Practical Aspects Of Care Research Articles

Understanding Elderly Chinese Cancer Patients in a Multicultural Clinical Setting: Embracing Mortality and Addressing Misperceptions of Vulnerability.

Chinese patients face higher risks of gastrointestinal (GI) cancers and greater cancer-related deaths than Canadian-born patients. The older population encounters barriers to quality healthcare, impacting their well-being and survival. Previous studies highlighted Chinese immigrant perceptions of not requiring healthcare support. During the COVID-19 pandemic, their underutilization of healthcare services garnered attention. The present study explores the experiences of older Chinese cancer patients to improve culturally sensitive cancer care. A total of twenty interviews carried out in Cantonese and Mandarin were conducted with Chinese immigrants, aged 60 or above, diagnosed with Stage 3 or 4 GI cancer. These interviews were transcribed verbatim, translated, and subjected to qualitative descriptive analysis. Among older Chinese immigrant patients, a phenomenon termed "Premature Acceptance: Normalizing Death and Dying" was observed. This involved four key themes: 1. acceptance and letting go, 2. family first, 3. self-sufficiency, and 4. barriers to supportive care. Participants displayed an early acceptance of their own mortality, prioritizing family prosperity over their own quality of life. Older Chinese patients normalize the reality of facing death amidst cancer. They adopt a pragmatic outlook, acknowledging life-saving treatments while willingly sacrificing their own support needs to ease family burdens. Efforts to enhance health literacy require culturally sensitive programs tailored to address language barriers and differing values among this population. A strengths-based approach emphasizing family support and practical aspects of care may help build resilience and improve symptom management, thereby enhancing their engagement with healthcare services.

Challenges of research with carers in a hospital setting in Australia: trialling the Carer Readiness Tool

A tool to help carers gauge their readiness to provide care to a patient on discharge from acute care – the Carer Readiness Tool – was implemented on two cancer/renal inpatient units. Data on carer needs and concerns obtained from the Carer Readiness Tool revealed that relatively inexperienced carers focused their concerns on practical aspects of care, such as mobility, transfers, aids and equipment, transport and parking. More experienced carers reported fewer needs but more concerns, including respite from caring, costs of caring and end-of-life care. Challenges in engaging carers in research, which impacted the formal evaluation of the Carer Readiness Tool, are discussed.

Opportunities and challenges of pharmacotherapy for pulmonary arterial hypertension in children.

Pediatric pulmonary hypertension (PAH) is a rare disease that carries a poor prognosis if left untreated. Although there are published guidelines for the treatment of children with pulmonary hypertension, due to the limited number of robust pediatric clinical trials, recommendations are often based on limited data or clinical experience. Furthermore, many practical aspects of care, particularly for the pediatric patient, are learned through experience and best navigated with a multidisciplinary team. While newer PAH therapies have been approved for adults, there is still limited but expanding experience in pediatrics. This new information will help improve the targets of goal-oriented therapy. Lastly, this review highlights practical aspects in the use of the different therapies available for the treatment of pediatric pulmonary hypertension.

Parental experiences of uncertainty following an abnormal fetal anomaly scan: Insights using Han's taxonomy of uncertainty.

For a number of prospective parents, uncertainty during pregnancy starts when an anomaly is found during a routine fetal anomaly scan. This may be followed by numerous tests to determine the etiology and nature of the anomaly. In this study, we aimed to understand how prospective parents perceive and manage uncertainty after being confronted with a structural anomaly during their routine ultrasound. Han's taxonomy of uncertainty was used as a framework to identify and understand the different types of uncertainty experienced. Interviews were held in the UK (n = 8 women and n = 1 male partner) and in the Netherlands (n = 7 women) with participants who had experienced uncertainty in their pregnancy after a fetal scan. Data were analyzed using thematic analysis, and the uncertainties experienced by parents were mapped against the dimensions of the Han taxonomy (sources, issues, and locus). Participants' experience of uncertainty was relevant to all dimensions and subcategories of the Han taxonomy, showing its applicability in the prenatal setting. Sources of uncertainty included receiving probabilistic or ambiguous information about the anomaly, or information that was complex and challenging to understand. Issues of uncertainty included were those that were scientific—such as a probable diagnosis with no further information, personal—such as the emotional impact of uncertainty, and practical—such as limited information about medical procedures and practical aspects of care. Additionally, participants described what helped them to manage uncertainty. This included active coping strategies such as searching for information on the Internet, external coping resources such as seeking social support, and internal coping resources such as using positivity and hope. Several recommendations for the healthcare professional to minimize uncertainty and help the patient deal with uncertainty have been proposed based on these findings.

