16 Delirium care of hospice patients: a qualitative interview study with staff and volunteers

2018 ◽  
Vol 8 (3) ◽  
pp. 365.3-366
Author(s):  
Imogen Featherstone ◽  
Miriam Johnson ◽  
Lesley Jones ◽  
Eleonora Coppo ◽  
Annmarie Hosie ◽  
...  
Keyword(s):  
Current Practice ◽  
Management Strategies ◽  
List Type ◽  
Structured Interviews ◽  
Allied Health Professionals ◽  
Qualitative Interview Study ◽  
Hospice Patients ◽  
Delirium Prevention ◽  
Care Gaps ◽  
Case Vignettes

IntroductionDelirium is a distressing condition which is commonly experienced by hospice patients. Although delirium can be prevented by around one-third in hospital inpatients (Siddiqi et al. 2016) there has been little research into effective strategies to prevent and manage delirium in hospices. Greater insight into the current practice attitudes and understanding of hospice staff and volunteers would inform the development of interventions that are tailored to improve delirium care in hospices.AimTo explore the understanding attitudes and practice of hospice staff and volunteers regarding the care of patients with delirium.Methods36 qualitative semi-structured interviews were conducted at two hospices. Participants were purposively sampled to include different disciplines (9 health care assistants, 8 nurses, 5 doctors, 4 volunteers, 3 board members, 2 allied health professionals, 2 managers, 2 domestic workers and 2 fundraisers). A topic guide and case vignettes prompted participants to describe their experiences in relation to delirium prevention recognition assessment and management. Three researchers are conducting thematic analysis to identify analyse and interpret themes from the interview data.ResultsProvisional results include themes of: ‘Supporting the distressing experience of delirium’; ‘Management strategies’ and ‘The burden of delirium care.’ Gaps in current practice relate to delirium prevention recognition and screening. Potential facilitators for developing interventions in hospices include education flexibility in staffing the role of volunteers and a supportive staff culture.ConclusionThis study will provide important insights into staff and volunteers’ current practice which will inform the development of a targeted intervention to improve delirium care in hospices.Reference. Siddiqi N, Harrison J, Clegg A, Teale E, Young J, Taylor J, Simpkins S. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database of Systematic Reviews2016;(3). Art. No.: CD005563. doi:10.1002/14651858.CD005563.pub3

Understanding Hospice Patients’ Beliefs About Their Life Expectancy: A Qualitative Interview Study

2020 ◽  
pp. 104990912094848
Author(s):  
Jennifer M. Taber ◽  
Clare L. Stacey ◽  
Denice K. Sheehan
Keyword(s):  
Life Expectancy ◽  
Advanced Disease ◽  
Well Being ◽  
Physical Symptoms ◽  
Future Research ◽  
Common Source ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Hospice Patients ◽  
Length Of Life

Background: Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making. Objective: To examine the nature and source of hospice patients’ life expectancy estimates, about which little is known. Design: Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response. Setting/Subjects: Participants were hospice patients ( n = 20, 55% male; 60% cancer). Measurement: We conducted thematic analysis using open and focused coding. Results: Many participants had difficulty answering the life expectancy question and expressed uncertainty about when they would die. One-third overestimated their length of life relative to actual survival. The most common source of patients’ prognostic beliefs was knowledge about their body, including physical symptoms and change over time. Half of patients reported that a provider had given them a prognostic estimate, and one-third agreed with, or gave estimates consistent with, the provider’s estimate. Some patients said providers do not know prognosis or that time of death was unknowable. Conclusions: Key findings were that 1) many hospice patients had difficulty estimating life expectancy, and 2) hospice patients’ life expectancy estimates were frequently based on their body and not on information from medical providers. These findings have implications for measuring prognostic awareness, as valid assessment is a necessary component of determining whether prognostic awareness is beneficial for patients. Future research should examine how life expectancy estimates are associated with well-being and whether results extend to larger samples of patients with advanced disease not in hospice.

scholarly journals Exploring Professional Circus Artists’ Experience of Performance-Related Injury and Management: A Qualitative Study

2019 ◽  
Vol 34 (1) ◽  
pp. 14-24
Author(s):  
Timothée Cayrol ◽  
Emma Godfrey ◽  
Jerry Draper-Rodi ◽  
Lindsay Bearne
Keyword(s):  
Help Seeking ◽  
Management Strategies ◽  
Easy Access ◽  
Personal Factors ◽  
Negative Consequences ◽  
Structured Interviews ◽  
Injury Management ◽  
Psychosocial Consequences ◽  
Qualitative Interview Study ◽  
Data Saturation

