210 - Palliative Care in Dementia

Introduction:Extreme neuropsychiatric symptoms (NPS) can be a heavy burden for nursing home (NH)-residents, relatives and caregivers. When conventional treatments are ineffective or have intolerable side effects, extreme NPS can be considered refractory. In these situations, continuous palliative sedation (CPS) is sometimes administered. We explored the trajectory leading to CPS and its application in NH-residents with dementia and refractory NPS.Methods:A qualitative interview study was performed in 2017. Relatives, elderly care physicians and other staff members involved with three NH-residents with dementia and extreme refractory NPS who received CPS were interviewed. These NH-residents lived on dementia special care units of three NHs in the Netherlands. We used consecutive sampling to select participants. Medical files were studied. Semi-structured interviews were conducted. Transcriptions were analyzed with thematic analysis, including directed content analysis.Results:Nine in-depth interviews with fourteen participants were held. Analysis resulted in five main themes with several subthemes reflecting phases of the trajectory leading to CPS and the CPS application itself, a sixth main theme concerned evaluations thereof. According to the first theme (run-up), the suffering of the NH-resident was described as unbearable/an inner struggle. Participants still had hope for improvement. Concerning the second theme (turning point), hope was lost, participants were convinced they had tried everything and experienced feelings of powerlessness and failure. Regarding theme three (considering CPS), intermittent sedation was applied in all three cases and peer consultation was employed. Honoring the wish of the NH-resident and therapeutic uncertainties, among others, were important subthemes. According to theme four (decision to start CPS), in each case one specific aspect was a decisive trigger for administering CPS. Concerning theme five (applying CPS) feelings of relief were experienced after starting with CPS.Conclusions:The trajectory leading up to CPS in NH-residents with dementia and extreme refractory NPS was complex and burdensome, but the application led to relief and contentment of all those involved. We recommend to include external consultation in the decision process and to apply intermittent sedation as a preceding step when CPS is considered.

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Characterizations of preschool technology education: analyses of seven individual preschool teachers’ and childcare attendants’ descriptions of their teaching

International Journal of Technology and Design Education ◽

10.1007/s10798-021-09678-2 ◽

2021 ◽

Author(s):

Pernilla Sundqvist

Keyword(s):

Technology Education ◽

Narrative Analysis ◽

Digital Technology ◽

Preschool Teachers ◽

Learning Objective ◽

Structured Interviews ◽

Children's Play ◽

Staff Members ◽

The Subject ◽

Preschool Staff

AbstractIn recent decades the preschool has leaned more towards a learning-oriented pedagogy, where the subject of technology has been given a more prominent place. Still, studies on how individual preschool staff members perceive and teach technology is scarce. This study shows how seven preschool staff in Sweden describe their work with the subject of technology and how technology education is characterized in these descriptions. The data was produced by means of semi-structured interviews and a questionnaire and analyzed with narrative analysis. The results show very diverse practices of technology education, implying the learning possibilities for children in different preschools are not equal. Some of the staff describe a clear and conscious teaching of technology, while others describe teaching what can be viewed as a limited and/or shallow technology education, where technology is sometimes used as means for learning other subjects or contents rather than being the learning objective. Six ways to characterize technology education was found, namely: technology education (1) concerns technological objects and systems in children’s environment, (2) concerns learning to handle technological objects, (3) is doing experiments, (4) involves developing abilities, (5) is naturally included in children’s play and (6) departs from digital technology.

