scholarly journals Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study

2014 ◽  
Vol 29 (4) ◽  
pp. 354-362 ◽  
Author(s):  
Maureen Coombs ◽  
Tracy Long-Sutehall ◽  
Anne-Sophie Darlington ◽  
Alison Richardson
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
End Of Life ◽  
Health Care Professionals ◽  
Care Home ◽  
Rare Event ◽  
Community Services ◽  
Critical Care Units ◽  
The United Kingdom ◽  
Doctors And Nurses

Background: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. Aim: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. Design: Exploratory two-stage qualitative study Setting/participants: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. Findings: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. Conclusion: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.

scholarly journals A national survey exploring views and experience of health professionals about transferring patients from critical care home to die

2015 ◽  
Vol 29 (4) ◽  
pp. 363-370 ◽  
Author(s):  
Anne-Sophie E. Darlington ◽  
Tracy Long-Sutehall ◽  
Alison Richardson ◽  
Maureen A. Coombs
Keyword(s):  
Critical Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Care Home ◽  
Professional Role ◽  
National Study ◽  
Web Based ◽  
Critical Care Units ◽  
The United Kingdom ◽  
Doctors And Nurses

Background: Transferring critically ill patients home to die is poorly explored in the literature to date. This practice is rare, and there is a need to understand health care professionals’ (HCP) experience and views. Objectives: To examine (1) HCPs’ experience of transferring patients home to die from critical care, (2) HCPs’ views about transfer and (3) characteristics of patients, HCPs would hypothetically consider transferring home to die. Design: A national study developing a web-based survey, which was sent to the lead doctors and nurses in critical care units. Setting/participants: Lead doctors and senior nurses (756 individuals) working in 409 critical care units across the United Kingdom were invited to participate in the survey. Results: In total, 180 (23.8%) completed surveys were received. A total of 65 (36.1%) respondents had been actively involved in transferring patients home to die and 28 (15.5%) had been involved in discussions that did not lead to transfer. Respondents were supportive of the idea of transfer home to die (88.8%). Patients identified by respondents as unsuitable for transfer included unstable patients (61.8%), intubated and ventilated patients (68.5%) and patients receiving inotropes (65.7%). There were statistically significant differences in views between those with and without experience and between doctors and nurses. Nurses and those with experience tended to have more positive views. Conclusion: While transferring patients home to die is supported in critical care, its frequency in practice remains low. Patient stability and level of intervention are important factors in decision-making in this area. Views held about this practice are influenced by previous experience and the professional role held.

scholarly journals Minimum standards of clinical practice for physiotherapists working in critical care settings in the United Kingdom: A modified Delphi technique

2018 ◽  
Vol 20 (2) ◽  
pp. 118-131 ◽  
Author(s):  
Paul Twose ◽  
Una Jones ◽  
Gareth Cornell
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Clinical Practice ◽  
Delphi Technique ◽  
Minimum Standard ◽  
Knowledge And Skills ◽  
Critical Care Units ◽  
Modified Delphi ◽  
The United Kingdom ◽  
Modified Delphi Technique

Introduction Across the United Kingdom, physiotherapy for critical care patients is provided 24 h a day, 7 days per week. There is a national drive to standardise the knowledge and skills of physiotherapists which will support training and reduce variability in clinical practice. Methods A modified Delphi technique using a questionnaire was used. The questionnaire, originally containing 214 items, was completed over three rounds. Items with no consensus were included in later rounds along with any additional items suggested. Results In all, 114 physiotherapists from across the United Kingdom participated in the first round, with 102 and 92 completing rounds 2 and 3, respectively. In total, 224 items were included: 107 were deemed essential as a minimum standard of clinical practice; 83 were not essential and consensus was not reached for 34 items. Analysis/Conclusion This study identified 107 items of knowledge and skills that are essential as a minimum standard for clinical practice by physiotherapists working in United Kingdom critical care units.

scholarly journals Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units*

2018 ◽  
Vol 46 (5) ◽  
pp. 705-712 ◽  
Author(s):  
Mark J. W. McPhail ◽  
Francesca Parrott ◽  
Julia A. Wendon ◽  
David A. Harrison ◽  
Kathy A. Rowan ◽  
...  
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
Critical Care Units ◽  
The United Kingdom

scholarly journals Organizational Support Experiences of Care Home and Home Care Staff in Sweden, Italy, Germany and the United Kingdom during the COVID-19 Pandemic

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 767
Author(s):  
Connie Lethin ◽  
Andrea Kenkmann ◽  
Carlos Chiatti ◽  
Jonas Christensen ◽  
Tamara Backhouse ◽  
...  
Keyword(s):  
United Kingdom ◽  
Organizational Support ◽  
Care Home ◽  
External Support ◽  
Care Staff ◽  
Care Organization ◽  
Online Questionnaire ◽  
The United Kingdom ◽  
The Uk ◽  
Staff Experiences

