This study explored the quality of life (QOL) of advanced cancer patients before and after receiving hospital-based palliative shared care; also compared their quality of life with those of terminal ill patients in palliative care units. Sixty-eight cancer patients in a southern Taiwan hospital were selected, purposive sampling, as our study samples. Among these 68 patients in our study were under three care models; 20 patients were under general care, 17 patients were under hospital-based palliative shared care, and 31 patients were under palliative care. One week after their admission into care units, we evaluated their QOL using MQOL ¡VTaiwan version. The QOL data of these three groups of advanced cancer patients ,then grouped and compared as in general care unit, hospital-based palliative shared care unit, and palliative care unit. All data collected were analyzed using SPSS for Word 10.0 statistic software. Furthermore, we have in-depth interviewed with four chiefs of general care units, five patient caretakers, and one professional of hospital-based palliative share care. Contents of the in-depth interviews focused on in what aspects hospital-based palliative shared care provided help to terminally ill patients in terms of quality of life or life difficulty. Contents of the discussion were then analyzed and interpreted. Results of our analysis, measured by MQOL ¡V Taiwan version, showed there is no significant difference in QOL of advanced cancer patients between hospital-based palliative shared care and general care. But results of our in-depth interview with caretakers and caregives showed interesting aspects: 1. Physical symptoms of advanced cancer patients was brought under control. 2. Psychological symptoms of advanced cancer patients or their family was taken care of. 3. Advanced cancer patients or their family are all benefited from continued advice and instructions. 4. Provide cancer patients and their family with guidance and instructions as to preparing for death. 5. Support the emotional needs of family of advanced cancer patients. 6. Hospital-based palliative shared care offered palliative consultation, supporting patient caretakers and providing improvement QOL for cancer patients. 7. Mindset change to doctors: inform cancer patients or their family of developing cancer symptom so that early intervention can be ensued. 8. Caretakers of general care unit and hospital-based palliative shared care unit formed a joint team, enabling cancer patients and their family feel secured in treatment. In conclusion, hospital-based palliative shared care benefits patients and their family. Comparing with hospital-based palliative shared care, palliative care showed significant improvement in physical symptom domain, psychological domain, and the mean of four domains. In all palliative interventions, palliative care has better effect in improving QOL of cancer patients than hospital-based palliative shared care. By this study, we examined and evaluated the effectiveness of ¡§Hospital-based Palliative Shared Care Program¡¨ promoted by Bureau of Health Promotion, Department of Health, R.O.C. With the in-depth information revealed, we can improve this promotion program and ensure that patient¡¦s needs have been taken care of. We would also recommend any promotion program must focus on patients, and a model of combined effort of palliative shared care should be on top of all.

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Bakgrund: Fler och fler drabbas av cancer och med det drabbas än fler av de biverkningar som följer på cancerbehandlingar. Översikten avser att lyfta fram patientens upplevelser av hur deras fatigue påverkas av att delta i vårdinterventioner som sjuksköterskan leder.   Syfte: Syftet var att beskriva patienters erfarenheter av att delta i sjuksköterskeledda interventioner vid cancerrelaterad fatigue. Frågeställningar: 1. Hur upplevdes fatigue hos patienterna efter utförd sjuksköterskeledd intervention? 2. Hur uppfattade patienterna den sjuksköterskeledda interventionen? Metod: En litteraturöversikt utfördes av åtta vetenskapliga originalartiklar. Sökningarna gjordes i databaserna Cinahl Complete och PubMed med dataanalys utförd enligt Friberg. Resultat: Resultatet av översikten visade att patienterna upplevde en minskning av fatigue genom att delta i sjuksköterskeledda interventioner. Interventionerna främjade deras förmåga till egenvård och gav dem insikten att de själva kunde påverka symtom av fatigue i en positiv riktning. Patienterna upplevde också att det stöd och den hjälp de fick från sjuksköterskor i samband med interventionerna ökade viljan och förmågan att klara av att genomföra interventionen. Slutsats: Patienter och sjuksköterskor bör kunna få välja på fler vårdinterventioner som har till uppgift att minska upplevd fatigue. Sjuksköterskornas deltagande vid vårdinterventionen är av stor betydelse för att den ska bli genomförd på ett bra sätt. / Background: More and more people are affected by cancer and with that, even more are affected by the side effects that follow cancer treatments. The overview wants to emphasize the patient's experiences of how their fatigue is affected by participating in care interventions led by the nurse. Aim: The aim was to describe patients' experiences of participating in nurse-led interventions for cancer-related fatigue.  Questions: 1. How did the patients experience fatigue after undergoing nurse-led intervention? 2. How did patients perceive the nurse-led intervention?  Method: A literature review was performed of eight original scientific articles. The searches were made in the databases Cinahl Complete and PubMed with data analysis performed according to Friberg. Results The outcome of the review indicated that patients experienced a reduction in fatigue by participating in nurse-led interventions. These interventions promoted their ability for self-care and gave them the insight that they themselves could positively influence symptoms of fatigue. Patients also felt that the support and assistance they received from nurses during the interventions increased their willingness and ability to carry out the intervention. Conclusions Patients and nurses should be able to choose more care interventions that have the task of reducing perceived fatigue. Nurses' participation is very important for successful implementation of the care interventions.

Expansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences in utilization patterns that exist among the Medicaid population that participated in an optimal level of care (OLC) intervention inclusive of appointments scheduled to primary care providers. Using the integrated behavior model as a theoretical framework, the key research question focused on determining if there was a difference in ED use among Medicaid individuals who scheduled follow-up appointments compared to those that did not schedule follow-up appointments. The sample population consisted of 176 Medicaid enrollees who presented to the ED for treatment of nonurgent conditions and participated in an OLC intervention from June 2016 to July 2017. The results showed that there were no differences in ED utilization between the population that had scheduled appointments compared to the population that did not have scheduled appointments. A bivariate analysis on demographic variables also showed no differences in ED utilization among the variables. The social change implications of this study are that the practice of scheduling appointments with primary care providers does not reduce or affect ED utilization in the Medicaid population. This study contributes to positive social change through the findings that reducing ED utilization requires more than follow-up appointment scheduling with primary care providers. Further studies are warranted to understand the potential barriers and factors that affect ED utilization.

The abuse of substances by South African young people has led to the development of specialised residential treatment programmes. This qualitative and phenomenological study sought to explore child and youth care interventions which contributes towards children’s recovery from substance abuse/dependency. Data was collected through purposive sampling, with face -to -face interviews with a broad interview guide and it’s analysis was influenced by Patton and Creswell’s eight steps for qualitative data analysis and interpretation. The study confirmed the involvement of South African child and youth care workers in substance abuse programmes for young people. Specific interventions such as an existence of a therapeutic relationship between child and youth care workers, the use of the relationship as a model for other relationships, the availability and presence of the child and youth care worker, the adolescent development programme and young people’s involvement in their individual development programme that contributed to recovery from substance dependency were identified. / Social Work / M. Tech. (Child and Youth Care)

The abuse of substances by South African young people has led to the development of specialised residential treatment programmes. This qualitative and phenomenological study sought to explore child and youth care interventions which contributes towards children’s recovery from substance abuse/dependency. Data was collected through purposive sampling, with face -to -face interviews with a broad interview guide and it’s analysis was influenced by Patton and Creswell’s eight steps for qualitative data analysis and interpretation. The study confirmed the involvement of South African child and youth care workers in substance abuse programmes for young people. Specific interventions such as an existence of a therapeutic relationship between child and youth care workers, the use of the relationship as a model for other relationships, the availability and presence of the child and youth care worker, the adolescent development programme and young people’s involvement in their individual development programme that contributed to recovery from substance dependency were identified. / Social Work / M. Tech. (Child and Youth Care)

Obiettivo: Accrescere la conoscenza relativa a come supportare il coinvolgimento attivo dei pazienti anziani, descrivendo i contenuti di interventi per il coinvolgimento attivo con pazienti anziani attualmente presenti sul panorama scientifico, sviluppando un nuovo intervento e studiando le prime fasi della sua implementazione. Metodo: Nel primo studio, in risposta al primo obiettivo, è stata condotta una analisi sistematica della letteratura scientifica sul tema. Il secondo studio ha visto la conduzione di focus groups con professionisti sanitari e interviste individuali a pazienti anziani per raffinare e validare qualitativamente un nuovo intervento per il coinvolgimento attivo. Nel terzo studio, si è studiata l’implementazione iniziale dell’intervento in un contesto italiano di cure integrate attraverso una ricerca partecipativa. Risultati: Il principale risultato del primo studio è stato la sbilanciata attenzione tra i 35 interventi per il coinvolgimento attivo presenti in letteratura per le componenti emotive a favore di quelle educative e comportamentali. È sulla base dei risultati del primo studio e di un modello teorico che è stata sviluppata una prima bozza di intervento. Nel secondo studio, la prospettiva di professionisti sanitari e pazienti anziani ha fornito indicazioni per modificare l’intervento e renderlo potenzialmente implementabile nella pratica clinica. L’intervento che è risultato consiste di almeno due incontri mensili individuali, più un set personalizzato di esercizi riflessivi per il paziente da compilare in autonomia a casa. Infine, il terzo studio ha osservato come le diverse pratiche educative presenti nei diversi setting – ospedaliero, ambulatoriale, territoriale - di un contesto di cura integrato hanno generato diverse, specifiche, difficoltà per l’implementazione. Un certo sforzo di flessibilità e personalizzazione dei contenuti e delle procedure dell’intervento è stato dunque richiesto. Implicazioni: L’intervento sviluppato mostra potenzialità nel supportare il coinvolgimento attivo dei pazienti anziani, ma necessita di ulteriori studi relativi all’implementabilità sul lungo termine e alla sua efficacia. / Aim: To contribute knowledge about how patient engagement support can be provided to older adults, by describing the contents of interventions aimed at patient engagement for older adults, developing a patient engagement intervention, and studying its early-stage implementation. Methods: In study 1, a systematic review of the literature was performed. In study 2, a qualitative study with focus groups involving healthcare professionals and individual interviews to older adults was conducted to develop the intervention. In study 3, a qualitative study of a participatory process was accomplished to explore the early-stage implementation of the intervention in one integrated-care organization. Results: The main finding of study 1 was that the emotional dimension was less used than the educational and behavioural dimensions among the 35 patient engagement interventions for older adults. The findings from the study 1 were used, together with a theory of patient engagement, to develop a draft of an individual patient engagement intervention for older adults (PHEinAction). In the study 2, the views of healthcare professionals and older adults were used to refine and finally endorse it. The final version of PHEinAction consisted of at least two face-to-face one hour individual sessions one month apart, plus a set of personalized home-based exercises aimed to facilitate a range of emotional, behavioural, cognitive changes for patient engagement. Finally, the study 3 observed how the existing patient education practice of inpatient, outpatient and territorial settings differently challenged the implementation. A certain degree of flexibility of PHEinAction’s contents and procedures was required to address these challenges. Implications: PHEinAction shows promise as an intervention to improve patient engagement in older adults. However, more research is needed, especially focusing on long-term implementation studies and evaluation of effects with experimental studies.