Search results for: end-of-life care

Authors: A. Sathiya Susuman

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Background: The importance of maternal and child healthcare services cannot be stressed enough. These services are very important for the health and health outcomes of the mother and that of the child and in ensuring that both maternal and child deaths are prevented. The objective of the study is to inspire good quality maternal and child health care services in Swaziland. Specifically, is Swaziland on track with the 2015 Millennium Development Goals? Methods: The study used secondary data from the Swaziland Demographic and Health Survey 2006-07. This is an explorative and descriptive study which used pre-selected variables to study factors influencing the use of maternal and child healthcare services in Swaziland. Different types of examinations, such as univariate, bivariate, and multivariate statistical analysis were adopted. Results: The study findings showed a high use rate of antenatal care (97.3%) and delivery care (74.0%), and a low rate of postnatal care use (20.5%). The uptake childhood immunization is also high in the country, averaging more than 80.0%. Moreover, certain factors which were found to be influencing the use of maternal healthcare and childhood immunization include: woman’s age, parity, media exposure, maternal education, wealth status, and residence. The findings also revealed that these factors affect the use of maternal and child health differently. Conclusion: It is important to study factors related to maternal and child health uptake to inform relevant stakeholders about possible areas of improvement. Programs to educate families about the importance of maternal and child healthcare services should be implemented. Swaziland needs to work hard on child survival and maternal health care services, no doubt it is on track with the MDG 4 & 5.

Keywords: maternal healthcare, antenatal care, delivery care, postnatal care, child health, immunization, socio-economic and demographic factors

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Authors: M. A. Marlow, R. Sørly, H. K. Kaatrakoski

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Social work practice produces and circulates dominant narratives of young women in residential care. These stories are characterised by negative descriptions and hopelessness while dismissing the capabilities of narrative practice. This paper gives an account of how young women with histories in residential care can resist the dominant narratives. The analysis is based on a study of five young women aged 17 to 26 years old with different backgrounds and experiences with Norwegian residential care. The meaning of the context is analysed based on two interviews that were completed and one that was cancelled in the field. The contextual narrative analysis was oriented around the understanding of stories as performances and provided insight into a possible future storytelling practice in social work. The first author’s field notes are included as part of the data material in the analysis and provide a picture of important knowledge development related to stories and the value of being able to tell one’s own experiences. Faced with the dominant narratives that define young women with negative experiences with residential care, we provide a more contextualised understanding of storytelling as a possibility for positive change. To allow young women to create new stories from their lives, we, as both social workers and researchers, must be aware of what kinds of stories we relate to our own practices.

Keywords: context analysis, narrative research, rejection, residential care, social work practice

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Authors: Adrita Banerjee, Ajeet Kumar Singh

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Antenatal care (ANC) from a skilled provider is important to monitor the pregnancy and reduce the risk of morbidity for mother and baby during pregnancy and delivery. The quality of antenatal care can be monitored through the content of services received and the kind of information mothers are given during their visit. Objective: The paper tries to examine the association between ANC check-ups and size/ birth weight. It also focuses on investigating the relationship between utilization of recommended prenatal care for mothers and its effect on infant survival in Nepal. Data and methods: This paper uses data from Nepal demographic Health Survey 2011. To understand the relationship bi-variate statistical analysis and logistic regressions has been done. Maternal health care utilization include ANC check-ups i.e. the type of ante-natal care providers, the number and timing of the visit. The various components of the check-ups include intake of iron tablets/syrups, intestinal parasitic drugs, etc. Results: The results show that women who had no antenatal care visits about 40% had small sized babies at the time of birth compared to women to had at least 3 ANC check up. Women who had at least 3 check-ups 17% of the babies have a small size. It has also been found that about 50 % of the women prefer ANC check-ups during pregnancies which have resulted in lowering the infant mortality by about 40% during 1996-2011. Conclusion: Ante natal care check is care and monitoring of the pregnant woman and her foetus throughout pregnancy. ANC checks have an effect on the infant health and child survival. A woman who had at least three check-ups the possibilities of adverse effect on infant health and infant survival was significantly lower. The findings argue for a more enhanced focus on ANC check-ups for improving the maternal and child health in Nepal.

Keywords: maternal, health, pregnancy, outcome

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Authors: Anthoni Jeorge

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Throughout the history of the world, servant leadership has been researched, and favourable results such as individual, team, and organizational have been linked to the construct. This research paper designates St. Camillus de Lellis, a practitioner of servant leadership and founder of the Ministers of the Sick as a servant leader in his approach to care for the sick. Service is the visible face of his servant leadership. First of all, despite many challenges, St. Camillus de Lellis practiced leadership by the example of compassionate service to the sick. Second, he made service to the sick the highest priority of his life. Third, Camillus displayed servant leadership such that his manner of leadership gave birth to a New School of Service to the Sick. The paper identifies the distinctive dimensions and essential elements which characterized his service-centered leadership. Furthermore, discuss the six major characteristics of a servant leader as set forth by St. Camillus’s life example. The research illustrates the transformational power of servant leadership infield healthcare in general and, in doing so, provides servant leadership seekers ways servant leadership can transform elder care in one’s own field (St. Camillus Health Systems). Thus, it ascertains that servant leadership is best-fit for humanized elder care. Supported by the review of literature, the paper ascertains that Camillus, by identifying himself with the sick, gained deeper insights concerning the pain and suffering of the population. Uniquely drawn from his true grit, Camillus’ service-centered leadership is value-based, people-oriented, and compassion-filled. His way of service to the sick is the prolongation of gestures of mercy and compassion. It is hoped that the results of this study will help health care workers and servant leadership practitioners to humanize elder care and cultivate servant leadership attitude in their health care services to the sick. By incorporating such service-oriented elements into their leadership orientation, health care workers will be true servant leaders of the sick.

