Utility of Schwartz Center Rounds in fostering compassion, communication, teamwork, and caregiver support

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20640-e20640
Author(s):  
P. Mann ◽  
L. Schapira ◽  
T. Lynch ◽  
R. Penson
Keyword(s):  
Patient Care ◽  
Social Issues ◽  
Clinical Care ◽  
Cancer Center ◽  
Clinical Aspects ◽  
Structured Interviews ◽  
Caregiver Support ◽  
Emotional Issues ◽  
The Impact ◽  
Insight Into

e20640 Background: Schwartz Center Rounds are a multidisciplinary forum where clinicians discuss difficult emotional and social issues that arise in caring for patients with the goal of improving the patient-caregiver relationship. Rounds were initiated at the MGH Cancer Center in 1997 and have since grown to include 165 sites including 24 cancer centers nationwide. We report on a recent evaluation of the impact of Rounds. Methods: The Schwartz Center Rounds evaluation focused on three major research questions: 1) Do professional caregivers have increased insight into the non-clinical aspects of care after attendance at Rounds? 2) Is there increased teamwork among caregivers after attendance? 3) Do caregivers perceive increased support after attendance at Rounds? The evaluation included a retrospective survey of 256 caregivers at six sites where Rounds had existed for ≥ 3 years; 44 semi-structured interviews with participants at these sites; and pre/post surveys of 222 caregivers from ten hospitals newly implementing Rounds. Results: The highest percentage of attendees were nurses (35%), followed by physicians (23%), social workers (15%), psychologists (4%), physical therapists (6%) and clergy (5%). After attending Rounds, participants reported increased insight into psychosocial aspects of care; enhanced compassion; increased ability to respond to patients’ social and emotional issues; enhanced communication amongst caregivers; greater appreciation of colleagues’ roles and contributions. Attendees reported decreased feelings of stress and isolation and a greater sense of teamwork. Participants reported that Rounds discussions led to changes in institutional practices or policies. Conclusions: Schwartz Center Rounds provide a forum for discussion of challenging psychosocial and emotional issues arising during clinical care. Evaluation data suggests this educational strategy may enhance compassion, professional support, communication, teamwork, and instigate institutional changes that enhance patient care. We are currently exploring other outcomes, including but not limited to the impact of rounds on quality of patient care and patient safety. [Table: see text]

scholarly journals COVD-07. THE IMPACT OF COVID-19 ON PATIENTS AND CAREGIVERS AFFECTED BY BRAIN TUMORS: THE PATIENT NAVIGATOR PERSPECTIVE

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii22-ii22
Author(s):  
Kyle Walsh
Keyword(s):  
Clinical Trials ◽  
Brain Tumor ◽  
Clinical Care ◽  
Structured Interview ◽  
Patient Navigator ◽  
Structured Interviews ◽  
Social Distancing ◽  
Tumor Patient ◽  
Patient Navigators ◽  
The Impact

Abstract BACKGROUND Preliminary evidence indicates that glioma patients are at higher risk for COVID-19 complications due to systemic immunosuppression. Interruptions in cancer care may exacerbate patient and caregiver anxiety, but surveying patients/caregivers about their COVID-19 experiences is often limited by attainable sample sizes and over-reliance upon single-institution experiences. METHODS To explore how COVID-19 is impacting brain tumor patients/caregivers across the U.S., we performed semi-structured interviews with brain tumor patient navigators employed by two different 501(c)3 nonprofit organizations. A semi-structured interview guide was used, utilizing prompts and open-ended questions to facilitate dialogue. A core set of COVID-19 topics were covered, including: financial issues, coping strategies, geographic variability, variability by tumor grade/histology, disruptions in care continuity, accessing clinical trials, psychosocial issues, and end-of-life care. Interviews were audio-recorded, transcribed, and organized by discussion topic to identify emerging themes. Inductive sub-coding was completed using the constant comparison method, within and between transcripts. RESULTS/CONCLUSIONS Ten patient navigators were interviewed between April 15th and May 8th, with interviews lasting approximately one hour (range 38-77minutes). Navigators reported having contact with 183 unique brain tumor families during the pandemic (range 7–38 families per navigator). High concordance emerged across narratives, revealing important considerations for the neuro-oncology workforce. The most prominent theme was increased caregiver burden, attributed to maintaining social distancing by reducing visits from home-health aides and friends/family. A related theme that applied to both patients and caregivers was increased social isolation due to social distancing, suspension of in-person support groups, and church/temple closures. Accessing clinical trials was a recurrent issue, exacerbated by patients’ increasing unwillingness to travel. Glioblastoma patients, especially those with recurrent tumors, expressed greater reluctance to travel. Access to standard-of-care treatment was rarely interrupted, but reduced access to supportive services – especially physical and occupational therapy – was identified as an emerging COVID-related deficiency in clinical care.

