Medicare Hospice Benefits

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

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

Science.gov (United States)

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

2009-11-01

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

Interprofessional team meetings: Opportunities for informal interprofessional learning.

Science.gov (United States)

Nisbet, Gillian; Dunn, Stewart; Lincoln, Michelle

2015-01-01

This study explores the potential for workplace interprofessional learning, specifically the learning that occurs between health professionals as part of their attendance at their regular interprofessional team meetings. While most interprofessional learning research to date has focused on formal structured education programs, this study adds to our understanding of the complexities of the learning processes occurring between health professionals as part of everyday practice. Through observations of team meetings and semi-structured interviews, we found that the interprofessional team meeting provided a practical, time-efficient, and relevant means for interprofessional learning, resulting in perceived benefits to individuals, teams, and patients. The learning process, however, was influenced by members' conceptions of learning, participation within the meeting, and medical presence. This study provides a basis for further research to assist health professionals capitalize on informal learning opportunities within the interprofessional meeting.

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

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

2011-08-01

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

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

Science.gov (United States)

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

2011-10-01

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

The role of the hospice social worker in the nursing home setting.

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Amar, D F

1994-01-01

Data and case examples from two major metropolitan hospice programs are examined in order to arrive at a definition of the hospice social worker's role in the nursing home, and how it differs from that of the hospice social worker in home care. The nursing home population tends to be older, frailer, and with poorer mental status, making them less available to "talk therapies". The nursing home environment itself needs to be assessed as a significant part of the patient/family system. Social work interventions may focus on the patient, the family, the nursing home staff, or any combination of these elements. The hospice social worker on a nursing home team may do less counseling with patients, but the role draws on diverse other skills such as groupwork, negotiation, education, and advocacy.

Head and neck multidisciplinary team meetings: Effect on patient management.

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Brunner, Markus; Gore, Sinclair M; Read, Rebecca L; Alexander, Ashlin; Mehta, Ankur; Elliot, Michael; Milross, Chris; Boyer, Michael; Clark, Jonathan R

2015-07-01

The purpose of this study was for us to present our findings on the prospectively audited impact of head and neck multidisciplinary team meetings on patient management. We collected clinical data, the pre-multidisciplinary team meeting treatment plan, the post-multidisciplinary team meeting treatment plans, and follow-up data from all patients discussed at a weekly multidisciplinary team meeting and we recorded the changes in management. One hundred seventy-two patients were discussed in 39 meetings. In 52 patients (30%), changes in management were documented of which 20 (67%) were major. Changes were statistically more likely when the referring physician was a medical or radiation oncologist, when the initial treatment plan did not include surgery, and when the histology was neither mucosal squamous cell cancer nor a skin malignancy. Compliance to the multidisciplinary team meeting treatment recommendation was 84% for all patients and 70% for patients with changes in their treatment recommendation. Head and neck multidisciplinary team meetings changed management in almost a third of the cases. © 2014 Wiley Periodicals, Inc.

Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice Care.

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Shalev, Ariel; Phongtankuel, Veerawat; Lampa, Katherine; Reid, M C; Eiss, Brian M; Bhatia, Sonica; Adelman, Ronald D

2018-04-01

The transition into home hospice care is often a critical time in a patient's medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care. To understand PCPs' experiences, challenges, and preferences when their patients transition to home hospice care. Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods. Participants included PCPs from 3 academic group practices in New York City. Measured: Physician recordings were transcribed and analyzed using content analysis. Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care. Primary care physicians expressed varying degrees of involvement during a patient's transition to home hospice care, but many desired to be more involved in their patient's care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.

Landsat Science Team: 2017 Winter Meeting Summary

Science.gov (United States)

Schroeder, Todd A.; Loveland, Thomas; Wulder, Michael A.; Irons, James R.

2017-01-01

The summer meeting of the joint U.S. Geological Survey (USGS)-NASA Landsat Science Team (LST) was held July 26-28, 2016, at South Dakota State University (SDSU) in Brookings, SD. LST co-chair Tom Loveland [USGS’s Earth Resources Observation and Science Center (EROS)] and Kevin Kephart [SDSU] welcomed more than 80 participants to the three-day meeting. That attendance at such meetings continues to increase—likely due to the development of new data products and sensor systems—further highlights the growing interest in the Landsat program. The main objectives of this meeting were to provide a status update on Landsat 7 and 8, review team member research activities, and to begin identifying priorities for future Landsat missions.

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

OpenAIRE

LEVÁ, Monika

2013-01-01

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

Exploring dialectical behaviour therapy clinicians' experiences of team consultation meetings.

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Walsh, Cian; Ryan, Patrick; Flynn, Daniel

2018-01-01

This article presents a detailed idiographic analysis of Dialectical Behaviour Therapy (DBT) clinicians' experiences of team consultation meetings. DBT is an evidence-based psychological intervention with a demonstrated efficacy in the treatment of borderline personality disorder (BPD). Team consultation meetings encompass one of the primary components involved in this treatment model; where DBT clinicians regularly meet to discuss client work and enhance further learning. The present study's aim was to assess what are DBT clinicians' experiences of the consultation meeting component and whether it is useful or not. Semi-structured interviews were completed with 11 DBT clinicians (nine females, two males) from three different consultation teams. The research project utilised an interpretative phenomenological analysis (IPA) framework. Audio-recorded interview data was analysed using this framework. Four superordinate themes emerged from the interview data, which included ten subordinate themes. The superordinate themes focused on: (1) the acquisition of DBT technical knowledge and other MDT related expertise (2) participants' emotional experiences of DBT and consultation meetings, and how this can evolve over time (3) the underlying processes that occur in the consultation team including the development of a team bond and the impact of membership changes and (4) the largely consistent and reliable nature of consultation meetings and how they help maintain clinician motivation. Team consultation meetings were found to be supportive; playing an important role in maintaining clinician motivation through the availability of team support, opportunities to reflect and learn, and assistance in regulating emotions. Challenges arose in relation to team membership changes and acclimatisation to the type of feedback utilised in team consultation. The study's implications for practise are considered.

Exploring oral literacy in communication with hospice caregivers.

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

2013-11-01

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

Successful participation of patients in interprofessional team meetings: A qualitative study.

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van Dongen, Jerôme Jean Jacques; Habets, Iris Gerarda Josephine; Beurskens, Anna; van Bokhoven, Marloes Amantia

2017-08-01

The number of people with multiple chronic conditions increases as a result of ageing. To deal with the complex health-care needs of these patients, it is important that health-care professionals collaborate in interprofessional teams. To deliver patient-centred care, it is often recommended to include the patient as a member of the team. To gain more insight into how health-care professionals and patients, who are used to participate in interprofessional team meetings, experience and organize patient participation in the team meetings. A qualitative study including observations of meetings (n=8), followed by semi-structured interviews with participating health-care professionals (n=8), patients and/or relatives (n=11). Professionals and patients were asked about their experiences of patient participation immediately after the team meetings. Results from both observations and interviews were analysed using content analysis. The findings show a variety of influencing factors related to patient participation that can be divided into five categories: (i) structure and task distribution, (ii) group composition, (iii) relationship between professionals and patients or relatives, (iv) patients' characteristics and (v) the purpose of the meeting. Patient participation during team meetings was appreciated by professionals and patients. A tailored approach to patient involvement during team meetings is preferable. When considering the presence of patients in team meetings, it is recommended to pay attention to patients' willingness and ability to participate, and the necessary information shared before the meeting. Participating patients seem to appreciate support and preparation for the meeting. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

How to Get It -- Step 2: Meet the Palliative Care Team

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... a Provider 3. Meet the Team Palliative Care Team The palliative care team will spend a lot of time with you ... your goals. But what should you ask the team during the meeting? Here are some suggestions: What ...

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

Science.gov (United States)

Taylor, Andrea; French, Tara; Raman, Sneha

2018-03-01

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

Creative ritual in a hospice.

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Roche, J

1994-12-01

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

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

Science.gov (United States)

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

2013-04-01

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

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

Science.gov (United States)

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

2015-11-01

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

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

Directory of Open Access Journals (Sweden)

Grzegorz Godawa

2012-09-01

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

The volunteer program in a Children's Hospice.

Science.gov (United States)

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

2008-09-01

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

Landsat Science Team meeting: Winter 2015

Science.gov (United States)

Schroeder, Todd A.; Loveland, Thomas; Wulder, Michael A.; Irons, James R.

2015-01-01

The summer meeting of the joint U.S. Geological Survey (USGS)–NASA Landsat Science Team (LST) was held at the USGS’s Earth Resources Observation and Science (EROS) Center July 7-9, 2015, in Sioux Falls, SD. The LST co-chairs, Tom Loveland [EROS—Senior Scientist] and Jim Irons [NASA’s Goddard Space Flight Center (GSFC)—Landsat 8 Project Scientist], opened the three-day meeting on an upbeat note following the recent successful launch of the European Space Agency’s Sentinel-2 mission on June 23, 2015 (see image on page 14), and the news that work on Landsat 9 has begun, with a projected launch date of 2023.With over 60 participants in attendance, this was the largest LST meeting ever held. Meeting topics on the first day included Sustainable Land Imaging and Landsat 9 development, Landsat 7 and 8 operations and data archiving, the Landsat 8 Thermal Infrared Sensor (TIRS) stray-light issue, and the successful Sentinel-2 launch. In addition, on days two and three the LST members presented updates on their Landsat science and applications research. All presentations are available at landsat.usgs.gov/science_LST_Team_ Meetings.php.

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

Science.gov (United States)

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

2014-12-01

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

2017 Landsat Science Team Summer Meeting Summary

Science.gov (United States)

Crawford, Christopher J.; Loveland, Thomas R.; Wulder, Michael A.; Irons, James R.

2018-01-01

The summer meeting of the U.S. Geological Survey (USGS)-NASA Landsat Science Team (LST) was held June 11-13, 2017, at the USGS’s Earth Resources Observation and Science (EROS) Center near Sioux Falls, SD. This was the final meeting of the Second (2012-2017) LST.1 Frank Kelly [EROS—Center Director] welcomed the attendees and expressed his thanks to the LST members for their contributions. He then introduced video-recorded messages from South Dakota’s U.S. senators, John Thune and Mike Rounds, in which they acknowledged the efforts of the team in advancing the societal impacts of the Landsat Program.

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

Science.gov (United States)

Stelzer, Eva-Maria; Lang, Frieder R

2016-03-01

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

2010 Atmospheric System Research (ASR) Science Team Meeting Summary

Energy Technology Data Exchange (ETDEWEB)

Dupont, DL

2011-05-04

This document contains the summaries of papers presented in poster format at the March 2010 Atmospheric System Research Science Team Meeting held in Bethesda, Maryland. More than 260 posters were presented during the Science Team Meeting. Posters were sorted into the following subject areas: aerosol-cloud-radiation interactions, aerosol properties, atmospheric state and surface, cloud properties, field campaigns, infrastructure and outreach, instruments, modeling, and radiation. To put these posters in context, the status of ASR at the time of the meeting is provided here.

[The function of team-meetings for treatment teams on child and adolescent psychiatric wards].

Science.gov (United States)

Branik, Emil; Meng, Heiner

2006-01-01

In the daily work of multidisciplinary teams on child and adolescent psychiatric wards team-meetings play a central role to coordinate various treatment activities. In medical literature studies on the topic are lacking, and only few articles were found. The authors explore by a descriptive-hermeneutic analysis the numerous functions of meetings for the treatment team. To them belong catharsis, containment, reflection, regulation and integration. Psychodynamic, group dynamical and institutional factors will be described regarding their influence on the therapy management. Issues of power in institutions will be comprised in the discussion. The dialectical tension between professionalism and emotionality in the work with patients especially from the borderline-spectrum as well as between unity and diversity within the treatment team in regard to the different roles of each and everyone team member will be presented. Hints at how to manage these tensions will be given to preserve the therapeutical milieu on the ward.

Medicare Provider Data - Hospice Providers

Data.gov (United States)

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

Team self-regulation and meeting deadlines in project teams: antecedents and effects of temporal consensus

NARCIS (Netherlands)

Gevers, J.M.P.; van Eerde, W.; Rutte, C.G.

2009-01-01

In a longitudinal study among 48 project teams, we investigated how temporal consensus (i.e., the extent to which team members have a shared understanding of the temporal aspects of their collective task) affects the ability of teams to establish coordinated action and meet deadlines. In addition,

Prison hospice: an unlikely success.

Science.gov (United States)

Craig, E L; Craig, R E

1999-01-01

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

End of Life (Hospice Care)

Science.gov (United States)

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

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

Science.gov (United States)

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

2010-08-01

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

Ownership status and patterns of care in hospice: results from the National Home and Hospice Care Survey.

Science.gov (United States)

Carlson, Melissa D A; Gallo, William T; Bradley, Elizabeth H

2004-05-01

The number of for-profit hospices increased nearly 4-fold over the past decade, more than 6 times the growth of nonprofit hospices. Despite this growth, the impact of ownership on hospice care is largely unknown. We sought to assess differences in the provision of services to patients of for-profit and nonprofit hospices. Using the 1998 National Home and Hospice Care Survey, we examined services used by patients (N = 2080) cared for by 422 hospices nationwide. We used multivariable ordered logistic and logistic regression to assess the effect of profit status on service use, adjusting for potentially confounding patient and organizational characteristics. We calculated point estimates adjusted for sampling weights and standard errors adjusted for the clustering of patients within hospices. In ordered logistic models controlling for organizational and patient factors, patients of for-profit hospices received a significantly narrower range of services (adjusted odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.92) than patients of nonprofit hospices. This result is driven by patients of for-profit hospices receiving significantly fewer types of hospice services that federal regulations term "noncore" or more discretionary services (adjusted OR, 0.34; 95% CI, 0.15-0.75). The pattern of care differs in for-profit and nonprofit hospices. As the industry develops a substantial for-profit presence, it is critical for clinicians and other healthcare professionals to be alert to the potential impact of profit status on the care their patients receive.

Proceedings of the second Atmospheric Radiation Measurement (ARM) Science Team Meeting

International Nuclear Information System (INIS)

1992-12-01

The second Atmospheric Radiation Measurement (ARM) Science Team Meeting was held in Denver, Colorado, in October 1991. The five-day meeting provided a forum for a technical exchange among the members of the ARM Science Team and a discussion of the technical aspects of the project infrastructure. The meeting included several activities: Science Team presentations, discussions of the first site occupation plan, experiment design sessions, and poster sessions. This Proceedings document includes papers presented at the meeting. The papers included are those from the technical sessions, the experiment design sessions, the first site occupation, and descriptions of locales for future sites. Individual projects are processed separately for the database

Stress in hospice at home nurses: a qualitative study of their experiences of their work and wellbeing.

Science.gov (United States)

Tunnah, Karen; Jones, Angela; Johnstone, Rosalynde

2012-06-01

The literature has evaluated studies of hospice nurses and stress but very few studies have focused on community hospice nurses. This study explored hospice at home nurses' experiences of caring for palliative and dying patients. Hospice at home nurses working in the community across North West Wales were interviewed and a grounded theory approach was used to categorise the data into the following themes: job satisfaction, stressors, coping strategies, and support. Recommendations arising from the study include encouraging the use of clinical supervision, attendance at multidisciplinary meetings, and the provision of stress-awareness training, and raising awareness of the role of hospice at home nurses in primary care. Implementation of these recommendations might be beneficial for staff wellbeing. Further work would identify whether such recommendations can help to prevent sickness and promote staff retention.

Benefits, barriers and opinions on multidisciplinary team meetings

DEFF Research Database (Denmark)

Rosell, Linn; Alexandersson, Nathalie; Hagberg, Oskar

2018-01-01

BACKGROUND: Case review and discussion at multidisciplinary team meetings (MDTMs) have evolved into standard practice in cancer care with the aim to provide evidence-based treatment recommendations. As a basis for work to optimize the MDTMs, we investigated participants' views on the meeting func...

Music Therapy Clinical Practice in Hospice: Differences Between Home and Nursing Home Delivery.

Science.gov (United States)

Liu, Xiaodi; Burns, Debra S; Hilliard, Russell E; Stump, Timothy E; Unroe, Kathleen T

2015-01-01

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: journals.permissions@oup.com.

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

Science.gov (United States)

Wale, J; Arthur, A; Faull, C

2014-03-01

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

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

Science.gov (United States)

Campbell, Courtney S; Cox, Jessica C

2012-05-01

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

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

Directory of Open Access Journals (Sweden)

Carey Candrian

2017-04-01

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.

Long and short hospice stays among nursing home residents at the end of life.

Science.gov (United States)

Huskamp, Haiden A; Stevenson, David G; Grabowski, David C; Brennan, Eric; Keating, Nancy L

2010-08-01

To identify characteristics of nursing homes and residents associated with particularly long or short hospice stays. Observational study using administrative data on resident characteristics and hospice utilization from a large regional hospice linked with publicly available data on nursing home characteristics. A total of 13,479 residents who enrolled in hospice during 2001-2008. Logistic regression models of the probability of a long (>180 days) or very short (stay, adjusting for nursing home characteristics, a measure of nursing home quality developed using Minimum Data Set Quality Indicator/Quality Measures data, and resident characteristics. Nursing home characteristics were not statistically significant predictors of long stays. The probability of a short stay increased with the facility's nurse staffing ratio and decreased with the share of residents covered by Medicaid. Men (relative to women) and blacks (relative to whites) were less likely to have a long stay and more likely to have a short stay, while those 70 years or younger (relative to those 81-90) and residents with Alzheimer's disease/dementia were more likely to have long stays and less likely to have short stays. Fourteen percent of hospice users were discharged before death because they failed to meet Medicare hospice eligibility criteria, and these residents had longer lengths of stay, on average. Few facility characteristics were associated with very long or very short hospice stays. However, high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.

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

Science.gov (United States)

Price, Jayne; McCloskey, Sharon; Brazil, Kevin

2018-01-01

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

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

Science.gov (United States)

De Vries, Kay; Plaskota, Marek

2017-04-01

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

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

Science.gov (United States)

Ghesquiere, Angela; Bagaajav, Ariunsanaa

2018-01-01

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

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

Science.gov (United States)

Wesley, Carol; Tunney, Kathleen; Duncan, Ella

2004-01-01

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

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2016-07-26

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

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

Science.gov (United States)

Gilstrap, Cristina M; White, Zachary M

2015-01-01

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

The stresses of hospice volunteer work.

Science.gov (United States)

Brown, Mary V

2011-05-01

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

Development of a Customizable Programme for Improving Interprofessional Team Meetings: An Action Research Approach.

Science.gov (United States)

van Dongen, Jerôme Jean Jacques; van Bokhoven, Marloes Amantia; Goossens, Wilhelmus Nicolaas Marie; Daniëls, Ramon; van der Weijden, Trudy; Beurskens, Anna

2018-01-25

Interprofessional teamwork is increasingly necessary in primary care to meet the needs of people with complex care demands. Needs assessment shows that this requires efficient interprofessional team meetings, focusing on patients' personal goals. The aim of this study was to develop a programme to improve the efficiency and patient-centredness of such meetings. Action research approach: a first draft of the programme was developed, and iteratively used and evaluated by three primary care teams. Data were collected using observations, interviews and a focus group, and analysed using directed content analysis. The final programme comprises a framework to reflect on team functioning, and training activities supplemented by a toolbox. Training is intended for the chairperson and a co-chair, and aims at organizing and structuring meetings, and enhancing patient-centredness. Our findings emphasize the essential role of the team's chairperson, who, in addition to technically structuring meetings, should act as a change agent guiding team development. Findings show that the programme should be customizable to each individual team's context and participants' learning objectives. Becoming acquainted with new structures can be considered a growth process, in which teams have to find their way, with the chairperson as change agent.

Death representation of caregivers in hospice.

Science.gov (United States)

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

2012-11-01

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

Landsat science team meeting: Summer 2015

Science.gov (United States)

Schroeder, Todd; Loveland, Thomas; Wulder, Michael A.; Irons, James R.

2015-01-01

The summer meeting of the joint U.S. Geological Survey (USGS)–NASA Landsat Science Team (LST) was held at the USGS’s Earth Resources Observation and Science (EROS) Center July 7-9, 2015, in Sioux Falls, SD. The LST co-chairs, Tom Loveland [EROS—Senior Scientist] and Jim Irons [NASA’s Goddard Space Flight Center (GSFC)—Landsat 8 Project Scientist], opened the three-day meeting on an upbeat note following the recent successful launch of the European Space Agency’s Sentinel-2 mission on June 23, 2015 (see image on page 14), and the news that work on Landsat 9 has begun, with a projected launch date of 2023.

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

Science.gov (United States)

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

2015-12-01

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

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

Science.gov (United States)

Rahman, Anna N

2017-02-01

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

Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

Science.gov (United States)

Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

2014-01-01

Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

Children with intellectual disability and hospice utilization.

Science.gov (United States)

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

2017-02-01

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

Results from the national hospice volunteer training survey.

Science.gov (United States)

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

2010-03-01

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

Virtual Reality Hospice

OpenAIRE

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

2017-01-01

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

Cultural competency and diversity among hospice palliative care volunteers.

Science.gov (United States)

Jovanovic, Maja

2012-05-01

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

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

Science.gov (United States)

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

2011-01-01

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

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

Science.gov (United States)

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

2015-08-01

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

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

Science.gov (United States)

Groen, Kara Mills

2007-01-01

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

Future design of a Children's Hospice

DEFF Research Database (Denmark)

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

2017-01-01

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

International Energy Agency's Heat Pump Centre (IEA-HPC) Annual National Team Working Group Meeting

Science.gov (United States)

Broders, M. A.

1992-09-01

The traveler, serving as Delegate from the United States Advanced Heat Pump National Team, participated in the activities of the fourth IEA-HPC National Team Working Group meeting. Highlights of this meeting included review and discussion of 1992 IEA-HPC activities and accomplishments, introduction of the Switzerland National Team, and development of the 1993 IEA-HPC work program. The traveler also gave a formal presentation about the Development and Activities of the IEA Advanced Heat Pump U.S. National Team.

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

Science.gov (United States)

Cobbe, Sinead; Kennedy, Norelee

2012-07-01

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

Oncologic multidisciplinary team meetings: evaluation of quality criteria

NARCIS (Netherlands)

Ottevanger, N.; Hilbink, M.; Weenk, M.; Janssen, R.; Vrijmoeth, T.; Vries, A. de; Hermens, R.P.

2013-01-01

RATIONALE, AIMS AND OBJECTIVES: To develop a guideline with quality criteria for an optimal structure and functioning of a multidisciplinary team meeting (MTM), and to assess to what extent the Dutch MTMs complied with these criteria. METHOD: A literature search and expert opinions were used to

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

LENUS (Irish Health Repository)

Cobbe, Sinead

2012-07-01

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

Clinical and Socio-Demographic Predictors of Home Hospice Patients Dying at Home: A Retrospective Analysis of Hospice Care Association's Database in Singapore.

