Linking nursing pain assessment, decisionmaking and documentation.

A clinical nurse specialist’s (CNS) experience in the development and implementation of a pain assessment and treatment flowsheet (PATF) to enhance the nursing assessment, decision-making, and documentation of pain on a palliative care unit in a community hospital is described in this article. Members of the palliative care interdisciplinary team use the PATF for clinical decision-making in the day-to-day management of patients’ pain. The PATF is undergoing revision and re-implementation to promote the utilization of the tool beyond the specialty of palliative care and into the general patient population

Design and introduction of a quality of life assessment and practice support system: perspectives from palliative care settings

Background: Quality of life (QOL) assessment instruments, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are increasingly promoted as a means of enabling clinicians to enhance person-centered care. However, integration of these instruments into palliative care clinical practice has been inconsistent. This study focused on the design of an electronic Quality of Life and Practice Support System (QPSS) prototype and its initial use in palliative inpatient and home care settings. Our objectives were to ascertain desired features of a QPSS prototype and the experiences of clinicians, patients, and family caregivers in regard to the initial introduction of a QPSS in palliative care, interpreting them in context. Methods: We applied an integrated knowledge translation approach in two stages by engaging a total of 71 clinicians, 18 patients, and 17 family caregivers in palliative inpatient and home care settings. Data for Stage I were collected via 12 focus groups with clinicians to ascertain desirable features of a QPSS. Stage II involved 5 focus groups and 24 interviews with clinicians and 35 interviews with patients or family caregivers during initial implementation of a QPSS. The focus groups and interviews were recorded, transcribed, and analyzed using the qualitative methodology of interpretive description. Results: Desirable features focused on hardware (lightweight, durable, and easy to disinfect), software (simple, user-friendly interface, multi-linguistic, integration with e-health systems), and choice of assessment instruments that would facilitate a holistic assessment. Although patient and family caregiver participants were predominantly enthusiastic, clinicians expressed a mixture of enthusiasm, receptivity, and concern regarding the use of a QPSS. The analyses revealed important contextual considerations, including: (a) logistical, technical, and aesthetic considerations regarding the QPSS as a technology, (b) diversity in knowledge, skills, and attitudes of clinicians, patients, and family caregivers regarding the integration of electronic QOL assessments in care, and (c) the need to understand organizational context and priorities in using QOL assessment data. Conclusion: The process of designing and integrating a QPSS in palliative care for patients with life-limiting conditions and their family caregivers is complex and requires extensive consultation with clinicians, administrators, patients, and family caregivers to inform successful implementation

Improving End-of-Life Communication and Decision Making: The Development of a Conceptual Framework and Quality Indicators

AbstractContextThe goal of end-of-life (EOL) communication and decision making is to create a shared understanding about a person’s values and treatment preferences that will lead to a plan of care that is consistent with these values and preferences. Improvements in communication and decision making at the EOL have been identified as a high priority from a patient and family point of view.ObjectivesThe purpose of this study was to develop quality indicators related to EOL communication and decision making.MethodsWe convened a multidisciplinary panel of experts to develop definitions, a conceptual framework of EOL communication and decision making, and quality indicators using a modified Delphi method. We generated a list of potential items based on literature review and input from panel members. Panel members rated the items using a seven-point Likert scale (1 = very little importance to 7 = extremely important) over four rounds of review until consensus was achieved.ResultsAbout 24 of the 28 panel members participated in all four rounds of the Delphi process. The final list of quality indicators comprised 34 items, divided into the four categories of our conceptual framework: Advance care planning (eight items), Goals of care discussions (13 items), Documentation (five items), and Organization/System aspects (eight items). Eleven items were rated “extremely important” (median score). All items had a median score of five (moderately important) or greater.ConclusionWe have developed definitions, a conceptual framework, and quality indicators that researchers and health care decision makers can use to evaluate and improve the quality of EOL communication and decision making

Linking nursing pain assessment, decision-making and documentation

A clinical nurse specialist's (CNS) experience in the development and implementation of a pain assessment and treatment flowsheet (PATF) to enhance the nursing assessment, decision-making, and documentation of pain on a palliative care unit in a community hospital is described in this article. Members of the palliative care interdisciplinary team use the PATF for clinical decision-making in the day-to-day management of patients' pain. The PATF is undergoing revision and re-implementation to promote the utilization of the tool beyond the specialty of palliative care and into the general patient population

Prix de conférence à la mémoire de Helene Hudson : L’adoption d’une approche « en amont » dans les soins aux patients mourant du cancer : les mérites d’une approche palliative

