bluuebunny/crossref_metadata_2025_split huggingface dataset:
Group supervision to support competency development in palliative care in Norway
Authors: Landmark Bjørg , Wahl Astrid K , Bøhler Ann 
Published: May 2014

Aim To develop and evaluate a model of supervision created to provide continuous support throughout a 2-year postgraduate education programme. Methods Twenty five students attending the first 2-year postgraduate course in palliative care at the University College, Buskerud, Norway took part in a prospective study. A questionnaire was administered on five occasions: on commencement of studies, after 6 months, 12 months, 18 months and at the end of the programme. Student statements were analysed using methods of qualitative content analysis. Results Students’ appreciation of the value of supervision increased from the first to the last recording. Reflection and dynamic dialogue during group supervision were reported to be well-suited as methods of support in the development of insight into palliative care, integration of theory and practice, and development of skills. Conclusion Students stated that supervision confirmed knowledge, gave meaning and increased self-awareness in palliative care.
Exploring district nurses’ experience of a hospice at home service
Authors: Sullivan Kate A , McLaughlin Dorry , Hasson Felicity 
Published: May 2014

Background Hospice at home (HAH) services complement the role of the district nursing team, providing 24-hour palliative home care. However, little is known about district nurses’ experience or perceptions of working alongside the HAH service. Aim This study surveyed a representative sample of district nurses (DNs) to ascertain their experience of working alongside a HAH service. Method A self-completed postal questionnaire comprised of 14 items was distributed to 128 DNs. Results The evaluation found significant levels of satisfaction. All respondents indicated that they would refer a patient to the service again. However, the need for improved communication and increased awareness among DNs about the HAH service were also identified. Conclusion The findings support the idea that a HAH service can enable patients with advanced progressive disease to be cared for at home. While the findings of this study cannot be generalized, they add to the growing body of research about HAH services in palliative care.
Supportive and palliative care needs identified by multiple sclerosis patients and their families
Authors: Wollin Judy Ann , Yates Patsy M , Kristjanson Linda J 
Published: May 2014

Aim: To identify the supportive needs of individuals with multiple sclerosis (MS) and their families. Design, Sample and Method: In-depth interviews were carried out with people living with MS in the community, their family members and health professionals. The data were transcribed verbatim and recurring themes identified. Findings: The analysis of interviews revealed four themes: disbelief and devastation; losses and forced life choices; tracking down services and information; and sadness and relief. Conclusion: Given the duration, range of symptoms and distress often associated with MS, the findings of this research raise the important question of the role of palliative services in supporting the person with MS and his/her family.
Palliative care nurses’ perceptions of the Edmonton Symptom Assessment Scale: a pilot survey
Authors: Watanabe Sharon , McKinnon Sandra , Macmillan Karen , Hanson John 
Published: May 2014

Aim To evaluate, at a pilot level, palliative care nurses’ perceptions of the Edmonton Symptom Assessment Scale’s (ESAS’s) feasibility and usefulness. Methods All nurses working within the Edmonton Palliative Care Programme were provided with a one-page document containing five statements about the benefits and feasibility of the ESAS, and invited to rate each statement on a five-point Likert scale (1=strongly agree; 5=strongly disagree). Results Of the 74 nursing staff employed in the programme, 48 (64.9%) chose to participate in this study. Perceptions of the ESAS were most favourable among the 22 registered nurses: 21 (95.4%) believed the ESAS helped staff care for patients; and 17 (77.3%) believed patients benefited from implementation of the instrument. Most registered nurses found that the ESAS took little time and effort to complete. Licensed practical nurses and nursing attendants had a less favourable perception of the ESAS. Conclusion The results of this pilot study demonstrate that palliative care nurses’ perceptions of the ESAS are favourable generally, although they vary according to level of professional training. A full-scale study will be necessary to attain a more in-depth evaluation.
Development of a peer education programme for advance end-of-life care planning
Authors: Sanders Caroline , Seymour Jane , Clarke Amanda , Gott Merryn , Welton Maddie 
Published: May 2014

Aim: To develop and evaluate an education programme to help older people find out about treatment and care choices at the end of life. Design: An action research approach was used to develop an education booklet about end-of-life care. A programme of qualitative evaluation ran alongside the project. It comprised a combination of methods, including face-to-face and telephone interviews and questionnaires with those who took part in the small group discussions. Sample: The research team consisted of five academic researchers and eight people recruited from voluntary groups representing older adults to act as community advisors in developing the programme. The booklet was tested in small group discussions with members of the general public. Five community advisors volunteered to act as ‘peer educators’ and helped to lead the small group discussions after receiving a 3-day training course to prepare them for their role. The project took place in Sheffield. Results: The education discussions and the related booklet were perceived as acceptable in providing information about a sensitive issue. Peer educators felt that the training course prepared them well. Community advisors felt that they were treated as equal members of the research team. This project has served as a useful pilot study of the education programme that has now been extended to other areas of the UK.
Barriers to implementing an integrated care pathway for the last days of life in nursing homes
Authors: Watson Julie , Hockley Jo , Dewar Belinda 
Published: May 2014

