Bearing witness and being bounded; the experiences of nurses in adult critical care in relation to the survivorship needs of patients and families

Aim: To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. Background: The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such is the proximity to death and the pressure of work. Design: A constructivist grounded theory approach with constant comparative analysis. Methods: As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) applied. Results: The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding and the data presented reveals the challenges that nurses experience along the way. Conclusion: The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. Relevance to Clinical Practice: Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially this limits nurses’ ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds has contributed further to occupational stress in this care setting

Policy Conflicts in Home Care Systems

Technology to support care at home is a promising alternative to traditional approaches. However, home care systems present significant technical challenges. For example, it is difficult to make such systems flexible, adaptable, and controllable by users. The authors have created a prototype system that uses policy-based management of home care services. Conflict detection and resolution for home care policies have been investigated. We identify three types of conflicts in policy-based home care systems: conflicts that result from apparently separate triggers, conflicts among policies of multiple stakeholders, and conflicts resulting from apparently unrelated actions. We systematically analyse the types of policy conflicts, and propose solutions to enhance our existing policy language and policy system to tackle these conflicts. The enhanced solutions are illustrated through examples

'She's like a daughter to me': insights into care, work and kinship from rural Russia

This article draws on ethnographic research into a state-funded homecare service in rural Russia. The article discusses intersections between care, work and kinship in the relationships between homecare workers and their elderly wards and explores the ways in which references to kinship, as a means of authenticating paid care and explaining its emotional content, reinforce public and private oppositions while doing little to relieve the tensions and conflicts of care work. The discussion brings together detailed empirical insights into local ideologies and practices as a way of generating new theoretical perspectives, which will be of relevance beyond the particular context of study

The Physician as Conscientious Objector

This Article examines the right of doctors to object, because of conflicts with the doctor\u27s own morals, to treatment requested or refused by patients. Focusing mainly on end-of-life care, the author compares court opinions allowing or prohibiting doctors to withhold or withdraw life-sustaining treatment at the request of patients or their surrogates

Policy-based Home Care Systems

It is accepted that home care systems need to be customised and personalised for individual person. They also need to evolve over time. Besides, conflicts may occur between care services. We propose applying policy-based management in home care systems to facilitate the delivery and evolution of home care systems, and help the detection and resolution of conflicts in these systems

Moral Distress in Critical Care Nursing: The State of the Science

Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended

Causes of Household Conflict and Children Socio-Economic Growth in Lubero Territory, Democratique Republique of Congo

In many families, conflicts are unavoidable. Lack of respect, communication, and harmony create frictions between partners and family members. The conflict has an effect on the future socio-economic growth of children. Conflict is a misunderstanding between parents. Many factors are causes of conflicts. Banks (2015) reported that among those sources lack of financial autonomy, in-laws (especially mothers-in-law) involved in disagreements of husband/wife, lack of employment, etc. Many children have suffered and living out of their parental care because of their conflicts. This study provides considerate contributions to the understanding of the causes of household conflicts and their impact on children socio-economic growth. Survey and correlational research designs were used. A questionnaire was distributed to 167 respondents selected using the purpose-sampling technique. The findings show that there is very significant positive influence from households’ causes of conflicts and children socio-economic growth. It is also observed from results a negative relationship between parents and no care for children, which lead children to drop out from their studies (r=-0.154, p=0.047). Therefore, lack of adequate family conflicts management has led many families irresponsible to take care of their children socio-economic growth because of frictions between parents. Keywords:  Households, family conflicts, causes of conflicts, children socio-economic growt

A comparative review of palliative care development in six countries represented by the Middle East Cancer Consortium (MECC)

Palliative care development and services were reviewed in the region represented by the six members of the Middle East Cancer Consortium: Cyprus, Egypt, Israel, Jordan, the Palestinian Authority, and Turkey. The multimethod review synthesized evidence from ethnographic field visits to inpatient units, home care hospice teams and free-standing hospices, including interviews with hospice and palliative care clinicians, administrators, volunteers, policy makers and academic researchers. Public health data and relevant literature were collated together with internet-accessed information on services and health care systems. A total of 69 services were located; two country members have a history of relatively sustained development of hospice and palliative care, but provision across the Middle East Cancer Consortium region is highly variable at a local level. Considerable barriers to service development were identified in a region already struggling with many military and political conflicts. Key problems are a lack of secure funds and government support, inadequate professional training programs, opioid phobia in professionals and the public, and a lack of awareness and understanding of palliative care needs at public, government, and professional levels. Key areas for further attention were increasing national and international professional training and public education programs, improving opioid legislation and health care policies, negotiating for secure government or health insurance funding provision, raising awareness about the need for pediatric services and for patients with other illnesses, as well as for those with cancer, and working to integrate palliative care into mainstream health service provision and education

Restorative justice, mediation and relational conflict resolution in work with young people in residential care

Original article can be found at: http://www.informaworld.com/smpp/title~content=t713665951~db=all Copyright Informa / Taylor and FrancisConflict resolution approaches such as restorative justice and mediation are becoming increasingly important in policy and practice in work with children and young people, be this in relation to work with separating parents to minimise the difficulties and conflicts involved for their children, or in relation to youth justice. One of the main aims of such conflict resolution approaches in social work is to develop techniques and skills for workers and service users to enable them to deal with their conflicts and disputes in a more positive manner than is often currently the case. This article examines these approaches in family disputes and youth offending areas, and then develops these considerations further to examine the possibilities for extending restorative justice approaches within a relational conflict resolution approach for young people's residential units, and more widely in group care settings.Peer reviewe

Does the UK Local Finance Improvement Trust (Lift)Initiative Improve Risk Management in Public-Private Procurement?

The UK government introduced the Private Finance Initiative (PFI) and, latterly, the Local Improvement Finance Trust (LIFT) in an attempt to improve public service provision. As a variant of PFI, LIFT seeks to create a framework for the effective provision of primary care facilities. Like conventional PFI procurement, LIFT projects involve long-term contracts, complex multi-party interactions and thus create various risks to public sector clients. This paper investigates the advantages and disadvantages of LIFT with a focus on how this approach facilitates or impedes risk management from the public sector client perspective. Our paper concludes that LIFT has a potential for creating additional problems, including the further reduction of public sector control, conflicts of interest, the inappropriate use of enabling funds, and higher than market rental costs affecting the uptake of space in the buildings by local health care providers. However, there is also evidence that LIFT has facilitated new investment and that Primary Care Trusts (PCTs) have themselves started addressing some of the weaknesses of this procurement format through the bundling of projects and other forms of regional co-operation