From hospital to home care: a randomized controlled trial of a Pain Education Programme for cancer patients with chronic pain

AIM OF THE STUDY: To investigate the role of district nurses in the care of cancer patients with chronic pain at home, as well as the effects of a Pain Education Programme for patients and their district nurses. The Pain Education Programme consisted of a tailored multi-method approach in which they were educated about pain, instructed how to report pain, and how to contact health care providers. BACKGROUND: No educational programs for patients in pain have been studied in outpatients nor integrated with the home care provided. DESIGN AND METHODS: One hundred and four patients and their 115 district nurses were enrolled in a prospective, longitudinal, randomized controlled study. The primary outcome of interest was type of care provided by district nurses, satisfaction with the pain treatment, and agreement in estimating patients' pain intensity. RESULTS: Results showed that continuity of care was poor as only 36% of the district nurses were informed about patients' pain by hospital nurses. Pain was rarely the reason for referring the patient to district nursing after discharge. Although pain control was not a main reason for district nurses to visit a patient, pain was a subject for discussion in 76% of visits. Besides discussing the pain problem with patients, district nurses provided only a few pain-relieving interventions. District nurses randomized to the intervention group significantly better estimated patients' pain intensity, and were more satisfied about patients' pain treatment, but no differences were found in their assessment of patients' pain relief. CONCLUSIONS: These findings suggest a significant but moderate effect of the Pain Education Programme, with district nurses only playing a minor role in the treatment of cancer pain.     

外科大手术后患者延续性护理服务影响因素的质性研究

目的了解外科大手术后患者延续性护理服务的影响因素。方法采用现象学研究方法,对11名护士进行半结构式访谈,运用Colaizzi资料分析原则对资料进行整理分析,提炼主题。结果经分析提炼的主题是:护士知识缺乏、护士人力不足、医院社区衔接不畅、患者在执行医嘱时依从性差。结论可从提高护士延续性护理知识水平、加强护理人力资源配置、促进医院社区有效衔接及提高患者执行医嘱依从性等方面采取有效措施,不断提高延续护理服务的实施效果。     

我国延续性护理在癌痛居家患者中的研究进展

延续性护理对居家癌痛患者的生活质量具有重要作用,本文通过对国内癌痛居家患者开展延续性护理的必要性、具体形式和内容,及其干预后效果评价三方面内容进行综述,以期为构建和完善我国癌痛居家患者的延续性护理模式提供借鉴。     

Continuity of care in home health-care practice: two management paradoxes

Aim To explore continuity of care from a manager’s perspective: How do managers understand the concept of continuity of care and how do they assess continuity of care in home health-care? How do managers work to ensure continuity of care when managing care provision for patients in their homes? Background Continuity of care is considered a prerequisite for service quality. Managers can influence continuity of care through managing day-to-day work. Methods Semi-structured interviews of a purposive sample of 16 managers from 12 municipal units. Theory-driven and data-driven analysis was applied. Results Ideally, to promote continuity of care, the number of carers should be limited. Yet, in practice, discontinuity of care was accepted as a working compromise. The managers faced two paradoxes: the continuity ideal vs. the practicalities of home health-care, and caring for patients vs. caring for staff. Conclusions The managers were forced to prioritize, in conflict with ideals or professional standards, patients’ wellbeing or the wellbeing of the staff. Ensuring continuity of care for all patients did not seem feasible. Implications for nursing management The study highlights management paradoxes: possible unintended consequences of prioritizing needs for continuity of care should be objects of reflection in care management.     

Advanced home care for cancer patients at the end of life: a qualitative study of hopes and expectations of family caregivers

It is increasingly common that cancer patients are cared for at home at the end of life, with help from advanced home care teams. This may have positive implications for cancer patients and their families, but it may also be burdensome to the family caregivers with implications for their health and well-being. This qualitative study was therefore initiated to prospectively explore how family caregivers reason about their expectations of providing end-of-life care at home for relatives with cancer, enrolled in advanced palliative home care units. Ten interviews were conducted with 11 family caregivers at enrollment to the home care unit. A form of constant comparative analysis was used to generate two main themes from the data. One theme concerned the role transition into becoming a family caregiver, whereas the other theme relates to the transition to a new life situation of the caregiver (him/herself). The family caregivers describe themselves as the persons primarily bearing responsibility and providing care for their dying relatives. They were found to have many concerns about their own situation, especially in regard to issues temporally after the death of the patient, but seemed to have few expected sources of support related to these concerns. Professional support is described as expected primarily for care-related tasks, although hopes may be expressed about support in other areas. The distinction between resources described as existing in theory and those used in practice also are apparent in analysis of the interviews. If home care is to be a positive alternative to hospital care, individual expectations should be considered when planning supportive care.     

