Adding spontaneity to organizations - what hospice volunteers contribute to everyday life in German inpatient hospice and palliative care units: a qualitative study.

BACKGROUND: Volunteers have always been integral to hospice and palliative care. However, their roles have been left relatively undefined and broad. AIM: This study aims to examine the role of hospice volunteers in German inpatient hospice and palliative care. The question we seek to answer is: What do hospice volunteers contribute to everyday life in inpatient hospice and palliative care units? METHODS: We undertook a multicenter, on-site qualitative interview study, utilizing problem-centered interviews with 16 volunteers from five inpatient hospice units and one hospital palliative care unit. Interviews were analyzed using grounded theory. RESULTS: Analysis of the interviews revealed three typical characteristics of how hospice volunteers' describe their own role: (1) performing small acts of kindness, (2) creating a family-like atmosphere, (3) expecting emotional experiences. A common theme across all categories is the emphasis on spontaneous actions and personal experiences. The process of dying becomes an experience interpreted by volunteers as enriching, as a gift, as a "teacher". CONCLUSION: Granting hospice volunteers freedom to act spontaneously and intuitively benefits hospice and palliative care delivery. Organizations should leave sufficient room for spontaneity in order to involve volunteers effectively. Open and unstandardized roles facilitate dynamic work practices.

Detecting missing IS-A relations in the NCI Thesaurus using an enhanced hybrid approach.

BACKGROUND: The National Cancer Institute (NCI) Thesaurus provides reference terminology for NCI and other systems. Previously, we proposed a hybrid prototype utilizing lexical features and role definitions of concepts in non-lattice subgraphs to identify missing IS-A relations in the NCI Thesaurus. However, no domain expert evaluation was provided in our previous work. In this paper, we further enhance the hybrid approach by leveraging a novel lexical feature-roots of noun chunks within concept names. Formal evaluation of our enhanced approach is also performed. METHOD: We first compute all the non-lattice subgraphs in the NCI Thesaurus. We model each concept using its role definitions, words and roots of noun chunks within its concept name and its ancestor's names. Then we perform subsumption testing for candidate concept pairs in the non-lattice subgraphs to automatically detect potentially missing IS-A relations. Domain experts evaluated the validity of these relations. RESULTS: We applied our approach to 19.08d version of the NCI Thesaurus. A total of 55 potentially missing IS-A relations were identified by our approach and reviewed by domain experts. 29 out of 55 were confirmed as valid by domain experts and have been incorporated in the newer versions of the NCI Thesaurus. 7 out of 55 further revealed incorrect existing IS-A relations in the NCI Thesaurus. CONCLUSIONS: The results showed that our hybrid approach by leveraging lexical features and role definitions is effective in identifying potentially missing IS-A relations in the NCI Thesaurus.

'We need to get paid for our value': Work-place experiences and role definitions of peer recovery specialists/community health workers.

Despite growing research on peer recovery specialists and community health workers (CHWs) in fields such as substance use disorder (SUD) treatment and recovery support, their workplace experiences are little understood. Through semi-structured interviews with 21 CHWs and peer recovery specialists working within substance use disorder treatment and/or traditional health care settings, we identified six prevalent themes: Benefits/Pleasures of the Role; Reciprocity; Challenges; Duality of Lived Experience; Relationships with Medical Professionals and Supervisors; and Defining Metrics. These themes reveal a complex narrative of system failures, organizational hierarchies, and experiential realities in which shared experiences and personal connections with clients undergird both positive and negative aspects of the role. In the words of one study participant: "We have not taken a vow of poverty, we need to get paid for our value."

The Oncology Nursing Specialty.

The oncology nursing specialty seeks to reduce the risks, incidence, and burden of cancer by encouraging healthy lifestyles, promoting early detection, improving the management of cancer symptoms and side effects throughout the disease trajectory, and leading the coordination of complex care needs.

Role definition is key-Rapid qualitative ethnography findings from a team-based primary care transformation.

PURPOSE: Implementing team-based care into existing primary care is challenging; understanding facilitators and barriers to implementation is critical. We assessed adoption and acceptability of new roles in the first 6 months of launching a team-based care model focused on preventive care, population health, and psychosocial support. METHODS: We conducted qualitative rapid ethnography at a community-based test clinic, including 74 hours of observations and 28 semi-structured interviews. We identified implementation themes related to team-based care and specifically the integration of three roles purposively designed to enhance coordination for better patient outcomes, including preventive screening and mental health: (1) medical assistants as care coordinators; (2) extended care team specialists, including clinical pharmacist and behavioral health professional; and (3) advanced practice providers (APPs)-ie, nurse practitioners and physician assistants. RESULTS: All stakeholders (ie, patients, providers, and staff) reported positive perceptions of care coordinators and extended care specialists; these roles were well defined and quickly implemented. Care coordinators effectively managed care between visits and established strong patient relationships. Specialist colocation facilitated patient access and well-supported diabetes services and mental health care. We also observed unanticipated value: Care coordinators relayed encounter-relevant chart information to providers while scribing; extended care specialists supported informal continuing medical education. In contrast, we observed uncertain definition and expectations of the APP role across stakeholders; accordingly, adoption and acceptability of the role varied. CONCLUSIONS: Practice redesign can redistribute responsibility and patient connection throughout a team but should emphasize well-defined roles. Ethnography, conducted early in implementation with multistakeholder perspectives, can provide rapid and actionable insights about where roles may need refinement or redefinition to support ultimate physical and mental health outcomes for patients.

Mental health nurses' contributions to community mental health care: An Australian study.

Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses' experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15-min intervals over a 4-week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.