Can incremental haemodialysis reduce early mortality rates in patients starting maintenance haemodialysis?

Early mortality rates after the start of maintenance haemodialysis therapy are high. Compared with three-times weekly haemodialysis, incremental haemodialysis is associated with better preservation of residual renal function (RRF) and at least equivalent mid-term to long-term survival. However, there is paucity of data in relation to its use as a means of helping patients through the transitional period, when they first become dialysis dependent. Studies of incremental haemodialysis have overlooked early mortality as an outcome measure. This is primarily due to their retrospective design which makes it difficult to link early deaths to the frequency of haemodialysis. New data confirm previous observations associating incremental haemodialysis with favourable outcomes. They also raise the possibility that in selected groups and for short periods, the pursuit of set clearance targets during the early days of dialysis may not necessarily bring additional short-term gains. We argue that, while simpler ways of estimating RRF are being explored, future trials must consider implementing incremental haemodialysis focusing on practical aspects of care in the transitional period; safety monitoring in such regimes should be undertaken using conventional methods. Such an approach is likely to benefit a larger subset of haemodialysis population.

Justifications for using complementary and alternative medicine reported by persons with musculoskeletal conditions: A narrative literature synthesis.

BackgroundComplementary and alternative medicine (CAM) is very popular with patients frequently combining it with orthodox health care. The high prevalence of CAM use and satisfaction with CAM reported by patients directly challenges an orthodox system that can only approve such use if it results from the application of biomedical concepts and science. Studies highlighting this as a cultural, sociological and historical phenomenon emphasise the value of choice for consumers of health care. Musculoskeletal conditions typify common problems for which the effectiveness of orthodox care is often unclear. We postulated that the reasons people give for using or not using CAM for musculoskeletal conditions, would therefore indicate the full range of expectations that people have of health care. Furthermore, these reasons would indicate how much people feel orthodox health care is or is not meeting their expectations. Therefore, this study aims to investigate people’s reasons for choosing or avoiding CAM for non-traumatic musculoskeletal conditions.MethodsA systematic search and narrative synthesis was conducted of published qualitative and quantitative studies related to CAM and non-traumatic musculoskeletal conditions.ResultsWe identified 169 relevant papers detailing 152 separate studies, from which 1486 justifications were extracted concerning CAM use. Content analysis resulted in 11 distinct categories across four themes: practical aspects of care, clinical effectiveness, non-clinical outcomes of care, and a person’s philosophy of illness and care. People provided similar rationales for both using and avoiding CAM, emphasising that, whilst CAM is perceived by many patients with musculoskeletal conditions to fill gaps in care (such as practitioner time or quality of the therapeutic relationship), orthodox care also seeks to deliver these aspects of care. However, people who used CAM also highlighted its alignment with their general philosophy and ideas about illness and health care, and often emphasised CAM’s capacity to give them control over their condition and its treatment.ConclusionCurrently, CAM appears to have a significant role for patients with common painful long-term conditions in providing choices to enable individual needs to be met.

Caring for women with thyroid disorders in pregnancy

Thyroid hormone levels within the normal range are essential to support a healthy pregnancy. Since thyroid disorders are prevalent in women of childbearing age, midwives need to be fully aware of the implications of these conditions for the mother and fetus to ensure the best possible pregnancy outcomes. With increasing understanding about the interaction between the thyroid function of the mother and her offspring, this article is focused on the practical aspects of caring for women based on updated guidelines. This review considers the risks of maternal hypothyroidism and hyperthyroidism to the pregnant woman and her baby during and after pregnancy.

