Social Science and Medicine, 65(11), December 2007, pp.2317-2327.
Publisher:
Elsevier
... concerned with dying in the community. It is argued that, whilst previous work has highlighted the burdens the redomestication of care places upon carers, home care philosophies and policies have led to over-romanticised notions of care which privilege the value of caring relationships without acknowledging the dynamic interaction of such social relationships with the actual work of caring. Moreover,
Drawing on end of life care as an illustrative case, this paper critically examines the provision of care in the home, identifying a number of inherent tensions. For 60 years the hospital has been the preferred site of care. However, the UK caring division of labour is currently undergoing a process of (re)domestication and the provision of home care is increasingly regarded as a ‘gold standard’ for the organisation of care, in institutional and domestic contexts. This paper argues that while ‘home care’ policies serve a range of professional and political agendas, they contain unacknowledged contradictions and strains, creating challenges for both family and professional carers. The realities of home care are examined through reconceptualising qualitative data generated from three research projects concerned with dying in the community. It is argued that, whilst previous work has highlighted the burdens the redomestication of care places upon carers, home care philosophies and policies have led to over-romanticised notions of care which privilege the value of caring relationships without acknowledging the dynamic interaction of such social relationships with the actual work of caring. Moreover, such policy trends have created a nexus of social expectations and obligations for which modern society is unprepared. With reference to both end of life care, and home care more widely, it is argued that health care planners and professionals need to think more critically about the way care is delivered. Home is not merely about a physical space, but the social and emotional relationships therein. Good ‘home care,’ characterised by attention to patient-centred needs and flexible in design and scope, does not have to be located within the private sphere; relationships may actually be maintained and nurtured by enabling people to have a realistic choice of care in an institution.
Subject terms:
home care, nursing, sociology, dying, end of life care;
This is the first in a two-part series on emotional labour, a trained and individualised response to help manage the emotions of patients. It reviews relevant literature to define and explore this concept in nursing, and considers examples of emotional labour and research. It discusses the concept in nursing in relation to stress and burnout.
This is the first in a two-part series on emotional labour, a trained and individualised response to help manage the emotions of patients. It reviews relevant literature to define and explore this concept in nursing, and considers examples of emotional labour and research. It discusses the concept in nursing in relation to stress and burnout.
The author analyses the clinical implications of the government's End of Life Care Strategy. The article includes discussion of care planning and the coordination of care and training in end-of-life care.
The author analyses the clinical implications of the government's End of Life Care Strategy. The article includes discussion of care planning and the coordination of care and training in end-of-life care.
Subject terms:
nursing, palliative care, policy, death, dying, end of life care;
Thanks to the End of Life Care Strategy dying people should receive better care. In this article the author outlines the current barriers nurses face in practice.
Thanks to the End of Life Care Strategy dying people should receive better care. In this article the author outlines the current barriers nurses face in practice.
Subject terms:
nurses, nursing, palliative care, death, dying, end of life care;
There is one thing we know that we all have in common; that one day we will die. For most of us, given a choice, we would prefer to remain at home. Aiming to strengthen the role, confidence, systems and skills of primary health care teams (PHCTs) for the delivery of palliative care and patient support, this is a comprehensive resource book to support and enable primary care professionals to make improvements in the care provided for their patients. This book provides a practical structure for improved services and is also a practical handbook for the Macmillan Gold Standards Framework. As well as Macmillan nurses, it should also be of interest to practice and district nurses, social workers and all others involved in terminal care in the community.
There is one thing we know that we all have in common; that one day we will die. For most of us, given a choice, we would prefer to remain at home. Aiming to strengthen the role, confidence, systems and skills of primary health care teams (PHCTs) for the delivery of palliative care and patient support, this is a comprehensive resource book to support and enable primary care professionals to make improvements in the care provided for their patients. This book provides a practical structure for improved services and is also a practical handbook for the Macmillan Gold Standards Framework. As well as Macmillan nurses, it should also be of interest to practice and district nurses, social workers and all others involved in terminal care in the community.
Subject terms:
home care, nursing, patients, palliative care, primary care, dying;
Journal of Clinical Nursing, 24(11-12), 2015, pp.1676-1685.
Publisher:
John Wiley and Sons
Aims and objectives: To explore and critically examine stakeholders' views and perceptions concerning the nurse-led Palliative Care Discharge Service in an acute hospital setting and to inform sustainability, service development and future service configuration.
Background: The drive in policy and practice is to enable individuals to achieve their preferred place of care during their last days of life. However, most people in UK die in acute hospital settings against their wishes. To facilitate individuals' preferred place of care, a large acute hospital in northeast England implemented a pilot project to establish a nurse-led Macmillan Palliative Care Discharge Facilitator Service.
Design: A pluralistic evaluation design using qualitative methods was used to seek stakeholders' views and perceptions of this service.
