Chronic obstructive pulmonary disease (COPD) requiring long-term oxygen therapy (LTOT) is an incurable lung disease often complicated by other comorbidities. Research is limited for hospitalized COPD exacerbations with LTOT and palliative care services. The purpose of this quantitative research study was to determine the correlation between palliative care interventions and COPD patient outcomes specific to an intensive care unit (ICU) stay, invasive mechanical ventilator support, physician orders for cardiopulmonary resuscitation (CPR) code status, and hospital discharge to hospice care. The theoretical base for this study was Donabedian's quality improvement theory. The quasi-experimental, nonequivalent groups design divided COPD hospitalized patient sample into 2 groups, those with and those without palliative care, for comparison. An independent-samples t test, one-way MANOVA, and follow-up univariate ANOVAS was done to compare the means of ICU days and ventilator days; a cross tabulation, chi-square test of independence, and Fisher exact test was done to compare code status and place of hospital discharge. The mean number of the ICU days and ventilator days for palliative care patients was significantly higher than patients who did not receive palliative care. A significant interaction was found for palliative care and code status change from CPR to no CPR; however, data relating to palliative care and hospital discharge to hospice was insignificant. In conclusion, palliative care does not reduce costs by limiting the number of days spent in an ICU or the number of days on invasive mechanical ventilation; although, it may have an important role in the code status order change from CPR to no CPR to align with the patient's end of life care preference.

Falls among the elderly is a health concern affecting multiple patients annually. Hospice patients and those with multiple comorbidities are at the greatest risk of falling and sustaining injuries from falls. Aromatherapy has been used for reducing multiple symptoms as well as for decreasing falls. The practice-focused question explored whether an education program on using aromatherapy for fall prevention would increase knowledge of this intervention for an interdisciplinary group of hospice staff. The design was developed using Knowles's theory of andragogy and Bloom's taxonomy. Thirteen staff members from the same facility participated in the education program. The program was targeted to educate staff who worked with hospice patients about implementing the intervention in their practice. The program was also offered facility-wide to allow all staff the opportunity to increase their knowledge in using the intervention in their fall- reduction programs. Assessment tools including pretest, posttest, and evaluations were completed by all program participants. Using a Likert scale to calculate participant responses, results revealed an increase in knowledge gained from 15% to 60%. The participants rated the program favorably with a mean score of 4.4 to 4.6 out of 5. This program would be beneficial to hospice caregivers and a broader range of staff members including nonhospice nurses, therapists, and providers who are interested in decreasing falls in their patient population. The program would also be of interest to accrediting bodies, hospice, palliative care, oncologic, and geriatric organizations for alternative fall-reduction interventions. Reducing falls will result in a positive social change by decreasing fall-related injuries costs and improving quality at end-of-life.

Avoidable hospitalizations of hospice patients cost Medicare $3 billion a year. When hospice nurses are able to identify early signs and symptoms of acute illness and provide appropriate interventions to prevent such admissions, 20-60% of the hospitalizations are preventable. The practice problem addressed in this quality improvement doctor of nursing project was the 30% hospital admission rate of hospice patients as evidenced by chart review, admission data, and revocation data. The first purpose of the project was to identify evidence-based nursing care paths in the literature for the top 5 medical diagnoses related to avoidable hospital admissions. The second purpose was to develop an educational curriculum to educate the staff on the care paths with a pretest/posttest to assess knowledge gained from the education. Rosswurm and Larrabee's conceptual model was used to frame the project. Three content experts evaluated the curriculum plan using a 4 item dichotomous rating of 1 (not met) and 2 (met). An average score of 2 revealed that the curriculum content met the course objectives. Content experts validated each of the 16 pretest/posttest items using a Likert scale ranging from 1 (not relevant) to 4 (highly relevant). The content validation index score was .94, indicating that the pretest/posttest reflected the course objectives and content. Recommendations were made for structuring the pretest/posttest. The project promotes social change by assessing, intervening, and treating patients in the outpatient hospice setting to prevent avoidable hospitalizations, thus promoting patient well-being and fiscal responsibility of healthcare dollars.

