Principles and Purpose: The Patient Surrogate's Perspective and Role

1997 ◽  
Vol 6 (4) ◽  
pp. 461-469 ◽  
Author(s):  
Tom Koch
Keyword(s):  
Patient Care ◽  
Critical Role ◽  
Medical Community ◽  
Care Providers ◽  
Home Based ◽  
Patient Representatives ◽  
Home Based Care ◽  
Treatment Alternatives ◽  
Affect Patient Care

The critical role of surrogates—commonly if erroneously called “Informal caregivers”—has been generally ignored by clinical and bioethical literatures. While assumed to provide no more than ancillary support, these patient representatives directly or indirectly affect patient care to the extent they inhibit or facilitate both home-based care and patient decisions regarding treatment alternatives. Members of this group include relatives and neighbors who may or may not act in consort as advisors, assistants, care providers, and surrogate decisionmakers acting on the patient's behalf with members of the medical community. Not only do they often possess a critical voice strongly influencing both patient care decisions and, after discharge, home care and rehabilitation, this paper argues they do so from a perspective that is often radically different from one endorsed by medical professionals.

scholarly journals “You get three different hats on and try to figure it out:” home based care provision during a disaster

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sue Anne Bell ◽  
Sarah Dickey ◽  
Marie-Anne Rosemberg
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Focus Groups ◽  
Home Health ◽  
Care Provision ◽  
Care Providers ◽  
Home Based ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Home Based Care

Abstract Background Home based care is a vital, and growing, part of the health care system that allows individuals to remain in their homes while still receiving health care. During a disaster, when normal health care systems are disrupted, home based care remains a vital source of support for older adults. The purpose of this paper is to qualitatively understand the barriers and facilitators of both patients and providers that influence the provision of home based care activities in two hurricane affected communities. Methods Using qualitative inquiry informed by the social ecological model, five focus groups were conducted with home based care providers (n = 25) in two settings affected by Hurricane Irma and Hurricane Harvey. An open-source database of home health agencies participating in Centers for Medicare and Medicaid Services programs was used to identify participants. Data were manually coded and larger themes were generated from recurring ideas and concepts using an abductive analysis approach. Results Twenty five participants were included in one of five focus groups. Of the 22 who responded to the demographic survey, 65 % were registered nurses, 20 % were Licensed Vocational Nurses (LVN), and 15 % were other types of health care providers. 12 % of the sample was male and 88 % was female. Five themes were identified in the analysis: barriers to implementing preparedness plans, adaptability of home based care providers, disasters exacerbate inequalities, perceived unreliability of government and corporations, and the balance between caring for self and family and caring for patients. Conclusions This study provides qualitative evidence on the factors that influence home based care provision in disaster-affected communities, including the barriers and facilitators faced by both patients and providers in preparing for, responding to and recovering from a disaster. While home based care providers faced multiple challenges to providing care during and after a disaster, the importance of community supports and holistic models of care in the immediate period after the disaster were emphasized. We recommend greater inclusion of home health agencies in the community planning process. This study informs the growing body of evidence on the value of home based care in promoting safety and well-being for older adults during a disaster.

scholarly journals Examining the role of MEDLINE as a patient care information resource: an analysis of data from the Value of Libraries study

2017 ◽  
Vol 105 (4) ◽  
Author(s):  
Kathel Dunn ◽  
Joanne Gard Marshall ◽  
Amber L. Wells ◽  
Joyce E. B. Backus
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Patient Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Resources ◽  
Information Resource ◽  
Care Providers ◽  
Other Information

Objective: This study analyzed data from a study on the value of libraries to understand the specific role that the MEDLINE database plays in relation to other information resources that are available to health care providers and its role in positively impacting patient care.Methods: A previous study on the use of health information resources for patient care obtained 16,122 responses from health care providers in 56 hospitals about how providers make decisions affecting patient care and the role of information resources in that process. Respondents indicated resources used in answering a specific clinical question from a list of 19 possible resources, including MEDLINE. Study data were examined using descriptive statistics and regression analysis to determine the number of information resources used and how they were used in combination with one another.Results: Health care professionals used 3.5 resources, on average, to aid in patient care. The 2 most frequently used resources were journals (print and online) and the MEDLINE database. Using a higher number of information resources was significantly associated with a higher probability of making changes to patient care and avoiding adverse events. MEDLINE was the most likely to be among consulted resources compared to any other information resource other than journals.Conclusions: MEDLINE is a critical clinical care tool that health care professionals use to avoid adverse events, make changes to patient care, and answer clinical questions.

