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Improving The Reach And Effectiveness Of Palliative Care In Low-Resource Countries, Maryellen Potts

MUSC Theses and Dissertations

Purpose: The purpose of this compendium is to identify strategies to extend the reach and effectiveness of palliative care in low resource countries by 1) examining palliative care interventions, outcomes, and outcome measures, 2) evaluating a home-based palliative care program in rural India, and 3) exploring the concept of acceptability of rural medical practitioners in rural India. Problem: Limited access to effective palliative care services remains an urgent global concern for the over 19 million people requiring palliative care, the majority of whom live in low resource countries. An accompanying lack of research into palliative care interventions in resource-poor areas …

Exergame Grading Scheme: Concept Development And Preliminary Psychometric Evaluations In Cancer Survivors, Hsiao-Lan Wang, Chiung-Ju Liu, Marcus Kilpatrick, Heather Jim, Susan Mcmillan, Nisha Vijayakumar, Sally Mcdonald, Tapan Padhya, Jeffery Russell, Karen Vondruska, Constance Visovsky

Nursing Faculty Publications

The challenge of using exergames to promote physical activity among cancer survivors lies in the selection of the exergames that match their fitness level. There is a need for a standardized grading scheme by which to judge an exergame’s capacity to address specific physical fitness attributes with different levels of physical engagement. The study aimed to develop an Exergame Grading Scheme and preliminarily evaluate its psychometric properties. Fourteen (14) items were created from the human movement and exergame literature. The content validity index (CVI) was rated by content experts with two consecutive rounds ( and independently). The interrater reliability (IRR) …

Unbefriended And Unrepresented: Better Medical Decision Making For Incapacitated Patients Without Healthcare Surrogates, Thaddeus Pope

Faculty Scholarship

How should we make medical decisions for incapacitated patients who have no available legally-authorized surrogate decision maker? Because these patients lack decision making capacity, they cannot authorize treatment themselves. Because they lack a surrogate, nobody else can authorize treatment either. Clinicians and researchers have referred to these individuals as “adult orphans” or as “unbefriended,” “isolated,” or “unrepresented” patients. Clinicians and researchers have also described them as “unimaginably helpless,” “highly vulnerable,” and as the “most vulnerable,” because “no one cares deeply if they live or die.”

The persistent challenges involved in obtaining consent for medical treatment on behalf of these individuals …

An Ethical Argument For A Specific Model Of Palliative Care In Nigeria, Dozie Egbe

Electronic Theses and Dissertations

The need for palliative care in Nigeria is huge. But Nigeria has minimal palliative care activity that does not correspond to the great palliative care needs in the country. The great needs are heightened by poverty and poverty induced conditions. However, Nigeria has untapped sociocultural values that can boast palliative care in the country. Such values can be activated and constructively integrated in the practice of palliative care in Nigeria.

This project looks back to what palliative care has been in history and in developed nations to argue for a constructive and positive manner palliative care can evolve in Nigeria …

End The Patient’S Pain Instead Of The Patient: Focusing On Palliative Care Simultaneously With The Rise Of Legalized Physician-Assisted Suicide, Sheena Shah

Student Works

No abstract provided.

A Systematic Review - The Effect Of Hospice And Palliative Care, Justin M. Brown, David J. Havener, Jeffrey T. Byrne

Williams Honors College, Honors Research Projects

Many older adults nearing death experience unnecessarily invasive and costly healthcare treatments, often causing more harm than good. Hospice and palliative care interventions offer a possible solution to this problem by prioritizing high-quality and cost-effective care with a strong focus on comfort and satisfaction. The authors of this paper seek to answer the following question: Do hospice and palliative care interventions directed toward older adults at the end of life improve quality of life, cost of care, and satisfaction? This paper thoroughly reviews and critically appraises existing research related to the effect of hospice and palliative care directed toward older …

Mhealth In Palliative Care For Cancer Patients & Care Givers, Newton Andebe, Peter Waiganjo, John Weru

Internal Medicine, East Africa

Patients and caregivers in palliative care experience multidimensional pain. In current practice, information about a cancer patient progress is known when they visit a clinic or make a distress call when their conditions worsen. This strategy is not efficient for systematic monitoring of symptoms, which is key in improving palliative care. Mobile phones have helped to transform healthcare through diagnosis, health education and symptoms management of chronic illnesses. In this study, a mobile phone assessment tool was implemented at an outpatient palliative care clinic for cancer patients in Aga Khan University Hospital, Nairobi. The usefulness of the mobile phone application …

Managing 'Shades Of Grey': A Focus Group Study Exploring Community-Dwellers’ Views On Advance Care Planning In Older People, N Michael, C O'Callaghan, E Sayers

Medical Papers and Journal Articles

Background: Community-dwelling consumers of healthcare are increasing, many aging with life-limiting conditions and deteriorating cognition. However, few have had advance care planning discussions or completed documentation to ensure future care preferences are acted upon. This study examines the awareness, attitudes, and experiences of advance care planning amongst older people and unrelated offspring/caregivers of older people residing in the community.

