Knowledge and information needs of informal caregivers in palliative care : a qualitative systematic review

Objectives: To review current understanding of the knowledge and information needs of informal caregivers in palliative settings. Data sources: Seven electronic databases were searched for the period January 1994–November 2006: Medline, CINAHL, PsychINFO, Embase, Ovid, Zetoc and Pubmed using a meta-search engine (Metalib®). Key journals and reference lists of selected papers were hand searched. Review methods: Included studies were peer-reviewed journal articles presenting original research. Given a variety of approaches to palliative care research, a validated systematic review methodology for assessing disparate evidence was used in order to assign scores to different aspects of each study (introduction and aims, method and data, sampling, data analysis, ethics and bias, findings/results, transferability/generalizability, implications and usefulness). Analysis was assisted by abstraction of key details of study into a table. Results: Thirty-four studies were included from eight different countries. The evidence was strongest in relation to pain management, where inadequacies in caregiver knowledge and the importance of education were emphasized. The significance of effective communication and information sharing between patient, caregiver and service provider was also emphasized. The evidence for other caregiver knowledge and information needs, for example in relation to welfare and social support was weaker. There was limited literature on non-cancer conditions and the care-giving information needs of black and minority ethnic populations. Overall, the evidence base was predominantly descriptive and dominated by small-scale studies, limiting generalizability. Conclusions: As palliative care shifts into patients’ homes, a more rigorously researched evidence base devoted to understanding caregivers knowledge and information needs is required. Research design needs to move beyond the current focus on dyads to incorporate the complex, three-way interactions between patients, service providers and caregivers in end-of-life care setting

A parallel approach to analysis of costs/benefits and efficiency changes resulting from privatisation of health services

The marketisation of public health care systems is part of a long process, which is not necessarily clearly set out or understood at the beginning. Public policy plays an important role in creating internal markets and changing public health care systems. The findings of this review show that there are now recognisable steps in the process of moving from a state/ government run health care system to a marketised and privatised system but this can take place over many years

Care services for frail older people in South Korea

This paper examines the changed social circumstances of older people in South Korea and specifically the increased need for formal health and social services for those who are frail and have no informal carers. The article begins with a summary account of the country's exceptionally rapid demographic, economic and social transformations, which demonstrates a widening gap between the population's expectations and needs, and health and social service provision. It then examines the recently initiated and now burgeoning welfare programmes, with particular attention to health and social services for sick and frail older people. Most extant care services are accessed mainly by two minorities: the very poor and the rich. The dominant policy influence of physicians and a history of conflict between traditional and western medicine probably underlies the low current priority for ‘care’ as opposed to ‘cure’, as also for the management of chronic conditions and rehabilitation. Neither long-term care services nor personal social services are well developed. There is a marked disparity between the acute services, which are predominantly provided by private sector organisations in a highly competitive market and broadly achieve high standards, and public primary care and rudimentary residential services. The latter are weakly regulated and there are many instances of low standards of care

The development of quality indicators for Taiwanese institutional dementia care

This study is a mixed-method study that seeks to develop a set of institutional dementia care indicators to evaluate quality of care and inform the improvement of quality of life (QOL) for Taiwanese people with dementia living in care homes. It also uses comparative analysis to compare the different features of policy and its delivery in dementia care between Scotland and Taiwan, a comparison designed to aid the development of dementia care policy, and the establishment of quality indicators for institutional dementia care, in Taiwan. This study employed the person-centred care approach at the micro perspective, and the total quality management (TQM) approach at the macro perspective, in order to inform a seamless care model for people with dementia living in care homes. Data were collected in two stages: comments from experts in dementia care were recorded in an exercise using “Delphi” methodology; subsequently the opinions of service receivers were recorded in a fieldwork exercise. The Delphi exercise (stage one) acted as the pre-test, involving 24 experts in dementia care in Scotland and Taiwan in evaluating the usefulness and applicability of proposed quality indicators for institutional dementia care. Quantitative and qualitative data from the Delphi panel were analyzed. The fieldwork (stage two) collected 237 questionnaires (from 122 residents with dementia and 115 family members) in 14 Taiwanese care homes for people with dementia (including special care units within care homes). The field test data were analyzed using reliability and item analysis, confirmatory factor analysis (CFA), and descriptive and inferential statistics. Initially, 43 proposed quality indicators for institutional dementia care were identified through literature review. However, after two Delphi rounds, only six key dimensions (41 quality indicators) were identified by consensus as the important items for use in measurement of quality of care for people with dementia living in Taiwanese care homes. Through reliability and item analysis, and CFA, this research developed a model which is a three-factor structure (social care, health and personal care, and environment) with 18 quality indicators. The 18 quality indicators have high reliability, validity, and credibility and load onto a second order factor which represents quality of care for people with dementia living in care homes. Further analysis was then conducted to explore how relative ratings on these three factors differed according to measured characteristics of the residents and their family members. In general, only a few strong patterns of difference emerged and multiple linear regression analysis suggested that differences in ratings could not be attributed to influences of socio-economic and socio-demographic differences between respondents. The study concludes that the Delphi method could be used as a methodology for health services research to integrate the opinions of multidisciplinary dementia experts and that CFA is an effective technique to study the empirical factor structure. The findings suggest that the 18 quality indicators could be suitable criteria for people with dementia and their family members to evaluate care quality and select an appropriate care home. The indicators also have important policy implications for the Taiwanese Government and regulations intended to ensure that care homes meet the requirements of service receivers

Successful ageing in long-term care: international comparison and lesson learning