Psychology Staffing at Cancer Centers: Data From National Comprehensive Cancer Network Member Institutions

2020 ◽  
Vol 16 (11) ◽  
pp. e1343-e1354
Author(s):  
Laura Melton ◽  
Diana Krause ◽  
Jessica Sugalski
Keyword(s):  
National Comprehensive Cancer Network ◽  
Patient Care ◽  
Clinical Care ◽  
The United States ◽  
Direct Patient Care ◽  
Cancer Center ◽  
Network Member ◽  
Full Time ◽  
Cancer Centers ◽  
Cancer Network

PURPOSE: The field of psycho-oncology is relatively undeveloped, with little information existing regarding the use of psychologists at cancer centers. Comprising 30 leading cancer centers across the United States, the National Comprehensive Cancer Network (NCCN) set out to understand the trends in its Member Institutions. METHODS: The NCCN Best Practices Committee surveyed NCCN Member Institutions regarding their use of psychologists. The survey was administered electronically in the spring/summer of 2017. RESULTS: The survey was completed by 18 cancer centers. Across institutions, 94% have psychologists appointed to provide direct care to their cancer center patients. The number of licensed psychologist full-time equivalents (FTEs) on staff who provide direct patient care ranged from < 1.0 FTE (17%) to 17.0-17.9 FTEs (6%). Regarding psychologist appointments, 41% have both faculty and staff appointments, 41% have all faculty appointments, and 18% have all staff appointments. Forty-three percent of institutions indicated that some licensed psychologists at their centers (ranging from 1%-65%) do not provide any direct clinical care, and 57% indicated that all licensed psychologist on staff devote some amount of time to direct clinical care. The percent of clinical care time that is spent on direct clinical care ranged from 15%-90%. CONCLUSION: There is great variability in psychology staffing, academic appointments, and the amount of direct patient care provided by on-staff psychologists at cancer centers.

scholarly journals The Impact of Replacement Conventional Dentures on Eating Experience

2018 ◽  
Vol 4 (1) ◽  
pp. 29-40 ◽  
Author(s):  
H.F. Al-Sultani ◽  
J.C. Field ◽  
J.M. Thomason ◽  
P.J. Moynihan
Keyword(s):  
Quality Of Life ◽  
Social Issues ◽  
Complete Dentures ◽  
Social And Emotional ◽  
Cohen’S D ◽  
Related Quality ◽  
Emotional Issues ◽  
Cohen's D ◽  
The Impact

