Experiences of integrating community volunteers as extensions of the primary care team to help support older adults at home: a qualitative study.

BACKGROUND: Increasing the integration of community volunteers into primary health care delivery has the potential to improve person-focused, coordinated care, yet the use of volunteers in primary care is largely unexplored. Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) is a multi-component intervention involving trained community volunteers functioning as extensions of primary care teams, supporting care based on older adults' health goals and needs. This study aimed to gain an understanding of volunteer experiences within the program and client and health care provider perspectives on the volunteer role. METHODS: This study used a qualitative descriptive approach embedded in a pragmatic randomized controlled trial. Participants included Health TAPESTRY volunteers, health care providers, volunteer coordinator, and program clients, all connected to two primary care practice sites in a large urban setting in Ontario, Canada. Data collection included semi-structured focus groups and interviews with all participants, and the completion of a measure of attitudes toward older adults and self-efficacy for volunteers. Qualitative data were inductively coded and analyzed using a constant comparative approach. Quantitative data were summarized using descriptive statistics. RESULTS: Overall, 30 volunteers and 64 other participants (clients, providers, volunteer coordinator) were included. Themes included: 1. Volunteer training: "An investment in volunteers"; 2. Intergenerational volunteer pairing: "The best of both worlds"; 3. Understanding the volunteer role and its scope: "Lay people involved in care"; 4. Volunteers as extensions of primary care teams: "Being the eyes where they live"; 5. The disconnect between volunteers and the clinical team: "Is something being done?"; 6. "Learning… all the time": Impacts on volunteers; and 7. Clients' acceptance of volunteers. CONCLUSIONS: This study showed that it is possible to integrate community volunteers into the primary care setting, adding human connections to deepen the primary care team's understanding of their patients. Program implementation suggestions that emerged included: using role play in training, making volunteer role boundaries and specifications clear, and making efforts to connect volunteers and the primary care team they are supporting. This exploration of stakeholder voices has the potential to help improve volunteer program uptake and acceptability, as well as volunteer recruitment, retention, and training. TRIAL REGISTRATION: For RCT: https://clinicaltrials.gov/ct2/show/NCT02283723, November 5, 2014.

Healthcare professionals and volunteers education in palliative care to promote the best practice-an integrative review.

BACKGROUND: Family caregivers' empowerment can assume strategic importance in palliative care. Healthcare professionals and volunteers have been showing significant gaps in this field. Hence, education has been advocated as an effective strategy to fill this gap. While several educational initiatives exist, a comprehensive evidence synthesis on the effectiveness of educational training on healthcare professionals and volunteers is lacking. AIMS: An integrative review was conducted to explore worldwide initiatives, aiming to improve healthcare professionals and volunteers' competence in a palliative care setting especially in relation to the family caregiver. METHOD: A scoping literature review was conducted with systematic searches in multiple databases - REDALYC, CINAHL, SCIELO, EBSCO, ERIC and MEDLINE since January 2012. Studies were selected based on programmes content and its impact evaluation. Four researchers assessed the studies regarding their eligibility with reference to the inclusion and exclusion criteria. FINDINGS: Twenty-two studies met the eligibility criteria. Multi-professional learning was reported, emphasising nurses and physician's enrolment. Only few studies showed participants' learning outcomes. Inconsistencies in delivery mode and duration were identified. Impact evaluations were heterogeneous and relied on no validated instruments. Family caregiver's content was addressed only in three initiatives. CONCLUSIONS: Further research is needed using a more reliable design, mode of delivery and impact measurement of educational training. In addition, more initiatives associated with cost-effectiveness, shorter- and longer-term clinical impact are needed. Despite the strides already made towards the establishment of an evidence base for healthcare professionals in the field of palliative care, either greater consideration is required for family care providers in the education of healthcare professionals and respect for the cultural diversity.

Dementia Cafés as Hubs to Promote Community-Integrated Care for Dementia through Enhancement of the Competence of Citizen Volunteer Staff Using a New Assessment Tool.