Keywords: leadership, service, healthcare, compassion

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Authors: Jui-Hung Hung, Ching-Liang Hsieh, Yi-Wen Lin

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Modern medicine highly emphasizes the importance of palliative treatment. The inception of palliative and hospice care recently developed into the concept of caring for the patients’ and families’ physical, psychological and spiritual problems. There are several benefits related to palliative care such as reducing medical expenses, decreasing patients’ suffer, and supporting patient go through the finale of the life. Nowadays, in Taiwan, over 60-70% terminal cancer patients were covered in hospice care, and the coverage rate increased annually. Acupuncture is a well-known therapy used more than thousand years to relieve symptoms of cancer patient. Many reports showed that, even in the Western society, many reputable medical centers can provide Acupuncture therapy for patients. Accordingly, using Acupuncture for cancer patient care is a global trend. There are increased evidences indicate that Acupuncture can relieve the symptoms for cancer patients including pain, reduce the dosage of anesthetic, improve the cancer-related fatigue, relieve the chemotherapy-related nausea and vomiting, ease anxiety mood and even improving the quality of life. Furthermore, some trials show that Acupuncture may help relieve xerostomia, hot flash, sleep disorders, and some GI discomfort and so on. Acupuncture therapy has many advantages for clinical use with effective, low-cost, minimal side effect, suitable for cancer patients and even for elderly population. Especially in nowadays, there are more diversified challenges in modern medicine, all of them will make the higher medical budget. We suggest that Acupuncture will be one of methods for palliative care for cancer patients.

Keywords: Acupuncture, cancer, integrative medicine, palliative care

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Authors: Chizzoniti Domenico, Beggiora Klizia, Cattani Letizia, Moscatelli Monica

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This paper concerns the study of sustainable construction materials applied on the "Health Post", a prototype for the primary health care situated in alienated areas of the world. It's suitable for social and climatic Sub-Saharan context; however, it could be moved in other countries of the world with similar urgent needs. The idea is to create a Health Post with local construction materials that have a low environmental impact and promote the local workforce allowing reuse of traditional building techniques lowering production costs and transport. The aim of Primary Health Care Centre is to be a flexible and expandable structure identifying a modular form that can be repeated several times to expand its existing functions. In this way it could be not only a health care centre but also a socio-cultural facility.

Keywords: low costs building, sustainable construction materials, green construction system, prototype, health care, emergency

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Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

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Authors: Ridha Abdulla Al Hammam

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Purpose: to measure the extent of perceived structural empowerment and work commitment the intensive care unit in SMC have in their work place. Background: nurses’ access to power structures (information, recourses, opportunity, and support) directly influences their productivity, retention, and job satisfaction. Exploring nurses’ level and sources of work commitment (affective, normative, and continuance) is very essential to guide nursing leaders making decisions to improve work environment to facilitate effective nursing care. Both concepts (Structural Empowerment and Work Commitment) were never investigated in our critical care unit. Methods: a sample of 50 nurses attained from the Intensive Care Unit (Adult). Conditions for Workplace Effectiveness Questionnaire and Three-Component Model Employee Commitment Survey were used to measure the two concepts respectively. The study is quantitative, descriptive, and correlational in design. Results: the participants reported moderate structural empowerment provided by their work place (M=15 out of 20). The sample perceived high access to opportunity mainly through gaining more skills (M=4.45 out of 5) where the rest power structures were perceived with moderate accessibility. The participants’ affective commitment (M=5.6 out of 7) to work in the ICU overweighed their normative and continuance commitment (M=5.1, M=4.9 out of 7) implying a stronger emotional connection with their unit. Strong positive and significant correlations were observed between the participants’ structural empowerment scores and all work commitment sources. Conclusion: these results provided an insight on aspects of work environment that need to be fostered and improved in our intensive care unit which have a direct linkage to nurses’ work commitment and potentially to their quality of care they provide.

Keywords: structural empowerment, commitment, intensive care, nurses

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Authors: Kumari Bandana Bhatt, Navin Bhatt

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Background: Orphans and vulnerable children (OVC) are high risk of physical, mental, sexual and emotional abuse and face social stigma and discrimination which significantly increase the risk of mental and behavioral disorders such as anxiety, depression or emotional problems even they stay in well run child care homes. The objective of this study was to estimate the prevalence of depression and determine the determinants among OVC in child care homes in Nepal. Methods: An institutional-based analytical cross-sectional study was conducted in twenty orphanages of five districts of Nepal. Six hundred two children were recruited into the study. After the informed consent form obtaining, the guardian and assent were interviewed by a semi-structured questionnaire and Beck Depression Inventory-II (BDI-II). Logistic regression was used for detecting the association between variables at the significant level of =0.05. Results: The study revealed that 33.20% of OVC had depression. Among them 66.80% of children experienced minimal depression, 17.40% had mild depression, 11.30% had moderate depression 4.50% had severe depression. Sex, alcohol drinking, congenital problem, social support and bully were the main variables associated with depression among OVC of the child care homes in Nepal. Conclusion: Prevalence of depression was high among the orphans and vulnerable children living in child care homes especially among the female children in Nepal. Therefore, early identification and instituting of preventive measures of depression are essential to reduce this problem in this special group of children living in child care homes.

Keywords: Mental health, Depression, Orphans and vulnerable children, child care homes

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Authors: Ali Soroush, Mehdi Mirzaei Alavijeh, Touraj Ahmadi Jouybari, Fazel Zinat-Motlagh, Abbas Aghaei, Mari Ataee

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Diabetes is a disease with long cardiovascular, renal, ophthalmic and neural complications. It is prevalent all around the world including Iran, and its prevalence is increasing. The aim of this study was to determine the factors related to self-care behavior based on health belief model among sample of Iranian diabetic patients. This cross-sectional study was conducted among 301 type 2 diabetic patients in Gachsaran, Iran. Data collection was based on an interview and the data were analyzed by SPSS version 20 using ANOVA, t-tests, Pearson correlation, and linear regression statistical tests at 95% significant level. Linear regression analyses showed the health belief model variables accounted for 29% of the variation in self-care behavior; and perceived severity and perceived self-efficacy are more influential predictors on self-care behavior among diabetic patients.