Family Perspectives on Overall Care in the Intensive Care Unit.

Family members' perspectives about satisfaction with care provided in the intensive care unit (ICU) have become an important part of quality assessment and improvement, but national and international differences may exist in care provided and family perspectives about satisfaction with care. The purpose of the research was to understand family members' perspectives regarding overall care of medical patients receiving intensive care. Family members of medical patients who remained 48 hours or more in two adult ICUS at two healthcare institutions in the U.S. Pacific Northwest took part by responding to the Family Satisfaction with Care in the Intensive Care Unit survey. Qualitative content analysis was used to identify major categories and subcategories in their complimentary (positive) or critical (negative) responses to open-ended questions. The number of comments in each category and subcategory was counted. Of 138 responding family members, 106 answered the open-ended questions. The 281 comments were more frequently complimentary (n = 126) than critical (n = 91). Three main categories (competent care, communication, and environment) and nine subcategories were identified. Comments about the subcategory of emotional/interrelational aspects of care occurred most frequently and were more positive than comments about practical aspects of care. Findings were similar to those reported from other countries. Emotional/interrelational aspects of care were integral to family member satisfaction with care provided. Findings suggest that improving communication and decision-making, supporting family members, and caring for family loved ones as a person are important care targets. Initiatives to improve ICU care should include assessments from families and opportunity for qualitative analysis to refine care targets and assess changes.

Assessing patients needs in outpatients with advanced heart failure

Because of the progressive ageing of the population and the extensive use of recommended drugs, the number of patients with advanced heart failure (AHF) constantly increases. AHF is the most common cause of acute hospital admission. The outcome and quality of life are generally poor for repeated hospital readmission. To assess a mixed method approach: face-to-face semi-structured qualitative interview incorporating quantitative analysis of demographic data and qualitative exploration of perception of needs in outpatients AHF, plus Barthel score [BS], Short Portable Mental Status Questionnaire [SPMSQ] and Moriski Medication Adherence Scale [MS]). Longitudinal prospective study in 50 elderly (age > 75 years) patients with AHF (stage C and D AHA/ACC plus almost two hospital admission in the last 12 months with main diagnosis of HF). Patients and caregivers were asked what they considered to be their main needs, including social support and the provision of practical care, psychological support; and information and choice. In the same time, BS, SPMSQ and MS were delivered. The main areas of needs identified by patients were knowledge of available social and health services (80%) and disease and lifestyle habits (respectively 66% and 72% of patients), clear identification of the care-manager (70%), awareness of alarm and worsening symptoms (60%). Patients experienced difficulty in communication and information exchange, and fragmented co-ordination between social and care services was identified. The quality of life was generally poor for repeated hospital readmission, mainly for poor adherence to drugs and lifestyle, lacking attention to new onset or worsening symptoms, no planning of hospital discharge and for inadequate social support. The semi-structured interview is a useful tool to identify the patient information and educational needs. The main care needs identified by advanced HF outpatients relate to the everyday social and practical aspects of care. There is a need to reform the delivery of care to address the educational and lifestyle support.

Historical views, conventional approaches, and evolving management strategies for myeloproliferative neoplasms.

The classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPN), which include essential thrombocythemia, polycythemia vera, and myelofibrosis (MF), are in a new era of molecular diagnosis, ushered in by the identification of the JAK2(V617F) and cMPL mutations in 2005 and 2006, respectively, and the CALR mutations in 2013. Coupled with increased knowledge of disease pathogenesis and refined diagnostic criteria and prognostic scoring systems, a more nuanced appreciation has emerged of the burden of MPN in the United States, including the prevalence, symptom burden, and impact on quality of life. Biological advances in MPN have translated into the rapid development of novel therapeutics, culminating in the approval of the first treatment for MF, the JAK1/JAK2 inhibitor ruxolitinib. However, certain practical aspects of care, such as those regarding diagnosis, prevention of vascular events, choice of cytoreductive agent, and planning for therapies, present challenges for hematologists/oncologists, and are discussed in this article.

