Davina Porock

Lehman College | CUNY

Aims To develop a theoretically and psychometrically sound instrument to measure the ‘dose’ of person‐centred care practice in long‐term care. Background Although person‐centred care has been adopted for long‐term care across the world, there is a lack of theory‐based instruments to measure its impact. Two questionnaires were developed to measure...

Background: The provision of quality care in nursing home (NH) facilities is an ongoing challenge, and the literature indicates that the quality of care (QOC) is often suboptimal. While it is highly recommended that NH facilities adopt a culture of person-centered care (PCC) to ensure quality care, the outcomes of this shift on staff working in NH...

Background: Alzheimer's disease is one of a variety of progressive and ultimately fatal neurodegenerative diseases that are characterized by a number of nervous and mental symptoms and behavior disorders. These problems are likely to cause burden and strain on caregivers. In this study, we demonstrated the level and relationship of burden and stra...

The sleep of people with dementia living in long-term care is known to be disturbed. This pre–post controlled pilot study examined the effects of a person-centered dementia care intervention on sleep in assisted living residents with dementia. The three-month intervention included in-class staff training plus supervision and support in practice. Th...

Background: This paper focuses on communication between hospital staff and family carers of patients dying on acute hospital wards, with an emphasis on the family carers' perspective. The age at which people in the UK die is increasing and many continue to die in the acute hospital setting. Concerns have been expressed about poor quality end of li...

The current article reports the consensus recommendations from individuals living with dementia and their care partners on priorities for public policy and research funding, which were found using a nationwide, Delphi study. A modified snowball sample was used. Listservs, personal contacts, and advocacy groups were asked to distribute the survey. P...

Background This programme of research addressed shortcomings in the care of three groups of older patients: patients discharged from acute medical units (AMUs), patients with dementia and delirium admitted to general hospitals, and care home residents. Methods In the AMU workstream we undertook literature reviews, performed a cohort study of older...

A retrospective, cross-sectional study was conducted to describe the occurrence of daytime sleep (DS) and to examine factors associated with DS in nursing home residents. We used the Minimum Data Set 2.0 records of 300 residents in a nursing home from January 2005 to March 2010. Descriptive statistics, independent t-test, chi-square, Pearson correl...

Objectives: Breast cancer in older women raises a number of discrete issues, including how healthcare professionals can best decide which patients are candidates for surgery. A pilot study involving women aged ≥70years newly diagnosed with early operable primary breast cancer was conducted aiming to explore the potential value of comprehensive ger...

Background: Person-centered care has been widely promoted in long-term care settings. It is commonly referred to as a core concept that guides the care philosophy change in long-term care settings from a traditional medical model to a more humanistic approach to care. Current person-centered practice in long-term care settings is guided by multipl...

Hospital is considered an undesirable place to die. Concerns have been expressed about the quality of end of life care in this institutional setting, especially for patients dying with dementia. To explore end of life care for frail older people with and without dementia on acute hospital wards and whether there were differences between these two g...

To explore the responses of healthcare professionals to the admission of people with cognitive impairment to the acute hospital setting. While improving care for people with dementia has been identified as a national priority, providing appropriate care in acute hospitals for people with comorbid cognitive impairment presents challenges to healthca...

This qualitative study aimed to gain insight into the experience of hospitalisation from the perspectives of the older person with dementia, their family care-giver and other patients sharing the ward (co-patients). Non-participant observation of care on 11 acute hospital wards was supplemented by 39 semi-structured interviews with 35 family care-g...

To develop and evaluate a best practice model of general hospital acute medical care for older people with cognitive impairment. Randomised controlled trial, adapted to take account of constraints imposed by a busy acute medical admission system. Large acute general hospital in the United Kingdom. 600 patients aged over 65 admitted for acute medica...

e20540 Background: Physical activity (PA) in prostate cancer (PC) survivors improves general QOL and fatigue, but the relationship between PA and genitourinary symptoms in PC survivors is unknown. The incidence of sexual dysfunction may be as high as 68% during active surveillance and 78% in men receiving conventional therapies. PA has mitigated er...

e20588 Background: Decision making process related to cancer treatment is complex, influenced by tumour factors, patients and clinicians, and may affect outcomes eg quality of life (QOL). Studies are scarce in exploring this subject in the older population. This pilot study aimed to investigate this in older (≥70 years) women newly diagnosed with c...

Aims: To explore the experiences of family carers of people with cognitive impairment during admission to hospital. Background: Providing appropriate care in acute hospitals for people with co-morbid cognitive impairment, especially dementia or delirium or both, is challenging to healthcare professionals. One key element is close working with fa...