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The role of research in improving responsiveness of palliative care to migrants and other underserved populations in the Netherlands: a qualitative interview study

BMC Palliative Care ◽

10.1186/s12904-020-00701-2 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

M. Torensma ◽

B. D. Onwuteaka-Philipsen ◽

X. de Voogd ◽

D. L. Willems ◽

J. L. Suurmond

Keyword(s):

Palliative Care ◽

Healthcare Professionals ◽

Underserved Populations ◽

Ethnic Disparities ◽

Migration Background ◽

Structured Interviews ◽

Migrant Populations ◽

Funding Agencies ◽

Qualitative Interview Study ◽

Palliative Patient

Abstract Background The aging of migrant populations across Europe challenges researchers in palliative care to produce knowledge that can be used to respond to the needs of the growing group of patients with a migration background and address ethnic disparities in palliative care. The aim of this study was to identify what factors influence researchers’ efforts to address responsiveness of palliative care to patients with a migration background and other underserved populations in their projects. Methods We conducted semi-structured interviews with 11 researchers involved in seven projects under the Dutch national program for palliative care innovation. Results Researchers’ efforts to address responsiveness of palliative care in their projects were influenced by individual factors, i.e. awareness of the need for responsiveness to patients with a migration background; experience with responsiveness; and, differences in perceptions on responsiveness in palliative care. Researchers’ efforts were furthermore influenced by institutional factors, i.e. the interaction with healthcare institutions and healthcare professionals as they rely on their ability to identify the palliative patient with a migration background, address the topic of palliative care, and enrol these patients in research; scientific standards that limit the flexibility needed for responsive research; and, the responsiveness requirements set by funding agencies. Conclusion Researchers play a key role in ensuring research addresses responsiveness to patients with a migration background. Such responsiveness may also benefit other underserved populations. However, at times researchers lack the knowledge and experience needed for responsive research. To address this we recommend training in responsiveness for researchers in the field of palliative care. We also recommend training for healthcare professionals involved in research projects to increase enrolment of patients with a migration background and other underrepresented populations. Lastly, we encourage researchers as well as research institutions and funding agencies to allow flexibility in research practices and set a standard for responsive research practice.

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74 Improving Handover Between Doctors and Nurses on An Elderly Care Ward

Age and Ageing ◽

10.1093/ageing/afab030.35 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

K Suseeharan ◽

T Vedutla

Keyword(s):

High Risk ◽

Patient Care ◽

Positive Impact ◽

Elderly Care ◽

Task Completion ◽

Risk Area ◽

High Risk Area ◽

Staff Members ◽

Care Ward ◽

Doctors And Nurses

Abstract Background The Royal College of Physician guidelines (2011) identified handover as a “high risk step” in patient care, especially in recent times within the NHS where shift patterns lead to more disjointed care with a high reliance on effective handover by all staff members. Introduction At Cannock Chase hospital, Fairoak ward is an elderly care rehabilitation ward where there is a large multi-disciplinary team. While working on the ward as doctors we noticed that handover between the MDT was poor. Anecdotal evidence from both doctors and nurses felt that this was a high risk area in need of improvement. Aim to improve handover between doctors and nurses on this elderly care ward. Method To measure the quality of current handover practice we did a questionnaire. A total of 12 questionnaires were completed which showed that 92% of staff felt that handover on the ward was very poor and 50% preferred both written and verbal handover. We measured the number of tasks verbally handed over between doctors and nurses over 3 days. On average 65% of the tasks were completed. We then made the below interventions and re-audited to see if there was any improvement. Interventions over 3 week period: Results Questionnaire: Measuring task completion after interventions; Conclusion This project has made a positive change qualitatively and quantitatively to the ward handover practice. Staff satisfaction regarding handover has improved and the number of “handed over” tasks completed daily has significantly improved. The written handover sheet had poor utilisation by staff but in 4 months we are going to re-audit and trial the handover sheet again to further improve service delivery. We hope this improvement will have a positive impact on patient care on this elderly care ward.