INTRODUCTION: Dementia cafés have recently been attracting attention. The increased involvement of citizen volunteers and the competence of dementia café staff could enhance the potential of dementia cafés. The aim of the present study was to examine enhancement of the competence of citizen volunteers using a new assessment tool. METHODS: This cross-sectional analysis included 433 dementia café staff members, including medical and care professionals and citizen volunteers. A 20-item dementia café staff self-assessment (DCSA) instrument was newly developed. After confirmation of the reliability and validity of the instrument, DCSA scores among citizen volunteers were evaluated. RESULTS: DCSA showed very good psychometric properties. The mean (±SD) DCSA score was significantly higher for café staff with a medical and care professional background (n = 267) than for citizen volunteers (n = 166) (2.2±0.5 vs. 1.7±0.7, respectively; p < 0.001). The DCSA scores of citizen volunteers became significantly higher with increasing attendance (minimum: n = 24; 1.3±0.7; intermediate: n = 65; 1.6±0.6; and frequent: n = 77; 1.8±0.7; p < 0.01). CONCLUSION: Assessment of the competence of dementia café staff using the DCSA revealed the potential of citizen volunteers. This tool could also enhance the potential of dementia cafés.

Sustainability and scalability of a volunteer-based primary care intervention (Health TAPESTRY): a mixed-methods analysis.

BACKGROUND: Chronic diseases are a significant public health concern, particularly in older adults. To address the delivery of health care services to optimally meet the needs of older adults with multiple chronic diseases, Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) uses a novel approach that involves patient home visits by trained volunteers to collect and transmit relevant health information using e-health technology to inform appropriate care from an inter-professional healthcare team. Health TAPESTRY was implemented, pilot tested, and evaluated in a randomized controlled trial (analysis underway). Knowledge translation (KT) interventions such as Health TAPESTRY should involve an investigation of their sustainability and scalability determinants to inform further implementation. However, this is seldom considered in research or considered early enough, so the objectives of this study were to assess the sustainability and scalability potential of Health TAPESTRY from the perspective of the team who developed and pilot-tested it. METHODS: Our objectives were addressed using a sequential mixed-methods approach involving the administration of a validated, sustainability survey developed by the National Health Service (NHS) to all members of the Health TAPESTRY team who were actively involved in the development, implementation and pilot evaluation of the intervention (Phase 1: n = 38). Mean sustainability scores were calculated to identify the best potential for improvement across sustainability factors. Phase 2 was a qualitative study of interviews with purposively selected Health TAPESTRY team members to gain a more in-depth understanding of the factors that influence the sustainability and scalability Health TAPESTRY. Two independent reviewers coded transcribed interviews and completed a multi-step thematic analysis. Outcomes were participant perceptions of the determinants influencing the sustainability and scalability of Health TAPESTRY. RESULTS: Twenty Health TAPESTRY team members (53% response rate) completed the NHS sustainability survey. The overall mean sustainability score was 64.6 (range 22.8-96.8). Important opportunities for improving sustainability were better staff involvement and training, clinical leadership engagement, and infrastructure for sustainability. Interviews with 25 participants (response rate 60%) showed that factors influencing the sustainability and scalability of Health TAPESTRY emerged across two dimensions: I) Health TAPESTRY operations (development and implementation activities undertaken by the central team); and II) the Health TAPESTRY intervention (factors specific to the intervention and its elements). Resource capacity appears to be an important factor to consider for Health TAPESTRY operations as it was identified across both sustainability and scalability factors; and perceived lack of interprofessional team and volunteer resource capacity and the need for stakeholder buy-in are important considerations for the Health TAPESTRY intervention. We used these findings to create actionable recommendations to initiate dialogue among Health TAPESTRY team members to improve the intervention. CONCLUSIONS: Our study identified sustainability and scalability determinants of the Health TAPESTRY intervention that can be used to optimize its potential for impact. Next steps will involve using findings to inform a guide to facilitate sustainability and scalability of Health TAPESTRY in other jurisdictions considering its adoption. Our findings build on the limited current knowledge of sustainability, and advances KT science related to the sustainability and scalability of KT interventions.

Spiritual care in the training of hospice volunteers in Germany.

