Demand For Care Research Articles

The effects of hospice care education on first-year undergraduate nursing students in mainland China: A mixed-methods study

BackgroundWith the rising number of people with end-stage chronic diseases, the demand for hospice care has increased dramatically. As the future health professionals for the implementation of hospice care, undergraduate nursing students in mainland China still lack knowledge and skills of hospice care, thus hospice care education plays a vital role in its development. ObjectivesTo understand the effects of hospice care education on nursing students' death attitudes, end-of-life attitudes, humanistic care qualities, and their learning experiences. DesignThis study used a mixed-methods design. SettingA University of Chinese Medicine in mainland China. ParticipantsThe first-year undergraduate nursing students (n = 65). MethodsA mixed-methods study was conducted to evaluate the impact of a hospice care course from March to June 2021. The quantitative part included a quasi-experimental study designed with pre- and post-intervention measurements and the qualitative part included a descriptive qualitative study with semi-structured individual interviews. ResultsThe quantitative data revealed that after the course, nursing students experienced improvements in their death attitudes, end-of-life attitudes, and humanistic care qualities. Two categories were identified from the qualitative data. The category of “Gain from learning” included 4 themes (Confronting death and thinking about life; Understanding and agreeing with the idea of hospice care; Perceiving the humanistic spirit of medicine; Enhancing of the nursing discipline cognition and professional identity) and the category of “Course feedback” included 2 themes (Expressing recognition for the course arrangement; Making suggestions on the course optimization). ConclusionsHospice care education had a positive influence on nursing students. Students expressed satisfaction with the course arrangement. However, future hospice care courses should further optimize the curriculum designs by increasing the discussion of death-related topics, sharing more real clinical cases, recruiting students from different majors, and providing clinical practice, to provide high-quality nursing education for the development of hospice care.

Palliative Care in the Ageing European Population: A Cross-Country Comparison.

With Europe's ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a cohort of SHARE participants aged 65 years or older who had passed away between Wave 6 (2015) and Wave 7 (2017). Information on death circumstances, palliative care utilization, and associated variables were analysed. The study revealed that nearly 13.0% of individuals across these countries died under palliative care, with Slovenia having the lowest rate (0.3%) and France the highest (30.4%). Palliative care utilization in the last 30 days before death was observed in over 24.0% of participants, with the Czech Republic having the lowest rate (5.0%) and Greece the highest (48.8%). A higher risk of using or dying in palliative care was significantly associated with cognitive impairment (low verbal fluency), physical inactivity, and good to excellent self-perceived health. This work highlights the urgent need for enhanced global access to palliative care and advocates for the cross-country comparison of effective practices within Europe, tailored to the unique healthcare needs of older adults.

Noise Mapping and Measurements for Sound Environment Assessment in a Typical Chinese Water-Rich Village

The construction of beautiful villages in China is carrying more and more demand for leisure and health care, thus increasing requirements for the quality of the village environment. In this paper, Huanggongwang in Fuyang, Zhejiang Province in China, a typical water-rich village, was selected as the research object to study the sound environment quality by adapting noise mapping and field measurements. A village acoustic simulation model was established by the layout of the villages, roads, and water system; the three-dimensional spatial distribution of sound pressure level was based on actual sound source identification and measurements for sound environment evaluation. The result shows that the combination of the arithmetic mean value method for sound pressure level and noise pollution index approach can better represent the characteristics of sound environment quality compared with traditional noise evaluation standards. The average sound pressure level measured on-site in the village was 62.4 dB(A), and the PN index was 0.83, which reveals the importance of resolving the issue of environmental noise in the villages. Moreover, this evaluation method excludes the chance of actual measurement results. Therefore, it provides a better measure of the quality of the rural sound environment, which serves as a basis for the scientific planning of rural construction.

