resilience. The resource, caregivers' stable caring relationships with care recipients through their pre-illness identities (i.e., spouse, parent, or child), is amplified through music therapy. Engagement with this resource mediates the risk of increased care burden and results in resilience fostering purposefulness and value in caregiving. Resource-oriented music therapy provides a unique clinical avenue for supporting caregivers through pre-bereavement, and was acknowledged by caregivers as a unique and integral hospice service. Within this model, caregivers are better positioned to develop meaning from the experience of providing care through the death of a loved one.

Hospice clinical experiences for nursing students: living to the fullest.

Science.gov (United States)

Spicer, Sherri; Heller, Rebecca; Troth, Sarah

2015-01-01

Preparing future nurses to provide appropriate care for patients and their families at the end of life can be a formidable challenge for nurse educators. Most nursing schools thread end-of-life concepts throughout the curriculum. Grand Canyon University includes a 40-hour hospice clinical as a component of a home healthcare practicum. Students' weekly written reflections reveal the depth of affective learning that occurs during this experience. Article includes hospice materials and resources.

Knowledge and perceptions of hospice care of Chinese older adults.

Science.gov (United States)

Enguidanos, Susan; Yonashiro-Cho, Jeanine; Cote, Sarah

2013-06-01

Despite dramatic increases in hospice enrollment, ethnic disparities persist. With rapidly growing populations of Asian Americans, research is needed to elucidate factors that contribute to hospice underenrollment in subgroups of Asian populations. The purpose of this study was to explore older Chinese Americans' knowledge, understanding, and perceptions of hospice care. Three focus groups were conducted, one each in English, Mandarin, and Cantonese, all recruited from a Chinese social service agency. Focus groups were audiotaped and transcribed and then coded for themes. Thirty-four Chinese Americans participated in the groups, all but one reporting primary language other than English. Themes included lack of knowledge, death timing, burden (financial, emotional, physical toward family or government), peaceful death (relief of suffering), and quality of care (and its influence on perception of best care location). Findings indicate the need for hospice education and outreach to Chinese Americans. Additionally, to address concerns about burden and death in the home, efforts to improve access to hospice facilities are needed. Findings from this study provide direction for healthcare providers to address potential barriers to increasing access to hospice of Chinese Americans. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Hospice Care

Science.gov (United States)

... can also be found online . Information about the types of costs covered by a particular private policy is available from a hospital business office or hospice social worker, or directly from the insurance company. Local civic, charitable, or religious organizations may also ...

"Keep All Thee 'Til the End": Reclaiming the Lifeworld for Patients in the Hospice Setting.

Science.gov (United States)

West, Emily; Onwuteaka-Philipsen, Bregje; Philipsen, Hans; Higginson, Irene J; Pasman, H R W

2017-01-01

St Christopher's Hospice, London, was founded to provide specialist care to the incurably ill. We studied the dimensions of difference that set St Christopher's Hospice apart from hospital care of the dying, focusing on physical space and social organization. Material from 1953 to 1980 from the Cicely Saunders Archive was analyzed qualitatively. Through thematic analysis, quotes were found and analyzed using open coding. Five themes were developed. Themes identified were home/homelike, community, consideration of others, link with outside world, and privacy. The hospice philosophy functioned as the catalyst for the development of the physical environment of St Christopher's Hospice. Taking Habermas' concept of lifeworld, it seems that, in contrast to acute care, the need for hospice to formulate their own lifeworld to support and fully engage patients was central. As lifeworlds are culture sensitive, this underlines the need for variation in design and organization of hospices around the world.

The Japan HOspice and Palliative Care Evaluation Study 3: Study Design, Characteristics of Participants and Participating Institutions, and Response Rates.

Science.gov (United States)

Aoyama, Maho; Morita, Tatsuya; Kizawa, Yoshiyuki; Tsuneto, Satoru; Shima, Yasuo; Miyashita, Mitsunori

2017-08-01

This article describes the whole picture of Japan HOspice and Palliative Care Evaluation Study 3 (J-HOPE3 Study) including study design and demographic data. The aims of the J-HOPE3 study were to (1) evaluate the process, structure, and outcome of palliative care in the following care settings: acute hospitals, inpatient hospice/palliative care units (PCUs), and home hospice services; (2) examine bereaved family members' self-reported psychosocial conditions, such as grief and depression, as bereavement outcomes; (3) provide data to ensure and improve the quality of care provided by participating institutions through feedback concerning results for each institution; and (4) perform additional studies to explore specific clinical research questions. We conducted a cross-sectional, anonymous, self-report questionnaire survey involving patients' bereaved family members in 20 acute hospitals, 133 PCUs, and 22 home hospice services between May and July 2014. Two types of questionnaires were used: main and specific studies questionnaires. The questionnaire was sent to totally 13 584, and 10 157 returned the questionnaire. The analysis included 9126 family members' questionnaires from acute hospitals, PCUs, and home hospice services. Respondents' average age was 61.6 years, 55% were women, and 40% had been married to the deceased. With respect to the characteristics of participating institutions, most institutions did not have religious affiliations, and most PCUs and home hospice services provided bereavement care. These results of the analysis of common and additional questionnaires could play an important role in clinical settings, quality improvement, research, and public accountability.

The spiritual struggle of anger toward God: a study with family members of hospice patients.

Science.gov (United States)

Exline, Julie J; Prince-Paul, Maryjo; Root, Briana L; Peereboom, Karen S

2013-04-01

Anger toward God is a common form of spiritual struggle, one that people often experience when they see God as responsible for severe harm or suffering. The aim of this study was to assess the prevalence, correlates, and preferred coping strategies associated with anger toward God among family members of hospice patients. Teams from a large hospice in the midwestern United States distributed surveys, one per household, to family members of home-care patients. The survey assessed feelings toward God (anger/disappointment and positive feelings), depressive symptoms, religiosity, and perceived meaning. Participants also rated their interest in various strategies for coping with conflicts with God. Surveys (n=134) indicated that 43% of participants reported anger/disappointment toward God, albeit usually at low levels of intensity. Anger toward God was associated with more depressive symptoms, lower religiosity, more difficulty finding meaning, and belief that the patient was experiencing greater pain. Prayer was the most highly endorsed strategy for managing conflicts with God. Other commonly endorsed strategies included reading sacred texts; handling the feelings on one's own; and conversations with friends, family, clergy, or hospice staff. Self-help resources and therapy were less popular options. Anger toward God is an important spiritual issue among family members of hospice patients, one that is commonly experienced and linked with depressive symptoms. It is valuable for hospice staff to be informed about the issue of anger toward God, especially because many family members reported interest in talking with hospice team members about such conflicts.

Resources for Middle Eastern patients: online resources for culturally and linguistically appropriate services in home healthcare and hospice, part 3.

Science.gov (United States)

Young, Judith S

2013-01-01

As the population of patients for whom English is not their primary language grows, home care and hospice clinicians are challenged to provide culturally respectful and acceptable patient-centered care for cultures and languages unfamiliar to them. This article identifies resources for understanding the culture of Middle Eastern-born patients and appropriate patient education materials in most of the languages spoken by this population. The resources have been made available for free on the Web by healthcare professionals, government agencies, and support organizations from around the world.

Transcultural comparison of hospital and hospice as caring environments for dying patients.

Science.gov (United States)

Gates, M F

1991-01-01

Leininger's nursing Theory of Cultural Care Diversity and Universality provided the framework for this comparative study of two environments for persons who are dying; namely a hospital oncology unit and a free-standing hospice unit. Analysis of data from ethnographic and ethnonursing research methods including unstructured interviews, observation-participation, and field journal materials yielded contrasts with two settings. The presence of a caring atmosphere/ambience was apparent in both the hospital and hospice. Universal patterns common to both were: caring beliefs and practices of staff; identification of each setting as "community" or "home"; and multiple symbolic uses of humor and food. Diversities included hierarchical organizational structure and cure orientation in the hospital; interdisciplinary collaboration and care orientation in hospice; more pronounced use of touch as a caring modality; and greater evidence of symbolism and ritual related to death and dying in hospice. Adoption of the cultural care modes of accommodation, repatterning, and maintenance are suggested in promoting a caring atmosphere wherever dying patients are served.

Designing Effective Interactions for Concordance around End-of-Life Care Decisions: Lessons from Hospice Admission Nurses

Directory of Open Access Journals (Sweden)

Carey Candrian

2017-04-01

Full Text Available Near the end of life, hospice care reduces symptom-related distress and hospitalizations while improving caregiving outcomes. However, it takes time for a person to gain a sufficient understanding of hospice and decide to enroll. This decision is influenced by knowledge of hospice and its services, emotion and fear, cultural and religious beliefs, and an individual’s acceptance of diagnosis. Hospice admission interactions, a key influence in shaping decisions regarding hospice care, happen particularly late in the illness trajectory and are often complex, unpredictable, and highly variable. One goal of these interactions is ensuring patients and families have accurate and clear information about hospice care to facilitate informed decisions. So inconsistent are practices across hospices in consenting patients that a 2016 report from the Office of Inspector General (OIG entitled “Hospices should improve their election statements and certifications of terminal illness” called for complete and accurate election statements to ensure that hospice patients and their caregivers can make informed decisions and understand the costs and benefits of choosing hospice care. Whether complete and accurate information at initial admission visits improves interactions and outcomes is unknown. Our recent qualitative work investigating interactions between patients, caregivers, and hospice nurses has uncovered diverse and often diverging stakeholder-specific expectations and perceptions which if not addressed can create discordance and inhibit decision-making. This paper focuses on better understanding the communication dynamics and practices involved in hospice admission interactions in order to design more effective interactions and support the mandate from the OIG to provide hospice patients and their caregivers with accurate and complete information. This clarity is particularly important when discussing the non-curative nature of hospice care, and the

Hospice Counsellor Facing the Grief of the Terminally Ill Child and Its Family

Directory of Open Access Journals (Sweden)

Grzegorz Godawa

2012-09-01

Full Text Available The child’s illness, suffering and death provoke many emotions in the family. The ill child and its family both experience grief which is an emotional reaction to the danger of losing health or life. Support offered by home hospices for children aims at overcoming the destructive influence of illness. A hospice counsellor’s task is to improve the ill child and its family’s quality of life. He is helping the family overcome grief and prepare for the child’s death. The hospice team supports the family members who experience anticipatory and later, actual mourning. Preventing pathological effects of grief is a basic challenge for people who offer help.

End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

Science.gov (United States)

Keim-Malpass, Jessica; Lindley, Lisa C

2017-08-01

Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15-20 years with a life-limiting illness. A retrospective cohort design used 2007-2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

Care planning for pressure ulcers in hospice: the team effect.

Science.gov (United States)

Eisenberger, Andrew; Zeleznik, Jomarie

2004-09-01

The standards of care for patients at risk for or with a pressure ulcer in hospitals and nursing homes focus on prevention and ulcer healing using an interdisciplinary approach. Although not a primary hospice condition, pressure ulcers are not uncommon in dying patients. Their management in hospices, particularly the involvement of family caregivers, has not been studied. The objective of this study is to identify the factors that influence care planning for the prevention and treatment of pressure ulcers in hospice patients and develop a taxonomy to use for further study. A telephone survey was conducted with 18 hospice directors of clinical services and 10 direct-care nurses. Descriptive qualitative data analysis using grounded theory was utilized. The following three themes were identified: (1) the primary role of the hospice nurse is an educator rather than a wound care provider; (2) hospice providers perceive the barriers and burdens of family caregiver involvement in pressure ulcer care to be bodily location of the pressure ulcer, unpleasant wound characteristics, fear of causing pain, guilt, and having to acknowledge the dying process when a new pressure ulcer develops; and (3) the "team effect" describes the collaboration between family caregivers and the health care providers to establish individualized achievable goals of care ranging from pressure ulcer prevention to acceptance of a pressure ulcer and symptom palliation. Pressure ulcer care planning is a model of collaborative decision making between family caregivers and hospice providers for a condition that occurs as a secondary condition in hospice. A pressure ulcer places significant burdens on family caregivers distinct from common end-of-life symptoms whose treatment is directed at the patient. Because the goals of pressure ulcer care appear to be individualized for a dying patient and their caregivers, the basis of quality-of-care evaluations should be the process of care rather than the outcome

The experiences of Batswana families regarding hospice care of ...

African Journals Online (AJOL)

The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had ...

Motivations of German Hospice Volunteers: How Do They Compare to Nonhospice Volunteers and US Hospice Volunteers?

Science.gov (United States)

Stelzer, Eva-Maria; Lang, Frieder R

2016-03-01

We examined reasons of volunteering for hospice and nonhospice organizations in a study with 125 volunteers (22-93 years) from the United States and Germany. Motives of US and German hospice volunteers revealed similarities and few differences. Hospice volunteers are involved because they seek to help others, seek new learning experiences, seek social contacts, or seek personal growth. The US hospice volunteers reported motives related to altruistic concerns, enhancement, and social influence as more influential, while German hospice volunteers rated career expectations as being more important. Comparison of German hospice with nonhospice volunteers revealed stronger differences: German hospice volunteers scored higher on altruistic motives, while German nonhospice volunteers yielded higher scores on self-serving motives. Findings contribute to improved understanding of volunteering motivation and of activating or retaining hospice volunteers. © The Author(s) 2014.

Perceptions of the Pediatric Hospice Experience among English- and Spanish-Speaking Families.

Science.gov (United States)

Thienprayoon, Rachel; Marks, Emily; Funes, Maria; Martinez-Puente, Louizza Maria; Winick, Naomi; Lee, Simon Craddock

2016-01-01

Many children who die are eligible for hospice enrollment but little is known about parental perceptions of the hospice experience, the benefits, and disappointments. The objective of this study was to explore parental perspectives of the hospice experience in children with cancer, and to explore how race/ethnicity impacts this experience. We held 20 semistructured interviews with 34 caregivers of children who died of cancer and used hospice. Interviews were conducted in the caregivers' primary language: 12 in English and 8 in Spanish. Interviews were recorded, transcribed, and analyzed using accepted qualitative methods. Both English and Spanish speakers described the importance of honest, direct communication by medical providers, and anxieties surrounding the expectation of the moment of death. Five English-speaking families returned to the hospital because of unsatisfactory symptom management and the need for additional supportive services. Alternatively, Spanish speakers commonly stressed the importance of being at home and did not focus on symptom management. Both groups invoked themes of caregiver appraisal, but English-speaking caregivers more commonly discussed themes of financial hardship and fear of insurance loss, while Spanish-speakers focused on difficulties of bedside caregiving and geographic separation from family. The intense grief associated with the loss of a child creates shared experiences, but Spanish- and English-speaking parents describe their hospice experiences in different ways. Additional studies in pediatric hospice care are warranted to improve the care we provide to children at the end of life.

FastStats: Nursing Home Care

Science.gov (United States)

... Submit What's this? Submit Button NCHS Home Nursing Home Care Recommend on Facebook Tweet Share Compartir Data are ... Person’s Health Related Links Adult Day Services Centers Home Health Care Hospice Care National Study of Long-Term Care ...

Prison hospice: an unlikely success.

Science.gov (United States)

Craig, E L; Craig, R E

1999-01-01

Efforts to introduce hospice and palliative care into American prisons have become fairly widespread, in response to the sharp increase in inmate deaths. The primary impetus originally came from the alarming number of AIDS deaths among prisoners. The new combination therapies have proved very successful in treating AIDS, but are very costly, and many problems must be overcome to ensure their effectiveness in correctional settings. Although the AIDS epidemic seems to be in decline, prisons are experiencing a rise in the number of deaths due to "natural causes." In this article we present a review of the prison hospice scene--the response to this crisis in correctional health care. First, we discuss the challenges facing the introduction of hospice into the correctional setting. Then, we present a brief overview of recent developments and a discussion of some ways hospice components have been adapted for life behind bars. Finally, we indicate some of the prospects for the future. Hospice professionals, armed with thorough professional training and years of experience, often fear that correctional health care providers will only parody superficial aspects of the hospice approach. Continual nudging and nurturing by local and state hospice professionals is required in order to bring about this change in the first place and to sustain it through time. Prison hospice workers need not only initial training, but also ongoing education and personal contact with experienced hospice professionals. While the interest of the big national organizations is necessary, the real action happens when local hospices work with nearby prisons to attend to the needs of dying inmates.

End of Life (Hospice Care)

Science.gov (United States)

... days of life. Meier DE, et al. Hospice: Philosophy of care and appropriate utilization in the United ... Care Organization. http://www.nhpco.org/hospice-statistics-research-press-room/facts-hospice-and-palliative-care. Accessed ...

Nursing Unit Environment Associated with Provision of Language Services in Pediatric Hospices.

Science.gov (United States)

Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E

2017-04-01

Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.

Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities.

Science.gov (United States)

Kataoka-Yahiro, Merle R; McFarlane, Sandra; Koijane, Jeannette; Li, Dongmei

2017-05-01

Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.

'A bridge to the hospice': the impact of a Community Volunteer Programme in Uganda.

Science.gov (United States)

Jack, Barbara A; Kirton, J; Birakurataki, J; Merriman, A

2011-10-01

In Africa, the need for palliative care provision is escalating with an increasing number of people living with HIV/AIDS, coupled with rising cancer and AIDS-related cancer diagnoses. In Uganda there is a shortage of doctors, particularly in rural areas. To address this Hospice Africa Uganda developed a Community Volunteer Programme to train volunteers to help by providing support to patients in their own homes. The aim of this qualitative study was to evaluate the impact of the Community Volunteer Programme. Sixty-four interviews, with patients (21), community volunteer workers (CVWs) (32), and the hospice clinical teams (11) were conducted, using semi-structured digitally recorded individual, group and focus group interviews, at the Hospice Africa Uganda sites. The results reported the value of the Community Volunteer Programme, including the impact on patients and families, and how the CVWs acted as a 'bridge to the hospice' in identifying patients. Developing financial challenges that are emerging which could potentially impact on the programme were reported. The Community Volunteer Programme appears to be having a positive impact on patients, families and the hospice team, and is a model worthy of consideration by other developing countries to allow the expansion of palliative care.

Prison hospice and pastoral care services in California.

Science.gov (United States)

Linder, John F; Knauf, Keith; Enders, Sheila R; Meyers, Frederick J

2002-12-01

Hospice at the California Medical Facility (CMF) Vacaville dates back to the mid-1980s, when the acquired immune deficiency syndrome (AIDS) epidemic began to be felt throughout California's Department of Corrections. Vacaville has served for decades as the principal location for delivering health services to California's incarcerated men. Informal hospice-like services were inspired by Elisabeth Kubler-Ross and through inmate and community calls for more humane care for dying inmates. By 1990, efforts to formally establish a hospice were under way. In 1996, a 17-bed, state-licensed hospice began caring for dying inmates. An interdisciplinary team plans and delivers the care, meeting weekly to admit and review patients. The Pastoral Care Services (PCS) inmate volunteer program, with more than 50 trained participants, provides care and comfort to dying patients in hospice and to ill patients on the general medicine service. PCS volunteers perform many duties, including sitting vigil with actively dying inmates. Inmates enrolling in hospice have to forgo further curative therapy, consent to the program in writing, and have a 6-month or less survival prognosis; patients are not required to have a do-not-resuscitate (DNR) order, but are encouraged to consider one. Training for physicians, staff and PCS volunteers is provided by the University of California, Davis faculty of the West Coast Center for Palliative Education. Bereavement services are provided for PCS volunteers, other inmate "family" and staff. Family and friends of the deceased in the free community are followed by phone, mail, and primarily through referral to resources in their local area.

The stresses of hospice volunteer work.

Science.gov (United States)

Brown, Mary V

2011-05-01

The purpose of this phenomenological study was to explore the interpretation of stress, the appraisal of the stressors, as well as the top stressors experienced by hospice volunteers. Individual semistructured interviews were conducted with 15 hospice volunteers. The interviews were digitally recorded, transcribed, and analyzed, using qualitative research methods. Although the results indicated that the hospice volunteers did not perceive their work as stressful, 2 main themes regarding challenging experiences did emerge. Hospice-related issues and personal issues were of concern to the volunteers. In addition, the timing of the stressors revealed that the most stress was felt at the beginning of their volunteer services, which has implications for hospice volunteer coordinators as they support their volunteers in the field.

Death representation of caregivers in hospice.

Science.gov (United States)

Andruccioli, Jessica; Russo, Maria Maffia; Bruschi, Angela; Pedrabissi, Luigi; Sarti, Donatella; Monterubbianesi, Maria Cristina; Rossi, Sabina; Rocconi, Sabina; Raffaeli, William

2012-11-01

In this study, we investigated caregiver's death representation in hospice. The results presented here are a further analysis of the data collected in our previous study, concerning the evaluation of the caregiver in hospice. The data analysis of 24 caregivers of patients hospitalized in Rimini Hospice (Italy) underlined that caregivers avoiding death representation of the patient admitted to hospice had fewer protective factors (52.3%) and more risk factors (47.7%) than caregivers nonavoiding (66.5% and 33.5%, respectively). Caregivers avoiding death representation, moreover, experienced a greater distress (58%) than those nonavoiding (42%).

Feasibility and preliminary effects of an intervention targeting schema development for caregivers of newly admitted hospice patients.

Science.gov (United States)

Lindstrom, Kathryn B; Mazurek Melnyk, Bernadette

2013-06-01

The transition to hospice care is a stressful experience for caregivers, who report high anxiety, unpreparedness, and lack of confidence. These sequelae are likely explained by the lack of an accurate cognitive schema, not knowing what to expect or how to help their loved one. Few interventions exist for this population and most do not measure preparedness, confidence, and anxiety using a schema building a conceptual framework for a new experience. The purpose of this study was to test the feasibility and preliminary effects of an intervention program, Education and Skill building Intervention for Caregivers of Hospice patients (ESI-CH), using an innovative conceptual design that targets cognitive schema development and basic skill building for caregivers of loved ones newly admitted to hospice services. A pre-experimental one-group pre- and post-test study design was used. Eighteen caregivers caring for loved ones in their homes were recruited and twelve completed the pilot study. Depression, anxiety, activity restriction, preparedness, and beliefs/confidence were measured. Caregivers reported increased preparedness, more helpful beliefs, and more confidence about their ability to care for their loved one. Preliminary trends suggested decreased anxiety levels for the intervention group. Caregivers who completed the intervention program rated the program very good or excellent, thought the information was helpful and timely, and would recommend it to friends. Results show promise that the ESI-CH program may assist as an evidence-based program to support caregivers in their role as a caregiver to a newly admitted hospice patient.

Children with intellectual disability and hospice utilization.

Science.gov (United States)

Lindley, Lisa C; Colman, Mari Beth; Meadows, John T

2017-02-01

Over 42,000 children die each year in the United States, including those with intellectual disability (ID). Survival is often reduced when children with intellectual disability also suffer from significant motor dysfunction, progressive congenital conditions, and comorbidities. Yet, little is known about hospice care for children with intellectual disability. The purpose of this study was to explore the relationship between intellectual disability and hospice utilization. Additionally, we explored whether intellectual disability combined with motor dysfunction, progressive congenital conditions, and comorbidities influenced pediatric hospice utilization. Using a retrospective cohort design and data from the 2009 to 2010 California Medicaid claims files, we conducted a multivariate analysis of hospice utilization. This study shows that intellectual disability was negatively related to hospice enrollment and length of stay. We also found that when children had both intellectual disability and comorbidities, there was a positive association with enrolling in hospice care. A number of clinical implications can be drawn from the study findings that hospice and palliative care nurses use to improve their clinical practice of caring for children with ID and their families at end of life.

A Problem Solving Intervention for hospice caregivers: a pilot study.

Science.gov (United States)

Demiris, George; Oliver, Debra Parker; Washington, Karla; Fruehling, Lynne Thomas; Haggarty-Robbins, Donna; Doorenbos, Ardith; Wechkin, Hope; Berry, Donna

2010-08-01

The Problem Solving Intervention (PSI) is a structured, cognitive-behavioral intervention that provides people with problem-solving coping skills to help them face major negative life events and daily challenges. PSI has been applied to numerous settings but remains largely unexplored in the hospice setting. The aim of this pilot study was to demonstrate the feasibility of PSI targeting informal caregivers of hospice patients. We enrolled hospice caregivers who were receiving outpatient services from two hospice agencies. The intervention included three visits by a research team member. The agenda for each visit was informed by the problem-solving theoretical framework and was customized based on the most pressing problems identified by the caregivers. We enrolled 29 caregivers. Patient's pain was the most frequently identified problem. On average, caregivers reported a higher quality of life and lower level of anxiety postintervention than at baseline. An examination of the caregiver reaction assessment showed an increase of positive esteem average and a decrease of the average value of lack of family support, impact on finances, impact on schedules, and on health. After completing the intervention, caregivers reported lower levels of anxiety, improved problem solving skills, and a reduced negative impact of caregiving. Furthermore, caregivers reported high levels of satisfaction with the intervention, perceiving it as a platform to articulate their challenges and develop a plan to address them. Findings demonstrate the value of problem solving as a psycho-educational intervention in the hospice setting and call for further research in this area.

Results from the national hospice volunteer training survey.

Science.gov (United States)

Wittenberg-Lyles, Elaine; Schneider, Greg; Oliver, Debra Parker

2010-03-01

Although the role of volunteers is at the heart of hospice care, little is known about hospice volunteer training and volunteer activity. A survey was used to assess current training programs for hospice volunteers. Hospices were invited to participate in the study from a link on the website for the Hospice Volunteer Association and Hospice Educators Affirming Life Project. Survey results revealed that the majority of volunteer work is in patient care, with most hospice agencies requiring a minimum 12-month volunteer commitment and an average 4-hour volunteer shift per week. Volunteer training is separate from staff training, is provided by paid agency staff, and costs approximately $14,303 per year. Communication and family support are considered important curriculum topics. Revisions to current volunteer training curriculum and format are suggested.

Virtual Reality Hospice

OpenAIRE

Ejsing, Sebastian Kirkegaard; Vintersborg, Kathrine Mosbæk; Benford-Brown, Cory George; Turner, Daniel Severin Pohl

2017-01-01

This paper details the findings of a qualitative reception analysis performed in collaboration with Hospice Sjælland, as to the potentials of Virtual Reality technology in providing entertainment and respite. The analysis was performed utilizing a theoretical analytical model based on Kim Schrøder’s ‘Multidimensional Model of Mass Media Reception’ to discourse gathered from six interviews with four patients from Hospice Sjælland. Supporting this model was supplementary literature on cognitive...

Cultural competency and diversity among hospice palliative care volunteers.

Science.gov (United States)

Jovanovic, Maja

2012-05-01

This case study examines the current state of cultural competence in hospice and palliative care in the Greater Toronto Area (GTA). Because of changing demographic trends and ethnic minorities underutilizing hospice palliative care services, this research examined the current state of culturally competent care in a hospice setting, and the challenges to providing culturally competent care in a hospice in the GTA. A case study was conducted with a hospice and included in-depth interviews with 14 hospice volunteers. The findings reveal that volunteers encountered cultural clashes when their level of cultural competency was weak. Second, volunteers revealed there was a lack of adequate cultural competency training with their hospice, and finally, there was a lack of ethnic, cultural, and linguistic diversity among the hospice volunteers.

The experiences of Batswana families regarding hospice care of AIDS patients in the Bophirima district, North West province, South Africa.

Science.gov (United States)

Makhele, M F; Mulaudzi, F M

2012-01-01

The HIV/AIDS pandemic put significant strain on healthcare services in the country. Hospitals were no longer coping with the escalating number of AIDS patients. This resulted in the early discharge of patients, with some patients, too ill to be nursed at home, being sent to hospices for continued care. The Batswana had mixed feelings about hospice care, because their beliefs on patient care are based on the ubuntu philosophy, which emphasises the principle of caring for one another. The purpose of this study was to explore and describe the experiences of Batswana families regarding hospice care for patients in the Thlabane township in the province of the North West as well as to make recommendations to policy-makers to ensure that hospices are accepted by community members and utilised effectively. A qualitative, explorative, descriptive research design was applied. Purposive sampling was applied to select study participants with whom in-depth unstructured interviews were conducted. A qualitative data analysis was done by categorising, ordering, and summarising the data, and describing the findings. The findings indicated that families of patients in hospice care experienced such care as foreign to their culture. These families also experienced stigmatisation, firstly owing to the stigma associated with AIDS and secondly because they opted for hospice care. However, they also observed the high quality of care provided by the hospice and understood its benefits for AIDS patients. The study concluded that hospice care relieved families of terminally ill AIDS patients of the burden of care and enabled them to keep on working and earning a living. Recommendations to policy-makers included enhancing hospice care and ensuring the provisioning of culturally safe hospice care.

Policy for home or hospice as the preferred place of death from cancer: Scottish Health and Ethnicity Linkage Study population cohort shows challenges across all ethnic groups in Scotland.

Science.gov (United States)

Sharpe, Katharine H; Cezard, Genevieve; Bansal, Narinder; Bhopal, Raj S; Brewster, David H

2015-12-01

Place of cancer death varies ethnically and internationally. Palliative care reviews highlight limited ability to demonstrate equal access due to incomplete or unreliable ethnicity data. To establish place of cancer death by ethnicity and describe patient characteristics. We linked census, hospital episode and mortality data for 117 467 persons dying of cancer, 2001-2009. With White Scottish population as reference, prevalence ratios (PR), 95% CIs and p values of death in hospital, home or hospice adjusted for sex and age were calculated by ethnic group. White Scottish group and minority ethnic groups combined constituted 91% and 0.4% of cancer deaths, respectively. South Asian, Chinese and African Origin patients were youngest at death (66, 66 and 65.9 years). Compared with the Scottish White reference, the White Irish (1.15 (1.10 to 1.22), pScottish White patients were less likely to die in hospital and more likely to die at home or in a hospice regardless of socioeconomic indicator used. Cancer deaths occur most often in hospital (52.3%) for all ethnic groups. Regardless of the socioeconomic indicator used, more affluent Scottish White patients were less likely to die in hospital; existing socioeconomic indicators detected no clear trend for the non-White population. Regardless of ethnic group, significant work is required to achieve more people dying at home or the setting of their choice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Future design of a Children's Hospice

DEFF Research Database (Denmark)

Poulsen, Mikkel; Knudstrup, Mary-Ann; Hoff, Peter

2017-01-01

and the promotion of wellbeing are key elements in a children’s hospice, and since the relatives are deeply affected by the pa- tient’s condition, there is a need for the relatives to stay at the hospice while also maintaining work and social life. By creating flexible environments where patients and relatives can......Children’s hospices are a recent concept within the Danish context. Current- ly, only the small experimental institution “Lukashuset” at ”Sankt Lukas Stiftelsen” exists. There has been both an increased demand for and a pub- lic and political interest in creating a dedicated children’s hospice......, similar to those in those in Britain, where the concept is more widespread. In Den- mark, the only choice is represented by children’s wards, which are ill-suited to palliative treatment. The objective of this paper is to describe and present a children’s hospice which has been designed using...

The impact of a clinical rotation in hospice: medical students' perspectives.

Science.gov (United States)

Jacoby, Liva H; Beehler, Connie J; Balint, John A

2011-01-01

Medical educators agree that training in end-of-life care (EOLC) must be an integral part of medical education at all levels. While progress in this area of education has taken place, many gaps still exist. This article describes the self-reported impact of a required one-week hospice rotation for third-year medical students. Students completing their hospice rotation during a one-year period were asked to write an essay describing the most important lessons they learned. Qualitative analyses of the essays revealed 10 core themes and generated a coding schema for detailed analysis. Students' essays reflected knowledge gained, emotional reactions, cognitive insights, and relationship-centered skills. Comments focused on the following themes: benefits and philosophy of hospice; impact on future practice; interdisciplinary team approach; management of pain and suffering; facts about hospice; personal impact; communication with patients and families; dedication and skill of staff; role of families; and value of home care. Students consistently recognized the significance of positive role models. Learning about a new field of medicine helped broaden students' knowledge, skills, and beliefs, and expanded their assumptions about illness and suffering, the role of health care professionals, and the goals of medicine. Reflection and writing brought about self-awareness of the learning process itself. The study demonstrates that a robust clinical EOLC exposure can be effectively incorporated into undergraduate education and that student self-reports constitute a valuable mode of evaluation. Longitudinal assessments of trainees' competencies in EOLC are needed to optimize these educational endeavors.

A cross-cultural comparison of hospice development in Japan, South Korea, and Taiwan.

Science.gov (United States)

Glass, Anne P; Chen, Li-Kuang; Hwang, Eunju; Ono, Yuzuho; Nahapetyan, Lusine

2010-03-01

By 2050, one out of four people in Eastern Asia will be aged 65 and above. Thus, preparing to care for an older population is imperative. Addressing quality care for elders includes consideration of palliative and end-of-life care. A comparative study of the development of hospice and palliative care services in Japan, South Korea, and Taiwan, is presented, based on an extensive literature review. Both commonalities and differences were found. This article provides information on the origins and administration of hospice services in these three cases, as well as the degree of government involvement. Cultural and religious aspects are also considered, and obstacles to the spread of hospice services are discussed. This review compares experiences with hospice services and identifies factors that influence people's perceptions and adoption of hospice. Stronger financial support for hospice and palliative care through the government and insurance programs would help increase the availability and use of services. Also, the need for continuing education of healthcare providers, patients, families, and the community is urgent. However, promotion of understanding of better pain management and the worth of hospice and palliative care must be conducted in ways that are sensitive to the cultural values and traditions in Japan, South Korea, and Taiwan. Only when hospice and palliative care can be viewed as an admirable choice for one's loved ones, overcoming issues of truth telling, filial piety, worries about how one is judged, and religious considerations, will it become more widely accepted.

Communication dynamics in hospice teams: understanding the role of the chaplain in interdisciplinary team collaboration.

Science.gov (United States)

Wittenberg-Lyles, Elaine; Oliver, Debra Parker; Demiris, George; Baldwin, Paula; Regehr, Kelly

2008-12-01

Hospice chaplains provide a specific expertise to patient and family care, however, individual roles and responsibilities that facilitate the interdisciplinary team environment are less well known. The primary aim of this study was to investigate how hospice chaplains perceive their role in interdisciplinary team meetings and to what extent hospice chaplains share common experiences within the interdisciplinary team approach in hospice. Hospice chaplains within a 10-state region participated in a 39-item phone survey about professional roles, group roles, and structural characteristics that influence their ability to participate in interdisciplinary collaboration. Findings revealed that professional role conflict is experienced, primarily with social workers. Informal group task and maintenance roles included team spiritual care advisor and conflict manager, and structural characteristics consisted of extracurricular communication outside of the organization. Although chaplains foster interdisciplinary collaboration within the hospice team, future research needs to address improvements to the chaplain's role within the interdisciplinary team process.

Hospice or community network? Choices in end-of-life care in Jamaica.

Science.gov (United States)

Mendoza, Roger Lee

2017-09-01

Now considered a subspecialty of medicine and nursing, palliative care is a critical aspect of healthcare at the end of life. National and international healthcare agencies typically attribute its slow or haphazard growth in developing countries to various resource constraints. However, this study provides evidence of the substantial and widening gap between policy advocacy and patient choices in end-of-life care. It does so by establishing the incentives and risks that underlie decision-making by patients and providers against the relative scarcity of palliative care and hospices in these countries. Jamaica offers an illustrative case. It shares the socioeconomic conditions and isolated provision of hospice and palliative care that remain prevalent in many developing countries. Empirical information was collected from all Jamaican hospices, along with agency and media reports, for comparative institutional analysis. Financial and infrastructural challenges hamper hospice expansion and integration into formal healthcare systems in developing countries. Yet, other equally vital considerations are too often neglected. These include the high transaction costs of decision-making, which account for limited hospice accessibility, affordability, and efficiency, particularly to underserved populations. Risk and payoff calculations by patients and their families as well as hospices and their providers lead to two strategic options in maximizing hospice value and/or minimizing transaction costs in end-of-life care. Policy formulation and advocacy for hospice and palliative care should match aggregate demand. The socio-cultural milieu of care is critical and should be equally considered. Otherwise, providing and expanding free or subsidized palliative care at the end-of-life stage can become cost-inefficient relative to robust family and grassroots community networks.

Exploring the relationship between volunteering and hospice sustainability in the UK: a theoretical model.

Science.gov (United States)

Scott, Ros; Jindal-Snape, Divya; Manwaring, Gaye

2018-05-02

To explore the relationship between volunteering and the sustainability of UK voluntary hospices. A narrative literature review was conducted to inform the development of a theoretical model. Eight databases were searched: CINAHL (EBSCO), British Nursing Index, Intute: Health and Life Sciences, ERIC, SCOPUS, ASSIA (CSA), Cochrane Library and Google Scholar. A total of 90 documents were analysed. Emerging themes included the importance of volunteering to the hospice economy and workforce, the quality of services, and public and community support. Findings suggest that hospice sustainability is dependent on volunteers; however, the supply and retention of volunteers is affected by internal and external factors. A theoretical model was developed to illustrate the relationship between volunteering and hospice sustainability. It demonstrates the factors necessary for hospice sustainability and the reciprocal impact that these factors and volunteering have on each other. The model has a practical application as an assessment framework and strategic planning tool.

Prescribing practices in hospice patients with adult failure to thrive or debility.

Science.gov (United States)

Sera, Leah; Holmes, Holly M; McPherson, Mary Lynn

2014-04-01

Despite being a common admitting diagnosis, there is very little published literature on medication management in hospice patients admitted with a diagnosis of failure to thrive or debility. The purpose of this study was to describe medication prescribing practices in hospice patients with either of these primary diagnoses by characterizing prescribed medications by name and by pharmaceutical class, and determining whether the patient or the hospice organization provided each medication. A retrospective review of a patient information database compiled by a national hospice organization was conducted. Patients were included in this retrospective study if they were admitted to hospice care with a primary diagnosis of failure to thrive or debility, and if they were admitted on or after 1 January 2010, and discharged by death on or before 31 December 2010. Overall 293 patients and 6181 medication entries were evaluated. The most commonly prescribed drugs were acetaminophen, lorazepam, morphine, atropine, prochlorperazine, haloperidol, docusate, aspirin, and bisacodyl. The most commonly prescribed pharmacological classes were opioid and non-opioid analgesics, anxiolytics, anticholinergics, antihypertensives, laxatives, antidepressants, and supplements. The hospice organization provided over 90% of prescriptions for analgesics, antipsychotics, anticholinergics, and anxiolytics, and these medications were discontinued before death in less than 5% of patients. Recognized clinical components of failure to thrive syndrome include cognitive impairment, malnutrition, and depression. The hospice organization provided 80% of antidepressants, but infrequently provided appetite stimulants and drugs treating dementia. The most commonly provided drugs were those used for symptoms associated with most end-stage diseases.

'Where do I go from here'? A cultural perspective on challenges to the use of hospice services.

Science.gov (United States)

Frey, Rosemary; Gott, Merryn; Raphael, Deborah; Black, Stella; Teleo-Hope, Linda; Lee, Hyeonjoo; Wang, Zonghua

2013-09-01

Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non-Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access-to-care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self-identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non-users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care

The Maryland Division of Correction hospice program.

Science.gov (United States)

Boyle, Barbara A

2002-10-01

The Maryland Division of Correction houses 24,000 inmates in 27 geographically disparate facilities. The inmate population increasingly includes a frail, elderly component, as well as many inmates with chronic or progressive diseases. The Division houses about 900 human immunodeficiency virus (HIV)-positive detainees, almost one quarter with an acquired immune deficiency syndrome (AIDS) diagnosis. A Ryan White Special Project of National Significance (SPNS) grant and the interest of a community hospice helped transform prison hospice from idea to reality. One site is operational and a second site is due to open in the future. Both facilities serve only male inmates, who comprise more than 95% of Maryland's incarcerated. "Medical parole" is still the preferred course for terminally ill inmates; a number have been sent to various local community inpatient hospices or released to the care of their families. There will always be some who cannot be medically paroled, for whom hospice is appropriate. Maryland's prison hospice program requires a prognosis of 6 months or less to live, a do-not-resuscitate (DNR) order and patient consent. At times, the latter two of these have been problematic. Maintaining the best balance between security requirements and hospice services to dying inmates takes continual communication, coordination and cooperation. Significant complications in some areas remain: visitation to dying inmates by family and fellow prisoners; meeting special dietary requirements; what role, if any, will be played by inmate volunteers. Hospice in Maryland's Division of Correction is a work in progress.

Organizational and environmental correlates of the adoption of a focus strategy in U.S. hospices.

Science.gov (United States)

Apenteng, Bettye A; Nayar, Preethy; Yu, Fang; Adams, John; Opoku, Samuel T

2015-01-01

The hospice industry has experienced rapid growth in the last decade and has become a prominent component of the U.S. health care delivery system. In recent decades, the number of hospices serving nursing facility residents has increased. However, there is paucity of research on the organizational and environmental determinants of this strategic behavior. The aim of this study was to empirically identify the factors associated with the adoption of a nursing facility focus strategy in U.S. hospices. A nursing facility focus strategy was defined in this study as a strategic choice to target the provision of hospice services to skilled nursing facility or nursing home residents. This study employed a longitudinal study design with lagged independent variables in answering its research questions. Data for the study's dependent variables are obtained for the years 2005-2008, whereas data for the independent variables are obtained for the years 2004-2007, representing a 1-year lag. Mixed effects regression models were used in the multivariate regression analyses. Using a resource dependence framework, the findings from this study indicate that organizational size, community wealth, competition, and ownership type are important predictors of the adoption of a nursing facility focus strategy. Hospices may be adopting a nursing facility focus strategy in response to increasing competition. The decision to focus the provision of care to nursing facility residents may be driven by the need to secure stability in referrals. Further empirical exploration of the performance implications of adopting a nursing facility focus strategy is warranted.

Hospice utilization during the SARS outbreak in Taiwan

Directory of Open Access Journals (Sweden)

Lin Ming-Hwai

2006-08-01

Full Text Available Abstract Background The severe acute respiratory syndrome (SARS epidemic threw the world into turmoil during the first half of 2003. Many subsequent papers have addressed its impact on health service utilization, but few have considered palliative (hospice care. The aim of the present study was to describe changes in hospice inpatient utilization during and after the SARS epidemic in 2003 in Taiwan. Methods The data sources were the complete datasets of inpatient admissions during 2002 and 2003 from the National Health Insurance Research Database. Before-and-after comparisons of daily and monthly utilizations were made. Hospice analyses were limited to those wards that offered inpatient services throughout these two years. The comparisons were extended to total hospital bed utilization and to patients who were still admitted to hospice wards during the peak period of the SARS epidemic. Results Only 15 hospice wards operated throughout the whole of 2002 and 2003. In 2003, hospice utilization began to decrease in the middle of April, reached a minimum on 25 May, and gradually recovered to the level of the previous November. Hospices showed a more marked reduction in utilization than all hospital beds (e.g. -52.5% vs. -19.9% in May 2003 and a slower recovery with a three-month lag. In total, 566 patients were admitted to hospice wards in May/June 2003, in contrast to 818 in May/June 2002. Gender, age and diagnosis distributions did not differ. Conclusion Hospice inpatient utilization in Taiwan was indeed more sensitive to the emerging epidemic than general inpatient utilization. A well-balanced network with seamless continuity of care should be ensured.

Hospice decision making: diagnosis makes a difference.

Science.gov (United States)

Waldrop, Deborah P; Meeker, Mary Ann

2012-10-01

This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM. A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase. Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.

Negotiating the boundary between paid and unpaid hospice workers: a qualitative study of how hospice volunteers understand their work.

Science.gov (United States)

Field-Richards, Sarah E; Arthur, Antony

2012-12-01

To explore the nurse-volunteer relationship in a day hospice. Underpinned by an interpretive approach, face-to-face semistructured interviews were conducted with 12 day hospice volunteers. The nature and dynamics of the relationship between nursing staff and volunteers within the day hospice were characterized by increasing formality and changes in the division of labor, which challenged smooth working relationships. Volunteers see their role as becoming increasingly formalized partly as a response to increasing administrative demands on hospice nurses. The willingness of volunteers to take on new roles is variable. For volunteers to feel secure and valued and working relationships to remain strong, the process of how boundaries between paid and unpaid workers are negotiated needs to be transparent.

