| 1. |
- Thomas, Steve, et al.
(författare)
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Variation in resource allocation in urgent and emergency Care Systems in Ireland
- 2019
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Ingår i: BMC Health Services Research. - London, UK : BioMed Central. - 1472-6963. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland.Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county.Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions.Conclusions: This analysis advances the traditional approach of evaluating individual services or hospital resourcing. There are notable differences in utilisation of hospital-based emergency care resources at the regional level, indicating that populations within those regions which have been reconfigured have lower utilisation of hospital resources. There is a clear case for more integration in decision-making around funding and consideration of key principles, such as equity, to guide that process.
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| 2. |
- Brown, Hilary, et al.
(författare)
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Identifying care actions to conserve dignity in end-of-life care.
- 2011
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Ingår i: British Journal of Community Nursing. - : Mark Allen Group. - 1462-4753 .- 2052-2215. ; 16:5, s. 238-45
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Tidskriftsartikel (refereegranskat)abstract
- Community nurses have a central role in the provision of palliative and end-of-life care; helping people to die with dignity is an important component of this care. To conserve dignity, care should comprise a broad range of actions addressing the distress that might impact on the patient's sense of dignity. These care actions need to be defined. This study aims to suggest care actions that conserve dignity at the end of life based on evidence from local experience and community nursing practice. Data were collected by focus group interviews and analysed by framework analysis using the Chochinov model of dignity as a predefined framework. Suggestions on care actions were given in relation to all themes. As part of a multi-phase project developing and testing a dignity care pathway, this study might help community nurses to conserve dying patients' dignity.
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| 3. |
- Johnston, Bridget, et al.
(författare)
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An evaluation of the use of Telehealth within palliative care settings across Scotland
- 2012
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Ingår i: Palliative Medicine. - : SAGE Publications. - 0269-2163 .- 1477-030X. ; 26:2, s. 152-161
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of evidence-based research in the use of Telehealth within palliative care in the UK, particularly in Scotland. The aim of this project was to evaluate the current use of Telehealth applications within palliative care across Scotland, and how these and future applications are perceived by patients, carers and professionals. This paper reports on the qualitative findings from focus groups with patients and carers in three geographical areas in Scotland, and individual interviews with key stakeholders from across Scotland, who currently work within areas of high and low Telehealth activity. The key findings indicated that Telehealth initiatives are welcomed by patients and carers but that these should be an adjunct to clinical care rather than an alternative. The stakeholder interviews revealed several notable differences between those working within areas of high and low Telehealth activity. Principally, areas of high Telehealth activity appear to be driven by national and local policy and seem to benefit from a greater level of investment in Telehealth equipment and facilities than in the more central, and hence accessible, parts of Scotland.
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| 4. |
- Johnston, Bridget, et al.
(författare)
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Dignity-conserving care in palliative care settings : An integrative review
- 2015
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:13-14, s. 1743-1772
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Forskningsöversikt (refereegranskat)abstract
- Aims and objectivesTo report an integrative review of evidence relating to dignity-conserving care in palliative care settings. It will also suggest avenues for future research. BackgroundResearch suggests that dignity is welcomed by those receiving palliative and end of life care. However, as dignity is a subjective term, it is not always explicit how this may be employed by nurses. Given that the preferred place of care for patients with palliative care needs is the home, the issue of dignity may be particularly important for community nurses. Therefore, synthesising evidence of dignity-conserving care for community nurses caring for people with palliative care needs provides clarity in a complex area of palliative care research. DesignIntegrative literature review. MethodThe review involved key bibliographic and review databases CINAHL, MEDLINE, EMBASE, ASSIA and PsycInfo. Medical Subject Headings and free terms were undertaken for articles published from January 2009-September 2014 and retrieved papers were assessed against inclusion criteria. Final included articles were reviewed for reported dignity-conserving care actions, which were classified under nine themes of the Dignity Model. ResultsThirty-one articles were included. Nine Dignity Model themes were used to classify care actions: Level of Independence; Symptom Distress; Dignity-Conserving Perspectives; Dignity-Conserving Practices; Privacy Boundaries; Social Support; Care Tenor; Burden to Others; and Aftermath Concerns. Reported care actions included listening, conveying empathy, communication and involving patients in care. ConclusionCare actions could be classified under most of Dignity Model themes. However, there were less reported care actions related to Level of Independence and Aftermath Concerns, which meant that these had to be formulated independently. Future research should be structured around these areas to determine appropriate care actions for nurses to give dignity-conserving care that addresses these specific themes. Relevance to clinical practiceSynthesising the available evidence of dignity-conserving care identifies evidence-based care actions and provides guidance to nursesin clinical practice caring for patients with palliative care needs. Future opportunities for research are identified to guide promotion of dignity in palliative care.
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| 5. |
- Johnston, Bridget, et al.
(författare)
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Evaluation of the Dignity Care Pathway for community nurses caring for people at the end of life.
- 2012
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Ingår i: International Journal of Palliative Nursing. - : Mark Allen Group. - 1357-6321 .- 2052-286X. ; 18:10, s. 483-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: People nearing the end of life fear loss of dignity, and a central tenet of palliative care is to help people die with dignity. The Dignity Care Pathway (DCP) is an intervention based on the Chochinov theoretical model of dignity care. It has four sections: a manual, a Patient Dignity Inventory, reflective questions, and care actions.METHOD: The feasibility and acceptability of the DCP were evaluated using a qualitative design with a purposive sample of community nurses. Data was collected from April to October 2010 using in-depth interviews, reflective diaries, and case studies and then analysed using framework analysis.RESULTS: The DCP was acceptable to the community nurses, helped them identify when patients were at the end of life, identified patients' key concerns, and aided nurses in providing holistic end-of-life care. It requires the nurse to have excellent communication skills. Some of the nurses found it hard to initiate a conversation on dignity-conserving care.CONCLUSION: The DCP helps nurses to deliver individualised care and psychological care, which has previously been identified as a difficult area for community nurses. All of the nurses wished to continue to use the DCP and would recommend it to others.
