Transforming End-of-Life Care by Implementing a Patient-Centered Care Model

2018 ◽  
pp. 1
Author(s):  
Raffaella Dobrina ◽  
Maja Tenze ◽  
Alvisa Palese
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Patient Centered Care ◽  
Life Care ◽  
Care Model ◽  
Patient Centered ◽  
Centered Care

The spiritual strength story in end-of-life care: Two case studies

2011 ◽  
Vol 9 (4) ◽  
pp. 419-424 ◽  
Author(s):  
Robert G. Mundle
Keyword(s):  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Patient Centered Care ◽  
Life Care ◽  
Patient Centered ◽  
Centered Care

AbstractIn this article I analyze two brief case studies to propose that a “spiritual strength story” has five defining characteristics: (1) it is brief; (2) it is ontological; (3) it uses symbols and metaphors; (4) it is a “big story” or meta-narrative with a positive spiritual and/or religious focus that informs other narrative data; and (5) most conspicuously of all, it repeats. Cultivating awareness of the “spiritual strength” narrative type can help to improve the quality of inter-professional patient-centered care teamwork and understanding, especially in regard to the reflexive, embodied, and relational aspects of palliative and end-of-life care.

Hospice Patient Care Goals and Medical Students’ Perceptions: Evidence of a Generation Gap?

2020 ◽  
Vol 38 (2) ◽  
pp. 114-122
Author(s):  
Kathryn Levy ◽  
Pei C. Grant ◽  
Christopher W. Kerr ◽  
David J. Byrwa ◽  
Rachel M. Depner
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Patient Care ◽  
End Of Life ◽  
End Of Life Care ◽  
First Year ◽  
Life Care ◽  
Patient Centered ◽  
Hospice Patients ◽  
Centered Care

Background: The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates discrepancies between patients and physicians. Objective: The aim of this study is to compare end-of-life care goals of hospice patients and medical student perceptions of patient care goals. Design: Hospice patients and medical students were surveyed on their care goals and perceptions, respectively, using an 11-item survey of goals previously identified in palliative care literature. Medical student empathy was measured using the Interpersonal Reactivity Index. Settings/Participants: Eighty hospice patients and 176 medical students (97 first-year and 79 third-year) in a New York State medical school. Results: Medical students ranked 7 of the 11 care goals differently than hospice patients: not being a burden to family ( p < .001), time with family and friends ( p = .002), being at peace with God ( p < .001), dying at home ( p = .004), feeling that life was meaningful ( p < .001), living as long as possible ( p < .001), and resolving conflicts ( p < .001). Third-year students were less successful than first-year students in perceiving patient care goals of hospice patients. No significant differences in medical student empathy were found based on student year. Conclusions: Medical students, while empathetic, were generally unsuccessful in perceiving end-of-life care goals of hospice patients in the psychosocial and spiritual domains. Differences impeding the ability of medical students to understand these care goals may be generationally based. Increased age awareness and sensitivity may improve future end-of-life care discussions. Overall, there is a need to recognize the greater dimensionality of the dying in order to provide the most complete patient-centered care.

Fading Away in Plain Sight

2017 ◽  
Vol 23 (2) ◽  
pp. 121-123
Author(s):  
Shirley A. Lucier
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Life Care ◽  
Patient Relationship ◽  
Patient Centered ◽  
Centered Care ◽  
Family Choices ◽  
Heath Care

The failure of health care professionals and providers to recognize and discuss end-of-life care continues to resonate across our heath care continuum. The value of the patient–clinician interaction is paramount in advocating for and establishing effective communication and care.A meaningful nurse–patient relationship is a key component to facilitate discussion of patient and family choices in how care can be managed throughout the dying process. This article describes how, using Virginia Henderson’s nursing model of patient-centered care, a holistic and palliative approach to end-of-life care was successfully supported in the home.

Teaching Patient-Centered Care During the Silver Hour

2011 ◽  
Vol 16 (2) ◽  
Author(s):  
Marilyn Smith-Stoner
Keyword(s):  
Nursing Education ◽  
End Of Life ◽  
End Of Life Care ◽  
Ways Of Knowing ◽  
Patient Centered Care ◽  
Role Modeling ◽  
Life Transition ◽  
Patient Centered ◽  
Centered Care ◽  
Family Centered

Teaching students and clinicians about end-of-life care is an important part of healthcare. Utilizing the framework of the Silver Hour is one method of illustrating the urgent, intense comfort needs required by patients and families throughout the imminently dying process, wherever the patient may be receiving services. When death is imminent, it is extremely important to provide patient- and family-centered care as the waning moments of life transition to the first moments of death. A variety of instructional methods can be used can be used to teach students to provide multidimensional, patient-centered care at the end of life. The author begins by describing the basic concept of patient-centered care and by discussing the importance of teaching students about this level of care. Next she describes the concept of the Silver Hour, along with a discussion of how the Silver Hour relates to nursing education. She also notes the importance of both role modeling in providing patient-centered care and of drawing upon the five ways of knowing to strengthen the teaching of students about care during the Silver Hour.

