Concept Of Care Research Articles

Isabella’s lion: circular care, kinship, and healing in Brazilian Candomblé

This paper centers on Isabella, a Candomblé follower who struggled with severe rheumatoid arthritis from an early age, arguing that care and self-care practices in Candomblé are intertwined to such extent that they challenge the dichotomy of caring and being cared for. In contrast to a linear model of care that positions care-giver and care-­receiver at opposite ends of care relationships, the concept of ‘circular care’ describes forms of care that are directed at others and simultaneously at oneself. Exploring the religious kinship in a Candomblé house – with Candomblé deities (orixás) and between humans – this paper shows how circular care blurs the distinction between self and other. The emic concept of ‘the double mirror’ illustrates the ­‘constitutive alterity’ of humans and orixás who relate to each other through kinship building and collective care practices. Since circular care frames one’s care for the orixás and the religious family as healing self-care, failing to provide the correct care may in turn be experienced as detrimental self-neglect. The concept of circular care thus enables a deeper understanding of complex dynamics of care and self-care in the contexts of chronic illness, religion, kinship, and beyond.

Development of an interprofessional person-centred care concept for persons with care needs living in their own homes (interprof HOME): study protocol for a mixed-methods study

IntroductionPeople receiving home care usually have complex healthcare needs requiring the involvement of informal caregivers and various health professionals. In this context, successful collaboration is an important element of person-centred...

A Comparative Study of Compliance with Select Parameters of Patient Safety among Nurses and Doctors in Emergency, Intensive Care Unit, and a Ward of a Tertiary Care Hospital

Abstract Background: Patient safety is a critical component of health-care quality. Population-based studies from a number of nations around the world have consistently demonstrated unacceptably high rates of medical injury and preventable deaths. There is a need to capture these mistakes, identify compliance with standard operating procedures (SOPs) regarding patient safety, and not only learn from them but also to share them with others so that such mistakes are prevented. Methodology: An observational study was carried out in the emergency department, inpatient area, and intensive care units (ICUs) for 3 months each. The checklist had various parameters such as medication errors, correct patient identification, surgery, hospital-acquired infection, handover take over, patient care, and equipment upkeep. Results: Regarding the compliance of medication among nurses, expiry date was checked more frequently in the ICU setting, and pharmacological name was checked before injection more frequently in wards and ICU than in emergency. Compliance with handwashing/sanitizing and adherence to the WHO recommendations among nurses as well as doctors is more in the ICU setting while moving from one patient to another and is statistically significant. The present study revealed that compliance about biomedical waste management was better among nursing staff than physicians. This study found better communication among nursing staff as well as doctors about patient details at the time of shift change in ICUs as well as while shifting patients from one area to another, and this is statistically significant. It was found that records of adverse events are better maintained in intensive care areas than in wards and emergency. Call book register is not being maintained in emergency, and both were statistically significant. The nurses blamed the shortage of staff as the primary reason for noncompliance and partial compliance to SOPs. The hospital under study was grossly deficient vis-a-vis nursing staffing norms as many positions were vacant. Conclusion: There is better compliance with SOPs regarding medication administration, hand hygiene, hospital infection control practices, correct patient identification, handoffs, maintenance of records regarding adverse events, and maintenance of call book register in intensive care settings than in emergency and wards, which is in line with the concept of progressive patient care. Compliance is better among nursing staff as compared to doctors which can be explained by better attitude among nursing staff. The vacant positions of nursing staff need to be filled, which can have a good impact on adherence to SOPs.

A clinical practice review of therapeutic movement-based anterior cruciate ligament reconstruction return to sports bridge program: the biological, biomechanical and behavioral rationale.