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| 6. |
- Johnston, Bridget, et al.
(författare)
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What's Dignity Got To Do With It? Patient Experience of the Dignity Care Intervention : A Qualitative Evaluation Study
- 2017
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Ingår i: Sage Open Nursing. - : Sage Publications. - 2377-9608. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- The delivery of palliative care in the community setting has been recognized as a valued and challenging aspect of nursing care. To this end, care pathways have been shown to support nurses in a variety of settings to deliver individualized patient care. This study provides a qualitative evaluation of an end-of-life intervention known as the Dignity Care Intervention (DCI) based on patients' perspectives. The DCI consists of four sections: a manual, the Patient Dignity Inventory, reflective questions, and evidence-based care actions. A qualitative design underpinned by the philosophy of Merlau-Ponty was employed for the evaluation of the DCI. Data collection included individual interviews with participants (n = 25). Interview data were analyzed using framework thematic analysis. Four theme categories were identified: "experience of DCI,'' "responding to my illness concerns,'' "how illness affects me as a person,'' and "how illness concerns affect my relationships.'' The DCI was found to enable patients to discuss openly important issues with community nurses that they might not otherwise have raised. Participants conveyed satisfaction with the support they received through the DCI. The use of care pathways detailing interventions to manage clinical problems and ensure systematic integration of the best available evidence into care delivery can improve end-of-life care.
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| 7. |
- Kidd, Lisa, et al.
(författare)
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Telehealth in palliative care in the UK : a review of the evidence
- 2010
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Ingår i: Journal of Telemedicine and Telecare. - : SAGE Publications. - 1357-633X .- 1758-1109. ; 16:7, s. 394-402
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Forskningsöversikt (refereegranskat)abstract
- We reviewed telehealth applications which were being used in palliative care settings in the UK. Electronic database searches (Medline, CINAHL, PsychInfo and Embase), searches of the grey literature and cited author searches were conducted. In total, 111 papers were identified and 21 documents were included in the review. Telehealth was being used by a range of health professionals in oncology care settings that included specialist palliative care, hospices, primary care settings, nursing homes and hospitals as well as patients and carers. The most common applications were: out-of-hours telephone support, advice services for palliative care patients, carers and health professionals, videoconferencing for interactive case discussions, consultations and assessments, and training and education of palliative care and other healthcare staff. The review suggests that current technology is usable and acceptable to patients and health professionals in palliative care settings. However, there are several challenges in integrating telehealth into routine practice.
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| 8. |
- Söderman, Annika, 1980-, et al.
(författare)
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Grasping a new approach to older persons' dignity : A process evaluation of the Swedish Dignity Care Intervention in municipal palliative care
- 2024
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 38:2, s. 496-511
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Dignity in older persons is a goal of palliative care. This study aimed to perform a process evaluation of the Swedish Dignity Care Intervention (DCI-SWE) in municipal palliative care in Sweden, focusing on implementation, context, and mechanism of impact.Methods: This study had a process evaluation design. The Knowledge to Action framework supported the implementation of the DCI-SWE. The intervention was used by community nurses with older persons (n = 18) in home healthcare and nursing homes. Data were collected by focus groups- and individual interviews with community nurses (n = 11), health care professionals (n = 5) and managers (n = 5), reflective diaries, and field notes.Results: Grasping the DCI-SWE was challenging for some community nurses. Enhanced communication training and increased engagement from managers were requested. However, the DCI-SWE was perceived to enhance professional pride in nursing. In terms of fidelity, dose and reach the project was not fully achieved. Regarding mechanism of impact the DCI-SWE contributes to address older persons' loneliness and existential life issues, as it put conversations with older persons on community nurses' agenda.Conclusions: The DCI-SWE provided opportunities to maintain older persons' dignity and quality of life. However, with refinements of design and the DCI-SWE, the sustainability in the context may increase.
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| 9. |
- Östlund, Ulrika, et al.
(författare)
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Dignity conserving care at end-of-life : a narrative review.
- 2012
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 16:4, s. 353-67
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF THE RESEARCH: This narrative literature review uses systematic principles to define evidence regarding dignity conserving care at end-of-life from published research on dignity or distress in end-of-life care.METHODS: The Chochinov model of dignity was used as a pre-defined framework. Articles were reviewed using thematic analysis to produce a synthesis of findings. A total of 39 articles (26 qualitative and 13 quantitative) fulfilled the inclusion criteria and were found to give suggestions on care actions.KEY RESULTS: Several care actions were identified related to all themes contained within the Dignity Model, except aftermath concerns. Examples include: controlling symptoms; listening to the patient and taking them seriously; providing advice concerning how to cope on a daily basis; treating patients as equals and with respect, and; encouraging the family members' presence.CONCLUSIONS: Evidence for supporting palliative care services has previously been found to be weak in determining solutions to meet individual's important needs. Drawing together primary research, as in this study, is therefore of importance. The suggested care actions will be used to develop a dignity care pathway for end-of-life care, which is currently being evaluated by the authors. The intention is to provide more valid evidence for the effectiveness of the care actions suggested.
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