Science topic

Hospice Care - Science topic

Specialized health care, supportive in nature, provided to a dying person. A holistic approach is often taken, providing patients and their families with legal, financial, emotional, or spiritual counseling in addition to meeting patients' immediate physical needs. Care may be provided in the home, in the hospital, in specialized facilities (HOSPICES), or in specially designated areas of long-term care facilities. The concept also includes bereavement care for the family. (From Dictionary of Health Services Management, 2d ed)
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El trabajo de investigaciòn es un estudio sistematizado de un problema que evidencia el dominio del àrea de su especialidad, y se conciben como ir màs allà del conocimiento, profundizar, indagar, corroborar informaciòn que nos permita seguir desarrollando mejores formas de hacer en enfermerìa; evidenciar , hallar respuestas, orientarse hacia la innovación en las diversas especialidades. Los cuidados paliativos es una especialidad que implica la asistencia de los pacientes y familias en el proceso de final de vida, asumiendo que la persona es un ser multidimensional y que los cuidados enfermeros se orientan hacia la calidad de vida, a la adaptaciòn a la nueva situaciòn de enfermedad avanzada y progresiva, a la necesidad de identificar los niveles de complejidad del cuadro clìnico, a la posiciòn del profesional de enfermerìa que interactùa de forma permanente con otros profesionales del equipo de salud y al aporte que el enfermero brinda a la mejora y desarrollo de buenas pràcticas.
Los cuidados paliativos en lationoamerica es una especialidad relativamente nueva, y con mucho què aprender y mucho por hacer; cuales son las razones por las cuales enfermerìa paliativa no investiga?, cuales son los factores que predisponen a esta carencia de trabajos de investigaciòn en enfermerìa? a què se le atribuye la falta de publicaciòn cientìfica en enfermerìa paliativa?
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Creo que en general a las Enfermeras, están mostrando mayor interés por la Investigación, pero por falta de especialización en el área oncológica no se hace. Por otro lado quienes están en la atención directa, los tiempos para investigación no se consideran en sus tiempos laborales por ser la enfermera un recurso de alto costo para las instituciones.
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My co-authors and I have interviewed over 300 participants about end-of-life choices. We consistently find misconceptions about what hospice entails. What are the common misconceptions you have come across in your research? Why/how do you think the false knowledge is disseminated?
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Most people believe you go to a hospice to die, which is just not the case. We discharge over 50% of admissions. People can be admitted for respite and symptom control, with the aim of getting them back home.
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Benefits of inpatient hospice care
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General Inpatient hospice care (GIP) can be extremely beneficial for patients at end of life for symptom management. I work at a 20 bed facility. I often run across cases wherein the hospital needs to discharge the patient and the family doesn't think the patient is SNF appropriate and instead decide to decelerate care as they begin to understand the severity of the illness and the patient is approaching end of life.
Also, for instance, we (as a business segment), primarily do home health and home hospice. A large number of our referrals to the inpatient unit come to us because their symptoms aren't being managed well in the home and do require the use of an inpatient unit. Our job is to palliate the issue at hand and return the patient home once we resolved the issue. We consider ourselves the ER of hospices.
If a patient qualifies for RHC hospice benefit, they just have to pay room & board. If they'd previously resided at an ALF, this is an excellent option for someone approaching end of life as their likely to be able to afford it. It is a much better option than dying in a SNF. If you know your time is limited and have resources, I'd recommend the use of a Hospice IPU.
I hope this helped answer your question. Please reach out if you have anymore questions about GIP/IPU usage.
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advance care planning 
communication 
barriers to provide palliative care in dementia
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I would like to add these contents with the use of videophone technology in home hospice patients.Can anyone suggest resources on Team Model of Hospice Care and why the use of a videophone or other videoconferencing modalities make a difference in patient and family experience and the role of the providers on the team
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Dear Rincy
I do not experience. However read this articles, but take as consideration, that the new technologies suffer a huge development.
Regards
Whitten, P., Holtz, B., Meyer, E., & Nazione, S. (2009). Telehospice: reasons for slow adoption in home hospice care. Journal of telemedicine and telecare, 15(4), 187-190.
Oliver, D. R. P., Demiris, G., Day, M., Courtney, K. L., & Porock, D. (2006). Telehospice support for elder caregivers of hospice patients: two case studies. Journal of palliative medicine, 9(2), 264-267.
Chi, N. C., & Demiris, G. (2015). A systematic review of telehealth tools and interventions to support family caregivers. Journal of telemedicine and telecare, 21(1), 37-44.
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Does anybody know of any research exploring appointment management/attendance/adherence by patients attending hospices as outpatients?
I am interested in this area and currently researching the experiences of those who have missed appointments in order to explore how we can motivate attendance at such appointments, but I can't seem to find anything. I wonder if I'm maybe using limited search terms, or if there really is very little work surrounding the area. 
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You may find helpful the transtheoretical model approach by the Robert Wood Johnson foundation in the Diabetes Initiative program, in their studies the RWJF was able to design a model to increase patient attendance and medication adherence in their diabetes centers
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In our practice Hyoscine Butylbromide is used as a subcutaneous bolus dose when required or used in a Continuous Subcutaneous Infusion  CSCI.
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Hi Faye
There is no consistent evidence that shows that one antimuscarinic medication is better than another, nor that any medication has a better effect than placebo (Cochrane review). While they clearly have a physiological effect in volunteers and healthy adults, it might be that the symptom mechanism of death rattle is not well worked out. For example, antimuscarinics are great at drying salivary secretions but not good at drying bronchial or pulmonary secretions which may explain the negative effect in some studies (Bennett papers).  
