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Within a hospice environment, informal caregiving at the end of life can be a physically, psychologically, psychosocially and spiritually challenging experience, where the health and well-being of informal caregivers directly impacts the quality of end-of-life care of the resident. Inspired by a personal experience within palliative care, this practicum project focuses on how the design of an independent hospice facility can support the needs of informal caregivers in the delivery of palliative care. This holistic approach to palliative design integrates the overarching principles of healthy anticipatory grieving and patient-focused, family-centered end-of-life care, alongside the fundamental strategies of quality built environments and the tenets of biophilic design. Located on Waterfront Drive in the northeast corner of the Winnipeg Exchange District, the design of Exchange Hospice includes the adaptive reuse and partial new construction of an independent hospice facility. Exchange Hospice capitalizes on the healing potential of nature through direct, indirect, and symbolic connections to the natural environment.

Hospices and support teams offering palliative care have increased by over four fold in the U.K. during the last decade. However, evaluations have been limited, often because of a lack of suitable outcome measures. This study aimed to develop and test the validity and reliability of a measure of palliative care provided by support teams. Through detailed discussion of work objectives with care staff, assisted by review of the literature, the Support Team Assessment Schedule (STAS) was developed. STAS has 17 items, each scaled 0 (best) to 4 (worst), with definitions for each scale point. Median time to complete a STAS rating was 2 minutes (range <1- 15). Face validity was demonstrated by use in five settings. Criterion validity was assessed by comparing team ratings with ratings from patients and family members (or other carers) collected through interview. Patient and team ratings showed moderate correlations (rho ranging 0.45 - 0.66 for 5 out of 7 items): team ratings were usually closer to those of patients than those of family members. As a test of construct validity, quality of life (HCRA-QL) index items were shown to correlate with similar STAS items in patients more than four weeks before death (a STAS sub-scale of six items was correlated with the total HRCA-QL, Spearman rho -0.45). Reliability of STAS was assessed by comparing the ratings of different staff. Out of a total of 45 patient assessments, 16 items showed agreement or ratings within one score in 88% or more cases, Cohen's Kappas were greater than 0.48 (up to 0.87) and were highly significant (p < 0.0005). There were high correlation coefficients (Spearman's rho ranged 0.65 - 0.94). Split-half reliability and internal consistency was assessed using Spearman Brown coefficients and Cronbach's alpha for ratings at referral, at death or discharge, and on all weeks (combined). The coefficients ranged 0.68 - 0.89: slightly higher than the coefficients found for the HRCA-QL index. Serial scores of patients that improved (the majority) and deteriorated (a minority) under care, and results from first and last assessments of patients under the care of five support teams, indicate that the STAS was discriminating in practice. Although STAS was used to audit support team care the items are relevant to the assessment and evaluation of palliative care in other settings.

Aim: The aim of this study was to investigate relatives opinions of information, interaction, support, participation and care at a hospice unit. The aim was also to investigate whether there was a difference between women and men. Method: The study is a descriptive quantitative cross-sectional study. A questionnaire with closed and open-end questions was sent out to 66 relatives to patients who had died at the hospice unit. The closed questions were analyzed with SPSS. A content analyze was used for the open-end questions. Results: The most of the relatives were fully pleased with information, interaction, support and care. Relatives were most pleased with the interaction with the staff. Almost half of the relatives had wanted to participate more in the care of the patient and they had wanted more information to be able to participate. The men were more pleased with the information than the women. There were no significant differences in the other questions. Many relatives experienced the hospice unit as good. Conclusion: The study showed that the relatives were pleased with the hospice unit though some relatives were displeased with their participation in the care of the patient. These needs to be improved and further investigation are needed.

Thesis (Ph.D.)--Virginia Commonwealth University, 2008. / Title from title-page of electronic thesis. Prepared for: School of Social Work. Bibliography: leaves 157-178.

Thesis (M.S.H.S.A.)--Regis University, Denver, Colo., 2008. / Title from PDF title page (viewed on May 28, 2009). Includes bibliographical references.

Thesis (M.A.)--Trinity Evangelical Divinity School, 1995. / Abstract. Includes bibliographical references (leaves 73-78).

Thesis (M.T.S.)--Catholic Theological Union, 1984. / Bibliography: leaves 43-45.

Thèse--Méd.--Reims, 1973. N°: N° 1. / Bibliogr. ff. I-VI.