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Dissertations / Theses on the topic 'Hospice and Palliative Care'
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Wilson, Monika Anne. "Accompanying them home : the ethics of hospice palliative care." Queensland University of Technology, 2009. http://eprints.qut.edu.au/20536/.
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This inquiry, which employed a narrative research approach, critically explored the ethical dimension of hospice palliative care. Hospice palliative care is the profession specifically developed to care for the dying. The development of this practice has grown significantly since the 1980s in Australia, yet ethical inquiry into this professional practice has largely focused on particular issues, problems or dilemmas, such as euthanasia. Although particular ethical issues are important considerations, a broader investigation of the ethics of hospice palliative care practice has not been given sufficient consideration in the growing accumulation of the research literature in Australia. Jennings (1997) surmises that “systematic reflection on ethics in the hospice field is curiously underdeveloped” (p. 2). This study goes someway towards filling this gap. In building upon the Pallium research by European scholars and integrating a social practice framework (Isaacs, 1998) this inquiry provides an alternative account of the ethical agenda and one which has privileged an internal exploration, rather than assume that the ethics would be the same as any other health care modality or to simply adopt a dominant, principles-based approach. These internal explorations were located in the storied accounts of thirty interdisciplinary hospice palliative care professionals.
This thesis provides a thorough, textual conversation into the realm of ethical caregiving at the end of life. Several key insights were illuminated. Firstly, total care must be central to the philosophy underpinning hospice palliative care practice, but this concept and practice of total care was being eroded and contested. Secondly, a predominantly modernist account of personhood was located in the narrative accounts. This modernist account of personhood was thought to be insufficient for the practice of total care and needed to be reconceptualised. An embedded ontological account was provided which would assist with the understanding and practice of total care. Thirdly, initially it was thought that there was no common, shared understanding of the purpose of the practice. It was suggested that the profession was “wandering in the wilderness” when it came to the aim of its practice. However, the professionals did share a common telos (aim towards a good) and it was overwhelmingly relational. This led to the proposal of a new telos for hospice palliative care practice centered on the creation and maintenance of unique relationships which would assist people in their final stage of life. Lastly, the ethical frameworks which guided practice for the professionals were presented. In these frameworks it was significant values (acceptance of human mortality, total care and honest and open communication) and relationships (how we treat each other) which played the main role in what constituted hospice palliative care ethics. An account of a hospice palliative care ethical relationship was provided which included a proximity stance of in-between. Overall, any ethic for hospice palliative care must have at the heart the relationship between professional caregiver and living-dying person. The relationships in this social practice, between each other, accompanying one another, are our ethical compass.
This thesis concluded that hospice palliative care, as a social practice, has a rich ethical dimension as understood and articulated by its professional members. These insights have resulted in the construction of a new ethical framework reflecting, formalising and adapting the ethical dimension as understood by its professional members. This ethical framework - A Relational Ethic of Accompanying - is needed to help maintain, sustain and protect the unique identity of this profession. This framework adds to the “moral vocabulary” (Jennings, 1997) and “moral specificity” (ten Have & Clark, 2002) of hospice palliative care practice. In addition, it would provide important guidance to palliateurs reflecting on how best to provide quality, compassionate and ethical care at the end of life.
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Jaskiewicz, John Gerald Jr. "Dignity In Palliative Care: The Hospice at Skogafoss Falls." Thesis, Virginia Tech, 2011. http://hdl.handle.net/10919/33165.
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Hospice is a place of caring, a place where life is measured in quality, not quantity. During a terminally ill patientâ s final weeks, days or hours, it is important that hospice facilities provide comfort through any and every means possible. The physician administers pain relief, the building has the ability to administer a kind of relief the patient may not even cognitively perceive. Through the eyes of a terminally ill patient, the architect should consider the views, connections and relationships the patient has with their surroundings. Keeping the patientsâ experiences at the forefront of all design decisions, the architect can promote a sense of dignity within the patients that seems to be lost in most modern health care facilities.
This thesis proposes a 30-bed hospice to be built along the Skógafoss falls in Skógar, Iceland. The hospice design addresses the patientsâ connections to the physician, structure and natural surroundings through articulation of spaces based on these relationships. The placement of every element within the hospice, from the patientsâ bed to the physiciansâ offices, can have a drastic effect on the patientsâ experiences in many ways. Exploring layouts and forms not common in traditional health care design, the hospice at Skógafoss falls provides an experience unique to any hospice in the world. The spatial connections and materiality of the hospice allow the patients to determine their own relationships to the facility and the natural world beyond. Through simplicity and mindfulness, the hospice can be more than a place to die. Rather it is a place for one to spend their final hours with both comfort and dignity.Master of Architecture
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Jumah, Anne Mukeli. "The nature and extent of palliative care in the Nairobi Hospice." Diss., Pretoria : [s.n.], 2008. http://upetd.up.ac.za/thesis/available/etd-11202008-163831.
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Munene, Grace N. "An Assessment of a Hospice and Palliative Care Partnership Program." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc699969/.
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This project attempts to describe how a hospice and palliative care partnership program works. Through the assessment of one such program, the researcher sought to find out the essential components of the partnership including how the two partner organizations interact and work together. Data was collected using various methods: document review of organization documents such as newsletters, annual or quarterly reports, brochures and other available literature e.g. materials on organizations’ website and on social media; in-depth interviews with stakeholders of both organizations that included staff and board members; observation of staff working; and participant observation during organization events. The findings of the research shows that in order for organizations to have an effective partnership program in place, both partners need to have strong leadership in place, possess a willingness to learn from each other, maintain regular communication, and visit each other regularly. With this in place, several outcomes of the program are likely such as: increasing advocacy for hospice and palliative care, increasing visibility of the organizations both nationally and internationally, and provides an opportunity for organizations to network with other organizations in their locality in order to achieve partnership objectives. The study further reveals that global collaborations in the field of hospice and palliative care began with the advent of the international hospice movement. The assessment of this hospice partnership demonstrates how organizations can establish working relationships and the results likely to come out of such an initiative.
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Ferrel, Cynthia Lynn. "The experience of critical care nurses in initiating hospice care." abstract and full text PDF (free order & download UNR users only), 2008. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1453534.
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Wagner, Joan. "Hospice affirming life, a sanctuary for palliative care and bereavement." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ47657.pdf.
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Dawson, Patricia Shelagh Jean. "An exploration of bereavement intervention in palliative/hospice care programming." Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28712.
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Bereavement intervention is subsumed within palliative programme philosophy which encompasses the family as the unit of care and provides a continuum of care that extends beyond the death of a family member. There is no available research on the effect of post-bereavement intervention within palliative programming, and very limited research exists that evaluates the effect of intervention on bereavement outcome. This exploratory study endeavors to differentiate bereavement outcome between two populations having palliative/hospice program support but only one choosing to participate in bereavement follow-up. A mixed strategy of quantitative and grounded theory approaches provided an expanded analysis through which meaning structures and time/process parameters for grieving individuals were explored. The study extended from idiosyncratic data into the realm of larger systemic interactions. An important finding was that the amount of time for preparation for the death of a family member is crucial. Other mitigating factors influencing the grief outcome were social support, network viability, and age.Arts, Faculty of
Social Work, School of
Graduate
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Ellis, Susan Eileen. "Barriers Among Primary Care Providers to Utilizing Palliative/Hospice Care for Patients with Non-Cancerous Terminal Illness." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/612875.
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Patients with terminal illness may benefit greatly from hospice and palliative care. Studies of patients with chronic terminal illness revealed that those who did not received palliative or hospice care experienced poor quality medical care characterized by untreated symptoms, unmet spiritual and personal care needs, increased burden for the caregiver, and low patient and family satisfaction (Meier, 2011). According to the World Health Organization (2011), palliative care is offered at the time of diagnosis alongside potentially curative treatment and can be utilized during the trajectory of illness until death. Hospice is a Medicare benefit considered the model for quality, compassionate care during the last 6 months of life and is available to all patients regardless of age, religion, race, or illness (Medicare Hospice, 2011). This study examined why patients with non-cancerous terminal illness were not receiving timely palliative or hospice care by interviewing primary care providers. A systemic literature review suggested possible barriers including confusion between palliative and hospice care, lack of understanding about the scope and intent of hospice care (McAteer & Wellberry, 2013), prognostic uncertainty, timing, and no clear point to originate a referral (LeMond & Allen, 2011). Insufficient training for primary care providers, including the lack of familiarity with various prognostic tools that aid in determining eligibility for the patient with a non-cancerous, terminal diagnosis might also be a barrier to referral (McAteer & Wellberry, 2013). Lastly, primary care providers lacked confidence in communicating the need for advanced care planning in non-cancerous terminal illnesses according to a survey done by Karlekar, Collier, Paish, Olson, & Elsay (2014). The findings of this study confirmed the available literature. Much work is needed to educate providers and incorporate palliative care and hospice guidelines in academic institutions and in practice. Regulatory issues need continuous attention as the landscape of coverage, payment, and reimbursement changes rapidly. Further research is needed so that this vulnerable population will benefit from early interventions and a better understanding and acceptance of their non-cancerous terminal illness.
