Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.411
Filtrar
1.
Home Healthc Now ; 40(1): 19-26, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34994717

RESUMO

Approximately 4.7 million Veterans live in rural areas and face challenges receiving support and care for complex service-connected healthcare needs. The purpose of this qualitative descriptive study was to explore nurses' experiences caring for Veterans in rural home care/hospice settings. Semistructured interviews (N = 14) were conducted between August 2020 and March 2021. Content and thematic analysis resulted in three central themes: Mission readiness: Ensuring safe home environments, Partnering with Veterans: Knowing when to lead and when to follow, and It's my duty: Caring with purpose and honor. Study findings highlight the need for cultural competence in both rural and Veteran cultures. Implications for practice reinforce currently emerging national priorities, including personal safety considerations and need for further professional development associated with screening for firearms and gun safety. Other implications for home care/hospice agencies, as well as nursing education, are discussed.


Assuntos
Serviços de Assistência Domiciliar , Hospitais para Doentes Terminais , Enfermeiras e Enfermeiros , Veteranos , Humanos , Pesquisa Qualitativa
2.
BMC Palliat Care ; 21(1): 3, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34980085

RESUMO

Denmark is considered one of the World's most secular societies, and spiritual matters are rarely verbalized in public. Patients report that their spiritual needs are not cared for sufficiently. For studying spiritual care and communication, twelve patients admitted to two Danish hospices were interviewed. Verbal and non-verbal communication between patients and healthcare professionals were identified and analysed. Methodically, the Interpretative Phenomenological Analysis was used, and the findings were discussed through the lenses of existential psychology as well as philosophy and theory of caring sciences. Three themes were identified: 1. When death becomes present, 2. Direction of the initiative, and 3. Bodily presence and non-verbal communication. The encounter between patient and healthcare professional is greatly influenced by sensing, decoding, and interpretation. A perceived connection between the patient and the healthcare professional is of great importance as to how the patient experiences the relationship with the healthcare professional.The patient's perception and the patient's bodily experience of the healthcare professional are crucial to whether the patient opens up to the healthcare professional about thoughts and needs of a spiritual nature and initiates a conversation hereabout. In this way we found three dynamically connected movements toward spiritual care: 1. From secular to spiritual aspects of care 2. From bodily, sensory to verbal aspects of spiritual care and 3. From biomedical to spiritual communication and care. Thus, the non-verbal dimension becomes a prerequisite for the verbal dimension of spiritual communication to develop and unfold. The behaviour of the healthcare professionals, characterised by the way they move physically and the way they touch the patient, was found to be just as important as verbal conversation when it comes to spiritual care. The healthcare professional can create a connection to the patient through bodily and relational presence. Furthermore, the healthcare professionals should let their sensing and impressions guide them when meeting the patient in dialog about matters of a spiritual nature. Their perception of the patient and non-verbal communication are a prerequisite for being able to meet patient's spiritual needs with care and verbal communication.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Dinamarca , Humanos , Comunicação não Verbal , Cuidados Paliativos , Pesquisa Qualitativa , Espiritualidade
3.
BMC Palliat Care ; 21(1): 2, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34980093

RESUMO

BACKGROUND: There is a lack of research to guide the implementation of voluntary assisted dying legislation within a hospice setting. Furthermore, there is limited published information related to the expectations of the community and staff to assist decision making regarding voluntary assisted dying in a community hospice. The aim of this study was to explore the expectations of staff, volunteers and members of the community as how a rural Australian community hospice could respond in relation to imminent enactment of Voluntary Assisted Dying legislation. METHODS: A total of 63 Hospice staff and volunteers and community members participated in 11 workshops. This qualitative study used the interpretive description method to analyse the workshop transcripts. RESULTS: While there was not a consensus view on community expectation, there was agreement among the participants for respect for a patient's individuality and choices. Furthermore, care offered in hospice needs to remain non-judgemental and patient focused regardless of whether voluntary assisted dying policy was implemented or not. Both opportunities and risks associated with implementation were identified by the participants. CONCLUSION: There was common ground around the respect for the dying person and the ideal of a "safe place" despite opposing views on what this may mean in practice. There is a need for clarity in organisational responses around policy, risk management, education, and staff support.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Suicídio Assistido , Austrália , Humanos , População Rural
4.
J Palliat Care ; 37(1): 41-47, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33213233