This clinical practice review describes the biological, biomechanical and behavioral rationale behind a return to sport bridge program used predominantly with non-elite, youth and adolescent high school and college athletes following anterior cruciate ligament (ACL) reconstruction. Post-physiotherapy, this program has produced outcomes that meet or exceed previous reports. With consideration for athletic identity and the Specific Adaptations to Imposed Demands (SAID) principle, the early program focus was on restoring non-impaired bilateral lower extremity joint mobility and bi-articular musculotendinous extensibility. Building on this foundation, movement training education, fundamental bilateral lower extremity strength and power, and motor learning was emphasized with use of external focus cues and ecological dynamics-social cognition considerations. Plyometric and agility tasks were integrated to enhance fast twitch muscle fiber recruitment, anaerobic metabolic energy system function, and fatigue resistance. The ultimate goal was to achieve the lower extremity neuromuscular control and activation responsiveness needed for bilateral dynamic knee joint stability. The rationale and conceptual basis of selected movement tasks and general philosophy of care concepts are described and discussed in detail. Based on the previously reported efficacy of this movement-based therapeutic exercise program we recommend that supplemental programs such as this become standard practice following release from post-surgical physiotherapy and before return to sports decision-making.

Operation of Mental Health Centres (CZP) in Poland during the SARS-CoV-2 pandemic.

The aim of the study is to characterise the changes in the operation of the Mental Health Centers (CZPs) in Poland during the SARS-CoV-2 pandemic. Changing the concept of psychiatric care and moving towards a community model under the CZPs is, inter alia, no need to present and implement strictly defined schedules by service providers, which allows to respond to the current needs of patients and allows for the adaptation of the conditions and methods of providing psychiatric care services in Poland during pandemic. On the basis of the experiences from the pandemic period, recommendations were presented the aim of which is improving work organisation of the CZPs in Poland. A new map of mental health services' organisation following the peak of the pandemic in Poland is urgently needed. Well-functioning community care fosters good understanding of patients' needs, which means that even in a situation of, for instance, there is no element of surprise and there are known channels and methods of reacting to an emergency situation. The pilot CZPs quickly and easily adapted their response methods to the changing or new needs/new circumstances. As part of the activities in the field of psychiatric care reforms in Poland, it seems appropriate, at the present stage, to use all observations and information on the operation and organisation of work of entities that were included during pandemic in the CZP pilot programme in order to continuously improve the functioning of a new model of mental healthcare.

Social Care and the Social Organization of Care as Key Categories for the Analysis of Public Policies

This work is part of the development of the UBACYT Research Project: Articulations between Mental Health and Primary Health Care in Argentina 2014- 2017: Discourses, Practices and Subjectivity in the process of implementing the National Mental Health Law N° 26,657, directed by Prof. Alicia Stolkiner. Its objective is to describe and analyze the categories of “social care” and “social organization of care” as keys for the analysis of public policies aimed at elderly people with dependency. In previous works, the care of the elderly was addressed as a right to be included in the public agenda and proposals for dependency care based on the community were analyzed, such as Day Clubs and Day Centers. Analysis of conceptions of care and the social organization of care as a key category in the analysis of public policies, which makes it possible to identify the distribution of care responsibilities between the state, market, family and community. It is a type of theoretical research of documentary and bibliographical analysis.

The need to consider 'temporality'in person-centred care of people with motor neurone disease.

The overall aim of this paper is to provide practical insight into the way that professionals caring for a person with motor neurone disease (MND) can recognise, respect and respond to that person's temporality; that is, the person that they have been, that they are nowand that they will be in the future. MND is an umbrella term for a group of four rare, devastating neurodegenerative terminal diseases of middle/later life. Previously, we have acknowledged the importance of different time periods in the trajectory of MND as an illness, for example, during the diagnosis stage through to end of life and decision-making at that time. Living with MND can cause anxiety at all stages of the disease trajectory especially as it can be difficult for people living with MND to communicate their desires and concerns to professionals and carers. It is important that professionals continue to provide holistic care throughout the illness trajectory and the aim of this paper is to explore past research about caring for someone with MND in relation to the concept of person-centred care. The paper is based on the concatenated exploration of the findings of a hermeneutic phenomenological project. Thus, this discursive paper links elements/studies which have been published previously to develop a model of person-centred care for people with MND which recognises and respects their temporality. We suggest MND has a significant impact on a person's lifeworld. The proposed person-centred care model focuses on understanding (interpreting) a person in a wider temporal frame and beyond the context of their illness. The expected collaborative outcomes are that: a person is acknowledged as more than a 'patient with MND'and that a professional is providing person-centred care based on individuality of the person, through a temporal lens. This requires a collaborative approach between the person, othersand professionals. Such person-centred care, focused on individuality, may prevent a person experiencing life in crisis and suffering towards the end of life.

