Wilson, Dottie C.; Grady, Kathleen A.
This monograph, the fourth in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to prepare a skilled team of trainers with information about hospices that is relevant to hospice interdisciplinary team training and to document experiences in…
English, David J.; Mortenson, Lee E.
This monograph, the first in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to assist hospice directors, educators, and other administrative staff members to understand the focus of the proposed training and its applicability to their…
Wilson, Dottie C.; Grady, Kathleen A.
This monograph, the second in a series of five, provides information for trainers on interdisciplinary team training and humanistic patient care in hospices. Designed to help outside trainers who may be invited by a hospice to conduct its training, the materials help instructors to understand the nature of hospices, to determine whether or not the…
Ellington, Lee; Clayton, Margaret F; Reblin, Maija; Cloyes, Kristin; Beck, Anna C; Harrold, Joan K; Harris, Pamela; Casarett, David
Hospice provides intensive end-of-life care to patients and their families delivered by an interdisciplinary team of nurses, aides, chaplains, social workers, and physicians. Significant gaps remain about how team members respond to diverse needs of patients and families, especially in the last week of life. The study objective was to describe the frequency of hospice team provider visits in the last week of life, to examine changes in frequency over time, and to identify patient characteristics that were associated with an increase in visit frequency. This was a retrospective cohort study using electronic medical record data. From U.S. not-for-profit hospices, 92,250 records were used of patients who died at home or in a nursing home, with a length of stay of at least seven days. Data included basic demographic variables, diagnoses, clinical markers of illness severity, patient functioning, and number of hospice team member visits in the last seven days of life. On average the total number of hospice team member visits in the last week of life was 1.36 visits/day. Most were nurse visits, followed by aides, social workers, and chaplains. Visits increased over each day on average across the last week of life. Greater increase in visits was associated with patients who were younger, male, Caucasian, had a spouse caregiver, and shorter lengths of stay. This study provides important information to help hospices align the interdisciplinary team configuration with the timing of team member visits, to better meet the needs of the patients and families they serve.
English, David J.; Mortenson, Lee E.
This monograph, the third in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to describe the steps in designing a training program for a particular hospice and the activities undertaken between the selection of the trainers and the…
Grady, Kathleen A.; Wilson, Dottie C.
This monograph, the fifth in a series of five, provides training information for hospice staff in improving interdisciplinary team functions and humanistic care provisions. Its purpose is to provide a skilled group trainer with the hospice-specific insights necessary to conduct training in humanistic patient care. Chapter 1 covers training program…
Lysaght Hurley, Susan; Barg, Frances K; Strumpf, Neville; Ersek, Mary
Tremendous growth in hospice over the past 30 years in the United States has increased the number of terminally ill patients dying at home. Recently, however, more hospice patients are dying at inpatient facilities. To understand the varying perceptions about care in the home and inpatient hospice, we conducted semistructured interviews with 24 interdisciplinary team (IDT) members and analyzed the data using the constant comparative method. Core interdisciplinary tasks, including identifying the focus of energy, tailoring family caregiver involvement, acknowledging who is in charge, and knowing both sides differed in the home and inpatient settings. Despite the overarching umbrella of hospice care, home and inpatient hospice settings create different foci for IDT members, burdens and privileges for family caregivers, and control of the care plan. Key differences between home and inpatient hospice processes of care highlight the complexity of patient-centered end-of-life care in the United States. © The Author(s) 2014.
Wittenberg-Lyles, Elaine; Debra, Parker Oliver; Demiris, George; Rankin, Anna; Shaunfield, Sara; Kruse, Robin L
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.
Qaseem, Brye; Shea, Judy; Connor, Stephen R; Casarett, David
Despite the emotional and interpersonal challenges that hospice staff face in providing care to patients near the end of life, no systematic effort has been made to evaluate the work environment that hospices provide to their staff. The aim of this project was to develop a job satisfaction survey that could be used to evaluate the hospice work environment and, ultimately, to guide interventions to improve the work experience for hospice staff. A first draft of the Survey of Team Attitudes and Relationships (STAR) was developed through semi-structured interviews with an interdisciplinary sample of staff from nine hospices, and then refined with input from additional interviews and from an expert panel. The draft was tested on larger samples of staff (n=160) from six hospices and revised with input from the expert panel. The final survey was tested with 599 staff from 10 hospices. The final survey contains 45 items in six domains: individual work rewards, teamwork, management support, organizational support, workload issues, and global assessment of job satisfaction. Items had excellent psychometric characteristics, with acceptable floor and ceiling effects. The overall STAR had a Cronbach's alpha of 0.93, indicating good homogeneity, and each domain had alpha values that are appropriate for between-group comparisons (range 0.74-0.84). These results suggest that the STAR offers a unique instrument to measure the work environment hospices provide to their staff.
Nancarrow, Susan A; Booth, Andrew; Ariss, Steven; Smith, Tony; Enderby, Pam; Roots, Alison
Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes. This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work. Ten characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles. We propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate.
Gable, Robert A.; Manning, M. Lee
Discusses interdisciplinary team collaboration for teachers, including structuring a successful team meeting, the 10-step interdisciplinary problem-solving meeting, evaluation of team collaboration, and effective team communication. (SR)
Casarett, David J; Spence, Carol; Haskins, Matthew; Teno, Joan
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.
Research and clinical experience have shown the importance of using a team approach in the rehabilitation of stroke patients. The interdisciplinary team approach is recommended in the managing or rehabilitation of such patients. This study sought to determine if the interdisciplinary team approach was utilized in the ...
Chihara, S; Hara, Y
Terminal care for cancer patients must be oriented to the dignity of human being. For this purpose our hospice has five principles, that is, to control physical pain, to relieve spiritual problems, to settle socio-economical matters, to give religious support and lighten family loads. To put into practice these five principles, various kinds of staff take their places as caregivers: physicians, nurses, helpers, chaplains, psychiatrists and voluntary workers. Moreover, the Hospice has many facilities such as a community hall, a kitchen for family members, guestrooms for family members and friends, a chapel for services and patient's rooms with one bed which make it possible for the patients to communicate intimately with family members or friends. During these 7 years, from April '81 to March '88, 398 terminally ill cancer patients have been treated at the Seirei Hospice. Through these experience, we have observed that most of terminally ill cancer patients do wish to live as long as possible in good condition without physical pain. So, we should conclusively emphasize that medical treatment including radiotherapy and cancer chemotherapy, attempting to reduce the physical distresses, ought to be continued until the time when the treatment might come to waste the patient's energy and only increase their agony.
Kegye, Adrienne; Pádi, Eva
Hospice care has been developing for 20 years. In the framework of the high standard palliative treatment hospice care involves symptom control as well as the psychosocial support of patients and their relatives. Developed as a model, the aims of the psychoeducational and supporting program were to reduce the psychological symptoms, form the active coping mechanisms, reduce feeling of isolation and help the communication of the patients treated in the Oncological Rehabilitation and Hospice Department of the Vaszary Kolos Hospital in Esztergom, Hungary. The program consisted of the following elements: analiticly orientated team psychoterapy, creative occupation, physiotherapy, dietetics guidance and oncological consulting. During the model supporting program the authors observed significant changes in both the patients and staff members which had a positive impact on the department's operation and the atmosphere, too. The model program showed that in team work can give beneficial and cost-efficient psychosocial support to patients using the carers' energy in the most effective way.
Lee K. Cerveny; Dale J. Blahna; Marc J. Stern; Michael J. Mortimer; James W. Freeman
Interdisciplinary (ID) teams were created by the US Forest Service in response to environmental legislation. In 2008, we surveyed 10 team leaders for National Environmental Policy Act (NEPA) analysis of 106 recreation-related projects conducted between 2005 and 2008. Results were compared with current workforce data and previous studies of ID team leadership and...
Day, Pat Spencer
The paper reviews difficulties in special education interdisciplinary team decision making and relates the experiences of one team's efforts to increase intra-team communication. Among problems cited are lack of focus in discussions, unequal levels of participation, and limited abilities to produce recommendations or provide therapy in a truly…
Beverley, L; Dobson, D; Atkinson, M; Caldwell, L
Interdisciplinary team collaboration is considered an essential component of most health care services. The overall goal of such collaboration in mental health services/ psychiatry is to provide a comprehensive biopsychosocial perspective organized around patient needs and stages of treatment. There is also increasing interest in using an interdisciplinary framework to monitor and evaluate patient care. Unfortunately, little information is available regarding treatment standards that address the issue of interdisciplinary team collaboration. This project was designed to formulate a set of interdisciplinary team standards of patient care. This article presents the standards and provides an overview of the interdisciplinary processes through which they were developed. An empirical evaluation of the standards within one service area--The Affective Disorders Clinic--is also included.
Pizzi, Michael A
The purpose of this phenomenological study was to answer the broad questions: what do professional caregivers for the dying think about what they do, and how does that thinking influence their practice in end-of-life care? The participants were 12 hospice professionals working in four specific disciplines: occupational therapy, physical therapy, social work, and nursing. In-depth interviews were conducted and audiotaped, and transcripts were printed. Constant comparison and thematic analysis was performed. One overarching theme and five subthemes were generated. The central theme, "promoting a good death," emerged from the data, as the participants continually discussed health, wellness, and quality-of-life work in which they engaged that were discipline-specific yet overlapping. The subthemes that emerged were: holism; framing and re-framing practice; client- and family-centered care; being with dying; and interdisciplinary team. All participants concluded that their work emanated from a health and wellness lens, and that quality of life at the end of life was their ultimate goal. Quality of life, for each discipline, included doing, being, and becoming one's authentic self until the end of life.
Full Text Available Abstract Background There are few studies that examine the processes that interdisciplinary teams engage in and how we can design health information systems (HIS to support those team processes. This was an exploratory study with two purposes: (1 To develop a framework for interdisciplinary team communication based on structures, processes and outcomes that were identified as having occurred during weekly team meetings. (2 To use the framework to guide 'e-teams' HIS design to support interdisciplinary team meeting communication. Methods An ethnographic approach was used to collect data on two interdisciplinary teams. Qualitative content analysis was used to analyze the data according to structures, processes and outcomes. Results We present details for team meta-concepts of structures, processes and outcomes and the concepts and sub concepts within each meta-concept. We also provide an exploratory framework for interdisciplinary team communication and describe how the framework can guide HIS design to support 'e-teams'. Conclusion The structures, processes and outcomes that describe interdisciplinary teams are complex and often occur in a non-linear fashion. Electronic data support, process facilitation and team video conferencing are three HIS tools that can enhance team function.
Understanding of interdisciplinary teamwork is evolving. During health care restructuring, leaders across organizations have challenging responsibilities when work groups must integrate changing organizational values with new modes of service delivery. In this environment, a well-functioning interdisciplinary team in which clinicians work as member-leaders has the potential to further organizational change and foster improvements in patient outcomes. In this paper it is argued that the term interdisciplinary team leadership should be embraced cautiously as it may be a revisionist approach to an old problem, namely a means to modify existing theories of leadership that have been vague and continue to be poorly understood despite considerable effort to explicate knowledge over several decades. Preliminary research suggests that interdisciplinary team leadership is a model of shared leadership that requires more development if it is to become the cornerstone of interdisciplinary team practice in a radically reforming health sector. Stewardship is proposed as a potential philosophy for interdisciplinary team leadership, and a new, shared leadership role of practice leader is suggested.
Broussard, Shorna R.; La Lopa, Joseph Mick; Ross-Davis, Amy
Problem solving, interpersonal skills, information literacy, and critical and independent thinking are essential qualities that employers seek, yet many undergraduates lack. We structured an interdisciplinary classroom and experiential learning environment where students from three undergraduate courses (Hospitality and Tourism Management,…
Heinendirk, Eva-Maria; Čadež, Ivan
Regarding the requirements of today’s work life, students should learn – beside the technical knowledge – how to work in teams. Successful team work, especially by interdisciplinary teams within construction processes, requires a wide range of competences and skills. Integration of these opportunities into education of construction engineers is discussed in this paper. The “Shift from Teaching to Learning” (WILDT, J. 2003) provides a strengthened focus on education of com...
Ciemins, Elizabeth L; Brant, Jeannine; Kersten, Diane; Mullette, Elizabeth; Dickerson, Dustin
Although an interdisciplinary approach is considered best practice for caring for patients at the end of life, or in need of palliative care (PC) services, there is growing tension between healthcare organizations' need to contain costs and the provision of this beneficial, yet resource-intensive service. To support the interdisciplinary team (IDT) approach by recognizing organizations, teams, patients, and families as complex adaptive systems, illustrated by a qualitative study of the experiences, roles, and attributes of healthcare professionals (HCPs) who work with patients in need of PC services. In-depth, semi-structured interviews of PC health professionals were conducted, transcribed, and independently reviewed using grounded theory methodology and preliminary interpretations. A combined deductive and inductive iterative qualitative approach was used to identify recurring themes. The study was conducted in a physician-led, not-for-profit, multispecialty integrated health system serving three large, Western, rural states. A purposive sample of 10 HCPs who regularly provide PC services were interviewed. A positive team/patient experience was related to individual attributes, including self-awareness, spirit of inquiry, humility, and comfort with dying. IDT attributes included shared purpose, relational coordination, holistic thinking, trust, and respect for patient autonomy. Professional and personal motivations also contributed to a positive team/patient experience. Interdisciplinary PC teams have the potential to significantly impact patient and team experiences when caring for seriously ill patients. Findings from this study support interventions that focus on relationship building and application of a complex systems theory approach to team development.
Bayerl, P.S.; Steinheider, B.
The integration of function-specific expertise into a shared knowledge base is a crucial, but complex process for success in interdisciplinary teams. This paper presents an empirically derived typology of knowledge integration problems and links their occurrence to degree of heterogeneity and
To compare multi- and interdisciplinary team approaches concerning team process (teamwork) and team effectiveness (team performance and staff satisfaction) in German medical rehabilitation clinics. A cross-sectional study with a descriptive-explorative design. Eighteen medical rehabilitation clinics divided into two groups (somatic and psychosomatic indication fields). The 18 head physicians or psychotherapists in the clinics and their complete rehabilitation teams (n = 824). An interview guide was designed to determine the team approach in a telephone interview. A staff questionnaire for team members measured teamwork and team effectiveness with psychometrically validated questionnaires and self-administered items. All 18 head physicians took part in the telephone interview. The response rate of the employee attitude survey averaged 46% (n = 378). Eight teams were categorized as multidisciplinary and seven teams as interdisciplinary. In three cases the results were ambiguous. These teams were not considered in the further study. As expected, the interdisciplinary team approach showed significantly better results for nearly all aspects of teamwork and team effectiveness in comparison with the multidisciplinary team approach. The differences between multi- and interdisciplinary approach concerning teamwork and team effectiveness were higher in the somatic (8 teams, n = 183) than in the psychosomatic indication fields (7 teams, n = 195). Teamwork and team effectiveness are higher in teams working with the interdisciplinary team approach. Therefore the interdisciplinary approach can be recommended, particularly for clinics in the somatic indication field. Team development can help to move from the multidisciplinary to the interdisciplinary approach.
Hope, Joanie Mayer; Lugassy, Daniel; Meyer, Rina; Jeanty, Freida; Myers, Stephanie; Jones, Sadie; Bradley, Joann; Mitchell, Rena; Cramer, Eva
To evaluate the impact of the Downstate Team-Building Initiative (DTBI), a model multicultural and interdisciplinary health care team-building program for health professions students. A total of 65 students representing seven health disciplines participated in DTBI's first three years (one cohort per year since implementation). During the 18-session curriculum, students self-evaluated their group's progress through Tuckman's four team-development stages (FORMING, STORMING, NORMING, PERFORMING) on an 11-point scale. Students completed matched pre- and postintervention program evaluations assessing five variables: interdisciplinary understanding, interdisciplinary attitudes, teamwork skills, multicultural skills, and team atmosphere. After participation, students completed narrative follow-up questionnaires investigating impact one and two years after program completion. Each year's team development curve followed a similar logarithmic trajectory. Cohort 1 remained in team development stage 3 (NORMING) while Cohorts 2 and 3 advanced into the final stage-PERFORMING. A total of 34 matched pre- and postintervention evaluations showed significant change in all major variables: Team atmosphere and group teamwork skills improved most (48% and 44%, respectively). Interdisciplinary understanding improved 42%. Individual multicultural skills (defined by ability to address racism, homophobia, and sexism) started at the highest baseline and improved the least (13%). Group multicultural skills improved 36%. Of 23 responses to the follow-up surveys, 22 (96%) stated DTBI was a meaningful educational experience applicable to their current clinical surroundings. DTBI successfully united students across health discipline, ethnicity, socioeconomic class, gender, and sexual orientation into functioning teams. The model represents an effective approach to teaching health care team building and demonstrates benefits in both preclinical and clinical years of training.
Dain, Aleksandra S; Bradley, Elizabeth H; Hurzeler, Rosemary; Aldridge, Melissa D
Complementary and alternative medicine (CAM) provides clinical benefits to hospice patients, including decreased pain and improved quality of life. Yet little is known about the extent to which U.S. hospices employ CAM therapists. To report the most recent national data regarding the inclusion of art, massage, and music therapists on hospice interdisciplinary teams and how CAM therapist staffing varies by hospice characteristics. A national cross-sectional survey of a random sample of hospices (n = 591; 84% response rate) from September 2008 to November 2009. Twenty-nine percent of hospices (169 of 591) reported employing an art, massage, or music therapist. Of those hospices, 74% employed a massage therapist, 53% a music therapist, and 22% an art therapist, and 42% expected the therapist to attend interdisciplinary staff meetings, indicating a significant role for these therapists on the patient's care team. In adjusted analyses, larger hospices compared with smaller hospices had significantly higher odds of employing a CAM therapist (adjusted odds ratio 6.38; 95% CI 3.40, 11.99) and for-profit hospices had lower odds of employing a CAM therapist compared with nonprofit hospices (adjusted odds ratio 0.52; 95% CI 0.32, 0.85). Forty-four percent of hospices in the Mountain/Pacific region reported employing a CAM therapist vs. 17% in the South Central region. Less than one-third of U.S. hospices employ art, massage, or music therapists despite the benefits these services may provide to patients and families. A higher proportion of large hospices, nonprofit hospices, and hospices in the Mountain/Pacific region employ CAM therapists, indicating differential access to these important services. Published by Elsevier Inc.
Neumann, Vera; Gutenbrunner, Christoph; Fialka-Moser, Veronika; Christodoulou, Nicolas; Varela, Enrique; Giustini, Alessandro; Delarque, Alain
Effective team working plays a crucial role in Physical and Rehabilitation Medicine (PRM). As part of its role of optimizing and harmonizing clinical practice across Europe, the Professional Practice Committee of Union of European Medical Specialists (UEMS) Physical and Rehabilitation Medicine (PRM) Section reviewed patterns of team working and debated recommendations for good practice at a meeting of national UEMS delegates held in Riga, Latvia, in September 2008. This consensus statement is derived from that discussion and from a review of the literature concerning team working. Effective team working produces better patient outcomes (including better survival rates) in a range of disorders, notably following stroke. There is limited published evidence concerning what constitute the key components of successful teams in PRM programmes. However, the theoretical basis for good team working has been well-described in other settings and includes agreed aims, agreement and understanding on how best to achieve these, a multi-professional team with an appropriate range of knowledge and skills, mutual trust and respect, willingness to share knowledge and expertise and to speak openly. UEMS PRM Section strongly recommends this pattern of working. PRM specialists have an essential role to play in interdisciplinary teams; their training and specific expertise enable them to diagnose and assess severity of health problems, a prerequisite for safe intervention. Training spans 4-5 years in Europe, and includes knowledge and critical analysis of evidence-based rehabilitation strategies. PRM physicians are therefore well-placed to coordinate PRM programmes and to develop and evaluate new management strategies. Their broad training also means that they are able to take a holistic view of an individual patient's care.
Nebel Pederson, Sarah; Emmers-Sommer, Tara M.
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…
Tornøe, Kirsten; Danbolt, Lars Johan; Kvigne, Kari; Sørlie, Venke
.... The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team's experience with teaching and training care workers in spiritual and existential care for the dying...
Guise, Jeanne-Marie; Geller, Stacie; Regensteiner, Judith G; Raymond, Nancy; Nagel, Joan
Mentoring is critical for academic success. As science transitions to a team science model, team mentoring may have advantages. The goal of this study was to understand the process, benefits, and challenges of team mentoring relating to career development and research. A national survey was conducted of Building Interdisciplinary Research Careers in Women's Health (BIRCWH) program directors-current and former scholars from 27 active National Institutes of Health (NIH)-funded BIRCWH NIH K12 programs-to characterize and understand the value and challenges of the team approach to mentoring. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Responses were received from 25/27 (93%) program directors, 78/108 (72%) current scholars, and 91/162 (56%) former scholars. Scholars reported that team mentoring was beneficial to their career development (152/169; 90%) and research (148/169; 88%). Reported advantages included a diversity of opinions, expanded networking, development of stronger study designs, and modeling of different career paths. Challenges included scheduling and managing conflicting opinions. Advice by directors offered to junior faculty entering team mentoring included the following: not to be intimidated by senior mentors, be willing to navigate conflicting advice, be proactive about scheduling and guiding discussions, have an open mind to different approaches, be explicit about expectations and mentors' roles (including importance of having a primary mentor to help navigate discussions), and meet in person as a team. These findings suggest that interdisciplinary/interprofessional team mentoring has many important advantages, but that skills are required to optimally utilize multiple perspectives.
Graber, Glenn C; Pionke, Christopher D
This paper outlines the development and implementation of a new course in Engineering Ethics at the University of Tennessee. This is a three-semester-hour course and is jointly taught by an engineering professor and a philosophy professor. While traditional pedagogical techniques such as case studies, position papers, and classroom discussions are used, additional activities such as developing a code of ethics and student-developed scenarios are employed to encourage critical thinking. Among the topics addressed in the course are engineering as a profession and its role in society; ethical successes and failures; risk, safety, and the environment; professional responsibilities; credit and intellectual property; and international concerns. The most significant aspect of the course is that it brings both engineering and non-engineering points of view to the topics at hand. This is accomplished in two ways. First, as mentioned previously, it is team-taught by engineering faculty with an interest in ethical and societal issues, and by philosophy faculty with expertise in the field of professional ethics and an interest in science and technology. Second, the course is offered to both engineers and non-engineers. This mix of students requires that all students must be able to explain their technical and ethical decisions in a non-technical manner. Work teams are structured to maximize interdisciplinary interaction and to foster insights by each student into the professional commitments and attitudes of others.
James W. Freeman; Marc J. Stern; Michael Mortimer; Dale J. Blahna; Lee K. Cerveny
Interdisciplinary teamwork has become a foundation of natural resources planning and management in the US. Yet, we know little about the degree of interdisciplinary collaboration of natural resource planning teams. We conducted 10 case studies of Forest Service NEPA (National Environmental Policy Act) teams working on projects related to the 2005 Travel Management Rule...
Duthie, Katherine; Riddell, Meghan; Weller, Carol; Coltan, Lavinia I; Benzies, Karen; Olson, David M
Strategic prioritization of research agendas to address health problems with a large social and economic burden has increased the demand for interdisciplinary research. Universities have addressed the need for interdisciplinary research in their strategic documents. However, research training to equip graduates for careers in interdisciplinary research teams has not kept pace. We offer recommendations to graduate students, universities, health services organizations, and health research funders designed to increase the capacity for interdisciplinary research team training, and provide an example of an existing training program.
In reviewing the literature, there are few articles describing the role of the speech-language pathologist in hospice. Communication impairments can impact upon the hospice team's ability to provide symptom control and supportive psychosocial care, and diminish the patient's ability to guide the decision making process and maintain social closeness with family. Swallowing difficulties may result in discomfort for patients and concern from caregivers. Patient care provided by the speech-language pathologist can align with the framework of the World Health Organization's components of palliative care. Four primary roles of the speech-language pathologist in hospice can be described. (1) To provide consultation to patients, families, and members of the hospice team in the areas of communication, cognition, and swallowing function; (2) To develop strategies in the area of communication skills in order to support the patient's role in decision making, to maintain social closeness, and to assist the client in fulfillment of end-of-life goals; (3) To assist in optimizing function related to dysphagia symptoms in order to improve patient comfort and eating satisfaction, and promote positive feeding interactions for family members and (4) To communicate with members of the interdisciplinary hospice team, to provide and receive input related to overall patient care. Further development of the speech-language pathologist as a participating member of the hospice interdisciplinary team would support the overall goal of providing quality care for patients and families served by hospice.
Hospice and palliative care have important roles for cancer patients in an incurable state to alleviate their total pain and to achieve the best quality of life. Interdisciplinary team-doctors, nurses, therapists, social workers and so on provide effective support in order to fulfill the varying needs of patients and families. Pain relief as a palliative medicine is most urgently required by seventy percent of patients on admission to our Hospice at the Salvation Army Kiyose Hospital. A case is presented with some comments on pain management. Music therapy is also introduced. This is one of the complementary methods for consolation of the mind and body of patients. Some of them seem to find it beneficial.
Stalmeijer, Renee E; Gijselaers, Wim H; Wolfhagen, Ineke H A P; Harendza, Sigrid; Scherpbier, Albert J J A
Many undergraduate medical education programmes offer integrated multi-disciplinary courses, which are generally developed by a team of teachers from different disciplines. Research has shown that multi-disciplinary teams may encounter problems, which can be detrimental to productive co-operation, which in turn may diminish educational quality. Because we expected that charting these problems might yield suggestions for addressing them, we examined the relationships between team diversity, team processes and course quality. We administered a questionnaire to participants from 21 interdisciplinary teams from 1 Dutch and 1 German medical school, both of which were reforming their curriculum. An adapted questionnaire on team learning behaviours, which had been validated in business contexts, was used to collect data on team processes, team learning behaviours and diversity within teams. We examined the relationship between the team factors and educational quality measures of the courses designed by the teams. A total of 84 teachers (60%) completed the questionnaire. Bivariate correlation analysis showed that several aspects of diversity, conflict, working climate and learning behaviour were correlated with course quality. The negative effects of the diversity measures, notably, value diversity, on other team processes and course quality and the positive association between psychological safety and team learning suggest that educational quality might be improved by enhancing the functioning of multi-disciplinary teams responsible for course development. The relationship between team processes and educational quality should be studied among larger study populations. Student ratings should also be considered in measuring educational quality.
Adya, Monica; Temple, Bryan K.; Hepburn, Donald M.
With global specialization of work units within organizations, interdisciplinary work practices comprised of collaborative efforts between technical and business teams are increasingly common in today's workplace. While higher education has responded by creating opportunities for remote teams to learn from collaborative work, occasions for…
Waldrop, Deborah P.; Rinfrette, Elaine S.
Hospice care is available for 6 months before death but the length of use varies widely, suggesting that there are different perspectives on the appropriate timing for this transition. This qualitative study explored hospice professionals' views on the appropriate timing for and communication about hospice. Ethnography of team meetings informed…
Mancuso, Vincent Francis
In the modern workplace, collaboration is no longer only a face-to-face process. When working together, it is common for teams to rely on technology and operate across geographic, temporal and cultural boundaries. Most research, when looking at distributed teams, takes a uni-disciplinary perspective and fails to address the entire problem space.…
the black box of teamwork in search for relational elements critical to successful collaboration and communication. Few single studies exists which explore how RC could be observed and improved in this context. The present study examines surgical teams in selected operating rooms (OR) focusing on RC......In surgical teams, where health professionals are highly interdependent and work under time pressure, it is of particular importance that the team work is well-functioning to secure treatment quality and patient safety. Using the theory of relational coordination (RC) may be the key to unlocking...
Polanco, Frinny R; Dominguez, Dinora C; Grady, Christine; Stoll, Pamela; Ramos, Catalina; Mican, Joann M; Miranda-Acevedo, Robert; Morgan, Marcela; Aizvera, Jeasmine; Purdie, Lori; Koziol, Deloris; Rivera-Goba, Migdalia V
HIV infection occurs in disproportionately high rates among racial and ethnic minorities in the United States, making it imperative that individuals from these groups be included in research studies. However, it is often difficult to recruit HIV-infected Hispanics and African Americans in clinical trials, but a skilled interdisciplinary team that includes researchers with racial and ethnic diversity can help. This article describes a successful approach for building an interdisciplinary team that values the participation of racial and ethnic minorities in clinical trials and has the skills to work with these groups. The success of the Adelante (a Spanish word meaning forward) Team can be attributed to team members who actively participate in decision-making, are empowered, and function in a cohesive manner. Successful research teams build relationships with research participants to increase the probability that racial and ethnic minorities will enroll and participate fully in research. Published by Elsevier Inc.
Current trends in health care research point to a shift from disciplinary models to interdisciplinary team-based mixed methods inquiry designs. This keynote address discusses the problems and prospects of creating vibrant mixed methods health care interdisciplinary research teams that can harness their potential synergy that holds the promise of addressing complex health care issues. We examine the range of factors and issues these types of research teams need to consider to facilitate efficient interdisciplinary mixed methods team-based research. It is argued that concepts such as disciplinary comfort zones, a lack of attention to team dynamics, and low levels of reflexivity among interdisciplinary team members can inhibit the effectiveness of a research team. This keynote suggests a set of effective strategies to address the issues that emanate from the new field of research inquiry known as team science as well as lessons learned from tapping into research on organizational dynamics. © The Author(s) 2016.
O'Cathain, Alicia; Murphy, Elizabeth; Nicholl, Jon
Combining qualitative and quantitative methods in a single study-otherwise known as mixed-methods research-is common. In health research these projects can be delivered by research teams. A typical scenario, for example, involves medical sociologists delivering qualitative components and researchers from medicine or health economics delivering quantitative components. We undertook semistructured interviews with 20 researchers who had worked on mixed-methods studies in health services research to explore the facilitators of and barriers to exploiting the potential of this approach. Team working emerged as a key issue, with three models of team working apparent: multidisciplinary, interdisciplinary, and dysfunctional. Interdisciplinary research was associated with integration of data or findings from the qualitative and quantitative components in both the final reports and the peer-reviewed publications. Methodological respect between team members and a principal investigator who valued integration emerged as essential to achieving integrated research outcomes.
Kezadri-Hamiaz, Mounira; Rosu, Daniela; Wilk, Szymon; Kuziemsky, Craig; Michalowski, Wojtek; Carrier, Marc
The use of business workflow models in healthcare is limited because of insufficient capture of complexities associated with behavior of interdisciplinary healthcare teams that execute healthcare workflows. In this paper we present a novel framework that builds on the well-founded business workflow model formalism and related infrastructures and introduces a formal semantic layer that describes selected aspects of team dynamics and supports their real-time operationalization.
Gomez, Fernando; Curcio, Carmen Lucia
The underlying rationale to support interdisciplinary collaboration in geriatrics and gerontology is based on the complexity of elderly care. The most important characteristic about interdisciplinary health care teams for older people in Latin America is their subjective-basis framework. In other regions, teams are organized according to a theoretical knowledge basis with well-justified priorities, functions, and long-term goals, in Latin America teams are arranged according to subjective interests on solving their problems. Three distinct approaches of interdisciplinary collaboration in gerontology are proposed. The first approach is grounded in the scientific rationalism of European origin. Denominated "logical-rational approach," its core is to identify the significance of knowledge. The second approach is grounded in pragmatism and is more associated with a North American tradition. The core of this approach consists in enhancing the skills and competences of each participant; denominated "logical-instrumental approach." The third approach denominated "logical-subjective approach" has a Latin America origin. Its core consists in taking into account the internal and emotional dimensions of the team. These conceptual frameworks based in geographical contexts will permit establishing the differences and shared characteristics of interdisciplinary collaboration in geriatrics and gerontology to look for operational answers to solve the "complex problems" of older adults.
Howe, Judith L.; Sherman, Deborah Witt
Despite the increasing public demand for enhanced care of older patients and those with life-threatening illness, health professionals have had limited formal education in geriatrics and palliative care. Furthermore, formal education in interdisciplinary team training is limited. In order to remedy this situation, proactive interventions are being…
Lungeanu, Alina; Huang, Yun; Contractor, Noshir S.
Interdisciplinary teams are assembled in scientific research and are aimed at solving complex problems. Given their increasing importance, it is not surprising that considerable attention has been focused on processes of collaboration in interdisciplinary teams. Despite such efforts, we know less about the factors affecting the assembly of such teams in the first place. In this paper, we investigate the structure and the success of interdisciplinary scientific research teams. We examine the assembly factors using a sample of 1,103 grant proposals submitted to two National Science Foundation interdisciplinary initiatives during a 3-year period, including both awarded and non-awarded proposals. The results indicate that individuals’ likelihood of collaboration on a proposal is higher among those with longer tenure, lower institutional tier, lower H-index, and with higher levels of prior co-authorship and citation relationships. However, successful proposals have a little bit different relational patterns: individuals’ likelihood of collaboration is higher among those with lower institutional tier, lower H-index, (female) gender, higher levels of prior co-authorship, but with lower levels of prior citation relationships. PMID:24470806
Norup, Anne; Guldberg, Anne-Mette; Friis, Claus Radmer
OBJECTIVE: To describe the work of an interdisciplinary visual team in a stroke unit providing early identification and assessment of patients with visual symptoms, and secondly to investigate frequency, type of visual deficits after stroke and self-evaluated impact on everyday life after stroke...
Taylor, Johanna; Aldridge, Jan
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
Amin, Alpesh N; Owen, Mary M
Since the introduction of the National Patient Safety Goals (Joint Commission International Center for Patient Safety, 2005) into the Joint Commission on Accreditation of Healthcare Organizations standards, there appears to be a positive movement toward improvement in patient care outcomes and safety. Case management has been an integral part of the care team, and has emphasized standards of performance in quality of care, collaboration and resource utilization since 1995. When Leapfrog defined hospitalist intensivists as one of the three requirements necessary to be a safe hospital, an opportunity was borne to create a professional partnership. With the patient and the safety as the central focus of care, case managers and hospitalists are beginning to exponentially change the face of healthcare. This article will demonstrate the value of this partnership.
Iyoke, Chukwuemeka Anthony; Lawani, Lucky Osaheni; Ugwu, George Onyemaechi; Ajah, Leonard Ogbonna; Ezugwu, Euzebus Chinonye; Onah, Paul; Onwuka, Chidinma Ifechi
Interdisciplinary team working could facilitate the efficient provision and coordination of increasingly diverse health services, thereby improving the quality of patient care. The purpose of this study was to describe knowledge of interdisciplinary team working among obstetricians and gynecologists in two teaching hospitals in South East Nigeria and to determine their attitude toward an interdisciplinary collaborative approach to patient care in these institutions. This was a questionnaire-based cross-sectional study. Data analysis involved descriptive statistics and was carried out using Statistical Package for the Social Sciences software version 17.0 for Windows. In total, 116 doctors participated in the study. The mean age of the respondents was 31.9±7.0 (range 22-51) years. Approximately 74% of respondents were aware of the concept of interdisciplinary team working. Approximately 15% of respondents who were aware of the concept of interdisciplinary team working had very good knowledge of it; 52% had good knowledge and 33% had poor knowledge. Twenty-nine percent of knowledgeable respondents reported ever receiving formal teaching/training on interdisciplinary team working in the course of their professional development. About 78% of those aware of team working believed that interdisciplinary teams would be useful in obstetrics and gynecology practice in Nigeria, with 89% stating that it would be very useful. Approximately 77% of those aware of team working would support establishment and implementation of interdisciplinary teams at their centers. There was a high degree of knowledge of the concept and a positive attitude toward interdisciplinary team working among obstetricians and gynecologists in the study centers. This suggests that the attitude of physicians may not be an impediment to implementation of a collaborative interdisciplinary approach to clinical care in the study centers.
Collisson, Beverly A; Benzies, Karen; Mosher, Andrea A; Rainey, Kelly J; Tanaka, Satomi; Tracey, Curtis; Xu, Chen; Olson, David M
Within a dynamic health research environment with trends toward increasing accountability, governments and funding agencies have placed increased emphasis on knowledge translation (KT) as a way to optimize the impact of research investments on health outcomes, research products and health service delivery. As a result, there is an increasing need for familiarity with the principles of KT frameworks and components of KT strategies. Accordingly, health research trainees (graduate students and post-doctoral fellows) must be supported to enhance their capacity to understand KT principles and the practicalities of implementing effective KT practices.In this paper, the unique opportunities and challenges that trainees within an interdisciplinary research team encounter when they begin to understand and apply constructive and relevant KT practices are considered. Our commentary is based on trainee experiences within the Preterm Birth and Healthy Outcomes Team (PreHOT), an interdisciplinary research team.
Asselin, J; Osunlana, A M; Ogunleye, A A; Sharma, A M; Campbell-Scherer, D
Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed-method randomized control trial of a 6-month participatory, team-based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6-month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams. © 2016 World Obesity.
Abby J. Roche
Full Text Available To address gaps in knowledge and to tackle complex social–ecological problems, scientific research is moving toward studies that integrate multiple disciplines and ways of knowing to explore all parts of a system. Yet, how these efforts are being measured and how they are deemed successful is an up-and-coming and pertinent conversation within interdisciplinary research spheres. Using a grounded theory approach, this study addresses how members of a sustainability science-focused team at a Northeastern U.S. university funded by a large, National Science Foundation (NSF grant contend with deeply normative dimensions of interdisciplinary research team success. Based on semi-structured interviews (N = 24 with researchers (e.g., faculty and graduate students involved in this expansive, interdisciplinary team, this study uses participants’ narrative accounts to progress our understanding of success on sustainability science teams and addresses the tensions arising between differing visions of success present within the current literature, and perpetuated by U.S. funding agencies like NSF. Study findings reveal that team members are forming definitions of interdisciplinary success that both align with, and depart from, those appearing in the literature. More specifically, some respondents’ notions of team success appear to mirror currently recognized outcomes in traditional academic settings (i.e., purpose driven outcomes—citations, receipt of grant funding, etc.. At the same time, just as many other respondents describe success as involving elements of collaborative research not traditionally acknowledged as a forms of “success” in their own right (i.e., capacity building processes and outcomes—relationship formation, deep understandings of distinct epistemologies, etc.. Study results contribute to more open and informed discussions about how we gauge success within sustainability science collaborations, forming a foundation for
Peláez, R; Aguilar, J L; Segura, C; Fermández, S; Mendiola, M A; Forner, J C
To report on the creation and development of an interdisciplinary anesthesiology and nursing team to provide anesthesia outside the operating room. We describe the creation of an interdisciplinary team and preanesthesia evaluation protocols for using nurses specializing in anesthesia for procedures outside the operating room. We analyzed the anesthetic procedures performed outside the operating room, the rate of suspensions due to failure of the procedure, and their impact on the rate of associated complications, from October 2006 to October 2007. Since the start of the project, 586 procedures outside the operating room have been performed. No suspensions or delays were observed that were due to comorbidity not detected in the preanesthesia evaluation carried out by the nurses. The incidences of complications and inadequate sedations were comparable to those reported for other similar interdisciplinary groups in this area. The creation of an interdisciplinary team of anesthesiologists and specialized nurses for providing anesthesia outside the operating room optimizes resources and improves routine clinical practice. It has allowed for universal preanesthesia evaluation, improved the distribution of resources, and proven a stimulus to the care-giving process.
Håheim, Lise Lund; Mørland, Berit; Wisløff, Torbjørn Fosen; Lyngstadaas, Anita
The aim of this study was to evaluate the use of interdisciplinary review teams that have been the main and central work form in making health technology assessments at the Norwegian Centre for Health Technology Assessment. Evaluation questionnaires were sent to all 112 participants in the 17 review teams for the period of January 1998 to June 2003 after completion of the literature assessment. Questions were on the theme/mandate of the assessments, composition of the review team, organization of the work, the working method, and update of the report. The teams ranged from 4 to 14 persons regarded as opinion leaders in their field. The project periods lasted from 4 to 33 months. In all, fifty-five participants gave fifty-eight responses (51.8 percent) to the questionnaires. A total of 83 percent thought the theme was well argued, and 62 percent thought the mandate for the assessments was sufficiently clear. Approximately 80 percent were positive to the composition of the review team. In all, 22 percent expressed that the work method was too extensive and 43 percent wanted more tuition. General comments were that the working method gave competence in assessing medical literature, relevant professional training, and tuition in a working method that ensured the legitimacy of their work. The review team participants were satisfied with most aspects of the work. The Norwegian Centre for Health Technology Assessment will continue using interdisciplinary review teams in making health technology assessments.
Gillon, Suzie; Hurlow, Adam; Rayment, Clare; Zacharias, Hannah; Lennard, Rosemary
Corneal donation is a sight restoring procedure. Internationally demand exceeds supply. It is a tissue that palliative care patients may be able to donate, yet donation rates from this group are low. To explore the attitudes, knowledge, practice, and experience of corneal donation from hospice staff with direct clinical contact with patients. Anonymous paper questionnaire with fixed response and free text components. Questionnaires were delivered to 704 clinical multi-disciplinary team members in 12 hospices within the Yorkshire Palliative Medicine Regional Learning Group, UK. 434 completed questionnaires were received. Most respondents believed that corneal donation is a rewarding opportunity of which patients and families should be aware, but over 90% of respondents rarely or never raised the topic, and only 33% felt that it was part of their role. Key reasons for not engaging in discussions were: concerns about the impact of the discussion on patients and families, a belief held by hospice staff that they lacked essential knowledge, negative experiences of corneal donation, concern about enucleation, a perception that donation is not part of hospice culture, low levels of training and the personal significance of eyes. Despite positive staff attitudes towards corneal donation, many barriers to discussing donation were identified, which may reduce donation rates. This could be improved by local policies encompassing further education, prompts in documentation and availability of leaflets.
Osunlana, A. M.; Ogunleye, A. A.; Sharma, A. M.; Campbell‐Scherer, D.
Summary Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed‐method randomized control trial of a 6‐month participatory, team‐based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6‐month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams. PMID:26815638
Tornøe, Kirsten; Danbolt, Lars Johan; Kvigne, Kari; Sørlie, Venke
Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients' spiritual and existential suffering is therefore important. The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team's experience with teaching and training care workers in spiritual and existential care for the dying in nursing homes and home care settings. The team of expert hospice nurses participated in a focus group interview. Data were analyzed using a phenomenological hermeneutical method. The mobile teaching team taught care workers to identify spiritual and existential suffering, initiate existential and spiritual conversations and convey consolation through active presencing and silence. The team members transferred their personal spiritual and existential care knowledge through situated "bedside teaching" and reflective dialogues. "The mobile teaching team perceived that the care workers benefitted from the situated teaching because they observed that care workers became more courageous in addressing dying patients' spiritual and existential suffering. Educational research supports these results. Studies show that efficient workplace teaching schemes allowexpert practitioners to teach staff to integrate several different knowledge forms and skills, applying a holisticknowledge approach. One of the features of workplace learning is that expert nurses are able to guide novices through the complexities of practice. Situated learning is therefore central for becoming proficient. Situated bedside teaching provided by expert mobile hospice nurses may be an efficient way to develop care workers' courage and competency to provide spiritual and
Bittle, Marianne; O'Rourke, Kathleen; Srinivas, Sindhu K
To develop an interdisciplinary, interactive, skills review program to improve team responses during a postpartum hemorrhage (PPH). Online didactic modules in combination with an interdisciplinary skills program consisting of seven hemorrhage-related stations. The project was conducted in the Women's Health Department in a quaternary-care Magnet- and Baby Friendly-designated academic medical center in Philadelphia, Pennsylvania. Women cared for at this center have comorbidities that place them at greater risk for PPH. A need was identified to implement a multidisciplinary and comprehensive program to assess hemorrhage risk and appropriately recognize and intervene with all PPHs in this setting. The 276 participants, including registered nurses, obstetric and family medicine attending physicians and residents, advanced practice nurses, and ancillary staff in the hospital's Women's Health Department, completed the initial obstetric hemorrhage program. The program included online didactic modules, seven interdisciplinary skills stations led by trained nurses and providers, and an in situ simulation. Successful completion of the online modules was a prerequisite for participation in the skills stations. All participants completed a written program evaluation at the conclusion of the program. Results of the postassessment survey indicated that participants rated the program 3.94 of 4.00 for overall effectiveness to improve interdisciplinary team responses to PPH. Comments were overwhelmingly positive, and participants expressed increased confidence and knowledge related to PPH after completion of the program. An interdisciplinary program that included online didactic modules, interactive skills stations, and simulation improved team confidence and responses to PPH. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.
Miller, Barbara Kopp; Ishler, Karen J
SUMMARY The Rural Elderly Assessment Project (REAP) was designed to train occupational therapy, physical therapy, physician assistant, and public health faculty and students to conduct interdisciplinary team health assessments with rural, community-dwelling older adults. This article highlights key features of the project's design and implementation and presents preliminary evaluation data from the 25 students who participated in the project. Students completed several pre- and post-test measures. Statistically significant improvements were observed in all but one of the knowledge, skill, and attitude domains that were specifically targeted by the project. Students identified a variety of benefits they received from participating in the project, and all students indicated that they would recommend the project to another student. Implications for project replication and interdisciplinary team training of allied health students are discussed.
Vungkhanching, Martha; Tonsing, Kareen N
This study investigated social workers' role clarity as members of an interdisciplinary team in traumatic and acquired brain injury treatment settings. A total of 37 social workers from 7 Western countries completed an anonymous online survey questionnaire. The majority of participants have more than 10 years of experience working in brain injury treatment settings (59.5%), and about 54% have been in their current employment for more than 10 years. Findings revealed that there were significant positive correlations between perceived respect, team collaboration, and perceived value of self for team with role clarity. Multiple regression analysis revealed that perceived value of self for team was a significant predictor of role clarity (p < .05).
de Graaf, Everlien; Zweers, Daniëlle; Valkenburg, Anna Ch; Uyttewaal, Allegonda; Teunissen, Saskia Ccm
A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. The aims of this study are to explore whether hospice assist at home service enables patients at hometo express end-of-life preferences and die in their preferred location. In addition, this study provides insight into symptomburden, stability and early referral. A retrospective cross-sectional evaluation study was performed (December 2014-March 2015), using hospice assist at home patient records and documentation. Primary outcome includes congruence between preferred and actual place of death. Secondary outcomes include symptom burden, (in)stability and early identification. Between June 2012 and December 2014, 130 hospice assist at home patients, living at home with a life expectancy home, a collaboration between general practitioners, district nurses, trained volunteers and a hospice team, facilitates (1) general practitioner-initiated consultation by Nurse Consultant Hospice, (2) fortnightly interdisciplinary consultations and (3) 24/7 hospice backup for patients, caregivers and professionals. A total of 130 patients (62 (48%) men; mean age, 72 years) were enrolled, of whom 107/130 (82%) died and 5 dropped out. Preferred place of death was known for 101/107 (94%) patients of whom 91% patients died at their preferred place of death. Hospice assist at home service supports patients to die in their preferred place of death. Shared responsibility of proactive care in primary care collaboration enabled patients to express preferences. Hospice care should focus on local teamwork, to contribute to shared responsibilities in providing optimal palliative care. © The Author(s) 2016.