OBJECTIVE: Hospice volunteers often encounter questions related to spirituality. It is unknown whether spiritual care receives a corresponding level of attention in their training. Our survey investigated the current practice of spiritual care training in Germany. METHOD: An online survey sent to 1,332 hospice homecare services for adults in Germany was conducted during the summer of 2012. We employed the SPSS 21 software package for statistical evaluation. RESULTS: All training programs included self-reflection on personal spirituality as obligatory. The definitions of spirituality used in programs differ considerably. The task of defining training objectives is randomly delegated to a supervisor, a trainer, or to the governing organization. More than half the institutions work in conjunction with an external trainer. These external trainers frequently have professional backgrounds in pastoral care/theology and/or in hospice/palliative care. While spiritual care receives great attention, the specific tasks it entails are rarely discussed. The response rate for our study was 25.0% (n = 332). SIGNIFICANCE OF RESULTS: A need exists to develop training concepts that outline distinct contents, methods, and objectives. A prospective curriculum would have to provide assistance in the development of training programs. Moreover, it would need to be adaptable to the various concepts of spiritual care employed by the respective institutions and their hospice volunteers.

Predisaster integration of community emergency response teams.

OBJECTIVE: The Community Emergency Response Team (CERT) program has been increasingly used within local emergency management systems since the United States' Federal Emergency Management Agency (FEMA) adopted and began promoting the program in 1993. The objective of this study was to explore the integration of CERT programs within local emergency management systems predisaster. DESIGN: Qualitative, semistructured telephone interviews were used to collect data from a purposive sample of CERT program coordinators. SETTING: Telephone interviews were conducted with CERT program coordinators in FEMA Region VII (Iowa, Kansas, Missouri, and Nebraska). SUBJECTS, PARTICIPANTS: Twenty-five local county emergency managers participated in this study. RESULTS: This study found that the integration of CERTs varied significantly. The extent to which most teams were integrated allowed them to be placed along an integration continuum and classified as one of three types including Least Integrated, Somewhat Integrated, and Highly Integrated. Other team characteristics seemed to covary with the team integration. A phenomenon of team Piggy Backing-where the integration of the team was no longer relevant-was also found. CONCLUSIONS: This study concludes by making a key recommendation that could benefit any CERT-add a module to the CERT training curriculum designed to integrate the individuals associated with the CERT program within their local emergency management system.

What can volunteer co-providers contribute to health systems? The role of people living with HIV in the Thai paediatric HIV programme.

In Thailand people living with HIV (PLHIV) have played a major role in shaping policy and practice. They have acted as volunteer co-providers, although their potential in terms of paediatric service provision has seldom been explored from a health systems perspective. We describe the Thai paediatric HIV care system and use both demand- and supply-side perspectives to explore the impact, opportunities and challenges of PLHIV acting as volunteer co-providers. We employed qualitative methods to assess experiences and perceptions and triangulate stakeholder perspectives. Data were collected in Khon Kaen province, in the poorest Northeastern region of Thailand: three focus group discussions and two workshops (total participants n = 31) with co-providers and hospital staff; interviews with ART service-users (n = 35). Nationally, key informant interviews were conducted with policy actors (n = 20). Volunteer co-providers were found to be ideally placed to broker the link between clinic and communities for HIV infected children and played an important part in the vital psychosocial support component of HIV care. As co-providers they were recognized as having multiple roles linking and delivering services in clinics and communities. Clear emerging needs include strengthened coordination and training as well as strategies to support funding. Using motivated volunteers with a shared HIV status as co-providers for specific clinical services can contribute to strengthening health systems in Asia; they are critical players in delivering care (supply side) and being responsive to service-users needs (demand side). Co-providers blur the boundaries between these two spheres. Sustaining and optimising co-providers' contribution to health systems strengthening requires a health systems approach. Our findings help to guide policy makers and service providers on how to balance clinical priorities with psycho-social responsiveness and on how best to integrate the views and experience of volunteers into a holistic model of care.

Development of a hospital reiki training program: training volunteers to provide reiki to patients, families, and staff in the acute care setting.

Creating a healing and healthy environment for patients, families, and staff is an ongoing challenge. As part of our hospital's Integrative Care Program, a Reiki Volunteer Program has helped to foster a caring and healing environment, providing a means for patients, family, and staff to reduce pain and anxiety and improve their ability to relax and be present. Because direct care providers manage multiple and competing needs at any given time, they may not be available to provide Reiki when it is needed. This program demonstrates that a volunteer-based program can successfully support nurses in meeting patient, family, and staff demand for Reiki services.

