Nurse prescribing in end-of-life care in the community: meeting patients' needs

2021 ◽  
Vol 3 (11) ◽  
pp. 454-458
Author(s):  
Susan Latter
Keyword(s):  
Palliative Care ◽  
End Of Life Care ◽  
Access To Medicines ◽  
Self Management ◽  
Medicines Management ◽  
Community Based ◽  
Home Setting ◽  
Nurse Prescribing ◽  
Community Meeting

This article outlines the important role of medicines in managing community-based palliative care in the last year of life, together with the central role of nurses prescribing in this context. The article discusses the key needs of patients and carers managing palliative care medicines in the home setting, which include a requirement for streamlined, rapid access to medicines, as well as information about and support for daily self-management of medicines. The article draws on recent research in the field of palliative care medicines management and highlights the implications for nurse prescribers.

scholarly journals Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study

2022 ◽  
Vol 19 (2) ◽  
pp. 667
Author(s):  
Helen Yue-Lai Chan ◽  
Cecilia Nim-Chee Chan ◽  
Chui-Wah Man ◽  
Alice Dik-Wah Chiu ◽  
Faith Chun-Fong Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hong Kong ◽  
End Of Life ◽  
Delphi Study ◽  
End Of Life Care ◽  
Care Home ◽  
Local Context ◽  
Life Care ◽  
Home Setting ◽  
Modified Delphi

Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.

scholarly journals Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians’ experiences, perceptions and perspectives

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037466
Author(s):  
Patricia Harasym ◽  
Sarah Brisbin ◽  
Misha Afzaal ◽  
Aynharan Sinnarajah ◽  
Lorraine Venturato ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Long Term Care ◽  
Symptom Assessment ◽  
Assessment Tools ◽  
Life Care ◽  
Community Based ◽  
Term Care

ObjectiveThe COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities.DesignQualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework.SettingResidential long-term care.Participants23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians.ResultsMotivation barriers include families’ lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population.ConclusionFindings reveal that validating families’ concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.

End-of-Life Care for Children Enrolled in a Community-Based Pediatric Palliative Care Program

2014 ◽  
Vol 17 (5) ◽  
pp. 589-591 ◽  
Author(s):  
Lisa M. Niswander ◽  
Philene Cromwell ◽  
Jeanne Chirico ◽  
Alyssa Gupton ◽  
David N. Korones
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Program ◽  
Pediatric Palliative Care ◽  
Life Care ◽  
Palliative Care Program ◽  
Community Based

scholarly journals Evaluation of a Community-Based Self-Management Program to Increase Access to Rehabilitation for People Living with HIV

2019 ◽  
Vol 18 ◽  
pp. 232595821988333 ◽  
Author(s):  
Patricia Solomon ◽  
Nancy Margaret Salbach ◽  
Kelly Kathleen O’Brien ◽  
Stephanie Nixon ◽  
Larry Baxter ◽  
...  
Keyword(s):  
Peer Education ◽  
Management Program ◽  
Self Management ◽  
Rehabilitation Services ◽  
People Living With Hiv ◽  
Community Based ◽  
Centered Care ◽  
Living With Hiv ◽  
Future Work

We qualitatively evaluated a novel educational program to help people living with HIV understand the role of rehabilitation, facilitate access to rehabilitation, and promote self-management of chronic disease in Canada. The program incorporated components of self-efficacy, client-centered care, peer education, and problem-based learning. Delivery of the community-engaged program was viewed as feasible and acceptable; however, a flexible delivery model was deemed important. Perceived learning was related to rehabilitation, advocacy, and taking responsibility for one’s health. A co-leader model and access to online resources were strengths. Future work should assess the ability to apply advocacy knowledge and skills to access rehabilitation services.

scholarly journals What matters most for end-of-life care? Perspectives from community-based palliative care providers and administrators

BMJ Open ◽  
2015 ◽  
Vol 5 (6) ◽  
pp. e007492 ◽  
Author(s):  
Bina Mistry ◽  
Daryl Bainbridge ◽  
Deanna Bryant ◽  
Sue Tan Toyofuku ◽  
Hsien Seow
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Care Providers ◽  
Community Based ◽  
What Matters