RESUMO

Evidence for massage therapy (MT) in hospice patients remains limited. We conducted a prospective pilot study on MTs impact on quality of life of hospice patients and caregivers. Patient-caregiver dyads were enrolled if patients scored ≥5 on pain, depression, anxiety, or well-being using the revised Edmonton Symptom Assessment System Revised (ESAS-r). The patient received MT weekly for up to 3 massages with assessments completed at baseline, after each massage, and 1 week after the final massage for patients and at baseline and 1 week after final massage for caregivers. A satisfaction survey was completed at study completion. A pro-rated area under the curve (AUC) was utilized to assess the primary endpoints of change in ESAS-r for patient ratings of pain, depression and anxiety as well as the Linear Analogue Self-Assessment (LASA). Median difference scores (end of study value)-(baseline value) for each participant and caregiver were calculated. Of 27 patients and caregivers enrolled, 25 patients received MT. Fifteen patients completed all 3 MT sessions and were given the final symptom assessment and satisfaction survey and their caregivers completed final assessments. The proportion of patients considered success (AUC > baseline) in the primary endpoints were the following: pain 40.9%, depression 40.9%, anxiety 54.5%, LASA 54.5%. Median difference scores were largely zero indicating no significant temporal change in symptoms. Patients were highly satisfied with MT. This pilot study indicated that MT was a feasible and well-received intervention in our population of patients with inadequately controlled symptoms.


Assuntos
Hospitais para Doentes Terminais , Neoplasias , Cuidadores , Humanos , Massagem , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida
5.
J Palliat Care ; 37(1): 34-40, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34410180

RESUMO

Objectives: Centers for Medicare and Medicaid Services requirements for Emergency Preparedness Planning (EPP) by hospice organizations significantly increased in 2017. This study seeks to assess the involvement of various hospice personnel in EPP before and since the onset of the novel coronavirus disease COVID-19 pandemic. Methods: A link to an anonymous online survey was sent to members of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association, targeting members involved in hospice care in the United States. A descriptive analysis of the data was performed. Results: Prior to the pandemic, 39.8% of respondents were "moderately" or "very" involved with the development and revisions of the Emergency Preparedness Plan. Since the beginning of the pandemic, this increased to 59%, which largely occurred among physicians. Clinical Nurse and Nurse Practitioner involvement in development/revisions remained low. Approximately 30% of respondents desired more involvement across the areas of EPP. Conclusion: The involvement of personnel of various disciplines is varied and the involvement of physicians appears to have increased with the onset of the COVID-19 pandemic. A notable portion of personnel desired more involvement across all aspects of EPP. More research is needed in this important but little-understood area.


Assuntos
COVID-19 , Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Idoso , Humanos , Medicare , Pandemias , SARS-CoV-2 , Estados Unidos
6.
Am J Hosp Palliat Care ; 39(1): 27-33, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33685252

RESUMO

OBJECTIVES: Little is known about the experiences of caregivers who provide care to persons with terminal delirium (TD) in home settings. This scarcity of information is suggestive that further research is needed about care for hospice patients with delirium in the home and community. AIM: To elicit views, feelings, and end-of-life care experiences of primary caregivers assisting dying persons with TD in hospice at home. DESIGN: Qualitative, exploratory, cross-sectional study design was chosen. In-depth semistructured interviews explored caregiver experiences in caring for persons with TD. Qualitative thematic framework analysis was used. PARTICIPANTS: Fifteen bereaved adult primary caregivers who received services from a hospice care program affiliated with a large nonprofit health system in the US Midwest. RESULTS: Caregiver experiences were broad and reflected 4 major themes: symptomology, coping, effective and noneffective interventions, and support. The most distressing factors for caregivers were behaviors and symptomology of TD. They did not know what to say, how to respond, and how best to behave with someone who had delirium. Many caregivers had the impression that medication does not lessen delirium symptoms and that nonpharmacologic interventions are effective and beneficial only when they were important and meaningful to patients before delirium onset. CONCLUSIONS: This study added new knowledge from direct and personal perspectives of caregivers providing end-of-life care to patients at home. Understanding developed about provision of care to someone with TD in home hospice. Improved comprehension of caregiver experiences can help professional hospice and palliative care staff better prepare caregivers for when patients have TD.


