Hospice program integration: An issue for policymakers

Abstract

The attachment process and the resultant caregiving behaviors are crucial components of an individual's feelings of self-worth. Loss of valued relations and support may adversely affect a person's psychological well-being. When such loss is experienced during the later years of life, the reorientation of attachment needs may become focused on a pet as a source and object of caring. Consequently, the loss of a pet can produce grief and mourning, which are intensified by the lack of supportive networks.

The findings reveal that the people-pet bond has a positive influence on attachment needs. The active social lives of our sample do not mitigate the significance that pets paly in the elderly's attachment system. The absence of mourning rituals for the death of pets raises significant questions for the professional as to the most appropriate way to help the bereaved deal with the stress produced by the loss of a companion animal.     

Hospice program integration: An issue for policymakers

As the number of hospice programs in the United States expands, policymakers face a variety of issues concerning the care of the terminally ill. Do hospice programs offer a truly unique approach in caring for the dying? Are hospice services cost effective? Should hospice programs become integrated into the mainstream of medical care service delivery? Based on data from hospice programs in an industrialized Midwestern state, this paper explores the strategies employed by hospice programs to become integrated, the conflicts that have arisen among providers of hospice care, and the impact of hospice program integration on patient care.

Results show that as hospice programs become more integrated, they have lost some of the idealism on which they were founded, have altered organizational structures, and have changed certain patient services. However, there is no evidence to suggest that integration of hospice programs into the medical mainstream has decreased the quality of patient care or patient satisfaction for hospice services.     

An epidural analgesia program: balancing risks and benefits

An alternative to parenteral narcotic management is the administration of analgesics into the epidural space. The recognition and prevention of complications or side effects of epidural analgesia are prime concerns in planning nursing care for these patients.     

Hospice care in Calgary: Survey of family physicians on their knowledge,experience, and attitudes

ObjectiveTo explore Calgary family physicians’ knowledge about hospices, their attitudes toward the referral process, and their understanding of barriers to referral for hospice care.DesignSurveys were mailed to 400 randomly selected participants. The survey contained 18 questions related to hospice care, physician experience, attitudes, and perceived barriers to making a hospice referral.SettingCalgary, Alta.ParticipantsFamily physicians.ResultsIn total, 104 surveys were mailed back. Family physicians agreed that palliative care in a hospice setting can greatly improve quality of life for patients, but only 2 of 6 knowledge questions about hospice care were answered correctly by most. Family physicians with special areas of interest or subspecialties were more likely to feel well-informed about hospice referrals (P = .017), indicated a higher comfort level discussing hospice and palliative care (P = .030), and were less likely to defer discussing it with patients (P = .023). Physicians with a special interest in palliative medicine were more likely to correctly answer the knowledge questions (P < .034) and to be familiar with the referral process (P < .001), patient eligibility (P < .001), and the palliative home care program (P = .003). Qualitative analysis revealed support for palliative home care and consultation services but concerns about caregiver coping and family issues. Concerns about disengagement of family physicians and uncertainty about the referral process are obstacles to referral.ConclusionWhile Calgary family physicians are appreciative of hospice care, there are knowledge gaps. It is important to engage family physicians in the referral process.     

Poor communication and knowledge deficits: obstacles to effective management of children's postoperative pain

AIM OF THE STUDY: To explore the perceptions of nurses and parents of the management of postoperative pain in children. This paper focuses on issues of knowledge and communication. BACKGROUND: Nurses are the key health care professionals with responsibility for managing children's pain, however, nurses are not well supported educationally to manage the level of responsibility. RESULTS: Using matched interviews between 20 parents and 20 nurses many issues arose relating to the nurse/parent communication process. It was also clear that despite nurses' knowledge of pain management being deficient, they had expectations that required parents to have a level of knowledge they did not possess. CONCLUSIONS: The findings suggest that nurses' poor communication with parents and nurses' knowledge deficits in relation to children's pain management create obstacles to effective pain management. These obstacles need to be addressed in order to improve the management of children's pain through better education of nurses and two way communication with parents.     

