Are Indian hospitals good places for the dying elderly?
Suhita Chopra Chatterjee, Jaydeep Sengupta in Death and Dying in India, 2017
Many Western countries have a range of care settings for people like Moni Dadu who suffer from chronic debilitating diseases like COPD, renal failure, liver disorder, advanced congestive heart failure and cancers of various types before they finally die. There are Long Term Care settings – nursing homes, care homes, assisted-living facilities, foster and day care homes, palliative centers, hospices and hospice services at home. Though still fragmented, governments are trying to work out a continuum of health care services, and most have developed end-of-life care policies and programs for seniors with the growing realization that the type of medical care that elderly patients receive at the end of life has to be different. It needs be supportive rather than invasive in nature and focused on symptom management control rather than aimed at extending life. An inability to acknowledge such differences often lead to disproportionate and unstandardized care – either overcare or undercare. In recent years, a growing appreciation of the specific medical care needs of the elderly have led to development of separate set of quality indicators/measures for those most likely to die or become severely disabled in the next two years, indicated by several factors like advanced age, functional decline, disability and self-rated poor health. In 2000, health researchers in America developed Assessing Care of Vulnerable Elderly (ACOVE) indicators that reflect the most comprehensive examination ever conducted of the quality of medical care provided to vulnerable older Americans.1
Research design, data, and key concepts
Tor Inge Romoren in Last Years of Long Lives, 2004
The research literature in gerontology is often based on varying and imperfect definitions of what constitutes a caregiver. This problem not only produces obscure results, but creates difficulty in comparing studies. Robyn Stone (1991) has shown how the term caregiver is defined according to different criteria in the research literature, namely: the type of care provided (e.g. nursing, practical help, emotional support, financial support);the extent (volume), frequency, and duration of the caregiving;the relationship of the caregiver to the recipient of the care (e.g. type of family relationship, friendship); andthe characteristics of the care recipient (e.g. age, level of functioning, illnesses).
Existing theories in cancer care
Carol L. Cox, Maya Zumstein-Shaha in A Theory of Cancer Care in Healthcare Settings, 2017
Orem referred to her conceptual model as the Self-Care Deficit Theory (Fawcett and Desanto-Madeya, 2013; Orem et al., 2003; Orem et al., 1995). Refer to Figure 3.1 in the Appendix in this chapter, which delineates Orem’s theory. The core concept is entitled self-care, which corresponds with “health-related activities performed by individuals on their own behalf to maintain life, health and well-being” (Desbiens et al., 2012: 2115). Orem proposed a classification of nursing situations that comprise seven groups, with the final group being that of life-limiting illness; the focus is on quality of life that is seriously affected, until it reaches the point where life can no longer continue. The focus then shifts to maintaining the person’s comfort at the end-of-life. Nursing is provided to patients with self-care deficits and to their families to help patients satisfy their self-care demands (Orem et al., 2003; Orem et al., 1995).
If we keep doing what we’re doing we’ll keep getting what we’re getting: A need to rethink “academic” medicine
Published in Medical Teacher, 2018
Michael Wilkes, Christine Cassel, Marc Klau
KP is not new in medical education; they currently train over 900 students from 50 affiliated university programs each in more than 30 specialties. However, these trainees are visitors from different schools, at KP for limited period and each responsible to their home institution thus making innovative education difficult. Discovery is also crucial to the KP mission with over $100 million in federal research funding, 1300 clinic trails, $39 million in KP funded health outcomes research, and a team of 140 full time researchers (Kaiser-Permanente 2017). In the clinical arena, the KP system functions like a mini national health system with a single source of funding, a global budget, and the ultimate accountability measured by the health of the population served. Rather than profiting from more aggressive care, KP benefits from the reverse – the healthier it can keeps patients the more advantages there are to both patients and the system. The specialists do not drive the enterprise, rather primary care and specialty care are equal partners that function as part of care teams. Care covers a continuum from home, provider offices, hospital, skilled nursing facilities (aka “nursing homes”), and hospice. Similarly, the focus is not only on disease but on illnesses meaning that emphasis is placed on primary and secondary prevention, diagnosis, treatment, chronic condition management and follow-up, supportive care, and palliative care. Patient-centered care is integrated over time with a long time horizon given a small voluntary disenrollment (<2% per annum).
The impact of early spasticity on the intensive functional rehabilitation phase and community reintegration following traumatic spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2020
Andréane Richard-Denis, Bich-Han Nguyen, Jean-Marc Mac-Thiong
The total inpatient rehabilitation LOS consisted in our main outcome variable. The discharge destination after intensive functional rehabilitation was categorized into: 1) discharge home; 2) transitional inpatient rehabilitation facility; 3) long-term nursing home and others (readmission to acute care hospital, or death). More precisely, in the province of Quebec, when an extended period of intensive functional rehabilitation is required and “specialized” training is completed (sphincter management, SCI education, etc.), individuals are sent to an affiliated transitional rehabilitation facility. This transitional rehabilitation facility can provide additional mobility and functional training, while being less expensive than the specialized intensive functional rehabilitation facility.22 This information was collected retrospectively using a review of the intensive functional rehabilitation clinical charts.
Zombies Wanted! Descriptions of Nurses in Psychiatric-Mental Health Care in Swedish Recruitment Advertisements
Published in Issues in Mental Health Nursing, 2021
Sebastian Gabrielsson, Johanna Salberg, Josefin Bäckström
The tasks most commonly described in the advertisements were unspecified patient-oriented tasks, including unspecified patient work, conventional RN duties without further specification, advisory work, assessments, and treatments. More than half of the advertisements specified medical tasks as central for nurses. Of these, the most common were handling medications, follow-up of medications, and medical assessments, along with technical medical tasks, such as drawing blood and performing medical treatments. We found that less than a third of the advertisements specified nursing tasks as a responsibility. Nursing tasks described were, for example, unspecified nursing, assessment of patients’ nursing needs, planning nursing, supportive counselling, and promoting and preserving health. Very few advertisements specified lead nursing as a nurse’s responsibility. Close to a quarter of the advertisements described administrative tasks like keeping a patient journal, while developmental tasks were rarely described. Some advertisements described tasks focussing on family members. A few advertisements specified psychotherapeutic tasks or supervisory tasks.
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