Hospice

Background Palliative care has proven over time that it can help prolong life spans with the use of hospices. The literature reports that most patients with cancer are diagnosed in the later stages and since there is no cure, they will require palliative care at some point during their illness. However, most developing countries, including India, have failed to establish hospices; as a result, large numbers of cancer patients are still deprived of palliative care. To initiate better access to hospices, it is important to understand the benefits of the same. Therefore, the present study aims to explore the advantages of hospice care from the perspectives of advanced cancer patients living in hospice centres. Methods The present study uses the method of exploratory research. Using purposive sampling, 8 participants living in a hospice in Bengaluru, India were selected and semi-structured interviews were conducted to collect data from the patients. This data was analysed using thematic...

Hand aufs Herz… heißt diese Ausstellung über Menschen im Hospiz. Sie stellt die Hände von Männern und Frauen vor, die bereit waren, sich mit uns offen über ihr Leben und Sterben zu unterhalten.

Originalzitate… aus den Interviews, die wir mit jedem einzelnen Gast führten, begleiten jedes Bild. Sie erklären die Motive, die sich erst in den Gesprächen herauskristallisierten. So war es uns möglich, zentrale Themen jedes einzelnen Menschen aufzugreifen – ohne genau zu wissen, wohin uns diese fotografische Reise führen würde.

Die Lieblingsfarbe… des vorgestellten Menschen bestimmt die farbliche Gestaltung jedes einzelnen Exponats.

Ausführliche Texte… ergänzen die individuellen Geschichten. Die Texte spiegeln unsere eigenen Gedanken sowie Diskussionen wider und greifen Befunde aus der aktuellen, meist psychologischen Forschung auf.

Wir laden Sie ein… uns auf unserer Reise zu begleiten und sich von der Vielfalt der Eindrücke überraschen zu lassen.

This article presents a new avenue for healthcare risk managers to drive improvement for patients and healthcare organizations alike: Working to reduce avoidable patient suffering. It briefly describes the problem of patient suffering, differentiates between avoidable and unavoidable suffering, and suggests that common risk management tools can be used to tackle the problem. It also highlights a success story from one large health system.

Pain and symptom control challenges are common in palliative care, and the search for other therapeutic strategies is ongoing. Unfortunately, patients and their caregivers are receiving little information or support from healthcare providers regarding the increasingly popular cannabinoid-based medicines (CBM). Clinicians, meanwhile, feel understandably perplexed by the discrepancy between the available evidence and the rapid interest in which patients and their families have demonstrated for CBM. There is an urgent need to address the many challenges that are delaying the appropriate integration of CBM into clinical practice, notwithstanding the obvious need for a solid general knowledge of pharmacology, mechanism of action and available clinical evidence supporting its use. The authors will address these challenges and provide practical recommendations regarding patient assessment for the use of CBM. The authors will also make suggestions regarding patient expectations in order to define clear objectives, review the necessary precautions prior to initiating treatment, aid in selecting the appropriate strain and route of administration as well as establishing proper titration and monitoring protocols. The authors will also discuss the lesser known but potentially therapeutic psychoactive effects of cannabis. As this class of therapeutic agents are likely to play a major role in palliative medicine in the near future, clinicians would benefit from familiarizing themselves with CBM and we can expect that patients and their caregivers will appreciate receiving support in their search for safe and effective therapeutic alternatives.

This work aims to reconstruct the historical trajectory of the emergence and development of the hospice movement, from its beginnings (in the medieval hospices) to its institutionalization. This historiographic analysis seeks, rather than being a description of chronologically ordered events, to give some explanation as to what were the conditions of possibility that allowed the birth of such phenomena: This is a philosophy of care at the end of life associated with a proposal of humanization of health that takes as its fundamental axis the concepts of dignity and person. In order to achieve this it will be attempted, on the one hand, to give an account of how the development of the hospice movement is inscribed in broader structural processes of change of social meanings and attitudes to death and, on the other, show the link between this phenomenon and the development of other types of movements during the postwar period, such as Palliative Care, bioethics (both in clinical practice and in research with human beings) and those linked to the promotion of respect for patients' rights (mostly linked to the practice of euthanasia). The need to deepen the trajectory of the hospice movement since its pre-modern beginnings is linked to the fact that today these types of institutions continue to be faithful to the original religious spirit with which arose. This spirit, as we shall see later, is linked to the care of the dying from a philanthropic perspective that gives importance to both socioeconomic factors - is a movement aimed at generally poor people - as well as to the understood cure, not from a biological point of view, but as a cure of the soul.