Science.gov (United States)

Lee, Yee Song; Akhileswaran, Ramaswamy; Ong, Eng Hock Marcus; Wah, Win; Hui, David; Ng, Sheryl Hui-Xian; Koh, Gerald

2017-06-01

Hospice care can be delivered in different settings, but many patients choose to receive it at home because of familiar surroundings. Despite their preferences, not every home hospice patient manages to die at home. To examine the independent factors associated with home hospice patient dying at home. Retrospective analysis of Hospice Care Association's database. Hospice Care Association is the largest home hospice provider in Singapore. The study included all patients who were admitted into home hospice service from January 1, 2004 to December 31, 2013. Cox proportional hazards modeling with time as constant was used to study the relationship between independent variables and home death. A total of 19,721 patients were included in the study. Females (adjusted risk ratio [ARR] 1.09, 95% CI 1.04-1.15), older patients (ARR 1.01, 95% CI 1.00-1.01), shorter duration of home hospice stay (ARR 0.88, 95% CI 0.82-0.94), fewer episodes of hospitalization (ARR 0.81, 95% CI 0.75-0.86), living with caregivers (ARR 1.54, 95% CI 1.05-2.26), doctor (ARR 1.05, 95% CI 1.01-1.08) and nurse (ARR 1.06, 95% CI 1.04-1.08) visits were positive predictors of dying-at-home. Diagnosis of cancer (ARR 0.93, 95% CI 0.86-1.00) was a negative predictor of dying-at-home. Female, older age, living with a caregiver, non-cancer diagnosis, more doctor and nurse visits, shorter duration of home hospice stays, and fewer episodes of acute hospitalizations are predictive of dying-at-home for home hospice patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

Matsushima, T; Akabayashi, A; Nishitateno, K

2002-03-01

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

Hospice utilization during the SARS outbreak in Taiwan

Directory of Open Access Journals (Sweden)

Lin Ming-Hwai

2006-08-01

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

Hospice decision making: diagnosis makes a difference.

Science.gov (United States)

Waldrop, Deborah P; Meeker, Mary Ann

2012-10-01

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

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

Science.gov (United States)

Field-Richards, Sarah E; Arthur, Antony

2012-12-01

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

Symptom Clusters and Quality of Life in Hospice Patients with Cancer

Science.gov (United States)

Omran, Suha; Khader, Yousef; McMillan, Susan

2017-09-27

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

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

Science.gov (United States)

Krout, Robert E

2003-01-01

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

In Absentia: An Exploratory Study of How Patients Are Considered in Multidisciplinary Cancer Team Meetings

NARCIS (Netherlands)

Hahlweg, P.; Hoffmann, J.; Harter, M.; Frosch, D.L.; Elwyn, G.; Scholl, I.

2015-01-01

BACKGROUND: Multidisciplinary team meetings and shared decision-making are potential means of delivering patient-centred care. Not much is known about how those two paradigms fit together in cancer care. This study aimed to investigate how decisions are made in multidisciplinary team meetings and

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

Science.gov (United States)

Mascagni, Giulia

2016-11-22

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

Psychological contracts of hospice nurses.

Science.gov (United States)

Jones, Audrey Elizabeth; Sambrook, Sally

2010-12-01

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

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

Science.gov (United States)

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

2013-10-01

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

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

Science.gov (United States)

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

2014-09-01

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

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

Science.gov (United States)

Oud, Lavi

2017-01-01

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

Proceedings of the third Atmospheric Radiation Measurement (ARM) science team meeting

International Nuclear Information System (INIS)

1994-03-01

This document contains the summaries of papers presented at the 1993 Atmospheric Radiation Measurement (ARM) Science Team meeting held in Morman, Oklahoma. To put these papers in context, it is useful to consider the history and status of the ARM Program at the time of the meeting. Individual papers have been cataloged separately

Proceedings of the third Atmospheric Radiation Measurement (ARM) science team meeting

Energy Technology Data Exchange (ETDEWEB)

1994-03-01

This document contains the summaries of papers presented at the 1993 Atmospheric Radiation Measurement (ARM) Science Team meeting held in Morman, Oklahoma. To put these papers in context, it is useful to consider the history and status of the ARM Program at the time of the meeting. Individual papers have been cataloged separately.

Setting up a parathyroid multidisciplinary team meeting: one year's experience, outcomes and learning points.

Science.gov (United States)

Hancox, S H; Sinnott, J D; Kirkland, P; Lipscomb, D; Owens, E; Howlett, D C

2018-03-01

A parathyroid multidisciplinary team meeting was set up at East Sussex Healthcare Trust, from November 2014 to November 2015, in order to improve and streamline services for patients with parathyroid pathology. Data were collected on all new referrals for hyperparathyroidism, and on the outcomes for each patient discussed at the meeting, including the number of operations and management outcomes. A survey was sent out to the members of the multidisciplinary team meeting to determine their perception of its effectiveness. Seventy-nine new referrals were discussed throughout the year; 43 per cent were recommended for surgery, 41 per cent had a trial of conservative or medical management before re-discussion, and 16 per cent required further imaging. Ninety-two per cent of patients underwent an ultrasound, single-photon emission computed tomography/computed tomography or nuclear medicine (sestamibi) scan prior to the meeting. All ultrasound scans were performed by a consultant radiologist. The multidisciplinary team meeting has been successful, with perceived benefits for patients, improved imaging evaluation and efficiency of referral pathways, leading to more appropriate patient management.

Radiological input during paediatric multidisciplinary team meetings and its influence on clinical patient management.

Science.gov (United States)

Llewellyn-Jones, Glyn; Pereira, John

2016-04-01

There is little information about the role of the radiologist at multidisciplinary team meetings; in particular their influence on patient management. To evaluate the influence of radiologists on clinical patient management during multidisciplinary meetings. Prospective data were collected over a 5-week period from multidisciplinary team meetings across four paediatric clinical domains. Radiological input was recorded for each case discussion, including the type of influence and its potential effect on clinical patient management. One hundred and forty paediatric cases were reviewed. Radiological advice was requested from the radiologist for 25.7% (N = 36) of cases. In 17.9% (N = 25) this advice was judged to have influenced clinical patient management. There were two cases where new imaging findings were discovered. Radiologists influence clinical patient management during multidisciplinary team meetings primarily by providing differential diagnoses and guidance regarding future imaging, with respect to both the necessity and the modality. Occasionally, when imaging is reviewed at these meetings, new findings are discovered that impact on patient management. © 2016 The Royal Australian and New Zealand College of Radiologists.

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

Science.gov (United States)

Potvin, Noah; Bradt, Joke; Ghetti, Claire

2018-03-09

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

Hospice Care

Science.gov (United States)

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

The role of radiotherapy in hospice care

International Nuclear Information System (INIS)

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

1989-01-01

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

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

Science.gov (United States)

Morris, Jenny; Stewart, Amy; Richardson, Janet

2013-06-01

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

Vulnerable Family Meetings: A Way of Promoting Team Working in GPs’ Everyday Responses to Child Maltreatment?

Directory of Open Access Journals (Sweden)

Jenny Woodman

2014-08-01

Full Text Available This study uses observations of team meetings and interviews with 17 primary care professionals in four GP practices in England to generate hypotheses about how “vulnerable family” team meetings might support responses by GPs to maltreatment-related concerns and joint working with other professionals. These meetings are also called “safeguarding meetings”. The study found that vulnerable family meetings were used as a way of monitoring children or young people and their families and supporting risk assessment by information gathering. Four factors facilitated the meetings: meaningful information flow into the meetings from other agencies, systematic ways of identifying cases for discussion, limiting attendance to core members of the primary care team and locating the meeting as part of routine clinical practice. Our results generate hypotheses about a model of care that can be tested for effectiveness in terms of service measures, child and family outcomes, and as a potential mechanism for other professionals to engage and support GPs in their everyday responses to vulnerable and maltreated children. The potential for adverse as well as beneficial effects should be considered from involving professionals outside the core primary care team (e.g., police, children’s social care, education and mental health services.

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

Science.gov (United States)

MacDonald, D

1995-01-01

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

Medicare Hospice Data

Data.gov (United States)

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

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

Science.gov (United States)

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

2006-01-01

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

Exploring the dreams of hospice workers.

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

2014-06-01

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

'Shared-rhythm cooperation' in cooperative team meetings in acute psychiatric inpatient care.

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Vuokila-Oikkonen, P; Janhonen, S; Vaisanen, L

2004-04-01

The cooperative team meeting is one of the most important interventions in psychiatric care. The purpose of this study was to describe the participation of patients and significant others in cooperative team meetings in terms of unspoken stories. The narrative approach focused on storytelling. The data consisted of videotaped cooperative team meetings (n = 11) in two acute closed psychiatric wards. The QRS NVivo computer program and the Holistic Content Reading method were used. During the process of analysis, the spoken and unspoken stories were analysed at the same time. According to the results, while there was some evident shared-rhythm cooperation (the topics of discussion were shared and the participants had eye contact), there were many instances where the interaction was controlled and defined by health care professionals. This lack of shared rhythm in cooperation, as defined in terms of storytelling, was manifested as monologue and the following practices: the health care professionals controlled the storytelling by sticking to their opinions, by giving the floor or by pointing with a finger and visually scanning the participants, by interrupting the speaker or by allowing the other experts to sit passively. Implications for mental health nursing practice are discussed.

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

Science.gov (United States)

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

2017-05-01

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

Groups Meet . . . Teams Improve: Building Teams That Learn

Science.gov (United States)

Hillier, Janet; Dunn-Jensen, Linda M.

2013-01-01

Although most business students participate in team-based projects during undergraduate or graduate course work, the team experience does not always teach team skills or capture the team members' potential: Students complete the task at hand but the explicit process of becoming a team is often not learned. Drawing from organizational learning…

Racial/Ethnic Perspectives on the Quality of Hospice Care

Science.gov (United States)

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

2013-01-01

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

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

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Campbell, Courtney S; Black, Margaret A

2014-01-01

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

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

Science.gov (United States)

Lindley, Lisa C

2017-01-01

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

Oncology Social Workers' Attitudes toward Hospice Care and Referral Behavior

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Becker, Janet E.

2004-01-01

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

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

Directory of Open Access Journals (Sweden)

Kun-Siang Huang

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

Assessment of Intervention by a Palliative Care Team Working in a Japanese General Hospital: A Retrospective Study.

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Amano, Koji; Morita, Tatsuya; Tatara, Ryohei; Katayama, Hirofumi; Aiki, Sayo; Kitada, Namiki; Fumimoto, Hiromi; Sato, Emi

2015-09-01

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.

Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments

Directory of Open Access Journals (Sweden)

O'Briain D Sean

2007-06-01

Full Text Available Abstract Background The development of multidisciplinary team meetings (MDTMs for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines. Methods For one month, all work related to clinical meetings between pathology and radiology with clinical staff was documented and later analysed. Results The number of meetings to which pathology and radiology contribute at a large university teaching hospital, ranges from two to eight per day, excluding grand rounds, and amounts to approximately 50 meetings per month for each department. For one month, over 300 h were spent by pathologists and radiologists on 81 meetings, where almost 1000 patients were discussed. For each meeting hour, there were, on average, 2.4 pathology hours and 2 radiology hours spent in preparation. Two to three meetings per week are conducted over a teleconferencing link. Average meeting time is 1 h. Preparation time per meeting ranges from 0.3 to 6 h for pathology, and 0.5 to 4 for radiology. The review process in preparation for meetings improves internal quality standards. Materials produced externally (for example imaging can amount to almost 50% of the material to be reviewed on a single patient. The number of meetings per month has increased by 50% over the past two years. Further increase is expected in both the numbers and duration of meetings when scheduling issues are resolved. A changing trend in the management of referred patients with the development of MDTMs and the introduction of teleconferencing was noted. Conclusion Difficulties are being experienced by

Team Leader Structuring for Team Effectiveness and Team Learning in Command-and-Control Teams.

Science.gov (United States)

van der Haar, Selma; Koeslag-Kreunen, Mieke; Euwe, Eline; Segers, Mien

2017-04-01

Due to their crucial and highly consequential task, it is of utmost importance to understand the levers leading to effectiveness of multidisciplinary emergency management command-and-control (EMCC) teams. We argue that the formal EMCC team leader needs to initiate structure in the team meetings to support organizing the work as well as facilitate team learning, especially the team learning process of constructive conflict. In a sample of 17 EMCC teams performing a realistic EMCC exercise, including one or two team meetings (28 in sum), we coded the team leader's verbal structuring behaviors (1,704 events), rated constructive conflict by external experts, and rated team effectiveness by field experts. Results show that leaders of effective teams use structuring behaviors more often (except asking procedural questions) but decreasingly over time. They support constructive conflict by clarifying and by making summaries that conclude in a command or decision in a decreasing frequency over time.

Team Leader Structuring for Team Effectiveness and Team Learning in Command-and-Control Teams

Science.gov (United States)

van der Haar, Selma; Koeslag-Kreunen, Mieke; Euwe, Eline; Segers, Mien

2017-01-01

Due to their crucial and highly consequential task, it is of utmost importance to understand the levers leading to effectiveness of multidisciplinary emergency management command-and-control (EMCC) teams. We argue that the formal EMCC team leader needs to initiate structure in the team meetings to support organizing the work as well as facilitate team learning, especially the team learning process of constructive conflict. In a sample of 17 EMCC teams performing a realistic EMCC exercise, including one or two team meetings (28 in sum), we coded the team leader’s verbal structuring behaviors (1,704 events), rated constructive conflict by external experts, and rated team effectiveness by field experts. Results show that leaders of effective teams use structuring behaviors more often (except asking procedural questions) but decreasingly over time. They support constructive conflict by clarifying and by making summaries that conclude in a command or decision in a decreasing frequency over time. PMID:28490856

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

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Matthews, Michael; Peters, Cara; Lawson, Stephanie

2017-01-01

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

Managing design with the effective use of communication media : the relationship between design dialogues and design team meetings

NARCIS (Netherlands)

Emmitt, S.; Otter, den A.F.H.J.

2007-01-01

Effective and efficient design team communication is an essential component of architectural design and construction projects. Face-to-face communication, via meetings and dialogue, is an essential means for design team members to discuss and communicate design ideas. Meetings represent an important

Knowledge and perceptions of hospice care of Chinese older adults.

Science.gov (United States)

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

2013-06-01

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

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

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Chung Yul Lee, RN, PhD

2010-12-01

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

Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer.

Science.gov (United States)

Hunnicutt, Jacob N; Tjia, Jennifer; Lapane, Kate L

2017-03-01

Pain management is suboptimal in nursing homes. To estimate the extent to which receipt of hospice in nursing homes (NHs) increases the receipt of pain management for residents with cancer at the end of life. Study participants included Medicare beneficiaries with cancer who were NH residents in the last 90 days of life in 2011-2012 (n = 78,160). Residents in pain on hospice were matched to like residents without hospice by facility, type of pain assessment (self-report/staff assessment), and weeks until death (9064 matched strata, 16,968 unique residents). Minimum Data Set 3.0 provided information on residents' pain prevalence and receipt of pain management (scheduled analgesics, as needed [pro re nata {PRN}] medication, nonpharmacologic interventions). We developed conditional logistic models to estimate the association between hospice use and pain management, stratified by self-reported and staff-assessed pain. We found that pain prevalence was higher in residents using hospice versus those without hospice (e.g., residents who self-reported pain: hospice: 59.9%, 95% CIs = 59.3%-60.5%; nonhospice: 50.0%, 95% CI = 49.4%-50.6%). In matched analyses, untreated pain was uncommon (self-reported pain: 2.9% and 5.6% in hospice users and nonusers, respectively). Hospice use was associated with receipt of scheduled analgesics (self-reported: adjusted odds ratio = 1.85, 95% CI = 1.73-1.971) and PRN medication (self-reported: adjusted odds ratio = 1.31, 95% CI = 1.20-1.43). Pain prevalence and the association between hospice and pain management were similar in residents with staff-assessed pain. Untreated pain at the end of life among residents with cancer in NHs is unusual. Hospice is associated with increased pain management among those with documented pain. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Team Learning in Teacher Teams: Team Entitativity as a Bridge between Teams-in-Theory and Teams-in-Practice

Science.gov (United States)

Vangrieken, Katrien; Dochy, Filip; Raes, Elisabeth

2016-01-01

This study aimed to investigate team learning in the context of teacher teams in higher vocational education. As teacher teams often do not meet all criteria included in theoretical team definitions, the construct "team entitativity" was introduced. Defined as the degree to which a group of individuals possesses the quality of being a…

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

Science.gov (United States)

2010-10-01

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

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

Directory of Open Access Journals (Sweden)

Deborah Taira

2017-11-01

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

The significance of lifeworld and the case of hospice.

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Thoresen, Lisbeth; Wyller, Trygve; Heggen, Kristin

2011-08-01

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

Hospice and the politics of spirituality.

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Garces-Foley, Kathleen

2006-01-01

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

'The nice thing about doctors is that you can sometimes get a day off school': an action research study to bring lived experiences from children, parents and hospice staff into medical students' preparation for practice.

Science.gov (United States)

Spalding, Jessica; Yardley, Sarah

2016-12-01

Patient and public involvement in healthcare is important to ensure services meet their needs and priorities. Increasingly, patient experiences are being used to educate healthcare professionals. The potential contribution to medical education of children and parents using hospice services has not yet been fully explored. (1) To explore perceptions of what medical students must learn to become 'good doctors' among children, parents and staff in a hospice. (2) To collaborate with children/parents and staff to develop educational materials based on their lived experiences for medical students. (3) To assess feasibility of student-led action research in a children's hospice to develop research skills. Prospective ethical approval received. Volunteer children (n=7), parents (n=5) and staff (n=6) were recruited from a children's hospice. Data were generated in audio-recorded semistructured focus groups, individual interviews and/or activity workshops. Participants discussed what newly qualified doctors' needed to care for children with life-limiting conditions. Audio data were transcribed and combined with visual data for thematic analysis. Findings were refined by participant feedback. This paper presents thematic findings and educational material created from the project. Thematic analysis identified six learning themes: (1) treat children as individuals; (2) act as a person before being a doctor; (3) interpersonal communication; (4) appreciate the clinical environment; (5) learn from children, parents and other staff; (6) how to be a doctor as part of a team. The student researcher successfully developed qualitative research skills, coproducing materials with participants for sharing learning derived from lived experiences. All participants were willing and able to make valuable contributions, and believed that this was a worthwhile use of time and effort. Further work is required to understand how best to integrate the experiences of children in hospices into

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

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Mendieta, Maximiliano; Buckingham, Robert W

2017-11-01

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

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

Science.gov (United States)

2011-05-09

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

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

African Journals Online (AJOL)

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

2012-06-20

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

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

Science.gov (United States)

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

2017-01-01

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

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

Science.gov (United States)

Lee, Byoung Sook; Kwak, Su Young

2017-02-01

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

Ethical Dilemmas in Hospice and Palliative Care Units for Advanced Cancer Patients

Directory of Open Access Journals (Sweden)

Beyhan Bag

2013-02-01

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

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

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

2017-01-01

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

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

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

2018-06-01

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

Team Meetings within Clinical Domains - Exploring the Use of Routines and Technical Support for Communication

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Groth, Kristina; Lantz, Ann; Sallnäs, Eva-Lotta; Frykholm, Oscar; Green, Anders

Today, it is common that a team of clinicians, from different disciplines, instead of one single doctor, care for a patient. This is especially true when it concerns more complicated diseases in highly specialised health care. Going from one doctor to a team of doctors raises new dimensions/problems/issues when deciding about the diagnosis and how to treat the patient. Instead of one person deciding, based on the information given from others, a group of people need to agree on a decision. How do the participants during such decision meetings argue for their experience and skill? What kind of technologies are available and how do they support the communication in the meeting? Måseide (2006), for example, focuses on how different forms of evidence influence and regulate the judgements and decisions of medical practitioners during such meetings. Groth et al. (2008), for example, focuses on the technology used during such meetings, with a focus on audio, video, and images.

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

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Mitchell, C W; Shuff, I M

1995-12-01

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

Attitudes and knowledge of Iranian nurses about hospice care

Directory of Open Access Journals (Sweden)

Saber Azami-Aghdash

2015-01-01

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

FAA and NASA UTM Research Transition Team: Communications and Navigation (CN) Working Group (WCG) Kickoff Meeting

Science.gov (United States)

Jung, Jaewoo; Larrow, Jarrett

2017-01-01

This is NASA FAA UTM Research Transition Team Communications and Navigation working group kick off meeting presentation that addresses the followings. Objectives overview Overall timeline and scope Outcomes and expectations Communication method and frequency of meetings Upcoming evaluation Next steps.

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

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Mendoza, Roger Lee

2017-09-01

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

What is the role of a specialist regional mesothelioma multidisciplinary team meeting? A service evaluation of one tertiary referral centre in the UK.

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Bibby, Anna C; Williams, Katie; Smith, Sarah; Bhatt, Nidhi; Maskell, Nick A

2016-09-08

Multidisciplinary team meetings are standard care for cancer in the UK and Europe. Professional bodies recommend that mesothelioma cases should be discussed at specialist multidisciplinary team meetings. However, no evidence exists exploring the role of the specialist mesothelioma multidisciplinary team meeting. To evaluate the clinical activity of 1 specialist mesothelioma multidisciplinary team meeting and to determine how often a definitive diagnosis was made, whether the core requirements of the meeting were met and whether there was any associated benefit or detriment. A service evaluation using routinely collected data from 1 specialist mesothelioma multidisciplinary team meeting in a tertiary referral hospital in the South-West of England. All cases discussed between 1/1/2014 and 31/12/2015. The primary outcome measure was whether a definitive diagnosis was made. Secondary outcomes included whether treatment advice was offered, information on clinical trials provided or further investigations suggested. Additional benefits of the multidisciplinary team meeting and time taken from referral to outcome were also collected. A definitive diagnosis was reached in 171 of 210 cases discussed (81%). Mesothelioma was diagnosed in 153/210 (73%). Treatment advice was provided for 127 of 171 diagnostic cases (74%) and further investigations suggested for all 35 non-diagnostic cases. 86/210 cases (41%) were invited to participate in a trial, of whom 43/86 (50%) subsequently enrolled. Additional benefits included the avoidance of postmortem examination if the coroner was satisfied with the multidisciplinary team decision. The overall process from referral to outcome dispatch was specialist mesothelioma multidisciplinary team meeting was effective at making diagnoses and providing recommendations for further investigations or treatment. The core requirements of a specialist mesothelioma multidisciplinary team meeting were met. The process was timely, with most outcomes

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

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Verderber, Stephen

2014-01-01

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

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

Directory of Open Access Journals (Sweden)

Shih-Yi Lee

2015-06-01

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

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

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

2010-03-01

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

A Military Hospice Model

Science.gov (United States)

1983-05-06

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

Emotionality and teamwork in palliative nursing

DEFF Research Database (Denmark)

Nickelsen, Niels Christian

This paper discusses the performance of palliative support teams based in an empirical study in a hospice in Denmark. The analytic strategy is based in science and technology studies (STS). The study was carried out as a number of meetings among the researcher and five non-consolidated teams in s...

Minutes of TOPEX/POSEIDON Science Working Team Meeting and Ocean Tides Workshop

Science.gov (United States)

Fu, Lee-Lueng (Editor)

1995-01-01

This third TOPEX/POSEIDON Science Working Team meeting was held on December 4, 1994 to review progress in defining ocean tide models, precision Earth orbits, and various science algorithms. A related workshop on ocean tides convened to select the best models to be used by scientists in the Geophysical Data Records.

Hospice in a zoologic medicine setting.

Science.gov (United States)

Jessup, David A; Scott, Cheryl A

2011-06-01

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

Advance Directives in Hospice Healthcare Providers: A Clinical Challenge.

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

2017-11-01

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

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

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

2014-04-01

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

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

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Keim-Malpass, Jessica; Lindley, Lisa C

2017-08-01

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

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

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

2018-03-01

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

Literature Review of the Evidence Base for a Hospice at Home Service

OpenAIRE

Stosz, Laura

2008-01-01

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...

Challenges and Strategies for Hospice Caregivers: A Qualitative Analysis.