AIMS: Circus is a physically demanding profession, but injury and help-seeking rates tend to be low. This qualitative interview study explored the perceptions and beliefs about injury and help-seeking of circus artists. METHODS: Ten professional circus artists (5 males, 5 females; mean age 33 yrs, range 27–42) were enrolled. Individual, semi-structured interviews were conducted until data saturation of themes was reached. Data were analysed thematically. FINDINGS: Four themes were identified: 1) the injured artist; 2) professionalism; 3) circus life; and 4) artists’ experience of healthcare. Most participants described the circus as central to their lives, and injuries had wide-ranging psychosocial consequences. Injury adversely affected participants’ mood and threatened their identity. Situational and personal factors (e.g., the belief that pain was normal) pushed participants to use adaptive strategies to perform when injured. Continuous touring and financial constraints affected help-seeking. Easy access to healthcare was rare and participants often self-managed injuries. Experiences of healthcare varied, and participants desired flexible and accessible approaches to prevention and injury management. A modified version of the integrated model of psychological response to injury and rehabilitation process and the concept of identity provided a framework to understand participants. CONCLUSION: Injuries had extensive negative consequences. Work schedules, financial factors, employer support, the artist’s perception of the importance of the show, and the relationship between circus and identity influenced injury management and help-seeking. Injury prevention and management strategies could be optimised by developing centres of expertise, online resources, and better regulations of the profession.

scholarly journals Understanding the impact of incontinence on Veterans’ self-management strategies, quality of life and treatment experiences

2020 ◽  
Author(s):  
Linda Cowan ◽  
Sarah Bradley ◽  
Andrew R. Devendorf ◽  
Lelia Barks ◽  
Tatiana Orozco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Fecal Incontinence ◽  
Healthcare Provider ◽  
Caregiver Burden ◽  
Management Strategies ◽  
Self Management ◽  
List Type ◽  
Structured Interviews

AbstractBackgroundUrinary and fecal incontinence contribute to significant quality of life impairments for patients and caregivers. Preliminary research suggests that incontinence rates may be higher among Veterans. However, few studies have examined incontinence experiences among Veterans and their caregivers.ObjectivesWe aimed to demonstrate the feasibility of conducting a one-year, telephone survey with Veterans and their caregivers to help inform larger studies. By including both Veteran and caregiver perspectives, we explored how incontinence impacts Veterans’ self-management strategies, quality of life, and treatment experiences.DesignWe used a mixed methods design, employing quantitative (i.e., cross-sectional survey) and qualitative approaches (i.e., semi-structured interviews).ParticipantsOur sample included 64 Veterans with urinary incontinence, fecal incontinence, or mixed incontinence, and 36 caregivers. A subset of 18 Veterans and 8 caregivers completed semi-structured interviews.MethodsData were collected via telephone surveys over the course of 1-year from a small research team at the Veterans Health Administration (VHA). Participants completed measures about the Veteran’s incontinence severity, quality of life, and VHA treatment experiences. Interviews asked participants about their perceptions and satisfaction in receiving treatment for the Veterans’ incontinence. Qualitative themes were extracted using a Rapid Assessment Process model.ResultsVeterans’ self-reported physical quality of life correlated negatively and significantly with both urinary and fecal incontinence severity, as well as negatively and significantly with urinary continence bother (rs range: −.36 to −.47, ps < .01). Veterans’ mental quality of life correlated negatively and significantly with urinary incontinence bother (r = −.43, p < .001). About 67% Veterans experienced incontinence symptoms for 5-years or more, yet 44% waited at least 1-year to discuss incontinence with a VHA provider. Most Veterans (92%) reported speaking with a VHA provider about incontinence, while only 42% reported speaking with a non-VHA provider. Qualitative findings revealed that, upon speaking to a provider, Veterans felt comfortable but also desired more incontinence education from their providers, including obtaining more appropriate and tailored treatment options. While most Veterans followed their provider’s treatment recommendations, some felt unsatisfied with treatments that they perceived as embarrassing.ConclusionsRecruiting a substantial sample of Veterans with incontinence, and their caregivers, is feasible using our recruitment methods, which can inform larger studies. Our study revealed that incontinence symptoms interfere significantly with the quality of life of Veterans and their caregivers. Intervening at the healthcare level by educating providers and systematizing inquiry into incontinence for higher risk populations would be fruitful to explore.Contribution of the PaperWhat is already known about this topic?Urinary incontinence is more prevalent than fecal incontinence, and both are associated with significant impairments in physical, mental, and social functioning.Urinary and fecal incontinence become more prevalent with older age and additional chronic health conditions.There is a lack of incontinence diagnoses documented in Veteran’s medical records, even when incontinence is present. Few studies have reported on caregiver burden related to incontinence care.What this paper addsThis study is the first to report on the potential delay between Veteran’s experiencing symptoms of incontinence and informing their healthcare provider or caregiver about those symptoms (sometimes 5-years or more).Insights on Veteran and caregiver satisfaction with incontinence care can guide healthcare interventions to improve incontinence care.Both Veteran quality of life and caregiver burden correlated significantly and negatively with satisfaction with incontinence treatments tried and number of treatments tried. Only 21% of Veterans were satisfied with the treatment plan they were given, suggesting a potential knowledge gap or opportunity for improvement in healthcare provider approaches to incontinence management.