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Iannacone, Stephen Mark. "Systemic and Racial Barriers to Palliative Care." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/433062.
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Urban BioethicsM.A.
Those who have known an individual with a chronic medical condition or someone that has been diagnosed with a terminal illness have experienced the physical and emotional toll these diagnoses have on both patients and their loved ones. Medical providers encounter these situations daily and are often responsible for assisting the patient and their family in the decision-making process. The specialty of Hospice and Palliative Medicine was created specifically with these difficult, but very common, situations in mind. Even though the concept of palliative care has become mainstream and its practice is considered standard of care in many situations, it continues to be misunderstood, misrepresented, and underutilized, despite providing measurable benefits to patients, families and the healthcare system. This paper explores two systemic barriers to palliative care that contribute to this problem and highlights how race, cultural mistrust, and a long history of racial disparities in health care work together to undermine the effective delivery of palliative care.
Temple University--Theses
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Bergquist, Adam. "Evaluation of the pathways palliative care program at the Denver hospice." [Denver, Colo.] : Regis University, 2008. http://165.236.235.140/lib/ABergquist2008.pdf.
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Nilsson, Stina, and Sofie Wirén. "Copingstrategier hos vårdpersonal på Hospice." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-192600.
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Syfte: Syftet med studien var att ta del av hur vårdpersonal på Hospice beskriver sina olika känslor som uppstår i vården av patienter i livets slutskede, vilka copingstrategier de använder sig av för att bearbeta dessa känslor samt vilka faktorer som de upplever påverkar valet av copingstrategier. Metod: En kvalitativ metod med semistrukturerade intervjuer användes. Åtta kvinnliga deltagare ur vårdpersonalen på Hospice (lika fördelade mellan sjuksköterskor och undersköterskor med varierande ålder och erfarenhet) blev intervjuade. Resultat: Känslor av skuld, frustration, maktlöshet, stress och otillräcklighet upplevdes betungande. För att bearbeta dessa användes främst aktiv och problemfokuserad coping, framförallt samtal och stöd. Vårdpersonalen lägger stor vikt vid att kunna separera privatlivet från arbetslivet. Även känslofokuserad coping i form av distraktion eller avskärmning användes ibland. Detta för att uthärda i stunden och vid senare tillfälle bearbeta dessa upplevelser. Faktorer som påverkade bearbetningen var samarbetet i arbetsgruppen, tidsbrist, samt individuella egenskaper. Slutsats: Klimatet på arbetsplatsen, det vill säga organisation, attityder samt tid för gemensam reflektion är viktigt för bearbetningen. Det är också viktigt att blivande vårdpersonal får kunskap om palliativ vård och olika copingstrategier för att hantera sina känslor. Vårdutbildningar behöver ses över inom detta område. Hur coping används påverkar personalhälsan och även i förlängningen patientvården. Kunskap om copingstrategier måste finnas även på avdelningar där inte specifik palliativ vård bedrivs.Objective: The aim of this study was to learn how the healthcare personnel at Hospice describes their emotions during work with patients in palliative care, which coping strategies they use to deal with these emotions as well as factors they experience affects the choice of strategies. Methods: A qualitative approach with semi-structured interviews was used to collect data. Eight female participants with varying age and work experience from the Hospice nursing staff were interviewed. Results: Feelings of guilt, frustration, powerlessness, stress and inadequacy were perceived as difficult. To cope with these emotions active and problem-focused coping was used mainly for ventilation and social support seeking. They find it important to separate their private life from work. Emotion-focused coping was used at times for distraction or to distance themselves, to endure in the moment and later on process these emotions. Factors affecting the coping strategies were cooperation in the work group, time constraints and individual qualities. Conclusion: The workplace climate regarding organization, attitudes and times for group reflection, is significant for coping. It is important that aspiring health professionals learn about palliative care and coping strategies to manage their emotions. Nursing programs need to be reviewed in this area. How coping is used affect health among the staff and ultimately also the patient care. Knowledge of coping strategies is important in all areas of healthcare.
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Dobies, Pamela A. Roffol Herman Robert D. "Organizational design issues of establishing palliative care services in an acute care hospital." Diss., UMK access, 2005.
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Thesis (Ph. D.)--Henry W. Bloch School of Business and Public Administration and Dept. of Sociology. University of Missouri--Kansas City, 2005."A dissertation in public affairs and administration and sociology." Advisor: Robert D. Herman. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed June 23, 2006. Includes bibliographical references (leaves 194-204 ). Online version of the print edition.
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Day, Michele Oliver Debra. "Team communication and collaboration in hospice pain management." Diss., Columbia, Mo. : University of Missouri--Columbia, 2008. http://hdl.handle.net/10355/6632.
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Title from PDF of title page (University of Missouri--Columbia, viewed on Feb 25, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Dissertation advisor: Dr. Debra Oliver. Vita. Includes bibliographical references.
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Smith, Paula Caroline. "Family caregivers in palliative care : perception of their role and sources of support." Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340333.
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Lincoln, Danielle. "A descriptive analysis of the pilot paediatric palliative care unit at Witwatersrand Hospice, Johannesburg." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/11111.
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Includes bibliographical references (leaves 86-89).Aim of study: to analyze the profile and management of patients admitted to the pilot paediatric unit in order to make recommendations for the further development of the unit.
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Higginson, Irene Julie. "The development, validity, reliability and practicality of a new measure of palliative care : the Support Team Assessment Schedule." Thesis, University College London (University of London), 1992. http://discovery.ucl.ac.uk/1317889/.
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Hospices and support teams offering palliative care have increased by over four fold in the U.K. during the last decade. However, evaluations have been limited, often because of a lack of suitable outcome measures. This study aimed to develop and test the validity and reliability of a measure of palliative care provided by support teams. Through detailed discussion of work objectives with care staff, assisted by review of the literature, the Support Team Assessment Schedule (STAS) was developed. STAS has 17 items, each scaled 0 (best) to 4 (worst), with definitions for each scale point. Median time to complete a STAS rating was 2 minutes (range <1- 15). Face validity was demonstrated by use in five settings. Criterion validity was assessed by comparing team ratings with ratings from patients and family members (or other carers) collected through interview. Patient and team ratings showed moderate correlations (rho ranging 0.45 - 0.66 for 5 out of 7 items): team ratings were usually closer to those of patients than those of family members. As a test of construct validity, quality of life (HCRA-QL) index items were shown to correlate with similar STAS items in patients more than four weeks before death (a STAS sub-scale of six items was correlated with the total HRCA-QL, Spearman rho -0.45). Reliability of STAS was assessed by comparing the ratings of different staff. Out of a total of 45 patient assessments, 16 items showed agreement or ratings within one score in 88% or more cases, Cohen's Kappas were greater than 0.48 (up to 0.87) and were highly significant (p < 0.0005). There were high correlation coefficients (Spearman's rho ranged 0.65 - 0.94). Split-half reliability and internal consistency was assessed using Spearman Brown coefficients and Cronbach's alpha for ratings at referral, at death or discharge, and on all weeks (combined). The coefficients ranged 0.68 - 0.89: slightly higher than the coefficients found for the HRCA-QL index. Serial scores of patients that improved (the majority) and deteriorated (a minority) under care, and results from first and last assessments of patients under the care of five support teams, indicate that the STAS was discriminating in practice. Although STAS was used to audit support team care the items are relevant to the assessment and evaluation of palliative care in other settings.
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Walter, Suzanne. "The experience of sexuality of male cancer patients under palliative care at Hospice Wits Houghton." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/10628.
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The experience of advanced cancer leaves in its wake devastating effects, which are both complex and multi-dimensional for the patient, their family and society. The consequences are far-reaching and span psychological, physical and sexual dimensions. Unfortunately sexual dimensions are least addressed by researchers and healthcare professionals, even though most patients wish to have this area dealt with. Sexuality is a complex phenomenon that is influenced and shaped by physical, social, cultural and religious factors. The research that has been conducted on sexuality on the male cancer patient under palliative care has largely focussed on the physical aspects of sexuality such as erection, ejaculation and fertility. Studies conducted on the patients' actual experience of sexuality are few and no studies of this nature have been found to exist within the South African context.
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Carpenter, Stephen. "Patients' experience of and attitudes towards care in a lay caregiver run institution Tumelong Hospice, Winterveldt." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/10226.
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Bibliography leaves 66-68.The Tumelong Hospice in Winterveldt, North West Province, South Africa, is a residential care backup for a home based care program. It is unique in that it is run by a staff of lay caregivers trained in basic palliative care with the support of one professional nurse and a visiting doctor. The hospice experienced criticism from some professionals who feel that lay caregivers are not able to run a residential hospice service. Past experience in Winterveldt has shown that lay caregivers can deliver good care with appropriate training and backup support. A literature review revealed that little research has been done in palliative care in Africa. The aim of this study was to determine patients' experience of care in Tumelong Hospice, and whether the standard of care is acceptable to the people who utilise the serivce.