Introduction: Despite much research on the impact of edentulism and prosthetic rehabilitation on food and nutrient intake, there is little information on how replacing complete dentures affects social and emotional issues around eating. Objectives: To investigate, in a cohort study, how replacing conventional complete dentures affects eating-related quality of life (ERQoL). A secondary aim was to test the responsiveness of an Emotional and Social Issues Related to Eating (ESIRE) questionnaire to change in ERQoL. Methods: Participants, recruited from the Dental Hospital, Newcastle-upon-Tyne, UK, completed the self-administrated ESIRE questionnaire before and after provision of new conventional complete dentures. Paired t test was used to determine any change between pre- and posttreatment ESIRE scores, which can range from 0 (poor) to 100 (excellent). Cohen’s d effect size was used to measure the magnitude of change in ERQoL. Standardized response mean (SRM) was used to measure the responsiveness of the ESIRE questionnaire to changes in ERQoL. Results: Fifty-five participants aged 52 to 85 y (mean, 72 y), including 21 males (42%) and 29 females (58%), completed the study. A statistically significant improvement in the total ESIRE scores was found, mean (SE) +20.3 (3.30), P < 0.001. Equally, all domains of the ESIRE questionnaire showed significant improvements: enjoyment of food/eating, +27.3 (3.63), P < 0.001; self-consciousness/embarrassment, +18.1 (3.88), P < 0.001; interruption to meals, +13.3 (5.27), P < 0.05; confidence when eating, +18.7 (4.84), P < 0.001; time for eating/preparation of meals, +18.5 (4.85), P < 0.001); and functional ability to eat, +18.2 (3.67), P < 0.001). Cohen’s d was large (0.95) for the total score and ranged from medium (0.37) to large (1.30) for all domains. Value of SRM was large (0.87) for the total score and ranged from medium (0.36) to large (1.1) for all domains. Conclusion: Denture replacement can directly improve ERQoL. The ESIRE questionnaire was responsive to clinically important changes in ERQoL. Knowledge Transfer Statement: The results of this study improve the understanding of the impact of denture replacement on eating-related quality of life (ERQoL). Clinicians are encouraged to pay more attention to the impact of wearing conventional complete dentures on social and emotional issues around eating. The findings should motivate clinicians and inspire specialists in prosthodontics and oral rehabilitation to continue providing conventional complete dentures as a suitable treatment option for edentulous patients.

Documentation of goals of care (GOC) by medical oncologists is associated with improved oncology patient end-of-life (EOL) care outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1507-1507
Author(s):  
Han Xiao ◽  
Michael Riley ◽  
Richard Donopria ◽  
Steven Martin ◽  
Judith Eve Nelson ◽  
...  
Keyword(s):  
Patient Care ◽  
Linear Regression Analysis ◽  
Cancer Center ◽  
Oncology Patient ◽  
Patient Goals ◽  
Medical Oncologists ◽  
Hospice Referral ◽  
Care Outcomes ◽  
Eol Care ◽  
The Impact

1507 Background: Documenting GOC is integral to patient care and quality performance but has been underutilized by oncologists due to many barriers. As oncologists play a key role in initiating GOC discussions, we implemented a clinical initiative to improve their GOC documentation and evaluated the impact of such documentation on patient care during the EOL (last 30 days of life). Methods: We launched the initiative among 270 medical oncologists in an academic cancer center in 4/2020. A newly formulated GOC note to ease documentation was embedded in oncology outpatient and inpatient notes. Oncologists completed components in the GOC note that applied to their communication about GOC with the patient: 1) cancer natural history, 2) patient goals, and 3) EOL discussion: patient resuscitation preferences and, when pertinent, receptivity to hospice referral. GOC notes were pulled to a centralized location in the electronic health record (EHR) that displays documents relevant to patients’ values, goals and preferences. A dashboard allowed continual monitoring of documentation performance. We evaluated the association between GOC notes and outcomes of patient care at EOL. We further analyzed the impact of EOL discussion on EOL care. Results: The GOC note completion rate steadily rose after implementation. GOC notes were present in EHR for 46% of 10,006 patients who were either seen in outpatient clinic or discharged from hospital during the 1st week of January 2021. Among 1790 patients who died between 7/1/20 and 12/31/20 and had either at least an outpatient visit or hospitalization during EOL, the median days from first GOC note and first EOL discussion to the patient’s death were 71 days and 24 days, respectively. Linear regression analysis demonstrated that patients who had GOC note 60 days before death spent less time as inpatient during EOL (0.4 day less/patient, from 8.1 to 7.7, P = 0.01). When EOL discussion was documented 30 days before death, patients also spent less time in the hospital (1.2 days less/patient, from 9.7 to 8.5, P < 0.001) and in the ICU (0.3 days less/patient, from 1.7 to 1.4 ICU days, P = 0.04), and were 4% less likely to receive chemotherapy (from 38% to 34%, P = 0.004) at EOL. During the same period, among 1,009 patients with hospital admission in the last 30 days of life, those with a prior documented EOL discussion had shorter inpatient stay (7.7 vs 13.1 days, P < 0.001) and were more likely to be discharged to hospice (34% vs 22%, P = 0.003). Conclusions: During the COVID-19 pandemic, we successfully implemented GOC documentation by medical oncologists that is easily visible by the full care team. Documentation of GOC including EOL discussion was associated with fewer days in the hospital and ICU, increased hospice referral, and lower likelihood of receiving chemotherapy during patients’ last 30 days of life.