Keywords: diabetes, patients, self-care behaviors, health belief model

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Authors: Maha Atout, Pippa Hemingway, Jane Seymour

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Background: A mixed method systematic review was undertaken in order to explore issues related to the experiences of health care providers and parents in the care of children with palliative care needs. The aims of this systematic review were to identify existing evidence about the experiences of communication in the care of children with palliative care needs, to appraise the research conducted in this area and to identify gaps in the literature in order to recommend for future related studies. Method: A mixed method systematic review of research on the experience of communication in the care of children with palliative care needs, conducted with parents and health professionals was undertaken. The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period of 2000-2016. Inclusion was limited to studies of communication experience in the care of children with palliative care needs. Result: Thirty-eight studies were found. The studies were conducted in a variety of countries: Uganda, Jordan, USA, UK, Taiwan, Turkey, Ireland, Poland, Brazil, Australia, Switzerland, Sweden, Netherland, Lebanon, Spain, Greece, and China. The current review shows that parents tend to protect their children when they are discussing their illnesses with them, particularly where they have a life-threatening or life-limiting condition. The approach of parents towards the discussion of sensitive issues concerning death with their children is significantly affected by the cultural background of the families. Conservative cultures encourage collusion behaviours which tend to keep children unaware of the incurable nature of the disease. The major communication challenges reported by health professionals are facing difficulties in judging how much information should be given to parents, responding to difficult questions, conflicts with families and inadequate skills to support grieving families. Conclusion: It is probably significant for the future studies to consider the change of parent-child communication experience over time in order to understand how the parents could change their interaction styles with their children according to the different stages of their children’s disease. Moreover, further studies are required to investigate the experience of communication of parents of children with non-malignant life-threatening and life-limiting illnesses.

Keywords: children with life-threatening or life- limiting illnesses, end of life, experience of communication, healthcare care providers, paediatric palliative care

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Authors: Ellen Lagast, Melissa Ceuterick, Mark Leys

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Although adolescence is a stressful period with an increased risk for mental illnesses such as anxiety and depression, little in-depth knowledge is available on the determinants of the use of psychotropic drugs (BZD/SSRIs) and the effects. A qualitative research with adolescents in Flanders was performed. Based on indepth interviews, the interviewees indicate feelings of ambiguity towards their medication use because on the one hand the medication helps to manage their mental vulnerability and disrupted lives, but on the other hand they experience a loss of control of their self and their environment. Undesired side-effects and stigma led to a negative pharmaceutical self. The interviewed youngsters also express dissatisfaction about the prescription behavior with regard to psychotropic drugs of their general practitioner (GP). They wished to have received more information about alternative non-pharmaceutical treatment options. Notwithstanding these comments, the majority of the interviewees maintained trust in their GP to act in their best interest. This paper will relate the prescription behavior in primary care to the organization of mental health care to better understand the “phamaceuticalization” and medicalization of mental health problems in Belgium. Belgium implemented fundamental mental health care reforms to collaborate, to integrate care and to optimize continuity of care. Children and adolescents still are confronted with long waiting lists to access (non-medicalized) mental health services. This access to mental health care partly explains general practitioners’ prescription behavior of psychotropics. Moreover, multidisciplinary practices have not pervaded primary health care yet. Medicalization and pharmaceuticalization of mental health vulnerabilities of youth are both a structural and cultural problem.

Keywords: adolescents, antidepressants, benzodiazepines, mental health system, psychotropic drugs

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Authors: Jiranun Sreecharit, Anongnat Boonrut, Kunvadee Munvaradee, Phechnoy Singchungchai

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Hatyai Hospital as center of hospital with a capacity of 670 beds. Medicine intensive care units (MICU240) provide care for critically ill patients who are at high risk need to be monitored closely. Intravenous catheter is vital to help assess the level of water in the body fluids and medications. Potential complications such as infection. We need to have guidelines for the care of patients who received intravenous catheter used to achieve good results. The operations research in this study was intended 1) To study the effects of practice for nurses in caring for patients with central venous catheter to infection rate and 2) To assess the satisfaction of nurses and patient care practices in central venous catheterization patients in the MICU 240. The sample of the patient's central venous catheter crisis that everyone who admitted in MICU 240 during the period from October 2013 to May 2014. Samples prior to practice and 148 samples with 249 case of practice. A systematic review of the research NSWHealth Statewide Guideline for Intensive Care. Data were analyzed by statistics, percentages and frequency NON-PARAMETRICS with Mann-Whitney U. The finding revealed that: 1. Results of the practice patient care central venous catheter infection rates were found to be reduced from 35.14 percent to 25.3 percent. 2. The results of the evaluation of nurses and patients in the patient care practices central venous catheter found to be satisfied and happy to work 85 percent.