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Assessing Users’ Privacy and Security Concerns of Smart Home Technologies

i-com ◽

10.1515/icom-2019-0015 ◽

2019 ◽

Vol 18 (3) ◽

pp. 197-216 ◽

Cited By ~ 1

Author(s):

Verena Zimmermann ◽

Paul Gerber ◽

Karola Marky ◽

Leon Böck ◽

Florian Kirchbuchner

Keyword(s):

Smart Home ◽

Elderly Care ◽

Security And Privacy ◽

Structured Interviews ◽

Privacy And Security ◽

Privacy Concerns ◽

Private Lives ◽

Societal Level ◽

Home Users

AbstractSmart Home technologies have the potential to increase the quality of life, home security and facilitate elderly care. Therefore, they require access to a plethora of data about the users’ homes and private lives. Resulting security and privacy concerns form a relevant barrier to adopting this promising technology. Aiming to support end users’ informed decision-making through addressing the concerns we first conducted semi-structured interviews with 42 potential and little-experienced Smart Home users. Their diverse concerns were clustered into four themes that center around attacks on Smart Home data and devices, the perceived loss of control, the trade-off between functionality and security, and user-centric concerns as compared to concerns on a societal level. Second, we discuss measures to address the four themes from an interdisciplinary perspective. The paper concludes with recommendations for addressing user concerns and for supporting developers in designing user-centered Smart Home technologies.

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“Smartphone Apps Are Cool, but Do They Help Me?”: A Qualitative Interview Study of Adolescents’ Perspectives on Using Smartphone Interventions to Manage Nonsuicidal Self-Injury

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063289 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3289

Author(s):

Anja Čuš ◽

Julian Edbrooke-Childs ◽

Susanne Ohmann ◽

Paul L. Plener ◽

Türkan Akkaya-Kalayci

Keyword(s):

Mental Health ◽

Young People ◽

Mental Health Problems ◽

Health Interventions ◽

Structured Interviews ◽

Related Factors ◽

Self Injury ◽

Qualitative Interview Study ◽

Mental Health Interventions ◽

Nonsuicidal Self Injury

Nonsuicidal self-injury (NSSI) is a major mental health problem associated with negative psychosocial outcomes and it most often starts in early adolescence. Despite this, adolescents are rarely involved in informing the development of interventions designed to address their mental health problems. This study aimed to (1) assess adolescents’ needs and preferences about future interventions that are delivered through smartphones and (2) develop a framework with implications for designing engaging digital mental health interventions. Fifteen adolescent girls, aged 12–18 years, who met diagnostic criteria for a current NSSI disorder and were in contact with mental health services, participated in semi-structured interviews. Following a reflexive thematic analysis approach, this study identified two main themes: (1) Experiences of NSSI (depicts the needs of young people related to their everyday experiences of managing NSSI) and (2) App in Context (portrays preferences of young people about smartphone interventions and reflects adolescents’ views on how technology itself can improve or hinder engaging with these interventions). Adolescent patients expressed interest in using smartphone mental health interventions if they recognize them as helpful, relevant for their life situation and easy to use. The developed framework suggests that digital mental health interventions are embedded in three contexts (i.e., person using the intervention, mental health condition, and technology-related factors) which together need to inform the development of engaging digital resources. To achieve this, the cooperation among people with lived experience, mental health experts, and human computer interaction professionals is vital.

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Registered nurses’ role experiences of caring for older stroke patients: a qualitative study

BMC Nursing ◽

10.1186/s12912-021-00626-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Wei Cheng ◽

Jiong Tu ◽

Xiaoyan Shen

Keyword(s):