The changing face of personhood at the end of life: The ring theory of personhood

2014 ◽  
Vol 13 (4) ◽  
pp. 1123-1129 ◽  
Author(s):  
Lalit Kumar Radha Krishna ◽  
Suat Yee Kwek
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ring Theory ◽  
Life Care ◽  
Central Theme ◽  
Patient Centered ◽  
Patient Reports ◽  
Common Position ◽  
Centered Care

AbstractObjective:The manner in which personhood or “what makes you who you are” is conceived is key to the provision of patient-centered care and maintenance of the dignity and quality of life of terminally ill patients. However, there is little agreement on how this pivotal concept ought to be defined. Some have argued in favor of an innate concept of personhood, while others see an individual as a reflection of their familial identity or their conscious function, and all share a common position that personhood is unchanging, and hinges upon the central theme of their respective concepts. The present paper aims to explore a more clinically influenced perspective of personhood.Method:We report the case of a 42-year-old Malay Singaporean who had been a caregiver for her husband throughout his cancer and then became a cancer patient herself after his passing. This case explores her changing and multifaceted conceptions of personhood throughout her life and illness, and discussions about end-of-life care.Results:The patient reports a concept of personhood that encompasses the innate, individual, relational, and societal aspects, which are interlinked and vary in terms of depth and conviction according to the various times in her life and illness.Significance of results:Our findings support the ring theory of personhood, which provides a clinically supported model of the conception of personhood that is context dependent and encompasses the four abovementioned aspects.

scholarly journals Last Place of Care and End-of-Life Quality of Life in the United States: Evidence From a National Representative Data Set

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Yifan Lou ◽  
Nan Jiang ◽  
Katherine Ornstein
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Life Care ◽  
Person Centered Care ◽  
Centered Care ◽  
The Relationship

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.

scholarly journals Benchmarking European Home Care Models for Older Persons on Societal Costs: The IBenC Study

2021 ◽  
Vol 14 ◽  
pp. 117863292110224
Author(s):  
Lisanne I van Lier ◽  
Henriëtte G van der Roest ◽  
Vjenka Garms-Homolová ◽  
Graziano Onder ◽  
Pálmi V Jónsson ◽  
...  
Keyword(s):  
Home Care ◽  
Patient Centered Care ◽  
Mean Difference ◽  
Care Model ◽  
Patient Centered ◽  
Societal Costs ◽  
Centered Care ◽  
Care Models ◽  
Prospective Longitudinal ◽  
Care Performance

This study aims to benchmark mean societal costs per client in different home care models and to describe characteristics of home care models with the lowest societal costs. In this prospective longitudinal study in 6 European countries, 6-month societal costs of resource utilization of 2060 older home care clients were estimated. Three care models were identified and compared based on level of patient-centered care (PCC), availability of specialized professionals (ASP) and level of monitoring of care performance (MCP). Differences in costs between care models were analyzed using linear regression while adjusting for case mix differences. Societal costs incurred in care model 2 (low ASP; high PCC & MCP) were significantly higher than in care model 1 (high ASP, PCC & MCP, mean difference €2230 (10%)) and in care model 3 (low ASP & PCC; high MCP, mean difference €2552 (12%)). Organizations within both models with the lowest societal costs, systematically monitor their care performance. However, organizations within one model arranged their care with a low focus on patient-centered care, and employed mainly generalist care professionals, while organizations in the other model arranged their care delivery with a strong focus on patient-centered care combined with a high availability of specialized care professionals.

Patient and Family Engagement in THE Conversation

2017 ◽  
pp. 93-113
Author(s):  
Jennifer Freytag ◽  
Richard L. Street Jr.
Keyword(s):  
Health Outcomes ◽  
End Of Life ◽  
End Of Life Care ◽  
Family Engagement ◽  
Future Research ◽  
Life Care ◽  
Patient Centered ◽  
Communication Framework ◽  
Communicative Functions ◽  
Main Ideas

This chapter uses a patient-centered communication framework to examine observational studies of patient and family engagement in communication about end-of-life care. It analyzes how the literature has connected communication with health outcomes in end-of-life care. Within this analysis, it brings together three main ideas. First, family plays an important and overlooked role in communication about end-of-life care. Second, the literature describes communication that serves multiple functions, and it describes the special challenges presented by end-of-life care communication. Finally, it links these communicative functions with health outcomes and outlines directions for future research.

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