Yes / Occupancy is commonly used to measure bed management in hospices, however increasing complexity of children and young people, and technology dependence mean this is no longer effective. to develop a dependency tool that enables the hospice to safely and effectively manage the use of beds for planned short breaks (respite), preserving capacity for children requiring symptom management and end of life care. Methods: a comprehensive literature review and existing tools were used to inform the development of the Martin House Dependency Tool Framework. Training was provided to staff and the tool piloted before applying it across the hospice caseload. Findings: The Tool has been used on 431 children (=93.1% of caseload). The Tool enabled consistency of assessment and more effective management of resources, owing to a contemporaneous understanding of the clinical needs of those on the caseload. Conclusion: The tool has enabled consistent and transparent assessment of children, improving safety, effectiveness and responsiveness, and the management of the workforce and resources.

Constatant la place importante de la santé dans la société contemporaine, l’étude du passage d’un système de santé d’Ancien Régime au système actuel à l’échelle d’un département rural comme la Dordogne représente l’objet de ce travail. En 1803, sont affirmés par la loi, les monopoles, médical et pharmaceutique, et en 1939, les éléments principaux du système actuel sont en place. L’évolution du système nous semble la conséquence de la rencontre de demandes de santé et de bien-être de populations de plus en plus larges et d’offres de santé de la part d’individus qui se professionnalisent. Au XIXe siècle, (Première Partie) les docteurs en médecine éliminent la concurrence (officiers de santé, charlatans, autres offreurs de santé) et trouvent leur place dans la société (épidémies, hygiène, vie sociale) ; les pharmaciens passent de la fabrication/vente de produits simples à la vente de médicaments de plus en plus issus de l’industrie et autres produits de parapharmacie ; les sages-femmes et les sœurs congréganistes sont des auxiliaires ou des concurrentes. Les demandeurs de soins appartiennent à des groupes sociaux de plus en plus nombreux et font appel au système pour des pathologies de plus en plus variées. Les indigents sont pris en charge par les bureaux de bienfaisance, le dépôt de mendicité et les hôpitaux-hospices, en expansion numérique et élargissant leur clientèle hors de l’indigence. Au XXe siècle, (Deuxième Partie) le système oscille entre libéralisme défendu par les acteurs de santé (syndicalisme) et étatisme pour améliorer la santé de populations de plus en plus larges. La spécialisation médicale apparait et les pharmaciens, assurés du monopole par les spécialités, sont dans un système capitaliste. La mission sociale de l’Etat se réalise par l’organisation départementale de l’hygiène publique, par l’ouverture de dispensaires et le vote de lois (Aide Médicale Gratuite, Assistance aux vieillards, infirmes et invalides, Accidents du travail, Retraites Ouvrières et Paysannes, etc.). Les bureaux de bienfaisance semblent inadaptés. La spécialisation des structures hospitalières se réalise, les hôpitaux reçoivent les malades et la lutte contre les fléaux sociaux (tuberculose, syphilis,) mobilise les autorités et les soignants. Les progrès de la chirurgie permettent l’ouverture de cliniques chirurgicales privées dans les villes. Le financement du système (Troisième Partie) fait appel à trois modes : la charité privée organisée avec son corrolaire, l’assistance publique, la prévoyance avec les Sociétés de Secours Mutuels et enfin la solidarité sous la forme des Assurances Sociales. Aucun système n’a supplanté les autres et la coexistence des trois est une des caractéristiques du système de santé français, encore actuellement. / Considering the important place of health in our contemporary society, this work will focus on the study of the transition from an « Ancien Régime » health system to the current system, in a rural department such as the Dordogne. In 1803, the first laws were created to establish medical and pharmaceutical monopolies to lead, in 1939, to the main elements of our current system. The evolution of the system is a consequence of the meeting of the demands for health and well-being of ever-widening populations and the provision of health care by individuals becoming more professional. In the 19th century (Part I), medical doctors eliminated competition (health officers, quacks and other health care providers) and found their real place in society (epidemics, hygiene, social life). Pharmacists moved from manufacturing and selling simple products to the selling of increasingly industrial medecine and other parapharmacy products. Midwives and congregational sisters were either assistants or rivals. The demand for healthcare came from more and more different social groups and for more and more varied illnesses. The needy were taken care of by charitable offices, beggars’homes and hospital-hospices which were in growing numbers, expanding their clientele outside of indigence. In the 20th centuty (Part II) the system oscillated between liberalism defended by health providers (trade unionism) and statism to improve the health of increasingly large populations. The medical specialization appeared and the pharmacists, comforted by their monopole, became a part of a capitalist system. The State’s social mission was carried out through the organization of public health by geographical departement, through the opening of dispensaries and through the passing of laws (free medical aid, assistance to the elderly, infirm and disabled, industrial accidents, workers’ and peasant farmers’ pensions, etc.). Charitable offices seemed inadequate. The specialization of hospital structures took place, hospitals received patients and the fight against scourges (tuberculosis, syphilis) mobilised the authorities and carers. Advances in surgery made it possible to open private surgical clincs in the cities. The financing of the system (Part III) involved three modes : private charity and its corollary public assistance, foresight with the Mutual Aid Societies and solidarity in the form of Social Insurance. Until now, no system has supplanted the others and the coexistence of the three is one of the characteristics of the French Health System.