Patient Participation in Decision Making During Nursing Care in Greece-A Comparative Study

To describe patient participation in decision making during nursing care from patients' and nursing staff' perspectives. The sample consisted of medical and surgical patients (n = 300) and the nursing staff (n = 118) working in the respective wards in three general hospitals. A questionnaire was used for the study; data were collected from April 2009 to September 2010. Data were analyzed by an exploratory factor analysis. Patient participation was recorded at a medium level during nursing care, although it was rated as important from both patients and nursing staff. Exploratory factor analysis revealed the factor structure for the planning and implementation of the nursing care. Providers and receivers of nursing care perceived participation in a similar way. Interpersonal interaction was supported from older and less educated patients, as well as from university-educated nurses. Patient participation was greater in practical aspects of care and limited in technical medical issues and supportive services. Patient participation, although moderate, was evident during nursing care in hospital settings. Paternalism in the decision-making process was the dominant trend, whereas interpersonal interaction between the parties was recognized as a prerequisite for planning nursing care.

Vulnerability at the End of Life

In Australia, veterans are a vulnerable group, because of ageing, and high rates of chronic or life-threatening illnesses and poor mental health .This retrospective pilot study explored the home-based palliative care needs of veterans as they face the end of their life, compared to non-veterans. Medical records of ten deceased veterans and ten non-veterans in a home-based palliative care service were analyzed both for demographic data, and qualitative content. Veterans had significantly more comorbidities and were older at death. Qualitative data indicated common concerns, including the role of families and practical aspects of care. Some differences were found between veterans and non-veterans in their end-of-life care requirements. More awareness of veterans’ status may assist in care more tailored to their specific needs.

The Clinical Aspects of Case Management and its Role in Graduate Field Education

In graduate social work education, faculty advisors together with practice instructors can improve social work students' skills to link the practical aspects of ‘work responsibilities’ to the clinical underpinnings of case management. Often students are taught the direct services (case management) with a view solely focused on the practical aspects of care, and this curtails the students' opportunity to learn the clinical interventions that exist in all components of social work: to identify, understand and apply clinical dynamics to presenting problems. The authors discuss their work in addressing case management from a clinical perspective with MSW students and recommendations for its inclusion in graduate social work programs.

Care in Everyday Life: An Ethic of Care in Practice

In this timely and thought-provoking book, Marian Barnes explores the complexities of caring relationships in the contexts of paid work, families, friendships, neighbourhoods and communities. ‘Care’ is a highly contested concept and Barnes argues that, in the current social policy climate in the UK, it is has been devalued as something needed only by people unable to exercise choice. In fact, the book reveals that few human relationships and activities can thrive without some form of care being necessary—extending this to relationships between people and their environments, and to the way that policy makers relate to those affected by their decisions. Barnes argues that, within social care services, the philosophical basis of practice has been sacrificed as the context of care has been increasingly shaped by functional, managerial and economic influences. This certainly resonates with current debates in social work about the need to rediscover core skills and values within the profession—what Dybicz (2012, p. 271) has referred to as ‘recapturing Social Work's first voice’. It is also highly topical in the light of recent scandals in institutional settings, where ‘care’ has sometimes been entirely absent from services intended to meet complex health and social needs. Barnes highlights a tension here with parts of the disabled people's movement which have criticised the concept of care as paternalistic and oppressive. She rejects this perceived conflict between ‘rights’ and ‘care’, stating that ‘care is necessary not only to individual well-being but also to social justice’ (p. v) and this belief permeates her discussion throughout the book. Drawing heavily on the work of feminist care ethicists, in particular Joan Tronto and Selma Sevenhuijsen, Barnes argues for an integration of the emotional and practical aspects of care within social policy as well as in personal relationships. Care is described as a dynamic, relational process, requiring mutual respect, reciprocity and a moral sense of taking responsibility for others, whether in close relationships, the wider community or with strangers. There are also new ethical challenges created by the developing global market for care. In the policy arena, Barnes argues that an ethic of care cannot be applied without a real dialogue between the people making policies and those who will be subject to them, reflecting her earlier work on participative decision making and service user involvement.