Psychological contracts of hospice nurses.

Science.gov (United States)

Jones, Audrey Elizabeth; Sambrook, Sally

2010-12-01

Psychological contracts have been described as individuals' beliefs regarding the obligations, expectations, and contributions that exist between them and their employer. They can be influenced by the organization's culture and philosophy, through human resources policies, and through the employee's personality and characteristics. Owing to the recent economic crisis, hospices in the UK are currently in a transitional phase and are being expected to demonstrate efficiencies that might be more in line with a business model than a health-care environment. This may conflict with the philosophical views of hospice nurses. To support nurses through this transition, it might be helpful to understand the antecedents of hospice nurses' behaviour and how they construct their psychological contracts. Failure to offer adequate support might lead to negative outcomes such as a desire to leave the organisation, poorer quality work, or disruptive behaviour. This study used a modified grounded theory approach involving in-depth interviews to explore the context and content of the psychological contracts of hospice nurses in the UK. Four main themes emerged: the types of psychological contracts formed, how the contracts are formed, their contents, and the breaches and potential violations the nurses perceive.

Symptom Clusters and Quality of Life in Hospice Patients with Cancer

Science.gov (United States)

Omran, Suha; Khader, Yousef; McMillan, Susan

2017-09-27

Background: Symptom control is an important part of palliative care and important to achieve optimal quality of life (QOL). Studies have shown that patients with advanced cancer suffer from diverse and often severe physical and psychological symptoms. The aim is to explore the influence of symptom clusters on QOL among patients with advanced cancer. Materials and Methods: 709 patients with advanced cancer were recruited to participate in a clinical trial focusing on symptom management and QOL. Patients were adults newly admitted to hospice home care in one of two hospices in southwest Florida, who could pass mental status screening. The instruments used for data collection were the Demographic Data Form, Memorial Symptom Assessment Scale (MSAS), and the Hospice Quality of Life Index-14. Results: Exploratory factor analysis and multiple regression were used to identify symptom clusters and their influence on QOL. The results revealed that the participants experienced multiple concurrent symptoms. There were four symptom clusters found among these cancer patients. Individual symptom distress scores that were the strongest predictors of QOL were: feeling pain; dry mouth; feeling drowsy; nausea; difficulty swallowing; worrying and feeling nervous. Conclusions: Patients with advanced cancer reported various concurrent symptoms, and these form symptom clusters of four main categories. The four symptoms clusters have a negative influence on patients’ QOL and required specific care from different members of the hospice healthcare team. The results of this study should be used to guide health care providers’ symptom management. Proper attention to symptom clusters should be the basis for accurate planning of effective interventions to manage the symptom clusters experienced by advanced cancer patients. The health care provider needs to plan ahead for these symptoms and manage any concurrent symptoms for successful promotion of their patient’s QOL. Creative Commons

Correlates and Predictors of Conflict at the End of Life Among Families Enrolled in Hospice.

Science.gov (United States)

Kramer, Betty J; Boelk, Amy Z

2015-08-01

Despite the palliative care mandate to view family as the unit of care, and the high prevalence and detrimental consequences of conflict at the end of life, little research has been conducted with hospice families to understand what contributes to family conflict. Using a recently generated explanatory matrix of family conflict at the end of life, this study sought to identify the correlates and predictors of family conflict. As part of a larger mixed methods cross-sectional study, a 100-item survey was administered to 161 hospice family caregivers enrolled in a Medicare/Medicaid certified non-profit hospice organization located in the Midwest U.S. Although overall levels of conflict were relatively low, 57% of hospice caregivers reported experiencing some family conflict at the end of life. Contextual variables associated with family conflict included a history of family conflict, female gender, younger caregiver age, presence of children in the home, and less advance care planning discussions. Significant main effects in the prediction of family conflict in the final hierarchical multiple regression model included prior family conflict, caregiver age, caregiver gender, advance care planning discussions, family "coming out of the woodwork," communication constraints, and family members asserting control. The model explained 59% of the variance in family conflict. Results support the multidimensional theoretical model of family conflict specifying the importance of the family context, key conditions that set the stage for conflict, and essential contributing factors. Implications for routine assessment and screening to identify families at risk and recommendations for future research are highlighted. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Impact of nutritional status on the quality of life of advanced cancer patients in hospice home care.

Science.gov (United States)

Shahmoradi, Negar; Kandiah, Mirnalini; Peng, Loh Su

2009-01-01

Cancer patients frequently experience malnutrition and this is an important factor in impaired quality of life. This cross-sectional study examined the association between global quality of life and its various subscales with nutritional status among 61 (33 females and 28 males) advanced cancer patients cared for by selected hospices in peninsular Malaysia. The Patient Generated-Subjective Global Assessment (PG-SGA) and the Hospice Quality of Life Index (HQLI) were used to assess nutritional status and quality of life, respectively. Nine (14.7%) patients were well-nourished, 32 (52.5%) were moderately or suspected of being malnourished while 20 (32.8%) of them were severely malnourished. The total HQLI mean score for these patients was 189.9-/+51.7, with possible scores ranging from 0 to 280. The most problem areas in these patients were in the domain of functional well-being and the least problems were found in the social/spiritual domain. PG-SGA scores significantly correlated with total quality of life scores (r2= 0.38, pnutritional status exhibited a lower quality of life. Advanced cancer patients with poor nutritional status have a diminished quality of life. These findings suggest that there is a need for a comprehensive nutritional intervention for improving nutritional status and quality of life in terminally ill cancer patients under hospice care.

Vigilant at the end of life: family advocacy in the nursing home.

Science.gov (United States)

Shield, Renee R; Wetle, Terrie; Teno, Joan; Miller, Susan C; Welch, Lisa C

2010-05-01

Increasing numbers of Americans die in nursing homes. Little is known about the roles and experiences of family members of persons who die in nursing homes. The authors conducted 54 qualitative telephone interviews of close family or friends of individuals who had spent at least 48 hours in the last month of life in a nursing home. Respondents had earlier participated in a national survey that found 587 of 1578 decedents (37.2%) received end-of-life nursing home care. In qualitative interviews respondents described the last year of life, focusing on the nursing home experience. Interviews were analyzed by a multidisciplinary team to identify key themes of areas of concern. An important interview theme revealed families often felt the need to advocate for their dying relative because of low expectations or experiences with poor quality nursing home care. They noted staff members who did not fully inform them about what to expect in the dying process. Respondents reported burden and gratification in care they themselves provided, which sometimes entailed collaboration with staff. Interviews also identified ways hospice care impacted families, including helping to relieve family burden. End-of-life advocacy takes on increased urgency when those close to the dying resident have concerns about basic care and do not understand the dying course. Enhancing communication, preparing families at the end of life, and better understanding of hospice are likely to increase family trust in nursing home care, improve the care of dying residents, and help reduce family burden.

The role of radiotherapy in hospice care

International Nuclear Information System (INIS)

Nishimura, Tetsuo; Sugiyama, Akira; Shimizu, Teppei; Ichinohe, Kenji; Teshima, Takeshi; Kaneko, Masao; Hara, Yoshio; Chihara, Satoshi.

1989-01-01

The aim of palliative radiotherapy for the terminally ill is to improve the quality of the remaining span of life. From November 1982 to September 1987, 69 patients in the Seirei Hospice have been treated with such radiotherapy, and symptomatic relief was obtained in 64% of these patients. Radiotherapy also proved useful in achieving an improvement in their performance status. While the aim of hospice care is not directed towards treatment of the underlying disease, the use of radiotherapy is considered to have an important role in hospice care. (author)

Training and supporting hospice volunteers: a regional survey.

Science.gov (United States)

Lavenburg, Philip; Bernt, Frank M

2012-08-01

We surveyed volunteers from 8 hospices in the Delaware Valley regarding training, perceived needs, and role satisfaction. Results were consistent with previous studies: satisfaction with preservice training and with volunteering was very high; respondents reported feeling very prepared and confident about doing hospice work as a result of their volunteer training. In addition, longer volunteer preservice training was associated with higher levels of overall satisfaction with training; levels of volunteer satisfaction and fulfillment tended to be lower during the first year of volunteering; and participation in volunteer support teams was associated with finding volunteer work rewarding and with feeling a part of the hospice team. Implications for preservice training and ongoing support and education of hospice volunteers are discussed.

SARP: a value-based approach to hospice admissions triage.

Science.gov (United States)

MacDonald, D

1995-01-01

As hospices become established and case referrals increase, many programs are faced with the necessity of instituting waiting lists. Prioritizing cases for order of admission requires a triage method that is rational, fair, and consistent. This article describes the SARP method of hospice admissions triage, which evaluates prospective cases according to seniority, acuity, risk, and political significance. SARP's essential features, operative assumptions, advantages, and limitations are discussed, as well as the core hospice values which underlie its use. The article concludes with a call for trial and evaluation of SARP in other hospice settings.

Death and dying in the US: the barriers to the benefits of palliative and hospice care

Directory of Open Access Journals (Sweden)

Albert J Finestone

2008-09-01

Full Text Available Albert J Finestone, Gail InderwiesSchool of Medicine, Temple University, Philadephia, PA, USAIn August 2006, after a trip to the New Jersey Shore, Peggy was having great difficulty catching her breath. In consultation with her children, Peggy decided that she was ready for hospice care. But, she did not want to relinquish her independence just because shortness of breath and a weakening heart overtook her daily stride. However, a single episode at home had thrown Peggy into crisis. Since Peggy lived alone, hospice care at home presented a host of challenges including safety and how to manage her unstable cardiopulmonary condition. Peggy was an ideal candidate for the hospice’s TeleCare (see box monitoring program which provided a passive monitoring system, a medication dispenser, and vital signs monitoring for blood pressure, weight, and blood oxygen levels. In addition, the hospice authorized routine draws of BNP (beta naturetic peptide and BMP (basic metabolic profi le with GFR (glomerular filtration rate to manage her symptoms aggressively. Medications were adjusted accordingly to maximize quality of life and minimize symptoms. Though some would consider this treatment aggressive, it was the aggressive treatment of Peggy’s symptoms that allowed for an extended quality of life. There was sufficient evidence to support this action based on the concept of risk and reward, especially as there was a minimum of invasive therapies required. In Peggy’s case she went from being homebound and short of breath to living her life up to her final days.

Medicare Hospice Data

Data.gov (United States)

U.S. Department of Health & Human Services — More Medicare beneficiaries are taking advantage of the quality and compassionate care provided through the hospice benefit. As greater numbers of beneficiaries have...

Exploring the dreams of hospice workers.

Science.gov (United States)

Hess, Shirley A; Knox, Sarah; Hill, Clara E; Byers, Tara; Spangler, Patricia

2014-06-01

Nine adults who worked at least 1 year with patients at US hospice centers completed an in-person audiotaped dream session focusing on a dream about a patient. Data were analyzed using consensual qualitative research. Patients were generally manifestly present in participants' dreams, and dreams were typically realistic (i.e., not bizarre). In the dream, the dreamer typically interacted with the patient as a caretaker but was also typically frustrated by an inability to help as fully as desired. Dreams gave dreamers insight into the stress of hospice work, their own fears of death, and inter-/intrapersonal interactions beyond hospice work. Dreamers generally sought to take better care of themselves and find balance in their lives after the dream session. Implications for research and practice are discussed.

Palliative Sedation in Terminal Cancer Patients Admitted to Hospice or Home Care Programs: Does the Setting Matter? Results From a National Multicenter Observational Study.

Science.gov (United States)

Caraceni, Augusto; Speranza, Raffaella; Spoldi, Elio; Ambroset, Cristina Sonia; Canestrari, Stefano; Marinari, Mauro; Marzi, Anna Maria; Orsi, Luciano; Piva, Laura; Rocchi, Mirta; Valenti, Danila; Zeppetella, Gianluigi; Zucco, Furio; Raimondi, Alessandra; Matos, Leonor Vasconcelos; Brunelli, Cinzia

2018-03-13

Few studies regarding palliative sedation (PS) have been carried out in home care (HC) setting. A comparison of PS rate and practices between hospice (HS) and HC is also lacking. Comparing HC and HS settings for PS rate, patient clinical characteristics before and during PS, decision-making process, and clinical aspects of PS. About 38 HC/HS services in Italy participated in a multicenter observational longitudinal study. Consecutive adult cancer patients followed till death during a four-month period and undergoing PS were eligible. Symptom control and level of consciousness were registered every eight hours to death. About 4276 patients were screened, 2894 followed till death, and 531 (18%) underwent PS. PS rate was 15% in HC and 21% in HS (P Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Spirituality and job satisfaction among hospice interdisciplinary team members.

Science.gov (United States)

Clark, Leah; Leedy, Stephen; McDonald, Laurie; Muller, Barbara; Lamb, Cheryl; Mendez, Tracy; Kim, Sehwan; Schonwetter, Ronald

2007-12-01

As a continuing effort to enhance the quality of palliative care for the dying, this study examined (1) the prevalence of spirituality among hospice interdisciplinary team (IDT) members; (2) whether spirituality is related to job satisfaction; and (3) the structural path relationships among four variables: spiritual belief, integration of spirituality at work, self actualization and job satisfaction. The study surveyed 215 hospice IDT members who completed the Jarel Spiritual Well-Being Scale, the Chamiec-Case Spirituality Integration and Job Satisfaction Scales. Multiple regression and structural path modeling methods were applied to explain the path relationships involving all four variables. The IDT members surveyed were: nurses, 46.4%; home health aids, 24.9%; social workers, 17.4%; chaplains, 4.2%; physicians, 2.3%; and other, 4.8%. Ninety-eight percent of the respondents viewed themselves as having spiritual well-being. On a 0-100 scale, IDT staff reported high spiritual belief (mean = 89.4) and they were self-actualizing (mean = 82.6). Most reported high job satisfaction (mean = 79.3) and spiritual integration (mean = 67.9). In multiple regression, spirituality, integration and self-actualization explained 22% of the variation in job satisfaction (R = 0.48; adjusted R(2) = 0.218; df = 3,175; F = 17.2; p = 0.001). Structural path models revealed that job satisfaction is more likely to be realized by a model that transforms one's spirituality into processes of integrating spirituality at work and self actualization (chi(2) = 0.614; df = 1; p = 0.433) than a model that establishes a direct path from spirituality to job satisfaction (chi(2) = 1.65; df = 1; p = 0.199). Hospice IDT member's integration of their spirituality at work and greater self actualization significantly improve job satisfaction.

Racial/Ethnic Perspectives on the Quality of Hospice Care

Science.gov (United States)

Campbell, Cathy L.; Baernholdt, Marianne; Yan, Guofen; Hinton, Ivora D.; Lewis, Erica

2013-01-01

Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents. Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001). PMID:22952128

Dignity, death, and dilemmas: a study of Washington hospices and physician-assisted death.

Science.gov (United States)

Campbell, Courtney S; Black, Margaret A

2014-01-01

The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient's death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Palliative home-based technology from a practitioner's perspective: benefits and disadvantages

Directory of Open Access Journals (Sweden)

Johnston BM

2014-11-01

Full Text Available Bridget M Johnston Sue Ryder Care Centre for the Study of Supportive, Palliative, and End of Life Care, School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK Abstract: This critical review paper explores the concept of palliative home-based technology from a practitioner's perspective. The aim of the critical review was to scope information available from published and unpublished research on the current state of palliative home-based technology, practitioner-focused perspectives, patient-focused perspectives, quality of life, and the implications for clinical practice. Published and unpublished studies were included. An example of one UK patient-centered home-based technology is explored as an exemplar. The evidence suggests that despite the challenges, there are numerous examples of good practice in relation to palliative home-based technology. Improvements in technology mean that telehealth has much to offer people being cared for at home with palliative needs. However, some of the evaluative evidence is limited, and further rigor is needed when evaluating future technology-based solutions innovations. Keywords: technology, telehealth, telemedicine, information technology, palliative care, hospice, terminal illness

Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care.

Science.gov (United States)

Lindley, Lisa C

2017-01-01

Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.

Oncology Social Workers' Attitudes toward Hospice Care and Referral Behavior

Science.gov (United States)

Becker, Janet E.

2004-01-01

Members of the Association of Oncology Social Workers completed a survey, which included the Hospice Philosophy Scale (HPS) assessing the likelihood of the worker referring a terminally ill patient to hospice, background and experience, and demographics. The respondents held overwhelmingly favorable attitudes toward hospice philosophy and care,…

Developing design principles for a Virtual Hospice: improving access to care.

Science.gov (United States)

Taylor, Andrea; French, Tara; Raman, Sneha

2018-03-01

Providing access to hospice services will become increasingly difficult due to the pressures of an ageing population and limited resources. To help address this challenge, a small number of services called Virtual Hospice have been established. This paper presents early-stage design work on a Virtual Hospice to improve access to services provided by a hospice (Highland Hospice) serving a largely remote and rural population in Scotland, UK. The study was structured as a series of Experience Labs with Highland Hospice staff, healthcare professionals and patients. Experience Labs employ a participatory design approach where participants are placed at the centre of the design process, helping to ensure that the resultant service meets their needs. Data from the Experience Labs were analysed using qualitative thematic analysis and design analysis. A number of themes and barriers to accessing Highland Hospice services were identified. In response, an initial set of seven design principles was developed. Design principles are high-level guidelines that are used to improve prioritisation and decision making during the design process by ensuring alignment with research insights. The design principles were piloted with a group of stakeholders and gained positive feedback. The design principles are intended to guide the ongoing development of the Highland Hospice Virtual Hospice. However, the challenges faced by Highland Hospice in delivering services in a largely remote and rural setting are not unique. The design principles, encompassing digital and non-digital guidelines, or the design approach could be applied by other hospices in the UK or overseas. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Occupational stressors and coping as determinants of burnout in female hospice nurses.

Science.gov (United States)

Payne, N

2001-02-01

Stressors, coping and demographic variables were examined as predictors of burnout in a sample of hospice nurses. The study aimed to investigate the level of burnout among hospice nurses; to ascertain which aspects of nursing work were positively or negatively related to burnout; to examine the relative contributions made by these different variables and to suggest individual and organizational interventions to reduce levels of burnout. Eighty-nine female nurses from nine hospices completed a battery of questionnaires comprising the Maslach Burnout Inventory, Nursing Stress Scale, Ways of Coping Scale and a demographic information form. In general, the level of burnout (characterized by high emotional exhaustion, high depersonalization of patients and low personal accomplishment) was found to be low. In multiple regression analyses, 'death and dying', "conflict with staff', 'accepting responsibility' and higher nursing grade contributed to emotional exhaustion. 'Conflict with staff', 'inadequate preparation', 'escape' and reduced 'planful problem-solving' contributed to depersonalization. 'Inadequate preparation', 'escape', reduced 'positive reappraisal' and fewer professional qualifications contributed to lower levels of personal accomplishment. Overall, stressors made the greatest contribution to burnout and demographic factors contributed the least. The importance of not labelling individuals as good and bad 'copers' was discussed, as the effectiveness of a strategy may depend on the situation. It was concluded that the investigation of problem-focused and emotion-focused coping in relation to burnout, was oversimplifying the coping-burnout relationship. Suggestions for stress management included staff training in counselling skills, monitoring staff conflict, implementing stress inoculation training to teach appropriate use of coping skills and finally, monitoring particularly vulnerable groups of hospice staff such as unqualified nursing assistants and

Design and operation of the national home health aide survey: 2007-2008.

Science.gov (United States)

Bercovitz, Anita; Moss, Abigail J; Sengupta, Manisha; Harris-Kojetin, Lauren D; Squillace, Marie R; Emily, Rosenoff; Branden, Laura

2010-03-01

This report provides an overview of the National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides. NHHAS was designed to provide national estimates of home health aides who provided assistance in activities of daily living (ADLs) and were directly employed by agencies that provide home health and/or hospice care. This report discusses the need for and objectives of the survey, the design process, the survey methods, and data availability. METHODS NHHAS, a multistage probability sample survey, was conducted as a supplement to the 2007 National Home and Hospice Care Survey (NHHCS). Agencies providing home health and/or hospice care were sampled, and then aides employed by these agencies were sampled and interviewed by telephone. Survey topics included recruitment, training, job history, family life, client relations, work-related injuries, and demographics. NHHAS was virtually identical to the 2004 National Nursing Assistant Survey of certified nursing assistants employed in sampled nursing homes with minor changes to account for differences in workplace environment and responsibilities. RESULTS From September 2007 to April 2008, interviews were completed with 3,416 aides. A public-use data file that contains the interview responses, sampling weights, and design variables is available. The NHHAS overall response rate weighted by the inverse of the probability of selection was 41 percent. This rate is the product of the weighted first-stage agency response rate of 57 percent (i.e., weighted response rate of 59 percent for agency participation in NHHCS times the weighted response rate of 97 percent for agencies participating in NHHCS that also participated in NHHAS) and the weighted second-stage aide response rate of 72 percent to NHHAS.

Creative ritual in a hospice.

Science.gov (United States)

Roche, J

1994-12-01

St. Peter's Hospice, Albany, NY, is dedicated to meeting the emotional needs of patients, families, and staff. Creative ritual, hospice leaders have found, is a powerful tool that can: Provide an "arena" for healing, affirmation, reconciliation, and celebration Serve as a reminder of the sacred Evoke heartfelt emotion Effect renewal and inspiration Offer an opportunity to cleanse the soul of grief, anger, frustration, or guilt Provide tangible experiences of bonding and interdependence Prevent staff burnout St. Peter's staff show a good deal of imagination and variety in creating rituals. Possible themes include patients' birthdays or wedding anniversaries, religious celebrations, national holidays, and changes of seasons. A lighted candle, bouquet of flowers, or incense burner may be used to give the ritual a focus. Music is often played to help set the tone. Rituals involve a major shift in consciousness. They often allow participants to express feelings it would otherwise be difficult for them to put into words. At St. Peter's, participants may begin to communicate by sharing favorite prayers, poems, photos, or works of art. Or they may make music--the hospice provides the instruments--or pass around a Native American "talking stick." Such methods facilitate the bonding of patients and their families. Particularly important are those rituals which allow patients and estranged family members to reconcile. Others enable patients to acknowledge God-given gifts. Still other rituals are held for staff members, who thereby deal with the anger and sadness their work inevitably brings. For all at St. Peter's Hospice ritual is a source of healing, affirmation, renewal, inspiration, and grace.

Hospital information technology in home care.

Science.gov (United States)

Zhang, Xiao-Ying; Zhang, Pei-Ying

2016-10-01

The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.

Advancing Hospice and Palliative Care Social Work Leadership in Interprofessional Education and Practice.

Science.gov (United States)

Blacker, Susan; Head, Barbara A; Jones, Barbara L; Remke, Stacy S; Supiano, Katherine

2016-01-01

The importance of interprofessional collaboration in achieving high quality outcomes, improving patient quality of life, and decreasing costs has been growing significantly in health care. Palliative care has been viewed as an exemplary model of interprofessional care delivery, yet best practices in both interprofessional education (IPE) and interprofessional practice (IPP) in the field are still developing. So, too, is the leadership of hospice and palliative care social workers within IPE and IPP. Generating evidence regarding best practices that can prepare social work professionals for collaborative practice is essential. Lessons learned from practice experiences of social workers working in hospice and palliative care can inform educational efforts of all professionals. The emergence of interprofessional education and competencies is a development that is relevant to social work practice in this field. Opportunities for hospice and palliative social workers to demonstrate leadership in IPE and IPP are presented in this article.

An exploratory investigation of hospice marketing: How are palliative care providers marketing their services?

Science.gov (United States)

Matthews, Michael; Peters, Cara; Lawson, Stephanie

2017-01-01

Hospice and palliative care is a recent, but fast growing, industry in healthcare. Demographics suggest that hospice care will only increase. The purpose of this article is to examine strategic marketing initiatives hospice organizations currently employ. Data were collected at a hospice regional conference, capturing opinions from hospice organizations located in North and South Carolina. The results show that many hospice organizations do not have a dedicated marketing staff person, have a limited marketing budget, do not fully utilize all strategic planning tools, and have yet to differentiate themselves via branding. Implications of these findings for hospice providers are discussed.

Exploring oral literacy in communication with hospice caregivers.

Science.gov (United States)

Wittenberg-Lyles, Elaine; Goldsmith, Joy; Oliver, Debra Parker; Demiris, George; Kruse, Robin L; Van Stee, Stephanie

2013-11-01

Low oral literacy has been identified as a barrier to pain management for informal caregivers who receive verbal instructions on pain medication and pain protocols. To examine recorded communication between hospice staff and informal caregivers and explore caregiver experiences. Using transcripts of interactions (n = 47), oral literacy features were analyzed by examining the generalized language complexity using the Flesch-Kincaid grading scale and the dialogue interactivity defined by talking turns and interaction time. Means for longitudinal follow-up measures on caregiver anxiety, quality of life, perception of pain management, knowledge and comfort providing pain medication, and satisfaction were examined to explore their relationship to oral literacy. Communication between team members and caregivers averaged a fourth-grade level on the Flesch-Kincaid scale, indicating that communication was easy to understand. Reading ease was associated (r = 0.67, P < 0.05) with caregiver understanding of and comfort with pain management. Perceived barriers to caregiver pain management were lower when sessions had increased use of passive sentences (r = 0.61, P < 0.01), suggesting that passive voice was not an accurate indicator of language complexity. Caregiver understanding and comfort with administering pain medications (r = -0.82, P < 0.01) and caregiver quality of life (r = -0.49, P < 0.05) were negatively correlated with dialogue pace. As the grade level of talk with caregivers and hospice teams increased, associated caregiver anxiety increased. Caregivers with higher anxiety also experienced greater difficulty in understanding pain medication and its management. Specific adjustments that hospice teams can make to improve caregiver experiences are identified. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.

Science.gov (United States)

2010-10-01

... involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of... notifies the hospice if— (i) A significant change in a patient's physical, mental, social, or emotional... illness and related conditions; or (iv) A patient dies. (3) A provision stating that the hospice assumes...

Nurses take center stage in private duty home care.

Science.gov (United States)

Brackett, Nicole

2013-06-01

The Affordable Care Act gives America's largest group of health care providers--nurses--a unique chance to lead in improving outcomes, increasing patient satisfaction, and lowering costs. Nurses' roles continue to grow in settings from hospitals and long-term care facilities to home health and hospice agencies. Nurses are also key players in private duty home care, where they serve as care coordinators for clients. Working directly with doctors, therapists, in-home caregivers, and families, nurses are critical in delivering quality, seamless in-home care.

The hospice volunteer: a person of hospitality.

Science.gov (United States)

Welk, T A

1992-01-01

Volunteers are integral members of the hospice interdisciplinary team. They are distinguished from other members of the team only by role, not by expectation. The distinction is not between "volunteer" and "professional," because every team member is to be professional in the best sense of that word. If a distinction is to be made, it is that some hospice staff members are salaried while others donate their services. Volunteer staff members are expected to be as responsible and accountable as every other member of the team. ALL staff members must realize the importance of taking care of personal needs in order to be able to care for others. Even though the following article deals primarily with the volunteer hospice staff member, the points outlined can just as easily be applied to the salaried staff member.

One big happy family? Interdisciplinary variation in job satisfaction among hospice providers.

Science.gov (United States)

Casarett, David J; Spence, Carol; Haskins, Matthew; Teno, Joan

2011-08-01

Job satisfaction is particularly important in the hospice industry, given the emotional and interpersonal challenges that hospice staff face in providing care to patients near the end of life and their families. However, little is known about the job satisfaction of hospice providers, or about variation in satisfaction among disciplines. Staff at participating hospices completed the Survey of Team Attitudes and Relationships (STAR) using an online user interface. The STAR has 6 domains that comprise 45 items. Results were submitted for 8,495 staff from 177 hospices in 41 states. The mean total score was 28 on a 0-100 scale (range, 0-100; interquartile range, 8-45) and hospice-level scores ranged from 15 to 44. Nonclinical staff (n = 3260) and clinical staff (n = 5235) had similar total scores (28 for both). Among clinical staff, in a mixed effects model adjusting for individual and hospice characteristics, physicians had the highest total scores (adjusted mean 42; 95% confidence interval: 35-46) compared to chaplains (30; 28-33), bereavement coordinators (27; 24-30), nurses' aides (29; 27-33); nurses (26; 28-33), and social workers (25; 23-26). There is significant variation in job satisfaction both among hospices and disciplines.

The significance of lifeworld and the case of hospice.

Science.gov (United States)

Thoresen, Lisbeth; Wyller, Trygve; Heggen, Kristin

2011-08-01

Questions on what it means to live and die well are raised and discussed in the hospice movement. A phenomenological lifeworld perspective may help professionals to be aware of meaningful and important dimensions in the lives of persons close to death. Lifeworld is not an abstract philosophical term, but rather the opposite. Lifeworld is about everyday, common life in all its aspects. In the writings of Cicely Saunders, known as the founder of the modern hospice movement, facets of lifeworld are presented as important elements in caring for dying patients. Palliative care and palliative medicine today are, in many ways, replacing hospices. This represents not only a change in name, but also in the main focus. Hospice care was originally very much about providing support and comfort for, and interactions with the patients. Improved medical knowledge today means improved symptomatic palliation, but also time and resources spent in other ways than before. Observations from a Nordic hospice ward indicate that seriously ill and dying persons spend much time on their own. Different aspects of lifeworld and intersubjectivity in the dying persons' room is presented and discussed.

Hospice and the politics of spirituality.

Science.gov (United States)

Garces-Foley, Kathleen

2006-01-01

Within the hospice literature, spirituality and religion are usually defined in opposition to one another, with religion negatively associated with the external, authoritarian doctrines of Christianity and spirituality positively associated with the free search for truth, meaning, and authenticity. According to survey data, however, most Americans integrate spirituality and traditional religious commitments. The hospice literature is promoting spirituality to its own detriment by alienating potential patients and depriving religious patients of the resources that religious traditions and their affiliated religious communities have to offer.

Use of Compounded Dextromethorphan-Quinidine Suspension for Pseudobulbar Affect in Hospice Patients.

Science.gov (United States)

Wahler, Robert G; Reiman, Alfred T; Schrader, Joshua V

2017-03-01

Pseudobulbar affect (PBA) consists of unprovoked and uncontrollable episodes of laughing and/or crying. In end-of-life situations, PBA symptoms can be especially distressing to family and friends during an already heightened emotional time. Although a commercial product combining dextromethorphan and quinidine (DMQ) is FDA approved for use in PBA, many hospice patients are unable to swallow any solids or semisolids. An alternative formulation for these patients is needed. We present here two cases in which we used a compounded DMQ suspension successfully to treat PBA symptoms in the weeks before the patients' death. A retrospective chart review was completed on the two cases where the DMQ suspension was used. A description of the DMQ suspension formula is described. Both patients were under the care of a hospice program; one in home care and one in a skilled nursing facility. Episodes of PBA symptoms were summarized in a narrative of the patients' symptom relief. Both patients tolerated the administration of the DMQ suspension and there were noted improvements in PBA symptoms. DMQ suspension is an effective alternative for PBA symptoms in patients who cannot swallow oral solid medication.

The evolution of hospice in America: nursing's role in the movement.

Science.gov (United States)

Hoffmann, Rosemary L

2005-07-01

In the current society, many individuals fear death and the feelings of suffering and loneliness that often accompany death. Two visionaries in the United States, Florence Wald and Dr. Elisabeth Kubler-Ross, recognized these fears and planned the nation's first hospice movement in the 1970s. The hospice philosophy continues to prosper in the new millennium. In this article, the founding American hospice's philosophy, types of facilities, standards, health team composition, patient demographics, organizations, reimbursement, and research are compared and contrasted with those of the current hospice movement. Existing issues with the modern movement are also discussed.

Some observations of a psychiatric consultant to a hospice.

Science.gov (United States)

Shanfield, S B

1983-01-01

The experience of a psychiatric consultant to the inpatient and bereavement components of a hospice is reported. The bulk of the consultation is to the hospice staff. Activities of the consultant include attendance at a weekly patient care meeting and patient and staff groups, consultation with the bereavement team and the administrative leadership, and the evaluation of patients. Clarification of the inevitable psychologic problems that arise in dealing with the mostly elderly very ill patients with end-stage cancer as well as with their families is a major function. Many of the problems special to the hospice relate to loss, mourning, and death. Psychiatric diagnostic input has been helpful in the treatment of organic and functional psychiatric disorders including the treatment of the emotional components of pain and disordered grief which is manifest as depression. Consultation is provided to individuals at risk of problems in the bereavement period. The psychiatric consultant to a hospice is helpful in establishing and maintaining a sensitive therapeutic system of care for the patient and family. He provides an important presence and a forum for the discussion of psychologic issues for the staff. In addition, he has an important role in clarifying the psychodynamic issues involved with death, loss, and mourning for the patient, family, and staff. He provides input around the treatment of functional and organic psychiatric problems seen in the patient and family. Such activities require the continuing membership and leadership of a psychiatrist on the hospice team. The hospice is a laboratory for the understanding of death, loss, and mourning. Although they have been the subject of much inquiry, these issues can be studied fruitfully at the hospice because of the accessibility to dying patients and the bereaved, both before and after the death of their loved one (Kubler-Ross, 1970; Parkes, 1972; Schoenberg, Carr, Kutscher, Peretz, and Goldberg, 1974; Jacobs and

Conveying empathy to hospice family caregivers: team responses to caregiver empathic communication.

Science.gov (United States)

Wittenberg-Lyles, Elaine; Debra, Parker Oliver; Demiris, George; Rankin, Anna; Shaunfield, Sara; Kruse, Robin L

2012-10-01

The goal of this study was to explore empathic communication opportunities presented by family caregivers and responses from interdisciplinary hospice team members. Empathic opportunities and hospice team responses were analyzed from bi-weekly web-based videoconferences between family caregivers and hospice teams. The authors coded the data using the Empathic Communication Coding System (ECCS) and identified themes within and among the coded data. Data analysis identified 270 empathic opportunity-team response sequences. Caregivers expressed statements of emotion and decline most frequently. Two-thirds of the hospice team responses were implicit acknowledgements of caregiver statements and only one-third of the team responses were explicit recognitions of caregiver empathic opportunities. Although hospice team members frequently express emotional concerns with family caregivers during one-on-one visits, there is a need for more empathic communication during team meetings that involve caregivers. Hospice clinicians should devote more time to discussing emotional issues with patients and their families to enhance patient-centered hospice care. Further consideration should be given to training clinicians to empathize with patients and family caregivers. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Readily Identifiable Risk Factors of Nursing Home Residents' Oral Hygiene: Dementia, Hospice, and Length of Stay.

Science.gov (United States)

Zimmerman, Sheryl; Austin, Sophie; Cohen, Lauren; Reed, David; Poole, Patricia; Ward, Kimberly; Sloane, Philip D

2017-11-01

The poor oral hygiene of nursing home (NH) residents is a matter of increasing concern, especially because of its relationship with pneumonia and other health events. Because details and related risk factors in this area are scant and providers need to be able to easily identify those residents at most risk, this study comprehensively examined the plaque, gingival, and denture status of NH residents, as well as readily available correlates of those indicators of oral hygiene, including items from the Minimum Data Set (MDS). Oral hygiene assessment and chart abstract conducted on a cross-section of NH residents. NHs in North Carolina (N = 14). NH residents (N = 506). Descriptive data from the MDS and assessments using three standardized measures: the Plaque Index for Long-Term Care (PI-LTC), the Gingival Index for Long-Term Care (GI-LTC), and the Denture Plaque Index (DPI). Oral hygiene scores averaged 1.7 (of 3) for the PI-LTC, 1.5 (of 4) for the GI-LTC, and 2.2 (of 4) for the DPI. Factors most strongly associated with poor oral hygiene scores included having dementia, being on hospice care, and longer stay. MDS ratings of gingivitis differed significantly from oral hygiene assessments. The findings identify resident subgroups at especially high risk of poor oral health who can be targeted in quality improvement efforts related to oral hygiene; they also indicate need to improve the accuracy of how MDS items are completed. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

76 FR 26805 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

Science.gov (United States)

2011-05-09

..., and hospices in low-wage index areas are unfairly advantaged. The commenter felt that our not wage... Medicare & Medicaid Services 42 CFR Part 418 Medicare Program; Hospice Wage Index for Fiscal Year 2012... [CMS-1355-P] RIN 0938-AQ31 Medicare Program; Hospice Wage Index for Fiscal Year 2012 AGENCY: Centers...

Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study.

Science.gov (United States)

Oud, Lavi

2017-01-01

following further escalation of care to ICU. Together these findings can inform system- and clinician-level interventions to facilitate timely and consistent use of hospice to meet patients' goals of care.

Escalating energy costs threaten health care for critically ill and homebound seniors: home care nurses, aides and therapists drive 4.8 billion miles per year to reach shut-in patients.

Science.gov (United States)

2008-08-01

The rapidly rising cost of fuel has had a profound impact on the home care and hospice industry. In an effort to quantify the increased burden, the National Association for Home Care & Hospice's (NAHC) Foundation for Hospice and Home Care conducted a study showing that home care and hospice providers drive over 5 billion miles per year to deliver services --about two-and-a-half times the number driven by United Parcel Service, the international delivery service. The findings garnered significant interest by the media and elected officials. Reprinted in this issue of CARING Magazine are the press release that NAHC issued regarding the study, as well as a graphic representation of the study's findings that was circulated to the National Conference of State Legislatures at its most recent meeting in July. Also represented on these pages is a reprint from the Congressional Record of July 11, 2008, in which Senator Debbie Stabenow (D-MI), one of the highest ranking Democrats in the US. Senate, entered into the record an article from the front page of the New York Times of July 5, 2008, that covered the mileage study.

The experiences of Batswana families regarding hospice care of ...

African Journals Online (AJOL)

M. F. Makhele & F. M. Mulaudzi * Fhumulani Mavis Mulaudzi is an associate professor and Head of Department at the University of Pretoria. She has published widely on Indigenous knowledge system. She received South African Women in Science award in 2011 for indigenous knowledge system. mavis.mulaudzi@up.ac.za

2012-06-20

Jun 20, 2012 ... The Batswana had mixed feelings about hospice care, because their beliefs on patient care .... Family-centred care is a core value of the Batswana. Although ... HIV/AIDS has adversely affected the socio-economic status of many countries ... The construction of these hospices evoked mixed feelings among.

"I'm not trying to be cured, so there's not much he can do for me": hospice patients' constructions of hospice's holistic care approach in a biomedical culture.

Science.gov (United States)

Pederson, Sarah Nebel; Emmers-Sommer, Tara M

2012-01-01

The hospice philosophy was founded on a mission to provide comprehensive and holistic services to individuals at the end of life. Hospice interdisciplinary teams work together to offer therapies such as spiritual services, comfort care, and massage therapy to meet patients' physical, psychological, emotional, and spiritual needs. Although the hospice philosophy is guided toward patient-centered care, limited research has examined how patients understand holistic care services. Through a social constructionist lens and qualitative interviews, we examined hospice patients' understandings of holistic care and argue that these perceptions of care are constructed through the biomedical model of medicine.

Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey.

Science.gov (United States)

Stone, Robyn; Wilhelm, Jess; Bishop, Christine E; Bryant, Natasha S; Hermer, Linda; Squillace, Marie R

2017-10-01

To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies. Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics. Job satisfaction, consistent patient assignment, and provision of health insurance were associated with lower intent to leave the job. By contrast, being assigned insufficient work hours and on-the-job injuries were associated with greater intent to leave the job after controlling for fixed worker, agency, and labor market characteristics. African American workers and workers with a higher household income also expressed greater intent to leave the job. This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice".

Science.gov (United States)

Dai, Ying-Xiu; Chen, Tzeng-Ji; Lin, Ming-Hwai

2017-01-01

The term "palliative care" has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term "supportive care" instead of "palliative care" in naming palliative care units has been proposed in several studies. In Taiwan, terms other than "palliative" and "hospice" are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms "palliative" and "hospice" in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms "palliative" and "hospice" in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term "palliative," while 25.2% (n = 14) included the term "hospice." Religiously affiliated hospitals were less likely to use the terms "palliative" and "hospice" (χ 2 = 11.461, P = .001). There was also a lower prevalence of use of the terms "palliative" and "hospice" for naming palliative care units in private hospitals than in public hospitals (χ 2 = 4.61, P = .032). This finding highlights the strong stigma attached to the terms "palliative" and "hospice" in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

[Experience of Spiritual Conflict in Hospice Nurses: A Phenomenological Study].

Science.gov (United States)

Lee, Byoung Sook; Kwak, Su Young

2017-02-01

This aim of this phenomenological study was to describe and understand the experience of spiritual conflict in hospice nurses by identifying the meanings and structures of the experience. Participants were 12 nurses working for one year or more at hospice units of general hospitals in a metropolitan city and experiencing of spiritual conflict as hospice nurses. Over six months data were collected using individual in-depth interviews and analyzed with the method suggested by Colaizzi. The experience of spiritual conflict in participants was organized into three categories, six theme-clusters, and 13 themes. The participants felt existential anxiety on death and a fear of death which is out of human control and skepticism for real facts of human beings facing death. They also experienced agitation of fundamental beliefs about life with agitation of the philosophy of life guiding themselves and mental distress due to fundamental questions that are difficult to answer. Also they had distress about poor spiritual care with guilty feelings from neglecting patients' spiritual needs and difficulties in spiritual care due to lack of practical competencies. Findings indicate the experience of spiritual conflict in hospice nurses is mainly associated with frequent experience of death in hospice patients. The experience of spiritual conflict consisted of existential anxiety, agitation of fundamental beliefs and distress over poor spiritual care. So, programs to help relieve anxiety, agitation and distress are necessary to prevent spiritual conflict and then spiritual burnout in hospice nurses. © 2017 Korean Society of Nursing Science

The effects of hospice-shared care for gastric cancer patients.

Science.gov (United States)

Huang, Kun-Siang; Wang, Shih-Ho; Chuah, Seng-Kee; Rau, Kun-Ming; Lin, Yu-Hung; Hsieh, Meng-Che; Shih, Li-Hsueh; Chen, Yen-Hao

2017-01-01

Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients. A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81). Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, pgastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.

78 FR 45205 - Agency Information Collection Activities: Proposed Collection; Comment Request

Science.gov (United States)

2013-07-26

... ``test innovative payment and service delivery models to reduce program expenditures. . .while preserving... facilities, home health agencies, providers of home health care, hospices, religious nonmedical health care...) and Supporting Regulations [[Page 45206

Music Therapy is Associated With Family Perception of More Spiritual Support and Decreased Breathing Problems in Cancer Patients Receiving Hospice Care.

Science.gov (United States)

Burns, Debra S; Perkins, Susan M; Tong, Yan; Hilliard, Russell E; Cripe, Larry D

2015-08-01

Music therapy is a common discretionary service offered within hospice; however, there are critical gaps in understanding the effects of music therapy on hospice quality indicators, such as family satisfaction with care. The purpose of this study was to examine whether music therapy affected family perception of patients' symptoms and family satisfaction with hospice care. This was a retrospective, cross-sectional analysis of electronic medical records from 10,534 cancer patients cared for between 2006 and 2010 by a large national hospice. Logistic regression was used to estimate the effect of music therapy using propensity scores to adjust for non-random assignment. Overall, those receiving music therapy had higher odds of being female, having longer lengths of stay, and receiving more services other than music therapy, and lower odds of being married/partnered or receiving home care. Family satisfaction data were available for 1495 (14%) and were more likely available if the patient received music therapy (16% vs. 12%, P music therapy vs. those not. Patients who received music therapy were more likely to report discussions about spirituality (odds ratio [OR] = 1.59, P = 0.01), had marginally less trouble breathing (OR = 0.77, P = 0.06), and were marginally more likely to receive the right amount of spiritual support (OR = 1.59, P = 0.06). Music therapy was associated with perceptions of meaningful spiritual support and less trouble breathing. The results provide preliminary data for a prospective trial to optimize music therapy interventions for integration into clinical practice. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Personality characteristics of hospice volunteers as measured by Myers-Briggs Type Indicator.

