scholarly journals Organizational and individual barriers and facilitators to the integration of pediatric palliative care for children: A grounded theory study

2021 ◽  
pp. 026921632110261
Author(s):  
Anat Laronne ◽  
Leeat Granek ◽  
Lori Wiener ◽  
Paula Feder-Bubis ◽  
Hana Golan
Keyword(s):  
Palliative Care ◽  
Grounded Theory ◽  
Healthcare Provider ◽  
Care Center ◽  
Healthcare Providers ◽  
Pediatric Palliative Care ◽  
Structured Interviews ◽  
Grounded Theory Method ◽  
Organizational Barriers ◽  
Provider Barriers

Background: Pediatric palliative care has established benefits for children with cancer and their families. Overcoming organizational and healthcare provider barriers have been demonstrated as central for the provision of palliative care in pediatric oncology. A deeper understanding is needed of the influence of these barriers and the interactions between them, specifically in primary palliative care in hospital settings. Aim: To identify the organizational and healthcare provider barriers to the provision of primary pediatric palliative care. Design: This study utilized the grounded theory method. Semi-structured interviews were conducted and analyzed line by line, using NVivo software. Setting/participants: Forty-six pediatric oncologists, nurses, psychosocial team members, and other healthcare providers from six academic hospital centers participated in the research. Results: Organizational and healthcare provider factors were identified, each of which acted as both a barrier and facilitator to the provision of pediatric palliative care. Organizational barriers included lack of resources and management. Facilitators included external resources, resource management, and a palliative care center within the hospital. Individual barriers included attitudes toward palliative care among pediatric oncologists, pediatric oncologists’ personalities, and the emotional burden of providing palliative care. Facilitators include dedication and commitment, initiative, and sense of meaning. Provider facilitators for palliative care had a buffering effect on organizational barriers. Conclusion: Organizational and healthcare provider factors influence the quality and quantity of palliative care given to children and their families. This finding has implications on interventions structured to promote primary palliative care for children, especially in healthcare systems and situations where resources are limited.

scholarly journals Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers

2021 ◽  
pp. 104990912110126
Author(s):  
Valeria Cardenas ◽  
Anna Rahman ◽  
Yujun Zhu ◽  
Susan Enguidanos
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Health Condition ◽  
Insurance Companies ◽  
Structured Interviews ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.

scholarly journals What are healthcare providers’ understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019701 ◽  
Author(s):  
Shane Sinclair ◽  
Thomas F Hack ◽  
Shelley Raffin-Bouchal ◽  
Susan McClement ◽  
Kelli Stajduhar ◽  
...  
Keyword(s):  
Grounded Theory ◽  
Healthcare Provider ◽  
Healthcare Providers ◽  
Care Hospital ◽  
Care Services ◽  
Palliative Care Services ◽  
Patient Model ◽  
To Receive ◽  
Empirical Foundation ◽  
Insight Into

BackgroundHealthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed.ObjectivesThe aim of this study was to investigate healthcare providers’ perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model.DesignData were collected via focus groups with frontline healthcare providers and interviews with peer-nominated exemplary compassionate healthcare providers. Data were independently and collectively analysed by the research team in accordance with Straussian grounded theory.Setting and participants57 healthcare providers were recruited from urban and rural palliative care services spanning hospice, home care, hospital-based consult teams, and a dedicated inpatient unit within Alberta, Canada.ResultsFive categories and 13 associated themes were identified, illustrated in the Healthcare Provider Compassion Model depicting the dimensions of compassion and their relationship to one another. Compassion was conceptualised as—a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action.ConclusionsAn empirical foundation of healthcare providers’ perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.

scholarly journals A Grounded theory study of the intention of nurses to leave the profession

2017 ◽  
Vol 25 (0) ◽  
Author(s):  
Leyla Alilu ◽  
Vahid Zamanzadeh ◽  
Leila Valizadeh ◽  
Hosein Habibzadeh ◽  
Mark Gillespie
Keyword(s):  
Grounded Theory ◽  
Comparative Method ◽  
Intention To Leave ◽  
Self Control ◽  
Structured Interviews ◽  
Grounded Theory Method ◽  
Psychosocial Concerns ◽  
Constant Comparative Method ◽  
Bedside Nursing ◽  
Organizational Expectations

ABSTRACT Objective: this study explores the process of the development of an intention to leave bedside nursing. Method: the process was studied from the perspective of 21 nurses using the grounded theory method. Data were collected using semi-structured interviews and the constant comparative method of Corbin and Strauss was used for data analysis. Results: according to the participants, the two main categories, "social image of nursing", and "culture and structure of the bedside", were the contextual factors that influence why nurses are leaving bedside care provision. Disappointment with a perceived lack of progress or improvement in the clinical experience formed primary psychosocial concerns for the participants. Competence and a process of self-control were steps taken by the participants. These, associated with interventional conditions produced the outcomes of the loss of professional commitment and desire to leave bedside nursing. "Failure to integrate personal expectations with organizational expectations: in search of escape" was the central category of the study that linked the categories together. Conclusion: the findings of this study provide useful information about the needs of nurses for overcoming the intention to leave bedside care. The identification of this process can help in recognizing emerging problems and providing solutions for them.