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

2017-08-01

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

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2017-01-01

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

A self-care plan for hospice workers.

Science.gov (United States)

Jones, Sally Hill

2005-01-01

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

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

Science.gov (United States)

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

2018-02-01

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

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

Science.gov (United States)

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

2018-05-01

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

Variation in Hospice Services by Location of Care: Nursing Home Versus Assisted Living Facility Versus Home.

Science.gov (United States)

Unroe, Kathleen T; Bernard, Brittany; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M

2017-07-01

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.

Hospice assist at home : does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study

NARCIS (Netherlands)

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

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

Science.gov (United States)

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

2016-01-01

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

76 FR 71920 - Payment for Home Health Services and Hospice Care by Non-VA Providers

Science.gov (United States)

2011-11-21

... concerning the billing methodology for non-VA providers of home health services and hospice care. The proposed rulemaking would include home health services and hospice care under the VA regulation governing... to ``RIN 2900-AN98--Payment for home health and services and hospice care by non-VA providers...

[Hospice and palliative care in the outpatient department].

Science.gov (United States)

Ikenaga, M; Tsuneto, S

2000-10-01

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

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

Science.gov (United States)

Perry, Joshua E; Stone, Robert C

2011-01-01

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

Materials to prepare hospice families for dying in the home.

Science.gov (United States)

Kehl, Karen A; Kirchhoff, Karin T; Finster, Mark P; Cleary, James F

2008-09-01

Many changes occur in the final hours of life. Family members of those dying at home need to be prepared for these changes, both to understand what is happening and to provide care. The objectives of this study were to describe (1) the written materials used by hospices to prepare families for dying in the home setting and (2) the content of such materials. Questionnaires were sent to 400 randomly selected hospices, of which 170 responded (45.3%) sending their written materials. The most frequently used publications were Gone from My Sight (n = 118 or 69.4%), Final Gifts (n = 44 or 25.9%) and Caregiving (n = 14 or 8.2%). Half (56.5%) of the hospices used other publications and a majority (n = 87 or 51.2%) used multiple publications. Materials were given to the families by nurses (78.2%) or social workers (67.6%). More than 90% of the hospices had materials that addressed the following signs of impending death: decreased fluid intake, decreased food intake, breathing pattern changes, cold extremities, mottling, increased sleeping, changes at the moment of death, audible secretions, urinary output changes, disorientation, incontinence, overall decline and restlessness. Seven signs were addressed less than 30% of the time; pain (28.2%), dyspnea (19.4%), bed-bound state (18.2%), skin changes (18.2%), vital sign changes (17.1%), surge of energy (11.8%) and mandibular breathing (5.9%). Hospice staff should know the content of the materials offered by their agency so they can verbally address the gaps between the written materials and family needs.

The Hospice: An Integrated Bibliography.

Science.gov (United States)

Bodine, George E.; Sobotor, William

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

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

Science.gov (United States)

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

2018-05-02

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

Euthanasia from the perspective of hospice care.

Science.gov (United States)

Gillett, G

1994-01-01

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

The significance of lifeworld and the case of hospice

OpenAIRE

Thoresen, Lisbeth; Wyller, Trygve; Heggen, Kristin

2010-01-01

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

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

Science.gov (United States)

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

2017-04-01

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

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

Science.gov (United States)

Huggard, Jayne; Nichols, Jan

2011-12-01

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

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

Science.gov (United States)

2012-07-27

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

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

Science.gov (United States)

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

2016-12-01

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

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

Science.gov (United States)

Gates, M F

1991-01-01

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

Spiritual care in the training of hospice volunteers in Germany.

Science.gov (United States)

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

2016-10-01

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

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

Science.gov (United States)

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

2014-11-01

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

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

Science.gov (United States)

Spicer, Sherri; Heller, Rebecca; Troth, Sarah

2015-01-01

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

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

Science.gov (United States)

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

1999-06-25

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

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

Science.gov (United States)

Romo, Rafael; Gifford, Lisa

2007-01-01

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

Medicares Hospice Benefit - Analysis of Utilization and..

Data.gov (United States)

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

Communication Aspects of Hospice Care.

Science.gov (United States)

Jensen, Marvin D.

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

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

Science.gov (United States)

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

2013-09-01

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

Caregiver Activation and Home Hospice Nurse Communication in Advanced Cancer Care.

Science.gov (United States)

Dingley, Catherine E; Clayton, Margaret; Lai, Djin; Doyon, Katherine; Reblin, Maija; Ellington, Lee

Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design. We adapted Street's Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. Caregiver communication that reflected activation included demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses responded by providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. Few studies have investigated nurse/caregiver communication in home hospice, and, to our knowledge, no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice, thus resulting in enhanced outcomes for patients with advanced cancer.

American Academy of Hospice and Palliative Medicine

Science.gov (United States)

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

Task-Team-Process: The Development of Shared Representations in a Engineeing Design Team

DEFF Research Database (Denmark)

Badke-Schaub, Petra; Lauche, Kristina; Neumann, Andre

2009-01-01

In this article, an analysis of the development of team mental models in two engineering meetings is described. The authors present a two-stage model of the development of sharedness in teams, which formed the basis for a communication analysis of both meetings. The transcripts of the meetings were...... categorised referring to underlying cognitive acts and design strategies. The results are largely consistent with the assumptions of the model indicating a lack of sharedness. This was confirmed by changes of frequencies linked to task-, team-, and processrelated cognitive acts within and between the two...

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

Science.gov (United States)

Payne, N

2001-02-01

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

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

Directory of Open Access Journals (Sweden)

Shih-Chao Kang

2012-05-01

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

Impact of the lung oncology multidisciplinary team meetings on the management of patients with cancer.

Science.gov (United States)

Ung, Kim Ann; Campbell, Belinda A; Duplan, Danny; Ball, David; David, Steven

2016-06-01

Multidisciplinary team (MDT) meetings are increasingly regarded as a component of multidisciplinary cancer care. We aimed to prospectively measure the impact of MDT meetings on clinicians' management plans for lung oncology patients, and the implementation rate of the meeting recommendations. Consecutive patient cases presented at the weekly lung oncology MDT meetings were prospectively enrolled. Investigators compared the clinicians' management plans pre-meeting with the consensus plans post-meeting. The meeting was considered to have an impact on management plans if ≥1 of the following changes were detected: tumor stage, histology, treatment intent or treatment modality, or if additional investigations were recommended. Investigators reviewed hospital patient records at 4 months to determine if the meeting recommendations were implemented. Reasons for non-implementation were also recorded. Of the 55 eligible cases, the MDT meeting changed management plans in 58% (CI 45-71%; P management plans for lung oncology patients. The majority of MDT recommendations (72%) were implemented into patient care. These findings provide further evidence to support the role of MDT meetings as an essential part of the decision-making process for the optimal multidisciplinary management of patients with cancer. © 2014 Wiley Publishing Asia Pty Ltd.

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

Science.gov (United States)

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

2006-01-01

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

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

Science.gov (United States)

Payne, Richard; Kuchibhatla, Maragatha N.

2016-01-01

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

Supporting family carers providing end-of-life home care: a qualitative study on the impact of a hospice at home service.

Science.gov (United States)

Jack, Barbara A; O'Brien, Mary R; Scrutton, Joyce; Baldry, Catherine R; Groves, Karen E

2015-01-01

To explore bereaved family carers' perceptions and experiences of a hospice at home service. The increasing demand for the development of home-based end-of-life services is not confined to the western world; such services are also emerging in resource-poor countries where palliative care services are developing with limited inpatient facilities. Despite this growing trend, studies show a variety of interrelated factors, with an emphasis on the availability of informal carers and their ability to cope, which can influence whether terminally ill patients actually remain at home. A hospice at home service was developed to meet patients' and families' needs by providing individually tailored resources. A qualitative study. Data were collected by semi-structured, digitally recorded interviews from 20 family carers who had experienced the service. Interviews were transcribed verbatim and a thematic approach adopted for analysis. All participants reported a personal positive impact of the service. Family carers commented the service provided a valued presence, they felt in good hands and importantly it helped in supporting normal life. The impact of an individualised, targeted, hospice at home service using dedicated, palliative care trained, staff, is perceived positively by family carers and importantly, supportive of those with additional caring or employment commitments. The emergence of hospice at home services has resulted in more options for patients and their families, when the increased amount of care a family member has to provide in these circumstances needs to be adequately supported, with the provision of a flexible service tailored to individual needs and delivered by appropriately trained staff. © 2014 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

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

Science.gov (United States)

2013-08-07

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

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

Science.gov (United States)

2013-05-10

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

Parent Feedback about Individualized Education Program Team Meetings for Students in Kindergarten through Grade 12

Science.gov (United States)

Cooper-Martin, Elizabeth; Wilson, Heather M.

2014-01-01

This report presents parent feedback from a study that focused on experiences at Individualized Education Program (IEP) team meetings and also explored parent satisfaction with delivery of special education services. The study included all parents of Montgomery County (Maryland) Public Schools (MCPS) students who had educational disabilities, were…

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

International Nuclear Information System (INIS)

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

2004-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2004-03-15

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

Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study.

Science.gov (United States)

Raine, Rosalind; Xanthopoulou, Penny; Wallace, Isla; Nic A' Bháird, Caoimhe; Lanceley, Anne; Clarke, Alex; Livingston, Gill; Prentice, Archie; Ardron, Dave; Harris, Miriam; King, Michael; Michie, Susan; Blazeby, Jane M; Austin-Parsons, Natalie; Gibbs, Simon; Barber, Julie

2014-10-01

Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions. We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the 'Team Climate Inventory' and skill mix) on the implementation of MDT treatment plans. The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good 'Team Climate' (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91). Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to

Addressing cancer patient and caregiver role transitions during home hospice nursing care.

Science.gov (United States)

Hudson, Janella; Reblin, Maija; Clayton, Margaret F; Ellington, Lee

2018-05-15

Many family caregivers and hospice patients experience role changes resulting from advancing illness and the need for increased caregiver responsibility. Successful navigation of conflicts that arise because of these role transitions has been linked to higher quality of patient care and improved caregiver bereavement adjustment. Nursing communication with patients and their caregivers plays an important role in facilitating these transitions. Our objective is to describe patient-caregiver-nurse communication during transitions at end of life. A secondary, qualitative analysis was conducted on transcripts. Using an iterative process of constant comparison, coders inductively categorized nurse, caregiver, and patient communication behavior into overarching themes. Participants were home hospice nurses and cancer patient/spouse caregiver dyads; participants were >45 years of age, English speaking, and cognitively able to participate. Research took place in the home during nurse visits.ResultNineteen unique home hospice visits were analyzed. Patient-caregiver conflict occurred in two major content themes (1) negotiating transitions in patient independence and (2) navigating caregiver/patient emotions (e.g., frustration, sadness). Nurse responses to transition conflict included problem-solving, mediating, or facilitating discussions about conflicts. Nurse responses to emotional conflict included validation and reassurance.Significance of resultsOur findings provide insight into the topics and processes involved in patient and caregiver transitions in home hospice and the role hospice nursing communication plays in mediating potential conflict. Nurses are often asked to take on the role of mediator, often with little conflict resolution communication education; results can be used for nursing education.

Nursing Support of Home Hospice Caregivers on the Day of Patient Death.

Science.gov (United States)

Clayton, Margaret F; Hulett, Jennifer; Kaur, Kirandeep; Reblin, Maija; Wilson, Andrew; Ellington, Lee

2017-07-01

To describe nurse-caregiver communication on the day of patient death.
. A descriptive secondary analysis of 44 audio-recorded home hospice nursing visits on day of death.
. Nine hospices in Utah, Oregon, and Massachusetts.
. 42 caregiver-patient dyads, 27 hospice nurses.
. Transcripts of audio recordings were coded for supportive nursing communication and relative time spent in physical, psychosocial, and spiritual discussion.
. Tangible, emotional, informational, esteem, and networking supportive communication; nurses' self-reported communication effectiveness; caregiver religious affiliation.
. Nurses reported that their communication skills were less effective when discussing difficult topics as compared to their overall communication effectiveness. Eleven patients died before the nursing visit, 3 died during the visit, and 30 died post-visit. Nurses primarily engaged in discussions facilitating caregiver emotional, tangible, and informational support. More informational support was observed when patient death occurred during the nursing visit. Time spent in general conversation showed that physical care conversations predominated (80% of the average overall amount of conversation time), compared to lifestyle/psychosocial discussions (14%) and spiritual discussions (6%). Spiritual discussions were observed in only 7 of 44 hospice visits. Spiritual discussions, although short and infrequent, were significantly longer, on average, for caregivers without a religious affiliation.
. Nurses support caregivers on the day of patient death using multiple supportive communication strategies. Spiritual discussions are minimal.
. Communication skills programs can potentially increase self-reported communication effectiveness. Emerging acute spiritual concerns, particularly for caregivers without a previous religious affiliation, should be anticipated. Spiritual support is included in the hospice model of holistic care.

Utilization of Pets in a Hospice Program.

Science.gov (United States)

Doyle, Kathleen; Kukowski, Thomas

1989-01-01

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

The importance of multidisciplinary teamwork and team climate for relational coordination among teams delivering care to older patients.

Science.gov (United States)

Hartgerink, J M; Cramm, J M; Bakker, T J E M; van Eijsden, A M; Mackenbach, J P; Nieboer, A P

2014-04-01

To identify predictors of relational coordination among professionals delivering care to older patients. Relational coordination is known to enhance quality of care in hospitals. The underlying mechanisms, however, remain poorly understood. This cross-sectional study was part of a larger evaluation study examining the opportunity to prevent loss of function in older patients due to hospitalization in the Netherlands. This study was performed in spring 2010 among team members delivering care to older hospitalized patients (192 respondents; 44% response rate) in one hospital. Relational coordination was measured by the Relational Coordination survey; team climate by the Team Climate Inventory and questions were asked about participation in multidisciplinary team meetings and disciplines represented in these meetings. To account for the hierarchical structure, a multilevel analysis was performed. Correlation analysis revealed a positive relationship among being female, being a nurse and relational coordination; medical specialists showed a negative relationship. The number of disciplines represented during multidisciplinary team meetings and team climate were positively related with relational coordination. The multilevel analysis showed a positive relationship between the number of disciplines represented during multidisciplinary team meetings and team climate with relational coordination. The enhancement of team climate and attendance of diverse professionals during multidisciplinary team meetings are expected to improve relational coordination. Furthermore, this study underscores the importance of enhancing relational coordination between medical specialists and other professionals. © 2013 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.

The role and organisation of community palliative specialist nursing teams in rural England.

Science.gov (United States)

Leadbeater, Maria; Staton, Wendy

2014-11-01

This article describes a study that used a qualitative approach, purposive sampling and semi-structured telephone interviews conducted with specialist palliative care nurses from six rural community teams in England. The study investigated how services were organised and the issues of delivering specialist palliative nursing care in a rural area. Qualitative content analysis was used to analyse the data. The findings showed many similarities in that the majority of patients in rural areas were not accessing hospice services and there was a greater reliance on care at home. However, the challenges in delivering care ranged from managing patient expectations, geographical distance, lack of technology to support remote working and education for the specialist palliative care teams. The study makes specific recommendations for rural community specialist palliative care teams.

Rapid improvement teams.

Science.gov (United States)

Alemi, F; Moore, S; Headrick, L; Neuhauser, D; Hekelman, F; Kizys, N

1998-03-01

Suggestions, most of which are supported by empirical studies, are provided on how total quality management (TQM) teams can be used to bring about faster organizationwide improvements. Ideas are offered on how to identify the right problem, have rapid meetings, plan rapidly, collect data rapidly, and make rapid whole-system changes. Suggestions for identifying the right problem include (1) postpone benchmarking when problems are obvious, (2) define the problem in terms of customer experience so as not to blame employees nor embed a solution in the problem statement, (3) communicate with the rest of the organization from the start, (4) state the problem from different perspectives, and (5) break large problems into smaller units. Suggestions for having rapid meetings include (1) choose a nonparticipating facilitator to expedite meetings, (2) meet with each team member before the team meeting, (3) postpone evaluation of ideas, and (4) rethink conclusions of a meeting before acting on them. Suggestions for rapid planning include reducing time spent on flowcharting by focusing on the future, not the present. Suggestions for rapid data collection include (1) sample patients for surveys, (2) rely on numerical estimates by process owners, and (3) plan for rapid data collection. Suggestions for rapid organizationwide implementation include (1) change membership on cross-functional teams, (2) get outside perspectives, (3) use unfolding storyboards, and (4) go beyond self-interest to motivate lasting change in the organization. Additional empirical investigations of time saved as a consequence of the strategies provided are needed. If organizations solve their problems rapidly, fewer unresolved problems may remain.

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

Science.gov (United States)

Floriani, Ciro Augusto; Schramm, Fermin Roland

2010-06-01

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

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

Science.gov (United States)

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

2017-03-01

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

Why hospice nurses need high self-esteem.

NARCIS (Netherlands)

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

2007-01-01

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

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

Science.gov (United States)

2010-10-01

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

Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments.

LENUS (Irish Health Repository)

Kane, Bridget

2007-01-01

The development of multidisciplinary team meetings (MDTMs) for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines.

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

Science.gov (United States)

Makhele, M F; Mulaudzi, F M

2012-01-01

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

78 FR 13688 - National Advisory Committee on Rural Health and Human Services; Notice of Meeting

Science.gov (United States)

2013-02-28

.... April 5, 2013, 8:45 a.m.-11:15 a.m. Place: Hospice & Palliative Care of Western Colorado, 3090 North... findings from the meeting and develop a work plan for the next quarter and the following meeting. The... Nash at the Office of Rural Health Policy (ORHP) via telephone at (301) 443-0835 or by email at nnash...

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

Science.gov (United States)

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

2017-11-01

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

Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study.

Science.gov (United States)

Lamb, Benjamin W; Jalil, Rozh T; Sevdalis, Nick; Vincent, Charles; Green, James S A

2014-09-08

The prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally. Evidence exists of benefits to patients and healthcare professionals. However, MDT working is time and resource intensive. This study aims to explore members' views on existing practices of urology MDT working, and to identify potential interventions for improving the efficiency and productivity of the MDT meeting. Members of urology MDTs across the UK were purposively recruited to participate in an online survey. Survey items included questions about the utility and efficiency of MDT meetings, and strategies for improving the efficiency of MDT meetings: treating cases by protocol, prioritising cases, and splitting the MDT into subspeciality meetings. 173 MDT members participated (Oncologists n = 77, Cancer Nurses n = 54, Urologists n = 30, other specialities n = 12). 68% of respondents reported that attending the MDT meeting improves efficiency in care through improved clinical decisions, planning investigations, helping when discussing plans with patients, speciality referrals, documentation/patient records. Participants agreed that some cases including low risk, non-muscle invasive bladder cancer and localised, low-grade prostate cancer could be managed by pre-agreed pathways, without full MDT review. There was a consensus that cases at the MDT meeting could be prioritised by complexity, tumour type, or the availability of MDT members. Splitting the MDT meeting was unpopular: potential disadvantages included loss of efficiency, loss of team approach, unavailability of members and increased administrative work. Key urology MDT members find the MDT meeting useful. Improvements in efficiency and effectiveness may be possible by prioritising cases or managing some low-risk cases according to previously agreed protocols. Further research is needed to test the effectiveness of such strategies on MDT meetings, cancer care pathways and patient outcomes in clinical

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

Science.gov (United States)

Claxton-Oldfield, Stephen; Jones, Richard

2013-08-01

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

An interdisciplinary team communication framework and its application to healthcare 'e-teams' systems design.

Science.gov (United States)

Kuziemsky, Craig E; Borycki, Elizabeth M; Purkis, Mary Ellen; Black, Fraser; Boyle, Michael; Cloutier-Fisher, Denise; Fox, Lee Ann; MacKenzie, Patricia; Syme, Ann; Tschanz, Coby; Wainwright, Wendy; Wong, Helen

2009-09-15

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. 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. 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'. 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.

An interdisciplinary team communication framework and its application to healthcare 'e-teams' systems design

Directory of Open Access Journals (Sweden)

MacKenzie Patricia

2009-09-01

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.

Improving supervision: a team approach.

Science.gov (United States)

1993-01-01

This issue of "The Family Planning Manager" outlines an interactive team supervision strategy as a means of improving family planning service quality and enabling staff to perform to their maximum potential. Such an approach to supervision requires a shift from a monitoring to a facilitative role. Because supervisory visits to the field are infrequent, the regional supervisor, clinic manager, and staff should form a team to share ongoing supervisory responsibilities. The team approach removes individual blame and builds consensus. An effective team is characterized by shared leadership roles, concrete work problems, mutual accountability, an emphasis on achieving team objectives, and problem resolution within the group. The team supervision process includes the following steps: prepare a visit plan and schedule; meet with the clinic manager and staff to explain how the visit will be conducted; supervise key activity areas (clinical, management, and personnel); conduct a problem-solving team meeting; conduct a debriefing meeting with the clinic manager; and prepare a report on the visit, including recommendations and follow-up plans. In Guatemala's Family Planning Unit, teams identify problem areas on the basis of agreement that a problem exists, belief that the problem can be solved with available resources, and individual willingness to accept responsibility for the specific actions identified to correct the problem.

Dementia in Palliative Care in the Seychelles´ Hospice

Directory of Open Access Journals (Sweden)

Armando Carlos Roca Socarrás

2011-10-01

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

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

Directory of Open Access Journals (Sweden)

Saber Azami-Aghdash

2015-01-01

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

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

Science.gov (United States)

Springall, Fiona

2018-03-21

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

Using peer observers to assess the quality of cancer multidisciplinary team meetings: a qualitative proof of concept study

Directory of Open Access Journals (Sweden)

Harris J

2014-08-01

Full Text Available Jenny Harris,1 James SA Green,2,3 Nick Sevdalis,4 Cath Taylor1 1Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK; 2Department of Urology, Whipps Cross University Hospital, London, UK; 3Department of Health and Social Care, London South Bank University, London, UK; 4Department of Surgery and Cancer, Imperial College London, London, UK Background: Multidisciplinary team (MDT working is well established as the foundation for providing cancer services in the UK and elsewhere. A core activity is the weekly meeting (or case conference/tumor boards where the treatment recommendations for individual patients are agreed. Evidence suggests that the quality of team working varies across cancer teams, and this may impact negatively on the decision-making process, and ultimately patient care. Feedback on performance by expert observers may improve performance, but can be resource-intensive to implement. This proof of concept study sought to: develop a structured observational assessment tool for use by peers (managers or clinicians from the local workforce and explore its usability; assess the feasibility of the principle of observational assessment by peers; and explore the views of MDT members and observers about the utility of feedback from observational assessment. Methods: For tool development, the content was informed by national clinical consensus recommendations for best practice in cancer MDTs and developed in collaboration with an expert steering group. It consisted of ten subdomains of team working observable in MDT meetings that were rated on a 10-point scale (very poor to very good. For observational assessment, a total of 19 peer observers used the tool (assessing performance in 20 cancer teams from four hospitals. For evaluation, telephone interviews with 64 team members and all peer observers were analyzed thematically. Results: The tool was easy to use and areas for refinement were identified. Peer

Effective leadership within hospice and specialist palliative care units.

Science.gov (United States)

Barker, L

2000-01-01

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

The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature.