Science.gov (United States)

Mitchell, C W; Shuff, I M

1995-12-01

A sample of hospice volunteers (n = 99) was administered the Myers-Briggs Type Indicator (Myers & McCaulley, 1985). Frequencies of types observed were compared to population sample (n = 1,105) frequencies. Results indicated that, as a whole, hospice volunteers preferred extraversion over introversion, intuition over sensing, and feeling over thinking. Analysis of four-and two-letter preference combinations also yielded statistically significant differences. Most notably, the sensing-intuitive function appeared pivotal in determining of hospice volunteering. Suggestions are offered as to why the sensing-intuition function appeared central to hospice volunteering. Results appeared consistent with Jungian personality theory.

Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

Science.gov (United States)

Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C

2015-08-01

This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

Attitudes and knowledge of Iranian nurses about hospice care

Directory of Open Access Journals (Sweden)

Saber Azami-Aghdash

2015-01-01

Full Text Available Context: Due to expansion of chronic diseases and increase of health care costs, there is a need for planning and delivering hospice care for patients in their final stages of life in Iran. The aim of the present study is to investigate the knowledge and attitudes of nurses about delivering hospice care for End of Life (EOL patients. Materials and Methods: This cross-sectional study was conducted in 2012 with a sample size of 200 nurses that were selected by convenient (available sampling. The data collection instrument was a self-administered questionnaire whose validity was approved by experts′ opinions and its reliability was approved by test-retest method. Results : Among all participants of this study, 87% were female. The mean age of nurses was 32.00 ± 6.72. From all respondents 62% stated that they have no knowledge about hospice care and 80% declared that need for hospice care is increasing. Most of the participants felt that, appropriate services are not presented to patients in the final stages of their lives. About 80% believed that hospice care leads to reduction of health care costs, improvement of physical, mental and social health of patients and finally improvement of the quality of health care services. There was a significant relationship between age, employment history and level of education of nurses and their attitude and knowledge about how this service is provided. Conclusion : In view of the increase in chronic illnesses and the costs of caring, the need for provision of hospice care is felt more and more every day. However the awareness level of nurses about these services is low. Therefore the need for including these issues in nursing curriculum and holding scientific courses and seminars in this field is needed.

The volunteer program in a Children's Hospice.

Science.gov (United States)

Duggal, Shalu; Farah, Peggy; Straatman, Lynn Patricia; Freeman, Leanne; Dickson, Susan

2008-09-01

Canuck Place Children's Hospice (CPCH) is regarded as one of the leading pediatric palliative care systems in the world. Since 1995, it has been providing hospice care free of charge to children and their families living with life-threatening conditions. The pediatric palliative hospice is a relatively new practice in health care, in comparison to the longstanding adult model. As a result, development and implementation of volunteer programs in pediatric hospices is not currently represented in literature. With over 300 volunteers at present, CPCH has built a successful program that can serve as a model in pediatric volunteer services. To present the unique volunteer roles and experience at CPCH, and share ways volunteers work to support the efforts of the clinical team. Strategies to address current challenges in the volunteer program are also addressed. Descriptive design. A current CPCH volunteer discusses the volunteer program. Interviews were conducted with the founding volunteer director of CPCH and current volunteers. The volunteer program at CPCH fully embraces the life of each child and family. Volunteer selection is the groundwork for ensuring a cohesive work force, while training equips volunteers with the knowledge to carry out their role with confidence. Areas of improvement that have been recognized include offering effective feedback to volunteers and delivering adequate level of training for non-direct care roles. The talents of volunteers at CPCH are diverse, and CPCH aims to recognize and thank volunteers for their continuous contributions.

Impact of specialist home-based palliative care services in a tertiary oncology set up: a prospective non-randomized observational study.

Science.gov (United States)

Dhiliwal, Sunil R; Muckaden, Maryann

2015-01-01

Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission. Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters. Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes. Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction.

Residential hospice environments: evidence-based architectural and landscape design considerations.

Science.gov (United States)

Verderber, Stephen

2014-01-01

The residential hospice care movement is increasingly accepted and supported globally, and yet, unfortunately, the amount of literature on best practices in the planning and design of residential hospice facilities and adjacent outdoor spaces remains relatively small. This paper reports on a compendium of architectural and landscape design considerations that reflect the fundamental dimensions of the residential hospice experience: site and context, arrival spaces, communal and private spaces of the residential milieu, transitional spaces, and nature connectivity. Additionally, key staffing and administrative ramifications of this built-environment compendium are addressed, as are prognostications and challenges for the future.

Factors Associated with Attitude and Knowledge Toward Hospice Palliative Care Among Medical Caregivers

Directory of Open Access Journals (Sweden)

Shih-Yi Lee

2015-06-01

Conclusion: Life and work experience improve the accuracy of medical staff in providing hospice palliative care. A culture-based, case-oriented continuing education program and a timely revision of the Hospice Palliative Care Article are recommended to increase the consistency between the principle and the practice of hospice palliative care.

A Military Hospice Model

Science.gov (United States)

1983-05-06

the medical director of the hospice might find necessary in the manangement of an individual case. If, for instance, the patient required speech...patients to go through the classical five stages of death: denial, rage or 40 anger, bargaining, depression and finally acceptance. In this task the social

Hospice in a zoologic medicine setting.

Science.gov (United States)

Jessup, David A; Scott, Cheryl A

2011-06-01

Forty years ago, Dr. Elizabeth Kubler-Ross in her landmark book On death and dying observed "maybe at the end of our days, when we have worked and given, enjoyed ourselves and suffered, we are going back to the stage that we started out with and the circle of life is closed." Just as human life expectancy has steadily increased over the last 4 or 5 decades, animal life expectancy has increased, including that of zoologic species. With this has come a need for humans to openly and frankly deal with end-of-life issues for themselves and for their animals, including those in zoos. By necessity, zoos have been dealing with problems such as aggressive pain management and triage, and efforts to incorporate end-of-life care into zoologic medicine. But these efforts have yet to include formal acknowledgment that they are a basic form of hospice. Hospice for humans, and now for companion animals, includes much more than pain relief and geriatric care. This article reviews the concepts and basic practices of hospice and the closely related field of palliative care, their relatively recent application to companion animal care, potential applications to zoologic medicine, and the ways this could provide opportunities for personal growth of zoo visitors and staff, including veterinary staff.

Understanding the association between employee satisfaction and family perceptions of the quality of care in hospice service delivery.

Science.gov (United States)

York, Grady S; Jones, Janet L; Churchman, Richard

2009-11-01

Families often draw their conclusions about the quality of care received by a family member during the last months of life from their interactions with professional caregivers. A more comprehensive understanding of how these relationships influence the care experience should include an investigation of the association between employee job satisfaction and family perception of the quality of care. This cross-sectional study investigated the association at a regional hospice. Using the Kendall's tau correlation, employee satisfaction scores for care teams trended toward a positive correlation with family overall satisfaction scores from the Family Evaluation of Hospice Care (tau=0.47, P=0.10). A trend for differences in employee satisfaction between the care teams to associate with differences in overall family perceptions of the quality of care also was found using the Kruskal-Wallis analysis of variance (chi(2)(K-W)=9.236, P=0.075). Post hoc tests indicated that overall family perceptions of quality of care differed between the hospice's Residence Team and Non-Hospice Facilities Team. Finally, positive associations between employee satisfaction and the families' Intent to recommend hospice (tau=0.55, P=0.059) and Inform and communicate about patient (tau=0.55, P=0.059) were noted. Selected employee and family comments provide complementarity to further clarify or explain the respondent data. These results suggest that employee satisfaction is associated with family perceptions of the quality of hospice care. Opportunities for improving both employee job satisfaction and family perceptions of the quality of care are discussed.

A multimethod analysis of shared decision-making in hospice interdisciplinary team meetings including family caregivers.

Science.gov (United States)

Washington, Karla T; Oliver, Debra Parker; Gage, L Ashley; Albright, David L; Demiris, George

2016-03-01

Much of the existing research on shared decision-making in hospice and palliative care focuses on the provider-patient dyad; little is known about shared decision-making that is inclusive of family members of patients with advanced disease. We sought to describe shared decision-making as it occurred in hospice interdisciplinary team meetings that included family caregivers as participants using video-conferencing technology. We conducted a multimethod study in which we used content and thematic analysis techniques to analyze video-recordings of hospice interdisciplinary team meetings (n = 100), individual interviews of family caregivers (n = 73) and hospice staff members (n = 78), and research field notes. Participants in the original studies from which data for this analysis were drawn were hospice family caregivers and staff members employed by one of five different community-based hospice agencies located in the Midwestern United States. Shared decision-making occurred infrequently in hospice interdisciplinary team meetings that included family caregivers. Barriers to shared decision-making included time constraints, communication skill deficits, unaddressed emotional needs, staff absences, and unclear role expectations. The hospice philosophy of care, current trends in healthcare delivery, the interdisciplinary nature of hospice teams, and the designation of a team leader/facilitator supported shared decision-making. The involvement of family caregivers in hospice interdisciplinary team meetings using video-conferencing technology creates a useful platform for shared decision-making; however, steps must be taken to transform family caregivers from meeting attendees to shared decision-makers. © The Author(s) 2015.

Advance Directives in Hospice Healthcare Providers: A Clinical Challenge.

Science.gov (United States)

Luck, George R; Eggenberger, Terry; Newman, David; Cortizo, Jacqueline; Blankenship, Derek C; Hennekens, Charles H

2017-11-01

On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are no data concerning the prevalence of advance directives among hospice healthcare providers. We therefore explored the prevalence and factors influencing completion rates in a survey of hospice healthcare providers. Surveys that included 32 items to explore completion rates, as well as barriers, knowledge, and demographics, were e-mailed to 2097 healthcare providers, including employees and volunteers, at a nonprofit hospice. Of 890 respondents, 44% reported having completed an advance directive. Ethnicity, age, relationship status, and perceived knowledge were all significant factors influencing the completion rates, whereas years of experience or working directly with patients had no effect. Procrastination, fear of the subject, and costs were common reasons reported as barriers. Upon completion of the survey, 43% said they will now complete an advance directive, and 45% will talk to patients and families about their wishes. The majority of hospice healthcare providers have not completed an advance directive. These results are very similar to those for other healthcare providers treating patients with terminal diseases, specifically oncologists. Because, at completion, 43% said that they would now complete an advance directive, such a survey of healthcare providers may help increase completion rates. Copyright © 2017 Elsevier Inc. All rights reserved.

The case of Mr. Martinez: ethical conflicts in home care.

Science.gov (United States)

Green, M V

1997-06-01

Mr. Martinez recently was accepted into the Valley Hospice Program with a diagnosis of end-stage lung cancer. He currently lives with his daughter, Amelia, after moving from Puerto Rico 2 years ago after his wife died. His two sons and another daughter live within 20 minutes of Amelia's home. They are a close-knit family, and the children are committed to honoring Martinez' wishes to die in his room in Amelia's home.

Proportion and Patterns of Hospice Discharges in Medicare Advantage Compared to Medicare Fee-for-Service.

Science.gov (United States)

Teno, Joan M; Christian, Thomas J; Gozalo, Pedro; Plotzke, Michael

2018-03-01

When Medicare Advantage (MA) patients elect hospice, all covered services are reimbursed under the Medicare fee-for-service (FFS) program. This financial arrangement may incentivize MA plans to refer persons to hospice near end of life when costs of care typically rise. To characterize hospice discharge patterns for MA versus FFS patients and examine whether patterns differ by MA concentration across hospital referral regions (HRRs). The rate and pattern of live discharges and length of stay (LOS) between FFS and MA patients were examined. A multivariate mixed-effects model examined whether hospice patients in MA versus FFS had differential patterns of discharges. In addition, we tested whether concentrations of MA hospice patients in a patient's HRR were associated with different patterns of discharges. In fiscal year 2014, there were 1,199,533 hospice discharges with 331,142 MA patients having a slightly higher live discharge rate (15.8%) compared to 868,391 FFS hospice discharges (15.4%). After controlling for patient characteristics, the adjusted odds ratio (AOR) was 1.01 (95% CI 0.99-1.02). MA patients were less likely to have early live discharges (AOR 0.87 95% CI 0.84-0.91) and burdensome transitions (AOR 0.61 95% CI 0.58-0.64) but did not differ in live discharges post 210 days. Among hospice deaths, MA hospice patients were less likely to have a three-day or less LOS (AOR 0.95 95% 0.94-0.96) and a LOS exceeding 180 days (AOR 0.97 95% 0.96-0.99). The concentration of MA patients in a HRR had minimal impact. MA hospice patients' discharge patterns raised less concerns than FFS.

Implementing the first regional hospice palliative care program in Ontario: the Champlain region as a case study.

Science.gov (United States)

Pereira, José; Contant, Jocelyne; Barton, Gwen; Klinger, Christopher

2016-07-26

Regionalization promotes planning and coordination of services across settings and providers to meet population needs. Despite the potential advantages of regionalization, no regional hospice palliative care program existed in Ontario, Canada, as of 2010. This paper describes the process and early results of the development of the first regional hospice palliative care program in Ontario. The various activities and processes undertaken and the formal agreements, policies and documents are described. A participative approach, started in April 2009, was used. It brought together over 26 health service providers, including residential hospices, a palliative care unit, community and hospital specialist consultation teams, hospitals, community health and social service agencies (including nursing), individual health professionals, volunteers, patients and families. An extensive stakeholder and community vetting process was undertaken that included work groups (to explore key areas such as home care, the hospital sector, hospice and palliative care unit beds, provision of care in rural settings, e-health and education), a steering committee and input from over 320 individuals via e-mail and town-halls. A Transitional Leadership Group was elected to steer the implementation of the Regional Program over the summer of 2010. This group established the by-laws and details regarding the governance structure of the Regional Program, including its role, responsibilities, reporting structures and initial performance indicators that the Local Health Integration Network (LHIN) approved. The Regional Program was formally established in November 2010 with a competency-based Board of 14 elected members to oversee the program. Early work involved establishing standards and performance indicators for the different sectors and settings in the region, and identifying key clinical needs such as the establishment of more residential hospice capacity in Ottawa and a rural framework to ensure

The home health workforce: a distinction between worker categories.

Science.gov (United States)

Stone, Robyn; Sutton, Janet P; Bryant, Natasha; Adams, Annelise; Squillace, Marie

2013-01-01

The demand for home health aides is expected to rise, despite concerns about the sustainability of this workforce. Home health workers receive low wages and little training and have high turnover. It is difficult to recruit and retain workers to improve clinical outcomes. This study presents national estimates to examine how home health workers and the subgroup of workers differ in terms of sociodemographic characteristics, compensation, benefits, satisfaction, and retention. Hospice aides fare better than other categories of workers and are less likely to leave their job. Policymakers should consider strategies to increase the quality and stability of this workforce.

Challenges and Strategies for Hospice Caregivers: A Qualitative Analysis.

Science.gov (United States)

Oliver, Debra Parker; Demiris, George; Washington, Karla T; Clark, Carlyn; Thomas-Jones, Deborah

2017-08-01

Family caregivers of hospice patients are responsible for the day-to-day care of their loved ones during the final months of life. They are faced with numerous challenges. The purpose of this study was to understand the challenges and coping strategies used by hospice caregivers as they care for their family members. This study is a secondary analysis of data from an attention control group in a large randomized controlled trial testing a cognitive behavioral intervention with hospice caregivers. Audiotaped interviews were coded with initial themes and combined into final categories of caregiving challenges and strategies for managing the hospice caregiving experience. Caregivers shared narratives discussing challenges that included their frustrations with patient care issues, emotional challenges, frustrations with various health care systems, financial problems, and personal health concerns. They also discussed coping strategies involving patient care, self-care, and emotional support. The coping techniques were both problem and emotion based. There is a need for interventions that focus on strengthening both problem-based and emotional-based coping skills to improve the caregiving experience. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Issues Faced by Family Caregivers of Hospice Patients with Head and Neck Cancers.

Science.gov (United States)

McMillan, Susan C; Rodriguez, Carmen; Wang, Hsiao-Lan; Elliott, Amanda

2015-01-01

The purpose of this study was to explore issues reported by caregivers of Head and Neck cancer (HNC) patients newly admitted to hospice homecare. 26 caregivers providing hospice homecare to patients with HNC were induded. Caregiver depressive symptoms, social support and perceived health data were analyzed. The caregivers reported few depressive symptoms, good perceived social support, and good perceived health; however, there was large variation in the group with some individuals having significant problems. Caregivers appeared to be doing well physically, emotionally and socially, but baseline data were used, so follow-up data are needed. Further research is warranted. Family caregivers also are affected by the experience of cancer and may have depressive symptoms needing assessment and management. Hospice patients with HNC have a variety of symptoms specific to their disease and treatment that need assessment and management by their family caregivers. Caregivers of HNC patients in hospice and palliative care need and deserve attention from hospice providers as they care for patients.

A self-care plan for hospice workers.

Science.gov (United States)

Jones, Sally Hill

2005-01-01

Caring for dying patients and their families is a fulfilling, enriching, and meaningful experience. It can also be extremely stressful. Maintaining the balance between the output and input of energy in a caregiver's professional and personal life is an ongoing process. Clinical staff members often formulate plans of care for patients. To prevent worker burnout, hospice caregivers must develop a plan of self-care to balance their own needs with the needs of their patients. The goal of this article is to provide an overview of ways for hospice caregivers to relieve stress and develop an individualized self-care plan within the context of their work.

German Version of the Inventory of Motivations for Hospice Palliative Care Volunteerism: Are There Gender Differences?

Science.gov (United States)

Stelzer, Eva-Maria; Lang, Frieder R; Hörl, Melanie; Kamin, Stefan T; Claxton-Oldfield, Stephen

2018-02-01

The present study examined gender differences in motivations for volunteering for hospice using a German version of the Inventory of Motivations for Hospice Palliative Care Volunteerism (IMHPCV). The IMHPCV was translated into German and back-translated into English following the World Health Organization's guidelines for the translation and adaptation of instruments. In an online survey, 599 female and 127 male hospice volunteers from hospice organizations throughout Germany completed the translated version of the IMHPCV, the Scales of the Attitude Structure of Volunteers as well as questions pertaining to their volunteer experience. Based on an exploratory structural equation modeling approach, adequate model fit was found for the expected factor structure of the German version of the IMHPCV. The IMHPCV showed adequate internal consistency and construct validity. Both female and male hospice volunteers found altruistic motives and humanitarian concerns most influential in their decision to volunteer for hospice. Personal gain was least influential. Men rated self-promotion, civic responsibility, and leisure as more important than women. Analyses provided support for the use of the IMHPCV as a measurement tool to assess motivations to volunteer for hospice. Implications for recruitment and retention of hospice volunteers, in particular males, are given.

Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

Science.gov (United States)

Taylor, Donald H; Bhavsar, Nrupen A; Bull, Janet H; Kassner, Cordt T; Olson, Andrew; Boucher, Nathan A

2018-05-01

On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life. To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure. Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis. All age-eligible Medicare decedents who received care and died in North Carolina in calendar years 2009 and 2010. Costs to Medicare for hospice and other healthcare services. Medicare costs were reduced from hospice election until death using both 2009-2010 and new 2016 payment structures and rates. Mean cost savings were $1,527 with actual payment rates, and would have been $2,105 with the new payment rates (p payment rate change. Cost savings were found for all primary diagnoses analyzed except dementia.

Internship report on palliative care at St Catherine's hospice

OpenAIRE

Monteiro, Andreia Marlene da Silva

2016-01-01

This report, performed in the context of the completion of the masters in Palliative Care, presents the activities and learning experiences that I have acquired during the months of training in the different settings of palliative care. This internship was performed at St Catherine’s Hospice (Inpatient unit, Day hospice and Community team) and with the National Health Service of East Surrey Hospital Specialist Palliative Care Team. Alongside the institutional involvement, internship activitie...

Environmental impacts of informal settlements with second homes (vacation homes. A case study: Apuseni Nature Park.

Directory of Open Access Journals (Sweden)

OANA ALEXANDRA CIUPE

2017-10-01

Full Text Available The past decades has seen the rapid development of second homes in many country of the world. Therefore, secondary dwellings used for tourism-related purposes (vacation homes or second homes are a reality that becomes more pronounced and visible at both nationally and internationally level. However, the rapidity and the novelty of the phenomenon creates difficulties in terms of efficient management and suitable integration in spatial planning and urbanism plans, favoring - in a negative way - expanding of build-up areas (with second homes in a chaotic way. Since there has been no detailed investigation of second homes tourism from the perspective of informal settlements, this article follows a case-study design, with in-depth analysis of informal settlements with vacation homes found in Apuseni Nature Park. Based on long-term field research, will be exemplified 4 types of informal settlements with second homes (vacation homes identified in the case study. The aim of this paper is to critically analyse the effects of informal settlements with vacation homes on the natural environment.

In the business of dying: questioning the commercialization of hospice.

Science.gov (United States)

Perry, Joshua E; Stone, Robert C

2011-01-01

This article critically questions the commercialization of hospice care and the ethical concerns associated with the industry's movement toward "market-driven medicine" at the end of life. For example, the article examines issues raised by an influx of for-profit hospice providers whose business model appears at its core to have an ethical conflict of interest between shareholders doing well and terminal patients dying well. Yet, empirical data analyzing the experience of patients across the hospice industry are limited, and general claims that end-of-life patient care is inferior among for-profit providers or even that their business practices are somehow unseemly when compared to nonprofit providers cannot be substantiated. In fact, non-profit providers are not immune to potentially conflicting concerns regarding financial viability (i.e., "no margin, no mission"). Given the limitations of existing empirical data and contrasting ideological commitments of for-profit versus non-profit providers, the questions raised by this article highlight important areas for reflection and further study. Policymakers and regulators are cautioned to keep ethical concerns in the fore as an increasingly commercialized hospice industry continues to emerge as a dominant component of the U.S. health care system. Both practitioners and researchers are encouraged to expand their efforts to better understand how business practices and commercial interests may compromise the death process of the patient and patient's family--a process premised upon a philosophy and ethical tradition that earlier generations of hospice providers and proponents established as a trusted, end-of-life alternative. © 2011 American Society of Law, Medicine & Ethics, Inc.

The Hospice: An Integrated Bibliography.

Science.gov (United States)

Bodine, George E.; Sobotor, William

This extensive bibliography of books and articles provides an interdisciplinary overview of present day terminal care and the hospice alternative. Designed to aid in the development and implementation of terminal care programs stressing palliative and supportive services for both patients and their families, the bibliography includes abstracts of…

Euthanasia from the perspective of hospice care.

Science.gov (United States)

Gillett, G

1994-01-01

The hospice believes in the concept of a gentle and harmonious death. In most hospice settings there is also a rejection of active euthanasia. This set of two apparently conflicting principles can be defended on the basis of two arguments. The first is that doctors should not foster the intent to kill as part of their moral and clinical character. This allows proper sensitivity to the complex and difficult situation that arises in many of the most difficult terminal care situations. The second argument turns on the seduction of technological solutions to human problems and the slippery slope that may arise in the presence of a quick and convenient way of dealing with problems of death and dying.

Pain management in the nursing home.

Science.gov (United States)

Dumas, Linda G; Ramadurai, Murali

2009-06-01

This article is about pain management and some of the best practices to address the problem of pain in nursing home patients who have a serious illness and multiple comorbid conditions. Management of the emotional distress that accompanies chronic or acute pain is of foremost concern. In this article, the topics discussed include general pain management in a nursing home for a long-term care resident who has chronic pain, the relief of symptoms and suffering in a patient who is on palliative care and hospice, and the pain management of a postoperative patient with acute pain for a short transitional period (post-acute illness or surgery).

The significance of lifeworld and the case of hospice

OpenAIRE

Thoresen, Lisbeth; Wyller, Trygve; Heggen, Kristin

2010-01-01

Questions on what it means to live and die well are raised and discussed in the hospice movement. A phenomenological lifeworld perspective may help professionals to be aware of meaningful and important dimensions in the lives of persons close to death. Lifeworld is not an abstract philosophical term, but rather the opposite. Lifeworld is about everyday, common life in all its aspects. In the writings of Cicely Saunders, known as the founder of the modern hospice movement, facets of lifeworld ...

Competition, information, and quality: Evidence from nursing homes.

Science.gov (United States)

Zhao, Xin

2016-09-01

Economic theory suggests that competition and information can both be important for product quality, and yet evidence on how they may interact to affect quality is sparse. This paper estimates the impact of competition between nursing homes on their quality, and how this impact varies when consumers have better access to information. The effect of competition is identified using exogenous variation in the geographical proximity of nursing homes to their potential consumers. The change in information transparency is captured by the launch of the Five-Star Quality Rating System in 2009, which improved access to the quality information of nursing homes. We find that while the effect of competition on nursing home quality is generally rather limited, this effect becomes significantly stronger with increased information transparency. The results suggest that regulations on public quality reporting and on market structure are policy complements, and should be considered jointly to best improve quality. Copyright © 2016 Elsevier B.V. All rights reserved.

Emotional safety in the workplace: one hospice's response for effective support.

Science.gov (United States)

Huggard, Jayne; Nichols, Jan

2011-12-01

Emotional support is important for health professionals working in the demanding area of hospice/palliative care. While physical safety practices and effective human resource support are generally available to staff, one New Zealand hospice has taken this a step further by developing an emotional safety policy that incorporates personal, professional, and organizational measures designed to protect and promote staff members' emotional safety and to minimize stress and fatigue. The aim of this paper is to provide the background and rationale for this work, to introduce a case study around best practice, and to describe the development of the emotional safety policy, which provides effective support for all staff working at the hospice.

Research and implementation of geographic information service mode in digital home

Science.gov (United States)

Lei, B.; Liu, K.; Gan, Y.; Zhong, M.

2014-04-01

Accompanying infrastructure improvements and networking technology innovation, the development of digital home service industry has gotten more and more attention. However, the digital home service levels have not sufficiently met rising demand from users. Therefore, it is urgent to propose and develop new service modes for the digital home. Geographic information services can provide various spatial information services such as map search, spatial information query. It has become an inevitable trend to implement geographic information services in the digital home. This paper proposes three new geographic information services modes for the digital home after sufficient requirement analysis: pushed information service mode, interactive information service mode, personalized information service mode. The key technologies to implement geographic information services on digital televisions are studied, involving digital television middleware technology, network transmission technology and visualization technology. According to the service modes' characteristics mentioned above, a service system in the digital home is established to implement geographic information services on the basis of digital television. The implementation of geographic information services in the digital home not only enriches the digital home services content, but also promotes geographic information from specialization to public popularity.

77 FR 44242 - Medicare Program; Hospice Wage Index for Fiscal Year 2013

Science.gov (United States)

2012-07-27

... environment. A hospice uses an interdisciplinary approach to deliver medical, nursing, social, psychological....4047. 4. CBSA Nomenclature Changes The OMB regularly publishes a bulletin that updates the titles of... hospice wage index rules and notices would incorporate CBSA changes from the most recent OMB bulletins...

"I'm Not Trying to Be Cured, so There's Not Much He Can Do for Me": Hospice Patients' Constructions of Hospice's Holistic Care Approach in a Biomedical Culture

Science.gov (United States)

Nebel Pederson, Sarah; Emmers-Sommer, Tara M.

2012-01-01

The hospice philosophy was founded on a mission to provide comprehensive and holistic services to individuals at the end of life. Hospice interdisciplinary teams work together to offer therapies such as spiritual services, comfort care, and massage therapy to meet patients' physical, psychological, emotional, and spiritual needs. Although the…

Hospice and palliative social workers' experiences with clients at risk of suicide.

Science.gov (United States)

Washington, Karla T; Albright, David L; Parker Oliver, Debra; Gage, L Ashley; Lewis, Alexandria; Mooney, Megan J

2016-12-01

We sought to determine the frequency with which hospice and palliative social workers encounter patients, family caregivers, and other clients at risk of suicide, and to discover the extent to which hospice and palliative social workers feel prepared to address issues related to suicide in their professional practice. We conducted a cross-sectional survey of hospice and palliative social workers, recruiting a convenience sample of volunteer respondents through advertisements at professional conferences and listservs, and via social media accounts associated with national organizations, state hospice and palliative care associations, and individual healthcare professionals. Most respondents reported having worked with patients, family caregivers, or other clients who had exhibited warning signs of suicide during the previous year. Fewer respondents indicated that they had worked with patients and family members who had attempted or died by suicide. While the majority of respondents believed they possessed sufficient knowledge and skills to intervene effectively with individuals at risk of suicide, they indicated that additional education on this topic would be valuable for their professional practice. These study results suggest that suicide-related competencies are important in the practice of hospice and palliative social work. Future education and training efforts should include skill development in addition to knowledge building.

Quantum information to the home

International Nuclear Information System (INIS)

Choi, Iris; Young, Robert J; Townsend, Paul D

2011-01-01

Information encoded on individual quanta will play an important role in our future lives, much as classically encoded digital information does today. Combining quantum information carried by single photons with classical signals encoded on strong laser pulses in modern fibre-to-the-home (FTTH) networks is a significant challenge, the solution to which will facilitate the global distribution of quantum information to the home and with it a quantum internet. In real-world networks, spontaneous Raman scattering in the optical fibre would induce crosstalk between the high-power classical channels and a single-photon quantum channel, such that the latter is unable to operate. Here, we show that the integration of quantum and classical information on an FTTH network is possible by performing quantum key distribution (QKD) on a network while simultaneously transferring realistic levels of classical data. Our novel scheme involves synchronously interleaving a channel of quantum data with the Raman scattered photons from a classical channel, exploiting the periodic minima in the instantaneous crosstalk and thereby enabling secure QKD to be performed.

Quantum information to the home

Science.gov (United States)

Choi, Iris; Young, Robert J.; Townsend, Paul D.

2011-06-01

Information encoded on individual quanta will play an important role in our future lives, much as classically encoded digital information does today. Combining quantum information carried by single photons with classical signals encoded on strong laser pulses in modern fibre-to-the-home (FTTH) networks is a significant challenge, the solution to which will facilitate the global distribution of quantum information to the home and with it a quantum internet [1]. In real-world networks, spontaneous Raman scattering in the optical fibre would induce crosstalk between the high-power classical channels and a single-photon quantum channel, such that the latter is unable to operate. Here, we show that the integration of quantum and classical information on an FTTH network is possible by performing quantum key distribution (QKD) on a network while simultaneously transferring realistic levels of classical data. Our novel scheme involves synchronously interleaving a channel of quantum data with the Raman scattered photons from a classical channel, exploiting the periodic minima in the instantaneous crosstalk and thereby enabling secure QKD to be performed.

Quantum information to the home

Energy Technology Data Exchange (ETDEWEB)

Choi, Iris; Young, Robert J; Townsend, Paul D, E-mail: paul.townsend@tyndall.ie [Photonic Systems Group, Tyndall National Institute and Department of Physics, University College Cork, Cork (Ireland)

2011-06-15

Information encoded on individual quanta will play an important role in our future lives, much as classically encoded digital information does today. Combining quantum information carried by single photons with classical signals encoded on strong laser pulses in modern fibre-to-the-home (FTTH) networks is a significant challenge, the solution to which will facilitate the global distribution of quantum information to the home and with it a quantum internet. In real-world networks, spontaneous Raman scattering in the optical fibre would induce crosstalk between the high-power classical channels and a single-photon quantum channel, such that the latter is unable to operate. Here, we show that the integration of quantum and classical information on an FTTH network is possible by performing quantum key distribution (QKD) on a network while simultaneously transferring realistic levels of classical data. Our novel scheme involves synchronously interleaving a channel of quantum data with the Raman scattered photons from a classical channel, exploiting the periodic minima in the instantaneous crosstalk and thereby enabling secure QKD to be performed.

Spiritual care in the training of hospice volunteers in Germany.

Science.gov (United States)

Gratz, Margit; Paal, Piret; Emmelmann, Moritz; Roser, Traugott

2016-10-01

Hospice volunteers often encounter questions related to spirituality. It is unknown whether spiritual care receives a corresponding level of attention in their training. Our survey investigated the current practice of spiritual care training in Germany. An online survey sent to 1,332 hospice homecare services for adults in Germany was conducted during the summer of 2012. We employed the SPSS 21 software package for statistical evaluation. All training programs included self-reflection on personal spirituality as obligatory. The definitions of spirituality used in programs differ considerably. The task of defining training objectives is randomly delegated to a supervisor, a trainer, or to the governing organization. More than half the institutions work in conjunction with an external trainer. These external trainers frequently have professional backgrounds in pastoral care/theology and/or in hospice/palliative care. While spiritual care receives great attention, the specific tasks it entails are rarely discussed. The response rate for our study was 25.0% (n = 332). A need exists to develop training concepts that outline distinct contents, methods, and objectives. A prospective curriculum would have to provide assistance in the development of training programs. Moreover, it would need to be adaptable to the various concepts of spiritual care employed by the respective institutions and their hospice volunteers.

An analysis of knowledge and attitudes of hospice staff towards organ and tissue donation.

Science.gov (United States)

Wale, J; Arthur, A; Faull, C

2014-03-01

Only a minority of hospice patients eligible to donate tissue and organs choose to do so. Hospice care staff play a key role in discussions about donation, but their willingness to engage in these discussions and their understanding of issues around tissue and organ donation is poorly understood. To (i) identify factors associated with the wish of hospice doctors, nurses and healthcare assistants to donate their own organs after death; (ii) survey the experience of discussing the subject with patients; (iii) determine staff members' knowledge of organ and tissue donation and (iv) identify factors associated with knowledge of organ and tissue donation. Cross-sectional questionnaire survey of hospice care staff. 76 of the 94 care staff of one large UK hospice completed and returned the questionnaire. Staff wishing to donate their organs after death (43/76 56.6%) were more likely to be doctors or nurses than healthcare assistants (p=0.011) and more likely to have discussed organ or tissue donation with their family (pdonation with patients had more years' experience (p=0.045) and had similarly discussed donation with their own family (p=0.039). Those with greater knowledge were more likely to have discussed organ or tissue donation with a patient (p=0.042). A reluctance to instigate discussions about organ and tissue donation may prevent palliative patients and their families being allowed the opportunity to donate. Suboptimal knowledge among hospice staff suggests the need for greater liaison between hospice staff, and the organ and tissue donation teams.

The development of funding policies for hospices: is casemix-based funding an option?

Science.gov (United States)

Carter, H; MacLeod, R; Hicks, E; Carter, J

1999-06-25

The 1993 health reforms, with their emphasis on the purchasing of defined amounts or units of service, have led to the implementation of casemix-based funding for the acute medical and surgical services of the public hospitals. Despite growing interest in New Zealand in casemix-based funding for non-acute services such as palliative care, the nature of this service and the characteristics of its patient population pose particular difficulties for the development and implementation of casemix. This paper examines the feasibility of implementing casemix-based funding for hospice/palliative care services and discusses the development of casemix classification systems for palliative care. Problems associated with implementing casemix-based funding are considered including: the dual funding of hospices, the multi-agency nature of palliative care service provision and the need for the Health Funding Authority to identify and specify the hospice services it is willing to fund. While it is concluded that these problems will impede the introduction of casemix-based funding of hospice care, they highlight important issues that the hospice movement must address if it is to ensure its future within the new health environment.

Medicares Hospice Benefit - Analysis of Utilization and..

Data.gov (United States)

U.S. Department of Health & Human Services — Descriptive analyses reported in Medicares Hospice Benefit - Analysis of Utilization and Resource Use, published in Volume 4, Issue 3 of the Medicare and Medicaid...

Communication Aspects of Hospice Care.

Science.gov (United States)

Jensen, Marvin D.

No theories of communication can minimize the crisis of dying. But those who study commmunication can suggest ways of offering comfort and dignity to the dying person. Many of these ways go beyond words, for death cannot be addressed with verbal cliches. The theoretical work from which a communication scholar draws can help hospice volunteers and…

Readability of Hospice Materials to Prepare Families for Caregiving at the Time of Death

Science.gov (United States)

Kehl, Karen A.; McCarty, Kayla N.

2012-01-01

Many health care materials are not written at levels that can be understood by most lay people. In this descriptive study, we examined the readability of documents used by hospices to prepare families for caregiving at the time of death. We used two common formulae to examine the documents. The mean Flesch-Kincaid grade level was 8.95 (SD 1.80). The mean Simple Measure of Gobbledygook grade level was 11.06 (SD 1.36). When we used the Colors Label Ease for Adult Readers instrument, it became evident that medical terminology was the primary reason for the high grade levels. Most documents (78%) included medical terms that were directly (46.2%) or indirectly (25.6%) explained in the text. Modification of hospice materials could improve families’ comprehension of information important for optimal end-of-life care. PMID:22492500

American Academy of Hospice and Palliative Medicine

Science.gov (United States)

... Getting Involved Communities Advanced Lung Disease Forum Psychiatry, Psychology, Mental Health Forum Social Work Forum SIG Instructions ... MOC/OCC Workforce Study Global Palliative Care About History Position Statements Access to Palliative Care and Hospice ...

Impact of hospice care on end-of-life hospitalization of elderly patients with lung cancer in Taiwan

Directory of Open Access Journals (Sweden)

Shih-Chao Kang

2012-05-01

Conclusion: Hospice care has provided a humane and cost-efficient pathway for end-of-life elderly patients with lung cancer. Parenteral nutrition/hydration should be limited for terminal care patients. Opioids should be promoted for the relief of pain and dyspnea in acute ward care. Family physicians and radiation oncologists play important roles in hospice care. Compared with the prevalence of hospice care in the United Kingdom and other developed countries, hospice care in Taiwan is in the position to be expanded.

A Home-Based Palliative Care Consult Service for Veterans.

Science.gov (United States)

Golden, Adam G; Antoni, Charles; Gammonley, Denise

2016-11-01

We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

Factors associated with end-of-life by home-visit nursing-care providers in Japan.

Science.gov (United States)

Nakanishi, Miharu; Niimura, Junko; Nishida, Atsushi

2017-06-01

Home-visit nursing-care services in Japan are expected to provide home hospice services for older patients with non-cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end-of-life care by home-visit nursing-care providers in Japan. The present retrospective study was carried out using nationally representative cross-sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long-Term Care. A total of 138 008 randomly sampled home-visit nursing-care service users were included in this analysis. End-of-life care (study outcome) was defined as the provision of nursing-care within the last month of life. Of the 138 008 patients at home, 2280 (1.7%) received home-based nursing care within the last month of life, and end-of-life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end-of-life care when they used home-visit nursing-care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds. Among home-visit nursing-care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end-of-life care. Home-visit nursing-care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home-based end-of-life care. A community-based network between home-visit nursing-care providers and hospitals should also be established to attain an integrated end-of-life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991-998. © 2016 Japan Geriatrics Society.

Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer.

Science.gov (United States)

De Vries, Kay; Plaskota, Marek

2017-04-01

Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients. Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom. A phenomenological approach and Colaizzi's stages of analysis were employed to develop themes from the data. Facilitating a "peaceful death" was the primary goal of the nurses, where through the administration of palliative sedation they sought to enable and support patients to be "comfortable," "relaxed," and "calm" at the terminal stage of their illness. Ethical dilemmas related to decision making were a factor in achieving this. These were: medication decisions, "juggling the drugs," "causing the death," sedating young people, the family "requesting" sedation, and believing that hospice is a place where death is hastened. Hospice nurses in the U.K. frequently encounter ethical and emotional dilemmas when administering palliative sedation. Making such decisions about using palliative sedation causes general discomfort for them. Undertaking this aspect of care requires confidence and competence on the part of nurses, and working within a supportive hospice team is of fundamental importance in supporting this practice.

What are Hospice Providers in the Carolinas Doing to Reach African Americans in Their Service Area?

Science.gov (United States)

Payne, Richard; Kuchibhatla, Maragatha N.

2016-01-01

Abstract Background: Experts and national organizations recommend that hospices work to increase service to African Americans, a group historically underrepresented in hospice. Objective: The study objective was to describe strategies among hospices in North and South Carolina to increase service to African Americans and identify hospice characteristics associated with these efforts. Methods: The study was a cross-sectional survey using investigator-developed scales to measure frequency of community education/outreach, directed marketing, efforts to recruit African American staff, cultural sensitivity training, and goals to increase service to African Americans. We used nonparametric Wilcoxon tests to compare mean scale scores by sample characteristics. Results: Of 118 eligible hospices, 79 (67%) completed the survey. Over 80% were at least somewhat concerned about the low proportion of African Americans they served, and 78.5% had set goals to increase service to African Americans. Most were engaged in community education/outreach, with 92.4% reporting outreach to churches, 76.0% to social services organizations, 40.5% to businesses, 35.4% to civic groups, and over half to health care providers; 48.0% reported directed marketing via newspaper and 40.5% via radio. The vast majority reported efforts to recruit African American staff, most often registered nurses (63.75%). Nearly 90% offered cultural sensitivity training to staff. The frequency of strategies to increase service to African Americans did not vary by hospice characteristics, such as profit status, size, or vertical integration, but was greater among hospices that had set goals to increase service to African Americans. Conclusions: Many hospices are engaged in efforts to increase service to African Americans. Future research should determine which strategies are most effective. PMID:26840854

A study of Canadian hospice palliative care volunteers' attitudes toward physician-assisted suicide.

Science.gov (United States)

Claxton-Oldfield, Stephen; Miller, Kathryn

2015-05-01

The purpose of this study was to examine the attitudes of hospice palliative care (HPC) volunteers who provide in-home support (n = 47) and members of the community (n = 58) toward the issue of physician-assisted suicide (PAS). On the first part of the survey, participants responded to 15 items designed to assess their attitudes toward PAS. An examination of individual items revealed differences in opinions among members of both the groups. Responses to additional questions revealed that the majority of volunteers and community members (1) support legalizing PAS; (2) would choose HPC over PAS for themselves if they were terminally ill; and (3) think Canadians should place more priority on developing HPC rather than on legalizing PAS. The implications of these findings are discussed. © The Author(s) 2014.

78 FR 48233 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

Science.gov (United States)

2013-08-07

... Inspector General OMB Office of Management and Budget PEACE Prepare, Embrace, Attend, Communicate, and... and practice for those who are terminally ill. It is a holistic approach to treatment that recognizes... and intensifies, as needed, for continued symptom management. As we stated in the June 5, 2008 Hospice...

78 FR 27823 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

Science.gov (United States)

2013-05-10

... the Actuary OMB Office of Management and Budget OIG Office of Inspector General PRA Paperwork... are terminally ill. It is a holistic approach to treatment that recognizes that the impending death of... continued symptom management. As we stated in the June 5, 2008 Hospice Conditions of Participation final...

The Stress of Sadness: The Most Stressful Symptoms for Hospice Family Caregivers.

Science.gov (United States)

Ratkowski, Kristy L; Washington, Karla T; Craig, Kevin W; Albright, David L

2015-11-01

A family member or friend is often a hospice patient's primary caregiver and, as such, may face a significant number of stressors, including challenges related to managing patient symptoms. This study investigated the most stressful patient symptoms as reported by 111 hospice family caregivers of cancer (n=66) and cardiopulmonary (n=45) patients. Researchers calculated the mean level of stress caregivers attributed to 32 different patient symptoms commonly encountered at end of life. They found the symptoms perceived as most stressful for caregivers were psychological in nature. Study findings suggest that members of the hospice interdisciplinary team should connect patients and their caregivers to various types of support to address psychological symptoms, benefitting patients and caregivers alike. © The Author(s) 2014.

Diagnosis Related Groups as a Casemix/Management Tool for Hospice Patients

Science.gov (United States)

Johnson-Hürzeler, R.; Leary, Robert J.; Hill, Claire L.