One study even showed that patients dying with a high anticholinergic load (i.e. getting lots of antimuscarinic medication) had almost 3 times greater chance of getting death rattle. Which suggests that these drugs are not protecting against the symptom! (Sheehan paper) 
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I am currently working with my PhD research proposal focusing on developing learning strategies to improve compassionate care among undergraduate nursing students when they are caring for people at end-of-life care period. 
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Not sure if this is useful, but NICE have started producing quality standards, and their end-of-life guidance is here  http://www.nice.org.uk/guidance/qs13/chapter/list-of-statements
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I am in search of counseling material for palliative care of cancer patients.
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Please don't try too hard. Given formulae for counselling in the situation of threatening imminent death are likely to ring false or be inappropriate. Be quiet, pateint, un-prescriptive and listen, first to the patient, then to those family in attendance, then to other carers. Be un-hurried, and  ready to wait. That is why palliative care has an unpopular place in timed and evidence-based medicine. What troubles the patient?  What troubles the family, the carers? Do they have similar assessments of what matters? A most rewarding process.
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There are many studies and articles about the need for perinatal palliative care but I don't find much about caring for the pregnant woman who is diagnosed with a life threatening illness. any one involved i this type of study? 
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Geriatric medicine is becoming popular nowadays due to the increase in the patient who need attention/hospice care.
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Dear Sultan,
Thank you for your question. It would seem that the emphasis and importance placed on providing care and resources to elderly people, and the concurrent training of Geriatricians to look after them is going through a "U shaped" curve over the last 50-60 years.
In the early 1900s, work in this area really started in earnest with the formation of the National Health System in UK in 1948 by Aneurin Bevan, and the creation of the British Geriatric Society by Marjorie Warren and colleagues in 1947.
They both complemented each other as the NHS provided the means to enable to delivery of comprehensive Geriatric services to all based on need and funded by central taxation. The importance of this cannot be over emphasised, as often then those whom needs help the most can afford it the least, particularly for a majority of the elderly and very elderly in those days who do not have access to the benefits of pensions, state subsidies not the ability to afford private health care insurance or private health services prior to the second world war.
Services were streamlined across the country and available locally, close to where the elderly patients were. Also, the sheer scale of the NHS (i.e. every citizen and resident of the United Kingdom were it's pateints) brought with it the benefits of the economy of scale and allowed the provision of care to be rolled out on a large scale.
It was fertile land for the development and delivery of geriatric medicine.
With the passage of the NHS Bill (aka Health and Social Care Act) in 2012, the funding landscape will change drastically in the coming years.
 Care of Geriatric patients may still be a moral necessity, but it now carries with it the imperative to reduce costs of care and services. What is "efficient" and what is "necessary" is of course subjective and open to interpretation.
In developed countries, the availability of state pensions, state subsidies and personal savings will allow the access of the elderly and very elderly to services. However, in developing countries, there will likely be a generation whom will not be able to find the funds for these, nor have a sizeable political voice.
However, I believe that when the more well educated and financially more capable "Baby boomer" generation (1946-1964) and beyond joins the rank of the "Geriatric" population (i.e. >65), the importance of providing for an excellent geriatric healthcare service will become a political imperative once again. 
Hence the"curve" and attention will rise once more.
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I'm hoping to find more colleagues around the world to discuss thoroughly with about the philosophical underpinnings of approaching therapy within the end-of-life and palliative/hospice care setting.
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I don't work directly with dying patients, so your work would really put the existential theories and therapeutic ideas to the test. However, I approach therapy generally from an existential-humanistic approach. I really like Yalom's "Existential Psychotherapy" book. He bases a lot of his work on Rollo May (with whom he did psychoanalysis). Of course, Frankl's "Man's Search for Meaning" is a really useful book to explore existential themes surrounding meaning and purpose. I also really like Kirk Schneider's work on trying to formulate more directly an existential psychotherapy. Hope that helps.
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I am looking for a manual that includes samples of nursing care plans
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Palliative Care Nursing: A Guide to Practice (2012) 3rd edition Ausmed Publications. This is a popular textbook, used in many courses and clinical settings, written and edited mostly by nurses (I was an editor). There are case studies in each chapter that will assist in developing care plans.
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I am an emergency medical guardian/attorney.
The challenge is the tendency to try to "cure death" among some medical professionals. The resultant pain to the patient and their reaction to it, i.e. pulling out a breathing tube, should be taken into account in the treatment plan. Thoughts?
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Equating non-treatment with murder is extreme. Most of the jaw will need to be removed, and the patient will have to be strapped down during the entire rehabilitation because he has a history of pulling out his breathing tube. The cancer has been there for about twenty years, and he will almost surely die of something else first.
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Specific training and personal skills are needed for psychologists working in palliative care, I'd like to have a detailed explanation of these. Thank you for your help.
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Hi Adrian,
have you seen the work of the EAPC Task Force for psychologists? You can find their outputs here http://www.eapcnet.eu/Themes/Education/Psychologists/Taskforcepublications.aspx
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Supports for the Dying and Grieving: A look at Hospice through the lifespan and the benefits for those left behind when someone dies, support for widows, widowers, the childless, the siblings, and the orphans.
This is title to my dissertation but am seeking information from both sides the personal accounts or stories as well as the professional accounts or stories.
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A valid aspect from The Netherlands: lack of knowledge about hospice care. May view a hopice as a place of death in stead of a place where optimal QOL is central in the last phase of life. Both the public and referring physicians (who often refer very late in the process) lack knowledge. Families often regret late referrals ("If I had known that this is what hospice care is all about, I would have opted for much earlier referral for my loved one.").