Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program

Background While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice. Objectives We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner. Design To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling. Setting and participants Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer. Methods The work was carried out by means of 1) operationalization of key intervention components identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis. Results The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning. Conclusions The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice

Educational interventions and strategies for spiritual care in nursing and healthcare students and staff: A scoping review

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Aims and objectives: To map existing evidence about educational interventions or strategies in nursing and allied healthcare concerning students’ and staffs’ spiritual care provision. Background: Spiritual care is an important part of whole person care, but healthcare staff lack competence and awareness of spiritual issues in practice. To rectify this, it is important to identify what educational approaches are most helpful in supporting them to provide spiritual care. Design: A scoping review using the PRISMA-ScR checklist. Method: Searches in the databases CINAHL, MEDLINE, ATLA and ERIC were conducted for papers spanning January 2009–May 2020. Search terms were related to spirituality, spiritual care, education and clinical teaching. Appraisal tools were used. Results: From the 2128 potentially relevant papers, 36 were included. The studies were from 15 different countries and involved nurses, physicians and other healthrelated professions, and both quantitative, qualitative and mixed methods were used. The results are presented in three themes: Understanding of spirituality, Strategies in educational settings, and Strategies in practice settings. The review points to great diversity in the content, lengths and setting of the educational interventions or strategies. Conclusions: Courses in spiritual care should be implemented in curricula in both undergraduate and postgraduate education, and several studies suggest it should be mandatory. Courses should also be available for healthcare staff to raise awareness and to encourage the integration of spiritual care into their everyday practice. There is a need for greater consensus about how spirituality and spiritual care are described in healthcare settings. Relevance to clinical practice: Spiritual care must be included both in monodisciplinary and multidisciplinary educational settings. The main result of spiritual care courses is in building awareness of spiritual issues and self-awareness. To ensure the provision of spiritual care for patients in healthcare practices, continuing and multidisciplinary education is recommendedpublishedVersio

England's Approach to Improving End-of-Life Care: A Strategy for Honoring Patients' Choices

Outlines England's evidence-based End of Life Care Strategy, its impact, and possible lessons for palliative care in the United States, such as the use of death at home as a metric for progress and Web-based training for clinical and caregiving personnel

Educational interventions and strategies for spiritual care in nursing and healthcare students and staff: A scoping review

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Aims and objectives: To map existing evidence about educational interventions or strategies in nursing and allied healthcare concerning students’ and staffs’ spiritual care provision. Background: Spiritual care is an important part of whole person care, but healthcare staff lack competence and awareness of spiritual issues in practice. To rectify this, it is important to identify what educational approaches are most helpful in supporting them to provide spiritual care. Design: A scoping review using the PRISMA-ScR checklist. Method: Searches in the databases CINAHL, MEDLINE, ATLA and ERIC were conducted for papers spanning January 2009–May 2020. Search terms were related to spirituality, spiritual care, education and clinical teaching. Appraisal tools were used. Results: From the 2128 potentially relevant papers, 36 were included. The studies were from 15 different countries and involved nurses, physicians and other healthrelated professions, and both quantitative, qualitative and mixed methods were used. The results are presented in three themes: Understanding of spirituality, Strategies in educational settings, and Strategies in practice settings. The review points to great diversity in the content, lengths and setting of the educational interventions or strategies. Conclusions: Courses in spiritual care should be implemented in curricula in both undergraduate and postgraduate education, and several studies suggest it should be mandatory. Courses should also be available for healthcare staff to raise awareness and to encourage the integration of spiritual care into their everyday practice. There is a need for greater consensus about how spirituality and spiritual care are described in healthcare settings. Relevance to clinical practice: Spiritual care must be included both in monodisciplinary and multidisciplinary educational settings. The main result of spiritual care courses is in building awareness of spiritual issues and self-awareness. To ensure the provision of spiritual care for patients in healthcare practices, continuing and multidisciplinary education is recommendedpublishedVersio

ANGELAH: A Framework for Assisting Elders At Home

The ever growing percentage of elderly people within modern societies poses welfare systems under relevant stress. In fact, partial and progressive loss of motor, sensorial, and/or cognitive skills renders elders unable to live autonomously, eventually leading to their hospitalization. This results in both relevant emotional and economic costs. Ubiquitous computing technologies can offer interesting opportunities for in-house safety and autonomy. However, existing systems partially address in-house safety requirements and typically focus on only elder monitoring and emergency detection. The paper presents ANGELAH, a middleware-level solution integrating both ”elder monitoring and emergency detection” solutions and networking solutions. ANGELAH has two main features: i) it enables efficient integration between a variety of sensors and actuators deployed at home for emergency detection and ii) provides a solid framework for creating and managing rescue teams composed of individuals willing to promptly assist elders in case of emergency situations. A prototype of ANGELAH, designed for a case study for helping elders with vision impairments, is developed and interesting results are obtained from both computer simulations and a real-network testbed

End-of-life care: Patients’ preferences and relatives’ experiences : with focus on communication and advance care planning

