scholarly journals ‘There’s a Catch-22’ – The complexities of pain management for people with advanced dementia nearing the end of life: A qualitative exploration of physicians’ perspectives

2016 ◽  
Vol 31 (8) ◽  
pp. 734-742 ◽  
Author(s):  
Bannin De Witt Jansen ◽  
Kevin Brazil ◽  
Peter Passmore ◽  
Hilary Buchanan ◽  
Doreen Maxwell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
End Of Life ◽  
Knowledge Exchange ◽  
Structured Interview ◽  
Training Needs ◽  
Advanced Dementia ◽  
Treatment Approaches ◽  
The Impact ◽  
And Training

Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Setting/participants: A total of 23 physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care ( n = 9), psychiatry ( n = 7) and hospice care ( n = 7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialities. Cross-speciality mentoring and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusion: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.

scholarly journals A Survey of Attitudes and Beliefs about Care, Compassion and Communities Networks in Palliative Care. A Preliminary Study for the Development of a Compassionate University

Healthcare ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 946
Author(s):  
Silvia Librada Flores ◽  
Sonia Herminia Roa Trujillo ◽  
Nurlian Torrejano Gonzálex ◽  
María del Pilar García Buitrago ◽  
Miguel Ángel Lucas Díaz
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Terminal Illness ◽  
Statistical Significance ◽  
Training Needs ◽  
Living Environment ◽  
Self Compassion ◽  
Level Of Knowledge ◽  
The University ◽  
And Training

The aim of this study was to know the level of knowledge, sensitivities and training needs regarding care of people at the end of life in medicine, nursing and psychology students/academic and administration university personnel; and to identify skills to perceive and expressed values related to compassion it in their living environment. Method: a descriptive observational study was conducted among undergraduate medical, nursing and psychologist students, academic and administration personnel of the University of Bogotá in Colombia the survey was based on a web-based questionnaire (November 2019–April 2020). Levels of knowledge and sensitivities about care of people at the end of life, educational needs and compassion were assessed. Descriptive and comparative measures and statistical significance tests used, Student’s t and ANOVA (α = 0.05). Results: 465 people answered the survey; students (82.4%), academic (13.1%) and administration personnel (4.5%). 81.6% knew about palliative care concepts. 64.7% had not cared for other people with advanced or terminal illness. 44.7% talked about death without problems. The most evaluated training competences were humanity, dignity and compassion. Mean levels for compassion by Gilbert’s scale were 70.55 for self-compassion, 72.61 for compassion for others and 60.47 for compassion from others. Significant differences were found by age and gender in self-compassion values. Conclusions: the level of knowledge, sensitivities and training needs regarding care of people at the end of life in the University and the values related to compassion enables the development of Compassionate Universities.

Voices of Distress: The Emotional Peril of Not Attaining a Dietetic Internship in Ontario

2013 ◽  
Vol 1 (3) ◽  
pp. 9
Author(s):  
Jennifer Lee Brady ◽  
Annie Hoang ◽  
Olivia Siswanto ◽  
Jordana Riesel ◽  
Jacqui Gingras
Keyword(s):  
Empirical Research ◽  
Current Model ◽  
Well Being ◽  
Structured Interview ◽  
Application Process ◽  
Dietetic Education ◽  
Dietetic Internship ◽  
The Impact ◽  
And Training ◽  
Future Growth

Obtaining dietetic licensure in Ontario requires completion of a Dietitians of Canada (DC) accredited four-year undergraduate degree in nutrition and an accredited post-graduate internship or combined Master’s degree program. Given the scarcity of internship positions in Ontario, each year approximately two-thirds of the eligible applicants who apply do not receive a position XX, XX, XX, XX, XX, XX, in press). Anecdotally, not securing an internship position is known to be a particularly disconcerting experience that has significant consequences for individuals’ personal, financial, and professional well-being. However, no known empirical research has yet explored students’ experiences of being unsuccessful in applying for internship positions. Fifteen individuals who applied between 2005 and 2009 to an Ontario-based dietetic internship program, but were unsuccessful at least once, participated in a one-on-one semi-structured interview. Findings reveal that participants’ experiences unfold successively in four phases that are characterized by increasingly heightened emotional peril: naïveté, competition, devastation, and frustration. The authors conclude that the current model of dietetic education and training in Ontario causes lasting distress to students and hinders the future growth and vitality of the dietetic profession. Further research is required to understand the impact of the current model on dietetic educators, internship coordinators, and preceptors as coincident participants in the internship application process.

