“Such an institution represents the circle of life” – bringing an inpatient hospice into an academic setting: a pre-implementation exploratory study (original) (raw)
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Journal of Cancer Research and Clinical Oncology
Purpose The effect of the duration of an educational rotation presented at a palliative care unit on the palliative care knowledge gain and the increase of palliative care self-efficacy expectations are unclear. Methods This national prospective multicenter pre–post survey conducted at twelve German University Comprehensive Cancer Centers prospectively enrolled physicians who were assigned to training rotations in specialized palliative care units for three, six, or twelve months. Palliative care knowledge [in %] and palliative care self-efficacy expectations [max. 57 points] were evaluated before and after the rotation with a validated questionnaire. Results From March 2018 to October 2020, questionnaires of 43 physicians were analyzed. Physicians participated in a 3- (n = 3), 6- (n = 21), or 12-month (n = 19) palliative care rotation after a median of 8 (0–19) professional years. The training background of rotating physicians covered a diverse spectrum of specialties; most frequen...
An increasing older population dictates the need to organise palliative care and estabilish hospices
Collegium antropologicum, 2009
The aim of this study is to assess population needs for the organisation of palliative care and establishment of hospices. An opinion poll was created to investigate these needs. The research was carried out in 2007/2008 among 1564 citizens not working in health services, and 789 health service workers--a total of 2353 people questioned in 7 towns of the Republic of Croatia. The significant results obtained using adequate statistical methods confirm that 90.6% of all respondents favour the introduction of a palliative care system and 88% favour the establishment of hospices. This leads us to conclude that the need to establish a palliative care system and hospices has been recognised by citizens and health service workers, thus their implementation in the Republic of Croatia without further delay should be recommended.
Implementation Science
Background: Sweden has a policy of supporting older people to live a normal life at home for as long as possible. Therefore, it is often the oldest, most frail people who move into nursing homes. Nursing home staff are expected to meet the existential needs of the residents, yet conversations about death and dying tend to cause emotional strain. This study explores organizational readiness to implement palliative care based on evidence-based guidelines in nursing homes in Sweden. The aim was to identify barriers and facilitators to implementing evidence-based palliative care in nursing homes. Methods: Interviews were carried out with 20 managers from 20 nursing homes in two municipalities who had participated along with staff members in seminars aimed at conveying knowledge and skills of relevance for providing evidence-based palliative care. Two managers responsible for all elderly care in each municipality were also interviewed. The questions were informed by the theory of Organizational Readiness for Change (ORC). ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care. Results: Analysis of the data yielded ten factors (i.e., sub-categories) acting as facilitators and/or barriers. Four factors constituted barriers: the staff's beliefs in their capabilities to face dying residents, their attitudes to changes at work as well as the resources and time required. Five factors functioned as either facilitators or barriers because there was considerable variation with regard to the staff's competence and confidence, motivation, and attitudes to work in general, as well as the managers' plans and decisional latitude concerning efforts to develop evidence-based palliative care. Leadership was a facilitator to implementing evidence-based palliative care. Conclusions: There is a limited organizational readiness to develop evidence-based palliative care as a result of variation in the nursing home staff's change efficacy and change commitment as well as restrictions in many contextual conditions. There are considerable individual-and organizational-level challenges to achieving evidence-based palliative care in this setting. The educational intervention represents one of many steps towards developing a culture conducive to evidence-based nursing home palliative care.
Background: Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care’s complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service. Methods: Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data. Results: Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries. Conclusion: This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.
Implementation Science, 2014
Background: There is a wide gap between knowledge about palliative care and its application in everyday clinical practice, affecting many patients in our ageing population. However, changing health care practice is a complex and challenging process. Therefore, the EU funded IMplementation of quality indicators in PAlliative Care sTudy (IMPACT) project aims to develop optimal implementation strategies to improve the organization of palliative care for people with cancer or with dementia in Europe. Methods and design: The organization of palliative care in Europe will be mapped to develop and prepare strategies to improve it, and an overview of barriers and incentives regarding successful organizational changes in palliative care will be undertaken. A pre-test with a set of quality indicators (QIs), developed within the project, will be used to identify aspects of the organization of palliative care requiring change in hospitals, nursing homes, hospices, and primary care in five European countries. Based on the results of the pre-test, each setting will be invited to prioritise and improve aspects of their organization that appeared weak. The improvement objective they choose will be tailored to national and setting-specific barriers. Finally, a post-test with the same QIs will determine the effectiveness of the strategies used. An extensive process analysis will be conducted throughout the entire study. Discussion: It is expected that the IMPACT project will provide professionals and policy makers useful tools to facilitate effective implementation of high-quality palliative cancer and dementia care in different settings in Europe.