Background: Person-centred care has been identified as the ideal approach to caring for people with dementia. Developed in relation to long stay settings, there are challenges to its implementation in acute settings. However, international policy indicates that acute care for people with dementia should be informed by the principles of person-cent...

Objectives: Person-centered care (PCC) is a revolutionary approach to the culture change of elder care that is being adopted by nursing home providers across the nation. One aspect of PCC is the introduction of more self-contained units or households within long term care facilities. This study aimed to evaluate the effect of households on nursing...

Poor appetite and weight loss are common in patients with cancer, contributing to an increase in morbidity and mortality. Early identification of those at greatest risk is problematic. The Council on Nutrition Appetite Questionnaire (CNAQ) is short and easy to use, although it is not specific to cancer populations. The present study aimed to build...

This paper explores how emergency nurses manage the emotional impact of death and dying in emergency work and presents a model for developing expertise in end-of-life care delivery. Care of the dying, the deceased and the bereaved is largely conducted by nurses and nowhere is this more demanding than at the front door of the hospital, the Emergency...

The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants. Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest wit...

In an ageing society, like the UK, where long-term illness dominates healthcare, there has been a change in the way that the end-of-life is approached and experienced. Advancing technology, inadequate knowledge and inconsistency in palliative care services have complicated the ability to recognise imminent dying and many people access emergency ser...

The objectives of the study day were to (i) develop an in-depth understanding around the biology and treatment options; (ii) explore the specific physical and psychosocial needs and consideration including patients perspective; and (iii) gain insight into the development of a dedicated, holistic and multi-disciplinary clinic service and the importa...

e19518 Background: CGA is an analytical tool measuring physical and psychosocial function. Breast cancer is primarily a disease of the elderly. A pilot study was conducted evaluating a cancer-specific CGA tool in older women with primary operable breast cancer. Methods: Newly diagnosed women attending the Primary Breast Cancer Clinic for Older Wome...

Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in t...

To explore the meaning of falling for older people who had participated in a falls prevention programme to establish the importance of identity in falls prevention interventions. Data were collected in a 14-week video observation period of two consecutive falls prevention group programmes, examination of participant referral records and a series of...

Breast cancer has become a commonly diagnosed disease among Thai women in the last decade, despite the fact that Thai women generally have a lower rates than their Western counterparts. With the rising incidence and survival rates, it is crucial for nurses to look at the long term quality of life of these patients. A broad range of instruments have...

The emergency department (ED) is the gateway to the hospital setting. Despite the intentions from the end-of-life care strategy in the UK to improve care provision, the ED has increasingly become the access site for end-of-life support. Little attention has been given to this aspect of the work of the ED, even as the quality of end-of-life care in...

PARKER OLIVER P., DEMIRIS G., WITTENBERG-LYLES E. & POROCK D. (2010) European Journal of Cancer Care19, 729–735 The use of videophones for patient and family participation in hospice interdisciplinary team meetings: a promising approach Inclusion of patients and caregivers in decisions related to the delivery of care is inherent in the hospice phil...

The management of elderly patients with breast cancer is complex. Currently, most of their treatment guidelines have been adapted from studies conducted in younger patients. However, studies have shown that breast cancer in the elderly have distinctive biological characteristics from the young. Also, older patients have different needs from younger...

Aims: Many terminally ill adults receive care in acute hospitals and because of this there is an imperative to improve the end-of-life care provided. Accurate and timely diagnosis is a hallmark of quality care and initiation of appropriate treatment. A diagnosis of dying initiates comfort care often operationalised in the UK in terms of the Liver...

The difficulty in recruiting subjects for home-based telehealth research is well documented. This article shares the recruitment statistics and experiences in the Assessment of Caregivers for Team Intervention via Videophone Encounters pilot study, a home-based telehealth intervention. The study obtained 83% of the desired sample. Challenges includ...

Recent National Institutes of Health changes have focused attention on the potential scientific impact of research projects. Research with the excellent potential to change subsequent science or health care practice may have high scientific impact. Only rigorous studies that address highly significant problems can generate change. Studies with high...

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Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS Mortality Rating Index (MMRI) for use in clinical practice to predict the probability of death in six months for care ho...

Although much has been published in the literature on how to perform a Q methodological study, the use of interviews within this process has received little attention. The purpose of this review is to explore the use of interviews in a Q methodological study. An introduction to Q methodology is provided. The aims of an interview within a Q methodol...