The Acute Perioperative Pain Service: Impact, Organization, and Future Directions.

The Acute Perioperative Pain Service has been established as a relatively new but important concept and service in clinical patient care. Many surgical institutions have dedicated inpatient acute pain services with variable compositions. This review aims to investigate the purpose, clinical and economic implications, and future direction of the Acute Perioperative Pain Service (APPS). There is growing evidence of the multiple benefits of a dedicated APPS, especially pertaining to patients at higher risk of poorly controlled postoperative pain. Healthcare providers furthermore realize the importance of the perioperative pain management continuity of care, consisting of preoperative pain evaluations and post-discharge follow-up in an outpatient pain management setting, in coordination with the primary teams. The Transitional Pain Service (TPS) has emerged as the next step in this evolution and has been successfully implemented at various medical centers. With the growing number of surgical procedures and the increasing complexity of the patient population, effective management of acute postoperative pain continues to be challenging, despite ongoing advances in clinical care, analgesic modalities, and research. The APPS is becoming the clinical standard of care for managing postoperative pain, and its role continues to expand worldwide.

Person-centred oral hydration care for older people with dementia admitted to acute hospital wards: Empirical research qualitative.

To conduct an in-depth exploration of oral hydration care provided to people living with dementia in acute hospital wards, using a person-centred care framework. Oral hydration care is an important, yet rarely explored aspect of fundamental care for people with dementia admitted to acute hospitals. Using person-centred care as a conceptual framework we investigated how oral hydration care is delivered for people living with dementia in acute hospital wards. A qualitative, multiple-case study. The cases were three acute wards in one hospital. Direct observation of care for 13 people with dementia (132 h), semistructured interviews with ward staff (n = 28), ward leaders (n = 4), organisational leaders (n = 5), people with dementia (n = 6), their relatives (n = 5), documentary analysis of clinical inpatient records (n = 26) and relevant hospital policies. Data were analysed using framework analysis. Four themes were identified: (1) The acute hospital: oral hydration is obscured and not prioritised (2) Overshadowing of oral hydration at ward level (3) Siloed nature of hydration roles (4) Strategies for, and barriers to, delivering person-centred oral hydration care. This study combines the concept of person-centred care and oral hydration care for people living with dementia admitted to acute hospital wards, demonstrating that person-centred hydration care was complex and not prioritised. Nurses should consider means of improving prioritisation and cohesive delivery of person-centred hydration care in acute hospital wards.

Transition of care in adolescents with chronic disease: A concept analysis.

The aim of this concept analysis was to define the concept of transitional care as it applied to adolescents with chronic health conditions as they transfer from pediatric to adult care. Walker and Avant'seight step method was used to guide this concept analysis. An electronic search of the literature using CINAHL, PubMed, and MEDLINE was conducted in March of 2022. Articles were included if they were peer-reviewed articles published in English between 2016 and 2022 and aided in the development of the concept. A total of 14 articles met inclusion criteria within the search. These articles were used to identify the defining attributes of transitional care as it applied to adolescents with chronic disease. These attributes were empowerment, a comprehensive process, and transfer completion. The antecedents identified were aging, readiness, and support. For an individual to begin the transition process all of these must be present. Consequences include growth, independence, and improved quality of life and health outcomes. Model, borderline, related, and contrary cases were presented to exemplify the concept. Adolescents and young adults with chronic disease require unique care as they transition to adulthood. Defining the concept of transitional care as it relates to this population provided a foundation of knowledge that has implications for nursing practice. This conceptual structure provided a foundation of knowledge for theory development and encouraged widespread use of transition programs. Future research should explore the long-term outcomes of specific interventions used during transitional care.

