scholarly journals Improving End-of-Life Care for Diverse Populations: Communication, Competency, and System Supports

2019 ◽  
Vol 36 (6) ◽  
pp. 453-459 ◽  
Author(s):  
Sara G. McCleskey ◽  
Cindy L. Cain
Keyword(s):  
African American ◽  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Life Care ◽  
High Quality ◽  
High Quality Care ◽  
Provider Characteristics ◽  
Care Groups ◽  
Effective Care

Background: While disparities in end-of-life care have been well-documented, explanations for the persistence of disparities are less clear. This study sought to examine diverse perceptions of end-of-life care, especially regarding how medical professionals can better serve all populations. Objective: To investigate similarities and differences in end-of-life care preferences, across racial and ethnic groups. Design: This work consists of a qualitative study utilizing in-depth focus group discussions. Setting/Participants: Six community-based focus groups were conducted with a total of 39 participants. Two groups were composed of African American participants, 2 had Latino participants, and 2 groups had white participants. Results: Analysis produced 3 major themes: (1) clear, comprehensive, and culturally relevant provider–patient communication regarding serious illness; (2) provider characteristics and competency; and (3) health system supports and barriers. Although all groups had individuals who expressed a strong preference for direct communication, individuals varied within groups. All groups discussed concerns that the costs of care are high and that financial considerations are given more importance than high-quality care. Groups diverged in their focus on provider characteristics and feelings of marginalization. African American and Latino groups emphasized a desire to match characteristics with providers, and African American groups discussed that their marginalization in the health-care system requires hypervigilance to receive high-quality care. Conclusions: Improvements in care would come from acknowledging diversity within groups, provider demonstration of comfort and competence, more effective care coordination, and recruitment of providers who share similar characteristics with the communities they serve.

Das Lebensende zwischen Ökonomie und Ethik

2019 ◽  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Death And Dying ◽  
Technological Advancement ◽  
Life Care ◽  
Instrumental Reason ◽  
High Quality ◽  
High Quality Care ◽  
Entrepreneurial Spirit

Healthcare at an advanced age and at the end of one’s life is increasingly characterised by an entrepreneurial spirit, which in turn is guided by economic principles. It remains questionable whether organising the end of one’s life based on efficiency criteria leaves sufficient room for personal encounters and individualism. As indisputable as the significance of high-quality care is, especially at the end of someone’s life, the constant progression of technological advancement and economisation in dealing with death and dying is nevertheless endangered by the dominance of ‘instrumental reason’, which often leaves little room for holistic and individual approaches. The contributions to this volume explore ethical and existential realities at the end of a life and economic rationalities in providing end-of-life care. With contributions by Stefan Dinges, Angelika Feichtner, Gerald Gredinger, Olivia Kada, Franz Küberl, Christian Lagger, Claudia Lohr, Sylvia Reitter-Pfoertner, Corinna Schmohl, Patrick Schuchter, Willibald J. Stronegger, Christine Trischak Preface: Willibald J. Stronegger und Kristin Attems

Managing ICU staff welfare, morale, and burnout

2016 ◽  
Author(s):  
Gavin G. Lavery ◽  
Linda-Jayne Mottram
Keyword(s):  
Critical Care ◽  
Adverse Events ◽  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Scientific Basis ◽  
Care Staff ◽  
Life Care ◽  
High Quality ◽  
Degree Of Control

Low morale, stress, and burnout are significant and under-recognized in critical care staff. The link between these conditions is complex and not fully only understood with burnout as a potential end result. Conflict and lack of clear protocols regarding end-of-life care appear to be particularly prone to generate stress and potentially burnout. We have little scientific basis to design interventions, but expert opinion suggests multiple approaches at individual, departmental, and organizational levels. Many are based on giving workers a degree of control and flexibility where possible, and a feeling that their contribution is valuable and valued. Engagement (with an organization and its aims) is now viewed as the antithesis of burnout and only staff who are engaged can deliver high quality care. It is increasingly recognized that organizations that actively manage staff welfare are more likely to provide care that is safe, effective, and patient-centred, and less likely to error and adverse events.

scholarly journals Are Transfusions a Barrier to High-Quality End-of-Life Care in Hematology?

2018 ◽  
Vol 15 (4) ◽  
Author(s):  
Mark R. Litzow ◽  
Thomas W. LeBlanc
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
High Quality

scholarly journals Pediatric-Specific End-of-Life Care Quality Measures: An Unmet Need of a Vulnerable Population

2017 ◽  
Vol 13 (10) ◽  
pp. e874-e880 ◽  
Author(s):  
Emily E. Johnston ◽  
Abby R. Rosenberg ◽  
Arif H. Kamal
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Quality Measures ◽  
Care Quality ◽  
Patient Choice ◽  
Decision Makers ◽  
Hospital Death ◽  
Life Care ◽  
High Quality ◽  
National Quality

We must ensure that the 20,000 US children (age 0 to 19 years) who die as a result of serious illness annually receive high-quality end-of-life care. Ensuring high-quality end-of-life care requires recognition that pediatric end-of-life care is conceptually and operationally different than that for adults. For example, in-hospital adult death is considered an outcome to be avoided, whereas many pediatric families may prefer hospital death. Because pediatric deaths are comparatively rare, not all centers offer pediatric-focused palliative care and hospice services. The unique psychosocial issues facing families who are losing a child include challenges for parent decision makers and young siblings. Furthermore, the focus on advance directive documentation in adult care may be less relevant in pediatrics because parental decision makers are available. Health care quality measures provide a framework for tracking the care provided and aid in agency and provider accountability, reimbursement, and educated patient choice for location of care. The National Quality Forum, Joint Commission, and other groups have developed several end-of-life measures. However, none of the current quality measures focus on the unique needs of dying pediatric patients and their caregivers. To evolve the existing infrastructure to better measure and report quality pediatric end-of-life care, we propose two changes. First, we outline how existing adult quality measures may be modified to better address pediatric end-of-life care. Second, we suggest the formation of a pediatric quality measure end-of-life task force. These are the next steps to evolving end-of-life quality measures to better fit the needs of seriously ill children.

