Assessment and Clinical Decision-Making During Imminent Death in Hospice Music Therapy

2021 ◽  
Author(s):  
Erin Fox ◽  
Alexa Economos ◽  
Noah Potvin
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Music Therapy ◽  
Clinical Decision Making ◽  
Ways Of Knowing ◽  
Clinical Decision ◽  
Constructivist Grounded Theory ◽  
Situational Analysis ◽  
Music Therapists ◽  
Hospice And Palliative Care

Abstract Assessment is a critical aspect of treatment planning, and while there exist standards for facilitating music therapy assessments in a variety of clinical settings, no such standards exist for music therapists in hospice and palliative care. This gap in knowledge, which limits music therapists’ ability to provide patients and caregivers best practices promoting supported movement through the dying process, becomes particularly problematic when assessing patients who are imminently dying with a 24–72 hour prognosis. To further develop and define assessment and clinical decision-making processes used by music therapists in hospice and palliative care, the authors used a constructivist grounded theory and situational analysis methodology to analyze interviews of 15 hospice music therapists. The resulting theoretical model describes an ongoing process of assessment and clinical decision-making shaped by participants’ individual epistemologies. Epistemologies were comprised of 5 ways of knowing, which were termed experiential, personal, musical, ethical, and integral, and provided participants critical foundations for their practice. The results support a development of a model for reflective practice as well as continued research on epistemological foundations of clinical practice.

Music Therapy Pre-internship Education and Training: Support for a Methods-Based Approach

2021 ◽  
Author(s):  
Susan C Gardstrom ◽  
James Hiller ◽  
Annie Heiderscheit ◽  
Nancy L Jackson
Keyword(s):  
Music Therapy ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Education And Training ◽  
Population Based ◽  
Music Therapists ◽  
Training Support ◽  
And Training

Abstract As music therapists, music is our primary realm of understanding and action and our distinctive way of joining with a client to help them attain optimal health and well-being. As such, we have adopted and advocate for a music-focused, methods-based (M-B) approach to music therapy pre-internship education and training. In an M-B approach, students’ learning is centered on the 4 music therapy methods of composing, improvising, re-creating, and listening to music and how these music experiences can be designed and implemented to address the health needs of the diverse clientele whom they will eventually encounter as practicing clinicians. Learning is highly experiential, with students authentically participating in each of the methods and reflecting on these self-experiences as a basis for their own clinical decision-making. This is differentiated from a population based (P-B) approach, wherein students’ attention is directed at acquiring knowledge about the non-musical problems of specific “clinical populations” and the “best practice” music interventions that are presumed to address these problems. Herein, we discuss both approaches, identifying the limitations of a P-B perspective and outlining the benefits of an M-B curriculum and its relevance to 21st-century music therapy practice.

Reversibility of Delirium in Palliative Care (DRAFT)

2018 ◽  
Author(s):  
Tiffany Shaw ◽  
Eric Prommer
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Factors Associated ◽  
Frequent Event ◽  
Study Intervention

Delirium is a frequent event in patients with advanced cancer. Untreated delirium affects assessment of symptoms, impairs communication including participation in clinical decision-making. This study used specific diagnostic criteria for delirium and prospectively identified precipitating causes of delirium. The study identified factors associated with reversible and irreversible delirium. Impact of delirium on prognosis was evaluated. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case. Topics covered include delirium, neoplasms, palliative care, polypharmacy, risk factors, and therapeutics.