A qualitative study on the willingness and influencing factors of master of geriatric nursing specialist postgraduates to volunteer for home respite care for disabled elderly families

BackgroundAs China’s population ages, the demand for care for the disabled elderly is increasing, and family caregivers find it challenging to meet the comprehensive care needs of the disabled elderly. Through home respite services, families of the disabled elderly can receive help and support from specialized nursing professionals to ease the burden on family caregivers and provide high-quality services. This study explores the willingness and influencing factors of Master of Geriatric Nursing Specialist postgraduates in China to volunteer to provide home respite services for disabled elderly individuals.MethodsA qualitative study based on Grounded Theory used Strauss and Corbin’s programmatic version. A purposive sampling method was employed to conduct semi-structured interviews with 12 Master of Geriatric Nursing Specialist postgraduates from a tertiary hospital in Changsha, Hunan Province, China.ResultsThe willingness of Master of Geriatric Nursing Specialist postgraduates to volunteer to provide home respite services for the disabled elderly was established as a core category, which was influenced by three main categories: personal factors, service object factors, and social factors, and nine categories formed from 39 initial concepts were included under the main category.ConclusionsInfluenced by China’s traditional cultural background, Master of Geriatric Nursing Specialist postgraduates in China have shown high motivation in volunteering to provide home respite services for the families of the disabled elderly but have been challenged by several challenges from China’s healthcare environment and education system. Relevant departments need to adopt a series of policies and measures to increase volunteers’ willingness to participate in respite care and promote its development.

Healthcare resource allocation decisions and non-emergency treatments in the aftermath of Covid-19 pandemic. How should children with chronic illness feature in prioritisation processes?

In the aftermath of the Coronavirus disease 2019 (Covid-19) pandemic, allocation of non-urgent medical interventions is a persistent ethical challenge as health systems currently face an unprecedented backlog of patients requiring treatment. Difficult decisions must be made that prioritise certain patients over others. Ethical resource allocation requires that the needs of all patients are considered properly, but at present there is no guidance that can help support such decision-making which explicitly considers the needs of children with chronic and complex conditions. This paper reviews the NHS guidance for priorities and operational planning and examines how the needs of children with chronic illness are addressed in NHS objectives for restoring services and meeting elective care demands. The usual criteria for prioritisation featured in the NHS guidance fail to account for the distinct needs of children with chronic illnesses and fail to match more general considerations of what constitutes fair resource allocation decisions. To address this issue, two considerations, namely 'protecting age-related opportunity' and 'recognising complexity of care,' are proposed as additions to the existing approach. By providing a broader conception of needs, these criteria address inefficiencies of the current guidance and relevant ethical frameworks and help to embed a currently missing children-related ethical approach to healthcare policy making in general.

Use of a Modelling Tool to Optimise the Organisation of the Demand for Primary Oral Health Care in the Brazilian Unified Health System.

To describe the use of work process modelling to optimise the organisation of the demand for oral health treatment in primary care units in Brazil. The oral health care routine was at first described as the "AS IS" model, which was evaluated by the oral team professionals, rearranged, and further described as the "TO BE" model described using a business process management modelling tool. The significant increase in the demand of patients due to restrictions offered by the dental service in addition to non-urgent treatments being avoided by patients during COVID-19 pandemic was also considered. Structuring the work processes in a visual way using modelling tools was useful to picture the entire treatment process and adjust when needed. The use of the managerial tool was useful to understand and reorganise the workflow of organising the demand and ultimately improve the efficiency of the resources. The use of such managerial tools helped oral health professionals to efficiently rearrange their tasks and set priorities to meet their needs. With the use of management tools, each unit can readjust its structures and ways of working, aiming to improve the quality of public health care services provided to patients.

From Evidence-Based Guidelines to Clinical Practice: Pediatric Neuropsychology Care in Multidisciplinary Clinics.