Keywords: clinical practice guidelines, central venous catheter, infection satisfaction

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Authors: Ellen Bryant, Virginia Behmer, Rebecca Garbed, Jeanette O’Quin, Dana Howard

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As it currently stands, veterinary care in the United States is not accessible to everyone, and veterinarians regularly face cases of clients who are unable to provide necessary care to their animals regardless of the client’s desire to do so. There is currently limited research into how veterinarians address these issues of access to care. It is apparent that veterinarians regularly utilize funding or offer discounted services to treat cases that otherwise would go without care. With need currently exceeding the amount of funds and services available, veterinarians are tasked with deciding which cases are most deserving of assistance. This mixed methods study distributed a survey to companion animal veterinarians practicing in the United States to identify current trends in how these professionals apply principles of distributive justice in the scope of veterinary medicine. Ethical frameworks identified in human bioethics research into distributive justice were presented, along with demographic questions, to identify relationships between veterinarian priorities and the scope of their practice/respective roles/geographic region. By surveying veterinarians across a wide range of specialties, practice types, and clientele this study was able to assess how priorities and opinions shift based on external factors as well as among the respondents themselves. Participants were asked not only to choose how to distribute aid between different clients and case scenarios, but also asked directly which is the best way to distribute aid when need exceeds the resources available.

Keywords: access to veterinary care, bioethics, decision-making, distributive justice, subsidized care

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Authors: Huang Wei-Yi

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Objective: This article explores the intensive care nursing experience of a terminal lung cancer patient who received palliative care after tracheal intubation. The patient was nearing death, and the family experienced sadness and grief as they faced the patient’s deteriorating condition and impending death. Methods: The patient was diagnosed with lung cancer in 2018 and received chemotherapy and radiation therapy with regular outpatient follow-ups. Due to brain metastasis and recent poor pain control and treatment outcomes, the patient was admitted to the intensive care unit (ICU), where the tracheal tube was removed, and palliative care was initiated. During the care period, a holistic assessment was conducted, addressing the physical, psychological, social, and spiritual aspects of care. Medical records were reviewed, interviews and family meetings were held, and a comprehensive assessment was carried out by the critical care team in collaboration with the palliative care team. The primary nursing issues identified included pain, ineffective breathing patterns, fear of death, and altered tissue perfusion. Results: Throughout the care process, the palliative care nurse, along with the family, utilized listening, caring, companionship, pain management, essential oil massage, distraction, and comfortable positioning to alleviate the patient’s pain and breathing difficulties. The use of Morphine 6mg in 0.9% N/S 50ml IV drip q6h reduced the FLACC pain score from 6 to 3. The patient’s respiratory rate improved from 28 breaths/min to 18-22 breaths/min, and sleep duration increased from 4 to 7 uninterrupted hours. The holistic palliative care approach, coupled with the involvement of the palliative care team, facilitated expressions of gratitude, apologies, and love between the patient and family. Visiting hours were extended, and with the nurse’s assistance, these moments were recorded and shared with the patient’s consent, providing cherished memories for the family. The patient’s end-of-life experience was thus improved, and the family was able to find peace. This case also served to promote the concept of palliative care, ensuring that more patients and families receive high-quality nursing care. Conclusion: When caring for terminal patients, collaboration with the palliative care team, including social workers, clergy, psychologists, and nutritionists, is essential. Involving the family in decision-making and providing opportunities for closeness and expressions of gratitude improve personalized care and enhance the patient's quality of life. Upon transferring to the ward, the patient’s hemodynamic stability was maintained, including SBP 110-130 mmHg, respiratory rate 20-22 breaths/min, and pain score <3. The patient was later discharged and transitioned to home hospice care for ongoing support.

Keywords: intensive care, lung cancer, palliative care, ICU

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Authors: Ine Huybrechts, Anja Declercq, Emily Verté, Peter Raeymaeckers, Sibyl Anthierens

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Goal-oriented care is a concept gaining increased interest as an approach to go towards more coordinated and integrated primary care. It places patients’ personal life goals at the core of health care support, hereby shifting the focus from “what’s the matter with this patient” to “what matters to this patient.” In Flanders/Belgium, various primary care providers, health and social care organizations and governmental bodies have picked up this concept and have initiated actions to facilitate this approach. The implementation of goal-oriented care not only happens on the micro-level, but it also requires efforts on the meso- and macro-level. Within implementation research, there is a growing recognition that the context in which an intervention takes place strongly relates to its implementation outcomes. However, when investigating contextual variables, the external context and its impact on implementation processes is often overlooked. This study aims to explore how we can better identify and understand the external context and how it relates to the mechanism of change within the implementation process of goal-oriented care in Flanders/Belgium. Results can be used to support and guide initiatives to introduce innovative approaches such as goal-oriented care inside an organization or in the broader primary care landscape. We have conducted qualitative research, performing in-depth interviews with n=23 respondents who have affinity with the implementation of goal-oriented care within their professional function. This lead to in-depth insights from a wide range of actors, with meso-level and/or macro-level perspectives on the implementation of goal-oriented care. This means that we have interviewed actors that are not only involved with initiatives to implement goal-oriented care, but also actors that actively give form to the external context in which goal-oriented care is implemented. Data were collected using a semi-structured interview guide, audio recorded, and analyzed first inductively and then deductively using various theories and concepts that derive from organizational research. Our preliminary findings suggest t Our findings can contribute to further define actions needed for sustainable implementation of goal-oriented primary care. It gives insights in the dynamics between contextual variables and implementation efforts, hereby indicating towards those contextual variables that can be further shaped to facilitate the implementation of an innovation such as goal-oriented care. hat organizational theories can help understand the mechanism of change of implementation processes with a macro-level perspective. Institutional theories, contingency theories, resources dependency theories and others can expose the mechanism of change for an innovation such as goal-oriented care. Our findings can contribute to further define actions needed for sustainable implementation of goal-oriented primary care. It gives insights in the dynamics between contextual variables and implementation efforts, hereby indicating towards those contextual variables that can be further shaped to facilitate the implementation of an innovation such as goal-oriented care.

