Refractory suffering: The impact of team dynamics on the interdisciplinary palliative care team

2011 ◽  
Vol 9 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Kate Swetenham ◽  
Meg Hegarty ◽  
Katrina Breaden ◽  
Carol Grbich
Keyword(s):  
Palliative Care ◽  
Interdisciplinary Team ◽  
Team Cohesion ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Skill Sets ◽  
Team Members ◽  
Care Experience ◽  
The Individual ◽  
The Impact

AbstractObjective:This qualitative study aimed to describe the skill sets that experienced palliative care clinicians possess when managing refractory suffering.Method:Thirteen tape recorded semi-structured interviews and four online questionnaires were completed by participants with at least two years clinical palliative care experience. The research team undertook cross sectional thematic analysis of the transcribed interviews.Results:In the face of refractory suffering, team cohesion was identified as a key requirement to support the interdisciplinary team. However, team cohesion was found to be undermined by philosophical differences between team members, a paradigm shift concerning cure versus care and individual opinions regarding the chosen approach and levels of respect between the individual disciplines involved in the care of a person with a life limiting illness.Significance of results:The findings of this study highlight the precarious nature of the interdisciplinary team when significant challenges are faced. As a result of witnessing refractory suffering the division and fracturing of teams can easily occur; often team members are completely unaware of its cause. The findings of this study contribute to the limited literature on the nature of refractory suffering from the perspective of the interdisciplinary team.

scholarly journals A Qualitative Study of the Impact of COVID-19 on Hospice and Home-Based Palliative Care in Taiwan

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1029-1030
Author(s):  
YuHsuan (Olivia) Wang ◽  
Susan Enguidanos
Keyword(s):  
Palliative Care ◽  
Medical Team ◽  
Structured Interviews ◽  
Team Members ◽  
Time Points ◽  
Home Based ◽  
Alpha Variant ◽  
The Impact ◽  
Tremendous Impact

Abstract COVID-19 has had a tremendous impact on individuals and health care, particularly among those with serious illnesses. Although Taiwan initially reported low rates of COVID-19 (20.7 cases per million in 2020), by early 2021 the Alpha variant began spreading in Taiwan, which went into a soft lockdown from May to July. This study aimed to investigate the impact of COVID-19 on Hospice and Home-Based Palliative Care (HBPC) patients, family, and medical team member in Taiwan during different COVID-related time points. From November 2020 to May 2021, we conducted semi-structured interviews with 2 patient, 5 caregivers, and 8 medical team members in the hospice and HBPC setting to elicit their views about the impact of COVID-19 on care. Content analysis was used to guide the analysis of themes. Two researchers independently coded transcripts and met to reconcile codes. Results showed varying impact across the time points. In 2020, patients, caregivers, medical team members felt little impact of COVID-19. However, in 2021, HBPC caregivers reduced the frequency of HBPC visits to lower the household COVID-19 infection risk. Hospice and HBPC team members reported that more caregivers selected HBPC over hospice. They also observed an increase in complicated grief among family survivors following the soft lockdown. The impact of the pandemic on homecare provision increased as prevalence of COVID-19 increased, impacting care and quality of hospice and HBPC. Further research is needed to better understand the impact of the pandemic on the quality of hospice /HBPC and grief experiences.

scholarly journals A Multiple Stakeholder Perspective for Evaluating Community-Based Dementia Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 60-61
Author(s):  
Johan Suen
Keyword(s):  
Dementia Care ◽  
Structural Constraints ◽  
Care Provision ◽  
Care Providers ◽  
Structured Interviews ◽  
Community Based ◽  
Relational Factors ◽  
Care Relationships ◽  
The Individual ◽  
The Impact

