Philosophy Of Care Research Articles

A shelter from the abyss: exploring Cicely Saunders' vision of hospice care through the concept of worldview.

Over the past two decades, a debate has arisen concerning the history and philosophy of hospice and palliative care. This critical essay extends this debate by linking the analysis of Dame Cicely Saunders' writings with the concept of worldview, exploring the modern hospice movement vis-à-vis Saunders' approach to terminal care. Worldviews as cultural classifications of reality provide groups and individuals with meaning to navigate everyday and liminal situations. Using this concept in connection to the discipline of the sociology of knowledge, it is possible to grasp how the origins and principles of modern hospice care, from which current palliative care practices evolved, relate to the sociocultural environment of the postwar era in the West. The analysis focuses on a selected body of Saunders' writings, mainly written in the 1960s and 1970s, and discusses different components and functions of her revolutionary care paradigm. In this essay, I show that Saunders' vision of hospice care entails much more than a set of health care practices; it is a complex construct of knowledge and ideas that offers distinct procedures to shelter the dying from pain and loss of meaning. Her vision builds on medical advances and incorporates norms and attitudes related to secularised Protestant and New Age culture, which fostered privatised types of religion and individualistic ideologies and theodicies.

Paramedicine: A new research-focused international journal committed to advancing and transforming the profession

The Australasian College of Paramedicine is pleased to introduce Paramedicine, its relaunched, official peer-reviewed scientific journal. Paramedicine is the culmination of two decades of research publishing in paramedicine, and represents a game-changing evolution in partnership with Sage Publishing. Paramedicine’s vision is to advance and transform the discipline of paramedicine through high-quality research dissemination and discourse. Paramedicine’s mission is to deliver excellence in paramedicine through an international research forum that inspires robust discussion, enables research translation, encourages innovative thinking and informs leadership. Paramedicine will be distinctively different in what it will offer authors and how it will impact the profession internationally. It is a paramedic-led journal that has a clear focus on high-quality research underpinned by excellent science, embraces diverse quantitative and qualitative methodologies and seeks to create an uplift in the paramedicine research publishing experience for authors and readers. Through its professional publishing partnership with Sage Publishing, Paramedicine will pursue an international agenda that brings together the diverse systems, models of care, practice settings and professional philosophies that characterise paramedicine internationally, creating a connected dialogue aimed at advancing the profession.

Anthropological, Cultural and Ethical Aspects of Caring for Patients in Africa

Nowadays, faced with pandemic infectious diseases and incurable genetic pathologies with unfavorable prognoses, the concepts of quality of life, quality of care, and the challenges of the right to health for all are major challenges for global public health. These health crises push for anthropological, cultural, and ethical approaches that would promote good care for the sick in Africa. A synthesis study based on specialized scientific literature was carried out to present the different ways of providing care to patients. The objectives of this research were to: present the philosophy of care in ancient Greece, expose the anthropological and cultural aspects of care for the sick in Africa, and finally, show the contemporary ethical challenges of therapeutic patient care. The care of their sick counterparts is encoded in the genes of higher mammals, especially in “Homo Sapiens”. Over the years, care for the sick in ancient Greece, which was initially conceived as a blurry artistic mixture of metaphysics and physico-naturalism, gradually became rationalized and systematized to become “tekhnê”, the art and technique of modern medicine. Meanwhile, the traditional African approach to care, which has not evolved much and is mainly based on an agrarian civilization, has consisted of bringing together all cosmic and supernatural elements into a totality, where nature is combined and associated, and solidarity, caring, and empathy are combined, so that the entire community is invested in the healing mission. Therefore, the patient is never condemned to be alone in their hospital room to face their loneliness and nothingness.<

From theory to practice: the inclusion of hospitalized children's families in painful procedures.

