End-of-Life Care Policies and Practices in Pediatric Skilled Nursing Facilities

2013 ◽  
Vol 31 (7) ◽  
pp. 765-770 ◽  
Author(s):  
Sandra L. Friedman ◽  
David T. Helm ◽  
Ashley C. Woodman
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Life Care ◽  
Skilled Nursing ◽  
Care Policies ◽  
Policies And Practices

scholarly journals Preliminary Report of a Pilot Tele-Health Palliative Care and Bioethics Program for Residents in Skilled Nursing Facilities

2009 ◽  
Vol 3 ◽  
pp. PCRT.S3296
Author(s):  
Sean O'Mahony ◽  
Patricia Marthone ◽  
Gabriella Santoro ◽  
Clare Horn ◽  
Sandy Selikson ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Skilled Nursing Facilities ◽  
Rank Test ◽  
Nursing Facilities ◽  
Life Care ◽  
Skilled Nursing ◽  
Face To Face

Currently about 25% of Americans die in nursing homes, many with poorly controlled pain and other symptoms, with minimal provisions for psychosocial support. New models are necessary to lessen structural and process barriers to give effective end-of-life care in nursing homes. Objectives 1) To extend hospital-based Bioethics Consultation Services (BCS) and Palliative Care Services (PCS) at Montefiore Medical Center (MMC) in the Bronx to two local Skilled Nursing Facilities (SNFs), Morningside House Aging in America (MSH) using direct face-to-face consultations and Beth Abraham Health Systems (BAHS) via video consultations (VC); 2) Achieve improvements in quality of life and comfort for elderly residents and their families; 2a) Improve the level of practice and increase staff satisfaction with palliative care content-related knowledge and bioethical analysis. Methods We report preliminary findings of this two group quasi experimental project with results of pre- and post-tests rating content-related knowledge in aspects of end-of-life care for staff. Select pre-test and post-test questions were given to physicians and other staff, but were re-configured for, registered and licensed practice nurses, social workers, and certified nursing assistants from the End-of-Life Physician Education Resource Center (EPERC). Patient, family, and staff ratings of the quality of palliative care were measured with a Palliative Outcomes Scale (POS) one week prior to and post consultation. Results 72 staff attended in-services; 53 completed pre-tests and 49 post-tests. Overall knowledge scores increased for 9 of the 16 items that were analyzed. There were improvements in knowledge scores in 12 of 16 items tested for staff content related knowledge which were statistically significant in regard to management of cancer pain from 63.8% to 81.5% (p = 0.03) and a trend to significance for assessment and management of delirium from 31.6% to 61.9% (p = 0.073). Seventy five POS surveys were completed from 13 video-conferenced Palliative Care consultations and 14 direct face-to-face consultations from March 2008 to January 2009. There were improvements in ratings for some aspects of quality of care on the POS. Patient and staff aggregate response scores for the POS were significantly improved between baseline and follow-up (Wilcoxon signed-rank test p = 0.0143 and p = 0.005) at the videoconsultation site and for family and staff at the face-to-face consultation site (Wilcoxon signed-rank test p = 0.0016 and p = 0.0012). Conclusion Preliminary evidence suggests that use of real time videoconferencing to connect hospital-based Bioethics and Palliative Care clinicians with patients, families, and staff in Skilled Nursing Facilities may enhance some aspects of end-of-life care for their residents, as well as content related knowledge in core aspects of end-of-life care for interdisciplinary groups of staff or caregivers.

Developing a national quality register in end-of-life care: The Swedish experience

2011 ◽  
Vol 26 (4) ◽  
pp. 313-321 ◽  
Author(s):  
Staffan Lundström ◽  
Bertil Axelsson ◽  
Per-Anders Heedman ◽  
Greger Fransson ◽  
Carl Johan Fürst
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Nursing Facilities ◽  
Life Care ◽  
Quality Register ◽  
Dying Patients ◽  
National Quality ◽  
Hospital Wards ◽  
National Quality Register

Background: The complexity of end-of-life care, represented by a large number of units caring for dying patients, different types of organizations and difficulties in identification and prognostication, signifies the importance of finding ways to measure the quality of end-of-life care. Aim: To establish, test and manage a national quality register for end-of-life care. Design: Two questionnaires were developed with an attempt to retrospectively identify important aspects of the care delivered during the last week in life. An internet-based IT platform was created, enabling the physician and/or nurse responsible for the care during the last week in life to register answers online. Setting: Units caring for dying people, such as hospital wards, home care units, palliative in-patient care units and nursing facilities. Results: The register received status as a National Quality Register in 2006. More than 30,000 deaths in nursing facilities, hospital wards, palliative in-patient units and private homes were registered during 2010, representing 34% of all deaths in Sweden and 58% of the cancer deaths. Conclusions: We have shown that it is feasible to establish a national quality register in end-of-life care and collect data through a web-based system. Ongoing data analyses will show in what way this initiative can lead to improved quality of life for patients and their families. There is an ongoing process internationally to define relevant outcome measures for quality of care at the end-of-life in different care settings; the registry has a potentially important role in this development.