Methods: In total, 12 participants (five bereaved carers and seven health professionals) participated in the evaluation. Semi-structured interviews were conducted with bereaved carers who used this service for their relatives. A focus group and an individual interview were undertaken with health professionals who had used the service since its inception. Individual interviews were also conducted with the Discharge Facilitator and service manager. Analysis of all data was guided by Framework Analysis.
Results: Four key themes emerged relating to the role of the Discharge Facilitator Service: achieving preferred place of care; the Discharge Facilitator as the ‘conduit’ between hospital and community settings; delays in hospital discharge and stakeholders' perceptions of the way forward for the service.
Conclusion: The Discharge Facilitator Service acted as a reliable resource and support for facilitating the fast-tracking of end-of-life patients to their preferred place of care.
Relevance to clinical practice: Future planning for hospital-based palliative care discharge facilitating services need to consider incorporating strategies that include: increased profile of the service, expansion of service provision and the Discharge Facilitator's earlier involvement in the discharge process.
(Publisher abstract)
Aims and objectives: To explore and critically examine stakeholders' views and perceptions concerning the nurse-led Palliative Care Discharge Service in an acute hospital setting and to inform sustainability, service development and future service configuration.
Background: The drive in policy and practice is to enable individuals to achieve their preferred place of care during their last days of life. However, most people in UK die in acute hospital settings against their wishes. To facilitate individuals' preferred place of care, a large acute hospital in northeast England implemented a pilot project to establish a nurse-led Macmillan Palliative Care Discharge Facilitator Service.
Design: A pluralistic evaluation design using qualitative methods was used to seek stakeholders' views and perceptions of this service.
Methods: In total, 12 participants (five bereaved carers and seven health professionals) participated in the evaluation. Semi-structured interviews were conducted with bereaved carers who used this service for their relatives. A focus group and an individual interview were undertaken with health professionals who had used the service since its inception. Individual interviews were also conducted with the Discharge Facilitator and service manager. Analysis of all data was guided by Framework Analysis.
Results: Four key themes emerged relating to the role of the Discharge Facilitator Service: achieving preferred place of care; the Discharge Facilitator as the ‘conduit’ between hospital and community settings; delays in hospital discharge and stakeholders' perceptions of the way forward for the service.
Conclusion: The Discharge Facilitator Service acted as a reliable resource and support for facilitating the fast-tracking of end-of-life patients to their preferred place of care.
Relevance to clinical practice: Future planning for hospital-based palliative care discharge facilitating services need to consider incorporating strategies that include: increased profile of the service, expansion of service provision and the Discharge Facilitator's earlier involvement in the discharge process.
(Publisher abstract)
Subject terms:
palliative care, end of life care, dying, home care, nursing, nurses, hospitals, hospital discharge;
The Marie Curie Nursing Service (MCNS) provides home-based end of life care to around 28,000 people at the end of life in the UK each year. This report looks at the impact of the MCNS on place of death and hospital use at the end of life, and in particular at whether MCNS care allowed more people to die at home and reduced the use and costs of hospital care at the end of life. The evaluation used retrospective analysis and compared 29,538 people who received MCNS care and died between 2009 and 2011 and a matched control group of 29,538 people selected from the population of England who died in the same period. The report describes the study, including its methodology, and presents the results, covering place of death and hospital use and costs. It reports that there was a significant difference in place of death between those who received MCNS care and the matched controls: 76.7% of those who received MCNS care died at home and only 7.7% died in hospital, while 35% of the controls died at home and 41.6% died in hospital; people who received MCNS care were less likely to use all forms of hospital care than those in the control group. It concludes that the results provide evidence that home-based nursing care can reduce hospital use at the end of life and help more people to die at home, and evidence of the potential benefits of home-based nursing care.
The Marie Curie Nursing Service (MCNS) provides home-based end of life care to around 28,000 people at the end of life in the UK each year. This report looks at the impact of the MCNS on place of death and hospital use at the end of life, and in particular at whether MCNS care allowed more people to die at home and reduced the use and costs of hospital care at the end of life. The evaluation used retrospective analysis and compared 29,538 people who received MCNS care and died between 2009 and 2011 and a matched control group of 29,538 people selected from the population of England who died in the same period. The report describes the study, including its methodology, and presents the results, covering place of death and hospital use and costs. It reports that there was a significant difference in place of death between those who received MCNS care and the matched controls: 76.7% of those who received MCNS care died at home and only 7.7% died in hospital, while 35% of the controls died at home and 41.6% died in hospital; people who received MCNS care were less likely to use all forms of hospital care than those in the control group. It concludes that the results provide evidence that home-based nursing care can reduce hospital use at the end of life and help more people to die at home, and evidence of the potential benefits of home-based nursing care.