To understand nursing team professionals' strategies to include the family in painful procedures performed on hospitalized children. An exploratory-descriptive, qualitative study, carried out with nursing professionals. Data were collected through semi-structured interviews, guided by a script of topics, transcribed and submitted to thematic content analysis, in the light of Symbolic Interactionism, discussed considering the Family-Centered Care philosophy assumptions. Two central categories emerged, "Theoretical perspective: the family as a care agent in painful procedures" and "Practical perspective: experiences, challenges and strategies in painful procedures for family inclusion", with their respective subcategories. Nursing professionals have theoretical knowledge about family inclusion in painful procedures based on the assumptions: Family-Centered Care: dignity and respect; information sharing; joint participation; and family collaboration. However, knowledge is not applied in clinical practice; consequence of the interaction between beliefs and attitudes unfavorable to family presence.

Patient perception of humanized care in the intensive care unit. Systematic review

Humanized care is a care philosophy that focuses on the patient's experience, visualizing it as a person and not just as a disease. The objective of the research was to identify the perception of the patient in relation to humanized care in the intensive care unit through a systematic review. A qualitative approach was adopted, based on an integrative literary review of 17 articles from the PubMed/Medline, Virtual Library in Health/LILACS, SciELO, CINAHL, and institutional repositories databases, to answer the research question. Regarding the results, 16 investigative articles and one review article were identified, where it was recognized that humanized care is characterized by three dimensions that are the qualities of nursing (friendly treatment, visualizing it as a person, respecting its beliefs), openness to patient-nurse communication (looking into the patient's eyes, explaining the procedures in advance) and the provision of care (delivery of necessary information, respect for privacy). It is concluded that hospitalized patients and those in intensive care favorably perceive the humanized care provided by the nursing staff, which in most cases is frequently promoted

THE IMPACT OF FFC-AC-EIT ON DECREASING USE OF PSYCHOTROPIC MEDICATIONS AND OPIOIDS IN ASSISTED LIVING

Abstract The secondary aim of the study testing the impact of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) was to decrease psychotropic medications and opioids among assisted living residents. Function Focused Care is a philosophy of care in which direct care workers are taught how to evaluate older adults' underlying function and physical activity and optimize their participation in all activities. This randomized controlled trial included 85 communities and 781 residents across three states. A total of 501 out of 794 participants (63%) received at least one psychotropic medication or opioid. Except for opioid use at four months, there was no significant difference in the intervention groups with regard to medication use at any time point. The findings suggest that encouraging participation in physical activity during all care interactions does not result in an increase in the need for and prescribing of psychotropic medications or opioids.

THE MEANING OF EXPERIENCING FEAR OF FALLING AMONG OLDER ADULTS

Abstract Fear of falling (FOF) is prevalent among older adults. While the concept has been conceptually defined and factors associated with FOF has been extensively explored in nursing and other health sciences, the experience of this fear is often overlooked. The purpose of this study was to illuminate the phenomena of FOF using the rich descriptions elicited from four (Nf4) older adults. The meaning of these experiences was then interpreted in conjunction with the known and emergent FOF body of literature. Each participant was interviewed twice using videoconferencing as part of a larger study exploring the lived experience of being at risk for falling in the hospital. A total of eight interview transcripts were analyzed using van Manen’s interpretive phenomenological methodology. The philosophical underpinning of this study is the philosophy of caring in nursing outlined by Kari Martinsen. Three major interpretive themes emerged: Loss of Self, Part of my Existence, and Remaining Safe Within the Boundaries of Fear. These themes describe how FOF is the fear of being suspended in time and space and losing connection with oneself both physically and mentally during a fall. The fear becomes a part of one’s existence, ranging from worry to all-consuming panic, and the body becomes unpredictable. FOF means living within invisible boundaries of fear, where feelings of helplessness, uselessness, and isolation are common. Relationships with others can both temper and ignite the FOF, and caregivers must understand the meaning of this experience to improve support of older adults in managing this overwhelming experience.

Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units.