1983-01-01

to control the costs of care, and to remain prepared for changes in reimbursement methodologies, health care organizations are beginning to analyze their casemix and their costs per case of providing care. Increasing importance is thus assigned to the search for valid casemix measures and to the construction of information systems which will support casemix investigations. After two years of information systems development, The Connecticut Hospice has begun its search for casemix measures that are applicable to the care of the dying. In this paper, we present our findings on the application of one casemix measure - the DRG - in the specialized area of nonsurgical care of the terminally ill.

A Comparative Study on the Quality of Living for Therapeutic Cancer and Hospice Patients

International Nuclear Information System (INIS)

Kim, Seung Kook; Rhee, Dong Soo; Rou, Jae Man; Kim, Jong Deok

2004-01-01

This study carried a comparative analysis of quality of living perceived by cancer and hospice patients who received radiotherapy, and influential factors in order to provide basic data for nursing goals and establishment of strategy. The subjects of the study were 50 cancer patients who were more than twenty years old and was receiving radiotherapy in therapeutic radiology department of C university hospital, and fourteen hospice patients who were in J hospital in Gwangju. They were conveniently sampled according to the selection standard, and researchers personally interviewed them using questionnaire and patient scripts to obtain necessary data. The results were presented as follows: 1. When cancer and hospice patients were examined demographically, the number of 60 year-old patients were the most. The subjects whose marriage period was more than thirty-one years were the most. In medical expense, more than 70.0% of the patients bore their expenses themselves. 2. When disease-related characteristics of the cancer and pos piece patients were examined, more than 75% of the patients had experience of being in hospital, and more than experienced operation. However, for prevalence period, 57.5% of the cancer patients had less than six months, and 64.3% of the hospice patients had more than two years. 3. For physical symptoms of cancer patients, 77.5% had fatigue, 60.0% had loss of appetite, and 52.5% had loss of weight while for the hospice patients, 100% had loss of weight, and 92.9% had fatigue and loss of appetite. For the cancer patients, 0.0% had swelling, and 7.5% had bleeding, For the hospice patients, 7.1% had change in skin, and 14.3% had diarrhea. 4. Mean score of the cancer subjects were as follows: family support, social support, emotional and spiritual support, physical symptoms, and periods were 3.87, 2.88, 3.10, 2.80, and 2.94 respectively. Those of the hospice patients were 3.80, 1.96, 1.58, 2.64 and 3.24 respectively. 5. Mean score of family support

A Comparative Study on the Quality of Living for Therapeutic Cancer and Hospice Patients

Energy Technology Data Exchange (ETDEWEB)

Kim, Seung Kook [Dept. of Radiological Technology, Kwangju Health College, Kwangju (Korea, Republic of); Rhee, Dong Soo; Rou, Jae Man; Kim, Jong Deok [Dept. of Therapeutic Radiology, Chonnam University Hospital, Kwangju (Korea, Republic of)

2004-03-15

This study carried a comparative analysis of quality of living perceived by cancer and hospice patients who received radiotherapy, and influential factors in order to provide basic data for nursing goals and establishment of strategy. The subjects of the study were 50 cancer patients who were more than twenty years old and was receiving radiotherapy in therapeutic radiology department of C university hospital, and fourteen hospice patients who were in J hospital in Gwangju. They were conveniently sampled according to the selection standard, and researchers personally interviewed them using questionnaire and patient scripts to obtain necessary data. The results were presented as follows: 1. When cancer and hospice patients were examined demographically, the number of 60 year-old patients were the most. The subjects whose marriage period was more than thirty-one years were the most. In medical expense, more than 70.0% of the patients bore their expenses themselves. 2. When disease-related characteristics of the cancer and pos piece patients were examined, more than 75% of the patients had experience of being in hospital, and more than experienced operation. However, for prevalence period, 57.5% of the cancer patients had less than six months, and 64.3% of the hospice patients had more than two years. 3. For physical symptoms of cancer patients, 77.5% had fatigue, 60.0% had loss of appetite, and 52.5% had loss of weight while for the hospice patients, 100% had loss of weight, and 92.9% had fatigue and loss of appetite. For the cancer patients, 0.0% had swelling, and 7.5% had bleeding, For the hospice patients, 7.1% had change in skin, and 14.3% had diarrhea. 4. Mean score of the cancer subjects were as follows: family support, social support, emotional and spiritual support, physical symptoms, and periods were 3.87, 2.88, 3.10, 2.80, and 2.94 respectively. Those of the hospice patients were 3.80, 1.96, 1.58, 2.64 and 3.24 respectively. 5. Mean score of family support

Who Knew? Hospice Is a Business. What that Means for All of Us.

Science.gov (United States)

Rahman, Anna N

2017-02-01

A seasoned gerontologist whose work has explored end-of-life care, I thought I knew what I was getting into when I undertook care for my brother Jim. In April 2014, Jim, whose health was then declining rapidly due to liver cancer, moved from his apartment in Minneapolis to my house in Santa Monica. Jim had come for a liver transplant evaluation at the University of California, Los Angeles (UCLA). When the UCLA team declined to list him-his cancer was just too widespread-Jim elected to stay with my family and me, enrolling in hospice. I did my homework when shopping for a hospice provider. Colleagues in the field gave me referrals. I googled their recommendations and read the reviews. I interviewed admissions counselors. When Jim signed the admission papers, I was confident that we were in good hands with the agency we selected. For the most part, we were. Hospice is widely considered an effective program. Studies show that it prevents pain and suffering among dying patients and increases satisfaction with care. Although other health care programs are regularly pilloried in the press, hospice programs are often lauded. Indeed, they sometimes appear so mission driven that one might mistake them for charities. They are not. Whether for-profit or not-for-profit enterprises, they are businesses-and concerned about their bottom line. Through Jim's story and mine, this article highlights the implications of this business orientation for patients and providers. Methods for evaluating hospice programs nationally are critiqued. Finally, recommendations for improving the business of hospice care are offered. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Utilization of Pets in a Hospice Program.

Science.gov (United States)

Doyle, Kathleen; Kukowski, Thomas

1989-01-01

The therapeutic use of animals with specific populations has gained increased attention and interest. Pet placement in special settings such as prisons, mental institutions and hospices have shown beneficial results. Development of a pet visitation program requires specific planning and organization. (JD)

Health Information Technology and Nursing Homes

Science.gov (United States)

Liu, Darren

2009-01-01

Nursing homes are considered lagging behind in adopting health information technology (HIT). Many studies have highlighted the use of HIT as a means of improving health care quality. However, these studies overwhelmingly do not provide empirical information proving that HIT can actually achieve these improvements. The main research goal of this…

Information Cyberspace and Future Cyber Homes

Directory of Open Access Journals (Sweden)

Eduard Babulak

2006-04-01

Full Text Available The current Internet combines very complex communications infrastructures, while connecting users globally and at the same time creating information cyberspace systems. Large companies such as Philips are working on communications technologies that will facilitate fully automated households (i.e., Cyber Homes. Today, people are using are using small digital pagers and phones with embedded computers and displays, palm-size computers such as Palm Pilot, notebook-size panel computers and wall-size displays. Current research and development trends in the field of Telecommunications and computing industries continues towards a human centric computing, smart spaces, smart devices, clothing, fully automated houses etc. This new technology creates environment where computers are everywhere and provide online access to information at any time to anyone. In this paper, the author discusses new technological trends directions in the Internet, E-commerce and Automation Industries, while presenting his own vision on application of ubiquitous computing in the future cyber home automation. In support of creating future fully automated cyber homes, the author promotes creation of interdisciplinary and multinational research and development teams world-wide.

How might Levinas' concept of the other's priority and Derrida's unconditional hospitality contribute to the philosophy of the modern hospice movement?

Science.gov (United States)

Floriani, Ciro Augusto; Schramm, Fermin Roland

2010-06-01

Hospitality is commonly referred as one of the meanings of hospes, the Latin word which is also the root of hospice. This article explores the semantics of the word hospice - the seal of identity of modern hospice movement - and attempts to integrate the meaning of hospitality into the modern hospice movement, understood as unconditional reception. Therefore, the article analyzes the concept of unconditional hospitality, developed by Jacques Derrida and that of ethical responsibility proposed by Emmanuel Levinas based on the phenomenological experience of the other. From this point of view, these two concepts tie in with the meaning of hospice, bringing substantial grounding elements to the hospice movement for the construction of a protective ethos.

Why hospice nurses need high self-esteem.

NARCIS (Netherlands)

Olthuis, G.J.; Leget, C.J.W.; Dekkers, W.J.M.

2007-01-01

This article discusses the relationship between personal and professional qualities in hospice nurses. We examine the notion of self-esteem in personal and professional identity. The focus is on two questions: (1) what is self-esteem, and how is it related to personal identity and its moral

42 CFR 418.205 - Special requirements for hospice pre-election evaluation and counseling services.

Science.gov (United States)

2010-10-01

... evaluation and counseling services. 418.205 Section 418.205 Public Health CENTERS FOR MEDICARE & MEDICAID... Services § 418.205 Special requirements for hospice pre-election evaluation and counseling services. (a... evaluation and counseling services as specified in § 418.304(d) may be made to a hospice on behalf of a...

Perspective of patients, patients' families, and healthcare providers towards designing and delivering hospice care services in a middle income Country.

Science.gov (United States)

Azami-Aghdash, Saber; Ghojazadeh, Morteza; Aghaei, Mir Hossein; Naghavi-Behzad, Mohammad; Asgarlo, Zoleikha

2015-01-01

In view of the recent surge in chronic disease rates and elderly population in the developing countries, there is an urgent felt need for palliative and hospice care services. The present study investigates the views and attitudes of patients and their families, physicians, nurses, healthcare administrators, and insurers regarding designing and delivering hospice care service in a middle income country. In this qualitative study, the required data was collected using semi structured interviews and was analyzed using thematic analysis. Totally 65 participants from hospitals and Tabriz University of Medical Sciences were selected purposively to achieve data saturation. Analyzing the data, five main themes (barriers, facilitators, strategies, attitudes, and service provider) were extracted. Barriers included financial issues, cultural-religious beliefs, patient and family-related obstacles, and barriers related to healthcare system. Facilitators included family-related issues, cultural-religious beliefs, as well as facilitators associated with patients, healthcare status, and benefits of hospice service. Most participants (79%) had positive attitude towards hospice care service. Participant suggested 10 ways to design and deliver effective and efficient hospice care service. They thought the presence of physicians, nurses, and psychologists and other specialists and clergy were necessary in the hospice care team. Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system.

Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

Science.gov (United States)

Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.

2012-01-01

Purpose of the study: This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used…

Exploring the rewards and challenges of paediatric palliative care work - a qualitative study of a multi-disciplinary children's hospice care team.

Science.gov (United States)

Taylor, Johanna; Aldridge, Jan

2017-12-16

Children's hospices are a key provider of palliative care for children and young people with life-limiting and life-threatening conditions. However, despite recent policy attention to the provision of paediatric palliative care, little is known about the role of children's hospice staff and the factors that may impact on their wellbeing at work. This study explored the rewards and challenges of working in a children's hospice with an aim to identify staff support and development needs. We conducted an exploratory, qualitative study involving thematic analysis of semi-structured interviews with 34 staff and three focus groups with 17 staff working in a multi-disciplinary care team in a UK children's hospice. Participants identified rewards and challenges related to the direct work of caring for children and their families; team dynamics and organisational structures; and individual resilience and job motivation. Participants described the work as emotionally intensive and multi-faceted; 'getting it right' for children was identified as a strong motivator and reward, but also a potential stressor as staff strived to maintain high standards of personalised and emotional care. Other factors were identified as both a reward and stressor, including team functioning, the allocation of work, meeting parent expectations, and the hospice environment. Many participants identified training needs for different aspects of the role to help them feel more confident and competent. Participants also expressed concerns about work-related stress, both for themselves and for colleagues, but felt unable to discuss this at work. Informal support from colleagues and group clinical reflection were identified as primary resources to reflect on and learn from work and for emotional support. However, opportunities for this were limited. Providing regular, structured, and dedicated clinical reflection provides a mechanism through which children's hospice staff can come together for support and

Energy Consumption Information Services for Smart Home Inhabitants

Science.gov (United States)

Schwanzer, Michael; Fensel, Anna

We investigate services giving users an adequate insight on his or her energy consumption habits in order to optimize it in the long run. The explored energy awareness services are addressed to inhabitants of smart homes, equipped with smart meters, advanced communication facilities, sensors and actuators. To analyze the potential of such services, a game at a social network Facebook has been designed and implemented, and the information about players' responses and interactions within the game environment has been collected and analyzed. The players have had their virtual home energy usage visualized in different ways, and had to optimize the energy consumption basing on their own perceptions of the consumption information. Evaluations reveal, in particular, that users are specifically responsive to information shown as a real-time graph and as costs in Euro, and are able to produce and share with each other policies for managing their smart home environments.

Successful Interprofessional Collaboration on the Hospice Team.

Science.gov (United States)

Reese, Dona J.; Sontag, Mary-Ann

2001-01-01

Despite the holistic approach inherent in the hospice philosophy, social work may be viewed as ancillary to medicine. Social work, in turn, may lack sensitivity about other professions' expertise and values and therefore be unprepared to collaborate across cultural boundaries between professions. This article outlines the barriers and proposes…

Demographics, Resource Utilization, and Outcomes of Elderly Patients With Chronic Liver Disease Receiving Hospice Care in the United States.

Science.gov (United States)

Fukui, Natsu; Golabi, Pegah; Otgonsuren, Munkhzul; Mishra, Alita; Venkatesan, Chapy; Younossi, Zobair M

2017-11-01

Hospice offers non-curative symptomatic management to improve patients' quality of life, satisfaction, and resource utilization. Hospice enrollment among patients with chronic liver disease (CLD) is not well studied. The aim of tis tudy is to examine the characteristics of Medicare enrollees with CLD, who were discharged to hospice. Medicare patients discharged to hospice between 2010 and 2014 were identified in Medicare Inpatient and Hospice Files. CLDs and other co-morbidities were identified by International Classification of Diseases-ninth revision codes. Generalized linear model was used to estimate regression coefficients with P-values. Logistic regression was used to calculate odds ratios and 95% confidence intervals. A total of 2,179 CLD patients and 34,986 controls without CLD met the inclusion criteria. Non-alcoholic fatty liver disease, alcoholic liver disease, and hepatitis C virus (HCV) were the most frequent cause of CLD. CLD patients were younger (70 vs. 83 years), more likely to be male (57.7 vs. 39.3%), had longer hospital stay (length of stay, LOS) (19.4 vs. 13.0 days), higher annual charges ($175,000 vs. $109,000), higher 30-day re-hospitalization rates (51.6 vs. 34.2%), and shorter hospice LOS (13.7 vs. 17.7 days) than controls (all PCLD have longer and costly hospitalizations before hospice enrollment as compared with patients without CLD. It was highly likely that these patients were enrolled relatively late, which could potentially lead to less benefit from hospice.

When a desired home death does not occur: the consequences of broken promises.

Science.gov (United States)

Topf, Lorrianne; Robinson, Carole A; Bottorff, Joan L

2013-08-01

Evidence shows that most people prefer to die at home; however, the majority of expected deaths occur away from home. Although home deaths require family caregiver (FCG) commitment and care, we understand very little about their experiences in this context. The study's aim was to gain a better understanding of the experiences of FCGs when circumstances prevented a desired home death for a family member with advanced cancer. An interpretive description approach was used. Data collection involved semistructured interviews. Field notes and reflective journaling aided interpretive and analytical processes. The study was conducted in western Canada and included 18 bereaved FCGs. FCGs were committed to the promises made to care for their family member at home until death. These promises were challenged by a lack of preparedness for caregiving, difficulty accessing professional support and information, and frustration with the inadequate help they received. The events that precipitated dying family members leaving their home for hospital or hospice were unexpected and often influenced by FCGs' lack of situation-specific knowledge and ability to cope with complex caregiving responsibilities. FCGs found it extremely challenging to reconcile with breaking their promise to care at home until death and many were unable to do so. FCGs' despair about not being able to keep their promise for a home death was related to complicated bereavement. Prospective studies of the experiences of FCGs who are aiming for home deaths are needed to identify both short- and long-term interventions to effectively support death at home.

Population Health and Tailored Medical Care in the Home: the Roles of Home-Based Primary Care and Home-Based Palliative Care.

Science.gov (United States)

Ritchie, Christine S; Leff, Bruce

2018-03-01

With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background-home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed "home-based medical care") overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Information environment, behavioral biases, and home bias in analysts’ recommendations

DEFF Research Database (Denmark)

Farooq, Omar; Taouss, Mohammed

2012-01-01

Can information environment of a firm explain home bias in analysts’ recommendations? Can the extent of agency problems explain optimism difference between foreign and local analysts? This paper answers these questions by documenting the effect of information environment on home bias in analysts’...

Holding on to what you have got: keeping hospice palliative care volunteers volunteering.

Science.gov (United States)

Claxton-Oldfield, Stephen; Jones, Richard

2013-08-01

In all, 119 hospice palliative care volunteers from 3 community-based hospice programs completed the Volunteer Retention Questionnaire (VRQ), a 33-item survey designed for this study. The VRQ asks volunteers to rate the importance of each item to their decision to continue volunteering. The items that received the highest mean importance ratings included enjoying the work they do, feeling adequately prepared/trained to perform their role, and learning from their patients' experiences/listening to their patients' life stories. Being recognized (eg, pins for years of service or being profiled in the hospice newsletter), receiving phone calls/cards from their volunteer coordinator on special occasions, and being reimbursed for out-of-pocket expenses were among the items that received the lowest mean importance ratings. Suggestions for improving volunteer retention are provided.

78 FR 46421 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

Science.gov (United States)

2013-07-31

... State homes providing nursing home and adult day health services care to Veterans. VA requires... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality...

Information Technology in the Home Barriers, Opportunities, and Research Directions

National Research Council Canada - National Science Library

Lewis, Rosalind

2000-01-01

...; but what are the implications of increased Information Technology (IT) in the home? Can increased in-home IT create opportunities that will change the way we live and function within our homes and communities and facilitate greater societal benefits...

77 FR 45719 - Proposed Information Collection (Per Diem for Nursing Home Care of Veterans in State Homes; Per...

Science.gov (United States)

2012-08-01

... per diem to State homes providing nursing home and adult day health services care to Veterans. VA... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality...

Dementia in Palliative Care in the Seychelles´ Hospice

Directory of Open Access Journals (Sweden)

Armando Carlos Roca Socarrás

2011-10-01

Full Text Available Background: Dementia presents a high prevalence both in developed and developing countries. It is one of the main causes of terminal stage for a non oncological illness. Objective: To determine the behaviour of some biological variables in terminal stage patients with dementia. Method: A descriptive study was conducted in 16 patients with a diagnostic of dementia in terminal stage. These patients were admitted in the Seychelles´ Hospice between February 2010 and February 2011. The behaviour of dementia in relation to patient’s age, type of dementia, responses to the Folstein´s cognitive mini-test, Charlson´s and Barthel´s indexes, presence of non communicable chronic diseases, and health settings responsible for the remission was analyzed. Results: 31,3 % of patients admitted in the Hospice presented  dementia. The age group with more cases was that from 75 to 84 years old. Vascular dementia and Alzheimer’s Disease presented the same number of cases (37,5 % each. 56% of the patients died during the first 15 days of admission and only 12,5 % lived more than 6 months. Hypertension and cerebrovascular disease were the most common non communicable chronic diseases. 56% of cases had been remitted from hospitals. Conclusions: Dementia in terminal stages follows a behaviour that allows anticipating an appropriate strategy for palliative care in the Hospice.

Intracerebroventricular morphine for refractory cancer pain: transitioning to the home setting.

Science.gov (United States)

Adolph, Michael D; Stretanski, Michael F; McGregor, John M; Rawn, Bonnie L; Ross, Patrick M; Benedetti, Costantino

2010-08-01

Refractory cancer pain may be effectively controlled by titrating intracerebroventricular (ICV) preservative-free opioid. In this case report, a continuous infusion of ICV morphine permitted our patient with lung cancer and painful spinal metastases to be discharged to home hospice with family. The approach exploits the high potency of morphine injected into cerebrospinal fluid (CSF). Sterile, injectable, preservative-free morphine is directly infused into CSF through a subcutaneous Ommaya reservoir placed under the scalp by a neurosurgeon, with an attached catheter passed through a burr hole in the skull with its tip in a cerebral ventricle. Although investigators have described home care of patients receiving intraspinal analgesics, no report describes the process of transitioning the patient receiving continuous ICV morphine infusion to the home setting.

Perspective of patients, patients' families, and healthcare providers towards designing and delivering hospice care services in a middle income Country

Directory of Open Access Journals (Sweden)

Saber Azami-Aghdash

2015-01-01

Conclusion: Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system.

Developing a service improvement initiative for people with learning disabilities in hospice settings.

Science.gov (United States)

Springall, Fiona

2018-03-21

People with learning disabilities are often marginalised in healthcare, including in hospice settings, and as a result may not receive effective end of life care. Research in hospice settings has identified that many staff lack confidence, skills and knowledge in caring for people with learning disabilities, which can have a negative effect on the care these individuals receive. To address these issues, the author has proposed a service improvement initiative, which she developed as part of her learning disability nursing degree programme. This proposed initiative aimed to enhance end of life care for people with learning disabilities through the implementation of a community learning disability link nurse in the hospice setting. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Study of information needs of juveniles in Asero remand home ...

African Journals Online (AJOL)

The study examines the information needs of juveniles in Asero remand home, Abeokuta, Ogun State, Nigeria. A structured questionnaire was used to obtain data for the study. Interviews were also conducted with the staff of the home to supplement the data. Of the respondents 100% revealed that their major information ...

Effective leadership within hospice and specialist palliative care units.

Science.gov (United States)

Barker, L

2000-01-01

In this study the Repertory Grid interview technique was used to investigate constructs of leadership held by a group of male and female senior managers from within hospice and Specialist Palliative Care Units (SPCUs) in the UK. The themes that emerged were compared with those from existing research models of leadership. Men and women in these roles describe different constructs of effective leadership. The women's constructs that emerged were predominantly transformational, whilst the men's were predominantly transactional. Themes were also identified in this study, which differed from previous studied, i.e. those of political and environment awareness and the valuing of others' views regardless of their status. These themes do not feature highly in other research, and may be in response to the environment within which hospice and specialist palliative care functions.

Psychosociální stav pracovníků Hospice sv. Jana N. Neumanna v Prachaticích

OpenAIRE

LEVÁ, Monika

2013-01-01

This bachelor work deals with psycho-social condition of people working in the Hospice of St Jan N. Neumann in Prachatice. The work is aimed at hospice workers who are exposed to load situations which are typical for providing accompaniment for the dying. Hospice care needs the admittance of a multidisciplinar team. It requires cooperation of physicians, nurses, hospital attendants, psychologists, socal workers, clergies. Family and volunteers should also be included. The theoretical part is ...

Preparing for the unexpected: violence in the home care environment, one agency's story.

Science.gov (United States)

Browning, Sarah Via; Clark, Rebecca Culver; Glick, Roger E

2013-06-01

Home care and hospice agencies, bound by regulations, prepare for emergencies and disasters by creating policies and protocols for management of emergency situations, perhaps conducting table top or other types of drills, and discussing hazards likely to impact home care. Is this preparation merely an exercise to meet a requirement, or is it life-saving preparation? For one home care agency, the emergency exercise saved the day as the scenario enacted in the drill was actually lived out a few weeks after the exercise-a scenario the agency leaders hoped they would never face. This account explores how the agency prepared to meet the emergent situation and details lessons learned in the aftermath.

Home-Based Palliative Care Program Relieves Chronic Pain in Kerala, India: Success Realized Through Patient, Family Narratives.

Science.gov (United States)

Ajjarapu, Aparna Sai; Broderick, Ann

2018-06-14

An estimated 1.5 billion people across the globe live with chronic pain, and an estimated 61 million people worldwide experience unrelieved serious health-related suffering. One-sixth of the global population lives in India, where approximately 10 million people endure unrelieved serious health-related suffering. The state of Kerala is home to Pallium India, one of the most sophisticated palliative care programs in the country. This private organization in Trivandrum provides palliative and hospice care to underresourced populations and emphasizes holistic pain treatment. The current project features the pain stories of six patients who received treatment from Pallium India. Basic patient demographic information was collected, and a Pallium India staff member who was fluent in Malayalam and English asked questions about each patient's pain experience. Pain narratives illustrate the substantial impact of Pallium India's home visit program and the role of total pain assessment in delivering high-quality palliative care.

Assessing governance theory and practice in health-care organizations: a survey of UK hospices.

Science.gov (United States)

Chambers, Naomi; Benson, Lawrence; Boyd, Alan; Girling, Jeff

2012-05-01

This paper sets out a theoretical framework for analyzing board governance, and describes an empirical study of corporate governance practices in a subset of non-profit organizations (hospices in the UK). It examines how practices in hospice governance compare with what is known about effective board working. We found that key strengths of hospice boards included a strong focus on the mission and the finances of the organizations, and common weaknesses included a lack of involvement in strategic matters and a lack of confidence, and some nervousness about challenging the organization on the quality of clinical care. Finally, the paper offers suggestions for theoretical development particularly in relation to board governance in non-profit organizations. It develops an engagement theory for boards which comprises a triadic proposition of high challenge, high support and strong grip.

Palliative sedation at home for terminally ill children with cancer.

Science.gov (United States)

Korzeniewska-Eksterowicz, Aleksandra; Przysło, Łukasz; Fendler, Wojciech; Stolarska, Małgorzata; Młynarski, Wojciech

2014-11-01

The presence of symptoms that are difficult to control always requires adjustment of treatment, and palliative sedation (PS) should be considered. We analyzed our experience in conducting PS at home for terminally ill children with cancer during a seven-year period. We performed a retrospective analysis of medical records of children with cancer treated at home between the years 2005 and 2011. We analyzed the data of 42 cancer patients (18% of all patients); in 21 cases, PS was initiated (solid tumors n = 11, brain tumors [5], bone tumors [4], leukemia [1]). Sedation was introduced because of pain (n = 13), dyspnea (9), anxiety (5), or two of those symptoms (6). The main drug used for sedation was midazolam; all patients received morphine. There were no significant differences in the dose of morphine or midazolam depending on the patient's sex; age was correlated with an increase of midazolam dose (R = 0.68; P = 0.005). Duration of sedation (R = 0.61; P = 0.003) and its later initiation (R = 0.43; P = 0.05) were correlated with an increase of the morphine dose. All patients received adjuvant treatment; in patients who required a morphine dose increase, metoclopramide was used more often (P = 0.0002). Patients did not experience any adverse reactions. Later introduction of sedation was associated with a marginally higher number of intervention visits and a significantly higher number of planned visits (R = 0.53; P = 0.013). Sedation may be safely used at home. It requires close monitoring and full cooperation between the family and hospice team. Because of the limited data on home PS in pediatric populations, further studies are needed. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Use of Clinical Health Information Technology in Nursing Homes: Nursing Home Characteristics and Quality Measures

Science.gov (United States)

Spinelli-Moraski, Carla

2014-01-01

This study compares quality measures among nursing homes that have adopted different levels of clinical health information technology (HIT) and examines the perceived barriers and benefits of the adoption of electronic health records as reported by Nursing Home Administrators and Directors of Nursing. A cross-sectional survey distributed online to…

The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up?

Science.gov (United States)

Lupu, Dale; Quigley, Leo; Mehfoud, Nicholas; Salsberg, Edward S

2018-04-01

The need for hospice and palliative care is growing rapidly as the population increases and ages and as both hospice and palliative care become more accepted. Hospice and palliative medicine (HPM) is a relatively new physician specialty, currently training 325 new fellows annually. Given the time needed to increase the supply of specialty-trained physicians, it is important to assess future needs to guide planning for future training capacity. We modeled the need for and supply of specialist HPM physicians through the year 2040 to determine whether training capacity should continue growing. To create a benchmark for need, we used a population-based approach to look at the current geographic distribution of the HPM physician supply. To model future supply, we calculated the annual change in current supply by adding newly trained physicians and subtracting physicians leaving the labor force. The current U.S. supply of HPM specialists is 13.35 per 100,000 adults 65 and older. This ratio varies greatly across the country. Using alternate assumptions for future supply and demand, we project that need in 2040 will range from 10,640 to almost 24,000 HPM specialist physicians. Supply will range from 8100 to 19,000. Current training capacity is insufficient to keep up with population growth and demand for services. HPM fellowships would need to grow from the current 325 graduates annually to between 500 and 600 per year by 2030 to assure sufficient physician workforce for hospice and palliative care services given current service provision patterns. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The current status of bereavement follow-up in hospice and palliative care in Japan.

Science.gov (United States)

Matsushima, T; Akabayashi, A; Nishitateno, K

2002-03-01

In order to explore the implementation of bereavement care in hospice/palliative care settings in Japan, a self-administered questionnaire was sent to all 54 government-approved hospice/palliative care units (PCUs) in May of 1999 (recovery rate 93%). Results showed that bereavement follow-up is performed in 37 institutes (74%) and memorial cards and services are most frequently provided. Memorial cards are provided mainly by nurses, and memorial services involve many health care professionals as well as volunteers. Religious workers tended to be involved in memorial services and social group meetings. Individually oriented interventions such as telephone contacts, personal visits and personal counselling were reportedly used less often. The need for individual-oriented programmes was recognized, and many institutes were considering the expansion of their programmes to include them. However, the difficulties of implementing such care at hospice/PCUs were also raised. Two socio-cultural factors possibly affecting bereavement care in Japan, namely, the roles of family and religious (Buddhist) ceremonies were discussed. It was pointed out that the spirit of bereavement care may be embodied in existing religious ceremonies. We conclude that it is necessary to develop bereavement care programmes based on common, basic hospice care tenets while making full use of existing local resources and taking into account regional values.

Use of paracoxib by continuous subcutaneous infusion for cancer pain in a hospice population

OpenAIRE

Armstrong, Peter; Wilkinson, Pauline; McCorry, Noleen

2017-01-01

Objectives: To characterise the use of the parenteral non-steroidal anti-inflammatory drug parecoxib when given by continuous subcutaneous infusion (CSCI) in a hospice population. Clinical experience suggests parecoxib CSCI may be of benefit in this population, but empirical evidence in relation to its safety and efficacy is lacking.Methods: Retrospective chart review of patients with a cancer diagnosis receiving parecoxib CSCI from 2008 to 2013 at the Marie Curie Hospice, Belfast. Data were ...

Supporting the information domains of fall-risk management in home care via health information technology.

Science.gov (United States)

Alhuwail, Dari; Koru, Güneş; Mills, Mary Etta

2016-01-01

In the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians' fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.

Hospice palliative care article publications: An analysis of the Web of Science database from 1993 to 2013.

Science.gov (United States)

Chang, Hsiao-Ting; Lin, Ming-Hwai; Chen, Chun-Ku; Hwang, Shinn-Jang; Hwang, I-Hsuan; Chen, Yu-Chun

2016-01-01

Academic publications are important for developing a medical specialty or discipline and improvements of quality of care. As hospice palliative care medicine is a rapidly growing medical specialty in Taiwan, this study aimed to analyze the hospice palliative care-related publications from 1993 through 2013 both worldwide and in Taiwan, by using the Web of Science database. Academic articles published with topics including "hospice", "palliative care", "end of life care", and "terminal care" were retrieved and analyzed from the Web of Science database, which includes documents published in Science Citation Index-Expanded and Social Science Citation Indexed journals from 1993 to 2013. Compound annual growth rates (CAGRs) were calculated to evaluate the trends of publications. There were a total of 27,788 documents published worldwide during the years 1993 to 2013. The top five most prolific countries/areas with published documents were the United States (11,419 documents, 41.09%), England (3620 documents, 13.03%), Canada (2428 documents, 8.74%), Germany (1598 documents, 5.75%), and Australia (1580 documents, 5.69%). Three hundred and ten documents (1.12%) were published from Taiwan, which ranks second among Asian countries (after Japan, with 594 documents, 2.14%) and 16(th) in the world. During this 21-year period, the number of hospice palliative care-related article publications increased rapidly. The worldwide CAGR for hospice palliative care publications during 1993 through 2013 was 12.9%. As for Taiwan, the CAGR for publications during 1999 through 2013 was 19.4%. The majority of these documents were submitted from universities or hospitals affiliated to universities. The number of hospice palliative care-related publications increased rapidly from 1993 to 2013 in the world and in Taiwan; however, the number of publications from Taiwan is still far below those published in several other countries. Further research is needed to identify and try to reduce the

A contemplative care approach to training and supporting hospice volunteers: a prospective study of spiritual practice, well-being, and fear of death.

Science.gov (United States)

Scherwitz, Larry; Pullman, Marcie; McHenry, Pamela; Gao, Billy; Ostaseski, Frank

2006-01-01

Inspired by a 2,500-year-old Buddhist tradition, the Zen Hospice Project (ZHP) provides residential hospice care, volunteer programs, and educational efforts that cultivate wisdom and compassion in service. The present study was designed to understand how being with dying hospice residents affects hospice volunteers well-being and the role of spiritual practice in ameliorating the fear of death. A one-year longitudinal study of two volunteer cohorts (N = 24 and N = 22) with repeated measures of spiritual practice, well-being, and hospice performance during one-year service as volunteers. The Zen Hospice Guest House and Laguna Honda Residential Hospital of San Francisco, CA. All 46 individuals who became ZHP volunteers during two years. A 40-hour training program for beginning hospice volunteers stressing compassion, equanimity, mindfulness, and practical bedside care; a one-year caregiver assignment five hours per week; and monthly group meeting. Self-report FACIT spiritual well-being, general well-being, self-transcendence scale, and a volunteer coordinator-rated ZHP performance scale. The volunteers had a high level of self-care and well-being at baseline and maintained both throughout the year; they increased compassion and decreased fear of death. Those (n = 20) practicing yoga were found to have consistently lower fear of death than the group average (P = .04, P = .008, respectively). All rated the training and program highly, and 63% continued to volunteer after the first year's commitment. The results suggest that this approach to training and supporting hospice volunteers fosters emotional well-being and spiritual growth.

Caring to learn, learning to care: Inmate Hospice Volunteers and the Delivery of Prison End-of-Life Care

Science.gov (United States)

Cloyes, Kristin G.; Rosenkranz, Susan J.; Supiano, Katherine P.; Berry, Patricia H.; Routt, Meghan; Llanque, Sarah M.; Shannon-Dorcy, Kathleen

2017-01-01

The increasing numbers of aging and chronically ill prisoners incarcerated in Western nations is well documented, as is the growing need for prison-based palliative and end-of-life care. Less often discussed is specifically how end-of-life care can and should be provided, by whom, and with what resources. One strategy incorporates prisoner volunteers into end-of-life services within a peer care program. This article reports on one such program based on focused ethnographic study including in-depth interviews with inmate hospice volunteers, nursing staff, and corrections officers working in the hospice program. We describe how inmate volunteers learn hospice care through formal education and training, supervised practice, guidance from more experienced inmates, and support from correctional staff. We discuss how emergent values of mentorship and stewardship are seen by volunteers and staff as integral to prison hospice sustainability and discuss implications of this volunteer-centric model for response-ability for the end-of-life care of prisoners. PMID:28100141

Facilitating out-of-home caregiving through health information technology: survey of informal caregivers' current practices, interests, and perceived barriers.

Science.gov (United States)

Zulman, Donna M; Piette, John D; Jenchura, Emily C; Asch, Steven M; Rosland, Ann-Marie

2013-07-10

Many patients with chronic conditions are supported by out-of-home informal caregivers-family members, friends, and other individuals who provide care and support without pay-who, if armed with effective consumer health information technology, could inexpensively facilitate their care. We sought to understand caregivers' use of, interest in, and perceived barriers to health information technology for out-of-home caregiving. We conducted 2 sequential Web-based surveys with a national sample of individuals who provide out-of-home caregiving to an adult family member or friend with a chronic illness. We queried respondents about their use of health information technology for out-of-home caregiving and used multivariable regression to investigate caregiver and care-recipient characteristics associated with caregivers' technology use for caregiving. Among 316 out-of-home caregiver respondents, 34.5% (109/316) reported using health information technology for caregiving activities. The likelihood of a caregiver using technology increased significantly with intensity of caregiving (as measured by number of out-of-home caregiving activities). Compared with very low intensity caregivers, the adjusted odds ratio (OR) of technology use was 1.88 (95% CI 1.01-3.50) for low intensity caregivers, 2.39 (95% CI 1.11-5.15) for moderate intensity caregivers, and 3.70 (95% CI 1.62-8.45) for high intensity caregivers. Over 70% (149/207) of technology nonusers reported interest in using technology in the future to support caregiving. The most commonly cited barriers to technology use for caregiving were health system privacy rules that restrict access to care-recipients' health information and lack of familiarity with programs or websites that facilitate out-of-home caregiving. Health information technology use for out-of-home caregiving is common, especially among individuals who provide more intense caregiving. Health care systems can address the mismatch between caregivers' interest

Hospice palliative care article publications: An analysis of the Web of Science database from 1993 to 2013

Directory of Open Access Journals (Sweden)

Hsiao-Ting Chang

2016-01-01

Conclusion: The number of hospice palliative care-related publications increased rapidly from 1993 to 2013 in the world and in Taiwan; however, the number of publications from Taiwan is still far below those published in several other countries. Further research is needed to identify and try to reduce the barriers to hospice palliative care research and publication in Taiwan.

What their terms of living and dying might be: hospice social workers discuss Oregon's Death with Dignity Act.

Science.gov (United States)

Norton, Elizabeth M; Miller, Pamela J

2012-01-01

This article presents data from a qualitative study of nine social work hospice practitioners and experts as they discuss Oregon's Death with Dignity Act. Three themes emerged from the analysis: (a) values regarding physician-assisted death; (b) agency policies about the option; and (c) the role of hospice social workers with physician-assisted death. Three states now allow terminally ill persons to obtain a lethal prescription if criteria are met. Two other states are actively considering and may pass similar legislation over time. Hospice social work practitioners work with patients and families as they consider this option and their voices reflect the complexities and nuances of these interactions.

Swedish district nurses' attitudes to implement information and communication technology in home nursing.

Science.gov (United States)

Nilsson, Carina; Skär, Lisa; Söderberg, Siv

2008-01-01

The use of information and communication technology has increased in the society, and can be useful in nursing care. The aim of this study was to describe district nurses' attitudes regarding the implementation of information and communication technology in home nursing. The first and third authors performed five focus group discussions with 19 district nurses' from five primary healthcare centres in northern Sweden. During the focus group discussions, the following topics were discussed: the current and future use of information and communication technology in home nursing; expectations, advantages, disadvantages and hindrances in the use of information and communication technology in home nursing; and the use of information and communication technology from an ethical perspective. The transcribed focus group discussions were analysed using qualitative content analysis. The results showed that district nurses' attitudes were positive regarding the use of information and communication technology in their work. They also asked for possibilities to influence the design and its introduction. However, the use of information and communication technology in home nursing can be described as a complement to communication that could not replace human physical encounters. Improvements and risks, as well as the importance of physical presence in home nursing were considered vital. The results revealed that the use of information and communication technology requires changes in the district nurses' work situation.

Meaning-centered dream work with hospice patients: A pilot study.

Science.gov (United States)

Wright, Scott T; Grant, Pei C; Depner, Rachel M; Donnelly, James P; Kerr, Christopher W

2015-10-01

Hospice patients often struggle with loss of meaning, while many experience meaningful dreams. The purpose of this study was to conduct a preliminary exploration into the process and therapeutic outcomes of meaning-centered dream work with hospice patients. A meaning-centered variation of the cognitive-experiential model of dream work (Hill, 1996; 2004) was tested with participants. This variation was influenced by the tenets of meaning-centered psychotherapy (Breitbart et al., 2012). A total of 12 dream-work sessions were conducted with 7 hospice patients (5 women), and session transcripts were analyzed using the consensual qualitative research (CQR) method (Hill, 2012). Participants also completed measures of gains from dream interpretation in terms of existential well-being and quality of life. Participants' dreams generally featured familiar settings and living family and friends. Reported images from dreams were usually connected to feelings, relationships, and the concerns of waking life. Participants typically interpreted their dreams as meaning that they needed to change their way of thinking, address legacy concerns, or complete unfinished business. Generally, participants developed and implemented action plans based on these interpretations, despite their physical limitations. Participants described dream-work sessions as meaningful, comforting, and helpful. High scores on a measure of gains from dream interpretation were reported, consistent with qualitative findings. No adverse effects were reported or indicated by assessments. Our results provided initial support for the feasibility and helpfulness of dream work in this population. Implications for counseling with the dying and directions for future research were also explored.

Hospice assistance offered to the healthy siblings of a terminally ill child [Hospicyjne wsparcie zdrowego rodzeństwa terminalnie chorego dziecka

Directory of Open Access Journals (Sweden)

Grzegorz GODAWA

2017-11-01

Full Text Available A terminally ill child is the focus of attention of its close ones. The family wants to minimise the child’s suffering. Support is also offered by helping organisations. The concentration on the ill child can lead to the situation where the needs of the healthy siblings are neglected. „The total pain” of the ill child includes its family members, therefore, supporting the ill child’s healthy siblings is one of the main goals of children’s hospices. Hospice assistance is based on a family systems theory so the scope of hospice activities is very wide. Although helping the ill child is the priority, the hospices also protect the family from the destructive influence of illness. One of the forms of support offered to the healthy siblings has a psycho-pedagogical dimension. It aims at minimising the negative effects of the child’s illness and helping the siblings to go back to normal life after the child’s death. The interdisciplinary nature of hospice assistance is the chance for successful implementation of these assumptions.

Exploring the working role of hospice volunteers

OpenAIRE

Watts, Jacqueline H.

2011-01-01

Volunteering is now a regular feature of health and social care service provision with volunteers working in diverse contexts such as day care centres, ‘after school’ clubs, hospitals and hospices. The promotion of the idea of an active civil society by successive UK governments has led to the professionalisation of some voluntary work as the product of a partnership between the voluntary sector, government and business. More standardised working practices and semi-formalised aspects of volun...

The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients.

Science.gov (United States)

Krout, R E

2001-01-01

This article describes the process and results of a three-month music therapy clinical effectiveness study conducted with terminally ill patients. The purpose of this study was to quantify and evaluate the effectiveness of single-session music therapy interventions with hospice patients in three patient problem areas: pain control; physical comfort; and relaxation. Data from a total of 90 sessions conducted with a total of 80 subjects served by Hospice of Palm Beach County, Florida, were included in the study. Music therapy services were provided by five board-certified music therapists and one music therapist eligible for board certification. The subjects in this study were receiving regularly scheduled music therapy services from the hospice organization. The study used both behavioral observation and subject's self-reporting as methods of data reporting and recording. Subjects were observed for, or self-reported, their levels of pain control, physical comfort, and relaxation, both before and after each music therapy session. The subjects were served in the environments where music therapy services would normally be delivered (i.e., home, hospital, nursing home, or inpatient acute-care unit of the hospice organization). Music therapy services included live active and passive music-based experiences. These were designed to build and to establish rapport with patient or family, to facilitate family interaction and patient control, to provide support and comfort, to facilitate relaxation, to enable reminiscence and life review, to provide a frame-work for spiritual exploration and validation, and to encourage the identification and expression of feelings of anticipatory mourning and grief. A total of six hypotheses stated that there would be significant pre- to postsession differences in each of the three variables: pain control, physical comfort, and relaxation, as measured during two different session and data collection scenarios. These scenarios included the

Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients.