Empathic care as a command of a new clinical bioethics

The current context of healthcare, which perpetuates the subordinate position of the patient and the violation of patients’ rights, demands the construction of a bioethical theory based on the ethical commitment to change this reality. Consequently, Principialism, the hegemonic line of Clinical Bioethics, needs to be overcome, and another framework needs to be formulated, such as what is now proposed based on clinical empathy and empathic care. This new framework for Clinical Bioethics conforms to an innovative aspect called “Healthcare Bioethics,” which has been the subject of a series of studies. These studies aimed at the theoretical structure of Healthcare Bioethics but did not focus on empathic care as an ethical structuring of this new theoretical-normative proposition. This article proposes theoretical contributions to Healthcare Bioethics based on clinical empathy and, specifically, by formulating the empathic care concept as a constituent and structuring command of this new aspect of Clinical Bioethics. Empathic care is a central ethical command of the further reference of clinical practice, Healthcare Bioethics. However, as seen, empathy is a motivational phenomenon conditioned to subjective factors that concern the individuals themselves and the context in which they find themselves. Although empathy is essential to our well-being, self-esteem, sense of belonging, and positive emotions, often, the choice is not to be empathic, given the costs of being so. This is also true in healthcare. Thus, health institutions and systems must adopt training, continuing education of health professionals, and other motivational interventions to drive empathic choice. It is an illusion to expect this choice to be made predominantly without creating factors that motivate empathic care, which must be an ethical substrate for constructing these motivational interventions. Therefore, empathic care should be incorporated into the health area as a new paradigm that founds institutions and health systems centered on the patient and the quality of care.

"It'll never end, I'll never go": Representation of Caregiving in Samuel Beckett's Endgame and Footfalls.

Research on the unrepresentability of death in Samuel Beckett's oeuvre abound in Beckett scholarship, but little attention has been given to the artist's representation of caregiving to the dying in his plays. With reference to Martin Heidegger's concept of care and Albert Camus's idea of the absurd, this article analyzes Endgame (1957) and Footfalls (1976) by attending to Beckett's dramatic representation of caregiving as undergirded by a sense of its absurdity. The almost 20-year gap between the writing of both plays highlights the development of an understanding that this sense of absurdity is never about the caregiver's questioning of one's obligation to the dependent but about how one chooses to respond to caregiving as an absurd predicament. The pertinence of such a representation of caregiving by Beckett lies in its poignant articulation of a complex experience that is often left unexpressed by caregivers who prioritize their dependent loved ones over themselves.

APPLICATION OF FAMILY CENTERED CARE (FCC)

The role of the family in the theoretical system is as a caregiver for sick family members. Family involvement in client care is applied in care known as the Family Centered Care concept. The application of Family Centered Care can increase knowledge and attitudes of families in the care of clients who are hospitalized. The purpose of the study was to determine the level of application of Family Centered Care. The research method used is a descriptive study. The research sample was 100 respondents. The sampling technique used is accidental sampling. The data collection tool used is a family centered care questionnaire. The research analysis used univariate analysis in the form of a frequency distribution. The results showed that the application of family centered care was in the good category as many as 71 respondents (71%), and in the medium category as many as 29 respondents (29%). From the results of the study, it was stated that nurses had involved the family in care, where the family participated in making decisions on support plans, recovery and helping patients not to be anxious. The conclusion is that the application of family centered care is in the good category.

Cost-effectiveness of a telemonitoring programme in patients with cardiovascular diseases compared with standard of care

ObjectivesThe main aim of this work was to analyse the cost-effectiveness of an integrated care concept (NICC) that combines telemonitoring with the support of a care centre in addition to...

Care in nursing as a contested concept? A Bergsonian perspective.

The concept of care has occupied a central place in nursing philosophy and scholarship since the modern formation of the profession. Perhaps the defining character of the scholarship has been the recognition not only of the complexity of the concept of care, its elusiveness and ambiguity, but also the lack of consensus or agreement regarding its meaning and value. I will make two interconnected arguments: first, I will argue that disputes around care are not an accidental feature or an unfortunate condition of its applicability. Rather, care is an example of what I will call, following W.B. Gallie (1956), an "essentially contested" concept. Secondly, I will employ insights from the French philosopher Henri Bergson (1859-1941) to explore the concept of care and argue that the essentially contested processual nature of care is the source of its meaning and value.