Buttigieg, Sandra C; Cassar, Vincent; Scully, Judy W
The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. The authors draw on solid theoretical frameworks--the complexity theory, team effectiveness model and the social identity theory--to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level.
Kim, Charles; Jackson, Deborah; Keiller, Peter
A new, interdisciplinary, team-taught course has been designed to educate students in Electrical and Computer Engineering (ECE) so that they can respond to global and urgent issues concerning computer control systems in nuclear power plants. This paper discusses our experience and assessment of the interdisciplinary computer and nuclear energy…
Piunno, Paul A. E.; Boyd, Cleo; Barzda, Virginijus; Gradinaru, Claudiu C.; Krull, Ulrich J.; Stefanovic, Sasa; Stewart, Bryan
The advanced interdisciplinary research laboratory (AIRLab) represents a novel, effective, and motivational course designed from the interdisciplinary research interests of chemistry, physics, biology, and education development faculty members as an alternative to the independent thesis project experience. Student teams are assembled to work…
Walsh, Emily O.; Davis, Emily Calhoun
The complex consequences of current consumption practices, such as climate change and ecosystem degradation, necessitate increased interdisciplinary exploration. In order to raise student awareness of these consumption-related issues, we designed a first-year team-taught seminar on sustainability. This innovative interdisciplinary course links…
Benedict, Lyn; Robinson, Karen; Holder, Carolyn
As the complexity of care increases for hospitalized older adults, the clinical nurse specialist is essential for ongoing development of nursing practice and care standards. This article describes the Acute Care of the Elderly (ACE) model for interdisciplinary management of older adults and clinical specialist responsibilities within this interdisciplinary team. Within the model, clinical care specialists utilize clinical expertise and consultation skills reflecting three spheres of practice related to care of high-risk community-dwelling older adults admitted an acute medical unit. The goal for this patient group is to achieve medical stability while preserving maximum functioning. The Acute Care of the Elderly team members include primary nurses (staff nurses), physicians, clinical care specialists, therapies, social workers, dietitians, pharmacists, and a discharge planner. Under the leadership of the primarily nurse, the team develops a comprehensive care and discharge plan, implemented across a care continuum. Using protocols and working together, the team delivers cost-effective, coordinated care that promotes process improvement resulting in practice that is in alignment with current standards of care.
Head, Barbara A; Schapmire, Tara; Earnshaw, Lori; Faul, Anna; Hermann, Carla; Jones, Carol; Martin, Amy; Shaw, Monica Ann; Woggon, Frank; Ziegler, Craig; Pfeiffer, Mark
For students of the health care professions to succeed in today's health care environment, they must be prepared to collaborate with other professionals and practice on interdisciplinary teams. As most will care for patients with cancer, they must also understand the principles of palliative care and its integration into oncology. This article reports the success of one university's effort to design and implement an interdisciplinary curriculum teaching team-based palliative care in oncology which was mandatory for medical, nursing, social work, and chaplaincy students. Quantitative evaluation indicated that students made significant improvements related to palliative care knowledge and skills and readiness for interprofessional education. Qualitative feedback revealed that students appreciated the experiential aspects of the curriculum most, especially the opportunity to observe palliative teams at work and practice team-based skills with other learners. While there exist many obstacles to interprofessional education and hands-on learning, the value of such experiences to the learners justifies efforts to initiate and continue similar programs in the health sciences.
Wayde Cameron. Morse
Full Text Available Understanding complex socio-environmental problems requires specialists from multiple disciplines to integrate research efforts. Programs such as the National Science Foundation's Integrative Graduate Education and Research Traineeship facilitate integrated research efforts and change the way academic institutions train future leaders and scientists. The University of Idaho and the Tropical Agricultural Research and Higher Education Center in Costa Rica collaborate on a joint research program focusing on biodiversity conservation and sustainable production in fragmented landscapes. We first present a spectrum of integration ranging from disciplinary to transdisciplinary across seven aspects of the research process. We then describe our experiences and lessons learned conducting interdisciplinary graduate student team research. Using our program as a case study, we examine the individual, disciplinary, and programmatic bridges and barriers to conducting interdisciplinary research that emerged during our student team research projects. We conclude with a set of recommendations for exploiting the bridges and overcoming the barriers to conducting interdisciplinary research, especially as part of graduate education programs.
Full Text Available Team science models are frequently promoted as the best way to study complex societal and environmental problems. Despite increasing popularity, there is relatively little research on the processes and mechanisms that facilitate the emergence of integration of interdisciplinary teams. This article evaluates a suite of recent team-building and grant-writing activities designed to address water management in the Western U.S. We use qualitative methods to document the emergence of integrative capacity at the individual, group, and institutional levels, with particular attention to the role of graduate students and non-academic practitioners in a team science planning project. Our findings highlight the importance of social integration as a basis for conceptual integration and an ability to relate these concepts to real-world problems. The findings also demonstrate the value of qualitative evaluation measures of team readiness, capacity, and intellectual outputs to complement conventional evaluation indicators that rely on quantitative scientific outputs, particularly for team science projects still in the planning stages.
Fung, Lillia; Boet, Sylvain; Bould, M Dylan; Qosa, Haytham; Perrier, Laure; Tricco, Andrea; Tavares, Walter; Reeves, Scott
Crisis resource management (CRM) abilities are important for different healthcare providers to effectively manage critical clinical events. This study aims to review the effectiveness of simulation-based CRM training for interprofessional and interdisciplinary teams compared to other instructional methods (e.g., didactics). Interprofessional teams are composed of several professions (e.g., nurse, physician, midwife) while interdisciplinary teams are composed of several disciplines from the same profession (e.g., cardiologist, anaesthesiologist, orthopaedist). Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were searched using terms related to CRM, crisis management, crew resource management, teamwork, and simulation. Trials comparing simulation-based CRM team training versus any other methods of education were included. The educational interventions involved interprofessional or interdisciplinary healthcare teams. The initial search identified 7456 publications; 12 studies were included. Simulation-based CRM team training was associated with significant improvements in CRM skill acquisition in all but two studies when compared to didactic case-based CRM training or simulation without CRM training. Of the 12 included studies, one showed significant improvements in team behaviours in the workplace, while two studies demonstrated sustained reductions in adverse patient outcomes after a single simulation-based CRM team intervention. In conclusion, CRM simulation-based training for interprofessional and interdisciplinary teams show promise in teaching CRM in the simulator when compared to didactic case-based CRM education or simulation without CRM teaching. More research, however, is required to demonstrate transfer of learning to workplaces and potential impact on patient outcomes.
Tremblay, Dominique; Touati, Nassera; Roberge, Danièle; Denis, Jean-Louis; Turcotte, Annie; Samson, Benoît
Interdisciplinary teamwork (ITW) is designed to promote the active participation of several disciplines in delivering comprehensive cancer care to patients. ITW provides mechanisms to support continuous communication among care providers, optimize professionals' participation in clinical decision-making within and across disciplines, and foster care coordination along the cancer trajectory. However, ITW mechanisms are not activated optimally by all teams, resulting in a gap between desired outcomes of ITW and actual outcomes observed. The aim of the present study is to identify the conditions underlying outcome production by ITW in local oncology teams. This retrospective multiple case study will draw upon realist evaluation principles to explore associations among context, mechanisms and outcomes (CMO). The cases are nine interdisciplinary cancer teams that participated in a previous study evaluating ITW outcomes. Qualitative data sources will be used to construct a picture of CMO associations in each case. For data collection, reflexive focus groups will be held to capture patients' and professionals' perspectives on ITW, using the guiding question, 'What works, for whom, and under what circumstances?' Intra-case analysis will be used to trace associations between context, ITW mechanisms, and patient outcomes. Inter-case analysis will be used to compare the different cases' CMO associations for a better understanding of the phenomenon under study. This multiple case study will use realist evaluation principles to draw lessons about how certain contexts are more or less likely to produce particular outcomes. The results will make it possible to target more specifically the actions required to optimize structures and to activate the best mechanisms to meet the needs of cancer patients. This project could also contribute significantly to the development of improved research methods for conducting realist evaluations of complex healthcare interventions. To our
Minore, Bruce; Boone, Margaret
To address shortages of health professional human resources and overcome cultural barriers, interdisciplinary health care teams in most northern Canadian aboriginal communities include paraprofessionals recruited locally. This paper identifies factors fundamental to effective team functioning, arguing for an extension of the information on…
Full Text Available A major challenge in healthcare is lack of interdisciplinary collaboration (O’Daniel & Rosenstein, 2008. The Institute of Medicine report, To Err is Human: Building a Safer Health System (1999, shows that errors often occur due to lapses in partnership and communication. This article describes the implementation of TeamSTEPPS, an evidence-based tool for optimizing staff relationships and partnership, in a clinic in which a change in the care model had affected interprofessional collaboration and teamwork, threatening healthcare outcomes and staff engagement. The implementation of TeamSTEPPS, customized using elements of IDEO’s (2015 Human-Centered Design, shifted the culture of the clinic towards partnership, resulting in improved staff perceptions of teamwork and statistically significant improvements in the quality of patient care.
Vaie, S; Barros, S
The experience of the Curricular Training in a mental health work attendance to out-patients, CAPS, lead to this study development in the attempt to understand and characterize interdisciplinary team in this institution, as well as to understand the admittance of a nursing student in this team. The analysis of the replies disclosed that in the reports is found the concept of interdiscipline as well as of the multidiscipline (work in compartments). The conception which has of the model of assistance and of the admittance of the project in it is compatible with the conceptions that establish the description of the work: flexibility, the projects inter-relation the enlarged practice and the psychosocial rehabilitation. The fact that the service has a Program of lecturing--Assistance Integration, "naturalizes" and validates the participation of a nursing student in the projects of assistance or sociability.
Wranik, W Dominika; Haydt, Susan M; Katz, Alan; Levy, Adrian R; Korchagina, Maryna; Edwards, Jeanette M; Bower, Ian
Reliance on interdisciplinary teams in the delivery of primary care is on the rise. Funding bodies strive to design financial environments that support collaboration between providers. At present, the design of financial arrangements has been fragmented and not based on evidence. The root of the problem is a lack of systematic evidence demonstrating the superiority of any particular financial arrangement, or a solid understanding of options. In this study we develop a framework for the conceptualization and analysis of financial arrangements in interdisciplinary primary care teams. We use qualitative data from three sources: (i) interviews with 19 primary care decision makers representing 215 clinics in three Canadian provinces, (ii) a research roundtable with 14 primary care decision makers and/or researchers, and (iii) policy documents. Transcripts from interviews and the roundtable were coded thematically and a framework synthesis approach was applied. Our conceptual framework differentiates between team level funding and provider level remuneration, and characterizes the interplay and consonance between them. Particularly the notions of hierarchy, segregation, and dependence of provider incomes, and the link between funding and team activities are introduced as new clarifying concepts, and their implications explored. The framework is applied to the analysis of collaboration incentives, which appear strongest when provider incomes are interdependent, funding is linked to the team as a whole, and accountability does not have multiple lines. Emergent implementation issues discussed by respondents include: (i) centrality of budget negotiations; (ii) approaches to patient rostering; (iii) unclear funding sources for space and equipment; and (iv) challenges with community engagement. The creation of patient rosters is perceived as a surprisingly contentious issue, and the challenges of funding for space and equipment remain unresolved. The development and
Johnson, Jessie; Smith, Gilly; Wilkinson, Anne
This study explored the culture of one interdisciplinary rehabilitation team in British Columbia (BC), Canada, to identify the specific client, clinical, and family factors considered by team members when determining post-hospital discharge placement. The study took the form of an ethnography of a health care team on a stroke unit of a Canadian hospital using observations of the interdisciplinary rehabilitation team meetings and follow-up interviews with team members. The findings from the study indicate post-hospital discharge destination decisions were influenced by specific social, economic, and policy factors; specific types of interactions among members of the team; and the condition of stroke survivors, and the ability and willingness of the patient's family to contribute to home care.
Dani Laura Peruzzolo
Full Text Available Introduction: Specialized care for infants considers that the sooner the intervention in risk and symptoms occurs, the greater the possibility of obtaining better results. Aims: To describe the process of early intervention provided by an extension program of graduate studies in Occupational Therapy and Hearing, Speech and Languages Science courses and also discuss the theoretical and practical paths in the care for infants and in the Occupational Therapy area. Method: Case report with convenience sample. The study was carried out through an assessment interpreted in light of psychomotor, occupational therapeutic, and speech, hearing and language contributions. The intervention was under the responsibility of an occupational therapist supported by an interdisciplinary team. It occurred once a week from August 2011 to January 2012 and from March 2012 to July 2012. Data analysis was carried out by comparing the entry assessment test and the final assessment test. Results: The boy had not developed concepts of body schema and body image that could sustain his relationship with objects, space and other persons. He presented little linguistic evolution. Considering the contributions of occupational therapy in psychomotor clinic, the boy reconstructed his family place in early intervention. The possibility of language functioning connected to the boy’s demands allowed access to symbolism. Conclusion: The proposal of early occupational therapy intervention with a single therapist supported by an interdisciplinary team was able to overcome the structural and instrumental obstacles to the boy’s development.
Emery, Erin E.; Lapidos, Stan; Eisenstein, Amy R.; Ivan, Iulia I.; Golden, Robyn L.
Purpose: To demonstrate the feasibility of the BRIGHTEN Program (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking), an interdisciplinary team intervention for assessing and treating older adults for depression in outpatient primary and specialty medical clinics. The BRIGHTEN team collaborates "virtually"…
Müller, C; Plewnia, A; Becker, S; Rundel, M; Zimmermann, L; Körner, M
Interdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation. Considering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis. The exploration of team members' and clinical managers' descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient
O'Reilly, Pauline; Lee, Siew Hwa; O'Sullivan, Madeleine; Cullen, Walter; Kennedy, Catriona; MacFarlane, Anne
Interdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps. An integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals. A key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work. International
... rhythms that are resistant to therapy ( arrhythmias ). Stroke patients referred to hospice may have severe lack of consciousness or coma greater than three days duration, difficulty chewing or ...
Stålnacke, Britt-Marie; Haukenes, Inger; Lehti, Arja; Wiklund, Anncristine Fjellman; Wiklund, Maria; Hammarström, Anne
To examine potential gender bias in recommendations of further examination and rehabilitation in primary care for patients with chronic musculoskeletal pain after an interdisciplinary team assessment...
Brown, Michelle Cetner
In recent years, Science, Technology, Engineering, and Mathematics (STEM) education has become a significant focus of numerous theoretical and commentary articles as researchers have advocated for active and conceptually integrated learning in classrooms. Drawing connections between previously isolated subjects, especially mathematics and science, has been shown to increase student engagement, performance, and critical thinking skills. However, obstacles exist to the widespread implementation of integrated curricula in schools, such as teacher knowledge and school structure and culture. The Interdisciplinary Co-planning Team (ICT) model, in which teachers of different subjects come together regularly to discuss connections between content and to plan larger interdisciplinary activities and smaller examples and discussion points, offers a method for teachers to create sustainable interdisciplinary experiences for students within the bounds of the current school structure. The ICT model is designed to be an iterative, flexible model, providing teachers with both a regular time to come together as "experts" and "teach" each other important concepts from their separate disciplines, and then to bring their shared knowledge and language back to their own classrooms to implement with their students in ways that fit their individual classes. In this multiple-case study, which aims to describe the nature of the co-planning process, the nature of plans, and changes in teacher beliefs as a result of co-planning, three pairs of secondary mathematics and science teachers participated in a 10-week intervention with the ICT model. Each pair constituted one case. Data included observations, interviews, and artifact collection. All interviews, whole-group sessions, and co-planning sessions were transcribed and coded using both theory-based and data-based codes. Finally, a cross-case comparison was used to present similarities and differences across cases. Findings suggest that the
Kestenbaum, Allison; James, Jennifer; Morgan, Stefana; Shields, Michele; Hocker, Will; Rabow, Michael; Dunn, Laura B
There are many potential benefits to chaplaincy in transforming into a "research-informed" profession. However little is known or has been documented about the roles of chaplains on research teams and as researchers or about the effects of research engagement on chaplains themselves. This report describes the experience and impact of three chaplains, as well as tensions and challenges that arose, on one particular interdisciplinary team researching a spiritual assessment model in palliative care. Transcripts of our research team meetings, which included the three active chaplain researchers, as well as reflections of all the members of the research team provide the data for this descriptive, qualitative, autoethnographic analysis. This autoethnographic project evolved from the parent study, entitled "Spiritual Assessment Intervention Model (AIM) in Outpatient Palliative Care Patients with Advanced Cancer." This project focused on the use of a well-developed model of spiritual care, the Spiritual Assessment and Intervention Model (Spiritual AIM). Transcripts of nine weekly team meetings for the parent study were reviewed. These parent study team meetings were attended by various disciplines and included open dialogue and intensive questions from non-chaplain team members to chaplains about their practices and Spiritual AIM. Individual notes (from reflexive memoing) and other reflections of team members were also reviewed for this report. The primary methodological framework for this paper, autoethnography, was not only used to describe the work of chaplains as researchers, but also to reflect on the process of researcher identity formation and offer personal insights regarding the challenges accompanying this process. Three major themes emerged from the autoethnographic analytic process: 1) chaplains' unique contributions to the research team; 2) the interplay between the chaplains' active research role and their work identities; and 3) tensions and challenges in
Ong, Jeremy; Brennsteiner, Alex; Chow, Elizabeth; Hebert, Randy S
The quality of communication and support provided to families is associated with greater satisfaction with hospice care. Prior work has not explored whether the predictors of family satisfaction are different in different hospice care settings. The study objective was to explore whether correlates of family satisfaction are different in general inpatient hospice care versus routine home hospice care. Survey data from bereaved family members of approximately 1600 patients from a nonprofit, midsized hospice in western Pennsylvania were used. Data was obtained from Family Evaluation of Hospice Care (FEHC) survey responses from 2008-2013 and separated into two groups, general inpatient hospice care and routine home hospice care. The analysis was completed using a binomial logistic regression model. Three variables were associated with greater overall satisfaction in both care settings: being kept informed about the patient's condition (adjusted odds ratio [AOR]: 9.64, CI: 6.56-14.36); being provided with clear/consistent information (AOR: 2.34, CI: 1.47-3.72); and the perception that patients were provided with adequate treatment for anxiety (AOR: 2.64, CI: 1.19-5.81). Two variables, sufficient discussion with hospice team members concerning family members' religious or spiritual beliefs (AOR: 1.64, CI: 1.17-2.30) and being provided with the correct amount of emotional support after the patient's death (AOR: 2.01, CI: 1.10-3.66), were correlated with greater satisfaction in routine home hospice care only. Good communication is strongly associated with greater family satisfaction across hospice care settings. Hospices must ensure that they provide patients and families with consistent information and support.
Weinberg, Dana Beth; Cooney-Miner, Dianne; Perloff, Jennifer N; Babington, Lynn; Avgar, Ariel Chanan
Contradictory findings about the effectiveness of health care teams may relate to the actual structure of teams-loose rather than formal-and the nature of decision making-hierarchical rather than egalitarian. We introduce the concept of collaborative capacity-the likelihood that providers, no matter how brief their exchange, will collaborate as if they were members of an egalitarian team even in the absence of a formal team structure. To examine aspects and determinants of collaborative capacity, namely task interdependence, norms of working together, and egalitarian collaboration among interdisciplinary providers on health care units. We collected survey data from unit-based staff in 45 units across 9 hospitals and 7 health systems in upstate New York. One thousand five hundred twenty-seven surveys were returned for an overall response rate of 68.5%. Measures for team structure and collaboration do not vary significantly between hospitals, only by unit and occupational group, with higher status providers reporting greater interdependence, higher quality of interactions, and more collaborative influence in decision making. Clear task direction, namely an emphasis on patient-centered care, and organizational contexts supportive of work are both significantly associated with higher levels of task interdependence, quality of staff interactions, and collaborative influence. Collaborative capacity is somewhat constrained by a rigid hierarchy of health care occupations and division of labor that make teamwork more similar than different across hospitals. At the unit level, collaborative capacity may be improved, however, by an emphasis on patient-centered care and a context that supports providers' work.
Kuziemsky, Craig; Astaraky, Davood; Wilk, Szymon; Michalowski, Wojtek; Andreev, Pavel
Participatory medicine refers to the equal participation of patients and interdisciplinary healthcare team (IHT) members as part of care delivery. Facilitating workflow execution is a significant challenge for participatory medicine because of the need to integrate IHT members into a common workflow. A further challenge is that patient preferences should be considered when executing a workflow. To date there is limited research on supporting patient workflow as part of participatory medicine practices. To address that shortcoming we used a two-phase approach to develop a framework for participatory medicine that integrates different IHT members and workflows including the incorporation of patient preferences about care delivery options. Our framework uses a domain ontology to define the patient, IHT concepts and relations, as well as a workflow for operationalizing participatory medicine via an IHT. Proof of concept of the proposed framework is illustrated with a palliative care pain management case study. PMID:25954390
Kuziemsky, Craig; Astaraky, Davood; Wilk, Szymon; Michalowski, Wojtek; Andreev, Pavel
Participatory medicine refers to the equal participation of patients and interdisciplinary healthcare team (IHT) members as part of care delivery. Facilitating workflow execution is a significant challenge for participatory medicine because of the need to integrate IHT members into a common workflow. A further challenge is that patient preferences should be considered when executing a workflow. To date there is limited research on supporting patient workflow as part of participatory medicine practices. To address that shortcoming we used a two-phase approach to develop a framework for participatory medicine that integrates different IHT members and workflows including the incorporation of patient preferences about care delivery options. Our framework uses a domain ontology to define the patient, IHT concepts and relations, as well as a workflow for operationalizing participatory medicine via an IHT. Proof of concept of the proposed framework is illustrated with a palliative care pain management case study.
Åberg, Anna Cristina; Ehrenberg, Anna
The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care: Interactive assessment processes, A holistic care approach, and Proactive non-hierarchical interaction. Aspects of Time and Goal-Orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment - which is possibly best provided by older-friendly hospitals - appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.
Ehrlich, Olga; Walker, Rachel K
Hospice cancer patients experience poorly-controlled pain in spite of widely-disseminated evidence-based guidelines for use by hospice care practitioners. Pain management occurs in the context of the interdisciplinary team, centered on a caring triad in the home: the person with pain, their caregiver, and their nurse. This review: 1) Summarizes what is known about differing ways that members of the hospice caring triad (patients, caregivers, and nurses) interpret and respond to cancer pain, in order to develop a cancer pain social processes theoretical framework, 2) Identifies gaps in understanding of hospice cancer pain social processes, and 3) Identifies framework concepts for research-based clinical practice with potential to improve pain outcomes. Our integrative review of the literature resulted in the identification and synthesis of 21 unique studies of cancer pain social processes, which were categorized according to a social processes framework and hospice caring triad member roles, using a social processes concepts matrix. Pain meanings, goals, and related responses vary for persons with pain, caregivers, and nurses. Studies have explored individual social processes concepts or triad member roles. Studies identify the need for pain meaning to be included in hospice pain management plans. To our knowledge, no single study has generated a framework for hospice cancer pain social processes addressing and incorporating the roles of all three caring triad members. Therefore, comprehensive hospice cancer pain clinical evaluation and interventions plans may be missing key elements of pain management, especially for persons with ongoing poorly controlled pain. Copyright © 2016 Elsevier Ltd. All rights reserved.
... death. The goal is to give comfort and peace instead of a cure. Hospice care provides: Support ... D.A.M. is among the first to achieve this important distinction for online health information and ...
... http://www.cancer.org The American Cancer Society (ACS) provides free fact sheets and publications about hospice. The address of a local ACS chapter can be obtained by calling the organization’s ...
U.S. Department of Health & Human Services — A list of all Hospice Agencies that have been certified by Medicare. The list includes addresses, phone numbers, and date of original CMS certification, as well as...
Corcoran, Amy M; True, Gala; Charles, Natasha; Margo, Katherine L
Since the Association of American Medical Colleges geriatric competencies were released, educators are striving to incorporate them into medical student curricula. The purpose of this study is to examine medical students' reflections after an interdisciplinary, hospice staff-precepted clinical experience, and whether these reflections relate to the geriatric competencies which focus on palliative care. From July 2010 to June 2011, 155 2nd- and 3rd-year medical students participated in a required, half-day hospice experience, with 120 (77%) submitting narrative reflections for analysis. The narratives were analyzed using the constant comparative method associated with grounded theory, followed by consensus-building in an iterative process, to identify themes. Six themes were identified from the analysis of student narratives: demonstrating a new or expanded knowledge of hospice care (79%, 95/120), developing new insights about self and others (74%, 89/120), changing attitudes toward hospice care (63%, 76/120), linking patient needs with appropriate team members (43%, 52/120), understanding patient goals of care (43%, 51/120), and discussing palliative care as a treatment option (27%, 32/120). The authors conclude that a brief, interdisciplinary, hospice staff-precepted clinical experience is an effective model to inspire medical students to reflect on geriatric palliative care. Students clearly reflected on the geriatric palliative care competencies of symptom assessment and management, and gained insight into the role of the hospice team members and how hospice care can be a positive treatment option. Future educators should think about building on this type of high impact learning experience, and developing items to measure application of knowledge gained.
Reina Campos, M Remedios; Carrasco Rodríguez, Amalia
This article tends to illustrate the coordination mechanisms used through an example centred on a case study of a 65 year-old patient who presents obesity, hypertension, high cardiovascular risk, alcoholism, smoking and silent ischaemic strokes; divorced twice and with five children. After his last separation 8 years ago he moved to his father's house. While his father was still alive his health situation was stable and monitored by professionals of the primary care team. He was recently referred to the Social Worker at the Health Centre due to his lack of personal hygiene and housing. The interdisciplinary work of the Social Worker and Community Nurse Case Manager resulted in a shared action plan. His father died a year ago and since then there was no news of the patient in the health centre and also he did not collect his medication from the pharmacy. The house was owned by inheritance by the smallest of the four brothers, who had threatened to expel him. In the interview, the brother claimed that he didn't want to be helped and only received visits from one of his sons occasionally to receive money. Primary care professionals visited him several times at home. The patient was cooperative and engaged when preparing a joint plan with the professionals involved. This joint plan allowed to activate the care coordination for a successful management of his chronic conditions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Full Text Available Esme J Soan,1–3 Steven J Street,1,2 Sharon M Brownie,3,4 Andrew P Hills1–31Mater Mothers' Hospital, South Brisbane, 2Mater Research Institute – University of Queensland, South Brisbane, 3Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia; 4Green Templeton College, Oxford University, Oxford, UKAbstract: Noncommunicable diseases (NCDs, such as obesity and type 2 diabetes mellitus, are a growing public health challenge in Australia, accounting for a significant and increasing cost to the health care system. Management of these chronic conditions is aided by interprofessional practice, but models of care require updating to incorporate the latest evidence-based practice. Increasing research evidence reports the benefits of physical activity and exercise on health status and the risk of inactivity to chronic disease development, yet physical activity advice is often the least comprehensive component of care. An essential but as yet underutilized player in NCD prevention and management is the "accredited exercise physiologist," a specialist in the delivery of clinical exercise prescriptions for the prevention or management of chronic and complex conditions. In this article, the existing role of accredited exercise physiologists in interprofessional practice is examined, and an extension of their role proposed in primary health care settings.Keywords: interdisciplinary team, obesity, type 2 diabetes mellitus, exercise physiology, accredited exercise physiologist
Avramov, S; Fille, D; Kolak, R; Petrović, P; Stojić, M; Zivojnović, S
The interdisciplinary transplant team on Medical faculty--Novi Sad is formed at the beginning of the 1986, and first successfully cadaver binephrectomy was performed in April 1986, and kidneys was transported in Transplant Centre in Belgrade. The first human renal transplantation with cadaveric kidney was performed 20, May 1986, and result was excellent. The first human renal transplantation with living related kidney was performed 27, Sept 1986, and result also was excellent. During the last three years our transplant team performed 32 renal transplantations. cadaveric kidney transplantations - 25 living-related kidney transplantation - 6 kidney autotransplantation - 1 Our Concept and organisation of interdisciplinary transplant team in Medical Faculty--Novi Sad is the very efficacy model of organisation and at the same time the cheapest solution. In this paper we discuss our organization of human renal transplantation, and technique of donor-neprectomy (cadaveric and living-related) and cold perfusion of kidney with Collins solution. Our rules for implantation are shown as the Algorythm. At the end of this paper we present our results, based on three year's experience and list of the members of our interdisciplinary transplant team.
Kristin Ådnøy Eriksen
Full Text Available Background: Collaborative work is an inherently complex phenomenon. This article explores elements that enhance collaboration and argues that collaboration – understood as evolving processes whereby social entities actively and reciprocally engage in joint activities aimed at achieving a common goal – has not been given sufficient attention in the relevant Norwegian reforms. The Norwegian government implemented the Coordination Reform in January 2012, the aim of which was to provide a sustainable and high-quality health service (Ministry of Health and Care Services, 2012 . This article uses the term ‘collaboration reform’ as this is the literal meaning of the Norwegian title Samhandlingsreform, and because collaboration seems to describe the aim of the reform better than coordination. Aim: To explore how facilitated processes enhance collaboration in an interdisciplinary team, and discuss how the findings inform issues of collaboration between hospitals and municipal health services. Methods: The design was a cooperative inquiry, that is, a participatory and shared approach to research that aims to facilitate understanding of a shared experience by virtue of cycles of action and reflection. Findings/results: Taking part in facilitated processes gave the team members added awareness about their work, made them more able to handle complex situations and gave them confidence in their own competence and that of their and colleagues. The processes also gave team members opportunities for enhanced sharing and a broader agenda, to notice and detect, and to create a story about who we are and what we do. Conclusions: Trusting and knowing each other is a foundation for collaborative work. The facilitated processes provided structure and direction, addressed power imbalances and kept the focus goal-centred. Cross-boundary collaboration between hospitals and municipal health services could improve with an awareness of collaboration as an evolving
Moore, Kelsey; Talwar, Victoria; Moxley-Haegert, Linda
In pediatric settings, parents and children often seek spiritual and religious support from their healthcare provider, as they try to find meaning in their illness. Narrative practices, such as definitional ceremonies, can provide a unique framework for psychologists to explore children's spirituality and its role in the midst of illness. In addition, definitional ceremonies can be used as a means for psychologists to inform interdisciplinary teams' understanding of children's spirituality and its relevance in pediatric treatment settings. In this article, our objectives are to (a) provide a brief overview of the literature on children's spirituality, (b) review some of the literature on childhood cancer patients' spirituality, (c) highlight the importance of whole-person care for diverse pediatric patients, and (d) introduce definitional ceremonies as appropriate narrative practices that psychologists can use to both guide their therapy and inform interdisciplinary teams' understanding of children's spirituality. © The Author(s) 2015.
Gilstrap, Cristina M; White, Zachary M
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.
Liu, Xiaodi; Burns, Debra S; Hilliard, Russell E; Stump, Timothy E; Unroe, Kathleen T
Hospice music therapy is delivered in both homes and nursing homes (NH). No studies to date have explored differences in music therapy delivery between home and NH hospice patients. To compare music therapy referral reasons and delivery for hospice patients living in NH versus home. A retrospective, electronic medical record review was conducted from a large U.S. hospice of patients receiving music therapy between January 1, 2006, and December 31, 2010. Among the 4,804 patients, 2,930 lived in an NH and 1,847 patients lived at home. Compared to home, NH hospice patients were more likely to be female, older, unmarried, and Caucasian. For home hospice patients, the top referral reasons were patient/family emotional and spiritual support, quality of life, and isolation. The most frequent referral reasons for NH hospice patients were isolation, quality of life, and patient/family emotional and spiritual support. Differences in music therapy delivery depended mainly on patients' primary diagnosis and location of care. Results suggest differences in referral reasons and delivery based on an interaction between location of care and patient characteristics. Delivery differences are likely a result of individualized assessment and care plans developed by the music therapist and other interdisciplinary team members to address the unique needs of the patient. Thus, it is important to have professionally trained music therapists assess and provide tailored music-based interventions for patients with different referral reasons and personal characteristics. This study also supports staffing decisions based on patient need rather than average daily census. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Lau, Denys T; Joyce, Brian; Clayman, Marla L; Dy, Sydney; Ehrlich-Jones, Linda; Emanuel, Linda; Hauser, Joshua; Paice, Judith; Shega, Joseph W
Managing and administering medications to relieve pain and symptoms are common, important responsibilities for informal caregivers of patients receiving end-of-life care at home. However, little is known about how hospice providers prepare and support caregivers with medication-related tasks. This qualitative study explores the key approaches that hospice providers use to facilitate medication management for caregivers. Semistructured, open-ended interviews were conducted with 22 providers (14 nurses, four physicians, and four social workers) from four hospice organizations around an urban setting in the midwestern U.S. Based on the interviews, the following five key approaches emerged, constituting how the hospice team collectively helped caregivers manage medications: 1) establishing trust; 2) providing information; 3) promoting self-confidence; 4) offering relief (e.g., provided in-home medication assistance, mobilized supportive resources, and simplified prescriptions); and 5) assessing understanding and performance. Each hospice discipline used multiple approaches. Nurses emphasized tailoring information to individual caregivers and patients, providing in-home assistance to help relieve caregivers, and assessing caregivers' understanding and performance of medication management during home visits. Physicians simplified medication prescriptions to alleviate burden and reassured caregivers using their perceived medical authority. Social workers facilitated medication management by providing emotional support to promote self-confidence and mobilizing resources in caregivers' support networks and the community at large. Hospice nurses, physicians, and social workers identified distinct, yet overlapping, approaches in aiding caregivers with medication management. These findings emphasize the importance of interdisciplinary teamwork among hospice providers. Future research should investigate how common, standardized, effective, and efficient these approaches are in
Miller, Jason E; Walston, Timothy
Inspired by BIO2010 and leveraging institutional and external funding, Truman State University built an undergraduate program in mathematical biology with high-quality, faculty-mentored interdisciplinary research experiences at its core. These experiences taught faculty and students to bridge the epistemological gap between the mathematical and life sciences. Together they created the infrastructure that currently supports several interdisciplinary courses, an innovative minor degree, and long-term interdepartmental research collaborations. This article describes how the program was built with support from the National Science Foundation's Interdisciplinary Training for Undergraduates in Biology and Mathematics program, and it shares lessons learned that will help other undergraduate institutions build their own program.
Phillips, Louise Jane
How does dialogue generate knowledge by harnessing “difference” as a transformative force? This paper examines this question through an analysis of the collaborative practices of an interdisciplinary social and health care team who provide an advisory service for residential care homes in relation...... to residents with dementia. Drawing on Bakhtinian dialogic communication theory, an empirical analysis is presented of how knowledge is co-produced collaboratively in team case meetings. The focus is on the shifting relations between different voices, articulating different knowledge forms and professional...... identities, and on the relational construction of ”person-centred care” and the collective identity of the team in opposition to the practices and identities of residential care workers and relatives of residents. In conclusion, the paper discusses the implications of the empirical results in relation...
A Google search on “team chemistry” returns over 443,000 entries (October 2014) usually denoting some sort of team process, such as cohesion, shared mental models, and collective efficacy. Practitioners (e.g., athletic coaches and business managers) often emphasize the importance of team chemistry for optimal performance. For instance, former NFL quarterback and current business executive Roger Staubach noted that “In any team sport, the best teams have consistency and chemistry.” Researchers...
Full Text Available Aim: Management of diabetic foot infection (DFI is challenging; a multidisciplinary approach has been shown to reduce amputation rates. There is limited information on the effect of having an interdisciplinary diabetic foot team (IDT on patient load and outcomes at infectious disease departments. We aim to investigate the effect of the IDT approach on patient characteristics, the length of hospitalization, and amputation rates in patients hospitalized for DFI at the department of infectious disease. Material and Method: We retrospectively reviewed the files of patients who were hospitalized in the infectious disease department for DFI between January 2005 and October 2014. Patients hospitalized before the establishment of IDT (October 8, 2013 formed Group-1 and those hospitalized after the establishment of IDT formed Group-2. The members of IDT evaluated and treated all of the patients in Group-2. The groups were compared for patient characteristics, clinical findings, length of hospitalization, laboratory results, and outcome. Results: There were 53 patients in Group-1 and 39 patients in Group-2. The patient hospitalization rate increased after IDT (0.5 patients per month vs. 3.25 patients per month. Patients hospitalized after IDT had more advanced stage (Wagner grade 4-5 wounds (26.4% vs. 51.3%; p=0.013. However, the length of hospitalization did not change after IDT (23.4±11.0 vs. 21.0±14.5; p=0.478. Foot ulcers healed without surgical intervention in 13 (24.5% and 11 (28.2% patients in Group-1 and Group-2, respectively (p=0.691. Minor and major amputation rates were 30.2% and 9.4% in Group-1 and 30.8% and 7.7% in Group-2 (p=0.786. Discussion: Despite the fact that patients admitted after the establishment of IDT had more severe wounds, neither the length of hospitalization nor the amputation rate increased. Further studies are needed to evaluate the effectiveness of IDT in the management of DFI.
U.S. Department of Health & Human Services — The dataset shows characteristics of the hospice agencies that are shown on Hospice Compare, including information about hospice agencies such as address, phone...
Miller, Virginia M; Bahn, Rebecca S
Initiatives to hasten the translation of basic science discoveries to clinical care have necessitated the development of new approaches to interdisciplinary collaboration and training of future investigators. This has been nowhere more important than in the study of sex differences with implications for extension into areas of gender medicine. Clearly, gaining better understanding of the role that sex and gender play in health and disease is essential to the implementation of truly individualized medicine. This case report will describe our experiences in developing the Mayo Clinic Building Interdisciplinary Research Programs in Women's Health (BIRCWH) program, an interdisciplinary research and training program in women's health and sex and gender differences. We identify both our successes and the barriers we have encountered in order that others who are developing similar programs might benefit from our experiences.
P. V. C. Santos
Full Text Available Chemical dependency is currently one of the most important public health problems in our country. The study deals with a quantitative and qualitative research, whose goal is to evaluate the perception and performance of the interdisciplinary team in serving drug dependents in specialized network of mental health Sinop, Mato Grosso. Applied a semi-structured questionnaire with objective and subjective questions with 11 professionals in health care at the Psychosocial Care Center (CAPS and Medical Specialties Center (EMC. The results reveal the importance of the preparation of these professionals to work in service to dependents and interdisciplinarity proved to be the best option to achieve a dignified and humane care
Full Text Available The Global Partnership for Effective Diabetes Management has previously recommended the implementation of an interdisciplinary team (IDT approach to type 2 diabetes (T2DM management as one of 10 practical steps for health care professionals to help more people achieve their glycaemic goal. This article discusses some of the key contributors to success and also the challenges faced when applying IDT care, by examining case studies and examples from around the world. The real-world practices discussed show that implementing successful interdisciplinary care in diabetes is possible despite significant barriers such as established hierarchal structures and financial resource constraints. Instituting collaborative, integrated working relationships among multiple disciplines under strong leadership, together with enhanced and active communication and improved patient access to appropriate specialties is essential. Patients have a crucial role in the management of their own disease and including them as part of the treatment team is also critical. IDTs in diabetes care improve patient outcomes in terms of control of glycaemia and cardiometabolic risk factors, and decreased risk of diabetes complications. Ensuring access to an appropriate IDT, in whatever form, is paramount to enable the best care to be delivered.
McGill, Margaret; Blonde, Lawrence; Chan, Juliana C N; Khunti, Kamlesh; Lavalle, Fernando J; Bailey, Clifford J
The Global Partnership for Effective Diabetes Management has previously recommended the implementation of an interdisciplinary team (IDT) approach to type 2 diabetes (T2DM) management as one of 10 practical steps for health care professionals to help more people achieve their glycaemic goal. This article discusses some of the key contributors to success and also the challenges faced when applying IDT care, by examining case studies and examples from around the world. The real-world practices discussed show that implementing successful interdisciplinary care in diabetes is possible despite significant barriers such as established hierarchal structures and financial resource constraints. Instituting collaborative, integrated working relationships among multiple disciplines under strong leadership, together with enhanced and active communication and improved patient access to appropriate specialties is essential. Patients have a crucial role in the management of their own disease and including them as part of the treatment team is also critical. IDTs in diabetes care improve patient outcomes in terms of control of glycaemia and cardiometabolic risk factors, and decreased risk of diabetes complications. Ensuring access to an appropriate IDT, in whatever form, is paramount to enable the best care to be delivered.
Hamilton, Gillian; Ortega, Rosio; Hochstetler, Vicki; Pierson, Kristen; Lin, Peiyi; Lowes, Susan
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.
Loke, Song-Seng; Rau, Kung-Ming; Huang, Chih-Fang
Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% (p care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.
Guidelines for the structure and function of an interdisciplinary team for persons with brain injury. Joint Committee on Interprofessional Relations between Division 40 (Clinical Neuropsychology) of the American Psychological Association and the American Speech-Language-Hearing Association.
This report provides guidelines for the structure and function of interdisciplinary teams assembled for the delivery of clinical services to individuals with brain injury. Specifically, the report addresses issues concerning team membership, skills required of the team coordinator, and the processes that facilitate the attainment of team goals. These general suggestions are designed to give rehabilitation professionals and health care administrators some guiding principles for interdisciplinary teams involved in the clinical management of individuals with brain injury.
Fathi, Roya; Sheehan, Orla C; Garrigues, Sarah K; Saliba, Debra; Leff, Bruce; Ritchie, Christine S
The unique needs of homebound adults receiving home-based medical care (HBMC) (ie, home-based primary care and home-based palliative care services) are ideally provided by interdisciplinary care teams (IDTs) that provide coordinated care. The composition of team members from an array of organizations and the unique dimension of providing care in the home present specific challenges to timely access and communication of patient care information. The objective of this work was to develop a conceptual framework and corresponding quality indicators (QIs) that assess how IDT members for HBMC practices access and communicate key patient information with each other. A systematic review of peer-reviewed and gray literature was performed to inform a framework for care coordination in the home and the development of candidate QIs to assess processes by which all IDT members optimally access and use patient information. A technical expert panel (TEP) participated in a modified Delphi process to assess the validity and feasibility of each QI and to identify which would be most suitable for testing in the field. Thematic analysis of literature revealed 4 process themes for how HBMC practices might engage in high-quality care coordination: using electronic medical records, conducting interdisciplinary team meetings, sharing standardized patient assessments, and communicating via secure e-messaging. Based on these themes, 9 candidate QIs were developed to reflect these processes. Three candidate QIs were assessed by the TEP as valid and feasible to measure in an HBMC practice setting. These indicators focused on use of IDT meetings, standardized patient assessments, and secure e-messaging. Translating the complex issue of care coordination into QIs will improve care delivered to vulnerable home-limited adults who receive HBMC. Guided by the literature, we developed a framework to reflect optimal care coordination in the home setting and identified 3 candidate QIs to field-test in
Swierczewska, Magdalena; Lee, Seulki; Chen, Xiaoyuan
The Laboratory of Molecular Imaging and Nanomedicine of the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health has been led by Xiaoyuan Chen since 2009. The Laboratory of Molecular Imaging and Nanomedicine contains three interdisciplinary, versatile groups: the Theranostic Nanomedicine; PET/Optical Imaging Probe; and Biological Molecular Imaging Sections, consisting of chemists, engineers, biologists and clinicians working together to transfer biomedical technology from bench to bedside. To find out more about our laboratory and meet our group, please visit us at www.nibib.nih.gov/Research/Intramural/xchen.
Wilk, Szymon; Kezadri-Hamiaz, Mounira; Rosu, Daniela; Kuziemsky, Craig; Michalowski, Wojtek; Amyot, Daniel; Carrier, Marc
In healthcare organizations, clinical workflows are executed by interdisciplinary healthcare teams (IHTs) that operate in ways that are difficult to manage. Responding to a need to support such teams, we designed and developed the MET4 multi-agent system that allows IHTs to manage patients according to presentation-specific clinical workflows. In this paper, we describe a significant extension of the MET4 system that allows for supporting rich team dynamics (understood as team formation, management and task-practitioner allocation), including selection and maintenance of the most responsible physician and more complex rules of selecting practitioners for the workflow tasks. In order to develop this extension, we introduced three semantic components: (1) a revised ontology describing concepts and relations pertinent to IHTs, workflows, and managed patients, (2) a set of behavioral rules describing the team dynamics, and (3) an instance base that stores facts corresponding to instances of concepts from the ontology and to relations between these instances. The semantic components are represented in first-order logic and they can be automatically processed using theorem proving and model finding techniques. We employ these techniques to find models that correspond to specific decisions controlling the dynamics of IHT. In the paper, we present the design of extended MET4 with a special focus on the new semantic components. We then describe its proof-of-concept implementation using the WADE multi-agent platform and the Z3 solver (theorem prover/model finder). We illustrate the main ideas discussed in the paper with a clinical scenario of an IHT managing a patient with chronic kidney disease.
Attitude, Skills, Knowledge (ASK) - In this order, these are fundamental characteristics of scientific innovators. Through first-hand practice in using science to unpack and solve complex real-world problems, students can become self-motivated scientific leaders. This presentation describes the pedagogy of a recently developed interdisciplinary undergraduate science education program at the University of Massachusetts Amherst focused on addressing global challenges with scientific solutions. Integrated Concentration in Science (iCons) is an overarching concentration program that supplements the curricula provided within each student's chosen major. iCons is a platform for students to perform student-led research in interdisciplinary collaborative teams. With a schedule of one course per year over four years, the cohort of students move through case studies, analysis of real-world problems, development of potential solutions, integrative communication, laboratory practice, and capstone research projects. In this presentation, a track emphasizing renewable energy science is used to illustrate the iCons pedagogical methods. This includes discussion of a third-year laboratory course in renewable energy that is educationally scaffolded: beginning with a boot camp in laboratory techniques and culminating with student-designed research projects. Among other objectives, this course emphasizes the practice of using reflection and redesign, as a means of generating better solutions and embedding learning for the long term. This work is supported in part by NSF grant DUE-1140805.