Aim: This paper explores the barriers that needed to be overcome during the process of implementing an integrated care pathway for the last days of life as a way of developing quality end-of-life care in nursing homes. Methods: An action research methodology underpinned the study. Qualitative and quantitative data were collected in eight nursing homes before, during and after the implementation of the care pathway. Findings: Six main barriers were identified: a lack of knowledge of palliative care drugs and control of symptoms at the end of life; lack of preparation for approaching death; not knowing when someone is dying or understanding the dying process; lack of multidisciplinary team working in nursing homes; lack of confidence in communicating about dying; some nursing homes are not ready or able to change. These findings highlight a functional ‘rehabilitative’ culture that may not be so appropriate in the current context of nursing home care, and one that makes implementing an integrated care pathway for the last days of life less straightforward than in other settings. Conclusion: It cannot be presumed that the implementation of a care pathway for the last days of life in nursing homes is straightforward. This study suggests that an action research framework was extremely useful in highlighting and overcoming some obstacles when developing evidence-based practice. Action at both local and public policy level is required to fully address barriers that prevent quality end-of-life care in nursing homes.
The Liverpool Care Pathway in hospices: an exploratory study of doctor and nurse perceptions
Authors: Gambles Maureen , Stirzaker Susan , Jack Barbara A , Ellershaw John F 
Published: May 2014

Background: The Liverpool Care of the Dying Pathway (LCP) was developed to transfer the hospice model of care into other care settings. It is a multiprofessional document providing an evidence- based framework for the dying phase. Widely used in hospitals it has now been adopted for use in hospices. Method: A qualitative study exploring hospice doctors’ and nurses’ perceptions of the impact of the LCP using semi-structured interviews of a purposive sample were undertaken in a 30 bed hospice in the north-west of England. Data was thematically analysed for emerging themes. Results and Discussion: Eleven interviews were undertaken (eight nurses, three doctors). The results suggest that despite some initial scepticism the LCP has a valuable place in the hospice setting according to the doctors and nurses sampled. Alongside the potential for use in audit and research, perceived benefits include improving documentation, promoting continuity of care and enhancing communication and the care of relatives. Maintaining ongoing education and feedback on the use of the document were highlighted as important mechanisms for ensuring that the delivery of care remained optimum.
Is a STAS-based tool valid to triage patients at a specialist palliative care inpatient unit?
Authors: JY Fergus Cameron , S Nicol Jacqueline , B Russell Papiya 
Published: May 2014

Many tools exist to assess the symptoms and needs of palliative care patients, but no tool has been validated to prioritise patients referred for specialist inpatient palliative care. The aim of this study was to produce and validate such a tool. A prospective pilot study produced a Support Team Assessment Schedule- (STAS-) based tool – the Admission Assessment Tool (AAT) – and compared this with the existing system of triage at the Marie Curie Hospice, Edinburgh. Validity of the tool was not confirmed and the tool was modified and re-evaluated. One hundred and twenty-seven consecutive patients referred to the hospice received three AAT scores: from the bed manager; the admitting doctor; and the admitting nurse. The hospice’s multidisciplinary team assessed the urgency of each patient’s admission. The overall correct classification rate was approximately two thirds, but false positive rates were high and there was poor inter-rater correlation. It is concluded the AAT has not been validated.
Health-promoting conversations about hope and suffering with couples in palliative care
Authors: Gunilla Eva , Saveman Britt-Inger 
Published: May 2014

Background: Families living with a dying relative face existential challenges which need to be met by caregivers in a dialogue. Aim: To describe couples’ experiences of participating in nurse-initiated health-promoting conversations about hope and suffering during home-based palliative care. Method: Data comprised semi-structured evaluative interviews with six couples. Each couple together had previously participated in three health-fostering conversations with nurses. Data were analyzed by content. Result: Talking with nurses about existential issues such as hope and suffering made couples feel that they were part of a trustful relationship, and that it was a healing experience. It gave them the opportunity to unburden themselves, as well as a way of learning and finding new strategies for managing daily life. Conclusion: Health-promoting conversations about hope and suffering should be implemented as a natural part of the caring relationship between caregivers and families in the palliative context.
Staff perceptions of the impact of the Liverpool Care Pathway in aged residential care in New Zealand
Authors: Clark Jean , Marshall Bridget , Sheward Karen , Allan Simon 
Published: May 2014