The purpose of this study was to describe the extent and nature of CAM services that are provided and used in Texas hospices. The study investigated the significance of hospice setting characteristics such as age, geographic location, agency type, profit orientation, Medicare certification, and number of patients served as they relate to the likelihood of offering CAM, using a robust methodological and analytical strategy. Data was collected via self-administered mail surveys to 369 hospice directors in the state of Texas. A total usable response rate of 35.7% was obtained after an initial and one follow-up mail-out. A majority (N = 62, 56.4%) of hospices provided at least one type of CAM to their clients; however, a sizeable proportion of patients did not utilize the provided CAMs. The most frequently offered CAMs included massage, music, relaxation, spiritual healing and pet therapies with females and non-Hispanic whites being the most frequent users of these CAM services. Among CAM providers, short length of stay and funding were the primary obstacles to CAM provision, with most hospices relying on a combination of general hospice funds and volunteers to sustain the delivery of CAM services. The odds of offering CAM in ‘not-for-profit’ hospices were approximately four times higher than in ‘for-profit’ hospices (OR = 3.77, p = 0.022), while the odds of offering CAM increased by 13% for every 100 patients served by hospices (OR = 1.131, p = 0.015). Other hospice setting characteristics were not significantly related to CAM provision. In conclusion, a majority of hospices offered CAM services to their clients, although many patients are not utilizing these services. This observation might be connected with the fact that most CAM services are currently not being reimbursed through the Medicare Hospice Benefit, a government program that a majority of hospices depend upon for the coverage of substantial portions of their end-of-life services. Nevertheless, our study showed that CAM provision is related to the number of patients served and profit orientation status, but is not related to other measured characteristics of hospices. / text

published_or_final_version / Architecture / Master / Master of Landscape Architecture

Thesis (M.A.)--Catholic Theological Union at Chicago, 1996. / Vita. Includes bibliographical references (leaves [44]-47).

Thesis (Ph.D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed on June 24, 2009). Includes bibliographical references.

Thesis (Ph. D.)--Yale University, 1998. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 327-371).

This diploma thesis deals with the problem of the drinking-regime keeping in case of patients in hospices and in case of seniors living on their own. The phrase 'drinking regime' means correct fluid supplement which is necessary for a human body. It is the main way to recover the daily fluid loss. The intake of fluids is essential at any age, though even more essential it is at the old age, when the human body encounters considerable natural decrease in amount of fluids and what is more, when a man also loses the feeling of thirst. To stay healthy and in a good shape, it is necessary to maintain a balance between the intake and expenditure of fluids during a day. From this point of view, it is important to have a regular fluid intake during a day - especially to drink sth. before one starts to feel thirsty.

The general aim of this study was to determine the experiences of a sample of terminally ill patients in using spiritually focused psychotherapy. This was a qualitative study conducted to a sample of 2 terminally ill patients from hospice in Grahamstown, South Africa. The research was conducted in 3 phases: an initial in-depth interview conducted to determine the participants' level of spirituality as well as the extent to which their terminal illnesses had affected their functioning. This was followed by a minimum of 6 spiritually focused therapy (SFT) sessions as a second phase of the research. To determine the participants' experiences of SFT, 2-3 in-depth interviews were conducted during the 3m phase of the research study. The research revealed that a belief in a higher power helps terminally ill patients cope better with their illness and that social disconnectedness is related to HIV / AIDS stigma. It also revealed that terminal illness is co-morbid with other psychiatric symptoms such as depression, evokes existential concerns, results in a change in the level of spirituality and affects the whole family. Participants blamed themselves for their illness, but found that engaging in the process of forgiveness of self and others brought about psychological healing for them. They experienced SFT as a coping resource that assisted them to deal with the fear of death as well as increased insight into the development of psychopathology and spiritual blockages. It is recommended that a comprehensive and holistic assessment during intake be undertaken so that where spiritual needs are available, therapy can be spiritually augmented to ensure that such needs/ struggles are addressed. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

Background: The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patient’s wellbeing in terms of ‘capability’. It is a new measure with high potential for broad and international use. The aims of this study were the translation of the ICECAP-Supportive Care Measure from English into German and the content validation of this version. Methods: A multi-step and team-based translation process based on the TRAPD model was performed. An expert survey was carried out to assess content validity. The expert panel (n = 20) consisted of four expert groups: representative seniors aged 65+, patients aged 65+ living in residential care, patients aged 65+ receiving end-of-life care, and professionals in end-of-life care. Results: The German version of the ICECAP-Supportive Care Measure showed an excellent content validity on both item- and scale-level. In addition, a high agreement regarding the length of the single items and the total length of the questionnaire as well as the number of answer categories was reached. Conclusions: The German ICECAP-SCM is a valid tool to assess the quality of life at the end of life that is suitable for use in different settings. The questionnaire may be utilized in multinational clinical and economic evaluations of end-of-life care.