Last watch: developing an inpatient palliative volunteer program for U.s. Veterans in hospice.

This project offers encouraging evidence of the impact of providing companionship and compassionate care to actively dying Veterans. Veteran-centered care serves as a guide for volunteer program objectives including goals based on measuring outcomes of volunteer visits offered to Veterans, frequency of visits to those desiring volunteer involvement and documentation of goals on the resident plan of care. Forty-eight Veterans were admitted to the Palliative Integrated Care (PIC) Unit during the project review period with a median length of stay (LOS) of 7 days, ranging 1-50 days. Goals were met for Veterans with LOS > 3 days; however, it was more challenging to meet the needs of Veterans with shorter stays. Data for this project were collected over a 6-month period. The U.S. Department of Veterans Affairs (VA) is responding to the needs of end-of-life Veterans who do not have family or friends readily available through the No Veteran Dies Alone initiative.

A winning formula for community health.

St. Joseph's/Candler Health System takes the Foster G McGaw Prize for its holistic approach to improving the well-being of the people it serves. Puppets are even involved.

From home to hospital, a continuum of care: making progress towards Millennium Development Goals 4 and 5 in rural Bangladesh.

The Lutheran Aid to Medicine in Bangladesh (LAMB) health and development project in rural Bangladesh has developed an integrated maternal and child healthcare system providing appropriate, accessible and affordable health services for the poor, through a home-to-hospital, continuum-of-care approach. LAMB is thus an example of how high-quality maternity health services accessible to women of all socio-economic classes in a rural context can be provided, making progress towards Millennium Development Goals 4 and 5.

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.

Traditional birth attendants in rural Gambia: beyond health to social cohesion.

Studies of traditional birth attendants over-emphasise the health dimension. Based on ethnographic fieldwork (utilising participant observation, individual interviews, group discussions, participatory rapid appraisal, and literature review) in The Gambia, this paper discusses the multiplicity of the role(s) of TBAs in their communities. As general healthcare providers, 'mothers of the village', gurus of religious and socio-cultural rites, repositories of society's secrets, economic survivors, village leaders and elders, TBAs contribute to the 'gum that holds society together'. They actively engage in the political, economic, cultural, religious, gender, health and wellbeing of their societies. TBAs are important for social cohesion and welfare; not mere health practitioners. Reflections about TBAs open a window into understanding the wider rural Gambian society.

Rapid achievement of the child survival millennium development goal: evidence from the Navrongo experiment in Northern Ghana.

OBJECTIVE: To determine the impact of deploying nurses and volunteers to village locations on demographic and health outcomes. METHOD: We implemented an experimental design that emphasizes the value of aligning community health services with traditional social institutions that organize village life. Data for this analysis come from the Navrongo demographic surveillance system, a longitudinal database that tracks fertility, mortality, and migration events over time. The experiment uses conventional demographic methods for estimating mortality rates from longitudinal demographic surveillance registers. RESULTS: Posting nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated attainment of the childhood-survival millennium development goal (MDG) in the study areas relative to trends observed in comparison areas. CONCLUSION: Results from the Navrongo experiment demonstrate that community health and family planning programmes can have an impact on childhood mortality. Posting nurses to communities can dramatically accelerate the pace of progress in achieving the childhood-survival MDGs. Community-volunteer approaches, however, have no additional impact, a finding that challenges the child survival value of international investment in volunteer-based health programmes. The total cost of the intensive arm of the project is less than $10 per capita per year. Navrongo research thus demonstrates affordable means of attaining the child survival MDG agenda with existing technologies.

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.