Designing Palliative Care Facilities to Better Support Patient and Family Care: A Staff Perspective

Objective: To contribute staff perspectives on the design of palliative care facilities to better align with the philosophy of palliative care, in support of patient, family, and staff well-being. Background: The receipt of palliative care differs from other inpatient experiences owing to its distinct philosophy of care, longer lengths of stay, a greater presence of family members, and more frequent end-of-life events. While research regarding the optimal design of palliative care environments recognizes these differences, this knowledge has been slow to exert change on the guidelines and procurement processes that determine the design solutions possible within these settings. Sustained research attention is required. Methods: An online survey, comprising a series of open-ended questions, elicited the perceptions of palliative care staff regarding the relationship between the physical environment and the distinct philosophy of palliative care. Results: Responses from 89 Australian-based palliative care professionals confirmed the high value that staff place on environments that offer privacy, homeliness, safety, and access to gardens to assist the delivery of optimum care. Conclusions: Our findings illustrate that the implications of privacy and homeliness extend far beyond the patient room and that homeliness is about more than an aesthetic of comfort. This highlights a broader capacity for design to better support the philosophy of palliative care. Importantly, the data reveal a key relationship between staff well-being and the environments in which they work; environments that are unable to match the quality of care that staff aspire to deliver can engender frustration and distress.

Ten Good Reasons to Practice Neuroultrasound in Critical Care Setting

In the beginning, cerebral ultrasound (US) was not considered feasible because the intact skull was a seemingly impenetrable obstacle. For this reason, obtaining a clear image resolution had been a challenge since the first use of neuroultrasound (NUS) for the assessment of small deep brain structures. However, the improvements in transducer technologies and advances in signal processing have refined the image resolution, and the role of NUS has evolved as an imaging modality for the brain parenchyma within multiple pathologies. This article summarizes ten crucial applications of cerebral ultrasonography for the evaluation and management of neurocritical patients, whose transfer from and to intensive care units poses a real problem to medical care staff. This also encompasses ease of use, low cost, wide acceptance by patients, no radiation risk, and relative independence from movement artifacts. Bedsides, availability and reliability raised the interest of critical care intensivists in using it with increasing frequency. In this mini-review, the usefulness and the advantages of US in the neurocritical care setting are discussed regarding ten aspects to encourage the intensivist physician to practice this important tool.

Evaluation of a training program to assist care staff to better recognize and manage depression among palliative care patients and their families

This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed pre-intervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions may be needed to ensure that training program gains are maintained.

“You’re changing the pattern”: cognitive analytic team formulation with learning disabilities care staff

Purpose This study aims to explore how care staff working with people with learning disabilities experienced psychologist-facilitated team formulation sessions in a cognitive analytic style (contextual reformulation). Design/methodology/approach Eleven participants attended at least one contextual reformulation session regarding a client their team referred because of challenging behaviour. Post-intervention semi-structured interviews were analysed using qualitative inductive thematic analysis. Findings Five themes were developed: multiple roles and functions of sessions and clinicians; challenging behaviour in relationship; making links – understanding can be enlightening, containing and practical; the process of developing a shared understanding and approach; and caught between two perspectives. Findings suggested contextual reformulation helped staff see challenging behaviour as relational, provided them with the space to reflect on their emotions and relate compassionately to themselves and others, and ultimately helped them to focus their interventions on understanding and relationally managing rather than acting to reduce behaviour. Research limitations/implications Qualitative methodology allows no causal inferences to be made. Ten of 11 participants were female. Originality/value This qualitative study adds to the limited research base on team formulation in learning disabilities settings and specifically that using a cognitive analytic approach.