Tiew, Lay Hwa; Kwee, Jian Hui; Creedy, Debra K; Chan, Moon Fai
To explore Singapore hospice nurses' perspectives of spirituality and spiritual care. A descriptive, cross-sectional design was used. Spiritual care is integral to providing quality end-of-life care. However, patients often report that this aspect of care is lacking. Previous studies suggest that nurses' neglect of this aspect of care could be attributed to poor understanding of what spirituality is and what such care entails. This study aimed to explore Singapore hospice nurses' perspectives about spirituality and spiritual care. A convenience sample of hospice nurses was recruited from the eight hospices in Singapore. The survey comprised two parts: the participant demographic details and the Spirituality Care-Giving Scale. This 35-item validated instrument measures participants' perspectives about spirituality and spiritual care. Sixty-six nurses participated (response rate of 65%). Overall, participants agreed with items in the Spiritual Care-Giving Scale related to Attributes of Spiritual Care; Spiritual Perspectives; Spiritual Care Attitudes; and Spiritual Care Values. Results from general linear model analysis showed statistically significant main effects between race, spiritual affiliation and type of hospice setting, with the total Spiritual Care-Giving Scale score and four-factor scores. Spirituality was perceived to be universal, holistic and existential in nature. Spiritual care was perceived to be relational and centred on respecting patients' differing faiths and beliefs. Participants highly regarded the importance of spiritual care in the care of patients at end-of-life. Factors that significantly affected participants' perspectives of spirituality and spiritual care included race, spiritual affiliation and hospice type. Study can clarify values and importance of spirituality and care concepts in end-of-life care. Accordingly, spirituality and care issues can be incorporated in multi-disciplinary team discussions. Explicit guidelines regarding
DeSalvo, Robert J.; And Others
An elective case study course involving graduate students from various health profession disciplines from two universities was developed to provide a forum for health care teams to discuss the philosophical and functional impact of situations and their alternative solutions. The nonclinical, administratively-oriented problem situations stressed…
Abstract The German National Hospice and Palliative Care Register was implemented in 2011 by the German Association for Palliative Medicine to provide a nationwide description of the quality of hospice and palliative care. Every year, the register joints data of daily palliative care for a period of at least 3 months per year or up to 30 palliative care patients per palliative care service (palliative care units, hospices, palliative care teams and palliative counselling services). The reg...
... years, AHF worked to improve access to quality hospice care through public education, professional training, and consumer advocacy. Our vision was that hospice would be an integral part of our society, ...
Heuer, Albert J; Geisler, Sheryl; Kamienski, Mary; Langevin, Denise; O'Sullivan Maillet, Julie
Medicine in the 21st century requires expanded multidisciplinary problem-solving in order to deliver cost-effective, quality health care, yet many medical schools still educate their students in relative isolation with little interaction or understanding of other health care professionals. To begin to address this issue, the University of Medicine and Dentistry of New Jersey (UMDNJ) School of Health Related Professions and School of Nursing were invited by the New Jersey Medical School to introduce medical students at the New Jersey Medical School to a cross-section of health professions they are likely to encounter. These health professions included medical imaging, dietetics-nutrition, laboratory technology, nursing, physical therapy, physician assistant, respiratory therapy and social work. During a 60-min educational session, a simulated case-based approach heightened medical school students' awareness of the function and value of interdisciplinary collaboration. Faculty from each of the eight disciplines gave a brief summary of their profession, including their scope-of-practice and academic requirements. At the end of the session, participants were given a brief 12-item survey to evaluate the experience. Though this was only a small, explorative project, survey results suggested that participants increased their understanding of other health professions, including when to refer to and collaborate with these professions. Feedback from this pilot project may be used to optimize future initiatives of this type.
Conclusions: Students reflected that the storytelling helped them recognize the importance of relieving the suffering, respecting and understanding, communicating, team working, and family supporting in the hospice care.
Eisenberg, Dan; Lohnberg, Jessica A; Kubat, Eric P; Bates, Cheryl C; Greenberg, Lauren M; Frayne, Susan M
Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts. Published by
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...
Full Text Available Hospice care is about quality of life at a time when a person has an illness for which curative measures are no longer possible, and for which a physician has determined the patient has a life expectancy of about six months or less, a hospice program can support the process of death and dying in a compassionate way. A growing trend is to utilize physical therapy more frequently in hospice. Physical therapy has several vital roles in hospice care as follows: maximizing functional ability and comfort to enhance quality of life; assuring patient and care giver safety; helping people redesign their lives and life goals; providing support around physical, emotional and spiritual issues at the end of life. The purpose of this review is to provide 1 a description of hospice care, 2 an explanation of the roles of physical therapists in hospice care.
Csikos, Agnes; Busa, Csilla; Muszbek, Katalin
During the past 25 years, many developmental steps have occurred in Hungary in palliative care. Further education and service development is needed to provide a quality palliative care for all the Hungarian people. Hungary has a universal health care system with a developed infrastructure. The first Hungarian hospice team started in 1991. At that time, the concept of hospice care was unknown. Symptom control and psychosocial support for the dying patient was inadequate. The regulatory framework was based on the 1997 Health Care Act which was followed by significant palliative care legislation including documents on the legal requirements for palliative care (2004). National guidelines were developed in 2002. Home and inpatient hospice care are reimbursed by the National Insurance Fund. Patients and families pay nothing. The multidisciplinary team provides care for patients and families and hospice home care is widely available across the country. Inpatient units are still lacking in Hungary. Strong opioids are readily available in the country and can be prescribed for cancer and noncancer patients. Palliative care is taught in medical and nursing undergraduate and postgraduate education. From 2014, physicians in Hungary can take a one-year course to qualify for a license in palliative medicine. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Steenfeldt, Vibeke Østergaard
Det er formålet med afhandlingen Hospice – et levende hus. En analyse af levet liv og omsorg på hospice som bidrag til forståelse af åndelig omsorg at skabe vi¬den om den oplevelse det uhelbredeligt syge menneske, der tilbringer den sidste del af livet på et hospice, har af omsorgspraksis og levet...
Jacoby, Liva H; Beehler, Connie J; Balint, John A
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.
Dennis, Mary Kate; Washington, Karla T; Koenig, Terry L
Ethical decision making is critically important in hospice social work. Through in-depth interviews, researchers explored ethical dilemmas faced by 14 hospice social workers and the processes they used to move toward resolution. The dilemmas were integrated into a framework focused on the sources of ethical conflict: the client system, the agency, and the profession. Processes involved in resolving ethical dilemmas included consulting with other professionals, weighing the pros and cons of options, and bringing about desired outcomes. Findings suggest that hospice teams should be provided with opportunities to meaningfully discuss ethical decision making. Further, the involvement of social workers in administrative leadership is recommended to increase the likelihood that discipline-specific perspectives are incorporated into formal policies and procedures that shape practice in ethically complex situations.
Full Text Available Christian Gausvik,1 Ashley Lautar,2 Lisa Miller,2 Harini Pallerla,3 Jeffrey Schlaudecker4,5 1University of Cincinnati College of Medicine, 2The Christ Hospital, Cincinnati, OH, USA; 3Department of Family and Community Medicine, 4Division of Geriatric Medicine, University of Cincinnati, Cincinnati, OH, USA; 5Geriatric Medicine Fellowship Program, University of Cincinnati/The Christ Hospital, Cincinnati, OH, USA Abstract: Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR on an acute care for the elderly (ACE unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer
Molina Recio, Guillermo; García-Hernández, Laura; Molina Luque, Rafael; Salas-Morera, Lorenzo
Several studies have estimated the potential economic and social impact of the mHealth development. Considering the latest study by Institute for Healthcare Informatics, more than 165.000 apps of health and medicine are offered including all the stores from different platforms. Thus, the global mHealth market was an estimated $10.5 billion in 2014 and is expected to grow 33.5 percent annually between 2015 and 2020s. In fact, apps of Health have become the third-fastest growing category, only after games and utilities. This study aims to identify, study and evaluate the role of interdisciplinary research teams in the development of articles and applications in the field of mHealth. It also aims to evaluate the impact that the development of mHealth has had on the health and computer science field, through the study of publications in specific databases for each area which have been published until nowadays. Interdisciplinary nature is strongly connected to the scientific quality of the journal in which the work is published. This way, there are significant differences in those works that are made up by an interdisciplinary research team because of they achieve to publish in journals with higher quartiles. There are already studies that warn of methodological deficits in some studies in mHealth, low accuracy and no reproducibility. Studies of low precision and poor reproducibility, coupled with the low evidence, provide low degrees of recommendation of the interventions targeted and therefore low applicability. From the evidence of this study, working in interdisciplinary groups from different areas greatly enhances the quality of research work as well as the quality of the publications derived from its results.
National Highway Traffic Safety Administration (DOT), Washington, DC.
This document presents materials covering the television campaign against drunk driving called "TEAM" (Techniques for Effective Alcohol Management). It is noted that TEAM's purpose is to promote effective alcohol management in public facilities and other establishments that serve alcoholic beverages. TEAM sponsors are listed, including…
Ellington, Lee; Cloyes, Kristin G; Xu, Jiayun; Bellury, Lanell; Berry, Patricia H; Reblin, Maija; Clayton, Margaret F
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 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.
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...
Challenges and potential improvements in the admission process of patients with spinal cord injury in a specialized rehabilitation clinic - an interview based qualitative study of an interdisciplinary team.
Röthlisberger, Fabian; Boes, Stefan; Rubinelli, Sara; Schmitt, Klaus; Scheel-Sailer, Anke
The admission process of patients to a hospital is the starting point for inpatient services. In order to optimize the quality of the health services provision, one needs a good understanding of the patient admission workflow in a clinic. The aim of this study was to identify challenges and potential improvements in the admission process of spinal cord injury patients at a specialized rehabilitation clinic from the perspective of an interdisciplinary team of health professionals. Semi-structured interviews with eight health professionals (medical doctors, physical therapists, occupational therapists, nurses) at the Swiss Paraplegic Centre (acute and rehabilitation clinic) were conducted based on a maximum variety purposive sampling strategy. The interviews were analyzed using a thematic analysis approach. The interviewees described the challenges and potential improvements in this admission process, focusing on five themes. First, the characteristics of the patient with his/her health condition and personality and his/her family influence different areas in the admission process. Improvements in the exchange of information between the hospital and the patient could speed up and simplify the admission process. In addition, challenges and potential improvements were found concerning the rehabilitation planning, the organization of the admission process and the interdisciplinary work. This study identified five themes of challenges and potential improvements in the admission process of spinal cord injury patients at a specialized rehabilitation clinic. When planning adaptations of process steps in one of the areas, awareness of effects in other fields is necessary. Improved pre-admission information would be a first important step to optimize the admission process. A common IT-system providing an interdisciplinary overview and possibilities for interdisciplinary exchange would support the management of the admission process. Managers of other hospitals can supplement
Stensland, Meredith; Landsman, Miriam
Burnout is a critical problem for hospice care system, particularly given the potential increase in hospice utilization because of the increasing older adult population. Hospice care requires social workers and other professionals to work in interdisciplinary settings under conditions of prolonged stress. Guided by the Job Demands-Resources (JDR) model, this study sought to: (1) understand Iowa hospice workers' level of burnout, indicated by emotional exhaustion (EE); (2) identify organizational and personal determinants of EE. This web-based study used a cross-sectional survey administered to hospice staff across Iowa. Seventeen hospice organizations participated as study sites, and 244 out of 825 employees, consisting of interdisciplinary clinical workers and administrative personnel, completed the survey. Descriptive, correlational, and regression statistics were used to test study hypotheses. Regarding EE levels, 59% of participants were experiencing low EE, while the other 41% had moderate or high EE. Those lacking empathy, working full-time, and working for larger hospice organizations had greater EE. While findings largely support the JDR model, interactions between demands and resources offer only partial support. Results indicate the importance of hospices fostering supportive work environments and providing employee education about emotional benefits of respect, strategies for displaying workplace respect, and evaluation of respect-related initiatives.
Dobrina, Raffaella; Tenze, Maja; Palese, Alvisa
Current literature reports that nurses are the members of the health-care team who have the most contact with patients facing a life-threatening illness. The multidisciplinary palliative care approach means that hospice and palliative care nurses require a consistent theoretical foundation in order to be confident of and able to explain their role. The aim of this paper is to describe existing palliative care and hospice nursing models and theories and to identify their core concepts. Literature published between 2002 and 2012 on such models was reviewed and subjected to content analysis. Ten core concepts were identified that fell into three categories: patient, nurse, and therapeutic relationship. The themes and values identified in the end-of-life nursing models and theories are congruent with palliative care best practices based on a patient-centred and an interdisciplinary teamwork approach. In developing a therapeutic relationship with patients, nurses have a 'privileged' experience that may lead to existential growth and job satisfaction.
Pediatric palliative care and pediatric hospice care (PPC-PHC) are often essential aspects of medical care for patients who have life-threatening conditions or need end-of-life care. PPC-PHC aims to relieve suffering, improve quality of life, facilitate informed decision-making, and assist in care coordination between clinicians and across sites of care. Core commitments of PPC-PHC include being patient centered and family engaged; respecting and partnering with patients and families; pursuing care that is high quality, readily accessible, and equitable; providing care across the age spectrum and life span, integrated into the continuum of care; ensuring that all clinicians can provide basic palliative care and consult PPC-PHC specialists in a timely manner; and improving care through research and quality improvement efforts. PPC-PHC guidelines and recommendations include ensuring that all large health care organizations serving children with life-threatening conditions have dedicated interdisciplinary PPC-PHC teams, which should develop collaborative relationships between hospital- and community-based teams; that PPC-PHC be provided as integrated multimodal care and practiced as a cornerstone of patient safety and quality for patients with life-threatening conditions; that PPC-PHC teams should facilitate clear, compassionate, and forthright discussions about medical issues and the goals of care and support families, siblings, and health care staff; that PPC-PHC be part of all pediatric education and training curricula, be an active area of research and quality improvement, and exemplify the highest ethical standards; and that PPC-PHC services be supported by financial and regulatory arrangements to ensure access to high-quality PPC-PHC by all patients with life-threatening and life-shortening diseases. Copyright © 2013 by the American Academy of Pediatrics.
Hospice is considered the "gold standard" for end-of-life care, providing dying patients and their families access to a broad array of services across settings. Despite its comprehensive approach, hospice care remains underutilized; many patients who might benefit from hospice do not enroll, or enroll only in the last days of life. This Issue Brief summarizes a series of studies that shed light on the decision making process about hospice, and describes a simple, effective way to improve referrals to hospice among nursing home residents.
Agirtan, Canan A.; Akar, Taner; Akbas, Seher; Akdur, Recep; Aydin, Cahide; Aytar, Gulsen; Ayyildiz, Suat; Baskan, Sevgi; Belgemen, Tugba; Bezirci, Ozdecan; Beyazova, Ufuk; Beyaztas, Fatma Yucel; Buken, Bora; Buken, Erhan; Camurdan, Aysu D.; Can, Demet; Canbaz, Sevgi; Canturk, Gurol; Ceyhan, Meltem; Coskun, Abdulhakim; Celik, Ahmet; Cetin, Fusun C.; Coskun, Ayse Gul; Dagcinar, Adnan; Dallar, Yildiz; Demirel, Birol; Demirogullari, Billur; Derman, Orhan; Dilli, Dilek; Ersahin, Yusuf; Esiyok, Burcu; Evinc, Gulin; Gencer, Ozlem; Gokler, Bahar; Hanci, Hamit; Iseri, Elvan; Isir, Aysun Baransel; Isiten, Nukhet; Kale, Gulsev; Karadag, Ferda; Kanbur, Nuray; Kilic, Birim; Kultur, Ebru; Kurtay, Derya; Kuruoglu, Asli; Miral, Suha; Odabasi, Aysun B.; Oral, Resmiye; Orhon, Filiz Simsek; Ozbesler, Cengiz; Ozdemir, Dilsad Foto; Ozkok, M. Selim; Ozmert, Elif; Oztop, Didem B.; Ozyurek, Hamit; Pasli, Figen; Peksen, Yildiz; Polat, Onur; Sahin, Figen; Sahin, Ahmet Rifat; Salacin, Serpil; Suskan, Emine; Tander, Burak; Tekin, Deniz; Teksam, Ozlem; Tiras, Ulku; Tomak, Yilmaz; Tumer, Ali Riza; Turla, Ahmet; Ulukol, Betul; Uslu, Runa; Tas, Fatma V.; Vatandas, Nilgun; Velipasaoglu, Sevtap; Yagmur, Fatih; Yagmurlu, Aydin; Yalcin, Songul; Yavuz, Sukruye; Yurdakok, Kadriye
Objectives: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year…
Ritchie, Christine; Andersen, Robin; Eng, Jessica; Garrigues, Sarah K; Intinarelli, Gina; Kao, Helen; Kawahara, Suzanne; Patel, Kanan; Sapiro, Lisa; Thibault, Anne; Tunick, Erika; Barnes, Deborah E
The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers. To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center. 152 high-risk patients (≥5 ED visits or ≥2 hospitalizations in the past 12 months) enrolled from four medical clinics from 4/29/2013 to 5/31/2014. Patients received a comprehensive in-home assessment by a nurse practitioner/social worker (NP/SW) team, who then met with a larger interdisciplinary team to develop an individualized care plan. In consultation with the primary care team, standardized care protocols were activated to address relevant key issues as needed. A process evaluation based on the Consolidated Framework for Implementation Research identified key adaptations of the original model, which included streamlining of standardized protocols, augmenting mental health interventions and performing some assessments in the clinic. A summative evaluation found a significant decline in the median number of ED visits (5.5 to 0, p = 0.015) and hospitalizations (5.5 to 0, phealth increased from 31% at enrollment to 64% at 9 months (p = 0.002). Semi-structured interviews with Care Support team members identified patients with multiple, complex conditions; little community support; and mild anxiety as those who appeared to benefit the most from the program. It was feasible to implement GRACE/Care Support at an academic medical center by making adaptations based on local needs. Care Support patients experienced significant reductions in acute care utilization and significant improvements in self-rated health.
Beresford, L; Connor, S R
The National Hospice Organization grew out of efforts by the founders of the earliest hospice programs in the United States to protect their emotional investments in hospice care, to advocate for hospice interests in Congress and other public policy forums, to define standards for the fledgling movement, and to provide education on the nuts and bolts of running hospice programs for others who were interested in starting hospices in communities from coast to coast. Unlike the model of St. Christopher's Hospice in England, which began as a free-standing in-patient facility and later added home care services, most U.S. hospices started as home care-based programs, often largely manned by volunteers. Among the crucial issues that have dominated the work of NHO during its first 21 years were passage and maintenance of the Medicare hospice benefit, ideological battles over the hospice philosophy, and efforts to extend hospice care to other populations, such as people with AIDS.
While racial disparity in the use of hospice care by older African Americans is widely acknowledged, little is known about the values that they consider as important in receiving health care services along with direct experiences with having these values respected by hospice care providers. Using individual, face-to-face interviews, data were collected directly from 28 African American hospice patients about their experiences in hospice care. Content analysis was used to identify and categorize themes from multiple readings of the qualitative data. Resulting themes included: dying at home, open communications, independent decision-making, autonomy in daily life, unwillingness to be a burden, and relationships. Through the initial assessment, value preferences can be explored and then shared with hospice team members to ensure that services are provided in such a way that their values and preferences are respected.
Wahlfach Teamarbeit: Ergebnisse eines Pilotprojektes zur interprofessionellen und interdisziplinären Ausbildung mit formativem Team-OSCE (TOSCE [Teamwork elective: Results of a German pilot project on interprofessional and interdisciplinary education with formative team OSCE
Full Text Available [english] Aims: There is a growing need to implement teamworking in medical education. In reality, interdisciplinary and interprofessional education is often absent. Here we describe a pilot trial developed jointly by the nursing college and the medical faculty in Erlangen (Germany in which nursing students and undergraduate medical students formed interprofessional teams and were confronted with interprofessional cases using simulated patients (SPs and phantoms. The elective was planned using standard curriculum planning instruments and finally evaluated with a novel formative team OSCE (Objective Structured Clinical Evaluation instrument.Methods: During one year, 20 nursing students participated voluntarily in the project and 10 medical students took the course as an elective. Results: The pilot project was first performed with two tutors, one from the medical school and one from the nursing school, as well as one to two SPs. During the second course, there was only one tutor. Overall evaluation of the voluntary students was good, with some elements (acute stroke, factual knowledge, and general organizational problems that needed to be improved. Performance of a four-station team OSCE was feasible, but raters reported problems in assessing individuals and the team at the same time. Interobserver agreement was satisfactory (kappa 0.35.Conclusions: Interdisciplinary and interprofessional education between a nursing school and a medical school is feasible within an elective, but requires substantial personnel resources. Design and performance of a team OSCE is possible. The validity of the test has to be shown on follow-up.[german] Zielsetzung: Das Lernziel „Fähigkeit zur interprofessionellen und interdisziplinären Teamarbeit“ wird sowohl in der aktuellen Approbationsordnung für Ärzte als auch im Krankenpflegegesetz gefordert. In der Realität gibt es in beiden Ausbildungen kaum gemeinsame Lehreinheiten. Wir beschreiben ein Pilotprojekt
Gage, L. Ashley; Washington, Karla T.; Oliver, Debra Parker; Lewis, Alexandra; Kruse, Robin L.; Demiris, George
Research has documented numerous benefits and challenges associated with receipt of hospice care in nursing homes; however, study of this partnership from the perspective of residents’ family members has been limited. The purpose of this qualitative investigation was to explore family members’ experience with hospice services received in the nursing home setting. Researchers conducted a secondary data analysis of 175 family member interviews using a thematic analytic approach. Findings highlighted the critical role of communication in supporting residents and their family members. Care coordination, support and oversight, and role confusion also impacted family members’ experience of hospice care in the nursing home. Efforts directed at enhancing communication and more clearly articulating the roles of members of the health care team are indicated. PMID:25422516
The paper summarises the past and the present of the palliative care. The author describes the developement in the field from the times of antiquity, through the deep Christian vocation of middle ages to alleviate pain and misery, the eigthteenth century's enlighted ideas until the relatively recent developement of the idea of hospice pioneered in 1967by dr Cicely Saunders in England, and in 1964 by Chrzanowska in Poland. The role of hospice and palliative care at large is summarised, with special focus on emotional, affirmative, instrumental and information-centered support. The paradox of hospice is discussed, which rests on caring for the incurable patient and helping them comfortably to pass the terminal stages of their disease and life, with dignity, without pain, depression, negligence and deprivation. The hospice movement, drawing form Christian tradition, affirms life while accepting the inevitability of death, opposes the idea of euthanasia, educates the society about the issues related to dying, rests on a set of autonomous units the organisation of which is adapted to local needs, and, finally, acts in concordance with other agendas of the healthcare system. The Polish system constituted by palliative care reach-out teams and palliative units and hospices should be strongly supported and adequately founded to supply best care available to the dying and distressed.
Klick, Jeffrey C; Friebert, Sarah; Hutton, Nancy; Osenga, Kaci; Pituch, Kenneth J; Vesel, Tamara; Weidner, Norbert; Block, Susan D; Morrison, Laura J
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.
Levine, Stacie; O'Mahony, Sean; Baron, Aliza; Ansari, Aziz; Deamant, Catherine; Frader, Joel; Leyva, Ileana; Marschke, Michael; Preodor, Michael
The rapid increase in demand for palliative care (PC) services has led to concerns regarding workforce shortages and threats to the resiliency of PC teams. To describe the development, implementation, and evaluation of a regional interdisciplinary training program in PC. Thirty nurse and physician fellows representing 22 health systems across the Chicago region participated in a two-year PC training program. The curriculum was delivered through multiple conferences, self-directed e-learning, and individualized mentoring by expert local faculty (mentors). Fellows shadowed mentors' clinical practices and received guidance on designing, implementing, and evaluating a practice improvement project to address gaps in PC at their institutions. Enduring, interdisciplinary relationships were built at all levels across health care organizations. Fellows made significant increases in knowledge and self-reported confidence in adult and pediatric PC and program development skills and frequency performing these skills. Fellows and mentors reported high satisfaction with the educational program. This interdisciplinary PC training model addressed local workforce issues by increasing the number of clinicians capable of providing PC. Unique features include individualized longitudinal mentoring, interdisciplinary education, on-site project implementation, and local network building. Future research will address the impact of the addition of social work and chaplain trainees to the program. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
epistemology of interdisciplinary inquiry. Journal of Aesthetic Education, 10, 29-43. 12. Petrioni, P. (1994). Interprofessional teamwork. In A...Urgent Emergent Care Teams, Emergency Medicine Teams, Impactful Team Factors, Team Training, Team Optimization, Team Performance Improvement, Emergency...Urgent Emergent Care Teams, Emergency Medicine Teams, Urgent Care Teams, Impactful Team Factors, Team Training, Team Optimization, Team Performance
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U.S. Department of Health & Human Services — This data set contains the national average (mean) âtop-boxâ scores of Medicare-certified hospice agencies on Consumer Assessment of Healthcare Providers and...
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De Vries, Kay; Plaskota, Marek
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.
Kirolos, Irene; Tamariz, Leonardo; Schultz, Elizabeth A; Diaz, Yvonne; Wood, Barbara A; Palacio, Ana
Hospice and palliative care are underutilized among patients at the end of their lives despite evidence that they improve patient satisfaction and reduce costs. To synthesize evidence regarding interventions to increase hospice referral/enrollment. We conducted a systematic review of the literature and selected studies that evaluated interventions aimed at increasing hospice use. We performed a MEDLINE search (1979 to April 2013) supplemented by manual searches of bibliographies of key articles. Study design, quality criteria, population, interventions, and outcomes for each study were extracted. The main outcome evaluated was hospice referral/enrollment. Our search strategy yielded 419 studies, of which only 6 met our eligibility criteria. Three studies included nursing home populations; 1 included home care patients, 1 targeted care managers, and 1 reported on heart failure patients. Three studies had a cohort design, 2 were pre-post, and only 1 was randomized. Two studies evaluated a process to identify eligible subjects. Two evaluated the impact of advance care planning programs and 2 only provided education. Interventions that only provided education showed a median increase in referral of 5% (2.8%-17%) while interventions that identified hospice candidates showed a median increase in hospice referral of 19.5 % (19%-20%). Interventions of different levels of complexity can improve the use of hospice services among subjects with high mortality risk. An approach that allows the medical team to assess patients' treatment goals and that engages the treating physician seems to be the most successful one.
Sbaratta, Philip A.
At North Shore Community College (NSCC), students in career programs comprise 70% of the student population. To counter the vocational-school effect of programs heavily emphasizing career training, interdisciplinary, team-taught courses were initiated. However, the time required in planning, scheduling, and grading along with other problems…
Butler, Robert N.
There has been little comment in the hospice literature about the special problems of the elderly. Promotes the continued refinement of hospice concepts and practices in relation to both disease and age. (Author/CMG)
Trimble, Susan; Rottier, Jerry
Interdisciplinary middle school level teams capitalize on the idea that the whole is greater than the sum of its parts. Administrators and team members can maximize the advantages of teamwork using team assessments to increase the benefits for students, teachers, and the school environment. Assessing team performance can lead to high performing…
Gray, Helen; Adam, Joan; Brown, Duncan; McLaughlin, Patricia; Hill, Vicky; Wilson, Lorraine
St Columba's Hospice, Edinburgh, is a busy specialist palliative care unit with 30 inpatient beds. A previous publication reported the first strand of a qualitative exploratory study evaluating the impact of open visiting on patients at the hospice. This paper reports on the second strand, which sought to elicit the views of the hospice staff through focus group interviews. The main themes identified were valuing the family and friends as visitors, involving the family as part of the care team, patient powerlessness over visiting, shared rooms and their impact on visitors and patients, and the staff role as advocates or gatekeepers. Several strategies for developing a flexible and 'patient-controlled' visiting policy were identified, including quiet times without visitors, restriction of visitor numbers in shared rooms, and encouraging breaks from visiting. Since the study was completed, the hospice's visiting policy has been modified to ensure that it is patient-centred and meets the needs of patients and families.
Dudal, Sherri; Staack, Roland F; Stoellner, Daniela; Fjording, Marianne Scheel; Vieser, Eva; Pascual, Marie-Hélène; Brudny-Kloeppel, Margarete; Golob, Michaela
The bioanalytical scientist plays a key role in the project team for the drug development of biotherapeutics from the discovery to the marketing phase. Information from the project team members is required for assay development and sample analysis during the discovery, preclinical and clinical phases of the project and input is needed from the bioanalytical scientist to help data interpretation. The European Bioanalysis Forum target team 20 discussed many of the gaps in information and communication between the bioanalytical scientist and project team members as a base for providing a perspective on the bioanalytical scientist's role and interactions within the project team.
Wilson, Christopher M; Stiller, Christine H; Doherty, Deborah J; Thompson, Kristine A
Little is known regarding the extent to which physical therapy is integrated into Hospice and Palliative Care (HPC). The purpose of this study was to describe perceptions of physical therapists (PTs) regarding their role within HPC or working with patients having life-threatening illnesses and to develop a conceptual framework depicting a PTs role within HPC and factors affecting it. Ten PTs, 5 from the United States and 5 from Canada, with at least 5 years of physical therapy experience and 5 years working experience with patients having life-threatening illnesses or in HPC. Demographic data were collected by electronic questionnaire. A semistructured interview was conducted with each participant to investigate their perceptions about the role of PTs in HPC. Interview results were analyzed for trends between participants, practice settings, regions, and other sociocultural aspects. The constant comparative method of qualitative data analysis was used to identify similarities and differences and to develop themes and concepts relative to the role of PT in HPC. Participants identified their 3 primary roles in HPC: providing patient/family care, serving as an interdisciplinary team member, and fulfilling professional responsibilities outside of direct patient care. They described factors within and outside direct patient care which influenced their roles. Concepts included shifting priorities, care across the continuum, and changing perceptions of PTs within HPC. This study described perceptions of the role of PTs within HPC that may be utilized when coordinating future strategies to appropriately promote and expand the role.
Review: Christine von Blanckenburg, Birgit Böhm, Hans-Luidger Dienel & Heiner Legewie (2005. Leitfaden für interdisziplinäre Forschergruppen: Projekte initiieren – Zusammenarbeit gestalten [Guidelines for Interdisciplinary Research Teams: Initiating Projects—Developing Cooperation
Full Text Available Today, project-oriented work is an integral part of academic life. However, not all academics are ready to cope with this organizational aspect of scientific work or with the management of research teams. "Guidelines for Interdisciplinary Research Teams" provides a detailed outline of the various project stages, the potential conflicts and burgeoning power issues, as well as the basics and techniques of moderation. This volume offers excellent insight into the scientific enterprise and provides useful strategic options for managing teamwork. Thus, the volume is suitable for two purposes, namely as a set of guidelines for those inexperienced in scientific cooperation, and as a reference book for those who want to master their previous project experiences and utilize them in future enterprises. However, the intercultural aspect of scientific project organization is not discussed in the volume. URN: urn:nbn:de:0114-fqs0801179
The author summarizes the experiences of four long-term hospice staff support groups in which he served as facilitator. From these experiences he identifies what seem to be the key elements in the success or failure of a hospice staff support group, including its membership, the group contract, and the facilitator's leadership style. He outlines three developmental stages of the long-term staff support group: trust-building, individual support and team-focus. He suggests that the team-focused group is ideally suited to deal with crucial staff and agency sources of worker stress.
Unger, Kenneth M
When ventilatory support is withdrawn in an intensive care unit (ICU), the place of death for most patients is the hospital. However, the majority of terminally ill patients prefer to die at home. Few articles have addressed taking adult mechanically ventilated patients home from the ICU for withdrawal of ventilatory support (WVS). To determine the outcomes of a protocol-driven program of WVS in the home under hospice care. A retrospective chart review of 14 consecutive patients who had WVS at home. All subjects were mechanically ventilated ICU patients referred to hospice with a request for WVS to be performed in the patient's home. A protocol/checklist guided care. Medical records were reviewed to obtain demographic and medical information, particularly for duration of mechanical ventilation, the use of premedication, level of consciousness at the time of WVS, symptoms following WVS, pharmacologic measures used for symptom control after WVS, and survival time after WVS. At the time of WVS, five patients were awake or arousable and nine were stuporous or comatose. Ten patients required no medication before WVS; only four required medications for symptom control after WVS. Median survival after WVS was 18.15 hours. In all cases, symptomatic control was judged to be excellent. Successful WVS and a natural death at home is possible with logistic support from the hospice organization and the expertise of the hospice team, guided by a comprehensive protocol/checklist. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP).
Barry, Catherine N; Abraham, Kristen M; Weaver, Kendra R; Bowersox, Nicholas W
In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
choice patients make to forego aggressive treatment measures when they enroll in hospice. In a literal sense, to enroll in hospice means to bring in support for end-of-life care. It means to identify the need for expertise around symptom management at end-of-life, and agree to having a care team come and manage someone’s physical, psychosocial, and/or spiritual needs. As with all care, hospice can be stopped if it is no longer considered appropriate. To uncover the communication tensions undergirding a hospice admission interaction, we use Street’s ecological theory of patient-centered communication to analyze a case exemplar of a hospice admission interaction. This analysis reveals diverse points of struggle within hospice decision-making processes around hospice care and the need for communication techniques that promote trust and acceptance of end-of-life care. Lessons learned from talking about hospice care can inform other quality initiatives around communication and informed decision-making in the context of advance care planning, palliative care, and end-of-life care.
Candrian, Carey; Tate, Channing; Broadfoot, Kirsten; Tsantes, Alexandra; Matlock, Daniel; Kutner, Jean
to forego aggressive treatment measures when they enroll in hospice. In a literal sense, to enroll in hospice means to bring in support for end-of-life care. It means to identify the need for expertise around symptom management at end-of-life, and agree to having a care team come and manage someone’s physical, psychosocial, and/or spiritual needs. As with all care, hospice can be stopped if it is no longer considered appropriate. To uncover the communication tensions undergirding a hospice admission interaction, we use Street’s ecological theory of patient-centered communication to analyze a case exemplar of a hospice admission interaction. This analysis reveals diverse points of struggle within hospice decision-making processes around hospice care and the need for communication techniques that promote trust and acceptance of end-of-life care. Lessons learned from talking about hospice care can inform other quality initiatives around communication and informed decision-making in the context of advance care planning, palliative care, and end-of-life care. PMID:28420191
... PDF - 5.6 MB] Hospice patients Number of patients: 1.3 million (2013) Source: Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013-2014, table 1 [PDF - 5.6 MB] More Data Alzheimer’s disease Long-Term Care Services in the United ...
Kauffeld, S.; Lehmann-Willenbrock, N.K.; Grote, S.; Wastian, M.; von Rosenstiel, L.; Braumandl, I.; West, M.
Project teams are a contemporary organizing principle. They work on non-routine tasks. Team composition in project teams is often interdisciplinary (i.e., uniting team members from different departments or areas of expertise within an organization). Project teams face a number of challenges. In
Aghdam, Alireza Mohajjel; Aghaei, Mir Hossein; Hassankhani, Hadi; Rahmani, Azad
Awareness and attitudes of nurses regarding end of life care are important factors in providing hospice care. In an extensive literature review, we found no related articles investigating Iranian nurses awareness and attitudes about providing such care. The aims of this study were to investigate the awareness and attitudes of Iranian nurses in providing hospice care. In this descriptive-correlational study, 240 nurses employed in six educational centers were selected by non-randomized stratified sampling. The data collection instruments included an awareness test and attitudes regarding providing end of life care in hospice questionnaire. The data were analyzed using descriptive statistics and independent sample t-tests, one-way ANOVA, and Pearson correlation tests. The nurses' awareness score was 14.3 out of 29 and 55.7% of them stated that they had not received any education in providing end of life care. Also, by obtaining the score of 91.7 out of 120 the attitudes of participants in providing end of life care in hospices were positive. In addition, the highest attitudes score of nurses were in the dimensions of benefits of implementation and health care team. Considering low awareness of nurses about end of life care in hospices, continuing education should be provided for them in this regard. Especially, by considering the positive attitude of nurses, providing such programs could help develop hospice care in Iran.
The relationship between acculturation and attitudes of Latinos toward hospice was examined in a sample of 380 Latinos from southern New Jersey. A survey design, using self-administered questionnaires, including a bi-dimensional acculturation scale, examined attitudes toward hospice. The sample represented a cross-section of socioeconomic groups and various nationalities of Latinos. Findings revealed that education and income were significantly related to attitudes toward hospice but acculturation was not. Findings also revealed that more than one-half of participants were unfamiliar with the word "hospice" prior to the study. Respondents with higher incomes, higher levels of education, and who were older were more familiar and had more positive attitudes. Overall, despite respondents' limited knowledge of hospice, the majority would use it. These findings underscore the need to intensify hospice education in Latino communities taking into account Latinos' socioeconomic status.
McConnell, Tracey; Porter, Sam
More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children's hospice. Qualitative research incorporating interviews and a focus group. Data were analysed using thematic analysis. Purposeful sampling led to a total of 15 care team staff recruited from a children's hospice offering palliative and specialist care to life-limited children and young people. The hospice setting provides a model of excellence in supporting staff and mitigating challenging aspects of their role, which includes peer/organisational support, and regular ongoing training in key aspects of children's palliative care. Key recommendations for improving their experience included advanced communication training and knowledge sharing with other children's palliative care specialists within the acute setting. Service and policy initiatives should encourage open, informal peer/organisational support among the wider children's palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children's hospices and hospital settings.
Spelt, Elsbeth; Luning, Pieternelleke Arianne; Boekel, van Tiny; Mulder, Martin
Preparing science and engineering students to work in interdisciplinary teams necessitates research on teaching and learning of interdisciplinary thinking. A multidimensional approach was taken to examine student interdisciplinary learning in a master course on food quality management. The
Spelt, Elsbeth; Luning, Pieternelleke Arianne; Boekel, van Tiny; Mulder, Martin
Preparing science and engineering students to work in interdisciplinary teams necessitates research on teaching and learning of interdisciplinary thinking. A multidimensional approach was taken to examine student interdisciplinary learning in a master course on food quality management. The
Leo, Silvia Di; Bono, Laura; Romoli, Vittoria; West, Emily; Ambrosio, Raffaella; Gallucci, Michele; Pilastri, Paola; Ciura, Pietro La; Morino, Piero; Piazza, Massimo; Valenti, Danila; Franceschini, Catia; Costantini, Massimo
The Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce. Developing, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting. This is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices. The LCP was implemented in all the hospices involved. A high proportion of physicians (50%-100%) and nurses (94%-100%) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6% and 89.1%. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases. The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.
... Grief & Loss Resources Hospice and Palliative Care > Palliative Care Palliative Care Palliative Care Questions and Answers Palliative Care Questions and Answers Question Palliative Care Hospice Care ...
Dean, Stephanie; Libby, Katherine; McAuley, William J; Van Nostrand, Joan
Hospice bereavement services, though often overlooked in hospice research, are an important area of study due not only to the potential value of bereavement support but also the emphasis placed on such services by the Centers for Medicare and Medicaid Services. Moreover, access to these services is seldom understood or researched. Therefore, using the patient public use file of the 2007 National Home and Hospice Care Survey, we explored the relationships between patient, informal caregiver, and agency characteristics as well as discharges from hospice to gain perspective into bereavement service access to informal caregivers. Findings suggested that death at discharge from hospice may be an important moderator variable between access to hospice bereavement support and many other factors. However, even under controls for death at discharge, two agency characteristics remain significantly associated with access. Bereavement access tends to be more likely in agencies that provide only hospice care as opposed to other services, and in micropolitan agencies. Furthermore, death at discharge is less likely among African Americans, suggesting the value of enhanced culturally-appropriate and more targeted hospice care and hospice bereavement support for this population. Future research should explore the strategies used to effectively deliver bereavement services and how these strategies may benefit from targeted and culturally sensitive approaches.
Although the fields of hospice and palliative medicine and geriatrics have developed from separate origins, they share much in common. They share concerns for optimizing care of older adults with advanced illness. They both seek to address the common problem of care fragmentation for those with chronic illness. Both subspecialties see the patient and their loved ones as a unit requiring thoughtful, integrated care, rather than seeing the patient as a cluster of organ systems and conditions. The fields also share many core principles, including an emphasis on interdisciplinary care and care coordination. As increasing emphasis is placed on the medical home, chronic and advanced illness care, and systems changes to decrease care fragmentation, geriatrics and hospice and palliative medicine stand to benefit by blending efforts and common interests to improve care for patients and their loved ones. In 2009, a collaborative effort was begun involving the leadership of the American Geriatrics Society, the American Academy of Hospice and Palliative Medicine, and the John A. Hartford Foundation. The goal of the collaboration was to convene leaders in geriatrics and hospice and palliative medicine to identify areas of potential synergy between the two subspecialties and to design a plan for exploring and developing these areas of common interest. This article describes the progress of the collaborative effort to date. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
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.
Wladkowski, Stephanie P
Hospice offers holistic support for individuals living with terminal illness and their caregivers. Some individuals receiving hospice services experience a slower decline in health as than expected, resulting in a 'live discharge' from hospice. A live discharge affects both patient and caregiver(s).The current study (N=24) explored the experiences of caregivers of adults with dementia who experienced a live discharge from hospice. Findings emphasize the comprehensive services covered under the Medicare Hospice benefit and those lost after a live discharge. Implications for social workers supporting caregivers are discussed, including the need to view the patient-caregiver unit during a live discharge.
Full Text Available Mary Ellen Purkis1, Elizabeth Borycki1,2, Craig Kuziemsky3, Fraser Black4, Denise Cloutier-Fisher5, Lee Ann Fox6, Patricia MacKenzie7, Ann Syme1,8, Coby Tschanz1,41School of Nursing, 2School of Health Information Science, University of Victoria, Victoria, British Columbia; 3Telfer School of Management, University of Ottawa, Ottawa, Ontario; 4Victoria Hospice Society, Victoria, British Columbia; 5Department of Geography, University of Victoria, Victoria, British Columbia; 6Kingston General Hospital, Kingston, Ontario; 7School of Social Work, University of Victoria, Victoria, British Columbia; 8British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, CanadaBackground: Each year more than 240,000 Canadians die from terminal and chronic illnesses. It is estimated that 62% of those deaths require palliative care. Palliative care is a specialized domain of health professional team practice that requires discipline-specific knowledge, skills, judgment, and expertise in order to address patient hopes, wishes, symptoms, and suffering. With the emergence of palliative care as a specialized area of interdisciplinary practice, new practice models have also emerged, eg, the Latimer ethical decision-making model for palliative care. The purpose of this research was to undertake a descriptive ethnographic field study of palliative care team practices to understand better the interdisciplinary team communication and the issues that arise when members of different health professions work together as a team.Methods: Study data were collected by observing and videotaping palliative care team meetings. Data were then analyzed using direct content analysis.Results: The study findings substantiated many of the team practice concepts outlined in Latimer's model. Palliative care teams engage in a number of processes that address patient symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were
Story, Marilyn D.
Hospice is a family-centered concept of care which needs home economists from all subject-matter areas in volunteer or paid professional roles. In turn, home economists can grow personally as well as professionally through their involvement with hospice. (Author)
Kang, Jina; Kim, Yeol; Yoo, Yang Suk; Choi, Jin Young; Koh, Su Jin; Jho, Hyun Jung; Choi, Youn Seon; Park, Jeanno; Moon, Do Ho; Kim, Do Yeun; Jung, Yun; Kim, Won Chul; Lim, Seung Hee; Hwang, Seung Joo; Choe, Sang Ok; Jones, Desiree
Competency-based assessment helps to improve performance and to standardize education programs for hospice and palliative care professionals. This paper aims to report the process and results of developing the hospice and palliative care competencies by multidisciplinary experts in Korea. The competency development task force team of Korean hospice and palliative care professionals was comprised of seven physicians, four nurses, two social workers, and two clergy. To build consensus regarding competencies, the team performed a two-round Delphi survey. The importance of competency domains was assessed by using a 5-point Likert scale. After the completion of the Delphi survey, final competency domains were decided in a consensus meeting. The competencies were composed of knowledge, skills, and attitudes. The competency domains were identified as the following: 11 domains and 16 subdomains for physicians, 11 domains for nurses, 5 domains and 15 subdomains for social workers, as well as 3 domains and 5 subdomains for spiritual care providers. The high importance domains were different by specialties. Physical care and treatment for physicians, symptom management for nurses, bereavement care for social workers, and communication for spiritual care providers were ranked as highly important. For nurses and spiritual care providers, attitude-related domains were ranked the highest in importance. The competencies developed by multidisciplinary professionals are useful to identify the appropriate roles of each hospice and palliative care specialist involved in a team approach to patient care.
Lau, Denys T.; Joyce, Brian; Clayman, Marla L.; Dy, Sydney; Ehrlich-Jones, Linda; Emanuel, Linda; Hauser, Joshua; Paice, Judith; Shega, Joseph W.
Context Managing and administering medications to relieve pain and symptoms are common, important responsibilities for informal caregivers of patients receiving end-of-life care at home. However, little is known about how hospice providers prepare and support caregivers with medication-related tasks. Objectives This qualitative study explores the key approaches that hospice providers employ to facilitate medication management for caregivers. Methods Semi-structured, open-ended interviews were conducted with 22 providers (14 nurses, four physicians, and four social workers) from four hospice organizations around an urban setting in the Midwest U.S. Results Based on the interviews, the following five key approaches emerged, constituting how the hospice team collectively helped caregivers manage medications: 1) establishing trust; 2) providing information; 3) promoting self-confidence; 4) offering relief (e.g., provided in-home medication assistance, mobilized supportive resources, and simplified prescriptions); and 5) assessing understanding and performance. Each hospice discipline employed multiple approaches. Nurses emphasized tailoring information to individual caregivers and patients, providing in-home assistance to help relieve caregivers, and assessing caregivers’ understanding and performance of medication management during home visits. Physicians simplified medication prescriptions to alleviate burden and reassured caregivers using their perceived medical authority. Social workers facilitated medication management by providing emotional support to promote self-confidence and mobilizing resources in caregivers’ support networks and the community at large. Conclusion Hospice nurses, physicians, and social workers identified distinct, yet overlapping, approaches in aiding caregivers with medication management. These findings emphasize the importance of teamwork among hospice providers. Future research should investigate how common, standardized, effective
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.
Campbell, Courtney S; Cox, Jessica C
Although the overwhelming majority of terminally ill patients in Oregon who seek a physician's aid in dying are enrolled in hospice programs, hospices do not take a major role in this practice. An examination of fifty-five Oregon hospices reveals that both legal and moral questions prevent hospices from collaborating fully with physician-assisted death.
