Provider Perspectives on the Influence of Family on Nursing Home Resident Transfers to the Emergency Department: Crises at the End of Life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED). Methods. Multiple stakeholder focus groups (n = 35 participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach. Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care. Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers

What are the problems of the nuclear age that you think we can solve and how?

Abstract not availabl

The potential impact of reforms to the essential parameters of the council tax

Council Tax was introduced in Britain in 1993 and represents a unique international property tax. There is a growing belief that it is time to reform the number and structure of council tax bands but such views have a minimal empirical base. This paper sets out to assess the impact on personal and local government finances, and extends the analysis to the role of the tax multipliers linked to each band. The research is based on the experience of a representative sample of local authorities in Scotland. A statistical revaluation for 2000 is estimated for the existing eight band system, and from this base a ten band system is calculated. Financial implications are then simulated for each local authority taking account of central resource equalisation mechanisms. The results indicate that increases in bands will have little impact on the burden of the council tax compared with regular revaluations. Changing the tax multiplier range has the greatest impact on local authority finances and council tax payments

Counseling Native Americans

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89558/1/j.1556-6676.1990.tb01473.x.pd

A concept analysis of compassionate midwifery

AimTo report a concept analysis of compassionate midwifery.BackgroundRecently, compassion has been incorporated into United Kingdom nursing and midwifery language through strategy, policy, recruitment and education. Professional standards direct midwives to practise compassionately therefore the concept of compassionate midwifery exists, although this has yet to be explored as a concept in the UK or internationally. An understanding of what constitutes compassionate midwifery has the potential to increase midwifery knowledge and improve practice.DesignConcept Analysis.Data sourcesLiterature from 1990–2015 was searched using MEDLINE, CINAHL, PsycINFO and ETHOS. Grey literature and examples of everyday usage of the concept were searched using Google.MethodsAn adapted model of evolutionary concept analysis.ResultsExplanations of compassionate midwifery were absent in the literature therefore the gathered data were evaluated in relation to elements of the compassion process: recognition of suffering, emotion, motivation and action. Compassionate midwifery is defined as the interrelations of authentic presence, noticing suffering, empathy, connectedness/relationship, emotion work, motivation to help/support, empowering women and alleviating suffering through negotiation, knowledge and skills. Antecedents and consequences were also identified and depicted in a schematic representation of the concept.ConclusionThis concept analysis provides a unique examination of compassionate midwifery and starting point for reflection on practice, education and further analysis. Empirical studies will provide the potential to take the process further by studying the experience of compassionate midwifery from different perspectives. A theory of compassionate midwifery will develop as new findings emerge