Science.gov (United States)

Pillay, Brindha; Wootten, Addie C; Crowe, Helen; Corcoran, Niall; Tran, Ben; Bowden, Patrick; Crowe, Jane; Costello, Anthony J

2016-01-01

Conducting regular multidisciplinary team (MDT) meetings requires significant investment of time and finances. It is thus important to assess the empirical benefits of such practice. A systematic review was conducted to evaluate the literature regarding the impact of MDT meetings on patient assessment, management and outcomes in oncology settings. Relevant studies were identified by searching OVID MEDLINE, PsycINFO, and EMBASE databases from 1995 to April 2015, using the keywords: multidisciplinary team meeting* OR multidisciplinary discussion* OR multidisciplinary conference* OR case review meeting* OR multidisciplinary care forum* OR multidisciplinary tumour board* OR case conference* OR case discussion* AND oncology OR cancer. Studies were included if they assessed measurable outcomes, and used a comparison group and/or a pre- and post-test design. Twenty-seven articles met inclusion criteria. There was limited evidence for improved survival outcomes of patients discussed at MDT meetings. Between 4% and 45% of patients discussed at MDT meetings experienced changes in diagnostic reports following the meeting. Patients discussed at MDT meetings were more likely to receive more accurate and complete pre-operative staging, and neo-adjuvant/adjuvant treatment. Quality of studies was affected by selection bias and the use of historical cohorts impacted study quality. MDT meetings impact upon patient assessment and management practices. However, there was little evidence indicating that MDT meetings resulted in improvements in clinical outcomes. Future research should assess the impact of MDT meetings on patient satisfaction and quality of life, as well as, rates of cross-referral between disciplines. Copyright © 2015 Elsevier Ltd. All rights reserved.

"They Are Talking About Me, but Not with Me": A Focus Group Study to Explore the Patient Perspective on Interprofessional Team Meetings in Primary Care.

Science.gov (United States)

van Dongen, Jerôme Jean Jacques; de Wit, Maarten; Smeets, Hester Wilhelmina Henrica; Stoffers, Esther; van Bokhoven, Marloes Amantia; Daniëls, Ramon

2017-08-01

The number of people with multiple chronic conditions receiving primary care services is growing. To deal with their increasingly complex health care demands, professionals from different disciplines need to collaborate. Interprofessional team (IPT) meetings are becoming more popular. Several studies describe important factors related to conducting IPT meetings, mostly from a professional perspective. However, in the light of patient-centeredness, it is valuable to also explore the patients' perspective. The aim was to explore the patients' perspectives regarding IPT meetings in primary care. A qualitative study with a focus group design was conducted in the Netherlands. Two focus group meetings took place, for which the same patients were invited. The participants, chronically ill patients with experience on interprofessional collaboration, were recruited through the regional patient association. Participants discussed viewpoints, expectations, and concerns regarding IPT meetings in two rounds, using a focus group protocol and selected video-taped vignettes of team meetings. The first meeting focused on conceptualization and identification of themes related to IPT meetings that are important to patients. The second meeting aimed to gain more in-depth knowledge and understanding of the priorities. Discussions were audio-taped and transcribed verbatim, and analyzed by means of content analysis. The focus group meetings included seven patients. Findings were divided into six key categories, capturing the factors that patients found important regarding IPT meetings: (1) putting the patient at the center, (2) opportunities for patients to participate, (3) appropriate team composition, (4) structured approach, (5) respectful communication, and (6) informing the patient about meeting outcomes. Patients identified different elements regarding IPT meetings that are important from their perspective. They emphasized the right of patients or their representatives to take part

Proceedings of the sixth Atmospheric Radiation Measurement (ARM) Science Team meeting

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-06-01

This document contains the summaries of papers presented at the 1996 Atmospheric Radiation Measurement (ARM) Science Team meeting held at San Antonio, Texas. The history and status of the ARM program at the time of the meeting helps to put these papers in context. The basic themes have not changed. First, from its beginning, the Program has attempted to respond to the most critical scientific issues facing the US Global Change Research Program. Second, the Program has been strongly coupled to other agency and international programs. More specifically, the Program reflects an unprecedented collaboration among agencies of the federal research community, among the US Department of Energy`s (DOE) national laboratories, and between DOE`s research program and related international programs, such as Global Energy and Water Experiment (GEWEX) and the Tropical Ocean Global Atmosphere (TOGA) program. Next, ARM has always attempted to make the most judicious use of its resources by collaborating and leveraging existing assets and has managed to maintain an aggressive schedule despite budgets that have been much smaller than planned. Finally, the Program has attracted some of the very best scientific talent in the climate research community and has, as a result, been productive scientifically.

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

Science.gov (United States)

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

2016-01-01

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

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

Science.gov (United States)

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

2012-05-01

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

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

Science.gov (United States)

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

2018-04-01

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

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

OpenAIRE

Armstrong, Peter; Wilkinson, Pauline; McCorry, Noleen

2017-01-01

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

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

Science.gov (United States)

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

2015-01-01

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

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

Science.gov (United States)

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

2016-01-01

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

Virtual Teams.

Science.gov (United States)

Geber, Beverly

1995-01-01

Virtual work teams scattered around the globe are becoming a feature of corporate workplaces. Although most people prefer face-to-face meetings and interactions, reality often requires telecommuting. (JOW)

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

Science.gov (United States)

Schröder, Christina; Bänsch, Alexander; Schröder, Harry

2004-01-01

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

Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

Science.gov (United States)

Restivo, Léa; Apostolidis, Thémis; Bouhnik, Anne-Déborah; Garciaz, Sylvain; Aurran, Thérèse; Julian-Reynier, Claire

2016-01-01

The contribution of patients' non-medical characteristics to individual physicians' decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients' non-medical characteristics are presented at MDT meetings and how this information may affect the team's final medical decisions. Observations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians' verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed. In the final sample of patients' records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient's age and his/her "likeability" were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients' non-medical characteristics and with uncertainty about the outcome of the therapeutic options available. The design of the study made it difficult to draw definite cause-and-effect conclusions. The Social Representations approach suggests that patients' non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians' everyday professional practice. The links observed between patients

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

Science.gov (United States)

Kramer, Betty J; Boelk, Amy Z

2015-08-01

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

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

Science.gov (United States)

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

2017-01-01

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

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

Directory of Open Access Journals (Sweden)

Hsiao-Ting Chang

2016-01-01

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

Creating Shared Understanding in Product development Teams

DEFF Research Database (Denmark)

Nielsen, Louise Møller; Tollestrup, Christian

, they also have to figure out what their users and stakeholders find important. In other words, the team has to frame their project around real user needs, problems or opportunities – and figure out what people really want, and at the same time come to an agreement about this framing within the team......It is the first meeting in a new promising project. Everyone around the table is enthusiastic about the project and excited to get going. There is a good atmos¬phere and the discussion travels back and forth. Everyone tries to present their point of view, which results in a broad discussion on very...... 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...

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

Science.gov (United States)

Norton, Elizabeth M; Miller, Pamela J

2012-01-01

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

Proceedings of the fifth Atmospheric Radiation Measurement (ARM) science team meeting

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-04-01

This document contains the summaries of papers presented at the 1995 Atmospheric Radiation Measurement (ARM) Science Team meeting held in San Diego, California. To put these papers in context, it is useful to consider the history and status of the ARM program at the time of the meeting. The history of the project has several themes. First, the Program has from its very beginning attempted to respond to most critical scientific issues facing the US Global Change Research Program. Second, the Program has been strongly coupled to other agency and international programs. Indeed, the Program reflects an unprecedented collaboration among various elements of the federal research community, among the US Department of Energy`s national laboratories, and between an agency`s research program and the related international programs, such as Global Energy and Water Experiment and TOGA. Next, ARM has always attempted to make the most judicious use of its resources by collaborating and leveraging existing assets and has managed to maintain an aggressive schedule despite budgets that have been much smaller than planned. Finally, the Program has attracted some of the very best scientific talent in the climate research community and has, as a result, been productive scientifically. This introduction covers the first three points--the papers themselves speak to the last point. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database.

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

Science.gov (United States)

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

2015-10-01

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

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

Directory of Open Access Journals (Sweden)

Grzegorz GODAWA

2017-11-01

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

Exploring the working role of hospice volunteers

OpenAIRE

Watts, Jacqueline H.

2011-01-01

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

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

Science.gov (United States)

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

2008-01-01

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

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

African Journals Online (AJOL)

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

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

Science.gov (United States)

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

2017-09-01

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

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

Science.gov (United States)

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

2013-01-01

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

Team learning center design principles

Energy Technology Data Exchange (ETDEWEB)

Daily, B.; Loveland, J.; Whatley, A. [New Mexico State Univ., Las Cruces, NM (United States)] [and others

1995-06-01

This is a preliminary report of a multi-year collaboration of the authors addressing the subject: Can a facility be designed for team learning and would it improve the efficiency and effectiveness of team interactions? Team learning in this context is a broad definition that covers all activities where small to large groups of people come together to work, to learn, and to share through team activities. Multimedia, networking, such as World Wide Web and other tools, are greatly enhancing the capability of individual learning. This paper addresses the application of technology and design to facilitate group or team learning. Many organizational meetings need tens of people to come together to do work as a large group and then divide into smaller subgroups of five to ten to work and then to return and report and interact with the larger group. Current facilities were not, in general, designed for this type of meeting. Problems with current facilities are defined and a preliminary design solution to many of the identified problems is presented.

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

Science.gov (United States)

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

2017-08-01

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

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

Science.gov (United States)

2013-11-14

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

Developing competencies for pediatric hospice and palliative medicine.

Science.gov (United States)

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

2014-12-01

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

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

Science.gov (United States)

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

2014-08-01

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

An art therapy group for bereaved youth in hospice care.

Science.gov (United States)

McIntyre, B B

1990-09-01

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

Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health.

Science.gov (United States)

Lindley, Lisa C; Mixer, Sandra J; Mack, Jennifer W

2016-01-01

Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.

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

Science.gov (United States)

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

2015-07-01

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

Planning meeting to form the CMSN Team: Building a unified computational model for the resonant X-ray scattering of strongly correlated materials. Final report

International Nuclear Information System (INIS)

van Veenendaal, M.

2008-01-01

The planning meeting was held May 21-23 2008 at Argonne National Laboratory (ANL). The purpose of the meeting was to establish a network on building computational model for resonant elastic and inelastic x-ray scattering. This course of action was recommended by program officer Dale Koelling after the initial submission of a proposal for a Computational Materials Science Network to Basic Energy Sciences. The meeting consisted of talks and discussion. At the end of the meeting three subgroups were formed. After the successful formation of the team, a new proposal was written which was funded by BES. Since this was a planning meeting there were no proceedings. The program and titles of talks are given.

Nice Teams Finish Last The Secret to Unleashing Your Team's Maximum Potential

CERN Document Server

Miller, Brian Cole

2010-01-01

Don't rock the boat. Don't make waves. Don't offend anyone. There's a palpable feeling that clouds many team meetings and keeps them from being productive: over-politeness. And while the conflict that naturally exists in most organizations hasn't gone away, it manifests itself in passive-aggression, mediocrity, and a molasses-like inability to get anything done. Nice Teams Finish Last provides the antidote to this all-too-common tendency, giving managers, team leaders and members, and facilitators the practical support they need to battle "the nice trap" and start getting results! The book hel

The codesign of an interdisciplinary team-based intervention regarding initiating palliative care in pediatric oncology.

Science.gov (United States)

Hill, Douglas L; Walter, Jennifer K; Casas, Jessica A; DiDomenico, Concetta; Szymczak, Julia E; Feudtner, Chris

2018-04-07

Children with advanced cancer are often not referred to palliative or hospice care before they die or are only referred close to the child's death. The goals of the current project were to learn about pediatric oncology team members' perspectives on palliative care, to collaborate with team members to modify and tailor three separate interdisciplinary team-based interventions regarding initiating palliative care, and to assess the feasibility of this collaborative approach. We used a modified version of experience-based codesign (EBCD) involving members of the pediatric palliative care team and three interdisciplinary pediatric oncology teams (Bone Marrow Transplant, Neuro-Oncology, and Solid Tumor) to review and tailor materials for three team-based interventions. Eleven pediatric oncology team members participated in four codesign sessions to discuss their experiences with initiating palliative care and to review the proposed intervention including patient case studies, techniques for managing uncertainty and negative emotions, role ambiguity, system-level barriers, and team communication and collaboration. The codesign process showed that the participants were strong supporters of palliative care, members of different teams had preferences for different materials that would be appropriate for their teams, and that while participants reported frustration with timing of palliative care, they had difficulty suggesting how to change current practices. The current project demonstrated the feasibility of collaborating with pediatric oncology clinicians to develop interventions about introducing palliative care. The procedures and results of this project will be posted online so that other institutions can use them as a model for developing similar interventions appropriate for their needs.

Multidisciplinary safety team (MDST) factors of success.

Science.gov (United States)

2014-11-01

This project included a literature review and summary that focused on subjects related to team building, team/committee member : motivational strategies, and tools for effective and efficient committee meetings. It also completed an online survey of ...

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

Science.gov (United States)

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

2018-04-20

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

Employee Driven Innovation in Team (EDIT)

DEFF Research Database (Denmark)

Kristiansen, Marianne; Bloch-Poulsen, Jørgen

2010-01-01

existing organizational routines and work practice in order to produce value for the organization, better work flow, and improved work life quality. These meetings are discussed in relation to similar organizational constructs within Scandinavian action research. The action research process made it clear....... This can be done by using, e.g., pro and con groups or a bystander. This demands, too, that team members, managers, and action researchers develop dissensus sensibility to open up for more voices, for indirect criticism, and for more democracy in the decision process trying to balance dialogues...... in multidimensional tensions between consensus and dissensus. The article grounds the complexities of this process in thick presentations of DHTMs in Team Product Support, Danfoss Solar Inverters and Team Children, Citizen Service, the Municipality of Silkeborg, Denmark. It demonstrates how these meetings created...

Teams and teamwork at NASA Langley Research Center

Science.gov (United States)

Dickinson, Terry L.

1994-01-01

The recent reorganization and shift to managing total quality at the NASA Langley Research Center (LaRC) has placed an increasing emphasis on teams and teamwork in accomplishing day-to-day work activities and long-term projects. The purpose of this research was to review the nature of teams and teamwork at LaRC. Models of team performance and teamwork guided the gathering of information. Current and former team members served as participants; their collective experience reflected membership in over 200 teams at LaRC. The participants responded to a survey of open-ended questions which assessed various aspects of teams and teamwork. The participants also met in a workshop to clarify and elaborate on their responses. The work accomplished by the teams ranged from high-level managerial decision making (e.g., developing plans for LaRC reorganization) to creating scientific proposals (e.g., describing spaceflight projects to be designed, sold, and built). Teams typically had nine members who remained together for six months. Member turnover was around 20 percent; this turnover was attributed to heavy loads of other work assignments and little formal recognition and reward for team membership. Team members usually shared a common and valued goal, but there was not a clear standard (except delivery of a document) for knowing when the goal was achieved. However, members viewed their teams as successful. A major factor in team success was the setting of explicit a priori rules for communication. Task interdependencies between members were not complex (e.g., sharing of meeting notes and ideas about issues), except between members of scientific teams (i.e., reliance on the expertise of others). Thus, coordination of activities usually involved scheduling and attendance of team meetings. The team leader was designated by the team's sponsor. This leader usually shared power and responsibilities with other members, such that team members established their own operating

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

NARCIS (Netherlands)

Blignaut-van Westrhenen, Nadine; Fritz, E.

2013-01-01

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

Challenges and Approaches to Make Multidisciplinary Team Meetings Interoperable - The KIMBo Project.

Science.gov (United States)

Krauss, Oliver; Holzer, Karl; Schuler, Andreas; Egelkraut, Reinhard; Franz, Barbara

2017-01-01

Multidisciplinary team meetings (MDTMs) are already in use for certain areas in healthcare (e.g. treatment of cancer). Due to the lack of common standards and accessibility for the applied IT systems, their potential is not yet completely exploited. Common requirements for MDTMs shall be identified and aggregated into a process definition to be automated by an application architecture utilizing modern standards in electronic healthcare, e.g. HL7 FHIR. To identify requirements, an extensive literature review as well as semi-structured expert interviews were conducted. Results showed, that interoperability and flexibility in terms of the process are key requirements to be addressed. An architecture blueprint as well as an aggregated process definition were derived from the insights gained. To evaluate the feasibility of identified requirements, methods of explorative prototyping in software engineering were used. MDTMs will become an important part of modern and future healthcare but the need for standardization in terms of interoperability is imminent.

Multidisciplinary team meetings (MDTM) in detection of Alzheimer's disease: data from the IDEM study.

Science.gov (United States)

Rolland, Y; Tavassoli, N; Gillette-Guyonnet, S; Perrin, A; Hermabessière, S; Ousset, P-J; Nourhashemi, F; Cestac, P; Vellas, B

2013-02-01

The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG) in Germany and the Haute Autorité de Santé (HAS) in France have recently set out guidelines on prescription of anti-dementia medication. The HAS proposes in particular that continuation of these drugs for longer than one year should be decided in multidisciplinary team meetings (MDTM). To assess the feasibility of MDTM and the satisfaction of coordinating physicians from institutions for the dependent elderly (nursing home, NH) and expert physicians from memory clinics who have participated in the meetings. Survey carried out among physicians who had participated in the MDTM held as part of the IDEM study (Interest of systematic tracking of dementia cases in NH: analysing the contribution of MDTM in Alzheimer's disease and related diseases; PHRC National 2009, Code 0910701). The survey evaluated the organization of MDTM and the physicians' opinion of these meetings. The cases of 574 patients were discussed in MDTM involving 133 healthcare professionals (32 coordinating physicians, 48 expert physicians, 4 general practitioners and 49 other health professionals). The mean number of participants was 4.2±1.6. About 16 minutes were spent discussing the case of each resident. About 90% of physicians considered that the meetings were useful. Overall assessment of their efficacy was 11.5/20 for the coordinating physicians and 14.1/20 for the expert physicians. The benefits of MDTM in relation to the work entailed were considered important by 60% of expert physicians and 33% of coordinating physicians. Our survey confirmed the feasibility of MDTM in the field of Alzheimer's disease. The overall benefit/workload ratio of the meetings was considered to be favorable for the expert physicians. The benefits of MDTM were turned out to be less appreciated by the coordinating physicians according to high workload

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

Science.gov (United States)

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

2012-04-01

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

Tracking the evolution of hospice palliative care in Canada: A comparative case study analysis of seven provinces

Directory of Open Access Journals (Sweden)

Richards Judy-Lynn

2010-06-01

Full Text Available Abstract Background An aging population, rise in chronic illnesses, increase in life expectancy and shift towards care being provided at the community level are trends that are collectively creating an urgency to advance hospice palliative care (HPC planning and provision in Canada. The purpose of this study was to analyze the evolution of HPC in seven provinces in Canada so as to inform such planning and provision elsewhere. We have endeavoured to undertake this research out of awareness that good future planning for health and social care, such as HPC, typically requires us to first look backwards before moving forward. Methods To identify key policy and practice events in HPC in Canada, as well as describe facilitators of and barriers to progress, a qualitative comparative case study design was used. Specifically, the evolution and development of HCP in 7 strategically selected provinces is compared. After choosing the case study provinces, the grey literature was searched to create a preliminary timeline for each that described the evolution of HPC beginning in 1970. Key informants (n = 42 were then interviewed to verify the content of each provincial timeline and to discuss barriers and facilitators to the development of HPC. Upon completion of the primary data collection, a face-to-face meeting of the research team was then held so as to conduct a comparative study analysis that focused on provincial commonalities and differences. Results Findings point to the fact that HPC continues to remain at the margins of the health care system. The development of HPC has encountered structural inheritances that have both sped up progress as well as slowed it down. These structural inheritances are: (1 foundational health policies (e.g., the Canada Health Act; (2 service structures and planning (e.g., the dominance of urban-focused initiatives; and (3 health system decisions (e.g., regionalization. As a response to these inheritances, circumventions

Tracking the evolution of hospice palliative care in Canada: a comparative case study analysis of seven provinces.

Science.gov (United States)

Williams, Allison M; Crooks, Valorie A; Whitfield, Kyle; Kelley, Mary-Lou; Richards, Judy-Lynn; DeMiglio, Lily; Dykeman, Sarah

2010-06-01

An aging population, rise in chronic illnesses, increase in life expectancy and shift towards care being provided at the community level are trends that are collectively creating an urgency to advance hospice palliative care (HPC) planning and provision in Canada. The purpose of this study was to analyze the evolution of HPC in seven provinces in Canada so as to inform such planning and provision elsewhere. We have endeavoured to undertake this research out of awareness that good future planning for health and social care, such as HPC, typically requires us to first look backwards before moving forward. To identify key policy and practice events in HPC in Canada, as well as describe facilitators of and barriers to progress, a qualitative comparative case study design was used. Specifically, the evolution and development of HCP in 7 strategically selected provinces is compared. After choosing the case study provinces, the grey literature was searched to create a preliminary timeline for each that described the evolution of HPC beginning in 1970. Key informants (n = 42) were then interviewed to verify the content of each provincial timeline and to discuss barriers and facilitators to the development of HPC. Upon completion of the primary data collection, a face-to-face meeting of the research team was then held so as to conduct a comparative study analysis that focused on provincial commonalities and differences. Findings point to the fact that HPC continues to remain at the margins of the health care system. The development of HPC has encountered structural inheritances that have both sped up progress as well as slowed it down. These structural inheritances are: (1) foundational health policies (e.g., the Canada Health Act); (2) service structures and planning (e.g., the dominance of urban-focused initiatives); and (3) health system decisions (e.g., regionalization). As a response to these inheritances, circumventions of the established system of care were taken

Forging Provincial Reconstruction Teams

National Research Council Canada - National Science Library

Honore, Russel L; Boslego, David V

2007-01-01

The Provincial Reconstruction Team (PRT) training mission completed by First U.S. Army in April 2006 was a joint Service effort to meet a requirement from the combatant commander to support goals in Afghanistan...

OA11 Public health and hospices: what is really possible?

Science.gov (United States)

Hartley, Nigel; Richardson, Heather

2015-04-01

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

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

Science.gov (United States)

2010-10-01

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

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

Science.gov (United States)

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

2008-10-01

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

Music Therapy and Spiritual Care in End-of-Life: A Qualitative Inquiry into Ethics and Training Issues Identified by Chaplains and Music Therapists.

Science.gov (United States)

Masko, Meganne K

2016-01-01

Music therapists are increasingly employed by hospices. As such, they are often called upon to provide additional spiritual care to patients receiving end-of-life care. However, researchers have not yet examined the appropriateness of music therapists providing spiritual care as part of the hospice team, or ethics and training issues related to music therapist-led spiritual care. The purpose of this study was to explore the thoughts and attitudes of hospice chaplains and music therapists (MTs) about ethics and training issues related to music therapists providing spiritual care as part of the hospice interdisciplinary team. The study used semi-structured interviews with a purposive sample of music therapists and chaplains specializing in hospice care as part of a larger exploratory mixed methods study. Each interview was recorded, transcribed, and analyzed using a two-step process including both a modified phenomenological inductive approach and thematic analysis. Participants discussed ethics and training issues related to the provision of music therapist-led spiritual care as part of the hospice team. These issues included scope of practice, cultural competence and maintaining personal boundaries, and spiritual care training topics such as educational content and educational methods. While it was clear that both chaplains and music therapists felt it was appropriate for music therapists to provide spiritual care as part of the hospice team, there is a need for formal and informal spiritual care training for music therapists doing this type of work. Training should potentially include information about comparative religions, cultural competence, scope of practice, and maintaining personal boundaries. © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Communication skills to develop trusting relationships on global virtual engineering capstone teams

Science.gov (United States)

Zaugg, Holt; Davies, Randall S.

