Selecting whether to die at home or in a hospital setting

Abstract

Data from a 1978 health care study in rural North Carolina were analyzed to investigate whether people prefer to die at home rather than in a hospital setting and the reasons for their preference. Medical, financial, personal and family-related reasons were investigated as possible explanations for selecting a preferred site of death. Differences between respondents in demographic, socioeconomic, and health-related variables were analyzed to determine their possible effects on where an individual preferred to die.

The results indicate that financial reasons were most likely to be given for preferring to die at home followed closely by individual reasons and then by family and health considerations. Statistically significant differences indicated that those who preferred to die at home were younger, white, more educated, were not satisfied with the quality of medical services, considered their health as excellent and were afraid of hospitals. The implications of these results were considered.     

Selecting whether to die at home or in a hospital setting

Data from a 1978 health care study in rural North Carolina were analyzed to investigate whether people prefer to die at home rather than in a hospital setting and the reasons for their preference. Medical, financial, personal and family-related reasons were investigated as possible explanations for selecting a preferred site of death. Differences between respondents in demographic, socioeconomic, and health-related variables were analyzed to determine their possible effects on where an individual preferred to die.

The results indicate that financial reasons were most likely to be given for preferring to die at home followed closely by individual reasons and then by family and health considerations. Statistically significant differences indicated that those who preferred to die at home were younger, white, more educated, were not satisfied with the quality of medical services, considered their health as excellent and were afraid of hospitals. The implications of these results were considered.     

Time to go home: assisting families to take their child home following a planned hospital or hospice death

During the past decade an increasing number of children whose deaths are planned, have died in their own homes. Smaller numbers die in hospitals and children's hospices. A minority of parents has always taken their child home with them after death from hospital or hospice. A survey was carried out to identify the numbers of children who are taken home in this way from selected hospitals and children's hospices in Southern England and South Wales. Information was sought on current policies and practices and the views of professionals. Replies from 20 units suggest that fewer than 10 per cent of children are taken home. Seven of the units had written policies and these generally had a higher rate of taking home. All hospitals/hospices should have a bereavement policy sensitive to the unique needs of children and families and including guidance on taking the child home should they wish to.     

Lived experiences of Jordanian mothers caring for a child with disability

Abstract

Purpose: Caring for a child with a disability in the family is associated with a major increase in care-giving demands and burden. This qualitative study explores the perspectives, challenges and adaptations of Jordanian mothers living with a child with disability.

Methods: Phenomenological qualitative tradition was utilized. Seven Jordanian mothers of children with disability were purposefully selected as having rich experiences for caring for a child with a disability. In-depth interviews were conducted using a semi-structured guide, audio-taped and transcribed verbatim. Interpretive phenomenological analysis was used to extract main themes and subthemes.

Results: Mothers’ experiences were reflected into four main themes: (1) increased perceived stigma, (2) fear for the future, (3) increased perceived care-giving burden and (4) adaptations to the child’s disability.

Conclusions: This study highlights key gaps in the provision of family-centered services for this population as well as multiple sociocultural issues impacting participation and quality of life. Healthcare professionals must deal with the child’s disability from a family-centered and cultural perspective.

• Implications for rehabilitation

• When therapists meet the whole family’s needs through a family-centered approach, the child with disability is less likely to be ignored, maltreated or abused.

• Family-centered practice adopts a sociocultural model which looks at the child from a wider point of view rather than just the disability itself. It requires therapists to review the context in which the child lives and address the specific needs of parents, siblings and other involved family members.

• Culture plays a huge role in shaping the family’s perspective on disability and has a huge impact and implications for service delivery and development, quality of life and participation for children with disability and their families.

• Rehabilitation professionals must accommodate their time schedules to provide families with the communication, education, advocacy and consultations needed.

     

The experiences of mothers caring for a child with severe atopic eczema

• ? Atopic eczema is a relatively common disease which frequently occurs during childhood.
• ? This paper reports the findings of a research study which explored the effects upon family life of caring for a child with severe atopic eczema.
• ? Seventy-seven accounts written by mothers of preschool children with this disease were analysed using qualitative latent content analysis.
• ? The focus of this paper is on the implications of the disease for the mothers' role and the additional work generated by the disease.
• ? The implications of these findings for nursing practice, in particular the work of health visitors and paediatric community nurses, is discussed.
• ? Throughout this paper the term ‘nurse’ is used to describe both nurses and health visitors.

     

Children's hospital at home

Rugby Children's Hospital at Home is an innovative community-based service for acutely ill children (Box 1). It enables children to be cared for at home during their illness by offering a plan of care in partnership with the child's parents. The child is visited as frequently as needed to ensure his or her safety and according to the child's condition (Samwell, 2000).     

Clients' experiences of living at home with a mechanical ventilator

Title.  Clients' experiences of living at home with a mechanical ventilator.
Aim.  This paper reports on a study of how clients experience living with home mechanical ventilation and how they experience care and supervision of healthcare personnel.
Background.  The number of people living at home with mechanical ventilators is increasing, and this is considered a successful approach to reducing incapacity and mortality.
Method.  Qualitative interviews were conducted with 10 service users in 2006. The informants were 18–75 years old and had varying diagnoses and levels of functioning. The interviews were tape recorded, transcribed and analysed by qualitative content analysis.
Findings.  Two main themes emerged: Theme 1. Having a home ventilator enhances quality of life – a life worth living. The ventilator treatment builds up strength and improves well-being. Participants emphasized that it was important to feel in control of their own situation and had an overriding wish to live a normal and active life; Theme 2. Competence and continuity of healthcare personnel are factors for success. The experience was that competence and follow-up by healthcare personnel varied, and that good quality teaching and information were important.
Conclusion.  Users of home mechanical ventilators should be active partners in their own care so that their experience is taken into account. It is important for clients having home mechanical ventilation to be empowered and have control in their daily lives, as well as having competent caregivers and continuity of care.     

Tuberculosis: infection control in hospital and at home

This article examines infection control issues relating to tuberculosis (TB) in acute and community settings. Background information on TB is discussed briefly along with key challenges to global and national control. A programme to prevent infection composed of specific hierarchical levels is outlined, using national and international guidance, and suggestions are made for infection control in the community. The article will be useful for nurses involved in the care of patients with confirmed or suspected TB.