...American Hospice Patient/Family with Board Certified Music Therapy as a Component of their Plan of Care Elizabeth Joy Gifford University of San Francisco, lgiffman1@aol.com Follow this and additional works at: http://repository.usfca.edu/dnp Part of the Nursing Commons Recommended Citation Gifford, Elizabeth Joy, "The Experience of African American Hospice Patient/Family with Board Certified Music Therapy as a Component of their Plan of Care" (2009). Doctor of Nursing Practice (DNP) Projects. Paper 14. This Project is brought to you for free and open access by the Theses and Dissertations at USF Scholarship Repository. It has been accepted for inclusion in Doctor of Nursing Practice (DNP) Projects by an authorized administrator of USF Scholarship Repository. For more information, please contact zjlu@usfca.edu. COMPREHENSIVE EXAM 2 Section I: Introduction Statement of the Problem Although 60% of African Americans in the United States have stated that they would want hospice care when they are dying (AARP, 2003), they only comprise 8% of all hospice enrollees (NHPCO, 2007), despite the fact that they represent 13% of the total population in this country (U.S. Census Bureau, 2008). In fact, hospice care in this nation has always been underutilized by African Americans (Connor, Elwert, Spence, & Christakis, 2008). In the San Francisco Bay Area, among Medicare-certified hospice agencies that submit data to the State of California, only 2% of all the hospice enrollees...
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...Enhancing end-of-life care (EoLC) is a core component of international governments’ health policies. Across the globe, nurses make significant contributions to EoLC and, at this delicate time, have the power to positively influence the health and wellbeing of those facing death. Indeed, health promotion is a core component of the nurse’s role. Originating in the UK, EoLC pathways have been adopted around the world.Their broad aim is to optimise the quality of the dying process, enabling people to ‘die well’ across care settings. This paper examines EoLC pathways in terms of promoting health and wellbeing in this discrete stage of the dying trajectory. Concepts of health and health promotion are described briefly and the idea of health-promoting palliative care and its association with a good death examined. The ensuing discussion relates to two EoLC documents. While acknowledging that much has been achieved it is argued that, despite the potential for promoting health and wellbeing, a professionally led, biomedical approach predominates, and in terms of promoting health and wellbeing at the end of life there is a pressing need for proactive advance care planning at an earlier point in the illness trajectory. Key words: End-of-life care l Care pathways l Terminal care l Health promotion Michael Allen is Staff Nurse, Chemotherapy Day Unit, Singleton Hospital, Abertawe Bro- Morgannwg University Hospital Board, Swansea, Wales; Tessa Watts is Senior Lecturer, Swansea University,...
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...安寧緩和療護的道德研究與探討 中華民國一○一年六月 壹、摘要 本論文的寫作目的，主要是要探討安寧緩和療護的存在所引起道德方面上的爭議。雖然安寧病房之所以會存在，是不想讓那些得了絕症或治療過程極其痛苦的病患繼續受苦，因而放棄治療，讓他們能夠儘可能安詳的走完最後一程；但是從另一個觀點來看，安寧照護也可以被視為消極的間接殺人；若病人無法接受臨終事實，但醫護人員及家屬共同決定不告知臨終事實，依社會工作「案主自決」原則，顯有違專業倫理；當病患意願與醫療理性相左時，如何進行溝通等諸如此類議題，正相繼衝擊安寧緩和醫療團隊、臨終為不可逆事件，即使病人不願或不肯接受實情，但知的權利仍不應輕言剝奪；醫護人員及家屬應如何協商，讓病患有機會參與重大決策，不致覺得只能自己孤獨面對死亡？這些情形非常值得我們探討。 貳、何謂安寧緩和療護 根據世界衛生組織（WHO）的規範，安寧緩和醫療照顧提供罹患無法治癒疾病的病人，積極性的全方位照顧。緩和醫療照顧是肯定生命，視死亡為自然的過程，不提早也不延後死亡，積極提供疼痛及其他窘迫症狀的緩解，提供支持系統，幫助病人盡可能提升生命品質，幫助家人度過病人生病與其身後期間所遭遇的種種壓力。 叄、安寧療護的目的 安寧療護服務的目的是為生命走到末期病患及家屬提供專業團隊服務，經由完整的身、心、靈之關懷與醫療，減輕末期病患的身體疼痛、不適應症及心理壓力，對病患及家屬提供心靈扶持，輔導其接受臨終事實，陪伴病患安詳走完人生最後一程，協助家屬面對病患死亡，達到生死兩相安的境界。 安寧療護以維護末期病人的生活品質和尊嚴為主，大林慈院家醫科陳世琦醫師透露了一般醫院在診療時常常只著重結果，但是卻忽略了病人的感受。