scholarly journals Physicians’ decreased tendency to choose palliative care for patients with advanced dementia between 1999 and 2015

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Saila Haapasalmi ◽  
Reetta P. Piili ◽  
Riina Metsänoja ◽  
Pirkko-Liisa I. Kellokumpu-Lehtinen ◽  
Juho T. Lehto
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Legal Protection ◽  
Postal Survey ◽  
Advanced Dementia ◽  
Background Factors ◽  
Physician Decision Making ◽  
Care Approach ◽  
Life Threatening ◽  
The Impact

Abstract Background Physicians’ decision-making for seriously ill patients with advanced dementia is of high importance, especially as the prevalence of dementia is rising rapidly, and includes many challenging ethical, medical and juridical aspects. We assessed the change in this decision-making over 16 years (from 1999 to 2015) and several background factors influencing physicians’ decision. Methods A postal survey including a hypothetical patient-scenario representing a patient with an advanced dementia and a life-threatening gastrointestinal bleeding was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. The target groups were general practitioners (GPs), surgeons, internists and oncologists. The respondents were asked to choose between several life-prolonging and palliative care approaches. The influence of physicians’ background factors and attitudes on their decision were assessed. Results The response rate was 56%. A palliative care approach was chosen by 57 and 50% of the physicians in 1999 and 2015, respectively (p = 0.01). This change was statistically significant among GPs (50 vs 40%, p = 0.018) and oncologists (77 vs 56%, p = 0.011). GPs chose a palliative care approach less often than other responders in both years (50 vs. 63% in 1999 and 40 vs. 56% in 2015, p < 0.001). In logistic regression analysis, responding in 2015 and being a GP remained explanatory factors for a lower tendency to choose palliative care. The impact of family’s benefit on the decision-making decreased, whereas the influence of the patient’s benefit and ethical values as well as the patient’s or physician’s legal protection increased from 1999 to 2015. Conclusions Physicians chose a palliative care approach for a patient with advanced dementia and life-threatening bleeding less often in 2015 than in 1999. Specialty, attitudes and other background factors influenced significantly physician decision-making. Education on the identification and palliative care of the patients with late-stage dementia are needed to make these decisions more consistent.

A Case–Control Study Evaluating the Impact of Dedicated Palliative Care Training on Critical Care Interventions at the end of Life

2021 ◽  
pp. 082585972110374
Author(s):  
Jee Y. You ◽  
Lie D. Ligasaputri ◽  
Adarsh Katamreddy ◽  
Kiran Para ◽  
Elizabeth Kavanagh ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
High Risk ◽  
End Of Life ◽  
Poor Prognosis ◽  
Medical Interventions ◽  
Risk Of Death ◽  
Before And After ◽  
The Difference ◽  
The Impact

Many patients admitted to intensive care units (ICUs) are at high risk of dying. We hypothesize that focused training sessions for ICU providers by palliative care (PC) certified experts will decrease aggressive medical interventions at the end of life. We designed and implemented a 6-session PC training program in communication skills and goals of care (GOC) meetings for ICU teams, including house staff, critical care fellows, and attendings. We then reviewed charts of ICU patients treated before and after the intervention. Forty-nine of 177 (28%) and 63 of 173 (38%) patients were identified to be at high risk of death in the pre- and postintervention periods, respectively, and were included based on the study criteria. Inpatient mortality (45% vs 33%; P = .24) and need for mechanical ventilation (59% vs 44%, P = .13) were slightly higher in the preintervention population, but the difference was not statistically significant. The proportion of patients in whom the decision not to initiate renal replacement therapy was made because of poor prognosis was significantly higher in the postintervention population (14% vs 67%, P = .05). There was a nonstatistically significant trend toward earlier GOC discussions (median time from ICU admission to GOC 4 vs 3 days) and fewer critical care interventions such as tracheostomies (17% vs 4%, P = .19). Our study demonstrates that directed PC training of ICU teams has a potential to reduce end of life critical care interventions in patients with a poor prognosis.