Methods: Qualitative descriptive research, which included focus groups with older people (55+ years) and older people’s offspring/caregivers living in an Australian city and surrounding rural region. Data was analysed using an inductive and comparative approach. Sampling was both convenience and purposive. …

“Life Within The Person Comes To The Fore”: Pastoral Workers’ Practice Wisdom On Using Arts In Palliative Care, Clare O'Callaghan, Libby Byrne, Eleni Cokalis, David Glenister, Margaret Santilli, Rose Clark, Therese Mccarthy, Natasha Michael

Medical Papers and Journal Articles

Background: Pastoral care (also chaplaincy, spiritual care) assists people to find meaning, personal resources, and connection with self, others, and/or a higher power. Although essential in palliative care, there remains limited examination of what pastoral workers do. This study examined how pastoral workers use and consider the usefulness of art-based modalities.

Methods: Qualitative research was used to examine the practice wisdom (tacit practice knowledge) of pastoral workers experienced in using visual arts and music in palliative care. Two focus groups were conducted. Thematic analysis was informed by grounded theory.

Results: Six pastoral workers shared information. Three themes emerged. First, pastoral …

The Rhetoric Of Hospitality: Conditions Of Death In America, Margaret Anne Callahan

LSU Doctoral Dissertations

The Right of Hospitality: Conditions of Death in America calls Western biomedicine’s approach to death into question. Death unifies all human experiences and is always possible, despite the human tendency to deny its existence and, instead, orient the self towards a futurity that is always out of reach. This project investigates the structures influencing how death in America occurs, and traces the roots of Western culture’s rejection of death to the execution by hemlock of Socrates’ immortalized in the Phaedo. Western biomedicine’s institutionalization of medicine requires that both patients and doctors enter into imbalanced hospitable relationships, and these pressures, along …

Gaps In Pain Management In Assisted Living, Pamela G. Wisor

DNP and Student Works

Assisted living (AL) is a growing lifestyle choice option available to the ailing aged in the United States. Increases in chronic disease may predispose this population to acute and chronic pain due to increased longevity with medical advances. The elderly populations in these facilities are frail with multiple chronic illnesses and cognitive and/or functional impairment adding to the difficulty in effective pain management practices. The burden of providing pain management in AL is on the nursing assistant whose education and scope of practice may not include performing pain assessment that impact resident quality of life and outcomes. Continuing education in …

Family Communication Concerning End-Of-Life Care Preferences, Lindsay Jo Peterson

USF Tampa Graduate Theses and Dissertations

Communication concerning the care one wishes to receive at the end of life (EOL) is central to ensuring that wishes are honored. Many studies have examined doctor-patient or doctor-family EOL communication. However, relatively few studies have focused on the occurrence of EOL care discussions among family members. This is an important topic, as research suggests that advance directives (ADs) are ineffective if patients have not involved surrogate decision-makers, most of whom are family members. This study examined EOL care discussions among family members. It used quantitative and qualitative data from a diverse sample of older adults from West Central Florida …

The Perception For Good Death Of Community Dwelling Japanese And Thailand Respondents, Michiyo Ando, Supawadee Somchit, Mitsunori Miyashita, Laiad Jamjan

Asian/Pacific Island Nursing Journal

Having a “good death” is a very important goal of palliative care, and it is useful for nurses to understand cultural differences in the perception of a good death to propose nursing care. The purpose of this study was to compare the perception of a “good death” among community-dwelling Japanese and Thai people. Three hundred sixty-nine respondents completed the Good Death Questionnaire. The research design was a cross-sectional study. The scores of the Japanese respondents on “good relationships with medical staff,” “being respected as an individual,” and “fighting against cancer” were higher among Thai respondents. On the other hand, “environmental …

Gw Nursing, Fall 2016, George Washington University, School Of Nursing

GW Nursing Magazine

No abstract provided.