scholarly journals CAREGIVER BURDEN, BENEFIT, AND PERCEPTIONS OF END-OF-LIFE CARE QUALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S668-S668
Author(s):  
Elizabeth A Luth ◽  
Teja Pristavec
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Quality Care ◽  
Care Quality ◽  
National Study ◽  
Life Care ◽  
Care Needs ◽  
Caregiving Burden ◽  
High Burden

Abstract End-of-life care quality (EOLCQ) gauges our success in providing quality care to dying individuals. EOLQC measures rely on reports from bereaved family members who provide care for dying loved ones, but analyses seldom account for how caregivers’ experiences influence their EOLCQ perceptions. Caregivers frequently experience burden, which is linked to poor health outcomes and may negatively bias EOLCQ reports. Individuals may also perceive caregiving benefits that can offset deleterious burden effects, but potentially encourage overly positive EOLCQ perceptions. This paper links National Study of Caregivers (2011) and National Health and Aging Trends Study (2011-2016) data, using regression analysis and a sample of 380 EOL caregivers to examine how caregiving burden and benefits perceptions shape and moderate EOLCQ reports. Caregiving burden is unrelated to EOLCQ in adjusted models. Benefits are associated with marginally greater odds of being informed about the dying person’s condition and reporting their personal care needs were met. Burden and benefits moderate these two measures. Despite benefits, low burden caregivers report they were informed about the dying person’s condition with 90% probability. Regardless of burden, high benefits caregivers report the same with 90% probability. Low burden and benefits caregivers report met care needs with 90% probability. High burden and benefits caregivers have 90% probability of such reports. Given these reports are used in formal hospice care evaluations by CMS, additional research should explore why caregiving burden and benefit are associated with some EOLCQ measures and why individuals reporting high burden and benefits provide more positive EOLCQ appraisals.

Fostering trusting relationships with older immigrants hospitalised for end-of-life care

2016 ◽  
Vol 25 (6) ◽  
pp. 760-772 ◽  
Author(s):  
Megan-Jane Johnstone ◽  
Helen Rawson ◽  
Alison Margaret Hutchinson ◽  
Bernice Redley
Keyword(s):  
Health Services ◽  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Essential Element ◽  
Host Institution ◽  
Life Care ◽  
Moral Commitment ◽  
Older Immigrants ◽  
English Speaking

Background: Trust has been identified as a vital value in the nurse–patient relationship. Although increasingly the subject of empirical inquiries, the specific processes used by nurses to foster trust in nurse–patient relationships with older immigrants of non-English speaking backgrounds hospitalised for end-of-life care have not been investigated. Aims: To explore and describe the specific processes that nurses use to foster trust and overcome possible cultural mistrust when caring for older immigrants of non-English speaking backgrounds hospitalised for end-of-life care. Research design: A qualitative descriptive approach was used. Twenty-two registered nurses were recruited from four metropolitan health services in Melbourne, Australia. Ethical considerations: Research approval was granted by the Human Research Ethics Committees of the host institution and four participating health services. Findings: Thematic analysis revealed that fostering trust encompassed the following three commensurate stages: establishing trust, strengthening trust and sustaining trust. Underpinning the successful achievement of these stages was the nurses’ moral commitment (reflected in their intentional, conscious and conscientious approach) to fostering trust as an essential ingredient of quality end-of-life care. Discussion: This study has shown that while professional competencies are important to providing quality end-of-life care to older immigrant patients of non-English speaking backgrounds, it is a nurse’s moral commitment to fostering trust that may ultimately lay the foundations for a trusting quality care relationship to be established and sustained. Conclusion: This study has captured the processes used by nurses to foster trust as an essential element of quality end-of-life care in older immigrants. The characteristics of trust and the different factors influencing its expression in diverse cultural contexts are, however, under-researched. Accordingly, gaps remain in the knowledge and understanding of the specific cultural nuances and manifestations of trust across and within different cultures. This is an area that is germane to further cross-cultural and international collaborative scholarly inquiry and research.

Experiences of a Group of Senior Nursing Students with End of Life Care and Death in Turkey

2020 ◽  
pp. 003022282096123
Author(s):  
Deniz Sanli ◽  
Fatma Iltus
Keyword(s):  
Nursing Students ◽  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Death And Dying ◽  
Life Care ◽  
Death Attitudes ◽  
Positive Attitudes ◽  
Dying Patients ◽  
And Behaviors

Nursing students may feel unprepared to manage the care of dying individuals and may experience anxiety and fear related to death and dying. Preparing nursing students for this situation can help them provide quality care to dying patients. This study aimed to examine the end-of-life care values and behaviors and death attitudes of senior nursing students. In examining these variables, the Values and Behaviors of Intensive Care Nurses for End-of-Life Instrument and the Death Attitude Profile-Revised Scale were used. It was found that the students developed positive attitudes and behavior towards end-of-life care, and that they believed death to be a natural part of life and there is life after death. Students who felt that the information they received during their education was partially sufficient were more likely to have negative death attitudes. It can be recommended that teaching strategies in the education of the nursing students be developed.

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