Keywords: goal-oriented care, implementation processes, organizational theories, person-centered care, implementation research

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Authors: Jiazhi Zeng, Leiyu Shi, Xia Zou, Wen Chen, Li Ling

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Background: China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Due to the household registration system, migrants are in a vulnerable state when they attempt to access to primary care services. A strong primary care system can reduce health inequities and mitigate socioeconomic disparities in healthcare utilization. Literature indicated that migrants were more reliant on the primary care system than local residents. Although the Chinese government has attached great importance to creating an efficient health system, primary care services are still underutilized. The referral system between primary care institutions and hospitals has not yet been completely established in China. The general populations often go directly to hospitals instead of primary care institutions for their primary care. Primary care institutions generally consist of community health centers (CHCs) and community health stations (CHSs) in urban areas, and township health centers (THCs) and rural health stations (THSs) in rural areas. In addition, primary care services are also provided by the outpatient department of municipal hospitals and tertiary hospitals. A better understanding of migrants’ experiences with primary care in the above-mentioned medical institutions is critical for improving the performance of primary care institutions and providing indications of the attributes that require further attention. The purpose of this pioneering study is to explore rural-to-urban migrants’ experiences in primary care, compare their primary care experiences in four types of medical institutions in Guangzhou, China, and suggest implications for targeted interventions to improve primary care for the migrants. Methods: This was a cross-sectional study conducted with 736 rural-to-urban migrants in Guangzhou, China, in 2014. A multistage sampling method was employed. A validated Chinese version of Primary Care Assessment Tool - Adult Short Version (PCAT-AS) was used to collect information on migrants’ primary care experiences. The PCAT-AS consists of 10 domains. Analysis of covariance was conducted for comparison on PCAT domain scores and total scores among migrants accessing four types of medical institutions. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results: After controlling for socio-demographic characteristics, migrant characteristics, health status and health insurance status, migrants accessing primary care in tertiary hospitals had the highest PCAT total scores when compared with those accessing primary care THCs/ RHSs (25.49 vs. 24.18, P=0.007) and CHCs/ CHSs(25.49 vs. 24.24, P=0.006). There was no statistical significant difference for PCAT total scores between migrants accessing primary care in CHCs/CHSs and those in municipal hospitals (24.24 vs. 25.02, P=0.436). Factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P < 0.001). Conclusions: This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Migrants receiving primary care from THCs, RHSs, CHSs and CHSs reported worse primary care experiences than those receiving primary care from tertiary hospitals. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. Further research exploring the specific reasons for poorer PCAT scores of primary care institutions users will be needed.

Keywords: China, PCAT, primary care, rural-to-urban migrants

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Authors: Jonathan Turner, Julie Doyle, Laura O’Philbin, Dympna O’Sullivan

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People living with dementia should be at the centre of decision-making regarding goals for daily living. These goals include basic activities (dressing, hygiene, and mobility), advanced activities (finances, transportation, and shopping), and meaningful activities that promote well-being (pastimes and intellectual pursuits). However, there is limited involvement of people living with dementia in the design of technology to support their goals. A project is described that is co-designing intelligent computer-based support for, and with, people affected by dementia and their carers. The technology will support self-management, empower participation in shared decision-making with carers and help people living with dementia remain healthy and independent in their homes for longer. It includes information from the patient’s care plan, which documents medications, contacts, and the patient's wishes on end-of-life care. Importantly for this work, the plan can outline activities that should be maintained or worked towards, such as exercise or social contact. The authors discuss how to integrate care goal information from such a care plan with data collected from passive sensors in the patient’s home in order to deliver individualized planning and interventions for persons with dementia. A number of scientific challenges are addressed: First, to co-design with dementia patients and their carers computerized support for shared decision-making about their care while allowing the patient to share the care plan. Second, to develop a new and open monitoring framework with which to configure sensor technologies to collect data about whether goals and actions specified for a person in their care plan are being achieved. This is developed top-down by associating care quality types and metrics elicited from the co-design activities with types of data that can be collected within the home, from passive and active sensors, and from the patient’s feedback collected through a simple co-designed interface. These activities and data will be mapped to appropriate sensors and technological infrastructure with which to collect the data. Third, the application of machine learning models to analyze data collected via the sensing devices in order to investigate whether and to what extent activities outlined via the care plan are being achieved. The models will capture longitudinal data to track disease progression over time; as the disease progresses and captured data show that activities outlined in the care plan are not being achieved, the care plan may recommend alternative activities. Disease progression may also require care changes, and a data-driven approach can capture changes in a condition more quickly and allow care plans to evolve and be updated.

Keywords: care goals, decision-making, dementia, self-care, sensors

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Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas

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Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.

Keywords: dialysis, kidney failure, nursing, supportive care

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Authors: Nasim Hashemi, Abbas Sheikhtaheri

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Telemedicine is the use of telecommunication and information technologies to provide health care services that would often not be consistently available in distant rural communities to people at these remote areas. Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Thus, teleophthalmology can overcome geographical barriers and improve quality, access, and affordability of eye health care services. Since teleophthalmology has been widespread applied in recent years, the aim of this study was to determine the different applications of teleophthalmology in the world. To this end, three bibliographic databases (Medline, ScienceDirect, Scopus) were comprehensively searched with these keywords: eye care, eye health care, primary eye care, diagnosis, detection, and screening of different eye diseases in conjunction with telemedicine, telehealth, teleophthalmology, e-services, and information technology. All types of papers were included in the study with no time restriction. We conducted the search strategies until 2015. Finally 70 articles were surveyed. We classified the results based on the’type of eye problems covered’ and ‘the type of telemedicine services’. Based on the review, from the ‘perspective of health care levels’, there are three level for eye health care as primary, secondary and tertiary eye care. From the ‘perspective of eye care services’, the main application of teleophthalmology in primary eye care was related to the diagnosis of different eye diseases such as diabetic retinopathy, macular edema, strabismus and aged related macular degeneration. The main application of teleophthalmology in secondary and tertiary eye care was related to the screening of eye problems i.e. diabetic retinopathy, astigmatism, glaucoma screening. Teleconsultation between health care providers and ophthalmologists and also education and training sessions for patients were other types of teleophthalmology in world. Real time, store–forward and hybrid methods were the main forms of the communication from the perspective of ‘teleophthalmology mode’ which is used based on IT infrastructure between sending and receiving centers. In aspect of specialists, early detection of serious aged-related ophthalmic disease in population, screening of eye disease processes, consultation in an emergency cases and comprehensive eye examination were the most important benefits of teleophthalmology. Cost-effectiveness of teleophthalmology projects resulted from reducing transportation and accommodation cost, access to affordable eye care services and receiving specialist opinions were also the main advantages of teleophthalmology for patients. Teleophthalmology brings valuable secondary and tertiary care to remote areas. So, applying teleophthalmology for detection, treatment and screening purposes and expanding its use in new applications such as eye surgery will be a key tool to promote public health and integrating eye care to primary health care.