20 Adolescent and caregiver perspectives on living with a limb fracture: A qualitative study

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e12-e13
Author(s):  
Manisha Bharadia ◽  
Stevi Golden-Plotnik ◽  
Michael van Manen ◽  
Mithra Sivakumar ◽  
Amy Drendel ◽  
...  
Keyword(s):  
Social Dynamics ◽  
Qualitative Content Analysis ◽  
Functional Limitations ◽  
Pediatric Emergency ◽  
Family Impact ◽  
Structured Interviews ◽  
Discharge Instructions ◽  
Caregiver Support ◽  
Fracture Function ◽  
The Impact

Abstract Primary Subject area Emergency Medicine - Paediatric Background Fractures occur in up to half of children by age 16 years. After initial emergency care for a fracture, function is universally impaired in children, and impacts extend to the immediate family. Knowledge of expected functional limitations is key to providing proper discharge instructions and anticipatory guidance to families. Objectives Our study objectives were to understand: 1) how adolescents (12-17 years) describe the functional impact of fractures on their lives; 2) how adolescents’ reports of their experiences compare to those of their caregivers; and 3) the impact of the fracture on the family unit. Design/Methods We conducted individual, semi-structured interviews from June 2019 to November 2020 with adolescents and their caregivers, 7-14 days following their initial visit to a pediatric emergency department. We utilized qualitative content analysis methodology. Recruitment proceeded until thematic saturation was achieved. Coding and analysis were concurrent with recruitment and interviews. A secondary coder reviewed 40% of the transcripts, and the coding team met regularly to discuss the coding framework and key themes. The interview script was modified in an iterative process, to reflect emerging themes. Results We completed a total of 29 interviews. The most commonly affected functions were: a) showering and hygiene (which required the most caregiver support); b) sleep variability (due to pain and cast-related discomfort); and c) exclusion from sports/activities. Many adolescents experienced disruptions to social activities and gatherings. Adolescents valued independence and often chose to take more time to complete a task to preserve this, regardless of inconvenience. Both adolescents and caregivers reported feelings of frustration as a result of day-to-day impacts imposed by the injury. Generally, caregivers’ perspectives were in keeping with the experiences that adolescents described for themselves. Notable family impacts included what we described as ‘sibling burden’ or conflicts that arose when a sibling had to take on extra chores/tasks. Conclusion These themes highlight an opportunity to better tailor discharge instructions for adolescents with fractures. Key messages include: 1) expect pain and impaired sleep, especially in the first few days; 2) allow extra time to complete tasks independently, especially for grooming and hygiene; 3) consider family impact, especially sibling burden; 4) prepare for changes in activities and social dynamics; and 5) frustration is normal, for both adolescents and caregivers. Future work can focus on developing a novel, family-informed tool to assess functional outcomes following injury.

scholarly journals The impact of blame culture on paramedic practice

2018 ◽  
Vol 7 (3) ◽  
pp. 214-227
Author(s):  
Andrew Kirk ◽  
Kevin Armstrong ◽  
Niina Nurkka ◽  
Annette Jinks
Keyword(s):  
Medical Profession ◽  
Clinical Care ◽  
Content Type ◽  
The Public ◽  
Inappropriate Use ◽  
Blame Culture ◽  
Working Practices ◽  
Use Of Social Media ◽  
The Impact ◽  
Insight Into