Achieving international consensus on the concept of woman-centred care: A Delphi study

ProblemThere is no internationally-informed understanding of how midwives perceive woman-centred care and use it in practice. BackgroundWoman-centred care is integral to the role of the midwife and to determining standards of practice. Few empirical studies have explored the meaning of woman-centred care, and those that have are limited to country specific research. AimTo gain an in-depth understanding and consensus on the concept of woman-centred care from an international perspective. MethodsA three round Delphi study was conducted, with surveys distributed online to a group of international expert midwives to draw consensus on the topic of woman-centred care. FindingsA panel of 59 expert midwives representing 22 countries participated. Fifty-nine statements about woman-centred care, of which 63% of statements reached the 75% a priori agreement level, were developed and categorised under four emergent themes: defining characteristics of woman-centred care (n = 17), the role of the midwife in woman-centred care (n = 19), woman-centred care and systems of care (n = 18), woman-centred care in education and research (n = 5). DiscussionParticipants agreed that woman-centred care should be provided by any health care professional in any health care setting. Systems of maternity care should provide holistic care tailored for the individual woman rather than subject her to routine practices and policies. Although continuity of care is important to midwifery practice, it was not reported as a core characteristic of woman-centred care. ConclusionThis is the first study to investigate the concept of woman-centred care as it is experienced globally by midwives. The findings of this study will be used to contribute to the development of an internationally informed evidence-based definition of woman-centred care.

Uncertainty quantification of microcirculatory characteristic parameters for recognition of cardiovascular diseases

BackgroundCardiovascular disease is one of the leading causes of death worldwide. However, according to studies, 90% of cardiovascular diseases can be prevented. Cardiovascular function parameters are an important basis for the diagnosis of cardiovascular diseases. The pulse wave also contains a wealth of physiological and pathological information, which can reflect the trend of cardiac function parameters at an early stage, so the measurement and analysis of the pulse wave signal becomes more and more important. The wearable pulse signal acquisition device has gradually become a new trend. In the mobile health scenario, convenient use is the prerequisite for long-term and rapid health monitoring. The data containing diverse pulse wave signals is the basis for obtaining more comprehensive and accurate human physiopathological information. Accurate data analysis and processing is the key to realizing the important goal of cardiovascular health monitoring. ObjectiveBased on the concept of mobile health care, wearable devices are developed to obtain physiological signals. The zero-dimensional model and the optimization algorithm are combined to complete the uncertainty quantification of the microcirculation parameters. Then, a feature set containing the cardiovasvular parameters can be constructed. The machine learning algorithm can be used to build a model that can accurately realize cardiovascular disease identification. MethodsThis paper adopts laboratory-developed equipment to acquire the wrist pulse wave and fingertip volume pulse wave. A total of 323 samples were collected from healthy populations, hypertensive patients and patients with coronary heart disease (CHD). The pulse blood flow model in fingertip microcirculation is established, and the uncertainty quantification of model parameters is completed based on slime mold algorithm (SMA). After comparing and analyzing the performance of four algorithms on pulse wave classification, the identification model of cardiovascular diseases is established based on the microcirculatory characteristic parameter set and random forest algorithm (RF). ResultsRF showed good classification performance among the four classification algorithms. The identification accuracy of the model built on the microcirculatory characteristic parameter set and RF algorithm all reached more than 88%. The highest recognition accuracy was 95.51% for coronary heart disease samples, 92.11% for healthy samples, and 88.55% for hypertensive samples. It can be seen that the model based on RF algorithm has a good ability to distinguish the characteristic parameters in different cardiovascular health states. ConclusionsThe wearable device designed in this paper can facilitate the daily health monitoring of cardiovascular disease. By using the combination of the physical model and machine learning model, the uncertainty quantification of microcirculation parameters and the identification of cardiovascular disease was finally completed. The recognition model based on machine learning provides a new idea and method for the research of cardiovascular health monitoring through pulse waves.