Abstract For holistic interventions and research on dementia, it is fundamental to understand care experiences from the perspectives of carers, care recipients, and care professionals. While research on care dyads and triads have highlighted the effects of communication and interactional aspects on care relationships, there is a lack of knowledge on how individual-contextual and relational factors shape the provision and receipt of care in terms of decision-making processes, resource allocation, and expectations of care outcomes. Thus, this paper sheds light on (i) how carers negotiate care provision with other important life domains such as employment, household/family roles and conflicts, as well as their own health problems, life goals, values, and aspirations for ageing; (ii) how older adults with dementia perceive support and those who provide it; (iii) the structural constraints faced by care professionals in delivering a team-based mode of dementia care; and, taken together, (iv) how community-based dementia care is impeded by barriers at the individual, relational, and institutional levels. Findings were derived from semi-structured interviews and observational data from fieldwork conducted with 20 persons with dementia (median age = 82), 20 of their carers (median age = 60), and 4 professional care providers. All respondents were clients and staff of a multidisciplinary and community-based dementia care system in Singapore. Our analysis indicates the impact of dementia care is strongly mediated by the interplay between institutional/familial contexts of care provision and the various ‘orientations’ to cognitive impairment and seeking support, which we characterised as ‘denial/acceptance’, ‘obligated’, ‘overprotective’, and ‘precariously vulnerable’.

Impact of the Depth-to-Width Ratio of Periodically Stratified Tidal Channels on the Estuarine Circulation

2015 ◽  
Vol 45 (8) ◽  
pp. 2048-2069 ◽  
Author(s):  
Elisabeth Schulz ◽  
Henk M. Schuttelaars ◽  
Ulf Gräwe ◽  
Hans Burchard
Keyword(s):  
Eddy Viscosity ◽  
Transport Model ◽  
Stable Stratification ◽  
Estuarine Circulation ◽  
Width Ratio ◽  
Cross Sectional ◽  
Tidal Straining ◽  
The Individual ◽  
Periodic Stratification ◽  
The Impact

AbstractThe dependency of the estuarine circulation on the depth-to-width ratio of a periodically, weakly stratified tidal estuary is systematically investigated here for the first time. Currents, salinity, and other properties are simulated by means of the General Estuarine Transport Model (GETM) in cross-sectional slice mode, applying a symmetric Gaussian-shaped depth profile. The width is varied over four orders of magnitude. The individual along-channel circulation contributions from tidal straining, gravitation, advection, etc., are calculated and the impact of the depth-to-width ratio on their intensity is presented and elucidated. It is found that the estuarine circulation exhibits a distinct maximum in medium-wide channels (intermediate depth-to-width ratio depending on various parameters), which is caused by a maximum of the tidal straining contribution. This maximum is related to a strong tidal asymmetry of eddy viscosity and shear created by secondary strain-induced periodic stratification (2SIPS): in medium channels, transverse circulation generated by lateral density gradients due to laterally differential longitudinal advection induces stable stratification at the end of the flood phase, which is further increased during ebb by longitudinal straining (SIPS). Thus, eddy viscosity is low and shear is strong in the entire ebb phase. During flood, SIPS decreases the stratification so that eddy viscosity is high and shear is weak. The circulation resulting from this viscosity–shear correlation, the tidal straining circulation, is oriented like the classical, gravitational circulation, with riverine outflow at the surface and oceanic inflow close to the bottom. In medium channels, it is about 5 times as strong as in wide (quasi one-dimensional) channels, in which 2SIPS is negligible.

Sexuality and Intimacy Needs Within a Hospitalized Palliative Care Population: Results From a Qualitative Study

2021 ◽  
pp. 104990912110369
Author(s):  
Anne Kelemen ◽  
Clara Van Gerven ◽  
Katherine Mullins ◽  
Hunter Groninger
Keyword(s):  
Palliative Care ◽  
Family Relationships ◽  
Comparative Method ◽  
Future Research ◽  
Spiritual Needs ◽  
Structured Interviews ◽  
Course Of Illness ◽  
Serious Illness ◽  
Medical Teams ◽  
The Impact

Background: Palliative care (PC) clinicians are well trained to address physical, psychosocial and spiritual needs of patients who have a serious illness. However, one area that is often overlooked is intimacy and sexuality. Objective: To explore patient concerns regarding intimacy as it relates to illness, family reactions, physician conversations, and coping strategies and challenges. Methods: Eligible subjects (at least 18 years old, capacitated, receiving PC consultation at the lead author’s institution) participated in semi-structured interviews between November and December 2017. Transcripts were open-coded and analyzed using Dedoose 3.5.35 software. A constant comparative method was used to identify patterns in the data. Results: 21 interviews were analyzed and several themes emerged. Participants described the effect of physical and mental/emotional changes on their relationships. Family relationships, romantic relationships, and sexuality were prominent in patients’ experiences of intimacy and how it changed as the illness progressed. Relationships were often noted to strengthen during the course of illness, while sexual activity was frequently reported to be negatively impacted. Patients consistently reported little provider communication on the impact of illness on intimacy beyond instructions about what sexual activities they could or could not engage in. Conclusion: This study underlines the significant impact of serious, progressive illness on relationships, sexuality, and physical and emotional intimacy. It highlights that these topics continue to be priorities for patients with serious illness, and that medical teams frequently fail to address them at all. Future research should further explore these issues across diverse patient populations.