Jenkins, Todd M; Chapman, Kathryn L; Ritchie, Christine S; Arnett, Donna K; McGwin, Gerald; Cofield, Stacey S; Maetz, H Michael
The literature predominately describes hospice utilization among Medicare recipients, with a limited number of reports describing use among all age groups. This study aimed to describe and compare patterns of hospice use among decedents of all ages in Alabama using a population-based approach. We obtained death certificates for Alabama residents who died from January 1, 2002 to December 31, 2005 (n=178,420). To ascertain hospice use, we linked death certificates to the hospice administering care using state-mandated listings of deaths reported by hospices. Additionally, each decedent's residence at death was geocoded and area-level socioeconomic status (SES) measures were added. From 2002 to 2005, a total of 43,638 Alabamians died while under hospice care, representing a quarter (24.5%) of all deaths in the state. During this four-year span, the rate of hospice use increased by nearly 15% (22.2%-25.6%). As expected, rates of hospice use increased with age at death. For the SES indicators for poverty, education, and income, rates of hospice use increased as SES improved. However, this pattern was found to vary by race and metro/nonmetro status. In addition to revealing racial, geographic, and other disparities in hospice care across Alabama, our results indicate usage rates in Alabama trail behind those observed nationally. We also identified previously unreported interactions between race, urbanization level, and poverty classification. Future studies should explore whether such relationships exist elsewhere and the rationale for their occurrence. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Parker Oliver, Debra; Demiris, George; Washington, Karla; Kruse, Robin L; Petroski, Greg
Untrained family caregivers struggle with complicated medical management regimens for hospice patients. An intervention was tested to improve caregiver's perception of pain management and patient's pain. The intervention was tested with a 2-group (usual care vs intervention) randomized controlled trial using parallel mixed-methods analysis of 446 caregivers in 3 Midwestern hospice programs representing rural and urban settings. Web conferencing or telephones were used to connect caregivers with the hospice care team during care plan meetings. Caregiver's perceptions of pain management were the primary outcome. Secondary outcomes included caregiver quality of life, patient's pain, and anxiety. Video recordings, field notes, and caregiver and staff interviews provided qualitative data. The overall perception of pain management was not changed by the participation in hospice team meetings. Perceptions of fatalism improved for intervention participants, and the intervention participants perceived their patients' pain was better controlled than those in the control group. The intervention was found to be feasible to deliver in rural areas. Caregiver's anxiety and patient's pain were correlated ( r = .18; P = .003), and subanalysis indicated that caregivers of patients with cancer may benefit more from the intervention than other hospice caregivers. Qualitative analyses provided understanding of caregiver's perceptions of pain, cost, and facilitators and barriers to routine involvement of family in care plan meetings. Limitations and Conclusion: The hospice philosophy is supportive of caregiver involvement in care planning, and technology makes this feasible; the intervention needs modification to become translational as well as additional measurement to assess effectiveness. Caregiver education and emotional support should occur outside the meeting, and a strong leader should facilitate the meeting to control efficiency. Finally, the intervention may benefit caregivers
Casarett, David J; Quill, Timothy E
Hospice programs offer unique benefits for patients who are near the end of life and their families, and growing evidence indicates that hospice can provide high-quality care. Despite these benefits, many patients do not enroll in hospice, and those who enroll generally do so very late in the course of their illness. Some barriers to hospice referral arise from the requirements of hospice eligibility, which will be difficult to eliminate without major changes to hospice organization and financing. However, the challenges of discussing hospice create other barriers that are more easily remedied. The biggest communication barrier is that physicians are often unsure of how to talk with patients clearly and directly about their poor prognosis and limited treatment options (both requirements of hospice referral) without depriving them of hope. This article describes a structured strategy for discussing hospice, based on techniques of effective communication that physicians use in other "bad news" situations. This strategy can make hospice discussions both more compassionate and more effective.
DIANE E. MEIER
.... It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services...
Bercovitz, Anita; Sengupta, Manisha; Jones, Adrienne; Harris-Kojetin, Lauren D
Objective-This report presents national estimates on the provision and use of complementary and alternative therapies (CAT) in hospice. Comparisons of organizational characteristics of hospice care providers are presented by whether the provider offered CAT. Comparisons of selected characteristics of patients discharged from hospice are presented by whether they received care from a provider that offered CAT, and whether they received a CAT service. Methods-Estimates are based on data from the 2007 National Home and Hospice Care Survey (NHHCS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Results-In 2007, 41.8% of hospice care providers offered CAT services, had a CAT provider on staff or under contract, or both. Among hospice care providers offering CAT, over one-half offered massage (71.7%), supportive group therapy (69.0%), music therapy (62.2%), pet therapy (58.6%), or guided imagery or relaxation (52.7%). Of the hospice care providers that offered CAT, 21.5% had at least one discharged hospice patient who received CAT during hospice care. Overall, 4.9% of all discharged hospice patients received at least one CAT from the hospice care provider. Over one-half of discharged patients (56.5%) received care from a provider that offered CAT, and of those, 8.6% received at least one CAT from the hospice care provider during their stays. There were no differences in demographics, health, functional status, or admission diagnoses between patients discharged from hospice either by whether they received care from a provider that offered CAT or whether they received CAT.
Singleton, Rivers, Jr.; Brock, D. Heyward
Outlines an interdisciplinary workshop in bioethics for secondary teachers taught by a team consisting of a scientist, a philosopher, and a literary critic. Discusses definitions, topics, reading selections, problems, and value. (DC)
Lindley, Lisa C; Colman, Mari Beth; Meadows, John T
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.
The modern hospice movement emerged in the late 1960s largely as a reaction to the way in which death and dying were dealt with in the hospital building. From the early development of the hospice movement, setting was considered to be very important. Hospice buildings were more residential and "homely" than their hospital counterparts. However, with the widespread development of "hospice home-care" programmes in the 1980s, this emphasis on place and setting changed, and along with it the meaning of the term "hospice" has changed. The current claim of the hospice movement is that "hospice" is a philosophy of care not a building or place.Home is now widely considered to be the best place to die, a place of familiar surroundings and the company of family and friends. The modern preference to die at home relies on traditional models of home, family and community. Dying at home was at one time commonplace and envisioned within the design of the home, and caring was a normal expectation of key family members. In modern society, however, dying is generally not a considered function within the design brief of the home and families may be unable, through economic, geographical or other reasons, to be carers. Thus, for some, home may not be the best place to die and family may not be the best carer. As a result, many people, despite their preference for home, still end up dying in the hospital building. This paper discusses the spatial issues surrounding the concept of home as hospice and questions the universal suitability of the contemporary home as a hospice.
Ten Have, Elsbeth C M; Nap, Raoul E; Tulleken, Jaap E
The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. A daily recurrent situation in ICUs in which both leadership behavior and interdisciplinary teamwork are integrated concerns the interdisciplinary rounds (IDRs). Although IDRs
Poulsen, Mikkel; Knudstrup, Mary-Ann; Hoff, Peter
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...... control furnishings, light, and climate, the users have personal control over the environment and can create a tempo- rary home. Creating a stable environment for the relatives and patients alike benefits the well-being of all users. In conclusion, the architecture of a children’s hospice must facilitate...
Nishimura, Tetsuo; Sugiyama, Akira; Shimizu, Teppei; Ichinohe, Kenji; Teshima, Takeshi; Kaneko, Masao; Hara, Yoshio; Chihara, Satoshi.
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.
Sirriyeh, Reema; Armitage, Gerry; Lawton, Rebecca; Gardner, Peter
This study explores the experiences of health professionals in managerial roles at various levels in child and adult hospice care in northern England, studying perspectives around managing medical error, the issues that arise, and the challenges faced. A multicentred, descriptive, exploratory design was adopted. The sample comprised 10 hospice managers (five deputy and five senior managers) from four hospices (two adult and two children's) in the north of England. Participants took part in individual semi-structured interviews, which lasted between 45-60 minutes each. Interviews were transcribed and analysed by a team of three researchers, including two health psychologists and one nurse using a qualitative analytic framework. Emerging themes appeared to be inter-related and were ultimately linked to two meta-concepts; underpinning and fundamental to the data, these issues were intrinsically tied to all emerging themes. Primary themes were defined by their explanatory power and regularity. Primary themes highlighted the impact of managing error on management teams at a professional and personal level, the challenges for error management in hospice settings, the use of error management tools, and the conceptualization of blame in these settings. The strong influence of the health-care setting in which an error takes place on the outcomes of an error event for the health professional, managers, health-care organizations, and ultimately patients was evident.
Full Text Available Being aware of the tradition of research on spirituality in theology and the existence of detailed publications and research concerning psychology of religion and religiosity in psychology as well as other sciences in Poland, the authors propose the recognition and adaptation of the FICA tool for spirituality research. The belief in the importance of deepening the knowledge and providing tools to research spirituality of human existence results from a long practice of the authors in palliative and hospital care. Understanding a difficulty in operationalizing the category of spirituality, they attempted at searching for a method that would be applicable to persons at the end of their lives as well as to all the suffering. Having analyzed the research tools built by Polish science as well as available ones on religiosity and spirituality the following paper aims at presenting the unknown FICA tool (F – Faith and Believe, I – Importance, C – Community, A – Address in Care in Poland by Prof. Dr. Christina M. Puchalski, USA, being adapted to Polish practice. The tool presented allows for the evaluation of spiritual experience of persons taken medical and social care of by every member of multidisciplinary team of professionals. Since the FICA tool is a qualitative scale it does not need a normalization and standardization methodology. However, a cultural adaptation is crucial in order to make the practical tool become help in answering spiritual and existential questions posed by patients to workers and voluntaries engaged in the process of Care.
Woitha, K; Schneider, N; Wünsch, A; Wiese, B; Fimm, S; Müller-Mundt, G
Palliative care is an approach that improves the quality of life of patients with incurable and progressive illnesses; therefore, in these situations physiotherapy can play an important role. This study was carried out to examine the integration and utilization of physiotherapy in palliative and hospice care services in Germany. A cross-sectional survey including all palliative care units, specialized outpatient palliative care teams and hospices in Germany (n = 680) in 2013 was carried out. The response rate was 43.5 % (n = 296). Physiotherapy is predominantly applied in palliative care units (79 %) but rarely in hospices (38 %) and outpatient palliative care teams (30 %). A structured physiotherapeutic assessment is rarely carried out even on palliative care units (26 %). Positive effects of physiotherapy are especially described for symptoms, such as edema, pain, constipation and dyspnea. Despite its significant potential to relieve symptoms, physiotherapy is not systematically integrated into palliative care practice in Germany.
Ten Have, Elsbeth C. M.; Nap, Raoul E.; Tulleken, Jaap E.
The implementation of interdisciplinary teams in the intensive care unit (ICU) has focused attention on leadership behavior. Daily interdisciplinary rounds (IDRs) in ICUs integrate leadership behavior and interdisciplinary teamwork. The purpose of this intervention study was to measure the effect of
Teno, Joan M; Bowman, Jason; Plotzke, Michael; Gozalo, Pedro L; Christian, Thomas; Miller, Susan C; Williams, Cindy; Mor, Vincent
Little is known about how hospice live discharges vary by hospice providers' tax status and chain affiliation. To characterize hospices with high rates of problematic patterns of live discharges. Three hospice-level patterns of live discharges were defined as problematic when the facility rate was at the 90th percentile or higher. A hospice with a high rate of patients discharged, hospitalized, and readmitted to hospice was considered to have a problematic live discharge pattern, which we have referred to as burdensome transition. The two other problematic live discharge patterns examined were live discharge in the first seven days of a hospice stay and live discharge after 180 days in hospice. A multivariate logistic model examined variation in the hospice-level rate of each discharge pattern by the hospice's chain affiliation and profit status. This model also adjusted for facility rates of medical diagnoses, nonwhite patients, average age, and the state in which the hospice program is located. In 2010, 3028 hospice programs had 996,208 discharges, with 18.0% being alive. Each proposed problematic pattern of live discharge varied by chain affiliation. For-profit providers without a chain affiliation had a higher rate of burdensome transitions than did for-profit providers in national chains (18.2% vs. 12.1%, P live discharges are higher among for-profit providers, especially those not affiliated with a hospice chain. Copyright © 2015 American Academy of Hospice and Palliative Medicine. All rights reserved.
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...
... palliative care can also provide tailored support to meet the needs of these heroes. The Affordable Care Act... individuals in their final days. Hospice care gives medical services, emotional support, and spiritual...
Dealing with a death in the family is always difficult. Hospice professionals can ease some of the burden by learning about each family's particular religious and cultural beliefs, ensuring that everyone's emotional and cultural needs are addressed.
... care? • How long has the hospice been in business? • How often will a nurse or social worker ... the service follows rules for patient safety and quality. Go to Quality Check ® at www. qualitycheck. org ...
Snapp, Janet; Kelley, Debra; Gutgsell, Terence L
Implementing a Pharmacy and Therapeutics Committee (P&T) as a management strategy for Hospice of the Bluegrass in Lexington, Kentucky, has proven to be effective in reducing costs and improving patient outcomes. Early efforts of the committee yielded the establishment of protocols and guidelines, educational programs, pharmacy newsletters for nurses, and patient education material. In the spring of 2000, Hospice of the Bluegrass developed a preferred drug list (PDL) consisting of the medications it considered essential for effective pain and symptom control. The addition of a clinical pharmacist and a P&T committee has resulted in significant cost savings and improved pharmacotherapeutic care for patients of Hospice of the Bluegrass. This model is an option for any hospice looking to achieve the same outcomes.
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v AJ: The bachelor thesis deals with feeding of seniors in hospice. The aim of the thesis is to investigate the nutritional state of seniors in hospice, their dietary habits, and their satisfaction with feeding. The importance of nutrition, the main components of diet (proteins, saccharides, lipids, vitamins, minerals, and trace elements), examinational methods of nutritional state, and dietary system is emphasized in the theoretical part of the thesis. Further, the trophotherapy and the meth...
Rahman, Anna N
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: email@example.com.
Townsend, Apollo; March, Alice L; Kimball, Jan
African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches (N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community. © The Author(s) 2015.
Chang, P M-H; Liu, Y-Y L; Chao, T-C; Lin, H-L; Chen, M-B; Chen, P-M; Chiou, T-J
The terminal cancer patients increase needs for hospice care day by day. A new hospice consulting system has been developed in Taiwan to provide options for terminal cancer patients in choosing a suitable post-acute hospice care while a combined hospice care system is also given by the consulting team in the acute wards. Hereinafter is our report. From March 2005 to January 2006, 313 terminal cancer patients were analysed. These patients had signed consent forms for palliative treatment and had received consultations from the new hospice consulting system. Multivariate analysis showed that the home care patients had better performance status (P = 0.012), less shortness of breath (P = 0.006), less limbs swelling (P = 0.043), less flatulency (P = 0.000) and less constipation (P = 0.018). Among the 162 patients with regular follow-up, the symptoms/signs were significantly improved after intervention of consulting team in pain (P = 0.000), shortness of breath (P = 0.000), difficulty in sleeping (P = 0.002), nausea (P = 0.004), constipation (P = 0.008), changes in skin (P = 0.024) and adoption (P = 0.000). This new system had significant improvement in the terminal cancer patients' symptoms/signs control in acute wards and could contribute to the care quality of home care patients.
Full Text Available Communication is fundamental in scientific practice and an integral part of academic work. The practice of communication cannot be neglected by those who are trying to advance scientific research. Effective means should continuously be identified in order to open channels of communication within and among disciplines, among scientists and between scientists and the general public.The increasing importance of interdisciplinary communication has been pointed out by an increasing number of researchers and scholars, as well as in conferences and roundtables on the subject. Some authors even estimate that "interdisciplinary study represents the future of the university." Since interdisciplinary study is "the most underthought critical, pedagogical and institutional concept in modern academy" it is important to think and reflect, and even do some research, on this concept or notion. Research and practice based reflections with regards to this issue are important especially because the increasing complexity and proliferation of scientific research is generating countless specialties, sub-specialties and sub-sub-specialties, with their respective special languages; which were "created for discrete local areas of research based upon the disconnected branches of science." On the other hand, scientific, technical and societal problems are requiring multi- or inter-disciplinary consideration. Consequently, interdisciplinary communication channels are being needed with urgency, and scientific research should be integrated, not just in the context of its discipline, but also in the context of related disciplines. Much more reflection and research should be done on this issue. Research on adequate research integration and communication is urgently required, i.e. meta-research efforts should be done in order to relate research results in an adequate and more useful way. This meta-research effort might be done in the context of each particular
Full Text Available In face of the final phase of a terminal disease, the patient’s family is always in a difficult position. A progressing chronic disease (especially cancer of one of the family members directly influences the mental and physical state of their closest of kin. Hospice care helps the dying patients and their families. The term “hospitium” is connected through classical Latin to the word “hospes”, which means a person connected with another in a lasting relationship arising out of hospitality, (a host taking care of newcomers, a traveller, or one visiting a road house. Whereas the concept of palliative care was derived from the following English words: palliate – to relieve pain; palliation – making the symptoms of a disease less severe without curing it. The hospice movement has a very long history, and reaches back to pagan traditions. Initially care was provided in shelters, asylums for the poor and inns. In France, a hospice (asylum founded in the 15th century for the care over the poorest stands to this day. A great change in the history of nursing was initiated in the 19th century. It was a time of intensive development for medicine and discoveries in the field of biology. Palliative and hospice care as well as palliative medicine owe their professional origins to C. Sanders, the founder of St Christopher’s Hospice in London in 1967. It is also known that in 1987, a palliative care ward began its functioning in Montreal. In Poland, the need to organise household care over seriously ill patients was noticed by H. Chrzanowska (1964, who is seen as the precursor of this kind of care. In the 1980s and 1990s, the idea of hospices experienced a real boom in Poland. Currently a hospice stands for a centre of care over patients in their so-called terminal phase of the disease, where interdisciplinary care is provided. This care creates the conditions for a dignified life until the very end, and thus suffering, pain and death are no
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.
Full Text Available Abstract Background While most people faced with a terminal illness would prefer to die at home, less than a third in England are enabled to do so with many dying in National Health Service hospitals. Patients are more likely to die at home if their carers receive professional support. Hospice rapid response teams, which provide specialist palliative care at home on a 24/7 on-call basis, are proposed as an effective way to help terminally ill patients die in their preferred place, usually at home. However, the effectiveness of rapid response teams has not been rigorously evaluated in terms of patient, carer and cost outcomes. Methods/Design The study is a pragmatic quasi-experimental controlled trial. The primary outcome for the quantitative evaluation for patients is dying in their preferred place of death. Carers’ quality of life will be evaluated using postal questionnaires sent at patient intake to the hospice service and eight months later. Carers’ perceptions of care received and the patient’s death will be assessed in one to one interviews at 6 to 8 months post bereavement. Service utilisation costs including the rapid response intervention will be compared to those of usual care. Discussion The study will contribute to the development of the evidence base on outcomes for patients and carers and costs of hospice rapid response teams operating in the community. Trial registration: Current controlled trials ISRCTN32119670.
Park, K S; Yeom, H A
While the need for hospice care is increasing in Korea, there is limited research describing the way hospice care is understood by hospital ward nurses who may have relatively limited opportunities for hospice education in their workplace. This study aimed to describe Korean nurses' attitudes towards hospice care and to examine the relationships between nurses' attitudes towards hospice care and their demographic and work-related characteristics. This was a cross-sectional descriptive study. A total of 348 registered nurses recruited from six general hospitals were surveyed using a structured questionnaire. Measurements included general and work-related characteristics and the Frommelt Attitude Toward Care of the Dying Scale. The mean score for nurses' attitudes towards hospice care was 2.52 out of a maximum of 3.0. More positive attitudes towards hospice care were associated with older age, married status, a higher level of education, working at a hospice unit, a higher job position, more years of work experience, having previous experience caring for dying patients and having received education in hospice care. Factors predicting nurses' attitudes towards hospice care included the number of years of work experience and working at a hospice unit in a hospital, with an explanatory power of 22%. The study was conducted in tertiary care hospitals in Seoul metropolitan area; results may therefore differ in other geographical regions. Education on hospice care should be targeted to less experienced, younger staff nurses who have no previous education on hospice care or have not worked in a hospice unit. Tertiary hospitals need to provide more opportunities for their nurses to obtain continuing education on hospice care or increase the number of courses available at the institutional level in order to enhance their nurses' attitudes towards hospice care. © 2014 International Council of Nurses.
Washington, Karla T.; Pike, Kenneth C.; Demiris, George; Oliver, Debra Parker
Purpose The purpose of this study was to describe the unique characteristics of informal hospice cancer caregiving. Methods Researchers conducted a secondary analysis of data drawn from a randomized clinical trial of an informal hospice caregiving intervention (N=348). Demographic characteristics and measures of the informal caregiving experience of hospice patients and their informal caregivers were compared based on the patient’s diagnosis using chi-square tests for association of categorical variables and t tests for continuous variables. Results Informal caregivers of cancer patients differed from their non-cancer counterparts in a number of respects including patient age, caregiver age, patient residence, relationship between patient and caregiver, amount and duration of care provided, likelihood to incur out-of-pocket expenses related to patient care, caregiver problem-solving style, and impact on caregiver daily schedule. There were no statistically significant differences between cancer and non-cancer caregivers in terms of gender, race, employment status, anxiety, and quality of life. Conclusions While cancer and non-cancer caregivers are similar in many respects, a number of unique features characterize the informal hospice cancer caregiving experience. Attention to these unique features will allow hospice providers to tailor supportive care interventions to better address cancer caregivers’ needs. PMID:25547480
HCS, Inc., Potomac, MD.
This publication contains a curriculum to prepare nurses for delivery of hospice care for the terminally ill. It provides training manuals for both participant and facilitator in a preservice or inservice Hospice Education Program. Each manual (participant and facilitator) includes nine modules: (1) Hospice Care Concept; (2) Communication Skills;…
Becker, Janet E.
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,…
Fairman, Nathan; Montross Thomas, Lori P.; Whitmore, Stephanie; Meier, Emily A.
Abstract Background: Patient suicides can affect clinicians both personally and professionally, with frequent reports of psychological and behavioral changes occurring in response to this type of patient death. Although hospice clinicians have regular exposure to dying patients, the impact of patient suicide on this group has been understudied. Objectives: This study examined the personal and professional impact of patient suicides among hospice clinical staff, the coping strategies used by this group, and their recommendations for staff support after a patient suicide. Design: Utilizing an online survey, 186 hospice staff qualitatively described the impact of patient suicides on them as people and professionals, their resulting coping strategies, and any recommendations for supporting others. Three study investigators coded all of the staff responses at a paragraph level and summarized the most common emergent themes using grounded theory procedures. Setting/Subjects: One hundred eighty-six clinical staff members who worked in an academic nonprofit hospice setting. Measurements: An open-ended, qualitative survey was used to gather data about demographics, clinical experience, exposure to known or suspected suicides, recommendations for support in the event of a patient suicide, the personal and professional impacts of suicide, and coping strategies. Results: The themes expressed by the hospice staff in reaction to patient suicides included: psychological responses such as feelings of guilt and self-doubt, changes in professional attitudes, and changes in clinical practice such as greater sensitivity to signs of suicide. When coping with a patient suicide, hospice staff described the use of team-based support strategies, debriefings, and personal spiritual practices. Recommendations for future support included facilitated debriefings, individual counseling, spiritual practices, leaves of absence, self-care activities, and educational interventions. Conclusion: Data
Hess, Shirley A; Knox, Sarah; Hill, Clara E; Byers, Tara; Spangler, Patricia
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.
Shin, Jennifer; Casarett, David
Hospice programs provide comprehensive, compassionate care to dying patients and their families. However, many patients do not enroll in hospice, and those who do generally receive hospice care only in the last weeks of life. Although patients and families rely on their physicians to discuss hospice, there is often inadequate communication between patients and physicians about end-of-life issues. We describe a Six-Step Roadmap for navigating discussions about hospice adapted from the SPIKES protocol for delivering bad news: setting up the discussion, assessing the patient's perception, inviting a patient to discuss individual goals and needs, sharing knowledge, empathizing with the patient's emotions, and summarizing and strategizing the next steps.
Dillon, Ellis C
Little is known about how patient and family engagement manifests in home hospice care. This qualitative study included interviews and observation of home hospice care with 18 patients, 11 caregivers, and 26 hospice workers in the United States. Structural factors (e.g., home setting, ample time, personal relationships), hospice worker strategies (e.g., patient education and presenting choices), and family member support facilitated engagement. Barriers to engagement included difficult relationships and unavailable or unwilling family members. Home hospice care demonstrates potential strategies for continuous, informed, and holistic engagement. These engagement strategies may translate to other arenas of health care.
... 42 Public Health 5 2010-10-01 2010-10-01 false Survey teams. 488.314 Section 488.314 Public Health...-Term Care Facilities § 488.314 Survey teams. (a) Team composition. (1) Surveys must be conducted by an interdisciplinary team of professionals, which must include a registered nurse. (2) Examples of professionals...
Boucher, Nathan A; Kuchibhatla, Maragatha; Johnson, Kimberly S
Describe social goods and services for which hospices assist patients and families and the resources hospices use to do so. Basic social supports and services not routinely covered by insurers may be needed by terminally ill patients and their families. Little is known about hospices' provision of such social supports and services. A 2014-2015 cross-sectional survey of hospices nationwide. Participating hospices had been in operation for at least 3 years and were located in any of the 50 states or District of Columbia. Hospices were surveyed about availability and sources of internal funds and referral to obtain basic social supports for patients. Descriptive statistics, bivariate analysis, and categorization were used to describe hospice practices. Measures included frequency and nature of goods and services provision in the prior year; and extent to which hospices used internal funds or community referral for goods and services. Over 80% (n = 203) reported internal funds covered services not reimbursed by insurers; 78% used funds in last year. Hospices used internal funds for food (81.7%), shelter (57.8%), utility bills (73.5%), and funeral costs (50%). Hospices referred patients/families to community organizations to obtain a similar range of services, including transportation, clothing, linens/towels, furniture/appliances, home repairs, and caregiver support. Hospices are using internal resources and accessing community resources to provide patients with basic social needs not routinely covered by insurance.
Lum, Hillary D; Horney, Carolyn; Koets, David; Kutner, Jean S; Matlock, Daniel D
Availability of cardiac medications in hospice for acute symptom management of heart failure is unknown. This study explored hospice approaches to cardiac medications for patients with heart failure. Descriptive study using a quantitative survey of 46 US hospice agencies and clinician interviews. Of 31 hospices that provided standard home medication kits for acute symptom management, only 1 provided medication with cardiac indications (oral furosemide). Only 22% of the hospice agencies had a specific cardiac medication kit. Just over half (57%) of the agencies could provide intravenous inotropic therapy, often in multiple hospice settings. Clinicians described an individualized approach to cardiac medications for patients with heart failure. This study highlights opportunities for practice guidelines that inform medical therapy for hospice patients with heart failure. © The Author(s) 2015.
Cooper, Lesley; Gray, Helen; Adam, Joan; Brown, Duncan; McLaughlin, Patricia; Watson, Julie
Over the past 20 years, visiting policies within adult care settings have progressed from strictly enforced times to more flexible arrangements. The Scottish Commission for the Regulation of Care (SCRC, 2003) advocates open visiting in hospices, which allows access at all times of day. However, little research has been carried out to investigate the assumption that an 'open visiting' policy in a hospice benefits patients and carers and improves the quality of care. This article describes the first strand of a qualitative exploratory study designed to evaluate the impact that open visiting has on patients and the multidisciplinary team in a hospice. A purposive sample of ten inpatients was interviewed. Data were analysed thematically. Patients acknowledged the benefits of contact with family and friends, such as maintaining links with the outside world and improvement in mood. However, they also reported that visitors could be intrusive and, depending on the nature of the relationship, were not always sensitive to cues that the patient was tiring or in pain. Patients indicated a need for more control of visiting arrangements, particularly related to timing, visitor numbers and restrictions on who could visit. These data will contribute to the second strand of the study which involves interviewing multidisciplinary team members.
Casarett, David J; Harrold, Joan; Oldanie, Betty; Prince-Paul, MaryJo; Teno, Joan
There is very little high-quality evidence to guide clinical practice in hospice care. In the areas of medical therapy, patient-centered and family-centered outcomes, and patient safety, there are numerous high-impact questions for which answers are needed. Although randomized controlled trials are the gold standard for research, such trials are difficult, time consuming, and expensive to conduct in a hospice population. Moreover, they cannot examine the implementation of therapies in real-world settings. Therefore, there is a need for novel, complementary approaches to research in this unique population. This article describes the initial experience of the Coalition of Hospices Organized to Investigate Comparative Effectiveness (CHOICE). CHOICE is a national network of hospices that use electronic health record-based data collection procedures to answer key questions relevant to clinical care and policy. By using a rich source of existing data to conduct observational studies, CHOICE is able to overcome many of the most significant challenges of randomized controlled trials in hospice. However, this approach also created unique challenges related to governance and privacy concerns. CHOICE is a growing research network that has the potential to make a contribution to the science of palliative care in a hospice population.
Connor, Stephen R; Gwyther, Elizabeth
The Worldwide Hospice Palliative Care Alliance (WHPCA) is an international non-governmental organization registered as a charity in England and Wales that was established in 2008 following a series of international gatherings that highlighted the important need for palliative care to be included in global policy and health planning. The vision of the WHPCA is a world with universal access to hospice and palliative care. Its mission is to foster, promote and influence the delivery of affordable, quality palliative care. This article describes the evolution of the WHPCA and what it has been able to accomplish in the eight years since its formation. These accomplishments include effective advocacy with United Nations bodies, acceptance as a non-governmental organization in official relations with the World Health Organization and the UN Economic and Social Council, publication of many position papers on critical aspects of palliative care, publication of the Global Atlas of Palliative Care at the End of Life, development of toolkits for palliative care development, publication of the international edition of ehospice, and management of World Hospice and Palliative Care Day each year. Some of the many challenges to the growth and development of palliative care globally are described along with future plans. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Recognizes the need for improved professional training in the care of the dying. Discusses ways in which such training might be provided in the light of British experience. Suggests that hospice programs should incorporate an education program aimed to meet deficiencies revealed in recent studies. (Author)
Antoinette McCallin, Ph.D., M.A. (hons, B.A., RGON
Full Text Available The aim of this emerging grounded theory study was to discover the main concerns of health professionals working in interdisciplinary teams, and to explain the processes team members used to continually resolve practice problems. Data collected from forty-four participants from seven disciplines in two teaching hospitals in New Zealand, included eighty hours each of interviewing and participant observation. In this paper the theory of pluralistic dialoguing is presented. It is argued that interdisciplinary work is possible whenthe team replaces the discipline focus with a client-focused care and thinks differently about service delivery. Thinking cooperatively requires individual team members to dialogue with colleagues, thereby deconstructing traditional ways of thinking and reconstructing new approaches to interdisciplinary practice. Although dialoguing was an informal process occurring within clinical spaces, as the effects of health reform and restructuring intensify teams also need to establish formal dialogue groups to facilitate team practice development and support team learning in the continually changing fast-paced practice context.
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.
Lindley, Lisa C; Mark, Barbara A; Daniel Lee, Shoou-Yih; Domino, Marisa; Song, Mi-Kyung; Jacobson Vann, Julie
Children at the end of life often lack access to hospice care at home or in a dedicated facility. The factors that may influence whether or not hospices provide pediatric care are relatively unknown. The purpose of this study was to understand the institutional and resource factors associated with provision of pediatric hospice care. This study used a retrospective, longitudinal design. The main data source was the 2002 to 2008 California State Hospice Utilization Data Files. The sample size was 311 hospices or 1368 hospice observations over seven years. Drawing on institutional and resource dependence theory, this study used generalized estimating equations to examine the institutional and resource factors associated with provision of pediatric hospice care. Interaction terms were included to assess the moderating effect of resource factors on the relationship between institutional factors and provision of care. Membership in professional groups increased the probability (19%) of offering hospice services for children. Small- (-22%) and medium-sized (-11%) hospices were less likely to provide care for children. The probability of providing pediatric hospice care diminished (-23%) when competition increased in the prior year. Additionally, small size attenuated the accreditation-provision relationship and medium size magnified the membership-provision relationship. Professional membership may promote conformity to industry standards of pediatric care and remove the unknowns of providing hospice care for children. Hospices, especially medium-sized hospices, interested in developing or expanding care for children may benefit by identifying a pediatric champion to join a professional group. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Zheng, Nan Tracy; Li, Qinghua; Hanson, Laura C; Wessell, Kathryn L; Chong, Natalie; Sherif, Noha; Broyles, Ila H; Frank, Jennifer; Kirk, M Alexis; Schwartz, Carol R; Levitt, Alan F; Rokoske, Franziska
With increasing use of the Medicare hospice benefit, policymakers recognize the need for quality measurement to assure that terminally ill patients receive high-quality care and have the information they need when selecting a hospice. Toward these goals, Centers for Medicare & Medicaid Services has been collecting standardized patient-level quality data via the Hospice Item Set (HIS) since July 1, 2014. This article presents a first look at the national hospice HIS quality data. We calculated seven quality measures using the HIS data. These measures are endorsed by the National Quality Forum and focus on important care processes hospice providers are required to perform at admission, including discussion of patient preferences regarding life-sustaining treatments, care for spiritual and existential concerns, and symptom management (pain, opioid-induced constipation, and dyspnea). Our sample included 1,218,786 hospice patients discharged from 3922 hospices from October 1, 2014 to September 30, 2015. More than 90% of patients received screenings and assessments captured by six of the seven quality measures. The only exception was pain assessment, for which the national mean score was 78.2%. A small number of hospices (156, 4.0%) had perfect scores for all seven quality measures. Most hospices conduct critical assessments and discuss treatment preferences with patients at admission, although few hospices have perfect scores. Copyright © 2017. Published by Elsevier Inc.
Tsalatsanis, Athanasios; Barnes, Laura E; Hozo, Iztok; Djulbegovic, Benjamin
Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed...
... provide coverage for hospice care under Part A. See Tax Equity and Fiscal Responsibility Act of 1982...-hospice's cap determinations in future cap years. See, e.g., Los Angeles Haven Hospice, Inc. v. Leavitt...
This article, Part 2 of a 2-part series, continues the examination of the Medicare compliance climate and its impact on hospice providers. This 2nd part focuses on hospice-specific compliance risk areas and specific risk-reduction strategies. The case example from Part 1 is continued.
Since society and science need interdisciplinary works, the interesting topic of chaos is chosen for interdisciplinary education in physics. The educational programme contains various university-level activities such as computer simulations, chaos experiment and team projects besides ordinary teaching. According to the participants, the programme…
Antoinette McCallin, Ph.D., M.A. (hons), B.A., RGON
The aim of this emerging grounded theory study was to discover the main concerns of health professionals working in interdisciplinary teams, and to explain the processes team members used to continually resolve practice problems. Data collected from forty-four participants from seven disciplines in two teaching hospitals in New Zealand, included eighty hours each of interviewing and participant observation. In this paper the theory of pluralistic dialoguing is presented. It is argued that int...
Walker, Andreas; Breitsameter, Christof
The present article considers conflicts and conflict regulation in hospices. The authors carried out a qualitative study in three hospices in North Rhine-Westphalia, Germany, to explore how conflicts arise and how conflict regulation proceeds. Hospice nurses should act according to a set of ethical codes, to mission statements of the institution and to professional standards of care. In practice the subjective interpretations of codes and/or models concerning questions of care are causes of c...
Now, more than ever, palliative medicine has been gaining recognition for its essential role in cancer treatment. Since its beginning, it has emphasized the importance of collaboration among multidisciplinary professionals, valuing a comprehensive and holistic philosophy, addressing a wide range of hopes and suffering that patients and families experience. There are three models (approaches) for the medical teams: multidisciplinary, interdisciplinary, and transdisciplinary. Palliative care teams often choose the interdisciplinary team model, and the teams in the palliative care units may often choose the transdisciplinary team model. Recently, accumulating research has shown the clinical benefits of the interdisciplinary/transdisciplinary approach in palliative care settings. Clarifying appropriate functions and ideal features of physicians in the health care team, and enforcing the suitable team approach will contribute to improve the quality of whole medical practice beyond the framework of "palliative medicine".
Highlights the different forms of interdisciplinary teaching methods (integrated, related-arts, and correlated education) in order to provide a historical perspective of interdisciplinary education to art educators. Provides eight guidelines for future interdisciplinary programs in art education. Intends to prepare art educators for the…
Rammage, L A; Nichol, H; Morrison, M D
The University of British Columbia Voice Clinic provides care to patients with various types of voice disorder, and the effectiveness of therapy is enhanced by an interdisciplinary approach. The Voice Clinic team includes an otolaryngologist, speech pathologist, psychiatrist, and singing teacher consultant. This paper particularly highlights the interactions between the speech pathologist and psychiatrist in their therapy programs for voice disordered patients.
Most individuals in the United States have access to and use smartphones to facilitate effective collaboration. Health information technology is invaluable to the improvement of collaboration and communication in the healthcare setting. The versatile nature of technology has demonstrated that healthcare professionals are dependent on its use. Smartphones play a key role in keeping interdisciplinary team members connected.
Hofmarcher, Maria M.; Röhrling, Gerald; Riedel, Monika
In 2000 the idea of a Family Hospice Sabbatical was generated to further unburden the public health care sector facilitating family care for dying relatives or severely ill children at home. Austrian employees would have three options: uncompensated reduction of work time, change of work time or uncompensated sabbatical. The care giver can take care of spouses, partners, parents, grant parents, children, step children, foster kids, siblings and step parents.
Kuhrmann, Marco; Münch, Jürgen
Software development consists to a large extend of human-based processes with continuously increasing demands regarding interdisciplinary team work. Understanding the dynamics of software teams can be seen as highly important to successful project execution. Hence, for future project managers......, knowledge about non-technical processes in teams is significant. In this paper, we present a course unit that provides an environment in which students can learn and experience the impact of group dynamics on project performance and quality. The course unit uses the Tuckman model as theoretical framework...... of those factors. Moreover, students experienced what problems occur when teams work under stress and how to form a performing team despite exceptional situations....
Vachon, M L
The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century.
Wickson-Griffiths, Abigail; Kaasalainen, Sharon; Herr, Keela
An interdisciplinary approach to managing pain has been widely used in managing specific pain conditions (eg, lower back and fibromyalgia) but not reviewed specifically for older adults. Interdisciplinary approaches have been used in primary, residential long-term, and acute care settings, where a variety of health care professionals work on pain teams to manage pain in older adults. Given the multidimensional nature of pain in older adults, interdisciplinary approaches to managing pain are recommended in practice. This article reviews the rationale supporting an interdisciplinary approach to managing pain in older adults and summarizes studies that have evaluated this approach. Published by Elsevier Inc.
Wilson, Janet; Steers, Julie; Steele, Kath; Turner, James; Tinker, Alison
Background: Hospices and other palliative and end-of-life care providers are now required to develop services that aim to improve the quality of end-of-life care and choice in terms of place of care and death for those living with or dying from a life-threatening illness. In 2010, an NHS clinical commissioning group in South Yorkshire, UK, produced a strategic plan that aimed to improve the quality and choice of end-of-life care locally. To that end, it established a project team to review th...
Johnson, Kimberly S; Kuchibhatla, Maragatha; Tulsky, James A
Previous research suggests that lack of knowledge of hospice is a barrier to the use of hospice care by African Americans. However, there is little data examining racial differences in exposure to hospice information. Examine racial differences in self-reported exposure to hospice information and determine how this exposure impacts beliefs about hospice care. We surveyed 200 community-dwelling older adults (65 or older). We used Spearman's correlations to examine the relationship between responses to individual items on the Hospice Beliefs and Attitudes Scale (HBAS) and self-reported exposure to hospice information (never heard of hospice, heard a little, or heard a lot). We used multivariate analyses to examine predictors of exposure to hospice information and beliefs about hospice care (total score on HBAS). Compared to whites (n = 95), African Americans (n = 105) reported significantly less exposure to hospice information (p = 0.0004). Nineteen percent of African Americans and 4% of whites had never heard of hospice; 47.6% of African Americans and 71.6% of whites had heard a lot about hospice. In multivariate analysis controlling for demographics and health status, African Americans had a two times higher odds of reporting that they had never heard of hospice or heard only a little about hospice versus heard a lot about hospice (odds ratio [OR] = 2.24 [1.17, 4.27]. Greater exposure to hospice information was associated with more favorable beliefs about hospice care (outcome: total score on HBAS; parameter estimate 1.34, standard error 0.44, p = 002). African Americans reported less exposure to information about hospice than whites. Greater exposure to hospice information was associated with more favorable beliefs about some aspects of hospice care. Because knowledge is power, educational programs targeting older African Americans are needed to dispel myths about hospice and to provide minorities with the tools to make informed choices about end-of-life care.
Pischke, Erin C; Knowlton, Jessie L; Phifer, Colin C; Gutierrez Lopez, Jose; Propato, Tamara S; Eastmond, Amarella; de Souza, Tatiana Martins; Kuhlberg, Mark; Picasso Risso, Valentin; Veron, Santiago R; Garcia, Carlos; Chiappe, Marta; Halvorsen, Kathleen E
Global environmental problems such as climate change are not bounded by national borders or scientific disciplines, and therefore require international, interdisciplinary teamwork to develop understandings of their causes and solutions. Interdisciplinary scientific work is difficult enough, but these challenges are often magnified when teams also work across national boundaries. The literature on the challenges of interdisciplinary research is extensive. However, research on international, interdisciplinary teams is nearly non-existent. Our objective is to fill this gap by reporting on results from a study of a large interdisciplinary, international National Science Foundation Partnerships for International Research and Education (NSF-PIRE) research project across the Americas. We administered a structured questionnaire to team members about challenges they faced while working together across disciplines and outside of their home countries in Argentina, Brazil, and Mexico. Analysis of the responses indicated five major types of barriers to conducting interdisciplinary, international research: integration, language, fieldwork logistics, personnel and relationships, and time commitment. We discuss the causes and recommended solutions to the most common barriers. Our findings can help other interdisciplinary, international research teams anticipate challenges, and develop effective solutions to minimize the negative impacts of these barriers to their research.
Pischke, Erin C.; Knowlton, Jessie L.; Phifer, Colin C.; Gutierrez Lopez, Jose; Propato, Tamara S.; Eastmond, Amarella; de Souza, Tatiana Martins; Kuhlberg, Mark; Picasso Risso, Valentin; Veron, Santiago R.; Garcia, Carlos; Chiappe, Marta; Halvorsen, Kathleen E.
Global environmental problems such as climate change are not bounded by national borders or scientific disciplines, and therefore require international, interdisciplinary teamwork to develop understandings of their causes and solutions. Interdisciplinary scientific work is difficult enough, but these challenges are often magnified when teams also work across national boundaries. The literature on the challenges of interdisciplinary research is extensive. However, research on international, interdisciplinary teams is nearly non-existent. Our objective is to fill this gap by reporting on results from a study of a large interdisciplinary, international National Science Foundation Partnerships for International Research and Education (NSF-PIRE) research project across the Americas. We administered a structured questionnaire to team members about challenges they faced while working together across disciplines and outside of their home countries in Argentina, Brazil, and Mexico. Analysis of the responses indicated five major types of barriers to conducting interdisciplinary, international research: integration, language, fieldwork logistics, personnel and relationships, and time commitment. We discuss the causes and recommended solutions to the most common barriers. Our findings can help other interdisciplinary, international research teams anticipate challenges, and develop effective solutions to minimize the negative impacts of these barriers to their research.
... do not want, thus decreasing health care costs and increasing quality. However, delivery of high-quality hospice and palliative care cannot take place without sufficient number of health professionals with appropriate training and skills. The rapid expansion of hospice and palliative care programs over the past two to three decades has tak...
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. ... 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 ...
Harris, Pamela S; Stalam, Tapati; Ache, Kevin A; Harrold, Joan E; Craig, Teresa; Teno, Joan; Smither, Eugenia; Dougherty, Meredith; Casarett, David
To determine whether it is possible to predict, at the time of hospice enrollment, which patients will die within 6 months. Electronic health record-based retrospective cohort study. Patients admitted to 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness). Hospice patients. Mortality at 6 months following hospice admission. Among 126,620 patients admitted to 10 hospices, 118,532 (93.6%) died within 6 months. In a multivariable logistic regression model, five characteristics were independent predictors of 6-month mortality. For instance, patients younger than 65 years were less likely to die within 6 months (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.45-0.91; p=0.014). Conversely, male patients were more likely to die within 6 months (OR 1.47; 95% CI 1.05-2.02; p=;0.036). After adjusting for other variables in this model, there were several subgroups with a low probability of 6-month probability (e.g., stroke and Palliative Performance Scale [PPS] score=50; adjusted probability of 6-month mortality=39.4%; 95% CI: 13.9%-72.5%). However, 95% confidence intervals of these 6-month mortality predictions extended above 50%. Hospices might use several variables to identify patients with a relatively low risk for 6-month mortality and who therefore may become ineligible to continue hospice services if they fail to show significant disease progression.
...) The discharge planning process must include planning for any necessary family counseling, patient education, or other services before the patient is discharged because he or she is no longer terminally ill. ... from hospice care. (a) Reasons for discharge. A hospice may discharge a patient if— (1) The patient...
Wu, Hung-Lan; Volker, Deborah L
This article presents a discussion of the relevance of Humanistic Nursing Theory to hospice and palliative care nursing. The World Health Organization has characterized the need for expert, palliative and end-of-life care as a top priority for global health care. The specialty of hospice and palliative care nursing embraces a humanistic caring and holistic approach to patient care. As this resonates with Paterson and Zderad's Humanistic Nursing Theory, an understanding of hospice nurses' experiences can be investigated by application of relevant constructs in the theory. This article is based on Paterson and Zderad's publications and other theoretical and research articles and books focused on Humanistic Nursing Theory (1976-2009), and data from a phenomenological study of the lived experience of Taiwanese hospice nurses conducted in 2007. Theoretical concepts relevant to hospice and palliative nursing included moreness-choice, call-and-response, intersubjective transaction, uniqueness-otherness, being and doing and community. The philosophical perspectives of Humanistic Nursing Theory are relevant to the practice of hospice and palliative care nursing. By 'being with and doing with', hospice and palliative nurses can work with patients to achieve their final goals in the last phase of life. Use of core concepts from Humanistic Nursing Theory can provide a unifying language for planning care and describing interventions. Future research efforts in hospice and palliative nursing should define and evaluate these concepts for efficacy in practice settings. © 2011 Blackwell Publishing Ltd.