Assuntos
Delírio , Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Adulto , Cuidadores , Estudos Transversais , Humanos , Doente Terminal
7.
Am J Hosp Palliat Care ; 39(1): 68-71, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33926274

RESUMO

AIMS: The inability to prescribe blood transfusions is a potential barrier to timely hospice enrollment for patients with blood cancers. The benefits and harms of transfusions near the end of life (EOL), however, are poorly characterized and patients' preferences are unknown. We sought to characterize the recollections of bereaved caregivers about the relationships between transfusions and hospice enrollment decisions. METHODS: We recruited 18 bereaved caregivers of 15 decedents who died within 6-18 months of the interview. Interviews focused on caregivers' recollections of transfusion and hospice enrollment decisions. Transcripts were analyzed for themes. RESULTS: We identified 2 themes. First, caregivers described that transfusions were necessary and the decisions to receive transfusions or not were deferred to the clinicians. Second, only 1 caregiver recalled transfusions as relevant to hospice decisions. In that instance there was a delay. Caregivers identified difficulties recognizing death was imminent, hope for miracles, and the necessity of accepting life was ending as more relevant barriers. CONCLUSIONS: The results indicate clinicians' beliefs in transfusion at EOL may be a more relevant barrier to hospice enrollment than patients' preferences. Strategies to evaluate accurately and discuss the actual benefits and harms of transfusions at the EOL are necessary to advise patients and integrate their preferences into decisions.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Leucemia Mieloide Aguda , Transfusão de Sangue , Cuidadores , Humanos , Leucemia Mieloide Aguda/terapia
8.
Home Healthc Now ; 39(6): 344-350, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34738970

RESUMO

Telehospice has been recognized as a way to meet the needs of hospice patients and their caregivers. The purpose of this study was to examine the comfort of hospice staff using telehospice to connect virtually with patients and caregivers. The hospice in this study uses Alpha Virtual Assist (AVA), which employs a commercial remote patient monitoring platform and a communication platform that focuses on holistic patient and caregiver comfort as well as interpersonal and interprofessional communication. A mixed methods research design was used. An online survey of hospice staff that included quantitative and qualitative items was used to collect data. Forty-four hospice staff agreed to participate. No differences were found in comfort levels with using AVA between nurses and other staff. Three themes emerged from the qualitative responses: Positive responses about AVA; AVA as an assistive device; and Problems with connectivity. Hospice staff were comfortable using telehospice technology and have effectively used this tool with hospice patients and their caregivers before and during the pandemic.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Cuidadores , Comunicação , Humanos , Pandemias
9.
Hu Li Za Zhi ; 68(6): 32-42, 2021 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-34839489

RESUMO

BACKGROUND: Hospice shared care is a model of care widely used in patients with terminal cancer. Appropriate interventions to improve related symptoms should be provided during disease progression through the end of life. PURPOSE: The purpose of this study was to explore the related symptoms and to compare symptom severity before and after the implementation of hospice shared care and medical care interventions. METHODS: Fifty patients with terminal cancer were enrolled in this longitudinal, quasi-experimental research. Inclusion criteria included having an expected life span of < 6 months and agreeing to enter hospice shared care. RESULTS: The three most-frequently noted physical symptoms were, in rank order: "pain", "weakness", and "dyspnea". In terms of severity, "pain" was the most severe, followed by "weakness" and "disturbance of sleep". The three most-frequently noted psychological symptoms were, in rank order: "depression", "worry about the disease", and "afraid of dragging others down". In terms of severity, "depression" was the most severe, followed by "anxiety" and "worry about the disease". The frequency and severity of the top-3 social and spiritual distress symptoms were, in rank order: "unfinished wish", "economic difficulties", and "painlessness". During the study period, the severity of physical symptoms improved gradually, while the severity of psychological symptoms improved significantly. The top-3 items in the original medical team`s hospice-care interventions were, in rank order: "tube care", "laboratory test", and "wound care" in the non-pharmacological category; "symptom control medication", "antibiotic injection", and "intravenous fluid infusion" in the pharmacological category; and "cognitive clarification of the prognosis condition", "do not conduct resuscitation discussions and signing", and "emotional stress consoling" in the problem-coordination and interview categories. The interventions implemented by the hospice specialist team included "emotional stress interview", "team communication", and "cognitive clarification of prognosis condition" in the problem coordination and interview categories, and "massage", "consultation", and "nursing advice" in the non-pharmacological category. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The symptoms identified in this study provide clinical staff with a reference for the rapid assessment of patients with terminal-stage cancer. Manpower from various professional fields are committed to providing diversified services in the care teams, which positively affect the control of related symptoms. The experience presented in this article may be used as a reference to promote the hospice shared care model.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Neoplasias , Assistência Terminal , Ansiedade , Humanos , Massagem , Neoplasias/terapia
10.
J Hosp Palliat Nurs ; 23(5): 484-491, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34469410