「從參與安寧療護以來，一直在學習，也深受感動。」大林慈院家醫科林名男主任表示，希望提供的安寧療護，能夠盡力改善病人的生活品質，讓病人了無遺憾地往生，而家屬也能安心。 「不是放棄，而是勇敢面對生命不可逆的進程。」長期在花蓮慈院心蓮病房服務的家醫科謝至鎠醫師，在花蓮慈院海報展上也說明了安寧療護的重要性，過去進「安寧病房」往往被誤解為「等死」，但事實上，安寧療護是藉由藥物的使用、芳香療法、中西醫照護、藝術治療等方式，用心傾聽患者的心聲，尊重每一個生命，不延長也不縮短患者的生命，讓病人在臨終的過程中帶著尊嚴。 肆、安寧照顧的重要措施 安寧照顧主要對象是末期病人，在國內僅用於癌末病人的使用； 在國外除了癌末患者之外，還包括了愛滋病的病人。這些病人除了 要面對死亡的問題之外，還必須面對身心痛苦的問題。這些問題安 寧照顧又是如何來解決。我們由前述緩和照護的定義，提供了六種措施來解決末期病人的各種問題。 (一)舒適的照護 現代醫療體糸中，無論是在手術、診斷及急救等，皆是重視病情的治癒或延續病人的生命。癌症患者在初期時，有些可以藉著手術及放射性治療而痊癒。但是，病患到了末期時，癌細胞轉移其他部位，不管醫護人員用多先進的醫療技術，也是沒辦法讓病人復原。所以對醫護人員來說容易產生極大的挫折感，而這些絕症的病人，很容易是被放棄的一群。當醫療對末期病人無效時，並不代表對他們的關懷也無效。安寧照顧重視對病人的關心及照顧，強調以照護（care）為主，並且是舒適的照護。另外，安寧照顧在硬體上有舒適的設備，備有洗澡機、休閒室、陽光室、祈禱室、佛堂、咖啡廳、意樂治療室及兒童遊樂區等設施。裏面的設備盡可能不讓病人有住在醫院的感覺，而讓病人感受像居家的環境。在軟體的設備中，安寧照顧有醫療團隊...
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...all sick through spirituality (Amitabha Hospice Service Offering Kindness & Clarity, 2000). Death rates for mother and children's were tremendously high, fewer people lived over the age of 40, and most of every resource was devoted to survival. Christianity began to spread in Europe and churches or monasteries which lead to the intake of sick and the disabled. Women who were well off or lost their husbands volunteered to work in the monasteries as care takers. During Medieval times during crusades, travelers discovered places of refuge with the nunneries as well as the monasteries. During the development of medicine and hospitals, the ill patients found treatment at these facilities but as diseases formed and the fear of outbreaks developed family members preferred for the care to take place in the home. The community would then prepare food and provide clothing for the individuals families who were taking care of them. The aftermath of WWII helped healthcare services provide better medicine for the ill which saved a lot of lives. The name hospice originated from the care of the terminally ill patients by Mme Jeanne Garnier and founded The Dames de Calaire in Lyon, France during 1842. Hospice care is an important part of health care usually according to (NHPCO - National Hospice and Palliative Care Organization, 05/1). Dame Cicely Saunders continued the hospice care services as she began her duties and established a hospice named St. Christopher's in the suburban...
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...Hospice care The main goal of hospice care is to aid patients to live their last days as alert and pain-free as possible. Hospice care attempts to manage symptoms so that the person's last days may be spent with dignity and a good quality of life. Hospice care treats the person rather than the underlying disease; it focuses on quality of life rather than length. Hospice care is family oriented; it includes the patient and the family in the care and decision making. The care is planned to cover all 24 hours of a day, and all 7 days of the week. Care is given in the home, a hospital, nursing home, or hospice facility. Hospice care is what we resort to when the patient can no longer be helped by a curative approach, and the patient is expected to live less than 6 months. Hospice is palliative care, which means that the approach is to relieve symptoms, but not to cure the disease; its main purpose is the improvement of the patient’s quality of life. The patient, his/her family and the physician decider when hospice care should begin. Hospice care is managed by an interdisciplinary care team. What it means is that the different disciplines interact and work together towards a common goal. Doctors, nurses, CNA’s, social workers, therapists, and volunteers work together to care for the patient and his/her family. All of these people offer their support based on their individual special areas. Together, they give the patient and their loved ones complete palliative care aimed...