2013-05-01

As universities seek to provide cost-effective, cross-cultural experiences using global virtual (GV) teams, the 'soft' communication skills typical of all teams, increases in importance for GV teams. Students need to be taught how to navigate through cultural issues and virtual tool issues to build strong trusting relationships with distant team members. Weekly team meetings provide an excellent opportunity to observe key team interactions that facilitate relationship and trust-building among team members. This study observed the weekly team meetings of engineering students attending two US universities and one Asian university as they collaborated as a single GV capstone GV team. In addition local team members were interviewed individually and collectively throughout the project to determine strategies that facilitated team relations and trust. Findings indicate the importance of student choice of virtual communication tools, the refining of communication practices, and specific actions to build trusting relationships. As student developed these attributes, collaboration and success was experienced on this GV team.

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

Science.gov (United States)

Lindstrom, Kathryn B; Mazurek Melnyk, Bernadette

2013-06-01

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

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

Science.gov (United States)

Claxton-Oldfield, Stephen; Bhatt, Anamika

2017-06-01

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

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

Science.gov (United States)

2010-07-22

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

Hydrogen Storage Technical Team Roadmap

Energy Technology Data Exchange (ETDEWEB)

None

2013-06-01

The mission of the Hydrogen Storage Technical Team is to accelerate research and innovation that will lead to commercially viable hydrogen-storage technologies that meet the U.S. DRIVE Partnership goals.

Consequences of team charter quality: Teamwork mental model similarity and team viability in engineering design student teams

Science.gov (United States)

Conway Hughston, Veronica

Since 1996 ABET has mandated that undergraduate engineering degree granting institutions focus on learning outcomes such as professional skills (i.e. solving unstructured problems and working in teams). As a result, engineering curricula were restructured to include team based learning---including team charters. Team charters were diffused into engineering education as one of many instructional activities to meet the ABET accreditation mandates. However, the implementation and execution of team charters into engineering team based classes has been inconsistent and accepted without empirical evidence of the consequences. The purpose of the current study was to investigate team effectiveness, operationalized as team viability, as an outcome of team charter implementation in an undergraduate engineering team based design course. Two research questions were the focus of the study: a) What is the relationship between team charter quality and viability in engineering student teams, and b) What is the relationship among team charter quality, teamwork mental model similarity, and viability in engineering student teams? Thirty-eight intact teams, 23 treatment and 15 comparison, participated in the investigation. Treatment teams attended a team charter lecture, and completed a team charter homework assignment. Each team charter was assessed and assigned a quality score. Comparison teams did not join the lecture, and were not asked to create a team charter. All teams completed each data collection phase: a) similarity rating pretest; b) similarity posttest; and c) team viability survey. Findings indicate that team viability was higher in teams that attended the lecture and completed the charter assignment. Teams with higher quality team charter scores reported higher levels of team viability than teams with lower quality charter scores. Lastly, no evidence was found to support teamwork mental model similarity as a partial mediator of the team charter quality on team viability

The concept of hospice in theory and practice.

Science.gov (United States)

Nayak, S

2001-12-01

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

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

Science.gov (United States)

Kehl, Karen A.; McCarty, Kayla N.

2012-01-01

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

Impact of provider level, training and gender on the utilization of palliative care and hospice in neuro-oncology: a North-American survey.

Science.gov (United States)

Walbert, Tobias; Glantz, Michael; Schultz, Lonni; Puduvalli, Vinay K

2016-01-01

Specialized palliative care (PC) services have emerged to address symptoms and provide end-of-life management for patients with brain tumors. The utilization patterns of PC in neuro-oncology are unknown. A 22-question survey was distributed to participants of the society for neuro-oncology annual meeting 2012 (n = 4487). Nonparametric methods including Wilcoxon two-sample and Kruskal-Wallis tests were used to assess differences in responses. 239 (5.3 %) evaluable responses were received; 79 % of respondents were physicians, and 17 % were nurses or midlevel providers. Forty-seven percent were medical or neuro-oncologists, 31 % neurosurgeons and 11 % radiation oncologists. Forty percent had no formal training in PC, 57 % had some formal training and 3 % completed a PC fellowship. Seventy-nine percent practiced in an academic setting. Of the respondents, 57 % referred patients to PC when symptoms required treatment and 18 % at end of life. Only 51 % of all providers felt comfortable dealing with end-of-life issues and symptoms, while 33 % did not. Fifty-one percent preferred a service named "Supportive Care" rather than "Palliative Care" (MDs > midlevel providers, p training in neuro-oncology and PC, and medical versus surgical neuro-oncology training were significantly associated with hospice referral, comfort in dealing with end-of-life issues, and ease of access to PC services. Provider level, specialty, gender, training in PC and neuro-oncology have significant impact on the utilization of PC and hospice in neuro-oncology.

Meeting of the ITER CTA Project Board

International Nuclear Information System (INIS)

Vlasenkov, V.

2002-01-01

The meeting of the ITER CTA Project Board (PB) took place in Toronto, Canada on 16 September 2002 on the occasion of the fifth Negotiations Meeting (N-5). Thirteen participants, PB members and experts from Canada, EU, Japan, RF and the International Team (IT) attended the meeting chaired by Acad. E. Velikhov. PB heard progress reports of the participating parties and the comments concerning the status of participants team (PT) and the IT were presented

MeetingVis: Visual Narratives to Assist in Recalling Meeting Context and Content.

Science.gov (United States)

Shi, Yang; Bryan, Chris; Bhamidipati, Sridatt; Zhao, Ying; Zhang, Yaoxue; Ma, Kwan-Liu

2018-06-01

In team-based workplaces, reviewing and reflecting on the content from a previously held meeting can lead to better planning and preparation. However, ineffective meeting summaries can impair this process, especially when participants have difficulty remembering what was said and what its context was. To assist with this process, we introduce MeetingVis, a visual narrative-based approach to meeting summarization. MeetingVis is composed of two primary components: (1) a data pipeline that processes the spoken audio from a group discussion, and (2) a visual-based interface that efficiently displays the summarized content. To design MeetingVis, we create a taxonomy of relevant meeting data points, identifying salient elements to promote recall and reflection. These are mapped to an augmented storyline visualization, which combines the display of participant activities, topic evolutions, and task assignments. For evaluation, we conduct a qualitative user study with five groups. Feedback from the study indicates that MeetingVis effectively triggers the recall of subtle details from prior meetings: all study participants were able to remember new details, points, and tasks compared to an unaided, memory-only baseline. This visual-based approaches can also potentially enhance the productivity of both individuals and the whole team.

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

Science.gov (United States)

2011-05-09

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

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

Science.gov (United States)

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

2015-08-01

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

75 FR 971 - Pacific Fishery Management Council; Public Meeting

Science.gov (United States)

2010-01-07

... Pacific Fishery Management Council's (Council) Scientific and Statistical Committee, Coastal Pelagic Species Management Team, and Groundfish Management Team will hold a working meeting, which is open to the... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National...

Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study.

Science.gov (United States)

Hahlweg, Pola; Didi, Sarah; Kriston, Levente; Härter, Martin; Nestoriuc, Yvonne; Scholl, Isabelle

2017-11-17

The quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation. An adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis. N = 249 cases were observed in N = 29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation. The quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints

Meeting of the ITER CTA project board

International Nuclear Information System (INIS)

Vlasenkov, V.

2002-01-01

This is information about meeting of the ITER CTA project board, which took place in Moscow, Russian Federation on 22 April 2002 on the occasion of the Third Negotiators Meeting (N3). Thirteen participants, representing PB members and experts from Canada (CA), the European Union (EU), Japan(JA), the Russian federation (RF) and the International Team (IT) attended the meeting chaired by Acad. E. Velikhov. The Project Board took note of the comments made concerning the status of the Participants Teams(PTs)

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

Science.gov (United States)

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

2017-09-01

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

Mr. Traore introduces team supervision. Case scenarios for training and group discussion.

Science.gov (United States)

1993-01-01

This supplement to "The Family Planning Manager" presents a case example and five case discussion questions to illustrate the concept of team supervision. In contrast to traditional supervision, where an emphasis is placed on inspection and the uncovering of deficiencies, team supervision uses a facilitative, advocacy-oriented approach. Problem-solving and decision-making responsibilities are assumed by the clinic staff, who identify and analyze problems in group meetings. Thus, the focus shifts from assessing individual performance to evaluating how well they meet clinic objectives as a team. In the team meetings, the visiting supervisor asks the team as a whole to analyze clinic problems and ensures that all staff members are aware of the significance of their contributions. The supervisor also clarifies the division of labor required for implementing solutions and performance standards. Staff are asked if they have concerns they would like communicated to the next organizational level. The supervisory report of the visit can serve as a guide for implementing the recommendations. This approach may require that supervisors and clinic managers receive training in problem solving, motivating staff, team building, and providing constructive feedback.

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

OpenAIRE

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

2008-01-01

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

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

Science.gov (United States)

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

2017-05-01

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

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

Science.gov (United States)

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

2014-02-01

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

The productivity of teams in the meeting context: Case study

Directory of Open Access Journals (Sweden)

G. Gonçalves

2015-05-01

Full Text Available Organizational life encompasses complex processes and daily activities aimed at increasing efficiency and effectiveness. Workplace meetings are one of such activities that, despite their usefulness in helping organizations to achieve their goals, can be an overlooked practice, with high financial burdens. This exploratory study intends to build an organizational diagnosis formula aimed at assessing the cost-benefit effectiveness of workplace meetings. Based on a sample of seven meetings in a management unit of a higher education public institution, our data show that each meeting results, on average, in six decisions, with the estimated cost in personnel time for each meeting of 496.68€ and a resulting productivity ratio of 198.67€ per decision. The application of our diagnosis formula might contribute to maximize the effectiveness of meetings and organizational performance.

76 FR 22677 - Pacific Fishery Management Council; Public Meeting

Science.gov (United States)

2011-04-22

... Groundfish Management Team (GMT). The meeting is open to the public. DATES: The conference call will be held... the Groundfish Management Team to review the developing Ecosystem Fishery Management Plan. The GMT... Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS), National...

Meeting excellence: 33 tools to lead meetings that get results

National Research Council Canada - National Science Library

Parker, Glenn; Hoffman, Robert

2006-01-01

... Chapter 17 - TELECONFERENCE TIPS Chapter 18 - ACHIEVING CLEAR COMMUNICATION IN A MULTICULTURAL MEETING Chapter 19 - HOW TO MAKE A DECISION Chapter 20 - PRESENTING AT A TEAM MEETINGChapter 21 - ...

Factors Affecting University Teaching Team Effectiveness in Detached Working Environments

Science.gov (United States)

Bennett, Roger; Kane, Suzanne

2014-01-01

This paper presents the outcomes of a study of the factors that contribute to teaching team effectiveness in situations where team members rarely meet face to face. Academic faculty within a university Business School were asked to report the degrees to which they believed that the module teaching teams to which they belonged contained members who…

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

Science.gov (United States)

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

2017-03-01

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

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

Science.gov (United States)

Mrig, Emily Hammad; Spencer, Karen Lutfey

2018-03-01

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

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

Science.gov (United States)

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

2017-06-01

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

Experience as Knowledge in a New Product Development Team: Implications for Knowledge Management

Science.gov (United States)

Cooper, Lynne P.

2009-01-01

This study was conducted to better understand how New Product Development (NPD) team members apply their experiences to meet the task needs of their project. Although "experience" is highly valued in team members, little research has looked specifically at experiences as a type of knowledge, and how this knowledge is used in work settings. This research evaluated nearly 200 instances where team members referenced past experiences during team meetings. During these experience exchanges, team members structured the sharing of their experiences to include three common elements: the source of the experience, the nature of the experience, and the degree of relevance to the current work of the team. The experiences fell into four categories: people (relationships), process, product, and politics. This paper describes how team members structured, applied, and integrated their individual experiences and presents the resulting implications for knowledge management systems that wish to exploit experience knowledge.

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

Science.gov (United States)

Hotchkiss, Jason T

2018-01-01

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

Hospice Care

Science.gov (United States)

... Volunteer Donate Search Heart.org Search Get Your Local Info Find out what is happening at your ... your care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist. ...

Guiding Principles for Team-Based Pediatric Care.

Science.gov (United States)

Katkin, Julie P; Kressly, Susan J; Edwards, Anne R; Perrin, James M; Kraft, Colleen A; Richerson, Julia E; Tieder, Joel S; Wall, Liz

2017-07-24

The American Academy of Pediatrics (AAP) recognizes that children's unique and ever-changing needs depend on a variety of support systems. Key components of effective support systems address the needs of the child and family in the context of their home and community and are dynamic so that they reflect, monitor, and respond to changes as the needs of the child and family change. The AAP believes that team-based care involving medical providers and community partners (eg, teachers and state agencies) is a crucial and necessary component of providing high-quality care to children and their families. Team-based care builds on the foundation of the medical home by reaching out to a potentially broad array of participants in the life of a child and incorporating them into the care provided. Importantly, the AAP believes that a high-functioning team includes children and their families as essential partners. The overall goal of team-based care is to enhance communication and cooperation among the varied medical, social, and educational partners in a child's life to better meet the global needs of children and their families, helping them to achieve their best potential. In support of the team-based approach, the AAP urges stakeholders to invest in infrastructure, education, and privacy-secured technology to meet the needs of children. This statement includes limited specific examples of potential team members, including health care providers and community partners, that are meant to be illustrative and in no way represent a complete or comprehensive listing of all team members who may be of importance for a specific child and family. Copyright © 2017 by the American Academy of Pediatrics.

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

Science.gov (United States)

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

2009-01-01

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

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

Science.gov (United States)

Imrie, Susan; Troop, Nicholas A

2012-06-01

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

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

Science.gov (United States)

McGrath, Pam

2004-01-01

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

IAEA Expert Team Returns from Iran

International Nuclear Information System (INIS)

2012-01-01

Full text: A senior IAEA expert team is returning from Iran after two days of discussions with Iranian officials held on 20 and 21 February 2012. The meeting followed previous discussions held on 29 to 31 January 2012. During both the first and second round of discussions, the Agency team requested access to the military site at Parchin. Iran did not grant permission for this visit to take place. Intensive efforts were made to reach agreement on a document facilitating the clarification of unresolved issues in connection with Iran's nuclear programme, particularly those relating to possible military dimensions. Unfortunately, agreement was not reached on this document. 'It is disappointing that Iran did not accept our request to visit Parchin during the first or second meetings', IAEA Director General Yukiya Amano said. 'We engaged in a constructive spirit, but no agreement was reached'. (IAEA)

Meeting of the ITER CTA Project Board

International Nuclear Information System (INIS)

Vlasenkov, V.

2002-01-01

The meeting of the ITER co-ordinated technical activities project board took place in Tokyo, Japan, on 21 January 2002, coinciding with the second Negotiators meeting (N2). Twelve participants, project board members and experts from Canada, European Union, the Russian Federation and the international team attended the meeting. The project board agreed to provide an R and D plan by June 2002, to be linked with the procurement allocation, for the period following the CTA. The ITER International Team Leader developed a proposal on establishing the working groups for drafting technical specifications for the most urgent procurement items

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

Science.gov (United States)

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

2014-12-01

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

Team Mentoring for Interdisciplinary Team Science: Lessons From K12 Scholars and Directors.

Science.gov (United States)

Guise, Jeanne-Marie; Geller, Stacie; Regensteiner, Judith G; Raymond, Nancy; Nagel, Joan

2017-02-01

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.

Team Conflict in ICT-Rich Environments: Roles of Technologies in Conflict Management

Science.gov (United States)

Correia, Ana-Paula

2008-01-01

This study looks at how an information and communication technologies (ICT)-rich environment impacts team conflict and conflict management strategies. A case study research method was used. Three teams, part of a graduate class in instructional design, participated in the study. Data were collected through observations of team meetings, interviews…

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

Science.gov (United States)

Zalenski, Robert J; Raspa, Richard

2006-10-01

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

Emergent team roles in organizational meetings: Identifying communication patterns via cluster analysis.

NARCIS (Netherlands)

Lehmann-Willenbrock, N.K.; Beck, S.J.; Kauffeld, S.

2016-01-01

Previous team role taxonomies have largely relied on self-report data, have focused on functional roles and have described individual predispositions or personality traits. Instead, this study takes a communicative approach and proposes that team roles are produced, shaped and sustained in

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

Science.gov (United States)

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

2017-09-01

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

Why hospice nurses need high self-esteem.

Science.gov (United States)

Olthuis, Gert; Leget, Carlo; Dekkers, Wim

2007-01-01

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

An assessment of hospice bereavement programs for Hispanics.

Science.gov (United States)

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

2011-01-01

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

34 CFR 300.328 - Alternative means of meeting participation.

Science.gov (United States)

2010-07-01

... Programs, and Educational Placements Development of Iep § 300.328 Alternative means of meeting participation. When conducting IEP Team meetings and placement meetings pursuant to this subpart, and subpart E...

Multidisciplinary team working across different tumour types: analysis of a national survey.

Science.gov (United States)

Lamb, B W; Sevdalis, N; Taylor, C; Vincent, C; Green, J S A

2012-05-01

Using data from a national survey, this study aimed to address whether the current model for multidisciplinary team (MDT) working is appropriate for all tumour types. Responses to the 2009 National Cancer Action Team national survey were analysed by tumour type. Differences indicate lack of consensus between MDT members in different tumour types. One thousand one hundred and forty-one respondents from breast, gynaecological, colorectal, upper gastrointestinal, urological, head and neck, haematological and lung MDTs were included. One hundred and sixteen of 136 statements demonstrated consensus between respondents in different tumour types. There were no differences regarding the infrastructure for meetings and team governance. Significant consensus was seen for team characteristics, and respondents disagreed regarding certain aspects of meeting organisations and logistics, and patient-centred decision making. Haematology MDT members were outliers in relation to the clinical decision-making process, and lung MDT members disagreed with other tumour types regarding treating patients with advanced disease. This analysis reveals strong consensus between MDT members from different tumour types, while also identifying areas that require a more tailored approach, such as the clinical decision-making process, and preparation for and the organisation of MDT meetings. Policymakers should remain sensitive to the needs of health care teams working in individual tumour types.

Meeting of the ITER CTA Project Board

International Nuclear Information System (INIS)

2001-01-01

Full text: A preparatory meeting of the Co-ordinated Technical Activities (CTA) Project Board took place in Vienna on 16 July 2001. The Board Members of Canada, EU, Japan, RF and of the CTA International Team participated in the Meeting, which was chaired by Acad. E. Velikhov. The major item on the Meeting Agenda was the discussion of the scope of the CTA. In this discussion the following comments were expressed: One of the prime objectives during the CTA is to develop technical specifications for procurement of critical items (magnets, vacuum vessel, and buildings). It was noted that the discussions with potential suppliers should confirm manufacturing processes in details in order to explore possible schedule reduction strategies. Safety analysis and licensing preparation should proceed on all proposed sites up to the preferred site designation, to ensure the overall implementation schedule is minimized and to resolve major technical issues needed for licensing. Several R and D issues remain to be further developed during the CTA. Special attention should be given by the Participants to two areas: Diagnostics; Heating and Current Drive Systems. Arrangements for continuation of the ITER Physics Expert Groups activities should be provided. To this end a new framework, called International Tokamak Physics Activity, is being planned. The Board encouraged the Participants' Representatives in the Co-ordinating committee of this activity to support the preparation for urgent Topical Group Meetings. The Board agreed that the Design Authority will be invested in the International Team and that proposals for site specific design changes should be agreed upon by the International Team Leader before being studied in detail. The Meeting agreed on some arrangements which will remain from the EDA, namely the ITER EDA Council Office in Moscow as Office of the PB Chair, and the ITER Office located at the IAEA in Vienna as agreed by the IAEA. The Board recommended that effective

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

Directory of Open Access Journals (Sweden)

Albert J Finestone

2008-09-01

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

LEADING EFFECTIVE MEETINGS IN A HOSPITALITY ORGANIZATION

Directory of Open Access Journals (Sweden)

Slobodan Ivanovic

2010-06-01

Full Text Available Today’s business environment demands of the individual manager to lead effective meetings. This is a skill which has to be studied and to be used and constantly optimized in order to keep the team focused on the goals that were set. Meetings keep track of a teams and the organizations goals that are being met or not being met. The specific focus of a certain meeting depends on what on what is to be achieved, whether that be setting goals or keeping evidence of what is being done, and to do this one needs the proper information tolead it correctly and efficiently.

Self-reported teamwork in family health team practices in Ontario: organizational and cultural predictors of team climate.

Science.gov (United States)

Howard, Michelle; Brazil, Kevin; Akhtar-Danesh, Noori; Agarwal, Gina

2011-05-01

To determine the organizational predictors of higher scores on team climate measures as an indicator of the functioning of a family health team (FHT). Cross-sectional study using a mailed survey. Family health teams in Ontario. Twenty-one of 144 consecutively approached FHTs; 628 team members were surveyed. Scores on the team climate inventory, which assessed organizational culture type (group, developmental, rational, or hierarchical); leadership perceptions; and organizational factors, such as use of electronic medical records (EMRs), team composition, governance of the FHT, location, meetings, and time since FHT initiation. All analyses were adjusted for clustering of respondents within the FHT using a mixed random-intercepts model. The response rate was 65.8% (413 of 628); 2 were excluded from analysis, for a total of 411 participants. At the time of survey completion, there was a median of 4 physicians, 11 other health professionals, and 4 management and clerical staff per FHT. The average team climate score was 3.8 out of a possible 5. In multivariable regression analysis, leadership score, group and developmental culture types, and use of more EMR capabilities were associated with higher team climate scores. Other organizational factors, such as number of sites and size of group, were not associated with the team climate score. Culture, leadership, and EMR functionality, rather than organizational composition of the teams (eg, number of professionals on staff, practice size), were the most important factors in predicting climate in primary care teams.

Social Workers' Perceptions of Job Satisfaction, Interdisciplinary Collaboration, and Organizational Leadership.

Science.gov (United States)

Marmo, Suzanne; Berkman, Cathy

2018-01-01

To address job satisfaction, and therefore employment retention, of hospice social workers, this study examined how relationships with other members of the interdisciplinary hospice team and perceptions of hospice leadership may be associated with job satisfaction of hospice social workers. The sample of 203 hospice social workers was recruited by e-mailing invitations to hospice social workers identified by hospice directors in three states, use of online social media sites accessed by hospice social workers, and snowball sampling. Study measures included professional experience, hospice characteristics, interdisciplinary collaboration, perception of servant leadership, and intrinsic and extrinsic job satisfaction. Variables significant in the model for intrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, and feeling valued by the hospice physician. Variables significant in the model for extrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, feeling valued by the hospice physician, and number of social workers at the hospice. Interdisciplinary collaboration was more important for intrinsic job satisfaction and leadership style was more important for extrinsic job satisfaction. Profit status of the hospice, experience of the social worker, caseload size, and other variables were not significant in either model. These results support previous findings that leadership style of the hospice director and relationships with hospice colleagues are important for hospice social workers' job satisfaction. Such low-cost modifications to the hospice work environment, albeit not simple, may improve job satisfaction of hospice social workers.

A.A., constructivism, and reflecting teams.

Science.gov (United States)

Nevels, B

1997-12-01

Numerous studies and clinical anecdotes reveal a relationship between attendance at A.A. meetings and/or degree of involvement in A.A. and maintenance of sobriety. Hypotheses as to how A.A. and/or the A.A. meeting is helpful to its members have ranged from a focus on factors common to all therapy groups, to aspects of A.A. "treatment" which are behavioral in nature. Presented here is another way of understanding A.A.'s effectiveness within the frame of more recent, constructivistic approaches to family therapy. In particular, the A.A. topic meeting is compared to the reflecting team concept of Tom Anderson.

Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation.

Science.gov (United States)

Monaghan, J; Channell, K; McDowell, D; Sharma, A K

2005-03-01

To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF). Consecutive assessment of the three forms of care was completed. The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward. (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors. MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two); and improved team working (measured using the team climate inventory) than do MDT meetings. In the present study, standard weekly MDT meetings did not meet the standards set for MDT care by the NSF. The use of a MDT ward round allows these standards to be achieved.

17 April 2008 - Head of Internal Audit Network meeting visiting the ATLAS experimental area with CERN ATLAS Team Leader P. Fassnacht, ATLAS Technical Coordinator M. Nessi and ATLAS Resources Manager M. Nordberg.

CERN Multimedia

Mona Schweizer

2008-01-01

17 April 2008 - Head of Internal Audit Network meeting visiting the ATLAS experimental area with CERN ATLAS Team Leader P. Fassnacht, ATLAS Technical Coordinator M. Nessi and ATLAS Resources Manager M. Nordberg.

Trauma team activation: Not just for trauma patients

Directory of Open Access Journals (Sweden)

Phoenix Vuong

2017-01-01

Full Text Available Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontraumatic hemorrhage. We present two cases in which the trauma team was activated for noninjured patients in hemorrhagic shock. The utilization of the TTA protocol and subsequent management by the trauma team are reviewed as we believe these were critical factors in the successful recovery of both patients. Beyond the primary improved survival outcomes of severely injured patients, trauma center designation has a “halo effect” that encompasses patients with nontraumatic hemorrhage.

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

Science.gov (United States)

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

2016-01-01

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

Evaluation of Subcutaneous Phenobarbital Administration in Hospice Patients.

Science.gov (United States)

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

2016-04-01

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

Use of a Shared Mental Model by a Team Composed of Oncology, Palliative Care, and Supportive Care Clinicians to Facilitate Shared Decision Making in a Patient With Advanced Cancer.

Science.gov (United States)

D'Ambruoso, Sarah F; Coscarelli, Anne; Hurvitz, Sara; Wenger, Neil; Coniglio, David; Donaldson, Dusty; Pietras, Christopher; Walling, Anne M

2016-11-01

Our case describes the efforts of team members drawn from oncology, palliative care, supportive care, and primary care to assist a woman with advanced cancer in accepting care for her psychosocial distress, integrating prognostic information so that she could share in decisions about treatment planning, involving family in her care, and ultimately transitioning to hospice. Team members in our setting included a medical oncologist, oncology nurse practitioner, palliative care nurse practitioner, oncology social worker, and primary care physician. The core members were the patient and her sister. Our team grew organically as a result of patient need and, in doing so, operationalized an explicitly shared understanding of care priorities. We refer to this shared understanding as a shared mental model for care delivery, which enabled our team to jointly set priorities for care through a series of warm handoffs enabled by the team's close proximity within the same clinic. When care providers outside our integrated team became involved in the case, significant communication gaps exposed the difficulty in extending our shared mental model outside the integrated team framework, leading to inefficiencies in care. Integration of this shared understanding for care and close proximity of team members proved to be key components in facilitating treatment of our patient's burdensome cancer-related distress so that she could more effectively participate in treatment decision making that reflected her goals of care.

Team Learning Ditinjau dari Team Diversity dan Team Efficacy

OpenAIRE

Pohan, Vivi Gusrini Rahmadani; Ancok, Djamaludin

2010-01-01

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 ...

Team Learning Ditinjau dari Team Diversity dan Team Efficacy

OpenAIRE

Vivi Gusrini Rahmadani Pohan; Djamaludin Ancok

2015-01-01

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 ...

Team Work: Time well Spent

Science.gov (United States)

Moore Johnson, Susan; Reinhorn, Stefanie K.; Simon, Nicole S.

2016-01-01

Teachers in high-poverty schools often feel stressed and fatigued. We might expect that if we ask these teachers to take on even more work by meeting regularly in collaborative improvement teams, they will respond with skepticism, even resentment. But in a study of 83 teachers in six outstanding high-poverty schools, these researchers found the…

Team-Based Multidisciplinary Research Scholarship in the Geosciences

Science.gov (United States)

Wernette, P. A.; Houser, C.; Quick, C.

2016-12-01

The traditional approach to undergraduate research can be time-intensive for both the mentee and mentor, and can deter potential undergraduates and faculty from participating in research. The Aggie Research Leadership (ARL) and Aggie Research Scholars (ARS) programs represent a team-based, vertically-tiered, and multidisciplinary approach to research that can successfully address complex and relevant research questions. The program is structured such that faculty mentor one or more graduate students or postdocs, who, in turn, mentor teams of 2 to 8 undergraduate students. While it is the responsibility of the graduate student or postdoc to put together a team that works for their research question, undergraduate teams are encouraged to be multidisciplinary in order to leverage the experience and perspective that comes from students in different areas of study. Team leaders are encouraged to discuss their research teams with the faculty mentor regularly to address any potential issues that they might be having, but team leaders are required to meet regularly with other team leaders to discuss any issues that they might be having. Meeting with new and experienced team leaders is a valuable approach to a graduate student or postdoc developing their own set of best practices for mentoring. This experience is invaluable in their future careers, regardless of the field of study. By collaborating with students from other fields of study, no one student is required to become an expert in all topics relating to the research. Another significant advantage of the ARL/ARS programs is that complex research questions are able to be examined because teams typically continue longer than a single semester or academic year. Research teams are vertically-tiered and typically include freshman through seniors. In this way, younger students on the projects are mentored by senior students when they first arrive. Eventually, the younger students will advance through to senior students and

78 FR 70076 - Large Scale Networking (LSN)-Middleware and Grid Interagency Coordination (MAGIC) Team

Science.gov (United States)

2013-11-22

... projects. The MAGIC Team reports to the Large Scale Networking (LSN) Coordinating Group (CG). Public... Coordination (MAGIC) Team AGENCY: The Networking and Information Technology Research and Development (NITRD... MAGIC Team meetings are held on the first Wednesday of each month, 2:00-4:00 p.m., at the National...

Complexity of health-care needs and interactions in multidisciplinary medical teams

NARCIS (Netherlands)

Molleman, E.; Broekhuis, Manda; Stoffels, A.M.R.R.; Jaspers, F.

By using an information processing and social identity approach, this study examines the relationships between the complexity of the health care needs of a patient and (1) the interactions among physicians during team meetings and (2) how the meeting participants evaluate the discussion. Three

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

Science.gov (United States)

Baird, Lucy; Spiller, Juliet Anne

2017-01-01

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

MRP (materiel requirements planning) II education: a team-building experience.

Science.gov (United States)

Iemmolo, G R

1994-05-01

Conestoga Wood Specialties, a leader in the woodworking industry, is constantly striving for continuous improvement in manufacturing and service. Recently, the company embarked on a major MRP II education effort that served as a framework for team building. This team building concept has carried over into other aspects related to the business, such as the formalization of the sales and operations planning meeting. At Conestoga Wood, it is recognized that successful team building is necessary to achieve and maintain world-class performance.

Mutually shared team competence of professionals in early childhood intervention

OpenAIRE

Ališauskienė, Stefanija; Kairienė, Daiva

2011-01-01

The article is based on theoretical study as well as on written survey. The aim of theoretical analysis to present a theoretical model of the concept of the mutually shared team competence in an interprofessional team meeting early special needs of child and family and to find out presumptions of its development. The aim of survey is to reveal ECI professionals' reflections about competences necessary for teamwork. The mutually shared team competence is analysed on the basis of the teamwork p...

Assessing Teamwork Skills for Assurance of Learning Using CATME Team Tools

Science.gov (United States)

Loughry, Misty L.; Ohland, Matthew W.; Woehr, David J.

2014-01-01

Colleges of business must meet assurance of learning requirements to gain or maintain AACSB accreditation under the new standards adopted April 8, 2013. Team skills are among the most important skills desired by recruiters, yet employers and scholars perceive that team skills are frequently deficient in college graduates. This article describes…

Case Study: Student Perceptions of Groups & Teams in Leadership Education

Science.gov (United States)

Coers, Natalie; Lorensen, Marianne; Anderson, James C., II.

2009-01-01

Working in groups and teams is a common practice in today's college classroom, partly in order to meet the growing demand by employers that students entering the workforce have leadership and group experience. This practice has many inherent benefits and challenges. The experiences created must meet the needs of both students and other…

Summary of Prioritized Research Opportunities. Building America Planning Meeting, November 2-4, 2010

Energy Technology Data Exchange (ETDEWEB)

none,

2011-02-01

This report outlines the results of brainstorming sessions conducted at the Building America Fall 2010 planning meeting, in which research teams and national laboratories identified key research priorities to incorporate into multi-year planning, team research agendas, expert meetings, and technical standing committees.

77 FR 58416 - Large Scale Networking (LSN); Middleware and Grid Interagency Coordination (MAGIC) Team

Science.gov (United States)

2012-09-20

..., Grid, and cloud projects. The MAGIC Team reports to the Large Scale Networking (LSN) Coordinating Group... Coordination (MAGIC) Team AGENCY: The Networking and Information Technology Research and Development (NITRD.... Dates/Location: The MAGIC Team meetings are held on the first Wednesday of each month, 2:00-4:00pm, at...

Design Team communication and Design Task Complexity, the Preference for Dialogus

NARCIS (Netherlands)

Otter, den A.F.H.J.; Emmitt, S.

2008-01-01

The way in which dialogues and group meetings affect the progress of multidisciplinary architectural design teams can be easily underestimated by managers. This is due to the importance of group meetings to review designs, share information, make decisions and hence progress the design. The aim of

Final ITER CTA project board meeting

International Nuclear Information System (INIS)

Vlasenkov, V.

2003-01-01

The final ITER CTA Project Board Meeting (PB) took place in Barcelona, Spain on 8 December 2002. The PB took notes of the comments concerning the status of the International Team and the Participants Teams, including Dr. Aymar's report 'From ITER to a FUSION Power Reactor' and the assessment of the ITER project cost estimate

Meet-U: Educating through research immersion.

Science.gov (United States)

Abdollahi, Nika; Albani, Alexandre; Anthony, Eric; Baud, Agnes; Cardon, Mélissa; Clerc, Robert; Czernecki, Dariusz; Conte, Romain; David, Laurent; Delaune, Agathe; Djerroud, Samia; Fourgoux, Pauline; Guiglielmoni, Nadège; Laurentie, Jeanne; Lehmann, Nathalie; Lochard, Camille; Montagne, Rémi; Myrodia, Vasiliki; Opuu, Vaitea; Parey, Elise; Polit, Lélia; Privé, Sylvain; Quignot, Chloé; Ruiz-Cuevas, Maria; Sissoko, Mariam; Sompairac, Nicolas; Vallerix, Audrey; Verrecchia, Violaine; Delarue, Marc; Guérois, Raphael; Ponty, Yann; Sacquin-Mora, Sophie; Carbone, Alessandra; Froidevaux, Christine; Le Crom, Stéphane; Lespinet, Olivier; Weigt, Martin; Abboud, Samer; Bernardes, Juliana; Bouvier, Guillaume; Dequeker, Chloé; Ferré, Arnaud; Fuchs, Patrick; Lelandais, Gaëlle; Poulain, Pierre; Richard, Hugues; Schweke, Hugo; Laine, Elodie; Lopes, Anne

2018-03-01

We present a new educational initiative called Meet-U that aims to train students for collaborative work in computational biology and to bridge the gap between education and research. Meet-U mimics the setup of collaborative research projects and takes advantage of the most popular tools for collaborative work and of cloud computing. Students are grouped in teams of 4-5 people and have to realize a project from A to Z that answers a challenging question in biology. Meet-U promotes "coopetition," as the students collaborate within and across the teams and are also in competition with each other to develop the best final product. Meet-U fosters interactions between different actors of education and research through the organization of a meeting day, open to everyone, where the students present their work to a jury of researchers and jury members give research seminars. This very unique combination of education and research is strongly motivating for the students and provides a formidable opportunity for a scientific community to unite and increase its visibility. We report on our experience with Meet-U in two French universities with master's students in bioinformatics and modeling, with protein-protein docking as the subject of the course. Meet-U is easy to implement and can be straightforwardly transferred to other fields and/or universities. All the information and data are available at www.meet-u.org.

Primary care team working in Ireland: a qualitative exploration of team members' experiences in a new primary care service.

Science.gov (United States)

Kennedy, Norelee; Armstrong, Claire; Woodward, Oonagh; Cullen, Walter

2015-07-01

Team working is an integral aspect of primary care, but barriers to effective team working can limit the effectiveness of a primary care team (PCT). The establishment of new PCTs in Ireland provides an excellent opportunity to explore team working in action. The aim of this qualitative study was to explore the experiences of team members working in a PCT. Team members (n = 19) from two PCTs were interviewed from May to June 2010 using a semi-structured interview guide. All interviews were audio-recorded and transcribed. Data were analysed using NVivo (version 8). Thematic analysis was used to explore the data. We identified five main themes that described the experiences of the team members. The themes were support for primary care, managing change, communication, evolution of roles and benefits of team working. Team members were generally supportive of primary care and had experienced benefits to their practice and to the care of their patients from participation in the team. Regular team meetings enabled communication and discussion of complex cases. Despite the significant scope for role conflict due to the varied employment arrangements of the team members, neither role nor interpersonal conflict was evident in the teams studied. In addition, despite the unusual team structure in Irish PCTs - where there is no formally appointed team leader or manager - general issues around team working and its benefits and challenges were very similar to those found in other international studies. This suggests, in contrast to some studies, that some aspects of the leadership role may not be as important in successful PCT functioning as previously thought. Nonetheless, team leadership was identified as an important issue in the further development of the teams. © 2014 John Wiley & Sons Ltd.

Technical discussions on Emissions and Atmospheric Modeling (TEAM)

Science.gov (United States)

Frost, G. J.; Henderson, B.; Lefer, B. L.

2017-12-01

A new informal activity, Technical discussions on Emissions and Atmospheric Modeling (TEAM), aims to improve the scientific understanding of emissions and atmospheric processes by leveraging resources through coordination, communication and collaboration between scientists in the Nation's environmental agencies. TEAM seeks to close information gaps that may be limiting emission inventory development and atmospheric modeling and to help identify related research areas that could benefit from additional coordinated efforts. TEAM is designed around webinars and in-person meetings on particular topics that are intended to facilitate active and sustained informal communications between technical staff at different agencies. The first series of TEAM webinars focuses on emissions of nitrogen oxides, a criteria pollutant impacting human and ecosystem health and a key precursor of ozone and particulate matter. Technical staff at Federal agencies with specific interests in emissions and atmospheric modeling are welcome to participate in TEAM.

Resource assessment/commercialization planning meeting

Energy Technology Data Exchange (ETDEWEB)

None

1980-01-24

The U.S. Department of Energy, Division of Geothermal Energy and Division of Geothermal Resource Management, sponsored a Resource Assessment/Commercialization Planning meeting in Salt Lake City on January 21-24, 1980. The meeting included presentations by state planning and resource teams from all DOE regions. An estimated 130 people representing federal, state and local agencies, industry and private developers attended.

2013 Building America Research Planning Meeting Summary

Energy Technology Data Exchange (ETDEWEB)

Metzger, C. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hunt, S. [Confluence Communications, Missoula, MT (united States)

2014-02-01

The Building America Research Planning Meeting was held October 28-30, 2013, in Washington, DC. This meeting provides one opportunity each year for the research teams, national laboratories and Department of Energy (DOE) managers to meet in person to share the most pertinent information and collaboration updates. This report documents the presentations, highlights key program updates, and outlines next steps for the program.

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

Science.gov (United States)

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

2017-01-01

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

Sport-specific nutrition: practical strategies for team sports.

Science.gov (United States)

Holway, Francis E; Spriet, Lawrence L

2011-01-01

Implementation of a nutrition programme for team sports involves application of scientific research together with the social skills necessary to work with a sports medicine and coaching staff. Both field and court team sports are characterized by intermittent activity requiring a heavy reliance on dietary carbohydrate sources to maintain and replenish glycogen. Energy and substrate demands are high during pre-season training and matches, and moderate during training in the competitive season. Dietary planning must include enough carbohydrate on a moderate energy budget, while also meeting protein needs. Strength and power team sports require muscle-building programmes that must be accompanied by adequate nutrition, and simple anthropometric measurements can help the nutrition practitioner monitor and assess body composition periodically. Use of a body mass scale and a urine specific gravity refractometer can help identify athletes prone to dehydration. Sports beverages and caffeine are the most common supplements, while opinion on the practical effectiveness of creatine is divided. Late-maturing adolescent athletes become concerned about gaining size and muscle, and assessment of maturity status can be carried out with anthropometric procedures. An overriding consideration is that an individual approach is needed to meet each athlete's nutritional needs.

Organization of the ITER Co-ordinated Technical Activities International Team

International Nuclear Information System (INIS)

2001-01-01

At its meeting in Toronto on 7 November 2001, the ITER Co-ordinated Technical Activities (CTA) project board took note of the organizational arrangements for the CTA International Team at the Garching and Naka joint work sites. The organization chart of the team remains almost unchanged from that of the ITER Engineering Design Activities (EDA). However, there is no special division responsible for plasma and field control. Activities in plasma control will be taken over by the Physics Unit. This newsletter also includes the ITER CTA International Team structure

The anatomy of clinical decision-making in multidisciplinary cancer meetings

Science.gov (United States)

Soukup, Tayana; Petrides, Konstantinos V.; Lamb, Benjamin W.; Sarkar, Somita; Arora, Sonal; Shah, Sujay; Darzi, Ara; Green, James S. A.; Sevdalis, Nick

2016-01-01

Abstract In the UK, treatment recommendations for patients with cancer are routinely made by multidisciplinary teams in weekly meetings. However, their performance is variable. The aim of this study was to explore the underlying structure of multidisciplinary decision-making process, and examine how it relates to team ability to reach a decision. This is a cross-sectional observational study consisting of 1045 patient reviews across 4 multidisciplinary cancer teams from teaching and community hospitals in London, UK, from 2010 to 2014. Meetings were chaired by surgeons. We used a validated observational instrument (Metric for the Observation of Decision-making in Cancer Multidisciplinary Meetings) consisting of 13 items to assess the decision-making process of each patient discussion. Rated on a 5-point scale, the items measured quality of presented patient information, and contributions to review by individual disciplines. A dichotomous outcome (yes/no) measured team ability to reach a decision. Ratings were submitted to Exploratory Factor Analysis and regression analysis. The exploratory factor analysis produced 4 factors, labeled “Holistic and Clinical inputs” (patient views, psychosocial aspects, patient history, comorbidities, oncologists’, nurses’, and surgeons’ inputs), “Radiology” (radiology results, radiologists’ inputs), “Pathology” (pathology results, pathologists’ inputs), and “Meeting Management” (meeting chairs’ and coordinators’ inputs). A negative cross-loading was observed from surgeons’ input on the fourth factor with a follow-up analysis showing negative correlation (r = −0.19, P < 0.001). In logistic regression, all 4 factors predicted team ability to reach a decision (P < 0.001). Hawthorne effect is the main limitation of the study. The decision-making process in cancer meetings is driven by 4 underlying factors representing the complete patient profile and contributions to case review by all core

FPGA design best practices for team-based reuse

CERN Document Server

Simpson, Philip Andrew

2015-01-01

This book describes best practices for successful FPGA design. It is the result of the author’s meetings with hundreds of customers on the challenges facing each of their FPGA design teams. By gaining an understanding into their design environments, processes, what works and what does not work, key areas of concern in implementing system designs have been identified and a recommended design methodology to overcome these challenges has been developed. This book’s content has a strong focus on design teams that are spread across sites. The goal being to increase the productivity of FPGA design teams by establishing a common methodology across design teams; enabling the exchange of design blocks across teams. Coverage includes the complete FPGA design flow, from the basics to advanced techniques.  This new edition has been enhanced to include new sections on System modeling, embedded design and high level design. The original sections on Design Environment, RTL design and timing closure have all been expand...

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

Science.gov (United States)

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

2018-03-01

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

Team research at the biology-mathematics interface: project management perspectives.

Science.gov (United States)

Milton, John G; Radunskaya, Ami E; Lee, Arthur H; de Pillis, Lisette G; Bartlett, Diana F

2010-01-01

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 background and an experimentally oriented biology student. The team mentors typically ranked the students' performance very good to excellent over a range of attributes that included creativity and ability to conduct independent research. However, the research teams experienced problems meeting prespecified deadlines due to poor time and project management skills. Because time and project management skills can be readily taught and moreover typically reflect good research practices, simple modifications should be made to undergraduate curricula so that the promise of initiatives, such as MATH-BIO 2010, can be implemented.

Environmental control medical support team

Science.gov (United States)

Crump, William J.; Kilgore, Melvin V., Jr.

1988-01-01

The activities conducted in support of the Environmental Control and Life Support Team during December 7, 1987 through September 30, 1988 are summarized. The majority of the ongoing support has focused on the ECLSS area. Through a series of initial meetings with the ECLSS team and technical literature review, an initial list of critical topics was developed. Subtasks were then identified or additional related tasks received as action items from the ECLSS group meetings. Although most of the efforts focused on providing MSFC personnel with information regarding specific questions and problems related to ECLSS issues, other efforts regarding identifying an ECLSS Medical Support Team and constructing data bases of technical information were also initiated and completed. The specific tasks are as follows: (1) Provide support to the mechanical design and integration of test systems as related to microbiological concerns; (2) Assist with design of Human Subjects Test Protocols; (3) Interpretation and recommendations pertaining to air/water quality requirements; (4) Assist in determining the design specifications required as related to the Technical Demonstration Program; (5) Develop a data base of all microorganisms recovered from previous subsystem testing; (6) Estimates of health risk of individual microbes to test subjects; (7) Assist with setting limits for safety of test subjects; (8) Health monitoring of test subjects; (9) Assist in the preparation of test plans; (10) Assist in the development of a QA/QC program to assure the validity, accuracy and precision of the analyses; and (11) Assist in developing test plans required for future man in the loop testing.

Age, forgiveness, and meeting behavior: A multilevel study

NARCIS (Netherlands)

Schulte, E.-M.; Lehmann-Willenbrock, N.K.; Kauffeld, S.

2013-01-01

Purpose: This paper aims to examine the effects of age on counteractive team meeting behaviors (e.g. complaining). Forgiveness is included as a potential buffer against these behaviors. A multilevel model is developed to test individual and team level age effects. Design/methodology/approach: A

Killer Apps: Developing Novel Applications That Enhance Team Coordination, Communication, and Effectiveness

OpenAIRE

Buengeler, Claudia; Klonek, Florian; Lehmann-Willenbrock, Nale; Morency, Louis-Philippe; Poppe, Ronald

2017-01-01

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 contexts that are meaningful and challenging for both. First, we discuss interaction processes during team meetings as a research topic for both Groupies and Geeks. Second, we highlight teamwork in heal...

Seventh ITER technical meeting on safety and environment

International Nuclear Information System (INIS)

Raeder, J.; Gordon, C.

2000-01-01

From February 15 to 18, 2000, the Seventy Technical Meeting on Safety and Environment was held at the Garching Joint Work Site which now hosts the Safety, Environment and Health Group of the ITER Joint Central Team. At this meeting, safety experts from the Home Teams worked with the SEHG members on reviews and agreements on the contents of GSSR and on the tasks and the schedule for the production of GSSR as well as the design information to be used and for the analyses to be done

Eighth ITER technical meeting on safety and environment

International Nuclear Information System (INIS)

Gordon, C.; Raeder, J.