Journal of applied health sciences =, 2023
Introduction: The health system is one of the most complex systems in any country. According to the definition of the World Health Organization, the health care system includes health infrastructure that provides a spectrum of programs and services and provides health care to individuals, families and the community. A basic human right is the right to health care, which includes health activities such as preventive, curative and palliative treatment. The organization of palliative medicine is necessary at all levels of health care. Aims: Situational analysis of the organization of palliative care in the Clinical Center of the University of Sarajevo. Examining the knowledge and approach of healthcare workers in the process of providing palliative care at the Clinical Center of the University of Sarajevo. To examine the attitude of healthcare workers towards the Awareness and attitudes of nurses of the Clinical center of the University of Sarajevo (ccus) towards the organization of palliative care way palliative care is organized in the Clinical Center of the University of Sarajevo. Material and methods: 141 subjects employed at the Clinical Center of the University of Sarajevo (CCUS) participated in the research. The research is descriptive and analytical. The results are presented in tables and graphs, chi-square and Fisher's exact test were used for testing the significance of differences. Results: It was found that there are different knowledge, attitudes and approaches of the respondents regarding the way palliative care is organized, the provision of services and treatment in the hospital. The majority of respondents (64%) believe that palliative care should be organized in institutions for palliative care that meet the conditions of the prescribed standards and criteria for palliative care. Conclusion: Significant differences were found in the knowledge, practice and attitudes of health workers about palliative care.
2017
Objectives: There are barriers related to the clinical use of p alliative care. The aim of the study is to examine the nurses’ perceptions of palliative care and the obstacles ın practices. Methods:The sampling of the study was composed of 120 nurse s who accepted to participate in the study. In order to collect the data, a questionnaire was used , which contained questions and expressions about t he demographic data and palliative care. Our study dem onstrated that most of the participants emphas ized that they would like to receive training about palliativ e care. The data were analyzed with SPSS version 15 .00 for Windows. Descriptive statistics were presented as f requencies, percentages, means and standard deviati ons. A p value <.05 was considered statistically significant . Results:The most important obstacles were insufficient education, communication and health policies. %57.5 of them state that nurses do not realize the pallia tive care requirements; %66.6 of them think...
American journal of medical quality : the official journal of the American College of Medical Quality, 2018
BMC Palliative Care
Background Physicians who practice in a hospice are responsible for working with patients and nursing staff to develop a medication plan, monitor symptoms and pain, and adjust medication if necessary. In inpatient hospices in Germany, physicians are part of a multi-professional approach, but not part of the hospice team itself. However, there is no, or hardly any, literature on medical practice in a hospice setting. Therefore, we wanted to know how physicians reflect upon their role in hospice within a multi-professional setting, how they communicate with patients, relatives, nursing staff and other physicians, and what the limitations of these communication processes are. Methods By means of two qualitative studies we explored how physicians classify their activities as part of the hospice organization. The study design followed Grounded Theory procedures. Results The physicians named an appropriate interpretation of the patient's wishes as the challenge of everyday practice wh...
The Hospice Friendly Hospitals Programme : Overview 2007-2013
2014
Review of Activities, Outputs and Outcomes 2.1 Introduction 2.2 Standards and Audit 2.3 Culture Change 2.4 Capacity Development 2.5 Influencing the System 2.6 Overall Achievements 3 Key Learning and Next Steps 3.1 Key Learning Overview 3.2 Sharing the Vision 3.3 Governance and Management 3.4 Engagement 3.5 Key Drivers 3.6 Tools Generated Bibliography Contents International research suggests that not only does good end-of-life care impact positively on patients and their families, it also has the potential to reduce costs 4. 1 This report was compiled based on an analysis of secondary data detailed in the bibliography. It was overseen by the HFH Evaluation Project Advisory Group. 2 CS0, (2011) Principal CSO Statistics-Number of Births, Deaths and Marriages.