High demand for pediatric neuropsychological care has highlighted the time- and resource-intensive nature of traditional comprehensive evaluations. Emerging care models address these constraints by facilitating tiered neuropsychological services provided in various contexts, including multidisciplinary clinics (MDCs). We aim to demonstrate feasibility and acceptability of tiered neuropsychological care in MDCs through examples from a single institution. A review of all current MDC practices at a tertiary pediatric care center was conducted to describe clinic workflow, services provided, and triage strategies. Pediatric neuropsychologists (n = 5) and other health care providers (n = 31) completed a survey focused on experience with neuropsychology consultation in MDCs. Neuropsychologists provided care in 11 MDCs, including universal monitoring with consultative interviews and questionnaires, as well as targeted screening. Neuropsychologists (89%) and other health professionals (100%) reported that tiered neuropsychological services improved patient care within MDCs. Other health professionals reported utilizing results from neuropsychology MDC care to inform their clinical approach (48-90%), referrals (58%), and treatment or surveillance decisions (55-71%). Tiered neuropsychological care in pediatric MDCs is feasible, and provider experience ratings indicate high acceptability. Practical steps for development of MDCs are provided, including identifying teams, clinic goals and outcomes, operational logistics, and billing.

Incentivizing Demand for Supply-Constrained Care: Institutional Birth in India

Abstract If overcrowding harms health care quality, the impacts of encouraging more people to use services are not obvious. Impacts will depend on whether marginal entrants benefit and whether they benefit enough to offset the congestion externalities imposed on inframarginal users. We develop a general-equilibrium model that formalizes these ideas. We examine them empirically by studying JSY, a program in India that paid women to give birth in medical facilities. We find evidence that JSY increased perinatal mortality in areas with low health-system capacity, was particularly harmful in more-complex births, reduced the quality of facilities' postnatal care, and generated harmful spillovers onto other services.

The relationship between psychological distress and the nursing humanistic care demands in postoperative cancer inpatients: a cross-sectional study

PurposeWe aimed to investigate cancer patients' experiences of psychological distress after surgery and the factors that influence it, and to analyze the relationship between this and the nursing humanistic care demands.MethodsThis study used a convenience sampling method to survey 432 cancer patients undergoing surgical treatment in the specialized cancer hospital in Beijing. The survey used socio-demographic information, the Distress Management Screening Measures, and the Nursing Humanistic Care Demands questionnaire. Questionnaire Star was used to collect data online. SPSS24.0 software was used to test the relationship between psychological distress and nursing humanistic care demands.ResultsThe mean scores for psychological distress and nursing humanistic care demands were 3.95 ± 2.71 and 147.02 ± 19.88, respectively, and showed a moderately positive correlation. The main issues that caused psychological distress in patients were: worry, financial problems, surroundings, nervousness, sleep, and pain. Regression analysis showed that gender, financial burden, personality trait, and need for humanistic care in nursing explained 24.5% of the total variance in the model and were independent predictors of psychological distress.ConclusionCancer inpatients have significant psychological distress after surgery and exhibit high levels of nursing humanistic care demands. This study fills the research gap on humanistic care for psychological distress management, nursing humanistic care demands positively predicted psychological distress. Nursing staff should pay attention to the psychological suffering of patients and develop individualized care measures to alleviate their psychological suffering by accurately identifying their nursing humanistic care demands.

Nature's Healing Touch: Exploring the Therapeutic Benefits of Ecotherapy and Ecopsychology in Cancer Supportive Care

Cancer care demands holistic strategies to address the intricate challenges faced by individuals during their journey. This narrative review explores the emerging field of ecotherapy and ecopsychology, encompassing nature-based interventions to enhance psychosocial well-being in the context of cancer. Ecotherapy, defined as the connection between nature and human well-being, offers a diverse range of modalities, including nature-based interventions, animal-assisted therapies, and virtual reality. Drawing from Vedic traditions, it highlights the human-cosmos analogy, emphasizing the interconnectedness between individuals and the nature. Theoretical frameworks such as the Biophilia Hypothesis, Attention Restoration Theory, Systems Theory, Place Attachment Theory and Stress Recovery Theory underpin ecotherapeutic practices. This review outlines the multifaceted benefits of ecotherapy, spanning stress reduction, emotional well-being, medical recovery, resilience building, social connectedness, and empowerment. Future directions underscore the need for individualized approaches, healthcare professional training, and collaborative efforts to unlock the full potential of ecotherapy in promoting psychosocial well-being throughout the cancer care continuum.