Science.gov (United States)

Tarumi, Yoko; Wilson, Mitchell P; Szafran, Olga; Spooner, G Richard

2013-01-01

The stool softener docusate is widely used in the management of constipation in hospice patients. There is little experimental evidence to support this practice, and no randomized trials have been conducted in the hospice setting. To assess the efficacy of docusate in hospice patients. This was a 10-day, prospective, randomized, double-blind, placebo-controlled trial of docusate and sennosides vs. placebo and sennosides in hospice patients in Edmonton, Alberta. Patients were included if they were age 18 years or older, able to take oral medications, did not have a gastrointestinal stoma, and had a Palliative Performance Scale score of 20% or more. The primary outcome measures were stool frequency, volume, and consistency. Secondary outcomes were patient perceptions of bowel movements (difficulty and completeness of evacuation) and bowel-related interventions. A total of 74 patients were randomized into the study (35 to the docusate group and 39 to the placebo group). There were neither significant differences between the groups in stool frequency, volume, or consistency, nor in difficulty or completeness of evacuation. On the Bristol Stool Form Scale, more patients in the placebo group had Type 4 (smooth and soft) and Type 5 (soft blobs) stool, whereas in the docusate group, more had Type 3 (sausage like) and Type 6 (mushy) stool (P=0.01). There was no significant benefit of docusate plus sennosides compared with placebo plus sennosides in managing constipation in hospice patients. Docusate use should be considered on an individual basis. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Pain assessment and management in end of life care: a survey of assessment and treatment practices of hospice music therapy and nursing professionals.

Science.gov (United States)

Groen, Kara Mills

2007-01-01

The primary focus of this paper is to describe current trends in pain assessment in end of life care with a secondary focus on music therapy techniques commonly used to address pain for hospice patients. These trends were determined through a survey of 72 board certified music therapists and 92 hospice and palliative nurses. Survey results indicate that most music therapists in the hospice setting incorporate formal pain assessment into their practice; both nursing professionals and music therapists surveyed utilize multiple assessment tools to assess patient pain. Although there are currently a variety of pain assessment tools used, this study indicates that nursing professionals most frequently use the Numerical Rating Scale (NRS) and FACES scales, and identified them as appropriate for use by nonnursing members of the interdisciplinary hospice team. This paper also describes music therapy techniques most often utilized by music therapists with hospice patients to address acute and chronic pain symptoms.

Educational needs of hospice social workers: spiritual assessment and interventions with diverse populations.

Science.gov (United States)

Wesley, Carol; Tunney, Kathleen; Duncan, Ella

2004-01-01

Based on a national survey, this study analyzes the roles and educational needs of hospice social workers regarding assessment and intervention in spirituality, religion, and diversity of their patients. Sixty-two social workers responded to the survey. Results suggest that spiritual care is shared among hospice team members and that most social workers feel comfortable in addressing these issues. However, role conflict and role ambiguity also exist. Respondents to the survey often felt ill-prepared to deal with some complex faith-based conflicts related to diversity. They saw themselves in need of assessment models and end-of-life decision-making interventions regarding assisted suicide and euthanasia. This study provides recommendations for social work practice, education, and research.

Music therapy with imminently dying hospice patients and their families: facilitating release near the time of death.

Science.gov (United States)

Krout, Robert E

2003-01-01

Hospice care seeks to address the diverse needs of terminally ill patients in a number of physical, psychosocial, and spiritual areas. Family members of the patient often are included in the care and services provided by the hospice team, and hospice clinicians face a special challenge when working with families of patients who are imminently dying. When loved ones are anticipating the patient's impending death, they may find it difficult to express feelings, thoughts, and last wishes. Music therapy is a service modality that can help to facilitate such communication between the family and the patient who is actively dying, while also providing a comforting presence. Music therapy as a way to ease communication and sharing between dying patients and their loved ones is discussed in this article. The ways in which music therapy can facilitate a means of release for both patients and family members in an acute care unit of a large US hospice organization are specifically described. Case descriptions illustrate how music therapy functioned to allow five patients and their families to both come together and let go near the time of death. Elements to consider when providing such services to imminently dying patients and their families are discussed.

Collaboration and emotions to the test: the experience of FILe volunteers in hospices.

Science.gov (United States)

Mascagni, Giulia

2016-11-22

This study seeks to provide an in-depth analysis of care-based interaction in the experiences of volunteers working in lenitherapy (pain therapy) through the case study of hospices in Florence, Italy. A qualitative method of data collection was chosen: the field research made use of open-ended questionnaires distributed to trained but unspecialised volunteers (V = 32) and to volunteers with hospital-based medical expertise (PV = 35) acting for the Italian Lenitherapy Foundation (FILe) and operating in hospices within the ex-ASL (Local Health Unit) of Florence. By analysing the 67 questionnaires collected, it has been possible to reconstruct and interpret the interactional dynamics that exist between the various figures present within a hospice, bringing into focus the most salient aspects of both the organisational context and emotional setting. The research experience, by highlighting everyday unseen aspects that are inaccessible to an 'internal' eye, has made it possible to better characterise the dynamics of unsuccessful collaboration between team members and potential areas of conflict. Finally, where these dynamics have been observed, an attempt has been made to outline priorities for change and possible directions to be taken, so as to promote defusing actions and restore synergy and fluidity to the FILe system.

Revisiting perceptions of quality of hospice care: managing for the ultimate referral.

Science.gov (United States)

Churchman, Richard; York, Grady S; Woodard, Beth; Wainright, Charles; Rau-Foster, Mary

2014-08-01

Hospice services provided in the final months of life are delivered through complex interpersonal relationships between caregivers, patients, and families. Often, service value and quality are defined by these interpersonal interactions. This understanding provides hospice leaders with an enormous opportunity to create processes that provide the optimal level of care during the last months of life. The authors argue that the ultimate referral is attained when a family member observes the care of a loved one, and the family member conveys a desire to receive the same quality of services their loved one received at that facility. The point of this article is to provide evidence that supports the methods to ultimately enhance the patient's and family's experience and increase the potential for the ultimate referral. © The Author(s) 2013.

An art therapy group for bereaved youth in hospice care.

Science.gov (United States)

McIntyre, B B

1990-09-01

Through art, music, and drama children can creatively express the feelings of sadness and anger that occur when a family member dies. In so doing, they can often avoid later difficulties resulting from unresolved emotions. Hospices may want to develop an art therapy group to facilitate this process with clients and their families.

Hospice Admission and Survival After 18F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry.

Science.gov (United States)

Gareen, Ilana F; Hillner, Bruce E; Hanna, Lucy; Makineni, Rajesh; Duan, Fenghai; Shields, Anthony F; Subramaniam, Rathan M; Siegel, Barry A

2018-03-01

We have previously reported that PET using 18 F-fluoride (NaF PET) for assessment of osseous metastatic disease was associated with substantial changes in intended management in Medicare beneficiaries participating in the National Oncologic PET Registry (NOPR). Here, we use Medicare administrative data to examine the association between NaF PET results and hospice claims within 180 d and 1-y survival. Methods: We classified NOPR NaF PET results linked to Medicare claims by imaging indication (initial staging [IS]; detection of suspected first osseous metastasis [FOM]; suspected progression of osseous metastasis [POM]; or treatment monitoring [TM]) and type of cancer (prostate, lung, breast, or other). Results were classified as definitely positive scan findings versus probably positive scan findings versus negative scan findings for osseous metastasis for IS and FOM; more extensive disease versus no change or less extensive disease for POM; and worse prognosis versus no change or better prognosis for TM, based on the postscan assessment. Our study included 21,167 scans obtained from 2011 to 2014 of consenting NOPR participants aged 65 y or older. Results: The relative risk of hospice claims within 180 d of a NaF PET scan was 2.0-7.5 times higher for patients with evidence of new or progressing osseous metastasis than for those without, depending on indication and cancer type (all P PET scan results are highly associated with subsequent hospice claims and, ultimately, with patient survival. NaF PET provides important information on the presence of osseous metastasis and prognosis to assist patients and their physicians when making decisions on whether to select palliative care and transition to hospice or whether to continue treatment. © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

Formal and informal home learning activities in relation to children's early numeracy and literacy skills: the development of a home numeracy model.

Science.gov (United States)

Skwarchuk, Sheri-Lynn; Sowinski, Carla; LeFevre, Jo-Anne

2014-05-01

The purpose of this study was to propose and test a model of children's home numeracy experience based on Sénéchal and LeFevre's home literacy model (Child Development, 73 (2002) 445-460). Parents of 183 children starting kindergarten in the fall (median child age=58 months) completed an early home learning experiences questionnaire. Most of the children whose parents completed the questionnaire were recruited for numeracy and literacy testing 1 year later (along with 32 children from the inner city). Confirmatory factor analyses were used to reduce survey items, and hierarchical regression analyses were used to predict the relation among parents' attitudes, academic expectations for their children, reports of formal and informal numeracy, and literacy home practices on children's test scores. Parental reports of formal home numeracy practices (e.g., practicing simple sums) predicted children's symbolic number system knowledge, whereas reports of informal exposure to games with numerical content (measured indirectly through parents' knowledge of children's games) predicted children's non-symbolic arithmetic, as did numeracy attitudes (e.g., parents' enjoyment of numeracy). The home literacy results replicated past findings; parental reports of formal literacy practices (e.g., helping their children to read words) predicted children's word reading, whereas reports of informal experiences (i.e., frequency of shared reading measured indirectly through parents' storybook knowledge) predicted children's vocabulary. These findings support a multifaceted model of children's early numeracy environment, with different types of early home experiences (formal and informal) predicting different numeracy outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

Quality of information accompanying on-line marketing of home diagnostic tests.

Science.gov (United States)

Datta, Adrija K; Selman, Tara J; Kwok, Tony; Tang, Teresa; Khan, Khalid S

2008-01-01

To assess the quality of information provided to consumers by websites marketing medical home diagnostic tests. A cross-sectional analysis of a database developed from searching targeted websites. Data sources were websites written in English which marketed medical home diagnostic tests. A meta-search engine was used to identify the first 20 citations for each type of home diagnostic medical test. Relevant websites limited to those written in English were reviewed independently and in triplicate, with disputes resolved by two further reviewers. Information on the quality of these sites was extracted using a pre-piloted performer. 168 websites were suitable for inclusion in the review. The quality of these sites showed marked variation. Only 24 of 168 (14.2%) complied with at least three-quarters of the quality items and just over half (95 of 168, 56.5%) reported official approval or certification of the test. Information on accuracy of the test marketed was reported by 87 of 168 (51.7%) websites, with 15 of 168 (8.9%) providing a scientific reference. Instructions for use of the product were found in 97 of 168 (57.9%). However, the course of action to be taken after obtaining the test result was stated in only 63 of 168 (37.5%) for a positive result and 43 of 168 (25.5%) for a negative result. The quality of information posted on commercial websites marketing home tests online is unsatisfactory and potentially misleading for consumers.

Is informal care a substitution for home care among migrants in the Netherlands?

NARCIS (Netherlands)

Koopmans, G.T.; Foets, M.; Devillé, W.

2010-01-01

Background: Among migrants the level of home care use seems to be lower than among the native population. As migrants may prefer informal care for several reasons, they possibly use these sources of care instead of home care. We therefore, examined the use of home care in relation to household

Breakdown in informational continuity of care during hospitalization of older home-living patients: A case study

Directory of Open Access Journals (Sweden)

Rose Mari Olsen

2014-05-01

Full Text Available Introduction: The successful transfer of an older patient between health care organizations requires open communication between them that details relevant and necessary information about the patient's health status and individual needs. The objective of this study was to identify and describe the process and content of the patient information exchange between nurses in home care and hospital during hospitalization of older home-living patients.Methods: A multiple case study design was used. Using observations, qualitative interviews and document reviews, the total patient information exchange during each patient's episode of hospitalization (n = 9, from day of admission to return home, was captured.Results: Information exchange mainly occurred at discharge, including a discharge note sent from hospital to home care, and telephone reports from hospital nurse to home care nurse, and meetings between hospital nurse and patient coordinator from the municipal purchaser unit. No information was provided from the home care nurses to the hospital nurses at admission. Incompleteness in the content of both written and verbal information was found. Information regarding physical care was more frequently reported than other caring dimensions. Descriptions of the patients’ subjective experiences were almost absent and occurred only in the verbal communication.Conclusions: The gap in the information flow, as well as incompleteness in the content of written and verbal information exchanged, constitutes a challenge to the continuity of care for hospitalized home-living patients. In order to ensure appropriate nursing follow-up care, we emphasize the need for nurses to improve the information flow, as well as to use a more comprehensive approach to older patients, and that this must be reflected in the verbal and written information exchange.

Medicare constrains social workers' and nurses' home care for clients with Alzheimer's disease.

Science.gov (United States)

Cabin, William D

2015-01-01

The Medicare home health prospective payment system (PPS) has existed for 13 years, yielding significant profits to providers. However, studies indicate many unresolved questions about whether PPS improves patient quality of care, is cost-effective, and reduces patient levels of unmet need. In addition, PPS has undermined the provision of social work home health services. The article presents the views of 29 home health care nurses regarding the impact ofPPS on their care decisions for people with Alzheimer's disease and their caregivers. The nurses identify Alzheimer's disease symptom management and psychosocial needs as phantoms, omnipresent below the surface but not attended to by home care clinicians. The interviews support the greater involvement of social workers to more adequately address the psychosocial needs of Medicare home health patients. The article contends that the current failure to simultaneously address the cost, needs, and quality-of-life issues of people with Alzheimer's disease who are cared for at home is analogous to the end-of-life care situation before passage of the Medicare Hospice Benefit. A collaborative demonstration project--social work and nursing--is proposed to determine how PPS might better address quality of life and costs of home-based people with Alzheimer's disease and their caregivers.

Encounters With Health-Care Providers and Advance Directive Completion by Older Adults.

Science.gov (United States)

Koss, Catheryn

2018-01-01

The Patient Self-Determination Act (PSDA) requires hospitals, home health agencies, nursing homes, and hospice providers to offer new patients information about advance directives. There is little evidence regarding whether encounters with these health-care providers prompt advance directive completion by patients. To examine whether encounters with various types of health-care providers were associated with higher odds of completing advance directives by older patients. Logistic regression using longitudinal data from the 2012 and 2014 waves of the Health and Retirement Study. Participants were 3752 US adults aged 65 and older who reported not possessing advance directives in 2012. Advance directive was defined as a living will and/or durable power of attorney for health care. Four binary variables measured whether participants had spent at least 1 night in a hospital, underwent outpatient surgery, received home health or hospice care, or spent at least one night in a nursing home between 2012 and 2014. Older adults who received hospital, nursing home, or home health/hospice care were more likely to complete advance directives. Outpatient surgery was not associated with advance directive completion. Older adults with no advance directive in 2012 who encountered health-care providers covered by the PSDA were more likely to have advance directives by 2014. The exception was outpatient surgery which is frequently provided in freestanding surgery centers not subject to PSDA mandates. It may be time to consider amending the PSDA to cover freestanding surgery centers.

[Pain control by continuous infusion of morphine using subarachnoid catheter access to the port--a report of a home death case].

Science.gov (United States)

Kawagoe, Koh; Matsuura, Shinobu

2008-12-01

This is a case of a 50s male with cecal cancer suffering from severe pain caused by osteolytic metastasis to the lumbar vertebra, right iliac bone, and the head of the right femur. The pain was palliated by continuous infusion of morphine using a subarachnoid catheter that had access to the subcutaneous "Port". The maximum dose of morphine used a day was 384 mg, which corresponded to 57,600 mg/day of oral morphine. Sixty eight days after the start of home hospice care, the patient died at home because of diffuse peritonitis caused by intestinal rupture.

Quality of information accompanying on-line marketing of home diagnostic tests

Science.gov (United States)

Datta, Adrija K; Selman, Tara J; Kwok, Tony; Tang, Teresa; Khan, Khalid S

2008-01-01

Objective To assess the quality of information provided to consumers by websites marketing medical home diagnostic tests. Design A cross-sectional analysis of a database developed from searching targeted websites. Setting Data sources were websites written in English which marketed medical home diagnostic tests. Main outcome measures A meta-search engine was used to identify the first 20 citations for each type of home diagnostic medical test. Relevant websites limited to those written in English were reviewed independently and in triplicate, with disputes resolved by two further reviewers. Information on the quality of these sites was extracted using a pre-piloted performer. Results 168 websites were suitable for inclusion in the review. The quality of these sites showed marked variation. Only 24 of 168 (14.2%) complied with at least three-quarters of the quality items and just over half (95 of 168, 56.5%) reported official approval or certification of the test. Information on accuracy of the test marketed was reported by 87 of 168 (51.7%) websites, with 15 of 168 (8.9%) providing a scientific reference. Instructions for use of the product were found in 97 of 168 (57.9%). However, the course of action to be taken after obtaining the test result was stated in only 63 of 168 (37.5%) for a positive result and 43 of 168 (25.5%) for a negative result. Conclusions The quality of information posted on commercial websites marketing home tests online is unsatisfactory and potentially misleading for consumers. PMID:18263912

Identifying risk factors for healthcare-associated infections from electronic medical record home address data

Directory of Open Access Journals (Sweden)

Rosenman Marc B

2010-09-01

Full Text Available Abstract Background Residential address is a common element in patient electronic medical records. Guidelines from the U.S. Centers for Disease Control and Prevention specify that residence in a nursing home, skilled nursing facility, or hospice within a year prior to a positive culture date is among the criteria for differentiating healthcare-acquired from community-acquired methicillin-resistant Staphylococcus aureus (MRSA infections. Residential addresses may be useful for identifying patients residing in healthcare-associated settings, but methods for categorizing residence type based on electronic medical records have not been widely documented. The aim of this study was to develop a process to assist in differentiating healthcare-associated from community-associated MRSA infections by analyzing patient addresses to determine if residence reported at the time of positive culture was associated with a healthcare facility or other institutional location. Results We identified 1,232 of the patients (8.24% of the sample with positive cultures as probable cases of healthcare-associated MRSA based on residential addresses contained in electronic medical records. Combining manual review with linking to institutional address databases improved geocoding rates from 11,870 records (79.37% to 12,549 records (83.91%. Standardization of patient home address through geocoding increased the number of matches to institutional facilities from 545 (3.64% to 1,379 (9.22%. Conclusions Linking patient home address data from electronic medical records to institutional residential databases provides useful information for epidemiologic researchers, infection control practitioners, and clinicians. This information, coupled with other clinical and laboratory data, can be used to inform differentiation of healthcare-acquired from community-acquired infections. The process presented should be extensible with little or no added data costs.

Understanding attitudes toward information and communication technology in home-care: Information and communication technology as a market good within Norwegian welfare services.

Science.gov (United States)

Øyen, Karianne Røssummoen; Sunde, Olivia Sissil; Solheim, Marit; Moricz, Sara; Ytrehus, Siri

2018-09-01

The aim of this study was to better understand nurses' and other staff members' attitudes toward the usefulness of information and communication technology in home-care settings. Research has found that beliefs about the expected benefits of information and communication technology impact the use of technology. Furthermore, inexperience with using information and communication technology may cause negative attitudes. This article is based on a questionnaire to 155 nurses and other staff members in home-care in Sogn og Fjordane county in Norway. The results revealed minimal use of information and communication technology at work; however, participants had positive attitudes regarding the potential benefits of information and communication technology use in home-care. Individuals' extensive use of and familiarity with different solutions in private lives could be an important context for explaining employees' attitudes. Given that information and communication technology is both a welfare service and a market good, this may explain individuals' positive attitudes toward information and communication technology despite their lack of experience with it at work. Experiences with information and communication technology as a market good and the way new technologies can affect work routines will affect the implementation of information and communication technology in home-care.

The experiences of professional hospice workers attending creative arts workshops in Gauteng

NARCIS (Netherlands)

Blignaut-van Westrhenen, Nadine; Fritz, E.

2013-01-01

Object: This article explores the experiences of professional hospice workers using a creative process for debriefing them in order to facilitate the expression and communication of complex thoughts and feelings. The creative arts workshops were developed with the understanding in mind that caring

Undetected cognitive impairment and decision-making capacity in patients receiving hospice care.

Science.gov (United States)

Burton, Cynthia Z; Twamley, Elizabeth W; Lee, Lana C; Palmer, Barton W; Jeste, Dilip V; Dunn, Laura B; Irwin, Scott A

2012-04-01

: Cognitive dysfunction is common in patients with advanced, life-threatening illness and can be attributed to a variety of factors (e.g., advanced age, opiate medication). Such dysfunction likely affects decisional capacity, which is a crucial consideration as the end-of-life approaches and patients face multiple choices regarding treatment, family, and estate planning. This study examined the prevalence of cognitive impairment and its impact on decision-making abilities among hospice patients with neither a chart diagnosis of a cognitive disorder nor clinically apparent cognitive impairment (e.g., delirium, unresponsiveness). : A total of 110 participants receiving hospice services completed a 1-hour neuropsychological battery, a measure of decisional capacity, and accompanying interviews. : In general, participants were mildly impaired on measures of verbal learning, verbal memory, and verbal fluency; 54% of the sample was classified as having significant, previously undetected cognitive impairment. These individuals performed significantly worse than the other participants on all neuropsychological and decisional capacity measures, with effect sizes ranging from medium to very large (0.43-2.70). A number of verbal abilities as well as global cognitive functioning significantly predicted decision-making capacity. : Despite an absence of documented or clinically obvious impairment, more than half of the sample had significant cognitive impairments. Assessment of cognition in hospice patients is warranted, including assessment of verbal abilities that may interfere with understanding or reasoning related to treatment decisions. Identification of patients at risk for impaired cognition and decision making may lead to effective interventions to improve decision making and honor the wishes of patients and families.

A Review of Palliative and Hospice Care in the Context of Islam: Dying with Faith and Family.

Science.gov (United States)

Mendieta, Maximiliano; Buckingham, Robert W

2017-11-01

By starting to understand Muslim culture, we can seek common ground with Islamic culture within the American experience and bridge opportunities for better palliative and hospice care here and in Middle Eastern countries. The United States, Canada, and Europe are education hubs for Middle Eastern students, creating an opportunity for the palliative and hospice care philosophy to gain access by proxy to populations of terminally ill patients who can benefit from end-of-life care. The aim was to assess the state of research and knowledge about palliative and hospice care within the context of Muslim culture and religion. Within the guide of the key search terms, we learned that at a glance, over 100 articles meet the search criteria, but after a closer inspection, only a portion actually contributed knowledge to the literature. This confirmed the need for research in this vein. More importantly, we posit that once the layers of culture, religion, norms, and nationality are removed, human beings share a kinship based on family, spirituality, death and dying, and fear of pain. This is evident when we compare the Middle Eastern end-of-life experience with the western end-of-life care. A true opportunity to make a lasting impact at the patient level exists for palliative and hospice care researchers if we seek to understand, gain knowledge, and respect Muslim culture and Islamic issues at the end of life.

Specification of an integrated information architecture for a mobile teleoperated robot for home telecare.

Science.gov (United States)

Iannuzzi, David; Grant, Andrew; Corriveau, Hélène; Boissy, Patrick; Michaud, Francois

2016-12-01

The objective of this study was to design effectively integrated information architecture for a mobile teleoperated robot in remote assistance to the delivery of home health care. Three role classes were identified related to the deployment of a telerobot, namely, engineer, technology integrator, and health professional. Patients and natural caregivers were indirectly considered, this being a component of future field studies. Interviewing representatives of each class provided the functions, and information content and flows for each function. Interview transcripts enabled the formulation of UML (Universal Modeling Language) diagrams for feedback from participants. The proposed information architecture was validated with a use-case scenario. The integrated information architecture incorporates progressive design, ergonomic integration, and the home care needs from medical specialist, nursing, physiotherapy, occupational therapy, and social worker care perspectives. The integrated architecture iterative process promoted insight among participants. The use-case scenario evaluation showed the design's robustness. Complex innovation such as a telerobot must coherently mesh with health-care service delivery needs. The deployment of integrated information architecture bridging development, with specialist and home care applications, is necessary for home care technology innovation. It enables continuing evolution of robot and novel health information design in the same integrated architecture, while accounting for patient ecological need.

Personal Web home pages of adolescents with cancer: self-presentation, information dissemination, and interpersonal connection.

Science.gov (United States)

Suzuki, Lalita K; Beale, Ivan L

2006-01-01

The content of personal Web home pages created by adolescents with cancer is a new source of information about this population of potential benefit to oncology nurses and psychologists. Individual Internet elements found on 21 home pages created by youths with cancer (14-22 years old) were rated for cancer-related self-presentation, information dissemination, and interpersonal connection. Examples of adolescents' online narratives were also recorded. Adolescents with cancer used various Internet elements on their home pages for cancer-related self-presentation (eg, welcome messages, essays, personal history and diary pages, news articles, and poetry), information dissemination (e.g., through personal interest pages, multimedia presentations, lists, charts, and hyperlinks), and interpersonal connection (eg, guestbook entries). Results suggest that various elements found on personal home pages are being used by a limited number of young patients with cancer for self-expression, information access, and contact with peers.

OA11 Public health and hospices: what is really possible?

Science.gov (United States)

Hartley, Nigel; Richardson, Heather

2015-04-01

Whilst a growing number of hospices are proactively engaging in the public health agenda, questions remain about whether this is an approach that hospices can adopt successfully. (Sallnow et al . 2014). The experience of St Christopher's in the development of its social hub (The Anniversary Centre) offers insights into the challenges and how these are best addressed. The Anniversary Centre was established to provide a more open and flexible approach to end of life care and to challenge and change public attitudes towards death and dying. It sought, also, to contest an existing culture of care, shifting from professional management of problems to one in which people take a lead in their own care and wellbeing. A review of the progress of the Centre in achieving these aims has been undertaken five years after its establishment. Questions focus on: The degree to which the centre has engaged more of the local communities How much its users are able to determine their own priorities, care and wellbeing through attendance at the centre What evidence of a public health approach exists in the support it provides. The Centre offers a new and alternative way of supporting people living with a life threatening condition. Although successes have been achieved, organisational and historical cultural barriers continue to limit progress. Hospice culture can prohibit public health approaches to palliative care. However, related innovation is possible when clear values and stories are shared, champions are identified and professional assumptions are challenged. Sallnow L, Paul S. Understanding community engagement in end-of-life care: developing conceptual clarity. Crit Public Health 2015;25(2):231-8. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

42 CFR 418.76 - Condition of participation: Hospice aide and homemaker services.

Science.gov (United States)

2010-10-01

... reported to an aide's supervisor. (vi) Maintenance of a clean, safe, and healthy environment. (vii..., emotional, and developmental needs of and ways to work with the populations served by the hospice, including... techniques and ambulation. (xi) Normal range of motion and positioning. (xii) Adequate nutrition and fluid...

Social Work Involvement in Advance Care Planning: Findings from a Large Survey of Social Workers in Hospice and Palliative Care Settings.

Science.gov (United States)

Stein, Gary L; Cagle, John G; Christ, Grace H

2017-03-01

Few data are available describing the involvement and activities of social workers in advance care planning (ACP). We sought to provide data about (1) social worker involvement and leadership in ACP conversations with patients and families; and (2) the extent of functions and activities when these discussions occur. We conducted a large web-based survey of social workers employed in hospice, palliative care, and related settings to explore their role, participation, and self-rated competency in facilitating ACP discussions. Respondents were recruited through the Social Work Hospice and Palliative Care Network and the National Hospice and Palliative Care Organization. Descriptive analyses were conducted on the full sample of respondents (N = 641) and a subsample of clinical social workers (N = 456). Responses were analyzed to explore differences in ACP involvement by practice setting. Most clinical social workers (96%) reported that social workers in their department are conducting ACP discussions with patients/families. Majorities also participate in, and lead, ACP discussions (69% and 60%, respectively). Most respondents report that social workers are responsible for educating patients/families about ACP options (80%) and are the team members responsible for documenting ACP (68%). Compared with other settings, oncology and inpatient palliative care social workers were less likely to be responsible for ensuring that patients/families are informed of ACP options and documenting ACP preferences. Social workers are prominently involved in facilitating, leading, and documenting ACP discussions. Policy-makers, administrators, and providers should incorporate the vital contributions of social work professionals in policies and programs supporting ACP.

What explains racial differences in the use of advance directives and attitudes toward hospice care?

Science.gov (United States)

Johnson, Kimberly S; Kuchibhatla, Maragatha; Tulsky, James A

2008-10-01

Cultural beliefs and values are thought to account for differences between African Americans and whites in the use of advance directives and beliefs about hospice care, but few data clarify which beliefs and values explain these differences. Two hundred five adults aged 65 and older who received primary care in the Duke University Health System were surveyed. The survey included five scales: Hospice Beliefs and Attitudes, Preferences for Care, Spirituality, Healthcare System Distrust, and Beliefs About Dying and Advance Care Planning. African Americans were less likely than white subjects to have completed an advance directive (35.5% vs 67.4%, Pconflict with the goals of palliative care, and distrust the healthcare system. In multivariate analyses, none of these factors alone completely explained racial differences in possession of an advance directive or beliefs about hospice care, but when all of these factors were combined, race was no longer a significant predictor of either of the two outcomes. These findings suggest that ethnicity is a marker of common cultural beliefs and values that, in combination, influence decision-making at the end of life. This study has implications for the design of healthcare delivery models and programs that provide culturally sensitive end-of-life care to a growing population of ethnically diverse older adults.

77 FR 23273 - Proposed Information Collection; Comment Request: Home Equity Conversion Mortgage Counseling...

Science.gov (United States)

2012-04-18

... Collection; Comment Request: Home Equity Conversion Mortgage Counseling Client Survey AGENCY: Office of the... information: Title of Proposal: Home Equity Conversion Mortgage Counseling Client Survey. OMB Control Number... reverse mortgage counseling. As part of HUD's evaluation of its HECM counseling program, performance...

Is There a Place for Humor in Hospice Palliative Care? Volunteers Say "Yes"!

Science.gov (United States)

Claxton-Oldfield, Stephen; Bhatt, Anamika

2017-06-01

A survey was conducted to examine the frequency, acceptability, and functions of humor between hospice palliative care volunteers and their patients, from the volunteers' perspective. Thirty-two volunteers completed the survey, which was developed for this study. The results revealed that most patients and volunteers initiated humor either "often" or "sometimes" in their interactions. Over half of the volunteers considered humor to be either "very important" or "extremely important" in their interactions with patients (42% and 13%, respectively), with the patient being the determining factor as to whether and when it is appropriate or not (ie, volunteers take their lead from their patients). Volunteers mentioned a number of functions that humor serves within their patient interactions (eg, to relieve tension, to foster relationships/connections, and to distract). Laughter and humor fulfills one of the main goals of hospice palliative care, namely, improving patients' overall quality of life.

75 FR 42943 - Medicare Program; Hospice Wage Index for Fiscal Year 2011

Science.gov (United States)

2010-07-22

... Budget Neutrality Adjustment Factor (BNAF) 4. Effects of Phasing out the BNAF III. Solicitation of... disparity in wages from one geographical location to another, a committee was formulated to negotiate a wage... the methodology to be used for updating the hospice wage index. In the August 8, 1997 Federal Register...

Agency ownership, patient payment source, and length of service in home care, 1992 2000.

Science.gov (United States)

Han, Beth; McAuley, William J; Remsburg, Robin E

2007-08-01

Little is known about whether an association exists between agency ownership and length of service among home care patients with different payment sources. This study investigated how for-profit and not-for-profit agencies responded to policy changes in the 1990s with respect to length of service. We examined length of service among 37,364 home care patients using the 1992, 1994, 1996, 1998, and 2000 National Home and Hospice Care Surveys. We used Kaplan-Meier methods and Cox regression models. After we adjusted for patient and agency characteristics, our results revealed that agency ownership was not associated with length of service for patients with private insurance, Medicare, Medicaid, Medicare plus Medicaid, or Medicare plus private insurance. This finding was consistent from 1992 through 2000. Length of service among patients with Medicare decreased significantly from 1998 through 2000, but length of service among patients with Medicaid did not change significantly from 1992 through 2000. Agency ownership is not associated with patient length of service in home care. Regardless of the policy changes in the home care arena in the 1990s, for-profit and not-for-profit home health agencies behaved similarly with regard to length of service among patients within differently structured payment systems.

End-of-life dreams and visions: a longitudinal study of hospice patients' experiences.

Science.gov (United States)

Kerr, Christopher W; Donnelly, James P; Wright, Scott T; Kuszczak, Sarah M; Banas, Anne; Grant, Pei C; Luczkiewicz, Debra L

2014-03-01

End-of-life dreams and visions (ELDVs) have been well documented throughout history and across cultures. The impact of pre-death experiences on dying individuals and their loved ones can be profoundly meaningful. Our aim was to quantify the frequency of dreams/visions experienced by patients nearing the end of life, examine the content and subjective significance of the dreams/visions, and explore the relationship of these factors to time/proximity to death. This mixed-methods study surveyed patients in a hospice inpatient unit using a semi-structured interview. Sixty-six patients admitted to a hospice inpatient unit between January 2011 and July 2012 provided informed consent and participated in the study. The semi-structured interviews contained closed and open-ended questions regarding the content, frequency, and comfort/distress of dreams/visions. Fifty-nine participants comprised the final sample. Most participants reported experiencing at least one dream/vision. Almost half of the dreams/visions occurred while asleep, and nearly all patients indicated that they felt real. The most common dreams/visions included deceased friends/relatives and living friends/relatives. Dreams/visions featuring the deceased (friends, relatives, and animals/pets) were significantly more comforting than those of the living, living and deceased combined, and other people and experiences. As participants approached death, comforting dreams/visions of the deceased became more prevalent. ELDVs are commonly experienced phenomena during the dying process, characterized by a consistent sense of realism and marked emotional significance. These dreams/visions may be a profound source of potential meaning and comfort for the dying, and therefore warrant clinical attention and further research.

The concept of hospice in theory and practice.

Science.gov (United States)

Nayak, S

2001-12-01

Initially the word 'hospice' was used to convey the friendly and warm feeling between the guest and the host. Later the place where this feeling was experienced represented the meaning of the word. Hospice is a union between the tough and rigid principles of curative clinical science and more flexible 'compassion' of human behaviour. The aim should be more on to relieve distressing symptoms of advanced cancer and other terminal diseases by control of symptoms and good nursing. In India one in 10 deaths is related to cancer and a sizeable section of this huge population die in unrelieved pain and suffering. AIDS cases are rising in the developing countries, which cannot afford expensive treatment. So the provision of good palliative care will remain for many years to come. But with the advent of antibiotics, doctors changed their goal from palliative care to absolute cure. The incurable cases were gradually made to feel unwelcome. The best option between the two is compassion of the old days and the modern scientific advances. Principles of ethics in clinical practice rotate around autonomy, beneficence, non-maleficence and justice. Euthansia poses a big question. Lack of awareness among patients, doctors and paramedical personnel causes unrelieved pain in cancer and other terminal diseases. Gastro-intestinal symptoms, respiratory symptoms, lymphoedema and complications of cancer and other diseases can be looked carefully to give proper benefit to the patients. Complementary and alternative medicine plays a key role in palliative care and improves the quality of life.

76 FR 26731 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

Science.gov (United States)

2011-05-09

... care under Part A. See Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), Public Law 97-248, Sec... future cap years. See, e.g., Los Angeles Haven Hospice, Inc. v. Leavitt, 2009 WL 5868513 (C.D. Cal. 2009... the recalculation. The impact of this methodology will be that the fractional allocations for some...

Organizational factors associated with the use of information systems in nursing homes.

Science.gov (United States)

Davis, Jullet A; Brannon, Diane; Whitman, Marilyn V

2009-01-01

The use of information systems (ISs) in nursing homes is gradually increasing, yet little is known about the factors that promote the use of these systems. Using resource dependency theory as the conceptual framework, this study examines how chain membership, ownership status, and innovativeness are associated with ISs use in nursing homes. We analyzed the results of the 2004 National Nursing Home Survey. The sampling process consisted of a stratified probability design. A total of 1,174 nursing homes participated in the survey. The results of the regression analysis revealed that facilities that were members of a chain were significantly more likely to use all types of ISs and ISs for administrative tasks than were nonchain facilities. In addition, nonprofit nursing homes were significantly more likely to use administrative systems. The demand for nursing home services is expected to increase substantially with the aging baby boomers. The use of ISs may assist nursing homes to improve service delivery by collecting and analyzing service, finance, and administrative data that are necessary to achieve operational efficiencies. Membership in a multifacility chain may both increase the need for network-wide communication and provide resources promoting use.

75 FR 62413 - Notice of Proposed Information Collection: Comment Request; HUD-Owned Real Estate-Dollar Home...

Science.gov (United States)

2010-10-08

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5380-N-38] Notice of Proposed Information Collection: Comment Request; HUD- Owned Real Estate--Dollar Home Sales Program AGENCY: Office of... information: Title of Proposal: HUD-Owned Real Estate--Dollar Home Sales Program. OMB Control Number, if...

Changing patterns in place of cancer death in England: a population-based study.

Directory of Open Access Journals (Sweden)

Wei Gao

Full Text Available Most patients with cancer prefer to die at home or in a hospice, but hospitals remain the most common place of death (PoD.This study aims to explore the changing time trends of PoD and the associated factors, which are essential for end-of-life care improvement.The study analysed all cancer deaths in England collected by the Office for National Statistics during 1993-2010 (n = 2,281,223. Time trends of age- and gender-standardised proportion of deaths in individual PoDs were evaluated using weighted piecewise linear regression. Variables associated with PoD (home or hospice versus hospital were determined using proportion ratio (PR derived from the log-binomial regression, adjusting for clustering effects. Hospital remained the most common PoD throughout the study period (48.0%; 95% CI 47.9%-48.0%, followed by home (24.5%; 95% CI 24.4%-24.5%, and hospice (16.4%; 95% CI 16.3%-16.4%. Home and hospice deaths increased since 2005 (0.87%; 95% CI 0.74%-0.99%/year, 0.24%; 95% CI 0.17%-0.32%/year, respectively, p<0.001, while hospital deaths declined (-1.20%; 95% CI -1.41 to -0.99/year, p<0.001. Patients who died from haematological cancer (PRs 0.46-0.52, who were single, widowed, or divorced (PRs 0.75-0.88, and aged over 75 (PRs 0.81-0.84 for 75-84; 0.66-0.72 for 85+ were less likely to die in home or hospice (p<0.001; reference groups: colorectal cancer, married, age 25-54. There was little improvement in patients with lung cancer of dying in home or hospice (PRs 0.87-0.88. Marital status became the second most important factor associated with PoD, after cancer type. Patients from less deprived areas (higher quintile of the deprivation index were more likely to die at home or in a hospice than those from more deprived areas (lower quintile of the deprivation index; PRs 1.02-1.12. The analysis is limited by a lack of data on individual patients' preferences for PoD or a clinical indication of the most appropriate PoD.More efforts are needed to reduce

Investigating the Challenges and Opportunities in Home Care to Facilitate Effective Information Technology Adoption.

Science.gov (United States)

Koru, Güneş; Alhuwail, Dari; Topaz, Maxim; Norcio, Anthony F; Mills, Mary Etta

2016-01-01

As home care utilization increases, information technology (IT) becomes a critical tool for providing quality home care. However, most home health agencies (HHAs) in the United States are in a position to adopt and leverage IT solutions in budget-constrained settings, where it is crucial to address important and pressing challenges and opportunities for achieving effectiveness in IT adoption. (1) Explore HHAs' challenges and opportunities related to delivering home care as well as performing administrative functions and conducting business, (2) learn about current IT implementation levels and activities in home care, and (3) make recommendations to facilitate efforts and initiatives designed for adopting IT in home care effectively. Semistructured interviews were conducted to elicit rich contextual information from the participants recruited from 13 local HHAs in one of the states in the United States. Established systems analysis techniques were used to ask questions during the interviews. Framework, a qualitative research method, was used to analyze the qualitative data obtained from the interviews. Coordinating clinical and administrative workflows was an important challenge. Inadequate access to patients' medical history and difficulties with medication reconciliation detracted from the quality of care. Hiring, training, scheduling, and retaining qualified personnel constituted another important challenge. Training and educating patients, caregivers, and families hold important opportunities for improving the quality of care. All except one HHA adopted electronic health records (EHR) but many continued to struggle considerably in their day-to-day functions. Health information exchange (HIE) seems to be the most needed technology. Telehealth solutions were perceived to be promising but their added value and financial viability in the long run were questioned. The recommendations for effective IT adoption include keeping a quality improvement focus, keeping a

The Effect of Publicized Quality Information on Home Health Agency Choice.

Science.gov (United States)

Jung, Jeah Kyoungrae; Wu, Bingxiao; Kim, Hyunjee; Polsky, Daniel

2016-12-01

We examine consumers' use of publicized quality information in Medicare home health care markets, where consumer cost sharing and travel costs are absent. We report two findings. First, agencies with high quality scores are more likely to be preferred by consumers after the introduction of a public reporting program than before. Second, consumers' use of publicized quality information differs by patient group. Community-based patients have slightly larger responses to public reporting than hospital-discharged patients. Patients with functional limitations at the start of their care, at least among hospital-discharged patients, have a larger response to the reported functional outcome measure than those without functional limitations. In all cases of significant marginal effects, magnitudes are small. We conclude that the current public reporting approach is unlikely to have critical impacts on home health agency choice. Identifying and releasing quality information that is meaningful to consumers may help increase consumers' use of public reports. © The Author(s) 2015.

A cloud-based home health care information sharing system to connect patients with home healthcare staff -A case report of a study in a mountainous region.

Science.gov (United States)

Nomoto, Shinichi; Utsumi, Momoe; Sasayama, Satoshi; Dekigai, Hiroshi

2017-01-01

We have developed a cloud system, the e-Renraku Notebook (e-RN) for sharing of home care information based on the concept of "patient-centricity". In order to assess the likelihood that our system will enhance the communication and sharing of information between home healthcare staff members and home-care patients, we selected patients who were residing in mountainous regions for inclusion in our study. We herein report the findings.Eighteen staff members from 7 medical facilities and 9 patients participated in the present study.The e-RN was developed for two reasons: to allow patients to independently report their health status and to have staff members view and respond to the information received. The patients and staff members were given iPads with the pre-installed applications and the information being exchanged was reviewed over a 54-day period.Information was mainly input by the patients (61.6%), followed by the nurses who performed home visits (19.9%). The amount of information input by patients requiring high-level nursing care and their corresponding staff member was significantly greater than that input by patients who required low-level of nursing care.This patient-centric system in which patients can independently report and share information with a member of the healthcare staff provides a sense of security. It also allows staff members to understand the patient's health status before making a home visit, thereby giving them a sense of security and confidence. It was also noteworthy that elderly patients requiring high-level nursing care and their staff counterpart input information in the system significantly more frequently than patients who required low-level care.

Developing competencies for pediatric hospice and palliative medicine.

Science.gov (United States)

Klick, Jeffrey C; Friebert, Sarah; Hutton, Nancy; Osenga, Kaci; Pituch, Kenneth J; Vesel, Tamara; Weidner, Norbert; Block, Susan D; Morrison, Laura J

2014-12-01

In 2006, hospice and palliative medicine (HPM) became an officially recognized subspecialty. This designation helped initiate the Accreditation Council of Graduate Medical Education Outcomes Project in HPM. As part of this process, a group of expert clinician-educators in HPM defined the initial competency-based outcomes for HPM fellows (General HPM Competencies). Concurrently, these experts recognized and acknowledged that additional expertise in pediatric HPM would ensure that the competencies for pediatric HPM were optimally represented. To fill this gap, a group of pediatric HPM experts used a product development method to define specific Pediatric HPM Competencies. This article describes the development process. With the ongoing evolution of HPM, these competencies will evolve. As part of the Next Accreditation System, the Accreditation Council of Graduate Medical Education uses milestones as a framework to better define competency-based, measurable outcomes for trainees. Currently, there are no milestones specific to HPM, although the field is designing curricular milestones with multispecialty involvement, including pediatrics. These competencies are the conceptual framework for the pediatric content in the HPM milestones. They are specific to the pediatric HPM subspecialist and should be integrated into the training of pediatric HPM subspecialists. They will serve a foundational role in HPM and should inform a wide range of emerging innovations, including the next evolution of HPM Competencies, development of HPM curricular milestones, and training of adult HPM and other pediatric subspecialists. They may also inform pediatric HPM outcome measures, as well as standards of practice and performance for pediatric HPM interdisciplinary teams. Copyright © 2014 by the American Academy of Pediatrics.

