scholarly journals Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018

2019 ◽  
Vol 12 ◽  
pp. 117863291983431 ◽  
Author(s):  
Liv Wergeland Sørbye ◽  
Simen A Steindal ◽  
Mary H Kalfoss ◽  
Olaug E Vibe
Keyword(s):  
Palliative Care ◽  
Structured Interview ◽  
Assessment Instrument ◽  
Holistic Care ◽  
Time Of Death ◽  
Key Factors ◽  
Pharmacological Management ◽  
Subcutaneous Injections ◽  
Death Data ◽  
Interrai Assessment

In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer- and cardiovascular diagnoses were the strongest predictor for using morphine ( P < 0.05). Identification of the residents’ needs for opioids is a challenge for palliative care nurses, both ethically and legally.

scholarly journals Measuring capability wellbeing in adults at different stages of life for use in economic evaluation of health and care interventions: a qualitative investigation in people requiring kidney care

2021 ◽  
Author(s):  
Paul Mark Mitchell ◽  
Samantha Husbands ◽  
Sabina Sanghera ◽  
Fergus John Caskey ◽  
Jemima Scott ◽  
...  
Keyword(s):  
Life Stage ◽  
Structured Interview ◽  
Health Conditions ◽  
Economic Evaluations ◽  
Qualitative Investigation ◽  
Key Factors ◽  
Younger Adults ◽  
Patient Groups ◽  
The Life Course ◽  
The Impact

Abstract Purpose Capability wellbeing measures, such as the ICECAP measures, have been proposed for use in economic evaluations to capture broader outcomes of health and care interventions. The ICECAP measures have been developed to reflect capabilities at different stages of life. Some patient groups include patients of different ages and at different stages of life, so it is not always apparent which ICECAP measure is most relevant. This study explores the impact of age and life stage on completion, where both ICECAP-A and ICECAP-O were completed by the same patient. Methods A think-aloud study, and an associated semi-structured interview were conducted with people receiving kidney care as a renal outpatient, kidney transplant outpatient, or through receiving facility-based haemodialysis. Qualitative analysis focused on (1) differences in responses across measures by individuals, where attributes had conceptual overlap, (2) key factors in self-reported capability levels, and (3) measure preference. Results Thirty participants were included in the study, with a mix of older and younger adults. Attributes with similar wording across measures produced similar responses compared to attributes where wording differed. Age and health were key factors for self-reported capability levels. ICECAP-A was slightly preferred overall, including by older adults. Conclusion This study suggests use of ICECAP-A in patients with certain chronic health conditions that include a mix of adults across the life course. This study highlights the importance of considering the stage of life when using capability measures and in economic evaluations of health and care interventions more generally.

scholarly journals The Illness Experience: Palliative Care Given the impossibility of Healing

2016 ◽  
Vol 50 (spe) ◽  
pp. 47-53 ◽  
Author(s):  
Margarida Maria Florêncio Dantas ◽  
Maria Cristina Lopes de Almeida Amazonas
Keyword(s):  
Palliative Care ◽  
Participant Observation ◽  
Descriptive Analysis ◽  
Terminally Ill ◽  
Medical Model ◽  
Structured Interview ◽  
Subject Position ◽  
The Subject ◽  
Experience Of Illness ◽  
Therapeutic Possibilities

This paper presents a reflection about being terminally ill and the various ways that the subject has at its disposal to deal with this event. The objective is to understand the experience of palliation for patients undergoing no therapeutic possibilities of cure. The methodology of this study has the instruments to semi-structured interview, the participant observation and the field diary, and the Descriptive Analysis of Foucault’s inspiration how the narratives of the subjects were perceived. The Results of paper there was the possibility of looking at the experience of illness through the eyes of a subject position assumed by the very sick. As conclusion we have than when choosing palliative care, the terminally ill opts for a way to feel more comfortable and resists the impositions of the medical model of prolonging life.

scholarly journals Palliative care in paediatric oncology: perceptions, expertise and practices from the perspective of the multidisciplinary team

2015 ◽  
Vol 36 (2) ◽  
pp. 56-62 ◽  
Author(s):  
Adriana Ferreira da Silva ◽  
Helena Becker Issi ◽  
Maria da Graça Corso da Motta ◽  
Daisy Zanchi de Abreu Botene
Keyword(s):  
Palliative Care ◽  
Multidisciplinary Team ◽  
Structured Interview ◽  
Paediatric Oncology ◽  
Lessons Learned ◽  
Team Members ◽  
Descriptive Research ◽  
The Family ◽  
Research Questions ◽  
Oncology Unit

OBJECTIVE: To reveal the perceptions, expertise and practices of multi-professional teams providing palliative care to children in a paediatric oncology unit. The research questions were based on everyday care, facilitations and difficulties, essential aspects of professional approaches, and the inter-disciplinary focus of care for children in palliative care and their families. METHOD: Qualitative, exploratory and descriptive research. Data were collected from June to October 2013 from nine professional multidisciplinary team members by means of a semi-structured interview submitted to thematic analysis. RESULTS: The following four themes emerged from analysis: palliative care: conceptions of the multi-professional team; the construction of singular care; the facilitations and difficulties experienced by the team and significant lessons learned. CONCLUSIONS: The subjects revealed that the team also suffers with the death of a child and, like the family, moves toward the construction of coping mechanisms for the elaboration of mourning. Paradoxically, the team shares knowledge to determine the foundations of a singular therapeutic project and inserts the family in this process so that it can be the protagonist of the child's care.