The current literature on operationalizing and implementing recovery-oriented inpatient care in diverse settings remains limited. The present study systematically examined factors affecting the implementation of one aspect of recovery-oriented care in a large and diverse national sample of Veterans Health Administration (VHA) inpatient mental health units. VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient scale (RAIN). Sites scoring either one standard deviation above (n = 8; i.e., high-scoring sites) or one standard deviation below (n = 5; i.e., low-scoring sites) the mean on the RAIN factor of inpatient treatment planning subscale were included for additional analyses (N = 13). We used a qualitative approach known as emergent thematic analysis to assess the implementation of inpatient treatment planning elements (e.g., goal setting, shared decision-making) from qualitative interviews, observation notes, and chart reviews collected for the 13 sites. The analysis was guided by Normalization Process Theory. The eleven themes that emerged across the elements of recovery-oriented inpatient treatment planning mostly represented commonalities across sites, such as a shared treatment philosophy of acute care. However, five themes emerged as "differentiators" that distinguished high- and low-scoring sites and included veteran input, elicitation of recovery goals, the value of group programming, and the purpose of family involvement. Findings provide insight into contextual factors and processes that impacted the implementation of recovery-oriented treatment planning at these VHA inpatient mental health units. To further facilitate the implementation of recovery-oriented inpatient treatment planning elements, future research should examine staff's collective understanding of recovery-oriented inpatient care.

The 'good death' in Mainland China - A Scoping Review.

Since the mid 80'ies, the western palliative care philosophy has influenced the development of palliative care in mainland China. However, it has caused several challenges. To explore the understanding of the 'good death' among authorities, professionals, patients, and their relatives in end-of-life care settings in mainland China. Scoping review. The PRISMA-ScR checklist was used. The study is not registered. End-of-life care settings, Mainland China. Authorities, healthcare professionals, adult patients, and general population in mainland China. Literature searches were performed through Medline, CINAHL, PsycInfo, and Web of Sciences from 2001-2021, last search 21.4.2021. Inclusion criteria were: Empirical research studies investigating 'good death' or political documents about 'good death', perspectives from authorities, professionals, patients, and/or relatives, and studies following the Declaration of Helsinki. Exclusion criteria were: Literature reviews, languages other than English and Chinese, editorials, letters, comments, and children's death/dying.The analysis consisted of analysing the data including a descriptive numerical summary analysis and a qualitative thematic analysis. Nineteen articles and two political documents were included. The 19 studies were carried out from 2003-2020, with data collected from 1999 to 2019. The political documents were written in 2012 and 2017, respectively. The thematic analysis resulted in three themes: 'Medicalisation of death', 'Communication about death - a clash between two philosophies', and 'Dying and death were socially dependent'. The medicalisation of death meant the understanding of the 'good death' primarily focused on physical symptoms and treatments. The good death was understood as painless and symptom-free, where all symptoms could be measured and assessed. Dignity and shared decision-making were connected to the understanding of the 'good death'. However, the contents of the 'good death' varied across the different actors. The understanding of the 'good death' in mainland China was a negotiation between Chinese traditional philosophy and contemporary western medicine practice. There was a tension between openness and silence about death, which reflected the importance of death education. The understanding of the 'good death' consisted partly of a timely and practical preparation for the death and afterlife, partly of a matter of social and financial issues. There seemed to be a clash between two different cultures in the understanding of a good death in Mainland China, where western philosophy seemed to rule the political medical actors while traditional Chinese philosophy seemed to rule parts of the population.

Providers' Perspectives on High-Quality Dementia Care in Long-Term Care.

To understand dementia care providers' perspectives on high-quality care for persons living with dementia (PLWD) in long-term care (LTC). A qualitative study using a directed content analysis approach. Nine national LTC dementia care providers. We facilitated 5 listening sessions centered around dementia care philosophies, models, and practices. Two researchers first mapped qualitative data to the Holistic Approach to Transformational Change (HATCh) model for dementia care using a directed content analysis approach. They then identified themes and subthemes emerging from the data using a conventional analysis approach. They coded data iteratively and solicited input from 3 additional researchers to reach consensus where needed. Member checks were performed to ensure the trustworthiness of the data during 2 follow-up listening sessions. The 9 participants described the importance of understanding the experiences of PLWDs in order to provide high-quality dementia care and to deliver such care with the residents and their preferences as the focus. They emphasized experiential education as essential for families and all staff, regardless of role. They noted the need to balance safety with resident choice, as well as the corresponding need for facility leadership and regulators to support such choices. The listening sessions revealed areas to foster person-centered care for PLWD, but also highlighted barriers to implementing this philosophy in LTC settings. Emergent themes included care practices that center on resident preferences and are supported by staff with the experiential education and communication skills necessary to relate to and support PLWD. These findings provide contextual information for researchers seeking to identify and test interventions that reflect LTC providers' priorities for PLWD and emphasize the need to align research priorities with provider priorities.