Aim: To determine staff perceptions of the impact of the Liverpool Care Pathway for the dying patient (LCP) in three aged residential care facilities in New Zealand. Methods: A mixed methodology approach was adopted, including the use of a survey, focus groups, and individual interviews. Findings: Fifteen of 194 staff participated in the focus groups (five nurses and nine health-care assistants). The interviewees included three GPs, one registered nurse, and one manager. The post-implementation survey response rate of 13% was poorer than the 32% response rate to a pre-implementation survey reported elsewhere. Nevertheless, there was congruence across the data sources. The participating staff perceived multiple benefits to residents, family, whãnau, and staff following implementation of the LCP. Conclusion: As a tool the LCP was effective in supporting, guiding, and prompting care delivery. However, challenges remained, particularly regarding environmental factors.
Factors influencing nurses' attitudes toward death
Authors: Gama Georgeana , Vieira Margarida , Barbosa Filipe 
Published: May 2014

Background: Studies on nurses' attitudes to caring for terminally ill patients indicate that death and dying create fears and anxieties for health-care providers. Aim: To identify nurses' most common attitudes toward death and the sociodemographic, professional, and training factors that significantly affect those attitudes. Method: This was a descriptive correlational study with a sample of 360 nurses from the internal medicine, oncology, hematology, and palliative care departments of five health institutions in Lisbon (response rate 70.6% of all nurses). Data were collected using a sociodemographic and professional questionnaire (QSDE) and the Portuguese versions of the Death Attitude Profile-Revised (DAP-R) scale and the Adult Attachment Scale (AAS). Results: Older nurses (P<0.0001) and nurses with more work experience (P<0.0001) had higher escape acceptance. Female nurses had higher religious acceptance (P<0.0001). Medicine, oncology, and hematology nurses had significantly higher fear attitudes (P<0.01), avoidance of death attitudes (P<0.0001), and escape acceptance attitudes (P<0.0002) than palliative care nurses. Conclusion: This study contributes to a better understanding of the factors that underlie nurses' attitudes toward death. This may be useful for creating relevant and effective pre- and post-graduate nursing training.
A retrospective pilot study to explore the timing of cessation of laxatives before death in a palliative care unit
Authors: Clark K , Hipwell A , Byfieldt N , Clark K 
Published: May 2014

Context: Constipation is common and sometimes distressing in palliative care patients. Laxatives are often prescribed, but there is little guidance as to the most appropriate time to cease these medications as death approaches. Objective: To conduct a retrospective pilot review of usual prescribing of laxatives toward the end of life in a specialist palliative care unit. Methods: The notes of all 92 inpatients who died over a 2-month period were reviewed, with the main outcomes of interest being the number and types of laxatives prescribed and the documentation of bowel movements in relation to time of death. Results: On admission 70% of the patients were receiving laxatives, with a mean of two different types per person. The mean number of days before death that people had a bowel movement recorded by nursing staff was 3.8 (standard deviation (SD) 3.55). No differences were identified between those who had not received laxatives at any point, those who received laxatives until death, and those who ceased laxatives at distinct time points. However, differences were found between those who were commenced on an end-of-life care pathway (mean 4.30 days; SD 3.84) and those who were not (mean 2.50 days; SD 2.31) (P=0.01). Conclusions: The correct timing for cessation of laxatives as death approaches remains unclear. Further work is needed to understand how bowel function changes with disease progression and the subjective experiences of patients.
Identifying and preventing ageism among health-care professionals
Authors: Weir Evelyn C 
Published: May 2014

Acknowledging, confronting and changing the current practice of age-based decision making and ageism in the provision of health care is a political priority and a topic of public and media interest. Health-care providers function in a society that may be considered to have ‘ageist roots’ and when an individual begins training in health care, he or she presents with his/her own acquired stereotypical imagery and beliefs. If these students are ‘ageist’ before they begin their training, then the training period must address this. This article considers the evolution of ageism and the influences from childhood and adult life that contribute to ageist behaviour. Using a wide range of literature from a variety of sources, the evidence of exposure to ageist behaviour in health-care education is reviewed and a series of strategies to reverse the trend are examined.
A study of occupational therapy interventions in oncology and palliative care
Authors: Cooper Jill , Littlechild Barbara 
Published: May 2014

The purpose of this study was to identify the variety of interventions carried out by occupational therapists in oncology and palliative care settings and the proportion of time spent in each of these. Data were recorded onto a daily sheet, itemizing 10-minute blocks of activity. Results showed the proportion of time spent by occupational therapists in direct and indirect patient activity as well as information on the range and ages of patients and diagnoses treated. The authors' conclusion confirms that a large proportion of occupational therapy time is dedicated to indirect and non-patient-related activities, reflecting the complex nature of this patient group. It also reflects the senior status of occupational therapists working in oncology and palliative care and their professional commitments of teaching other professions, caseload management, continuing professional development and contributions to current national agendas in oncology and palliative care. Different patient groups require different occupational therapy interventions and time allocation to meet their diverse functional requirements.
Clinical education in a nursing home setting: A structured framework for student learning
Authors: McCallum Christine 
Published: May 2014