scholarly journals Understanding Low-value Care and Associated De-implementation Processes: A Qualitative Study of Choosing Wisely Interventions Across Canadian Hospitals

2021 ◽  
Author(s):  
Gillian Parker ◽  
Monika Kastner ◽  
Karen Born ◽  
Nida Shahid ◽  
Whitney Berta
Keyword(s):  
Process Model ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Choosing Wisely ◽  
Structured Interviews ◽  
Team Members ◽  
Implementation Processes ◽  
Healthcare Settings ◽  
National Campaigns ◽  
The Impact

Abstract Background:Choosing Wisely (CW) is an international movement comprised of national campaigns in more than 20 countries to reduce low-value care (LVC). Hospitals and healthcare providers are examining existing practices and putting interventions in place to reduce practices that offer little to no benefit to patients or may cause them harm. De-implementation, the reduction or removal of a healthcare practice is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations.Methods:Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis.Results:Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, specifically the impact of harm and resources. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions.Conclusions: This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

scholarly journals The influence of environment: Experiences of users of myoelectric arm prosthesis—a qualitative study

2017 ◽  
Vol 42 (1) ◽  
pp. 28-36 ◽  
Author(s):  
Cathrine Widehammar ◽  
Ingvor Pettersson ◽  
Gunnel Janeslätt ◽  
Liselotte Hermansson
Keyword(s):  
Environmental Factors ◽  
Environmental Aspects ◽  
Structured Interviews ◽  
Environmental Barriers ◽  
Myoelectric Prosthesis ◽  
Local Access ◽  
People’S Attitudes ◽  
The Individual ◽  
The Impact ◽  
And Training

Background: Prostheses are used to varying degrees; however, little is known about how environmental aspects influence this use. Objectives: To describe users’ experiences of how environmental factors influence their use of a myoelectric arm prosthesis. Study design: Qualitative and descriptive. Methods: A total of 13 patients previously provided with a myoelectric prosthetic hand participated. Their age, sex, deficiency level, etiology, current prosthesis use, and experience varied. Semi-structured interviews were audiotaped, transcribed, and analyzed through inductive content analysis. Results: Four categories were created from the data: “Prosthesis function,” “Other people’s attitudes,” “Support from family and healthcare,” and “Individual’s attitude and strategies.” The overarching theme, “Various degrees of embodiment lead to different experiences of environmental barriers and facilitators,” emerged from differences in individual responses depending on whether the individual was a daily or a non-daily prosthesis user. Environmental facilitators such as support from family and healthcare and good function and fit of the prosthesis seemed to help the embodiment of the prosthesis, leading to daily use. This embodiment seemed to reduce the influence of environmental barriers, for example, climate, attitudes, and technical shortcomings. Conclusion: Embodiment of prostheses seems to reduce the impact of environmental barriers. Support and training may facilitate the embodiment of myoelectric prosthesis use. Clinical relevance For successful prosthetic rehabilitation, environmental factors such as support and information to the patient and their social network about the benefits of prosthesis use are important. Local access to training in myoelectric control gives more people the opportunity to adapt to prosthesis use and experience less environmental barriers.