New Haven (1974)-Characteristics of a Hospice program of care

Abstract

Under physician leadership, Hospice, Inc., started a home care program for terminally ill cancer patients and their families in March 1974. This paper is based on the 3-year evaluation by the medical director who argues that priority of care should be directed to physical needs, managed in a problem-oriented approach.     

New Haven (1974)-Characteristics of a Hospice program of care

Under physician leadership, Hospice, Inc., started a home care program for terminally ill cancer patients and their families in March 1974. This paper is based on the 3-year evaluation by the medical director who argues that priority of care should be directed to physical needs, managed in a problem-oriented approach.     

A study of the effectiveness of the bereavement program of Severance Hospice]

Grief that is not acknowledged and worked through may manifest itself in some emotional, mental or physical problem. In recent years much as been learned about coping with grief which the hospice program can utilize to help family members cope with their grief. This study was carried out to determine the helpfulness of the bereavement care of Severance Hospice and to learn more about the grief response of the bereaved. The tools used to collect data were an assessment form used in the bereavement program and the Grief Experience Inventory developed by Sanders and revised and translated by the researcher. Data was obtained from bereaved family members (54 for the final grief assessment and 39 for the grief response assessment) receiving bereavement follow-up, from July 1989 to March 1991. Results of the study were as follows: 1. Final Grief Assessment Regarding the resolution of their grief the majority of the bereaved accepted the reality of the death of their family member, while slightly more than three-quarters were able to express their feelings toward their loss. A large majority had returned to activities of daily living well or fairly well and had reinvested their energy in a person other than the deceased. In addition, the physical condition of the majority was good or fairly good. A majority of the bereaved considered the bereavement care to be helpful and almost three-quarters were not considered to be in need of more follow-up. 2. Grief Response Assessment Age was found to have a moderately positive correlation to appetite disturbance (r = .41, P less than .01) and loss of vigor (r = .37, P less than .01) A moderately positive correlation was found between the number of contacts and sleep disturbance (r = 2.38, P less than .01) Significant differences were found between men and women in regard to guilt (t = 2.38, P less than .05), social isolation (t = 2.44, P less than .05) and depersonalization (t = 2.07, P less than .05) with men having the more intense grief. Significant differences were found in the grief responses of somatization (F = 5.82, P less than .001), physical symptoms (F = 5.87, P less than .001), appetite disturbance (F = 4.40, P less than .01), despair (3.79, P less than .01), anger (Fp2.83, P less than .05), social isolation (F = 3.61, P less than .05), guilt (F = 3.62, P less than .05) and depersonalization (F = 2.58, P less than .05).(ABSTRACT TRUNCATED AT 400 WORDS)     

Monitoring for underutilization of RBC components and platelets

BACKGROUND: Monitoring blood transfusion for overutilization is standard practice at most institutions. STUDY DESIGN AND METHODS: This study monitored for underutilization of blood transfusion over a 14-month period, by evaluating patients who had Hb levels that were reported to be <5 g per dL or platelet counts <10 x 10(9) per L and who did not receive an RBC or platelet transfusion within 24 hours of the reported results. RESULTS: During the study period, 24,004 units of RBCs and 3,967 units of apheresis platelets were transfused. There were 148 patients who had a Hb level that was reported to be <5 g per dL or a platelet count reported to be <10 x 10(9) per L and who did not receive a transfusion during the 24 hours after the reporting of these results. In 5 cases, the patients died before the reporting of the low Hb or platelet counts, which precluded the low Hb or low platelet count reports from triggering transfusion therapy. In 8 cases, an underutilization review investigation could not be done, because of the unavailability of patient charts. Of the remaining 135 cases, investigation revealed justifiable reasons for withholding transfusion in 133. In 2 cases, the withholding of transfusion was deemed by peer review to be inappropriate, as the patients should have received a transfusion. Overall, there was one documented underutilization of RBC transfusion therapy during a period when 24,004 units were transfused and one underutilization of platelet transfusion therapy during a period when 3,967 units of apheresis platelets were transfused. CONCLUSION: Monitoring for underutilization of transfusion therapy fulfills the requirements of the Joint Commission on the Accreditation of Healthcare Organizations: While the underutilization of transfusion therapy did not appear to be a significant problem at this medical center, determining the reasons for withholding transfusions shed light on important patient care-related issues, including preexisting causes of falsely low platelet counts and Hb levels, delays in investigating critical laboratory values, and the need for policies for the treatment of patients who refuse transfusion for personal or religious reasons.     