Establishing a Multi-disciplinary Adult Oncology Unit at Muhimbili National Hospital: Lessons Learned, Challenges, and Opportunities Amidst Tanzania's Growing Cancer Burden

In light of the escalating cancer burden in Tanzania, Muhimbili National Hospital (MNH) embarked on a transformative initiative, utilizing the Capability, Opportunity, Motivation (COM-B) framework to meticulously design an implementation strategy. This collaborative effort yielded a dedicated chemotherapy ward, an expanded workforce, and ongoing professional development programs. The success of MNH's Adult Oncology Unit highlights the critical significance of adaptability, stakeholder engagement, and an unwavering commitment to meet the rising demand for cancer care in resource-constrained environments.

The Perspective of Cancer Patients in Palliative Care on Unmet Needs: A Qualitative Synthesis Using Meta-Ethnography.

As cancer patients approach the end of life, their needs become more complex, increasing the demand for palliative care. Advanced-stage cancer patients encounter increasing unmet psychological, physical, autonomy, and communication needs, reflecting the difference between patients' perceived requirements and the support from health care professionals. The objective of this study was to synthesize qualitative evidence on unmet needs in palliative cancer care among inpatient and outpatient adults. We conducted a meta-ethnographic review according to Noblit and Hare's framework and the operationalized guidelines developed by Sattar. The eMERGe Reporting Guidance was followed. A literature search was conducted in Cinahl, Embase, Medline, Scopus, Web of Science, PsycINFO and Google Scholar for gray literature. For all the studies, direct quotes from the participants and authors' results were identified, coded and analyzed in NVivo 1.7.1 and extracted as I and II order constructs from which higher third-order themes originated. Eight studies were included. Four new themes emerged, representing areas where palliative cancer care patients expressed a need for help: the need for comprehensive, patient-centered care, the need for maintaining a sense of autonomy and dignity, the need for attentive support to patients' soul and the need for accessible and timely care. Palliative care patients require a secure, suffering-free end-of-life journey with informed decision-making and team support. Ensuring continuity of care, validating their suffering, and allocating sufficient time are crucial aspects of care. This involves maintaining a consistent care plan, respecting patients' emotions and experiences, and providing services tailored to individual needs.

A sustainable and green approach towards the utilization of biopolymers for effective wound dressing applications: A detailed review

Millions of people worldwide are suffering and struggling to obtain the most effective wound care/treatment. In previous years, a steep rise in metabolic disorders such as diabetic wound ulcers has been noticed. The primary function of an effective wound dressing is to protect the wound bed from contamination and provide an accelerated healing environment. Biopolymers, a natural boon, can be used for distinct applications from food packaging, biomedicine, and biomedical applications. Natural and synthetic biopolymers have distinct advantages, such as biocompatibility, biodegradability, and environmental friendliness. Cellulose, chitosan, alginates, hyaluronic acid, collagen, etc., are natural biopolymers primarily used to develop wound dressings. Most common synthetic biopolymers such as PVA, PCL, and PLA are examples of how an individual biopolymer or its blends can be used to develop an effective wound dressing. Biopolymer properties for wound dressing applications can be improved by applying the concepts of nanotechnology, bioengineering, and drug delivery. These improvements may help meet the current and future wound care demands for tissue repair and restoration. The current review focuses on using natural and synthetic functionalized biopolymers for effective wound-dressing applications and exhibiting their antibacterial and antimicrobial properties.

Short of capacity? Why the government must address the capacity constraints in the English National Health Service.

A decade of low investment in the English National Health Service (NHS) resulted in strong headline productivity growth but undermined the health system's resilience and left it exposed during the COVID-19 pandemic. Projected demographic pressures, driven by the aging of the baby-boom generation and the rise in multi-morbidity levels in the population, will add pressures to already stretched health care resources. As the NHS faces the twin challenges of recovering services after the pandemic and meeting care needs from an aging population, our projections of demand for care indicate the NHS almost certainly needs significantly more beds as well as more staff. Productivity improvements in hospital care can reduce the amount of additional resources needed, but this will require significant concomitant investment in community-based health and long-term-care services.