Building resilience in retail supply chains: Lessons learned from COVID-19 and future pathways

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Atif Saleem Butt
Keyword(s):  
Supply Chain ◽  
Supply Chains ◽  
United Arab Emirates ◽  
Cash Flows ◽  
Lessons Learned ◽  
Third Party ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Content Type ◽  
The Impact

PurposeThis study explores the countermeasures taken by retailers to mitigate the effects of COVID-19 on supply chain disruptions.Design/methodology/approachThis research uses a multiple case study approach and undertakes 36 semi-structured interviews with senior management of the four largest retailers of the United Arab Emirates. The respondents were designated at different positions such as Vice President, Director and Project Manager.FindingsResults reveal that retailers are employing six countermeasures to mitigate the effects of COVID-19 on supply chains. Particularly, retailers are securing required demand, preserving cash flows, redirecting inventory, adding capacity to their distribution centres, becoming more flexible with their direct or third-party logistics provider and finally widening delivery options for their suppliers to mitigate the impact of COVID-19.Research limitations/implicationsThis study has some limitations. First, the results of this study cannot be generalized to a broader population as it attempts to build an initial theory. Second, this study uses a cross-sectional approach to explore the countermeasures employed by retailing firms to mitigate the effects of COVID-19.Originality/valueA notable weakness in a supply chain disruption literature is an unfulfilled need for research examining the strategies employed by retailers to respond to/address the challenges posed by COVID-19. Our study fills this gap.

A qualitative exploration of young people and prison officers’ experiences of empathy within a young offenders’ institution

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Emily Anne Tarrant ◽  
Alison Torn
Keyword(s):  
Young People ◽  
Subjective Experience ◽  
Holistic Approach ◽  
Structured Interviews ◽  
Institutional Investment ◽  
Content Type ◽  
The Individual ◽  
Relationship Factors ◽  
The Impact ◽  
The Relationship

Purpose This study aims to explore the ways in which young people and prison staff (Prison Officers) within a youth custodial establishment experience empathy. Previous research tends to view empathy as a stable trait and one which people can develop through individual-centred therapy. There has been little consideration of the impact of relationship factors and context in relation to empathy experience and expression. The current study aims to address this by exploring the role of the custodial context in shaping empathy, including the potential impact of relationships, environmental factors and culture. Design/methodology/approach A qualitative approach was used to enable breadth and depth in the exploration of this area. Individual, semi-structured interviews were carried out with a purposive sample of three young people and three Prison Officers. Data was analysed using inductive thematic analysis informed by the guidelines of Braun and Clarke (2006) and King and Horrocks (2010). Findings Constructed themes included “constructions of empathy”, “recipe for empathy”, “institutional investment”, “the value of empathy” and “doing empathy”. Together, they provide detailed insight into the interplay of personal and wider contextual factors influencing the experience of empathy in a custodial setting. The findings suggest that the way in which young people and staff experience empathy in the custodial environment is unique. The findings suggest that empathy takes place within the context of relationships and is influenced by the nature of those relationships, along with the wider social context within which it occurs. Practical implications The findings of the current study support a move away from understanding empathy as an individual personality trait and instead viewing it as a dynamic experience that is changeable based upon the relationship and the context within which it occurs. The findings suggest that interventions aiming to develop empathy should look beyond the level of the individual and the relationship and focus upon developing environments that are supportive of empathy. Originality/value This study provides unique insights into the subjective experience of empathy in a custodial setting, presenting as one of the first to take a more holistic approach to understand this phenomenon.

scholarly journals Prevalence of musculoskeletal conditions and related disabilities in Bangladeshi adults: a cross-sectional national survey

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Ahmad Zahid-Al-Quadir ◽  
M. Mostafa Zaman ◽  
Shamim Ahmed ◽  
Mahfuzur Rahman Bhuiyan ◽  
Md Mujibur Rahman ◽  
...  
Keyword(s):  
Adhesive Capsulitis ◽  
Adult Population ◽  
Health Assessment ◽  
Formal Schooling ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Musculoskeletal Conditions ◽  
Soft Tissue Rheumatism ◽  
Degree Of Disability ◽  
The Impact