scholarly journals The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study

2019 ◽  
Vol 57 (1) ◽  
pp. 93-99 ◽  
Author(s):  
Paola Di Giulio ◽  
Silvia Finetti ◽  
Fabrizio Giunco ◽  
Ines Basso ◽  
Debora Rosa ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Advanced Dementia ◽  
Staff Education ◽  
The Impact

scholarly journals Improving End-of-Life Care: Palliative Care Embedded in an Oncology Clinic Specializing in Targeted and Immune-Based Therapies

2017 ◽  
Vol 13 (9) ◽  
pp. e729-e737 ◽  
Author(s):  
David J. Einstein ◽  
Susan DeSanto-Madeya ◽  
Matthew Gregas ◽  
Jessica Lynch ◽  
David F. McDermott ◽  
...  
Keyword(s):  
Palliative Care ◽  
Usual Care ◽  
End Of Life ◽  
Odds Ratio ◽  
Care Clinic ◽  
Usual Practice ◽  
Embedded Model ◽  
Enrollment Rates ◽  
Oncology Practice ◽  
The Impact

Purpose: Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. Materials and Methods: We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care). We abstracted data from the medical records of 114 patients who died during the 3 years after this model’s implementation. Results: Compared with usual care (n = 88), patients with access to the embedded model (n = 26) encountered palliative care as outpatients more often ( P = .003) and earlier (mean, 231 v 109 days before death; P < .001). Hospice enrollment rates were similar ( P = .303), but duration was doubled (mean, 57 v 25 days; P = .006), and enrollment > 7 days before death—a core Quality Oncology Practice Initiative metric—was higher in the embedded model (odds ratio, 5.60; P = .034). Place of death ( P = .505) and end-of-life chemotherapy (odds ratio, 0.361; P = .204) did not differ between the two arms. Conclusion: A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.

scholarly journals Desafíos para responder a las necesidades de formación docente en Educación Media Superior / Challenges to Respond to the Needs of Educational Training in Higher Education

2019 ◽  
Vol 7 (2) ◽  
pp. 59-70
Author(s):  
Dr. José de la luz Sánchez Tepatzi ◽  
Dra. María Valentina Téllez Montes ◽  
Mtro. Alejandro Sánchez Guzmán
Keyword(s):  
Higher Education ◽  
Educational Level ◽  
Large Scale ◽  
Training Needs ◽  
Educational Training ◽  
Context Data ◽  
Higher Secondary Education ◽  
The Impact ◽  
And Training ◽  
Formación Docente

ABSTRACTThis paper analyzes the proposal of the Integral Reform of Higher Secondary Education (RIEMS) to meet the training needs of teachers of that educational level and the challenges for its implementation. To put this proposal in context, data from a study carried out in the state of Tlaxcala in 2014 are retaken. One of the fields that he was investigating were professional profiles and training needs. The results of the study indicate that their needs are mainly related to fields related to didactics, and the areas of greatest deficiency revealed by large-scale evaluations. Different studies emphasize problems in training: the scarce approach with teachers to identify their needs, the absence of a pedagogical system that responds to the conditions of teachers, and few studies of the impact of training on improving teaching and learning.RESUMENEste trabajo analiza la propuesta de la Reforma Integral de la Educación Media Superior (RIEMS) para atender las necesidades de formación de los profesores de ese nivel educativo y los retos para su implementación. Para poner en contexto dicha propuesta se retoman datos de un estudio realizado en el estado de Tlaxcala en el año 2014. Uno de los campos que indagaba eran los perfiles profesionales y las necesidades de formación. Los resultados del estudio señalan que sus necesidades versan principalmente en torno a campos relacionados con la didáctica, y las áreas de mayor deficiencia que revelan las evaluaciones de gran escala. Distintos estudios enfatizan como problemas en la formación: el escaso acercamiento con los docentes para identificar sus necesidades, ausencia de un sistema pedagógico que responda a las condiciones de los profesores, y pocos estudios del impacto de la formación en la mejora de la enseñanza y el aprendizaje.