Home-Based Versus Out-Patient/In-Patient Care for People with Serious Mental Illness

1994 ◽  
Vol 165 (2) ◽  
pp. 204-210 ◽  
Author(s):  
B. Audini ◽  
I. M. Marks ◽  
R. E. Lawrence ◽  
J. Connolly ◽  
V. Watts
Keyword(s):  
Phase I ◽  
Patient Care ◽  
Phase Ii ◽  
Emergency Admission ◽  
Care Quality ◽  
Patient Admissions ◽  
Seriously Mentally Ill ◽  
Home Based ◽  
Randomised Controlled ◽  
Home Based Care

Background.The effect of a randomised controlled withdrawal of home-based care was studied for half of a sample of seriously mentally ill (SMI) patients from an inner London catchment area, compared with the effects of continuing home-based care.Method.Patients, aged 18–64, had entered the trial at month 0 when facing emergency admission for SMI. After at least 20 months home-based care (Phase I), patients were randomised at month 30 into Phase II (months 30–45) to have either further home-based care (DLPII, n = 33) or be transferred to out-/in-patient care (DLP-control, n = 33). They were assessed at 30, 34, and 45 months. Phase I control patients (n = 10) were assessed again at month 45. Measures used were number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.Results.The slim clinical and social gains from home-based v. out-/in-patient care during Phase I were largely lost in Phase II. Duration of crisis admissions increased from Phase I to Phase II in both DLPII and DLP-control patients. During Phase II, patients' and relatives' satisfaction remained greater for home-based than out-/in-patient care patients. At 45 months, compared with the Phase I controls, DLPII patients and relatives were more satisfied with care. Such satisfaction was independent of clinical/social gains.Conclusions.The loss of Phase I gains were perhaps due to attenuation of home-based care quality and to benefits of Phase I home-based care lingering into Phase II in DLP-controls. The Phase II home-based care team suffered from low morale.

scholarly journals Role of Home‐Based Care Programs During Hurricanes Harvey, Irma, and Maria

2019 ◽  
Vol 67 (8) ◽  
pp. 1754-1756 ◽  
Author(s):  
Tamar Wyte‐Lake ◽  
Maria Claver ◽  
Rachel Johnson‐Koenke ◽  
Darlene Davis ◽  
Aram Dobalian
Keyword(s):  
Home Based ◽  
Home Based Care

scholarly journals Father Involvement, Care, and Breadwinning: Genealogies of Concepts and Revisioned Conceptual Narratives

Genealogy ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. 14 ◽  
Author(s):  
Andrea Doucet
Keyword(s):  
Father Involvement ◽  
Critical Role ◽  
Historical Sociology ◽  
Paid Work ◽  
Care Providers ◽  
Political Risks ◽  
Binary Oppositions ◽  
Indirect Care ◽  
The Life Course

This paper addresses an enduring puzzle in fathering research: Why are care and breadwinning largely configured as binary oppositions rather than as relational and intra-acting concepts and practices, as is often the case in research on mothering? Guided by Margaret Somers’ historical sociology of concept formation, I conduct a Foucauldian-inspired genealogy of the concept of “father involvement” as a cultural and historical object embedded in specific histories, conceptual networks, and social and conceptual narratives. With the aim of un-thinking and re-thinking conceptual possibilities that might expand knowledges about fathering, care, and breadwinning, I look to researchers in other sites who have drawn attention to the relationalities of care and earning. Specifically, I explore two conceptual pathways: First the concept of “material indirect care”, from fatherhood research pioneer Joseph Pleck, which envisages breadwinning as connected to care, and, in some contexts, as a form of care; and second, the concept of “provisioning” from the work of feminist economists, which highlights broad, interwoven patterns of care work and paid work. I argue that an approach to concepts that connect or entangle caring and breadwinning recognizes that people are care providers, care receivers, financial providers, and financial receivers in varied and multiple ways across time. This move is underpinned by, and can shift, our understandings of human subjectivity as relational and intra-dependent, with inevitable periods of dependency and vulnerability across the life course. Such a view also acknowledges the critical role of resources, services, and policies for supporting and sustaining the provisioning and caring activities of all parents, including fathers. Finally, I note the theoretical and political risks of this conceptual exercise, and the need for caution when making an argument about fathers’ breadwinning and caregiving entanglements.