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Jenkins, Todd M. "Hospice use in Alabama a cross-sectional assessment /." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2009r/jenkins.pdf.
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Curtis, Mary. "A sociological critique of 'grand narratives' in the history of hospice and palliative care." Thesis, University of Plymouth, 2008. http://hdl.handle.net/10026.1/1106.
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This thesis is a sociological history and critique of hospice and palliative care: their goals, narratives, and social, clinical and ethical practices. Hospice developed in Britain as a result of and challenge to interventionist biomedicine within hospitals where dying came to be viewed as medical failure. From the mid twentieth century hospice was promoted as a 'philosophy of care' that had at its locus a concept of 'whole' person family care for people who are dying. For the first tune patients and then: relatives became the unit of care. Henceforth, hospice established for itself three major 'goals'; (1) hoUstic symptom management, (2) acting as a surrogate family for dying persons and their relatives in an atmosphere of homeliness where staff (3) worked together in non-hierarchical multidisciplmary teams. The hospice agenda m caring for the dying aimed to 'promote living and even to facihtate personal growth during the dying process' (Moller, 1996:40). This was postulated as the ideal standard in offering humane care to the dying patient and for achieving a 'good death'. For many years hospice philosophy was practiced in volimtary hospices that were charitable organisations deliberately located outside the National Health Service. An exponential growth in the number of such organisations during the 1970s and 1980s spawned a movement which subsequently led to the creation of a new medical specialty in 1987, that of palliative medicine. Hospices' 'grand narrative' refers to the dominant 'official' story about their development and about the activities that were or are carried out withm them. In addition to offering a new way of looking at hospice history, I used the 'goals' of hospice as espoused in the 'grand narrative' to guide my observations in two hospices in one British region. I explore how hospice professionals employ methods of control that help both manage the dying process and maintain institutional order. The study took place over a four year period with the aim of determining to what extent the 'grand narrative' matched practice or whether as Lawton (2000) proposed there is a 'gap between rhetoric and reahty' of hospice care. This thesis represents a challenge to hospice, a refusal to valorise the story proponents have told and continue to tell about the practices that are carried out under the banner 'hospice' and more recently palliative care/medicine.
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Arber, Anne Marie. "Building reputation : the significance of pain talk in hospice and palliative care team meetings." Thesis, University of Surrey, 2004. http://epubs.surrey.ac.uk/2578/.
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Garcia, Maria J. "Systematic Review of the Literature on Why There is Hospice Underutilization." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5009.
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Despite hospice and palliative care services being available for patients at the end-of-life, it remains an easily accessible health care service which has been mostly underutilized and/or misunderstood. For this project, the practice problem was underutilization of hospice and palliative care services. A systematic review of the literature which focused on under usage of end-of-life care was conducted. MEDLINE, CINAHL, and ProQuest Nursing and Allied Source databases were searched (2005 to 2017). Studies that evaluated interventions for increasing hospice and palliative care services were selected. Conceptual variables included studies that addressed the under usage of end-of-life care. Kolcoba's comfort theory, Parse's theory of human becoming and Chochinov's dignity model was included to identify the issue, gather the data, and help transfer researched data into practice. The tools applied for analysis and synthesis were the appraisal of guidelines research and evaluation and the grading of recommendations, assessment, development and evaluation. The under usage of hospice and palliative care according to this systematic review, has resulted in (a)suffering negative effects on patients at the end of life, who do not receive adequate palliative or comfort care, (b) additional distress for families dealing with grief and denial, and (c) may result in unneeded acute care, adding significantly to the cost of care. This doctoral project formed a cogent set of recommendations consisting of, communication guidance and community education for a local hospice agency and the community. The contribution of positive social change in this community was through education and knowledge to bridge the gap into practice and improve end-of-life care in the community.
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Nilsbacken, Elisabeth. "Finns det plats för humor i den palliativa omvårdnaden? : De palliativa patienternas perspektiv." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-802.
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Humor är så integrerad i mänskliga interaktioner att det ofta uppstår spontant och utan eftertanke eller planering. Humor förknippas vanligtvis med skratt, glädje och känslor av gemenskap och välbefinnande. Forskning visar att det är patienter som initierar mest humor i vårdrelationer. Denna litteraturstudie är en metasyntes och består av tio vetenskapliga artiklar. Syftet var att belysa obotligt sjuka patienters upplevelse av humor i den palliativa vården. Det visade sig att humor var viktig och tjänade otaliga funktioner. Enligt patienterna var humor en värdefull del av kommunikationen generellt och den medkännande personliga omvårdnaden i synnerhet. Humor var närvarande igenom alla studiers intervjuer och observationer. En stor majoritet av patienterna värderade humor mycket både före och under sin sjukdom. Humor beskrevs av patienter som en bro till deras friska identitet. När vårdpersonalen använde humor kände sig patienter sedda som människor inte bara som mottagare av vård. Mild humor var den mest utbredda och bestod av leenden, spontana kommentarer, godmodiga skämt, stunder av värme och lättsam lekfullhet. Den empatiska, respektfulla, terapeutiska användningen av humor som personalen skapade genom sitt sätt att vara, skyddade patienternas integritet, självkänsla och känsla av värde. Humor hade en stor betydelse i vårdrelationer som blev djupare och mera personliga. Humor visade sig vara en viktig del i den medkännande och mera personliga omvårdnaden. Kombinerat med professionell skicklighet och empati, är humor för värdefull för att förbises.
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Wright, David. "Delirium and the Good Death: An Ethnography of Hospice Care." Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23606.
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Delirium is a disturbance of consciousness and cognition that affects many terminally ill patients before death. It can manifest as confusion, hallucinations, and restlessness, all of which are known to be distressing to patients, families, and professional caregivers. Underlying the contemporary palliative care movement is a belief in the idea that a good death is possible; that dying can be made better for patients and families through the proper palliation of distressing symptoms and through proper attention to psychological, social, and spiritual issues that affect wellbeing at the end of life. Given that delirium is potentially disruptive to all that the good death assumes, i.e., mental awareness, patient-family communication, peace and comfort, the question was asked: What is the relationship between end-of-life delirium and the good death in hospice care? Ethnographic fieldwork was conducted at a freestanding residential hospice over a period of 15 months in a suburban community in eastern Canada. The research methods included participant observation (320 hours over 80 field visits), interviews with 28 hospice caregivers, and document analysis. The findings of this study provide an in-depth examination of the nature of caregiving relationships with patients and with families in end-of-life care. They illustrate how a commitment toward providing for the good death prevails within the cultural community of hospice, and how the conceptualization, assessment, and management of end-of-life delirium are organized within such a commitment. In this setting, experiences of conscious and cognitive change in dying are woven by hospice caregivers into a coherent system of meaning that is accommodated into prevailing scripts of what it means to die well. At the same time, delirium itself provides a facilitative context whereby processes of supporting families through the patient’s death are enabled. This study highlights the relevance of considering the contextual and cultural features of individual end-of-life care settings that wish to examine, and perhaps improve, the ways in which care of delirious patients and their families is provided.
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Ford, Joseph. "Empathy in doctor-patient palliative care consultations : a conversation-analytic approach." Thesis, Loughborough University, 2017. https://dspace.lboro.ac.uk/2134/27661.
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This thesis analyses doctors empathising with patients in palliative care interactions. Historically, palliative care has treated not only patients physical pain but their emotional pain, as well. Although the importance of empathy (defined for the purposes of this thesis as The doctor s expressed understanding of the patient s emotional experience ) has been emphasised in this environment, however, there has been no prior research showing how palliative care doctors actually empathise with their patients in practice. Drawing upon 37 recordings of doctor-patient consultations collected in a UK hospice, this thesis addresses this omission by using conversation analysis (CA) to analyse several facets of empathy in this environment. The analysis begins in chapter four by considering the ways in which doctors can empathise with patients. It shows how doctors can empathise semantically, either by reworking what the patient has themselves said or by showing understanding on a normative basis. It also considers non-semantic ways of displaying empathy (e.g. response cries), showing how these are fundamentally different to the semantic type of empathic display. Overall, this chapter shows that empathy is not restricted to particular formats but, rather, is dependent upon the content of the doctor s turn. The analysis then moves on consider the wider context of doctors empathic responses. Chapter five, first of all, analyses cases where patients emotions become the topic of the interaction, either because the doctor asks about them directly or because the patient raises an emotionally-implicative topic. The emphasis here is on how palliative care doctors can talk to patients about, and empathise with, their emotions without necessarily having to do anything about those emotions. Chapter six then focuses on cases where patients emotions are discussed alongside the more task-driven aspects of the consultation, either because the patient s physical condition has had an emotional impact on them or because their presenting problem is inherently emotional. In contrast to chapter five, then, the source of the patient s emotions here can be treated by the doctor without the emotions being topicalised. The final two chapters of the analysis focus on doctors empathising with patients not in response to something that the patient has said but in the service of some task. Chapter seven shows how doctors can empathically bridge the gap between their medical and the patient s experiential perspectives at moments where it becomes clear that there is a disparity between the two. These include moments where the patient expresses expectations that go beyond what can realistically be provided, moments where the patient might take offence at the doctor s advice and moments where the doctor must reassure patients about their symptoms without seeming to criticise their emotional responses to those symptoms. Chapter eight, meanwhile, shows how doctors can empathically demonstrate that their practice is being driven by a due consideration of the patient s feelings. Specifically, it shows how doctors can draw upon patients feelings in helping them come to a decision about a treatment, cite those feelings when accounting for a treatment that they have recommended and frame a difficult topic as an outgrowth of sentiments that the patient has already expressed. In conclusion, this thesis shows how empathy is not clearly demarcated in palliative care. While there are cases where patients emotions are discussed and empathised with for the sake of discussing and empathising with them, more commonly, empathy and emotion are interwoven alongside and into the task-driven aspects of consultations. This thesis thus shows the interactional manifestation of palliative care s underlying philosophy, with patients emotional pain addressed alongside their physical pain in an integrated, holistic way.