Hospice services are utilized by more than 1.6 million people yearly, and there are a great number of caregivers who are tasked with caring for these individuals at home. Caregivers are at risk for fatigue, burnout, and decline in their own physical and mental health. While the Centers for Medicare and Medicaid Services (CMS) cover costs of temporary respite care for hospice patients, the caregivers' needs for respite care are often unrecognized and unaddressed. The purpose of this project was to plan a respite program within the hospice agency consisting of revised respite policy and procedures, the Caregiver Reaction Assessment (CRA) tool to routinely assess the caregiver for burnout and/or fatigue, and a detailed outline for the implementation of respite care. Anderson's behavioral model of service was used to guide the project's understanding of the underutilization of respite services. This project was guided by the practice-focused question examining the development of an evidence based caregiver respite program within the hospice agency. The program was developed based on a review of peer reviewed research studies and the input of a project team of local experts. The project team participated in the project that created a respite policy which includes a biweekly caregiver assessment and step-by-step directions on how to implement respite care. A final report was developed and submitted to the Hospice agency. This revised policy and procedure includes a blueprint for implementation and a full set of recommendations on the process, use of the CRA, educational in-services, and evaluative methods. These recommendations have the potential for positive social change by increasing patient and caregiver outcomes, serving as an example for other hospice agencies to follow, and improving care at the end of life.

Improving the quality of remaining life for individuals who are terminally ill and their families is an issue that has become increasingly important in recent years. This issue has evolved from perceived deficiencies of conventional health care institutions in meeting the needs of people who are in the final stages of their life, when curative measures are no longer deemed appropriate. In response to deficiencies in care of the terminally ill and their families, there has been a movement toward humanizing conventional health care and making it more holistic. Hospice care, which is consistent with this movement, has evolved as an alternative to hospitals and nursing homes. The purpose (of this study was to investigate the physical environment (building and grounds) of a free-standing hospice facility to identify the features that would contribute to the design and renovation of other hospices and health care facilities that plan to adopt a hospice program of care. In this study, an attempt was made to examine how architectural factors combine in a hospice setting to meet the needs of the dying and their families and those who work in hospices. Specifically, this study used a qualitative, case study approach to describe and develop an understanding of the feelings and experiences of the users of a particular hospice facility concerning the physical environment of that facility. Post Occupancy Evaluation Methodology, which is a process to assess the performance of the built environment after it has been occupied for some time, was employed. Qualitative analysis of the data revealed three distinct environments within the facility to be of major importance to the users when discussing the physical surroundings. The three separate areas of importance were the grounds, the administrative offices, and the patient care unit. The findings of the study will be of use to designers, architects, and planners, as well as hospice advocates, as they will assist them in conceptualizing essential components of hospice design and in creating better hospice facilities in the future.

The goal of this study was to explore the nature and extent of palliative care in the Nairobi Hospice, in Kenya. Owing to the limited information available on this subject, the study is based on a research question that seeks to deepen understanding of the experiences of palliative care services by patients facing life-threatening illnesses. In answering the research question, the study employed a variety of methods. First, it used qualitative research approach in order to unearth personal experiences of the value of services received. Second, it employed applied research with the aim of using results to influence the formulation and improvement of palliative care programs in Nairobi. Further, the study employed the case study method as the research strategy. Focus group interviews were utilised as the data collection technique. The researcher used an interview schedule and administered semi-structured questions on a group basis. Availability sampling method was used to draw a sample of 20 patients receiving palliative care at the Nairobi Hospice. Confirmation from the study indicated that patients receive medical care, counselling, and spiritual care as well as day care services, usually provided by the hospice staff. The study further confirmed the value of palliative care. Services provided offered a number of benefits for the patients for instance, enhanced hope, mobility, as well as improved state of health for these patients. At the same time the study underscored the value of spiritual guidance. However this was provided as an additional service, being offered outside the hospice. Measures to integrate this service would improve the value of palliative care services in general. Further, it was noted that there was no particular time frame for receiving palliative care at the hospice since patients receive care at different intervals. The study also disclosed that patients’ illnesses impacted on their families negatively for example, a number of these patients were either abandoned or separated from their families, their families suffered financial strains while others were in denial and felt very desperate about the whole situation. The study conclusively indicated that social workers can play a vital role in palliative care provision by either conducting regular home visits, educating and creating awareness as well as offering counselling services to both the patients and their families. / Dissertation (MSW)--University of Pretoria, 2008. / Social Work and Criminology / MSW (Health Care) / Unrestricted

Diploma thesis surveys South Moravian countryside. The importance of the close connection with people who live there on a spiritual and intellectual level. There is a forbidden place in former Sudetenland, island in the fields - ruin of farmstead. Project found it interesting to keep it in solitude, but as a place of meditation. Project of the small monastery and the community of people helping in hospice.

Can architecture ease the departure of people and their loved ones and remove or at least alleviate the stigmatization and taboo of death? The aim of this work is to design an ideal space for palliative care. The aim is not to design another hospice, or home for the elderly people, which has been designed and built more or less enough (see Analytical section). The task I set out was to accommodate this space on the basis of its broad context, to focus on the right urban location, operational content, relationships with and around, linking, opening, ... but also the very idea of death, leaving parting. The theme of palliative care is very complex and societal, which is reflected in its own design, which represents a new model of palliative care architecture. Palliative Care Center.

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