Purpose The purpose of this paper is to explore English and Finnish paramedic perceptions of the healthcare blame culture, its relationship to complaints, the use of defensive practice and if this impacts on paramedic practice and clinical care. Design/methodology/approach Participants were recruited from English and Finnish ambulance services that have similar organisational and professional scopes of practice. The aim was to gain insight into the similarities and differences between the countries regarding the existence of a blame culture in paramedic practice. Semi-structured focus groups and interviews involving 20 English and Finnish paramedics were undertaken. Qualitative perceptions concerning the reality of a blame culture in paramedic practice and its impact on professional roles were sought. Findings Three major themes that were identified in the thematic analysis included: blame culture and its influences; the impact of complaints against paramedics; and the use of defensive practice within their roles. These data themes were similar for both groups of participants. The majority of participants thought the healthcare blame culture to be widespread and believed that this was likely to directly influence paramedics’ working practices. Originality/value Whilst the impact of blame culture and complaints on the medical profession has previously been examined, this study makes an important contribution by exploring the factors that impact on paramedics’ lives and their practice, within two European countries. The inappropriate use of social media by some members of the public in both countries was a disturbing issue for many participants and was identified as an area for further research.

scholarly journals Exploring the effects of long-term anti-social behaviour victimisation

2020 ◽  
pp. 026975802096197
Author(s):  
Vicky Heap
Keyword(s):  
Qualitative Research ◽  
Social Behaviour ◽  
Empirical Work ◽  
Criminal Behaviour ◽  
Structured Interviews ◽  
Different Types ◽  
The Impact ◽  
Mental And Physical Health ◽  
Insight Into

Despite victimological interest in the impacts of different types of criminal victimisation, there is little empirical work that examines the effects of sub-criminal behaviour on victims. This article begins to redress the balance by reporting the findings from a qualitative research project in England that investigated the effects of long-term anti-social behaviour victimisation. Semi-structured interviews explored victims’ accounts of the long-term anti-social behaviour they experienced and the resultant effects it had on their lives. The research uncovered that victims experience a range of mental and physical health effects as well as behavioural changes and has provided the first in-depth insight into the impact of this type of victimisation. The findings suggest the cumulative harms associated with anti-social behaviour need to be better acknowledged, understood and addressed, with greater support made available to victims.

The failure of non‐binding declarations to achieve university sustainability

2007 ◽  
Vol 8 (3) ◽  
pp. 301-316 ◽  
Author(s):  
S.A. Bekessy ◽  
K. Samson ◽  
R.E. Clarkson
Keyword(s):  
Best Practice ◽  
Small Scale ◽  
Structured Interviews ◽  
Pilot Studies ◽  
Content Type ◽  
Institute Of Technology ◽  
University Leaders ◽  
The University ◽  
The Impact ◽  
Insight Into

PurposeThis paper aims to assess the impact and value of non‐binding agreements or declarations in achieving sustainability in universities.Design/methodology/approachA case study of Royal Melbourne Institute of Technology (RMIT) University is presented, analysing the reasons for lack of progress towards sustainability and evaluating best ways forward. Using a timeline and analysis of historical records for the 12 years since RMIT first engaged in the sustainability agenda, major trends in the process of implementing policies are identified. Secondly, 15 semi‐structured interviews with university leaders and key sustainability stakeholders from across the university are analysed to provide insight into how and why the university has failed to achieve sustainability.FindingsNew implications for successfully achieving sustainability arise from these findings. Accountability is a key issue, as RMIT appears to reap benefits from being signatory to declarations without achieving genuine progress. To ensure that declarations are more than simply greenwash, universities must open themselves up to scrutiny of progress to determine whether commitments have been honoured.Practical implicationsRelying on small‐scale “club” activities establishing demonstrations and raising awareness is unlikely to lead to permanent change. The evidence of RMIT's engagement with sustainability shows that, for example, even when successful pilot studies are conducted, these initiatives may do little to affect the mainstream practices of a university unless certain conditions exist. Furthermore, given the on‐paper commitments institutions have made, and the role of the university in society, small‐scale and gradual changes in university practice are a far from adequate response to the urgent sustainability imperative.Originality/valueThe initial engagement of RMIT University with the sustainability agenda 12 years ago marked it as a world leader in sustainability best‐practice. Analysing how and why such a disappointing lack of action has resulted from such promising beginnings provides insight into future directions for implementing sustainability in universities. The paper argues that considering the key responsibility of universities in leading the sustainability agenda, a more systemic and serious response is required.