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Swart, M. Teresa. "An evaluation of factors that contribute to late referral of cancer patients by oncologists and doctors working in oncology to hospice services in the Western Cape." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10998.
Full textAbstract:
Includes abstract.Includes bibliographical references (leaves 138-149).
A survey was done in the City of Cape Town Health District to identify possible barriers and other factors that influence the referral of patients to hospice by oncologists. Factors that influenced referral of patients to hospice included lack of training of oncologists in palliative care, the view of the oncologist's individual role in the care of his patients as well as the ability to communicate comfortably with patients regarding end-of-life care. Reasons for non-referral included hospice not being available in the area or not accessible to patients, the perception of the doctor that he/she is giving up on the patient, previous dissatisfaction with service by hospice and not wanting to lose control of the treatment of the patient.
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Gill, Megumi. "Voices of healthcare workers : experience of being on an interdisciplinary team in hospice palliative care." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42209.
Full textAbstract:
Having a model of interdisciplinary teamwork is an important part of clinical practice in hospice palliative care. It plays an integral role in providing patient care by multi-disciplines of healthcare professionals who are required to address the intricate needs of patients at the end of life. Yet, the nature of participating in an interdisciplinary patient care team has not been fully understood in theory or clinical work. The purpose of this research was to generate an understanding of the experience of being on an interdisciplinary team in hospice palliative care through healthcare workers’ own voices, using a content analysis method in a qualitative research paradigm. A total of 11 healthcare professionals across medical and psychosocial disciplines participated in this study. Data were collected from semi-structured interviews with these participants and were analyzed for thematic contents. The following six themes regarding the nature and quality of working as a member of an interdisciplinary team emerged; (a) collaborative work, (b) quality of relationships, (c) communication, (d) team building activities, (e) personal qualities, and (f) institutional influence. A conceptual framework is proposed as an “integrative and multidimensional” model of an interdisciplinary team approach to hospice palliative care. The proposed model offers a holistic view of an interdisciplinary team approach. Implications for clinical practice and future research are discussed. Further, suggestions are offered in order to enrich the understanding of interdisciplinary teamwork, to enhance the quality of patient care, to support and advocate the well-being of healthcare workers, and to develop accountability for hospice palliative care programs.
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Miller, Amie Jacqueline. "Hospice Nurses- Attitudes and Knowledge about Pain Management." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4165.
Full textAbstract:
It has been well established that many people will suffer with pain at the end of life, and untreated pain contributes to reduced quality of life. Many barriers contribute to this issue including a lack of knowledge in nurses who care for dying patients. Many nurses in general practice settings do not possess adequate knowledge about basic pain management principles; and the same may be true about hospice nurses despite the assumption that hospice nurses are more adept at pain management. Contributing to this problem may be the attitudes that nurses, including hospice nurses, have regarding pain and its management. This study sought to identify the knowledge levels of hospice nurses. Because attitudes may affect the delivery of effective pain management, the study also sought to determine attitudes of hospice nurses regarding pain and its management. Thirty-five hospice nurses completed two instruments: The Pain Management Principles Assessment Test measured levels of knowledge and the Nurses Pain Management Attitude Survey determined attitudes. Data was analyzed using means, standard deviations, frequencies and percentages. A correlation between knowledge level and attitude was also calculated, along with a correlation between knowledge level and certification status. The overall mean knowledge score for the nurses studied was 21.74 (72.3%), which falls below accepted standards. The mean attitude score found was 82.34, which demonstrates only slightly positive attitudes. These findings support the idea that knowledge and attitude are not synonymous and that a nurse may have a positive attitude about the management of pain, without sufficient knowledge to effectively alleviate pain. It is often said that hospice nursing is a calling, and these are the nurses who are at the forefront of pain management. This study demonstrates that slightly more positive attitudes may indicate that this group of nurses is motivated to gain a better knowledge base. This should motivate hospices and other education institutions to incorporate more specific instruction regarding pain management into their curricula. Despite some common misconceptions pain does not have to be an unavoidable part of life, and with a better knowledge base hospice nurses could more effectively deliver compassionate, expert care.
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Karmann, Alexander, Markus Schneider, Andreas Werblow, and Uwe Hofmann. "Hospizstudie: Standorte und demographische Rahmenbedingungen von Hospizangeboten in Sachsen." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-150582.
Full textAbstract:
Ziel dieser Studie ist, einen aktuellen Statusbericht zu Standortdichte, räumlicher Bedarfsabdeckung und demografischen Rahmenbedingungen für die ambulante und stationäre hos-pizliche und palliative Versorgung in Sachsen zu erstellen. Dabei sollen aktuelle Versorgungslücken identifiziert und der künftige Bedarf (2020–2030–2050) an Angeboten auf Ebene der Landkreise und Kreisfreien Städte herausgearbeitet werden.
Für die Ableitung der Normwerte zeigt sich, dass angesichts der hohen Sterblichkeitsunterschiede zwischen den Bundesländern eine Bedarfsermittlung auf der Basis bundesdurchschnittlicher Normwerte je Bevölkerung nicht zufriedenstellend ist. Deshalb empfiehlt die Studie, in der regionalen Planung der Hospiz- und Palliativversorgung auf die erwarteten Sterbefälle abzustellen, die sich unter Berücksichtigung der Altersstruktur ergeben. Dieses bedeutet, dass die Normwerte der DGP zur Berechnung der Sollwerte um Bevölkerungsstruktur und Sterblichkeit korrigiert werden.
In einer abschließenden Bewertung werden – vor dem Hintergrund einer Stärken- und Schwächenanalyse aus Experteninterviews – weitere Handlungsempfehlungen abgeleitet, die auch die Dimensionen von Qualität der Leistungserbringung, Ausbildung, Finanzierung und deren Anreizwirkung sowie Integration einbeziehen.
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Källström, Karlsson Inga-Lill. "Att leva nära döden : patienters och vårdpersonals erfarenheter inom hospicevård." Doctoral thesis, Örebro universitet, Hälsoakademin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-5439.
Full textAbstract:
This research focused on experiences of dying patients and hospice nurses in a hospice unit. The research objectives were to (i) acquire more extensive knowledge about how dying patients and hospice nurses experience life and death and (ii) describe patients who were cared for during a 10-year period in an inpatient hospice ward. Data were gathered via interviews with 19 nurses and 11 patients. An interpretive description method was used to analyze interview results. Data were also gathered from institutional care records that included gender, age, marital status, diagnosis, referral source, and length of stay (666 women and 555 men). Descriptive statistics were used to describe basic features of the study's data and to compare differences between women and men. The main finding from interviewing the nurses was that they were struggling to acknowledge and unveil the person within the weakening body. In doing so, they used various strategies such as (i) striving to understand patients’ experiences of body function loss; (ii) encouraging patients to uphold body functions and daily habits; (iii) acknowledging and balancing patients’ need for body control; and (iv) providing tender care for the body. After 2 years of work in hospice care, nurses described that facing the dying and death of many patients had an impact on daily work and private life. The close relationship with the dying patient led to existential issues concerning the meaning of life and death, which were conceptualized into this theme: death as an agent of change. Eleven years later, the presence of death took a less dominant place in the nurses’ lives, and the theme became: death as a companion in life. In the long-term, nurses emphasized that their relationships with dying patients fostered their professional and personal growth. The findings from interviewing the patients revealed that when death became a reality, life took on new meaning, and they acquired new values that were important to preserve or protect; this triggered need for feeling secure within this situation. These revelations were manifest in three sub-themes: (i) when possible death becomes a reality; (ii) living with death as a reality, and (iii) a need for a feeling of security. And this main theme was conceptualized: making sense of life close to death. Results regarding patients in hospice ward care over a 10-year period revealed significant differences between women and men. More women than men were single, had cancer with relatively short trajectories, and were referred from the oncology department. More men than women were diagnosed with types of cancer with somewhat longer trajectories. Despite longer trajectories, length of stay was shorter for men than for women. The most frequent referral source was the hospital. But compared to women, men (particularly younger men) were more often referred from home-based hospice care. The findings expand knowledge about dying and its various configurations; consequently, care and support needs will vary. For the dying person, it is important to know that care is provided according to the person’s preferences and given when needed.