RESUMO

The term social model hospice first appeared late in the 20th century as a label for a complementary model to medical hospice care. Two decades later, the term is inconsistently defined and used by scholars, health care providers, public consumers, and those within the movement. The purpose of this review is to trace the development of the concept and confirm an evolving definition based on Rodgers' evolutionary method. Database and hand searching was done for the years 1975 to 2020, resulting in 25 publications for analysis. Unique antecedents include presence of a resource crisis, unmet needs falling outside the scope of medical hospice care, and desire to experience death outside the medical system and/or personal home. Attributes include a dedicated home, round-the-clock, individualized end-of-life care; care option when dying at home becomes unmanageable; collaboration with medical hospice services; nonprofit organization funded by community philanthropy; environment to support loved ones; and community volunteer involvement. Noted consequences are effective end-of-life care for dying patients and their families, innovative health care design, nationwide network of like-minded providers, and platform for end-of-life community education. Clarity of the concept will facilitate access to end-of-life care, further the model's development, formalize research endeavors, and foster community education.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Assistência Terminal , Humanos
11.
Int J Palliat Nurs ; 27(7): 334-350, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34569281

RESUMO

BACKGROUND: Literature for preparing hospice nurses to deliver end-of-life care is sparse. AIM: To investigate how nurses in one UK hospice prepared to deliver end-of-life care in their role. METHODS: A classic grounded theory approach was used to investigate the experiences of 22 registered nurses in one UK hospice, to discover how they prepared for their role. A total of 17 individual interviews and one focus group were conducted. Constant comparison of data and member checking were performed to establish validity. FINDINGS: Findings were synthesised into five categories: the 'shared ideal', feeling good at the job, making a difference, experience/exposure to hospice work and the importance of role models. The shared ideal formed the core category, which explained how hospice nurses feel a sense of 'fit' with their work. CONCLUSION: The feeling of a nurse feeling well-suited to the work and that there the work was a good 'fit' for them was identified as a core element to nurses' feelings of preparedness to provide end-of-life care.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Enfermeiras e Enfermeiros , Assistência Terminal , Teoria Fundamentada , Hospitais para Doentes Terminais , Humanos , Enfermeiras e Enfermeiros/psicologia , Reino Unido
12.
Artigo em Inglês | MEDLINE | ID: mdl-34501599

RESUMO

This study aimed to explore the effectiveness of an inpatient hospice palliative care unit (PCU) and palliative consultation service (PCS) on comprehensive quality of life outcome (CoQoLo) among terminally ill cancer patients. This was a prospective longitudinal study. Terminally ill cancer patients who met the inclusion criteria and received PCU or PCS in a northern Taiwanese medical center were recruited. The CoQoLo Inventory was used to measure CoQoLo level pre- and seven days following hospice care between August 2018 and October 2019. A total of 90 patients completed the study. No significant differences were found in CoQoLo levels between the PCU and PCS groups pre- and seven days following care. However, the CoQoLo level of patients significantly improved seven days following care in both PCU and PCS groups, compared with pre-hospice care. Patients' age, religious belief, marital status, closeness with family, palliative prognostic index (PPI), and symptom severity were significant concerning CoQoLo levels after adjusting for patients' baseline characteristics. PCU and PCS showed no difference in CoQoLo levels, but both of them can improve CoQoLo among terminally ill cancer patients. These patients could receive PCU or PCS to achieve a good CoQoLo at the end-of-life stage.


