Patient and family reactions to day hospitalization of the chronically ill

Thesis (M.S.)--Boston UniversityThe innovation of a day hospital for the long term mentally ill patient brings to light new areas of possible exploration. This study sought to look at what perceptions six patients and a member of the patients' families had concerning day hospitalization and its effects. The patients, all long term mentally ill females, had been actively participating in a specific day hospital program of a large Boston area state hospital. The patients between the ages of thirty and forty-six years of age had been in the hospital for approximately five and one-half months. Previously, they had been hospitalized from nine months to twenty-seven years with a mean of eighteen years and one month [TRUNCATED

Better Palliative Care for Older People

Most deaths in European and other developed countries occur in people aged over 65, but relatively little health policy concerns their needs in the last years of life. As life expectancy increases, the number of people living to older ages is also increasing in many countries. At the same time, the relaive number of people of working age is declining and he age of potential caregivers is increasing. Palliatve care is therefore of growing public health importance. Older people have traditionally received less palliative care than younger people and services have focused on cancer. This booklet is part of the WHO regional Office for Europe's work to present evidence for health policy - and decision-makers in a clear and understandable form. It presents the needs of older people, the different trajectories of illnesses they suffer, evidence of underassessment of pain and other symptoms, their need to be involved in decision-making, evidence for effecive palliative care solutions, and issues for the future

Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: The study protocol of the PalTeC-H project

Background: The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands. Methods/Design. We designed a controlled before and after study. The intervention is the establishment of a network for palliative care nurse champions, aiming to improve the quality of hospital end-of-life care. Assessments are performed among bereaved relatives, nurses and physicians on seven wards before and after introduction of the intervention and on 11 control wards where the intervention is not applied. We focus on care provided during the last three days of life, covered in global ratings of the quality of life in the last three days of life and the quality of dying, and various secondary endpoints of treatment and care affecting quality of life and dying. Discussion. With this study we aim to improve the understanding of and attention for patients' needs, and the quality of care in the dying phase in the hospital and measure the impact of a quality improvement intervention targeted at nurses

Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project

BACKGROUND: The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands. METHODS/DESIGN: We designed a controlled before and after study. The intervention is the establishment of a network for palliative care nurse champions, aiming to improve the quality of hospital end-of-life care. Assessments are performed among bereaved relatives, nurses and physicians on seven wards before and after introduction of the intervention and on 11 control wards where the intervention is not applied. We focus on care provided during the last three days of life, covered in global ratings of the quality of life in the last three days of life and the quality of dying, and various secondary endpoints of treatment and care affecting quality of life and dying. DISCUSSION: With this study we aim to improve the understanding of and attention for patients’ needs, and the quality of care in the dying phase in the hospital and measure the impact of a quality improvement intervention targeted at nurses

The Family Experience of Participating in an ICU Support Group: A Pilot Study

The purpose of this study was to describe the experience of family members participating in an intensive care unit support group. The family experience of an adult family member\u27s critical illness is filled with emotional distress, suffering, and difficulty coping. Few family nursing interventions to care for family members of ICU patients have been researched. Research is inconsistent regarding the value of a support group in the ICU setting of a hospital. A qualitative design, using hermeneutic phenomenology was chosen. Five interviews were conducted with seven family members. The experience of participating in an ICU support groups was analyzed within Van Manen\u27s (1990) framework of lived space, lived relation, lived body, and lived time. An overall pattern of gaining strength was uncovered. Within the support group experience, families found their lived space occupied by trying to understand, wherein subthemes of exchanging information, decision making, and sense of direction were identified. Being not alone was a reflection of families\u27 lived relation with subthemes of nursing presence and being together with other families. The life world of lived body was identified as comforting. After initial experiences of vulnerability with others in the support group and intensive care unit setting, families found comfort by sharing their story and sharing suffering. The final life world of lived time was experienced by family members as pausing; an opportunity to take a break from the experience of having a loved one as a patient in the ICU. Findings suggest support groups can be a useful intervention for ICU nurses to help families gain strength to endure the stressful experience of having a family member hospitalized in the ICU

Community Adjustment of Chronic Psychiatric Patients: Dropouts vs. Non-Dropouts

This study examined the chronic psychiatric patients who were referred to Fountain House for psychosocial rehabilitation. Differences between the dropouts vs. the non-dropouts were tested. Applying a longitudinal design and using discriminant analysis, it was found that 70% of patients dropout over a period of six months; and that patients' personal characteristics as well as service variables are predictors of dropout and community adjustment. Although issues of collecting follow-up data on the dropouts were inherent, it was possible to identify patterns of adjustment for the non-dropouts. It was found that patients who stay longer in a rehabilitation setting, attend therapy, and comply with medication had better adjustment levels than others. This led to the conclusion that comprehensive long-term treatment is more effective than other single specialized model of treatment. Theories of milieu therapy, ego psychology, and empirical research pertaining to adjustment and dropout provided a rationale for developing this study, its conclusions, and its recommendations. One recommendation to emerge from this study is that deinstitutionalization should be perceived as a step in the rehabilitation process rather than as a goal by itself. This study concludes that it is possible for chronic psychiatric patients to adjust to the community, but only if all elements of the system work as a complementary unit in which inpatient and aftercare facilities are integrated around the goals of rehabilitation and independent living. The application of milieu therapy based upon sound social work philosophy, research, and methods is essential for the promotion of the adjustment process and reduction of the dropout rate in aftercare facilities. Continuation of research and commitment for long-term, comprehensive treatment will meet the scientific and clinical challenges for dealing with those patients who are "difficult to reach." A second recommendation is that in addition to the usual concern with patient adjustment to services, there is a need to be concerned with the adjustment of services to patients