Gotay, Carolyn Cook
There is little research documenting the psychosocial support needs of hospice patients and their families. To assess hospice patients' and families' use of and perceptions of need for support, 77 patients and their families were interviewed during home care for terminal illness (Group 1), and 50 family members (84% spouses) were interviewed 1…
Ache, Kevin; Harrold, Joan; Harris, Pamela; Dougherty, Meredith; Casarett, David
To describe individuals with advance directives at the time of hospice enrollment and to determine whether they have patterns of care and outcomes that are different from those of individuals without advance directives. Electronic health record-based retrospective cohort study with propensity score-adjusted analysis. Three hospice programs in the United States. Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 49,370). Timing of hospice enrollment before death, rates of voluntary withdrawal from hospice, and site of death. Most participants (35,968, 73%) had advance directives at the time of hospice enrollment. These participants were enrolled in hospice longer (median 29 vs 15 days) and had longer survival times before death (adjusted hazard ratio = 0.62; 95% confidence interval (CI) 0.58-0.66; P < .001). They were less likely to die within the first week after hospice enrollment (24.3% vs 33.2%; adjusted odds ratio (aOR) = 0.83, 95% CI = 0.78-0.88; P < .001). Participants with advance directives were less likely to leave hospice voluntarily (2.2% vs 3.4%; aOR = 0.82, 95% CI = 0.74-0.90; P = .003) and more likely to die at home or in a nursing home than in an inpatient unit (15.3% vs 25.8%; aOR = 0.82, 95% CI = 0.77-0.87; P < .001). Participants with advance directives were enrolled in hospice for a longer period of time before death than those without and were more likely to die in the setting of their choice. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Barnette Donnelly, Cassandra; Armstrong, Karen Andrea; Perkins, Molly M; Moulia, Danielle; Quest, Tammie E; Yancey, Arthur H
Growing numbers of emergency medical services (EMS) providers respond to patients who receive hospice care. The objective of this investigation was to assess the knowledge, attitudes, and experiences of EMS providers in the care of patients enrolled in hospice care. We conducted a survey study of EMS providers regarding hospice care. We collected quantitative and qualitative data on EMS provider's knowledge, attitudes, and experiences in responding to the care needs of patients in hospice care. We used Chi-squared tests to compare EMS provider's responses by credential (Emergency Medical Technician [EMT] vs. Paramedic) and years of experience (0-5 vs. 5+). We conducted a thematic analysis to examine open-ended responses to qualitative questions. Of the 182 EMS providers who completed the survey (100% response rate), 84.1% had cared for a hospice patient one or more times. Respondents included 86 (47.3%) EMTs with Intermediate and Advanced training and 96 (52.7%) Paramedics. Respondent's years of experience ranged from 0-10+ years, with 99 (54.3%) providers having 0-5 years of experience and 83 (45.7%) providers having 5+ years of experience. There were no significant differences between EMTs and Paramedics in their knowledge of the care of these patients, nor were there significant differences (p education on the care of hospice patients. A total of 36% respondents felt that patients in hospice care required a DNR order. In EMS providers' open-ended responses on challenges in responding to the care needs of hospice patients, common themes were family-related challenges, and the need for more education. While the majority of EMS providers have responded to patients enrolled in hospice care, few providers received formal training on how to care for this population. EMS providers have expressed a need for a formal curriculum on the care of the patient receiving hospice.
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.
Cobbe, Sinead; Kennedy, Norelee
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.
Matthews, Michael; Peters, Cara; Lawson, Stephanie
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.
Robberstad, Mari; Bentsen, Signe Berit; Berg, Tore Julsrud; Iversen, Marjolein M
The national clincial guidelines for diabetes recommend that diabetic foot ulcers be treated by interdisciplinary diabetic foot ulcer teams. This study aims to survey the extent of diabetic foot ulcer teams in the specialist health service in Norwegian hospitals and to describe their clinical composition, organisation and working routines. The study is cross-sectional with the use of a questionnaire survey. The criteria for participating were somatic hospitals with 24-hour operations and a specialist function for patients with diabetes mellitus. A total of 41 hospitals participated of the 51 that fulfilled the criteria. Altogether 17 of 41 hospitals had diabetic foot ulcer teams. The teams had a broad clinical composition and followed national recommendations for surveying risk factors and treatment of diabetic foot ulcers. Nine foot ulcer teams had written routines for assessment, five used the Noklus diabetes patient records to document ulcer treatment, and ten had planned interdisciplinary meetings. Only one-quarter of the teams included both medical and surgical competence in the planned interdisciplinary collaboration. The diabetic foot ulcer teams had broad clinical competence and followed national clinical guidelines. The teams had a short waiting time for the initial consultation, half had written guidelines, and 60 % had planned interdisciplinary meetings. Far fewer had included both medical and surgical competence in the planned interdisciplinary collaboration.
Full Text Available Abstract Background Within the United Kingdom, a developing role for primary care services in cancer and palliative care has resulted in an increase in palliative home care teams. The provision of professional care in the home setting seeks to provide necessary services and enhanced choice for patients whose preference is to die at home. A mismatch between patient preference for home death and the actual number of people who died at home was identified within Bradford, the locality of this study. In response to this mismatch, and reflecting the policy environment of wishing to enhance community service provision, the four Primary Care Trusts (PCTs in the city sought to offer support to patients who wished to remain in their own homes through the final stages of a terminal illness. To offer this support they set up a dedicated hospice at home team. This would provide services and support for patients in achieving a dignified, symptom free and peaceful death, allowing families to maximise time spent together. The aim of the study was to evaluate the Bradford hospice at home service from the perspective of carers, nurses and General Practitioners. Methods Postal questionnaires were sent to carers (n = 289, district nurses (n = 508 and GP's (n = 444 using Bradford's hospice at home service. Resulting quantitative data was analysed using the Statical Package for Social Sciences (SPSS and qualitative data was analysed using grounded theory techniques. Results The data from carers, district nurses and GPs provide general support for the Bradford hospice at home service. Carers valued highly the opportunity to 'fulfil a promise' to the individual who wished to be cared for at home. District nurses and GPs cited the positive impact of access to specialist expertise. This was a 'reassuring presence' for primary healthcare teams and offered 'relief of carer anxiety' by providing prompt, accessible and sensitive care. Conclusion Carers and health
Meirink, Jacobiene Albertina
In this study we aimed to examine teacher learning within a context of collaboration in interdisciplinary teams. Five interdisciplinary teams were studied for a period of one year. Data was collected on what and how the teachers learned, by means of examining changes in beliefs and by asking
Teno, Joan M; Shu, Janet E; Casarett, David; Spence, Carol; Rhodes, Ramona; Connor, Stephen
Previous research has noted that many persons are referred to hospice in the last days of life. The National Hospice and Palliative Care Organization collaborated with Brown Medical School to create the Family Evaluation of Hospice Care (FEHC) data repository. In 2005, 106,514 surveys from 631 hospices were submitted with complete data on the hospice length of stay and bereaved family member perceptions of the timing of hospice care. Of these surveys, 11.4% of family members believed that they were referred "too late" to hospice. This varied from 0 to 28.1% among the participating hospice programs with 30 or more surveys. Among those with hospice lengths of stay of less than a month, only 16.2% reported they were referred "too late." Although the bereaved family member perceptions of the quality of end-of-life care did not vary by length of stay for each of the FEHC domains, the perception of being referred "too late" was associated with more unmet needs, higher reported concerns, and lower satisfaction. Our results suggest that family members' perception of the timing of hospice referral-not the length of stay-is associated with the quality of hospice care. This perception varies substantially among the participating hospice programs. Future research is needed to understand this variation and how hospice programs are delivering high quality of care despite short length of stay.
Kirby, Eric G
As a result of a drastic increase in new patients, two major shifts are occurring in the US hospice care industry: an increase in the number of for-profit providers, and hospices are increasing in size through acquisitions and mergers. Hospices are trying to both increase the number of innovative programs they offer and decrease their operating expenses to improve their margins and attract more patients. This study seeks to investigate if strategic groups exist within the industry as hospices try to become more innovative and efficient, which grouping factors are most significant, and to determine whether there is a relationship between group membership and performance. Cluster analysis and ANOVA are used to analyze data from 93 California hospices. Three strategic groups exist within the market, innovative practices significantly affect group membership, and innovation-oriented groups outperform others in terms of quality of care. Many hospices focus on innovation, and evidence suggests that continued pursuit of innovative practices is critical, whereas efficiency does not appear to have a significant impact on quality of care. Focus on such evidence-based practices is important for long-term success. This is the first study to investigate strategic group formation in the hospice care industry.
Bakanic, Von; Singleton, Margaret; Dickinson, George E
The purpose of this study was to gauge the attitudes of internal medicine (IM) physicians and hospice nurses on the hospice programs in a Southeastern US county. A postal survey sought views on the following issues: (1) the level of control that hospice affords dying patients; (2) health care professionals' education and communication involving the dying process; (3) the hospice referral process; (4) characteristics of a "good death"; and (5) gender versus professional role regarding hospice attitudes. The data revealed that occupational role in hospice care has a more significant function in the development of cognitive attitudes than of gender regarding hospice programs and that professional education needs more emphasis on the study of end-of-life issues, as well as open communication between health care professionals and patients during the dying process. Physicians were less likely than nurses to agree that patient control was important. Additionally, what constitutes a good death was similar to previous studies. © The Author(s) 2014.
Wilwert, Monica M; Watkins, Catherine A; Ettinger, Ronald L; Cowen, Howard J; Qian, Fang
The relationships between dentist characteristics and professional education with involvement of Iowa dentists in hospice care were investigated. Using the 1999 Iowa Health Professional database, a survey requesting information regarding involvement in and training for care of hospice patients was mailed to all licensed dentists (N = 1,210). Two mailings yielded a 54.6% response rate. Of the 638 dentist respondents, the mean age was 47, 86% were male, 88% general dentists, and 295 (46%) reported providing some treatment for hospice patients. At least one dentist reported providing hospice patient care in 72 of Iowa's 99 counties. About 90% of dentists treating hospice patients were general practitioners. Males were more likely to provide treatment (p hospice patients in the office (IO, 40%). The most prevalent treatments were denture relines (31% IO; 71% OO), examinations (16% IO; 68% OO), and emergency treatment (12.5% IO; 53% OO). More than 86% of surveyed dentists indicated that their professional education did not adequately train them to meet the clinical, psychosocial, communication, or spiritual needs of hospice patients. © 2011 Special Care Dentistry Association and Wiley Periodicals, Inc.
Gerry, Edwina M
A clinical audit was developed and conducted at St Gemma's Hospice, Leeds, to provide evidence of the standard of privacy and dignity afforded to patients in the wards and Day Hospice. It involved setting standards from key documents and including patients, carers, and staff in developing questionnaires. The questionnaires were administered to 30 patients and 130 members of the multidisciplinary team. The response rates were 91% (patients) and 78% (staff). Evaluation of the questionnaires showed that 70% of patients rated their satisfaction with privacy and dignity as 'excellent', with the remaining 30% rating it 'very good'. For the most part, the ratings of staff and patients were in agreement and indicated achievement of the expected standard. However, some areas of concern were identified, including providing opportunity for hand washing prior to meals, closer monitoring of visitor numbers, avoiding interruption to staff, and maintaining privacy during conversations with staff. Disseminating the results of the audit resulted in some important discussions in the clinical teams and the formulation of an action plan to address the concerns.
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.
Klink, Jenna; Koundinya, Vikram; Kies, Kim; Robinson, Courtney; Rao, Amulya; Berezowitz, Claire; Widhalm, Melissa; Prokopy, Linda
This paper shares the details of an evaluation plan from an interdisciplinary climate change project that developed decision support tools (DSTs) for agricultural advisors and farmers. It showcases how evaluation enhanced the project work by providing opportunities for the team to reflect on and use data to improve performance. The plan included both formative and summative approaches, team member interviews to assess team functioning, usability testing of DSTs, outreach and marketing campaig...
De Lima, Liliana; Radbruch, Lukas
The International Association for Hospice and Palliative Care (IAHPC) is a membership-based organization dedicated to the development and improvement of hospice and palliative care worldwide. The mission of IAHPC is to improve the quality of life of adults and children with life-threatening conditions and their families. The vision of IAHPC is universal access to high-quality palliative care, integrated into all levels of health care systems in a continuum of care with disease prevention, early diagnosis, and treatment, to assure that any patient's or family caregiver's suffering is relieved to the greatest extent possible. IAHPC focuses on the advancement of four areas of palliative care: education, access to medicines, health policies, and service implementation. IAHPC works on three levels: at the grass roots, developing resources, and educational strategies that enable health workers to provide cost-effective palliative care; at the national level, working with government representatives to improve national policies to ensure adequate care and access to medicines; and at the international level, advocating with the UN organizations to ensure that access to palliative care and to essential medicines for palliative care and pain treatment is stipulated and incorporated as an obligation of member states. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Perkins, J; Tryssenaar, J
Interdisciplinary education has been recommended as a way of preparing students for team practice after graduation. There is debate in the literature over the best way to implement interdisciplinary education sessions, and many factors can influence their effectiveness. This paper is a case description report of a pilot project developed to promote interdisciplinary learning. The Northern Studies Stream of McMaster University's School of Occupational Therapy and Physiotherapy in Ontario, Canada developed a project that combined students from the occupational therapy and physiotherapy programs for small group tutorials held during clinical placements. The project incorporated suggestions from the literature in order to encourage cooperation and interdisciplinary learning. Participants were mature, second-degree students with similar levels of clinical experience. The sessions were a required part of the academic course, but were ungraded. Tutorials focused on issues relevant to clinical practice for both groups and were facilitated by faculty from both professions. Evaluation was positive, suggesting student characteristics (eg, level of experience and maturity) and session design features that may be helpful in planning future interdisciplinary education experiences.
Like all health care institutions, preventive medicine institutions, too, need a quality assurance structure. An integrated system consisting of "balanced score card", "finite-elements-model" and "interdisciplinary quality circles" is presented. This organisational structure allows the implementation of quality assurance in complex institutions as well, such as health care organisations. In addition, this concept guarantees broad acceptance by all team members, not least due to complexity reduction.
Sasnett, Bonita; Clay, Maria
The US Institute of Medicine recommends that all health professionals should deliver patient-centered care as members of interdisciplinary health science teams. The current application of the Bolman and Deal Leadership model to health sciences provides an interesting point of reference to compare leadership styles. This article reviews several applications of that model within academic health care and the aggregate recommendations for leaders of health care disciplines based on collective findings.
Poulsen, Mikkel; Knudstrup, Mary-Ann; Hoff, Peter
connection to nature. The architecture utilises nature as a palliative element. Sensory stimulation for the patients is achieved through nature, lights, window placement, senso- ry gardens, and materiality. Functions are placed according to privacy and proximity to one another. A home-like atmosphere...... the integrated design approach to sustaina- ble architecture (Knudstrup, 2004) in an architectural Master’s thesis project. The architecture should aid and facilitate palliative treatment for the patients, while relatives and staff also benefit from the healing architecture. The hos- pice is designed...... on the foundations of accessibility requirements, the theory of healing (Frandsen et al., 2011) and palliative architecture (REHPA, 2016), as well as experiences from “Lukashuset”. The hospice is to be placed in Hammer Bakker, allowing the building to have a calm and natural environment that provides a closer...
Johnson, Kimberly S; Elbert-Avila, Katja; Kuchibhatla, Maragatha; Tulsky, James A
To examine the characteristics of hospice enrollees with dementia who were discharged alive because their condition stabilized or improved and predictors of death in the year after discharge. Cross-sectional analysis of clinical and administrative data. For-profit hospice provider. Hospice enrollees aged 65 and older with an admission diagnosis of dementia who died or were discharged alive because their condition stabilized or improved between January 1, 1999, and December 31, 2003. Demographic variables and hospice length of stay; data did not include functional status or comorbidities. Of 24,111 enrollees with dementia, 1,204 (5.0%) were discharged alive because their condition stabilized or improved; the remainder died while receiving hospice. The median length of stay for those who died was 12 versus 236 days for those discharged alive. Those discharged alive were more likely to be female or have a length of stay exceeding 180 days and less likely to be in the oldest age group (≥ 85), be African American, or reside in a nursing home. In a subgroup of 303 patients discharged alive, 75.5% were still alive at 1 year; none of the demographic variables were associated with death after hospice discharge. A small proportion of hospice enrollees with dementia was discharged alive. Most died shortly after enrollment. Future research should examine other factors that may predict which hospice enrollees with dementia are likely to be discharged alive and their subsequent trajectory, such as functional status, comorbidities, and preferences for care. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
O'Connor, Nina R; Dougherty, Meredith; Harris, Pamela S; Casarett, David J
Textbooks report that patients with ESRD survive for 7-10 days after discontinuation of dialysis. Studies describing actual survival are limited, however, and research has not defined patient characteristics that may be associated with longer or shorter survival times. The goals of this study were to determine the mean life expectancy of patients admitted to hospice after discontinuation of dialysis, and to identify independent predictors of survival time. Data for demographics, clinical characteristics, and survival were obtained from 10 hospices for patients with ESRD who discontinued dialysis before hospice admission. Data were collected for patients admitted between January 1, 2008 and May 15, 2012. All hospices were members of the Coalition of Hospices Organized to Investigate Comparative Effectiveness network, which obtains de-identified data from an electronic medical record. Of 1947 patients who discontinued dialysis, the mean survival after hospice enrollment was 7.4 days (range, 0-40 days). Patients who discontinued dialysis had significantly shorter survival compared with other patients (n=124,673) with nonrenal hospice diagnoses (mean survival 54.4 days; hazard ratio, 2.96; 95% confidence interval, 2.82 to 3.09; P<0.001). A Cox proportional hazards model identified seven independent predictors of earlier mortality after dialysis discontinuation, including male sex, referral from a hospital, lower functional status (Palliative Performance Scale score), and the presence of peripheral edema. Patients who discontinue dialysis have significantly shorter survival than other hospice patients. Individual survival time varies greatly, but several variables can be used to predict survival and tailor a patient's care plan based on estimated prognosis.
... Living with Paralysis > Health > Staying active > Team sports Team sports ☷ ▾ Page contents Basketball Quad rugby Sled hockey ... on the East and West coasts. There are teams and divisions all over the country for men, ...
transdisciplinary teams. The strict use of disciplines to address problems creates cognitive boundaries or barriers to problem solving. The theory of common...and transdisciplinary members, but multidisciplinary or interdisciplinary teams are the most common. Each type of team has unique strengths and...Verlag, 2001. Klein, Julie T. “Evaluation of Interdisciplinary and Transdisciplinary Research: A Literature Review.” American Journal of Preventive
Dolin, Rachel; Hanson, Laura C; Rosenblum, Sarah F; Stearns, Sally C; Holmes, George M; Silberman, Pam
The proportion of patients disenrolling from hospice before death has increased over the decade with significant variations across hospice types and regions. Such trends have raised concerns about live disenrollment's effect on care quality. Live disenrollment may be driven by factors other than patient preference and may create discontinuities in care, disrupting ongoing patient-provider relationships. Researchers have not explored when and how providers make this decision with patients. The objective of this study was to ascertain provider perspectives on key drivers of live discharge from the Medicare hospice program. We conducted semistructured telephone interviews with 18 individuals representing 14 hospice providers across the country. Transcriptions were coded and analyzed using a template analysis approach. Analysis generated four themes: 1) difficulty estimating patient prognosis, 2) fear of Centers for Medicare & Medicaid Services audits, 3) rising market competition, and 4) challenges with inpatient contracting. Participants emphasized challenges underlying each decision to discharge patients alive, stressing that there often exists a gray line between appropriate and inappropriate discharges. Discussions also focused on scenarios in which financial motivations drive enrollment and disenrollment practices. This study provides significant contributions to existing knowledge about hospice enrollment and disenrollment patterns. Results suggest that live discharge patterns are often susceptible to market and regulatory forces, which may have contributed to the rising national rate. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Enguidanos, Susan; Yonashiro-Cho, Jeanine; Cote, Sarah
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.
The author talks about an interdisciplinary unit on insects, and presents activities that can help students practice communication skills (interpersonal, interpretive, and presentational) and learn about insects with hands-on activities.
Boucher, Nathan A; Nix, Harvey
Patients with advanced or terminal illness, especially racial and ethnic minorities, would benefit from greater access to hospice and palliative care. Expanding the PA role in these areas would help fill gaps in both access and patients' understanding of what hospice and palliative care can offer. This article describes why hospice and palliative care are needed, what PAs can and do offer hospice and palliative care delivery, and what challenges should be overcome to expand PA practice in hospice and palliative care. The article also reviews the legislative outlook for PA practice in hospice care.
O papel da odontologia na equipe interdisciplinar: contribuindo para a atenção integral ao idoso The role of dentistry in the interdisciplinary team: contributing to comprehensive health care for the elderly
Rosemary Sadami Arai Shinkai
Full Text Available Este trabalho bibliográfico teve por objetivo discutir a atuação da odontologia na atenção integral à saúde do idoso, considerando-se a necessidade da abordagem interdisciplinar. É apresentada a atual situação da odontologia geriátrica e os problemas que ocorrem no Brasil pela falta de estudos específicos e de recursos humanos capacitados em geriatria e gerontologia dentro da odontologia. São destacadas as interações entre as diversas profissões de saúde e a odontologia, para a promoção de saúde, prevenção específica e reabilitação de pacientes idosos, com ênfase na importância da comunicação e troca de informações.This literature review focuses on dentistry's role in comprehensive health care for the elderly. The authors discuss the need for an interdisciplinary approach. They begin by analyzing the current situation in geriatric dentistry and related problems in Brazil, relating primarily to the lack of specific studies and human resources with training in geriatrics and gerontology. The authors emphasize interactions between dentistry and other health professions for health promotion, specific prevention, and rehabilitation of elderly patients, with special attention to the importance of communication and information exchange.
Dy, Sydney Morss; Kiley, Kasey B; Ast, Katherine; Lupu, Dale; Norton, Sally A; McMillan, Susan C; Herr, Keela; Rotella, Joseph D; Casarett, David J
Measuring quality of hospice and palliative care is critical for evaluating and improving care, but no standard U.S. quality indicator set exists. The Measuring What Matters (MWM) project aimed to recommend a concise portfolio of valid, clinically relevant, cross-cutting indicators for internal measurement of hospice and palliative care. The MWM process was a sequential consensus project of the American Academy of Hospice and Palliative Medicine (AAHPM) and Hospice and Palliative Nurses Association (HPNA). We identified candidate indicators mapped to National Consensus Project (NCP) Palliative Care Guidelines domains. We narrowed the list through a modified Delphi rating process by a Technical Advisory Panel and Clinical User Panel and ratings from AAHPM and HPNA membership and key organizations. We narrowed the initial 75 indicators to a final list of 10. These include one in the NCP domain Structure and Process (Comprehensive Assessment), three in Physical Aspects (Screening for Physical Symptoms, Pain Treatment, and Dyspnea Screening and Management), one in Psychological and Psychiatric Aspects (Discussion of Emotional or Psychological Needs), one in Spiritual and Existential Aspects (Discussion of Spiritual/Religious Concerns), and three in Ethical and Legal Aspects (Documentation of Surrogate, Treatment Preferences, and Care Consistency with Documented Care Preferences). The list also recommends a global indicator of patient/family perceptions of care, but does not endorse a specific survey instrument. This consensus set of hospice and palliative care quality indicators is a foundation for standard, valid internal quality measurement for U.S. Further development will assemble implementation tools for quality measurement and benchmarking. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Aeling, Jennifer Annette; Chavez, Ernest
The current study sought to understand the differences hospice nurses perceived in caring for older adult patients who utilize hospice for longer and shorter periods, older adult patients' experience of hospice services, and if length of hospice stays influenced the patients' end-of-life experience. Interpretative Phenomenological Analysis was used to extract themes and subthemes from 10 interviews conducted with hospice nursing staff. Four major themes were identified pertaining to nurses perspective on older adults' views of hospice and how length of hospice use impacts end-of-life care. These themes suggest hospice nursing staff believe longer hospice stays are more positive and that older adults identify more positive aspects of hospice when using it for longer periods of time. Results suggest that nurses believe length of use directly impacts patient care and the experience of hospice services. Participating nurses reported that older adults have a lack of information on hospice services. It was suggested that more information is needed and that providing such education may lead to longer hospice stays.
Dingfield, Laura; Bender, Laura; Harris, Pamela; Newport, Kristina; Hoover-Regan, Margo; Feudtner, Chris; Clifford, Sheila; Casarett, David
Most pediatric hospice patients receive services from agencies typically oriented to adults. Information regarding how pediatric hospice patients differ from adult hospice patients is lacking. We aim to assess differences between pediatric and adult hospice patients regarding patient characteristics and outcomes. We compiled a retrospective inception cohort of patients enrolled at nine hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness) between August 1, 2008 and June 30, 2012. Measurements included patient characteristics and outcomes, including discharge from hospice and site of death. Among 126,620 hospice patients, 986 (0.8%) were 18 years of age or younger. Pediatric patients were less likely to have an admitting diagnosis of cancer (odds ratio [OR] 0.62; 95% confidence interval [CI]: 0.54-0.72). Although children were less likely to use oxygen at enrollment (OR 0.31; 95% CI: 0.26-0.37), they were more likely to have an enteral feeding tube (OR 4.04; 95% CI: 3.49-4.67). Pediatric patients were half as likely as adults to have a do-not-resuscitate order (DNR) order upon hospice enrollment (OR 0.52; 95% CI: 0.46-0.59). The average hospice length of stay for pediatric patients was longer than that of adults (103 days versus 66 days, p<0.001). Children were more likely to leave hospice care (OR 2.59; 95% CI: 2.00-3.34), but among patients who died while enrolled in hospice, pediatric patients were more likely to die at home (OR 3.25; 95% CI: 2.27-3.88). Pediatric hospice patients differ from adult patients in their broader range of underlying diagnoses and their use of hospice services.
Patricia A Marken; Christine Zimmerman; Christopher Kennedy; Robert Schremmer; Katharine V Smith
.... Interdisciplinary teams consisting of pharmacy students and residents, student nurses, and medical residents responded to preliminary questions regarding difficult conversations, listened to a brief...
Belbin, R Meredith Meredith
Meredith Belbin's work on teams has become part of everyday language in organizations all over the world. All kinds of teams and team behaviours are covered. At the end of the book is a self-perception inventory so that readers can match their own personalities to particular team roles. Management Teams is required reading for managers concerned with achieving results by getting the best from their key personnel.
Kozak, Leila E; Kayes, Lucy; McCarty, Rachelle; Walkinshaw, Catharine; Congdon, Sean; Kleinberger, Janis; Hartman, Valerie; Standish, Leanna J
To assess the use of complementary and alternative medicine in hospice care in the state of Washington. Hospices offering inpatient and outpatient care in Washington State were surveyed by phone interview. Response rate was 100%. Results indicated that 86% of Washington State hospices offered complementary and alternative services to their patients, most frequently massage (87%), music therapy (74%), energy healing (65%), aromatherapy (45%), guided imagery (45%), compassionate touch (42%), acupuncture (32%), pet therapy (32%), meditation (29%), art therapy (22%), reflexology (19%), and hypnotherapy (16%). Most hospices relied on volunteers with or without small donations to offer such services. Complementary and alternative therapies are widely used by Washington State hospices but not covered under hospice benefits. Extensive use of these therapies seems to warrant the inclusion of complementary and alternative providers as part of hospice staff, and reimbursement schedules need to be integrated into hospice care.
Steadman, Mark E.
A graduate course in health care accounting and finance was presented by an interdisciplinary team of accounting, nursing, and allied health faculty. Recommendations for the course included early planning, team teaching, integration, student engagement in presentations, cross-listing of classes, case study method, and team projects. (SK)
Chung Yul Lee, RN, PhD
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.
Marleide da Mota Gomes
Full Text Available The modern Brazilian Neurology was born in the campus of Praia Vermelha, Universidade Federal do Rio de Janeiro (UFRJ. The former National Hospice for the Insane (NHI as well as some of its facilities were fundamental for the teaching about diseases of the nervous system to the students of the UFRJ's Medical School, caring for patients with neurosyphilis and epilepsy, as well as children with neurological impairment. We highlight the role of Juliano Moreira, director of the NHI (1903-1930, and his team, including Antonio Austregésilo Rodrigues Lima, the "father" of the Brazilian Neurology, in the construction of the modern Brazilian Psychiatry and Neurology.
Wilson, Augustine R; Fabri, Peter J; Wolfson, Jay
The medical community has only recently begun to address how human error affects patient safety. In order to confront human error in medicine, there is a need to teach students who are entering the health professions how potential errors may manifest and train them to prevent or mitigate these problems. The objective is to describe a semester-long, interdisciplinary, human error and patient safety course taught at the University of South Florida. Six interdisciplinary groups, composed of students from five of the university's colleges, were formed. The curriculum consisted of expert lecturers, readings, case studies, and analysis of patient safety problems. Students were evaluated based on their group's work on the final project and peer evaluations. Nursing students scored the highest in each category evaluated. Physicians and medical students had the lowest evaluations in team participation and active engagement. All students rated the course highly and indicated that it enhanced their ability to work in interprofessional settings. The students showed improved knowledge and substantive skill level relative to patient safety and human error concepts. Working in interdisciplinary teams gave the students a better understanding of the role each discipline can have in improving health care systems and health care delivery.
Vivi Gusrini Rahmadani Pohan; Djamaludin Ancok
This research attempted to observe team learning from the level of team diversity and team efficacy of work teams. This research used an individual level of analysis rather than the group level. The team members measured the level of team diversity, team efficacy and team learning of the teams through three scales, namely team learning scale, team diversity scale, and team efficacy scale. Respondents in this research were the active team members in a company, PT. Alkindo Mitraraya. The total ...
Pohan, Vivi Gusrini Rahmadani; Ancok, Djamaludin
This research attempted to observe team learning from the level of team diversity and team efficacy of work teams. This research used an individual level of analysis rather than the group level. The team members measured the level of team diversity, team efficacy and team learning of the teams through three scales, namely team learning scale, team diversity scale, and team efficacy scale. Respondents in this research were the active team members in a company, PT. Alkindo Mitraraya. The total ...
... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules: ESRD and hospice patients. 417.423... Special rules: ESRD and hospice patients. (a) ESRD patients. (1) A Medicare beneficiary who has been... not disenroll the beneficiary except as provided in § 417.460. (b) Hospice patients. A Medicare...
Lim, Taekyu; Nam, Seung-Hyun; Kim, Mi Sun; Yoon, Kyung Sook; Kim, Bong-Seog
Hospice care is perceived as enhancing life quality for patients with advanced, incurable illness, but cost comparisons to nonhospice patients are difficult to make. Several studies demonstrated that palliative hospice care reduced medical expenditure in terminally ill patients compared with that of nonhospice care. Patients with terminal cancer who were registered in Hospice Care Program (HCP) by the written consent and died during same admission period in Seoul Veterans Hospital, Seoul, Korea, between January 2009 and December 2009 were included. We compared medical expenditure according to the ward type (hospice ward and general ward) in patients who received palliative hospice care in Seoul Veterans Hospital, Korea. The daily total average expenditure for each inpatient was 193 930 and 266 161 in the hospice and general ward, respectively (P = .001). Daily expenditure of parenteral nutrition and laboratory blood tests/X-ray was also significantly lower in hospice ward compared with general ward (P = .002 and P = .006), respectively; 12 (17%) of 72 patients had been admitted in the intensive care unit during hospice care period in general ward (P = .014); 1 (3%) of 32 patients received blood products in hospice ward, but 13 (18%) patients received blood products in general ward during palliative hospice care (P = .039). Hospice ward type in palliative hospice therapy may contribute to reduce economic medical costs as well as to more specific total care for terminally ill patients with cancer.
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.
Fieweger, Margaret A.
While many health care delivery systems are criticized for the dehumanizing way they treat patients, hospice care presents a refreshing alternative to health care for the terminally ill. Patients appropriate for hospice care are those with six months or less to live. Interpersonal communication education is an important component of hospice care…
Amano, Koji; Morita, Tatsuya; Tatara, Ryohei; Katayama, Hirofumi; Aiki, Sayo; Kitada, Namiki; Fumimoto, Hiromi; Sato, Emi
Our objective was to explore the effectiveness of a palliative care team (PCT) by investigating potential differences in opioid prescription between patients who had had PCT involvement before admission to an inpatient hospice and those who had not. A total of 221 patients met the criteria; they were divided into an intervention group (n = 140) and a control group (n = 81). The daily dose of opioid before admission to the hospice was significantly higher in the intervention group (P < .001). The difference between the maximum opioid dose and the initial dose, the rate of increase in opioids until death, and the length of stay in the hospice were not significantly different between the groups. A PCT contributes to more appropriate use of opioids before admission to a hospice. © The Author(s) 2014.
Tofteng, Ditte Maria Børglum; Rasmussen, Gitte Lyng
the interdisciplinary cooperation in the local practice. What the systemic logic brings into the interdisciplinary cooperation is not just an organizational framework and support, but also a specific vocabulary and a specific task or way of thinking, which in some ways overrules the individual professionals’ own...... the professional knowledge and tasks. Our project shows that the professionals coming from outside the local school often disturb this fine local balancing of professional orientations and coupling of skills. Both because it can be a very slow process of getting in touch with and bringing in these professionals...
Gundrosen, Stine; Andenæs, Ellen; Aadahl, Petter; Thomassen, Gøril
Communication errors can reduce patient safety, especially in emergency situations that require rapid responses by experts in a number of medical specialties. Talking to each other is crucial for utilizing the collective expertise of the team. Here we explored the functions of "team talk" (talking between team members) with an emphasis on the talk-work relationship in interdisciplinary emergency teams. Five interdisciplinary medical emergency teams were observed and videotaped during in situ simulations at an emergency department at a university hospital in Norway. Team talk and simultaneous actions were transcribed and analysed. We used qualitative discourse analysis to perform structural mapping of the team talk and to analyse the function of online commentaries (real-time observations and assessments of observations based on relevant cues in the clinical situation). Structural mapping revealed recurring and diverse patterns. Team expansion stood out as a critical phase in the teamwork. Online commentaries that occurred during the critical phase served several functions and demonstrated the inextricable interconnections between team talk and actions. Discourse analysis allowed us to capture the dynamics and complexity of team talk during a simulated emergency situation. Even though the team talk did not follow a predefined structure, the team members managed to manoeuvre safely within the complex situation. Our results support that online commentaries contributes to shared team situation awareness. Discourse analysis reveals naturally occurring communication strategies that trigger actions relevant for safe practice and thus provides supplemental insights into what comprises "good" team communication in medical emergencies.
Geert Jensen, Birgitte; Rasmussen, Jørgen; Volf, Mette
and facilitating processes in a methodical and systematic manner. The user centred framing of designers, their imaginative capabilities and their expressive skills enable them to span complex boundaries within and across multidisciplinary teams. The aim of the present paper is to outline that designer's methods......Sense Making has become the strategic fuel for meaningful Change Making in organizations today. 1 When designers enter into and facilitate large interdisciplinary teams it changes the role of the designer from being characterised by aesthetic professionalism to thinking strategically...... and visual skills can be the link between mental models and languages that occur in interdisciplinary teams. The designer's methods such as visualization and prototyping as well as their Sensemaking methods2 can strengthen a team's chance to imagine future scenarios and their implications. It provides...
Shen, Ji; Liu, Ou Lydia; Sung, Shannon
College science education needs to foster students' habit of mind beyond disciplinary constraints. However, little research has been devoted to assessing students' interdisciplinary understanding. To address this problem, we formed a team of experts from different disciplines to develop interdisciplinary assessments that target…
Wexler, Sharon Stahl; D'Amico, Catherine O'Neill; Foster, Norma; Cataldo, Karen A; Brody, Patricia; Huang, Zheng-Bo
Falls are a common, yet serious complication for hospitalized patients. The Ruby Red Slipper Program is an interdisciplinary fall management program that includes development and education of unit-based fall management teams. Initial outcomes demonstrated significant reductions in falls.
Lin, Ming-Hwai; Moh, Shwu-Lan; Kuo, Yu-Cheng; Wu, Pin-Yuan; Lin, Chiung-Ling; Tsai, Mei-Hui; Chen, Tzeng-Ji; Hwang, Shinn-Jang
Even though terminal cancer patients receive help from a hospice palliative care team, they have to suffer the pressure of death with deteriorating conditions. This study aims to evaluate the effect of art therapy for these terminal cancer patients. The patients involved were terminal cancer patients who were under the care of team members, which included physicians, nurses, social workers, clergy, art therapists, and volunteers in a hospice palliative care unit in Taiwan. The art therapy in our study took the form of visual fine art appreciation and hands-on painting. The effects of the art therapy were evaluated according to patients' feelings, cognitions, and behaviors. There were 177 patients (105 males and 72 females; mean age: 65.4 ±15.8 years) in the study. Each patient received a mean of 2.9 ± 2.0 sessions of the art therapy and produced a mean of 1.8 ± 2.6 pieces of art. During the therapy, most patients described their feelings well, and created art works attentively. Patients expressed these feelings through image appreciation and hands-on painting, among which the landscape was the most common scene in their art. After the therapy, the mean score of patients' artistic expressions (one point to each category: perception of beauty, art appreciation, creativity, hands-on artwork, and the engagement of creating artwork regularly) was 4.0 ± 0.7, significantly higher than the score before therapy (2.2 ± 1.4, p art therapy through visual art appreciation and hands-on creative artwork.
Azami-Aghdash, Saber; Jabbari, Hossein; Bakhshian, Fariba; Shafaei, Leila; Shafaei, Soheyla; Kolahdouzan, Kasra; Mohseni, Mohammad
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. 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. 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. 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.
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.
Relações de trabalho em equipes interdisciplinares: contribuições para novas formas de organização do trabalho em saúde Relaciones de trabajo en equipos interdisciplinarios: contribuciones para nuevas formas de organización del trabajo en salud Work relations in interdisciplinary teams: contributions towards new forms of work organization in health
Full Text Available Estudo de natureza qualitativa realizado com equipes interdisciplinares de saúde em dois hospitais públicos do sul do Brasil. Uma equipe presta cuidados paliativos a doentes com câncer e outra cuidados a idosos. O estudo contribui para pensar as relações de trabalho ao analisar a contribuição destas experiências para constituição de novas formas de organização do trabalho (NFOT em saúde. Os resultados revelam que a perspectiva interdisciplinar possibilita melhores relações de trabalho entre profissionais e entre eles e doentes/família, aproxima os profissionais das necessidades do doente e contribui para uma assistência de melhor qualidade. Conclui que a prática interdisciplinar aproxima-se de NFOT favorecendo o vínculo, o acolhimento o acesso e contribuindo para a efetivação do Sistema Único de Saúde.Estudio de naturaleza cualitativa desarrollado con equipos interdisciplinarios de salud en dos hospitales públicos en el sur de Brasil. Un equipo que realiza cuidados paliativos a enfermos con cáncer, y otro que atiende ancianos. Al analizar la contribución de esas experiencias para la constitución de nuevas formas de organización del trabajo en salud, el estudio contribuye para pensar las relaciones de trabajo. Los resultados revelan que la perspectiva interdisciplinaria posibilita mejores relaciones de trabajo entre los profesionales, y entre esos profesionales y los enfermos/familia, al aproximarlos de las necesidades del enfermo y contribuir para la realización de un trabajo de asistencia de mejor calidad. Se puede concluir que la práctica interdisciplinaria se aproxima de nuevas formas de organización del trabajo, y al propiciar el vínculo, la protección y el acceso, contribuye para la efectividad del Sistema Único de Salud.This is a qualitative study developed with the interdisciplinary health care teams of two public hospitals in Brazil. One team gave palliative care to cancer patients and the other gave
In June 2015, hospices were described as ‘dingy’ on two popular British television dramas. This spurred a social media protest using the hashtag #notdingy. Images were a central component of the #notdingy campaign, which asserted that hospices are positive places in which to be cared for, in many cases until death. In this essay I analyse both the formal qualities of these images as well as their encoded meanings and symbolism (Pauly 2005). I argue that the value of these kinds of images lies...
Chabrán, H. Rafael; Kozek, Mark
We describe our team-taught, interdisciplinary course "Numb3rs in Lett3rs & Fi1ms: Mathematics in Literature and Cinema," which explores mathematics in the context of modern literature and cinema. Our goal with this course is to advance collaborations between mathematics and the written/theatre-based creative arts.
Dunbar, David; Terlecki, Melissa; Watterson, Nancy; Ratmansky, Lisa
This article describes how two faculty members at Cabrini College--one from biology and the other from psychology--incorporated interdisciplinary community-based research in an honors course on environmental watershed issues. The course, Environmental Psychology, was team-taught in partnership with a local watershed organization, the Valley Creek…
Walker, Andreas; Breitsameter, Christof
The present article considers conflicts and conflict regulation in hospices. The authors carried out a qualitative study in three hospices in North Rhine-Westphalia, Germany, to explore how conflicts arise and how conflict regulation proceeds. Hospice nurses should act according to a set of ethical codes, to mission statements of the institution and to professional standards of care. In practice the subjective interpretations of codes and/or models concerning questions of care are causes of conflicts among nurses, with doctors, patients and family members. The management has two choices to react to these conflicts. It can either tolerate the conflicts, as long as they do not disturb the daily routine. Or it can increase the degree of organisation by integrating the different viewpoints into its own program and/or by restructuring its organisational units.
Ankuda, Claire K; Fonger, Evan; O'Neil, Thomas
It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates. To measure the rates of hospice enrollees electing full code, the characteristics predicting full code status, and the association of full code status with various hospice live discharge patterns. Retrospective cohort study of electronic medical record data. A total of 25,636 decedents enrolled in two Michigan hospices between 2009 and 2014. Code status was defined as full code versus do-not-resuscitate (DNR) orders. Covariates include demographics, location (home, hospice facility, nursing home, and hospital), primary diagnosis, and length of stay. Hospice live discharge was defined as short (0-14 days), medium (15-179 days), and long (>179 days). A total of 12.9% of hospice enrollees elected full code status. This was significantly (p live discharge compared with those with DNR orders (95% confidence interval [CI] 1.44-2.16) and 2.47 times the odds of short live discharge (95% CI 1.69-3.62) with no significant difference in long live discharge. The association of full code orders with hospice live discharge was stronger for nonwhite enrollees, with a live discharge rate of 23.8% versus 11.6% for African Americans with full code versus DNR orders. Those electing full code status on admission to hospice are at high risk of live hospice discharge after short enrollments, particularly nonwhite enrollees.
Lindley, Lisa C
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.
Tse, Chung Sang; Morrison, Laura J; Ellman, Matthew S
Physicians' lack of comfort and skill in communicating about hospice care results in deficits and delays in hospice referrals. Preclinical exposure to hospice may lay a foundation to improve medical students' knowledge and comfort with hospice care. To understand how preclinical medical student (MS)-2s respond both educationally and emotionally to a required hospice care experience (HCE). Accompanied by hospice clinicians, MS-2s spent 3 hours seeing inpatient or home hospice patients followed by a 1-hour debriefing. Students submitted written reflections to e-mailed educational and emotional prompts. Two hundred and two MS-2s from 2 academic cohorts completed the HCE at 1 of 2 hospice sites. Written reflective responses were analyzed qualitatively, where salient themes extracted and responses were coded. Ninety-two students submitted 175 responses to Prompt #1 (educational impact) and 85 students entered 85 responses to prompt #2 (emotional impact) of the HCE. Eleven themes were identified for prompt #1, most frequently focusing on hospice services and goals and hospice providers' attitudes and skills. Prompt #2 elicited a diverse spectrum of emotional responses, spanning positive and negative emotions. Most often, students reported "no specified emotional reaction," "sad/depressed," "difficult /challenging," "heartened/encouraged," and "mixed emotions." In an HCE, preclinical students reported learning core aspects of hospice care and experiencing a broad spectrum of emotional responses. These findings may assist educators in the planning of HCEs for preclinical students, including debriefing sessions with skilled clinicians and opportunities for triggered reflection.
West, Michael A; Lyubovnikova, Joanne
The ubiquity and value of teams in healthcare are well acknowledged. However, in practice, healthcare teams vary dramatically in their structures and effectiveness in ways that can damage team processes and patient outcomes. The aim of this paper is to highlight these characteristics and to extrapolate several important aspects of teamwork that have a powerful impact on team effectiveness across healthcare contexts. The paper draws upon the literature from health services management and organisational behaviour to provide an overview of the current science of healthcare teams. Underpinned by the input-process-output framework of team effectiveness, team composition, team task, and organisational support are viewed as critical inputs that influence key team processes including team objectives, leadership and reflexivity, which in turn impact staff and patient outcomes. Team training interventions and care pathways can facilitate more effective interdisciplinary teamwork. The paper argues that the prevalence of the term "team" in healthcare makes the synthesis and advancement of the scientific understanding of healthcare teams a challenge. Future research therefore needs to better define the fundamental characteristics of teams in studies in order to ensure that findings based on real teams, rather than pseudo-like groups, are accumulated.
Pereira, José; Contant, Jocelyne; Barton, Gwen; Klinger, Christopher
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
Pawuk, Laura G; Schumacher, John E
A middle-aged man with lung cancer breathes more easily and reduces his need for pain medication after participating in music-focused relaxation. An 8-year-old boy with cancer writes songs and records a CD for his family. An elderly woman in the final stages of Alzheimer's who is no longer able to speak sings a few words of her favorite lullaby to her adult daughter. A much-loved grandmother dies peacefully as her family sings her favorite spiritual songs to the accompaniment of a music therapist's folk harp. These illustrations demonstrate the role that music therapy plays in attending to the physical, emotional, and spiritual needs of hospice and palliative care patients and families while respecting their dignity and celebrating their lives.
