Transitions at the end of life for older adults - patient, carer and professional perspectives

BackgroundThe end of life may be a time of high service utilisation for older adults. Transitions between care settings occur frequently, but may produce little improvement in symptom control or quality of life for patients. Ensuring that patients experience co-ordinated care, and moves occur because of individual needs rather than system imperatives, is crucial to patients’ well-being and to containing health-care costs.ObjectiveThe aim of this study was to understand the experiences, influences and consequences of transitions between settings for older adults at the end of life. Three conditions were the focus of study, chosen to represent differing disease trajectories.SettingEngland.ParticipantsThirty patients aged over 75 years, in their last year of life, diagnosed with heart failure, lung cancer and stroke; 118 caregivers of decedents aged 66–98 years, who had died with heart failure, lung cancer, stroke, chronic obstructive pulmonary disease or selected other cancers; and 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services.Design and methodsThis was a mixed-methods study, composed of four parts: (1) in-depth interviews with older adults; (2) qualitative interviews and structured questionnaire with bereaved carers of older adult decedents; (3) telephone interviews with care commissioners and providers using case scenarios derived from the interviews with carers; and (4) analysis of linked Hospital Episode Statistics (HES) and mortality data relating to hospital admissions for heart failure and lung cancer in England 2001–10.ResultsTransitions between care settings in the last year of life were a common component of end-of-life care across all the data sets that made up this study, and many moves were made shortly before death. Patients’ and carers’ experiences of transitions were of a disjointed system in which organisational processes were prioritised over individual needs. In many cases, the family carer was the co-ordinator and provider of care at home, excluded from participation in institutional care but lacking the information and support to extend their role with confidence. The general practitioner (GP) was a valued, central figure in end-of-life care across settings, though other disciplines were critical of GPs’ expertise and adherence to guidelines. Out-of-hours services and care homes were identified by many as contributors to unnecessary transitions. Good relationships and communication between professionals in different settings and sectors was recognised by families as one of the most important influences on transitions but this was rarely acknowledged by staff.ConclusionsDevelopment of a shared understanding of professional and carer roles in end-of-life transitions may be one of the most effective ways of improving patients’ experiences. Patients and carers manage many aspects of end-of-life care for themselves. Identifying ways to extend their skills and strengthen their voices, particularly in hospital settings, would be welcomed and may reduce unnecessary end-of-life transitions. Why the experiences of carers appear to have changed little, despite the implementation of a range of relevant policies, is an important question that has not been answered. Recommendations for future research include the relationship between policy interventions and the experiences of end-of-life carers; identification of ways to harmonise understanding of the carers’ role and strengthen their voice, particularly in hospital settings; identification of ways to reduce the influence of interprofessional tensions in end-of-life care; and development of interventions to enhance patients’ experiences across transitions.FundingThe National Institute for Health Research Health Services and Delivery Research programme

The Cowl - v.44 - n.21 - Apr 23, 1986

The Cowl - student newspaper of Providence College. Vol 44 - No. 21 - April 23, 1986. 20 pages

The Cowl - v.44 - n.21 - Apr 30, 1986

The Cowl - student newspaper of Providence College. Vol 44 - No. 21 - April 30, 1986. 20 pages

The Effect of Work-Related Stress and Burnout on Nursing Performance and Job Satisfaction: a Study of Hospitals in Saudi Arabia.

