scholarly journals Dying in acute hospitals: voices of bereaved relatives

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Diarmuid Ó Coimín ◽  
Geraldine Prizeman ◽  
Bettina Korn ◽  
Sarah Donnelly ◽  
Geralyn Hynes
Keyword(s):  
Quality Of Care ◽  
End Of Life ◽  
Good Practice ◽  
Hospital Environment ◽  
Service Improvement ◽  
Care Providers ◽  
Care Needs ◽  
Experience Of Care ◽  
Acute Hospitals

Abstract Background Internationally there is an increasing concern about the quality of end-of-life care (EoLC) provided in acute hospitals. More people are cared for at end of life and die in acute hospitals than in any other healthcare setting. This paper reports the views of bereaved relatives on the experience of care they and the person that died received during their last admission in two university adult acute tertiary hospitals. Methods Relatives of patients who died were invited to participate in a post-bereavement postal survey. An adapted version of VOICES (Views of Informal Carers - Evaluation of Services) questionnaire was used. VOICES MaJam has 36 closed questions and four open-ended questions. Data were gathered in three waves and analysed using SPSS and NVivo. 356 respondents completed the survey (46% response rate). Results The majority of respondents (87%: n = 303) rated the quality of care as outstanding, excellent or good during the last admission to hospital. The quality of care by nurses, doctors and other staff was highly rated. Overall, care needs were well met; however, findings identified areas of care which could be improved, including communication and the provision of emotional and spiritual support. In addition, relatives strongly endorsed the provision of EoLC in single occupancy rooms, the availability of family rooms on acute hospital wards and the provision of bereavement support. Conclusions This research provides a powerful snapshot in time into what works well and what could be improved in EoLC in acute hospitals. Findings are reported under several themes, including the overall quality of care, meeting care needs, communication, the hospital environment and support for relatives. Results indicate that improvements can be made that build on existing good practice that will enhance the experience of care for dying persons and their relatives. The study adds insights in relation to relative’s priorities for EoLC in acute hospitals and can advance care providers’, policy makers’ and educationalists’ priorities for service improvement.

Exploring caregivers' perspectives on improving care for older people at the end of life in Thailand

2019 ◽  
Vol 25 (7) ◽  
pp. 326-332
Author(s):  
Kanyanat Supaporn ◽  
Sang-arun Isaramalai ◽  
Wandee Suttharangsee
Keyword(s):  
Quality Of Care ◽  
Older People ◽  
End Of Life ◽  
Care Quality ◽  
Ageing Population ◽  
Home Setting ◽  
Experience Of Care ◽  
Care Recipients ◽  
Care For Older People

Background: Older people in Thailand receive general medical and social care at the end of life, and many rarely access palliative services. In light of this, improving the quality of care for the ageing population relies on addressing the needs of family caregivers, who provide the majority of care in a home setting. Understanding caregivers' perspectives when caring for a friend or relative will help to improve the quality of care that they provide. Aim: To explore caregivers' perspectives on improving care for older people in Thailand in the palliative stage. Methods: A qualitative study using in-depth interviews and observation of 10 older people in the palliative stage and their caregivers was undertaken. Data were analysed using content analysis. Findings: Data analysis revealed three themes: caregivers cared to repay the older person's previous kindness, caregivers cared and changed their caregiving behaviour to minimise the older person's perception of being abandoned or being a burden, and to follow Thai ancestral traditions, so that the older person could die peacefully. Conclusion: This study provides specific instructions for those who provide care for older Thai people in the palliative stage. Finding ways to address caregivers' perspectives on improving care quality could enhance the experience of care recipients.

scholarly journals Qualitative Assessment of the Quality of Care for Preterm, Low Birth Weight, and Sick Newborns in Ethiopia

2021 ◽  
Vol 14 ◽  
pp. 117863292110251
Author(s):  
Solomie Jebessa ◽  
James A Litch ◽  
Kirsten Senturia ◽  
Tedros Hailu ◽  
Amaha Kahsay ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Health Care Providers ◽  
System Capacity ◽  
Qualitative Assessment ◽  
Care Providers ◽  
Experience Of Care

This study assesses the quality of care for preterm, low birth weight (LBW), and sick newborns across the public health care system levels in 3 regions of Ethiopia. Qualitative data based on the WHO framework to assess provision and experience of care was collected using in-depth interviews and focus group discussions with women who recently delivered preterm, LBW, and sick newborns, as well as health care providers and health extension workers, and facility administrators associated with study health facilities. This qualitative approach revealed perspectives of patients, health care providers and facility administrators to assess what is actually happening in facilities. Clinical guidelines for the care of preterm, LBW, and sick newborns were not available in many facilities, and even when available, often not followed. Most providers reported little or no communication with parents following hospital discharge. Human resource challenges (shortage of skilled staff, motivation and willingness, lack of supervision, and poor leadership) inhibited quality of care. Participants reported widespread shortages of equipment and supplies, medication, physical space, water, electricity, and infrastructure. Economic insecurity was a critical factor affecting parents’ experience. Acceptance by users was impacted by the perceived benefits and cost. Users reported they were less likely to accept interventions if they perceived that there would be financial costs they couldn’t afford. The quality of care for preterm, LBW, and sick newborns in Ethiopia as reported by recently delivered women, health care providers and facility administrators is compromised. Improving quality of care requires attention to process of care, experience of care, and health system capacity, structure, and resources.

