...MA, MS,§ for the RANDFSouthern California Evidence-Based Practice Center (See editorial comments by Dr. Jean S. Kutner, pp 160–162) The objective of this study was to systematically review the literature to better understand the conceptualization of satisfaction with end-of-life care and the effectiveness of palliative care interventions on this outcome. Data sources included Medline and the Database of Reviews of Effects. The review included relevant qualitative studies and intervention studies using satisfaction as an outcome from 1990 to 2005. Reviewing 24,423 citations yielded 21 relevant qualitative studies, four systematic reviews, and eight additional intervention studies. The qualitative literature described the domains of accessibility and coordination; competence, including symptom management; communication and education; emotional support and personalization of care; and support of patients’ decision-making. For collaboration and consultation interventions, eight of 13 studies showed a significant effect on satisfaction. A metaanalysis found that palliative care and hospice teams improved satisfaction, although most studies did not include satisfaction as an outcome. For other types of interventions, only two of six showed a significant effect. For heart failure coordination of care, only seven of 32 studies addressed this as an outcome; two of the three that compared satisfaction between groups showed a significant difference. Evaluations used many different measures...
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...Despite high levels of satisfaction expressed by hospice employees when compared to employees in other sectors of health care, hospice social workers have the lowest job satisfaction compared to other professionals on the hospice interdisciplinary team (Casarret, Spencer, Haskins, & Teno, 2011; Monroe & DeLoach, 2004). Job satisfaction amongst health care employees contributes to the retention or tenure of qualified and experienced employees (Fritzsche & Parrish, 2005; Head, Washington & Myers, 2013; Kobayshi & McCallister, 2013; Miller, 2008). High turnover has been shown to be associated with decreased job satisfaction among direct care hospice workers and has also been shown to compromise quality of care for hospice patients (Dill & Kagle,...
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...their personal beliefs and listen and respect the beliefs and traditions of others. Legally Nursing implications require nurses to maintain licensure, obey state and federal laws and to remain within their scope of practice. Within these legal and ethical issues the American Association Code of Nursing ethics, personal and societal values, legal aspects and legal responsibilities all affect decisions. Two different cases will be discussed and explored; an advance directive case involving a woman by the name of Marianne, and a malpractice case involving a nurse and the involved healthcare organization. The American Nurses Association Code of Nursing Ethics can influence the final decision made in the case study involving Marianne’s family by designating a surrogate. According to "American Nurses Association" (2011), “The nurse supports patients self-determination by participating in discussions with surrogates, providing guidance, referral to other resources as necessary, and identifying and addressing problems in the decision-making process” (1.4). In the case study involving malpractice, the nurse being called upon as a witness, has a duty and responsibility to report the incidents to the employer. The "American Nurses Association" (2011) website further states,” all nurses have a responsibility to assist those who identify potentially questionable practice” (3.5). If the hospital fails to correct the actions, the...
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...to research: application in end-of-life studies Hung-Lan Wu & Deborah L. Volker Accepted for publication 24 July 2009 Correspondence to D.L. Volker: e-mail: dvolker@mail.nur.utexas.edu Hung-Lan Wu PhD RN Nursing Instructor Meiho Institute of Technology, Pingtung, Taiwan Deborah L. Volker PhD RN AOCN Associate Professor The University of Texas at Austin School of Nursing, Austin, Texas, USA W U H . L . & V O L K E R D . L . ( 2 0 0 9 ) The use of theory in qualitative approaches to research: application in end-of-life studies. Journal of Advanced Nursing 65(12), 2719–2732. doi: 10.1111/j.1365-2648.2009.05157.x Abstract Title. The use of theory in qualitative approaches to research: application in end-of-life studies. Aim. This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end-of-life studies. Background. Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end-of-life studies is used to illustrate application of theory to study design and findings. Data sources. A review of theoretical literature was carried out, focusing on definitions and use of theory in qualitative end-of-life studies published in English between 1990 and 2008...