scholarly journals Culturally safe care & the Ontario midwifery model: exploring the challenges of serving uninsured immigrant clients

2021 ◽  
Author(s):  
Isuri Herath
Keyword(s):  
Discourse Analysis ◽  
Healthcare Provider ◽  
Immigrant Women ◽  
Healthcare Providers ◽  
Structured Interviews ◽  
The Relationship ◽  
Safe Care

Immigrant women’s healthcare has been one of the major areas of research in the literature on settlement in Ontario, but little research exists on the relationship between immigrant women and their healthcare providers, and even less that is from the perspective of the healthcare provider. This study used semi-structured interviews with 10 midwives who serve uninsured immigrant clientele in order to understand how they navigate challenges to provide culturally safe care. Discourse analysis revealed that participants discussed barriers that were both logistical and conceptual in nature when providing care to uninsured immigrant clients. Midwives indicated that logistical barriers and fear of providing insufficient culturally safe care were factors that made practices more reluctant to take on uninsured immigrant clients. Their discussion of culturally safe care was informed by the Ontario midwifery model, but their strategies for delivering culturally safe care often involved a renegotiation of this model.

scholarly journals The First Step to Initiate Pediatric Palliative Care: Identify Patient Needs and Cooperation of Medical Staff

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 127
Author(s):  
Su Hyun Bae ◽  
Yeo Hyang Kim
Keyword(s):  
Palliative Care ◽  
Medical Staff ◽  
Care Service ◽  
Care Center ◽  
Palliative Care Service ◽  
Disease Diagnosis ◽  
Pediatric Palliative Care ◽  
Number Of Patients ◽  
Palliative Care Services ◽  
Limiting Condition

Few Korean hospitals had experience in pediatric palliative care. Since the beginning of the national palliative care project, interest in pediatric palliative care has gradually increased, but the establishment of professional palliative care is still inadequate due to a lack of indicators. This study aimed to find considerations in the process of initiating palliative care services. The general and clinical characteristics of 181 patients aged less than 24 years who were registered at the pediatric palliative care center from January 2019 to August 2021 were evaluated. Life-limiting condition group 1 had the largest number of patients. The primary need for palliative care was psychological and emotional support, followed by information sharing and help in communication with the medical staff in decision-making processes. Seventy-two patients were technologically dependent, with one to four technical supports for each patient. The registration of patients with cancer increased with time, and the time from disease diagnosis to consultation for pediatric palliative care service was significantly reduced. In conclusion, before starting pediatric palliative care, it is necessary to understand the needs of patients and their families and to cooperate with medical staff.

scholarly journals P038: Does the pediatric emergency department have a role in pediatric palliative care?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S90-S91
Author(s):  
A. Côté ◽  
N. Gaucher ◽  
A. Payot
Keyword(s):  
Emergency Medicine ◽  
Palliative Care ◽  
Continuity Of Care ◽  
Health Care Professionals ◽  
Moral Distress ◽  
Healthcare Providers ◽  
Clinical Situation ◽  
Pediatric Emergency ◽  
Pediatric Palliative Care ◽  
Pediatric Emergency Medicine

Introduction: Very little is known regarding the emergency department’s (ED) role in the care of paediatric patients with complex chronic and life-limiting illnesses. In fact, the provision of paediatric palliative care (PPC) in the paediatric ED has, of yet, never been explored. This study aims to explore pediatric emergency medicine healthcare professionals’ perspectives regarding their role in PPC and to compare these to other health care professionals’ understandings of the ED’s role in PPC. Methods: Interdisciplinary semi-structured focus groups were held with healthcare providers from pediatric emergency medicine, pediatric palliative care, pediatric complex care and pediatric intensive care. Exploratory open-ended questions introduced naturally occurring discussions and interactions. Data was transcribed in full and analysed using NVivo© software. Data analysis was performed by thematic analysis and theoretical sampling. Results: From January to October 2016, 58 participants were interviewed; most were female nurses and physicians. ED providers seek to maintain continuity of care and uphold pre-established wishes throughout PPC patients’ ED visits by listening and supporting the patient and family, evaluating the clinical situation, communicating with primary care teams and organising rapid admissions to wards. Some ED providers recognized having no choice to provide palliative care approach under certain circumstances despite thinking it might not be part of their culture and role. Each interdisciplinary team demonstrated particular values and cultures, influencing their understandings of the ED’s role in PPC; continuity of care is complicated by these distinct philosophies. Limitations to providing PPC in the ED are related to unsuitable physical environments, lack of uninterrupted time, efficiency expectations, unknown patients, provider lack of knowledge and moral distress. Solutions were directed at improving communication between teams and humanizing care to develop a sensibility to quality PPC in the ED. Conclusion: Although the perspective of pediatric ED’s role in caring for PPC patients is heterogeneous, several barriers to providing high quality emergency PPC can be overcome. Future studies will explore the experiences of PPC families presenting to the ED.