Cross-Cultural Dynamics In Palliative Care: The Emerging Canadian Scenario, Chidi Oguamanam

Dalhousie Law Journal

As modern technologies leverage medical sciences, life expectancy is on the rise in Canada, and indeed globally with a remarkable increase in the elderly population in need of health care. The same is true of the diversity of cultural groups who are now patrons and stakeholders in Canada's health care landscape. An emergent feature ofthis landscape is the complexity ofcontexts for negotiating and mediating medical care delivery at the end of life. This paper examines the gaps in regulatory and legal interventions as well as the gaps and opportunities to negotiate the transition to palliative care in cross-cultural contexts that …

Exploring The Relationship Between And Among Registered Nurses' Spiritual Well-Being, Spiritual Care Perspectives, And Their Provision Of Spiritual Care In Acute Care Settings, Barbara J. Kitchener

Seton Hall University Dissertations and Theses (ETDs)

Abstract

Despite acknowledgment that spiritual care is an essential aspect of holistic nursing care, nurses often feel ill-prepared for, uncomfortable with, and uncertain about providing spiritual care. Studies have indicated that nurses who have a strong sense of their own spiritual well-being and/or a positive perspective [attitude, value, belief] about spiritual care are more inclined to provide spiritual care to their patients. However there is a scarcity of such studies among acute care nurses. This descriptive correlational study aimed to explore relationships between and among acute care nurses’ spiritual well-being (SWB), spiritual care perspectives (SCP), and their provision of spiritual …

Palliative And Supportive Care In Turkey: Literature Review And Current Status Of Research, Imatullah Akyar

International Nursing Research Congress (INRC)

Session presented on Sunday, July 24, 2016:

Purpose: The aim of this study was to examine the current literature on palliative and supportive care in Turkey, discuss current status and future research areas.

Methods: This study was conducted as a literature review. Literature review focused on palliative and supportive care studies done in Turkey. PubMed and Turkish National databases through Turkish Academic Network and Information Center were searched in 12-16 October 2015 with keywords 'Turkey/Turkish', 'palliative care', 'supportive care'. All hits including palliative and supportive care papers from Turkey written either in English or Turkish were included whereas letters to …

Los Baños Times, Vol. 36, No. 7, College Of Development Communication, University Of The Philippines Los Baños

Los Baños Times

No abstract provided.

Multi-Symptom Management In Hospice Patients During End-Of-Life Transition, Ashley N. B. Sirianni

Theses and Dissertations

The purpose of this quality improvement project is to compare the provider’s perception following an educational model of using single symptom management versus multi-symptom management during the end-of-life transition in adult patients for improved quality of life outcomes. The appraised evidence indicates that it is critical to have anticipatory medications at the patient’s residence to manage multiple symptoms rather than focusing exclusively on a single symptom management such as pain management. In February 2016, the author conducted an educational model among hospice providers for increasing knowledge and awareness of multi-symptom management. Thirty (n = 30) Clinical Nursing Directors, Licensed Practical …

Perceptions Of Hospice Among Social Work Students: The Influences Of Sociodemographic Factors, Delia Vanessa Valenzuela

Electronic Theses, Projects, and Dissertations

The older adult population is rapidly growing along with the use and continued need for hospice care services. Due to these circumstances there is on ongoing demand for experienced and knowledgeable social workers to meet the unique needs of this population. Research in this study indicates that social workers currently working in the hospice field do not feel adequately prepared to work with dying and bereaved patients. Furthermore, research shows a lack of education within social programs and social work textbooks regarding the subject of end of life care. The purpose of this study was to gain a better understanding …

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At Akuhn, Stephen Omondi Otieno

Master of Medicine in Internal Medicine

Background: An advance directive is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves, and which is then used to guide decisions on life-sustaining treatment in the event that they become incapacitated. Advance directives can take one of four forms: a living will, a limitation of care document, a do-not-resuscitate order, and an appointment of a surrogate by durable power of attorney. The completion rate of advance directives varies from region to region, and it is influenced by different patient, caregiver, legal, institutional, cultural, and religious factors. …

Describing The End Of Life Knowledge, Beliefs, And Preferences Of Alaska Native And American Indian Peoples, Colleen Marie Kelley

Theses and Dissertations

This dissertation is comprised of three manuscripts that will be submitted for publication, describing the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The first manuscript is a literature review that examines what is known about the understanding about the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The second manuscript offers results of an exploratory descriptive study designed to describe the end of life knowledge of hospice care services, beliefs about dying, and preferences for end of life care of Alaska Native and American Indian Peoples. Finally, …

Avera's Journey Utilizing Big Data & Analytics To Understand Population Health In South Dakota, Preston Renshaw

South Dakota Demography Conference

No abstract provided.