Creation of a palliative care advanced practice registered nurse peer-review process

2019 ◽  
Vol 25 (12) ◽  
pp. 596-602
Author(s):  
Patrice R. Fedel ◽  
Nicole E. Hembel ◽  
Lindsey M. Mueller
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Peer Review ◽  
Professional Growth ◽  
Review Process ◽  
Clinical Decision Making ◽  
Peer Review Process ◽  
Clinical Decision ◽  
Advanced Practice ◽  
Case Review

The mark of a true profession is the ability to self-regulate. As such, advanced practice registered nurses (APRNs) are challenged by their professional organisations to participate in self-evaluation and peer review. Peer review is a method for evaluating the care provided by the APRN to both ensure quality nursing care and promote professional growth. Despite guidelines to participate in a formal peer-review process, there is little information within the nursing profession on how to accomplish peer review. A comprehensive literature review failed to provide a framework for peer review that is practice focused, fosters a learning environment and encompasses the thought process and clinical decision-making of the palliative care advanced practice nurse. A group of palliative care APRNs set out to create a process that encompassed the breadth of clinical decision-making in palliative care advanced nursing practice. Using the eight domains of palliative care, a narrative case review structure was created. The resulting process both assisted the APRNs in professional growth and provided timely feedback for the annual performance evaluation.

scholarly journals Competências do enfermeiro para o cuidado paliativo em cardiologia

2018 ◽  
Vol 12 (9) ◽  
pp. 2341 ◽  
Author(s):  
Bruna Christine Floriano Brabo ◽  
Manoela Gomes Grossi Laprano
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Structured Interview ◽  
Social Needs ◽  
Joint Decision ◽  
Multiprofessional Team ◽  
Terapia Intensiva

RESUMOObjetivo: analisar as competências profissionais do enfermeiro para o cuidado paliativo em Unidade de Terapia Intensiva Cardiológica. Método: estudo qualitativo, descritivo e exploratório fundamentado no referencial teórico das Competências Centrais em Cuidados Paliativos e realizado na UTI de um hospital cardiológico. Realizou-se a entrevista semiestruturada com oito enfermeiros. Para a interpretação dos dados, utilizaram-se a análise de conteúdo e a categorização. Resultados: prevaleceram enfermeiras de 31 a 41 anos, com mais de dez anos de experiência na profissão e com, ao menos, um curso de pós-graduação. As competências mais citadas estão relacionadas aos constituintes centrais dos cuidados paliativos, à família, ao autoconhecimento, ao desenvolvimento profissional e ao conforto físico. As categorias menos citadas retratam as necessidades psicológicas, espirituais, o trabalho em equipe, a comunicação e a tomada de decisão ética e clínica. Não houve relatos das necessidades sociais. As competências não aplicadas referem-se à atuação na equipe multiprofissional, à tomada de decisão conjunta e à educação dos profissionais e da família. Conclusão: prevaleceram citações de competências relacionadas à assistência. Após recente implantação do serviço, observa-se a necessidade do fortalecimento da equipe multiprofissional e da educação dos profissionais de Enfermagem. Descritores: Cuidados Paliativos; Competência Profissional; Cuidados Críticos; Enfermagem; Unidade de Terapia Intensiva; Cardiologia.ABSTRACT Objective: to analyze the professional competencies of the nurse for palliative care in the Cardiology Intensive Care Unit. Method: a qualitative, descriptive, exploratory study based on the theoretical reference of the Central Skills in Palliative Care and carried out at the ICU of a cardiological hospital. A semi-structured interview was conducted with eight nurses. For the interpretation of the data, the content analysis and the categorization were used. Results: nurses from 31 to 41 years old, with more than ten years of experience in the profession and with at least one postgraduate course prevailed. The most cited competences are related to the central constituents of palliative care, family, self-knowledge, professional development and physical comfort. The less-quoted categories portray psychological, spiritual, teamwork, communication, and ethical and clinical decision-making. There were no reports of social needs. The competences that were not applied, refer to the performance in the multiprofessional team, the joint decision making and the education of the professionals and the family. Conclusion: citations of competence related to care prevailed. After the recent implementation of the service, the need to strengthen the multiprofessional team and the education of nursing professionals is observed. Descritores: Palliative Care; Profissional Competence; Critical Care; Nursing; Intensive Care Units; Cardiology.RESUMEN Objetivo: analizar las competencias profesionales del enfermero para el cuidado paliativo en Unidad de Terapia Intensiva Cardiológica. Método: estudio cualitativo, descriptivo, exploratorio fundamentado en el referencial teórico de las Competencias Centrales en Cuidados Paliativos y realizado en la UTI de un hospital cardiológico. Se realizó la entrevista semiestructurada con ocho enfermeros. Para la interpretación de los datos, se utilizaron el análisis de contenido y la categorización. Resultados: prevalecieron enfermeras de 31 a 41 años, con más de diez años de experiencia en la profesión y con, al menos, un curso de postgrado. Las competencias más citadas están relacionadas a los constituyentes centrales de los cuidados paliativos, a la familia, al autoconocimiento, al desarrollo profesional y al confort físico. Las categorías menos citadas retratan las necesidades psicológicas, espirituales, el trabajo en equipo, la comunicación y la toma de decisión ética y clínica. No hubo informes de las necesidades sociales. Las competencias no aplicadas se refieren a la actuación en el equipo multiprofesional, a la toma de decisión conjunta y a la educación de los profesionales y de la familia. Conclusión: prevalecieron citaciones de competencias relacionadas a la asistencia. Después de la reciente implantación del servicio, se observa la necesidad del fortalecimiento del equipo multiprofesional y de la educación de los profesionales de Enfermería. Descritores: Cuidados Paliativos; Competencia Profissional; Cuidados críticos; Enfermería; Unidades de cuidados intensivos; Cardiología.   