Identification of environmental Therapeutic Goals (TGs) has proven essential in providing useful guidance for planning and design (Cohen & Weisman 1991).  Though age-specific environmental dimensions have been suggested by several researchers during 1980’s to 1990’s, none of them focused on dying patients and their experience in hospice care environment, so the need for categorizing dimensions for hospice environment is evident. The objective of this study is to identify the Therapeutic Goals of hospice environment focusing on patients’ experience. This study employed a systematic literature review with an
approach developed by Hawker and colleagues in 2002. This study had considered a wide-ranging literature search: 7 electronic databases search (PubMed, PsycINFO, Social Science Citation Index, Science Citation Index, ProQuest Dissertations & Thesis, Avery, and Cochrane Library), reference list search, examination of literature recommended by relevant experts, and Google search for books, reports, and guidelines.  In total 48 literature included; 39 full text articles, 2 books, 5 guidelines, and 2 reports. The data has extracted from these literature onto a standard template (matrix) for comparison and analysis for coding and thematic development. The study identified eight themes as TGs which have direct influence on patients’ experience of hospice care environment: provide continuity of self, provision of access to nature, provision of privacy, facilitate social interaction, maximize safety & security, provision of autonomy, regulate stimulation, and
provision of spiritual care. These goals reflect two characteristics; each expresses a basic or derived major patient’s need, and a potential environmental facilitator for the satisfaction of the need (Lawton et al. 2000). As the physical environment of hospice has significant impact on the patients’ quality of life and the possibility of a good death (Cohen et al. 2001), these TGs have a positive effect on patients’ lives.

This examination will define and delineate the process of grief and bereavement as well as investigate grief through the lens of several seminal bereavement theorists. In addition, further exploration of research by several of the prominent modern theorists whose models are often used to assist with the grief process will be discussed, including controversies surrounding the models and grief therapy as a whole. Finally the discussion will revolve around determining the efficacy of each theory in correlation to how it may be effectively used with bereaved clients.

This correlational quantitative research investigated to what extent, if any, a correlation between reported compassion satisfaction, burnout, and secondary traumatic stress of individual hospice employees and the number of patient deaths experienced in a 14-day period. The theoretical framework included the Job Demands-Resource Model. Data were collected via SurveyMonkey® from 117 hospice employees (registered nurses, licensed practical nurses, nursing assistants or certified nursing assistants, social workers, and chaplains) from for-profit and not-for-profit hospice companies across the United States. Spearman Correlation were computed to test the hypotheses. The results of the bivariate correlation indicated the number of deaths individual hospice employees experience have no significant correlation on compassion satisfaction (r = -0.124, p >.05) and secondary traumatic stress (r = -0.005, p >.05), but has a positive and significant correlation on burnout (r = 0.261, p < .005). Overall, the results indicate that as deaths experienced increased, burnout tends to increase. The lack of correlation between number of deaths experienced and levels of compassion satisfaction and levels of secondary traumatic stress suggests hospice employees generally acquire satisfaction from their work and have natural mechanisms to avoid reliving the patient’s life experiences. These findings have implications for future research on the importance of understanding how the number of patient deaths relates to the hospice employees’ psychological impact, to maintain hospice employees, and ensure quality of care for years to come.
Keywords: Hospice employees, Job Demands-Resource Model, compassion satisfaction, burnout, secondary traumatic stress, and deaths experienced.