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Hill, Hazel Catherine. "Psychosocial support within the everyday work of hospice ward nurses : an observational study." Thesis, University of Stirling, 2016. http://hdl.handle.net/1893/24356.
Full textAbstract:
Psychosocial support is said to be an inherent component of nursing care and a major focus of palliative care. Literature exists which outlines perceptions of the psychosocial needs of patients and how psychosocial support should be provided. However, there is a lack of empirical evidence on how psychosocial support is operationalised in practice. This study provides a valuable and substantial new contribution to the evidence on the psychosocial needs expressed by patients in a hospice ward and how nurses immediately respond to these needs within their everyday practice. A study gathering data via observations with matched interviews of patients and nurses, organisational, documentary, and demographic variables, was conducted over an eight month period. Thirty-eight nurses (registered and auxiliary) and 47 patients were included in a maximum variation sampling strategy. Data was analysed using constant comparative qualitative techniques. Patients expressed a wide variety of psychosocial needs, often only signalling them whilst receiving care for other reasons. Considering these needs in relation to Maslow’s (1943) hierarchy of needs suggests that in-patients more commonly express prerequisites to physiological care and ‘lower level’ safety needs rather than the more thoroughly researched and espoused ‘higher’ level psychosocial needs. The nurses reacted to these psychosocial needs with a range of responses which indicated a diminishing level of immediate support: ‘dealing’, ‘deferring’, ‘diverting’ and ‘ducking’. The majority of the nurses were observed using each of these responses at some point during data collection. A variety of the responses were used for each type and context of psychosocial need. These responses were influenced by the ward’s workplace culture. This study demonstrates a requirement for more thorough consideration of the true psychosocial needs of patients, which appear to vary dependent on the context of care. Consideration should be v given to workplace culture and its influence over psychosocial support, with nurses being supported to expand their response repertoire so that patients’ psychosocial needs are acknowledged more. Increasing nurses’ knowledge of the reality of psychosocial support through education and research will encourage formalisation of the place of psychosocial support in the planning, documentation and provision of care. This study shows that ward nurses can offer psychosocial support as an inherent component of their everyday work. Findings derived from this research indicate that developing an understanding of how patients express psychosocial needs in practice, through a consideration of Maslow’s (1943) hierarchy of needs, may increase recognition and support of psychosocial needs and enable nurses to respond more comprehensively.
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Blom, Hanna, and Hultberg Alice Koobs. "Sjuksköterskors upplevelser av att ge palliativ vård till patienter i särskilt boende och hospice : En litteraturstudie." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-38840.
Full textAbstract:
Den palliativa vården är en helhetsvård där sjuksköterskor ska arbeta utifrån ett förhållningssätt baserat på de fyra hörnstenarna och de sex S:n. Det blir allt vanligare att vårdas den sista tiden i livet inom slutenvården utanför sjukhuset. Syftet var att belysa sjuksköterskors upplevelser av palliativ vård i särskilt boende och hospice. Studien genomfördes som en litteraturstudie som baserades på åtta kvalitativa vetenskapliga artiklar. I resultatet framkom tre huvudkategorier: känslomässiga upplevelser som innefattade sjuksköterskors emotionella påverkan av att vårda patienter i livets slutskede. Den andra huvudkategorin relationer avsåg samspelet mellan patienter, närstående och sjuksköterskor. Den tredje huvudkategorin arbetets olika utmaningar inkluderade underkategorierna sjuksköterskors kompetens inom palliativ vård, upplevelse av tidsbrist avseende tidens betydelse i vårdandet av patienter i livets slutskede. Kommunikation mellan professionerna som innefattade kommunikationen mellan sjuksköterskor och läkare samt teamarbete mellan sjuksköterskor, läkare, undersköterskor och övrig vårdpersonal. Att vårda patienter i livets slutskede i särskilt boende eller på hospice gjorde att uttryckte känsla av otillräcklighet. Sjuksköterskor arbetade under ständig tidspress där otillräckligheten var ett faktum vilket påverkade den palliativa vården negativt. Samarbete och kommunikation mellan sjuksköterskor, patient, närstående och övrig vårdpersonal var viktiga faktorer för god omvårdnad. Sjuksköterskors arbetsbelastning, arbetet under ständig tidspress och teamarbetet mellan vårdpersonal i särskilt boende och hospice bör belysas ytterligare genom vidare forskning för att utveckla nationella och lokala riktlinjer för palliativ vård i livets slutskede.The palliative care is an overall care. The nurses’ must have an approach based on personal centred care. The care today is based in greater occurrence outside hospital services. It’s more common to die outside hospital services. The purpose was to illustrate nurses’ experiences of palliative care in nursing home and hospice. The study was conducted as a literature study based on eight qualitative scientific articles. The result showed three main categories: emotional experiences which included nurses’ emotional affects in caring of dying patients. The second main category relationships, intended the interplay between patients, relatives and nurses. The third main category different challenges of the work with associated subcategories: nurses’ competence in palliative care, experience of lack of time intended the valuable of time in caring of patients in the end of life. Communication between professions which included communication between nurses and physicians and teamwork between nurses, physicians, nurse assistants and other health care professionals. To care for patients in final stage of life in nursing home or hospice was emotional challenging. Nurses who constantly worked under time pressure experienced inadequacy which affected the palliative care negative. Corporation and communication between nurses, patients, relatives and other health care professionals were important parts for good nursing care. Nurses’ workload, work under constant time pressure and team work between healthcare professionals in nursing home and hospice should be illustrate through further research to develop national and local guidelines for palliative care in the end of life.
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Davis, Justin. "Examining Disparities Related to the Use of Hospice Care: Cancer vs. Non-cancer Diagnoses." Digital Archive @ GSU, 2012. http://digitalarchive.gsu.edu/iph_theses/228.
Full textAbstract:
Americans often face end-of-life with ineffective pain/symptom control. While hospice care prevents suffering for the terminally ill, only around 40% of individuals access services. Although few studies describe differences in terms of cancer vs. non- cancer diagnoses, hospice utilization/access disparities appear to exist. Analyzing 14 sociodemographic and clinical variables for 3,905 hospice discharge cases, this study highlights observed disproportions between cancer and non-cancer groups, identifying significant relationships amongst patient characteristics and hospice diagnosis. Factors found significantly related to diagnosis include components of the following: age, primary payment source, mortality status at discharge, hospice initiation location, length of stay, physical function, cognitive function, and presence of pain symptoms. Results confirm low overall hospice utilization rates, while validating diagnosis-specific differences driven by individual and population-based characteristics. In order to increase utilization/access rates and eliminate current disparities, patients presenting with certain terminal diseases may require greater provider flexibility in terms of hospice eligibility requirements.
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Romero, Celena. "Impact of Palliative Care on Patients with Severe Chronic Obstructive Pulmonary Disease." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5650.
Full textAbstract:
Chronic obstructive pulmonary disease (COPD) requiring long-term oxygen therapy (LTOT) is an incurable lung disease often complicated by other comorbidities. Research is limited for hospitalized COPD exacerbations with LTOT and palliative care services. The purpose of this quantitative research study was to determine the correlation between palliative care interventions and COPD patient outcomes specific to an intensive care unit (ICU) stay, invasive mechanical ventilator support, physician orders for cardiopulmonary resuscitation (CPR) code status, and hospital discharge to hospice care. The theoretical base for this study was Donabedian's quality improvement theory. The quasi-experimental, nonequivalent groups design divided COPD hospitalized patient sample into 2 groups, those with and those without palliative care, for comparison. An independent-samples t test, one-way MANOVA, and follow-up univariate ANOVAS was done to compare the means of ICU days and ventilator days; a cross tabulation, chi-square test of independence, and Fisher exact test was done to compare code status and place of hospital discharge. The mean number of the ICU days and ventilator days for palliative care patients was significantly higher than patients who did not receive palliative care. A significant interaction was found for palliative care and code status change from CPR to no CPR; however, data relating to palliative care and hospital discharge to hospice was insignificant. In conclusion, palliative care does not reduce costs by limiting the number of days spent in an ICU or the number of days on invasive mechanical ventilation; although, it may have an important role in the code status order change from CPR to no CPR to align with the patient's end of life care preference.
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Whitsitt, Sharla Gae Groene Robert William. "Music as a mood state inducer for hospice/palliative care patients and its effect on perceived pain." Diss., UMK access, 2006.
Find full textAbstract:
Thesis (M.M. Ed.)--Conservatory of Music. University of Missouri--Kansas City, 2006."A thesis in music education." Typescript. Advisor: Robert Groene. Vita. Title from "catalog record" of the print edition Description based on contents viewed Nov. 9, 2007. Includes bibliographical references (leaves 91-102). Online version of the print edition.