Embracing the continuity of care experience: A new Australian graduate entry master of midwifery course with a student caseload of 15 women per year

BackgroundWomen receiving continuity of midwifery care have increased satisfaction and improved outcomes. Preparation of midwifery students to work in continuity models from the point of graduation may provide an ongoing midwifery workforce that meets rising demand from women for access to such care. Aim of the paperThe aim of this paper is to describe an innovative midwifery course based on a continuity model, where students acquire more than 50 % of clinical hours through continuity of care experiences. Additional educational strategies incorporated in the course to enhance the CCE experience within the philosophy of midwifery care, include a virtual maternity centre, case-based learning and the Resources Activities Support Evaluation (RASE) pedagogical model of learning. DiscussionAustralian accredited midwifery courses vary in structure, format and philosophy; this new course provides students with an alternative option of study for those who have a particular interest in continuity of midwifery care. ConclusionA midwifery course which provides the majority of clinical hours through continuity of care may prepare graduates for employment within midwifery group practice models by demonstrating the benefits of relationship building, improved outcomes and the reality of an on-call lifestyle.

Pediatric and Adult Cardiologists' and Respirologists' Referral Practices to Palliative Care.

Children and adults with advanced cardiac or respiratory disease may benefit from specialized palliative care (SPC), but there has been little SPC research in this area. To explore pediatric cardiologists' and respirologists' (pediatric clinicians) beliefs about and referral practices to SPC and compare these results to adult cardiologists and respirologists (adult clinicians). Pediatric and adult clinicians were sent a survey exploring SPC referral practices and beliefs. Responses were summarized with descriptive statistics. Pediatric and adult clinicians' responses were compared using Pearson's chi-square test. The response rate was 56% (989/1759); 9% (87/989) were pediatric clinicians. Pediatric clinicians were more likely than adult clinicians to be female, work in an academic center, and experience fewer patient deaths (P<0.001). Pediatric clinicians reported better access to SPC clinical nurse specialists, spiritual care specialists and bereavement counselors (P<0.001), while adult clinicians reported better access to palliative care units (P<0.001). Pediatric clinicians referred to SPC earlier, while adult clinicians tended to refer after disease directed therapies were stopped (P<0.001). More than half of all clinicians felt patients had negative perceptions of the phrase "palliative care". Although most clinicians were satisfied with SPC quality (73-82%), fewer adult clinicians were satisfied with SPC availability (74 vs. 47%; P<0.001). Fewer pediatric clinicians felt that SPC prioritized oncology patients (13 vs. 53%; P<0.001). There are important differences between pediatric and adult clinicians' beliefs about and referral practices to SPC. This may reflect unique features of pediatric diseases, provider characteristics, care philosophies, or service availability.

Ubuntu as an Instrument to Foster Holistic Nursing: The Views of South African Student Nurses.

Introduction: Ubuntu is an African philosophy that reflects holistic and comprehensive care among people in the community. Holistic nursing is a philosophy of caring that focuses on holistic healing and humanism. The purpose of the study was to explore the views of the South African final-year student nurses on the ability of Ubuntu to foster holistic nursing. Methods: An exploratory descriptive qualitative method was used. Eight focus group interviews were conducted with final-year student nurses at selected universities. Colaizzi seven steps process of data analysis was utilized. Results: One of the themes that emerged was that Ubuntu can be an instrument to foster holistic nursing Ubuntu and holistic nursing share many common attributes, hence, the teaching and learning of Ubuntu could foster the type of caring embodied by holistic nursing. Discussion: Ubuntu represents an important care philosophy that can foster holistic nursing, especially when the inner driving force of the nurses is primarily to care for patients.

