RESUMEN
BACKGROUND: Only a small number of patients have utilized the home-based end-of-life care service in Shanghai that has been offered since 2012. This study explores how home-based end-of-life care is delivered in community health service centers in Shanghai and examines the difficulties in the delivery of the care. METHODS: This was a qualitative study in which data were collected from interviews and analyzed using qualitative content analysis. Nineteen health care providers with experience in delivering home-based end-of-life care in 12 community health service centers were recruited. The interviews were conducted between August 2018 and February 2019. RESULTS: Four themes emerged from the interviews: (i) Patients under home-based end-of-life care: Patients receiving the care were cancer patients with less than 1 year of life expectancy. The criteria for patients were broad. (ii) Service structure: The service was delivered regularly by the physicians and nurses using the approaches of home visits and/or telephone follow-ups. (iii) Service process: The service consisted of multiple components, including monitoring the patient's condition, managing the patient's symptoms, giving daily care instructions, performing nursing procedures, and giving psychological support. However, most of the care focused on monitoring the patients and managing their physical discomfort. (iv) Difficulties in delivering care: Being unable to provide the service and feeling powerless when facing psycho-spiritual problems were the two major difficulties. Three factors contributed to the suspension of the service: The gap between the service and the needs of the patients, a lack of patients, and low work motivation. The demand that the truth be concealed from the families and their attitude of avoiding talking about death were the key factors of the failure of psycho-spiritual care. CONCLUSIONS: Several issues should be addressed before the service can be further developed, including fully understanding the needs and preferences of local patients and their families, securing more financial support and a better supply of drugs, delivering better training for staff, and ensuring greater rewards for individuals and institutions providing the service.
Asunto(s)
Personal de Salud/psicología , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Neoplasias/terapia , Cuidado Terminal/psicología , Adulto , China/epidemiología , Femenino , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Investigación CualitativaRESUMEN
OBJECTIVES: The objective was to promote evidence-based practice in screening for delirium in patients in the palliative care ward of a cancer hospital in Shanghai. INTRODUCTION: Delirium is common but under recognized among patients in palliative care settings. Early detection is essential for timely management. Practice guidelines recommend an initial screening at first contact, followed by continuous screening. METHODS: The Joanna Briggs Institute's three-phase Practical Application of Clinical Evidence System and the Getting Research into Practice audit and feedback tool were used to enhance evidence-based practice. In phase 1, four audit criteria were developed and a baseline audit was conducted. In phase 2, barriers to compliance were identified, and strategies were adopted to promote best practice. In phase 3, a follow-up audit was conducted. RESULTS: In the baseline audit, no delirium screening was performed, either on admission or regularly during hospitalization, hence compliance with these two audit criteria was 0%. Two out of 18 nurses had received training in delirium management, however neither had been trained to use the delirium screening tool. Compliance with the two criteria for nurse training was 11% and 0%, respectively. Four barriers were identified, including lack of a standardized screening tool, lack of a standardized screening procedure, inadequate knowledge on the part of the nurses, and potential inconsistencies between nurses in the rating of screening criteria. After applying strategies to address these barriers, compliance with the four audit criteria was 100%, 100%, 72%, and 72%, respectively, in the follow-up audit. CONCLUSIONS: Best practice in delirium screening was successfully established in the ward.