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Rice, Lori G. "A NEW RESOURCE FOR HEALTH CARE PROVIDERS MAKING END-OF LIFE DECISIONS: DEVELOPING AND EVALUATING A HOSPICE/PALLIATIVE CARE WEB SITE." Thesis, The University of Arizona, 2003. http://hdl.handle.net/10150/610615.
Full textAbstract:
The purpose of this project was to develop a Hospice/Palliative care website for
use by health care providers who are responsible for end of life decisions in an acute care
facility. Up to 60% of deaths in the United States occur in acute care hospitals; of these
deaths, 75% to 80% occur after decisions to forego treatments. In a survey of nurses and
physicians, 55% believed that patients are sometimes overburdened by the treatments
given, and more than half believed that mechanical ventilators, cardiopulmonary
resuscitation, and dialysis were often used inappropriately (Synder & Quill, 2001).
Physicians are often ill prepared to assist patient and families with end-of-life,
especially regarding hospice care. A web site regarding hospice/palliative care was
considered an ideal venue to address the need for easily accessible, accurate information
for physicians making end of life decisions.
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Aghajan, ghazi Alice Lejla, and Elin Nilsson. "Palliativ vård på ett hospice i ett utvecklingsland – en observationsstudie." Thesis, Luleå tekniska universitet, Institutionen för hälsovetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-69037.
Full textAbstract:
Background: The aim of palliative care is to keep the quality of life by integrating a person-centered care at the end of life. Palliative care and hospice care do not focus only on symptoms and medication. Self-esteem, dignity and support were major components for the patient at the end of life. Aim: The aim of this study was to describe how palliative care is given at a hospice in a developing country. Method: The used method was a qualitative participant observation study. The participants were health care staff at a hospice, they were chosen before the study began. The observation took place three times per week for six weeks. The researcher intertwined volunteering and observing at the same time. The data was analyzed with a qualitative content analysis. Result: The study resulted in six categories: environment, nursing records, nursing care, infection control and meals. Conclusion: The conclusion was that nature and safety had a big impact on the environment. The health care staff worked as a team to fulfill their goals.Bakgrund: Syftet med palliativ vård är att hålla välbefinnandet genom att integrera en personcentrerad vård i livets slutskede. Palliativ vård och hospicevård fokuserar inte bara på symptom och medicinering. Självkänsla, värdighet och stöd är viktiga komponenter för patienten i livets slutskede. Syfte: Syftet med denna studie var att beskriva hur palliativ vård ges på ett hospice i ett utvecklingsland. Metod: Den använda metoden var en kvalitativ deltagande observationsstudie. Deltagarna var vårdpersonal på ett hospice, de valdes innan studien började. Observationen ägde rum tre gånger per vecka i sex veckor. Forskarna sammanflätade volontärarbetet och observationen samtidigt. Uppgifterna analyserades med en kvalitativ innehållsanalys. Resultat: Studien resulterade i sex kategorier: miljö, omvårdnads register, omvårdnad, infektionskontroll och måltider. Slutsats: Slutsatsen var att natur och säkerhet hade stor inverkan på miljön. Vårdpersonalen arbetade som ett team för att uppfylla sina mål.
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Ahmed, Aabid Abdulmajid. "The Impact of Palliative Care on Health Status in HIV-Positive Children." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3271.
Full textAbstract:
HIV-positive children in sub-Saharan Africa have numerous challenges to overcome. These challenges increase psychosocial stress as well as symptom burden including fatigue, weight loss, pain, and mental changes. The symptoms may persist even after initiation of antiretroviral therapy, so such children need additional care. Palliative care lays emphasis on holistic patient-centered care, including physical, psychological, social, and spiritual symptoms, alongside antiretroviral therapy. There is limited data on the impact of integrating palliative care with standard HIV care and treatment in children. The purpose of this study was to fill the gap in the literature by investigating the impact of palliative care on health status in HIV-positive children on antiretroviral therapy. The theoretical framework was based on the humanistic nursing theory. Using the Mann Whitney U and logistic regression tests, the health-related quality of life of 97 children who received palliative care in addition to standard HIV care was compared to 180 HIV-positive children who received standard HIV care only through chart reviews. According to study results, children receiving palliative care alongside antiretroviral therapy have better physical and psychosocial health compared to children receiving only antiretroviral therapy. Increasing age was a contributing factor to better psychosocial and physical health in patients receiving palliative care. Emotional, social, and school functioning are important factors that determine treatment outcomes in children on antiretroviral therapy, and addressing those factors through palliative care will create a positive social change by improving treatment outcomes, quality of life, and longevity.
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Ballen-Sanchez, Maria. "Spiritual care interventions to improve the quality of life in patients with advanced cancer receiving palliative care." Honors in the Major Thesis, University of Central Florida, 2012. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/658.
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Title: Spiritual Care Interventions and Quality of Life in Cancer Patients Receiving Palliative Care Background: Despite the evidence supporting spiritual care in nursing and an increased quality of life among patients, patients feel that their spiritual needs are not being supported by medical professionals. Nurses agree that the role they play is significant in addressing the needs of cancer patients; however, they feel that they lack the knowledge for addressing spirituality concerns at the end of life. The purpose of this study is to identify spiritual care interventions that nurses can implement to improve quality of life (QOL) in patients with advanced cancer receiving palliative care. Method: This literature review consisted of articles retrieved from several databases, including CINAHL, PubMED, and PsychINFO, PsychARTICLES, ATLA Religion databases using the key words "cancer'" and "quality of life" "therapeutic communication", "spirit' therapy", "relaxation therapy", and "self-care". Inclusion criteria consisted of research conducted after the year 2000, peer reviewed work and research studies written in the English language. Results: Results from this literature review include recommended nursing interventions that provide spiritual care to patients with advanced cancer receiving palliative care for the purpose of improved quality of life. Spiritual care interventions identified in this study include Meaning Centered Group Psychotherapy (MCGP), Supportive Group Psychotherapy (SGP), mental relaxation, mental images, TM, art therapy, socializing, communicative acts, aromatherapy, massage, exercise, hatha yoga, meditation, and activities such as gardening, watching TV, resting/sleeping and socializing.B.S.N.
Bachelors
Nursing
Nursing
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Corker, Deborah Jo. "PHYSICIAN'S EXPERIENCES WITH DEATH AND DYING: A PHENOMENOLOGICAL STUDY." OpenSIUC, 2010. https://opensiuc.lib.siu.edu/dissertations/212.
Full textAbstract:
This qualitative phenomenological study attempts to gain the physician's essences, meanings and understanding surrounding death and dying. Starting with themes revealed in literature, in-depth interviews were used to ask selected physicians providing care: How does death affect them? Are physicians receiving adequate training in end-of-life care? Does the medical culture still see death as failure? How do they find meaning in end-of-life care? Using three different groups of physicians: early in career, mid-career, and retired, this research attempted to examine the phenomena of death and dying over apparent time and developmental experiences of physicians. Results: Physicians have not been adequately trained to handle end-of-life care. Communications skills, specific end-of-life care training and support for physicians dealing with death and dying are needed.
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Drangel-Wulcan, Anna-Karin. "Sjuksköterskors erfarenheter av att tillsammans med närstående ge omsorg till den döda kroppen inom hospice : En intervjustudie." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-6688.
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Background: In the hospice care specialized palliative care is practiced on patients that are at the end of their lives, and nurses meet grieving relatives on a daily basis, both after and before the event of death. When the patient is deceased the relatives are offered to be present in the room while the nurses provide care for the deceased individual. It’s not as well-known if the relatives are offered to help the nurses care for the dead body. Aim: The purpose of the study is to investigate whether nurses’ have experiences of caring for the dead body together with the relatives. Method: A qualitative method has been used with semi-structured telephone interviews. The material has been analyzed with a qualitative content analysis according to Granheim and Lundman (2004). Eight nurses in the hospice care, in the middle and south of Sweden, have been interviewed. From these eight nurses, five have experiences of providing care for the dead body together with the relatives. Results: The analysis resulted in a main theme, participation in the light, with three subthemes, mutual caring which is beneficial both for nurses and relatives, professional approach which is based on experience and knowledge, as well as collegial learning. Nurses that have the experience of caring for the dead body with the relatives, are seen to have a readiness for action and to provide the care in a respectful fashion. Central for nurses are their interest in participating and to offer others to join in. Discussions: The discussion is based on Andershed’s (1998) theoretical frame of understanding, with the metaphor participation in the light, as well as current research. In the discussion the concepts to know, to be, to do are used. The nurses in the study are contented to provide the care for the dead body together with the relatives. They feel gratification with the relatives’ participation, as they share the experience with them. It provides closure.
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Bergendal, Adam. "Architecture as medicine : Rethinking care for the terminally ill." Thesis, KTH, Arkitektur, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-163431.