Depathologization as Healing Justice

Abstract Healing justice, as with disability justice, and transformative justice/abolition, has largely been a queer-, trans-, woman of color-led intervention into the rights-based, reform-based, and neo/liberal agendas of whitestream movements. We see each of these movements for justice as deeply intertwined with the others, where interdependence and leaving no one behind are key commitments that are not compatible with the individualism of rights and reforms. In this roundtable conversation, we define depathologization and its relation to (queering) anti-normativity; discuss it as an important coalitional site of liberation; an intervention of abolitionist worldmaking. We argue that healing need not be understood in a corrective, carceral (medical) or ableist lens. Rather, healing justice models a philosophy and praxis of anticolonial resistance, communal interdependence, and abolitionist care. We offer the conversation as praxis and a way of learning and unlearning from each other.

The Committee on the Rights of Persons with Disabilities—The Role of National Human Rights Institutions: A Comment

Abstract The role attributed to national human rights institutions is a key factor for the success of the Convention on the Rights of Persons with Disabilities, but it is not the only one. This Comment highlights the unique success of the Convention and its causes: (1) a generalized paradigm shift from a philosophy of care to an individual rights approach that is rooted in domestic law; (2) the establishment of national human rights institutions; and (3) the empowerment of persons with disabilities and their NGOs.

Early Integration of Palliative Care in Frail Patients with Hip Fracture.

Frailty is a condition of vulnerability characterized by instability and inconsistency after a stressor event. It is associated with a range of adverse outcomes including delirium, falls, disability, mortality, and increased healthcare utilization. A subset of frail patients who are increasingly high risk for poor outcomes are older adults with hip fracture. Palliative care is a philosophy of care focused on maximizing the quality of life for seriously ill patients and their families. For frail patients with hip fracture, timely referrals to palliative care are essential to have a meaningful impact on quality of life. Recommendations for frailty screening have been offered by professional organizations; however, multiple barriers to routine preoperative frailty assessment exist. This quality improvement project evaluated the feasibility of utilizing a frailty screening tool on patients (age > 65) with hip fracture to readily identify patients with palliative care needs at the time of admission. Although nurses' compliance with the screening tool was less than expected, having a standardized process to accurately identify this high risk population resulted in a higher percentage of appropriate palliative care referrals when compared to usual practice. Improvement in quality of life was reported in patients who received a palliative care consultation.

P09.07.A Signs and Symptoms in the last days of life of the glioblastoma patients - A Descriptive and Retrospective Study

Abstract Background Despite scientific advances to develop techniques for early diagnosis and treatment of glioblastoma, the disease continues to have a remarkably poor prognosis. Studies have shown that in patients with glioblastoma, not only the presence of end-of-life signs and symptoms but also their frequency differs from those in the rest of cancer patients. The complexity of glioblastoma symptoms makes the integration of a palliative care philosophy essential. Objective To identify the main signs and symptoms that occur in patients with glioblastoma in their last seven days of life in a neuro-oncology ward. Material and Methods This was a descriptive and retrospective study regarding the signs and symptoms in the last seven days of life of patients with glioblastoma who were admitted to the neurology ward of a national oncology reference center. The patients were admitted after neuro-oncologist consultations between 2019 and 2020. The data collection instrument used was based on the document “The Last Hours of Living”. Confidentiality of the participants was guaranteed, and authorization was obtained from the institution’s ethics committee. Results The sample had 17 patients (13 men and 4 women), with an average hospital stay of 17.3 days. The men and women had average ages of 61.8 and 63 years, respectively. Clinical and nursing records revealed that the most prevalent signs and symptoms were “decreased level of consciousness” (94%); “rare and unexpected events” (94%); “respiratory dysfunction” (88%); and “loss of ability to swallow” (76%). In the last seven days of life, the approximate times of presentation for these signs and symptoms were: decreased level of consciousness, 6 days; rare and unexpected events, 2 days; respiratory dysfunction, 3 days; and loss of ability to swallow, 6 days. Support was requested from the in-hospital palliative care support team for 76.4% of patients. Conclusion The identification of reduced level of consciousness and alterations in swallowing as the most prevalent symptoms is consistent with the findings of previous studies. The prevalence of rare and unexpected events (such as fever, myoclonus and seizures) aligns with previous studies that indicated a difference in the signs and symptoms presented by patients with glioblastoma in the last days of life and patients with other oncological diseases. In this sense, the instrument used for data collection may not be the most appropriate for the population with primary central nervous system tumors. The decreased level of consciousness and impaired communication can complicate the assessment of signs and symptoms, such as pain, nausea, anxiety and depression. It is essential to conduct research studies with more representative samples. The recording of the signs and symptoms presented, as well as interventions and the evaluation of their effectiveness, are essential to ensure the quality of end-of-life.

