Nurses Perception towards the Care of Patients with Terminal Illness in University of Nigeria Teaching Hospital, Enugu State, Nigeria

Background: Part of becoming a good nurse is being able to understand one’s own perception of death and dying, which can affect the quality of care a patient with terminal illness will receive. This study was carried out to assess the nurses perception towards the care of patients with terminal illness in University of Nigeria Teaching Hospital, Enugu State, Nigeria Part of becoming a good nurse is being able to understand one’s own perception of death and dying, which can affect the quality of care a dying patient will receive. Methods: A descriptive survey method was used, and the population of 284 nurses was used, the instrument used for data collection was questionnaire and checklist developed based on the objectives of the study. The data collected were analyzed and presented using descriptive statistics of frequency and percentages. Results: The result of the study revealed that Nurses at UNTH have a positive perception of deaths with the most prevalent nurses perception being death is the cessation of all life processes (100%), In caring for the dying patients; 97.6% agreed that it is a good thing to care for the dying, 98% agreed that the rights of the patients should be protected even till death, 97.3% nurses should aim at achieving a peaceful death in all patients at the end of life and 97.6% agreed that it is good to involve the family members in the care of the dying patient. The study revealed religion (65.8%), belief (84.6%), previous experience with a dying patient (79.1%) and loss of a loved one (79.4%) as personal factors which influenced the perception of nurses towards the care of the dying. Furthermore, 78.7% and 72.8% of the respondents identified Euthanasia and Advance directive as legal and ethical factors influencing the care of the dying (x-0.728 with a p-value of 0.502).Also, in examining the relationship between nurses perception of death and their years of experience the result showed that the years of experience did not significantly influence nurses care of the dying (x=4.653, with a p-value of 0.166). Conclusion: It is however recommended that basic knowledge and continuing educational program on palliative care should be made available for student nurses and practicing nurses respectively.

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The Care of the Dying—Whose Job is it?

Psychiatry in Medicine ◽

10.2190/p28c-3tv2-d3wm-vw7t ◽

1970 ◽

Vol 1 (2) ◽

pp. 103-107 ◽

Cited By ~ 8

Author(s):

Elisabeth Kübler-Ross

Keyword(s):

Terminal Illness ◽

Death And Dying ◽

Medical Psychology ◽

Special Significance ◽

Philosophy And Religion ◽

Life Threatening ◽

Objective Interest ◽

Dying Patient ◽

Care Of The Dying

Death and dying have always had deep emotional significance. But there is clearly an increasing scientific and objective interest in the process of terminal illness, dying and death, of special significance to physicians and perhaps too long avoided by them. This new interest, no doubt, is in part a reaction to medical technology's compelling contributions to medicine's life-promotion function, but perhaps also in part a profound humanitarian concern for the paradoxical life-threatening consequences of civilization's (including medicine) “progress.” Death and its vicissitudes are no longer solely the province of poets, philosophy and religion. All well-educated physicians must learn to regard death, as they do birth, as part of life. Psychiatry and medical psychology have much to contribute in this pedagogical task. The author describes one approach to a more “therapeutic” understanding and management of the dying patient and the emotional significance of the process of dying.

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Patient’s Satisfaction With Quality of Care at a National Health Insurance Clinic at a Tertiary Center, South-South Nigeria

Journal of Patient Experience ◽

10.1177/2374373520981471 ◽

2021 ◽

Vol 8 ◽

pp. 237437352098147

Author(s):

Temitope Esther Olamuyiwa ◽

Foluke Olukemi Adeniji

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Quality Of Care ◽

Health Insurance ◽

National Health Insurance ◽

National Health ◽

Bivariate Analysis ◽

P Value ◽

Tertiary Center

Introduction: Patient satisfaction is a commonly used indicator for measuring the quality of health care. This study assessed patients’ satisfaction with the quality of care at the National Health Insurance Scheme (NHIS) clinic in a tertiary facility. Methods: It was a descriptive cross-sectional study in which 379 systematically selected participants completed an interviewer-administered, semi-structured questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 23. Bivariate analysis was performed using Pearson χ2 with a P value set at ≤ .05. Results: The study found out that about half (193, 50.9%) of the respondents were satisfied with the availability of structure. Patients were not satisfied with waiting time in the medical records, account, laboratory, and pharmacy sections. Overall, 286 (75.5%) of the respondents were satisfied with the outcome of health care provided at the NHIS clinic. A statistically significant association ( P = .00) was observed between treatment outcome and patient satisfaction. Conclusion: There is a need to address structural deficiencies and time management at the clinic.