Clinical education is a vital link in the development of entry-level competence for health professional students. A need exists, however, for quality clinical education experiences for students in nursing home settings. As the population ages and the number of patients recovering from acute illness increases, student exposure to the practice of physical therapy is required in this setting. This article introduces a three-tiered clinical education model for use by physical therapy students in a nursing home setting. Clinical, administrative and research skill development are highlighted. Integration of a variety of learning experiences across this spectrum helps students preparing for work in this environment after graduation.
Rehabilitative care in a specialist palliative day care centre: A study of patients’ perspectives
Authors: Belchamber CA , Gousy MH 
Published: May 2014

This qualitative study set out to explore cancer patients’ perceptions of a rehabilitative care approach, which they experienced in an independent specialist palliative day care centre. A phenomenological approach was chosen and through semistructured interviews, patients’ perceptions of their symptoms, beliefs and attitudes towards their rehabilitative care were explored. The relevance and benefits of the rehabilitative care approach were then identified using quality of life markers established during data analysis. The main factors uncovered and shown to contribute to the rehabilitation process were: environmental factors; participant interaction; normalization; health-care professional interaction; nutrition; mobilization; and education. However, more research is needed to understand how some of the treatment modalities discussed can help reduce fatigue, pain, dyspnoea and nausea in this group of people.
Exploring students' views of interprofessional education: 1year on
Authors: Johnson Ros 
Published: May 2014

The promotion of interprofessional education at a pre-qualifying level presents higher education institutes with complex cultural, organizational and education challenges. Research into students' experiences of these new learning environments is needed to ensure successful implementation. This study explores health- and social-care students' views of their second interprofessional module. Qualitative comments were collected from 67 Level 2 students and subjected to content analysis, and compared with the views of the same cohort after their first interprofessional module. The findings reveal both positive and negative experiences, relating to the quality of facilitation and group dynamics. Students were more comfortable with the enquiry-based learning approach than at level 1, but many were unable to relate the module to clinical practice and expressions of professional rivalry emerged.
Using standard office software in computer-assisted cognitive rehabilitation
Authors: Gunning Stephen , Clegg Frances 
Published: May 2014

Although specialized computer software for cognitive rehabilitation was initially welcomed, it has turned out to have limited value in functionally-based neurorehabilitation. The last 20 years have seen an exponential rise in the use of domestic computers, an increase in computer literacy and a wide availability of sophisticated yet user-friendly software. Most of the authors' patients at the Harrowbased Regional Rehabilitation Unit are now computer literate and have been found to prefer to reacquire their previous keyboard skills before developing new skills. All these skills can be relevant to everyday life or the workplace. Standard office software (as opposed to specialized software) offers these opportunities and additionally, provides great scope for assessing and compensating for many cognitive deficits. The flexibility of current software also means that therapeutic applications can be created around the user's needs, rather than expecting the user to adapt existing programmes. The authors have also found office software to be useful when working with patients who have impaired executive skills. This article details how the authors have developed the use of computers to play an important role in cognitive rehabilitation.
Identifying cognitive impairment and emotional distress in people admitted to stroke rehabilitation
Authors: Macniven Jamie AB , McKeown Alison C , Chambers Hannah M , Lincoln Nadina B 
Published: May 2014

The authors describe a local audit of cognitive and emotional difficulties for people admitted to a stroke rehabilitation service. In total, 19 people who had sustained a stroke participated. All participants were found to be impaired in one or more areas of cognitive functioning. Over 60% of participants scored within the significant range on measures of anxiety and/or depression. A high proportion of the audit data directly contradicted existing shared medical and multidisciplinary opinion of the emotional and cognitive status of the participants. The results are discussed in the context of recent national stroke guidelines from the British Psychological Society, the NHS and the Royal College of Physicians.
Advantages of low-cost mobility aids in health-care settings
Authors: Swain Jane , Jeffery Karen 
Published: May 2014

Rope bed ladders, hand blocks and transfer boards have been available for years in a number of health-care settings. They are recommended for clients with some mobility, who would otherwise need manual assistance, yet research indicates that they are an underused resource. This article sets out to promote awareness of these and similar ‘low-tech’ aids by identifying the advantages of promoting independence by equipping and educating clients to move themselves. The use of hand blocks, bed ladders, lifting poles (‘monkey poles’) and transfer boards are examined. The type of patients for whom they may be helpful, the assessment of the clients and contraindications are considered and recommendations are made for the provision of these aids.