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...American Hospice Patient/Family with Board Certified Music Therapy as a Component of their Plan of Care Elizabeth Joy Gifford University of San Francisco, lgiffman1@aol.com Follow this and additional works at: http://repository.usfca.edu/dnp Part of the Nursing Commons Recommended Citation Gifford, Elizabeth Joy, "The Experience of African American Hospice Patient/Family with Board Certified Music Therapy as a Component of their Plan of Care" (2009). Doctor of Nursing Practice (DNP) Projects. Paper 14. This Project is brought to you for free and open access by the Theses and Dissertations at USF Scholarship Repository. It has been accepted for inclusion in Doctor of Nursing Practice (DNP) Projects by an authorized administrator of USF Scholarship Repository. For more information, please contact zjlu@usfca.edu. COMPREHENSIVE EXAM 2 Section I: Introduction Statement of the Problem Although 60% of African Americans in the United States have stated that they would want hospice care when they are dying (AARP, 2003), they only comprise 8% of all hospice enrollees (NHPCO, 2007), despite the fact that they represent 13% of the total population in this country (U.S. Census Bureau, 2008). In fact, hospice care in this nation has always been underutilized by African Americans (Connor, Elwert, Spence, & Christakis, 2008). In the San Francisco Bay Area, among Medicare-certified hospice agencies that submit data to the State of California, only 2% of all the hospice enrollees...
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...research diary in the quantitive measure of a mixed methods study and to recommend resulting changes to practice. Reflexivity is often regarded as a useful tool for ensuring the standard of qualitative research. Reflexivity provides transparent information about the positionality and personal values of the researcher that could affect data collection and analysis; this research process is deemed to be best practice. A reflective research diary also allows researchers to record observations about the research process. However, such diaries are rarely used in quantitative research and are even contraindicated. A reflective research diary maintained while conducting a retrospective audit of 150 hospice casenotes. A reflective research diary was written at the end of every research session to keep a detailed history of the research process and to critically reflect on the researcher's thoughts, feelings and observations on the day's work. This paper raises questions about whether reflexivity is appropriate in quantitative research, whether it has the capacity to add something of value or whether it endangers the robustness of the method. The authors consider the place of grounded theory's commitment to reflexivity in this mixed-methods study and discuss whether reflexivity offers any benefits to researcher development. Use of reflexivity had a positive impact on the progress of the quantitative measure of this study: it enabled work to be reviewed efficiently and served...
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...So, only the patients who don't have CPR were those who had palliative.” ( Participant 1) “We know that palliative should focus in the quality of life and make the quality of life better.” ( Participant 1) The last quote here is an example of the ideal perception of palliative care where PC should be conceive as a care that enhances the quality of life. Other codes also represent the falsifying understanding of PC as hospice or end of life care. “They're mixing it with the hospice…Unfortunately, they combine PC and hospice in SA. There is a special people for hospice and special people for PC.” (Participant 1) In Saudi Arabia both healthcare providers, patients and their family perceived PC as the care of dying people. It is usually mixed with hospice and end of life care. Perhaps this misperception is related to the way that PC is delivered in the Saudi healthcare system. Cultural Aspect and Social Background: Culture refer to the attitude and the beliefs of a particular group of people and how they interact and share these beliefs together. Subthemes involve: Shared family decision-making versus patient’s autonomy, the role of alternative medicine and home remedies. An example of these will be the...
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...Vulnerable Population and Self-Awareness Paper NUR/440 – Health Assessment and Promotion For Vulnerable Population 12 December 2011 Vulnerable Populations and Self Awareness Introduction This paper is a study of the vulnerable population of the elderly in the United States and will discuss the mindfulness of this author’s personal biases, attitudes, and conceived stereotypes regarding this population. The patient chosen as an example for this paper is Norma James from the University of Phoenix “neighborhood”. Mrs James is a widow who’s vulnerability relating to health care will be compared with information gathered through research and applied to the elderly population and those with chronic illness. The vulnerabilities faced by Norma will be a realistic representation of the challenges associated with this population. Elderly Patients with Chronic Illness Despite the efforts of healthcare providers and various organizations across the United States to reduce or eliminate disparities within vulnerable healthcare populations, significant disparities continue to cause limited access to healthcare. This limitation poses risk to populations such as elderly and those living in poverty. The health domains of vulnerable populations can be divided into 3 categories: physical, psychological, and social. Those with physical needs include the elderly, chronically ill and disabled, chronic medical conditions include respiratory diseases, diabetes, hypertension, dyslipidemia...