Interpretación ambiental y etnobotánica: Trayectos educativos de un Proyecto de Extensión y Voluntariado Universitario con los actores sociales de la flora medicinal de las Sierras de Córdoba (Argentina) / Environmental interpretation and ethnobotany: Educational Paths of a University Extension Project and Volunteer Work with the Social Actors of Medicinal Plants of Sierras of Cordoba, Argentina

Se presenta la génesis, los objetivos, el alcance y valoración de un Proyecto de Extensión y Voluntariado Universitario atravesado por el eje teórico-conceptual y metodológico de la etnobotánica y por el enfoque de la Interpretación Ambiental, en torno a los actores sociales de la flora medicinal de las sierras de Córdoba. Con el objeto de revitalizar los procesos socioculturales de transmisión entre generaciones en relación con el conocimiento y uso de plantas medicinales en localidades rurales del Departamento Santa María, se implementaron "talleres de etnobotánica participativa" junto al diseño y creación de un "sendero turístico de interpretación", una "farmacia viva" y una "botica serrana". Asimismo se analiza en qué medida las competencias adquiridas y las prácticas sociales puestas en juego, contribuyeron a la formación de los estudiantes universitarios, así como a hacer un uso más sustentable de estos recursos nativos.

An overview of the ACE Project-advocating for clinical excellence: transdisciplinary palliative care education.

BACKGROUND: Excellence in palliative care demands attention to the multidimensional aspects of patient and family suffering, yet too few psycho-oncology professionals report adequate preparation in this vital area. METHODS: A total of 148 competitively selected psychologists, social workers, and spiritual care professionals participated in intensive educational courses to enhance their palliative care delivery, leadership, and advocacy skills. Extensive process and outcome evaluations measured the effectiveness of this educational program. RESULTS: To date, 2 national courses have been completed. The courses received strong overall evaluations, with participants rating increased confidence in defined palliative care skills. CONCLUSIONS: The initial results of this innovative National Cancer Institute-funded transdisciplinary training for psycho-oncology professionals affirm the need and feasibility of the program. See the Advocating for Clinical Excellence Project Web site (www.cityofhope.org/ACEproject) for additional course information.

Impact of a community-based integrated management of childhood illnesses (IMCI) programme in Gegharkunik, Armenia.

BACKGROUND: Maternal and child health status in the Martuni region of Gegharkunik marz, Armenia, precipitously declined following Armenia's independence in 1991. In response, the American Red Cross (ARC) and the Armenian Red Cross Society (ARCS) implemented the WHO community-level Integrated Management of Childhood Illnesses (IMCI) strategy, complementing recent clinical IMCI training in the region in which 387 community health volunteers from 16 villages were trained as peer educators, and approximately 5000 caretakers of children under age 5 were counselled on key nutrition and health practices. METHODS: A pre-post independent sample design was used to assess the programme's impact. The evaluation instrument collected respondent demographic characteristics and knowledge, attitudes and practices consistent with 10 health indicators typical of child survival interventions. At baseline and at follow-up, 300 mothers were interviewed using a stratified simple random sampling of households with at least one child less than age 2. RESULTS: The assessment confirmed the population's poor health status and limited knowledge and application of recommended child care practices. The campaign reached its target: at follow-up, 67% had seen media messages within the past month, 82% had received the IMCI informational booklet, and 30% had seen other materials. Evidence of the success of the programme included the following: exclusive breastfeeding increased 31.4%, maternal knowledge of child illness signs increased 30%, knowledge of HIV increased 28.5%, and physician attended deliveries increased 15%. CONCLUSIONS: This evaluation documented the significant and substantial impact of the community IMCI programme on both knowledge and practice in rural areas of Armenia. Consideration should be given to continuing and expanding this project as a complement to health sector development activities in this region.

Evaluation of a community nursing initiative: palliative care.

It is estimated that one in five people over 65years old will die in a care home in the UK. These residents require palliative care that is often delivered by social and voluntary care workers. This paper aims to evaluate a palliative care programme that has been running for the past few years and is facilitated by community nurses. An anonymous questionnaire was distributed to 50 carers within four care homes who had undertaken the programme since its implementation two years ago. A total of 38questionnaires were returned giving an above-average response rate of 77% . Results showed that the majority of participants found the course very valuable and stated that it had improved their delivery of palliative care. The programme was positively evaluated and has proved to be a valuable way of improving integrated care and meeting the Scottish Government recommendations of improving the delivery of palliative care irrespective of diagnosis and care setting.

