A phenomenological study of nurses’ understanding of honesty in palliative care

2010 ◽  
Vol 17 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Eva Erichsen ◽  
Elisabeth Hadd Danielsson ◽  
Maria Friedrichsen
Keyword(s):  
Palliative Care ◽  
Phenomenological Study ◽  
Moral Character ◽  
Moral Conflict ◽  
Staff Members ◽  
Dying Patients ◽  
Home Based ◽  
Care At Home ◽  
Home Based Care ◽  
Seriously Ill

Honesty is essential for the care of seriously ill and dying patients. The current study aimed to describe how nurses experience honesty in their work with patients receiving palliative care at home. The interviews in this phenomenological study were conducted with 16 nurses working with children and adults in palliative home-based care. Three categories emerged from analyses of the interviews: the meaning of honesty, the reason for being honest and, finally, moral conflict when dealing with honesty. The essence of these descriptions was that honesty is seen as a virtue, a good quality that a nurse should have. The nurses’ ethical standpoint was shown in the moral character they show in their work and in their intention to do good. This study could help nurses to identify different ways of looking at honesty to promote more consciousness and openness in ethical discussions between colleagues and other staff members.

scholarly journals Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xhyljeta Luta ◽  
Baptiste Ottino ◽  
Peter Hall ◽  
Joanna Bowden ◽  
Bee Wee ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cost Effectiveness ◽  
End Of Life ◽  
Resource Use ◽  
Economic Value ◽  
Healthcare Delivery ◽  
Dying Patients ◽  
Home Based ◽  
Population Type ◽  
Care Models

Abstract Background As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings. Methods Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions. Results A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers’ outcomes. The evidence of interventions delivered across other settings was generally inconsistent. Conclusions Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.

Palliative care programs for patients with breast cancer: the benefits of home-based care

2013 ◽  
Vol 2 (5) ◽  
pp. 407-416 ◽  
Author(s):  
Hsien Seow ◽  
Daryl Bainbridge ◽  
Deanna Bryant
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Home Based ◽  
Home Based Care

Physicians’ experiences with the treatment of seriously ill and dying patients in acute care hospitals in Germany beyond palliative care.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e20725-e20725
Author(s):  
Asita Behzadi ◽  
Anja Hermann ◽  
Gesine Leithaeuser ◽  
Peter C. Thuss-Patience
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Dying Patients ◽  
Seriously Ill

scholarly journals Palliative care at home: Carers and medication management

2008 ◽  
Vol 6 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Barbara A. Anderson ◽  
Debbie Kralik
Keyword(s):  
Palliative Care ◽  
Medication Management ◽  
Symptom Relief ◽  
Symptom Control ◽  
Subcutaneous Administration ◽  
Care Practice ◽  
Home Based ◽  
Palliative Care Setting ◽  
Care At Home ◽  
At Home

ABSTRACTObjective:The decision to receive palliative care at home brings with it the complexity of managing a medication regime. Effective symptom control is often directly linked to medication management and relies on access to medications at all times. In home-based palliative care practice, polypropylene syringes of medications may be drawn up and left in clients' domestic refrigerators for subcutaneous administration by carers to provide immediate relief for symptoms such as pain and nausea. However, although there has been some discussion in the literature about the need for ready access to medications for symptom control of clients receiving care in the community, the feasibility of this practice has received scant attention. The aim of this article is to present the carers' experiences of administering medications in this manner.Methods:Semistructured interviews with 14 carers, who were administering medication in a home-based palliative care setting, were analyzed using qualitative methods to develop meaning units and themes.Results:Interviews revealed that this practice was highly valued. The carers willingly assumed the responsibility of medication administration, as it allowed the clients to remain at home where they desired to be. They could provide immediate symptom relief, which was of utmost importance to both the client and carer. The carers were empowered in their caring role, being able to participate in the care provided, rather than standing on the sidelines as helpless observers. Carers acknowledged the security and ethical issues associated with the presence of certain medications in the home and valued the 24-h telephone support that was available to them. After clients had died, the carers reflected on their involvement in care and felt a sense of pride and achievement from administering medications in this way because they had been able to care for their loved ones at home and fulfill their wish to die there.Significance of results:These interviews confirm the feasibility of this practice, which is a component of quality end-of-life care.

scholarly journals What does it take to deliver brilliant home-based palliative care? Using positive organisational scholarship and video reflexive ethnography to explore the complexities of palliative care at home

2018 ◽  
Vol 33 (1) ◽  
pp. 91-101 ◽  
Author(s):  
Aileen Collier ◽  
Michael Hodgins ◽  
Gregory Crawford ◽  
Alice Every ◽  
Kerrie Womsley ◽  
...  
Keyword(s):  
Palliative Care ◽  
Service Management ◽  
Video Recording ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services ◽  
Care At Home ◽  
Or Team ◽  
Different Levels ◽  
At Home

Background: Despite the increasing number of people requiring palliative care at home, there is limited evidence on how home-based palliative care is best practised. Aim: The aim of this participatory qualitative study is to determine the characteristics that contribute to brilliant home-based palliative care. Design: This study was inspired by the brilliance project – an initiative to explore how positive organisational scholarship in healthcare can be used to study brilliant health service management from the viewpoint of patients, families, and clinicians. The methodology of positive organisational scholarship in healthcare was combined with video-reflexive ethnography. Setting/participants: Home-based specialist palliative care services across two Australian states participated in the study. Clinicians were able to take part in the study at different levels. Pending their preference, this could involve video-recording of palliative care, facilitating and/or participating in reflexive sessions to analyse and critique the recordings, identifying the characteristics that contribute to brilliant home-based palliative care, and/or sharing the findings with others. Results: Brilliance in home-based palliative care is contingent on context and is conceptualised as a variety of actions, people, and processes. Care is more likely to be framed as brilliant when it is epitomised: anticipatory aptitude and action; a weave of commitment; flexible adaptability; and/or team capacity-building. Conclusion: This study is important because it verifies the characteristics of brilliant home-based palliative care. Furthermore, these characteristics can be adapted for use within other services.