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

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-00239 ◽

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).

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Abstract WMP88: Shorter Door-to-Needle Times of Intravenous Alteplase Improve “Efficiency” of Care and Moderately Affect “Quality” of Care: Study Based on a Large Comprehensive Stroke Center

Stroke ◽

10.1161/str.51.suppl_1.wmp88 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Suja S Rajan ◽

Jessica N Wise ◽

Marquita Decker-palmer ◽

Thanh Dao ◽

Cynthia Salem ◽

...

Keyword(s):

Quality Of Care ◽

Clinical Outcomes ◽

Heart Association ◽

P Value ◽

Regression Analyses ◽

Inpatient Mortality ◽

Care Outcomes ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: The American Heart Association (AHA) recently raised the bar on timely treatment of acute ischemic stroke (AIS) with intravenous (IV) alteplase, by recommending door-to-needle times of 30 minutes or less for 50% or more of the AIS patients. Our study looks at the effectiveness of this new standard, by examining the effect of varying door-to-needle times on efficiency and quality of care, and clinical outcomes. Methods: Our study examined 762 AIS patients treated with IV alteplase in a large academic health system from 2015-2018, and compared their outcomes after treatment within 30, 45 and 60 minutes of arrival. The outcomes compared were: 1) Efficiency of care outcome - Length of stay (LOS); 2) Quality of care outcomes - Inpatient mortality and Disability at discharge; 3) Clinical outcomes - Discharge and 90-day modified Rankin Scale (mRS), and Post-alteplase (24 hr) NIH Stroke Scale (NIHSS). Adjusted logistic and linear regression analyses were used, after controlling for baseline patient socio-demographic and clinical characteristics. Results: Based on the adjusted regression analyses (Table 1), being treated within 30 minutes of arrival reduced the average LOS by 1.3 days (p-value: 0.02), but did not affect the quality of care outcomes. Similarly, being treated within 45 minutes of arrival reduced LOS by 0.9 days (p-value: 0.04). Being treated within 60 minutes of arrival did not affect LOS, but reduced the odds of inpatient mortality by 68% (p-value: 0.00), and disability at discharge by 29% (p-value: 0.08). Being treated within 30 minutes of arrival was associated with better mRS and NIHSS scores as compared with being treated within 45 or 60 minutes. Conclusion: Quicker IV alteplase treatment significantly improved efficiency of care and clinical outcomes. Quality of care outcomes did not improve beyond the 60 minute door-to-needle threshold. This study provides evidence supporting AHA’s new recommendation of 30 minutes or less door-to-needle time.

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PENERAPAN PRAKTIK KEPERAWATAN BERBASIS BUKTI PURSED LIP BREATHING PADA PASIEN DENGAN PENYAKIT PARU OBSTRUKTIF KRONIK DI RUANG RSU PUSAT PERSAHABATAN JAKARTA

Jurnal Keperawatan Widya Gantari Indonesia ◽

10.52020/jkwgi.v2i2.857 ◽

2019 ◽

Vol 2 (2) ◽

Author(s):

Seven Sitorus

Keyword(s):

Quality Of Care ◽

Pulmonary Disease ◽

Significant Influence ◽

Exercise Tolerance ◽

P Value ◽

Evidence Based ◽

Copd Exacerbation ◽

Before And After ◽

Evidence Based Nursing

Background: Chronic Obstruction Pulmonary Disease (COPD) is disease characterized by obstruction air flow in the breath not wholly reversible. One treatment can be done on improving exercise tolerance is exercise respiration as pursed lip breathing ( PLB ). Purse lip breathing is a techniques of breathing carried out to expelling air by creating power through in move closer /pursed lips. Purpose: provide an illustration of the application of the practice of evidence based nursing of pursed lip breathing in patients COPD in RSUP Persahabatan Jakarta. Method: the implementation of the practice of evidence based nursing pursed lip breathing is applied to 12 people sample ( 10 men and 2 women ) diagnosed with COPD exacerbation. Result: the majority of sex respondents is man as many as 10 ( 83,3 % ) persons and women as many as 2 ( 16,7 % ) a person .mean the age of respondents is 61,5 years ± 10.4 .mean the value of PEF ( Peak Expiratory Flow ), the value of the saturation oxygen , the value of respiratori rate before the intervention in a consecutive manner is 131.6 ± 44.6; 92.1 ± 2.44; 31.5 ± 2 . While value after the intervention is 175.0 ± 60.0; 97,1 ± 1.6; 22,6 ± 1.7 with P value = 0.001, α = 0.05. Conclusions: there are significant influence the application of pursed lip breathing between before and after the intervention in patients COPD. Advice: Intervention evidence based nursing can be applied to all patients COPD so reached the quality of care of nursing based on research

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Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

10.1101/2020.12.11.20232611 ◽

2020 ◽

Author(s):

Bénédicte Razafinjato ◽

Luc Rakotonirina ◽

Jafeta Benony Andriantahina ◽

Laura F. Cordier ◽

Randrianambinina Andriamihaja ◽

...