Nursing Education ◽

Older People ◽

Registered Nurses ◽

Elderly Care ◽

The Elderly ◽

Working Environment ◽

Structured Interviews ◽

Stroke Patients ◽

Care Needs ◽

Nursing Clinical Practice

Abstract Background With China’s population ageing rapidly, stroke is becoming one of the major public health problems. Nurses are indispensable for caring for older patients with acute and convalescent stroke, and their working experiences are directly linked to the quality of care provided. The study aims to investigate registered nurses’ experiences of caring for older stroke patients. Methods A qualitative descriptive design was adopted. Data were collected via semi-structured interviews with 26 registered nurses about their lived experiences of caring for older stroke patients. Thematic analysis was used to analyze the data. Results Two main themes were identified. First, the nurses identified an obvious gap between their ideal role in elderly care and their actual practice. The unsatisfactory reality was linked to the practical difficulties they encountered in their working environment. Second, the nurses expressed conflicting feelings about caring for older stroke patients, displaying a sense of accomplishment, indifference, annoyance, and sympathy. Caring for older stroke patients also affects nurses psychologically and physically. The nurses were clear about their own roles and tried their best to meet the elderly people’s needs, yet they lack time and knowledge about caring for older stroke patients. The factors influencing their working experiences extend beyond the personal domain and are linked to the wider working environment. Conclusions Sustaining the nursing workforce and improving their working experiences are essential to meet the care needs of older people. Understanding nurses’ lived working experiences is the first step. At the individual level, nurse mangers should promote empathy, relieve anxiety about aging, and improve the job satisfaction and morale of nurses. At the institutional level, policymakers should make efforts to improve the nursing clinical practice environment, increase the geriatric nursing education and training, achieve a proper skill mix of the health workforce, and overall attract, prepare and sustain nurses regarding caring for older people in a rapidly aging society.

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Mealtime Care for People With Dementia: What Do Nursing Home Staff Think?

Innovation in Aging ◽

10.1093/geroni/igaa057.591 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 182-183

Author(s):

James Faraday ◽

Clare Abley ◽

Catherine Exley ◽

Joanne Patterson

Keyword(s):

Nursing Homes ◽

Ethnographic Study ◽

Direct Care ◽

Care Staff ◽

Direct Care Staff ◽

Structured Interviews ◽

Staff Members ◽

People With Dementia ◽

Comparison Approach ◽

The Right

Abstract More and more people with dementia are living in nursing homes (NH). Often, they depend on NH staff for help with eating and drinking. It is important that staff have the skills and support they need to provide good care at mealtimes. This qualitative study explores mealtime care for people with dementia, from the perspective of NH staff. Semi-structured interviews with NH staff (n=16) were carried out in two nursing homes. The homes were chosen to have diverse characteristics: one home had a large number of beds and was part of a small local organization; the other had a small number of beds and was part of a large national organization. Various staff members were interviewed, including direct care staff, senior carers, nurses, managers, and kitchen staff. Interviews were audio-recorded and transcribed verbatim. A constant comparison approach was taken, so that data from early interviews were explored in more depth subsequently. From the analysis, five themes emerged as important in mealtime care for people with dementia living in nursing homes: Setting the right tone; Working well as a team; Knowing the residents; Promoting autonomy and independence; Gently persevering. This work forms part of a larger ethnographic study on the topic, which includes data from residents with dementia, and family carers. Results will inform the development of a staff training intervention to optimize mealtime care for this population.

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Supportive care: men’s expectations who undergoing in vitro fertilization treatment

BMC Research Notes ◽

10.1186/s13104-020-05407-5 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Roghieh Bayrami ◽

Roksana Janghorban ◽

Fatemeh Effati-Daryani ◽

Masoumeh Hajshafiha

Keyword(s):

In Vitro Fertilization ◽

Supportive Care ◽

Deep Understanding ◽

Healthcare Setting ◽

Main Theme ◽

Structured Interviews ◽

Treatment Expectations ◽

Vitro Fertilization ◽

Data Saturation

Abstract Objective Infertile couples perceive some needs and expectations during treatment. Most studies have focused on infertile women’s needs. The study was done to explore the expectations of men who undergoing in in vitro fertilization (IVF) treatment. Participants were men whose wives undergo IVF treatment in the IVF clinic of Shahid Motahhri hospital in Urmia. Purposive sampling was performed and data collection was done through in-depth semi-structured interviews until data saturation. Results “Supportive care” was emerged as the main theme consisted of two categories. The first category was “to be treated with attention in healthcare setting” which included three subcategories: Receiving couple based care, establishing counseling centers, and continuous care. The second category was “to be welcomed in the society” which included two subcategories: Financial support from community and close family, and changing community views about IVF treatment. Expectations of men undergoing IVF focuses on supportive care. They seek to receive the kind of care from health care setting and society. A deep understanding of the needs could help practitioners to consider men’s expectations, and assist policy makers and researchers to design and implement interventions and programs in infertility clinics which enhance the partnership of infertile men and fulfill their expectations.