2000-01-01

From November 27 to 30, 2000 the Eighth ITER Technical Meeting on Safety and Environment was held by the ITER Joint Central Team (JCT) at the Garching Joint Work Site, which also hosts the ITER Safety, Environment and Health Group (SEHG). At this meeting, safety experts from the Home Teams (HT) worked together with the SEHG members towards the following main objectives: review of Generic Site Safety Report (GSSR) results and drafts; review of the Plant Design Description (PDD) summary of safety; update on the status of the R and D tasks contributing to GSSR

2013 Building America Research Planning Meeting Summary

Energy Technology Data Exchange (ETDEWEB)

Metzger, Cheryn E. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hunt, Stacy [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2014-02-01

The Building America (BA) Research Planning Meeting was held October 28-30, 2013, in Washington, DC. This meeting provides one opportunity each year for the research teams, national laboratories and Department of Energy (DOE) managers to meet in person to share the most pertinent information and collaboration updates. This report documents the presentations, highlights key program updates, and outlines next steps for the program.

Putting the MeaT into TeaM Training: Development, Delivery, and Evaluation of a Surgical Team-Training Workshop.

Science.gov (United States)

Seymour, Neal E; Paige, John T; Arora, Sonal; Fernandez, Gladys L; Aggarwal, Rajesh; Tsuda, Shawn T; Powers, Kinga A; Langlois, Gerard; Stefanidis, Dimitrios

2016-01-01

Despite importance to patient care, team training is infrequently used in surgical education. To address this, a workshop was developed by the Association for Surgical Education Simulation Committee to teach team training using high-fidelity patient simulators and the American College of Surgeons-Association of Program Directors in Surgery team-training curriculum. Workshops were conducted at 3 national meetings. Participants completed preworkshop and postworkshop questionnaires to define experience, confidence in using simulation, intention to implement, as well as workshop content quality. The course consisted of (A) a didactic review of Preparation, Implementation, and Debriefing and (B) facilitated small group simulation sessions followed by debriefings. Of 78 participants, 51 completed the workshops. Overall, 65% indicated that residents at their institutions used patient simulation, but only 33% used the American College of Surgeons-the Association of Program Directors in Surgery team-training modules. The workshop increased confidence to implement simulation team training (3.4 ± 1.3 vs 4.5 ± 0.9). Quality and importance were rated highly (5.4 ± 00.6, highest score = 6). Preparation for simulation-based team training is possible in this workshop setting, although the effect on actual implementation remains to be determined. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Intelligent Virtual Assistant's Impact on Technical Proficiency within Virtual Teams

Science.gov (United States)

Graham, Christian; Jones, Nory B.

2016-01-01

Information-systems development continues to be a difficult process, particularly for virtual teams that do not have the luxury of meeting face-to-face. The research literature on this topic reinforces this point: the greater part of database systems development projects ends in failure. The use of virtual teams to complete projects further…

Multidisciplinary team (MDT) approach to management of malignant ...

African Journals Online (AJOL)

Background: Multidisciplinary Team meetings (MDTs) in cancer management emphasize collaborative decision making and treatment planning among core members of the specialties relevant to an index case, who come together to share their knowledge and make recommendations for an 'all-inclusive' patient ...

76 FR 27019 - Interagency Ocean Observation Committee, Meeting of the Data Management and Communications...

Science.gov (United States)

2011-05-10

... Observation Committee, Meeting of the Data Management and Communications Steering Team AGENCY: National Ocean... meeting of the IOOC's Data Management and Communications Steering Team (DMAC-ST). The DMAC-ST membership... the IOOC in December 2010 to assist with technical guidance with respect to the management of ocean...

Building the occupational health team: keys to successful interdisciplinary collaboration.

Science.gov (United States)

Wachs, Joy E

2005-04-01

Teamwork among occupational health and safety professionals, management, and employees is vital to solving today's complex problems cost-effectively. No single discipline can meet all the needs of workers and the workplace. However, teamwork can be time-consuming and difficult if attention is not given to the role of the team leader, the necessary skills of team members, and the importance of a supportive environment. Bringing team members together regularly to foster positive relationships and infuse them with the philosophy of strength in diversity is essential for teams to be sustained and work to be accomplished. By working in tandem, occupational health and safety professionals can become the model team in business and industry delivering on their promise of a safe and healthy workplace for America's work force.

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

Science.gov (United States)

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

1983-01-01

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

Building Trust in High-Performing Teams

Directory of Open Access Journals (Sweden)

Aki Soudunsaari

2012-06-01

Full Text Available Facilitation of growth is more about good, trustworthy contacts than capital. Trust is a driving force for business creation, and to create a global business you need to build a team that is capable of meeting the challenge. Trust is a key factor in team building and a needed enabler for cooperation. In general, trust building is a slow process, but it can be accelerated with open interaction and good communication skills. The fast-growing and ever-changing nature of global business sets demands for cooperation and team building, especially for startup companies. Trust building needs personal knowledge and regular face-to-face interaction, but it also requires empathy, respect, and genuine listening. Trust increases communication, and rich and open communication is essential for the building of high-performing teams. Other building materials are a shared vision, clear roles and responsibilities, willingness for cooperation, and supporting and encouraging leadership. This study focuses on trust in high-performing teams. It asks whether it is possible to manage trust and which tools and operation models should be used to speed up the building of trust. In this article, preliminary results from the authors’ research are presented to highlight the importance of sharing critical information and having a high level of communication through constant interaction.

Study on team evaluation. Team process model for team evaluation

International Nuclear Information System (INIS)

Sasou Kunihide; Ebisu, Mitsuhiro; Hirose, Ayako

2004-01-01

Several studies have been done to evaluate or improve team performance in nuclear and aviation industries. Crew resource management is the typical example. In addition, team evaluation recently gathers interests in other teams of lawyers, medical staff, accountants, psychiatrics, executive, etc. However, the most evaluation methods focus on the results of team behavior that can be observed through training or actual business situations. What is expected team is not only resolving problems but also training younger members being destined to lead the next generation. Therefore, the authors set the final goal of this study establishing a series of methods to evaluate and improve teams inclusively such as decision making, motivation, staffing, etc. As the first step, this study develops team process model describing viewpoints for the evaluation. The team process is defined as some kinds of power that activate or inactivate competency of individuals that is the components of team's competency. To find the team process, the authors discussed the merits of team behavior with the experienced training instructors and shift supervisors of nuclear/thermal power plants. The discussion finds four team merits and many components to realize those team merits. Classifying those components into eight groups of team processes such as 'Orientation', 'Decision Making', 'Power and Responsibility', 'Workload Management', 'Professional Trust', 'Motivation', 'Training' and 'staffing', the authors propose Team Process Model with two to four sub processes in each team process. In the future, the authors will develop methods to evaluate some of the team processes for nuclear/thermal power plant operation teams. (author)

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

Science.gov (United States)

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

2017-04-01

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

Are real teams healthy teams?

NARCIS (Netherlands)

Buljac, M.; van Woerkom, M.; van Wijngaarden, P.

2013-01-01

This study examines the impact of real-team--as opposed to a team in name only--characteristics (i.e., team boundaries, stability of membership, and task interdependence) on team processes (i.e., team learning and emotional support) and team effectiveness in the long-term care sector. We employed a

Creating and supporting a mixed methods health services research team.

Science.gov (United States)

Bowers, Barbara; Cohen, Lauren W; Elliot, Amy E; Grabowski, David C; Fishman, Nancy W; Sharkey, Siobhan S; Zimmerman, Sheryl; Horn, Susan D; Kemper, Peter

2013-12-01

To use the experience from a health services research evaluation to provide guidance in team development for mixed methods research. The Research Initiative Valuing Eldercare (THRIVE) team was organized by the Robert Wood Johnson Foundation to evaluate The Green House nursing home culture change program. This article describes the development of the research team and provides insights into how funders might engage with mixed methods research teams to maximize the value of the team. Like many mixed methods collaborations, the THRIVE team consisted of researchers from diverse disciplines, embracing diverse methodologies, and operating under a framework of nonhierarchical, shared leadership that required new collaborations, engagement, and commitment in the context of finite resources. Strategies to overcome these potential obstacles and achieve success included implementation of a Coordinating Center, dedicated time for planning and collaborating across researchers and methodologies, funded support for in-person meetings, and creative optimization of resources. Challenges are inevitably present in the formation and operation of effective mixed methods research teams. However, funders and research teams can implement strategies to promote success. © Health Research and Educational Trust.

Development and Validation of a Family Meeting Assessment Tool (FMAT).

Science.gov (United States)

Hagiwara, Yuya; Healy, Jennifer; Lee, Shuko; Ross, Jeanette; Fischer, Dixie; Sanchez-Reilly, Sandra

2018-01-01

A cornerstone procedure in Palliative Medicine is to perform family meetings. Learning how to lead a family meeting is an important skill for physicians and others who care for patients with serious illnesses and their families. There is limited evidence on how to assess best practice behaviors during end-of-life family meetings. Our aim was to develop and validate an observational tool to assess trainees' ability to lead a simulated end-of-life family meeting. Building on evidence from published studies and accrediting agency guidelines, an expert panel at our institution developed the Family Meeting Assessment Tool. All fourth-year medical students (MS4) and eight geriatric and palliative medicine fellows (GPFs) were invited to participate in a Family Meeting Objective Structured Clinical Examination, where each trainee assumed the physician role leading a complex family meeting. Two evaluators observed and rated randomly chosen students' performances using the Family Meeting Assessment Tool during the examination. Inter-rater reliability was measured using percent agreement. Internal consistency was measured using Cronbach α. A total of 141 trainees (MS4 = 133 and GPF = 8) and 26 interdisciplinary evaluators participated in the study. Internal reliability (Cronbach α) of the tool was 0.85. Number of trainees rated by two evaluators was 210 (MS4 = 202 and GPF = 8). Rater agreement was 84%. Composite scores, on average, were significantly higher for fellows than for medical students (P < 0.001). Expert-based content, high inter-rater reliability, good internal consistency, and ability to predict educational level provided initial evidence for construct validity for this novel assessment tool. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

Improving Communication Skills among High School Assistant Principals To Increase Administrative Team Effectiveness.

Science.gov (United States)

Hosack, Mary Browne

This paper describes a practicum program that was developed to increase the effectiveness of the administrative team at one high school. A lack of communication skills had prevented the target group from working together as a team. Strategies included role-play activities, workshops, and communication skill-development meetings. A series of…

Carbon Capture Multidisciplinary Simulation Center Trilab Support Team (TST) Fall Meeting 2016 Report

Energy Technology Data Exchange (ETDEWEB)

Draeger, Erik W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

2017-01-03

The theme of this year’s meeting was “Predictivity: Now and in the Future”. After welcoming remarks, Erik Draeger gave a talk on the NNSA Labs’ history of predictive simulation and the new challenges faced by upcoming architecture changes. He described an example where the volume of analysis data produced by a set of inertial confinement fusion (ICF) simulations on the Trinity machine was too large to store or transfer, and the steps needed to reduce it to a manageable size. He also described the software re-engineering plan for LLNL’s suite of multiphysics codes and physics packages with a new push toward common components, making collaboration with teams like the CCMSC who already have experience trying to architect complex multiphysics code infrastructure on next-generation architectures all the more important. Phil Smith then gave an overview outlining the goals of the project, namely to accelerate development of new technology in the form of high efficiency carbon capture pulverized coal power generation as well as further optimize existing state of the art designs. He then presented a summary of the Center’s top-down uncertainty quantification approach, in which ultimate target predictivity informs uncertainty targets for lower-level components, and gave data on how close all the different components currently are to their targets. Most components still need an approximately two-fold reduction in uncertainty to hit the ultimate predictivity target, but the current accuracy is already rather impressive.

The Diversity of Providers on the Family Medicine Team.

Science.gov (United States)

Bazemore, Andrew; Wingrove, Peter; Peterson, Lars; Petterson, Stephen

2016-01-01

Family physicians are increasingly incorporating other health care providers into their practice teams to better meet the needs of increasingly complex and comorbid patients. While a majority of family physicians report working with a nurse practitioner, only 21% work with a behavioral health specialist. A better understanding of optimal team composition and function in primary care is essential to realizing the promise of a patient-centered medical home and achieving the triple aim. © Copyright 2016 by the American Board of Family Medicine.

A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes.

Science.gov (United States)

Geach, Nicole; Moghaddam, Nima G; De Boos, Danielle

2017-10-03

Team formulation is promoted by professional practice guidelines for clinical psychologists. However, it is unclear whether team formulation is understood/implemented in consistent ways - or whether there is outcome evidence to support the promotion of this practice. This systematic review aimed to (1) synthesize how team formulation practice is defined and implemented by practitioner psychologists and (2) analyse the range of team formulation outcomes in the peer-reviewed literature. Seven electronic bibliographic databases were searched in June 2016. Eleven articles met inclusion criteria and were quality assessed. Extracted data were synthesized using content analysis. Descriptions of team formulation revealed three main forms of instantiation: (1) a structured, consultation approach; (2) semi-structured, reflective practice meetings; and (3) unstructured/informal sharing of ideas through routine interactions. Outcome evidence linked team formulation to a range of outcomes for staff teams and service users, including some negative outcomes. Quality appraisal identified significant issues with evaluation methods; such that, overall, outcomes were not well-supported. There is weak evidence to support the claimed beneficial outcomes of team formulation in practice. There is a need for greater specification and standardization of 'team formulation' practices, to enable a clearer understanding of any relationships with outcomes and implications for best-practice implementations. Under the umbrella term of 'team formulation', three types of practice are reported: (1) highly structured consultation; (2) reflective practice meetings; and (3) informal sharing of ideas. Outcomes linked to team formulation, including some negative outcomes, were not well evidenced. Research using robust study designs is required to investigate the process and outcomes of team formulation practice. © 2017 The British Psychological Society.

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

Science.gov (United States)

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

2015-02-01

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

77 FR 12008 - Civil Nuclear Trade Advisory Committee Public Meeting

Science.gov (United States)

2012-02-28

... make statements is greater than can be reasonably accommodated during the meeting, ITA may conduct a... within 90 days of the meeting. Man K. Cho, Team Leader for Energy, Office of Energy and Environmental...

Virtual Team and Trust Relationship: Focus Group Interviews in Multimedia Super Corridor Status Companies

Directory of Open Access Journals (Sweden)

Norizah Aripin

2011-12-01

Full Text Available This paper aims to discuss the trust relationship in virtual teams in Multimedia Super Corridor (MSC status companies. The study used qualitative method that is phenomenology approach through focus group interviews. In-depth interview were also used with semi-structured and openended questions. The interviews involved six staffs at different position in virtual team (two team leaders, and four team members. The interviews were recorded, transcribed and analyzed according to the thematic analysis. Results showed that dimensions on virtual team trust relationship including interpersonal communication, personality, team members size, face-to-face meeting needs, safety information when discussing face-to-face in public places, and difficulty to recall interaction via video conferencing with other team members.

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

Science.gov (United States)

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

2017-05-01

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

Supportive Supervision: Meeting to Build Interdisciplinary Teams in the Northern Central Regional Office of the CEN CINAI

Directory of Open Access Journals (Sweden)

Georgianella Araya-Alegría

2015-01-01

Full Text Available This article is the result of a participatory action research project aimed at providing a novel approach for the Northern Central Regional Office of the CEN CINAI [Education and Nutrition Centers (CEN and the Children’s Nutrition and Comprehensive Care Centers (CINAI] to build knowledge on an unfinished process: “Supportive Supervision” (supervisión capacitante.  Based on a naturalistic premise, we tried to answer a question that guided us in the group creation and transformation, switching our meetings from a vertical standpoint to a horizontal relationship providing accompaniment, support and construction, as well as analysis and reflection. The article shows the aspects that justified the development of the participative action research process under a methodological proposal that involves those of us who participated and contributed to build knowledge with our experience and from different locations within the Region.  A total of 29 professionals participated, willing to jointly meet a purpose: construct knowledge based on team work and on a process full of uncertainty that encourages us to constantly revise what has already been built and enables us to re-read and retake what has already been written and to systematize what could not be written before. In order words, to make this process a new way of developing knowledge that implies a more concrete standpoint to understand what “Supportive Supervision” is and how it is done, with the purpose of always looking for improvement within the National Directorate of CEN CINAI.

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

Science.gov (United States)

Paul, Sally; Quinn, Helen

2015-04-01

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

Meeting of the ITER CTA Project Board

International Nuclear Information System (INIS)

Vlasenkov, V.

2001-01-01

The meeting of the ITER CTA Project Board took place in Toronto, Canada on 7 November 2001, on the occasion of the first Negotiations Meeting. Twelve participants, representing PB members and experts from Canada, the EU, Japan, the RF and the international Team (IT), attended the meeting chaired by Acad. E. Velikhov. Discussions on the preliminary work programme for the CTA and organizational arrangements for the IT and PT took most of the time of the meeting. The Project Board approved the preliminary work programme as presented by the IT leader

Successful participation of patients in interprofessional team meetings : a qualitative study

NARCIS (Netherlands)

Anna Beurskens; Marloes Amantia van Bokhoven; Jerôme Jean Jacques van Dongen; Iris Habets

2016-01-01

Background: The number of people with multiple chronic conditions increases as a result of ageing. To deal with the complex health-care needs of these patients, it is important that health-care professionals collaborate in interprofessional teams. To deliver patient-centred care, it is often

Worlds meet in Building 180.

CERN Multimedia

Raphael Vuillermet

In the assembly hall of Building 180, several teams of various nationalities and different countries work together for the ATLAS forward muon detector. For nearly two years, Americans, Chinese, Europeans, Israelis, Japanese, Pakistanis and Russians are assembling and testing the so-called "Big Wheels" and the muon EIL4 stations. Each team is independent in its tasks: one team is assembling the mechanical structure, another one is installing services and muon chambers, while a third is testing the electronics and the gas system. A team is in charge of the transport and storage of the sectors and another is assembling the sectors in the ATLAS cavern. A total of nearly 60 people are participating in this project. Some members for the ATLAS Big Wheel team in the assembly hall of building 180. People from different cultures and religions and with different mother tongues are working side by side in harmony. Everyone in building 180, from technicians to professors, has the opportunity to meet and work with...

Summary of Prioritized Research Opportunities: Building America Program Planning Meeting, Washington, D.C., November 2-4, 2010

Energy Technology Data Exchange (ETDEWEB)

2011-02-01

This report outlines the results of brainstorming sessions conducted at the Building America Fall 2010 planning meeting, in which research teams and national laboratories identified key research priorities to incorporate into multi-year planning, team research agendas, expert meetings, and technical standing committees.

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

Science.gov (United States)

Lindholm, Kristin

2017-12-01

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

Fifth technical meeting on quality

International Nuclear Information System (INIS)

Girard, A.

1998-01-01

This article reports on the 5th Technical Meeting on Quality which was held in San Diego on 20-22 October 1997 and which was attended by representatives of the Home and Joint Central Team and of manufacturers currently involved in the Large R and D projects. The meeting made progress towards the finalization of the ITER Quality Manual document for inclusion in the Final Design Report and the definition of the quality necessary for ITER procurement and construction

Dire deadlines: coping with dysfunctional family dynamics in an end-of-life care setting.

Science.gov (United States)

Holst, Lone; Lundgren, Maren; Olsen, Lutte; Ishøy, Torben

2009-01-01

Working in a hospice and being able to focus on individualized, specialized end-of-life care is a privilege for the hospice staff member. However, it also presents the hospice staff with unique challenges. This descriptive study is based upon two cases from an end-of-life care setting in Denmark, where dysfunctional family dynamics presented added challenges to the staff members in their efforts to provide optimal palliative care. The hospice triad--the patient, the staff member and the family member--forms the basis for communication and intervention in a hospice. Higher expectations and demands of younger, more well-informed patients and family members challenge hospice staff in terms of information and communication when planning for care. The inherent risk factors of working with patients in the terminal phase of life become a focal point in the prevention of the development of compassion fatigue among staff members. A series of coping strategies to more optimally manage dysfunctional families in a setting where time is of the essence are then presented in an effort to empower the hospice team, to prevent splitting among staff members, and to improve quality of care.

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

Science.gov (United States)

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

2018-03-07

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

77 FR 42484 - Civil Nuclear Trade Advisory Committee (CINTAC) Public Meeting

Science.gov (United States)

2012-07-19

.... If the number of registrants requesting to make statements is greater than can be reasonably.... Copies of CINTAC meeting minutes will be available within 90 days of the meeting. Man K. Cho, Team Leader...

A Dozen Reasons Some Meetings Bomb--And Others Work Wonders.

Science.gov (United States)

Bradford, Leland P.

1978-01-01

Effective meetings require three simultaneous operations: task activity (working on the agenda), maintenance (keeping the group in good working order), and team building (strengthening group's capacity to face future issues successfully). Discusses twelve reasons for group dysfunction during meetings. (EM)

A Project Team Analysis Using Tuckman's Model of Small-Group Development.

Science.gov (United States)

Natvig, Deborah; Stark, Nancy L

2016-12-01

Concerns about equitable workloads for nursing faculty have been well documented, yet a standardized system for workload management does not exist. A project team was challenged to establish an academic workload management system when two dissimilar universities were consolidated. Tuckman's model of small-group development was used as the framework for the analysis of processes and effectiveness of a workload project team. Agendas, notes, and meeting minutes were used as the primary sources of information. Analysis revealed the challenges the team encountered. Utilization of a team charter was an effective tool in guiding the team to become a highly productive group. Lessons learned from the analysis are discussed. Guiding a diverse group into a highly productive team is complex. The use of Tuckman's model of small-group development provided a systematic mechanism to review and understand group processes and tasks. [J Nurs Educ. 2016;55(12):675-681.]. Copyright 2016, SLACK Incorporated.

Report of the US Department of Energy's team analyses of the Chernobyl-4 Atomic Energy Station accident sequence

International Nuclear Information System (INIS)

1986-11-01

In an effort to better understand the Chernobyl-4 accident of April 26, 1986, the US Department of Energy (DOE) formed a team of experts from the National Laboratories including Argonne National Laboratory, Brookhaven National Laboratory, Oak Ridge National Laboratory, and Pacific Northwest Laboratory. The DOE Team provided the analytical support to the US delegation for the August meeting of the International Atomic Energy Agency (IAEA), and to subsequent international meetings. The DOE Team has analyzed the accident in detail, assessed the plausibility and completeness of the information provided by the Soviets, and performed studies relevant to understanding the accident. The results of these studies are presented in this report

Killer Apps: Developing Novel Applications That Enhance Team Coordination, Communication, and Effectiveness.

Science.gov (United States)

Buengeler, Claudia; Klonek, Florian; Lehmann-Willenbrock, Nale; Morency, Louis-Philippe; Poppe, Ronald

2017-10-01

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 contexts that are meaningful and challenging for both. First, we discuss interaction processes during team meetings as a research topic for both Groupies and Geeks. Second, we highlight teamwork in health care settings as an interdisciplinary research challenge. Third, we discuss how an automated solution for optimal team design could benefit team effectiveness and feed into team-based interventions. Fourth, we discuss team collaboration in massive open online courses as a challenge for both Geeks and Groupies. We argue for the necessary integration of social and computational research insights and approaches. In the hope of inspiring future interdisciplinary collaborations, we develop criteria for evaluating killer apps-including the four proposed here-and discuss future research challenges and opportunities that potentially derive from these developments.