The Development Of A New Model For Assessing African-American Spirituality In Palliative Care, John C. Welch

Electronic Theses and Dissertations

Research has shown that African-Americans are least likely to receive adequate palliative interventions leading to concerns about the quality of health care in general and palliative care in particular for this population. Acknowledging patient preferences are essential in administering quality health care especially when a patient's condition is terminal. But when African-Americans are least likely to complete living wills or durable power of attorneys for health care and more likely to continue to request life sustaining treatments when near death, conflicts between patients and medical professionals can result.

Recognizing patient spirituality and addressing their spiritual needs can help the patient, …

Rekindling The Passion For Nursing, Susan M. Cannon

Nursing Theses and Capstone Projects

Nurses often experience compassion fatigue and burnout when working in stressful environments. Nurses tend to put the needs of their patients above their own needs. It is imperative for the work environment to promote relaxation and restoration, to avert compassion fatigue and nursing burnout. All employees of the project director’s organization were encouraged to attend Caring for the Caregiver Day, a hospital-sponsored event which provided education and promoted self-help interventions aimed to decrease compassion fatigue and burnout. The event included aromatherapy, music therapy, art therapy, pet therapy, massage therapy, and education on compassion fatigue for nurses. In addition, the Progressive …

Chronic Pain Management With Opioids: An Assessment Of Alaska Nurse Practitioner Practices, Stephanie Klein

Student Projects for Graduate Degrees

The purpose of this project was to determine chronic opioid pain management practices of Alaskan Nurse Practitioners (NPs) in primary care, compare them to best practices, and describe perceived barriers to evidence-based guideline use. Participants included NPs in Alaska who work in primary care and currently have an active Alaska NP license and Alaska mailing address. This project answered the questions of to what extent primary care NP practices are consistent with current Federation of State Medical Boards (2013) guidelines when managing chronic non-cancer pain with opioid therapy as well as identified the perceived barriers to guideline use. A cross …

Impact Of Nursing Interventions On Positive Confusion Assessment Method (Cam) Scores, Katie Halsell

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Delirium occurs in patients of all ages, especially in the older adult population. Symptoms vary from patient to patient, and delirium is often misdiagnosed. Patients with delirium have a higher cost of care and a longer length of stay in the hospital. Delirium is a stressful event for both the nurse and the patient, resulting in poor patient outcomes. The Confusion Assessment Method (CAM) tool is used to diagnose delirium in confused patients; a positive CAM score indicates delirium. Nursing interventions are used to treat delirium. Interventions used range from non-pharmacologic measures to use of pharmacological measures and restraints. This …

Spiritual Frameworks In Pediatric Palliative Care: Understanding Parental Decision-Making, Lindy Grief Davidson

USF Tampa Graduate Theses and Dissertations

Parents of seriously ill children are charged with making complicated medical decisions, and many of those decisions are made during their children’s hospitalizations. As medical staff seek to support parents, it is important for them to understand what resources parents are drawing upon for decision-making. This project explored parental decision-making by examining the following research questions: RQ1: What resources do parents draw upon to make medical decisions for their seriously ill children? RQ2: How do parents enact their spiritual or religious frameworks in clinical settings when faced with medical decisions for their seriously ill children? Methods of research included ethnographic …

Bringing ‘Something More’ To The Bedside: The Importance Of Clinical Wisdom At End Of Life, M Coombs, W Ayley, J Pickthorne, P Larkin

School of Nursing and Midwifery

Knowing what to do and what to say at end of life can be challenging. There is much that we, and others, bring to this liminal space where people move from life to death; there is much to consider for anyone who works with, and cares for those who are dying. No matter how experienced we are, nor how long we have been practising, we will never come to a point where we have encountered all of the countless different care situations at end of life where complex needs of patients are to be met. We will never contend with …

Cultural Relevancy Of Palliative And End-Of-Life Care: Conversations With Indigenous Elders, Mary J. Isaacson

Biennial Convention (CONV)

Session presented on Monday, November 9, 2015:

Purpose: Access to palliative and end-of-life (EOL) care is severely limited for South Dakota (SD) Native American/American Indians [NA/AI] (Isaacson et al., 2014), which is of significant concern given their high morbidity and mortality rates (SD Vital Statistics Report, 2012). Palliative care professionals and NA/AI healthcare providers identify funding, infrastructure, and misperceptions specific to the NA/AI population and palliative/EOL care as barriers to access (Isaacson et al., 2014). Addressing these barriers and feasibility concerns must occur by bringing together key individuals and include persons receptive to the voices and concerns of NA/AIs residing …