Background: While there is much research on work-related stress among nurses in the literature, little attention has been focused on the effect of work-related stress and burnout on nursing performance and job satisfaction in hospitals within Saudi Arabia. In particular, studies from the western region of Saudi Arabia are lacking. Therefore, this study focuses on nurses in Jeddah, the country’s entry port and a city that regularly hosts pilgrims. Jeddah is highly multicultural, and the second largest city in Saudi Arabia with nearly 4 million people including travellers; it has the largest foreigner to citizen population ratio in Saudi Arabia, and a particularly high proportion of hospital nurses non-native to Saudi Arabia. Aim: The aim of this thesis was to identify research gaps and to contribute to existing knowledge by developing hypotheses pertaining to the level of work-related stress and burnout among hospital nurses in different hospital types in Jeddah. The study further evaluated the relationship between work-related stress and burnout, and how this related to nursing performance and job satisfaction. The analysis also examined the relationships between these variables among hospital nurses, and whether relationships are different for different hospital types. Methods: A systematic review of existing research into nursing stress in Saudi Arabia between 2003 and 2014 was carried out. From the 81 articles identified from the database search, 8 met the inclusion criteria. At the onset a pilot study was conducted was done among hospital nurses in King Abdulaziz University.Thereafter, a quantitative survey of 567 nurses derived from three large hospitals representing each sector (private, public and other governmental agency sector hospitals) was conducted. Bilingual questionnaires were used to collect quantifiable, reliable, and valid data in order to test the hypothesis derived from the pilot study.The data was analysed by quantitative research method of cross-sectional analysis and correlational study. Findings: Results showed levels of work-related stress varied among nurses depending on the type of hospital where the nurses were employed. Furthermore, there was a positive relationship between levels of work-related stress and burnout among hospital nurses working in all three types of hospitals in Saudi Arabia. However, there was a very weak relationship between work-related stress and job performance among private hospital (International Medical Center) nurses compared to the strength of this relationship observed in public hospitals. Stress was a significant predictor of burnout among nurses while burnout was the strongest descriptor of the relationship between work-related stress and job satisfaction among nurses. The analysis outcome revealed that work-related stress had the highest impact on job satisfaction, which was facilitated by burnout. Nurses working in the public (King Fahad Hospital) and university (King Abdulaziz University Hospital) hospitals reported high levels of stress and burnout, and also conveyed low levels of job performance and high levels of dissatisfaction compared with nurses working in the International Medical Center (IMC) . The type of hospital moderated the effect between burnout and job satisfaction in both King Fahad Hospital (KFH) and King Abdulaziz University Hospital (KAUH) but did not affect the International Medical Center (IMC).The relationship between stress and burnout was significantly stronger in nurses working in the IMC compared with the KFH and KAUH hospitals. However, burnout was not important in the relationship between stress and satisfaction for those who worked in IMC. Therefore, hospital type did appear to moderate the mediation effect between burnout and job satisfaction, even though, the mediation effect occurred only in KFH and KAUH hospitals but not in IMC . Conclusion: The study demonstrated that there is evidence of work-related stress among nurses in Jeddah, Saudi Arabia.Its prevalence depended on the age,experience,nationality and the employment status of the nurses. Work-related stress and burnout impacted negatively on job performance and job satisfaction in nurses in public (KFH) and university (KAUH) hospitals but not in private (IMC) hospitals.Notably,there is a mediated relationship between work-related stress and burnout and a moderated mediation difference between the type of hospitals. Both work-related stress and burnout have shown an effect on the level of job satisfaction of nurses and their job performance. In essence,measures should be taken to help alleviate work-related stress and burnout levels of nurses working in non-privately funded hospitals Saudi Arabia. This study recommends an increase hiring Saudi Arabian nurses,a review of task allocation policies for nurses,provision of targeted training for nurses,increased focused government funds allocation to healthcare,an adoption of an integrated stress prevention, intervention and management program throughout the healthcare system of Saudi Arabia

A parent education curriculum for families with an autism spectrum disorders child

This project provides a comprehensive, parenting education program that focuses on educating parents of young newly-diagnosed ASD children about coordinated services, supporting the family to promote the ASD child\u27s growth and development, and supporting the family system during critical early years

Building back better for children:Developing relevant and sustainable systems of care for children with mental health problems in Sierra Leone

This dissertation presents four studies related to the development of a contextually relevant and sustainable Child and Adolescent Mental Health (CAMH) care system in the post-emergency, low-resource environment of Sierra Leone. The first study describes priorities, barriers and facilitators of mental health care for former child soldiers from the perspective of local service providers. The second study gives an overview of formal and informal mental health care systems for the general child and adolescent population, and explores local perceptions of child mental health, help-seeking behavior, and stigma. The third study describes child witchcraft as an idiom of distress, with implications for mental health interventions. The fourth study uses the Interactive Systems Framework to analyze the apparent lack of success in developing a CAMH care system for Sierra Leone in the context of two humanitarian crises. A concluding chapter discusses issues of context and sustainability, using findings from across the four studies, with references to literature on current knowledge and practices. It also discusses two areas that warrant further exploration (diagnostics and epidemiology, and interventions) and closes with some thoughts on the contributions of this dissertation to the general field of global CAMH: first, the value of an interdisciplinary approach to global CAMH research, second, the demonstrated effectiveness of a Rapid Qualitative Inquiry to deepen our understanding of child idioms of distress, and third, the usefulness of the Interactive Systems Framework as both an analytic and prescriptive tool for the development of a CAMH care system in a low-resource setting

Human factors aspects of control room design: Guidelines and annotated bibliography

A human factors analysis of the workstation design for the Earth Radiation Budget Satellite mission operation room is discussed. The relevance of anthropometry, design rules, environmental design goals, and the social-psychological environment are discussed