The Hospice Decision: Psychosocial Facilitators and Barriers

1997 ◽  
Vol 35 (2) ◽  
pp. 193-217 ◽  
Author(s):  
Dennis P. McNeilly ◽  
Kristine Hillary
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Home Health Care ◽  
Hospice Care ◽  
Care Patient ◽  
Home Health ◽  
Care Staff ◽  
Future Research ◽  
Health Care Staff ◽  
Hospice Patient

This study examined the social and contextual process of discussion and decision making around the use of the hospice in order to clarify the facilitative and obstructive aspects to hospice patient entry. Four participants groups of physicians, hospice and home health care patient family survivors, and hospice and home health care staff, completed four complementary mail surveys of their discussions and decision process for hospice care. Non-parametric analysis of the data reaffirmed the central and key role of the physician as the expected initiator and gatekeeper of the hospice discussion and decision-making process. Physicians were found generally aware of hospice and to have discussed hospice with their patients, though that awareness and the frequency of hospice patient discussions varied by the type of medical practice. Patient family survivors were unaware of hospice prior to the terminal illness, with a majority of hospice patient family survivors receiving their initial hospice information from relatives. Implications of these results and issues for future research are identified.

scholarly journals Recent planning approaches and mobility concepts for home health care services in Austria – A review

2018 ◽  
Vol 68 (4) ◽  
pp. 205-222
Author(s):  
Patrick Hirsch
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Rural Areas ◽  
Health Care Services ◽  
Home Health ◽  
Future Research ◽  
Comprehensive Overview ◽  
Family Structures ◽  
Routing And Scheduling ◽  
Sustainable Solutions

Summary Home health care (HHC) services are faced with a rising demand in Austria. This is due to an increased life expectancy, changing family structures, and the trend to grow old at home. The percentage of their working time that is spent by the HHC staff for travelling from one client to the next one reaches 30% and even more in some rural areas. Changing the assignment of HHC staff to clients and the sequence of visits can lead to major reductions in the travel distances, and therefore, to more sustainable solutions. The aim of this paper is to provide a comprehensive overview on the logistical planning of HHC services in Austria. In order to meet the future requirements, it is important to analyze different mobility concepts for the HHC staff and to provide tailored solution approaches for routing and scheduling. The reader learns about the current HHC situation in Austria, the logistical requirements for planning these services, possible mobility concepts for the HHC staff, and potential threats for HHC operations. The developed solution methods are presented in brief and the main findings are highlighted and discussed. The paper concludes with an outlook on potential future research paths in HHC routing and scheduling.

scholarly journals Breastfeeding in COVID-19: A Pragmatic Approach

2020 ◽  
Vol 37 (13) ◽  
pp. 1377-1384
Author(s):  
Yvonne Peng Mei Ng ◽  
Yi Fen Low ◽  
Xin Lei Goh ◽  
Doris Fok ◽  
Zubair Amin
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Team ◽  
Care Staff ◽  
Future Research ◽  
Health Care Staff ◽  
Care Providers ◽  
Joint Decision ◽  
Skin Contact ◽  
Novel Coronavirus

The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in changes to perinatal and neonatal care, concentrating on minimizing risks of transmission to the newborn and health care staff while ensuring medical care is not compromised for both mother and infant. Current recommendations on infant care and feeding when mother has COVID-19 ranges from mother–infant separation and avoidance of human milk feeding, to initiation of early skin-to-skin contact and direct breastfeeding. Health care providers fearing risks of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) maternal–infant transmission may veer toward restricted breastfeeding practices. We reviewed guidelines and published literature and propose three options for infant feeding depending on various scenarios. Option A involves direct breastfeeding with the infant being cared for by the mother or caregiver. In option B, the infant is cared for by another caregiver and receives mother's expressed milk. In the third option, the infant is not breastfed directly and does not receive mother's expressed milk. We recommend joint decision making by parents and the health care team. This decision is also flexible as situation changes. We also provide a framework for counseling mothers on these options using a visual aid and a corresponding structured training program for health care providers. Future research questions are also proposed. We conclude that evidence and knowledge about COVID-19 and breastfeeding are still evolving. Our options can provide a quick and flexible reference guide that can be adapted to local needs. Key Points

Children’s Participation in the Decision-Making Process During Hospitalization: an observational study