scholarly journals THE ROLE OF HUMAN RESOURCE IN ORGANIZATIONAL PERFORMANCE IN THE AUTOMOTIVE INDUSTRY

2021 ◽  
Vol 37 (1) ◽  
pp. 19-28
Author(s):  
Endre Szabó ◽  
Katinka Bajkai-Tóth ◽  
Ildikó Rudnák ◽  
Róbert Magda
Keyword(s):  
Human Resources ◽  
Organizational Performance ◽  
Human Resource ◽  
Automotive Industry ◽  
Structured Interview ◽  
Training System ◽  
Preventive Action ◽  
The Impact ◽  
And Training

In the course of the research, we examined the impact of the selection and training system of a Hungarian automotive company on organizational performance, which together ensure the future development of the company. It contributes to the optimization of sales, purchasing and logistics processes, ensures customer satisfaction and the success of the company. In this fast-paced and globalized world, it is essential for companies to be aware that one of the most important factors of production is human resources themselves, whose proper selection and training are a key element in maintaining and developing economic competitiveness. Human resources play the biggest role in the operation of an economic organization. Process quality and process orientation reduce costs, increase profitability, and improve processes to always meet growing requirements. This is the basis of the quality strategy. Therefore, it consistently applies preventive quality assurance methods, learns from failures, eliminates the causes of mistakes without delays and transfers its experience to all areas of the company for preventive action. It is customer-oriented and strives for excellence in all areas, and thus makes it an obligation for everyone to aim for the highest level of customer service. Due to the special peculiarities and characteristics of the labor force, it cannot be compared to any of the production resources. Taking this as a basis, the human resource management used to be more of a functional purpose, while in recent decades human factors have become an essential source of competitiveness. The market operation and performance of an organization depends significantly on how we can select the most suitable workforce. We need to see what the strategic points that determine the role of HR are, and we are also looking for the answer in which direction the needs, expectations and professionalism given by the generational difference move the activities of human resources. The aim of the research is to get an answer to how the employees of one of the leading Hungarian players in the automotive industry perceive the importance of the selection and training of the workforce in maintaining and improving competitiveness. To this end, we used a semi-structured interview, with the help of which we evaluated the current selection and training processes in the light of competitiveness and made suggestions for the improvement and refinement of these processes.

scholarly journals Healing at the End of Life: The Voice of the Patient

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Cory Ingram
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Life Story ◽  
Patient Centered ◽  
Whole Person ◽  
Centered Care ◽  
The Impact

In palliative care we have the privilege to care for seriously ill people and their families. Some people value capturing their life story or illness journey on film. I have been fortunate to have been invited into the lives of many people close the end of life for a heartfelt conversation.On an interactive iPad incorporated in the poster, the recorded narrative of patients and one bereft spouse the poster audience will experience the lived experience of people close to the end of life as they reflect on their lives. The narratives will demonstrate how each lived with a new found improved quality of life in the face of increasing symptoms, declining functioning and the approaching end of life; otherwise known as healing. Topics of healing and quality of life, patient-centered care, dignity, human development, spirituality and love will be the focus of their stories. The stories lay bare the very practical, emotional, existential, and personal experience central to our provision of whole person care through palliative care. The poster audience will experience a renewed sense of the impact of a dedicated approach to whole person care as experienced through those on the receiving end.

Sign in / Sign up

Export Citation Format

Share Document