Keywords: applications, telehealth, telemedicine, teleophthalmology

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Authors: D. I. Yani, S. Isaramalai, C. Kritpracha

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Adherence to health behaviors is essential to achieve successful TB treatment. This study aimed to examine the effect of a family-based DOTS support program on adherence to health behaviors in patients with pulmonary TB. Sixty TB patients and their families were selected using cluster randomization of community health centers. The subjects were assigned into a control group, who received the routine care, and an experimental group, who received both routine care and care from the family-based DOTS support program. Paired t-test and the independent t-test were applied. The total score of adherence to health behaviors in the experimental group was significantly higher after receiving care from the family-based DOTS support program than the pretest score (t = -10.34, p < .001). Suggestions were made to expand the application of this program in various contexts and to extend knowledge for nursing practices and research.

Keywords: self-care deficit nursing theory, family-based DOTS program, pulmonary tuberculosis, adherence, health behaviors

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Authors: Varsha Reddy Jayar

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Background: Our elderly family members deserve our best care. It's our responsibility to ensure they're healthy and safe. The population of India is increasing rapidly. People are literally being born in the streets, and there is a high growth on taxes and healthcare costs. Indian families are challenged with taking care of everyone. When you have elderly parents and a demanding job, it can be difficult to take care of them. You might not have enough time to care for them when you're already working or dealing with emotional difficulties. Living alone in old age can cause older individuals to face many health risks. Many seniors find living and caring for themselves challenging when they live by themselves. This study explored the factors that affect whether or not elderly people choose to live in old age homes. Methods: This study was carried out on 123 elderly people living in different old age homes in Karnataka, India. The reason for their residence at the home was explored using an interview. Results: It was found that the most common reason for living in an old age home is due to abuse from children and grandchildren; the majority reported were Daughter in law issues in the family specific to the adjustment and understanding amongst them. Conclusion: More and more elderly people in India are choosing to stay in old age homes as they get older. The government and voluntary agencies must have some sort of arrangements for institutional support.

Keywords: old age home, elderly, Aging, challenges of aging

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Authors: Hsiao-Lin Fang

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Every life is precious, and comprehensive care should be provided to individuals who are in the final stages of their lives. Hospice-shared care aims to provide optimal symptom control and palliative care to terminal (cancer) patients through the implementation of shared care, and to support patients and their families in making various physical and psychological adjustments in the face of death. This report examines a 10-year-boy diagnosed with Out-of-Hospital Cardiac Arrest (OHCA). The individual fainted when swimming at school and underwent 31 minutes of cardiopulmonary resuscitation (CPR). While receiving treatment at the hospital, the individual received extracorporeal membrane oxygenation(ECMO) due to unstable hemodynamics. Urgent cardiac catheterization found: Suspect acute fulminant myocarditis or underlying cardiomyopathy with acute decompensation, After the active rescue by the medical team, hemodynamics still showed only mean pressure value. With respect to the patient, interdepartmental hospice-shared care was implemented and a do-not-resuscitate (DNR) order was signed after family discussions were conducted. Assistance and instructions were provided as part of the comfort care process. A farewell gathering attended by the patient’s relatives, friends, teachers, and classmates was organized in an intensive care unit (ICU) in order to look back on the patient’s life and the beautiful memories that were created, as well as to alleviate the sorrow felt by family members, including the patient’s father and sister. For example, the patient was presented with drawings and accompanied to a garden to pick flowers. In this manner, the patient was able to say goodbye before death. Finally, the patient’s grandmother and father participated in the clinical hospice care and post-mortem care processes. A hospice-shared care clinician conducted regular follow-ups and provided care to the family of the deceased, supporting family members through the sorrowful period. Birth, old age, sickness, and death are the natural phases of human life. In recent years, growing attention has been paid to human-centered hospice care. Hospice care is individual holistic care provided by a professional team and it involves the provision of comprehensive care to a terminal patient. Hospice care aims to satisfy the physical, psychological, mental, and social needs of patients and their families. It does not involve the cessation of treatment but rather avoids the exacerbation or extension of the suffering endured by patients, thereby preserving the dignity and quality of life during the end-of-life period. Patients enjoy the company of others as they complete the last phase of their lives, and their families also receive guidance on how they can move on with their own lives after the patient’s death.