2002 ◽  
Vol 9 (6) ◽  
pp. 583-598 ◽  
Author(s):  
Ingrid Runeson ◽  
Inger Hallström ◽  
Gunnel Elander ◽  
Göran Hermerén
Keyword(s):  
Health Care ◽  
Decision Making ◽  
University Hospital ◽  
Care Staff ◽  
Health Care Staff ◽  
Staff Members ◽  
Children’S Participation ◽  
Decision Making Processes ◽  
Children's Participation ◽  
Degree Of Participation

Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child’s view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children’s participation in decision making concerning their health care.

scholarly journals Clowning in health care settings: The point of view of adults

2016 ◽  
Vol 12 (3) ◽  
pp. 473-488 ◽  
Author(s):  
Alberto Dionigi ◽  
Carla Canestrari
Keyword(s):  
Health Care ◽  
Positive Emotions ◽  
Emotional Reactivity ◽  
Psychological Symptoms ◽  
Empirical Studies ◽  
Well Being ◽  
Care Staff ◽  
Future Research ◽  
Health Care Staff ◽  
Pilot Studies

Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research.

scholarly journals A PROFILE OF CAREGIVING AMONG SEPSIS SURVIVORS RECEIVING POST-ACUTE HOME HEALTH CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S218-S218
Author(s):  
Jo-Ana D Chase ◽  
Christina R Whitehouse ◽  
Lizeyka Jordan ◽  
Kathryn H Bowles
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Home Health Care ◽  
Medication Administration ◽  
Home Health ◽  
Future Research ◽  
Medical Procedures ◽  
Care Needs ◽  
Sepsis Survivors ◽  
Training And Support

Abstract Sepsis survivors transitioning from hospital-to-home are clinically complex. Family caregivers can face challenges managing patients’ care needs; however, skilled home health care (HHC) can serve as an important resource during this care transition. This study’s purpose was to describe caregiving needs among older sepsis survivors receiving post-acute HHC, and identify sources of unmet caregiving needs. We conducted a retrospective analysis of a national dataset of Medicare beneficiaries starting a new HHC episode who were after hospital discharge for sepsis between 2013 and 2014 (n=165,228). All patients received at least one HHC visit the first week after hospital discharge. Caregiving activities included seven items from the start of care Outcome and Assessment Information Set. Descriptive statistics were used to examine types of caregiving activities and needs, demographics, and clinical information. Proportions of patients with unmet caregiving needs ranged from 9%-29%, with the largest proportion of unmet needs in activities of daily living (ADL) assistance (29%), medication administration (28%), and medical procedures/treatments (25%). Unmet caregiving needs across activities were largely due to a caregiver needing training/supportive services (75%-88%), suggesting that many sepsis survivors receiving HHC have caregivers who are available to help, but who lack the knowledge and skills to manage patients’ complex care needs. Thus, HHC providers should address caregiving training and support needs, especially related to assistance with ADLs, medication administration, and medical procedures/treatments. Future research is needed to determine specific educational strategies for caregiver training and support, especially related to skills and knowledge assessment, and training delivery and monitoring.

Moving to a Culture of Safety in Community Home Health Care

2008 ◽  
Vol 13 (1_suppl) ◽  
pp. 20-24 ◽  
Author(s):  
Lynn Stevenson ◽  
Cora McRae ◽  
Waqar Mughal
Keyword(s):  
Health Care ◽  
Focus Groups ◽  
Community Health ◽  
Acute Care ◽  
Community Health Workers ◽  
Home Health Care ◽  
Health Workers ◽  
Risk Identification ◽  
Home Health ◽  
Care Staff

Objective Community home health care workers and their clients are faced with a mixture of occupational health and safety challenges that are not typically experienced by health care providers or patients in the acute care sector. The aim of this project was to explore the concept of safety in community home health in one health care authority in British Columbia. Methods A participatory action research approach was employed to explore staff and client safety risks in this environment. In the first phase, three focus groups were held with staff (n 5 39) and the data analysed to identify themes. These were validated by additional focus groups. In the second phase, interviews were held with staff followed by chart reviews. Finally, in phase three, an interdisciplinary working group developed a risk identification tool for staff which was subsequently piloted. The exploration focused on answering the following questions: What constitutes safety in community home health care? What are the priority areas for action in relation to safety? What type of risk identification would be most helpful to community health workers to prepare them adequately to meet their clients’ and their own safety needs? Results Risk themes identified included: poor communication, acute care staff not understanding the needs of community staff, working alone, mobility, medication concerns, lack of pre-screening of clients’ homes, and community health workers accepting a high degree of risk. Conclusions Findings suggest that typical notions of safety and risk in acute care are not easily translated into the community sector, that staff and clients’ safety concerns are intertwined, and staff require better and more timely information from acute care staff when patients are discharged home.

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