A Survey of Hospice and Palliative Care Clinicians' Experiences and Attitudes Regarding the Use of Palliative Sedation.

Science.gov (United States)

Maiser, Samuel; Estrada-Stephen, Karen; Sahr, Natasha; Gully, Jonathan; Marks, Sean

2017-09-01

A variety of terms and attitudes surround palliative sedation (PS) with little research devoted to hospice and palliative care (HPC) clinicians' perceptions and experiences with PS. These factors may contribute to the wide variability in the reported prevalence of PS. This study was designed to better identify hospice and palliative care (HPC) clinician attitudes toward, and clinical experiences with palliative sedation (PS). A 32-question survey was distributed to members of the American Academy of Hospice and Palliative Medicine (n = 4678). The questions explored the language clinicians use for PS, and their experiences with PS. Nine hundred thirty-six (20% response rate) responded to the survey. About 83.21% preferred the terminology of PS compared with other terms. A majority felt that PS is a bioethically appropriate treatment for refractory physical and nonphysical symptoms in dying patients. Most felt PS was not an appropriate term in clinical scenarios when sedation occurred as an unintended side effect from standard treatments. Hospice clinicians use PS more consistently and with less distress than nonhospice clinician respondents. Benzodiazepines (63.1%) and barbiturates (18.9%) are most commonly prescribed for PS. PS is the preferred term among HPC clinicians for the proportionate use of pharmacotherapies to intentionally lower awareness for refractory symptoms in dying patients. PS is a bioethically appropriate treatment for refractory symptoms in dying patients. However, there is a lack of clear agreement about what is included in PS and how the practice of PS should be best delivered in different clinical scenarios. Future efforts to investigate PS should focus on describing the clinical scenarios in which PS is utilized and on the level of intended sedation necessary, in an effort to better unify the practice of PS.

76 FR 624 - Proposed Information Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program...

Science.gov (United States)

2011-01-05

... Collection (Patient Satisfaction Survey Michael E. DeBakey Home Care Program) Activity: Comment Request... satisfaction with the quality of services/care provided by home care program staff. An agency may not conduct... Form 10-0476).'' SUPPLEMENTARY INFORMATION: Title: Patient Satisfaction Survey Michael E. DeBakey Home...

What explains racial differences in the use of advance directives and attitudes toward hospice care?

OpenAIRE

Johnson, Kimberly S.; Kuchibhatla, Maragatha; Tulsky, James A.

2008-01-01

Cultural beliefs and values are thought to account for differences between African Americans and Whites in the use of advance directives and beliefs about hospice care. However, little data clarifies which beliefs and values explain these differences.

Does information matter? Competition, quality, and the impact of nursing home report cards.

Science.gov (United States)

Grabowski, David C; Town, Robert J

2011-12-01

We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. © Health Research and Educational Trust.

The 2015 Class of Hospice and Palliative Medicine Fellows-From Training to Practice: Implications for HPM Workforce Supply.

Science.gov (United States)

Lupu, Dale; Salsberg, Ed; Quigley, Leo; Wu, Xiaoli

2017-05-01

A relatively new specialty, hospice and palliative medicine (HPM), is unusual in that physicians can enter from 10 different specialties. This study sought to understand where HPM physicians were coming from, where they were going to practice, and the job market for HPM physicians. Describe characteristics of the incoming supply of HPM physicians, their practice plans, and experience finding initial jobs. In October 2015, we conducted an online survey of physicians who completed accredited HPM fellowships the previous June. We had electronic mail addresses for 195 of the 243 graduating fellows. About 112 HPM fellows responded (58% of those invited). The most common prior training was internal medicine (45%), followed by family medicine (23%), pediatrics (12%), and emergency medicine (10%). More than 40% had practiced medicine before their HPM training. After graduation, 97% were providing 20 or more hours per week of patient care, with most hours in palliative care. About 72% devoted more than 20 hours per week to palliative care, whereas only 13% worked that much in hospice care. About 81% reported no difficulty finding a satisfactory practice position. About 98% said that they would recommend HPM to others, and 63% took the time to provide written comments that were highly positive about the specialty. New HPM physicians are finding satisfying jobs. They are enthusiastic in recommending the specialty to others. Most are going into palliative medicine, leaving questions about how the need for hospice physicians will be filled. Although jobs appear to be numerous, there are practice areas with more limited opportunities. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Home nurses' turnover intentions: the impact of informal supervisory feedback and self-efficacy.

Science.gov (United States)

Van Waeyenberg, Thomas; Decramer, Adelien; Anseel, Frederik

2015-12-01

To examine how home nurses' turnover intentions are affected by the quality and frequency of supervisory feedback and by their own self-efficacy. Little is known about effective retention strategies for the growing home healthcare sector that struggles to retain an adequate workforce. While the work environment and supervisors have been found to play a key-role in nurses' turnover intentions, home nurses mostly work autonomously and apart from their supervisors. These circumstances require a customized approach and need to be understood to ensure high-quality home health care. We used a correlational, cross-sectional survey design. A convenience sample of 312 home nurses was selected from a division of a large home health care organization in Flanders, Belgium. Data were collected in 2013 using structured questionnaires and analysed using descriptive statistics, structural equation modelling and relative weight analysis. The quality of feedback was related to lower levels of turnover intentions. This relationship was fully mediated by home nurses' self-efficacy. Frequent favourable feedback was directly related to lower turnover intentions while the relationship between frequent unfavourable feedback and turnover intentions was conditional on home nurses' level of self-efficacy. This study contributes to our understanding of home nurses' turnover intentions and the role of informal supervisory feedback and home nurses' self-efficacy. © 2015 John Wiley & Sons Ltd.

Teaching communication skills to hospice teams: comparing the effectiveness of a communication skills laboratory with in-person, second life, and phone role-playing.

Science.gov (United States)

Hamilton, Gillian; Ortega, Rosio; Hochstetler, Vicki; Pierson, Kristen; Lin, Peiyi; Lowes, Susan

2014-09-01

Communication skills are critical in hospice care but challenging to teach. Therefore, a hospice agency developed a communication skills laboratory for nurses and social workers. Learners role-played 3 common hospice scenarios. The role-play modalities were in-person, Second Life, and telephone. Learners were scored on 4 communication aspects. Learners in all modalities rated the laboratory as very effective. However, learners in the Second Life and phone modality showed greater improvements from scene 1 to 3 than those in the in-person modality. There were no significant differences in improvement between the Second Life and phone modalities. Results support the effectiveness of this communication skills laboratory while using different teaching modalities and show phone and Second Life role-plays were more effective than an in-person role-play. © The Author(s) 2013.

Development of a Health Care Information System for the Elderly at Home

Directory of Open Access Journals (Sweden)

Wang Dong

2016-01-01

Full Text Available The growing population aging is a serious social problem in the world today. Accidental death at home is increasing because abnormal conditions can not be discovered in time, especially to the elderly who live alone. Besides, according to statistics, over 80 percent of the elderly need the service of home care in China. A health care information system for the elderly at home is developed to monitor the real–time state of the elderly remotely in this thesis. The system can show the current positions of the elderly in the house and judge whether they are in dangerous locations or have dangerous activities. In the case of emergency, the elderly can press the emergency button. The system also provides some help for the elderly’s daily life. The system offers the advantage for living at home more safely and more comfortably, and has better application prospect

Human factors and ergonomics in home care: Current concerns and future considerations for health information technology

Science.gov (United States)

Or, Calvin K.L.; Valdez, Rupa S.; Casper, Gail R.; Carayon, Pascale; Burke, Laura J.; Brennan, Patricia Flatley; Karsh, Ben-Tzion

2010-01-01

Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention. PMID:19713630

75 FR 60347 - Information Sharing Among Federal Home Loan Banks

Science.gov (United States)

2010-09-30

... business days between the hours of 10 a.m. and 3 p.m. at the Federal Housing Finance Agency, Fourth Floor... FEDERAL HOUSING FINANCE BOARD 12 CFR Part 914 FEDERAL HOUSING FINANCE AGENCY 12 CFR Part 1260 RIN 2590-AA35 Information Sharing Among Federal Home Loan Banks AGENCY: Federal Housing Finance Agency...

"Willing but unwilling": attitudinal barriers to adoption of home-based health information technology among older adults.

Science.gov (United States)

Young, Rachel; Willis, Erin; Cameron, Glen; Geana, Mugur

2014-06-01

While much research focuses on adoption of electronic health-care records and other information technology among health-care providers, less research explores patient attitudes. This qualitative study examines barriers to adoption of home-based health information technology, particularly personal electronic health records, among older adults. We conducted in-depth interviews (30-90 min duration) with 35 American adults, aged 46-72 years, to determine their perceptions of and attitudes toward home-based health information technology. Analysis of interview data revealed that most barriers to adoption fell under four themes: technological discomfort, privacy or security concerns, lack of relative advantage, and perceived distance from the user representation. Based on our findings, systems to promote home-based health information technology should incorporate familiar computer applications, alleviate privacy and security concerns, and align with older adults' active and engaged self-image.

Political economy of hope as a cultural facet of biomedicalization: A qualitative examination of constraints to hospice utilization among U.S. end-stage cancer patients.

Science.gov (United States)

Mrig, Emily Hammad; Spencer, Karen Lutfey

2018-03-01

A growing body of social science literature is devoted to describing processes of biomedicalization. The issue of biomedicalization is especially relevant for individuals suffering from end-stage cancer and hoping that aggressive end-of-life interventions, which are riddled with uncertainty around quantity or quality of life, will produce a 'cure'. To examine hospice underutilization among end-stage cancer patients, we apply the anthropological concept 'political economy of hope,' which describes how personal and collective 'hope' is associated with the political and economic structures that produce biomedicalization processes. Previous studies have examined hospice underutilization among end-stage cancer patients and have identified barriers stemming from patient and physician characteristics or health insurance reimbursement policies. Yet, these studies do not provide an organized synthesis of how barriers articulate, how they are part of the longitudinal decision-making process, or describe the sociocultural context surrounding hospice care enrollment decisions. This paper focuses on US-specific mechanisms and is based on qualitative, in-depth, interviews with physicians at an academic hospital (N = 24). We find that hospice underutilization results from a web of interconnected constraints surrounding end-stage cancer patients. Our research reveals how hospice care contradicts the political and economic structures associated with end-stage cancer care and illustrates how end-stage cancer patients are transformed into a form of biovalue, a fundamental commodity sustaining the political economy of hope. Copyright © 2018 Elsevier Ltd. All rights reserved.

Perceptions of family members of palliative medicine and hospice patients who experienced music therapy.

Science.gov (United States)

Gallagher, Lisa M; Lagman, Ruth; Bates, Debbie; Edsall, Melissa; Eden, Patricia; Janaitis, Jessica; Rybicki, Lisa

2017-06-01

Evidence shows that music therapy aids in symptom management and improves quality of life for palliative medicine and hospice patients. The majority of previous studies have addressed patient needs, while only a few addressed the needs of family members. The primary purpose of this study was to understand family members' perceptions of music therapy experienced by a relative in palliative medicine or hospice. Patient self-reported scales and music therapist assessment of change were also investigated. Patients scored their symptoms (pain, anxiety, depression, shortness of breath, and mood) before and after music therapy sessions. One family member present during the session assessed perceived effect on the patient's pain, anxiety, depression, shortness of breath, stress level, restlessness, comfort level, mood, and quality of life. The effect on family member's stress level, quality of life, and mood and helpfulness of the music therapy session for the patient and self were studied. Recommendations about future patient participation in music therapy and qualitative comments were also solicited. Fifty family member/patient dyads participated in the study. Family member perceptions were positive, with 82% of responders indicating improvement for self and patient in stress, mood, and quality of life; 80% rating the session as extremely helpful; and 100% of 49 recommending further music therapy sessions for the patient. Patients reported statistically significant improvement in pain, depression, distress, and mood scores. Family members of patients in palliative medicine and hospice settings reported an immediate positive impact of music therapy on the patient and on themselves. More research needs to be conducted to better understand the benefits of music therapy for family members.

Mindful Self-Care and Secondary Traumatic Stress Mediate a Relationship Between Compassion Satisfaction and Burnout Risk Among Hospice Care Professionals.

Science.gov (United States)

Hotchkiss, Jason T

2018-01-01

Effective self-care in hospice is anecdotally proclaimed to reduce burnout risk. Yet, the topic has received little empirical attention. This study developed a model for predicting burnout risk from compassion satisfaction (CS), secondary traumatic stress (STS), and mindful self-care. Hospice care professionals (n = 324). Cross-sectional self-report survey. Mindful self-care was correlated with CS ( r = 0.497, p Burnout ( r = -0.726, p Burnout. Mindful self-care and STS mediated a relationship between CS and Burnout. Each self-care category was statistically significant protective factors against burnout risk ( p Burnout in order of strength were self-compassion and purpose (SC; r = -0.673), supportive structure (SS; r = -0.650), mindful self-awareness (MS; r = -0.642), mindful relaxation (MR; r = -0.531), supportive relationships (SR; r = -0.503), and physical care (PC; r = -0.435). However, for STS, only SS ( r = -0.407, p Burnout compared to published norms. Those who engaged in multiple and frequent self-care strategies experienced higher professional quality of life. Implications for hospice providers and suggestions for future research are discussed.

Effects of electronic health information technology implementation on nursing home resident outcomes.

Science.gov (United States)

Pillemer, Karl; Meador, Rhoda H; Teresi, Jeanne A; Chen, Emily K; Henderson, Charles R; Lachs, Mark S; Boratgis, Gabriel; Silver, Stephanie; Eimicke, Joseph P

2012-02-01

To examine the effects of electronic health information technology (HIT) on nursing home residents. The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents' subjective assessment of the HIT intervention were generally positive. The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior. © The Author(s) 2012

Wrestling with Social Media on Information Systems’ Home Ground

DEFF Research Database (Denmark)

Haahr, Lars

2014-01-01

While there are many possible approaches and areas of research for the study of social media, a review shows that only a few of these are used in extant information systems literature. The paper therefore suggests that increased awareness of the possibilities can strengthen research in social media....... It is also suggested that information systems scholars can strengthen their interdisciplinary position by making the information systems discipline itself the home ground for research about social media. To address the issue of possible approaches and areas of research, the paper develops a framework...... that includes conceptual framing and methodology as well as research areas in the information systems discipline. First, the framework guides a review of extant literature about external social media. Going forward, the framework facilitates the development of a future research agenda about social media...

Implications of Information and Communication Technologies (ICT) for School-Home Communication

Science.gov (United States)

Heath, Don; Maghrabi, Rozan; Carr, Nora

2015-01-01

Research demonstrates the positive impact of parental involvement on students, families and schools. Studies also indicate a close connection between effective school-home communication and increased parental involvement and engagement in learning. Effective selection and use of Information Communication Technologies (ICT) invites more effective…

Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education.

Science.gov (United States)

Henriksen, Eva; Burkow, Tatjana M; Johnsen, Elin; Vognild, Lars K

2013-08-09

Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient's TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO's standard for information security risk management. A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. Most of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality

A pilot study on the effects and feasibility of compassion-focused expressive writing in Day Hospice patients.

Science.gov (United States)

Imrie, Susan; Troop, Nicholas A

2012-06-01

Research has found that writing about stress can confer physical and psychological health benefits on participants and that adopting a self-compassionate stance may have additional benefits. This pilot study evaluated a self-compassionate expressive writing intervention in a Day Hospice setting. Thirteen patients with life-limiting illnesses wrote on two occasions about recent stressful experiences. Half also received a self-compassion instruction for their writing. Outcome measures were taken at baseline and one week after the second writing session, and text analysis was used to identify changes in the types of words used, reflecting changes in psychological processes. Patients given the self-compassion instruction increased in their self-soothing and self-esteem in contrast to patients in the stress-only condition. Happiness broadly increased in both groups although reported levels of stress generally increased in patients given the self-compassion instruction but decreased in patients in the stress-only condition. Those given the self-compassion instruction also increased in their use of causal reasoning words across the two writing sessions compared with those in the stress-only condition. Expressive writing appears to be beneficial in patients at a hospice and was viewed as valuable by participants. The inclusion of a self-compassion instruction may have additional benefits and a discussion of the feasibility of implementing expressive writing sessions in a Day Hospice is offered.

Affirming the Connection: Comparative Findings on Communication Issues from Hospice Patients and Hematology Survivors

Science.gov (United States)

McGrath, Pam

2004-01-01

The following discussion presents comparative findings from hospice patients and hematology survivors on the topic of talking about dying to significant others within their network of family and friends. The insights have been gathered from an Australian research program that is exploring the notion of spirituality in relation to serious illness.…

Implications of Information and Communication Technologies (ICT for School-Home Communication

Directory of Open Access Journals (Sweden)

Don Heath

2015-07-01

Full Text Available Research demonstrates the positive impact of parental involvement on students, families and schools. Studies also indicate a close connection between effective school-home communication and increased parental involvement and engagement in learning. Effective selection and use of Information Communication Technologies (ICT invites more effective school-home communication, increasing parental involvement and improving student outcomes. However, ICT adoption rates are heterogeneous, influenced by cultural, socioeconomic and other factors. Also, gaps may exist between parent/school communication preferences. Our multi-case study investigates principals and parents from three different public elementary schools (suburban/high wealth; urban/low wealth; urban magnet/mixed income to understand the impact of misalignment in ICT adoption and use on school-home communication. We find misperceptions by parents and principals regarding their ICT adoption beliefs and actual use. Our results also indicate alignment between parent and principal ICT preferences and expectations improves parent satisfaction with the principal and the school, while misalignment has the opposite effect.

Maslow's hierarchy of needs: a framework for achieving human potential in hospice.

Science.gov (United States)

Zalenski, Robert J; Raspa, Richard

2006-10-01

Although the widespread implementation of hospice in the United States has led to tremendous advances in the care of the dying, there has been no widely accepted psychological theory to drive needs assessment and intervention design for the patient and family. The humanistic psychology of Abraham Maslow, especially his theory of motivation and the hierarchy of needs, has been widely applied in business and social science, but only sparsely discussed in the palliative care literature. In this article we review Maslow's original hierarchy, adapt it to hospice and palliative care, apply the adaptation to a case example, and then discuss its implications for patient care, education, and research. The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) selfactualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence.

Corporate Investors Increased Common Ownership In Hospitals And The Postacute Care And Hospice Sectors.

Science.gov (United States)

Fowler, Annabelle C; Grabowski, David C; Gambrel, Robert J; Huskamp, Haiden A; Stevenson, David G

2017-09-01

The sharing of investors across firms is a new antitrust focus because of its potential negative effects on competition. Historically, the ability to track common investors across the continuum of health care providers has been limited. Thus, little is known about common investor ownership structures that might exist across health care delivery systems and how these linkages have evolved over time. We used data from the Provider Enrollment, Chain, and Ownership System of the Centers for Medicare and Medicaid Services to identify common investor ownership linkages across the acute care, postacute care, and hospice sectors within the same geographic markets. To our knowledge, this study provides the first description of common investor ownership trends in these sectors. We found that the percentage of acute care hospitals having common investor ties to the postacute or hospice sectors increased from 24.6 percent in 2005 to 48.9 percent in 2015. These changes have important implications for antitrust, payment, and regulatory policies. Project HOPE—The People-to-People Health Foundation, Inc.

Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound.

Science.gov (United States)

Yang, Nancy; Ornstein, Katherine A; Reckrey, Jennifer M

2016-07-01

Homebound adults experience significant symptom burden. To examine demographic and clinical characteristics associated with high symptom burden in the homebound, and to examine associations between symptom burden and time to hospitalization, nursing home placement, and death. Three hundred eighteen patients newly enrolled in the Mount Sinai Visiting Doctors Program, an urban home-based primary care program, were studied. Patient sociodemographic characteristics, symptom burden (measured via the Edmonton Symptom Assessment Scale), and incidents of hospitalization, nursing home placement, and death were collected via medical chart review. Multivariate Cox proportional hazards models were used to analyze the effect of high symptom burden on time to first hospitalization, nursing home placement, and death. Of the study sample, 45% had severe symptom burden (i.e., Edmonton Symptom Assessment Scale score >6 on at least one symptom). Patients with severe symptom burden were younger (82.0 vs. 85.5 years, P nursing home placement or death. The homebound with severe symptom burden represents a unique cohort of patients who are at increased risk of hospitalization. Tailored symptom management via home-based primary and palliative care programs may prevent unnecessary health care utilization in this population. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Why hospice nurses need high self-esteem.

Science.gov (United States)

Olthuis, Gert; Leget, Carlo; Dekkers, Wim

2007-01-01

This article discusses the relationship between personal and professional qualities in hospice nurses. We examine the notion of self-esteem in personal and professional identity. The focus is on two questions: (1) what is self-esteem, and how is it related to personal identity and its moral dimension? and (2) how do self-esteem and personal identity relate to the professional identity of nurses? We demonstrate it is important that the moral and personal goals in nurses' life coincide. If nurses' personal view of the good life is compatible with their experiences and feelings as professionals, this improves their performance as nurses. We also discuss how good nursing depends on the responses that nurses receive from patients, colleagues and family; they make nurses feel valued as persons and enable them to see the value of the work they do.

Home delivery of medication - the role of a patient information leaflet on maximising service uptake.

Science.gov (United States)

Watson, L; Ahmed, N; Mccall, H; Minton, J; Benn, P; Edwards, S; Waters, L

2014-12-01

There are currently over 30,000 HIV-positive individuals in London and over 25,000 on anti-retroviral therapy. In 2009/2010, this equated to £170m spent by London's NHS on anti-retroviral drugs. Ways employed to reduce this cost include standardising the drugs patients are on and delivering medication to patients at home. Home delivery (HD) medication is exempt from value-added tax. The savings made from 10 patients using the home delivery service would free up resources to provide anti-retroviral therapy to one further patient. Studies have shown that concerns surrounding potential breaches of confidentiality are a potential barrier to some people using the home delivery service. In order to challenge these concerns, a leaflet was devised highlighting the major benefits to both the patient and the NHS of home delivery and addressing concerns over confidentiality. The leaflet was handed out to patients at the Mortimer Market Centre who were currently on anti-retroviral medication but not on home delivery. They were asked to complete a survey on their views of the service before and after reading the leaflet, whether they had been previously aware of the service and whether their concerns had been addressed. Some 79% felt that the patient information leaflet addressed all of their concerns, and it helped 11% decide whether to consider using home delivery. However, as more patients were opposed to the service after reading the patient information leaflet than those considering it, more work needs to be done to explore patients' concerns and other factors influencing home delivery service uptake. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

An assessment of hospice bereavement programs for Hispanics.

Science.gov (United States)

Arriaza, Pablo; Martin, Shadi S; Csikai, Ellen L

2011-01-01

Hispanics are the fastest growing minority group in the United States, numbering over 42 million and comprising 15% of the total population (U.S. Census Bureau, 2008 ). Hispanics are a heterogeneous group that experience disparities in accessing health care, including at the end of life. Specific gaps can be identified in the care of bereaved Hispanic individuals and families. This exploratory study examined bereavement services available and perceived needs for Hispanics in Florida. Hospice bereavement coordinators indicated that limited services were available specifically for Spanish-speakers and that language and cultural barriers were challenges when communicating, offering, and delivering bereavement services to Hispanics. Implications for social workers include the need to increase access to and evaluate the effectiveness of bereavement services for Hispanics.

Home in the heat: Dramatic seasonal variation in home range of desert golden eagles informs management for renewable energy development

Science.gov (United States)

Braham, Melissa A.; Miller, Tricia A.; Duerr, Adam E.; Lanzone, Michael J.; Fesnock, Amy; LaPre, Larry; Driscoll, Daniel; Katzner, Todd E.

2015-01-01

Renewable energy is expanding quickly with sometimes dramatic impacts to species and ecosystems. To understand the degree to which sensitive species may be impacted by renewable energy projects, it is informative to know how much space individuals use and how that space may overlap with planned development. We used global positioning system–global system for mobile communications (GPS-GSM) telemetry to measure year-round movements of golden eagles (Aquila chrysaetos) from the Mojave Desert of California, USA. We estimated monthly space use with adaptive local convex hulls to identify the temporal and spatial scales at which eagles may encounter renewable energy projects in the Desert Renewable Energy Conservation Plan area. Mean size of home ranges was lowest and least variable from November through January and greatest in February–March and May–August. These monthly home range patterns coincided with seasonal variation in breeding ecology, habitat associations, and temperature. The expanded home ranges in hot summer months included movements to cooler, prey-dense, mountainous areas characterized by forest, grasslands, and scrublands. Breeding-season home ranges (October–May) included more lowland semi-desert and rock vegetation. Overlap of eagle home ranges and focus areas for renewable energy development was greatest when eagle home ranges were smallest, during the breeding season. Golden eagles in the Mojave Desert used more space and a wider range of habitat types than expected and renewable energy projects could affect a larger section of the regional population than was previously thought.

Using Home Irrigation Users' Perceptions to Inform Water Conservation Programs

Science.gov (United States)

Warner, Laura A.; Chaudhary, Anil Kumar; Lamm, Alexa J.; Rumble, Joy N.; Momol, Esen

2017-01-01

Targeted agricultural education programs can play a role in solving complex water issues. This article applies importance-performance analysis to examine dimensions of water resources that may inform local water conservation campaigns in the United States. The purpose of this study was to generate a deep understanding of home irrigation users'…

Privacy and senior willingness to adopt smart home information technology in residential care facilities.

Science.gov (United States)

Courtney, K L

2008-01-01

With large predicted increases of the older adult (65 years and older) population, researchers have been exploring the use of smart home information technologies (IT) in residential care (RC) facilities to enhance resident quality of life and safety. Older adults' perceptions of privacy can inhibit their acceptance and subsequent adoption of smart home IT. This qualitative study, guided by principles of grounded theory research, investigated the relationship between privacy, living environment and willingness of older adults living in residential care facilities to adopt smart home IT through focus groups and individual interviews. The findings from this study indicate that privacy can be a barrier for older adults' adoption of smart home IT; however their own perception of their need for the technology may override their privacy concerns. Privacy concerns, as a barrier to technology adoption, can be influenced by both individual-level and community-level factors. Further exploration of the factors influencing older adults' perceptions of smart home IT need is necessary.

Recipients of home care and the role of informal care in Europe.

NARCIS (Netherlands)

Genet, N.; Naiditch, M.

2010-01-01

Introduction: As resources and criteria of eligibility are very different across countries, clients differ in their dependency, frailty and availability of informal care. In some countries recipients of home care more behave like critical consumers knowing their rights than those in other countries.

Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness.

Science.gov (United States)

Werner, Nicole E; Jolliff, Anna F; Casper, Gail; Martell, Thomas; Ponto, Kevin

2018-08-01

Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N = 20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed 'in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM. Practitioner Summary: We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.

Job satisfaction and quality of life among home care workers: a comparison of home care workers who are and who are not informal carers.

Science.gov (United States)

Chou, Yueh-Ching; Fu, Li-Yeh; Kröger, Teppo; Ru-Yan, Chiu

2011-06-01

Job satisfaction and quality of life among home care workers who serve simultaneously as informal carers for their own family members have seldom been explored. This study examined how this dual role influences job satisfaction and quality of life by comparing these dual carers with home care workers who do not provide informal care. The study also explored whether the factors related to job satisfaction and quality of life between these two groups were different. Standardized self-administered questionnaires (Job Satisfaction Survey, the World Health Organization Quality of Life (WHOQOL) scales and various social demographic questions) were administered to the two groups of home care workers in Taiwan from March to April 2009. A total of 1,641 home care workers working in 119 non-government organizations sponsored by 23 local authorities completed and returned the questionnaires. The two groups did not differ in individual characteristics, work characteristics or job satisfaction. Analysis results indicate that the lowest mean scores for all home care workers were the domains of promotion and pay within their job satisfaction and the domain of environment within their quality of life. Multiple regression analysis revealed a significant effect of unpaid caregiving in terms of quality of life but not in terms of job satisfaction. Moreover, job satisfaction and quality of life among home care workers were significantly determined by both their work conditions (e.g. travelling time, salary and length of work experience) and personal variables (e.g. age, family income and family support).

Designing a Probe To Explore Home Information Systems in the United Kingdom.

Science.gov (United States)

Davenport, Elisabeth; And Others

1996-01-01

Describes a three-year study of home information systems in the United Kingdom being conducted by Queen Margaret College (Scotland). Topics include development of an interview protocol; interactive multimedia; perceptions of technology; use of technology; work versus entertainment; gender issues; and time factors. (Author/LRW)

Evaluation of Subcutaneous Phenobarbital Administration in Hospice Patients.

Science.gov (United States)

Hosgood, Jessica Richards; Kimbrel, Jason M; McCrate Protus, Bridget; Grauer, Phyllis A

2016-04-01

Phenobarbital is used in hospice and palliative care to treat refractory symptoms. In end-of-life care, Food and Drug Administration approved routes of administration may be unreasonable based on patients' status. In these cases, phenobarbital may be administered subcutaneously for symptom management. However, according to the American Hospital Formulary Service, subcutaneous administration of commercially available injectable phenobarbital is cautioned due to possible skin reactions. This study evaluates the tolerability of phenobarbital administered subcutaneously. Of 69 patients and 774 distinct subcutaneous phenobarbital injections, 2 site reactions were recorded (2.9% of patients; 0.3% of injections). Both were mild, grade 1 reactions. Each patient continued to receive subcutaneous phenobarbital via newly placed ports with no additional reactions. Based on these findings, phenobarbital appears to be well tolerated when administered subcutaneously. © The Author(s) 2014.

Is it acceptable to video-record palliative care consultations for research and training purposes? A qualitative interview study exploring the views of hospice patients, carers and clinical staff.

Science.gov (United States)

Pino, Marco; Parry, Ruth; Feathers, Luke; Faull, Christina

2017-09-01

Research using video recordings can advance understanding of healthcare communication and improve care, but making and using video recordings carries risks. To explore views of hospice patients, carers and clinical staff about whether videoing patient-doctor consultations is acceptable for research and training purposes. We used semi-structured group and individual interviews to gather hospice patients, carers and clinical staff views. We used Braun and Clark's thematic analysis. Interviews were conducted at one English hospice to inform the development of a larger video-based study. We invited patients with capacity to consent and whom the care team judged were neither acutely unwell nor severely distressed (11), carers of current or past patients (5), palliative medicine doctors (7), senior nurses (4) and communication skills educators (5). Participants viewed video-based research on communication as valuable because of its potential to improve communication, care and staff training. Video-based research raised concerns including its potential to affect the nature and content of the consultation and threats to confidentiality; however, these were not seen as sufficient grounds for rejecting video-based research. Video-based research was seen as acceptable and useful providing that measures are taken to reduce possible risks across the recruitment, recording and dissemination phases of the research process. Video-based research is an acceptable and worthwhile way of investigating communication in palliative medicine. Situated judgements should be made about when it is appropriate to involve individual patients and carers in video-based research on the basis of their level of vulnerability and ability to freely consent.

Informal Caregiver Challenges for Advanced Cancer Patients During End-of-Life Care in Johannesburg, South Africa and Distinctions Based on Place of Death.

Science.gov (United States)

O'Neil, Daniel S; Prigerson, Holly G; Mmoledi, Keletso; Sobekwa, Mfanelo; Ratshikana-Moloko, Mpho; Tsitsi, Jacob M; Cubasch, Herbert; Wong, Michelle L; Omoshoro-Jones, Jones A O; Sackstein, Paul E; Blinderman, Craig D; Jacobson, Judith S; Joffe, Maureen; Ruff, Paul; Neugut, Alfred I; Blanchard, Charmaine L

2018-03-28

In sub-Saharan Africa, late diagnosis with cancer is common. Many dying patients rely on family members for care; little is known about the challenges African informal caregivers face. To better understand the challenges of informal caregivers at the end of life in South Africa, both at home and in inpatient facilities. We included advanced cancer patients and caregivers from a public hospital in Johannesburg, South Africa. Study nurses interviewed patients and caregivers about their experiences. Using univariate and multivariate analyses, we determined the factors associated with greater caregiver difficulty, focusing on patients dying at home vs. in inpatient facilities. Among 174 informal caregivers, 62 (36%) reported "a lot" of challenges. These caregivers struggled most with keeping the patient clean (16%) and with patient interactions (34%). Symptoms associated with greater difficulty included pain (odds ratio [OR] 2.4 [95% CI 1.2-4.7]), urinary incontinence (OR 2.3 [95% CI 1.1-4.9]), fecal incontinence (OR 2.4 [95% CI 1.0-5.7]), insomnia (OR 2.9 [95% CI 1.3-6.9]), fatigue (OR 6.3 [95% CI 1.8-21.6]), extremity weakness (OR 2.9 [95% CI 1.3-6.9]), shame (OR 4.2 [95% CI 1.5-12.0]), and sadness (OR 2.3 [95% CI 1.1-4.8]). Caregivers of patients dying at home reported the greatest difficulty with patients' physical symptoms; caregivers of those dying in facilities reported the greatest difficulty with emotional symptoms. Informal caregivers of patients dying at home reported challenges with practical functional care; this effect was reduced in the inpatient setting. Skills training for these caregivers could relieve some of this burden. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Enhancing the Utilization of Information Communication Technology (ICT) among Home Economics Lecturers in South Eastern Nigeria

Science.gov (United States)

Ejinkeonye, Uju Bridget; Usoroh, Comfort I.

2016-01-01

The study was on enhancing the utilization of information communication Technology (ICT) among Home Economics lecturers in south Eastern Nigeria. The study adopted a survey method. The area of the study is south eastern Nigeria. Three research questions guided the study. The population was made up of 63 Home Economics lecturers from the six…

A quality improvement approach to cognitive assessment on hospice admission: could we use the 4AT or Short CAM?

Science.gov (United States)

Baird, Lucy; Spiller, Juliet Anne

2017-01-01

Background Prevalence studies show that 13%-42% of patients admitted to specialist palliative care inpatient units have delirium. Symptoms of delirium are often subtle and easily missed, or misdiagnosed as fatigue or depression, and so the use of a screening tool could improve early identification and management of delirium and lead to improved outcomes. Patients admitted to hospices are often frail and tired, therefore a quick and easy-to-use method of cognitive assessment is essential. Methods A quality improvement (QI) approach (PDSA: Plan, Do, Study, Act) was used to improve screening for delirium on admission to a hospice unit. A baseline measure was taken of the rate of performance of cognitive assessment on admission. Five PDSA cycles were then undertaken which involved implementing change and then evaluating results through auditing case notes and interviewing staff. Results The first cycle determined staff preference between two cognitive assessment methods: the Short Confusion Assessment Method and the four 'A's Test (4AT). Two further PDSA cycles embedded the 4AT (the preferred tool) into the admission process, establishing it as a usable tool in the hospice setting for up to 92% of admissions. A subsequent cycle showing poor sustainability prompted staff education and changes to admission documentation, resulting in an increase in cognitive assessment being performed, from 50% to 76%. Conclusion The 4AT is a usable tool in the hospice inpatient setting to assess patients' cognitive state on admission and can easily be incorporated into the admission process. The QI approach highlighted the need to link staff awareness of their use of the screening tool with perceived improvements in the treatment of delirium, which prompted the creation and implementation of a 'Delirium Checklist'. Some initial lack of sustainability was addressed by staff education and changes to the admission paperwork to ensure compliance with the use of the 4AT and sustained

An examination of the research priorities for a hospice service in New Zealand: A Delphi study.

Science.gov (United States)

de Vries, Kay; Walton, Jo; Nelson, Katherine; Knox, Rhondda

2016-06-01

Palliative care research is relatively diverse and prioritizing research in this field is dependent on multiple factors such as complex ethical decisions in designing and conducting the research; access to participants who may be deemed "vulnerable" and an increasingly medically focused approach to care. The aim of this study was to inform organizational decision-making and policy development regarding future research priorities for a hospice service in New Zealand. A modified three-round Delphi technique was employed. Participants were drawn from one dedicated specialist palliative care service that delivers care in the community, day-care, hospice inpatient, aged residential care, and acute hospital palliative care service. A purposive sample included palliative care staff (n = 10, 18, 9, for rounds 1-3, respectively) volunteers (n = 10, 12, 11); and patients and family carers (n = 6, 8, for rounds 1 and 2). Patients and family carers were not involved in the third round. At final ranking of six research themes encompassing 23 research topics were identified by staff and volunteers. These were: symptom management; aged care; education; community; patient and family; and bereavement support and young people. Patients and family carers agreed on four themes, made up of 10 research topics. These were: decision-making, bereavement and loss, symptom management; and recognition of need and response of service. The study generated a rich set of research themes and specific research topics. The perspectives of staff and volunteers are significantly different from those of patients and family members, in spite of the recognition by all concerned that palliative care services work within a philosophy of patient-centered care. Open discussion of ideas has the potential to engage both staff and patients and carers in quality improvement initiatives, and to reinforce the value of research for patient care.

Solar Energy: Uses for Your Home. The CIRcular: Consumer Information Report 15.

Science.gov (United States)

Bank of America NT & SA, San Francisco, CA.

This report defines active and passive solar energy systems, describes home uses for solar energy, and offers guidelines for choosing and installing a system. Much of the information is specific to the state of California. Uses for solar energy which are presented include passive space heating, passive cooling, active space heating, household…

Gender Differences in Caregiving at End of Life: Implications for Hospice Teams.

Science.gov (United States)

Washington, Karla T; Pike, Kenneth C; Demiris, George; Parker Oliver, Debra; Albright, David L; Lewis, Alexandria M

2015-12-01

Researchers have identified important gender differences in the experience of caring for a family member or friend living with advanced disease; however, trends suggest that these differences may be diminishing over time in response to changing gender roles. In addition, while many studies have found caregiving experiences and outcomes to be poorer among female caregivers, noteworthy exceptions exist. The primary aim of this exploratory study was to determine how, if at all, current day caregiving at end of life varies by gender. We conducted a secondary analysis of data from a multisite randomized controlled trial of a family caregiving intervention performed between 2010 and 2014. We compared female and male hospice family caregivers on baseline variables using χ(2) tests for association of categorical variables and t-tests for continuous variables. Our sample included 289 family caregivers of individuals receiving services from one of two hospice agencies located in the northwestern United States. Demographic data and other categorical variables of interest were provided via caregiver self-report using an instrument created specifically for this study. Reaction to caregiving and caregiving burden were measured using the Caregiver Reaction Assessment (CRA). As it related to caregiving, females had significantly lower self-esteem and more negative impact on their schedule, health, and family support than males. No gender differences were detected with regard to the impact of caregiving on individuals' finances. Despite changing social expectations, pronounced gender differences persist in caregiving at the end of life.

Quality and use of consumer information provided with home test kits: room for improvement.

Science.gov (United States)

Grispen, Janaica E J; Ickenroth, Martine H P; de Vries, Nanne K; van der Weijden, Trudy; Ronda, Gaby

2014-10-01

Diagnostic self-tests (tests on body materials that are initiated by consumers with the aim of diagnosing a disorder or risk factor) are becoming increasingly available. Although the pros and cons of self-testing are currently not clear, it is an existing phenomenon that is likely to gain further popularity. To examine consumers' use of and needs for information about self-testing, and to assess the quality of consumer information provided with home test kits, as perceived by consumers and as assessed using a checklist of quality criteria. A cross-sectional Internet survey among 305 self-testers assessed their use of and needs for information and their perception of the quality of consumer information provided with self-test kits. A meta-search engine was used to identify Dutch and English consumer information for home diagnostic tests available online at the time of the study. The quality of this consumer information was evaluated using a checklist of quality criteria. The consumers' information needs were in line with the most frequently used information, and the information was perceived as being of moderate to good quality. The information was mostly in agreement with clinical practice guidelines, although information on reliability and follow-up behaviour was limited. Approximately half of the instruction leaflets did not include information on the target group of the test. Although generally of moderate to good quality, some aspects of the information provided were in many cases insufficient. European legislation concerning self-tests and accompanying information needs to be adapted and adhered to more closely. © 2012 John Wiley & Sons Ltd.

[Nursing home placement of people with dementia: a secondary analysis of qualitative data and literature review on perspectives of informal caregivers and healthcare professionals].

Science.gov (United States)

Nguyen, Natalie; Renom-Guiteras, Anna; Meyer, Gabriele; Stephan, Astrid

2018-06-01

Background: Nursing home placement of people with dementia can become necessary when informal care is no longer sufficient. Informal carers experience the transition period as an additional burden. Aim: Experiences and views of informal carers and healthcare professionals regarding the transition from people with dementia to a nursing home are investigated to improve the support for informal carers. Method: This secondary analysis included data from all five focus groups with n = 30 informal carers and healthcare professionals conducted as part of the “RightTimePlaceCare” project. To supplement the material which resulted from a single interview question, a literature analysis with the same focus was conducted. Results: The merged results indicated that informal carers needed professional support early on at home until after the nursing home placement. Concerns regarding nursing homes, financial aspects and family related issues were important aspects in the decision making. Healthcare professionals recommended provision of early guidance regarding those matters and making own experiences with nursing homes. Healthcare professionals should serve as mediators during the transition process and improve the collaboration between service providers. Conclusions: Empowering families to make informed choices could be facilitated by offering advice at home about their options for formal support services, financial support, and housing solutions. Healthcare professionals should support caregivers to make a decision, coordinate the placement and to cope with the new situation.

[Usefulness of palliative care for the patients with recurrent gastric cancer by home-IVH].

Science.gov (United States)

Sairenji, M; Okamoto, T; Motohashi, H; Kobayashi, O; Tsuburaya, A; Okugawa, T; Rino, Y; Tsukamoto, Y; Takamiya, M; Matoba, K

1995-12-01

Depending upon the type of cancer involved, the period of the end stage varies greatly, and with it decreases the quality of life (QOL). In gastric cancer, for example, the terminal stage is usually short and the QOL diminishes abruptly. Thus, it takes time keeping this decrease in QOL to minimum, despite the complications, so that the patient's last days will be even somewhat more acceptable. Improvement in QOL for the patient who cannot eat due to recurrent gastric cancer can be effectively achieved by alleviation through IVH. With this in mind, the conditions consonant with the application of home IVH are as follows: 1) The patient's pain can be kept under control at home. 2) The patient wishes to remain. 3)There is sufficient human support at home. The caretakers in the family, and especially the key person(s) must exert much effort and labor and they need rest as well. Home medical care in the terminal stage presupposes a social environment involving day care, short stay, and hospice nursing facilities of all kinds. At present, public services of this kind differ with the community, much remains uninformed to public, and clinic-hospital networking will be needed more than ever. In this difficult situation, the home-care medical services provided by the private sector are effective. These services are only for the short term, of course, and there will be a financial problem. Various measures (tax deduction, public assistance) must be considered to support the patients and caretakers.

Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

Science.gov (United States)

Behkami, Nima A.

2012-01-01

It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

Research on the model of home networking

Science.gov (United States)

Yun, Xiang; Feng, Xiancheng

2007-11-01

It is the research hotspot of current broadband network to combine voice service, data service and broadband audio-video service by IP protocol to transport various real time and mutual services to terminal users (home). Home Networking is a new kind of network and application technology which can provide various services. Home networking is called as Digital Home Network. It means that PC, home entertainment equipment, home appliances, Home wirings, security, illumination system were communicated with each other by some composing network technology, constitute a networking internal home, and connect with WAN by home gateway. It is a new network technology and application technology, and can provide many kinds of services inside home or between homes. Currently, home networking can be divided into three kinds: Information equipment, Home appliances, Communication equipment. Equipment inside home networking can exchange information with outer networking by home gateway, this information communication is bidirectional, user can get information and service which provided by public networking by using home networking internal equipment through home gateway connecting public network, meantime, also can get information and resource to control the internal equipment which provided by home networking internal equipment. Based on the general network model of home networking, there are four functional entities inside home networking: HA, HB, HC, and HD. (1) HA (Home Access) - home networking connects function entity; (2) HB (Home Bridge) Home networking bridge connects function entity; (3) HC (Home Client) - Home networking client function entity; (4) HD (Home Device) - decoder function entity. There are many physical ways to implement four function entities. Based on theses four functional entities, there are reference model of physical layer, reference model of link layer, reference model of IP layer and application reference model of high layer. In the future home network

Evaluation of a Home-Based Hospice and Palliative Care Program in a Community Health Center in Korea

Directory of Open Access Journals (Sweden)

Su Hyun Kim

2009-03-01

Conclusions: A home-based palliative service program delivered by the community health center appears to be an appropriate care model for managing physical symptoms. Reinforcing services for psychosocial and spiritual counseling and encouraging affiliation with free-standing inpatient healthcare providers are warranted. [Asian Nursing Research 2009;3(1:24–30

Patient-Related Determinants of the Administration of Continuous Palliative Sedation in Hospices and Palliative Care Units: A Prospective, Multicenter, Observational Study.