Humanity is on the threshold of recognizing the fundamental error in its view of life and death. Both death as well as active life is necessary to the vital formation of a larger, more essential whole. In this paper, I apply the sociology of knowledge and change as it pertains to death and focus on ways in which we can step outside its traditional frameworks and limitations. I also discuss topics related to death such as birth, aging, sickness, and war, and examine cultural differences in attitudes toward death. I offer varying perspectives including the Buddhist view and from these draw implications and conclusions. I apply the lenses of contemporary social scientists such as Edgar Morin, Kenneth Gergen, Edward Stewart, Milton Bennett, Mary Catherine Bateson, E. Doyle McCarthy, Philip Slater, and Piotr Sztompka. To these I add other relevant passages from the writings and speeches of key thinkers on the topic of death, in particular, Buddhist philosopher, peacebuilder, and educator, Daisaku Ikeda. To construct a more humanistic and sustainable view of life, it is first of all crucial to establish a culture which perceives death in its larger living context as but one cycle in the expansive eternity of life.

[ENG]
Family counselling is a form of help given to the family members who struggle with problems disturbing their normal functioning. Serious illness is one of the factors which threatens family well-being. When it affects a child, its family has to confront a lot of difficulties which result from the patient's unsatisfied needs. Questions which are raised are sometimes difficult to answer. Family counselling in palliative hospice care is aimed at the ill patient and their relatives. Giving advice is a form of support offered to the family in a thanatological situation. Medical, nursing, pedagogical, social and religious counselling is especially significant. Analysis of these fields makes it possible to understand the idea of counselling and work of the members of an interdisciplinary hospice team.

[PL]
Poradnictwo rodzinne jest formą udzielania pomocy członkom rodziny, która zmaga się z problemami zakłócającymi jej normalne funkcjonowanie. Jednym z czynników, który w istotny sposób zaburza dobrostan rodziny, jest poważna choroba. Gdy dotyka ona dziecko, rodzina zostaje skonfrontowana z wieloma trudnościami, które wynikają z niezaspokojonych potrzeb chorego. Potrzeby te rodzą pytania, na które trudno niekiedy znaleźć odpowiedź. Poradnictwo rodzinne realizowane w opiece paliatywno-hospicyjnej skupia się na chorym pacjencie i jego bliskich. Celem udzielania porad jest pomoc rodzinie będącej w sytuacji tanatologicznej. Szczególne znaczenie ma poradnictwo medyczno-pielęgnacyjne, pedagogiczne, socjalne i duchowo-religijne. Analiza wymienionych obszarów poradnictwa pozwala na zrozumienie jego istoty oraz zadań realizowanych przez członków interdyscyplinarnego zespołu hospicyjnego.

Background: The use of compassionate extubation (CE) to alleviate suffering by terminating mechanical ventilation and withdrawing the endotracheal tube requires professional adherence and efficiency. The Hospice Palliative Care Act, amended on January 9, 2013, legalizes the CE procedure in Taiwan.
Methods: From September 20, 2013 to September 2, 2014, the hospice palliative care team at a community hospital received 20 consultations for CE. Eight cases were excluded because of non-qualification. Following approval from the Ethics Committee, the medical records of the remaining 12 patients were reviewed and grouped by the underlying disease: A, “terminal-stage cancer”; B, “non-cancer out-of-hospital cardiac arrest”; and C, “non-cancer organ failure”. Time to extubation using a cut-off at 48 hours was assessed.
Results: The mean ages of patients (standard deviation) in groups A, B, and C were 66.3 (14.9) years, 72 (19.1) years, and 80.3 (4.0) years, respectively. The mean number of days of intubation at consultation were 6.8 (4.9), 7.3 (4.9), and 179.3 (271.6), respectively. The mean total doses of opioids (as morphine-equivalent dose) in the 24 hours preceding CE were 76 (87.5) mg, 3.3 (5.8) mg, and 43.3 (15.3) mg. The median times from extubation (range) to death were 97 (0.2–245)
hours, 0.3 (0.2–0.4) hours, and 6.1 (3.6–71.8) hours. Compared to those requiring 48-hour preparatory time, patients requiring 48 hours to the moment of CE were younger (62.8 years vs
75.5 years), required a mean time of 122 hours (vs 30 hours) to CE (P=0.004), had shorter length of stay (33.3 days vs 77.8 days), required specialist social worker intervention in 75% of cases (vs 37.5%), and had a median duration of intubation of 11.5 days (vs 5.5 days).
Conclusion: CE was carried out according to protocol, and the median time from extubation to death varies determined by the underlying disease which was 0.3 hour in patients admitted after out-of-hospital cardiac arrest and 97 hours in patients with advanced cancer.