‘The night is for sleeping’: how nurses care for conflicting temporal orders in older person care

ABSTRACT This paper examines the conflicting temporal orders of the regional nurse, a role which has been introduced to deal with the increasing demands of aged care and workforce shortages in regional settings. We build on ethnographic research in the Netherlands, in which we examine regional district nurses as a new professional role that attends to (sub)acute care needs, connecting and coordinating different places of care during out of office hours. We use the concept of ‘temporal regional order’ to reflect on the different ways caring practices are temporally structured by management and care practitioners, in close interaction with patients and informal care givers. In the results three types of disruptions of the regional temporal order are distinguished: interfering bodily rhythms and needs; (un)expected workings of technologies; and disrupting acts of patient and relatives. It was region nurses’ prime responsibility to stabilise these interferences and prevent or soften a disruption of the regional order. In accomplishing this, we show how nurses craft their professional role in between various care settings, without getting involved too much in patient care, to be mobile as ‘temporal caregivers’.

A missed opportunity: the NHS Long Term Workforce Plan and the support workforce

The NHS Long Term Workforce Plan was published by NHS England in July 2023. The plan sets out a 15-year strategy to ensure that the NHS has sufficient staffing capacity and capability to meet rising demand for health care. This article critically considers the implications of the plan for the NHS clinical support workforce. It concludes that although the plan represents a step forward compared to previous strategies, it does not adequately address the needs of the support workforce and the longstanding issues and constraints that they can face.

IS THERE A ROLE FOR BILIODIGESTIVE BYPASS SURGERY IN TREATING CHOLESTASIS IN ADVANCED PANCREATIC CANCER?

The unresectable pancreatic head tumors develop obstructive jaundice and cholestasis during follow-up. Cholestasis is associated with complications and treatment options are endoscopic stenting (ES) and biliary bypass surgery (BBS). The aim of the current study was to compare the safety and efficacy of biliary bypass surgery (BBS) and endoscopic stenting (ES) for cholestasis in advanced pancreas cancer. This is a retrospective cohort of patients with cholestasis and unresectable or metastatic pancreas cancer, treated with BBS or ES. Short and long-term outcomes were evaluated. We considered the need for hospital readmission due to biliary complications as treatment failure. A total of 93 patients (BBS=43; ES=50) were included in the study. BBS was associated with a higher demand for postoperative intensive care (37 vs.10%; p=0.002, p<0.050), longer intensive care unit stay (1.44 standard deviation±2.47 vs. 0.66±2.24 days; p=0.004, p<0.050), and longer length of hospital stay (7.95±2.99 vs. 4.29±5.50 days; p<0.001, p<0.050). BBS had a higher risk for procedure-related complications (23 vs. 8%; p=0.049, p<0.050). There was no difference in overall survival between BBS and ES (p=0.089, p>0.050). ES was independently associated with a higher risk for treatment failure than BBS on multivariate analysis (hazard ratio 3.97; p=0.009, p<0.050). BBS is associated with longer efficacy than ES for treating cholestasis in advanced pancreatic cancer. However, the BBS is associated with prolonged intensive care unit and hospital stays and higher demand for intensive care.

Demand and Equilibrium Price of Health Care: A Structural Equation Approach

Abstract In this article, we propose a new approach to estimating health-care demand. The aim of this paper is to determine the production costs of health care from the demand function of care. To do this, we used an approach based on structural equations where consumption and demand are estimated to capture the dynamics of health costs within a self-managed public hospital. Following this approach, based on the equilibrium between supply and demand of health care, we used the social and professional characteristics of beneficiary to estimate the demand function, which will approximate the cost of health care. The results showed that the demand for care is largely dependent on economic, demographic, and perception factors. Also, the back testing and corroboration tests of the predictions affirm that the functions developed will allow a better cost forecast for the hospital unit, able to propose a budgetary and partial cost approach in the future. Some limitations can be mentioned in connection with the accessibility to accounting data and also the ignorance of time dimension or dynamic evolution of cost demand.

The evaluation of a decision support system integrating assistive technology for people with dementia at home.