Keywords: hospice-shared care, extracorporeal membrane oxygenation (ECMO), hospice-shared care, child patient

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Authors: Ibragim Issabekov, Byron Crape, Lyazzat Toleubekova

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Background: Palliative care substantially improves the quality of life of terminally-ill patients. Symptom control is one of the keystones in the management of patients in palliative care settings, lowering distress as well as improving the quality of life of patients with end-stage diseases. The most common symptoms causing significant distress for patients are pain, nausea and vomiting, increased respiratory secretions and mental health issues like depression. Aims are: 1. to identify best practices in symptom management in palliative patients in accordance with internationally approved guidelines and compare aforementioned with actual practices in Kazakhstan; to evaluate the criteria for assessing symptoms in terminally-ill patients, 2. to review the availability and utilization of pharmaceutical agents for pain control, management of excessive respiratory secretions, nausea, and vomiting, and delirium and 3. to develop recommendations for the systematic approach to end-of-life symptom management in Kazakhstan. Methods: The use of qualitative research methods together with systematic literature review have been employed to provide a rigorous research process to evaluate current approaches for symptom management of palliative patients in Kazakhstan. Qualitative methods include in-depth semi-structured interviews of the healthcare professionals involved in palliative care provision. Results: Obstacles were found in appropriate provision of palliative care. Inadequate education and training to manage severe symptoms, poorly defined laws and regulations for palliative care provision, and a lack of algorithms and guidelines for care were major barriers in the effective provision of palliative care. Conclusion: Assessment of palliative care in this medium-income transitional-economy country is one of the first steps in the initiation of integration of palliative care into the existing health system. Achieving this requires identifying obstacles and resolving these issues.

Keywords: end-of-life care, middle income country, palliative care, symptom control

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Authors: Elizabeth Grier, Meg Gemmill, Mary Martin, Leora Reiter, Herman Tang, Alexandra Donaldson, Isis Lunsky, Mia Wu

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Background: Individuals with Cerebral Palsy (CP) and/or IDD face numerous physical and mental health challenges, including difficulty accessing effective palliative care. The aim of this study is to assess the knowledge and comfort of healthcare providers in providing community-based palliative care for patients with Cerebral Palsy (CP) and severe to profound Intellectual and Developmental Disabilities (IDD). Methods: This study includes a mixed methods approach obtaining both quantitative and qualitative data. Quantitative data from palliative care practitioners was obtained through an online survey assessing comfort in symptom management, grief assessment, and goals of care discussion. This survey was distributed to physicians and allied health practitioners across Canada through the College of Family Physicians of Canada Member Interest Groups for Palliative Care and for IDD. Survey results guided the development of a semi-structured interview template, which was used to conduct a focus group on the same topic. Participants were four palliative care providers (3 physicians and one spiritual care practitioner). The focus group transcript is currently undergoing thematic analysis using NVivo 12 software. Results: 57 palliative care practitioners completed the survey. 87% of participants indicated they have provided palliative care services for persons with CP and/or IDD. Findings suggest practitioners are somewhat confident in identifying specific physical symptoms (dyspnea, pressure ulcers) but less confident in identifying physical/emotional pain, addressing grief, and prognosticating life expectancy in this population. 54% of responses indicated they had little/no training on palliating those with CP or IDD, and 45% somewhat or strongly disagree members of their profession can manage symptoms for this population. Focus group analysis is underway, and results will be available at the time of the poster presentation. Conclusion: Persons with CP and IDD are more likely to experience severe health inequities when accessing palliative care. Results of this study suggest further education is needed for palliative care professionals to address the barriers and challenges in providing palliative care to this patient population.

Keywords: palliative care, symptom management, health equity, community healthcare, intellectual and developmental disabilities

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Authors: Jenny Fairthorne, Yuka Mori, Helen Leonard

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Background: Primary care-givers of children with autism spectrum disorder (ASD) or intellectual disability (ID) have poorer health and quality of life (QoL) than primary care-givers (hereafter referred to as just care-givers) of typically developing children. We aimed to review original research which described factors impacting the health of care-givers of children with ASD or ID and to discuss how these factors might influence care-giver health. Methods: We searched Web of Knowledge, Medline, Scopus and Google Scholar using selections of words from each of three groups. The first comprised terms associated with ASD and ID and included autism, pervasive development disorder, intellectual disability, mental retardation, disability, disabled, Down and Asperger. The second included terms related to health such as depression, physical, mental, psychiatric, psychological and well-being. The third was terms related to care-givers such as mother, parent and care-giver. We included an original paper in our review if it was published between 1st January 1990 and 31st December, 2016, described original research in a peer-reviewed journal and was written in English. Additional criteria were that the research used a study population of 15 persons or more; described a risk or protective factor for the health of care-givers of a child with ASD, ID or a sub-type (such as ASD with ID or Down syndrome). Using previous research, we developed a simple and objective five-level tool to assess the strength of evidence provided by the reviewed papers. Results: We retained 33 papers. Factors impacting primary care-giver health included child behaviour, level of support, socio-economic status (SES) and diagnostic issues. Challenging child behaviour, the most commonly identified risk factor for poorer care-giver health and QoL was reported in ten of the studies. A higher level of support was associated with improved care-giver health and QoL. For example, substantial evidence indicated that family support reduced care-giver burden in families with a child with ASD and that family and neighbourhood support was associated with improved care-giver mental health. Higher socio-economic status (SES) was a protective factor for care-giver health and particularly maternal health. Diagnostic uncertainty and an unclear prognosis are factors which can cause the greatest concern to care-givers of children with ASD and those for whom a cause of their child’s ID has not been identified. We explain how each of these factors might impact caregiver health and how they might act differentially in care-givers of children with different types of ASD or ID (such as Down syndrome and ASD without ID). Conclusion: Care-givers of children with ASD may be more likely to experience many risk factors and less likely to experience the protective factors we identified for poorer mental health. Interventions to reduce risk factors and increase protective factors could pave the way for improved care-giver health. For example, workshops to train care-givers to better manage challenging child behaviours and earlier diagnosis of ASD (and particularly ASD without ID) would seem likely to improve care-giver well-being. Similarly, helping to expand support networks might reduce care-giver burden and stress leading to improved health.