Freund, Katherine; Weckmann, Michelle T; Casarett, David J; Swanson, Kristi; Brooks, Mary Kay; Broderick, Ann
Hospice is a service that patients, families, and physicians find beneficial, yet a majority of patients die without receiving hospice care. Little is known about how many hospitalized patients are hospice eligible at the time of hospitalization. Retrospective chart review was used to examine all adult deaths (n = 688) at a tertiary care center during 2009. Charts were selected for full review if the death was nontraumatic and the patient had a hospital admission within 12 months of the terminal admission. The charts were examined for hospice eligibility based on medical criteria, evidence of a hospice discussion, and hospice enrollment. Two hundred nine patients had an admission in the year preceding the terminal admission and a nontraumatic death. Sixty percent were hospice eligible during the penultimate admission. Hospice discussions were documented in 14% of the hospice-eligible patients. Patients who were hospice eligible had more subspecialty consults on the penultimate admission compared to those not hospice eligible (P = 0.016), as well as more overall hospitalizations in the 12 months preceding their terminal admission (P = 0.0003), and fewer days between their penultimate admission and death (P = 0.001). The majority of terminally ill inpatients did not have a documented discussion of hospice with their care provider. Educating physicians to recognize the stepwise decline of most illnesses and hospice admission criteria will facilitate a more informed decision-making process for patients and their families. A consistent commitment to offer hospice earlier than the terminal admission would increase access to community or home-based care, potentially increasing quality of life. Copyright © 2011 Society of Hospital Medicine.
Buengeler, C.; Klonek, F.; Lehmann-Willenbrock, N.; Morency, L.-P.; Poppe, R.
As part of the Lorentz workshop, “Interdisciplinary Insights into Group and Team Dynamics,” held in Leiden, Netherlands, this article describes how Geeks and Groupies (computer and social scientists) may benefit from interdisciplinary collaboration toward the development of killer apps in team
Olthuis, G.J.; Leget, C.J.W.; Dekkers, W.J.M.
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
Safrai, Mary B.
The reach of art therapy in assisting a hospice patient in confronting existential issues at the end of life is illustrated in this article with a case that took place over the course of 22 semiweekly sessions. Painting with an art therapist allowed the patient to shift from a state of anxiety and existential dread to a more accepting, fluid…
Quinn-Lee, Lisa; Olson-McBride, Leah; Unterberger, April
Hospice work has been regarded as particularly stressful due to the complexity inherent in the provision of end-of-life care. Burnout and death anxiety are especially relevant to hospice social workers because they regularly function in a high-stress, high-loss environment. The purpose of this study was threefold: to determine the prevalence of burnout and death anxiety among hospice social workers; to examine associations between burnout and death anxiety; and to explore the factors which may contribute to the development of death anxiety and burnout. Participants completed four items: the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the Death Anxiety Questionnaire (DAQ), a demographic questionnaire, and a set of open-ended questions. Findings indicate that mean scores on the subscales of the MBI-HSS ranged from the low to moderate range and that a strong positive correlation existed between death anxiety and the depersonalization subscale of the MBI. Three key themes emerged from the qualitative data: (a) personal interest in hospice social work developed through a variety of ways; (b) although death anxiety decreased from exposure and understanding of the death process, there was increased death anxiety surrounding working with certain patients; and (c) burnout was primarily related to workload or difficult cases.
Warhuus, Jan; Günzel-Jensen, Franziska; Robinson, Sarah
Questions we care about (Objectives): When students have to work on challenging tasks, as it is often the case in entrepreneurship classrooms that leverage experiential learning, team success becomes central to the students learning. Yet, the formation of teams is often left up to the students....... A rigorous coding and inductive analysis process was undertaken. Pattern and relationship coding were used to reveal underlying factors, which helped to unveil important similarities and differences between student in different teams’ project progress and perception of learning. Results: When students...... functioning entrepreneurial student teams as most teams lack personal chemistry which makes them anchor their work too much in a pre-defined project. In contrast, we find that students that can form their own teams aim for less diverse teams than what is achieved by random assignment. However, the homophily...
Thompson, Britta M; Haidet, Paul; Borges, Nicole J; Carchedi, Lisa R; Roman, Brenda J B; Townsend, Mark H; Butler, Agata P; Swanson, David B; Anderson, Michael P; Levine, Ruth E
The purpose of this study was to explore the relationships among variables associated with teams in team-based learning (TBL) settings and team outcomes. We administered the National Board of Medical Examiners (NBME) Psychiatry Subject Test first to individuals and then to teams of Year three students at four medical schools that used TBL in their psychiatry core clerkships. Team cohesion was analysed using the Team Performance Scale (TPS). Bivariate correlation and linear regression analysis were used to analyse the relationships among team-level variables (mean individual TPS scores for each team, mean individual NBME scores of teams, team size, rotation and gender make-up) and team NBME test scores. A hierarchical linear model was used to test the effects of individual TPS and individual NBME test scores within each team, as well as the effects of the team-level variables of team size, team rotation and gender on team NBME test scores. Individual NBME test and TPS scores were nested within teams and treated as subsampling units. Individual NBME test scores and individual TPS scores were positively and statistically significantly (p team NBME test scores, when team rotation, team size and gender make-up were controlled for. Higher team NBME test scores were associated with teams rotating later in the year and larger teams (p teams at four medical schools suggest that larger teams on later rotations score higher on a team NBME test. Individual NBME test scores and team cohesion were positively and significantly associated with team NBME test scores. These results suggest the need for additional studies focusing on team outcomes, team cohesion, team size, rotation and other factors as they relate to the effective and efficient performance of TBL teams in health science education. © 2015 John Wiley & Sons Ltd.
Nielsen, Louise Møller; Tollestrup, Christian
if they have reached an agreement and everyone nods their approval. Everyone leaves the meeting, confident that they know what to do. A few weeks after, it is time for the second meeting. The team spirit is still high and there is a nice buzz in the meeting room, before the meeting starts. The introduction...... and that nobody really understood each other. The situation described above could perhaps be taken out of several different contexts and scenarios. Most people, who have been working in teams, probably recognize it, and especially people with experi-ences from interdisciplinary teams can confirm...... that this situation is part of many projects. Lack of shared understanding or frames is just one of the difficulties facing interdisciplinary design teams working in the early phases of innovation. Besides managing their different values, perspectives and interests that cause them to see different things as important...
Kane, Anne T; Perry, Donna J
Interdisciplinary research assumes that teams of highly specialized scientists develop new knowledge by bridging their respective horizons. Nurse educators preparing nursing doctoral students to conduct interdisciplinary research need insight into how members of interdisciplinary research teams experience knowledge horizons in these complex contexts. Based on the work of the philosopher Bernard Lonergan, this pilot study uses Transcendental Method for Research with Human Subjects to explore interdisciplinary researchers' experiences with and attitudes toward interdisciplinary research. Results reveal the overarching conceptual category of "engaged interdisciplinary inquiry" which includes six themes: (i) valuing interdisciplinary engagement; (ii) direct engagement; (iii) interior engagement; (iv) disengagement; (v) facilitated engagement and (vi) engaged researcher development. Results also suggest engagement depends on vigorous "back and forth", or dialogue, with self and others, and demonstrate the study method is fruitful for cognitive inquiry. This pilot supports expanded study to inform preparation for and conduct of interdisciplinary research involving nurses and raises important questions about how the trend toward interdisciplinary research affects nursing science. © 2016 John Wiley & Sons Ltd.
.... Statement of Need B. Overall Impact 1. Introduction 2. Detailed Economic Analysis 3. Cost Allocation of... compassionate care philosophy and practice for those who are terminally ill. It is a holistic approach to..., access to information, and choice'' (42 CFR 418.3). Palliative care is at the core of hospice philosophy...
Nuñez, Alicia; Holland, Jason M; Beckman, Lisa; Kirkendall, Abbie; Luna, Nora
As the older U.S. population becomes more ethnically diverse, there will be an increased need for culturally sensitive hospice care services. Hispanics often experience multiple barriers to quality end-of-life care services. To address the underlying disparities in the cultural, emotional, and spiritual aspects of hospice care, the objective of the present qualitative study was to examine the emotional and spiritual needs of Hispanic patients' families while in hospice. Semistructured in-person interviews were conducted with 29 Hispanic patients' families regarding their perceived experience of the hospice-based emotional and spiritual support received. Demographic information was collected on both the family member and the patient. Interviews were digitally recorded, transcribed, and analyzed using thematic content analysis. Participant narratives fell into five main themes: (1) the influence of Hispanic culture in the relationship with hospice care providers; (2) types of social support received from hospice; (3) barriers to receiving support; (4) lack of health literacy regarding hospice care; and (5) cultural preferences for religious/spiritual support in hospice. Our results provide insight into the specific emotional and spiritual needs of Hispanic families receiving hospice services. Our findings highlight that cultural values play an important role in the hospice care experiences of Hispanic families.
Full Text Available Aud Moe,1,2 Hildfrid V Brataas1,2 1Faculty of Health Science, Nord University, Steinkjer, Nord-Trøndelag, 2Center of Care Research, Mid-Norway, Steinkjer, Nord-Trøndelag, Norway Background: When functional impairment occurs, assistance to achieve self-help can lead to qualitatively more active everyday life for recipients and better use of community resources. Home-based everyday rehabilitation is a new interdisciplinary service for people living at home. Rehabilitation involves meeting the need for interprofessional services, interdisciplinary collaboration, and coordination of services. Everyday rehabilitation is a service that requires close interdisciplinary cooperation. The purpose of this study was to gain knowledge about employees' experiences with establishing a new multidisciplinary team and developing a team-based work model. Method: The study had a qualitative design using two focus group interviews with a newly established rehabilitation team. The sample consisted of an occupational therapist, two care workers with further education in rehabilitation, a nurse, a physiotherapist, and a project leader. Data were analyzed by thematic content analysis. Results: The data highlight three phases: a planning phase (ten meetings over half a year, a startup phase of trials of interdisciplinary everyday rehabilitation in practice (2 months, and a third period specifying and implementing an everyday rehabilitation model (6 months. During these phases, three themes emerged: 1 team creation and design of the service, 2 targeted practical trials, and 3 equality of team members and combining interdisciplinary methods. Conclusion: The team provided information about three processes: developing work routines and a revised team-based flow chart, developing team cooperation with integrated trans- and interdisciplinary collaboration, and working with external exchange. There is more need for secure network solutions. Keywords: everyday rehabilitation
Zheng, Nan Tracy; Mukamel, Dana B; Caprio, Thomas V; Temkin-Greener, Helena
Hospice care provided to nursing home (NH) residents has been shown to improve the quality of end-of-life (EOL) care. However, hospice utilization in NHs is typically low. This study examined the relationship between facility self-reported EOL practices and residents' hospice use and length of stay. The study was based on a retrospective cohort of NH residents. Medicare hospice claims, Minimum Data Set, Online Survey, Certification, and Reporting system and the Area Resource File were linked with a survey of directors of nursing (DON) regarding institutional EOL practice patterns (EOLC Survey). In total, 4,540 long-term-care residents who died in 2007 in 290 facilities which participated in the EOLC Survey were included in this study. We measured NHs' tendency to offer hospice to residents and to initiate aggressive treatments (hospital transfers and feeding tubes) for EOL residents based on DON's responses to survey items. Residents' hospice utilization was determined using Medicare hospice claims. The prevalence of hospice use was 18%. The average length of stay was 93 days. After controlling for individual risk factors, facilities' self-reported practice measures associated with residents' likelihood of using hospice were tendency to offer hospice (p = .048) and tendency to hospitalize (p = .002). Residents in NHs reporting higher tendency to hospitalize tended to enroll in hospice closer to death. Residents' hospice utilization is not only associated with individual and facility characteristics but also with NHs' self-reported EOL care practices. Potential interventions to effect greater use of hospice may need to focus on facility-level care processes and practices.
Milton, John G.; Radunskaya, Ami E.; Lee, Arthur H.; de Pillis, Lisette G.; Bartlett, Diana F.
The success of interdisciplinary research teams depends largely upon skills related to team performance. We evaluated student and team performance for undergraduate biology and mathematics students who participated in summer research projects conducted in off-campus laboratories. The student teams were composed of a student with a mathematics…
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Home; Journals; Pramana – Journal of Physics. Aditya Team. Articles written in Pramana – Journal of Physics. Volume 55 Issue 5-6 November-December 2000 pp 727-732 Contributed Papers. Tokamak Plasmas : Mirnov coil data analysis for tokamak ADITYA · D Raju R Jha P K Kaw S K Mattoo Y C Saxena Aditya Team.
Bunyan, L. W.
The purpose of this study was to review current developments in team teaching and to assess its potential in the Calgary, Alberta, schools. An investigation into team teaching situations in schools in the eastern half of the United States and Canada revealed characteristics common to successful programs (e.g., charismatic leadership and innovative…
de Graaf, Everlien; Zweers, Daniëlle; Valkenburg, Anna Ch; Uyttewaal, Allegonda; Teunissen, Saskia Ccm
BACKGROUND: A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. AIM: The aims of
Misicko, Martin W.
This study describes the experiences of a secondary high school involved in the adoption of an interdisciplinary curriculum. An interdisciplinary curriculum is defined as both the precalculus and physics curriculums taught collaboratively throughout the school year. The students' academic performances were analyzed to gage the success of the interdisciplinary model. The four year study compared students taught precalculus in a traditional discipline-based classroom versus those facilitated in an interdisciplinary precalculus/physics model. It also documents the administrative changes necessary in restructuring a high school to an interdisciplinary team teaching model. All of the students in both pedagogical models received instruction from the same teacher, and were given identical assessment materials. Additionally, the curriculum guidelines and standards of learning were duplicated for both models. The primary difference of the two models focused on the applications of mathematics in the physics curriculum. Prerequisite information was compared in both models to ensure that the students in the study had comparable qualifications prior to the facilitation of the precalculus curriculum. Common trends were analyzed and discussed from the student's performance data. The students enrolled in the interdisciplinary model appeared to outperform the discipline-based students in common evaluative assessments. The themes and outcomes described in this study provide discussion topics for further investigation by other school districts. Further study is necessary to determine whether scheduling changes may have influenced student performances, and to examine whether other content areas may experience similar results.
Timmins, Fiona; Timmins, Bernard; O'Rourke, Pearl; Long, Siobhan; Ekins, Ray; Coyle, Eugene
This paper concerns a reflection on one interdisciplinary doctorate supervision project. It outlines key elements for success within this supervisory context. The aim of this paper is to present a reflection on interdisciplinary doctorate supervision project experience and examine these experiences in light of literature on the topic. Reflection was carried out using Rolfe et al. (2010) framework for reflexivity. The supervised engineering project aimed to develop, demonstrate and evaluate a new framework for the design of customisable assistive technology (AT) which involved professionals working with AT and users with disabilities. As this research occurs in between disciplines, it required an innovative and interdisciplinary approach, with an ultimate merger between health sciences and design engineering disciplines and external liaison with adults with disabilities and a disability service provider. Interdisciplinary research is popular contemporarily and addresses societal needs. In the case outlined, clear understandings were developed, in addition to clear territorial boundaries that helped guide the novel research. Steps to success in interdisciplinary research supervision include selecting the appropriate interdisciplinary team; ensuring open communication; establishing and agreeing boundaries of the research and supervision; keeping an open mind; tolerance of lack of expertise in some areas; regular meetings and communication; keeping the student focused and agreeing publication plans in advance. Copyright © 2014 Elsevier Ltd. All rights reserved.
Ranjan Kumar Datta
Full Text Available Interdisciplinary researchers and educators, as community members, creators of knowledge, and environmental activists and practitioners, have a responsibility to build a bridge between community practice, academic scholarship, and professional contributions aimed at establishing environmental sustainability. In this paper, I focus on an undervalued area of environmental politics, practices, and often unarticulated assumptions which underlie human–environmental relations. This article challenges interdisciplinary studies that are not connected with practice by reconfiguring the meaning of a community-based, interdisciplinary approach. Drawing from works by Foucault, Latour, and Haraway, this paper first shows how to reconfigure the meaning of an interdisciplinary approach. Second, using Bourdieu and Brightman’s ethnographic studies as a framework, the paper situates practice as central to our efforts to deconstruct and replace current interdisciplinary initiatives with a practice-based approach. Through a practice-based interdisciplinary approach (PIA, environmental educators and researchers gain an awareness of and learn to make an investment in sustainable communities. As teams of environmental researchers practising in the local community, they are meaningfully involved with the community, with each other, and with the environment.
A great variety of complex phenomena in many scientific fields exhibit power-law behavior, reflecting a hierarchical or fractal structure. Many of these phenomena seem to be susceptible to description using approaches drawn from thermodynamics or statistical mechanics, particularly approaches involving the maximization of entropy and of Boltzmann-Gibbs statistical mechanics and standard laws in a natural way. The book addresses the interdisciplinary applications of these ideas, and also on various phenomena that could possibly be quantitatively describable in terms of these ideas.
Hermsen, M.A.; Have, H.A.M.J. ten
Working as a multidisciplinary or interdisciplinary team is an essential condition to provide good palliative care. This widespread assumption is based on the idea that teamwork makes it possible to address the various needs of the patient and family more effectively. This article is about teamwork
Schapmire, Tara; Hermann, Carla; Earnshaw, Lori; Faul, Anna; Jones, Carol; Kayser, Karen; Martin, Amy; Shaw, Monica Ann; Woggon, Frank; Pfeifer, Mark
Abstract Background: Interprofessional education is necessary to prepare students of the health professions for successful practice in today's health care environment. Because of its expertise in interdisciplinary practice and team-based care, palliative care should be leading the way in creating educational opportunities for students to learn the skills for team practice and provision of quality patient-centered care. Multiple barriers exist that can discourage those desiring to create and implement truly interdisciplinary curriculum. Design: An interdisciplinary faculty team planned and piloted a mandatory interdisciplinary palliative oncology curriculum and responded to formative feedback. Setting/Subjects: The project took place at a large public metropolitan university. Medical, nursing, and social work students and chaplains completing a clinical pastoral education internship participated in the curriculum. Measurements: Formative feedback was received via the consultation of an interdisciplinary group of palliative education experts, focus groups from students, and student evaluations of each learning modality. Results: Multiple barriers were experienced and successfully addressed by the faculty team. Curricular components were redesigned based on formative feedback. Openness to this feedback coupled with flexibility and compromise enabled the faculty team to create an efficient, sustainable, and feasible interdisciplinary palliative oncology curriculum. Conclusion: Interdisciplinary palliative education can be successful if faculty teams are willing to confront challenges, accept feedback on multiple levels, and compromise while maintaining focus on desired learner outcomes. PMID:24972279
Head, Barbara A; Schapmire, Tara; Hermann, Carla; Earnshaw, Lori; Faul, Anna; Jones, Carol; Kayser, Karen; Martin, Amy; Shaw, Monica Ann; Woggon, Frank; Pfeifer, Mark
Background: Interprofessional education is necessary to prepare students of the health professions for successful practice in today's health care environment. Because of its expertise in interdisciplinary practice and team-based care, palliative care should be leading the way in creating educational opportunities for students to learn the skills for team practice and provision of quality patient-centered care. Multiple barriers exist that can discourage those desiring to create and implement truly interdisciplinary curriculum. An interdisciplinary faculty team planned and piloted a mandatory interdisciplinary palliative oncology curriculum and responded to formative feedback. The project took place at a large public metropolitan university. Medical, nursing, and social work students and chaplains completing a clinical pastoral education internship participated in the curriculum. Formative feedback was received via the consultation of an interdisciplinary group of palliative education experts, focus groups from students, and student evaluations of each learning modality. Multiple barriers were experienced and successfully addressed by the faculty team. Curricular components were redesigned based on formative feedback. Openness to this feedback coupled with flexibility and compromise enabled the faculty team to create an efficient, sustainable, and feasible interdisciplinary palliative oncology curriculum. Interdisciplinary palliative education can be successful if faculty teams are willing to confront challenges, accept feedback on multiple levels, and compromise while maintaining focus on desired learner outcomes.
Andersen, Hanne; Wagenknecht, Susann
In interdisciplinary research scientists have to share and integrate knowledge between people and across disciplinary boundaries. An important issue for philosophy of science is to understand how scientists who work in these kinds of environments exchange knowledge and develop new concepts and th...... they engage in when participating in interdisciplinary research in a group, and we compare our findings with those of other studies in interdisciplinary research.......In interdisciplinary research scientists have to share and integrate knowledge between people and across disciplinary boundaries. An important issue for philosophy of science is to understand how scientists who work in these kinds of environments exchange knowledge and develop new concepts...
Teno, Joan M; Casarett, David; Spence, Carol; Connor, Stephen
Many family members of patients enrolled in hospice for less than seven days state that the hospice referral was made "at the right time." To examine bereaved family members' perceptions of the timing of hospice referral to identify aspects of the referral process that can be improved. Open-ended interviews were conducted in seven hospice programs, interviewing bereaved family members of hospice patients who died within the first week of hospice enrollment. Of the 100 narrative interviews, 99 respondents stated that their family member was either referred "too late" (n=41) or "at the right time" (n=58) to hospice services. When families stated that referral was "at the right time," their perceptions were based on the patient having refused earlier referral (n=8), a rapid decline in the patient's condition resulting in the late referral (n=20), or a belief in all things coming together as they were meant to (n=11). In contrast, when families stated that referral was "too late," their reasons were centered on concerns with the health care providers' role in decision making (n=24), with the leading concerns being inadequate physician communication (n=7), not recognizing the patient as dying (n=11), or problematic hospice delays in referral from the nursing home or home health agency (n=4). Despite the patient refusing an earlier hospice referral, five family members believed the referral was "too late." Whereas family members identified expected concerns with communication, more than one in three stated an earlier hospice referral was not possible. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
John Cairns Jr.
Full Text Available ABSTRACT: The quest for sustainable use of the planet will require evidence, analysis and judgment from a wide array of disciplines. In order to produce a systematic and orderly analysis of this information, a synthesis will be essential. This synthesis will be generated most effectively if the individuals designing the research and providing the data interact in a variety of ways. Disciplines are isolated from each other and not accustomed to working together; however, this isolation is changing rapidly. Still, there are many issues not yet satisfactorily resolved. This manuscript illustrates these issues and makes suggestions for improving the situation.
Johnson, David B.
The Special Intensive Program for Scientists and Engineers (SIPSE) at Diablo Valley College in California replaces the traditional engineering calculus and physics sequences with a single sequence that combines the two subjects into an integrated whole. The project report provides an overview of SIPSE, a section that traces the project from…
Cook, E. E.
Describes a program designed to answer the emotionalism and sensationalism propounded by the broad spectrum ecologist. Courses include the areas of government, agriculture, economics, engineering, and natural resources. (GS)
Athaide, Gerard A.; Desai, Harsha B.
Given increasing industry demand for integrative learning, marketing curricula need to emphasize interdisciplinary approaches to teaching. Although team teaching is a useful method for achieving cross-functional integration, there are very few frameworks for effectively implementing team teaching. Consequently, marketing educators seeking to offer…
Ng, Betsy L. L.; Yap, Kueh C.; Hoh, Yin K.
Abstract: Students' perception of 8 criteria (rationale of the problem; interdisciplinary learning; facilitator asked essential questions; learner's skills; assessments; facilitation procedures; team's use of resources [team collaboration], and facilitator within a problem-based learning context) were assessed for a food biotechnology course that…
Gabrielová, Jana; Veleminsky, Milos
This paper addresses the issue of interdisciplinary collaboration between medical and non-medical professions in health and social care. The introduction defines basic terms such as interdisciplinary cooperation, interdisciplinary team, and health and social care. Additionally, it highlights the significance and contribution of interdisciplinary collaboration in the care of the patient/client in health and social care. The aim of the paper is to identify factors influencing the process of interdisciplinary collaboration between, in particular, social workers and physicians. In compliance with the main goal of the research, the following partial goals were included: 1) to identify factors that limit the process of interdisciplinary collaboration between social workers and physicians, and 2) to identify factors which support the process of interdisciplinary collaboration between social workers and physicians. Based on the research goals, a systematic review was selected as the research method for the paper. The research dataset consisted of articles obtained from the following databases: EBSO, PUBMED/MEDLINE, SCIENCE DIRECT and SCOPUS. The databases were search using the following keywords: interprofessional cooperation, interdisciplinary, collaboration, social work, and physicians/doctors. Using the results, the following factors supporting interdisciplinary collaboration were identified: acknowledgement of colleagues' expertise, recognition of roles, positive level of communication, and mutual respect. Factors that limit interdisciplinary processes included the following: varying professional perspectives, theoretical differences, lack of knowledge, and poor communication.
Full Text Available Ethical dilemmas that face heathcare team members referring patients to hospice programs include the ability of clinicians to predict accurately a patient bad prognosis. They affect day-to-day patient management in palliative care programs including healthcare team members concern over the use of morphine because possible respiratory depression in the patient, the question of providing enteral or parenteral nutritional support to patients who refuse to eat and the question of providing parenteral fluids to patients who are unable to take fluids during the terminal phrases of illness. A final ethical dilemma concerns the methodology for quality of life research in palliative care. Understanding and resolving these ethical dilemmas is an important factor determining the quality of the caring for the patient. The ethical dilemmas that are discussed in the article likely to occur in this period can be prevented through his/her participation in the decisions concerning his or her treatment. [Archives Medical Review Journal 2013; 22(1.000: 65-79
Qualitative evaluation of the implementation of the Interdisciplinary Management Tool: a reflective tool to enhance interdisciplinary teamwork using Structured, Facilitated Action Research for Implementation.
Nancarrow, Susan A; Smith, Tony; Ariss, Steven; Enderby, Pamela M
Reflective practice is used increasingly to enhance team functioning and service effectiveness; however, there is little evidence of its use in interdisciplinary teams. This paper presents the qualitative evaluation of the Interdisciplinary Management Tool (IMT), an evidence-based change tool designed to enhance interdisciplinary teamwork through structured team reflection. The IMT incorporates three components: an evidence-based resource guide; a reflective implementation framework based on Structured, Facilitated Action Research for Implementation methodology; and formative and summative evaluation components. The IMT was implemented with intermediate care teams supported by independent facilitators in England. Each intervention lasted 6 months and was evaluated over a 12-month period. Data sources include interviews, a focus group with facilitators, questionnaires completed by team members and documentary feedback from structured team reports. Data were analysed qualitatively using the Framework approach. The IMT was implemented with 10 teams, including 253 staff from more than 10 different disciplines. Team challenges included lack of clear vision; communication issues; limited career progression opportunities; inefficient resource use; need for role clarity and service development. The IMT successfully engaged staff in the change process, and resulted in teams developing creative strategies to address the issues identified. Participants valued dedicated time to focus on the processes of team functioning; however, some were uncomfortable with a focus on teamwork at the expense of delivering direct patient care. The IMT is a relatively low-cost, structured, reflective way to enhance team function. It empowers individuals to understand and value their own, and others' roles and responsibilities within the team; identify barriers to effective teamwork, and develop and implement appropriate solutions to these. To be successful, teams need protected time to take
This literature review aimed to identify the evidence base for a hospice at home service at the end of life for facilitating death at home to narrow the gap between preference and reality. This study defines ‘hospice at home’ as hospice style care provided in the home environment; this means specialist palliative care, equipment and medication is available 24/7. However, services operating under this term are not uniform across the literature. Terms encountered in the literature that are used...
Dougherty, Meredith; Harris, Pamela S; Teno, Joan; Corcoran, Amy M; Douglas, Cindy; Nelson, Jackie; Way, Deborah; Harrold, Joan E; Casarett, David J
To compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. Electronic health record-based retrospective cohort study. Nonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 85,581; 7,451 (8.7%) assisted living facility, 78,130 (91.3%) home). Hospice length of stay, use of opioids for pain, and site of death. The assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%; odds ratio (OR) = 13.3, 95% confidence interval (CI) = 12.3-14.4; P < .001) and enroll in hospice closer to death (median length of stay 24 vs 29 days). Assisted living residents were less likely to receive opioids for pain (18.1% vs 39.7%; OR = 0.33, 95% CI = 0.29-0.39, P < .001) and less likely to die in an inpatient hospice unit (9.3% vs 16.1%; OR = 0.53, 95% CI = 0.49-0.58, P < .001) or a hospital (1.3% vs 7.6%; OR = 0.16, 95% CI = 0.13-0.19, P < .001). Three are several differences between residents of assisted living receiving hospice care and individuals living at home receiving hospice care. A better understanding of these differences could allow hospices to develop guidelines for better coordination of end-of-life care for the assisted living population. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.
Parast, Layla; Elliott, Marc N; Hambarsoomian, Katrin; Teno, Joan; Anhang Price, Rebecca
To examine the effect of mode of survey administration on response rates and response tendencies for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey and develop appropriate adjustments. Survey response data were obtained after sampling and fielding of the CAHPS Hospice Survey in 2015. Sampled caregivers and decedents were randomized to one of three modes: mail only, telephone only, and mixed mode (mail with telephone follow-up). Linear regression analysis was used to examine the effect of mode on individual responses to questions (6 composite measures and 2 global measures that examine hospice quality). U.S. hospice programs (N = 57). Primary caregivers of individuals who died in hospice (N = 7,349). Outcomes were 8 hospice quality measures (6 composite measures, 2 global measures). Analyses were adjusted for differences in case-mix (e.g., decedent age, payer for hospice care, primary diagnosis, length of final episode of hospice care, respondent age, respondent education, relationship of decedent to caregiver, survey language, and language spoken at home) between hospices. Response rates were 42.6% for those randomized to mail only, 37.9%, for those randomized to telephone only, and 52.6% for those randomized to mixed mode (P mode effects (P mode experiments for hospital CAHPS, hospice primary caregivers tend to respond more negatively by telephone than by mail. Valid comparisons of hospice performance require that reported hospice scores be adjusted for survey mode. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.
Weng, Tzu-Chieh; Yang, Ya-Chun; Chen, Ping-Jen; Kuo, Wen-Fu; Wang, Wei-Lin; Ke, Ya-Ting; Hsu, Chien-Chin; Lin, Kao-Chang; Huang, Chien-Cheng; Lin, Hung-Jung
Abstract Hospice and palliative care has been recognized as an essential part of emergency medicine; however, there is no consensus on the optimal model for the delivery of hospice and palliative care in the emergency department (ED). Therefore, we conducted a novel implementation in a tertiary medical center in Taiwan. In the preintervention period, we recruited a specialist for hospice and palliative medicine in the ED to lead our intervention. In the early stage of the intervention, starti...
Hwang, Deborah; Teno, Joan M; Clark, Melissa; Shield, Renée; Williams, Cindy; Casarett, David; Spence, Carol
Nursing homes (NHs) are increasingly the site of hospice care. High quality of care is dependent on successful NH-hospice collaboration. To examine bereaved family members' perceptions of NH-hospice collaborations in terms of what they believe went well or could have been improved. Focus groups were conducted with bereaved family members from five diverse geographic regions, and included participants from inner city and rural settings, with oversampling of African Americans. A total of 28 participants (14.8% African American, mean age 61.4 years) identified three major aspects of collaboration as important to care delivery. First, most (67.9%) voiced concerns with knowing who (NH or hospice) is responsible for which aspects of patient care. Second, nearly half (42.9%) stated concern about information coordination between the NH and hospice. Finally, 67.9% of the participants mentioned the need for hospice to advocate for high-quality care rather than their having to directly do so on behalf of their family members. The important concerns raised by bereaved family members about NH-hospice collaboration have been incorporated into the revised Family Evaluation of Hospice Care, a post-death survey used to evaluate quality of hospice care. Published by Elsevier Inc.
Lafferty, C L
This article asserts that in light of changing conditions in the healthcare environment, transformational leadership is the most appropriate leadership style for the hospice registered nurse case manager. The author defines transformational leadership and, tracing from early leadership theories, demonstrates how the transformational-transactional leadership paradigm emerged from preceding leadership theories. The components of transformational leadership--transformational behavior and transformational characteristics--are linked to hospice theory and hospice-specific nursing practices. The expanding role of the hospice R.N. case manager is addressed in light of transformational leadership and culture building. Specific actions are proposed in the arenas of research, education, and community, corporate, and legislative involvement.
Kim, Mee-Ok; Lee, Kun-Sei; Kim, Jung-Hoe; Joo, Ji-Soo
It is necessary to develop a proper payment system for more health care facilities to provide hospice and palliative cares. In deciding the proper level of payment for hospice per diem fee, willingness to pay (WTP) may provide one of the critical information. This study was conducted to determine WTP for hospice care and to analyze those factors affecting WTP. A contingent valuation method with a double-bounded dichotomous-choice model was used. Interview survey was organized and conducted by a survey company from April 4 to 18, 2008. The mean WTP was calculated through an infinite integration of survival functions. The average willingness to pay was found to be 42,240 Korean won (KRW) (USD 35), with the amount becoming higher as hospice services were deemed more necessary or where average monthly household income was higher. The amount was also higher among male respondents than females. To compare this WTP with actual cost (32,500 KRW) (USD 27) for hospice care. To facilitate hospice service, hospice specific payment system should be developed. This study provides information regarding the general public's preference of hospice service and their WTP for hospice care, and it may be useful in the decision-making process.
Kamal, Arif H; Nicolla, Jonathan M; Power, Steve
Rapid changes in how palliative care clinicians are evaluated and paid present an imperative for clinicians to adeptly and routinely perform quality improvement in usual practice. Like empathic communication and facilitating goals of care discussions, quality improvement skills must be learned, honed, and practiced, so identifying problems and brainstorming solutions becomes a natural component of delivering serious illness care. Using our experience in both failures and successes in performing quality improvement, here we provide a prioritized list of 10 pearls specifically aimed to palliative care and hospice professionals. We aim to demystify quality improvement, highlight areas where rigor and a systematic approach are needed for success, and offer our own lessons learned and mistakes made to promote success for our colleagues and our field. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Hriceniak, J; Bauce, K
A theory is an explanation of the interrelation among facts, concepts, or propositions. A number of theories are used in the process of hospice program assessment, including nursing process, change systems, and role theory. Collaboration between systems is crucial to the development of a smooth-running, effective hospital-community network. As a result of the theories utilized, the tools and skills needed to effect change, the driving and restraining forces that need to be identified, and the need to focus on a specific goal have been described. Although the theories utilized in this hospice study will not predict the outcome of the project, they have provided us with structure that enables us to guide our action and organize our approach to program analysis.
Raffaeli, William; Andruccioli, Jessica; Florindi, Stefania; Ferioli, Isabella; Monterubbianesi, Maria Cristina; Sarti, Donatella; Castellani, Francesca; Giarelli, Guido
In this study, we investigated patient's meaning attribution to pain in hospice and pain therapy unit, using a qualitative approach: narrative-based medicine. The data presented here were related to patients (n = 17) hospitalized in Rimini Hospice (Italy). These data were compared to those of patients (n = 21) with noncancer pain (control sample). The interviews were then analyzed according to the technique of thematic narrative analysis. The results of our research identified a differential process in pain processing in relationship to the meaning that the patient attributed to pain. The thematic analysis of the interviews allowed the inductive construction of a specific network of pain dimensions, which were summarized in "the pain chronogram."
Taylor, Vanessa; Middleton-Green, Laura; Carding, Sally; Perkins, Paul
The involvement of two nurses to dispense and administer controlled drugs is routine practice in most clinical areas despite there being no legal or evidence-based rationale. Indeed, evidence suggests this practice enhances neither safety nor care. Registered nurses at two hospices agreed to change practice to single nurse dispensing and administration of controlled drugs (SNAD). Participants' views on SNAD were evaluated before and after implementation. The aim of this study was to explore the views and experiences of nurses who had implemented SNAD and to identify the views and concerns of those who had not yet experienced SNAD. Data was obtained through semi-structured interviews. Qualitative thematic analysis of interview transcripts identified three key themes: practice to enhance patient benefit and care; practice to enhance nursing care and satisfaction; and practice to enhance organisational safety. The findings have implications for the understanding of influences on medicines safety in clinical practice and for hospice policy makers.
Bodell, J; Weng, M A
Culturally competent nursing care regarding the ethical dilemma of terminal dehydration (withholding or withdrawing food and fluid) for the Jewish hospice patient involves applying the ethical principles of justice, autonomy, beneficence, and nonmaleficence to nursing interventions by identifying outcomes that focus on the high value Jews place on life; avoiding stereotyping as to what it means to be Jewish; knowledge of various Jewish traditions surrounding death and dying; and good communication with the patient and his or her family.
Szeliga, Marta; Mirecka, Jadwiga
The subject of the presented work was an attempt at optimization of the methods used for verification of the candidates for medical voluntary workers in a hospice and decreasing the danger of a negative influence of an incompetent volunteer on a person in a terminal stage of a disease and his or her relatives. The study was carried out in St. Lazarus Hospice in Krakow, Poland, and included 154 adult participants in four consecutive editions of "A course for volunteers - a guardian of the sick" organized by the hospice. In order to improve the recruitment of these workers, the hitherto methods of selection (an interview with the coordinator of volunteering and no less than 50% of attendance in classes of a preparatory course for volunteers") were expanded by additional instruments-the tests whose usefulness was examined in practice. Knowledge of candidates was tested with the use of a written examination which consisted of four open questions and an MCQ test comprising 31 questions. Practical abilities were checked by the Objective Structured Clinical Examination (OSCE). A reference point for the results of these tests was a hidden standardized long-term observation carried out during the subsequent work of the volunteers in the stationary ward in the hospice using the Amsterdam Attitude and Communication Scale (AACS). Among the tests used, the greatest value (confirmed by a quantitative and qualitative analysis) in predicting how a given person would cope with practical tasks and in contact with the sick and their relatives had a practical test of the OSCE type.
Goparaju Purna SUDHAKAR
Full Text Available Popularity ofteams is growing in 21st Century. Organizations are getting theirwork done through different types of teams. Teams have proved that thecollective performance is more than the sum of the individual performances.Thus, the teams have got different dimensions such as quantitative dimensionsand qualitative dimensions. The Quantitative dimensions of teams such as teamperformance, team productivity, team innovation, team effectiveness, teamefficiency, team decision making and team conflicts and Qualitative dimensionsof teams such as team communication, team coordination, team cooperation, teamcohesion, team climate, team creativity, team leadership and team conflictshave been discussed in this article.
Kortsarts, Yana; Morris, Robert W.; Utell, Janine M.
Bioinformatics is a relatively new interdisciplinary field that integrates computer science, mathematics, biology, and information technology to manage, analyze, and understand biological, biochemical and biophysical information. We present our experience in teaching an interdisciplinary course, Introduction to Bioinformatics, which was developed…
Khapova, S.N.; Arthur, M.B.
This is the opening article in a Human Relations special issue on 'Interdisciplinary approaches to contemporary career studies'. After introducing a story of an 'exceptional - but real' career, we argue for an urgent shift toward greater interdisciplinary inquiry. We reflect on the story to describe
Stefanidis, Dimitrios; Ingram, Katherine M; Williams, Kristy H; Bencken, Crystal L; Swiderski, Dawn
Interdisciplinary team training in a simulation center recreates clinical team interactions and holds promise in improving teamwork of clinicians by breaking down educational silos. The objective of our study was to assess the appropriateness of interdisciplinary training with general surgery residents and nursing students. Over 2 consecutive academic years (2012-2013 and 2013-2014), general surgery residents participated in interdisciplinary team-training simulation-based sessions with senior nursing students. Scenario objectives included demonstration of appropriate teamwork and communication, and clinical decision making; sessions incorporated interdisciplinary debriefing of the scenarios. Participants were asked to assess their team-training experience and the appropriateness of their team-training partner. Responses were compared. A total of 16 team-training sessions were conducted during the study period. Overall, 12 surgery residents (67%) and 44 nursing students (63%) who had participated in at least 1 session responded to the survey. Although both residents and nursing students indicated that the knowledge and team skills acquired during these sessions were useful to them in clinical practice (73% vs 86%, respectively; p = not significant), residents rated their educational value lower (3.3 vs 4.3 on a 5-point scale, respectively; p students (p students, debriefing (91%), observation of others (68%), and interaction with resident physicians (66%) ranked highest; 48% of student nurses preferred residents as team-training partners whereas 100% residents preferred practicing nurses and 0% with nursing students owing to their limited clinical experience. Interdisciplinary team training and debriefing of surgery residents with nursing students is feasible and highly valued by nursing students. Nevertheless, our experience indicates that residents do not prefer nursing students as team-training partners owing to their limited clinical experience and would rather
Claxton-Oldfield, Stephen; Claxton-Oldfield, Jane
The goal of this study was to examine the impact of hospice palliative care work on volunteers' lives. In-depth interviews were conducted with 23 direct-patient care volunteers. More than half of the volunteers became involved in hospice palliative care because of their own experiences with family members and/or friends who have died. Most of the volunteers reported that they were different now or had changed in some way since they have been volunteering (e.g., they had grown in some way, have learned how to keep things in perspective). In addition, most of the volunteers felt that their outlook on life had changed since they started volunteering (e.g., they were more accepting of death, and they learned the importance of living one day at a time). Volunteers reported doing a number of different things to prevent compassion fatigue or burnout (e.g., reading a book, listening to music, talking to others, and taking time off from volunteering). Most of the volunteers said that they would tell anyone who might be thinking of volunteering in hospice palliative care that it is a very rewarding activity and/or that they should try it. Finally, many of the volunteers offered suggestions for doing things differently in their programs.
The hospice movement was launched by the Croatian Society of Hospice and Palliative Care, Croatian Medical Association, founded and headed by the author until 2009. In this article, the author describes the development of the hospice movement in four periods, as follows: first period 1994-1999, the beginnings; second period 2000-2005, a period of great hopes and initial achievement of first goals; third period 2006-2008, a period of stagnation, the 'burn-out' syndrome, looking for new ways and people; and fourth period 2009-? Let us hope it will bring true finding way out, a new period of struggling for acceptable solutions, which has already been accomplished in many countries. The hope dies last, the hope in positive powers among the citizens of Croatia. Only the most important facts are presented, whereas citations from numerous lectures, events held all over Croatia and publications in many books and newspapers are omitted. Descriptions of numerous trips for training, education, for one month, two weeks, one week or several days in the USA, Canada, UK, Poland, Hungary, Austria, Switzerland, Norway, etc., and of visits paid by many guests from the UK, USA, Canada, Italy, Germany, Switzerland, Poland, Hungary, Romania, Bulgaria, Israel, Bosnia and Herzegovina, Serbia, Macedonia, etc. are also omitted. All these facts will be presented in the monograph that has been prepared for publication.
Armando Carlos Roca Socarrás
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.
In the state of Pennsylvania, a collaborative model has been developed for improving pediatric palliative care and end-of-life care services to children with life-limiting conditions and their families. The inspiration and efforts of several bereaved parents provided the initial impetus for this encouraging model. Pennsylvania's model involves cooperation and collaboration among several groups and initiatives across the state, as well as the integration of parent-professional collaboration at all levels and in each initiative. The collaborating groups include 1) a volunteer grassroots resource and education initiative, Helping Hands-Healing Hearts; 2) the Pittsburgh Pediatric Palliative Care Coalition, a coalition of concerned parents and experienced palliative and hospice care providers working together to improve service availability; and 3) the Pennsylvania Children's Hospice and Palliative Care Coalition, which developed as an outcome of a state-level Pennsylvania Pediatric Hospice Care Task Force, and which, among other activities, works with the Pennsylvania Department of Public Welfare and several Pennsylvania legislators on pertinent policy and legislative initiatives.
Sweeney, Catherine; O'Sullivan, Eleanor; McCarthy, Marian
Palliative care is a complex area of healthcare best delivered by an interdisciplinary team approach. Breaking bad news is an inherent part of caring for people with life-limiting conditions. This study aims to explore an interdisciplinary breaking bad news role-play in a palliative care module. Participants were undergraduate medical and nursing…
What do combustion engines, fusion reactors, weather forecast, ocean flows, our sun, and stellar explosions in outer space have in common? Of course, the physics and the length and time scales are vastly different in all cases, but it is also well known that in all of them, on some relevant length scales, the material flows that govern the dynamical and/or secular evolution of the systems are chaotic and often unpredictable: they are said to be turbulent. The interdisciplinary aspects of turbulence are brought together in this volume containing chapters written by experts from very different fields, including geophysics, astrophysics, and engineering. It covers several subjects on which considerable progress was made during the last decades, from questions concerning the very nature of turbulence to some practical applications. These subjects include: a basic introduction into turbulence, statistical mechanics and nonlinear dynamics, turbulent convection in stars, atmospheric turbulence in the context of nume...
Nerantzis, Nikolaos; Mitrouda, Aikaterini; Reizopoulou, Ioanna; Sidiropoulou, Eirini; Hatzidimitriou, Antonios
On November 9th, 2015, three didactical hours were dedicated to Interdisciplinary Astronomy Activities (http://wp.me/p6Hte2-1I). Our students and their teachers formed three groups and in rotation, were engaged with the following activities: (a) viewing unique images of the Cosmos in the mobile planetarium STARLAB (http://www.planitario.gr/tholos-starlab-classic-standard.html), (b) watching the following videos: Journey to the end of the universe (https://youtu.be/Ufl_Nwbl8xs), Rosetta update (https://youtu.be/nQ9ivd7wv30), The Solar System (https://youtu.be/d66dsagrTa0), Ambition the film (https://youtu.be/H08tGjXNHO4) in the school's library. Students and teachers were informed about our solar system, the Rosetta mission, the universe, etc. and (c) tactile activities such as Meet our home and Meet our neighbors (http://astroedu.iau.org, http://nuclio.org/astroneighbours/resources) and the creation of planets' 3D models (Geology-Geography A' Class Student's book, pg.15). With the activities above we had the pleasure to join the Cosmic Light Edu Kit / International Year of Light 2015 program. After our Interdisciplinary Astronomy Activities, we did a "small" research: our students had to fill an evaluation about their educational gains and the results can be found here http://wp.me/p6Hte2-2q. Moreover, we discussed about Big Ideas of Science (http://wp.me/p3oRiZ-dm) and through the "big" impact of the Rosetta mission & the infinity of our universe, we print posters with relevant topics and place them to the classrooms. We thank Rosa Doran (Nuclio - President of the Executive Council) for her continuous assistance and support on innovative science teaching proposals. She is an inspiration.
... Accident DME Durable Medical Equipment FEHC Family Evaluation of Hospice Care FY Fiscal Year GIP General.... 6 436 CVA/Stroke....... 26,897 4 7 185 Prostate Cancer.. 20,262 3 8 783.7 Adult Failure 18,304 3 To... Alzheimer's 58,200 6 Disease. 7 290.0 Senile Dementia 37,667 4 Uncomp.. 8 436 CVA/Stroke....... 31,800 3 9...
