Background: Palliative care focuses on improving quality of life for patients and their families by providing relief from the stress, pain, and other symptoms of a serious disease or injury. Trauma care has a heavy focus on improving resuscitation efforts, which has left little room in the literature for studies on utilization of palliative care in this population. Objective: The purpose of this DNP project was to better understand the use of palliative care for trauma patients at a Level 1 trauma center in southern Arizona to inform a future quality improvement (QI) project. Project Design: A survey was completed to determine 1) how palliative care is utilized for trauma patients at this institution; 2) what barriers exist for the use of palliative care in this population; 3) what is the culture of the trauma team regarding palliative care; and 4) whether there are differences in palliative care use between physicians and advanced practice providers (APPs) on the trauma service. Participants and Setting: Eleven trauma APPs and attending physicians at a Level 1 trauma center in southern Arizona. Measurements: APPs and physicians were surveyed using a survey tool created by the author to answer the project questions. This survey assessed barriers to the use of palliative care, situations and patient characteristics prompting palliative consults, previous education in palliative care, comfort with difficult topics and symptoms, and suggestions for improving palliative care use at this facility. Results: As a team, there was agreement between APPs and attending physicians that lack of timely availability of palliative care staff was a barrier to initiating consults, in addition resistance from families regarding palliative care. Both groups were also likely to consult palliative care for assistance with transitions of care and when there is family conflict in decision making. Both groups felt that increased availability of palliative staff to cover nights and weekends, as well as provider education on palliative concepts would improve utilization of palliative care. Conclusion: Future QI projects should focus on provider-identified interventions to improve palliative care use, such as continuing education on palliative care and increased availability of palliative care staff.

Thesis (MPH)--University of Limpopo, 2009. / Background: An understanding of the effectiveness of the hospital-based palliative care programme and the extent to which it changes the way patients are managed in the general medical wards is required, in order to develop evidence-based palliative care guidelines for Public Hospitals on the management of HIV/AIDS patients. Purpose: The study aimed to identify and describe the effectiveness of the Palliative Care programme on the management of HIV/AIDS patients at Chris Hani Baragwanath Hospital. The objectives of the study included to: • Determine the proportion of HIV positive patients admitted into Chris Hani Baragwanath general medical wards accessing services of a hospital-based palliative care team • Identify the care and support needs experienced by HIV positive patients • Compare the frequency of the met and unmet needs of HIV positive patients in those referred as opposed to those not referred to the hospital-based palliative care team Methods: Non-random quota sampling of 50 HIV positive patients confirmed by an ELISA test, and admitted with HIV related illnesses were selected from admission records of medical wards in Chris Hani Baragwanath Hospital. 8 (16%) of the patients were too ill to communicate, 12 (24%) declined the interview and 30 (60%) gave consent to be interviewed. The data was collected using researcher administered questionnaires, and captured on Microsoft Excel 2003. Descriptive statistics were analyzed using STATA 10. Participants were assessed for enrolment into the hospital-based palliative care programme, common palliative care needs experienced and the frequency of identification and provision of palliative care needs provided for patients in the medical wards with focus on physical symptoms, pain, psychosocial problems, integration of care and counselling needs. The group was further divided into those under a palliative care program and those not under palliative care, for further data analysis. Results: Findings revealed that very few patients (27%) with HIV&AIDS were accessing services of the hospital-based palliative care. Significant proportion (67%-77%) of HIV infected patients were experiencing physical symptoms, pain and psychosocial problems requiring palliative care interventions. Further findings revealed that for those participants who were not referred for the palliative care programme, symptoms and pain complaints were not effectively identified and treated by health personnel. Provision of psychosocial and spiritual support was inadequate and that the quality of life for HIV/AIDS patients was compromised due to lack of comprehensive and integrated holistic care. These components were found to be effectively addressed amongst the referred group. iv Conclusion and recommendations: Hospital-based palliative-care has limited effectiveness due to the small size of the team which is working against demands from increasing numbers of HIV positive patients. All health providers working in medical wards need to be trained in palliative care, to develop a capacity to integrate palliative care principles into the routine medical care of HIV/AIDS patients.

Diss. Malmö : Malmö högskola, 2007.

The development of palliative care in terms of recognizing the needs of the dying, palliative care becoming a nursing and medical speciality, the involvement of the World Health Organization in palliative care and the continuous development of treatment modalities available to cancer patients creates the expectation that the outcomes for the patient should also be positively influenced. The purpose of the study was to determine the most common symptoms of advanced cancer patients treated in a public and private hospital in Tshwane, and whether advances in palliative care improved the outcomes for these patients by decreasing the prevalence of symptoms experienced. The design of the study was a quantitative survey. The population consisted of patients with advanced cancer receiving palliative treatment as out patients in radiation and medical oncology clinics in a public and private hospital the Tshwane Metropolitan area. The sampling method was convenient and the sample size was 148 participants (n=148). Data was gathered by means of an interview and self report. Data analysis was done by means of descriptive statistics. The results of the study indicated that a high number of patients still experience problems that could have been prevented. Pain was found to be the biggest problem for patients (76.4%) followed by weakness and fatigue (65.5%), nausea and vomiting (65.5%) and a dry mouth (46.6%). Thirst was reported by 41.2% of the sample. The study provides evidence that the development of palliative care did not have a positive outcome for patients by reducing the prevalence of symptoms experienced.