Keywords: autism, caregivers, health, intellectual disability, mothers, review

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Authors: Omer Ibrahim Abdallh Omer

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Cancer patients often face complex medication regimens, leading to challenges in treatment adherence and clinical outcomes. Pharmacist-led medication therapy management (MTM) has emerged as a potential solution to optimize medication use and improve patient outcomes in oncology settings. In this prospective intervention study, we aimed to evaluate the impact of pharmacist-led MTM on treatment adherence and clinical outcomes among cancer patients. Participants were randomized to receive either pharmacist-led MTM or standard care, with assessments conducted at baseline and follow-up visits. Pharmacist interventions included medication reconciliation, adherence counseling, and personalized care plans. Our findings reveal that pharmacist-led MTM significantly improved medication adherence rates and clinical outcomes compared to standard care. Patients receiving pharmacist interventions reported higher satisfaction levels and perceived value in pharmacist involvement in their cancer care. These results underscore the critical role of pharmacists in optimizing medication therapy and enhancing patient-centered care in oncology settings. Integration of pharmacist-led MTM into routine cancer care pathways holds promise for improving treatment outcomes and quality of life for cancer patients.

Keywords: cancer, medications adherence, medication therapy management, pharmacist

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Authors: Ru-Yu Lien, Shih-Hsin Hung, Shu-Fen Lu, Ju-Jen Shie, Wen-Ju Yang, Yuann-Meei Tzeng, Chien-Ying Wang

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Background: The quality of care in intensive care units (ICUs) is crucial, especially for terminally ill patients. Shared decision-making (SDM) with families is essential to ensure appropriate care and reduce suffering. Aim: This study explores the effectiveness of an end-of-life decision support Patient Decision Aid (PDA) in an ICU setting. Methods: This study employed a cross-sectional research design conducted in an ICU from August 2020 to June 2023. Participants included family members of end-of-life patients aged 20 or older. A total of 319 participants. Family members of end-of-life patients received the PDA, and data were collected after they made medical decisions. Data collection involved providing family members with a PDA during family meetings. A post-PDA questionnaire with 17 questions assessed PDA effectiveness and anxiety levels. Statistical analysis was performed using SPSS 22.0. Results: The PDA significantly reduced anxiety levels among family members (p < 0.001). It helped them organize their thoughts, prepare for discussions with doctors, and understand critical decision factors. Most importantly, it influenced decision outcomes, with a shift towards palliative care and withdrawal of life-sustaining treatment. Conclusion: This study highlights the importance of family-centered end-of-life care in ICUs. PDAs promote informed decision-making, reduce conflicts, and enhance patient and family involvement. These tools align patient values and goals with medical recommendations, ultimately leading to decisions that prioritize comfort and quality of life. Implementing PDAs in healthcare systems can ensure that patients' care aligns with their values.

Keywords: shared decision-making, patient decision aid, end-of-life care, intensive care unit, family-centered care

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Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: Maternal mortality has been shown to be lower in urban areas than in rural areas. However, disparities for the fast-growing population of urban poor who struggle as much their rural counterparts to access quality healthcare are masked by the urban averages. The aim of this paper is to report on the findings of antenatal adequacy among slum residents in Addis Ababa, Ethiopia. Methods and Materials: A quantitative and cross-sectional community-based study design was employed. A stratified two-stage cluster sampling technique was used to determine the sample and data was collected using structured questionnaire administered to 837 women aged 15-49 years. Binary logistic regression models were employed to identify predictors of adequacy of antenatal care. Results: The majority of slum residents did not have adequate antenatal care services i.e., only 50.7%, 19.3% and 10.2% of the slum resident women initiated early antenatal care, received adequate antenatal care service contents and had overall adequate antenatal care services. Pregnancy intention, educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.9 times more likely to have overall adequate care compared to those with no formal education. Similarly, women whose last pregnancy was intended and clients of private healthcare facilities were 1.8 and 2.8 times more likely to have overall adequate antenatal care compared to those whose last pregnancy was unintended and clients of public healthcare facilities respectively. Conclusion: In order to improve ANC adequacy in the study area, the policymaking, planning, and implementation processes should focus on the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

Keywords: Addis Ababa, adequacy of antenatal care, slum residents, maternal mortality

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Authors: Zarish Jawad, Nikita Chugh, Karina Dadar

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Introduction: This paper aims to identify barriers indigenous women face in accessing prenatal care in Canada. It explores the differences in prenatal care received between indigenous and non-indigenous women. The objective is to look at changes or programs in Canada's healthcare system to reduce barriers to accessing safe prenatal care for indigenous women. Methods: A literature search of 12 papers was conducted using the following databases: PubMed, Medline, OVID, Google Scholar, and ScienceDirect. The studies included were written in English only, including indigenous females between the age of 19-35, and review articles were excluded. Participants in the studies examined did not have any severe underlying medical conditions for the duration of the study, and study designs included in the review are prospective cohort, cross-sectional, case report, and case-control studies. Results: Among all the barriers Indigenous women face in accessing prenatal care, the three most significant barriers Indigenous women face include a lack of culturally safe prenatal care, lack of services in the Indigenous community, proximity of prenatal facilities to Indigenous communities and costs of transportation. Discussion: The study found three significant barriers indigenous women face in accessing prenatal care in Canada; the geographical distribution of healthcare facilities, distrust between patients and healthcare professionals, and cultural sensitivity. Some of the suggested solutions include building more birthing and prenatal care facilities in rural areas for indigenous women, educating healthcare professionals on culturally sensitive healthcare, and involving indigenous people in the decision-making process to reduce distrust and power imbalances. Conclusion: The involvement of indigenous women and community leaders is important in making decisions regarding the implementation of effective healthcare and prenatal programs for indigenous women. However, further research is required to understand the effectiveness of the solutions and the barriers that make prenatal care less accessible for indigenous women in Canada.

Keywords: indigenous, maternal health, prenatal care, barriers

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