This paper is a report of a study of the perceptions of nurses who work in abortion services. International debate surrounds abortion. In England and Wales the Abortion Act which was introduced in 1967 recently came under public review in relation to its legal limit of 24 weeks gestation. The review did not extend to those working within abortion s...

This article discusses a pilot study testing a videophone intervention enabling hospice patients and caregivers to remotely participate in interdisciplinary team meetings, with the goal of improving pain management. The aim of this study was to test potential outcome measures and combine the data with qualitative observations to assess the overall...

Majority of breast cancer are diagnosed at >65 years. Efforts to develop clinical service and research are spent mainly on younger patients. Little is known about the biology and long-term clinical outcome of breast cancer in the elderly. However there is data suggesting that there are differences. Knowledge related to breast cancer in the elderly...

The majority of patients in the United Kingdom would choose to die at home, however, less than 20% of patients achieve this. Community nurses are central to care at the end of life, however, little attention has been given to the attitudes of community nurses to this role and how these may influence patient care, and ultimately facilitate patient p...

POROCK D., CHEUNG, K.L., MORGAN D.A.L., WINTERBOTTOM L., RICHARDSON H. & ELLIS I.O. (2009) European Journal of Cancer Care18, 527–529 Care of the older woman with primary breast cancer: a sign of the times?

This study used participant feedback to qualitatively evaluate an intervention (Assessing Caregivers for Team Intervention through Videophone Encounters [ACTIVE]) that used videophone technology to include patients and/or their family caregivers in hospice interdisciplinary team meetings. Data were generated during individual interviews with hospic...

Despite the assumption that the home is the preferred place of death, most people will die in institutional care, specifically in acute hospital wards. Inevitably, this relatively public setting puts the privacy and dignity of the dying patient and grieving visitors at considerable risk. Our study used observation of practice and staff interviews t...

This article describes the implementation and evaluation of a novel form of assessment of communication skills and knowledge for all branches of nursing students in a multi-campus UK Midlands university. The assessment took the form of a recorded scenario which was presented on DVD and a series of assessment questions inviting students to consider...

Radiation skin and oral mucosa reactions are common side-effects of head and neck radiation therapy caused by damage to normal tissue. This damage can be dose-limiting, meaning that the severity of acute reactions particularly in the oral mucosa may require time off treatment, potentially interfering with the effectiveness of radiation therapy in t...

As patients are cared for in their homes by family caregivers, several challenges arise in effective pain and symptom management. Despite hospice's reputation as the gold standard for terminal care, there is still a need to improve pain management practices, including challenges that caregivers face, related to pain assessment, reluctance and fear...

The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data...

Advances in cancer care and treatment have created a new and somewhat anomalous category of patients with a diagnosis of non-curative disease who still have a considerable period of life remaining. During much of this time they may remain relatively well, without manifest need for clinical care. The responses of patients to this challenging situati...

This study describes how staff in long-term care facilities recognize dying in residents. From the staff interviews, a process of increasing death awareness was revealed identifiable through five cue groups. "Ambiguous Cues" begin the process in which an adverse event precipitates thinking about the end of life and culminates in "Decision Cues." "R...

The project analyzed staff descriptions of undocumented care given to dying nursing home residents. Registered nurses, licensed practical nurses, certified nurse aids, and social service designees were interviewed using an unstructured interview guide. Transcripts were coded by two members of the team and a thematic analysis was guided with the the...

This review applied meta-analytic procedures to integrate primary research findings that tested exercise interventions among people treated for cancer. Extensive literature searching strategies located published and unpublished intervention studies that tested exercise interventions with at least five participants (k = 30). Primary study results we...

This project reports on the experience of two hospice caregivers using videophone technology to enhance communication with their care providers. The data show the overall satisfaction and technical feasibility with videophone technology in home hospice. The case studies have great implication for future research because they reveal many unexpected...

COURTNEY K., DEMIRIS G., OLIVER D.P. & POROCK D. (2005) European Journal of Cancer CareConversion of the Caregiver Quality of Life Index to an interview instrument

This article uses a human factors evaluation framework to assess the usability of commercially available videophone technology. One study focuses on minimally functionally impaired seniors living in an assisted living facility. The second study focuses on usability for hospice staff. Seniors found the technology easy to use and were willing to acce...

To provide an overview of mechanisms of dyspnea and causes of dyspnea in chronic obstructive pulmonary disease (COPD) and lung cancer and to critically review current pharmacologic and nonpharmacologic management of dyspnea for COPD and lung cancer. Published articles, abstracts, textbooks, and the authors' personal experiences with dyspnea managem...