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...process is very similar in each of these states. They allow a competent adult resident of that state to obtain a prescription from a physician for a lethal dose of medication, for the purposes of causing death through self administration. The law does not allow lethal injection or allow individuals to acquire a lethal prescription through advanced directive to be used when mentally incapable in the future. There are also limits as to when the prescription can be written. Two physicians, one of whom writes the prescription, must confirm that the patient has a terminal illness (likely to cause death within six months), is competent to make a decision, and is doing so voluntarily. Individuals must be informed of the options of hospice and comfort care. Also, to minimize the risk of impulsive decisions, an individual must make a written request and two verbal requests over a period of fifteen days. The patient must be referred...
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...Mr Charles Winston is a forty two year old Afro-Caribbean male with end stage pancreatic cancer. He is married with two children and had previously worked as a solicitor- he has been admitted to the local hospice. For the purpose of this assignment the focus will be on pain, the importance of being pain free and what this would mean for Charles will be discussed through-out this case study. The World Health Organization (2008) say that freedom from cancer pain must be regarded as a human rights issue. Charles's pain was poorly controlled on admission so it took several hours for the nurse to assess and come to an agreement with Charles about how to manage his pain. The End of Life Care Strategy, written by the Department of Health have published the following guideline; " Ensure that pain amongst people approaching the end of life are kept to an absolute minimum with access to skilful symptom management for optimum quality of life." (Department of Health, 2008, p33). Historically, pain was seen as an emotion rather than a sensation that was experienced by the heart and not the brain (Meldrum, 2003). Pain in today’s society is seen as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (International Association of the Study of Pain, 2011). Therefore, pain is not only experienced on a physical level such as intensity, location and quality but also with emotional feelings such as anxiety, frustration and depression. Pain is a multidimensional...
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...America’s Aging Population Sarah Akin Emerging Healthcare Issues 21st Century HMCD 326 Abstract America’s aging population is increasing at a significant rate because of all the medical innovations and information that we have received on preventative methods. With that comes the financial burden of how are we going to pay for this? Who is going to provide the resources to care for our elderly population? Research and the reform of Medicare have been taken into consideration, because of this aging population. As a prediction was indicated over a decade ago with the abundance of physicians, has become a well decreased number. America’s population is aging and change is among us. The change on the way medicine is practiced is slowly changing as a result the amount of physicians going into general/family health practices is decreasing. A new/old way of medicine is at an increase and is predicted to become the future of medicine. Allopathic and Osteopathic medicine are those medical practices on the rise. The future of medicine depends on the demand of practice. Dr. Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education, stated, “We estimate that we will see domestic production of medical school graduates functionally surpass our current total number of GME postgraduate year-one pipeline positions [posts that lead to initial specialty certification] by 2015 or sooner, and this does not include some 10,000 non–U.S.-citizen international medical graduates...
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...Dignity in End of Life: The Role of Nurses LITERATURE REVIEW INTRODUCTION A literature review is a critical appraisal of researches that provides a comprehensive and up to date knowledge on a specific topic (Coughlan, Ryan and Cronin 2013). The purpose of literature review in nursing includes evaluating current practice and making recommendations for policy development and change. Thus, the purpose of this literature review is to establish the current perspectives of patients, family and nurses on the factors that improve dignity in the end of life. Resultantly, this literature review will explore the role of nurses’ based on the findings of the perspectives that patients, family and health professionals have concerning the issue of dignity in the end of life care. In that regard, the paper follows a systematic approach which involves an introduction that explains the concept of end of life and the types of end of life care available. The paper then proceeds to explore the concept of dignity as viewed from several perspectives through the use of literature on the models of dignity means of measuring dignity and the themes associated with this conception. Consequently, the factors that improve dignity are laid out and discussed at length. Eventually, the paper will achieve its secondary goal which is to determine and expound on the topic of the roles that a nurse plays in end of life care not only for the patient but also for their family. End of life care Before the discussion...