Multi-level classroom learning prepares nurses for future collaboration in palliative care: an educational initiative.

Palliative care (PC) education should be an important part of both the graduate and undergraduate nursing curriculum. Nursing's philosophy of holistic care, which aims to improve the quality of life of patients and families, aligns with the primary objective of PC, positioning nurses to take the lead in expanding and improving PC delivery to all patients with a life-threatening diagnosis. The best way to facilitate this level of care is when staff nurses and advanced practice nurses work collaboratively. To establish a new standard for nursing education that emphasises intradisciplinary care. To fill the gap in PC education for nursing students, a dedicated elective PC class was developed for undergraduate and graduate students at a large midwestern University in the United States. Through an interactive approach to learning, both groups were able to experience and more fully understand how they would work collaboratively with each other to provide high-quality PC. Intradisciplinary PC education is an opportunity for students to learn the precepts of PC in an environment that will mirror their post-graduation practice environment.

“The Ghost in Search of Help”: Silas Weir Mitchell’s Sentimental Quarantine, Charlotte Perkins Gilman’s Sympathetic Utopia, and Sigmund Freud’s Mitleidsimitation

For the hardship imposed on patients, Silas Weir Mitchell’s Rest Cure remains notorious. This essay reconstructs Mitchell’s philosophy of care, primarily scrutinizing his understanding of sympathy as a vector for the person-to-person transmission of mental illness. The praxis of sequestration central to Rest Cure methodology functioned as a quarantine measure, designed to prevent bystanders from interacting sympathetically with ailing patients and acquiring analogous disorders. Engagements with the antisympathetic components of Mitchell’s treatment had a formative impact on Charlotte Perkins Gilman, a former patient, and Sigmund Freud, a Rest Cure practitioner. Gilman would later fashion sympathy into an emancipatory force for utopia. Freud would become disillusioned with the Rest Cure by the time of Studies on Hysteria, even as the volume’s case histories conform to a paradigm of contagious neuroses. Freud remained cautious of sympathy’s pathological properties, and his concerns survive in psychoanalytic prohibitions against emotive interface between doctor and patient.

O100 - Feasibility of embedding feedback from women participating in continuity of care experiences with pre-registration midwifery students

Quality midwifery care is woman-centred in both philosophy and model of care (ICM, 2022). Assessment of midwifery student clinical learning has typically depended on preceptor/supervisor feedback, university academic feedback and self-reflection but has not routinely embedded women’s feedback to improve student learning and practice. One pre-registration midwifery program in south-east Queensland has begun to routinely seek feedback from women about their experiences with a midwifery student providing a continuity of care experience (CoCE). The aim of this study was to evaluate the feasibility of conducting a routine, online survey of women’s perceptions of satisfaction and respect during CoCE with a midwifery student. Data from the first 12 months (July 2019 – July 2020) of this online survey was analysed and reported. The online survey was found to be feasible, reliable and valid. Over half of the women invited to complete the survey did so (response rate of 57%, n = 501). Most women reported being more satisfied with their student than they had hoped; would have a midwifery student in future pregnancies; and would recommend a midwifery student to their friends and family. Students in this study cared for a larger number of women through CoCE than the prescribed minimum of 10 required by the national regulator (Nursing and Midwifery Board of Australia, 2022) (20 CoCE minimum in this BMid program). For each woman, the student provided more antenatal care, attendance at labour and birth and postnatal contacts than minimum program requirements. Women reported greater satisfaction and respect as the number of antenatal visits and postnatal contacts with their student increased. Similarly, women were more satisfied when their student attended their labour and birth. This presentation will discuss processes to routinely obtain women’s feedback (including ethical approval); survey content; approach to data analysis; findings and future directions.