Subject terms:
home care, hospitals, nursing, older people, palliative care, cancer, costs, death, dying, end of life care;
The Marie Curie Nursing Service (MCNS) provides home-based end of life care to around 28,000 people at the end of life in the UK each year. This paper summarises research which looked at the impact of the MCNS on place of death and hospital use at the end of life, and in particular at whether MCNS care allowed more people to die at home and reduced the use and costs of hospital care at the end of life. The research used retrospective analysis and compared 29,538 people who received MCNS care and died between 2009 and 2011 and a matched control group of 29,538 people selected from the population of England who died in the same period. The paper briefly describes the study methodology and presents key points from the results, covering place of death and hospital use and costs. It reports that people who received MCNS care were significantly more likely to die at home than those who received 'standard' care: 76.7% of those who received MCNS care died at home and only 7.7% died in hospital, while 35% of the controls died at home and 41.6% died in hospital; people who received MCNS care were less likely to use all forms of hospital care than those in the control group. The study concluded that the results provide evidence that home-based nursing care can reduce hospital use at the end of life and help more people to die at home, and of the potential benefits of home-based nursing care.
The Marie Curie Nursing Service (MCNS) provides home-based end of life care to around 28,000 people at the end of life in the UK each year. This paper summarises research which looked at the impact of the MCNS on place of death and hospital use at the end of life, and in particular at whether MCNS care allowed more people to die at home and reduced the use and costs of hospital care at the end of life. The research used retrospective analysis and compared 29,538 people who received MCNS care and died between 2009 and 2011 and a matched control group of 29,538 people selected from the population of England who died in the same period. The paper briefly describes the study methodology and presents key points from the results, covering place of death and hospital use and costs. It reports that people who received MCNS care were significantly more likely to die at home than those who received 'standard' care: 76.7% of those who received MCNS care died at home and only 7.7% died in hospital, while 35% of the controls died at home and 41.6% died in hospital; people who received MCNS care were less likely to use all forms of hospital care than those in the control group. The study concluded that the results provide evidence that home-based nursing care can reduce hospital use at the end of life and help more people to die at home, and of the potential benefits of home-based nursing care.
Subject terms:
home care, hospitals, nursing, older people, palliative care, cancer, costs, death, dying, end of life care;
NATIONAL HEALTH SERVICE. National End of Life Care Programme, NATIONAL NURSE CONSULTANT GROUP (PALLIATIVE CARE)
Publisher:
National Health Service. National End of Life Care Programme
Publication year:
2011
Pagination:
20p.
Place of publication:
Leicester
Written for health and social care professionals who care for a person who has died and their carers, this guidance document details the key elements of care provision in the immediate period following death (the final step of the end of life care pathway). It was prepared following a review of the evidence base and 4 rounds of consensus building with representatives of organisations with a responsibility for caring for people after death. It is principally for nurses and those who have nursing tasks delegated to them, and uses the term care after death (instead of the traditional term 'last offices') in order to reflect the nursing tasks involved, including ongoing support of the family and carers. It sets out key principles, and is intended as a guide for training and for informing the development of organisational protocols for this area of care. It covers pathways of care for the deceased person, care before death, care at the time of death, best practice and legal issues, care after death, personal care after death, transfer of the deceased person, and recording care after death. Brief appendices cover deaths requiring reports to the coroner, information required by mortuary staff and funeral directors, and information on key stakeholders involved in the development of the guidance.
Written for health and social care professionals who care for a person who has died and their carers, this guidance document details the key elements of care provision in the immediate period following death (the final step of the end of life care pathway). It was prepared following a review of the evidence base and 4 rounds of consensus building with representatives of organisations with a responsibility for caring for people after death. It is principally for nurses and those who have nursing tasks delegated to them, and uses the term care after death (instead of the traditional term 'last offices') in order to reflect the nursing tasks involved, including ongoing support of the family and carers. It sets out key principles, and is intended as a guide for training and for informing the development of organisational protocols for this area of care. It covers pathways of care for the deceased person, care before death, care at the time of death, best practice and legal issues, care after death, personal care after death, transfer of the deceased person, and recording care after death. Brief appendices cover deaths requiring reports to the coroner, information required by mortuary staff and funeral directors, and information on key stakeholders involved in the development of the guidance.
Subject terms:
nurses, nursing, patients, palliative care, care pathways, care planning, death, dying, end of life care;
People should be able to die in the place of their choice. New guidance from the National End of Life Care Programme (NEoLCP) gives practical advice on how to ensure patients' preferred priorities are achieved.
People should be able to die in the place of their choice. New guidance from the National End of Life Care Programme (NEoLCP) gives practical advice on how to ensure patients' preferred priorities are achieved.
Subject terms:
holistic care, home care, nursing, palliative care, hospital discharge, terminal illness, care planning, communication, dying, end of life care;