How confident are community nurses in caring for patients who are dying? A qualitative study of community nurses’ experience’s of providing end of life care in the community

Abstract Aim The purpose of this study was to explore how confident community nurses are in providing end of life care in the community. Background The amount of palliative care being provided in the community is growing as more patients are deciding to die at home. Community nurses are the community professionals who are taking on the primary role of caring for these patients. Literature has considered the experiences of this population (Wilkes and Beale, 2001; Rose and Glass, 2006; Seale, 1992); however, there is little that addresses how confident community nurses are in providing this care. Method Ten semi-structured interviews were completed with community nurses involved in palliative care, utilising an interpretive phenomenological approach. The interviews were recorded and subsequently analysed using Giorgi’s framework of analysis (1985). Findings The five main theme categories that were identified were confidence, providing palliative care, experience, training and support. Although forming separate categories, the themes were also interwoven, forming a complex picture of the confidence of community nurses. Conclusions The picture that the community nurses presented was of confidence being a complex layered phenomenon. Professionally, they appeared confident in their role. Behind this, however, they were less confident in certain aspects of the work and their ability to provide the care. It was seen as possible to increase confidence, largely through experience of the role and mentoring through practice. Training was also seen to be important, but not as significant as is presented in recent policies and strategies. Central to growing in confidence and maintaining confidence was a support network, comprising of organisational structures as well as interpersonal relationships with colleagues and the wider community team

Post Discharge Follow-up Telephone Calls for Patients who Received Hospital Based Palliative Care Services to Improve Quality of Care and Outcomes: A Pilot Study

Background There is a rising number of patients with chronic health conditions concurrent with an increasing number of hospital readmissions within 30 days and emergency department visits. Predominantly based in acute care facilities, palliative care services have been effective in improving the quality of life in patients with chronic health conditions. However, the largest population that could benefit from palliative care services is community based in the home setting. Purpose The purpose of this project was the implement and evaluate follow-up telephone calls made in addition to visiting nursing (VNA) services to detect in early decline in patients who have received in-patient palliative care services compared to a 12-month retrospective analysis of a mirror population. Methods Five telephone calls were made over a 30-day time frame using the palliative performance scale as the method of measurement to augment VNA services with an additional layer of monitoring for early detection of decline. A 12-month retrospective analysis of a mirror population was performed for baseline comparison. ER visits, 30-day hospital readmissions, hospice admissions, and hospice lengths of stay were the methods of outcome. Results One participant was included in the implement telephone calls for inconclusive results. While, the retrospective data populations of 45 patients accounted for 141 hospitalizations, 71 30-day readmissions, 65 ER visits, 15 hospice admissions, and an average hospice length of stay of 58.3 days. Conclusions Patients who receive palliative care services in the hospital would benefit from the extension of in-person palliative care into the home setting for better symptom management and advanced care planning to improve quality of care and outcomes

From narrative to spectacle: An examination of contemporary theatre performance

Drawing on Debord and Baudrillard, this thesis takes its starting point the shift from text to image dominated representations of the world. It argues the parallel shifts in theatre practice and reception away from work which subordinates itself to textual narrative and towards theatre with foreground the non-textual theatrical elements is becoming more defined in Britain. Within there is a concern with the relationship between narrative, the spectacle and disruptive modes of engagement, drawing out in each chapter a different aspect of the implications for creating and engaging with theatre where the spectacle of society is ubiquitous.The introductory chapter will first outline how narrative can be defined and discuss the significance of experience of reality through spectacular representation looking at how the notion of the spectator and the experience of engagement with theatre have changed, then the following six chapters will address the relationship between the spectacle and virtuosity in performance; the implications for politics of identity and for resistance to the spectacle; the experience of immersion through participation in spectacular performance; and distance through engagement with ironic spectacle, before in the final chapter, addressing theatre which constructs itself as international through multilingualism and new media technology.Each chapter focuses on one or two practitioners examining one of their performances in detail in relation to one of the areas outlined above. This analysis will be based on my own experience as a spectator, research into the companies, their reception in the media and academic writing, and where possible through interviews with members of the company

