Pro-active Palliative Care for Hospitalized Primary Care Patients

BackgroundEarly integration of palliative care (PC) improves outcomes for patients with cancer and heart failure. Data on the role of PC in complex general medicine patients is scant.MeasuresWe identified high-mortality risk patients from our primary care practice by screening with mortality indices upon hospital admission. We measured documentation of advanced care planning (ACP), including health care proxy (HCP) and goals of care (GOC), at admission and discharge.InterventionWe offered pro-active PC consultation to attending physicians of patients with high mortality risk. Patients who received pro-PC consultation were compared to patients whose attending physicians declined consultation (pro-PC declined) as well as patients who received usual care (UC).OutcomesCompared to UC and pro-PC declined groups, the pro-active PC group demonstrated increased rates of HCP and GOC documentation.ConclusionsOur initiative identified hospitalized primary care patients with high-mortality risk, improved gaps in ACP, and was feasible to implement.     

Scenario-Long-term Care for the Elderly Long-term Care for the Elderly in Japan

To improve understanding of clinical care and nursing in all world regions, with this issue of Image we introduce scenarios in which an author in one country portrays a national situation, then several from other world regions respond.     

Traveling for Care: Factors Influencing Health Care Access for Rural Dwellers

Abstract This study explored 19 rural dwellers' perceptions of health care issues through semi-structured interviews. Sample selection, data collection, and analysis adhered to the grounded theory method in that an interactive design was maintained. The strategy of traveling for care describes how rural dwellers deal with the problem of varying access to health care. This study uncovers the influencing factors that impact on rural dwellers' decisions when traveling for care. Most rural dwellers choose to wait before seeking health care; those factors that contributed to the decision to wait includes limited financial resources to pay for health care, prior experiences within the system, and the prevalent belief that they can provide self-care effectively. When self-care was not successful they evaluated their resources to assist in their decision making. The last phase of this strategy was choosing the distance they would go to receive health care. Choosing the distance varied greatly among the participants. A few choose to go without health care whereas others would go to any lengths to resolve their health problem.     

Pharmacology for Nursing Care

Book reviewed in this article: Pharmacology for Nursing Care 2nd edn by Richard A Lehne Pain Management and Nursing Care edited by Dawn Carroll & David Bowsher Alongside the Person in Pain Holistic Care and Nursing Practice by M Fordham & V Dunn The Care of Wounds by Carol Dealey Blackwell Scientific Publications Urological Nursing edited by Clive Laker Living Sexuality (Issues for Nursing and Health) edited by Christine Webb Interpretive Phenomenology Embodiment, Caring, and Ethics sn Health and Illness edited by P Benner Seclusion and Mental Health A Break With the Past by Ann Alty & Tom Mason Chapman & Hall The Handbook of Psychotherapy edited by Petrüska Clarkson & Michael Pokorny Routledge Project Management and Control by David W J Day Macmillan, Basingstoke The Research Experience in Nursing edited by Jill Buckeidee & Richard McMahon Chapman and Hall Nursing Research Theory and Practice edited by Michael Hardey & Anne Mulhall Chapman and Hall Unifying Nursing Practice and Theory edited by Judith Lathlean & Barbara Vaughan Butterworth Heinemann