District nurse consultations with vulnerable patients over wishes for end-of-life care

2014 ◽  
Vol 19 (9) ◽  
pp. 458-460 ◽  
Author(s):  
Richard Griffith
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
District Nurse ◽  
Vulnerable Patients

District nurse advocacy for choice to live and die at home in rural Australia

2014 ◽  
Vol 22 (4) ◽  
pp. 479-492 ◽  
Author(s):  
Frances M Reed ◽  
Les Fitzgerald ◽  
Melanie R Bish
Keyword(s):  
End Of Life ◽  
Rural Areas ◽  
End Of Life Care ◽  
Research Question ◽  
Empirical Literature ◽  
Life Care ◽  
District Nurse ◽  
District Nurses ◽  
Rural Australia ◽  
At Home

Background: Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. Objectives: The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. Method: Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. Results: 34 international studies revealed themes of ‘the nursing relationship’, ‘environment’, ‘communication’, ‘support’ and ‘the holistic client centred district nursing role. Discussion: Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. Conclusion: It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.

Multi-dimensional approach to end-of-life care: The Welfare Model

2018 ◽  
Vol 26 (7-8) ◽  
pp. 1955-1967
Author(s):  
Shin Wei Sim ◽  
Tze Ling Gwendoline Beatrice Soh ◽  
Lalit Kumar Radha Krishna
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Clinical Care ◽  
Best Interests ◽  
Life Care ◽  
Clinical Practices ◽  
Vulnerable Patients ◽  
Team Evaluation ◽  
Welfare Model

Appropriate and balanced decision-making is sentinel to goal setting and the provision of appropriate clinical care that are attuned to preserving the best interests of the patient. Current family-led decision-making in family-centric societies such as those in Singapore and other countries in East Asia are believed to compromise these objectives in favor of protecting familial interests. Redressing these skewed clinical practices employing autonomy-based patient-centric approaches however have been found wanting in their failure to contend with wider sociocultural considerations that impact care determinations. Evaluation of a number of alternative decision-making frameworks set out to address the shortcomings of prevailing atomistic and family-centric decision-making models within the confines of end-of-life care prove these alternative frameworks to be little better at protecting the best interests of vulnerable patients. As a result, we propose the Welfare Model that we believe is attentive to the relevant socio-culturally significant considerations of a particular case and better meets the needs of end-of-life care goals of preserving the welfare of patients. Employing a multi-professional team evaluation guided by regnant psychosocial, legal, and clinical standards and the prevailing practical and clinical realities of the particular patient’s setting the Welfare Model provides a clinically relevant, culturally sensitive, transparent, and evidence-based approach to care determinations.

scholarly journals Goals of care and COVID-19: A GOOD framework for dealing with uncertainty

2020 ◽  
Vol 18 (4) ◽  
pp. 379-381
Author(s):  
Aldis H. Petriceks ◽  
Andrea Wershof Schwartz
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Critical Component ◽  
Deep Uncertainty ◽  
Goals Of Care ◽  
Vulnerable Patients

AbstractAs the COVID-19 pandemic continues, more patients will require palliative and end-of-life care. In order to ensure goal-concordant-care when possible, clinicians should initiate goals-of-care conversations among our most vulnerable patients and, ideally, among all patients. However, many non-palliative care clinicians face deep uncertainty in planning, conducting, and evaluating such interactions. We believe that specialists within palliative care are aptly positioned to address such uncertainties, and in this article offer a relevant update to a concise framework for clinicians to plan, conduct, and evaluate goals-of-care conversations: the GOOD framework. Once familiar with this framework, palliative care clinicians may use it to educate their non-palliative care colleagues about a timely and critical component of care, now and beyond the COVID-19 era.

scholarly journals Health System Intervention to Improve Communication About End-of-Life Care for Vulnerable Patients

2018 ◽  
Author(s):  
J. Randall Curtis ◽  
Lois Downey ◽  
Anthony Back ◽  
Elizabeth Nielsen ◽  
Sudiptho Paul ◽  
...  
Keyword(s):  
Health System ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
System Intervention ◽  
Vulnerable Patients ◽  
Health System Intervention

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

Die Entwicklung eines Instruments zur «Evaluation stationärer Hospize aus der Perspektive hinterbliebener Angehöriger» (EHPA)

Pflege ◽  
2011 ◽  
Vol 24 (3) ◽  
pp. 171-182
Author(s):  
Mandy Lohe ◽  
Manja Zimmermann ◽  
Christiane Luderer ◽  
Katharina Sadowski
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Subjektive Bewertung ◽  
Ethische Probleme

Als Einrichtungen des Gesundheitswesens sind stationäre Hospize in Deutschland zur Qualitätssicherung und internen Qualitätsentwicklung verpflichtet. Die Bedeutung der Patientenzufriedenheit als einer der indirekten Indikatoren zur Beurteilung der Pflege- und Betreuungsqualität ist mittlerweile unumstritten. Eine subjektive Bewertung des Hospizes durch den Gast selbst birgt sowohl praktische als auch ethische Probleme. Eine Befragung der Angehörigen empfiehlt sich. Der vorliegende Artikel beschreibt die Entwicklung eines Instruments zur Evaluation stationärer Hospize aus der Sicht hinterbliebener Angehöriger. Mit dessen Hilfe soll die Frage, wie Angehörige die Begleitung und Pflege beurteilen, die ihnen sowie ihrem verstorbenen Familienmitglied durch das Hospiz zuteil wurde, beantwortet werden. Die Konstruktion der Fragen erfolgte auf Basis bestehender Konzepte zum Assessment der end-of-life care und einer Analyse aller identifizierten Instrumente zur Evaluation stationärer Hospize aus der Perspektive hinterbliebener Angehöriger. Die Fragebogenentwicklung umfasste neben der umfassenden Literaturrecherche die Bildung eines Itempools, die Itemauswahl, die kritische Diskussion der Fragen im Expertenkreis sowie einen standardisierten und kognitiven Pretest. Entstanden ist ein fünfdimensionaler Fragebogen, der physische, psychologische, soziale, spirituelle und versorgungsorganisatorische Aspekte der end-of-life care integriert. Das Instrument umfasst 53 Items in Form überwiegend geschlossener Fragen.

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