Patients' satisfaction with the care given by district nurses at home and at primary health care centres

The main purpose of this study was to investigate patients' satisfaction with the care given by the district nurses at home and at the primary health care centres in one area of Greater Stockholm. The questionnaire entitled 'Quality of Care from the Patient's Perspective' (QPP) was used. A total of 168 adult, home-care (HC) and 264 outpatient clinic (OC) patients answered this questionnaire. Maximum median scores were reported for most items designed to measure the four following dimensions: 'medical-technical' competence of the district nurses; 'physical-technical' conditions of the care organization; 'identity orientation' in the attitudes and actions of the district nurses and the 'socio-cultural' atmosphere of the care organization; and the perceived accessibility of nursing care. Some areas were identified as being in need of improvement, for example, pain alleviation, safety of the patients' home environment, the possibility of the patients participating in the decision-making process, the feeling that the care is not based on the patients' desires and needs, and the possibility of always meeting the same district nurse. Differences between HC and OC patients and between sub-groups were found regarding demographic characteristics and self-rated, physical health and psychological well-being. HC and OC patients with poor, self-rated, physical health were identified as being likely to be dissatisfied with the care.     

临终患儿居家临终关怀方法的研究

目的 探讨临终患儿的居家临终关怀护理方法.方法 对58例临终居家患儿采用个性化的临终护理计划和临终关怀方式,采用调查问卷对相关指标进行调查,并对结果进行分析.结果 在居家临终关怀中,家长对患儿疼痛管理和症状护理的满意度最高.不同学历的家长,在临终关怀中对心理支持,游戏娱乐支持和死亡教育这3项上,认同程度有显著的差异.通过居家临终关怀,家长的焦虑、抑郁心理得到显著的缓解.结论 开展个性化居家临终护理,能够提高临终患儿的生活质量,改善家长的不良情绪,值得推广.     

Functional levels and nurse workload of elderly awaiting nursing home placement and nursing home residents: a comparative study

The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses’ physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly’s functional levels may illuminate the extent of the carers’ workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi‐Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly’s need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.     

The Medical Care Continuity (MCC) project. A pilot study of video-assisted home care within the eTEN European Community program. The Italian experience

Goals of work  This study aimed to use an integrated system (Medical Care Continuity (MCC) system) consisting of computer, video telephone, and a high-definition camera to monitor at home chemotherapy side effects in cancer outpatients. Patients and methods  The system allowed 24 h/day video consultation with an intermediate medical call center with possible connection to a specialized hospital if necessary. All patients were provided with internationally validated and project-oriented questionnaires exploring patients’ health status and opinions on usefulness and complexity of study devices. The content of each call was recorded on a computer database. An approximate estimate of avoided hospital admissions was calculated. Main results  Median duration of experimentation and frequency of patient/doctor contacts were 2.1 months and 4.2 contact per week, respectively. Overall, a 98% positive opinions on the experimental system was reported at the end of the study by all participants, with a 21% conversion rate with respect to the opinions gathered at study entry. Changes in patient management after a medical call were made in 32% of cases. It was calculated that approximately 2.2 per month unnecessary hospital admissions were avoided. Conclusions  The MCC system was well managed by both patients and caregivers. These results show that it has the potential to improve medical assistance by virtue of a constant access to medical advice and reduce unnecessary hospital admissions.     

Factors predicting home death for terminally ill cancer patients receiving hospital-based home care: the Lyon comprehensive cancer center experience

This study aimed to determine factors favoring home death for cancer patients in a context of coordinated home care. A retrospective study was conducted among patients followed up by the home care coordinating unit of the cancer center of Lyon. The main endpoint was place of death. Univariate analysis included general characteristics (age, gender, rural or urban residence, disease), Karnofsky Index (KI), type of care at referral (chemotherapy, palliative care, or other supportive care), and coordinating medical oncologist (MCO) home visits. Significant factors were used in a logistic regression analysis. Of 250 patients, 90 (36%) had home death. Low KI and MCO home visit were correlated with home death (odds ratio, respectively, 2.1 and 3.1). These results indicate that health care support favors home death. A hospital-based home care unit is effective for bridging the gap between community and hospital. MCO home visits offer concrete support to health care professionals, patients, and relatives.     

Patient safety in primary care has many aspects: an interview study in primary care doctors and nurses

Rationale, aims and objectives Scientific definitions of patient safety may be difficult to apply in routine health care delivery. It is unknown what primary care workers consider patient safety. This study aimed to clarify the concept of patient safety in primary care. Methods We held 29 semi‐structured interviews with a purposeful sample of primary care doctors and nurses regarding their perceptions of patient safety. The answers were analysed in an iterative procedure with respect to common themes. Results A broad range of specific aspects of primary care were named in relation with patient safety. Medication safety was most frequently mentioned. Most items were categorized as organizational, while the remaining aspects were linked to culture or professionalism. Scientific definitions of patient safety were not mentioned, but some primary care workers gave ‘do not harm the patient’ as a short definition for patient safety. Conclusion Patient safety programmes have mostly targeted specific issues, such as incident reporting and medication safety. However, doctors and practice nurses had a broad view of what constitutes patient safety in primary care. This has implications for the measurement and improvement of patient safety in primary care.