Developing an eHealth intervention for cancer symptom management for rural residents.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 207-207 ◽  
Author(s):  
Stephanie Gilbertson-White ◽  
Chi Yeung ◽  
Keri Nace Mercer ◽  
Dorota Bartoczszyk ◽  
Todd Papke
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Symptom Management ◽  
Self Management ◽  
Rural Residents ◽  
Cancer Symptoms ◽  
Cancer Symptom Management ◽  
Web App ◽  
The Web

207 Background: A disproportionate number of late-stage cancer diagnoses occur in rural residents. Paradoxically this population, with an increased need for palliative care, has minimal access to these services. As smartphone and high-speed internet connectivity reaches near universal penetrance across the country, eHealth technologies have the potential to address this palliative care access gap. Oncology Associated Symptoms and Individualized Strategies (OASIS) web-app was developed to provide tailored cancer symptom self-management support and address this gap. Methods: A two-phased, mixed-methods design was used to: (1) assess stakeholder needs and opinions on the role of eHealth technologies to manage cancer symptoms; and (2) beta test a symptom self-management web-app. Adult patients with advanced cancer and clinic staff from two rural cancer clinics were recruited. A descriptive qualitative approach was used to analyze the patient interviews and staff focus groups. Themes related to symptom management needs and the role of technology were identified. OASIS was developed to address the themes found in phase 1. OASIS consists of 57 self-management strategies for 15 cancer symptoms and a visual symptom/strategy tracker for patients to monitor their symptoms and improve their self-management skills. Results: n = 15 patients were interviewed and n = 11 staff participated in focus groups. Themes identified were “fatalistic acceptance”, “teaching self how to manage symptoms”, and “balancing information needs”. To address these themes OASIS was developed and beta-tested with n = 10 rural residents with advanced cancer. 100% of participants were able to access OASIS via their home internet connection, 80% understood how to use the web-app after one 15 min teaching session, and 50% requested access to the web-app for family to help them with their symptoms. Conclusions: Patients and staff in rural communities have significant cancer symptom management needs and are interested in using eHealth technologies to address these needs. OASIS was found to be accessible, user friendly, easily navigated, and visually appealing. Future research is needed to evaluate the feasibility and acceptability as well as the efficacy of OASIS.

scholarly journals Palliative Care and Advance Care Planning in Pulmonary Hypertension

2018 ◽  
Vol 17 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Charles L. Rhee ◽  
Michael Cuttica
Keyword(s):  
Palliative Care ◽  
Pulmonary Hypertension ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Progressive Disease ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Pulmonary hypertension (PH) is a progressive disease with high associated morbidity and mortality despite the development of novel therapies. Palliative care is a multidisciplinary field focused on optimization of quality of life and overall supportive care for patients and their families in the setting of life-limiting illness. Although the benefits of palliative care in oncology are well described, there are few studies regarding the timing and involvement of palliative care in PH patients. In this paper, we describe the importance of longitudinal advance care planning, including suggestions for addressing difficult topics such as end-of-life care, and the role of palliative care providers in helping guide these discussions throughout the course of the illness.

The Role of Home Care in Palliative Care Services

2004 ◽  
Vol 5 (3) ◽  
pp. 151-157 ◽  
Author(s):  
Eileen Hanley
Keyword(s):  
Palliative Care ◽  
Staff Development ◽  
Home Care ◽  
End Of Life Care ◽  
Care Providers ◽  
Care Services ◽  
Palliative Care Services ◽  
Key Topics ◽  
Home Care Providers

This article addresses the increasing interest in end of life care and the need for improving access to palliative care services in patients/families served by the home care industry. The author discusses factors leading to this growing demand as well as some of the recent research conducted in the field of palliative care. The benefits of and underutilization of hospice services are discussed. The author addresses a variety of options for home care providers to consider expanding access to palliative care services including recent changes in regulation that allow for collaboration with Medicare certified hospice programs. A discussion of key topics to include in staff development initiatives related to palliative care is included as are education and clinical practice resources.

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