scholarly journals Self-reported impact of caregiving on voluntary home-based caregivers in Mutale Municipality, South Africa

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Ntsieni S. Mashau ◽  
Vhonani O. Netshandama ◽  
Makondelela J. Mudau
Keyword(s):  
Palliative Care ◽  
Survey Design ◽  
The Elderly ◽  
Chronic Illnesses ◽  
Limpopo Province ◽  
Cross Sectional ◽  
Home Based ◽  
Home Based Care ◽  
Descriptive Survey ◽  
The Impact

Background: The establishment of home-based care (HBC) programmes in developing countries has resulted in a shift of burden from hospitals to communities where palliative care is provided by voluntary home-based caregivers.Aim: The study investigated the impact of caregiving on voluntary home-based caregivers.Setting: The study was conducted at HBC organisations located in Mutale Municipality of Limpopo Province, South Africa.Methods: A quantitative cross-sectional descriptive survey design was applied to investigate the impact of caregiving on voluntary home-based caregivers. The sample was comprised of (N = 190) home-based caregivers. Home-based caregivers provide care to people in need of care in their homes, such as orphans, the elderly and those suffering from chronic illnesses such as tuberculosis, HIV and/or AIDS, cancer and stroke. Self-administered questionnaires were used to collect data which were analysed descriptively using the Statistical Package for the Social Sciences software, Version 20.Results: The results showed that 101 (53.2%) participants were worried about their financial security because they were not registered as workers, whilst 74 (39.0%) participants were always worried about getting infection from their clients because they often do not have protective equipment.Conclusion: Voluntary home-based caregivers have an important role in the provision of palliative care to people in their own homes, and therefore, the negative caregiving impact on the lives of caregivers may compromise the provision of quality palliative care.

Findings and lessons learnt from early termination of a pragmatic comparative effectiveness trial of video consultations in home-based palliative care

2020 ◽  
pp. bmjspcare-2020-002553
Author(s):  
Huong Q. Nguyen ◽  
Carmit McMullen ◽  
Eric C Haupt ◽  
Susan E Wang ◽  
Henry Werch ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Symptom Burden ◽  
Home Visits ◽  
Implementation Barriers ◽  
Process Measures ◽  
Home Based ◽  
Seriously Ill Patients ◽  
Payment Policies ◽  
Seriously Ill

BackgroundHealth systems need evidence about how best to deliver home-based palliative care (HBPC) to meet the growing needs of seriously ill patients. We hypothesised that a tech-supported model that aimed to promote timely inter-professional team coordination using video consultation with a remote physician while a nurse is in the patient’s home would be non-inferior compared with a standard model that includes routine home visits by nurses and physicians.MethodsWe conducted a pragmatic, cluster randomised non-inferiority trial across 14 sites (HomePal Study). Registered nurses (n=111) were randomised to the two models so that approximately half of the patients with any serious illness admitted to HBPC and their caregivers were enrolled in each study arm. Process measures (video and home visits and satisfaction) were tracked. The primary outcomes for patients and caregivers were symptom burden and caregiving preparedness at 1–2 months.ResultsThe study was stopped early after 12 months of enrolment (patients=3533; caregivers=463) due to a combination of low video visit uptake (31%), limited substitution of video for home visits, and the health system’s decision to expand telehealth use in response to changes in telehealth payment policies, the latter of which was incompatible with the randomised design. Implementation barriers included persistent workforce shortages and inadequate systems that contributed to scheduling and coordination challenges and unreliable technology and connectivity.ConclusionsWe encountered multiple challenges to feasibility, relevance and value of conducting large, multiyear pragmatic randomised trials with seriously ill patients in the real-world settings where care delivery, regulatory and payment policies are constantly shifting.

scholarly journals Palliative care is effective: but hospital symptom outcomes superior

2018 ◽  
Vol 10 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Kathy Eagar ◽  
Sabina Petranella Clapham ◽  
Samuel Frederic Allingham
Keyword(s):  
Palliative Care ◽  
Regression Models ◽  
Severe Symptom ◽  
Palliative Care Team ◽  
Logistic Regression Models ◽  
Home Based ◽  
Hospital Patients ◽  
Care At Home ◽  
The Difference ◽  
At Home

ObjectivesTo explore differences in severe symptom outcomes for palliative care patients receiving hospital care compared with those receiving care at home.MethodsChange in symptom distress from the start of an episode of palliative care to just prior to death was measured for 25 679 patients who died under the care of a hospital or home-based palliative care team between January 2015 and December 2016. Logistic regression models controlled for differences between hospital and home and enabled a comparison of the number of severe symptoms just prior to death.ResultsAll symptoms improved and over 85% of all patients had no severe symptoms prior to death. Pain control illustrates this with 7.4% of patients reporting severe pain distress at episode start and 2.5% just prior to death. When comparing all symptom outcomes by place of death, hospital patients are 3.7 times more likely than home patients to have no severe symptoms.Conclusion Symptom outcomes are better for hospital patients. Patients at home have less improvement overall and some symptoms get worse. Reasons for the difference in outcomes by hospital and home are multifactorial and must be considered in relation to the patient’s right to choose their place of care.

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