Polycystic ovary syndrome as a gender-specific cardiometabolic risk factor

With aprevalence of 15%, polycystic ovary syndrome (PCOS) is the most common endocrinopathy in fertile-aged women. Insulin resistance and obesity play apivotal role in the pathophysiology of PCOS, modulate the severity of symptoms and are associated with an increased risk for cardiometabolic sequelae such as diabetes, non-alcoholic fatty liver disease and atherosclerotic cardiovascular disease. PCOS should be considered as agender-specific cardiovascular risk factor. Therefore, if traits indicative for PCOS are present, affected women should undergo PCOS diagnostics as afirst step, thereby making it possible to initiate cardiovascular primary prevention strategies in this population of young women at high cardiometabolic risk. In women with known PCOS, screening and treatment of cardiometabolic risk factors and/or diseases should be routinely integrated into the concept of PCOS care. The close link between insulin resistance/obesity and PCOS can be used to improve PCOS-specific symptoms and enhance cardiometabolic health.

Impact of Introducing a PACU24 Concept on the Perioperative Outcome of Patients with Advanced Ovarian Cancer Treated with Cytoreductive Surgery.

Patients with ovarian cancer who undergo multivisceral surgery usually require intensive care monitoring postoperatively. In view of the ever-fewer numbers of high-care/intensive care beds and the introduction of fast-track treatment concepts, it is increasingly being suggested that these patients should be cared for postoperatively in 24-h Post Anesthesia Care Units (PACU24). No analyses have been carried out to date to investigate whether such a postoperative care concept might be associated with a potential increase in postoperative complications in this patient cohort. A PACU24 unit was set up in our institution in 2015 and it has become the primary postoperative care pathway for patients with ovarian cancer who have undergone cytoreductive (debulking) surgery. A structured, retrospective analysis of data from patients treated before (control group) and after (PACU group) the introduction of this care concept was carried out, with a particular focus on postoperative complications and secondary admission to an intensive care unit where necessary. The data of 42 patients were analyzed for the PACU group and 45 patients for the control group. According to the analysis, the preoperative and surgical data of both groups were comparable (age, ASA, BMI, FIGO stage, duration of surgery, blood loss). The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM score) as a measure for the risk of postoperative complications was higher in the PACU group (11.1% vs. 9.7%, p=0.001). Patients in the PACU group underwent bowel resection with anastomosis significantly more often (76.3% vs. 33.3%, p<0.001), although the extent of surgery was otherwise comparable. The total number, type and severity of postoperative complications and the duration of the overall stay in hospital did not differ between the two groups. None of the patients required secondary transfer from the PACU or normal ward to an intensive care unit (ICU). Our data support the assumption that the care concept of transferring patients to a PACU24 represents a safe and cost-saving care pathway for the postoperative care of patients even after complex gynecological-oncological procedures.

Staying with the silence: Silence as affording care in online alcohol and other drug counselling.

As the name 'talk therapy' suggests, a key aim of alcohol and other drug counselling, psychotherapy and other talk therapies is to discuss issues, concerns and feelings with a health professional. Implicit here is the therapeutic value of talking through issues with a trained professional. But as with all interactions, therapeutic encounters involve silences and pauses as key aspects of the communicative process. Despite their ubiquity in the therapeutic encounter, research tends to either dismiss silences as inconsequential or as having undesirable effects, such as generating awkwardness or even disengagement from treatment. Drawing on Latour's (2002) concept of 'affordance' and a qualitative study of an Australian alcohol and other drug counselling service, we explore the varied functions of silences in online text-based counselling sessions. For clients, these include the role of silence in affording opportunities to engage in other everyday practices, such as socialising, caregiving or working - practices that can generate comfort and reduce distress, which in turn may support the therapeutic encounter. Similarly, for counsellors, temporal silences provide opportunities to confer with other counsellors and provide tailored care. However, protracted silences can raise concerns about the safety and wellbeing of clients who do not respond promptly or who exit encounters unexpectedly. Similarly, the sudden cessation of online care encounters (often associated with technical difficulties) can leave clients feeling frustrated and confused. In tracking these diverse affordances of silence, we draw attention to its generative potential in care encounters. We conclude by exploring the implications of our analysis for conceptions of care that underpin alcohol and other drug treatment.