With a decreasing workforce of carers and a transition from care homes to home care, people with dementia (PwD) increasingly rely on informal caregivers (ICs) and assistive technologies (ATs). There is growing evidence that ATs in the home environment can reduce workload for formal carers (FCs) and ICs, reduce care costs, and can have a positive influence on quality of life (QoL) for PwD and their caregivers. In practice, using multiple ATs still often implies using different separate point solutions and applications. However, the integral, combined use of the data generated using various applications can potentially enhance the insight into the health and wellbeing status of PwD and can provide decision support for carers. The purpose of the current study was to evaluate the use of a DSS that integrated multiple ATs into one dashboard through a small-scale field study. The current study presents the formative evaluation of a Decision Support System (DSS) connected to multiple ATs. This DSS has been developed by means of co-creation during an international project. The DSS provides an insight into the physical and cognitive status of a PwD, as well as an insight into sleep activity and general wellbeing. Semi-structured interview sessions were held in three countries (Netherlands, Italy, and Taiwan) with 41 participants to gain insight into the experiences of formal and informal carers and PwD with both the ATs and the DSS Alpha prototype dashboard. The results showed that participants using the DSS were satisfied and perceived added value and a fit with certain care demands from the PwD. In general, ICs and FCs have limited insight into the status of PwD living independently at home, and in these moments, the DSS dashboard and AT bundle can provide valuable insights. Participants experienced the DSS dashboard as well-organized and easy to navigate. The accuracy of the data displayed in the dashboard is important, the context, and (perceived) privacy issues should be tackled according to all users. Furthermore, based in the insight gained during the evaluation a set of design improvements was composed which can be used to further improve the DSS for the Beta evaluation. The current paper evaluates a possible solution for excess AT usage and how the use of a DSS which integrated multiple AT into one single technology could support caregivers in providing care for PwD. The formative evaluation scrutinized the integration of the developed DSS and the composed bundle of ATs across diverse cultural contexts. Insights from multi-center observations shed light on user experiences, encompassing overall usability, navigational efficacy, and attitudes toward the system. FCs and ICs expressed positivity toward the DSS dashboard's design and functionalities, highlighting its utility in remote monitoring, tracking changes in the person's abilities, and managing urgent situations. There is a need for personalized solutions and the findings contribute to a nuanced understanding of DSS and AT integration, providing insights for future developments and research in the field of DSS for the care of PwD.

Technical Efficiency of Prevention Services for Functional Dependency in Japan's Public Long-term Care Insurance System: An Ecological Study.

Public long-term care insurance (LTCI) systems can promote equal and wider access to quality long-term care. However, ensuring the financial sustainability is challenging owing to growing care demand related to population aging. To control growing demand, Japan's public LTCI system uniquely provided home- and community-based prevention services for functional dependency for older people (ie, adult day care, nursing care, home care, functional screening, functional training, health education, and support for social activities), following nationwide protocols with decentralized delivery from 2006 until 2015. However, evaluations of the effects of these services have been inconclusive. We estimated the marginal gain and technical efficiency of local prevention services using 2009-2014 panel data for 474 local public insurers in Japan, based on stochastic frontier analysis. The outcome was the transformed sex-and age-adjusted ratio of the observed to expected number of individuals aged ≥65 years certified for moderate care. Higher outcome values indicate lower population risk of moderate functional dependency in each region in each year. The marginal gains of the provided quantities of prevention services as explanatory variables were estimated, adjusting for regional medical and welfare access, care demand and supply, and other regional factors as covariates. Prevention services (except functional screening) significantly reduced the population risk of moderate functional dependency. Specifically, the mean changes in outcome per 1% increase in adult day care, other nursing care, and home care were 0.13%, 0.07%, and 0.04%, respectively. The median technical efficiency of local public insurers was 0.94 (interquartile range: 0.89-0.99). These findings suggest that population-based services with decentralized local operation following standardized protocols could achieve efficient prevention across regions. This study could inform current discussions about the range of benefit coverage in public LTCI systems by presenting a useful option for the provision of preventive benefits.