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Societies have an ethical responsibility to provide the dying with the highest possible quality of care. Yet, terminal patients are sometimes lost in a healthcare system that emphasizes procedure over the individual. This project envisions a new approach - a restructuring of the current system. A shared facility that combines rehabilitation and home care with end of life care, promoting flexible treatment to be tailored to each patient according to their individual needs.Vårt samhälle har ett etiskt ansvar att tillhandahålla döende med högsta möjliga vårdkvalitet. Trots det åsidosätts ibland döende patienter i ett sjukvårdssystem som betonar metod över individen. Detta projekt föreslår en ny strategi - en omstrukturering av det nuvarande systemet. Istället för uppdelade vårdstrukturer föreslås en sammansatt vårdanläggning som kombinerar rehabilitering och avancerad hemsjukvård med sluten palliativ vård, som främjar flexibel behandling och som skräddarsys för varje patient utifrån dess individuella behov.
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Poore, Miranda. "An investigation of attachment orientation, compassion fatigue, compassion satisfaction and resilience in hospice and palliative care nursing staff." Thesis, University of Southampton, 2016. https://eprints.soton.ac.uk/400977/.
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Firstly, the literature exploring associations between attachment orientation, burnout, compassion fatigue and compassion satisfaction in employees was reviewed. This added to a previous review by exploring compassion satisfaction and investigating potential mechanisms to account for any associations between these constructs. Twenty-six empirical studies were identified. Collectively, the reviewed articles suggested that secure attachment style offers protection from burnout and that attachment anxiety is associated with higher levels of burnout and compassion fatigue amongst employees. Results relating to attachment avoidance are less clear and a limited number of studies make it difficult to draw conclusions in relation to compassion satisfaction. In reviewing the proposed mechanisms for associations between the constructs under review, commonalities were identified, including internalised representations of self and others that predispose towards maladaptive coping responses and difficulties with affect regulation. Limitations of the reviewed studies include an array of different measures of attachment and burnout, restricting opportunity for comparisons between studies, cross-sectional designs and lack of clarity around the concepts being measured. The empirical paper investigated associations between attachment orientation, compassion fatigue (comprising burnout and secondary trauma), compassion satisfaction and resilience in a sample of 64 hospice and palliative care nursing staff. It was predicted that attachment anxiety would be significantly and positively associated with both sub-components of compassion fatigue and negatively related to compassion satisfaction, and that attachment avoidance would be positively associated with burnout and negatively related to compassion satisfaction. The present study sought to explore associations between attachment avoidance and secondary trauma as the current evidence base is inconclusive in this regard. Hypotheses were supported, with the exception of associations between attachment anxiety and compassion satisfaction, which were not significant. It was also hypothesised that resilience would mediate relationships between attachment orientation and burnout, secondary trauma and compassion satisfaction: this hypothesis was not supported. A novel, implicit measure of attachment orientation was administered but failed to significantly correlate with any of the predictor or criterion variables. Suggestions for how this measure may be used in future research are offered. Burnout, secondary trauma, compassion satisfaction and resilience scores remained stable over time, highlighting the importance of establishing appropriate intervention programmes in order to support those experiencing compassion fatigue. Limitations, clinical implications and directions for further research are discussed.
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Matthews, Barbara. "The individual context, and met and unmet palliative care needs of stage III and IV HIV/AIDS isiXhosa speaking patients in the Grahamstown hospice service." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11193.
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Includes bibliographical references (leaves 87-102).Palliative care developed as a response to the specific needs experienced by terminally ill cancer patients and their families. The modern palliative care movement began in London in 1967 and African palliative care developed against this backdrop. The HIV pandemic has confronted African palliative care workers with new challenges to provide accessible, affordable, culturally sensitive care in resource limited settings. The domains of palliative care are well recognised and the provision of holistic patient centered care requires that the individual context of each person requiring palliative care is considered as these influenced the experience of life-threatening illness. The HIV burden in South Africa is complicated by other health care issues, poverty, and the implications of a multi-cultural, multi-racial society which add to the complexities of palliative care service provision. This study considered the individual context and palliative care needs of a group of HIV positive patients who access palliative care from Grahamstown Hospice.
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Schaepe, Christiane. "And here we are allowed to do it - An ethnographic field study about the role of the palliative care nurses in Uganda." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24457.
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Palliativ vård – vård i livets slutskede – är inte prioriterat i tredje världen. I Uganda grundades 1993 Hospice Africa Uganda (HAU), ett hospice som var tänkt som modell för andra afrikanska länder. Här utbildas bl a sjuksköterskor som har rätt att skriva ut morfin och andra läkemedel efter en nio månader lång kurs. I den här etnografiska fältstudien används observationer, intervjuer och gruppintervjuer för att undersöka sjuksköterskan roll inom palliativ vård i Uganda. I studien deltar sammanlagt 20 sjuksköterskor som jobbar på HAU, Mulago hospital och studenter i palliativ vård-kursen på HAU. Resultatet visar att sjuksköterskanS roll är mångfacetterad. Utöver förskrivning av läkemedel är deras roll att utföra vården holistisk, där de tar hänsyn till fysisk, psykosocial och andlig smärta. I sitt arbete möter de många utmaningar men de har även möjlighet att förbättra patientens livskvalitet.Palliative care – end of life care – is not a priority in developing countries. In 1993 Hospice Africa Uganda (HAU) was founded and chosen as a model for other african counties. Among other things nurses are authorised to prescribe morphine and other palliative care drugs after undergoing a nine months clinical palliative care course at HAU. In this ethnographic field study observations, interviews and group interviews are used in order to explore the role of the palliative care nurse specialist in Uganda. In total there are 20 participants involved in this study, who are working at HAU, Mulago hospital and students from the clinical palliative care course. The result of the study reveal that the role of the palliative care nurse specialist is multifaceted. Beyond prescribing drugs their role is to deliver holistic care by taking into consideration the physical, psychosocial and spiritual pain patients and their family can have. They encounter many challenges in their work but they also have the possibility to improve the quality of the patients life.
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Gustavsson, Camilla, and Catharina Nilsson. "Omvårdnadsbehov och omvårdnadsåtgärder vid hjärtsvikt i palliativt skede." Thesis, Karlstads universitet, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-47596.
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Bakgrund: Hjärtsvikt är en allvarlig sjukdom med hög mortalitet och förr eller senare uppstår behov av palliativ vård. Syftet med studien var att beskriva omvårdnadsbehov samt omvårdnadsåtgärder vid hjärtsvikt i palliativt skede. Metod: Den metod som användes var systematisk litteraturstudie. Nio artiklar inkluderades. De granskades och huvudkategorier med underkategorier bildades. Resultat: De sex kategorier som framkom var; Brister i kommunikation, information och stöd; Existentiella; Dyspné; Fatigue och depression; Ångest och Minskad rörelseförmåga. Patienternas behov var symtomlindring, god omvårdnad och bättre kommunikation vid vård i livets slutskede. Konklusion: Distriktsköterskan fungerade som en länk åt patienten. Samarbete med andra professioner var önskvärt. Kunskap, information, symtomlindring och god vård spelade en viktig roll i omvårdnaden av patienter med hjärtsvikt. De resultat som framkom ger en vägvisning om vilka faktorer som spelar roll för omvårdnaden av patienter med hjärtsvikt i palliativt skede.Background: Heart failure is a serious illness with high mortality and sooner or later arises the need for palliative care. The aim of this study was to describe the care needs and care measurses for patients with heart failure in a palliative stage. Method: the method used was a systematic literature study. Nine articles were included. They were reviewed then categories and subcathegories was formed. Results: The six categories that emerged were deficits in communication, information and support; Existential; Dyspnea; Fatigue and Depression; Anxiety and Reduced mobility. Patients’ needs where symptom relief, good care and better communication at the end of life. Conclusion: The districtnurse acts as a link to the patient. Cooperation with other professions is desirable. Knowledge, information, symptom relief and good care play an important role in the care of patients with heart failure. The result that emerged gives a guidance on which factors play an important role in care of patients with heart failure in the palliative phase.
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Tsikai, Franciscah Ndayiziveyi. "A study to explore factors that influence family caregivers of patients receiving palliative care from Island Hospice to seek help at emergency unit in Harare, Zimbabwe." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27072.
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Background: This study investigated the factors that influence family caregivers of patients receiving palliative care from Island Hospice to seek help at emergency unit. The study was conducted at Island Hospice Service in Harare, Zimbabwe where Palliative care has been practiced in Zimbabwe since 1979 mainly using the home-based care model where patients are cared for by family caregivers with the support of the palliative care teams. Aim:To explore and understand issues that influence family caregivers at Island Hospice to seek help at emergency units for patients who are terminally ill. Method: This was a phenomenological study using semi-structured qualitative interviews with fifteen adult family caregivers who were the main carers of Island Hospice patients who presented at the emergency unit during the January to September 2015 period. Data were collected in Shona language using semi structured digitally recorded interviews. Data analysis through identifying themes that emerged from the transcripts. Results: Family caregivers reported the need for availability of palliative care medicine and other resources in the home setting. The family caregivers reported the need to be given information regarding the patient's diagnosis and prognosis as that would prepare them emotionally. They described challenges as pressure from relatives, witchcraft issues as well as lack of practical skills in providing care. Conclusion Considering the lack of resources and support the respondents do not support the idea of home deaths, they would rather send patients to the emergency rooms. A more organized end of life care and support for family caregivers and patients could be instituted by the hospice organization.
