Bei der vorliegenden Bachelorarbeit handelt es sich um eine Betrachtung rechtlicher Rahmenbedingungen und gesunheitspolitischer Faktoren in Bezug auf den Einsatz und die Notwendigkeit Sozialer Arbeit in der ambulanten palliativen Versorgung, mit Schwerpunkt der Spezialisierten Ambulanten Palliativversorgung im fünften Sozialgesetzbuch. Mittels systemischer Literaturrecherche werden rechtliche, strukturelle und gesellschaftliche Gründe untersucht, die für oder gegen das Vorkommen von Sozialarbeiter*innen in der ambulanten Palliativversorgung für Erwachsene vorliegen. Desweiteren werden rechtliche Möglichkeiten für den Einsatz dieser Profession im Rahmen des Sozialgesetzbuch V aufgezeigt. Bei den Untersuchungen handelt es sich ausschließlich um eine theoretische Analyse. Diese Bachelorarbeit ist eine sehr komplexe wissenschaftliche Arbeit, die sowohl gesundheitspolitische, professionstheoretische, aber auch leistungsrechtliche sowie leistungserbringungsrechtliche Punkte berührt. In acht Kapiteln werden einschlägige Begriffe erläutert, die Entstehung der Palliative Care und die Entwicklung des Sterbens in der Moderne aufgezeigt. Die rechtlichen Rahmenbedingungen der ambulanten Palliativversorgung werden betrachtet sowie die komplexe Organisations- und Versorgungskultur der Selbstverwaltung in der gesetzlichen Krankenversicherung. Schließlich gibt es einen Ein- und Ausblick in die Potentiale der Sozialen Arbeit im Kontext End-of-Life-Care und Netzwerkkordination.:Abkürzungsverzeichnis Abbildungsverzeichnis 1 Einleitung 2 Begrifflichkeiten 2.1 Gesundheit 2.2 Palliative Care 2.3 Gesundheitspolitik 3 Entstehung und Bedeutung der Palliative Care 3.1 Entwicklungen des Sterbens in der Moderne 3.2 Anfänge der palliativen Versorgung 3.3 Total Pain und die vier Säulen der palliativen Arbeit 3.4 Versorgungsangebote in Deutschland 4 Palliative Care in der ambulanten Versorgung 4.1 Rechtliche Grundlagen 4.2 Allgemeine ambulante Palliativversorgung 4.3 Spezialisierte ambulante Palliativversorgung 4.3.1 Der Gemeinsame Bundesausschusses und die Richtlinie 4.3.2 Der Spitzenverband der gesetzlichen Krankenkassen 4.3.3 Organisationsstruktur und Versorgungskultur 5 Soziale Arbeit in der ambulanten Palliativversorgung 5.1 Kernziele und Arbeitsauftrag 5.2 Aufgaben in der palliativen Versorgung 5.3 Psychosoziale Probleme 6 Kritische Auseinandersetzung 6.1 Resümee der SAPV-Rechtsgrundlagen 6.1.1 Empfehlungen der Fachverbände 6.1.2 Tragende Gründe 7 Ausblick und Potential der Sozialen Arbeit 7.1 Soziale Arbeit im Kontext End-of-Life Care 7.2 Netzwerkkoordination 8 Fazit Literaturverzeichnis Anhang

This study seeks to investigate fear of death in first-year student nurses. It considers how this might be ameliorated through teaching and learning interventions that involve addressing emotional and spiritual intelligence within the affective domain. Fear of death, for this study, is defined as fear of death and of caring for dying people and their families. A pragmatic paradigm and a mixed method approach were used to explore the feelings and experiences of newly recruited student nurses in relation to fear of death and the care of the dying person and their families. Quantitative and qualitative methods were used to examine the impact of two different interventions intended to reduce the fear of death. A questionnaire was used to measure aspects of fear of death. The students were then randomly allocated to three groups. The members of two of the groups experienced an intervention, either a psychological self-help programme called 'Do Something Different', (Fletcher and Pine, 2009) or a weekly group meeting that explored relationships and the use of spiritual strategies based on Family Constellation theory (Hellinger, 2006). The third group acted as a control. After a period of time in clinical practice, the questionnaire was administered again and the results analysed and interpreted. The relationship between the students' fear of death and their age, previous experiences, ethnicity and spiritual beliefs was explored. Findings indicate that the interventions had a positive influence on reducing the students' fear of death. The qualitative part of the study involved semi-structured interviews with fifteen of the students who had completed both questionnaires. Their experiences of preparation for caring for dying people and of being in an intervention group were discussed. The interviews were analysed using interpretive phenomenological analysis (IPE). Influencing factors from home, such as cultural issues, and from within the clinical context, such as mentorship, were identified. The thesis contributes to nursing education and practice by showing that early preparation for caring for dying people can be effective in reducing fear of death. Results demonstrate that there is value in using strategies to help the student to develop emotional and spiritual intelligence in order to prepare for aspects of dying, before they experience the death of a patient. This preparation enhances the quality of the therapeutic relationship between student and patient. Another outcome is that students need a particular quality of support, at home and in clinical practice and that there are particular implications for Black, Asian and Minority Ethnic (BAME) students. Mentors of students need to be trained to be sensitive to the students' needs when caring for people who are dying. Greater attention to preparation for death and care of the dying is likely to enhance the provision of end of life care and may also reduce attrition in first-year student nurses.

Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.