Asunto(s)
Auditoría Clínica/métodos , Delirio/diagnóstico , Práctica Clínica Basada en la Evidencia/métodos , Tamizaje Masivo/métodos , Cuidados Paliativos/estadística & datos numéricos , Auditoría Clínica/clasificación , Delirio/epidemiología , Delirio/enfermería , Diagnóstico Precoz , Educación en Enfermería , Adhesión a Directriz , Hospitalización/estadística & datos numéricos , Humanos , Conocimiento , Enfermeras y Enfermeros/estadística & datos numéricos , Habitaciones de Pacientes/estadística & datos numéricos , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: Healthcare providers are facing the challenge of helping cancer patients cope with the impact of outpatient-based chemotherapy. A nurse-led care program was proposed to address this challenge. OBJECTIVE: The aim of this study was to examine the effects of a nurse-led care program for patients receiving outpatient-based chemotherapy. METHODS: This was a single-center, open-label, 2-arm parallel trial with equal randomization (NCT02228200). Breast cancer patients in Hong Kong were randomly allocated to the intervention arm or the control arm. The control arm received routine hospital care. The intervention arm received the nurse-led care plus the routine hospital care. The quality of life, self-efficacy, symptom distress levels, and satisfaction with care were evaluated with questionnaires before randomization (T0), in the middle of chemotherapy (T1), and 1 month after chemotherapy (T2). Individual interviews were conducted with some participants in the intervention arm at T2. RESULTS: The intervention arm participants reported significantly lower distress levels from oral problems, fatigue, peripheral neuropathy, distressful feelings, and higher satisfaction with care. According to the satisfaction evaluation and the interviews, the participants stated that the service was helpful in providing information and communication opportunities, filling the service gap after drug administration, providing psychological support, relieving discomfort, and building confidence. CONCLUSION: Breast cancer patients received support from the provision of comprehensive, continuous, and individualized care. IMPLICATIONS FOR PRACTICE: The nurse-led care program could be applied to breast cancer patients in other hospitals in Hong Kong. Exploring its applicability to cancer settings in other countries is recommended.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Mama/enfermería , Centros de Día/organización & administración , Pautas de la Práctica en Enfermería , Adulto , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Hong Kong , Humanos , Persona de Mediana Edad , Investigación en Evaluación de EnfermeríaRESUMEN
PURPOSE: To evaluate the cost-effectiveness of a nurse-led care program for breast cancer patients receiving outpatient-based chemotherapy. METHOD: An open-label, single-center randomized controlled trial was conducted. Patients receiving the nurse-led care and those receiving the routine care were compared in terms of quality of life, as well as in health service utilizations and total cost of care. A cost-utility analysis was conducted. RESULTS: A total of 124 patients were recruited. The data of 116 subjects who completed the study were used for the cost-utility analysis. There were 81 unscheduled hospital visits and 43 hospital admissions. The common reasons for utilizing health services were infections and fevers, skin problems, digestive system problems, and mouth/teeth/throat problems. There were no differences in health service utilizations between the nurse-led and routine care groups for subjects receiving four-cycle chemotherapy. For those receiving six-cycle chemotherapy, the estimated number of emergency department visits was 2.188 times (95% Confidence Interval, 1.051 to 4.554) higher for the routine care group when compared with the nurse-led care group (pâ¯=â¯.038). The incremental cost-utility ratios were £8856 and £18,936 per quality-adjusted life year gained for subjects receiving four-cycle and six-cycle chemotherapy, respectively. CONCLUSIONS: Cancer patients make unscheduled health service visits when receiving outpatient-based chemotherapy, which leads to increased health service costs. The nurse-led care reduces emergency departments visits made by breast cancer patients undergoing six-cycle adjuvant chemotherapy. For breast cancer patients undergoing four-cycle chemotherapy and six-cycle chemotherapy, the nurse-led care could be cost-effective.
Asunto(s)
Atención Ambulatoria/economía , Antineoplásicos/administración & dosificación , Neoplasias de la Mama/terapia , Pautas de la Práctica en Enfermería/economía , Adulto , Antineoplásicos/economía , Quimioterapia Adyuvante , Análisis Costo-Beneficio , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Costos de la Atención en Salud , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Calidad de VidaRESUMEN
BACKGROUND: More patients are dying in non-palliative care settings than in palliative care settings. How health care providers care for adult patients at the end-of-life stage in non-palliative care settings has not been adequately explored. The aim of this study was to explore the experiences of health care providers in caring for patients at the end-of-life stage in non-palliative care settings. METHODS: This is a qualitative study. Twenty-six health care providers from eight health care institutions which are based in Shanghai were interviewed individually between August 2016 and February 2017. Three levels of health care, i.e., acute care, sub-acute care, or primary care, was provided in the health care institutions. The interviews were analyzed using qualitative content analysis. RESULTS: Three themes emerged from the interviews: (i) Definition of the end-of-life stage: This is mainly defined based on a change in treatment. (ii) Health care at the end-of-life stage: Most patients spent their last weeks in tertiary/secondary hospitals, transferring from one location to another and receiving disease- and symptom-focused treatment. Family-dominated decision making was common when discussing treatment options. Nurses instinctively provided extra care attention to patients, but nursing care is still task-oriented. (iii) Challenges, difficulties, and the future. From the interviews, it was found that pressure from families was the main challenge faced by health care providers. Three urgent tasks before the end-of-life care can become widely available in the future were identified from the interviews, including educating the public on death, extending government support, and creating better health care environment. CONCLUSION: The end-of-life care system of the future should involve health care institutions at all levels, with established mechanisms of collaboration between institutions. Care should be delivered to patients with various life-threatening diseases in both palliative and non-palliative care settings. But first, it is necessary to address the obstacles to the development of end-of-life care, which involve health care providers, patients and their families, and the health care system as a whole.