Assuntos
Hospitais para Doentes Terminais , Neoplasias , Humanos , Pacientes Internados , Estudos Longitudinais , Neoplasias/terapia , Cuidados Paliativos , Estudos Prospectivos , Qualidade de Vida , Encaminhamento e Consulta , Doente Terminal
15.
Am J Infect Control ; 49(12): 1551-1553, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34400245

RESUMO

Home care and hospice are unique and rapidly growing healthcare settings. However, there is a lack of published findings related to evidence-based infection surveillance programs among these settings. Our health system hired a Home Care and Hospice Infection Preventionist to implement an infection surveillance program using evidence-based infection surveillance criteria appropriate for these settings, the Association for Professionals in Infection Control and Epidemiology (APIC) and Healthcare Infection Control Practices Advisory Committee (HICPAC) definitions for home health care and home hospice infections, National Healthcare Safety Network long-term care facility (LTCF) criteria, and McGeer criteria for LTCFs. These surveillance criteria were built into new surveillance databases for Home Care, Home Hospice, and inpatient Hospice House. Infection Prevention reported infections and trends to respective departments monthly and as needed in the event of any significant infections. For most infection types, there were less infections identified during January-April 2021 than for the same period in 2019-2020. Having Infection Prevention coordinate the Home Care and Hospice infection surveillance program will help establish reliable healthcare-associated infection baseline data and help identify the population at risk. Future enhancements to automatically identify infections among this patient population are planned once Home Care and Hospice begin using the health system's electronic medical record.


Assuntos
Infecção Hospitalar , Serviços de Assistência Domiciliar , Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Humanos , Controle de Infecções
17.
BMC Palliat Care ; 20(1): 115, 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273974

RESUMO

BACKGROUND: Patients approaching the end of their life do not experience their existential and spiritual needs being sufficiently met by the healthcare professionals responsible for their care. Research suggest that this is partly due to a lack of insight about spiritual care among healthcare professionals. By developing, implementing, and evaluating a research-based educational course on spiritual care targeting hospice staff, we aimed to explore the perceived barriers for providing spiritual care within a hospice setting and to evaluate the post-course impact among staff members. METHODS: Course development and evaluation was based on primary exploratory action research and followed the UK Medical Research Council's framework for complex intervention research. The course was implemented at two Danish hospices and comprised thematic days that included lectures, reflective exercises and improvised participatory theatre. We investigated the course impact using a questionnaire and focus group interviews. The questionnaire data were summarized in bar charts and analysis of the transcribed interviews was performed based on Interpretative Phenomenological Analysis. RESULTS: 85 staff members participated in the course. Of these, 57 answered the evaluative questionnaire and 15 participated in 5 focus group interviews. The course elements that the participants reported to be the most relevant were improvised theatre unfolding existential themes and reflexive group activities. 98% of participants found the course relevant, answering either "relevant" or "very relevant". 73,1% of participants answered "to a considerable extent" or "to a great extent" when asked to what extent they assessed the content of the course to influence their work in hospice. The focus group data resulted in 3 overall themes regarding perceived barriers for providing spiritual care: 1. Diverse approaches is beneficial for spiritual care, but the lack of a shared and adequate spiritual language is a communicative barrier, 2. Existential conversation is complicated by patients' overlapping physical and existential needs, as well as miscommunication, and 3. Providing spiritual care requires spiritual self-reflection, self-awareness, introspection, and vulnerability. CONCLUSIONS: This study provides insights into the barriers facing spiritual care in a hospice setting. Furthermore, the course evaluations demonstrate the valuable impact of spiritual care training for health care professionals. Further course work development is warranted to enhance the "science" of spiritual care for the dying.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Terapias Espirituais , Humanos , Cuidados Paliativos , Pesquisa Qualitativa , Espiritualidade
18.
J Alzheimers Dis ; 82(4): 1727-1736, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34219726