AI-based clinical decision-making systems in palliative medicine: ethical challenges

2021 ◽  
pp. bmjspcare-2021-002948
Author(s):  
Ludovica De Panfilis ◽  
Carlo Peruselli ◽  
Silvia Tanzi ◽  
Carlo Botrugno
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Clinical Decision ◽  
Point Of View ◽  
Ethical Challenges ◽  
Palliative Care Consultation

BackgroundImproving palliative care (PC) is demanding due to the increase in people with PC needs over the next few years. An early identification of PC needs is fundamental in the care approach: it provides effective patient-centred care and could improve outcomes such as patient quality of life, reduction of the overall length of hospitalisation, survival rate prolongation, the satisfaction of both the patients and caregivers and cost-effectiveness.MethodsWe reviewed literature with the objective of identifying and discussing the most important ethical challenges related to the implementation of AI-based data processing services in PC and advance care planning.ResultsAI-based mortality predictions can signal the need for patients to obtain access to personalised communication or palliative care consultation, but they should not be used as a unique parameter to activate early PC and initiate an ACP. A number of factors must be included in the ethical decision-making process related to initiation of ACP conversations, among which are autonomy and quality of life, the risk of worsening healthcare status, the commitment by caregivers, the patients’ psychosocial and spiritual distress and their wishes to initiate EOL discussionsConclusionsDespite the integration of artificial intelligence (AI)-based services into routine healthcare practice could have a positive effect of promoting early activation of ACP by means of a timely identification of PC needs, from an ethical point of view, the provision of these automated techniques raises a number of critical issues that deserve further exploration.

scholarly journals An Exploratory Qualitative Study of Computer Screening to Support Decision-Making about Use of Palliative Care Registers in Primary Care: GP Think Aloud and Patient and Carer Interviews

2021 ◽  
Vol 12 ◽  
pp. 215013272110244
Author(s):  
Gill Hubbard ◽  
Kirsten Broadfoot ◽  
Clare Carolan ◽  
Hugo C. van Woerden
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Decision Making ◽  
Screening Program ◽  
Clinical Decision ◽  
Think Aloud ◽  
Advanced Illness ◽  
Curative Intent ◽  
Sole Criterion