Background and aim: Advance care planning (ACP) is a communication process for mapping patients’ priorities for end-of-life care. Preparing for an introduction of ACP in Norwegian hospitals, we wanted to explore patients’ views on ACP and which topics they wanted to discuss, and how patients, relatives and clinicians experienced ACP conversations. Finally, we wanted to explore whether an invitation to ACP would influence perceptions about care and support among bereaved relatives. Methods: Focus group interviews (2014-15) were conducted with patients having advanced pulmonary diseases. Based on the results, a semi structured ACP conversation guide was developed. Individual ACP conversations were held with hospital inpatients in an ACP implementation pilot (2014–2017). Clinicians’ views on ACP were explored in focus group interviews. Responses to the post-bereavement survey of the ERANet-LAC International Care of the Dying Evaluation (CODE) project (2017-2020) in Argentina and Norway were studied to examine any associations between being offered an ACP conversation and perceptions about care and support. Transcribed focus group interviews and ACP documents were analysed by systematic text condensation, the survey results by descriptive statistics and mixed-effects ordinal regression models. Results: Focus group patients (13) called for support, information and transparency, and they preferred an invitation to an ACP conversation at certain “turning points” in the disease trajectory. Both the invitation and the conversation itself should be patient-centred and individually tailored. In the pilot, 51 patients with advanced lung disease took part in ACP conversations; relatives participated in 18 of them. All participants appreciated the conversations. Four themes emerged: (i) disturbing symptoms, (ii) existential topics, (iii) care planning, and (iv) important relationships. Clinicians acted as gatekeepers for participation, but the documentation of the conversations revealed information previously unknown to clinicians. Many of them saw ACP as pertinent, and called for implementation resources. The post-bereavement survey had 276 participants (Argentina: 98). Fifty-six percent had been invited to ACP conversations, and their perceptions about care and support were significantly more positive than those of the not-invited; in the latter group a majority (68%) would have wanted an invitation to an ACP conversation. Conclusion: ACP should be offered, with a patient-centred approach, at turning points in the disease trajectory. An attention towards present and future symptom control may be useful. ACP may support patients and relatives by responding to their needs, whether emotional or practical, and providing tailored information. Important aspects for implementing ACP are management support, education, training, feasible routines and allocated time to perform the conversations, as well as safe and easily retrievable documentation and sharing of this between healthcare levels.Doktorgradsavhandlin

Opportunity-Rich Schools and Sustainable Communities: Seven Steps to Align High-Quality Education With Innovations in City and Metropolitan Planning and Development

Details challenges and steps for linking quality education and community and economic vitality, including establishing a shared vision and metrics, aligning investments for prosperity, and expanding access via transportation. Lists promising practices

Sudden death processing: an ethnographic study of emergency care

The following doctoral thesis provides an ethnographic account of sudden deathwork performed by emergency personnel. The study centres on three accident and emergency departments in the North East of England. Sudden death practices and perceptions are revealed using thick description from focus groups, narratives and informant accounts. Three emergency disciplines: accident and emergency nurses, police traffic officers and paramedics provide the backdrop to describing three sudden death trajectories, which take the dead body from a state of collapse to a mortuary. Particular attention is paid to the significance of status passage as a temporal dimension of deathwork with due consideration being given to the concept of body handling as 'dirty work'. A feminist concept of embodiment challenges the dominant discourse of the death processing industry in relation to beneficence and non- maleficence for those who are left behind to grieve. The theatrical representation of the body to relatives is discussed within a dramaturgical frame, questioning what is appropriate and achievable within the boundaries of an emergency care environment. An exploration of the roles of emergency personnel illuminates problems of dealing with a phenomenon, which annihilates the possibility of a sense of order and emotionally incapacitates emergency personnel. The procedural base to sudden death is presented through accounts of emergency personnel contact with human suffering and emotional pain with the intention to build a substantive theory of a sudden death milieu. Finally, Schutzian relevances highlight key concepts of significance within the data demonstrating how, despite an evidence-base to practice, some myths are highly influential in shaping the behaviours of emergency personnel throughout the sudden death event. It is hoped that insight gained may provide a catalyst to inform change where needed, in service provision and enhance interprofessional working relationships

Treat him as a normal baby: paediatrician's framing of parental responsibility as advice in the management of a genetic condition

Oral Presentation - Parallel Session 2: 2E Risk and Uncertainty/Ethics: no. 2E.4Parental responsibility in the management of genetic conditions has been the focus of both family-oriented interview-based research (e.g. Arribas-Ayllon et al. 2008; 2011) as well as real-life face-to-face genetic counselling research (Sarangi fc; Thomassen and Sarangi 2012). The current paper is an attempt to contribute to the latter tradition involving paediatricians and parents where parental responsibility is constitutive of professional advice. The genetic condition in question is G6PD deficiency (commonly known as favism), a mild hereditary disorder prevalent in Asia (Zayts and Sarangi 2013). We draw on 18 consultations in a maternal unit in Hong Kong (recruitment ongoing) where paediatricians communicate with mothers of newborns diagnosed with G6PD. We employ theme-oriented discourse analysis – comprising activity analysis and accounts analysis (Sarangi 2010) – to examine how the paediatricians frame their advice-giving trajectories – on to which elements of parental responsibility (in terms of future actions and moral selves) can be mapped. We show how 'causal responsibility' (Sarangi, fc) that concerns potential consequences of the mothers' actions in managing the condition emerges as a dominant thread in our data corpus. 'Causal [parental] responsibility' is embedded in the paediatrician's advice-giving trajectories which include, among other things, how to 'treat' these children, ranging from safeguards against certain medications and food to prevention of negative physiological scenarios (such as an acute hemolytic reaction). We examine closely the attendant discourse devices through which parental responsibility is framed, e.g., modalisation, contrast, character/event work. We conclude that, in terms of temporality, 'causal [parental] responsibility' is 'forward-looking' as the mothers' responsible actions can normalise the child’s immediate and future wellbeing.postprin