Online video bridges gap between orientation and first session for arts in medicine volunteers.

An online video assignment was developed to facilitate transition from the orientation session to the first contact with hospital patients for music therapy majors and other students enrolled in an Arts in Medicine service learning course (AIMS). All students (N = 84) completed a 2 hour hospital orientation session. After the orientation session the experimental group (n = 42) completed an online video assignment before volunteering at the hospital The control group (n = 42) began volunteering after the orientation session without completing the video assignment. Analysis indicates the majority of both groups initiated their first session independently without assistance from other AIMS volunteers, an experienced AIM volunteer, an AIM assistant, or hospital staff member. The majority of both groups also engaged at least one patient during their first visit at the hospital. Content analysis of "first contact" weekly reports, however, indicated experimental group students wrote longer reports and included more positive comments, particularly about patients, compared to control group students. Volunteers in the experimental group also began their contacts as scheduled on the course calendar compared to later starting dates of control group volunteers.

Communication skills training in a hospice volunteer training program.

As hospice services have expanded, patient care volunteers have become increasingly important in providing support to the dying and their families. Fundamental to the success of hospice volunteers is the quality of interaction among the volunteer, the dying patient, and his or her family. This article examines the extent to which a specific hospice program provided communication skills training for its volunteers. Results indicate that, while listening, empathy, and nonverbal communication were touched upon, broader communication skills were not addressed and specific communication skills training was not provided. The implications for this lack of communication training are noted and methods of increasing active empathetic listening skills are proposed. The article concludes with a discussion of potential theoretical and pragmatic research contributions that the field of communication studies can make to hospice training programs.

Use of complementary and alternative medicine (CAM) by Washington State hospices.

PURPOSE: To assess the use of complementary and alternative medicine in hospice care in the state of Washington. METHODS: Hospices offering inpatient and outpatient care in Washington State were surveyed by phone interview. RESULTS: Response rate was 100%. Results indicated that 86% of Washington State hospices offered complementary and alternative services to their patients, most frequently massage (87%), music therapy (74%), energy healing (65%), aromatherapy (45%), guided imagery (45%), compassionate touch (42%), acupuncture (32%), pet therapy (32%), meditation (29%), art therapy (22%), reflexology (19%), and hypnotherapy (16%). Most hospices relied on volunteers with or without small donations to offer such services. CONCLUSIONS: Complementary and alternative therapies are widely used by Washington State hospices but not covered under hospice benefits. Extensive use of these therapies seems to warrant the inclusion of complementary and alternative providers as part of hospice staff, and reimbursement schedules need to be integrated into hospice care.

A contemplative care approach to training and supporting hospice volunteers: a prospective study of spiritual practice, well-being, and fear of death.

BACKGROUND: Inspired by a 2,500-year-old Buddhist tradition, the Zen Hospice Project (ZHP) provides residential hospice care, volunteer programs, and educational efforts that cultivate wisdom and compassion in service. OBJECTIVE: The present study was designed to understand how being with dying hospice residents affects hospice volunteers well-being and the role of spiritual practice in ameliorating the fear of death. DESIGN: A one-year longitudinal study of two volunteer cohorts (N = 24 and N = 22) with repeated measures of spiritual practice, well-being, and hospice performance during one-year service as volunteers. SETTING: The Zen Hospice Guest House and Laguna Honda Residential Hospital of San Francisco, CA. PARTICIPANTS: All 46 individuals who became ZHP volunteers during two years. INTERVENTIONS: A 40-hour training program for beginning hospice volunteers stressing compassion, equanimity, mindfulness, and practical bedside care; a one-year caregiver assignment five hours per week; and monthly group meeting. MAIN OUTCOME MEASURES: Self-report FACIT spiritual well-being, general well-being, self-transcendence scale, and a volunteer coordinator-rated ZHP performance scale. RESULTS: The volunteers had a high level of self-care and well-being at baseline and maintained both throughout the year; they increased compassion and decreased fear of death. Those (n = 20) practicing yoga were found to have consistently lower fear of death than the group average (P = .04, P = .008, respectively). All rated the training and program highly, and 63% continued to volunteer after the first year's commitment. The results suggest that this approach to training and supporting hospice volunteers fosters emotional well-being and spiritual growth.