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How are patients with rare diseases and their carers in the UK impacted by the way care is coordinated? An exploratory qualitative interview study

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-020-01664-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Amy Simpson ◽

Lara Bloom ◽

Naomi J. Fulop ◽

Emma Hudson ◽

Kerry Leeson-Beevers ◽

...

Keyword(s):

Care Coordination ◽

Structured Interviews ◽

School Work ◽

Travel Costs ◽

Care Plans ◽

Use Of Technology ◽

Number Of Factors ◽

Qualitative Interview Study ◽

The Uk ◽

The Impact

Abstract Background Care coordination is considered important for patients with rare conditions, yet research addressing the impact of care coordination is limited. This study aimed to explore how care coordination (or lack of) impacts on patients and carers. Semi-structured interviews were conducted with 15 patients and carers/parents in the UK, representing a range of rare conditions (including undiagnosed conditions). Transcripts were analysed thematically in an iterative process. Results Participants described a range of experiences and views in relation to care coordination. Reports of uncoordinated care emerged: appointments were uncoordinated, communication between key stakeholders was ineffective, patients and carers were required to coordinate their own care, and care was not coordinated to meet the changing needs of patients in different scenarios. As a result, participants experienced an additional burden and barriers/delays to accessing care. The impacts described by patients and carers, either attributed to or exacerbated by uncoordinated care, included: impact on physical health (including fatigue), financial impact (including loss of earnings and travel costs), and psychosocial impact (including disruption to school, work and emotional burden). Overall data highlight the importance of flexible care, which meets individual needs throughout patients’/carers’ journeys. Specifically, study participants suggested that the impacts may be addressed by: having support from a professional to coordinate care, changing the approach of clinics and appointments (where they take place, which professionals/services are available and how they are scheduled), and improving communication through the use of technology, care plans, accessible points of contact and multi-disciplinary team working. Conclusion This study provides further evidence of impacts of uncoordinated care; these may be complex and influenced by a number of factors. Approaches to coordination which improve access to care and lessen the time and burden placed on patients and carers may be particularly beneficial. Findings should influence future service developments (and the evaluation of such developments). This will be achieved, in the first instance, by informing the CONCORD Study in the UK.

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Australian Community Pharmacy Harm-Minimisation Services: Scope for Service Expansion to Improve Healthcare Access

Pharmacy ◽

10.3390/pharmacy9020095 ◽

2021 ◽

Vol 9 (2) ◽

pp. 95

Author(s):

Sara S. McMillan ◽

Hidy Chan ◽

Laetitia H. Hattingh

Keyword(s):

Community Pharmacy ◽

Healthcare Access ◽

Further Education ◽

Community Pharmacies ◽

Structured Interviews ◽

Pharmacy Staff ◽

Harm Minimisation ◽

Staff Members ◽

Education Support

Community pharmacies are well positioned to participate in harm-minimisation services to reduce harms caused by both licit and illicit substances. Considering developments in pharmacist practices and the introduction of new professional pharmacy services, we identified a need to explore the contemporary role of community pharmacy in harm minimisation. Semi-structured interviews were undertaken to explore the opinions of stakeholders, pharmacy staff, and clients about the role of community pharmacy in harm minimisation, including provision of current services, experiences, and expectations. Participants (n = 28) included 5 stakeholders, 9 consumers, and 14 staff members from seven community pharmacies. Three over-arching themes were identified across the three participants groups: (i) scope and provision, (ii) complexity, and (iii) importance of person-centred advice and support in relation to community pharmacy harm minimisation services. Community pharmacies are valuable healthcare destinations for delivery of harm minimisation services, with scope for service expansion. Further education, support, and remuneration are needed, as well as linkage to other sector providers, in order to ensure that pharmacists and pharmacy staff are well equipped to provide a range of harm minimisation services.

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