RESUMO

BACKGROUND: Hispanic older adults are a high-risk population for Alzheimer's disease and related dementias (ADRD) but are less likely than non-Hispanic White older adults to have ADRD documented as a cause of death on a death certificate. OBJECTIVE: To investigate characteristics associated with ADRD as a cause of death among Mexican-American decedents diagnosed with ADRD. METHODS: Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims, and National Death Index. RESULTS: The final sample included 853 decedents diagnosed with ADRD of which 242 had ADRD documented as a cause of death. More health comorbidities (OR = 0.40, 95% CI = 0.28-0.58), older age at death (OR = 1.18, 95% CI = 1.03-1.36), and longer ADRD duration (OR = 1.08, 95% CI = 1.03-1.14) were associated with ADRD as a cause of death. In the last year of life, any ER admission without a hospitalization (OR = 0.45, 95% CI = 0.22-0.92), more physician visits (OR = 0.96, 95% CI = 0.93-0.98), and seeing a medical specialist (OR = 0.46, 95% CI = 0.29-0.75) were associated with lower odds for ADRD as a cause of death. In the last 30 days of life, any hospitalization with an ICU stay (OR = 0.55, 95% CI = 0.36-0.82) and ER admission with a hospitalization (OR = 0.67, 95% CI = 0.48-0.94) were associated with lower odds for ADRD as a cause of death. Receiving hospice care in the last 30 days of life was associated with 1.98 (95% CI = 1.37-2.87) higher odds for ADRD as a cause of death. CONCLUSION: Under-documentation of ADRD as a cause of death may reflect an underestimation of resource needs for Mexican-Americans with ADRD.


Assuntos
Causas de Morte , Comorbidade , Demência/mortalidade , Documentação/normas , Americanos Mexicanos/estatística & dados numéricos , Fatores Etários , Idoso de 80 Anos ou mais , Feminino , Hospitais para Doentes Terminais , Hospitalização , Humanos , Revisão da Utilização de Seguros , Masculino , Medicare , Estados Unidos
19.
Artigo em Inglês | MEDLINE | ID: mdl-34200689

RESUMO

Emergency units have been gradually recognized as important settings for palliative care initiation, but require precise palliative care assessments. Patients with different illness trajectories are found to differ in palliative care referrals outside emergency unit settings. Understanding how illness trajectories associate with patient traits in the emergency department may aid assessment of palliative care needs. This study aims to investigate the timing and acceptance of palliative referral in the emergency department among patients with different end-of-life trajectories. Participants were classified into three end-of-life trajectories (terminal, frailty, organ failure). Timing of referral was determined by the interval between the date of referral and the date of death, and acceptance of palliative care was recorded among participants eligible for palliative care. Terminal patients had the highest acceptance of palliative care (61.4%), followed by those with organ failure (53.4%) and patients with frailty (50.1%) (p = 0.003). Terminal patients were more susceptible to late and very late referrals (47.4% and 27.1%, respectively) than those with frailty (34.0%, 21.2%) and with organ failure (30.1%, 18.8%) (p < 0.001, p = 0.022). In summary, patients with different end-of-life trajectories display different palliative care referral and acceptance patterns. Acknowledgement of these characteristics may improve palliative care practice in the emergency department.


Assuntos
Hospitais para Doentes Terminais , Cuidados Paliativos , Serviço Hospitalar de Emergência , Humanos , Encaminhamento e Consulta , Estudos Retrospectivos
20.
BMJ Support Palliat Care ; 11(3): 344-350, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34215568

RESUMO

BACKGROUND: Virtual reality (VR) technology as a therapeutic intervention has been gaining attention in healthcare settings in recent years. Studies suggest that using the technology can help alleviate symptoms such as pain and anxiety and induce positive emotions for people in hospital. Managing symptoms and promoting emotional and psychological well-being are core palliative care goals of relieving suffering of people with life-limiting illness. Accordingly, VR may be highly beneficial for use in hospice care yet remains underdeveloped in such settings. This qualitative study aimed to trial the technology and consider what benefits may emerge for hospice in patients. METHODS: A one-off VR session was offered to patients at a hospice in Scotland. Sessions were observed by a researcher and followed by qualitative semi-structured interviews to discuss the experience with those who took part. Interviews were audio recorded, transcribed and thematically analysed. RESULTS: Nineteen hospice patients successfully tried an immersive VR experience. VR sessions were acceptable for people within the hospice environment. The majority of participants enjoyed the experience. Many expressed joy and delight at the process. VR holds possibilities for relieving symptoms such as pain and anxiety frequently experienced by people in hospices. Furthermore, the technology offers the capacity to reconnect with a previous sense of self and to allow respite through the capacity to transcend current reality and connect with another meaningful reality. This exploratory study offers a starting point for larger studies to investigate the utility of VR for hospice patients.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Realidade Virtual , Humanos , Cuidados Paliativos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...