The COVID-19 pandemic has affected care workers all over the globe, as older and more vulnerable people face a high risk of developing severe symptoms and dying from the virus infection. The aim of this study was to compare staff experiences of stress and anxiety as well as internal and external organizational support in Sweden, Italy, Germany, and the United Kingdom (UK) in order to determine how care staff were affected by the pandemic. A 29-item online questionnaire was used to collect data from care staff respondents: management (n = 136), nurses (n = 132), nursing assistants (n = 195), and other healthcare staff working in these organizations (n = 132). Stress and anxiety levels were highest in the UK and Germany, with Swedish staff showing the least stress. Internal and external support only partially explain the outcomes. Striking discrepancies between different staff groups’ assessment of organizational support as well as a lack of staff voice in the UK and Germany could be key factors in understanding staff’s stress levels during the pandemic. Structural, political, cultural, and economic factors play a significant role, not only factors within the care organization or in the immediate context.

scholarly journals Resource and waste quantification scenarios for wind turbine decommissioning in the United Kingdom

2020 ◽  
Author(s):  
Kiran Tota-Maharaj ◽  
Alexander McMahon
Keyword(s):  
United Kingdom ◽  
Waste Management ◽  
Wind Turbine ◽  
End Of Life ◽  
Wind Turbines ◽  
Rapid Rise ◽  
The United Kingdom ◽  
Management Procedures ◽  
The Uk ◽  
Over Time

AbstractWind power produces more electricity than any other form of renewable energy in the United Kingdom (UK) and plays a key role in decarbonisation of the grid. Although wind energy is seen as a sustainable alternative to fossil fuels, there are still several environmental impacts associated with all stages of the lifecycle of a wind farm. This study determined the material composition for wind turbines for various sizes and designs and the prevalence of such turbines over time, to accurately quantify waste generation following wind turbine decommissioning in the UK. The end of life stage is becoming increasingly important as a rapid rise in installation rates suggests an equally rapid rise in decommissioning rates can be expected as wind turbines reach the end of their 20–25-year operational lifetime. Waste data analytics were applied in this study for the UK in 5-year intervals, stemming from 2000 to 2039. Current practices for end of life waste management procedures have been analysed to create baseline scenarios. These scenarios have been used to explore potential waste management mitigation options for various materials and components such as reuse, remanufacture, recycling, and heat recovery from incineration. Six scenarios were then developed based on these waste management options, which have demonstrated the significant environmental benefits of such practices through quantification of waste reduction and greenhouse gas (GHG) emissions savings. For the 2015–2019 time period, over 35 kilotonnes of waste are expected to be generated annually. Overall waste is expected to increase over time to more than 1200 kilotonnes annually by 2039. Concrete is expected to account for the majority of waste associated with wind turbine decommissioning initially due to foundations for onshore turbines accounting for approximately 80% of their total weight. By 2035–2039, steel waste is expected to account for almost 50% of overall waste due to the emergence of offshore turbines, the foundations of which are predominantly made of steel.

scholarly journals Death Notification in Italian Critical Care Unites and Emergency Services. A Qualitative Study with Physicians, Nurses and Relatives

2021 ◽  
Vol 18 (24) ◽  
pp. 13338
Author(s):  
Ines Testoni ◽  
Erika Iacona ◽  
Lorenza Palazzo ◽  
Beatrice Barzizza ◽  
Beatrice Baldrati ◽  
...  
Keyword(s):  
Critical Care ◽  
Qualitative Study ◽  
Protective Factors ◽  
Health Care Professionals ◽  
Emergency Services ◽  
Continuing Bonds ◽  
Critical Care Units ◽  
Death Notification ◽  
The Impact ◽  
Relational Difficulties

This qualitative study was conducted in critical care units and emergency services and was aimed at considering the death notification (DN) phenomenology among physicians (notifiers), patient relatives (receivers) and those who work between them (nurses). Through the qualitative method, a systemic perspective was adopted to recognise three different categories of representation: 23 clinicians, 13 nurses and 11 family members of COVID-19 victims were interviewed, totalling 47 people from all over Italy (25 females, mean age: 46,36; SD: 10,26). With respect to notifiers, the following themes emerged: the changes in the relational dimension, protective factors and difficulties related to DN. With respect to receivers, the hospital was perceived as a prison, bereavement between DN, lost rituals and continuing bonds. Among nurses, changes in the relational dimension, protective factors and the impact of the death. Some common issues between physicians and nurses were relational difficulties in managing distancing and empathy and the support of relatives and colleagues. The perspective of receivers showed suffering related to loss and health care professionals’ inefficacy in communication. Specifically, everyone considered DNs mismanaged because of the COVID-19 emergency. Some considerations inherent in death education for DN management among health professionals were presented.

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