Asunto(s)
Grupo de Atención al Paciente , Atención Primaria de Salud , Cuidado Terminal , Adulto , Planificación Anticipada de Atención , Actitud del Personal de Salud , China , Toma de Decisiones Clínicas , Enfermería de Cuidados Críticos , Humanos , Entrevistas como Asunto , Atención Primaria de Salud/métodos , Investigación Cualitativa , Cuidado Terminal/métodos , Cuidado Terminal/psicología , Centros de Atención TerciariaRESUMEN
Little is known about how nursing assistants (NAs) perceive the nature of their work and how their work contributes to work-related musculoskeletal disorders (WMSDs). This qualitative study addressed these gaps. Twenty-four NAs with WMSDs working in four nursing homes participated in semistructured focus group interviews. Their WMSDs were not limited to the lower back but involved several body parts. The risk factors for WMSDs included physical, psychosocial, organizational, and personal factors as well as coworkers and clients. However, it is the synergistic effects of long work hours without sufficient rest, work even with musculoskeletal pain because of staff shortages, ineffective management with insufficient prework training and inadequate equipment maintenance, and an aging workforce with strong commitment to resident care that play a crucial role in WMSDs among NAs working in nursing homes. The study found that multidimensional intervention strategies using engineering, administrative, and personal controls should be developed to reduce WMSDs among NAs working in nursing homes.
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Enfermedades Musculoesqueléticas/etiología , Asistentes de Enfermería/estadística & datos numéricos , Casas de Salud , Traumatismos Ocupacionales/complicaciones , Adulto , Estudios Transversales , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/epidemiología , Casas de Salud/organización & administración , Prevalencia , Investigación Cualitativa , Factores de Riesgo , Encuestas y Cuestionarios , Recursos HumanosRESUMEN
AIMS: The aim of this study was to understand the experiences of patients with breast cancer and their involvement during outpatient-based chemotherapy in Hong Kong. BACKGROUND: The outcome evaluation using a mixed-methods approach is not common in interventional studies of nurse-led chemotherapy care programmes. A qualitative approach could provide a deep understanding of the experiences of patients. DESIGN: A qualitative study was conducted. METHODS: This is part of a randomized controlled trial of a nurse-led care programme (NCT02228200). Individual interviews were conducted in 2013 with 10 patients with breast cancer after they had completed the chemotherapy. Qualitative content analysis was adopted to analyse the interviews. FINDINGS: Chemotherapy affected the patients in different ways. Some participants completed the chemotherapy treatment smoothly with minimum side effects, while others encountered many problems during the treatment, which had a great impact on their lives. Guided by their coping attitudes, which were affected by the Chinese culture, most participants adopted behavioural, social, cognitive and emotional strategies to actively cope with the chemotherapy. A few tolerated the treatment passively. Some thought that the process of undergoing chemotherapy was physically bearable, while some equated it with suffering. Others regarded it as a chance to get a new start. CONCLUSION: The experience of patients with breast cancer during chemotherapy can be likened to that of going on a hike. They reach the peak through different paths and bear different burdens. Yet, they have to go through until the end, regardless of how much of a burden they bear and how they achieve the peak.