Partnerships in public health: lessons from knowledge translation and program planning

The purpose of this study was to better understand how partnerships are initiated, maintained, and sustained in public health practice. A qualitative design was employed to conduct individual interviews and focus groups. The participants included practitioners from 6 purposively selected public health units in the Canadian province of Ontario that developed partnerships in program planning. It was found that partnerships play an essential role in program planning but that minimal information is available regarding the partnership process. Most partnerships are formed on an ad hoc basis, with little formalization. Public health professionals rely on their experiential knowledge when seeking out and working with partners.These findings can serve to inform future public health planning and strengthen the formation and maintenance of partnerships in public health and other sectors. Understanding how partnerships are initiated, maintained, and sustained is an important first step in supporting the use of research to advance collaborative public health efforts.     

A computer-assisted learning program in pharmacology: integrating scientific and nursing knowledge

The integration of nursing and scientific knowledge presents challenges to students grappling with the difficulties encountered in learning pharmacology. This paper outlines a collaborative project developed to assist undergraduate nursing students to learn and understand pharmacology. The innovative approach taken included the development of a CD-ROM incorporating clinical scenarios and animated graphics, with an accompanying teaching guide.     

Hospice Programs and the Hospice Movement: An Investigation Based on General Systems Theory

This study used General Systems Theory as the framework for examining hospice programs and the hospice movement. Data drawn from program administrators and archival sources were used to test the thesis that two broad types of hospice programs exist in the United States. Results indicate that independent programs tend to be characterized by processes that amplify change in the extant medical delivery system—that is, deviation amplification. Hospices associated with preexisting institutions tend to be characterized by processes that counteract change, thus maintaining the status quo—that is, deviation counteracting processes.     

Hospice and Heart Disease: Missed Opportunities

ABSTRACT

A relatively low percentage of eligible heart disease patients receive hospice care in the United States. In 2005, the most recent year with complete reporting, only 18.36% of patients who were dying of heart failure and were hospice eligible actually received hospice care. Reasons for this include the lack of reliable prognostic indicators, the lack of a consensus on when to stop life prolonging therapies, and the relatively high cost of life-prolonging (versus life-enhancing) pharmacotherapy such as dobutamine. In addition, most studies and case reports that address symptom management in hospice care focus on cancer patients, not those with nononcologic diagnoses. This lack of evidence may discourage practitioners who care for cardiac patients from referral to hospice programs, and may keep some hospice practitioners from aggressively targeting this population. Strategies to increase hospice program utilization by heart disease patients are discussed.     

Measuring hospice care: the National Hospice and Palliative Care Organization National Hospice Data Set

Hospice has seen rapid growth in recent years, but there is a lack of consistency among hospices when it comes to compliance with standards of care. Consequently, hospices vary in performance and in services they provide. With state hospice organizations, the NHPCO developed a National Data Set (NDS) intended to understand demographics, practices, and outcomes; illustrate industry effectiveness; facilitate communication of industry legislative needs; and to support agency performance and improvement. Our paper describes development of the NDS and data that are being collected, and summarizes key findings from the 2000, 2001, and 2002 NDS. The data collection process, which began in 1999, has evolved substantially over a 4-year period to the point that we believe the 2002 NDS represents a well-designed core that will receive only minor modifications annually. This database will be invaluable for comparative audit, clinical practice and managing services because only that which is measured can be improved.