Improving End-of-Life Care in Nursing Facilities: The Community State Partnership to Improve End-of-Life Care—California

2005 ◽  
Vol 8 (2) ◽  
pp. 300-312 ◽  
Author(s):  
Terry E. Hill ◽  
Marjorie Ginsburg ◽  
Judy Citko ◽  
Mary Cadogan
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Nursing Facilities ◽  
Life Care

Discussing End of Life Care: An Opportunity

2015 ◽  
Vol 20 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Amanda Stead ◽  
Caitlin McDonnell
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
End Of Life Care ◽  
Close Contact ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Skilled Nursing

Most deaths now occur in medical or skilled nursing settings. This brings speech-language pathologists, and other professionals, in close contact with clients who face death. While it can feel uncomfortable, speech-language pathologists are in a position to influence this phase of their client's quality-of-life life by addressing death and end of life wishes. This can be a goal of therapy.

scholarly journals An Exploration of Person-Centred Approach in End-of-Life Care Policies in England and Japan

2021 ◽  
Author(s):  
Chao Fang ◽  
Miho Tanaka
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Family Care ◽  
Cultural Analysis ◽  
Three Dimensions ◽  
Best Interests ◽  
Complex Nature ◽  
Life Care ◽  
Care Policies ◽  
Policy Discourses

Abstract Background: Increasing evidence has suggested that a person-centred approach is beneficial not only for improving care outcomes but also for mitigating the pressure on public health systems. However, policy implementation gaps have prevented the translation of this complex framework into useful practical, ethical and moral stances for end-of-life care. This article aims to explore the meaning and implications of person-centredness in end-of-life care policy discourses.Methods: By perceiving policy documents as a medium embodied with socio-political and cultural norms, we analysed how person-centred approach in end-of-life care is constructed within specific socio-cultural contexts and the implications of these contexts on resultant care. Focusing on England and Japan, we conducted a critical policy analysis to examine and compare key policy and legal documents collected between 2007 and 2019 in these two post-industrial and socio-culturally distinctive countries. Results: Our analysis found that the person-centred approach is mobilised in policy discourses primarily through three interconnected dimensions: individual, relational and existential. While acknowledging that both countries have developed varied policy and legal mechanisms to emphasise holistic and integrated care with respect to these three dimensions, we also identified significant gaps in the policies both within and between England and Japan. They include ambiguity in defining patients’ best interests, fragmented support for social and family care and the neglect of existential needs. Conclusions: This cross-cultural analysis has revealed the complex nature of discourses around person-centred approach in English and Japanese end-of-life care policies, which often concentrate on the multifaceted aspects of experiences as one approaches the end of life. Despite this, we argue that a more holistic construction of person-centred approach is needed in end-of-life care policies not only in England and Japan but also more broadly, to encapsulate the richness of end-of-life experiences.

Euthanasia and Withdrawal of Treatment in People with Disabilities and Intractable Diseases: Comparison Between Japan and Western Countries

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 171-171
Author(s):  
Miho Tanaka ◽  
◽  
Satoshi Kodama ◽  
◽  
Keyword(s):  
Literature Review ◽  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
People With Disabilities ◽  
Worth Living ◽  
Life Care ◽  
Deep Roots ◽  
Western Countries ◽  
Care Policies

"Background: In Japan, groups advocating for people with disabilities and intractable diseases (hereafter “PWDs”) have recently voiced serious concerns regarding end-of-life care policies. For example, when non-partisan MPs announced a draft bill on allowing forgoing life-sustaining treatments (LSTs) in 2012, these groups protested. One group in particular strongly protested against a TV documentary by the Japanese public broadcasting corporation in 2019, in which a patient with a serious neurologic intractable disease died by physician-assisted suicide in Switzerland. Objective: To present the specific concerns voiced by PWDs regarding end-of-life care policies and to compare debates between Japan and Western countries on the topic. Method: Comprehensive literature review. Results: Several important points emerged. In Japan, PWDs felt that those living with LSTs would consider it a life without dignity. In Western countries, the following issues surfaced: negative images of people with disabilities have deep roots in society due to the long and tragic history of discrimination; people with disabilities might become victims of society’s value judgment, such as “life with a severe disability is not worth living”; and laws and safeguard policies cannot eliminate the concerns of a slippery slope. Conclusion: Western countries have recently discussed the risks of legalising euthanasia, while discussions in Japan have focused more on the risks of legislation on forgoing LSTs. Future literature review studies and interviews with advocacy groups aimed at identifying similar situations in other East Asian countries are warranted. "

Sign in / Sign up

Export Citation Format

Share Document