Background Palliative care has proven over time that it can help prolong life spans with the use of hospices. The literature reports that most patients with cancer are diagnosed in the later stages and since there is no cure, they will require palliative care at some point during their illness. However, most developing countries, including India, have failed to establish hospices; as a result, large numbers of cancer patients are still deprived of palliative care. To initiate better access to hospices, it is important to understand the benefits of the same. Therefore, the present study aims to explore the advantages of hospice care from the perspectives of advanced cancer patients living in hospice centres. Methods The present study uses the method of exploratory research. Using purposive sampling, 8 participants living in a hospice in Bengaluru, India were selected and semi-structured interviews were conducted to collect data from the patients. This data was analysed using thematic...

[ENG]
Paediatric palliative care addresses a wide range of needs of an ill child and the persons close to them (Friedrichsdorf, Bruera 2018: 7). One of the support areas is the personality development of the child and their family members. Thereby, palliative care becomes part of the process of educating the family environment. The use of grounded theory as an appropriate approach to explore educational issues is justified to research this area (Chong, Yeo 2015: 266). This article presents the results of the author’s own research using grounded theory in Kathy Charmaz’s constructivist approach. The results have been presented using a model of education in the family of a child encompassed by paediatric palliative care. The model shows the basic educational assumptions, principles, and methods as well as the determinants and implementation perspectives of this process. The support provided by the hospice has a tanatopedagogical dimension.

[PL]
Pediatryczna opieka paliatywna odpowiada na szeroki zakres potrzeb chorego dziecka i jego bliskich (Friedrichsdorf, Bruera 2018: 7). Jednym z obszarów wsparcia jest rozwój osobowościowy dziecka i członków rodziny. W ten sposób opieka paliatywna włącza się w proces edukacji środowiska rodzinnego. Dla zbadania tego obszaru zasadne jest zastosowanie teorii ugruntowanej, będącej adekwatnym podejściem do eksploracji zagadnień edukacyjnych (Chong, Yeo 2015: 266). W artykule zaprezentowano wyniki autorskich badań przeprowadzonych z wykorzystaniem teorii ugruntowanej w konstruktywistycznym ujęciu K. Charmaz. Wyniki badań zostały zaprezentowane za pomocą modelu edukacji realizowanej w rodzinie objętej opieką hospicjum domowego dla dzieci. Model pokazuje podstawowe założenia, zasady i metody edukacyjne, a także uwarunkowania i perspektywy realizacji tego procesu. Wsparcie udzielone przez hospicjum posiada tanatopedagogiczny wymiar.

This congress will enable doctors and nurses, pharmacists, health professionals, spiritual supporters and social workers to share their experiences and expertise in an international platform and will shed light on the developments in this area. We predict that this congress will bring together an average of 500 specialists with the Support of Republic of Turkey Ministry of Health, the congress will be organized by Bezmialem Vakıf University, Istanbul Provincial Health Directorate, General Secretariat of Physician Rights Association.