To test Winningham's psychobiologic entropy hypothesis in patients receiving biochemotherapy for melanoma. Descriptive, correlational, cross-sectional study. Midwest cancer center. 25 male and female patients who were receiving biochemotherapy or who had completed treatment 6-12 months prior. Data were collected using a series of questionnaires and...

Currently, 24% of all deaths nationally occur in nursing homes making this an important focus of care. However, many residents are not identified as dying and thus do not receive appropriate care in the last weeks and months of life. The aim of our study was to develop and validate a predictive model of 6-month mortality risk using functional, emot...

Hospice programs rely on interdisciplinary team (IDT) collaboration in the delivery of quality care at the end of life. The hospice philosophy advocates patient autonomy in decision making, and treatment of the patient and family as a unit of care. Including patients and families in IDT meetings regarding their care is a logical corollary of this p...

As research interests in telehealth applications increase, traditional behavioral instruments need to be adapted for use for new mediums in telehealth evaluation. Display and method of presentation changes can affect the reliability and occasionally the validity of the revised instruments. This paper explores critical concerns to be addressed with...

Key Points. .. ➤ Fatigue diminished and activity levels resumed 6–12 months after biochemotherapy for a variety of cancers. ➤ Depression is a known side effect of biotherapy, and patients need comprehensive assessment and treatment to manage this distressing symptom. ➤ The relationship between nutrient intake and fatigue in overweight or obese pati...

Educating parents of children with cancer is a primary nursing responsibility in pediatric oncology. A survey using Delphi techniques was conducted with nurses attending a Children's Oncology Group Nursing Workshop to identify priority educational topics from pediatric oncology nurses' perspective. In round 1 of the survey, nurses were asked to ide...

The purpose of this qualitative study was to describe and explore the experience of fatigue in patients who had received biotherapy or biochemotherapy. A one-time face-to-face interview was conducted with 10 patients who had consented to be in a larger quantitative study of fatigue. Seven were men and all but two were currently receiving treatment....

Background: Curriculum is an important component of nurse education and is thought to vary from country to country. Aim: To determine the level of cardiac knowledge in Greek and English final-year student nurses. Method: Subjects were final-year diploma and degree student nurses (n = 161) from Greece and England. Pictographs (testing knowledge in a...

The purpose of this study was to systematically review the empiric evidence on end-of-life care in nursing homes in the United States The guiding research question for this review was what is the state of research evidence in end-of-life care in long-term care? We conducted a systematic review of the literature. The review was limited to published...

To determine which wound-healing factors impact on the severity of radiation skin and oral mucosal reactions in head and neck cancer and to test modifications to the Radiation Therapy Oncology Group (RTOG) acute toxicity scoring system. A consecutive sample of 53 head and neck cancer patients who were scheduled for curative or palliative radiation...

This study aimed to determine the accuracy of using self-reported signs and symptoms to identify the presence of lymphedema as well as the usefulness of identifying clinically measurable lymphedema on the basis of certain symptoms elicited by the Lymphedema Breast Cancer Questionnaire (LBCQ). This analysis used logistic regression to identify sympt...

Clinical decision-making is an integral component of the role of the professional nurse. The aim of the study was to identify the quality of decision making of Greek and English coronary care nurses during the acute and recovery phases post-myocardial infarction (MI), and determine factors that best predict clinical decision-making in these two dis...

To compare hospice residents in nursing homes with residents who are noted as end-stage, but not in hospice programs. Descriptive comparison of the outcomes reported on Minimum Data Set (MDS) for all residents admitted to Missouri nursing homes in 1999. Nursing homes. Residents of nursing homes designated as either hospice or end-stage on admission...

Permanent placement in a Long-Term-Care (LTC) facility following hospitalization or when staying at home is no longer a viable option is the reality for a growing number of Americans. When death is imminent, the specialized knowledge and skill of the hospice team is required and accepted as an important component of end-of-life (EOL) care. The prov...

Pain is a significant health issue, especially among hospitalized patients and elders. Nurses are the key to effective pain management; however, several studies over the past 20 years have demonstrated that nurses lack the knowledge necessary to manage pain effectively. Staff development educators have used a number of education methods to address...

The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use. The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing. A review using systematic m...

Radiation skin and oral mucosa reactions are common side-effects of head and neck radiation therapy caused by damage to normal tissue. This damage can be dose-limiting, meaning that the severity of acute reactions particularly in the oral mucosa may require time off treatment, potentially interfering with the effectiveness of radiation therapy in t...