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Higgins, Philip C. "Is the Waiting the Hardest Part?: How Cancer Family Caregivers Experience Quality of Care at the End of Life." Thesis, Boston College, 2013. http://hdl.handle.net/2345/bc-ir:103541.
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Thesis advisor: Kathleen McInnis-DittrichCancer caregivers are key stakeholders across the cancer trajectory, particularly in the final weeks of life and the bereavement period that follows. Current measures are limited in capturing caregiver assessment of the quality of end-of-life (EOL) care. Because none include caregiver perception of patient suffering or prolongation of death, the author sought to develop and validate a new measure of caregiver-perceived quality of EOL care that includes these dimensions. Data for this study comes from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N=275 dyads). CwC investigators interviewed cancer patients and caregivers prior to the patient's death, and then caregivers again following the patient's death, on a range of psychosocial issues related to EOL care and bereavement. The present study represents a refinement of the author's previous work in developing and validating the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale, a comprehensive measure of caregiver-perceived quality of EOL care. Factor analysis revealed four distinct factors: Prolongation of Death, Perceived Suffering, Shared Decision-Making, and Preparation for the Death. Each item loaded strongly on only a single factor. The author examined the new measure's factor structure, and evaluated its reliability (using Cronbach's α) and convergent validity (via associations between CEQUEL and key EOL outcomes). CEQUEL and its subscales showed moderate to acceptable Cronbach's α (range: 0.52-0.78). Higher scores (indicating better perceived quality of care) were positively associated with therapeutic alliance (ρ=.13; p≤.05) and hospice enrollment (z=-2.09; ≤;.05), and negatively associated with bereaved caregiver regret (ρ=-.36, p≤.001) and a diagnosis of Posttraumatic Stress Disorder (z=-2.06; p≤.05). Scores did not vary by caregiver characteristics other than religious affiliation, with Catholics scoring lower than non-Catholics, and those without religious affiliation scoring lower than those with an affiliation. Models predicting CEQUEL scores were compared using multiple regression analysis and AICc values. In unadjusted analyses, dying in a hospital, inpatient hospice length of stay (LOS) < 1 week, patients feeling seen as a whole person by their physician, and caregiver religiosity predicted CEQUEL scores. Only dying in a hospital (B=-1.65, SE=0.42, p=0.000) and inpatient hospice LOS < 1 week (B=-1.87, SE=-.69, p=0.008) remained significant in adjusted analysis. These findings suggest that CEQUEL is a brief, valid measure of quality of EOL care from the caregiver's perspective. This study also identifies key factors that can be modified to improve caregiver evaluation of quality of care and associated bereavement outcomes. CEQUEL is the first scale of its kind to include perceived suffering and prolongation of death. If validated in future work, it may prove a useful quality indicator for the delivery of EOL care and a risk indicator for poor bereavement adjustment. Implications for research, clinical practice and policy are discussed
Thesis (PhD) — Boston College, 2013
Submitted to: Boston College. Graduate School of Social Work
Discipline: Social Work
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Wu, Shu-Mei, and 吳淑美. "On Autonomy of Hospice Palliative Care." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/05297291103861230146.
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碩士國立中正大學
法律學研究所
99
Abstract The primordial purpose of medical treatment is to cure and help patients stay healthy again. However, medical treatment is not a panacea. Patients should have the right to access Hospice Palliative Care to relief their sufferings if their diseases cannot be cured. Hospice Palliative Care also improves the qualities of life, offers dignity within medical treatment procedures, and renders dignity during dying process to patients regardless in psychology and in body. Hospice Palliative Care also facilitates dependents to accept the dying patients and pass the lamentation smoothly, too. Deviating from the traditional physician-oriented treatment model, the decision-making right of patients themselves is turning into the core of modern medical treatment procedures both in regular disease treatments and in last phase disease treatments. To implement the willingness and decision-making right of last phase patients, Hospice Palliative Care Act had been stipulated in Taiwan. The Act provides all the citizens with the rights in advance to sign Hospice Palliative Care Act and retain their agents, so incurable patients can express the willingness to give up the treatments of cardiopulmonary resuscitation prior to dying. The Act also stipulates the sequences of agents and the methods to express not to implement cardiopulmonary resuscitation if the status of patients is in unconsciousness or inexpressiveness. In addition, the Act regulates the elements to terminate or revoke cardiopulmonary resuscitation while executing cardiopulmonary resuscitation to those patients who sign Hospice Palliative Care Act. During last phase medical treatment stage, Patients usually confront the intervention of dependents in choosing medical procedures within our society. Patients themselves are even excluded the rights to be informed the disease conditions and to accept proper medical procedures. To avoid medical lawsuit, physicians transfer the duty to explain the situation of patients from the patients themselves to the dependents. Therefore, the decision-making rights to accept Hospice Palliative Care for the last phase patients are to be suppressed. In a worse situation, physicians provide first aids to those patients without the willingness to accept cardiopulmonary resuscitation, coercing the patients to take medical measures unnecessary. Through the lawsuits filed in the courts, such as civil, criminal, and administrative, we understand that the lawsuits can be reduced if the patients give their voice about accepting Hospice Palliative Care to physicians and dependents in advance. Educating physicians and public to respect the decision-making rights of patients themselves who accept Hospice Palliative Care and infusing the details about Hospice Palliative Care into the system of social insurance, life education, and tax system. Then, our society will achieve the realm without regret for both the patients and their dependents.
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Chiou, Jenf-Fong, and 邱仲峰. "Evaluation of Quality of Care in Hospice Palliative Care Units: A Comparison to Non-Hospice Palliative Cancer Patients Care Units." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/73269133273646499443.
Full textAbstract:
碩士台北醫學院
醫學研究所
89
Since 1982 year, cancer was the first cause of death in Taiwan. The Hospice Palliative Care, which was originated from England, is a better medical care for terminal cancer patients. To define the quality of Hospice Palliative Care it is necessary to have an excellent evaluation tool, and further to use these evaluations in practice to improve the quality of the Hospice Palliative Care. The purpose of this study was to use the Palliative Care Outcome Scale(The POS), which published by Higginson et al in 1999, as quality indicator for Hospice Palliative Care units and Non-Hospice Palliative Care units in Taiwan. The POS has been translated and developed as a Chinese version. An attempt to modify the Chinese version of POS to become a scale for more proper to clinical use in Taiwan. Hopefully, to create a new and proper scale for native people. The Chinese Palliative Care Outcome Scale through a serial of rigorous tests for its reliability and validity. Content validity presented by professional validity, there were ten questions in the questionnaire, and every question’s CVI (Content Validity Index) must be over 0.86. Criterion-related validity showed Spearman rank correlation very well (0.59-0.68). Pearson Correlation Coefficients showed the stability P value<0.0v5. The internal consistency of questionnaire, Coefficients of Cronbach’s a value for patient and medical care staff group were 0.73 and 0.74. Inter-rater reliability for evaluators were 0.97, 0.88, 0.81 and P value <0.05. The investigation period of this study was from August to December in 2000. There are two investigated groups, one is Hospice Palliative Care Group that Mackay Memorial Hospital, Cardinal Tien Hospital, and Taoyuan Hospital were included, total has 75 patients. The other group was Non-Hospice Palliative Care, total has 90 patients from Mackay Memorial Hospital, Tasyuan Hospital and Taipei Medical University Hospital. The visiting and scaling for study have been done for patient and primary medical care staff at the same time. The descriptive analysis for patients (18 property variables) and hospital (7 property variables) were analyzed as cofactor that affected the quality of Hospice Palliative Care. The result of study showed that the patient property variables for metastatic organ and case admitted source, and the hospital property variables for hospital differentiation, total hospice beds, physician and nurse man powers had effected on the quality of the Hospice Palliative Care. If we did the multiple regression of these six variables, the result presented that the hospital differentiation has significant difference for P value =0.0117. The Hospice Palliative Care units has better quality of care which compare to the Non-Hospice Palliative Care units, no matter it was patient or medical staff group. There all has significant difference on the quality outcome between patient and medical staff of Hospice Palliative Care units and Non- Hospice Palliative Care units. Furthermore, the medical staff group showed better quality outcome than patients group. In the Non-Hospice Palliative Care Hospital, which had the concept of Hospice Palliative Care, had the best quality evaluation outcome. The Chinese Palliative Care Outcome Scale is a reliable and useful tool for quality evaluation. It is worth to promote to the Hospice Palliative Care relative hospitals as a quality indicator. In order to create an excellent outcome scale and an questionnaire suitable for our own society, according to this study results to modify and change the contents to be a new and better Chinese Palliative Care Outcome Scale.