Praca z osobami chorymi terminalnie zwraca uwagę na współistnienie osób potrzebujących i najsłabszych. Podkreśla sens uczestniczenia w życiu społecznym każdego człowieka oraz szacunek dla spraw ostatecznych. Działania i postawy zarówno lekarzy, personelu stałego, jak i wolontariuszy oparte na dzieleniu swojego życia z życiem drugiego człowieka są bezpośrednio związane z priorytetami humanistycznych wartości, z procesem solidaryzowania społeczności, nastawionym na zmianę rzeczywistości społecznej w kierunku pełnowartościowego współistnienia człowieka z drugim człowiekiem. Podstawowymi działaniami hospicjum są: rozpoznanie potrzeb pacjentów i możliwości zarówno praktycznych, jak i emocjonalnych pracowników stałych i wolontariuszy, nastawienie na aktywne działanie oraz twórcze kreowanie życia własnego i podopiecznego. Ważne jest „tu i teraz”, ponieważ na „zaraz” lub „potem” może być już za późno. Dla osób starszych dotkniętych chorobami onkologicznymi, które z racji swojego stanu zdrowia (a często również ze względu na sytuację rodzinną) nie mogą liczyć na stałą i efektywną opiekę domową, takie podejście do wzajemnych relacji jest szczególnie cenne, gdyż zapewnia im godne życie.
Godność jest jedną z podstawowych wartości ludzkich. Dbając o godne życie, pamiętać należy o godnym umieraniu, traktując śmierć jako zwieńczenie życia. Zapewnienie godnej śmierci wszystkim, których życie dobiega końca stanowi wyznacznik człowieczeństwa, realizowany dzięki wsparciu i opiece bliskich, a jeśli nie jest to możliwe – dzięki opiece kadry wyspecjalizowanych instytucji takich jak hospicja.

[ENG]
There are many negative effects of illness such as grief which results from the experience of suffering. The action must be taken in order to restore the patient's well-being. This kind of support should be educational. One of the ways of helping the small patient and their family is the support offered by the hospice team. The hospice counselor's rule is particularly important as his action is aimed at improving the quality of the ill child's life and counteracting the destructive influence of grief. The aim of the article is to describe grief. present its relation to illness and show educational ways of dealing with it.

In the world, Palliative and Hospice Care (PHC) are approaches conceived to improve the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems; physical; psychosocial; spiritual. In Ukraine, the first efforts to develop PHC already have been made 20 years ago. In 2006-2017 the breakthrough was made. In our research, we have analyzed the activities of both governmental bodies and non-governmental organizations in the field of development of PHC. Our main conclusions are that PHC in Ukraine is just starting to develop; the philosophy of PHC just forming. Organizations which develop PHC are very young. As Ukraine is the former Soviet country, paternalistic traditions are very alive here so that many directives, orders and other documents go from above (from Ministry of Health mostly) and t...

It is what you can do with your disability that counts, not what you cannot do. During the Disability Pride parade that took place last week on Thursday the 3 rd of December, we had the chance of having a chat with an amazing man who should be an example to all of those who feel they have been 'hard done by' in life. He is an example of positivity to the maximum, and someone who through his disability has become a true example of strong character, courage and a spirit of not giving up no matter what the situation. This is his story. Anthony Ghillino, at the age of 16 was involved in a serious car accident that left him paralysed from the shoulders downwards. Anthony dislocated his 4 th vertebra, with the result that it severed his spinal cord which led to his disability and being wheelchair bound for life. He manoeuvres his wheelchair with his chin. Directly after the serious accident occurred, he was taken to hospital where he was told he would never walk again. That was 23 years ago. He recalled a moment that changed his life for the better that occurred at the hospital where he was a patient. While lying in ICU after the accident, feeling very sorry for himself, he recalled hearing an extremely irritating noise. When his mother came to visit later that day he asked her what exactly the noise was. She replied by saying: " The noise is the person next to you, Anthony, who broke his neck 4 cm higher up than you did and as a result he cannot breathe by himself because his diaphragm is also paralysed ". That noise that Anthony was hearing was the only way this patient could communicate or call the nurse if he needed something. At that point Anthony had a lightbulb moment and realised that when one is disabled, the focus should be less on what you don't have, but more on what you do have and for Anthony it meant that he was grateful in that he had quite a bit. He is able to talk for himself, think for himself and communicate. There are much better things to focus on for Anthony in his disability than those that he can't do, and for him that was the biggest shift in his mind-set that has paved a way for great success for himself personally. Anthony was able to study further through the Quad Para Association at Cape Peninsula University of Technology which he enjoyed thoroughly. He now works at the Quad Para Assn of the Western Cape and is the Project Manager. Anthony is able to help other people, which for him is something he would never have thought he would be able to do, especially after his accident. He is also extremely grateful for the carers who help him a great deal and are a great pillar of strength. Anthony ended off by telling us that one of the main things he has learnt in the 23 years of living with a disability is that disability has no boundaries. It doesn't matter how rich you are, nor how poor you are, if you have a disability you are affected equally and therefore you should be humble and able to help whoever is suffering with disability mentally, physically and emotionally as much as you can.