Land-uses as Quality of Making Successful Streets in Sulaimaniya City Centre, Iraq

2021 ◽  
Author(s):  
Musaab Al-Obeidy ◽  
Keyword(s):  
Global Positioning System ◽  
Structured Interview ◽  
City Centre ◽  
Key Factors ◽  
City Center ◽  
Qualitative And Quantitative ◽  
Points Of Interest ◽  
Global Positioning ◽  
Questionnaire Surveys

Although, the diverse activities and uses are one of the significant key factors to improve quality of streets, some places and shops in Mawlawi Street are disappeared or used by few number of people, while others are used by high number of people. Moreover, just some attractions and points of interest (POIs) are located in the Global Positioning System (GPS). This issues lead to lake of finding urban diversity in Mawlawi Street. This paper examines and find out the diversity of activities and uses that improves the quality of streets and makes successful streets in Sulaimaniya City Centre. It is also to identify POIs provided in GPS. The study employed a mix-methodology method. 330 questionnaire surveys, 20 semi-structured interview, and qualitative and quantitative observation, were conducted in Mawlawi Street. The results show that the diverse activities and choices are important key to make streets of Sulaimaniya City Center successful. There is also a need to define and insert many places on map for enhancing diversity. To secure the quality of the Street, this study suggests to improve the quality of goods and shops, provide night activities, and refresh some left places and shops along the Street.

15 Triggers for the pharmacological management of delirium in palliative care: a mixed methods study

2018 ◽  
Vol 8 (3) ◽  
pp. 365.2-365
Author(s):  
Catherine L Fairfield ◽  
Anne M Finucane ◽  
Juliet A Spiller
Keyword(s):  
Palliative Care ◽  
Severe Form ◽  
Screening Tools ◽  
Pharmacological Intervention ◽  
Inpatient Setting ◽  
List Type ◽  
Structured Interviews ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
High Prevalence

IntroductionDelirium is a serious neurocognitive disorder with a high prevalence in palliative care and debate regarding its management is ongoing.AimsTo describe how delirium and its symptoms is documented in patient recordsTo determine the use of delirium screening tools and how these are viewed by staffTo identify triggers for pharmacological intervention in delirium management in a terminally ill population.MethodsA retrospective case-note review concerning all patients admitted to a hospice inpatient setting between 1–17th August 2017 and semi-structured interviews with 7 hospice doctors and nurses.Results21 patients were reviewed. 62% were screened for delirium using the 4AT on admission. 76% had documented symptoms of delirium and of these 81% died without delirium resolution. There were inconsistencies in the documentation of delirium and the term itself was used infrequently. Non-pharmacological measures were poorly documented. Midazolam was the most commonly used medication. Triggers for pharmacological intervention included failure of non-pharmacological measures distress agitation and risk of patient harm. Nursing staff recognised delirium in its severe form but were less likely to do so in milder cases.ConclusionsTriggers for pharmacological intervention are in-keeping with guidelines however the level of understanding of delirium’s presentation varied between participants. This along with the high prevalence of delirium frequent use of midazolam and limited awareness and documentation of non-pharmacological measures (e.g. structured family support) highlights the need for further training and research.

scholarly journals Updates in palliative care – overview and recent advancements in the pharmacological management of cancer pain

2018 ◽  
Vol 18 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Helen Wood ◽  
Andrew Dickman ◽  
Angela Star ◽  
Jason W Boland
Keyword(s):  
Palliative Care ◽  
Cancer Pain ◽  
Pharmacological Management

32 Examining the key factors impacting on the implementation of an educational program on constipation in specialist palliative care

2018 ◽  
Vol 8 (3) ◽  
pp. 371.3-372
Author(s):  
S McIlfatrick ◽  
DHL Muldrew ◽  
E Carduff ◽  
M Clarke ◽  
J Coast ◽  
...  
Keyword(s):  
Palliative Care ◽  
Lived Experience ◽  
Educational Program ◽  
Complex Interventions ◽  
Successful Implementation ◽  
List Type ◽  
Social Suffering ◽  
Specialist Palliative Care ◽  
Key Factors ◽  
Services Research