scholarly journals “We have a ticking time bomb”: a qualitative exploration of the impact of canine epilepsy on dog owners living in England

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Amy E. Pergande ◽  
Zoe Belshaw ◽  
Holger A. Volk ◽  
Rowena M. A. Packer
Keyword(s):  
Quality Of Life ◽  
Lifestyle Changes ◽  
Idiopathic Epilepsy ◽  
Clinical Aspects ◽  
Structured Interviews ◽  
Online Groups ◽  
Additional Support ◽  
Almost All ◽  
The Impact

Abstract Background Idiopathic epilepsy is a common neurological condition in dogs. Previous research has focused on clinical aspects of seizure management in dogs with idiopathic epilepsy with little attention given to the emotional and logistical challenges for their owners. The current study aimed to explore the impacts of owning a dog with idiopathic epilepsy on owner quality of life and lifestyle, using qualitative methods. Methods Owners of dogs with idiopathic epilepsy living in England were recruited via social media and word of mouth, and then selected using purposive sampling to participate in face-to-face semi-structured interviews. Epilepsy management was explored through in-depth accounts of owner experiences and influencing factors. Interviews were recorded and transcribed verbatim and thematic analysis was used to construct key themes. Results Twenty-one interviews were completed. Almost all owners had made lifestyle changes in order to care for their dog, including substantial modifications to routines and, in some cases, employment. Many owners discussed a very emotionally close dog-owner bond, and described experiencing frequent feelings of fear, stress and uncertainty regarding their dog’s health. Friends, family and colleagues did not always understand the magnitude of commitment required to care for a dog with idiopathic epilepsy. This, combined with a fear of leaving their dog unsupervised, had social implications in some instances and lead to increased use of the Internet and online groups for peer support. Conclusions The commitment required to care for a dog with idiopathic epilepsy, and the lifestyle changes made by their owners, may be far greater than previously estimated. Further consideration of these factors by veterinary professionals and the friends and families of owners of dogs with idiopathic epilepsy could improve owner quality of life, and facilitate the provision of additional support.

Improving Patient Safety through the Use of Nursing Surveillance

2017 ◽  
Vol 51 (s2) ◽  
pp. 34-43 ◽  
Author(s):  
Karen K. Giuliano
Keyword(s):  
Patient Care ◽  
Clinical Care ◽  
Warning System ◽  
Rapid Response Team ◽  
Hospital Length ◽  
Rapid Response ◽  
Hospital Length Of Stay ◽  
Clinical Implications ◽  
Response Team ◽  
The Impact

Surveillance and monitoring each represent a distinct process in patient care. Monitoring involves observation, measurement, and recording of physiological parameters, while surveillance is a systematic, goal-directed process based on early detection of signs of change, interpretation of the clinical implications of such changes, and initiation of rapid, appropriate interventions. Through use of an illustrative clinical example based on Early Warning System scoring and rapid response teams, this article seeks to distinguish between nurse monitoring and surveillance to demonstrate the impact of surveillance on improving both care processes and patient care. Using a clinical example, differences between surveillance and monitoring as a trigger for deployment of the rapid response team were reviewed. The use of surveillance versus monitoring resulted in a mean reduction in rapid response team deployment time of 291 minutes. The median hospital length of stay for patients whose clinical care included using surveillance to initiate the deployment of the rapid response team was reduced by 4 days. Monitoring relies on observation and assessment while nursing surveillance incorporates monitoring with recognition and interpretation of the clinical implications of changes to guide decisions about subsequent actions. The clinical example described here supports that the use of an automated surveillance system versus monitoring had a measurable impact on clinical care.

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