Harward, Donna H; Tresolini, Carol P; Davis, William A
To explore whether participation in a three-hour health affairs interdisciplinary case conference (HAICC) changed medical students' knowledge and attitudes about the role of interdisciplinary teams in health care. Faculty from ten University of North Carolina at Chapel Hill health professions' schools helped to design the HAICC. Conference goals included improving students' knowledge and attitudes about the skills of various health professions and the benefits of interdisciplinary care. From 2001-04, 2,005 health professions students, including 615 second-year medical students, participated in the HAICC. Working in teams, students, using the World Health Organization's International Classification of Function and Disability, interviewed a standardized patient and, then, developed a patient-centered management plan. A self-report instrument to assess medical students' knowledge about each of the ten health professions and to assess students' attitudes about working with other health professionals was administered before and after the conference. Repeated measures were used to assess whether medical students' knowledge and attitudes about interdisciplinary teams changed as a result of participating in HAICC. A total of 605 medical students (98.5%) completed both instruments. Following participation in the HAICC, there were significant increases in students' knowledge about the training and skills of all ten professions, the advantages of working in an interdisciplinary team, and the importance of care provided by these professions. In general, there were significant improvements in students' attitudes toward the value of interdisciplinary team work and leadership by all health professionals. Participation in a three-hour HAICC resulted in medical students' increased knowledge about and attitudes toward the role of interdisciplinary teams in health care.
Christakis, N A; Iwashyna, T J
Hospice terminal care is now used by 10% to 15% of elderly Americans at variable points before their deaths. By examining the duration of patient survival after enrollment in hospice care, we sought to identify individual and market factors associated with the timing of hospice use. We linked Medicare claims, census information, and Area Resource File data to form a national cohort of 151,410 hospice patients admitted in 1993 and followed up until late 1996. We examined this cohort with Cox regression and other means. The primary outcome measure was survival after hospice enrollment. The patients had a mean +/- SD age of 79.0 +/- 7.4 years; 10.2% were nonwhite; 51.4% were female; and 71.3% had cancer. Median survival after hospice enrollment was 30 days (interquartile range, 10-86 days). After adjustment for measured patient, provider, and market factors, several variables were associated with relatively earlier hospice enrollment, farther from death. Compared with complementary groups, nonwhites were enrolled in hospice 4 days earlier; women, 5 days earlier; older people, 1 day earlier; and those with substance abuse, psychiatric disease, or dementia, each 3 days earlier. After adjustment, income and education were not associated with the timing of enrollment. Patients residing in markets with more hospital beds, greater hospice capacity, or a higher proportion of generalists were enrolled earlier. Even after adjustment for certain clinical attributes, individual social factors and local market factors were associated with survival after hospice enrollment. Certain socially disadvantaged groups were enrolled earlier, as were those residing in areas with more medical institutions. The decision to enroll patients in hospice may depend on both nonclinical and clinical factors.
Taylor, Andrea; French, Tara; Raman, Sneha
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.
Riggs, Alexa; Breuer, Brenda; Dhingra, Lara; Chen, Jack; Portenoy, Russell K; Knotkova, Helena
In the U.S., palliative care programs improve access to hospice through enhanced communication and efficiencies in hospice eligibility review and enrollment. For community-based programs, this task may begin with telephone contact. To evaluate the incidence and predictors of hospice enrollment following telephonic outreach by a nurse after referral to a community-based, specialist palliative care program. During 2012-2014, 299 consecutive patients who were referred to a palliative care program and subsequently enrolled in hospice provided electronic health record data for a retrospective cohort study. Those who elected hospice after telephonic outreach and before the first palliative care home visit, were compared with those who enrolled in hospice after palliative care visits began, using both bivariate and multivariate analyses. Mean (SD) age was 74.1 (18.7) years; 60.2% were women, 44.4% were White, 22.5% were Hispanic, 20.9% were Black, and 9.6% were Asian. In total, 177 patients (59.2%) elected hospice following telephonic outreach and 122 (40.8%) enrolled after home visits began. The former group received a mean of 4.5 calls (median = 3.0) before hospice election. In multivariate analysis, hospice enrollment following telephonic outreach alone was associated with hospital or nursing home referral, not married status, and poor performance status (all P palliative care program did so following telephonic outreach alone. Both sociodemographic and clinical characteristics predicted this outcome. Palliative care programs can improve hospice access through initial telephonic outreach by trained professionals. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Yim, Cindi K; Barrón, Yolanda; Moore, Stanley; Murtaugh, Chris; Lala, Anuradha; Aldridge, Melissa; Goldstein, Nathan; Gelfman, Laura P
Patients with advanced heart failure (HF) enroll in hospice at low rates, and data on their acute medical service utilization after hospice enrollment is limited. We performed a descriptive analysis of Medicare fee-for-service beneficiaries, with at least one home health claim between July 1, 2009, and June 30, 2010, and at least 2 HF hospitalizations between July 1, 2009, and December 31, 2009, who subsequently enrolled in hospice between July 1, 2009, and December 31, 2009. We estimated panel-negative binomial models on a subset of beneficiaries to compare their acute medical service utilization before and after enrollment. Our sample size included 5073 beneficiaries: 55% were female, 45% were ≥85 years of age, 13% were non-white, and the mean comorbidity count was 2.38 (standard deviation 1.22). The median number of days between the second HF hospital discharge and hospice enrollment was 45. The median number of days enrolled in hospice was 15, and 39% of the beneficiaries died within 7 days of enrollment. During the study period, 11% of the beneficiaries disenrolled from hospice at least once. The adjusted mean number of hospital, intensive care unit, and emergency room admissions decreased from 2.56, 0.87, and 1.17 before hospice enrollment to 0.53, 0.19, and 0.76 after hospice enrollment. Home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization after their enrollment. Their pattern of hospice use suggests that earlier referral and improved retention may benefit this population. Further research is necessary to understand hospice referral and palliative care needs of advanced HF patients. © 2017 American Heart Association, Inc.
Unroe, Kathleen T; Bernard, Brittany; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M
To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay. Retrospective cohort study using hospice patient electronic medical record data. Large, national hospice provider. Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings. Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months. There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
Highet, Bridget H; Hsieh, Yu-Hsiang; Smith, Thomas J
Hospice is underutilized, with over 25% of enrolled patients receiving hospice care for 3 days or less. The inner city emergency department (ED) is a highly trafficked area for patients in the last 6 months of life, and is a potential location for identification of hospice-eligible patients and early palliative care (PC) intervention. We evaluated the feasibility of an ED PC intervention to identify hospice-eligible patients to accelerate PC consultation and hospice enrollment. This prospective, pilot study established a program in the ED via education and a direct line of communication between the ED and PC to identify hospice-eligible patients, with the goal of facilitating disposition to hospice within 24 h. Data were analyzed for time to PC consultation, length of stay, emergency physician (EP) appropriateness of referral, and time from hospitalization to mortality. In a 6-month period, EPs identified 88 hospice-eligible patients with 91% accuracy. Of the patients identified, 59% died within 3 months of their visit to the ED. Time to PC consultation was 2.3 days (SD 2.3), and 57% of those seen by PC were discharged to hospice, vs. 30% of those not consulted (p = 0.038). The potential median hospice length of stay was 31.5 days, better than for the institution as a whole. Our pilot study presents a unique approach to early identification and disposition of hospice-appropriate patients, and suggests EPs may have sufficient prognostic accuracy to perform this task. Copyright © 2016 Elsevier Inc. All rights reserved.
Wang, Shi-Yi; Aldridge, Melissa D.; Gross, Cary P.; Canavan, Maureen; Cherlin, Emily; Johnson-Hurzeler, Rosemary; Bradley, Elizabeth
Objectives We sought to characterize the number and types of care transitions in the last 6 months of life made by patients who used hospice and examined factors associated with having multiple transitions in care. Design, Setting, and Participants We performed a retrospective cohort study of fee-for-service Medicare beneficiaries, aged 66 years or older who died between July 1, 2011 and December 31, 2011, and were enrolled in hospice at some time during the last 6 months of life. We used hierarchical generalized linear modeling to identify patient, hospice, and regional factors associated with transitions. We also described the sequence of transitions across healthcare settings. Measures Healthcare transitions after hospice enrollment included from/to hospital, skilled nursing facility, home health agency program, hospice, or home without receiving any service above. Results Among 311,090 hospice decedents, 31,675 (10.2%) had at least one transition after hospice enrollment and this varied substantially across the United States. A total of 6.6% of all decedents had more than one transition in care after hospice enrollment, with a range from 2–19 transitions. Among hospice users with transitions, 53.4% were admitted to hospitals, 17.7% were admitted to skilled nursing facilities, 9.6% used home health agencies, and 25.8% had transitions to home without receiving services we examined. In adjusted analyses, decedents who were younger, nonwhite, enrolled in a for-profit or small hospice program, or had less access to hospital-based palliative care had significantly higher odds of having at least one transition. Conclusion A notable proportion of hospice users experience at least one transition in care in the last 6 months of life, suggesting further research on their impact on patients and families is warranted. PMID:26889841
Metcalfe, Alison; Pumphrey, Rachel; Clifford, Collette
The overall aim of this study is to determine hospice nurses' perception of the importance of genetics to hospice care provision and their personal level of confidence in carrying out genetics-related activities within an end-of-life care context. Hospices nurses regularly care for patients and their families affected by inherited genetic conditions (e.g. some cancers). Therefore, nurses need knowledge and awareness of the implications of genetic conditions and confidence in their abilities to provide appropriate care and support for patients and families. Survey. Questionnaires were sent to a stratified sample of hospice nurses (n = 1149) in England and Wales. Using Likert scales, nurses were asked to rate the importance of and their confidence in undertaking a range of scenario-based activities that accompany caring for a patient and family affected by a genetic condition in the hospice setting. Open questions invited comments on their experiences of nursing patient/family in similar situations. Follow-up telephone interviews were carried out with hospice nurse educators to explore emerging issues. Response rate was 29% (n = 328). Hospice nurses felt that all aspects of genetics-related care were 'very important' to hospice care, but lacked confidence in their ability to carry out the activities. Many respondents had not considered the relevance of genetics to hospice-care prior to completing the questionnaire but now considered it essential to end-of-life care even if they were not confident to provide it. Hospice nurses' need genetics education focusing on the psychosocial implications of caring for patients and families affected by genetic conditions to enable them to provide the complex care and support in face of the difficult issues that arise in practice. This study highlights the genetics education needs of hospice nurses in providing end-of life care for patients and their families affected by inherited genetic conditions.
Lia Leão Ciuffo
Full Text Available Objective. Understanding the role of nurses as members of interdisciplinary teams in the care of children with suspected sexual abuse. Methodology. This is a qualitative research based on the sociological phenomenology of Alfred Schutz. In 2008 were interviewed eleven nurses who worked in reference institutions for the care of child victims of sexual abuse in Rio de Janeiro. Results. The category called 'Interacting with other professionals in child care' emerged from the analysis of performance of professionals. The intersubjective relations between the nurses and the interdisciplinary team will enable to understand the intent of care from the perspective of social, emotional and psychological needs of children and their families. Conclusion. Interdisciplinarity favored the development of actions based on acceptance, listening and agreements on possible solutions in the care of children with suspected sexual abuse.
This article, Part 1 of a 2-part series, provides an overview of the current Medicare compliance climate and its implications for hospice providers. Content focuses on the 7 elements of a comprehensive compliance framework as defined by the Health and Human Services Office of the Inspector General in its 1999 Compliance Guidance for Hospices. A brief case example is provided and serves to set the stage for Part 2, which will explore hospice-specific risk areas and specific risk-reduction strategies.
Callard, Felicity; Fitzgerald, Des; Woods, Angela
Interdisciplinarity is often framed as an unquestioned good within and beyond the academy, one to be encouraged by funders and research institutions alike. And yet there is little research on how interdisciplinary projects actually work-and do not work-in practice, particularly within and across the social sciences and humanities. This article centres on "Hubbub", the first interdisciplinary 2-year research residency of The Hub at Wellcome Collection, which is investigating rest and its opposites in neuroscience, mental health, the arts and the everyday. The article describes how Hubbub is tracing, capturing and reflecting on practices of interdisciplinarity across its large, dispersed team of collaborators, who work across the social sciences, humanities, arts, mind and brain sciences, and public engagement. We first describe the distinctiveness of Hubbub (a project designed for a particular space, and one in which the arts are not positioned as simply illustrating or disseminating the research of the scientists), and then outline three techniques Hubbub has developed to map interdisciplinary collaboration in the making: (1) ethnographic analysis; (2) "In the Diary Room", an aesthetics of collaboration designed to harness and capture affective dynamics within a large, complex project; and (3) the Hubbub Collaboration Questionnaire, which yields quantitative and qualitative data, as well as a social network analysis of collaborators. We conclude by considering some themes that other inter-disciplinary projects might draw on for their own logics of tracking and tracing. This article forms part of an ongoing thematic collection dedicated to interdisciplinary research.
Fertman, Carl I; Dotson, Suzanna; Mazzocco, Gail O; Reitz, S Maggie
Meeting the health needs of individuals in rural communities involves addressing the challenges of complex multifaceted health problems, limited local health resources and services, isolation, and distance. Interdisciplinary collaboration can create solutions to health care problems that transcend conventional, discipline-specific methods, procedures, and techniques. This paper reports on the four-pronged approach of the Western Maryland Area Health Education Center used to prepare allied health students to be interdisciplinary team members in rural areas. It describes the development of four interdisciplinary instructional team member training venues (in-class instruction, Web-based modules, service-learning programs, and faculty development workshops) that integrate opportunities to develop and practice interdisciplinary health promotion skills in rural communities. Challenges to implementing the model are described, including developing faculty and student training participation, integrating training venues into existing programs at participating institutions, and designing a unified program evaluation.
Clarke-Tasker, Veronica A
Researchers seeking federal and other sources of funding for their proposed studies have found the request for applications are for those developed by multidisciplinary teams including but not limited faith based and grass root organizations. Nurses, pharmacist, physicians, allied health providers, students, clergy and lay organizations are working together to decrease health disparities. Academic settings have the infrastructure and human resources that can promote interdisciplinary opportunities for partnerships across campus, within their school, colleges and community. The author provides recommendations for building a multidisciplinary research team.
Balzer, J W
The health care industry is looking to continuous quality improvement as a process to both improve patient care and promote cost effectiveness. Interdisciplinary teams are learning to work together and to use data-driven problem solving. Humor adds a creative and welcome touch to the process that makes it easier and more fun to work in teams. The team leader or facilitator who uses humor along the journey sanctions the risk-taking behavior that accompanies creative solutions to tough problems.
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.
Goparaju Purna SUDHAKAR
Popularity of teams is growing in 21st Century. Organizations are getting their work done through different types of teams. Teams have proved that the collective performance is more than the sum of the individual performances. Thus, the teams have got different dimensions such as quantitative dimensions and qualitative dimensions. The Quantitative dimensions of teams such as team performance, team productivity, team innovation, team effectiveness, team efficiency, team decision making and tea...
... 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...
Lepore, Michael J.; Miller, Susan C.; Gozalo, Pedro
Purpose: Medicare hospice is a valuable source of quality care at the end of life, but its lower use by racial minority groups is of concern. This study identifies factors associated with hospice use among urban Black and White nursing home (NH) decedents in the United States. Design and Methods: Multiple data sources are combined and multilevel…
Olthuis, G.J.; Dekkers, W.J.M.; Leget, C.J.W.; Vogelaar, P.J.W.
Good nursing is more than exercising a specific set of skills. It involves the personal identity of the nurse. The aim of this article is to answer two questions: (1) what kind of person should the hospice nurse be? and (2) how should the hospice nurse engage in caring conversations? To answer these
Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.
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…
Mesler, Mark A.
Participant-observation research was conducted in the home care components of a free-standing inpatient facility associated with several hospice organizations over three years. The data are reported using negotiated order theory as a framework for understanding the hospice movement and its attempts to change the experience of dying. (JPS)
...: Organizational Environment § 418.110 Condition of participation: Hospices that provide inpatient care directly. A... hospice must have a written disaster preparedness plan in effect for managing the consequences of power... changes in the edition of the Code are incorporated by reference, CMS will publish a notice in the Federal...
Hegedűs, Katalin; Lukács, Miklós; Schaffer, Judit; Csikós, Agnes
Hospice-palliative care has existed in Hungary for more than 20 years but physicians know very little about it. The objective of the study is to give detailed practical information about the possibilities and the reasonability of hospice care and the process of how to have access to it. The authors review and analyze the database of the national Hospice-Palliative Association database to provide most recent national data on hospice-palliative care. In addition, legal, financial and educational issues are also discussed. At present there are 90 active hospice providers in Hungary, which provide service for more than 8000 terminally ill cancer patients. According to WHO recommendations there would be a need for much more service providers, institutional supply and more beds. There are also problems concerning the attitude and, therefore, patients are admitted into hospice care too late. Hospice care is often confused with chronic or nursing care due to lack of information. The situation may be improved with proper forms of education such as palliative licence and compulsory, 40-hour palliative training for residents. The authors conclude that a broad dissemination of data may help to overcome misbeliefs concerning hospice and raise awareness concerning death and dying.
This paper describes the Portage County, Ohio community hospice program, emphasizing the linkages between family life specialists, health professionals, volunteers, and students. Hospice service is defined as a specialized, home-based program for the management of pain and other symptoms of terminal illness, with the family as the unit of care.…
Darrah, Neha J; O'Connor, Nina R
Patient handoffs are an increasingly emphasized skill in medical and nursing education, and handoff education is required by the Accreditation Council for Graduate Medical Education. Traditional handoff tools lack content that is unique to hospice and palliative medicine. The objective of the study was to develop a comprehensive curriculum to teach and assess patient handoffs in hospice and palliative medicine fellowships. Eight hospice physicians, nurse practitioners, and nurses were interviewed to determine core content for a hospital-to-hospice handoff. This content was used to create a verbal handoff template and direct observation assessment tool, which were reviewed by the same hospice providers for content validity. The handoff template was taught to two groups of palliative medicine fellows and one group of internal medicine residents using an interactive didactic and role play, and feedback was obtained to further refine the curriculum. After refinement, the complete handoff curriculum (verbal handoff template, didactic with role play, assessment by faculty using direct observation tool) was successfully integrated into a hospice and palliative medicine fellowship, satisfying Accreditation Council for Graduate Medical Education requirements related to transitions in care. The hospital-to-hospice handoff is a unique opportunity to teach patient safety in a palliative medicine context. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Cartwright, Juliana C.; Miller, Lois; Volpin, Miriam
Purpose: The purpose of this study was to describe good quality care at the end of life (EOL) for hospice-enrolled residents in assisted living facilities (ALFs). Design and Methods: A qualitative descriptive design was used to obtain detailed descriptions of EOL care provided by ALF medication aides, caregivers, nurses, and hospice nurses in…
Pavoni, Daniela Soccoloski; Medeiros, Cássia Regina Gotler
The Family Health Strategy requires a redefinition of the health care model, characterized by interdisciplinary team work. This study is aimed at knowiong the work processes in a Family Health Team. The research was qualitative, and 10 team members were interviewed. Results demonstrated that the nurse performs a variety of functions that could be shared with other people; this overloads him/her and makes inherent job task execution difficult. Task planning and performing are usually done in teams, but some professionals get more involved in these activities. It was concluded that there is a need for the team to reflect upon work process as well as reassess task assignment, so that each individual is able to perform the work and contribute for an integrated work.
Miller, Susan C
The use of hospice care in nursing homes (NHs) has grown exponentially, but an increasing concern is the lack of access to resident and family-centered palliative care when residents do not elect hospice, and in time periods prior to election. This concern is amplified by the high magnitude of palliative care needs present for NH residents (and their families) when the NH will be their final residence; and, it is amplified because of short hospice stays, half of which are 22 days or less. This manuscript describes the use of the Medicare hospice care in NHs and discusses the policy, staff and physician barriers to timely hospice referral. It also describes the challenges NHs face in expanding residents' access to palliative care. Opportunities and approaches for increasing palliative care expertise and practice in NHs are presented.
Mizell, Deborah; Washington-Brown, Linda J; Russell, Angela
Today, most medical professionals focus on a cure. However, hospice care provides a quality of life for those persons nearing the end of life or persons experiencing a life-limiting illness. The distressing reality is that most nurses are not taught the full scope of end of life care (EOL) in schools of nursing. Because of this educational deficit, a variance in care is created that may adversely affect the dying patient and family's wishes. In our RN to BSN program, we established a partnership with a national hospice organization to provide (1) leadership in end-of-life course development, (2) lecturers experienced in hospice and palliative care, (3) field placement for students with hospice nurses, and (4) nursing scholarships to complete the bachelor's degree. The end result of this partnership is to educate registered nurses about hospice and palliative care, as well as to increase the nursing workforce in this area.
Mixer, Sandra J; Lindley, Lisa; Wallace, Heather; Fornehed, Mary Lou; Wool, Charlotte
Wide variations exist among perinatal hospices, and barriers to perinatal palliative care exist at the healthcare level. Research in the area of culturally sensitive perinatal palliative care has been scarce, a gap which this study addresses. To evaluate the relationship between the nurse work environment and the delivery of culturally sensitive perinatal hospice care. This retrospective, correlational study used data from the National Home and Hospice Care Survey, which includes a nationally representative sample of hospice care providers. A multivariate logistic regression model was used to estimate the relationship between the delivery of culturally sensitive care and the nurse work environment. Accreditation, teaching status, and baccalaureate-prepared registered nurse staff had an impact on the provision of culturally sensitive perinatal care Conclusions: The hospice and nursing unit environments, specifically in regards to education and technology, may be important contributors to the delivery of culturally sensitive care.
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.
Shalev, Ariel; Phongtankuel, Veerawat; Kozlov, Elissa; Shen, Megan Johnson; Adelman, Ronald D; Reid, M C
Despite the documented benefits of palliative and hospice care on improving patients' quality of life, these services remain underutilized. Multiple factors limit the utilization of these services, including patients' and caregivers' lack of knowledge and misperceptions. To examine palliative and hospice care awareness, misperceptions, and receptivity among community-dwelling adults. Cross-sectional study. New York State residents ≥18 years old who participated in the 2016 Empire State Poll. Palliative and hospice care awareness, misperceptions, and receptivity. Of the 800 participants, 664 (83%) and 216 (27%) provided a definition of hospice care and palliative care, respectively. Of those who defined hospice care, 399 (60%) associated it with end-of-life care, 89 (13.4%) mentioned it was comfort care, and 35 (5.3%) reported hospice care provides care to patients and families. Of those who defined palliative care (n = 216), 57 (26.4%) mentioned it provided symptom management to patients, 47 (21.9%) stated it was comfort care, and 19 (8.8%) reported it was applicable in any course of an illness. Of those who defined hospice or palliative care, 248 (37.3%) had a misperception about hospice care and 115 (53.2%) had a misperception about palliative care. Most community-dwelling adults did not mention the major components of palliative and hospice care in their definitions, implying a low level of awareness of these services, and misinformation is common among community-dwelling adults. Palliative and hospice care education initiatives are needed to both increase awareness of and reduce misperceptions about these services.
Pawłowski, Leszek; Lichodziejewska-Niemierko, Monika; Pawłowska, Iga; Leppert, Wojciech; Mróz, Piotr
Volunteers working in hospice and palliative care facilities in Poland undertake various activities which are performed in accordance with legal regulations and the individual policies of each hospice. The aim of this study was to explore the roles and training of volunteers working in hospice and palliative care settings. A cross-sectional survey was carried out that investigated the services performed by volunteers and their preparation for work within residential hospices. Questionnaires were distributed to volunteers and hospice representatives, and the responses obtained underwent statistical analysis. A total of 180 volunteers and 28 hospice representatives from 29 residential hospices participated in this survey. All hospices surveyed were supported by volunteers. 79% of volunteers worked alongside patients and performed the following services: accompanying patients (76%), feeding patients (61%), cleaning rooms (48%), dressing and bathing (42%) and organising leisure time (40%). Fewer volunteers were involved in activities outside of patient support-for example, charity work and fundraising (34%), cleaning hospice buildings (23%) as well as providing information and education (22%). According to volunteers, prior to undertaking their duties, 64% participated in theoretical training and 37% took part in a practical course. The majority attended courses relating to general knowledge of hospice and palliative care (64%) and volunteer rights and duties (55%). Overall, proper training was an essential requirement needed to be fulfilled by volunteers, particularly when involved in direct patient support. Most volunteers were simultaneously involved in various areas of service; therefore, their training should be comprehensive. 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/
Denise J. Stokholm, Marianne
Future wellbeing is depending on human competences in order to strengthen a sustainable development. This requires system thinking and ability to deal with complexity, dynamic and a vast of information. `We need to move away from present principles of breaking down problems into components and give...... and intercultural teams in design and the understanding of design as a process of transformation and information management call for a model with capacity to facilitate both `the what` and `the how` This paper will describe a systemic model of design based on a holistic approach to design developed by the author...... in relation to a design-engineering education at Aalborg University. It will exemplify how the model has been used in workshops on team designing, challenged design learning and affected design competence. In specific it will investigate the influence of visual models of the perception of design, design...
Nowak, Bryan P
With the implementation of the Affordable Care Act, the U.S. government committed to a transition in payment policy for health care services linking reimbursement to improved health outcomes rather than the volume of services provided. To accomplish this goal, the Department of Health and Human Services is designing and implementing new payment models intended to improve the quality of health care while reducing its cost. Collectively, these novel payment models and programs have been characterized under the moniker of value-based purchasing (VBP), and although many of these models retain a fundamental fee-for-service (FFS) structure, they are seen as essential tools in the evolution away from volume-based health care financing toward a health system that provides "better care, smarter spending, and healthier people." In 2014, approximately 20% of Medicare provider FFS payments were linked to a VBP program. The Department of Health and Human Services has committed to a four-year plan to link 90% of Medicare provider FFS payments to value-based purchasing by 2018. To achieve this goal, all items and services currently reimbursed under Medicare FFS programs will need to be evaluated in the context of VBP. To this end, the Medicare Hospice benefit appears to be appropriate for inclusion in a model of VBP. This policy analysis proposes an adaptable model for a VBP program for the Medicare Hospice benefit linking payment to quality and efficiency in a manner consistent with statutory requirements established in the Affordable Care Act. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Casarett, David; Harrold, Joan; Harris, Pamela S; Bender, Laura; Farrington, Sue; Smither, Eugenia; Ache, Kevin; Teno, Joan
In the U. S., hospices sometimes provide high-intensity "continuous care" in patients' homes. However, little is known about the way that continuous care is used or what impact continuous care has on patient outcomes. To describe patients who receive continuous care and determine whether continuous care reduces the likelihood that patients will die in an inpatient unit or hospital. Data from 147,137 patients admitted to 11 U.S. hospices between 2008 and 2012 were extracted from the electronic medical records. The hospices are part of a research-focused collaboration. The study used a propensity score-matched cohort design. A total of 99,687 (67.8%) patients were in a private home or nursing home on the day before death, and of these, 10,140 (10.2%) received continuous care on the day before death. A propensity score-matched sample (n = 24,658) included 8524 patients who received continuous care and 16,134 patients who received routine care on the day before death. Using the two matched groups, patients who received continuous care on the day before death were significantly less likely to die in an inpatient hospice setting (350/8524 vs. 2030/16,134; 4.1% vs. 12.6%) (odds ratio [OR] 0.29; 95% CI 0.27-0.34; P < 0.001). When patients were cared for by a spouse, the use of continuous care was associated with a larger decrease in inpatient deaths (OR 0.12; 95% CI 0.09-0.16; P < 0.001) compared with those patients cared for by other family members (OR 0.37; 95% CI 0.32-0.42; P < 0.001). It is possible that unmeasured covariates were not included in the propensity score match. Use of continuous care on the day before death is associated with a significant reduction in the use of inpatient care on the last day of life, particularly when patients are cared for by a spouse. Copyright © 2015. Published by Elsevier Inc.
Wrigley, Hannah; Taylor, Elizabeth Johnston
Oral care is a hallmark of attentive, high-quality nursing care. Oral care improves a patient's sense of well-being, communication, and nutritional status, and lowers the risk for pneumonia. However, for patients with severe trismus, oral care may seem impossible. Trismus is the inability to open the mouth more than 35 mm and often results from medical therapies for head and neck cancers. This article details a simple approach to oral care that was implemented successfully with five hospice patients with severe trismus.
Johnson-Hurzeler, Rosemary; Barnum, Evelyn; Leary, Robert; Hill, Claire
This paper describes the new management information system at The Connecticut Hospice in Branford, Connecticut. The system is of particular interest for three reasons: (1) it represents the application of computer technology to a new and important field of medicine in the care of those patients with a terminal illness and their families; (2) it is a real life example of the successful application of state-of-the-art data-based, integrated systems design techniques; and (3) as a comprehensive and responsive on-line system which was implemented on a micro-computer, it demonstrates the realization of big-system capabilities on a small machine.
'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.
Spalding, Jessica; Yardley, Sarah
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
Teno, Joan M; Plotzke, Mike; Christian, Thomas; Gozalo, Pedro
In the final days of life, symptoms are exacerbated and often families need both education and emotional support from hospice professional staff. The Medicare Hospice Benefit provides a per-diem payment with no requirements on the frequency of patient visits. To examine individual characteristics, hospice program, and geographic variation in hospice visits by professional staff during the last 2 days of life. This retrospective cohort study of 661 557 Medicare hospice beneficiaries included all patients who died in federal fiscal year 2014 (October 1, 2013-September 30, 2014) in hospice services while receiving routine home care in the last 2 days of life. Data analysis was conducted from March 9 to August 25, 2015. Medicare regulations require that hospice care centers report daily the frequency and duration of patient visits by professional staff, as well as the type of hospice staff who conduct these visits. We examined visit variation by hospice professional staff (physician, nursing staff, and social worker) during the last 2 days of life using a multivariable logistic model adjusting for decedent and hospice program characteristics. Of the 661 557 patients in the study, 81 478 (12.3%) received no professional staff visits in the last 2 days of life. State variation ranged from 590 of 15 399 patients (3.8%) in Wisconsin to 97 of 492 patients (19.7%) in Alaska, and hospice program interquartile variation ranged from 3.2% (25th percentile) to 19.5% (75th percentile). Black patients were less likely to have any visits than were white patients (7352 of 48 221 [15.2%] vs 70 365 of 585 377 [12.0%]; adjusted odds ratio, 1.30; 95% CI, 1.24-1.37). Those dying in a nursing home were 1.74 times less likely to have any visits than those dying at home (30 880 of 186 649 [16.5%] vs 40 973 of 386 654 [10.6%]; 95% CI, 1.62-1.88). Those dying on a Sunday were 3.35 times less likely to have a visit compared with persons dying on a Tuesday (19 519 of 95 979 [20.3%] vs 6784 of 92
Kapo, Jennifer; MacMoran, Holly; Casarett, David
Hospice has become the major provider of comprehensive end-of-life care in the United States, but is underutilized by African American patients. It is likely that whatever factors are responsible for lower rates of hospice utilization among African Americans also lead to lower rates of return to hospice after discharge, but this is not known. To determine whether African American patients who leave hospice are less likely to return before death. Retrospective cohort study. University-affiliated hospice. All patients discharged after a first admission. All patient characteristics were defined by abstraction of electronic medical records at the time of hospice discharge. Of 358 discharged patients, 98 (27%) were decertified and 260 (73%) left voluntarily. Ninety-six patients returned to hospice during the study period. In bivariate analysis, African Americans were less likely to return than were other patients (odds ratio (OR) 0.47, 95% CI: 0.28-0.80; p = .005). In a multivariable logistic regression model, African American ethnicity was independently associated with a decreased likelihood of return. Ethnic disparities in hospice utilization may extend even to those patients who do enroll in hospice. African Americans who leave hospice during their first admission and their families may be less likely to have access to the comprehensive services that hospice programs provide near the end of life, including intensive nursing care, pain and symptom management, and education.
Sørensen, Brigitte; Andersen, Helle Tvorup; Duus, Lene
by a team with members from the five educations. The team has developed an 8 -week learning mod-ule, which focuses on innovation and entrepreneurship. The interdisciplinary module has an inno-vative didactic design using blended learning as the overarching principle. Relevance Our workshop contributes...... to the topic:” Innovative and sustainable teaching for health and social care education”. The interdisciplinary learning module contributes at several levels to match future challenges in the health services for students and teachers. The different innovative learning methods also contribute to students...
Casarett, David; Spence, Carol; Clark, Melissa A; Shield, Renée; Teno, Joan M
Despite progress towards safer care in most settings, there has been much less attention to improving safety in hospices, which care for more than 1,500,000 patients every year. In this article, we describe three serious conflicts that arise when safety measures from other settings are applied to hospice. First, safety measures that are imposed in order to reduce morbidity and mortality may be irrelevant for a hospice patient whose goals focus on comfort. Second, safety measures that are defined in patients with a life expectancy of years can be inappropriate for hospice patients whose typical survival is measured in days. Third, it can be very difficult to assign responsibility for the safety of hospice patients, whose care is provided mostly by family and friends. Therefore, generally accepted safety measures are often inappropriate for hospice care, and can lead to unintended consequences if they are applied without critical evaluation or modification. Instead, we suggest three principles that can guide the development of hospice-appropriate safety measures by considering a patient's goals and life expectancy, and the degree to which responsibility for a patient's care is shared.
Cherlin, Emily J; Brewster, Amanda L; Curry, Leslie A; Canavan, Maureen E; Hurzeler, Rosemary; Bradley, Elizabeth H
Despite evidence that enrollment with hospice services has the potential to reduce hospital readmission rates, previous research has not examined exactly how hospitals may promote the appropriate use of hospice and palliative care for their discharged patients. Therefore, we sought to explore the strategies used by hospitals to increase the use of hospice and palliative care for patients at risk of readmission. We conducted a secondary analysis of qualitative data from a study of hospitals that were participating in the State Action on Avoidable Readmissions (STAAR) initiative, a quality improvement collaborative. We used data attained from 46 in-depth interviews conducted during 10 hospital site visits using a standard discussion guide and protocol. We used a grounded theory approach using the constant comparative method to generate recurrent and unifying themes. We found that a positive effect for hospitals participating in the STAAR initiative was enhanced engagement in efforts to promote greater use of hospice and palliative care as a possible method of reducing unplanned readmissions, the central goal of the STAAR initiative. Hospital staff described strategies to increase the use of hospice and palliative care that included (1) designing and implementing tracking systems to identify patients most at risk of being readmitted, (2) providing education about hospice and palliative care to family, internal and external clinical groups, and (3) establishing closer links to posthospital settings. National efforts to reduce rehospitalizations may result in improved integration of hospice and palliative care for patients who are at risk of readmission.
Lindley, Lisa C; Edwards, Sheri L
To map and describe the geographic distribution of pediatric hospice care need versus supply in California over a 4-year time period (2007-2010). Multiple databases were used for this descriptive longitudinal study. The sample consisted of 2036 children and adolescent decedents and 136 pediatric hospice providers. Geocoded data were used to create the primary variables of interest for this study-need and supply of pediatric hospice care. Geographic information systems were used to create heat maps for analysis. Almost 90% of the children and adolescents had a potential need for hospice care, whereas more than 10% had a realized need. The highest density of potential need was found in the areas surrounding Los Angeles. The areas surrounding the metropolitan communities of Los Angeles and San Diego had the highest density of realized hospice care need. Sensitivity analysis revealed neighborhood-level differences in potential and realized need in the Los Angeles area. Over 30 pediatric hospice providers supplied care to the Los Angeles and San Diego areas. There were distinctive geographic patterns of potential and realized need with high density of potential and realized need in Los Angeles and high density of realized need in the San Diego area. The supply of pediatric hospice care generally matched the needs of children and adolescents. Future research should continue to explore the needs of children and adolescents at end of life at the neighborhood level, especially in large metropolitan areas.
Whitebird, Robin R; Asche, Stephen E; Thompson, Gretchen L; Rossom, Rebecca; Heinrich, Richard
Working in hospice care is a highly challenging yet rewarding profession. However, the challenges of working with dying patients and their families can overwhelm even the most highly dedicated professional, leading to burnout, compassion fatigue, anxiety, and depression. The aim of this study was to better understand how stress affects the mental health of hospice workers in terms of burnout and compassion fatigue and how they cope with these issues. Data for this study are from Compassion Fatigue and You, a cross-sectional survey of hospice staff from across Minnesota. We surveyed 547 hospice workers throughout Minnesota to better understand the overall mental health of staff, including levels of stress, burnout, and compassion fatigue, and how they cope with these issues. The study was conducted in 2008 and 2009 through a private, not-for-profit research institute affiliated with a large Midwestern health plan. Hospice staff reported high levels of stress, with a small but significant proportion reporting moderate-to-severe symptoms of depression, anxiety, compassion fatigue, and burnout. Staff reported managing their stress through physical activity and social support, and they suggested that more opportunities to connect with coworkers and to exercise could help decrease staff burnout. Poor mental health places staff at risk for burnout and likely contributes to staff leaving hospice care; this is a critical issue as the profession attempts to attract new staff to meet the expanding demands for hospice care.
Full Text Available INTRODUCTION: The vision for palliative care service provision in New Zealand is for all people who are dying and their families to have timely access to culturally appropriate, quality palliative care services. An Auckland hospice's records show that the ethnically diverse population statistics were not reflected in the referrals for hospice services. The aim of this research was to gain a patient-and-their-family perspective on the hospice, including exploration of components of service care that could be improved for various cultural groups. METHODS: Patients currently under the care of the hospice and family members were recruited from hospice records. Semi-structured interviews were conducted to explore the emerging issues. The study collected data from a purposive sample of 18 palliative care patients or carer family members, ranging in age from 39 to 81 years, who reflected the ethnic diversity of the population of the region. Interviewing was carried out by an experienced research assistant and continued until data saturation was reached. FINDINGS: Four key themes emerged-hospice personnel's approach to patients, quality of service, cultural barriers, and strategies for future improvement. It was determined that the latter two were the most significant to address in this article. CONCLUSION: The study revealed the need for information-giving and education, including public profiling of the hospice to strengthen community involvement. Strategies to reduce ethnic disparities include strengthening the awareness of, and access to, services by connecting with cultural groups through churches, community and specific cultural media.
Wang, Xiao; Knight, Louise S; Evans, Anne; Wang, Jiangxia; Smith, Thomas J
The benefits of hospice for patients with end-stage disease are well established. Although hospice use is increasing, a growing number of patients are enrolled for ≤ 7 days, a marker of poor quality of care and patient and family dissatisfaction. In this study, we examined variations in referrals among individuals and groups of physicians to assess a potential source of suboptimal hospice use. We conducted a retrospective chart review of 452 patients with advanced cancer referred to hospice from a comprehensive cancer center. We analyzed patient length of service (LOS) under hospice care, looking specifically at median LOS and percent of short enrollments (%LOS ≤ 7), to examine the variation between individual oncologists and divisions of oncologists. Of 394 successfully referred patients, median LOS was 14.5 days and %LOS ≤ 7 was 32.5%, consistent with national data. There was significant interdivisional variation in LOS, both by overall distribution and %LOS ≤ 7 ( P hospice referral practices between providers (coefficient of variation > 125%). As one example, median LOS of physicians in the Division of Thoracic Malignancies varied from 4 to 33 days, despite similarities in patient population. Nearly one in three patients with cancer who used hospice had LOS ≤ 7 days, a marker of poor quality. There was significant LOS variability among different divisions and different individual physicians, suggesting a need for increased education and training to meet recommended guidelines.
Lai, Wei-Shu; Ying, Wan-Ping; Chao, Co-Shi Chantal
The aim of hospice palliative education care is to train nurses in hospice philosophy, terminal care skills, nursing care competencies, and professional reliability. Student nurses, staff nurses, and advanced practice nurses must be taught through a proper sequence, from novice to expert. Working together with patients and their families, nurses can educate and care for the physical, social and spiritual needs of terminally ill patients. Currently, problems faced in hospice palliative care education include: 1. The lack of a systematic plan focusing on hospice palliative care and terminal care in nursing schools; 2. The absence of comfort care, communications, ethics, and other relevant issues in extant education and training; 3. The limited number of institutes that currently provide in-service training; 4. The shortage of teachers proficient in both hospice care knowledge and practice; and 5. The current overdependence on traditional nursing education models, which hinders student nurse originality and delays staff nurse growth. Faced with the present issues, self-reflection, localization, and multiple teaching strategies should be the critical developmental directions of hospice palliative education. In order to improve terminal care quality, it is also important to integrate practice, education, and research in order to train more hospice palliative nurses.
Kraynik, Sally E; Casarett, David J; Corcoran, Amy M
Dying patients whose implantable cardioverter defibrillators (ICDs) continue to deliver shocks may experience significant pain, and the National Quality Forum has endorsed routine deactivation of ICDs when patients near the end of life. The overarching goal of this quality improvement project was to increase rates of ICD deactivation among hospice patients. ICD deactivation rates pre- vs. post-intervention; and clinicians' knowledge and confidence regarding ICD management. A multifaceted intervention included clinical tools, education, and standardized documentation templates in the electronic medical record. The proportion of patients whose ICD was deactivated increased after the intervention (pre- vs. post-intervention: 39/68, 57% vs. 47/56, 84%; odds ratio 3.88; 95% confidence interval 1.54-10.37; P = 0.001). Clinicians' knowledge and confidence regarding ICD management improved (pre- vs. post-intervention median questionnaire scores: 5 vs. 9 on a scale of 0 to 10; Wilcoxon signed-rank test Z = -5.01; P < 0.001). A multifaceted intervention can increase rates of ICD deactivation among patients near the end of life. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Full Text Available In the modern age, advances in processes, technology and clinical imperatives generated an evolution of the health care organization, particularly regarding hospitals, born as generic shelter and poor house. Nowadays the availability of high technologies and the intensity of intervention on patients are the main factors to warrant the modern hospital for acute care. This evolution trend brings out the need for new models of health care, focused on people’s different request about assistance (e.g. day-hospital, day-surgery, integrated home care, hospice. The present study gives an outline of the Italian situation, which is deeply changed in the latest years. New models of heath care emerged in Italy, as it had previously in the United States and other European countries, as able to improve assistance and reduce costs: the average hospital stay decreased, while the number of day-hospital and day-surgery increased. In spite of the rise observed in the last 3-4 years, both integrated home care and hospice availability remain still limited, especially considering the high potential request of the elderly population and the oncologic patients.
Full Text Available The purpose of this work is to contribute to the body of knowledge on processesby which students develop interdisciplinary understanding of contents, as well as to suggest technology-enhanced means for supporting them in these processes in the context of higher education. In doing so, we suggest a rethinking of three traditional practices that tend to characterise typical higher education instruction: (1 compartmentalisation of disciplines; (2 traditional pedagogy; and (3 traditional hierarchies based on levels of expertise. Our high-level conjecture was that meaningful dialogue with peers and experts supports both the deepening of ideas in one knowledge domain and the formation of connections between ideas from several domains, both of which are required for the development of interdisciplinary understanding. We developed the Boundary Breaking for Interdisciplinary Learning (BBIL model, which harnesses technology to break boundaries between disciplines, learners and organisational levels of hierarchy. Findings indicate that 36 undergraduate students who participated in an interdisciplinary online course that implemented the BBIL model have significantly improved their interdisciplinary understanding of the course contents. This study illustrates how innovative use of available, free and low-cost technology can produce a ‘positive disruption’ in higher education instruction.
Harrold, Joan; Byhoff, Elena; Harris, Pamela; Szolarova, Robertina; Bender, Laura; Craig, Teresa; Casarett, David
Although hospices need to be able to anticipate patient acuity, there are currently no published models that predict the frequency of visits that a new hospice patient is likely to receive. To identify patient characteristics that are associated with the frequency of health care provider visits in the first 8 days of hospice care. An electronic health record (EHR)-based retrospective cohort study was conducted in seven hospice programs in the United States. Participants were 35,232 patients who were admitted between October 1, 2008 and May 31, 2011 and received hospice care at home on the day of enrollment. The main outcome measure was the average number of visits per day by nurses, social workers, chaplains, and home health aides in the first 8 days of home hospice care (day of admission plus up to 7 subsequent days). In a mixed effects regression model, 14 independent predictors of visit frequency were identified. For instance, several demographic characteristics were associated with more frequent visits, as were lower Palliative Performance Scale (PPS) scores (60: 1.41 visits/day, 95% CI 1.36-1.47; p<0.001), the presence of pain (pain: 1.77 visits/day; 95% CI 1.72-1.82 versus no pain: 1.44 visits/day, 95% CI .39-1.59; p<0.001). Patients admitted to home hospice from a hospital also received more frequent visits compared with other patients (hospital: 1.73 visits/day, 95% CI 1.67-1.79 versus home: 1.42 visits/day, 95% CI 1.40-1.44; p<0.001). An acuity index based on these variables could help hospices to better anticipate patient needs and staff workload, and could be used to guide strategic planning as hospices take part in accountable care organizations (ACOs).
Pfiffner, S. M.; Davis, K. L.; Phelps, T. J.; Kieft, T. L.; Gihring, T. M.; Onstott, T. C.; Nthangeni, B.; Piater, L.; van Heerden, E.