IntroductionConstipation is one of the most common symptoms in patients in specialist palliative care (SPC) settings and can cause considerable physical psychological and social suffering for the patient and their family. Due to the high variability in constipation assessment and management in SPC settings questions exist around how to implement an educational program in practice to address this clinical gap.AimTo develop and test the feasibility and acceptability of a novel educational intervention for HCPs to manage constipation experienced by people in SPC settings.MethodUsing the MRC framework for complex interventions and guided by the consolidated framework for implementation research an online resource was developed considering the content context and processes for implementation.ResultsAssessment prevention and management were identified as the core aspects. Six sessions with theoretical content application to practice and reflection through interacting with colleagues were developed in line with the best available evidence. Incentives including an educational bursary and alignment with revalidation and support from senior management champions and the research team were identified as key elements needed successful implementation. Funding IT infrastructure and attitudes to the content have been flagged as potential barriers to success.ConclusionA six week blended program covering the key concepts for assessment and management of constipation in palliative care has been created. Content evidence from the literature and empirical data on the preferred structure and method of delivery as well as key considerations of the contextual factors have been identified as key factors for implementation.References. Craig P, et al.Developing and evaluating complex interventions: The new medical research council guidance. BMJ Clinical Research Ed2008;337(October):a1655. Available at: http://discovery.ucl.ac.uk/168426/. Damschroder LJ, et al. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science2009;4(50).. Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl?=13576321&AN=13991056&h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&crl=c [Accessed: 2017 August 21]. Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 2017 August 21]

Provisional Educational Needs of Health Care Providers in Palliative Care in Three Nursing Homes in Ontario

1997 ◽  
Vol 13 (3) ◽  
pp. 13-17 ◽  
Author(s):  
Chris Patterson ◽  
William Molloy ◽  
Rosalie Jubelius ◽  
G.H. Guyatt ◽  
M. Bédard
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Nursing Homes ◽  
Health Care Providers ◽  
Educational Needs ◽  
Physical Symptoms ◽  
Spiritual Needs ◽  
Care Providers ◽  
Pharmacological Management ◽  
Traditional Lectures

Health care providers in three nursing homes in Ontario were surveyed to determine educational needs, barriers to meeting these needs, and the preferred format for education. Of the 415 health care providers asked to participate, 225 completed the questionnaire. Need was expressed for the majority of the 35 educational topics identified, including the role of the palliative care team, management of physical symptoms, pharmacological and non-pharmacological management of pain, stress management, spiritual needs, culture and death, and counseling. Group discussions and seminars were favored over traditional lectures. The primary factors influencing attendance at a palliative care workshop were loss of pay and time and location of the workshop.

Impact of palliative care on end-of-life management of cancer patients dying in the hospital.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20613-e20613
Author(s):  
Syed Mustafa Karim ◽  
Jamal M Zekri ◽  
Ehab Mosaad Abdelghany ◽  
Azhar Rizvi ◽  
Aboelkhair Al-Gahmi ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Healthcare Providers ◽  
Time Of Death ◽  
Chi Square ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Chi Square Test ◽  
Eol Care

e20613 Background: A substantial number of cancer patients receive inpatient care at the end-of-life (EoL). Involvement of palliative care teams during the course of cancer treatment has been shown to improve quality of life (QoL) in cancer patients. In this study, we compare the EoL care of cancer patients dying in the hospital under medical oncology (MO) and palliative care (PC) services. Methods: A retrospective review of medical records of adult cancer patients who received chemotherapy during their illness and died in our hospital between January 2010 and January 2012 was conducted. The quality metrics measured as endpoints were: chemotherapy given within 21 days of death, death in the ICU, CPR at time of death, and time from last chemotherapy to death (TLCD). These endpoints were compared between patients who died under the MO service (cohort A) and those dying under PC service (cohort B). Chi-square test and T-test were used to compare the endpoints between the two cohorts. Results: Of the 106 cancer patients who died in the hospital, 40 and 66 were in cohorts A and B respectively. 30% of all patients were 65 years of age or older, and were equally distributed between the two cohorts. Patients in cohort A were more likely to receive chemotherapy within last 3 weeks of life (27.5% versus 7.5%, p=0.012, 95% CI 4.16-37.15), to have CPR at time of death (15% versus 0%, p=0.005, 95% CI 4.2-29.8) and to die in the ICU (52.5% versus 1.5%, p=<0.001, 95% CI 33.3-67.1) as compared to patients in cohort B. The average time from last chemotherapy to death was significantly longer (221 days) for cohort B patients as compared to cohort A patients (96 days), p=0.01. Patients in cohort A who had PC consultation during their hospitalization had no differences in the measured endpoints when compared to patients in cohort B. Conclusions: Cancer patients who die in the hospital while under MO service without PC involvement tend to have more aggressive EoL care. This may impact negatively on some QoL features. Early referral to palliative care services may facilitate better understanding and fulfillment of the needs of cancer patients and their caregivers by the healthcare-providers.

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