[ENG]
The mother of a child cared for in hospice experiences numerous consequences of the illness. One of them is loneliness, which may become a threat for the mother as well as the whole family system. There is still, however, a scarcity of research in this field. The present study, conducted in a qualitative manner, pinpointed the scope and meaning of mothers’ loneliness. The analysis of data provided a basis for distinguishing a category of localized loneliness, that is loneliness associated with specific places, such as home, hospital and educational institution, that assumed a new significance in the context of an illness. The loneliness felt by mothers in those places is a difficult experience of an emotional and social nature.

[ENG]
The development of professional home care for ill people in Poland is connected with Hanna Chrzanowska (1902–1973) and her activity. To a significant extent, her  nursing  work  was  innovative,  which  resulted  from  the  fact  that  she  was  able  to  recognize  the  need  to  care  for  the  ill  outside  hospitals  and  nursing  homes.  An  accurate diagnosis of the family environment and local community resources was the first step to provide support. The next step was to assess the needs of an ill person and to offer appropriate support. Chrzanowska organized teams which consisted of both professional nurses and the ones in training. She based teamwork on their voluntary and professional involvement. One of her greatest achievements was organizing spiritual retreat for ill people. She helped them overcome physical and social barriers to integration. Nursing home care initiated by Chrzanowska was deeply rooted in religion. It also reflected her willingness to help people regardless of their faith or financial resources. The work of home hospices in Poland may be regarded as a continuation of Chrzanowska’s activity. However, the origins of hospice care are more complex. It seems necessary to present theoretical assuptions and practical solutions to the problems of the terminally ill in home hospice care. Chrzanowska’s legacy may help to overcome obstacles in the process of providing hospice care.

[PL]
Początek profesjonalnej domowej opieki nad chorym człowiekiem w Polsce jest związany z postacią Hanny Chrzanowskiej (1902–1973). Jej działalność pielęgniarska na terenie Krakowa była w dużym stopniu inno-watorska. Wyrażało się to poprzez umiejętność zauważenia problematyki pomocy obłożnie chorym oso-bom poza szpitalem i domem pomocy społecznej. Udzielenie pomocy było poprzedzone rzetelną oceną środowiska rodzinnego i zasobów lokalnej społeczności. Kolejnym krokiem było rozpoznanie potrzeb cho-rego człowieka i dostosowanie do nich działań pomocowych. Chrzanowska organizowała pomoc zespoło-wą dzięki wolontaryjnemu i zawodowemu zaangażowaniu pielęgniarek oraz osób przygotowujących się do tego zawodu. Jej zasługą były inicjatywy polegające na organizowaniu wyjazdowych rekolekcji dla chorych. Chrzanowska pomagała ludziom pokonać bariery fizyczne i socjalne, co ułatwiało integrację. Zapoczątkowana przez nią opieka pielęgniarska sprawowana w domu chorego człowieka miała głębokie uzasadnienie religijne. Była także wyrazem bezinteresownej pomocy, niezależnie od wyznania i zasobów material-nych chorego. Działalność domowych hospicjów w Polsce można uznać za swoistą kontynuację działalności Chrzanowskiej, choć geneza opieki hospicyjnej jest szersza. Zasadne wydaje się przedstawienie teoretycznych założeń i praktycznych rozwiązań problemów osób nieuleczalnie chorych, objętych domową opieką hospicyjną. Wykorzystanie spuścizny Chrzanowskiej może być pomocne w przezwyciężaniu trudności, jakie pojawiają się w czasie realizacji domowej opieki hospicyjnej.