scholarly journals Barriers and enablers to collaborative working between GPs and pharmacists: a qualitative interview study

2020 ◽  
Vol 70 (692) ◽  
pp. e155-e163 ◽  
Author(s):  
Polly Duncan ◽  
Matthew J Ridd ◽  
Deborah McCahon ◽  
Bruce Guthrie ◽  
Christie Cabral
Keyword(s):  
Improve Patient Safety ◽  
Structured Interviews ◽  
Allied Health Professionals ◽  
Face To Face ◽  
Professional Boundaries ◽  
Complex Patients ◽  
Qualitative Interview Study ◽  
Collaborative Working ◽  
Interdisciplinary Interventions ◽  
Competing Priorities

BackgroundMany UK GP practices now employ a practice pharmacist, but little is known about how GPs and pharmacists work together to optimise medications for complex patients with multimorbidity.AimTo explore GP and pharmacist perspectives on collaborative working within the context of optimising medications for patients with multimorbidity.Design and settingA qualitative analysis of semi-structured interviews with GPs and pharmacists working in the West of England, Northern England, and Scotland.MethodThirteen GPs and 10 pharmacists were sampled from practices enrolled in the 3D trial (a complex intervention for people with multimorbidity). Participants’ views on collaborative working were explored with interviews that were audiorecorded, transcribed, and analysed thematically. Saturation of data was achieved with no new insights arising from later interviews.ResultsGPs from surgeries that employed a pharmacist tended to value their expertise more than GPs who had not worked with one. Three key themes were identified: resources and competing priorities; responsibility; and professional boundaries. GPs valued pharmacist recommendations that were perceived to improve patient safety, as opposed to those that were technical and unlikely to benefit the patient. Pharmacists who were not known to GPs felt undervalued and wanted feedback from the GPs about their recommendations, particularly those that were not actioned.ConclusionA good working relationship between the GP and pharmacist, where each profession understood the other’s skills and expertise, was key. The importance of face-to-face meetings and feedback should be considered in future studies of interdisciplinary interventions, and by GP practices that employ pharmacists and other allied health professionals.

scholarly journals Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: A qualitative interview study using vignettes

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0014
Author(s):  
Emily Lyness ◽  
Jane Louise Vennik ◽  
Felicity Bishop ◽  
Pranati Misurya ◽  
Jeremy Howick ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Structured Interviews ◽  
Knee Oa ◽  
Qualitative Interview Study ◽  
Empathic Communication ◽  
Case Vignettes ◽  
Digital Training ◽  
Improve Patient

BackgroundOsteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach.AimTo explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations.Design & settingVignette study with qualitative semi-structured interviews.SettingPurposefully sampled patients (n=33) aged 45+ with hip/knee OA from Wessex GP practices.MethodFifteen participants watched two filmed OA consultations with a GP, and eighteen participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis.ResultsPatients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised and embedded within an empathic consultation. Discussing patients’ experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages.ConclusionPatients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.

scholarly journals How do people with knee osteoarthritis perceive and manage flares? A qualitative study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0086
Author(s):  
Emma Parry ◽  
Lisa Dikomitis ◽  
George Peat ◽  
Carolyn A. Chew-Graham
Keyword(s):  
Acute Pain ◽  
Help Seeking ◽  
Management Strategies ◽  
Self Management ◽  
Structured Interviews ◽  
Everyday Activity ◽  
Minimal Impact ◽  
Knee Oa ◽  
Disturbed Sleep ◽  
Qualitative Interview Study