Dance wherever you are: the evolution of multi-modal delivery for social inclusion of rural older adults

Background and Objectives Older adult social inclusion involves meaningful participation that is increasingly mediated by information communication technology (ICT) and in rural areas requires understanding of older adults’ experiences in the context of the digital divide. This paper examines how the multi-modal streaming (live, pre-recorded, blended in-person) of the Sharing Dance Older Adults program developed by Canada's National Ballet School (NBS) and Baycrest, influenced social inclusion processes and outcomes in rural settings. Research Design and Methods Data were collected from on-site observations of dance sessions, research team reflections, focus groups and interviews with older adult participants and their carers in pilot studies in the Peterborough Region of Ontario, and the Westman Region of Manitoba, Canada (2017-2019). There were 289 participants including older adults, people living with dementia, family carers, long-term-care staff, community facilitators, and volunteers. Analytic themes were framed in the context of rural older adult social exclusion. Results Remote delivery addressed barriers of physical distance by providing access to the arts-based program and enhancing opportunities for participation. Constraints were introduced by the use of technology in rural areas and mitigated by in-person facilitators and different streaming options. Meaningful engagement in dynamic interactions in the dance was achieved by involving local staff and volunteers in facilitation of and feedback on the program and its delivery. Different streaming technologies influenced social inclusion in different ways: live-stream enhanced connectedness, but constrained technical challenges; pre-recorded was reliable, but less social; blended delivery provided options, but personalization was unsustainable. Discussion and Implications Understanding different participants’ experiences of different technologies will contribute to more effective remote delivery of arts-based programs with options to use technology in various contexts depending on individual and organizational capacities.

Perceived Barriers, Benefits, Facilitators, and Attitudes of Health Professionals Towards Type 2 Diabetes Management in Oujda, Morocco: A Qualitative Focus Group Study

Background: In Morocco, the treatment of type 2 diabetes (T2D) is mainly focused on medication and only 2% of patients are coached towards a healthier lifestyle. In Oujda, Eastern Morocco the prevalence of T2D is 10.2%, and the current trend is alarming, especially for women. Therefore, the aim of this study is to explore healthcare professionals' (HCP) views about the perceived barriers and benefits towards an integrated care approach in primary healthcare centers (PHCCs) to T2D management in Oujda.Methods: A descriptive study using focus groups in 8 PHCCs. This resulted in a sample of 5 doctors and 25 nurses caring for diabetes patients. The transcripts of all conversations were coded to allow for thematic analysis.Results: The participants mentioned different barriers to an integrated approach of DM management:: excessive workload; poor reimbursement policy; lack of staff and equipment; interrupted drug supply; poor working environment; limited referral; gap in the knowledge of general practitioners; health beliefs; poverty; advanced age; gender; the use of psychotropic drugs. An integrated approach could be facilitated by simplified electronic records and referral; uninterrupted free care; staff recruitment; continuous professional development; internships. Benefits: structured care; promotion of care in PHCCs; empowerment of self-management.Conclusion: HCP views reflect the urge to strengthen the management of T2D in PHCCs. There is a need for HCP with expertise in physical activity and nutrition to solve the current gap in the multidisciplinary integrated care approach. The specific local context can contribute to patients' reluctance to change their lifestyles and is a challenge to provide care in an efficient and sustainable manner. More research is needed to see how a patient-centered multidisciplinary approach to T2D management can help motivate patients in Morocco to change to a healthier lifestyle.

Let's talk about sex(ual) wellbeing! Staff perceptions of implementing a novel service for people with Multiple Sclerosis

Background In people with multiple sclerosis (PwMS), a complex interplay of neurological dysfunction, polypharmacy and psychological issues, contrive to impair their sexual and reproductive wellbeing. Realising an unmet need, the Tayside MS service in collaboration with a sexual health clinician (LJ), established a ‘Pelvic Health Clinic’ to improve quality of life for PwMS. Objective To explore clinician's perceptions of implementing an MS Pelvic Health service with a view to establishing future outcomes for health care professionals about the utility in such a service. Method In this small-scale qualitative case study, we explored clinician's perceptions of such a clinic adjunct. Semi-structured interviews were conducted, transcribed, and thematically analysed in a reflexive manner. Results Five participants consented. Ten sub-themes emerged, which were organised into three main themes: service tensions, patient needs and practitioner feelings. Conclusion Clinicians highly valued the new MS ‘pelvic health clinic’. Knowing that there was a service available empowered clinicians to ask patients about sexual health needs. Specific referral criteria may help further develop the service and improve patient care. Staff welcome training and support in this area or the option to signpost onwards; either mechanism lends itself to enhancing MS patient needs.