What Is the Half-Life of Basketball Teams?

Science.gov (United States)

Hrepic, Zdeslav

2013-01-01

What do basketball teams have in common with radioactive nuclei? It turns out, there is more here than first meets the eye. The National Collegiate Athletic Association (NCAA) basketball tournaments feeds fans' craving when NBA competitions are not in swing, and the college tournament time has been referred to as "March Madness" or…

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

Directory of Open Access Journals (Sweden)

Saber Azami-Aghdash

2015-01-01

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

Planning a pharmacy-led medical mission trip, part 2: servant leadership and team dynamics.

Science.gov (United States)

Brown, Dana A; Brown, Daniel L; Yocum, Christine K

2012-06-01

While pharmacy curricula can prepare students for the cognitive domains of pharmacy practice, mastery of the affective aspects can prove to be more challenging. At the Gregory School of Pharmacy, medical mission trips have been highly effective means of impacting student attitudes and beliefs. Specifically, these trips have led to transformational changes in student leadership capacity, turning an act of service into an act of influence. Additionally, building team unity is invaluable to the overall effectiveness of the trip. Pre-trip preparation for teams includes activities such as routine team meetings, team-building activities, and implementation of committees, as a means of promoting positive team dynamics. While in the field, team dynamics can be fostered through activities such as daily debriefing sessions, team disclosure times, and provision of medical services.

77 FR 53179 - North Pacific Fishery Management Council; Public Meeting

Science.gov (United States)

2012-08-31

.... SUMMARY: The North Pacific Fishery Management Council's (NPFMC) Crab Plan Team (CPT) will meet in Seattle... Pacific Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS..., WA. Council address: North Pacific Fishery Management Council, 605 W. 4th Avenue, Suite 306...

Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work.

Science.gov (United States)

Mazzocato, Pamela; Forsberg, Helena Hvitfeldt; Schwarz, Ulrica von Thiele

2011-11-15

Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors. We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process. This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed

Ninth ITER technical meeting on safety and environment

International Nuclear Information System (INIS)

Raeder, J.; Gordon, C.

2001-01-01

The ninth ITER Technical Meeting on safety and environment, the last in the course of the ITER Engineering Design Activities (EDA), was held at the ITER Garching Joint Work site, 8 to 10 May 2001. At this Meeting, safety experts from the House Teams worked together with the members of the Safety, Environment and Health Groups (SEHG) of the ITER Joint Central Team (JCT) in the following areas: finalization of the Generic Site Safety report (GSSR) which is considered to be the most important objective of the present work; summary of the safety related R and D work done by the Home Teams for ITER during EDA; review of verification and validation work done on computer codes being applied for Safety and Environment (S and E) analyses; outline of work considered necessary for improving the S and E database, quantifying uncertainties of the code results and preparing the adaptation of ITER to a specific site

When Teams Fail to Self-Regulate: Predictors and Outcomes of Team Procrastination Among Debating Teams.

Science.gov (United States)

Van Hooft, Edwin A J; Van Mierlo, Heleen

2018-01-01

Models of team development have indicated that teams typically engage in task delay during the first stages of the team's life cycle. An important question is to what extent this equally applies to all teams, or whether there is variation across teams in the amount of task delay. The present study introduces the concept of team procrastination as a lens through which we can examine whether teams collectively engage in unplanned, voluntary, and irrational delay of team tasks. Based on theory and research on self-regulation, team processes, and team motivation we developed a conceptual multilevel model of predictors and outcomes of team procrastination. In a sample of 209 student debating teams, we investigated whether and why teams engage in collective procrastination as a team, and what consequences team procrastination has in terms of team member well-being and team performance. The results supported the existence of team procrastination as a team-level construct that has some stability over time. The teams' composition in terms of individual-level trait procrastination, as well as the teams' motivational states (i.e., team learning goal orientation, team performance-approach goal orientation in interaction with team efficacy) predicted team procrastination. Team procrastination related positively to team members' stress levels, especially for those low on trait procrastination. Furthermore, team procrastination had an indirect negative relationship with team performance, through teams' collective stress levels. These findings add to the theoretical understanding of self-regulatory processes of teams, and highlight the practical importance of paying attention to team-level states and processes such as team goal orientation and team procrastination.

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

Science.gov (United States)

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

2015-05-01

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

Simulation team training for improved teamwork in an intensive care unit.

Science.gov (United States)

Sandahl, Christer; Gustafsson, Helena; Wallin, Carl-Johan; Meurling, Lisbet; Øvretveit, John; Brommels, Mats; Hansson, Johan

2013-01-01

This study aims to describe implementation of simulator-based medical team training and the effect of this programme on inter-professional working in an intensive care unit (ICU). Over a period of two years, 90 percent (n = 152) of the staff of the general ICU at Karolinska University Hospital, Huddinge, Sweden, received inter-professional team training in a fully equipped patient room in their own workplace. A case study method was used to describe and explain the planning, formation, and results of the training programme. In interviews, the participants reported that the training had increased their awareness of the importance of effective communication for patient safety. The intervention had even had an indirect impact by creating a need to talk, not only about how to communicate efficaciously, but also concerning difficult care situations in general. This, in turn, had led to regular reflection meetings for nurses held three times a week. Examples of better communication in acute situations were also reported. However, the findings indicate that the observed improvements will not last, unless organisational features such as staffing rotas and scheduling of rounds and meetings can be changed to enable use of the learned behaviours in everyday work. Other threats to sustainability include shortage of staff, overtime for staff, demands for hospital beds, budget cuts, and poor staff communication due to separate meetings for nurses and physicians. The present results broaden our understanding of how to create and sustain an organizational system that supports medical team training.

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

Science.gov (United States)

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

2014-03-01

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

When Teams Fail to Self-Regulate: Predictors and Outcomes of Team Procrastination Among Debating Teams

Science.gov (United States)

Van Hooft, Edwin A. J.; Van Mierlo, Heleen

2018-01-01

Models of team development have indicated that teams typically engage in task delay during the first stages of the team’s life cycle. An important question is to what extent this equally applies to all teams, or whether there is variation across teams in the amount of task delay. The present study introduces the concept of team procrastination as a lens through which we can examine whether teams collectively engage in unplanned, voluntary, and irrational delay of team tasks. Based on theory and research on self-regulation, team processes, and team motivation we developed a conceptual multilevel model of predictors and outcomes of team procrastination. In a sample of 209 student debating teams, we investigated whether and why teams engage in collective procrastination as a team, and what consequences team procrastination has in terms of team member well-being and team performance. The results supported the existence of team procrastination as a team-level construct that has some stability over time. The teams’ composition in terms of individual-level trait procrastination, as well as the teams’ motivational states (i.e., team learning goal orientation, team performance-approach goal orientation in interaction with team efficacy) predicted team procrastination. Team procrastination related positively to team members’ stress levels, especially for those low on trait procrastination. Furthermore, team procrastination had an indirect negative relationship with team performance, through teams’ collective stress levels. These findings add to the theoretical understanding of self-regulatory processes of teams, and highlight the practical importance of paying attention to team-level states and processes such as team goal orientation and team procrastination. PMID:29674991

When Teams Fail to Self-Regulate: Predictors and Outcomes of Team Procrastination Among Debating Teams

Directory of Open Access Journals (Sweden)

Edwin A. J. Van Hooft

2018-04-01

Full Text Available Models of team development have indicated that teams typically engage in task delay during the first stages of the team’s life cycle. An important question is to what extent this equally applies to all teams, or whether there is variation across teams in the amount of task delay. The present study introduces the concept of team procrastination as a lens through which we can examine whether teams collectively engage in unplanned, voluntary, and irrational delay of team tasks. Based on theory and research on self-regulation, team processes, and team motivation we developed a conceptual multilevel model of predictors and outcomes of team procrastination. In a sample of 209 student debating teams, we investigated whether and why teams engage in collective procrastination as a team, and what consequences team procrastination has in terms of team member well-being and team performance. The results supported the existence of team procrastination as a team-level construct that has some stability over time. The teams’ composition in terms of individual-level trait procrastination, as well as the teams’ motivational states (i.e., team learning goal orientation, team performance-approach goal orientation in interaction with team efficacy predicted team procrastination. Team procrastination related positively to team members’ stress levels, especially for those low on trait procrastination. Furthermore, team procrastination had an indirect negative relationship with team performance, through teams’ collective stress levels. These findings add to the theoretical understanding of self-regulatory processes of teams, and highlight the practical importance of paying attention to team-level states and processes such as team goal orientation and team procrastination.

Team Learning and Team Composition in Nursing

Science.gov (United States)

Timmermans, Olaf; Van Linge, Roland; Van Petegem, Peter; Elseviers, Monique; Denekens, Joke

2011-01-01

Purpose: This study aims to explore team learning activities in nursing teams and to test the effect of team composition on team learning to extend conceptually an initial model of team learning and to examine empirically a new model of ambidextrous team learning in nursing. Design/methodology/approach: Quantitative research utilising exploratory…

The Research of Self-Management Team and Superior-Direction Team in Team Learning Influential Factors

OpenAIRE

Zhang Wei

2013-01-01

Team learning is a cure for bureaucracy; it facilitates team innovation and team performance. But team learning occurs only when necessary conditions were met. This research focused on differences of team learning influential factors between self-management team and superior-direction team. Four variables were chosen as predictors of team learning though literature review and pilot interview. The 4 variables are team motivation, team trust, team conflict and team leadership. Selected 54 self ...

The impact of team familiarity and team leader experience on team coordination errors: A panel analysis of professional basketball teams

NARCIS (Netherlands)

Sieweke, Jost; Zhao, B.

2015-01-01

To explore the dynamics involved in team coordination, we examine the impact of team familiarity and team leader experience on team coordination errors (TCEs). We argue that team familiarity has a U-shaped effect on TCEs. We study the moderating effects of team leader prior experience and team

75 FR 20985 - North Pacific Fishery Management Council; Public Meeting

Science.gov (United States)

2010-04-22

.... SUMMARY: The North Pacific Fishery Management Council's Crab Plan Team (CPT) will meet in Alaska on May 10... Pacific Fishery Management Council; Public Meeting AGENCY: National Marine Fisheries Service (NMFS... Room - May 14. Council address: North Pacific Fishery Management Council, 605 W. 4th Avenue, Suite 306...

GLOBAL TEAM MANAGEMENT: AN ESSENTIAL COMPONENT OF FIRMS’ INNOVATION STRATEGY

Directory of Open Access Journals (Sweden)

AZİM ÖZTÜRK

2013-05-01

Full Text Available In the world marketplace some firms compete successfully and others fail to gain global competitive advantage. Some researchers argue that innovation strategy is the answer to successfully meeting today’s and tomorrow’s global business challenges.  An important aspect of the innovation strategy is managing global teams effectively.  Thus, firms of tomorrow will be characterized by values such as teamwork, innovation, cultural diversity, and a global mindset.  The rapid globalization of business, and increasing competition will continue to drive the need for effective teamwork and/in innovation management.  The purpose of our research is to gain insight into global team management and its role as a major component of innovation strategy.  We discuss the changing and developing functions of teamwork, examine the characteristics of global teams, and finally offer a process to achieve effective global team management.

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

Science.gov (United States)

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

2018-03-01

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

An Examination of Leadership Types among Generation Y and Its Impact on Virtual Team Effectiveness

Science.gov (United States)

Graham, C. Matt

2013-01-01

The majority of database system development projects end in failure. Reasons that include, the system not being developed on time, the system was developed over budget, and the system developed did not meet the planned project's criteria. These failures are compounded by the use of virtual teams which includes problems with team formation, the…

The proliferation of multidisciplinary team meetings (MDTMs): how can radiology departments continue to support them all?

International Nuclear Information System (INIS)

Balasubramaniam, Ravivarma; Subesinghe, Manil; Smith, Jonathan T.

2015-01-01

To quantify the changes in multidisciplinary team meeting (MDTM) workload for consultant radiologists working in a single UK tertiary referral cancer institution, assess its impact and suggest solutions to these challenges. The annual number of MDTM cases was collated over a 5-year period (2009 - 2013). Qualitative information was obtained through questionnaire-based interviews of 47 consultant radiologists. Data analysed included number of MDTMs involved with, type of MDTM (oncological or non-oncological), time allocation for preparation and perceived deficiencies in the current MDTM. Thirteen thousand and forty-nine cases were discussed in MDTMs in 2009 with a continued yearly increase over the 5-year period. Fifty-five percent of MDTM attendances were at oncological MDTMs. Consultant radiologists attended a median of two MDTMs per week, each requiring 4 hours time commitment; 60 % used out-of-hours time for MDTM preparation. The most frequently cited MDTM deficiency was lack of sufficient clinical input. The MDTM is a challenging but worthwhile demand on the modern radiologist's time. Solutions to the increasing MDTM workload include demonstration of the benefits of MDTMs to hospital administrators to justify additional resources required, improving MDTM efficiency and ensuring this increased workload is accurately represented and remunerated in individual job plans. (orig.)

The proliferation of multidisciplinary team meetings (MDTMs): how can radiology departments continue to support them all?

Energy Technology Data Exchange (ETDEWEB)

Balasubramaniam, Ravivarma; Subesinghe, Manil; Smith, Jonathan T. [St. James' University Hospital, Leeds Teaching Hospitals NHS Trust, Department of Clinical Radiology, Leeds (United Kingdom)

2015-12-15

To quantify the changes in multidisciplinary team meeting (MDTM) workload for consultant radiologists working in a single UK tertiary referral cancer institution, assess its impact and suggest solutions to these challenges. The annual number of MDTM cases was collated over a 5-year period (2009 - 2013). Qualitative information was obtained through questionnaire-based interviews of 47 consultant radiologists. Data analysed included number of MDTMs involved with, type of MDTM (oncological or non-oncological), time allocation for preparation and perceived deficiencies in the current MDTM. Thirteen thousand and forty-nine cases were discussed in MDTMs in 2009 with a continued yearly increase over the 5-year period. Fifty-five percent of MDTM attendances were at oncological MDTMs. Consultant radiologists attended a median of two MDTMs per week, each requiring 4 hours time commitment; 60 % used out-of-hours time for MDTM preparation. The most frequently cited MDTM deficiency was lack of sufficient clinical input. The MDTM is a challenging but worthwhile demand on the modern radiologist's time. Solutions to the increasing MDTM workload include demonstration of the benefits of MDTMs to hospital administrators to justify additional resources required, improving MDTM efficiency and ensuring this increased workload is accurately represented and remunerated in individual job plans. (orig.)

A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 2. Provision of professional services

Directory of Open Access Journals (Sweden)

Karlsson Bengt

2012-09-01

Full Text Available Abstract Background Crisis resolution and home treatment (CRHT is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team. Methods The project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009. Results The average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams.

78 FR 11628 - Western Pacific Fishery Management Council; Public Meetings

Science.gov (United States)

2013-02-19

... meetings will run as late as necessary to complete scheduled business. 10 a.m.-12 Noon, Monday, March 11... Natural Resources (DLNR) Report 1. Deep Sea to Clouds (fisheries/watershed management) 2. Enforcement 3... Team 4. Noncommercial Advisory Committee F. Meetings and Workshops G. Other Business H. Standing...

Self-reported teamwork in family health team practices in Ontario

Science.gov (United States)

Howard, Michelle; Brazil, Kevin; Akhtar-Danesh, Noori; Agarwal, Gina

2011-01-01

Abstract Objective To determine the organizational predictors of higher scores on team climate measures as an indicator of the functioning of a family health team (FHT). Design Cross-sectional study using a mailed survey. Setting Family health teams in Ontario. Participants Twenty-one of 144 consecutively approached FHTs; 628 team members were surveyed. Main outcome measures Scores on the team climate inventory, which assessed organizational culture type (group, developmental, rational, or hierarchical); leadership perceptions; and organizational factors, such as use of electronic medical records (EMRs), team composition, governance of the FHT, location, meetings, and time since FHT initiation. All analyses were adjusted for clustering of respondents within the FHT using a mixed random-intercepts model. Results The response rate was 65.8% (413 of 628); 2 were excluded from analysis, for a total of 411 participants. At the time of survey completion, there was a median of 4 physicians, 11 other health professionals, and 4 management and clerical staff per FHT. The average team climate score was 3.8 out of a possible 5. In multivariable regression analysis, leadership score, group and developmental culture types, and use of more EMR capabilities were associated with higher team climate scores. Other organizational factors, such as number of sites and size of group, were not associated with the team climate score. Conclusion Culture, leadership, and EMR functionality, rather than organizational composition of the teams (eg, number of professionals on staff, practice size), were the most important factors in predicting climate in primary care teams. PMID:21571706

Better team management--better team care?

Science.gov (United States)

Shelley, P; Powney, B

1994-01-01

Team building should not be a 'bolt-on' extra, it should be a well planned, integrated part of developing teams and assisting their leaders. When asked to facilitate team building by a group of NHS managers we developed a framework which enabled individual members of staff to become more effective in the way they communicated with each other, their teams and in turn within the organization. Facing the challenge posed by complex organizational changes, staff were able to use 3 training days to increase and develop their awareness of the principles of teamwork, better team management, and how a process of leadership and team building could help yield better patient care.

Sustainability of cross-functional teams for marketing strategy development and implementation.

Science.gov (United States)

Kono, Ken; Antonucci, Don

2006-01-01

This article presents a case study on a cross-functional team used for marketing strategy development and execution at a health insurance company. The study found a set of success factors that contributed to the initial success of the team, but the factors were not enough to maintain the team's high level of productivity over time. The study later identified a set of 8 factors that helped sustain the team's high-productivity level. The 2 sets (ie, success and its subsequent sustainability factors) are analyzed against a normative model of team effectiveness. All the factors are explained by the normative model except for 1 sustainability factor, "challenge motivator." In fact, the study found the "challenge motivator" to be the most critical factor to keep up the team's productivity over time. Apart from a performance crisis, the authors developed 3 "challenge motivators"--first, more granular market information that could unearth hidden performance issues; second, constant value creation to shareholders as the firm being publicly traded; and third, the firm's strategic mandate to meet and exceed customer expectations that puts ultimate performance pressure on the marketing strategy team.

Team responsibility structure and team performance

NARCIS (Netherlands)

Doorewaard, J.A.C.M.; Hootegem, G. van; Huys, R.

2002-01-01

The purpose is to analyse the impact of team responsibility (the division of job regulation tasks between team leader and team members) on team performance. It bases an analysis on 36 case studies in The Netherlands which are known to have implemented team‐based work. The case studies were executed

Palliative sedation in Germany: factors and treatment practices associated with different sedation rate estimates in palliative and hospice care services.

Science.gov (United States)

Stiel, Stephanie; Nurnus, Mareike; Ostgathe, Christoph; Klein, Carsten

2018-03-13

Clinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany. Data sets from 221 organisations from a prior online survey were separated into two sub-groups divided by their estimated sedation rate A) lower/equal to 16% (n = 187; 90.8%) and B) higher than 16% (n = 19; 9.2%) for secondary analysis. Demographic factors and characteristics of PS treatment practices between the two groups were compared using T-Tests and Chi 2 / Fisher Exact Tests and considered significant (*) at two-sided p palliative and hospice care representatives show divergence, which may be influenced one by another. A comprehensive framework considering conceptual, clinical, ethical, and legal aspects of different definitions of PS could help to better distinguish between different types and nuances of PS.

Team cohesion and team success in sport.

Science.gov (United States)

Carron, Albert V; Bray, Steven R; Eys, Mark A

2002-02-01

The main aim of this study was to examine the relationship between task cohesiveness and team success in elite teams using composite team estimates of cohesion. A secondary aim was to determine statistically the consistency (i.e. 'groupness') present in team members' perceptions of cohesion. Elite university basketball teams (n = 18) and club soccer teams (n = 9) were assessed for cohesiveness and winning percentages. Measures were recorded towards the end of each team's competitive season. Our results indicate that cohesiveness is a shared perception, thereby providing statistical support for the use of composite team scores. Further analyses indicated a strong relationship between cohesion and success (r = 0.55-0.67). Further research using multi-level statistical techniques is recommended.

Interdisciplinary team working in physical and rehabilitation medicine.

Science.gov (United States)

Neumann, Vera; Gutenbrunner, Christoph; Fialka-Moser, Veronika; Christodoulou, Nicolas; Varela, Enrique; Giustini, Alessandro; Delarque, Alain

2010-01-01

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.

75 FR 54221 - Government/Industry Aeronautical Charting Forum Meeting

Science.gov (United States)

2010-09-03

... Aeronautical Navigation Services (AeroNav Services) Group, Regulatory Support and Coordination Team, AJW-372...: The ACF is separated into two distinct groups. The Instrument Procedures Group (IPG) will meet October 26, 2010 from 8:30 a.m. to 5 p.m. The Charting Group will meet October 27 and 28, 2010 from 8:30 a.m...

76 FR 12211 - Government/Industry Aeronautical Charting Forum Meeting

Science.gov (United States)

2011-03-04

... Aeronautical Navigation Products Group (AeroNav Products), Regulatory Support and Coordination Team, AJV-3B...: The ACF is separated into two distinct groups. The Instrument Procedures Group (IPG) will meet April 26, 2011 from 8:30 a.m. to 5 p.m. The Charting Group will meet April 27 and 28, 2011 from 8:30 a.m...

Facilitated IEP Meetings. PHP-c90

Science.gov (United States)

PACER Center, 2004

2004-01-01

To help special education planning teams reach agreements, the Minnesota Department of Education and the Minnesota Special Education Mediation Service (MNSEMS) provide the option of facilitated IEP meetings. This option is available for IEP (Individualized Education Program), IIIP (Individual Interagency Intervention Plan), and IFSP (Individual…

Evaluating the Relationship between Team Performance and Joint Attention with Longitudinal Multivariate Mixed Models

Science.gov (United States)

2016-09-23

Sweller, J. (2005). Cognitive load theory and complex learning: Recent developments and future directions. Educational Psychology Review, 17(2), 147–177...Relationship between Team Performance and Joint Attention with Longitudinal Multivariate Mixed Models 5a. CONTRACT NUMBER FA8650-14-D-6501-0009 5b...Annual Meeting, 19-23 September 2016. 14. Previous research indicates that measures of joint attention provide unique insight into team cognition

Improving Care Teams' Functioning: Recommendations from Team Science.

Science.gov (United States)

Fiscella, Kevin; Mauksch, Larry; Bodenheimer, Thomas; Salas, Eduardo

2017-07-01

Team science has been applied to many sectors including health care. Yet there has been relatively little attention paid to the application of team science to developing and sustaining primary care teams. Application of team science to primary care requires adaptation of core team elements to different types of primary care teams. Six elements of teams are particularly relevant to primary care: practice conditions that support or hinder effective teamwork; team cognition, including shared understanding of team goals, roles, and how members will work together as a team; leadership and coaching, including mutual feedback among members that promotes teamwork and moves the team closer to achieving its goals; cooperation supported by an emotionally safe climate that supports expression and resolution of conflict and builds team trust and cohesion; coordination, including adoption of processes that optimize efficient performance of interdependent activities among team members; and communication, particularly regular, recursive team cycles involving planning, action, and debriefing. These six core elements are adapted to three prototypical primary care teams: teamlets, health coaching, and complex care coordination. Implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief. Training should be based on assessment of needs and tasks and the use of simulations and feedback, and it should extend to live action. Teamlets represent a potential launch point for team development and diffusion of teamwork principles within primary care practices. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Knowledge sharing in international product development teams

DEFF Research Database (Denmark)