Objectives: This study aimed to understand factors that influence general practitioner (GP) use of automated computer screening to identify patients for the palliative care register (PCR) and the experiences of palliative care and this emerging technology from patients’ and carers’ perspectives. Methods: A computer screening program electronically searches primary care records in routine clinical practice to identify patients with advanced illness who are not already on a PCR. Five GPs were asked to “think aloud” about adding patients identified by computer screening to the PCR. Key informant interviews with 6 patients on the PCR and 4 carers about their experiences of palliative care while on the PCR and their views of this technology. Data were analyzed thematically. Results and Conclusions: Using computer screening, 29% additional patients were added by GPs to the PCR. GP decision-making for the PCR was informed by clinical factors such as: if being treated with curative intent; having stable or unstable disease; end-stage disease, frailty; the likelihood of dying within the next 12 months; and psychosocial factors such as, age, personality, patient preference and social support. Six (60%) patients/carers did not know that they/their relative was on the PCR. From a patient/carer perspective, having a non-curative illness was not in and of itself sufficient reason for being on the PCR; other factors such as, unstable disease and avoiding pain and suffering were equally if not more, important. Patients and carers considered that computer screening should support but not replace, GP decision-making about the PCR. Computer screening merits ongoing development as a tool to aid clinical decision-making around entry to a PCR, but should not be used as a sole criterion. Care need, irrespective of diagnosis, disease trajectory or prognosis, should determine care.

Clinical impact of a sub-epidermal moisture scanner: what is the real-world use?

2021 ◽  
Vol 30 (3) ◽  
pp. 198-208
Author(s):  
Louisa Musa ◽  
Nicky Ore ◽  
Gillian Raine ◽  
Glenn Smith
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Real World ◽  
Early Identification ◽  
Care Setting ◽  
Clinical Decision Making ◽  
Community Care ◽  
Clinical Decision ◽  
Increased Risk ◽  
Palliative Care Setting

Objective: The presence of sub-epidermal moisture (SEM) over a bony prominence is indicative of incipient pressure ulcer (pressure injury/decubitus/bedsore) (PU). Early identification of patients at increased risk of PU can prompt interventions that reduce the incidence and severity of hospital (or community)-acquired PUs (HAPUs). This study evaluated the clinical utility of a SEM Scanner device in HAPU management. Method: The study used a pragmatic ‘real-world’ approach. HAPU data before and during SEM Scanner use were obtained through routine audit. Patients had regular visual and daily SEM Scanner skin assessments over the sacrum and heels. Nursing care otherwise followed standard of care according to the established protocols of individual participating sites. HAPU incidence rates were determined and feedback gathered from health professionals on how the device influenced HAPU-related clinical decision-making. Results: There were 15 participating sites: 13 acute care, one palliative care and one community care setting. The sample size was 1478 patients. All sites reported a substantial reduction in mean HAPU incidence: 87.2% in acute care settings; 46.7% in the palliative care setting and 26.7% in the community care setting. A 100% incidence reduction was reported in 10 (66.7%) sites. In the palliative care setting, SEM Scanner results changed HAPU-related clinical decision-making for 40% of patients scanned. The community care site demonstrated a 82% change in clinical decision-making. Conclusion: In this study, SEM analysis fitted seamlessly into routine skin assessment and enabled early identification of increased risk of tissue damage, with clinically important reductions in the incidence of HAPU across all participating sites.

Clinical Decision-Making in Palliative Care

2018 ◽  
Author(s):  
Eduardo Bruera
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Clinical Decision Making ◽  
Disease Patient ◽  
Family Care ◽  
Clinical Decision ◽  
Care Patient ◽  
Cost Of Care ◽  
Decisional Control ◽  
Quality Cancer Care

Clinical decision making preference is defined as “an individual’s expectation of having the power to participate in decisions in order to obtain desirable consequences.” Understanding patients decisional control preferences is important as it improves patient-clinician communication, quality cancer care, patient satisfaction, and reduces cost of care. Palliative care decision-making differs from that of many other disease-oriented specialties. Palliative care clinical teams focus on personhood and family care rather than on disease management. Therefore, palliative care clinicians require a combination of disease, patient, and family information before decisions can be made. This chapter reviews various aspects essential for clinical decision-making in palliative care.

Sign in / Sign up

Export Citation Format

Share Document