BackgroundAcute flares in people with osteoarthritis (OA) are poorly understood. There is uncertainty around the nature of flares, their impact, and how these are managed.AimExplore understandings and experiences of flares in people with knee OA, describe self-management and help-seeking strategiesDesign & settingQualitative interview study of people with knee OA in England, United Kingdom.MethodSemi-structured interviews with 15 people with knee OA. Thematic analysis using constant comparison methods.ResultsWe identified four main themes: experiencing pain, consequences of acute pain, predicting and avoiding acute pain, and response to acute pain. People with OA described minor episodes which were frequent, fleeting, occurred during everyday activity, had minimal impact, and were generally predictable. This contrasted with severe episodes which were infrequent, had greater impact, and were less likely to be predictable. The latter generally led to feelings of low confidence, vulnerability and of being a burden. The term ‘flare’ was often used to describe the severe events but this was applied inconsistently and some would describe a flare as any increase in pain.Participants used numerous self-management strategies but tended to seek help when these had been exhausted, their symptoms led to emotional distress, disturbed sleep, or pain experience worse than usual. Previous experiences shaped whether people sought help and who they sought help from.ConclusionSevere episodes of pain are likely to be synonymous with flares. Developing a common language about flares will allow a shared understanding of these events, early identification and appropriate management.

scholarly journals Linking Conservation, Community Knowledge, and Adaptation to Extreme Climatic Events: A Case Study in Gorongosa National Park, Mozambique

2021 ◽  
Vol 13 (11) ◽  
pp. 6478
Author(s):  
Amemarlita Matos ◽  
Laura Barraza ◽  
Isabel Ruiz-Mallén
Keyword(s):  
National Park ◽  
Animal Species ◽  
Human Life ◽  
Management Strategies ◽  
Forest Products ◽  
Buffer Zone ◽  
Structured Interviews ◽  
Extreme Climatic Events ◽  
Water Provision

This study is based on ethnographic research that analyzes how traditional knowledge and local beliefs on biodiversity conservation relates to the local ability to adapt and be resilient to climatic changes in two communities around Gorongosa National Park, Mozambique: Nhanfisse in the buffer zone and Muanandimae in the core area. A total of 78 semi-structured interviews with heads of households were conducted. We found that both communities carried out practices and held beliefs associated with conservation, such as protecting trees and animal species considered sacred or perceived as beneficial for human life in terms of water provision and agricultural production. In addition to traditional ceremonies that respond to extreme climatic events such as drought and flood, other adaptation strategies used by the communities include moving to neighboring areas in search of better living conditions and using forest products in times of scarcity. We discuss that the management of the park should be agreed on, in a shared way, between local communities and conservation agents to ensure that these areas continue to perform the ecological, subsistence, and spiritual functions required. Our research results contribute to a better understanding of local adaptation dynamics towards extreme climatic events and improvement of management strategies.

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

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.

scholarly journals “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

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.

Therapy discontinuation in a primary care psychological service: why patients drop out

2020 ◽  
Vol 13 ◽  
Author(s):  
Aisan Ghaemian ◽  
Mahdi Ghomi ◽  
Miles Wrightman ◽  
Colm Ellis-Nee
Keyword(s):  
Drop Out ◽  
Treatment Withdrawal ◽  
List Type ◽  
Structured Interviews ◽  
Group Settings ◽  
Psychological Therapies ◽  
Psychological Service ◽  
Wide Range ◽  
Key Factor ◽  
Therapy Services

Abstract The present study aimed to explore patients’ experience with an Improving Access to Psychological Therapies (IAPT) service, and to investigate the reasons for discontinuing their treatment. A qualitative approach was adopted using thematic analysis of semi-structured interviews carried out with 818 patients attending for treatment in Talking Change from November 2015 to January 2019, retrospectively. The five main themes that emerged from the study were: ‘Felt better’, ‘Issues with group settings’, ‘Therapeutic alliance breakdown’, ‘Miscommunication’ and ‘Impracticalities’. The qualitative study uncovered a wide range of reasons for people who had dropped out from their treatment. The findings mainly emphasised general dissatisfaction and inconvenient appointments. However, improvement in symptoms of depression and anxiety was also identified as a key factor among patients who discontinued their treatment. This recovery is known as ‘progress withdrawal’ in which patients withdraw from treatment early due to good therapeutic progress. We present clinical and procedural implications arising from these themes. Key learning aims (1) To explore what can cause discontinuation of therapy. (2) To obtain the experience of people who have received treatment and dropped out from Talking Change Psychological Therapy services. (3) To explore whether people recovered as part of the treatment withdrawal and what may have helped towards that recovery.

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