Developing a hospital-based asthma case management program

The case management model, on the basis of current trends, is likely to be the main model for caring for chronic disease in the future. Since 2001, asthma care has been covered under chronic disease-management by Taiwan's Health Insurance Bureau. But there is no report describing a hospital-based asthma case management program. The purposes of this essay were to develop a hospital-based asthma case management model and introduce the procedures for this model: recruitment, monitoring, implementation, evaluation and follow-up. This model can be used as the standard case management model for caring for children with chronic asthma.     

Bereavement groups in the hospice program

This article reviews the nature of the therapeutic activity in bereavement groups--the rationale behind offering them in a hospice program for the general public--and then looks specifically at bereavement programs offered at Hospice House in Portland, Oregon. It covers eligibility, attendance, issues, methods used to consolidate the groups, blending of new members, and specifies the types of groups involved. Further, it explores the formation of a city-wide bereavement network, formed to provide mutual support for facilitators and counselors to exchange ideas, shape continuing education, encourage cross-referral and avoid duplication.     

The Broward County jails hospice program: hospice in the jail

Broward County's jail hospice program initiated service in 1995. Infirmary services for both men and women in the jail system are housed in one of Broward County's four jail sites. The County, in partnership with the local Medicare certified hospice, Hospice by the Sea, provides care to inmates both in the detention center and on release to the community. Compassionate release, "community control," and expedited case disposition are sometimes utilized. Jail stays are typically shorter than prison sentences. Consequently, expedient identification and enrollment of hospice-appropriate detainees differentiates hospice in a jail setting from prison hospice. Initial attitudinal resistance to hospice services for detainees has for the most part been overcome. Ongoing challenges largely consist of institutional impediments regarding supplies, special dietary needs of hospice patients, visitation procedures, and potential patient isolation.     

Peripherally inserted central catheters. Development of a hospital-based program

Peripherally inserted central catheter lines (PICCs) are the "new kids on the block" for intravenous therapy. This paper reports on the development of a protocol and training program for nurses at a 350-bed community hospital. The paper describes the development and implementation of this pilot program in 25 patients over a 1-year period.     

Organization of hospital-based acute pain management programs.

BACKGROUND: The management of acute pain is an aspect of hospital-based practice that has been neglected. Control of pain is important for ethical reasons, for compliance with new guidelines and standards, and for optimizing patient satisfaction and outcomes. METHODS: Be review the rationale for establishing priority to the control of acute pain, the importance of an institutional approach to improve pain management, and specific steps in the establishment and conduct of an acute pain program. RESULTS: Improvement in pain control depends on an institutional approach to facilitate changes in attitude and prioritization. Pain management programs should provide for patient and staff education, adequate documentation of care, institutional standards for pain control, quality assurance/continuous quality improvement (CQI) activities, and periodic review of practice and policy. CONCLUSIONS: Effective pain management can set the stage for a rehabilitational approach to postoperative care, which should lead to earlier recovery and improved outcomes.     

Children's perspectives of a pediatric hospice program

Little attention has been paid to documenting the experiences of children in pediatric palliative care programs, both those who are ill and their siblings. In this evaluation study of Canuck Place, a Canadian, free-standing hospice program, 26 ill children and 41 of their siblings completed mail-out questionnaires. In addition, four ill children and 10 siblings participated in face-to-face interviews. Results indicate that nearly all children were enthusiastic about the program's activities and the physical environment at Canuck Place. Engaging activities, physical amenities, and the social climate promoted by staff, volunteers, and other families were important contributors to the children's satisfaction. Suggestions for better serving adolescents included: a wider range of age-appropriate activities, games, and toys--especially for teens and older children; more trips and tours outside the building and around town; and caring staff and volunteers who are "attentive-in-the-moment". From the children's perspective, the key to Canuck Place's success is its social climate of caring, safety, friendliness, acceptance, and variety.     

The Maryland Division of Correction hospice program

The Maryland Division of Correction houses 24,000 inmates in 27 geographically disparate facilities. The inmate population increasingly includes a frail, elderly component, as well as many inmates with chronic or progressive diseases. The Division houses about 900 human immunodeficiency virus (HIV)-positive detainees, almost one quarter with an acquired immune deficiency syndrome (AIDS) diagnosis. A Ryan White Special Project of National Significance (SPNS) grant and the interest of a community hospice helped transform prison hospice from idea to reality. One site is operational and a second site is due to open in the future. Both facilities serve only male inmates, who comprise more than 95% of Maryland's incarcerated. "Medical parole" is still the preferred course for terminally ill inmates; a number have been sent to various local community inpatient hospices or released to the care of their families. There will always be some who cannot be medically paroled, for whom hospice is appropriate. Maryland's prison hospice program requires a prognosis of 6 months or less to live, a do-not-resuscitate (DNR) order and patient consent. At times, the latter two of these have been problematic. Maintaining the best balance between security requirements and hospice services to dying inmates takes continual communication, coordination and cooperation. Significant complications in some areas remain: visitation to dying inmates by family and fellow prisoners; meeting special dietary requirements; what role, if any, will be played by inmate volunteers. Hospice in Maryland's Division of Correction is a work in progress.     

A hospital-based chemotherapy education and training program

Impatient chemotherapy administered by nurses from the outpatient setting causes fragmentation of care by impeding the primary nursing model. The inpatient oncology nursing staff, highly motivated to expand their knowledge base for cancer patient care, expressed interest in chemotherapy administration. In a collaborative effort among the oncology clinical nurse specialist, nurse educator, and nurse manager, a program was designed based on The Oncology Nursing Society Cancer Chemotherapy Guidelines and Recommendations for Nursing Education and responses from an education-needs assessment survey. The program consists of a theoretical and a practical component. This article will describe the planning, implementation, and evaluation of the Chemotherapy Certification Program at St. Elizabeth's Hospital.     

End-of-life care in a children's hospice program

A project was completed in 1999 to evaluate the Canuck Place children's hospice program. This article reports only on the end-of-life care component. Results are provided from mail-out surveys with families who required end-of-life care and are supplemented by qualitative data which were collected from interviews with individuals prior to the survey. Eighteen families completed face-to-face interviews and another 70 families completed the mail-out questionnaire developed from the initial interviews. A total of 39 parents responded to the survey section about end-of-life care services. Results indicated that parents were reasonably comfortable discussing death with staff; they generally felt well prepared for their child's death because of the staff; the death of another child had a significant effect on families; parents' wishes at the time of their child's death were very supported by staff; and families were well supported by staff at the time of a child's death. Implications for practice and suggestions for future research are discussed.