The reciprocity of the quality of care providers' occupational life of and the quality of care: A cycle model

2013 ◽  
Author(s):  
Marco Ferrara ◽  
Sara Viotti ◽  
Daniela Converso ◽  
Valentina Trotta ◽  
Gloria Guidetti ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Care Providers ◽  
Cycle Model ◽  
Occupational Life

scholarly journals Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Maria Jennings ◽  
Joanna Morrison ◽  
Kohenour Akter ◽  
Hassan Haghparast-Bidgoli ◽  
Carina King ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Care Providers ◽  
Low Income ◽  
Diabetes Management ◽  
Local Health ◽  
Care Seeking ◽  
Care Providers ◽  
Structured Interviews ◽  
Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

scholarly journals The Patient Experience of Inpatient Care During the COVID-19 Pandemic: Exploring Patient Perceptions, Communication, and Quality of Care at a University Teaching Hospital in the United Kingdom

2021 ◽  
Vol 8 ◽  
pp. 237437352199774
Author(s):  
Thomas Key ◽  
Avadhut Kulkarni ◽  
Vikram Kandhari ◽  
Zayd Jawad ◽  
Angela Hughes ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Patient Experience ◽  
Health Care Professionals ◽  
Disease Transmission ◽  
Inpatient Care ◽  
University Teaching ◽  
Health Board ◽  
Experience Of Care

The coronavirus disease 2019 (COVID-19) pandemic has necessitated many rapid changes in the provision and delivery of health care in hospital. This study aimed to explore the patient experience of inpatient care during COVID-19 pandemic. An electronic questionnaire was designed and distributed to inpatients treated at a large University Health Board over a 6-week period. It focused on hospital inpatients’ experience of being cared for by health care professionals wearing personal protective equipment (PPE), explored communication, and patients’ perceptions of the quality of care. A total of 704 patients completed the survey. Results demonstrated that patients believe PPE is important to protect the health of both patients and staff and does not negatively impact on their care. In spite of routine use of PPE, patients were still able to identify and communicate with staff. Although visiting restrictions were enforced to limit disease transmission, patients maintained contact with their relatives by using various electronic forms of communication. Overall, patients rated the quality of care they received at 9/10. This single-center study demonstrates a positive patient experience of care at an unprecedented time.

Hospital end-of-life care: families’ free-text notes

2020 ◽  
pp. bmjspcare-2020-00239
Author(s):  
Sandra Kurkowski ◽  
Johannes Radon ◽  
Annika R Vogt ◽  
Martin Weber ◽  
Stephanie Stiel ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Qualitative Content Analysis ◽  
Free Text ◽  
Life Care ◽  
Quality Aspects ◽  
Care Of The Dying

BackgroundPalliative care strives to improve quality of life for patients with incurable diseases. This approach includes adequate support of the patients’ loved ones. Consequently, loved ones have personal experiences of providing end-of-life care for their next. This is a resource for information and may help to investigate the loved ones’ perspectives on need for improvements.AimTo identify further quality aspects considered important by loved ones to improve the quality of care at the end of life as an addition to quantitative results from the Care of the Dying Evaluation for the German-speaking area (CODE-GER) questionnaire.DesignWithin the validation study of the questionnaire ‘Care of the Dying Evaluation’ (CODETM) GER, loved ones were asked to comment (free text) in parallel on each item of the CODE-GER. These free-text notes were analysed with the qualitative content analysis method by Philipp Mayring.Setting/participantsLoved ones of patients (n=237), who had died an expected death in two university hospitals (palliative and non-palliative care units) during the period from April 2016 to March 2017.Results993 relevant paragraphs were extracted out of 1261 free-text notes. For loved ones, important aspects of quality of care are information/communication, respect of the patient’s and/or loved one’s will, involvement in decision-making at the end of life (patient’s volition) and having the possibility to say goodbye.ConclusionsIt is important for loved ones to be taken seriously in their sorrows, to be informed, that the caregivers respect the patients’ will and to be emotionally supported.Trial registration numberThis study was registered at the German Clinical Trials Register (DRKS00013916).

scholarly journals Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?

2008 ◽  
Vol 26 (23) ◽  
pp. 3860-3866 ◽  
Author(s):  
Craig C. Earle ◽  
Mary Beth Landrum ◽  
Jeffrey M. Souza ◽  
Bridget A. Neville ◽  
Jane C. Weeks ◽  
...  
Keyword(s):  
Quality Of Care ◽  
End Of Life ◽  
Cancer Care ◽  
Aggressive Treatment ◽  
Care Issue ◽  
Open Question

The purpose of this article is to review the literature and update analyses pertaining to the aggressiveness of cancer care near the end of life. Specifically, we will discuss trends and factors responsible for chemotherapy overuse very near death and underutilization of hospice services. Whether the concept of overly aggressive treatment represents a quality-of-care issue that is acceptable to all involved stakeholders is an open question.

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