Science.gov (United States)

van Deijck, Rogier H P D; Hasselaar, Jeroen G J; Verhagen, Stans C A H H V M; Vissers, Kris C P; Koopmans, Raymond T C M

2016-05-01

Knowledge of determinants that are associated with the administration of continuous palliative sedation (CPS) helps physicians identify patients who are at risk of developing refractory symptoms, thereby enabling proactive care planning. This study aims to explore which patient-related factors at admission are associated with receiving CPS later in the terminal phase of life. A prospective multicenter observational study was performed in six Dutch hospices and three nursing home-based palliative care units. The association between patient-related variables at admission (age, gender, diagnosis, use of opioids or psycholeptics, number of medications, Karnofsky Performance Status scale score, Edmonton Symptom Assessment System distress score, and Glasgow Coma Scale score) and the administration of CPS at the end of life was analyzed. A total of 467 patients died during the study period, of whom 130 received CPS. In univariate analysis, statistically significant differences were noted between the sedated and nonsedated patients with respect to younger age (P = 0.009), malignancy as a diagnosis (P = 0.05), higher Karnofsky Performance Status score (P = 0.03), the use of opioids (P Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.

Science.gov (United States)

Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K

2016-09-01

Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.

Home Automation : Smart home technology and template house design

OpenAIRE

Zheng, Zeya

2013-01-01

In this thesis, home automation’s general knowledge, technology information and each component will be introduced to the reader in the first half of the whole thesis. In the second half, thesis includes the Home Automation template design and market competitiveness analysis. The author assumes that the reader is going to spend lots of money to have a smart home. In this situation, the author introduces the home automation to the reader at each component. So the reader in this thesis actu...

Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy.

Science.gov (United States)

Chen, Chia-Ching; Yamada, Tetsuji; Nakashima, Taeko; Chiu, I-Ming

2017-01-01

The purposes of this study are: (1) to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC) service use; (2) to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3) to investigate health outcome disparity based on substitutability. The methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR), which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly. There exists a complement relationship between the informal home care (IHC) and community-based FHC services, and the elasticity's ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH) services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services. Policy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy

Directory of Open Access Journals (Sweden)

Chia-Ching Chen

2017-11-01

Full Text Available ObjectivesThe purposes of this study are: (1 to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC service use; (2 to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3 to investigate health outcome disparity based on substitutability.Methodology and dataThe methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR, which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly.ResultsThere exists a complement relationship between the informal home care (IHC and community-based FHC services, and the elasticity’s ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services.ConclusionPolicy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

Ensuring Quality Nursing Home Care

Science.gov (United States)

... cases, you can also call the Department of Health. Nursing homes are required to post information on how you ... nursing homes in your area, go to Medicare’s Nursing Home Compare website at ... information is not intended to diagnose health problems or to take the place of medical ...

A Survey of Hospice and Palliative Care Physicians Regarding Palliative Sedation Practices.

Science.gov (United States)

Lux, Michael R; Protus, Bridget McCrate; Kimbrel, Jason; Grauer, Phyllis

2017-04-01

Patients nearing the end of life may experience symptoms that are refractory to standard therapeutic options. Physicians may consider palliative sedation to relieve intolerable suffering. There is limited clinical literature regarding preferred medications for palliative sedation. To determine the preferred medications physicians use when implementing palliative sedation. An Internet-based, cross-sectional survey of hospice and palliative care physicians in the United States. A link to the survey was e-mailed to 3130 physician members of the American Academy of Hospice and Palliative Medicine, of which 381 physicians completed the survey. Physicians were not required to answer all questions. Nearly all (n = 335, 99%) respondents indicated that palliative sedation may be used (acceptable by 73% [n = 248] for refractory symptoms and acceptable by 26% [n = 87] only for imminently dying patients). Seventy-nine percent (n = 252) believed that opioids should not be used to induce palliative sedation but should be continued to provide pain control. Midazolam was the most commonly selected first-line choice for palliative sedation (n = 155, 42%). The most commonly reported second-line agents for the induction of palliative sedation were lorazepam, midazolam (for those who did not select midazolam as first-line agent), and phenobarbital with a reported preference of 20% (n = 49), 19% (n = 46), and 17% (n = 40), respectively. Of the physicians surveyed, 99% (n = 335) felt that palliative sedation is a reasonable treatment modality. Midazolam was considered a drug of choice for inducing and maintaining sedation, and opioids were continued for pain control.

Economy Home Improvement, Inc. Information Sheet

Science.gov (United States)

Economy Home Improvement, Inc. (the Company) is located in Lexington, Kentucky. The settlement involves renovation activities conducted at a property constructed prior to 1978, located in Lexington, Kentucky.

Attitudes of palliative home care physicians towards palliative sedation at home in Italy.

Science.gov (United States)

Mercadante, Sebastiano; Masedu, Francesco; Mercadante, Alessandro; Marinangeli, Franco; Aielli, Federica

2017-05-01

Information about the attitudes towards palliative sedation (PS) at home is limited. The aim of this survey was to assess the attitudes of palliative care physicians in Italy regarding PS at home. A questionnaire was submitted to a sample of palliative care physicians, asking information about their activity and attitudes towards PS at home. This is a survey of home care physicians in Italy who were involved in end-of-life care decisions at home. One hundred and fifty participants responded. A large heterogeneity of home care organizations that generate some problems was found. Indications, intention and monitoring of PS seem to be appropriate, although some cultural and logistic conditions were limiting the use of PS. Specialized home care physicians are almost involved to start PS at home. Midazolam was seldom available at home and opioids were more frequently used. These data should prompt health care agencies to make a minimal set of drugs easily available for home care. Further research is necessary to compare attitudes in countries with different sociocultural profiles.

76 FR 78261 - Proposed Data Collections Submitted for Public Comment and Recommendations

Science.gov (United States)

2011-12-16

... for Medicare and Medicaid Services (CMS) data on nursing home, home health, and hospice care); (3... these providers. The data will be collected in the 50 states and the District of Columbia from two types...

77 FR 33745 - Agency Forms Undergoing Paperwork Reduction Act Review

Science.gov (United States)

2012-06-07

... Medicaid Services (CMS) data on nursing home, home health, and hospice care); (3) update data more... will be collected in the 50 states and the District of Columbia from two types of LTC facilities: 11...

Cognitive Impairment and Pain Among Nursing Home Residents With Cancer.

Science.gov (United States)

Dubé, Catherine E; Mack, Deborah S; Hunnicutt, Jacob N; Lapane, Kate L

2018-06-01

The prevalence of pain and its management has been shown to be inversely associated with greater levels of cognitive impairment. To evaluate whether the documentation and management of pain varies by level of cognitive impairment among nursing home residents with cancer. Using a cross-sectional study, we identified all newly admitted U.S. nursing home residents with a cancer diagnosis in 2011-2012 (n = 367,462). Minimum Data Set 3.0 admission assessment was used to evaluate pain/pain management in the past five days and cognitive impairment (assessed via the Brief Interview for Mental Status or the Cognitive Performance Scale for 91.6% and 8.4%, respectively). Adjusted prevalence ratios with 95% CI were estimated from robust Poisson regression models. For those with staff-assessed pain, pain prevalence was 55.5% with no/mild cognitive impairment and 50.5% in those severely impaired. Pain was common in those able to self-report (67.9% no/mild, 55.9% moderate, and 41.8% severe cognitive impairment). Greater cognitive impairment was associated with reduced prevalence of any pain (adjusted prevalence ratio severe vs. no/mild cognitive impairment; self-assessed pain 0.77; 95% CI 0.76-0.78; staff-assessed pain 0.96; 95% CI 0.93-0.99). Pharmacologic pain management was less prevalent in those with severe cognitive impairment (59.4% vs. 74.9% in those with no/mild cognitive impairment). In nursing home residents with cancer, pain was less frequently documented in those with severe cognitive impairment, which may lead to less frequent use of treatments for pain. Techniques to improve documentation and treatment of pain in nursing home residents with cognitive impairment are needed. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Raheny House Nursing Home, Raheny House, 476 Howth Road, Raheny, Dublin 5.

LENUS (Irish Health Repository)

McKeown, Kieran

2015-04-18

More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008\\/9. The study was undertaken as part of the Irish Hospice Foundation\\'s Hospice Friendly Hospitals Programme (2007-2012).

[Perspective of informal caregivers on home care. Qualitative study with a computer program].

Science.gov (United States)

Prieto Rodríguez, M Angeles; Gil García, Eugenia; Heierle Valero, Cristina; Frías Osuna, Antonio

2002-01-01

A hot debate exists in our country as to the models of home care which must be developed. This study is aimed at ascertaining how the family caregivers of terminal cancer patients, of the elderly suffering from dementia and of individuals having undergone major operations in outpatient surgery programs rate the quality of the home care provided. A phenomenological type qualitative study based on discussion groups (9), triangular groups (5) and in-depth interviews (22). This study was conducted in Andalusia throughout the 1999-2000 period. The subjects of the study were the main caregivers of patients provided with home care through the healthcare centers. The information must be analyzed by means of a Nudist-4 software-aided content analysis. The analysis variables were those of the Servqual model. For the caregivers of cancer patients, the most important aspects of the quality of the home care provided were the Response Capacity and Accessibility. This analysis revealed that the patients suffered pain but the pain was not controlled. Negative aspects hindering accessibility were the lack of home care coverage outside of regular working hours, the difficulty of getting in touch by phone, the length of time it takes for someone to come and the visits solely on request. The caregivers of patients having undergone major outpatient surgery want Security and Reliability. They complain of the short length of time within which the patients are released from the hospital and of the home care provided by the health care center. The caregivers of the elderly with dementia place top priority on being provided with the materials they need to take care of these patients. Caregivers' and patients' expectations differ, depending on health problems, therefore, the type of home care provided should vary, according to the health problems involved. It is necessary to develop a flexible model, capable of adapting to different patient needs and the diverse circumstances that affect

Ethics and quality care in nursing homes: Relatives' experiences.

Science.gov (United States)

Jakobsen, Rita; Sellevold, Gerd Sylvi; Egede-Nissen, Veslemøy; Sørlie, Venke

2017-01-01

A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients' relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. The aim of the study is to investigate relatives of persons with dementia's experiences with quality care in nursing homes. The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological-hermeneutical method for the study of lived experiences. Participants and research context: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. Ethical considerations: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives' experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives

At Home in the Office. A Guide for the Home Worker.

Science.gov (United States)

Thomas, Neil; And Others

This guide provides information to persons interested in establishing a work-at-home program, specifically those in clerical or support staff positions who use modern automated office equipment. The text is divided into two sections. The Home Worker section provides a summary of the At Home in the Office Project, personality characteristics…

"It Is Like Heart Failure. It Is Chronic … and It Will Kill You": A Qualitative Analysis of Burnout Among Hospice and Palliative Care Clinicians.

Science.gov (United States)

Kavalieratos, Dio; Siconolfi, Daniel E; Steinhauser, Karen E; Bull, Janet; Arnold, Robert M; Swetz, Keith M; Kamal, Arif H

2017-05-01

Although prior surveys have identified rates of self-reported burnout among palliative care clinicians as high as 62%, limited data exist to elucidate the causes, ameliorators, and effects of this phenomenon. We explored burnout among palliative care clinicians, specifically their experiences with burnout, their perceived sources of burnout, and potential individual, interpersonal, organizational, and policy-level solutions to address burnout. During the 2014 American Academy of Hospice and Palliative Medicine/Hospice and Palliative Nurses Association Annual Assembly, we conducted three focus groups to examine personal narratives of burnout, how burnout differs within hospice and palliative care, and strategies to mitigate burnout. Two investigators independently analyzed data using template analysis, an inductive/deductive qualitative analytic technique. We interviewed 20 palliative care clinicians (14 physicians, four advanced practice providers, and two social workers). Common sources of burnout included increasing workload, tensions between nonspecialists and palliative care specialists, and regulatory issues. We heard grave concerns about the stability of the palliative care workforce and concerns about providing high-quality palliative care in light of a distressed and overburdened discipline. Participants proposed antiburnout solutions, including promoting the provision of generalist palliative care, frequent rotations on-and-off service, and organizational support for self-care. We observed variability in sources of burnout between clinician type and by practice setting, such as role monotony among full-time clinicians. Our results reinforce and expand on the severity and potential ramifications of burnout on the palliative care workforce. Future research is needed to confirm our findings and investigate interventions to address or prevent burnout. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights

Home Health Compare

Data.gov (United States)

U.S. Department of Health & Human Services — Home Health Compare has information about the quality of care provided by Medicare-certified home health agencies throughout the nation. Medicare-certified means the...

WA50 We can't do it alone: hospices and schools working together to educate and support children around death, dying and bereavement.

Science.gov (United States)

Paul, Sally; Quinn, Helen

2015-04-01

Educating and supporting children around death, dying and bereavement, in schools, frequently relies on the individual interest and expertise of staff (Rowling 2003). Moves to develop such work of ten results in one off projects led by external agencies. Support and education is therefore ad hoc and unequitable. A research study was undertaken between a hospice and school to develop practice in this area from a health promotion perspective. This presentation discusses the design and implementation of two practice innovations arising from this process. The innovations aimed to introduce and educate children on issues related to loss and change, whilst simultaneously ensure that school staff have the skills and confidence to support individual experiences within the school setting. This was from a harm education and early intervention standpoint. Collaborative inquiry, within an action research methodology, was used to advance the innovations. This involved school and hospice staff working together to design and facilitate the activities. A programme of activities for children aged 5 to 11 (the resilience project) was designed and integrated throughout the curriculum. This is currently being piloted. A bereavement training programme was designed and facilitated to all school staff. Evaluations reported an increase in confidence around supporting bereavement issues. The process highlighted that combing the skills and expertise of hospice and school staff was essential in developing sustainable activities, appropriate to the setting. The role of the hospice in engaging with communities to collaboratively develop education and support around death, dying and bereavement was emphasised. Rowling, L. Grief in school communities: effective support strategies. Buckingham and Philadelphia: Open University Press, 2003. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Robotic Services at Home: An Initialization System Based on Robots' Information and User Preferences in Unknown Environments

Directory of Open Access Journals (Sweden)

Nor Nur Safwati Mohd

2014-07-01

Full Text Available One important issue in robotic services is the construction of the robotic system in the actual environment. In other words, robots must perform environment sensing or have information on real objects, such as location and 3D dimensions, in order to live together with humans. It is crucial to have a mechanism to create an actual robotic system (intelligent space such that there is no initialization framework for the objects in the environment, or we have to perform SLAM and object recognition as well as mapping to generate a useful environmental database. In intelligent space research, normally the objects are attached to various sensors in order to extract the necessary information. However, that approach will highly depend on sensor accuracy and the robotic system will be burdened if there are too many sensors in an environment. Therefore, in this paper we present a system in which a robot can obtain information about an object and even create the furniture layout map for an unknown environment. Our approach is intended to improve home-based robotic services by taking into account the user or individual preferences for the Intelligent Space (IS. With this information, we can create an informational map of the home-based environment for the realization of robot assistance of humans in their daily activities at home, especially for disabled people. The result shows the system design and development in our approach by using model-based system engineering.

To be truly alive: motivation among prison inmate hospice volunteers and the transformative process of end-of-life peer care service.

Science.gov (United States)

Cloyes, Kristin G; Rosenkranz, Susan J; Wold, Dawn; Berry, Patricia H; Supiano, Katherine P

2014-11-01

Some US prisons are meeting the growing need for end-of-life care through inmate volunteer programs, yet knowledge of the motivations of inmate caregivers is underdeveloped. This study explored the motivations of inmate hospice volunteers from across Louisiana State (n = 75) through an open-ended survey, a grounded theory approach to analysis, and comparison of responses by experience level and gender. Participants expressed complex motivations; Inter-related themes on personal growth, social responsibility and ethical service to vulnerable peers suggested that inmate caregivers experience an underlying process of personal and social transformation, from hospice as a source of positive self-identity to peer-caregiving as a foundation for community. Better understanding of inmate caregiver motivations and processes will help prisons devise effective and sustainable end of life peer-care programs. © The Author(s) 2013.

16 CFR 460.16 - What new home sellers must tell new home buyers.

Science.gov (United States)

2010-01-01

... LABELING AND ADVERTISING OF HOME INSULATION § 460.16 What new home sellers must tell new home buyers. If you are a new home seller, you must put the following information in every sales contract: The type... exception to this rule. If the buyer signs a sales contract before you know what type of insulation will be...

Handling Stereotypes of Religious Professionals: Strategies Hospice Chaplains Use When Interacting with Patients and Families.

Science.gov (United States)

Lindholm, Kristin

2017-12-01

Stereotypes of religious professionals can create barriers for those who provide spiritual/pastoral care. Through interviews and journal entries, hospice chaplains ( n = 45) identified the following stereotypes that affected their work: chaplains as people whom others try to impress, who only talk about spiritual and religious topics, who are male, and who try to convert others. Participants reported using a variety of communication strategies to counteract stereotypes and make meaningful connections with the people they serve.

Internet protocol television for personalized home-based health information: design-based research on a diabetes education system.

Science.gov (United States)

Gray, Kathleen Mary; Clarke, Ken; Alzougool, Basil; Hines, Carolyn; Tidhar, Gil; Frukhtman, Feodor

2014-03-10

The use of Internet protocol television (IPTV) as a channel for consumer health information is a relatively under-explored area of medical Internet research. IPTV may afford new opportunities for health care service providers to provide health information and for consumers, patients, and caretakers to access health information. The technologies of Web 2.0 add a new and even less explored dimension to IPTV's potential. Our research explored an application of Web 2.0 integrated with IPTV for personalized home-based health information in diabetes education, particularly for people with diabetes who are not strong computer and Internet users, and thus may miss out on Web-based resources. We wanted to establish whether this system could enable diabetes educators to deliver personalized health information directly to people with diabetes in their homes; and whether this system could encourage people with diabetes who make little use of Web-based health information to build their health literacy via the interface of a home television screen and remote control. This project was undertaken as design-based research in two stages. Stage 1 comprised a feasibility study into the technical work required to integrate an existing Web 2.0 platform with an existing IPTV system, populated with content and implemented for user trials in a laboratory setting. Stage 2 comprised an evaluation of the system by consumers and providers of diabetes information. The project succeeded in developing a Web 2.0 IPTV system for people with diabetes and low literacies and their diabetes educators. The performance of the system in the laboratory setting gave them the confidence to engage seriously in thinking about the actual and potential features and benefits of a more widely-implemented system. In their feedback they pointed out a range of critical usability and usefulness issues related to Web 2.0 affordances and learning fundamentals. They also described their experiences with the system in

ConductHome: Gesture Interface Control of Home Automation Boxes

OpenAIRE

J. Branstett; V. Gagneux; A. Leleu; B. Levadoux; J. Pascale

2015-01-01

This paper presents the interface ConductHome which controls home automation systems with a Leap Motion using "invariant gesture protocols". This interface is meant to simplify the interaction of the user with its environment. A hardware part allows the Leap Motion to be carried around the house. A software part interacts with the home automation box and displays the useful information for the user. An objective of this work is the development of a natural/invariant/simpl...

Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea.

Science.gov (United States)

Lee, Youngin; Lee, Seung Hun; Kim, Yun Jin; Lee, Sang Yeoup; Lee, Jeong Gyu; Jeong, Dong Wook; Yi, Yu Hyeon; Tak, Young Jin; Hwang, Hye Rim; Gwon, Mieun

2018-03-07

This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, "old" and "new," by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p system registers lower patient out-of-pocket expenses (p payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.

Evolution of Home Automation Technology

OpenAIRE

Mohd. Rihan; M. Salim Beg

2009-01-01

In modern society home and office automation has becomeincreasingly important, providing ways to interconnectvarious home appliances. This interconnection results infaster transfer of information within home/offices leading tobetter home management and improved user experience.Home Automation, in essence, is a technology thatintegrates various electrical systems of a home to provideenhanced comfort and security. Users are grantedconvenient and complete control over all the electrical homeappl...

Palliative care in the home: a case study of secondary histiocytic sarcoma in a 3-year-old child

Directory of Open Access Journals (Sweden)

Zuzana Karabová

2013-12-01

Full Text Available This article describes the medical, psychological, and social challenges encountered during home-based, family-centred palliative care of a 3-year-old female with secondary histiocytic sarcoma diagnosed during treatment for T-cell acute lymphoblastic leukaemia. Histiocytic sarcoma is an exceedingly rare cancer in adults, but even less frequent and highly aggressive when presenting as a secondary cancer in children. Comprehensive, multidisciplinary paediatric hospice care services are not widely available across Slovakia,thus limiting the number of patients and families offered such highly specialized end-of-life care. This case study illustrates the primary benefits for the child and family of such a program as well as the impact on the medical and nursing professionals working in the fi eld of paediatric haematology-oncology.

Palliative and end-of-life care in South Dakota.

Science.gov (United States)

Minton, Mary E; Kerkvliet, Jennifer L; Mitchell, Amanda; Fahrenwald, Nancy L

2014-05-01

Geographical disparities play a significant role in palliative and end-of-life care access. This study assessed availability of palliative and end of life (hospice) care in South Dakota. Grounded in a conceptual model of advance care planning, this assessment explored whether South Dakota health care facilities had contact persons for palliative care, hospice services, and advance directives; health care providers with specialized training in palliative and hospice care; and a process for advance directives and advance care planning. Trained research assistants conducted a brief telephone survey. Of 668 health care eligible facilities, 455 completed the survey for a response rate of 68 percent (455 out of 668). Over one-half of facilities had no specific contact person for palliative care, hospice services and advance directives. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives. Despite a lack of a specific contact person, nearly 75 percent of facilities reported having a process in place for addressing advance directives with patients; slightly over one-half (53 percent) reported having a process in place for advance care planning. Of participating facilities, 80 percent had no staff members with palliative care training, and 73 percent identified lack of staff members with end-of-life care training. Palliative care training was most commonly reported among hospice/home health facilities (45 percent). The results of this study demonstrate a clear need for a health care and allied health care workforce with specialized training in palliative and end-of-life care.

Location, Location, Location: Characteristics and Services of Long-Stay Home Care Recipients in Retirement Homes Compared to Others in Private Homes and Long-Term Care Homes.

Science.gov (United States)

Poss, Jeffrey W; Sinn, Chi-Ling Joanna; Grinchenko, Galina; Blums, Jane; Peirce, Tom; Hirdes, John

2017-02-01

We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients. Copyright © 2017 Longwoods Publishing.

Nursing perception of patient transitions from hospitals to home with home health.

Science.gov (United States)

Smith, Shannon Bright; Alexander, Judith W

2012-01-01

The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.

Genetics Home Reference

Science.gov (United States)

... Page Search Home Health Conditions Genes Chromosomes & mtDNA Resources Help Me Understand Genetics Share: Email Facebook Twitter Genetics Home Reference provides consumer-friendly information about the effects of genetic variation on human health. Health Conditions More than 1,200 health ...

Alert management for home healthcare based on home automation analysis.

Science.gov (United States)

Truong, T T; de Lamotte, F; Diguet, J-Ph; Said-Hocine, F

2010-01-01

Rising healthcare for elder and disabled people can be controlled by offering people autonomy at home by means of information technology. In this paper, we present an original and sensorless alert management solution which performs multimedia and home automation service discrimination and extracts highly regular home activities as sensors for alert management. The results of simulation data, based on real context, allow us to evaluate our approach before application to real data.

Perspectives of cardiac care unit nursing staff about developing hospice services in iran for terminally ill cardiovascular patients: A qualitative study

Directory of Open Access Journals (Sweden)

Saber Azami-Aghdash

2015-01-01

Full Text Available Introduction: The present study was conducted aiming to determine the points of view of cardiac care units′ nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life. Materials and Methods: In this qualitative study, the perspectives of 16 Cardiac Care Unit (CCU nurses selected purposefully among hospitals of Tabriz-Iran University of Medical Sciences were investigated using semi-structured interviews and were analyzed in content analysis method. Results: 33 themes were finally extracted. Some nurses were for and some were against designing and providing Hospice services in Iran. The main reasons identified for supporting this plan included: Possibility of designing and providing these services consistent with high ethical values of Iranian society; approval of authorities due to increasing the load of chronic diseases and aged population; need of families due to the problems in taking care of patients and life concerns; better pain relief and respectful death; decrease of costs as a result of lower usage of diagnostic-therapeutic services, less use of expensive facilities and drugs, and better usage of hospital beds. Conclusion: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful.

Findings from a Clinical Learning Needs Survey at Ireland's first children's hospice.

Science.gov (United States)

Quinn, Claire; Hillis, Rowan

2015-12-01

Caring for children with life-limiting conditions places exceptional demands on health professionals. Staff require the optimal skills and expertise necessary to provide the highest quality of care and to achieve this it is essential to understand their learning requirements. The aim is to share the main findings from a Clinical Learning Needs Survey conducted at LauraLynn, currently Ireland's only children's hospice. To date no other Irish service has conducted a formal identification of professional learning and development needs specific to the Irish context. The findings from the study assist workforce planning by providing a glimpse into the immediate study needs of staff working in a children's palliative care setting. The study had two main aims: a) Assist clinical staff within one organisation to identify their own professional learning priorities in children's palliative care and b) Inform the design and delivery of a responsive suite of workshops, programmes and study sessions for children's palliative care. The study identified the key learning needs as end-of-life care, palliative emergencies, communication skill development and bereavement support. These findings are similar to those found internationally and demonstrate the commitment of a new organisation to ensure that specific employee learning requirements are met if the organisation and wider specialty of Irish children's palliative care is to continue its evolution.

Suicide among nursing home residents in Australia: A national population-based retrospective analysis of medico-legal death investigation information.

Science.gov (United States)

Murphy, Briony J; Bugeja, Lyndal C; Pilgrim, Jennifer L; Ibrahim, Joseph E

2018-05-01

Suicide among nursing home residents is a growing public health concern, currently lacking in empirical research. This study aims to describe the frequency and nature of suicide among nursing home residents in Australia. This research comprised a national population-based retrospective analysis of suicide deaths among nursing home residents in Australia reported to the Coroner between July 2000 and December 2013. Cases were identified using the National Coronial Information System, and data collected from paper-based coroners' records on individual, incident, and organizational factors, as well as details of the medico-legal death investigation. Data analysis comprised univariate and bivariate descriptive statistical techniques; ecological analysis of incidence rates using population denominators; and comparison of age and sex of suicide cases to deaths from other causes using logistic regression. The study identified 141 suicides among nursing home residents, occurring at a rate of 0.02 deaths per 100 000 resident bed days. The ratio of deaths from suicide to deaths from any other cause was higher in males than females (OR = 3.56, 95%CI = 2.48-5.12, P = home for less than 12 months (n = 71, 50.3%). Common major life stressors identified in suicide cases included the following: health deterioration (n = 112, 79.4%); isolation and loneliness (n = 60, 42.6%); and maladjustment to nursing home life (n = 42, 29.8%). This research provides a foundational understanding of suicide among nursing home residents in Australia and contributes important new information to the international knowledge base. Copyright © 2018 John Wiley & Sons, Ltd.

76 FR 5819 - Notice of Submission of Proposed Information Collection to OMB; HUD-Owned Real Estate-Dollar Home...

Science.gov (United States)

2011-02-02

... Proposed Information Collection to OMB; HUD-Owned Real Estate--Dollar Home Sales Program AGENCY: Office of... organizations, and government entities. The sale of these properties under this program makes it possible for... appropriate automated collection techniques or other forms of information technology, e.g., permitting...

End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients.

Science.gov (United States)

Nosek, Cheryl L; Kerr, Christopher W; Woodworth, Julie; Wright, Scott T; Grant, Pei C; Kuszczak, Sarah M; Banas, Anne; Luczkiewicz, Debra L; Depner, Rachel M

2015-05-01

End-of-life dreams and visions (ELDVs) are well documented throughout history and across cultures with impact on the dying person and their loved ones having profound meaning. Published studies on ELDVs are primarily based on surveys or interviews with clinicians or families of dead persons. This study uniquely examined patient dreams and visions from their personal perspective. This article reports the qualitative findings from dreams and visions of 63 hospice patients. Inductive content analysis was used to examine the content and subjective significance of ELDVs. Six categories emerged: comforting presence, preparing to go, watching or engaging with the deceased, loved ones waiting, distressing experiences, and unfinished business. © The Author(s) 2014.

Nursing Home Quality Initiative

Data.gov (United States)

U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

The use of information and communication technology to meet chronically ill patients' needs when living at home.

Science.gov (United States)

Skär, Lisa; Söderberg, Siv

2011-01-01

The aim of the study was to describe influences, benefits, and limitations in using information and communication technology to meet chronically ill patients' needs when living at home. The study is a descriptive, exploratory designed pilot study and the intervention was performed using an electronic communication program enabling communication between ill persons and the district nurse in real time by web cam pictures and sound. The participant used the programme once or twice a week from February to August 2008. Data were collected by means of repeated interviews and logbook notes, and were subjected to qualitative content analysis. The results showed that all participants appreciated being able to communicate regardless of time and place and their experiences of using information and communication technology revealed that it created feelings of safety and security. The information and communication technology became a tool in their communication and improved nursing care among seriously chronically ill persons living at home.

Use of parecoxib by continuous subcutaneous infusion for cancer pain in a hospice population.

Science.gov (United States)

Armstrong, Peter; Wilkinson, Pauline; McCorry, Noleen K

2018-03-01

To characterise the use of the parenteral non-steroidal anti-inflammatory drug parecoxib when given by continuous subcutaneous infusion (CSCI) in a hospice population. Clinical experience suggests parecoxib CSCI may be of benefit in this population, but empirical evidence in relation to its safety and efficacy is lacking. Retrospective chart review of patients with a cancer diagnosis receiving parecoxib CSCI from 2008 to 2013 at the Marie Curie Hospice, Belfast. Data were collected on treatment regime, tolerability and, in patients receiving at least 7 days treatment, baseline opioid dose and changes in pain scores or opioid rescue medication requirements. Parecoxib CSCI was initiated in 80 patients with a mean administration of 17.9 days (median 11, range 1-94). When used for a period of 7 days, there was a statistically significant reduction in pain scores (p=0.002) and in the number of rescue opioid doses required (p=0.001), but no statistically significant opioid-sparing effect (p=0.222). It was generally well tolerated, although gastrointestinal, renal adverse effects and local site irritation were reported. Parecoxib may have a valuable place in the management of cancer pain, especially towards the end of life when oral administration is no longer possible and CSCI administration is relied on. Further studies into the efficacy and tolerability of parecoxib CSCI are merited. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Ostomy Home Skills Program

Medline Plus

Full Text Available ... kit contains: A booklet with information on the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma ...

Home e-health system integration in the Smart Home through a common media server.

Science.gov (United States)

Pau, I; Seoane, F; Lindecrantz, K; Valero, M A; Carracedo, J

2009-01-01

Home e-health systems and services are revealed as one of the most important challenges to promote Quality of Life related to Health in the Information Society. Leading companies have worked on e-health systems although the majority of them are addressed to hospital or primary care settings. The solution detailed in this paper offers a personal health system to be integrated with Smart Home services platform to support home based e-care. Thus, the home e-health system and architecture detailed in this research work is ready to supply a seamless personal care solution both from the biomedical data analysis, service provision, security guarantee and information management s point of view. The solution is ready to be integrated within the Accessible Digital Home, a living lab managed by Universidad Politécnica de Madrid for R&D activities.

A survey of family members' satisfaction with the services provided by hospice palliative care volunteers.

Science.gov (United States)

Claxton-Oldfield, Stephen; Gosselin, Natasha; Schmidt-Chamberlain, Kirsten; Claxton-Oldfield, Jane

2010-05-01

A total of 22 family members, whose deceased loved ones had used the services of a hospice palliative care volunteer, responded to a brief survey designed to assess the importance of the different kinds of support offered to them (family members) by the volunteer, their impressions of the volunteers' personal qualities/characteristics, their general experiences with the volunteer, and their overall satisfaction with the volunteer services. The kind of support that received the highest importance rating from family members was the opportunity to take a much-needed break from the demands of caring for their loved one, closely followed by emotional support, the volunteer spending time with them, and the volunteer providing them with information. Family members rated volunteers highly on a list of qualities/characteristics that exemplify individuals who are effective in this role. In all, 85% of the family members felt that their volunteer was well trained and 95% did not feel that their or their loved one's privacy had been invaded by having a volunteer. Overall, family members were very satisfied with the volunteer support they received. Some limitations of the study are discussed.

Sears Home Improvement Products, Inc. Information Sheet

Science.gov (United States)

Sears Home Improvement Products, Inc. (the Company) is located in Longwood, Florida. The case involves renovation activities conducted at property constructed prior to 1978, located in cities across Minnesota, Wisconsin, California, Georgia, Nevada.

A comparison of home care clients and nursing home residents: can community based care keep the elderly and disabled at home?

Science.gov (United States)

Shugarman, L R; Fries, B E; James, M

1999-01-01

Admission cohorts from the Michigan Medicaid Home and Community-Based Waiver program and Ohio nursing homes were compared on measures of resource utilization including a modified Resource Utilization Groups (RUG-III) system, Activities of Daily Living (ADLs), and overall case mix. We found that, contrary to previous research, the two samples were remarkably similar across RUG-III categories. However, the nursing home sample was more functionally impaired on measures of ADL functioning and overall case mix. Results of this study may inform policymakers and providers of the potential for maintaining the appropriate population in the home with government-funded home care.

A qualitative evaluation of the crucial attributes of contextual information necessary in EHR design to support patient-centered medical home care.

Science.gov (United States)

Weir, Charlene R; Staggers, Nancy; Gibson, Bryan; Doing-Harris, Kristina; Barrus, Robyn; Dunlea, Robert

2015-04-16

Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas. A qualitative design using Cognitive Task Analyses and a modified Critical Incident Technique were used. The study was conducted in a large VA with a fully implemented EHR located in the western United States. Seventeen providers working in a PCMH model of care in Primary Care, Home Based Care and Geriatrics reported on a recent difficult transition requiring contextual information for decision-making. The transcribed interviews were qualitatively analyzed for thematic development related to contextual information using an iterative process and multiple reviewers with ATLAS@ti software. Six overarching themes emerged as attributes of contextual information: Informativeness, goal language, temporality, source attribution, retrieval effort, and information quality. These results indicate that specific attributes are needed to in order for contextual information to fully support clinical decision-making in a Medical Home care delivery environment. Improved EHR designs are needed for ease of contextual information access, displaying linkages across time and settings, and explicit linkages to both clinician and patient goals. Implications relevant to providers' information needs, team functioning and EHR design are discussed.

Interprofessional team building in the palliative home care setting: Use of a conceptual framework to inform a pilot evaluation.

Science.gov (United States)

Shaw, James; Kearney, Colleen; Glenns, Brenda; McKay, Sandra

2016-01-01

Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants' accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emphasises sharing power among team members and addressing the need for mutual emotional support may help to maximise interprofessional teamwork in palliative home care. These findings may be used to develop and test more comprehensive efforts to promote stronger interprofessional teamwork in palliative home health care delivery.

Home Learning, Technology, and Tomorrow's Workplace.

Science.gov (United States)

Rieseberg, Rhonda L.

1995-01-01

Discusses characteristics and trends of home schools and workplaces. Use of computers and computer applications (CD-ROMS, interactive software, and networking) in home schooling provides a compatible environment for future home-based businesses and telecommuting trends. Sidebars include information on home schools on line; standardized test…

Evaluation of a video, telephone follow-ups, and an online forum as components of a psychoeducational intervention for caregivers of persons with advanced cancer.

Science.gov (United States)

Leow, Mabel Q H; Chan, Sally W C

2016-10-01

Our aim was to evaluate caregivers' perceptions of a video, telephone follow-up, and online forum as components of a psychoeducational intervention. Qualitative semistructured face-to-face interviews were conducted with 12 participants two weeks post-intervention. The study was conducted from September of 2012 to May of 2015. Family caregivers were recruited from four home hospice organizations (HCA Hospice Care, Metta Hospice, Singapore Cancer Centre, and Agape Methodist Hospice) and the National Cancer Centre outpatient clinic in Singapore. A purposive sample was employed, and participants were recruited until data saturation. Qualitative interviews were transcribed verbatim. Transcripts were coded and analyzed using content analysis. Two of the research team members were involved in the data analysis. Two-thirds of participants were females (n = 8). Their ages ranged from 22 to 67 (mean = 50.50, SD = 11.53). About two-thirds were married (n = 7). Most participants were caring for a parent (n = 10), one for a spouse, and one for her mother-in-law. Caregivers favored the use of video for delivery of educational information. They liked the visual and audio aspects of the video. The ability to identify with the caregiver and scenarios in the video helped in the learning process. They appreciated telephone follow-ups from healthcare professionals for informational and emotional support. The online forum as a platform for sharing of information and provision of support was not received well by the caregivers in this study. The reasons for this included their being busy, not being computer savvy, rarely surfing the internet, and not feeling comfortable sharing with strangers on an online platform. This study provided insight into caregivers' perceptions of various components of a psychoeducational intervention. It also gave us a better understanding of how future psychoeducational interventions and support for caregivers of persons with advanced cancer could be

Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services.

Science.gov (United States)

Stiel, Stephanie; Nurnus, Mareike; Ostgathe, Christoph; Klein, Carsten

2018-03-13

Clinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany. Data sets from 221 organisations from a prior online survey were separated into two sub-groups divided by their estimated sedation rate A) lower/equal to 16% (n = 187; 90.8%) and B) higher than 16% (n = 19; 9.2%) for secondary analysis. Demographic factors and characteristics of PS treatment practices between the two groups were compared using T-Tests and Chi 2 / Fisher Exact Tests and considered significant (*) at two-sided p palliative and hospice care representatives show divergence, which may be influenced one by another. A comprehensive framework considering conceptual, clinical, ethical, and legal aspects of different definitions of PS could help to better distinguish between different types and nuances of PS.

Ostomy Home Skills Program

Medline Plus

Full Text Available ... Overview The skills kit contains: A booklet with information on the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma ...

[The planned home care transfer by a local medical support hospital and the introduction to home intravenous hyper alimentation--the making of a home care patient's instruction plan document].

Science.gov (United States)

Shinobu, Akiko; Ohtsu, Yoko

2004-12-01

It is important to offer continuous medical service without interrupting everyone's various job functions at the Tama Numbu-Chiiki Hospitals in order to secure the quality and safety of home medical care to patients and their families. From 1998 up to the present, home intravenous hyper alimentation (home IVH) has been introduced by individually exchanging information that was based on items such as clinical case, doctor and caregiver in charge of the day, and introductory information. Five years have passed since we started an introduction of home IVH, and it appears that the medical cooperation of home IVH between the Minami-tama medical region and its neighboring area has been established. Then, we arranged an examination of the past 2 years based on the 57 patients who elected to choose home IVH instruction. Consequently, we created "home IVH introduction plan document" in standardizing a flow from home IVH introduction to post-hospital intervention. Since November of 2003, the plan document has been utilized and carried out to 5 patients by the end of February in 2004. This home IVH introduction plan document was able to clarify the role of medical person in connection with the patient. Therefore, we could not only share the information, but also could transfer medical care smoothly from the hospital to the patient's home.

Numerical Activities and Information Learned at Home Link to the Exact Numeracy Skills in 5–6 Years-Old Children

Science.gov (United States)

Benavides-Varela, Silvia; Butterworth, Brian; Burgio, Francesca; Arcara, Giorgio; Lucangeli, Daniela; Semenza, Carlo

2016-01-01

It is currently accepted that certain activities within the family environment contribute to develop early numerical skills before schooling. However, it is unknown whether this early experience influences both the exact and the approximate representation of numbers, and if so, which is more important for numerical tasks. In the present study the mathematical performance of 110 children (mean age 5 years 11 months) was evaluated using a battery that included tests of approximate and exact numerical abilities, as well as everyday numerical problems. Moreover, children were assessed on their knowledge of number information learned at home. The parents of the participants provided information regarding daily activities of the children and socio-demographic characteristics of the family. The results showed that the amount of numerical information learned at home was a significant predictor of participants' performance on everyday numerical problems and exact number representations, even after taking account of age, memory span and socio-economic and educational status of the family. We also found that particular activities, such as board games, correlate with the children's counting skills, which are foundational for arithmetic. Crucially, tests relying on approximate representations were not predicted by the numerical knowledge acquired at home. The present research supports claims about the importance and nature of home experiences in the child's acquisition of mathematics. PMID:26903902

78 FR 73415 - Information To Be Distributed to the Federal Home Loan Banks and the Office of Finance

Science.gov (United States)

2013-12-06

...Section 20A of the Federal Home Loan Bank Act (Bank Act), requires the Director of the Federal Housing Finance Agency (FHFA) to make available to the Federal Home Loan Banks (Banks) such reports, records, or other information as may be available, relating to the condition of any Bank in order to enable each Bank to evaluate the financial condition of one or more of the other Banks individually and the Bank System as a whole. FHFA has adopted, and published in this issue of the Federal Register, a regulation to implement the statutory information sharing provisions, which will be located at 12 CFR part 1260. As required by Sec. 1260.2(b) of that regulation, FHFA is providing this notification to the Banks and the Bank System's Office of Finance of the categories of information that it will distribute under part 1260 beginning on the effective date noted below.

End-of-life experiences and expectations of Africans in Australia: cultural implications for palliative and hospice care.

Science.gov (United States)

Hiruy, Kiros; Mwanri, Lillian

2014-03-01

The ageing and frail migrants who are at the end of life are an increasing share of migrants living in Australia. However, within such populations, information about end-of-life experiences is limited, particularly among Africans. This article provides some insights into the sociocultural end-of-life experiences of Africans in Australia and their interaction with the health services in general and end-of-life care in particular. It provides points for discussion to consider an ethical framework that include Afro-communitarian ethical principles to enhance the capacity of current health services to provide culturally appropriate and ethical care. This article contributes to our knowledge regarding the provision of culturally appropriate and ethical care to African patients and their families by enabling the learning of health service providers to improve the competence of palliative care systems and professionals in Australia. Additionally, it initiates the discussion to highlight the importance of paying sufficient attention to a diverse range of factors including the migration history when providing palliative and hospice care for patients from African migrant populations.

Perceived timeliness of referral to hospice palliative care among bereaved family members in Korea.

Science.gov (United States)

Jho, Hyun Jung; Chang, Yoon Jung; Song, Hye Young; Choi, Jin Young; Kim, Yeol; Park, Eun Jung; Paek, Soo Jin; Choi, Hee Jae

2015-09-01

We aimed to explore the perceived timeliness of referral to hospice palliative care unit (HPCU) among bereaved family members in Korea and factors associated therewith. Cross-sectional questionnaire survey was performed for bereaved family members of patients who utilized 40 designated HPCUs across Korea. The questionnaire assessed whether admission to the HPCU was "too late" or "appropriate" and the Good Death Inventory (GDI). A total of 383 questionnaires were analyzed. Of participants, 25.8 % replied that admission to HPCU was too late. Patients with hepatobiliary cancer, poor performance status, abnormal consciousness level, and unawareness of terminal status were significantly related with the too late perception. Family members with younger age and being a child of the patient were more frequently noted in the too late group. Ten out of 18 GDI scores were significantly lower in the too late group. Multiple logistic regression analysis revealed patients' unawareness of terminal status, shorter stay in the HPCU, younger age of bereaved family, and lower scores for two GDI items (staying in a favored place, living without concerning death or disease) were significantly associated with the too late group. To promote timely HPCU utilization and better quality of end of life care, patients need to be informed of the terminal status and their preference should be respected.