No description available.

Although there is a growing movement to conceptualize palliative care as an integral part of comprehensive cancer care, access to coordinated palliative care services is often limited to end-of-life when efforts to control the disease have failed. Little was known about how this phenomenon is experienced in oncology nursing practice. A phenomenological approach was used to explore oncology nurses experience providing non-curative care in one of six outpatient cancer settings within an urban health region in Western Canada. Emerging understandings suggest that oncology nurses support patients‟ hopes for prolonged survival with non-curative treatment while revisiting treatment decisions in the context of witnessed suffering. In the context of mounting symptoms, oncology nurses strive to construct a „safety net‟ of community supports to rescue patients from crisis. Inherent tensions within this experience are shaped by how cancer care and palliative care are understood, how treatment decisions are framed within their care team, and organizational constraints in the provision of services in the community. These understandings invite further discussion about strategies to support oncology nursing practice in the provision of non-curative care. / Graduate

Although there is a growing movement to conceptualize palliative care as an integral part of comprehensive cancer care, access to coordinated palliative care services is often limited to end-of-life when efforts to control the disease have failed. Little was known about how this phenomenon is experienced in oncology nursing practice. A phenomenological approach was used to explore oncology nurses experience providing non-curative care in one of six outpatient cancer settings within an urban health region in Western Canada. Emerging understandings suggest that oncology nurses support patients‟ hopes for prolonged survival with non-curative treatment while revisiting treatment decisions in the context of witnessed suffering. In the context of mounting symptoms, oncology nurses strive to construct a „safety net‟ of community supports to rescue patients from crisis. Inherent tensions within this experience are shaped by how cancer care and palliative care are understood, how treatment decisions are framed within their care team, and organizational constraints in the provision of services in the community. These understandings invite further discussion about strategies to support oncology nursing practice in the provision of non-curative care. / Graduate

The neonatal intensive care unit (NICU) is frequently occupied by newborns who are marginally viable, or critically unwell, and could be considered terminally ill. It is a busy, highly technical environment with an arsenal of life-saving medical equipment at its disposal, and advances in technology used in this field stretch the boundaries of viability. Despite technological advances, increases in the margins of viability and highly skilled healthcare delivery, some newborns will still die in the NICU. In recent years, palliative care for the neonatal population has become increasingly topical and part of the lexicon of contemporary neonatal practice. Evidence-based protocols are available to inform this model of care, yet in reality, provision of palliative care to newborns is ad hoc. The reasons why implementing a palliative model of care have been problematic are unclear. The purpose of this study was to identify the barriers and facilitators to palliative care practice in neonatal nursing, and to develop policy recommendations to improve this area of practice. This exploratory research was conducted to answer two research questions: 1) What are the barriers and facilitators to palliative care practice in neonatal nursing? 2) How can the identified issues be addressed to inform policy and clinical guidelines in the practice environment? Phase one of this investigation developed, pilot tested, and administered an instrument to identify the barriers and facilitators to practice. Data analysis identified three subscales that indicated facilitators and barriers to palliative care practice. The second phase of this study used a translational research approach, utilizing interpretive methods to explore and contextualise the population study findings to inform policy development to improve palliative care practice in neonatal nursing. This research has identified that the facilitators that do exist for palliative care practice are subject to caveats that impinge markedly upon these facilitators. Furthermore, the barriers that were identified pose threats to the integration of a palliative model of care into Australian neonatal nursing practice. Thus, the overall results from this research have lead to a composite understanding of the barriers and facilitators to palliative care practice in Australian neonatal nursing, which may account for the gap between support of palliative care for marginally viable and critically ill newborns, and the application of this model of care in clinical practice. Translating the survey findings into policy directives that are applicable to the clinical environment has resulted in the development of recommendations that are aimed at improving palliative care practice in the NICU.

Background: Palliative care means improving quality of life along a spectrum of illnesses including cancer. Cancer is one of the leading causes of death. Having the discussion of goals of care including palliative care is important to have with individuals who have advanced cancer. There were limited studies that identify the providers’ attitudes, subjective norms, and perceived behavioral control on discussion of goals of care including palliative care. Purpose/Aim: This Doctoral Project consisted of identifying factors (i.e., attitudes, behaviors and subjective norms) in discussion of goals of care with their terminal cancer patients in the outpatient oncology clinic. Multiple studies have demonstrated the lack of knowledge providers have about palliative care. Through this study, the attitudes, subjective norms, and behaviors of providers were evaluated regarding goals of care for palliative care. Methods: An investigator developed questionnaire with six-point Likert-type scaling was used to measure each dimension (attitudes, subjective norms, and perceived behavioral control) regarding discussion of goals regarding care. These questionnaires were sent electronically to the oncology providers at Arizona Center for Cancer Care in Phoenix, Arizona. The data were collected through Qualtrics. Outcomes: Six providers participated in the survey. Results on the Attitude subscale indicated that the providers regarded discussing goals of care including palliative as very important and beneficial to patients. In comparison to this subscale score, the results on the Subjective Norms and Perceived Behavioral Control subscales were somewhat lower, though still above the mean, indicating that providers regarded the norm and level of resources available for discussing goals of care as somewhat lacking in their work setting. Further research is needed in this area of inquiry, including a quality improvement project to promote quality care in discussing goals of care including palliative care with patients who are diagnosed with advanced cancer.

Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and crosssectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources, and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.