This NSF-funded research experience for undergraduates (REU) took place in South Africa, where gold mines provided outstanding field sites to investigate biogeochemical processes in deep subsurface environments. Underrepresented minorities were encouraged to participate. Cross-disciplinary training was a major ambition for this REU Site: Biogeochemical Educational Experiences - South Africa. Students were selected from diverse academic disciplines (biology, chemistry, and geology) to participate in this interdisciplinary research program. Research projects included characterizing microbial communities with molecular and biochemical techniques, cultivating microorganisms, utilizing geochemical and isotopic parameters to constrain nutrient cycling in groundwater, investigating extreme enzymes and examining functional genes. During the REU, students collected biofilms and fissure water emanating from gas-rich boreholes in 2-3 km deep mines and performed laboratory research in teams under joint mentorship of U.S. and South African scientists. Research teams consisted of three to five students with at least one student from each country and at least two of the disciplines represented. Team membership reflected students' ranking of their choices among mentor-proposed projects. The REU encouraged students to increase scientific knowledge across disciplines, improve oral and written communication skills, and explore cultural and international challenges for scientific research in the global community. Each research team presented oral progress reports to the other research teams to provide communication skill development and to provide a forum for data exchange and interpretation among the various disciplines. Oral communication training culminated in a public presentation by each team at a university/industry science symposium. Mentors reviewed students' writing skills as they prepared text on experimental design, research findings, data interpretation, and literature
Johnson, Margaret O; Frank, Samuel; Mendlik, Matthew; Casarett, David
Although the early and middle stages of Huntington's Disease (HD) and its complications have been well described, less is known about the course of late-stage illness. In particular, little is known about the population of patients who enroll in hospice. Our goal is to describe the characteristics of patients with HD who enrolled in hospice. Retrospective cohort study of electronic medical record data from 12 not-for-profit hospices in the United States from 2008 to 2012. Of 164,032 patients admitted to these hospices, 101 (0.06%) had a primary diagnosis of HD. Their median age was 57 (IQR: 48-65) and 53 (52.5%) were female. Most patients were cared for by a spouse (n=36, 36.6%) or adult child (n=20, 19.8%). At the time of admission, most patients were living either at home (n=39, 38.6%) or in a nursing home (n=41, 40.6%). All were either bedbound or could ambulate only with assistance. The most common symptom reported during enrollment in hospice was pain (n=34, 33.7%) followed by anxiety (n=30, 29.7%), nausea (n=18, 17.8%) and dyspnea (n=10, 9.9%). Patients had a median length of stay in hospice of 42 days, which was significantly longer than that of other hospice patients in the sample (17 days) p<0.001. Of 101 patients who were admitted to hospice, 73 died, 11 were still enrolled at the time of data analysis, and 17 left hospice either because they no longer met eligibility criteria (n=14, 13.7%) or because they decided to seek treatment for other medical conditions (n=3, 3.0%). Of the 73 patients who died while on hospice, most died either in a nursing home (n=29; 40%) or a hospital (n=27; 37%). Seventeen patients (23%) died at home. No patient that started in a facility died at home. Patients with HD are admitted to hospice at a younger age compared to other patients (57 versus 76 years old), but have a significant symptom burden and limited functional status. Although hospice care emphasizes the importance of helping patients to remain in their homes, only a
Trauger-Querry, B; Haghighi, K R
Pain and symptom management are a major part of hospice care. Literature and direct experience suggest that pain can be resistant if psychological, emotional, or spiritual issues are not addressed. This article explains how art and music therapies can work in conjunction with traditional medical treatment of pain control in the hospice setting. The process of pain modulation through the use of art and music interventions is diagrammed and described. Brief clinical examples demonstrate the use of art and music therapies for pain reduction with a variety of hospice patients. Information regarding appropriate education and training necessary for art and music therapists to practice in their field is presented.
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.
Cimino, Nina M; McPherson, Mary Lynn
Palliative and hospice care are increasingly being provided in nursing home settings. The current article reviews the existing evidence relevant to nursing homes to provide practitioners with a greater understanding of the impact of palliative and hospice care on clinical care outcomes (e.g., pain, symptom management), processes of care outcomes (e.g., hospitalizations, cost of care), and family member or health care proxy perceptions of care. Overall, the provision of hospice or palliative care in nursing facilities can improve the clinical care residents receive, reduce hospitalizations, and improve family members' perception of care. Copyright 2014, SLACK Incorporated.
As hospital-based hospice programs proliferate across the country, most are under the leadership of a nurse administrator. Nurse administrators must be prepared to manage the many components that constitute the broad scope of this role. Cost-effective management is the greatest challenge. The author explores this management role, including a discussion of hospice-program reimbursement, hospital-based program advantages, options to increase staff productivity, management of drugs and durable medical equipment, inpatient admissions, volunteer services, and fund-raising. Cost-effective measures are explored throughout the discussion, along with a history and explanation of the hospice concept of care.
Iversen, Steffen Møllegaard
In this paper a didactical model is presented. The goal of the model is to work as a didactical tool, or conceptual frame, for developing, carrying through and evaluating interdisciplinary activities involving the subject of mathematics and philosophy in the high schools. Through the terms...... of Horizontal Intertwining, Vertical Structuring and Horizontal Propagation the model consists of three phases, each considering different aspects of the nature of interdisciplinary activities. The theoretical modelling is inspired by work which focuses on the students abilities to concept formation in expanded...... domains (Michelsen, 2001, 2005a, 2005b). Furthermore the theoretical description rest on a series of qualitative interviews with teachers from the Danish high school (grades 9-11) conducted recently. The special case of concrete interdisciplinary activities between mathematics and philosophy is also...
Binner, Jane; Branicki, Layla; Galla, Tobias; Jones, Nick; King, James; Kolokitha, Magdalini; Smyrnakis, Michalis
Evacuating a city is a complex problem that involves issues of governance, preparedness education, warning, information sharing, population dynamics, resilience and recovery. As natural and anthropogenic threats to cities grow, it is an increasingly pressing problem for policy makers and practitioners. The book is the result of a unique interdisciplinary collaboration between researchers in the physical and social sciences to consider how an interdisciplinary approach can help plan for large scale evacuations. It draws on perspectives from physics, mathematics, organisation theory, economics, sociology and education. Importantly it goes beyond disciplinary boundaries and considers how interdisciplinary methods are necessary to approach a complex problem involving human actors and increasingly complex communications and transportation infrastructures. Using real world case studies and modelling the book considers new approaches to evacuation dynamics. It addresses questions of complexity, not only ...
Schäfke, Werner; Mayoral, Juan A.; Hvidt, Martine Stagelund
This article provides novel empirical survey evidence on socialization factors leading lecturers to implement interdisciplinary teaching in law. Recent debates on the legal scholarship and higher education legal institutions advocates for the introduction of interdisciplinary approaches to legal...... studies. Nevertheless, there is still few evidence of how this lecturing philosophy might be affected by the socialization with other disciplines. For that purpose, we analyse the case of external lectures in the Faculty of Law at the University of Copenhagen in Denmark, who covers the majority...... of the teaching staff in this institution. To explain the adoption of interdisciplinary teaching, we rely on socialization factors connected to their former higher education and socialization in research and multidisciplinary environments....
This paper examines issues relating to the design/redesign of the pedagogy of interdisciplinary undergraduate subjects. Examples include: (a) law subjects for students in Business Management or Building and Surveying; (b) "English Communication for Business" for students in English; and (c) "Information technology in Business" for students in…
Annegret F. Hannawa
Full Text Available Approximately 43 million adverse events occur across the globe each year at a cost of at least 23 million disability-adjusted life years and $132 billion in excess health care spending, ranking this safety burden among the top 10 medical causes of disability in the world.1 These findings are likely to be an understatement of the actual severity of the problem, given that the numbers merely reflect seven types of adverse events and completely neglect ambulatory care, and of course they only cover reported incidents. Furthermore, they do not include statistics on children and incidents from India and China, which host more than a third of the world’s population. Best estimates imply that about two thirds of these incidents are preventable. Thus, from a public health perspective, medical errors are a seri- ous global health burden, in fact ahead of high-profile health problems like AIDS and cancer. Interventions to date have not reduced medical errors to satisfactory rates. Even today, far too often, hand hygiene is not practiced properly (even in developed countries, surgical procedures take place in underequipped operating theaters, and checklists are missing or remain uncompleted. The healthcare system seems to be failing in managing its errors − it is costing too much, and the complexity of care causes severe safety hazards that too often harm rather than help patients. In response to this evolving discussion, the International Society for Quality in Healthcare recently nominated an Innovations Team that is now developing new strategies. One of the emerging themes is that the medical field cannot resolve this problem on its own. Instead, interdisciplinary collaborations are needed to advance effective, evidence-based interventions that will eventually result in competent changes. In March 2013, the Institute of Communication and Health at the University of Lugano organized a conference on Communicating Medical Error (COME 2013 in
Cole, Kenneth D; Waite, Martha S; Nichols, Linda O
For a nationwide Geriatric Interdisciplinary Team Training (GITT) program evaluation of 8 sites and 26 teams, team evaluators developed a quantitative and qualitative team observation scale (TOS), examining structure, process, and outcome, with specific focus on the training function. Qualitative data provided an important expansion of quantitative data, highlighting positive effects that were not statistically significant, such as role modeling and training occurring within the clinical team. Qualitative data could also identify "too much" of a coded variable, such as time spent in individual team members' assessments and treatment plans. As healthcare organizations have increasing demands for productivity and changing reimbursement, traditional models of teamwork, with large teams and structured meetings, may no longer be as functional as they once were. To meet these constraints and to train students in teamwork, teams of the future will have to make choices, from developing and setting specific models to increasing the use of information technology to create virtual teams. Both quantitative and qualitative data will be needed to evaluate these new types of teams and the important outcomes they produce.
Azoulay, Daniel; Jacobs, Jeremy M; Cialic, Ron; Mor, Eliana Ein; Stessman, Jochanan
Although pain is common among advanced cancer patients, it can be controlled in a large proportion of patients. Several barriers hinder this, including the concern that opioids hasten death. We examined whether opioids influence survival among advanced cancer patients. Retrospective observational study from September 2006 to October 2007. In-patient hospice unit. Participants were 114 consecutive hospice patients (mean age 71.7 ± 13.9 years). Analysis of survival (days) following admission, according to opioid usage. Standardized Oral Morphine Equivalents (OME mg/d) were calculated. On admission 74.6% received opioids, rising to 92.1% at death. Mean opioid dosage was OME of 146 ± 245 mg/d, and mean survival was 12.3 ± 12.15 days. Mean survival, according to opioid dosage of 0, 1 to 119, and greater than or equal to 120 OME mg/d respectively at admission, was 16.7 ± 13.4, 11.2 ± 12.1, 10.0 ± 10.2 (P = .009), and according to dose at death was 17.0 ± 15.1, 12.3 ± 12.1, 11.1 ± 11.3 (P = ns). Increasing overall opioid dosage was associated with improved survival compared with no change or decreasing overall dosage (mean survival 14.0 ± 12.7 days versus 9.3 ± 9.8 versus 9.1 ± 11.4, days respectively, P = .01). Adjusting for clinical variables in Cox proportional hazards models, no significant association was found between mortality and of the following aspects of opioid usage: (1) dose on admission (Hazard Ratio [HR] 1.009, 95% confidence interval [CI] 0.999-1.019); (2) dose at death (HR 1.004, 95% CI 0.996-1.013); (3) mean dose (HR 1.006, 95% CI 0.997-1.016); (4) overall dose increase (HR 0.733, 95% CI 0.417-1.288) and decrease (HR 0.967, 95% CI 0.472-1.984); (5) day-by-day dosage changes (HR 1.005, 95% CI 0.996-1.013). Opioid usage, even at high dosages, had no effect on survival among advanced cancer patients in a hospice setting. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
McLoughlin, Kris A; Geller, Jeffrey L
The staffs of many mental health facilities describe their treatment planning processes as interdisciplinary, but as most practicing clinicians know, this is more of a myth than reality. Individualized, person-focused treatment planning itself is not a simple endeavor. Effective treatment planning is further complicated by the fact that most discipline training programs teach neither treatment planning nor interdisciplinary methods to provide care and treatment. Psychiatric treatment teams are at a disadvantage from the start. Additionally, although facility and agency administrators expect treatment planning to occur, often the infrastructure to support the work is not there. This article describes a practical and effective treatment planning implementation model or framework developed by the authors, concentrating on three sub-sets of the treatment planning system: structure, content, and process.
Redish, E F; Carleton, K L; Cooke, T J; Cooper, M; Crouch, C H; Dreyfus, B W; Geller, B; Giannini, J; Gouvea, J Svoboda; Klymkowsky, M W; Losert, W; Moore, K; Presson, J; Sawtelle, V; Thompson, K V; Turpen, C
In response to increasing calls for the reform of the curriculum for life science majors and pre-medical students (Bio2010, Scientific Foundations for Future Physicians, Vision & Change), an interdisciplinary team has created NEXUS/Physics: a reinvention of an introductory physics curriculum for the life sciences. The curriculum interacts strongly and supportively with introductory biology and chemistry cours-es taken by life sciences students, with the goal of helping students build general, multi-discipline scientific competencies. In order to do this, our two-semester NEXUS/Physics course sequence is positioned as a second year course so students will have had some exposure to basic concepts in biology and chemistry. NEXUS/Physics stresses interdisciplinary examples and the content differs markedly from traditional introductory physics to facilitate this, including extending the discussion of energy to include interatomic potentials and chemical reactions, extending the discussion of thermodynamics to ...
While the number of scholars working on the broad topic of food has never been greater, the topic is still divided among numerous disciplines and specialists who do not often communicate with each other. This paper discusses some of the deep differences between disciplinary approaches, and concludes that food scientists differ in some of their basic assumptions about human nature. After outlining some of the institutional issues standing in the way of interdisciplinary work, the paper argues for a more synthetic and empirical approach, grounded in the study of everyday life. True interdisciplinary collaboration will have to go beyond assembling multidisciplinary teams. Instead we must accept the limitations of the classic disciplinary paradigms, and be willing to question and test our methods and assumptions. Copyright © 2012 Elsevier Inc. All rights reserved.
Full Text Available This paper shares the details of an evaluation plan from an interdisciplinary climate change project that developed decision support tools (DSTs for agricultural advisors and farmers. It showcases how evaluation enhanced the project work by providing opportunities for the team to reflect on and use data to improve performance. The plan included both formative and summative approaches, team member interviews to assess team functioning, usability testing of DSTs, outreach and marketing campaign evaluation. Outreach evaluation included surveying those reached, monitoring project website traffic, and tracking and mapping outreach details. Marketing evaluation included pre-testing campaign materials, assessing open and click rates of email campaign, and monitoring associated traffic to website. The Useful to Usable (U2U team was generally high functioning, but team interviews allowed the evaluators and leaders to discern factors that were influencing intended outcomes, respond to needs, assign resources, and catalyze activities that were crucial in shaping the outcomes. Usability testing surfaced issues related to default values and search and help features that were addressed by the team and resulted in improved usability. Outreach evaluation found geographic and methodological gaps that were filled, resulting in more target audiences reached and more effective methods used (e.g., hands-on events. Marketing evaluation allowed for improving contact lists over time and improving campaign messaging before deployment. Evaluators and project leaders working on similar projects may adapt or utilize methods detailed in this paper, along with the recommendations, while designing and implementing improvement-oriented evaluation plans.
Niedzielski, Oksana K; Rodin, Gary; Emmerson, Debbie; Rutgers, Job; Sellen, Katherine M
Residential hospices are often purpose-built to enhance the experience of patients and families. However, there has been relatively little research on ambient and sensory experiences of patients and families. This study explored the ambient and sensory experience of residents and families in a residential hospice. Hospice users participated in personalizing environments and experiences, adapting and developing rituals, and enjoying the experience (including smells and sounds) of communal spaces and private rooms. Opportunity for developing new rituals, in particular, suggests an environment supportive of sense of control, social support, and positive distractors. The design of an inpatient hospice can offer a platform through which to support the delivery of flexible care practices, providing opportunities for personal expression, shared experiences, and the maintenance or development of rituals. © The Author(s) 2016.
Olthuis, Gert; Dekkers, Wim; Leget, Carlo; Vogelaar, Paul
Good nursing is more than exercising a specific set of skills. It involves the personal identity of the nurse. The aim of this article is to answer two questions: (1) what kind of person should the hospice nurse be? and (2) how should the hospice nurse engage in caring conversations? To answer these questions we analyse a nurse's story that is intended to be a profile of an exemplary hospice nurse. This story was constructed from an analysis of five semistructured interviews with hospice nurses, based on the 'ethics of the caring conversation', which is inspired by the ethical perspective of Paul Ricoeur. The research questions concentrate on the norms of respect, responsibility and reciprocity, which are integral parts of the 'ethics of the caring conversation'.
...: Patient Care Non-Core Services § 418.76 Condition of participation: Hospice aide and homemaker services.... (iii) Assistance in ambulation or exercises. (iv) Assistance in administering medications that are...
Ghesquiere, Angela; Thomas, Julie; Bruce, Martha L
Approximately 10% of the bereaved are at risk of bereavement-related mental health disorders. Hospices' bereavement services could potentially address needs of many at risk, but little is known about their service use. We analyzed data from 6160 bereaved family members of hospice patients. Risk of mental health problems was identified by hospice providers postloss. Of those characterized as "at-risk," 52% used services compared to 18% of the "low risk." Factors associated with service use among at-risk were female gender and younger age of death. Those who lost a child used services less than other bereaved. Although hospices appear to be skilled at identifying and providing bereavement services to the at-risk, services do not reach almost half. Results suggest the need to improve care access, especially among men and those losing a child. © The Author(s) 2014.
The use of arts in hospices is now well established. However, the voluntary nature of much hospice work in England encourages most regular creative activities to be provided by volunteers with minimal financial support. This article looks at how a successful arts and crafts exhibition for a hospice community was staged by a volunteer arts worker, helped by art and design students from the local university. It was not intended that the exhibition should be a research project; however, it became clear that to learn more about arts practice within a hospice environment, it would need to be appraised in some way. The project leader (and author) adopted an approach which reflected on the responses of people involved in the preparation and staging of the exhibition.
Lindley, Lisa C; Mixer, Sandra J; Cozad, Melanie J
The nursing shortage is projected to intensify in the United States. Organizations providing specialized hospice and palliative care will be particularly hard hit. The purpose of our study was to examine the influence of the nursing unit on registered nurse (RN) vacancies and test the moderating role of recruitment strategies in perinatal hospices. We estimated the association between the nursing unit and RN vacancies and tested the interaction effects of recruitment strategies (signing bonus and recruitment bonus). Our findings showed that increasing RN unit size and nursing leadership directly affected vacancies and that recruitment bonuses had stronger influence on reducing vacancies than signing bonuses. The findings offer critical insights for hospice administrators in attracting nurses among specialized hospice and palliative care providers. © The Author(s) 2015.
...) must provide, or arrange for the provision of, nursing and related services and specialized...), dietary services, physician services, dental services, pharmacy services, specialized rehabilitative... hospices to provide care for LTC facility residents largely parallels the language and intent of the...
Reese, Dona J; Buila, Sarah; Cox, Sarah; Davis, Jessica; Olsen, Meaghan; Jurkowski, Elaine
Research documents a lack of access to, utilization of, and satisfaction with hospice care for African Americans. Models for culturally competent hospice services have been developed but are not in general use. Major organizational barriers include (1) lack of funding/budgeting for additional staff for community outreach, (2) lack of applications from culturally diverse professionals, (3) lack of funding/budgeting for additional staff for development of culturally competent services, (4) lack of knowledge about diverse cultures, and (5) lack of awareness of which cultural groups are not being served. A participatory action research project addressed these organizational barriers through a multicultural social work student field placement in 1 rural hospice. The effectiveness of the student interventions was evaluated, including addressing organizational barriers, cultural competence training of staff, and community outreach. Results indicated that students can provide a valuable service in addressing organizational barriers through a hospice field placement.
Fairfield, Kathleen M; Murray, Kimberly M; Wierman, Heidi R; Han, Paul K J; Hallen, Sarah; Miesfeldt, Susan; Trimble, Edward L; Warren, Joan L; Earle, Craig C
Timely hospice referral is an essential component of quality end-of-life care, although a growing body of research suggests that for patients with various types of cancer, hospice referrals often occur very late in the course of care, and are marked by sociodemographic disparities. However, little is known about the ovarian cancer patient population specifically. We examined the extent and timing of hospice referrals in ovarian cancer patients over age 65, and the factors associated with these outcomes. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 8211 women aged 66+ with ovarian cancer who were diagnosed between 2001 and 2005 and died by December 31, 2007. We excluded women who were not eligible for Medicare A continuously during the 6 months prior to death. Outcomes studied included overall hospice use in the last 6 months of life and late hospice enrollment, defined as within 3 days of death. We examined variations in these two measures based on year of diagnosis and sociodemographic characteristics (age, race, marital status, rural residence, income, education) and type of Medicare received (fee-for-service vs. managed care). Among 8211 women in the cohort who died from ovarian cancer, 39.7% never received hospice care (3257/8211). Overall hospice care increased over the period of observation, from 49.7% in 2001 to 63.6% [corrected] in 2005, but the proportion of women receiving hospice care within 3 days of death did not improve. Among those who received hospice care, 11.2% (556/4954) and 26.2% (1299/4954) received such care within 3 and 7 days of death, respectively. A higher proportion of black women (46.5% vs. 38.4% among whites), women in the lowest income group (42.8% vs. 37.0% in the highest income group), and those receiving fee-for-service Medicare (41.3% vs.33.5% for women in managed care) never received hospice care. In multivariable models, factors associated with lack of hospice care included age
(Lengke et al., 2007). Nanotechnology infuse scientific branches from biology, chemistry, physics and engineering, hence called interdisciplinary subject opens new doors of applications (Kulzer and Orrit, 2004). The fundamental of nanotechnology lies in the fact that properties of material change dramatically when size.
Thaddeus R. Miller
Full Text Available Despite progress in interdisciplinary research, difficulties remain. In this paper, we argue that scholars, educators, and practitioners need to critically rethink the ways in which interdisciplinary research and training are conducted. We present epistemological pluralism as an approach for conducting innovative, collaborative research and study. Epistemological pluralism recognizes that, in any given research context, there may be several valuable ways of knowing, and that accommodating this plurality can lead to more successful integrated study. This approach is particularly useful in the study and management of social-ecological systems. Through resilience theory's adaptive cycle, we demonstrate how a focus on epistemological pluralism can facilitate the reorganization of interdisciplinary research and avoid the build-up of significant, but insufficiently integrative, disciplinary-dominated research. Finally, using two case studies - urban ecology and social-ecological research in Alaska - we highlight how interdisciplinary work is impeded when divergent epistemologies are not recognized and valued, and that by incorporating a pluralistic framework, these issues can be better explored, resulting in more integrated understanding.
MacKinnon, P. J.; Hine, D.; Barnard, R. T.
Science history shows us that interdisciplinarity is a spontaneous process that is intrinsic to, and engendered by, research activity. It is an activity that is done rather than an object to be designed and constructed. We examine three vignettes from the history of science that display the interdisciplinary process at work and consider the…
Discusses information overload and examines several ways in which actual and potential overload affects research choices for the solo researcher in interdisciplinary areas. Topics include information overload and teamwork; entry barriers to certain specialties, including necessary background knowledge; and information utilization and knowledge…
Manea, S; Dalla Pozza, L Visoná; Mola, E; Facchin, P
Because of a continued increase of complex patients and the development of many areas of sub-specialities in medicine, the use and quality of interdisciplinary communication has been found to be lacking, especially between hospital and primary care physicians, causing a significant gap in the documentation, coverage and care of individual patients. The study focuses on state of the art interdisciplinary communication, with consideration given to current used tools and priorities. An ad hoc questionnaire surveyed 118 physicians about their profession, the types of patients, the frequency of complex cases, the tools used to communicate with each patient and how the physicians rated these tools. The rate of patients needing interdisciplinary communication is 17% of the entire patient sample, all of this percentage having complex health care needs (terminally ill, disabled, often without a personal support network). Physicians frequently used paper documents, despite their lack of quality, as well as the telephone to communicate with other colleagues. Computer devices were scarcely used. Many Doctors (71%) value the actual interdisciplinary communication of low quality, despite the fact that it is considered to have a significant influence on the quality of health care. New tools and methods are needed. For example, dedicated standards of multidisciplinary and multi-professional Continuing Medical Education (CME), as well as the use of computer tools allowing for shared clinical records.
Cosens, Barbara; Fiedler, Fritz; Boll, Jan; Higgins, Lorie; Johnson, Gary; Kennedy, Brian; Strand, Eva; Wilson, Patrick; Laflin, Maureen
In the face of a myriad of complex water resource issues, traditional disciplinary separation is ineffective in developing approaches to promote a sustainable water future. As part of a new graduate program in water resources, faculty at the University of Idaho have developed a course on interdisciplinary methods designed to prepare students for…
Full Text Available Paul Y Takahashi,1 Gregory J Hanson,1,2 Bjorg Thorsteinsdottir,1 Holly K Van Houten,3 Nilay D Shah,3 James M Naessens,3 Jennifer L Pecina41Division of Primary Care Internal Medicine, 2Kogod Center of Aging, 3Division of Health Science Research, 4Department of Family Medicine, Mayo Clinic, Rochester, MN, USABackground: Using telemedicine for older adults with multiple comorbid conditions is a potential area for growth in health care. Given this older, ailing population, providers should discuss end-of-life care with patients.Objective: To determine the relationship between telemonitoring and hospice enrollment compared to usual care among older adults with chronic health problems.Methods: This was a secondary evaluation of a randomized controlled trial. The trial was performed at an academic medical center. Patients who were over the age of 60 and had a high risk of hospitalization and emergency department visits were recruited to the study. The primary outcome was hospice enrollment, and the secondary outcome was the mean number of days in hospice. The data were analyzed using Chi-squared tests and time-to-event analysis.Results: The average age of the cohort was 80.3 years. Nine patients (9.6% in the telemonitoring group were enrolled in hospice care, whereas four patients (4.0% in the usual care group were enrolled (P = 0.12. The mean number of days in hospice was 57.9 (SD ± 99.2 for the telemonitoring group, and 119.3 (SD ± 123.8 for the usual care group (P = 0.36. There was no significant difference regarding time to hospice referral.Conclusion: In this pilot analysis, there were no differences noted between groups in the number of patients that entered into hospice or the amount of time they stayed in hospice care. This was a small trial, and the power to detect a difference was 36%. It was encouraging that twice the number of patients enrolled in hospice care in the telemonitoring group compared to usual care despite the insignificant
Olthuis, Gert; Leget, Carlo; Dekkers, Wim
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.
for the creation of a special thanatology team called "The Care Team". This interdisciplinary team consisting of volunteer physicians, nurses, social...the status quo, (2) establish a fully operational hospice, or (3) establish a thanatology team that is specifically designed to help dying patients... Thanatology Team To some the status quo is not acceptable, yet at the same time establishing a fully operational hospice at Walter Reed Army Medical Center
Dai, Ying-Xiu; Chen, Tzeng-Ji; Lin, Ming-Hwai
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.
Kerr, Christopher W; Tangeman, John C; Rudra, Carole B; Grant, Pei C; Luczkiewicz, Debra L; Mylotte, Kathleen M; Riemer, William D; Marien, Melanie J; Serehali, Amin M
Outpatient programs have been traditionally offered in the U.S. under programs such as the Medicare Hospice Benefit. Recommendations now emphasize a blended model in which palliative care is offered concurrently with curative approaches at the onset of serious or life-limiting disease. The efficacy of nonhospice outpatient palliative care programs is not well understood. The aim of the study was to evaluate the clinical impact of a home-based palliative care program, Home Connections, implemented as a partnership between a not-for-profit hospice and two private insurers. This was a prospective, observational, database study of 499 Home Connections participants enrolled between July 1, 2008, and May 31, 2013. Measured outcomes were advance directive completion, site of death, symptom severity over time, program satisfaction, and hospice referral and average length of stay. Seventy-one percent of participants completed actionable advance directives after enrollment, and the site of death was home for 47% of those who died during or after participation in the program. Six of eight symptom domains (anxiety, appetite, dyspnea, well-being, depression, and nausea) showed improvement. Patients, caregivers, and physicians gave high program satisfaction scores (93%-96%). Home Connections participants who subsequently enrolled in hospice care had a longer average length of stay of 77.9 days compared with all other hospice referrals (average length of stay 56.5 days). A home-based palliative care program was developed between two local commercial payers and a not-for-profit hospice. Not only did this program improve symptom management, advance directive completion, and satisfaction, but it also facilitated the transition of patients into hospice care, when appropriate. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Harrold, Joan; Harris, Pam; Green, Dena; Craig, Teresa; Casarett, David J
Although many patients enter hospice close to death, some enroll for more than six months. In 2011 the U.S. Centers for Medicare and Medicaid Services (CMS) required that these long-stay patients receive a face-to-face visit by a physician or nurse practitioner to ensure that they continue to meet eligibility criteria. This study proposed to determine whether the face-to-face visit requirement increased the rate at which patients were decertified from hospice. The study was a retrospective cohort study in six U.S. hospices. Decertification from hospice within 10 months of enrollment was measured. Of 23,638 patients, 11,788 (49.9%) would have been affected by the face-to-face requirement. In bivariate analysis, there was a significant decrease in the decertification rate after the requirement was implemented-371/11,788 (3.2%) versus 578/11,850 (4.9%); odds ration (OR): 0.63; 95% CI 0.55-0.72; p<0.001. In a multivariable logistic regression model adjusting for changes in patient characteristics and clustered by hospice, there was still a reduction in decertifications-3.4% versus 5.2%; OR 0.67; 95% CI 0.47-0.97; p=0.034. Although the impact of the face-to-face requirement varied among hospices, all hospices had a decrease in decertification rates (absolute adjusted reduction between 1.4% and 3.6%). The face-to-face requirement may decrease hospice discharges, contrary to its intention.
Casarett, David J; Fishman, Jessica M; Lu, Hien L; O'Dwyer, Peter J; Barg, Frances K; Naylor, Mary D; Asch, David A
To be eligible for the Medicare Hospice Benefit, cancer patients with a life expectancy of 6 months or less must give up curative treatment. Our goal was to determine whether willingness to make this choice identifies patients with greater need for hospice services. Three hundred patients with cancer and 171 family members were recruited from six oncology practices. Respondents completed conjoint interviews in which their perceived need for five hospice services was calculated from the choices they made among combinations of services. Patients' preferences for treatment were measured, and patients were followed for 6 months or until death. Thirty-eight patients (13%) said they would not want cancer treatment even if it offered an almost 100% chance of 6-month survival. These patients, who would have been eligible for hospice, did not have greater perceived need for hospice services compared with other patients (n = 262; mean, 1.75 v 1.98; Wilcoxon rank sum test, P = .46), nor did their family members (mean, 1.95 v 2.04; Wilcoxon rank sum test, P = .80). Instead, independent predictors of patients' perceived need for hospice services included African American ethnicity, less social support, worse functional status, and a greater burden of psychological symptoms. For families, predictors included caregiver burden, worse self-reported health, working outside the home, and caring for a patient with worse functional status. The requirement that patients forgo life-sustaining treatment does not identify patients with greater perceived need for hospice services. Other characteristics offer a better way to identify the patients who are most likely to benefit from hospice.
DiBiasio, Eleanor L; Teno, Joan M; Clark, Melissa A; Spence, Carol; Casarett, David
Key to high-quality care of dying hospice patients at home is whether the hospice provides adequate training so the caregiver can safely care for the patient. The study objective was to develop and validate a survey of hospice training for caregivers to ensure safe, high-quality care in the home setting. Our survey design was cross-sectional. Bereaved respondents of individuals who died at home under the care of hospice were surveyed three to six months postdeath. Items were developed based on advice of an expert panel, focus groups of hospice caregivers, and literature review, with 12 items developed for testing and examining 8 key processes of care. We examined the validity and reliability of the assessment using factor analysis, correlational analyses, and multivariable modeling. Our sample consisted of 262 primary caregivers (mean age 62.4, 76.7% female, 58.8% non-Hispanic white). Six questions focused on providing the caregiver with information, while another six focused on the training that hospice provided. Based on model fit and Cronbach's alpha, we dropped the information items. The items that examined hospice training demonstrated a one-factor solution and a Cronbach's of 0.90. We examined correlations of the multi-item composite with overall rating of quality of care (0.53), overall distress (0.31), and whether the respondent would recommend this hospice to others (0.49). There were no significant sociodemographic correlates of concerns with training. Sufficient preliminary reliability and validity warrants further testing of this composite to examine the adequacy of training provided to family members to care safely for the patient.
To analyse the processes by which the hospice concept was translated into a reimbursable model of care in the USA and what was gained and what was lost in translation. Existing scholarship of the modern hospice movement typically focuses on the contributions of physicians to its inception and development. However, very little is known about the multifaceted role of nurses in the development of hospice care and the impact of Medicare policy on contemporary hospice care in the USA. Primary data were collected and interpreted using a blended social/policy history framework. Archival data were drawn from the papers of individuals and organisations integral to the American hospice movement; Congressional testimony; and, primary and secondary research data and reports. Interviews with key individuals were taped and transcribed verbatim. Data were analysed for emergent patterns, themes and subthemes. These were then contextualised within historiographical framework of twentieth century healthcare reforms. Nurses were central to the inception and development of hospice care in the United States. While they were intricately involved with most aspects of the hospice movement and helped to frame the policy debate, they were ultimately unable to wholly determine national policy or extend their influence beyond their own circles. The standardisation of hospice care in the USA served to improve the quality of care for many dying patients and their families. Yet, it also served to reinforce a false dichotomy between care for the living and care for the dying. As a result, the integration of palliative care concepts into standard clinical nursing practice remains problematic. This study illuminates the socio-political complexities that shape health policy and the subsequent impact on nursing practice. Its findings have broad implications for contemporary palliative care initiatives regardless of locale.
Mendoza, Roger Lee
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.
Shega, Joseph W; Hougham, Gavin W; Stocking, Carol B; Cox-Hayley, Deon; Sachs, Greg A
To evaluate the impact hospice enrollment has on the terminal care of patients with dementia and describe the symptom burden these patients experience, caregivers of dementia decedents were assessed in a mortality follow-back survey. Patients had been managed through academic outpatient geriatric clinics in Chicago, IL. A total of 135 family members or other knowledgeable informants of persons who had died with dementia were queried about the patient's preferred location of death, location of death, satisfaction with patient care, and assessment of patient's pain and most bothersome symptom. Patients who were enrolled in hospice were significantly more likely to die in their location of choice (odds ratio [OR] 9.67; 95% confidence interval [CI] 2.57-37.0), and less likely to die in the hospital, (OR 0.04; 95% CI 0.01-0.18), compared to nonenrollees. Caregivers of hospice enrollees were more likely to rate patient care as excellent or very good (OR 5.65; 95% CI 2.61-10.34), compared to nonenrollees. Over 50% of caregivers of hospice enrollees and nonenrollees reported patient pain at a moderate intensity or higher on average in the last two weeks of life. No effect was observed between a caregiver reporting pain at a moderate level or higher and whether the patient was enrolled in hospice (OR 0.58; 95% CI 0.22-1.54). Hospice enrollees did not experience improvement in their most bothersome symptom's frequency, severity, or amount of distress caused (P=0.21, 0.39, 0.95, respectively), compared to nonenrollees. These results suggest that dying patients with dementia who are enrolled in hospice programs are more likely to die in their locations of choice and their caregivers are more likely to perceive that care is excellent or good than those who do not obtain hospice services. No effect on pain or other symptoms could be demonstrated in this analysis.
Tsalatsanis, Athanasios; Barnes, Laura E; Hozo, Iztok; Djulbegovic, Benjamin
Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA). We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. We present a theoretical framework to facilitate the hospice referral process. Further rigorous
Full Text Available Abstract Background Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. Methods We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA. We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. Results The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. Conclusions We present a theoretical
Monroe, Todd B; Carter, Michael A; Feldt, Karen S; Dietrich, Mary S; Cowan, Ronald L
One condition associated with severe end-of-life pain that can lead to a poor quality of death is cancer. Cancer pain in people with dementia is of particular concern because of communication problems that occur with worsening disease. The aim of the current pilot study was to examine the association between hospice enrolment, dementia severity and pain among nursing home residents who died from advanced cancer. Between-groups cross-sectional chart audits of 55 nursing home residents with dementia who died from cancer were carried out. A total of 45% of residents were in hospice at the end-of-life. Residents in hospice were more likely to receive an opioid (80% vs 43%, P = 0.005); but less likely to show severe cognitive impairment (20% vs 50%, P = 0.050). Enrolment in hospice was associated with an increased likelihood of receiving an opioid after controlling for level of cognitive impairment (OR = 3.9, 95% CI = 1.1-14.0, P = 0.037). Lower levels of cognitive functioning were associated with a decreased likelihood of receiving an opioid after controlling for enrolment in hospice (OR = 0.3, 95% CI = 0.1-0.8, P = 0.030). Notably, 40% of nursing home residents with dementia who died from cancer did not receive any opioid during this time. Preliminary results suggest that hospice enrolment might be influenced by the facility or region of this particular country. Hospice enrolment predicts more opioid pain treatment in residents with dementia and terminal cancer; however, no resident with very severe dementia and terminal cancer was placed in hospice care. Severely cognitively impaired nursing home residents requiring opioids are at great risk of suffering from untreated advanced cancer pain. New methods are urgently required to improve end-of-life palliative care for nursing home residents with terminal cancer and severe dementia. © 2013 Japan Geriatrics Society.
...The Department of Veterans Affairs (VA) amends its regulations concerning the billing methodology for non-VA providers of home health services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA has specifically contracted, this rulemaking will only affect home health and hospice care providers who do not have existing negotiated contracts with VA. This rule also rescinds internal guidance documents that could be interpreted as conflicting with this final rule.
Payne, Richard; Kuchibhatla, Maragatha N.
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
Barclay, Joshua; Kuchibhatala, Maragatha; Tulsky, James A.; Johnson, Kimberly S.
Background Terminally ill patients with lower incomes are less likely to die at home, even with hospice care. Methods Analysis of VITAS hospice patients admitted to routine care in a private residence between January 1, 1999 and December 31, 2003. We matched zip codes to U.S. census tracts to generate annual median household incomes and divided the measure into $10,000 increments from ≤$20,000 to >$50,000). To examine the relationship between income and transfer from home before death, we used logistic regression (adjusted for demographics, diagnosis, region, length of stay). We also examined the interaction between income and level of hospice care (any vs. no continuous care) as a predictor of transfer from home. Unlike routine care which includes periodic visits by hospice, continuous care is a higher level of care, used for short periods of crisis to keep a patient at home and includes hospice services in the home at least 8 hours in a 24 hour period. Results Of the 61,063 enrollees admitted to routine care in a private residence, 13,804 (22.6%) transferred from home to another location (i.e. inpatient hospice unit, nursing home) with hospice care before death. Patients who transferred had a lower average median household income ($42,585 vs. $46,777, Pcare (49.38% vs. 30.61%, Pcare was 4. For patients who did not receive continuous care, the odds of transfer from home before death increased with decreasing annual median household incomes (OR range 1.26—1.76). For patients who received continuous care, income was not a predictor of transfer from home. Conclusions Patients with limited resources may be less likely to die at home, especially if they are not able to access needed support beyond what is available with routine hospice care. PMID:23420383
Wang, Shi-Yi; Aldridge, Melissa D.; Gross, Cary P.; Canavan, Maureen; Cherlin, Emily; Johnson-Hurzeler, Rosemary; Bradley, Elizabeth
Objectives Despite increased hospice use over the last decade, end-of-life care intensity continues to increase. To understand this puzzle, we sought to examine regional variation in intensive end-of-life care and determine its associations with hospice use patterns. Methods Using Medicare claims for decedents age ≥ 66 years in 2011, we assessed end-of-life care intensity in the last 6 months of life across hospital referral regions (HRRs) as measured by proportion of decedents per HRR experiencing hospitalization, emergency department (ED) use, intensive care unit (ICU) admission, and number of days spent in hospital (hospital-days) and ICU (ICU-days). Using hierarchical generalized linear models and adjusting for patient characteristics, we examined whether these measures were associated with overall hospice use, very short (≤ 7 days), medium (8–179 days), or very long (≥180 days) hospice enrollment, focusing on very short stay. Results End-of-life care intensity and hospice use patterns varied substantially across HRRs. Regional-level end-of-life care intensity was positively correlated with very short hospice enrollment. Comparing HRRs in the highest versus the lowest quintiles of intensity in end-of-life care, regions with more intensive care had higher rates of very short hospice enrollment, with adjusted odds ratios [AOR] 1.14 (99% confidence interval [CI]: 1.04–1.25) for hospitalization; 1.23 (CI: 1.12–1.36) for ED use; AOR 1.25 (CI: 1.14–1.38) for ICU admission; AOR 1.10 (CI: 1.00–1.21) for hospital-days and AOR 1.20 (CI: 1.08–1.32) for ICU-days. Conclusions At the regional level, increased end-of-life care intensity was consistently associated with very short hospice use. PMID:27111747
Haas, Barbara Ann; Sheehan, Judith M; Stone, Jennie Ann M; Hammer-Beem, Marji J
Health professions faculty think that interdisciplinary education is critical for students pursuing careers as health care professionals. Initial attempts at interdisciplinary education by simply combining students into groups without adequate curriculum adaptation, preparation, and planning have been ineffective. Applying the liberal arts interdisciplinary model, developed by William Newell, a transdisciplinary faculty team in the College of Health Professions of the University of New England identified the course content, design, and instructional processes necessary to create an interdisciplinary elective course. The eight-step model and how it was applied to the development of an ethics course for seven different health care professional disciplines is presented. The result of this applied design approach was a course that assisted the transition of health care professional students previously accustomed to studying and working within their own discipline to communicate, cooperate, and collaborate across discipline-specific lines. Copyright 2009, SLACK Incorporated.
Full Text Available What are the factors that hinder or support publishing interdisciplinary research? What does a successful interdisciplinary publishing process look like? We address these questions by analyzing the publishing process of the interdisciplinary research project titled "Mountland." Project researchers published most of their main results as a Special Feature of Ecology and Society. Using the story wall method and qualitative content analysis, we identified ten factors contributing to the success or failure of publishing interdisciplinary research. They can be assigned to four groups of resources: scientific resources, i.e., previous joint research, simultaneously written manuscripts; human resources, i.e., coordination, flexibility, composition of the team; integrative resources, i.e., vision of integration, chronology of results; and feedback resources, i.e., internal reviews, subject editors, external reviewers. According to this analysis, an ideal-typical publishing process necessitates, among other things, (1 a strong, interdisciplinary coordinator, (2 a clear shared vision of integration and a common framework, (3 flexibility in terms of money and time, (4 a certain sense of timing regarding when and how to exchange results and knowledge, (5 subject editors who are familiar with the specific project and its interdisciplinary merits, and (6 reviewers who are open minded about interdisciplinary efforts.
Holmes, Holly M; Kaiser, Karen; Jackson, Steve; McPherson, Mary Lynn
Reconciling medication use and performing drug utilization review on admission of a patient into hospice care are essential in order to safely prescribe medications and to prevent possible adverse drug events and drug-drug interactions. As part of this process, fully assessing herbal medicine and supplement use in hospice patients is crucial, as patients in hospice may be likely to use these medications and may be more vulnerable to their potential adverse effects. Our purpose was to identify herbals, vitamins, and supplements that should be routinely assessed on every hospice admission because of their higher likelihood of use or higher risk of adverse effects or drug interactions. Experts in the fields of palliative medicine, pharmacy, and alternative medicine were asked to complete a Web-based survey on 37 herbals, vitamins, supplements, and natural products, rating likelihood of use, potential for harm, and recommendation to include it on the final list on a scale of 1 to 5 (least to most likely to agree). Twenty experts participated in the survey. Using a cutoff of 3.75 for inclusion of a medication on the final list, 12 herbal medicines were identified that should be routinely and specifically assessed on hospice admission. Although assessing all herbal medicine use is ideal, thorough detection of herbals may be challenging. The list of herbals and supplements identified by this survey could be a useful tool for medication reconciliation in hospice and could aid in identifying potentially harmful medication use at the end of life.
Haines, Krista L; Jung, Hee Soo; Zens, Tiffany; Turner, Scott; Warner-Hillard, Charles; Agarwal, Suresh
End-of-life and palliative care are important aspects of trauma care and are not well defined. This analysis evaluates the racial and socioeconomic disparities in terms of utilization of hospice services for critically ill trauma patients. Trauma patients ≥15 years old from 2012 to 2015 were queried from the National Trauma Databank. Chi-square and multivariate logistic regression analyses for disposition to hospice were performed after controlling for age, gender, comorbidities, injury severity, insurance, race, and ethnicity. Negative binomial regression analysis with margins for length of stay (LOS) was calculated for all patients discharged to hospice. Chi-square analysis of 2 966 444 patient's transition to hospice found patients with cardiac disease, bleeding and psychiatric disorders, chemotherapy, cancer, diabetes, cirrhosis, respiratory disease, renal failure, cirrhosis, and cerebrovascular accident (CVA) affected transfer ( P care than Caucasian patients (OR: 0.65, 0.60, 0.73; P care and significantly affect LOS. Our data demonstrate prominent racial and socioeconomic disparities exist, with uninsured and minority patients being less likely to receive hospice services and having a delay in transition to hospice care when compared to their insured Caucasian counterparts.
Clayton, Margaret F; Reblin, Maija; Carlisle, McKenzie; Ellington, Lee
To identify and describe communication behaviors used by hospice nurses when eliciting and addressing concerns of patients with cancer and their caregivers. Secondary analysis. Home hospice in Salt Lake City, UT. Audio recordings from seven patient and caregiver dyads and five hospice nurses. Audio recordings were coded using the Roter Interaction Analysis System for patient and caregiver concern statements indicating negative affect and distress and the surrounding nurse communication behaviors. Concern content was categorized using domains developed by the National Consensus Project for Quality Palliative Care. Patient and caregiver concern statements and nurse communication behaviors. 180 patient and caregiver speaking turns containing concerns were identified across 31 hospice visits. Patients and caregivers expressed at least one concern in the vast majority of visits. The most prevalent distress areas reflected psychological and physical issues. Nurses used proportionally more positive emotion statements before patient and caregiver concerns, compared to the visit overall. Nurses asked proportionally more physical questions after concern statements. Nurses also used more emotional responses before and after patient and caregiver concerns, relative to the entire visit. Patients with cancer and caregivers frequently talk about distressing issues. Hospice nurses use specific communication behaviors to elicit and address those issues. Home hospice provides a venue to examine nurse communication behaviors used to elicit and respond to patient and caregiver distress. These strategies could be taught to nurses who encounter patient distress less frequently or are less comfortable with emotional conversations.
Thienprayoon, Rachel; Marks, Emily; Funes, Maria; Martinez-Puente, Louizza Maria; Winick, Naomi; Lee, Simon Craddock
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.
Casarett, D J; Hirschman, K B; Henry, M R
To assess the possible benefits and challenges of hospice involvement in nursing home care by comparing the survival and needs for palliative care of hospice patients in long-term care facilities with those living in the community. Retrospective review of computerized clinical care records. A metropolitan nonprofit hospice. The records of 1,692 patients were searched, and 1,142 patients age 65 and older were identified. Of these, 167 lived in nursing homes and 975 lived in the community. Patient characteristics, needs for palliative care, and survival. At the time of enrollment, nursing home residents were more likely to have a Do Not Resuscitate order (90% vs 73%; P home residents also had different admitting diagnoses, most notably a lower prevalence of cancer (44% vs 74%; P home residents, including constipation (1% vs 5%; P = .02), pain (25% vs 41%; P home residents had fewer needs for care (median 0, range 0-3 vs median 1, range 0-5; rank sum test P home residents had a significantly shorter survival (median 11 vs 19 days; log rank test of survivor functions P home residents who are referred to hospice, although nursing home residents may have fewer identifiable needs for care than do community-dwelling older people. However, the finding that nursing home residents' survival is shorter may be of concern to hospices that are considering partnerships with nursing homes. An increased emphasis on hospice care in nursing homes should be accompanied by targeted educational efforts to encourage early referral.