Civil defence information for every home

International Nuclear Information System (INIS)

Joutsi, L.

1995-01-01

In Finland, the local authorities and the central government are responsible for the general planning of civil defence and for joint protection measures, while individual citizens and corporations are responsible for individual protection measures. In practice, housing companies and employers are required to carry out the statutory preparations needed for civil defence. Preparation for accidents can be improved, for instance, by awareness of correct actions in each situation. The most important individual protection measures are first aid, basic fire extinguishing skills, provision of shelter, and acquisition of a reserve stock of provisions at home. A reserve stock means that there is a sufficient supply of non-perishable foodstuffs, medication and water vessels for a couple of days' needs at home. A warning of imminent danger is usually given by sounding a general alarm signal. Even slight changes in radiation are reported immediately. Shelter should primarily be sought indoors. Instructions may be given on the radio, on TV and by means of loudspeakers. If there is a radiation risk, the thyroid may be protected against radioactive iodine by taking iodine tablets, but they should not be taken until so instructed by the authorities. (2 figs.)

Home care in Europe: a systematic literature review

Science.gov (United States)

2011-01-01

Background Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care 'policy & regulation', 'financing', 'organisation & service delivery', and 'clients & informal carers'. Results Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the

Comparison of home and away-from-home physical activity using accelerometers and cellular network-based tracking devices.

Science.gov (United States)

Ramulu, Pradeep Y; Chan, Emilie S; Loyd, Tara L; Ferrucci, Luigi; Friedman, David S

2012-08-01

Measuring physical at home and away from home is essential for assessing health and well-being, and could help design interventions to increase physical activity. Here, we describe how physical activity at home and away from home can be quantified by combining information from cellular network-based tracking devices and accelerometers. Thirty-five working adults wore a cellular network-based tracking device and an accelerometer for 6 consecutive days and logged their travel away from home. Performance of the tracking device was determined using the travel log for reference. Tracking device and accelerometer data were merged to compare physical activity at home and away from home. The tracking device detected 98.6% of all away-from-home excursions, accurately measured time away from home and demonstrated few prolonged signal drop-out periods. Most physical activity took place away from home on weekdays, but not on weekends. Subjects were more physically active per unit of time while away from home, particularly on weekends. Cellular network-based tracking devices represent an alternative to global positioning systems for tracking location, and provide information easily integrated with accelerometers to determine where physical activity takes place. Promoting greater time spent away from home may increase physical activity.

La cura dell'incurabilità: l’esperienza dell’hospice

Directory of Open Access Journals (Sweden)

Maria Elena Bellini

2008-04-01

Full Text Available Tra i diversi lemmi che il termine “malattia” porta con sé, quello di malattia incurabile è forse tra quelli che suscita più emozioni e più significati di rabbia, dolore, paura. Parlare di incurabilità, significa infatti parlare di quella difficile fase della storia del paziente in cui la medicina “dichiara la sua sconfitta” e si arrende di fronte all’avanzare della malattia stessa. Quella fase in cui nulla sembra più possibile fare. In hospice, massima espressione della moderna medicina delle cure palliative, viene riscoperto il significato originario del termine Cura, quello della sollecitudine, rendendo possibile “curare” ciò che è stato dichiarato non più tale. La logica e la neutralità affettiva del curare (nel senso di to cure, cedono il posto all’empatia e alla com-passione del prendersi cura (to care. La malattia che nella storia del paziente è stata fino a quel momento l’hostes, il nemico da sconfiggere, diviene così l’hospis, l’ospite da accogliere nel difficile percorso incontro alla morte.

Evaluating palliative care needs in Middle Eastern countries.

Science.gov (United States)

Silbermann, Michael; Fink, Regina M; Min, Sung-Joon; Mancuso, Mary P; Brant, Jeannine; Hajjar, Ramzi; Al-Alfi, Nesreen; Baider, Lea; Turker, Ibrahim; ElShamy, Karima; Ghrayeb, Ibtisam; Al-Jadiry, Mazin; Khader, Khaled; Kav, Sultan; Charalambous, Haris; Uslu, Ruchan; Kebudi, Rejin; Barsela, Gil; Kuruku, Nilgün; Mutafoglu, Kamer; Ozalp-Senel, Gulsin; Oberman, Amitai; Kislev, Livia; Khleif, Mohammad; Keoppi, Neophyta; Nestoros, Sophia; Abdalla, Rasha Fahmi; Rassouli, Maryam; Morag, Amira; Sabar, Ron; Nimri, Omar; Al-Qadire, Mohammad; Al-Khalaileh, Murad; Tayyem, Mona; Doumit, Myrna; Punjwani, Rehana; Rasheed, Osaid; Fallatah, Fatimah; Can, Gulbeyaz; Ahmed, Jamila; Strode, Debbie

2015-01-01

Cancer incidence in Middle Eastern countries, most categorized as low- and middle-income, is predicted to double in the next 10 years, greater than in any other part of the world. While progress has been made in cancer diagnosis/treatment, much remains to be done to improve palliative care for the majority of patients with cancer who present with advanced disease. To determine knowledge, beliefs, barriers, and resources regarding palliative care services in Middle Eastern countries and use findings to inform future educational and training activities. Descriptive survey. Fifteen Middle Eastern countries; convenience sample of 776 nurses (44.3%), physicians (38.3%) and psychosocial, academic, and other health care professionals (17.4%) employed in varied settings. Palliative care needs assessment. Improved pain management services are key facilitators. Top barriers include lack of designated palliative care beds/services, community awareness, staff training, access to hospice services, and personnel/time. The nonexistence of functioning home-based and hospice services leaves families/providers unable to honor patient wishes. Respondents were least satisfied with discussions around advance directives and wish to learn more about palliative care focusing on communication techniques. Populations requiring special consideration comprise: patients with ethnic diversity, language barriers, and low literacy; pediatric and young adults; and the elderly. The majority of Middle Eastern patients with cancer are treated in outlying regions; the community is pivotal and must be incorporated into future plans for developing palliative care services. Promoting palliative care education and certification for physicians and nurses is crucial; home-based and hospice services must be sustained.

Deciding How to Stay Independent at Home in Later Years: Development and Acceptability Testing of an Informative Web-Based Module.

Science.gov (United States)

Garvelink, Mirjam Marjolein; Jones, C Allyson; Archambault, Patrick M; Roy, Noémie; Blair, Louisa; Légaré, France

2017-12-14

Seniors with loss of autonomy may face decisions about whether they should stay at home or move elsewhere. Most seniors would prefer to stay home and be independent for as long as possible, but most are unaware of options that would make this possible. The study aimed to develop and test the acceptability of an interactive website for seniors, their caregivers, and health professionals with short interlinked videos presenting information about options for staying independent at home. The approach for design and data collection varied, involving a multipronged, user-centered design of the development process, qualitative interviews, and end-user feedback to determine content (ie, needs assessment) in phase I; module development (in English and French) in phase II; and survey to test usability and acceptability with end users in phase III. Phase I participants were a convenience sample of end users, that is, seniors, caregivers, and professionals with expertise in modifiable factors (eg, day centers, home redesign, equipment, community activities, and finances), enabling seniors to stay independent at home for longer in Quebec and Alberta, Canada. Phase II participants were bilingual actors; phase III participants included phase I participants and new participants recruited through snowballing. Qualitative interviews were thematically analyzed in phase II to determine relevant topics for the video-scripts, which were user-checked by interview participants. In phase III, the results of a usability questionnaire were analyzed using descriptive statistics. In phase I, interviews with 29 stakeholders, including 4 seniors, 3 caregivers, and 22 professionals, showed a need for a one-stop information resource about options for staying independent at home. They raised issues relating to 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. A script was developed and evaluated by

A Consumer Health Information System to Assist Patients Select Quality Home Health Services

Directory of Open Access Journals (Sweden)

Dimitrios Zikos

2017-11-01

Full Text Available Patients evaluate the quality of home health agencies (HHAs using the Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey. This paper describes a prototype community health information system to help patients select appropriate and quality HHAs, according to the location, proprietary status, type of service, and year of HHA establishment. Five HCAHPS indicators were selected: “summary rating”, “quality of care”, “professional care”, “communication”, and “recommend agency”. Independent t-test analysis showed that agencies offering Speech Pathology, Medical-Social, or Home Health Aide services, receive significantly worse HCAHPS ratings, while mean ratings vary significantly across different US states. Multiple comparisons with post hoc ANOVA revealed differences between and within HHAs of different proprietary status (p < 0.001: governmental HHAs receiving higher ratings than private HHAs. Finally, there was observed a relationship between all five quality rating variables and the HHA year of establishment (Pearson, p < 0.001. The older the agency is, the better the HCAPS summary ratings. Findings provided the knowledge to design of a consumer health information system, to provide rankings filtered according to user criteria, comparing the quality rankings of eligible HHAs. Users can also see how a specific agency is ranked against eligible HHAs. Ultimately, the system aims to support the patient community with contextually realistic comparisons in an effort to choose optimal HH service.

ThinkHome Energy Efficiency in Future Smart Homes

Directory of Open Access Journals (Sweden)

Reinisch Christian

2011-01-01

Full Text Available Abstract Smart homes have been viewed with increasing interest by both home owners and the research community in the past few years. One reason for this development is that the use of modern automation technology in the home or building promises considerable savings of energy, therefore, simultaneously reducing the operational costs of the building over its whole lifecycle. However, the full potential of smart homes still lies fallow, due to the complexity and diversity of the systems, badly engineered and configured installations, as well as the frequent problem of suboptimal control strategies. Summarized, these problems converge to two undesirable conditions in the "not-so-smart" home: energy consumption is still higher than actually necessary and users are unable to yield full comfort in their automated homes. This work puts its focus on alleviating the current problems by proposing a comprehensive system concept, that shall ensure that smart homes can keep their promise in the future. The system operates on an extensive knowledge base that stores all information needed to fulfill the goals of energy efficiency and user comfort. Its intelligence is implemented as and within a multiagent system that also caters for the system's openness to the outside world. As a first evaluation, a profile-based control strategy for thermal comfort is developed and verified by means of simulation.

Home-based Healthcare Technology

DEFF Research Database (Denmark)

Verdezoto, Nervo

of these systems target a specific treatment or condition and might not be sufficient to support the care management work at home. Based on a case study approach, my research investigates home-based healthcare practices and how they can inform future design of home-based healthcare technology that better account......Sustaining daily, unsupervised healthcare activities in non-clinical settings such as the private home can challenge, among others, older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are being designed. However, most...

What Is Psychiatry?

Medline Plus

Full Text Available ... hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, rehabilitation programs, emergency rooms, hospice programs, and many other ...

[New legal regulations for palliative care with implications for politics and practice].

Science.gov (United States)

Melching, Heiner

2017-01-01

In December 2015 two different laws were adopted. Both are of importance for palliative care. One of the laws criminalizes commercial, "business-like" assisted suicide (§ 217 German Criminal Code), the other one aims to improve hospice and palliative care in Germany. Through the latter far-reaching changes in Social Code Books V and XI, as well as of the Hospital Finance Act have been made. This new Act to Improve Hospice and Palliative Care (HPG) focuses, amongst others, on: (a) Better funding of hospice services, by raising the minimum grant for patients in inpatient hospices paid per day by the health insurance funds by about 28.5%, and for outpatient hospice services by about 18%; (b) further development of general outpatient nursing and medical palliative care, and the networking of different service providers; (c) introduction of an arbitration procedure for service provider agreements to be concluded between the health insurance funds and the teams providing specialized home palliative care (SAPV); (d) the right to individual advice and support by the health insurance funds; (e) care homes may offer their residents advance care planning programs to be funded by the statutory health insurers; (f) palliative care units in hospitals can be remunerated outside the DRG system by per diem rates; (g) separate funding and criteria for multi-professional palliative care services within a hospital.While little concrete impact on hospice and palliative care can be expected following the new § 217 German Criminal Code, the HPG provides a good basis to improve care. For this purpose, however, which complementary and more concrete agreements are made to put the new legal regulations into practice will be crucial.

Latest Trends in Home Networking Technologies

Science.gov (United States)

Tsutsui, Akihiro

Broadband access service, including FTTH, is now in widespread use in Japan. More than half of the households that have broadband Internet access construct local area networks (home networks) in their homes. In addition, information appliances such as personal computers, networked audio, and visual devices and game machines are connected to home networks, and many novel service applications are provided via the Internet. However, it is still difficult to install and incorporate these devices and services because networked devices have been developed in different communities. I briefly explain the current status of information appliances and home networking technologies and services and discuss some of the problems in this and their solutions.

42 CFR 498.2 - Definitions.

Science.gov (United States)

2010-10-01

...) An entity approved by CMS to furnish outpatient diabetes self-management training. (12) End-stage...) Home health agency (HHA). (vii) Hospice. (viii) Religious nonmedical health care institution (RNHCI...

Comparative effects of valsartan plus either cilnidipine or hydrochlorothiazide on home morning blood pressure surge evaluated by information and communication technology-based nocturnal home blood pressure monitoring.

Science.gov (United States)

Fujiwara, Takeshi; Tomitani, Naoko; Kanegae, Hiroshi; Kario, Kazuomi

2018-01-01

The authors tested the hypothesis that a valsartan/cilnidipine combination would suppress the home morning blood pressure (BP) surge (HMBPS) more effectively than a valsartan/hydrochlorothiazide combination in patients with morning hypertension, defined as systolic BP (SBP) ≥135 mm Hg or diastolic BP ≥85 mm Hg assessed by a self-measuring information and communication technology-based home BP monitoring device more than three times before either combination's administration. This was an 8-week prospective, multicenter, randomized, open-label clinical trial. The HMBPS, which is a new index, was defined as the mean morning SBP minus the mean nocturnal SBP, both measured on the same day. The authors randomly allocated 129 patients to the valsartan/cilnidipine (63 patients; mean 68.4 years) or valsartan/hydrochlorothiazide (66 patients; mean 67.3 years) combination groups, and the baseline HMBPS values were 17.4 mm Hg vs 16.9 mm Hg, respectively (P = .820). At the end of the treatment period, the changes in nocturnal SBP and morning SBP from baseline were significant in both the valsartan/cilnidipine and valsartan/hydrochlorothiazide groups (P information and communication technology-based home BP monitoring device may become an alternative to ambulatory BP monitoring, which has been a gold standard to measure nocturnal BP and the morning BP surge. ©2018 Wiley Periodicals, Inc.

Marketing energy conservation options to Northwest manufactured home buyers

Energy Technology Data Exchange (ETDEWEB)

Hendrickson, P.L.; Mohler, B.L.; Taylor, Z.T.; Lee, A.D.; Onisko, S.A.

1985-06-01

This study relies on extensive, existing survey data and new analyses to develop information that would help design a marketing plan to achieve energy conservation in new manufactured homes. Existing surveys present comprehensive information about regional manufactured home occupants and their homes that are relevant to a potential conservation marketing plan. An independent analysis of the cost-effectiveness of various efficiency improvements provides background information for designing a marketing plan. This analysis focuses on the economic impacts of alternative energy conservation options as perceived by the home owner. Identifying impediments to conservation investments is also very important in designing a marketing plan. A recent report suggests that financial constraints and the need for better information and knowledge about conservation pose the major conservation investment barriers. Since loan interest rates for new manufactured homes typically exceed site-built rates by a considerable amount and the buyers tend to have lower incomes, the economics of manufactured home conservation investments are likely to significantly influence their viability. Conservation information and its presentation directly influences the manufactured home buyer's decision. A marketing plan should address these impediments and their implications very clearly. Dealers express a belief that consumer satisfaction is the major advantage to selling energy efficient manufactured homes. This suggests that targeting dealers in a marketing plan and providing them direct information on consumers' indicated attitudes may be important. 74 refs.

Valuing Attributes of Home Palliative Care With Service Users: A Pilot Discrete Choice Experiment.

Science.gov (United States)

Gomes, Barbara; de Brito, Maja; Sarmento, Vera P; Yi, Deokhee; Soares, Duarte; Fernandes, Jacinta; Fonseca, Bruno; Gonçalves, Edna; Ferreira, Pedro L; Higginson, Irene J

2017-12-01

Discrete choice experiment (DCE) is a quantitative method that helps determine which service attributes are most valued by people and consequently improve their well-being. The objective of this study was to test a new DCE on home palliative care (HPC). Cross-sectional survey using the DCE method with adult patients and their family caregivers, users of three HPC services in Portugal. Service attributes were based on a Cochrane review, a meta-ethnography, and the few existing DCEs on HPC: 1) team's availability, 2) support for family caregivers, 3) homecare support, 4) information and planning, and 5) waiting time. The experimental design consisted in three blocks of eight choice sets where participants chose between two service alternatives that combined different levels of each attribute. We piloted the DCE using cognitive interviewing. Interviews were analyzed for difficulties using Tourangeau's model of information processing. The DCE was conducted with 21 participants of 37 eligible (10 patients with median Palliative Performance Scale score = 45, 11 caregivers). Most participants found the DCE easy (median 2 from 1 to 5), although two patients did not finish the exercise. Key difficulties related to comprehension (e.g., waiting time sometimes understood as response time for visit instead of time from referral to care start) and judgment (e.g., indecision due to similar service alternatives). The DCE method is feasible and acceptable but not all patients are able to participate. In the main study phase, we will give more attention to the explanation of the waiting time attribute. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Smart Homes and Sensors for Surveillance and Preventive Education at Home: Example of Obesity

Directory of Open Access Journals (Sweden)

Jacques Demongeot

2016-08-01

Full Text Available (1 Background: The aim of this paper is to show that e-health tools like smart homes allow the personalization of the surveillance and preventive education of chronic patients, such as obese persons, in order to maintain a comfortable and preventive lifestyle at home. (2 Technologies and methods: Several types of sensors allow coaching the patient at home, e.g., the sensors recording the activity and monitoring the physiology of the person. All of this information serves to personalize serious games dedicated to preventive education, for example in nutrition and vision. (3 Results: We built a system of personalized preventive education at home based on serious games, derived from the feedback information they provide through a monitoring system. Therefore, it is possible to define (after clustering and personalized calibration from the at home surveillance of chronic patients different comfort zones where their behavior can be estimated as normal or abnormal and, then, to adapt both alarm levels for surveillance and education programs for prevention, the chosen example of application being obesity.

The influence of age, gender and other information technology use on young people's computer use at school and home.

Science.gov (United States)

Harris, C; Straker, L; Pollock, C

2013-01-01

Young people are exposed to a range of information technologies (IT) in different environments, including home and school, however the factors influencing IT use at home and school are poorly understood. The aim of this study was to investigate young people's computer exposure patterns at home and school, and related factors such as age, gender and the types of IT used. 1351 children in Years 1, 6, 9 and 11 from 10 schools in metropolitan Western Australia were surveyed. Most children had access to computers at home and school, with computer exposures comparable to TV, reading and writing. Total computer exposure was greater at home than school, and increased with age. Computer activities varied with age and gender and became more social with increased age, at the same time parental involvement reduced. Bedroom computer use was found to result in higher exposure patterns. High use of home and school computers were associated with each other. Associations varied depending on the type of IT exposure measure (frequency, mean weekly hours, usual and longest duration). The frequency and duration of children's computer exposure were associated with a complex interplay of the environment of use, the participant's age and gender and other IT activities.

Shifting hospital-hospice boundaries: historical perspectives on the institutional care of the dying.

Science.gov (United States)

Risse, Guenter B; Balboni, Michael J

2013-06-01

Social forces have continually framed how hospitals perceive their role in care of the dying. Hospitals were originally conceived as places of hospitality and spiritual care, but by the 18th century illness was an opponent, conquered through science. Medicalization transformed hospitals to places of physical cure and scientific prowess. Death was an institutional liability. Equipped with new technologies, increased public demand, and the establishment of Medicare in 1965, modern hospitals became the most likely place for Americans to die--increasing after the 1940s and spiking in the 1990s. Medicare's 1983 hospice benefit began to reverse this trend. Palliative care has more recently proliferated, suggesting an institutional shift of alignment with traditional functions of care toward those facing death.

Home Automation and Security System

OpenAIRE

Surinder Kaur,; Rashmi Singh; Neha Khairwal; Pratyk Jain

2016-01-01

Easy Home or Home automation plays a very important role in modern era because of its flexibility in using it at different places with high precision which will save money and time by decreasing human hard work. Prime focus of this technology is to control the household equipment’s like light, fan, door, AC etc. automatically. This research paper has detailed information on Home Automation and Security System using Arduino, GSM and how we can control home appliances using Android application....

Do Partial Home Smoking Bans Signal Progress toward a Smoke-Free Home?

Science.gov (United States)

Kegler, Michelle C.; Haardörfer, Regine; Bundy, Lucja T.; Escoffery, Cam; Berg, Carla J.; Fernandez, Maria; Williams, Rebecca; Hovell, Mel

2016-01-01

Understanding who establishes partial home smoking bans, what these bans cover, and whether they are an intermediate step in going smoke-free would help to inform smoke-free home interventions. Participants were recruited from United Way of Greater Atlanta's 2-1-1 contact center. Data were collected at baseline, 3 and 6 months via telephone…

Smart homes, private homes? An empirical study of technology researchers' perceptions of ethical issues in developing smart-home health technologies.

Science.gov (United States)

Birchley, Giles; Huxtable, Richard; Murtagh, Madeleine; Ter Meulen, Ruud; Flach, Peter; Gooberman-Hill, Rachael

2017-04-04

Smart-home technologies, comprising environmental sensors, wearables and video are attracting interest in home healthcare delivery. Development of such technology is usually justified on the basis of the technology's potential to increase the autonomy of people living with long-term conditions. Studies of the ethics of smart-homes raise concerns about privacy, consent, social isolation and equity of access. Few studies have investigated the ethical perspectives of smart-home engineers themselves. By exploring the views of engineering researchers in a large smart-home project, we sought to contribute to dialogue between ethics and the engineering community. Either face-to-face or using Skype, we conducted in-depth qualitative interviews with 20 early- and mid-career smart-home researchers from a multi-centre smart-home project, who were asked to describe their own experience and to reflect more broadly about ethical considerations that relate to smart-home design. With participants' consent, interviews were audio-recorded, transcribed and analysed using a thematic approach. Two overarching themes emerged: in 'Privacy', researchers indicated that they paid close attention to negative consequences of potential unauthorised information sharing in their current work. However, when discussing broader issues in smart-home design beyond the confines of their immediate project, researchers considered physical privacy to a lesser extent, even though physical privacy may manifest in emotive concerns about being watched or monitored. In 'Choice', researchers indicated they often saw provision of choice to end-users as a solution to ethical dilemmas. While researchers indicated that choices of end-users may need to be restricted for technological reasons, ethical standpoints that restrict choice were usually assumed and embedded in design. The tractability of informational privacy may explain the greater attention that is paid to it. However, concerns about physical privacy may

Exploring an informed decision-making framework using in-home sensors: older adults’ perceptions

Directory of Open Access Journals (Sweden)

Jane Chung

2014-03-01

Full Text Available Background Sensor technologies are designed to assist independent living of older adults. However, it is often difficult for older adults to make an informed decision about adopting sensor technologies.Objective To explore Bruce’s framework of informed decision making (IDM for in-home use of sensor technologies in community-dwelling elders.Method The IDM framework guided development of a semi-structured interview. A theory-driven coding approach was used for analysis.Results Participants supported most of the elements of the framework, but not all aspects of each element were addressed. Perceived usefulness of technologies was identified as an area for framework extension.Conclusion This paper provides useful information for health care professionals to consider how to enhance IDM of older adults regarding the use of sensor technologies. The results also illuminate elements of the IDM framework that may be critical to facilitating independent living for older adults.

Continuity and change in mothers' narratives of perinatal hospice.

Science.gov (United States)

Lathrop, Anthony; VandeVusse, Leona

2011-01-01

(1) To broadly explore the experiences of women who chose to continue pregnancies affected by lethal fetal diagnoses and (2) to develop knowledge useful to nurses and other healthcare professionals who provide perinatal hospice (PH) care. Qualitative descriptive study using narrative analysis. Fifteen women who learned during their pregnancies of a lethal fetal diagnosis and chose to continue the affected pregnancies. Participants' stories of their PH experiences were recorded in face-to-face interviews. A qualitative approach using narrative analysis was used to identify themes and develop suggestions for care. The element of time was prevalent in mothers' stories. Some aspects of mothers' experiences continued, particularly feelings of love and connection to their babies. Mothers also reported evolving changes in their thoughts and feelings. Personal changes such as increased compassion, faith, and strength were frequently mentioned. Mothers described transient phases of highs and lows. Drawing personal meanings or life lessons was the main way mothers connected their experiences to their present lives. Mothers' descriptions of their experiences can enhance nurses' understanding of perinatal loss. Established care practices, such as birth planning and creating mementoes, were supported. Nurses can help mothers experiencing loss by elucidating and reflecting their personal meanings.

A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review

OpenAIRE

Fang, Mei Lan; Sixsmith, Judith; Sinclair, Shane; Horst, Glen

2016-01-01

Background Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. Methods To explore atti...

Strapdown Homing Guidance System Design for Some Ammunition

Institute of Scientific and Technical Information of China (English)

无

2006-01-01

The strapdown homing guidance system for some ammunition was mainly studied. A strong tracking Kalman filter was designed for the strapdown homing guidance system using the information measured by the strapdown homing seeker to estimate relative movement variables between the ammunition and target. Then the optimal proportional law, which using the estimated information, guided the ammunition. Simulation results show that the designed strapdown homing guidance system with strong tracking Kalman filter can attack the maneuvering target effectively, and satisfy the performance index for the guided ammunition system.

Home-based music therapy--a systematic overview of settings and conditions for an innovative service in healthcare.

Science.gov (United States)

Schmid, Wolfgang; Ostermann, Thomas

2010-10-14

Almost every Western healthcare system is changing to make their services more centered around out-patient care. In particular, long-term or geriatric patients who have been discharged from the hospital often require home-based care and therapy. Therefore, several programs have been developed to continue the therapeutic process and manage the special needs of patients after discharge from hospital. Music therapy has also moved into this field of healthcare service by providing home-based music therapy (HBMT) programs. This article reviews and summarizes the settings and conditions of HBMT for the first time. The following databases were used to find articles on home-based music therapy: AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX. The search terms were "home-based music therapy" and "mobile music therapy". Included articles were analyzed with respect to participants as well as conditions and settings of HBMT. Furthermore, the date of publication, main outcomes, and the design and quality of the studies were investigated. A total of 20 international publications, 11 clinical studies and nine reports from practice, mainly from the United States (n = 8), were finally included in the qualitative synthesis. Six studies had a randomized controlled design and included a total of 507 patients. The vast majority of clients of HBMT are elderly patients living at home and people who need hospice and palliative care. Although settings were heterogeneous, music listening programs played a predominant role with the aim to reduce symptoms like depression and pain, or to improve quality of life and the relationship between patients and caregivers as primary endpoints. We were able to show that HBMT is an innovative service for future healthcare delivery. It fits with the changing healthcare system and its conditions but also meets the therapeutic needs of the increasing number of elderly and severely impaired people. Apart from music therapists, patients and their

Home-based music therapy - a systematic overview of settings and conditions for an innovative service in healthcare

Directory of Open Access Journals (Sweden)

Ostermann Thomas

2010-10-01

Full Text Available Abstract Background Almost every Western healthcare system is changing to make their services more centered around out-patient care. In particular, long-term or geriatric patients who have been discharged from the hospital often require home-based care and therapy. Therefore, several programs have been developed to continue the therapeutic process and manage the special needs of patients after discharge from hospital. Music therapy has also moved into this field of healthcare service by providing home-based music therapy (HBMT programs. This article reviews and summarizes the settings and conditions of HBMT for the first time. Methods The following databases were used to find articles on home-based music therapy: AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX. The search terms were "home-based music therapy" and "mobile music therapy". Included articles were analyzed with respect to participants as well as conditions and settings of HBMT. Furthermore, the date of publication, main outcomes, and the design and quality of the studies were investigated. Results A total of 20 international publications, 11 clinical studies and nine reports from practice, mainly from the United States (n = 8, were finally included in the qualitative synthesis. Six studies had a randomized controlled design and included a total of 507 patients. The vast majority of clients of HBMT are elderly patients living at home and people who need hospice and palliative care. Although settings were heterogeneous, music listening programs played a predominant role with the aim to reduce symptoms like depression and pain, or to improve quality of life and the relationship between patients and caregivers as primary endpoints. Conclusions We were able to show that HBMT is an innovative service for future healthcare delivery. It fits with the changing healthcare system and its conditions but also meets the therapeutic needs of the increasing number of elderly and severely

Home-based music therapy - a systematic overview of settings and conditions for an innovative service in healthcare

Science.gov (United States)

2010-01-01

Background Almost every Western healthcare system is changing to make their services more centered around out-patient care. In particular, long-term or geriatric patients who have been discharged from the hospital often require home-based care and therapy. Therefore, several programs have been developed to continue the therapeutic process and manage the special needs of patients after discharge from hospital. Music therapy has also moved into this field of healthcare service by providing home-based music therapy (HBMT) programs. This article reviews and summarizes the settings and conditions of HBMT for the first time. Methods The following databases were used to find articles on home-based music therapy: AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX. The search terms were "home-based music therapy" and "mobile music therapy". Included articles were analyzed with respect to participants as well as conditions and settings of HBMT. Furthermore, the date of publication, main outcomes, and the design and quality of the studies were investigated. Results A total of 20 international publications, 11 clinical studies and nine reports from practice, mainly from the United States (n = 8), were finally included in the qualitative synthesis. Six studies had a randomized controlled design and included a total of 507 patients. The vast majority of clients of HBMT are elderly patients living at home and people who need hospice and palliative care. Although settings were heterogeneous, music listening programs played a predominant role with the aim to reduce symptoms like depression and pain, or to improve quality of life and the relationship between patients and caregivers as primary endpoints. Conclusions We were able to show that HBMT is an innovative service for future healthcare delivery. It fits with the changing healthcare system and its conditions but also meets the therapeutic needs of the increasing number of elderly and severely impaired people. Apart from

Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework.

Science.gov (United States)

Lavallée, Jacqueline F; Gray, Trish A; Dumville, Jo; Cullum, Nicky

2018-06-01

Pressure ulcers are areas of localised damage to the skin and underlying tissue; and can cause pain, immobility, and delay recovery, impacting on health-related quality of life. The individuals who are most at risk of developing a pressure ulcer are those who are seriously ill, elderly, have impaired mobility and/or poor nutrition; thus, many nursing home residents are at risk. To understand the context of pressure ulcer prevention in nursing homes and to explore the potential barriers and facilitators to evidence-informed practices. Semi-structured interviews were conducted with nursing home nurses, healthcare assistants and managers, National Health Service community-based wound specialist nurses (known in the UK as tissue viability nurses) and a nurse manager in the North West of England. The interview guide was developed using the Theoretical Domains Framework to explore the barriers and facilitators to pressure ulcer prevention in nursing home residents. Data were analysed using a framework analysis and domains were identified as salient based on their frequency and the potential strength of their impact. 25 participants (nursing home: 2 managers, 7 healthcare assistants, 11 qualified nurses; National Health Service community services: 4 tissue viability nurses, 1 manager) were interviewed. Depending upon the behaviours reported and the context, the same domain could be classified as both a barrier and a facilitator. We identified seven domains as relevant in the prevention of pressure ulcers in nursing home residents mapping to four "barrier" domains and six "facilitator" domains. The four "barrier" domains were knowledge, physical skills, social influences and environmental context and resources and the six "facilitator" domains were interpersonal skills, environmental context and resources, social influences, beliefs about capabilities, beliefs about consequences and social/professional role and identity). Knowledge and insight into these barriers and

Predictors of home death of home palliative cancer care patients: a cross-sectional nationwide survey.

Science.gov (United States)

Fukui, Sakiko; Fujita, Junko; Tsujimura, Mayuko; Sumikawa, Yuka; Hayashi, Yayoi

2011-11-01

To identify factors influencing the place of death among home palliative cancer care patients, focusing on the role of nurses in terms of pre- and post-discharge from hospital to home care settings. A cross-sectional nationwide questionnaire survey was conducted at 1000 randomly selected homecare agencies in Japan. The questionnaires were completed by primary community nurses of home palliative patients just after their discharge. A total of 568 responses were analyzed (effective response rate, 69%). Multivariate logistic regression analysis revealed the following independent factors of place of death among those patients: desire for home death at referral by both patient and family caregiver; caregiver relationship to patient as daughter or daughter-in-law; totally bedridden functional status of patient; patient not suffering from depression and/or anxiety at referral; patients and caregivers duly informed about the dying process/death in detail, as well as instructed by community nurses about pain management and how to treat/prevent bedsores in home care settings. This study demonstrated the importance of both the hospital and community nurses' role in increasing the patients' chance of dying at home. Hospital nurses should support early transfer to home palliative care according to their assessment of the desire of patient/family caregiver for home death, the patients' clinical status, and caregivers' ability to provide patient care at home. Community nurses should inform patients/family caregiver in detail about the dying process/death just after discharge, relieve patient pain, treat/prevent bedsores, and instruct family caregivers on their symptom control. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

'The nice thing about doctors is that you can sometimes get a day off school': an action research study to bring lived experiences from children, parents and hospice staff into medical students' preparation for practice.

Science.gov (United States)

Spalding, Jessica; Yardley, Sarah

2016-12-01

Patient and public involvement in healthcare is important to ensure services meet their needs and priorities. Increasingly, patient experiences are being used to educate healthcare professionals. The potential contribution to medical education of children and parents using hospice services has not yet been fully explored. (1) To explore perceptions of what medical students must learn to become 'good doctors' among children, parents and staff in a hospice. (2) To collaborate with children/parents and staff to develop educational materials based on their lived experiences for medical students. (3) To assess feasibility of student-led action research in a children's hospice to develop research skills. Prospective ethical approval received. Volunteer children (n=7), parents (n=5) and staff (n=6) were recruited from a children's hospice. Data were generated in audio-recorded semistructured focus groups, individual interviews and/or activity workshops. Participants discussed what newly qualified doctors' needed to care for children with life-limiting conditions. Audio data were transcribed and combined with visual data for thematic analysis. Findings were refined by participant feedback. This paper presents thematic findings and educational material created from the project. Thematic analysis identified six learning themes: (1) treat children as individuals; (2) act as a person before being a doctor; (3) interpersonal communication; (4) appreciate the clinical environment; (5) learn from children, parents and other staff; (6) how to be a doctor as part of a team. The student researcher successfully developed qualitative research skills, coproducing materials with participants for sharing learning derived from lived experiences. All participants were willing and able to make valuable contributions, and believed that this was a worthwhile use of time and effort. Further work is required to understand how best to integrate the experiences of children in hospices into

What Is Psychiatry?

Medline Plus

Full Text Available ... including private practices, clinics, general and psychiatric hospitals, university medical centers, community agencies, courts and prisons, nursing homes, industry, government, military settings, rehabilitation programs, emergency rooms, hospice programs, and ...

Can the care transitions measure predict rehospitalization risk or home health nursing use of home healthcare patients?

Science.gov (United States)

Ryvicker, Miriam; McDonald, Margaret V; Trachtenberg, Melissa; Peng, Timothy R; Sridharan, Sridevi; Feldman, Penny H

2013-01-01

The Care Transitions Measure (CTM) was designed to assess the quality of patient transitions from the hospital. Many hospitals are using the measure to inform their efforts to improve transitional care. We sought to determine if the measure would have utility for home healthcare providers by predicting newly admitted patients at heightened risk for emergency department use, rehospitalization, or increased home health nursing visits. The CTM was administered to 495 home healthcare patients shortly after hospital discharge and home healthcare admission. Follow-up interviews were completed 30 and 60 days post hospital discharge. Interview data were supplemented with agency assessment and service use data. We did not find evidence that the CTM could predict home healthcare patients having an elevated risk for emergent care, rehospitalization, or higher home health nursing use. Because Medicare/Medicaid-certified home healthcare providers already use a comprehensive, mandated start of care assessment, the CTM may not provide them additional crucial information. Process and outcome measurement is increasingly becoming part of usual care. Selection of measures appropriate for each service setting requires thorough site-specific evaluation. In light of our findings, we cannot recommend the CTM as an additional measure in the home healthcare setting. © 2013 National Association for Healthcare Quality.

Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study.

Science.gov (United States)

Artico, Marco; D'Angelo, Daniela; Piredda, Michela; Petitti, Tommasangelo; Lamarca, Luciano; De Marinis, Maria Grazia; Dante, Angelo; Lusignani, Maura; Matarese, Maria

2018-07-01

Patients with advanced illnesses show the highest prevalence for pressure injuries. In the palliative care setting, the ultimate goal is injury healing, but equally important is wound maintenance, wound palliation (wound-related pain and symptom management), and primary and secondary wound prevention. To describe the course of healing for pressure injuries in a home palliative care setting according to different end-points, and to explore patient and caregiver characteristics and specific care activities associated with their achievement. Four-year retrospective chart review of 669 patients cared for in a home palliative care service, of those 124 patients (18.5%) had at least one pressure injury with a survival rate less than or equal to six months. The proportion of healed pressure injuries was 24.4%. Of the injuries not healed, 34.0% were in a maintenance phase, whereas 63.6% were in a process of deterioration. Body mass index (P = 0.0014), artificial nutrition (P = 0.002), and age pay attention to artificial nutrition, continuous deep sedation, and the caregiver's role and gender. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Home care, hospitalizations and doctor visits

OpenAIRE

Gonçalves Judite; Weaver France

2014-01-01

This study estimates the effects of formal home care on hospitalizations and doctor visits. We compare the effects of medically- and non-medically-related home care and investigate heterogeneous effects by age group and informal care availability. Two-part models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into cantons (i.e. states). The endogeneity of home care is addressed by using instrumental variables, canton and time fixed effec...

Information Impact: Journal of Information and Knowledge ...

African Journals Online (AJOL)

Information Impact: Journal of Information and Knowledge Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 7, No 2 (2016) >. Log in or Register to get access to full text downloads.

Student Nurses' Perception of Death and Dying

Science.gov (United States)

Niederriter, Joan E.

2009-01-01

Student nurses are involved in caring for patients who are actively dying or who have been told they have a terminal illness and are faced with the process of dying. Students encounter these patients in hospitals, nursing homes, at home or in hospice care settings. According to Robinson (2004), "nurses are the healthcare providers that are most…

76 FR 73649 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Science.gov (United States)

2011-11-29

... policy questions regarding this collection contact Leslie Jones at (410) 786-6599. For all other issues... reporting requirements for hospices, as set forth in the proposed Hospice Wage Index for Fiscal Year 2012.... Martique Jones, Director, Regulations Development Group, Division B, Office of Strategic Operations and...

Representing in-home and out-of-home energy consumption behavior in Beijing

International Nuclear Information System (INIS)

Yu Biying; Zhang Junyi; Fujiwara, Akimasa

2011-01-01

It is expected that in-home and out-of-home energy consumption behavior in a household might be correlated with each other, probably due to the existence of household budget constraints. Ownership and usage of energy-saving technologies for in-home appliances (or vehicles) might lead to the increase in out-of-home (or in-home) energy consumption. It is therefore necessary to jointly represent in-home and out-of-home energy consumption in the same modeling framework. With this consideration, we first build a new type of energy consumption model based on the Multiple Discrete-Continuous Extreme Value (MDCEV) modeling framework. Next, we conducted a questionnaire survey in Beijing in 2009 and successfully collected the information about households' energy consumption, ownership/usage of in-home appliances and vehicles, and households' and their members' attributes from 1014 households. Throughout an empirical analysis, it is confirmed that the MDCEV model is effective to simultaneously describe the in-home and out-of-home energy consumption behavior. In addition, it is revealed that a set of household and personal attributes affect the ownership and usage of in-home appliances and vehicles. Furthermore, it is shown that the unobserved factors play a much more important role in explaining energy consumption behavior than the observed attributes of households and their members. - Highlights: → Representing in-home and out-of-home energy consumption behavior jointly. → MDCEV model is built to describe household energy consumption behavior. → Log-linear competitive relationships are found among expenditures of end-uses. → Model results provide some insights about the influence of varied observed factors. → Unobserved factors are more important in explaining energy consumption behavior.

Tracking the evolution of hospice palliative care in Canada: A comparative case study analysis of seven provinces

Directory of Open Access Journals (Sweden)

Richards Judy-Lynn

2010-06-01

Full Text Available Abstract Background An aging population, rise in chronic illnesses, increase in life expectancy and shift towards care being provided at the community level are trends that are collectively creating an urgency to advance hospice palliative care (HPC planning and provision in Canada. The purpose of this study was to analyze the evolution of HPC in seven provinces in Canada so as to inform such planning and provision elsewhere. We have endeavoured to undertake this research out of awareness that good future planning for health and social care, such as HPC, typically requires us to first look backwards before moving forward. Methods To identify key policy and practice events in HPC in Canada, as well as describe facilitators of and barriers to progress, a qualitative comparative case study design was used. Specifically, the evolution and development of HCP in 7 strategically selected provinces is compared. After choosing the case study provinces, the grey literature was searched to create a preliminary timeline for each that described the evolution of HPC beginning in 1970. Key informants (n = 42 were then interviewed to verify the content of each provincial timeline and to discuss barriers and facilitators to the development of HPC. Upon completion of the primary data collection, a face-to-face meeting of the research team was then held so as to conduct a comparative study analysis that focused on provincial commonalities and differences. Results Findings point to the fact that HPC continues to remain at the margins of the health care system. The development of HPC has encountered structural inheritances that have both sped up progress as well as slowed it down. These structural inheritances are: (1 foundational health policies (e.g., the Canada Health Act; (2 service structures and planning (e.g., the dominance of urban-focused initiatives; and (3 health system decisions (e.g., regionalization. As a response to these inheritances, circumventions

Tracking the evolution of hospice palliative care in Canada: a comparative case study analysis of seven provinces.

Science.gov (United States)

Williams, Allison M; Crooks, Valorie A; Whitfield, Kyle; Kelley, Mary-Lou; Richards, Judy-Lynn; DeMiglio, Lily; Dykeman, Sarah

2010-06-01

An aging population, rise in chronic illnesses, increase in life expectancy and shift towards care being provided at the community level are trends that are collectively creating an urgency to advance hospice palliative care (HPC) planning and provision in Canada. The purpose of this study was to analyze the evolution of HPC in seven provinces in Canada so as to inform such planning and provision elsewhere. We have endeavoured to undertake this research out of awareness that good future planning for health and social care, such as HPC, typically requires us to first look backwards before moving forward. To identify key policy and practice events in HPC in Canada, as well as describe facilitators of and barriers to progress, a qualitative comparative case study design was used. Specifically, the evolution and development of HCP in 7 strategically selected provinces is compared. After choosing the case study provinces, the grey literature was searched to create a preliminary timeline for each that described the evolution of HPC beginning in 1970. Key informants (n = 42) were then interviewed to verify the content of each provincial timeline and to discuss barriers and facilitators to the development of HPC. Upon completion of the primary data collection, a face-to-face meeting of the research team was then held so as to conduct a comparative study analysis that focused on provincial commonalities and differences. Findings point to the fact that HPC continues to remain at the margins of the health care system. The development of HPC has encountered structural inheritances that have both sped up progress as well as slowed it down. These structural inheritances are: (1) foundational health policies (e.g., the Canada Health Act); (2) service structures and planning (e.g., the dominance of urban-focused initiatives); and (3) health system decisions (e.g., regionalization). As a response to these inheritances, circumventions of the established system of care were taken

Long-term home care scheduling

DEFF Research Database (Denmark)

Gamst, Mette; Jensen, Thomas Sejr

In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...