‘All the burden on all the carers’: exploring quality of life with family caregivers of Huntington’s disease patients

Existing research suggests that family caregivers of persons with Huntington's disease face a unique series of problems, linked to the complex nature of the disease. There is little research that explicitly investigates the impact of HD on the quality of life (QoL) of the family caregiver. The purpose of this study was to explore the quality of life issues for family carers of Huntington's disease patients in a focus group setting. Participants were recruited via a Huntington's Disease Association (HDA) family conference day. Six semi-directed focus groups (n=47) explored disease-specific aspects of QoL that were deemed important to family carers of this carer group. Data were analysed using Interpretative Phenomenological Analysis (IPA). Analysis of the focus group data identified four superordinate themes: 'Levels of Support', 'Dissatisfaction with Caregiving Role', 'Practical Aspects of Caring' and 'Feelings and Emotional Well-being'. These data provide evidence that QoL is compromised in many ways for HD family carers. The carers in this study often negated their own needs as their caregiving role overwhelmed them and 'took over' their lives.

Hope Against Hope in Cancer at the End of Life

Hope has many facets to it in the context of cancer. This article outlines an instrumental case study for a patient with aggressive lymphoma who rapidly deteriorated to the point of dying. How her and her family's hope was managed is outlined here from various perspectives. Interviews were carried out with the patient's family, medical consultant-in-charge (attending physician) and nurses caring for her at the end of life. The findings outline the transition from hope for cure to hope for a good death and the role that the patient and family's Christian hope played in this. Religiosity and spirituality of hope in terms of Christian hope is explored from the theological perspective. Practical aspects of care in the face of changing hope are discussed. Conclusions are drawn about reframing hope in a changing clinical situation with reference to theories of hope. The importance of acknowledging hope, coping, spirituality and religiosity, especially at end of life, is emphasised.

Palliative care for Sikhs.

This article provides an overview of the palliative care needs of Sikh patients. It describes the basis of Sikh beliefs and practices and discusses practical aspects of caring for terminally ill Sikh patients and their families. Issues before and after death are considered and the importance of an individual approach is highlighted.

Safety and the laboratory centrifuge

This provides an overview of modern centrifuges, accessory equipment, and the hazards and safe use of this equipment. Practical aspects of care and safe use of centrifuges, rotors, and accessory equipment and prevention of rotor failure and other accidents are addressed. It is intended to provide a basic resource for laboratory technical personnel and for those conducting laboratory safety audits. This should supplement but not replace the user’s manual provided by the manufacturer.

Residents as Teachers

Docendo ergo disco: I teach, therefore I learn. Reports on the role of residents as teachers have appeared in the medical literature for over thirty years, citing, in addition to the benefits to students, improvement in the knowledge and interactive skills of the residents1. It has been estimated that, at any given moment in this country, some 100,000 residents on hospital wards are working alongside half of the nation’s medical students, and that these students will receive 20% to 70% of their clinical instruction from residents2-4. Traditionally, the role of residents is complementary to that of attending physicians: principles taught by faculty in lecture format are applied to patient care in the clinical setting, where interaction between residents and students is common. Residents are effective teachers in these settings because they emphasize the practical aspects of care and understand the needs of students. Residents are often better suited, for example, to the teaching of basic technical skills than are staff members who have become less conscious of the individual steps that a novice must take to master a given procedure. Being less threatening gradewise, residents are also more approachable for answers to “stupid questions” than are members of the faculty. Since teaching by residents is crucial to the education of both students and residents, the issue is not whether residents should teach but how they can be enabled to do it most proficiently. There are at least six impediments to more proficient teaching by residents. (1) Insufficient role-modeling. Lack of faculty commitment to the teaching enterprise is perhaps the major obstacle to improving the enthusiasm, effort, and teaching skills of the residents. In too many institutions, teaching, especially of medical students, has become an elective, rather than a required, faculty responsibility. (2) Time constraints. As the influence of …

The presence of hospitalists in medical education.

The presence of hospitalists in medical education.