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...As an Athletic Trainer ethics play a major role. In many cases I evaluate many of the injuries sustained by my student-athletes offering varied suggestions on how we should move forward with either a Doctor Visit or in house rehabilitation. With this responsibility comes opposition from both parents and coaches as they insist I clear an athlete for play or don’t deliver the whole truth to the parents and or coach. Although not as controversial as assisted suicide it poses significant risks and eyebrow raises in the sports world. Doctors, nurses, and various medical personal have a harder role. They wager people’s lives and future and decide in some countries whether or not to permit such an act. In this essay we will explore the facts on Euthanasia: Assisted Suicide, my view, the world view and its progress. Before I begin, however, let me note what I will not try to do. I will not try to show you that Physician Assisted Suicide is a fully justifiable course of action what I will do is give you facts and statistics of this rapidly growing controversial issue.. What I will show you is the compatibility to the commitment to good end-of-life care. One of the most important public policy debates today surrounds the issues of euthanasia and assisted suicide. The outcome of that debate to whether or not it should be made available will profoundly affect family relationships, interaction between doctors and patients, and concepts of basic ethical behavior. Although not accepted widespread...
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...medicine. Comfort was the nurse's first consideration. A "good nurse" made patients comfortable. In the early 1900's, textbooks emphasized the role of a health care provider in assuring emotional and physical comfort and in adjusting the patient's environment. For example, in 1926, Harmer advocated that nursing care be concerned with providing an atmosphere of comfort. In the 1980's, a modern inquiry of comfort began. Comfort activities were observed. Meanings of comfort were explored. Comfort was conceptualized as multidimensional (emotional, physical, spiritual). Nurses provided comfort through environmental interventions. It was in this decade that Kolcaba began to develop a theory of comfort when she was a graduate student at Case Western Reserve in Cleveland, Ohio. She is currently a nursing professor at the University of Akron in Ohio. Kolcaba's (1992) theory was based on the work of earlier nurse theorists, including Orlando (1961), Benner, Henderson, Nightingale, Watson (1979), and Henderson and Paterson. Other non-nursing influences on Kolcaba's work included Murray (1938). The theory was developed using induction (from practice and experience), deduction (through logic), and from retroaction concepts (concepts from other theories). The basis of Kolcaba's theory is a taxonomic structure or grid that has 12 cells (Kolcaba, 1991; Kolcaba & Fisher, 1996). Three types of comfort are listed at the top of the grid and four contexts in which comfort occurs...
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...EUTHANASIA: The intentional killing by act or omission of a dependent human being for his alleged benefit. (If death is not intended, it is not an act of euthanasia) ARGUMENTS FOR EUTHANASIA: It provides away to relieve extreme pain It provides a way of relief when a person’s quality of life is low Frees up medical funds to help people It is another case of freedom of choice ARGUMENTS AGAINST EUTHANASIA: Euthanasia devalues human life Euthanasia can become a means of health care cost containment Physicians and other medical care people should not be involved in directly causing death There is a “slippery slope” effect that has occurred where euthanasia has been first been legalized for only the terminally and later laws are changed to allow it for other people or to be done non-voluntarily. Opposition overcomes 48 point deficit to defeat assisted suicide - Ballot Question 2 in Massachusetts 1 1 0 Google BOSTON, Nov. 7, 2012 /PRNewswire/ -- In a stunning upset, the voters of Massachusetts soundly defeated Ballot Question 2 on Election Day. Dealing a significant setback to the expansion of the assisted suicide movement throughout the United States by Compassion & Choices (the organization formerly known as the Hemlock Society), a diverse coalition of disability rights organizations, medical associations, nurses' groups, community leaders and faith-based organizations united in this effort. "Tonight was a huge victory for those of us in the...
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