Abstract Background Nationally representative data on burden of musculoskeletal conditions (MSK) in Bangladesh are not available. The objective of this study was to determine the prevalence of MSK conditions and related disabilities in the adult population of Bangladesh. Methods A total of 2000 individuals aged 18 years or older were targeted from 20 primary sampling units (urban and rural) of all former seven divisions of Bangladesh in 2015. Structured interviews were done using the modified Community Oriented Program for Control of Rheumatic Disorders questionnaire to detect positive respondents. Standard criteria were used for diagnosing MSK conditions by rheumatology residents. In case of uncertainty, opinion was taken from senior rheumatologists. A Bangla version of the Health Assessment Questionnaire was used to determine disability. Results A total of 1843 (92.1%) participated. Among them, 892 men and 951 women participated from rural (n = 716) and urban (n = 1127) areas. Their mean age was 40.5 (standard deviation 14.7) years. Almost a third did not have any formal schooling. Overall, 30.4% (95% confidence interval, 28.3–32.5) had MSK conditions. Low back pain (18.6%, 16.9–20.5), knee osteoarthritis (7.3%, 6.1–8.5) and soft tissue rheumatism 3.8% (2.9–4.7) were the three top-ranking MSK conditions. Rheumatoid arthritis (1.6%, 1.0–2.1), spondyloarthritis (1.2%, 7–1.8) and adhesive capsulitis (1.4%, 0.9–1.9) were relatively uncommon. Among those who had MSK conditions, 24.8% (21.3–28.6) had some degree of disability. Of them, 24.4% (21.0–28.1) had history of work loss during last 12 months. Conclusions The high burden of MSK conditions and related disabilities in Bangladesh warrants greater attention of the health system. Further studies are needed to estimate the impact of this group of conditions particularly addressing related disabilities and loss of work.

scholarly journals Adquisición de conocimientos en cuidados paliativos mediante un plan de estudios transversal en enfermería

2020 ◽  
Vol 19 (3) ◽  
pp. 322-344
Author(s):  
Antonio Valenzuela Vidal ◽  
Ana Folch Ayora ◽  
Joan Bou Esteller ◽  
Zaira Fernández Yañez ◽  
Sebastian Eroles Tena ◽  
...  
Keyword(s):  
Palliative Care ◽  
Nursing Students ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
P Value ◽  
Future Health ◽  
Cross Sectional ◽  
Care Experience ◽  
Compulsory Subject ◽  
Academic Year

La implementación de los cuidados paliativos en las universidades ha sido paulatina. Su reciente implantación requiere de su evaluación para la mejora en la formación de nuestros futuros profesionales. Por tanto, el objetivo de este trabajo es valorar el conocimiento en paliativos, en estudiantes de enfermería de la Universidad Jaume I, tras la implementación de un plan de estudios de enseñanza transversal y evaluación mediante una asignatura de carácter obligatorio. Método: Estudio observacional, de corte transversal, durante el curso académico 2017/2018 mediante la escala Palliative Care Quiz for Nursing. Análisis descriptivo, comparativo de las variables cuantitativas y cualitativas global y según aciertos/errores, significación estadística p-value <0,05.Resultados: La muestra de n=155, edad 22,21±6,61 años, con predominio del sexo femenino en el 80% (n=124). La esfera con mayor número de aciertos fue la relacionada con el control de dolor y los síntomas 69,1% y la esfera con más fallos la relacionada con la filosofía y los principios 46,9%. El conocimiento en paliativos viene explicado en un 16% por el curso académico y con la experiencia previa en paliativos. Conclusiones: Mediante nuestros resultados observamos, que la educación en paliativos desarrollada de forma transversal con la culminación de una asignatura obligatoria en cuarto curso, resulta ser efectiva en estudiantes de enfermería, donde el 63% ostentó una buena tasa de aciertos en conocimientos de paliativos.   The inclusion of palliative care content in university curricula has been gradual. Due to the recent incorporation of palliative care as a subject, an evaluation is necessary in order improve the education of our future health professionals. The objective of this study was thus to assess palliative care knowledge in nursing students at Jaume I University after the transversal inclusion of palliative care content throughout the program, culminating in a subject of an obligatory nature. Method: This observational cross-sectional study was undertaken over the 2017/2018 academic year using the Palliative Care Quiz for Nursing. A descriptive and comparative analysis of the quantitative and qualitative global variables was performed with respect to correct/incorrect responses. Statistical significance was set at p <0.05.Results: The sample included 155 participants, with a mean age of 22.21±6.61 years. Females (n=124) were predominant in the sample (80%). The domain which received the highest number of correct responses was related to the control of pain and symptoms (69.1%) and the domain which received the highest number of incorrect responses was related to philosophy and principles (46.9%). Academic year and prior palliative care experience explained 16% of the variance in knowledge. Conclusions: Through our results, we observed that palliative care education, implemented in a transversal manner and with the completion of compulsory subject in the fourth year, was effective in nursing students, with 63% achieving good scores with respect to palliative care knowledge.

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