Nurses’ roles and responsibilities in the provision of early palliative care: A grounded theory study.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 98-98
Author(s):  
Shan Darrel Mohammed ◽  
Pamela Savage ◽  
Camilla Zimmermann
Keyword(s):  
Palliative Care ◽  
Grounded Theory ◽  
Nurse Practitioners ◽  
Comfort Level ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Structured Interviews ◽  
Early Palliative Care ◽  
Practice Nurses ◽  
Roles And Responsibilities

98 Background: The benefits of providing early palliative care (EPC) are well researched. Few studies have explored the knowledge and skill used by nurses to help patients and families transition to and receive palliative care. In this study, we examine the roles and responsibilities of nurses in the provision of EPC and explore some of the barriers and facilitators they encounter as part of this complicated work. Methods: We drew on constructivist grounded theory to guide our methods and analysis. Nurses were recruited from several ambulatory care clinics in a comprehensive cancer center in Ontario, Canada. Nurses who participated in the study completed semi-structured interviews seeking to examine the roles, responsibilities, knowledge, and skills they utilized to provide EPC. Results: Ten nurse practitioners, six staff nurses, and four advanced practice nurses completed interviews for a total of 20 participants. Participants practiced in a variety of settings such as head and neck, breast, pancreatic, and hematology. The core category Brokering Palliative Care includes three subcategories: (1) Moving backwards and forward – stepping back to assess patients’ willingness to hear about EPC and then proceeding by selling the benefits of palliative to improving everyday function; (2) Addressing misconceptions and stigma – dealing with patients’ assumptions about palliative care as diminishing hope and accelerating the end of life; and (3) Advocating with the interprofessional team – bringing patient concerns forward to the team, managing interprofessional dynamics, and seeding the process of referral to EPC. Conclusions: Oncology nurses play a central role by brokering EPC for patients with serious cancers and their families. They draw on their proximity to patients, relational and communication capabilities, care coordination skills, and advocacy abilities. Brokering palliative care is conditional on nurses’ comfort level, experience, workload, and relationships with other healthcare professionals, especially oncologists. Moreover, the brokering work of nurses must be enacted within the boundaries of the nursing role and their relative position within the healthcare system.

scholarly journals Assistance to children in palliative care in the Brazilian scientific literature

2014 ◽  
Vol 32 (1) ◽  
pp. 99-106 ◽  
Author(s):  
Nathalia Rodrigues Garcia-Schinzari ◽  
Franklin Santana Santos
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Scientific Literature ◽  
Target Population ◽  
Study Data ◽  
Pediatric Palliative Care ◽  
Structured Interviews ◽  
Publication Type ◽  
The Family ◽  
Number Of Publications

Objective: To describe what has been published in Brazilian scientific literature regarding pediatric palliative care. Data sources: Bibliographic review with a descriptive approach. In LILACS and SciELO databases, the descriptors "palliative care", "child", "pediatrics", "terminal illness" and "death" were sought, from January 2002 to December 2011. The eight selected articles were analyzed according to year of publication, type of study, data collected, target population, pathology, professionals involved, types of care and main findings. Data synthesis: Regarding the year of publication, there was an increase in the number of publications related to pediatric palliative care. Regarding the type of study, four articles were literature reviews and four were qualitative researches. Data was collected mainly by semi-structured interviews. The participants of the majority of the studies were children's relatives and health professionals. The main pathology addressed was cancer and the nurses were the most frequently cited professionals. The types of care provided were related to physical aspects, general care and psychological, social and spiritual aspects (less emphasis). The main findings were: little emphasis on the children's needs, the importance of including the family in the care provided and the lack of preparation of the health team. Conclusions: Despite the difficulties and the challenges in establishing pediatric palliative care, many articles brought important considerations for the development of this practice in the country.

scholarly journals Culturally safe care & the Ontario midwifery model: exploring the challenges of serving uninsured immigrant clients

2021 ◽  
Author(s):  
Isuri Herath
Keyword(s):  
Discourse Analysis ◽  
Healthcare Provider ◽  
Immigrant Women ◽  
Healthcare Providers ◽  
Structured Interviews ◽  
The Relationship ◽  
Safe Care

Immigrant women’s healthcare has been one of the major areas of research in the literature on settlement in Ontario, but little research exists on the relationship between immigrant women and their healthcare providers, and even less that is from the perspective of the healthcare provider. This study used semi-structured interviews with 10 midwives who serve uninsured immigrant clientele in order to understand how they navigate challenges to provide culturally safe care. Discourse analysis revealed that participants discussed barriers that were both logistical and conceptual in nature when providing care to uninsured immigrant clients. Midwives indicated that logistical barriers and fear of providing insufficient culturally safe care were factors that made practices more reluctant to take on uninsured immigrant clients. Their discussion of culturally safe care was informed by the Ontario midwifery model, but their strategies for delivering culturally safe care often involved a renegotiation of this model.

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