Developing a Medically Informative and Socially Supportive Interactive Online Network (MISSION)

This thesis discusses virtual communities and social networks and their current and potential uses in health and medicine, proposing a novel virtual health network called a \u27Medically Informative and Socially Supportive Interactive Online Network\u27 (MISSION). The purposes of a MISSION are to 1) serve as an information resource for patients, 2) to facilitate conversation between patient and provider, 3) to potentially aid in office tasks (such as scheduling, billing, etc.), and 4) to aid in community-building acts in patients\u27 own local, physical communities. In this thesis, the concept of virtual communities and social networks are explored, the legal and ethical ramifications of a MISSION are surveyed, current applications similar to a MISSION are analyzed, and recommendations for designing a MISSION are offered. This thesis is intended for an audience of health care communication and information systems professionals who can help put a MISSION into action through working with health care providers and organizations

Exercise, Cognition, and the Aging Process among Active, Competitive, and Sedentary Middle-Aged and Older Adults

Purpose This study aimed to compare the cognitive measures of reaction time and dual-task performance among recreationally active, master athletes, and sedentary older adults aged 50 years or older. Methods 59 late middle-aged and older adults between the ages of 50 to 88 years old participated in reaction time and dual-task tests of which consisted of multiple trials on the same day. Subjects were placed either into the recreationally active, masters athlete, or sedentary activity level group based on the Rapid Assessment of Physical Activity (RAPA) form. For the gait speed with associated dual-task component, subjects walked 10-meters at two different speeds, either at habitual or fast-paced speed, while counting backward aloud by threes. For both the simple and choice reaction time tests, subjects responded by touching the MoART board when they saw a light appear. Both simple and choice reaction time was measured. They completed three sets of ten trials for each test and the average of the 30 trials was recorded. Results One-way ANOVA indicated no statistical differences between activity groups for simple reaction time time (p= .09) and for choice reaction time (p= .14). The scores showed a trend toward clinical relevance between the sedentary and masters athlete groups (p= .41) and between the recreationally active and masters athlete group (p= .08). For the dual-task assessment, one-way ANOVA analysis indicated no statistically significant difference in habitual dual-task decrement speed (p= .10) or fast dual-task decrement speed (p= .10) between activity groups. However, when comparing sedentary individuals to recreationally active, there is less of a difference in habitual dual-task decrement speed (p= .36) than when comparing sedentary individuals to masters athletes (p = .12). When comparing sedentary individuals to recreationally active, there is also less of a difference in fast dual-task decrement speed (p= .28) than when comparing sedentary individuals to masters athletes (p= .13). Conclusion The results of this study indicate that there are no significant differences among the activity groups (masters athletes, recreationally active, sedentary) when comparing cognitive measures (reaction time and dual-task performance). Although there was no statistical significance, the results indicate that there would be more significant trends if there were either a larger population size or a better way of indicating the subject’s current activity level. Knowing that there were trends toward clinical relevance, this study suggests that exercise has a positive influence on cognitive measures such as reaction time and dual-task performance. Throughout the aging process, cognitive ability declines and thus is detrimental among the elderly as it results in a greater risk for falls. Measures to prolong this decline, such as implementing an exercise program, are vital in order to improve quality of life and encourage a life of independence among the elderly

Oersted Medal Lecture 2007: Interactive simulations for teaching physics: What works, what doesn't, and why

We give an overview of the Physics Educational Technology (PhET) project to research and develop web-based interactive simulations for teaching and learning physics. The design philosophy, simulation development and testing process, and range of available simulations are described. The highlights of PhET research on simulation design and effectiveness in a variety of educational settings are provided. This work has shown that a well-designed interactive simulation can be an engaging and effective tool for learning physics