Quality of life is one of the main concerns in long-term care amongst ageing populations in many countries. This problem is historically unique and increases the demand for research material. This thesis looks at how different societies promote or fail to promote successful ageing of long-term care of older people, and considers how countries may learn from one another in their search for solutions. The three countries studied (England, the Netherlands and Taiwan) correspond to Esping-Anderson's three types of welfare system (Esping-Anderson, 1990). In addition, the Asian-European dimension has been employed as it is a neglected one. Data sources included conceptual, empirical and statistical documents on long-term care of older people. Moreover, this research used identical qualitative cross-national research methods on three levels in each country: national, county and municipal. A total of 142 interviews were carried out in 2004. This aim of this study was broadly to rank the three welfare systems where there were clear differences but to qualify this by pointing out the complexities and difficulties of mixed economy comparisons. The overall conclusion is that the Netherlands provides higher quality care to older people, thus confirming Esping-Andersen's finding about the superiority of social democratic systems. In reviewing current policies and research in needs and successful ageing, this qualitative comparative study has focused on needs, social inclusion, power and autonomy, care resources as well as partnership as crucial concepts in care systems and discovered good practice in each and lessons to be learnt

Changing healthcare systems in Asia

Outline of key changes in healthcare systems in Asia including company developments and trade union action

How the Transformational Leadership Style of Superintendents is Associated With Employees’ Organizational Commitment via the Mediating Effect of Extrinsic Motivation Within Nursing Homes for Disabled People in Taiwan

In 2013, about 4.8% of Taiwanese people qualified as having a disability; a disability is classified as having mild, moderate or severe, and in some cases, extremely severe intellectual disabilities or having multiple disabilities (Ministry of the Interior, Department of Statistics, 2013; Tseng, 2013). In 2013, there were 254 nursing homes for people with disabilities that were registered with the Social and Family Administration at the Ministry of Health and Welfare in Taiwan (Lee et al., 2013; Tseng, 2013). The current problems in Taiwan’s nursing homes for the disabled include overworked employees, employees with a poor work-life balance and excessive job stress, ineffective leadership, poor communication among administrators, and little or no staff support (Lee, 2007; Lin, 2008; Tseng, 2013). This results in a low sense of job accomplishment, a low sense of belonging, low morale, and lack of cohesiveness (Lee, 2007; Lin, 2008; Tseng, 2013). This negative cycle has led to high turnover rates and minimal retention and has had crippling effects on the organizations (Chou, 2005; Lee, 2007; Lee et al., 2013). According to the Taiwan Council of Labor Affairs, there is nearly a 50% turnover rate of professional employees at these institutions (Lee et al., 2013; Tseng, 2013). The purpose of this study was to measure the degree to which the superintendents at nursing homes for disabled people in Taiwan demonstrate transformational leadership and how this is associated with employees’ organizational commitment via the mediating effect of extrinsic motivation. Data for analysis, using the Multifactor Leadership Questionnaire (MLQ), the Work Preference Inventory (WPI), and the Organizational Commitment Questionnaire (OCQ), were collected from full-time employees who were randomly selected from 70 nursing homes for disabled people. An SPSS program was used to analyze the data and descriptive statistics, Pearson correlation coefficients, and sequential multiple regression analysis were used to answer the research questions. This study’s findings showed that gender was not associated with organizational commitment and that superintendents should recruit married employees and employees with college degrees in order to promote more organizational commitment. The findings also indicated that physical care employees’ commitment, compared with the commitment of social workers, special education teachers, and other professionals in nursing homes of Taiwan, was low. Superintendents, therefore, should conduct official self-assessments and unofficial sessions with them to understand which factors lead to their stress and, ultimately, their intention of leaving the organization. The data further showed that deploying transformational leadership practices would be an inevitable trend in order to increase organizational commitment and lower turnover rates aggressively. Lastly, the findings showed that transformational leadership contributed to the variability of organizational commitment significantly and that extrinsic motivation was the important factor of shared variability of organizational commitment. This means that transformational leaders of nursing homes should not only use strategic techniques to develop future innovations and offer high quality services but also take into consideration extrinsic motivation to promote organizational commitment

Living Arrangement Options for People with Intellectual Disabilities: A Scoping Review

This is one of a pair of reports prepared for the Moving Ahead Project. Its partner policy review, Mapping the National Intellectual Disability Landscape (Linehan et al., 2014), outlines current disability services, practices and policies in Ireland. This rapid scoping review provides a brief overview of national and international research exploring living arrangement options for people with intellectual disabilities

Women, Health and Aging: Building a Statewide Movement

Provides an overview of current policy and program environments that affect the state's most vulnerable elder population, and considers some effective strategies to address the growing needs of older persons in California

An Intelligent Clinical Decision Support System for Assessing the Needs of a Long-Term Care Plan

With the global aging population, providing effective long-term care has been promoted and emphasized for reducing the hospitalizations of the elderly and the care burden to hospitals and governments. Under the scheme of Long-term Care Project 2.0 (LTCP 2.0), initiated in Taiwan, two types of long-term care services, i.e., institutional care and home care, are provided for the elderly with chronic diseases and disabilities, according to their personality, living environment and health situation. Due to the increasing emphasis on the quality of life in recent years, the elderly expect long-term care service providers (LCSP) to provide the best quality of care (QoC). Such healthcare must be safe, effective, timely, efficiently, diversified and up-to-date. Instead of supporting basic activities in daily living, LCSPs have changed their goals to formulate elderly-centered care plans in an accurate, time-efficient and cost-effective manner. In order to ensure the quality of the care services, an intelligent clinical decision support system (ICDSS) is proposed for care managers to improve their efficiency and effectiveness in assessing the long-term care needs of the elderly. In the ICDSS, artificial intelligence (AI) techniques are adopted to distinguish and formulate personalized long-term care plans by retrieving relevant knowledge from past similar records