scholarly journals Care transition to skilled nursing facility – A model and a case study

2019 ◽  
Vol 8 (3) ◽  
pp. 38 ◽  
Author(s):  
Mohan Tanniru ◽  
Jacqueline Jones ◽  
Samer Kazziha ◽  
Michelle Hornberger
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Skilled Nursing Facility ◽  
Care Quality ◽  
Care Transition ◽  
Care Providers ◽  
Post Discharge ◽  
Nursing Facility ◽  
Skilled Nursing

Background: Healthcare providers have focused on improving patient care transitions to reduce unanticipated readmission costs, improve patient care quality post-discharge and increase patient satisfaction. This is especially true in US since the introduction of the Affordable Care Act. While there are several practices and evidence-based programs discussed in the literature to address care transition post-discharge, the key challenge remains the same – how to structure the care transition program to influence its effectiveness. In this paper, we focus on modeling one particular care transition – moving a patient from a hospital to a skilled nursing facility (SNF) – and discuss how improved capacity building and use of intermediaries such as advanced nurse practitioners have shown promise in reducing patient readmissions.Method: The methodology proposed here uses service dominant (SD) logic research to inductively derive a model for service exchanges between the two provider ecosystems. This model is then used to analyze service gaps and look for opportunities to innovate within an SNF and improve its capacity to deliver care. Use of intermediation that expands the service model with the addition of more care providers besides the hospital and SNF is also discussed to reduce patient readmissions.   Results: The study demonstrates that a number of actors have to work collaboratively to make care transition effective in meeting the patient and provider goals. Specifically, when two care facilities, hospital and SNF, are involved in care transition, opportunities exist to improve their internal capacity to address care within and across facilities.    Conclusion: The paper makes two important contributions. It shows the role of SD Logic in identifying opportunities for service innovations in support of care transition, and it shows the role of actors in provider-customer ecosystems to make the transition effective.    

scholarly journals Assessment of Utilization of HBCP Services for Children Diagnosed with Chronic and Terminal Illnesses Aged between 1-14 Years in Meru County, Kenya

2021 ◽  
pp. 29-45
Author(s):  
P. K. Kubai ◽  
A. M. Mutema ◽  
M. R. Kei
Keyword(s):  
Health Care ◽  
Care Program ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Home Based ◽  
Terminal Illnesses ◽  
Home Based Care

Introduction: Worldwide, 57 million people died in 2008 from Chronic Illnesses, an estimated 40 million were in need of HBCP services with 6.6 - 10.8 million Children and adolescents dying [1,2]. 98% of Children with Chronic and Terminal illnesses (CI/TI) are found in low and middle-income Countries. Chronic and Terminal illnesses in Children are on the rise in Sub Saharan Africa. Kenya has lagged in implementation of Home Based Care to mitigate effects of CI/TI [3]. According to WHO, 2017 and Ministry of Health-Kenya 2013, millions of Children are affected by these Illnesses such as Tuberculosis, Asthma, Congenital abnormalities, HIV/AIDS and Cancer among others [4,5]. These illnesses have made families’ to suffer emotional, psychosocial and economic hardships [6,7]. Evaluation of utilization of Home Based Care Program (EHBCP) services is significant in assessing effectiveness and quality delivery of HBCP [8,9].  Aims: To assess usage of minimum essential package required in provision of Home Based Care program services for Children aged between 1-14 years diagnosed with selected Chronic and Terminal illnesses in Meru County Kenya. Study Design:  A descriptive Cross Sectional Survey. Place and Duration of Study: Conducted in Meru County Kenya Health facilities between June 2018 and Dec 2019. Methodology: Descriptive Cross Sectional Survey of 245 Health Care Providers and Caregivers of Children diagnosed with selected by proportionate to size sampling and simple random sampling from different health facilities across Meru County was utilized. Results: Utilization, delivery of quality and effective Home Based Care program was positively associated with age, experience of Health Care Workers (HCWs) 4.8 [95% CI = 1.06 – 21.68, P = 0.041]. HCWs profession, gender and years of work were positively related to utilization and delivery of HBCP services 3.03 [95%CI = 1.64 – 5.59, P<0.001]. Conclusion: Current study concludes that utilization of Minimum HBCP essential package by participants was not effective and the quality delivery of minimum HBCP essential services was inadequate, which agrees with Sips et al., 2014 study that poor service delivery leads to inadequate utilization, it concludes that restructuring HBCP services would meet individual needs for ill Children.

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