Post-acute care (PAC) facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes , specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR) services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population. We intend to discuss successful methods to address the following aspects: hospital-PAC linkages, improved discharge planning, caregiver burden, and CR access and utilization through patient-centered programs. Regular home visits by healthcare providers result in decreased hospital readmission rates for patients utilizing home healthcare while improved hospital-PAC linkages reduced hospital readmissions by 25%. We conclude that widespread adoption of improvements in transitional care will play a key role in patient recovery and decrease hospital readmission, morbidity, and mortality.

Documentation is a key factor in supporting consistency and quality of patient care in the hospice setting, however variation among program provider practices, including documentation, were observed during the initial data collection phase of our National Cancer Institute (NCI) funded study, Cancer Pain in Elders: Promoting Evidence-Based Practices (EBPs) in Hospices. The study is a randomized trial to test a multifaceted intervention to promote adoption and maintenance of EBPs for cancer pain management involving 16 Midwestern hospices of varied size and structure. In the face of such variance, and especially in the absence of uniformly adopted outcome measures and documentation standards, quality improvement initiatives in this important and growing healthcare sector will be difficult to manage. This paper provides background on the importance of documentation, quality measures, outcomes of care, and regulatory imperatives in the hospice setting with specific observations from our...

This paper presents the theoretical framework and rationale for the ACTive intervention which proposes the use of video technology to facilitate patient and family participation in hospice interdisciplinary team meetings where plans of care are determined. It is surmised that patient and family involvement will improve communication and compliance in hospice care. An analysis of data from a pilot project of the ACTive intervention was conducted to explore active participation among family caregivers and the hospice team. Through the use of videophone technology caregivers participated in video-recorded team meetings. The actual communication behaviors of caregivers and team members were analyzed for active participation. Findings revealed that team–prompted caregiver participation was most common, however, team use of supportive talk in this context was considerably less frequent. The study also found that the team's use of active participation behaviors elicits caregiver active participation behaviors. The results of this study suggest the intervention was an effective way to involve family caregivers as active participants in the designing of care for their loved one. Findings also suggest that hospice staff would benefit from education and training on best practices for communicating with caregivers in the team meeting setting.

Abstract For safety reasons, the 2004–2005 Joint Commission on Accreditation of Healthcare Organizations standards require organizations to develop policy addressing various types of medication orders that have the potential for being ambiguous to those ...

In the world, Palliative and Hospice Care (PHC) are approaches conceived to improve the quality of life of patients and their families facing the problem associated with life-threatening illness, through the
prevention and relief of suffering by means of early identification and
impeccable assessment and treatment of pain and other problems; physical; psychosocial; spiritual. In Ukraine, the first efforts to develop PHC
already have been made 20 years ago. In 2006-2017 the breakthrough was made. In our research, we have analyzed the activities of both governmental bodies and non-governmental organizations in the field of
development of PHC. Our main conclusions are that PHC in Ukraine
is just starting to develop; the philosophy of PHC just forming. Organizations which develop PHC are very young. As Ukraine is the former
Soviet country, paternalistic traditions are very alive here so that many
directives, orders and other documents go from above (from Ministry
of Health mostly) and the grass-roots are rather rare. As many organizations have not yet undergone training yet, the main directions of the
work to develop PHC are advocacy; improvement of the legislation;
training for civic leaders, specialists and other stake-holders.

Dealing with physical pain represents a huge public health expenditure, especially for cancer-induced bone pain, one of the most difficult health issues, which impairs appetite, sleep, and mobility, negatively impacting quality of life and evoking mental problems. Although some literature has reported positive correlation between religion and pain management, there is a dearth of research examining the effectiveness of Buddhism
on this topic. This study investigates the usefulness of Buddhist beliefs in managing cancer-induced bone pain through a case example. It illustrates how an advanced cancer patient, with the assistance of a counsellor, perceived pain and coped with it and pain-induced mental problems via Buddhist teachings and practices, including the four noble
truths, the law of dependent origination, and karma. It offers alternative perspectives for helping professionals (such as physicians, nurses, counsellors, social workers, hospice and palliative service providers, and pain management practitioners) who are keen to equip themselves with a wider worldview and life view to better serve their clients.