Les progrès au niveau de la technologie et des pharmacothérapies font en sorte que les patients atteints de cancers malins vivent plus longtemps qu’auparavant. Cependant, la plupart d’entre eux sont loin d’atteindre l’espérance de vie de la population générale. L’adoption d’une « approche palliative » est une innovation qui pourrait promouvoir à la fois une meilleure planification de fin de vie et la fourniture de soins de meilleure qualité en fin de vie. Pourtant, dans une bonne partie du monde occidental, cette orientation en amont est rare. La tendance à dispenser des soins palliatifs tard dans la trajectoire de la maladie a entraîné de nombreuses difficultés au niveau des soins prodigués aux personnes atteintes d’un cancer avancé. Cet article décrit une initiative de recherche infirmière—l’iPANEL (Initiative pour une approche palliative en soins infirmiers : données probantes et leadership)—dont l’objectif est de générer des données probantes qui faciliteront l’intégration d’une approche palliative dans les soins aux personnes atteintes de conditions chroniques réduisant l’espérance de vie. Les infirmières en oncologie ont un rôle important à jouer dans la facilitation d’une approche palliative, puisqu’elles peuvent transformer les façons dont les patients atteints de cancer sont traités dans notre système de santé

Dying to Care: How can we provide sustainable quality care to persons living with advanced life limiting illness in British Columbia?

<p>Around the world, the oldest segment of the population is expected to grow the fastest. Within the OECD (Organisation for Economic Co-operation and Development) countries the population share of those 80 years and over is expected to increase from 4% in 2010 to 9.4% in 2050.1 As of July 1, 2010, seniors aged 65 years and over accounted for 14.1% of the Canadian population. Projections show that seniors could account for more than 20% of the population as soon as 2026 and could exceed 25% of the population by 2056. Seniors aged 80 years and over now represent 3.9% of the total Canadian population; the number of people over 80 residing in Canada by the year 2061 is projected to be 5.1 million. In addition, the fastest growing age groups within the 2009/2010 period were people aged 90 years and over.2</p> <p><br>As a consequence of the aging of our population, more people are living with advancing, chronic and life-limiting illness and often with multiple, interacting medical and social problems. At some point in this advancing illness trajectory, people die, and about 80% of these deaths will be caused by end stage chronic diseases such as cardiovascular, lung, and kidney disease, cancer, and dementias.3 In Western Canada, however, only 16% to 30% of people who die are identified as dying and receive palliative care services.4 The majority who access these services have cancer, a unique chronic disease as it can often be predicted when the end of life may be approaching. This is not the case with most chronic diseases. Consequently, most individuals with  advancing chronic life-limiting conditions such as heart disease, chronic obstructive pulmonary disease, kidney disease and dementias, do not access palliative care services but dwell “in the indistinct zone of chronic illness that has no specific care delivery system”. 5</p> <p><br>While specialist palliative care services are critical for those with complex care needs, such a model, alone, cannot meet current and future demand for the larger population outside of the traditional recipients of cancer care. The result is that many people who require and would benefit from a palliative approach are not served by specialized palliative care. Historically, these specialized models were not developed for those with advancing chronic non-malignant disease and such models are neither feasible nor desirable for the larger numbers affected by and dying from chronic illness.</p

Conceptual foundations of a palliative approach: a knowledge synthesis

Background: Much of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A “palliative approach” has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care. The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity. Methods We conducted a knowledge synthesis of empirical peer-reviewed literature. Search terms pertaining to “palliative care” and “chronic life-limiting conditions” were identified. A comprehensive database search of 11 research databases for the intersection of these terms yielded 190,204 documents. A subsequent computer-assisted approach using statistical predictive classification methods was used to identify relevant documents, resulting in a final yield of 91 studies. Narrative synthesis methods and thematic analysis were used to then identify and conceptualize key characteristics of a palliative approach. Results The following three overarching themes were conceptualized to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care. Conclusion Our findings provide much needed conceptual clarity regarding a palliative approach. Such clarity is of fundamental importance for the development of healthcare systems that facilitate the integration of a palliative approach in the care of people who have chronic life-limiting conditions.Applied Science, Faculty ofHealth and Social Development, Faculty of (Okanagan)Non UBCNursing, School ofNursing, School of (Okanagan)ReviewedFacult

Multidrug-resistant gonorrhea: A research and development roadmap to discover new medicines.

Emilie Alirol and colleagues discuss the development of new treatments for gonorrhea

Violent Police-Citizen Encounters: An Analysis of Major Newspaper Accounts

This paper investigates trends in police brutality using data found through the Lexis/Nexis system. Using the keywords police brutality, 15 newspapers classified as major papers by the Lexis/Nexis service were searched for descriptions of incidents of police misconduct against citizens that appeared from January 1, 1990 to May 31, 1992. One hundred and thirty distinct incidents of police brutality were analyzed based on the race and gender of the officers and of the victim, as well as issues of socioeconomic class. The situational characteristics surrounding the alleged assault were categorized and discussed. Minority citizens were involved in the vast majority of the incidents. The data also suggested a definite lack of penalties against the officers involved in abusive actions against citizens. Further, a citizen was equally likely to be assaulted for a disrespectful attitude towards a law enforcement officer than if the citizen had posed a serious bodily threat to the officer or another human being