Keyword(s):

Health Care ◽

Quality Of Care ◽

Community Health ◽

Access To Health Care ◽

Care Delivery ◽

Local Level ◽

Scale Up ◽

P Value ◽

The Impact

AbstractDespite the widespread global adoption of community health (CH) systems, there are evidence gaps in how to best deliver community-based care aligned with global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. PIVOT partnered with the Ministry of Public Health to pilot a new two-pronged approach for care delivery in rural Madagascar: one CHW provided care at a stationary CH site while 2-5 additional CHWs provided care via proactive household visits. The pilot included professionalization of the CHW workforce (i.e. recruitment, training, financial incentive) and twice monthly supervision of CHWs. We evaluated the impact of the CH pilot on utilization and quality of integrated community case management (iCCM) in the first six months of implementation (October 2019-March 2020).We compared utilization and proxy measures of quality of care (defined as adherence to the iCCM protocol for diagnosis, classification of disease severity, treatment) in the intervention commune and five comparison communes, using a quasi-experimental study design and relying on routinely collected programmatic data. Average per capita monthly under-five visits were 0.28 in the intervention commune and 0.22 in the comparison communes. In the intervention commune, 40.0% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 77.8% of observed visits in the intervention commune (vs 49.5% in the comparison communes, p-value=<0.001). A two-pronged approach to CH delivery and professionalization of the CHW workforce increased utilization and demonstrated satisfactory quality of care. National stakeholders and program managers should evaluate program re-design at a local level prior to national or district-wide scale-up.

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Abstract 13776: The Impact of Race on In-hospital Quality of Care Among Young Adults With Acute Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.13776 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Diana Benea ◽

Valeria Raparelli ◽

hassan behlouli ◽

Louise Pilote ◽

Rachel Dryer

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Young Adults ◽

Quality Of Care ◽

Clinical Characteristics ◽

Hospital Quality ◽

P Value ◽

White Race

Introduction: The extent to which race influences in-hospital quality of care among young adults with acute myocardial infarction (AMI) is unknown. We examined racial differences in in-hospital quality of AMI care in young adults and described the patient and/or clinical characteristics associated with potential disparities in care. Methods: Data from the GENESIS-PRAXY (Canada) and the VIRGO (U.S.) prospective cohorts of young adults with AMI were analyzed. Among a total of 4,048 adults with AMI (≤55 years) (median=49 years [IQR 44-52], 22% non-white, 58% women), we calculated an in-hospital quality of care score (QCS) for AMI (quality indicators divided by total, with higher scores indicating better care) based on AHA quality of care standards, reporting data disaggregated by race. We categorized race as white versus non-white, which included Black, Asian and North American Indigenous populations. Results: This cohort was comprised of 906 non-white individuals and 3142 white individuals. Non-white adults exhibited a clustering of adverse cardiac risk factors, psychosocial risk factors and comorbidities versus whites; they had higher rates of hypertension, diabetes, alcohol abuse and prior AMI and lower rates of physical activity. They were more likely to have a low SES and receive low social support, and were less likely to be employed, a primary earner, or married/living with a partner. Non-white individuals were also more likely to experience a NSTEMI and less likely to receive cardiac rehabilitation, smoking cessation counseling as well as dual antiplatelet therapy at discharge. Furthermore, non-white individuals had a lower crude QCS than whites (QCS=69.99 vs 73.29, P-value<0.0001). In the multivariable model adjusted for clinical and psychosocial factors, non-white race (LS Mean Difference=-1.49 95%CI -2.87, -0.11, P-value=0.0344) was independently associated with a lower in-hospital QCS. Conclusion: Non-white individuals with AMI exhibited higher rates of adverse psychosocial and clinical characteristics than white individuals yet non-white race was independently associated with lower in-hospital quality of care. Interventions are needed to improve quality of AMI care in non-white young adults.

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