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...Death is one of the most frightening and confusing times a person can go through. Watching a loved one pass away is also one of the hardest trials a person can experience. Many people assume that death is a time of pain and the only thing that they can do is mourn and watch their loved one fade away. But there are programs out there to help not just the dying person but also the families of the dying person. Palliative care and Hospice care are two of the programs in the U.S that are tailored to medical care, pain management, and emotional and spiritual support for the patient and family. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so. Palliative care focuses on relieving symptoms that are related to chronic illnesses, such as cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s and other dementias, AIDS, Amyotrophic Lateral Sclerosis and other neurological diseases. World Health Organization defines Palliative care as “improving the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support to from diagnosis to the end of life and bereavement” (“WHO”, 2013). Palliative care is accessed at any point during the course of a chronic illness regardless of life expectancy. It is typically provided through regular physician...
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...Running head: CANCER PAIN MANAGEMENT 1 Cancer Pain Management Lavon R. Williams University of South Alabama Running head: CANCER PAIN MANAGEMENT Cancer Pain Management Cancer is rapidly becoming a chronic illness, and an estimated that 10 million individuals in the United States are survivors of cancer (Sun, Borneman, Piper, Koczywas, & Ferrell, 2008). According to 2008, cancer statistics from the American Cancer Society, about 2 565,650 people die in the United States from cancer every year. Approximately 1.6 million new cases of cancer are expected to be diagnosed in the United States this year (American Cancer Society, 2012). This is why the health care needs of cancer patients are unique, and many are at risk for developing late or long-term side effects and pain from their primary treatments. These long-term effects may also hinder optimal physical, psychological, and cognitive functioning for patients (Sun et al., 2008). Pain is experienced by 30% to 50% of cancer patients receiving treatment and by 70% to 90% of patients with metastatic or advanced disease. In almost every cancer-related case pain is inadequately managed due to a lack of patient and professional knowledge of optimum management (Sun et al., 2008). This paper will discuss how nurses can help provide adequate pain management in advanced cancer patients. Patient and family needs Support for the patient and family may include education and information, coping skills, counseling and psychotherapy...
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...Clinical Audit An audit of subcutaneous syringe drivers in a non-specialist hospital K Dunne, K Sullivan, A Garvey, G Kernohan, A Diamond, C Duffy, J Hutchinson drug administration can facilitate the management of pain, control of nausea and vomiting, restlessness, confusion and drying secretions in the throat. Abstract T he use of syringe drivers as a method of drug delivery to control symptoms in palliative care is a common and accepted practice, but one which has evolved rather than been subject to close multiprofessional scrutiny and guideline formation. There is evidence that adverse incidents may arise as a result of syringe driver use (Medical Devices Agency (MDA), 1998), for example, errors in drug calculations, drug stability, equipment failure (including disconnection) and the wrong rate of infusion. Inadequate user training, poor servicing of equipment and inadequate documentation and record keeping are all thought to be contributing factors (MDA, 1998). In the hospital where this audit was carried out, syringe drivers are used to administer drugs to patients with cancer during the palliative phase of illness. The purpose of this clinical audit was to establish the standard of current practice in wards where syringe drivers were being used. A retrospective study of 13 cases of syringe driver use is presented. The results highlight many areas of unregulated practice with regard to setting up, monitoring and maintenance of syringe drivers. The choice of...
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...Children in Hospice Katrina Williams RES/110 April 26, 2012 Professor James Lazos Children in Hospice Research suggests that every year there are between 100,000 to 150,000 children born in the United States with a genetic disorder or defect. This represents approximately 20% of infant deaths each year. However, many of these children live to age well beyond the expectation, and some are enrolled in hospice. According to Armstrong-Daily and Zarbock (2001), “The concept of hospice today is applied to patients who are traveling through the final stages of their lives-in effect seeking shelter and comfort.” Hence, the main focus of this program is to prepare families for the death of a loved one. Although accepting these services is optional, families suddenly faced with the harsh reality that adulthood or even adolescence is not in their child’s future are in need of support services that offer much more than the comfort of a shoulder to cry on. There is an urgent need for organizations that strive to assist parents in helping the child to reach his or her full potential while encouraging loved ones to celebrate and cherish the time spent without the constant reminder that death is near. Caring for a child with a disability can be challenging. Immediately upon the child’s initial discharge from the hospital, life changes drastically. Parents are instantly bombarded with phone call from social workers, medical supply companies, and nursing staff for updates about...
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...Legal Aspects of Life Support In "Legal Aspects of Withholding and Withdrawing Life Support from Critically Ill Patients in the United States and Providing Palliative Care to Them," authors John M. Luce and Ann Alpers, present this article to increase an understanding of the legal obligation of physicians and practitioners. Studies have shown that most patients, who die in intensive care units in the United States, deaths are related to the withholding and withdrawal of life support and also the administration of palliative care. The process through which various medical interventions are withheld or removed from patients with the expectation that the patient will die of an underlying illnesses is withholding and withdrawal of life support. The prevention or treatment of pain or providing comfort during suffering in terminally ill patients is palliative care. Physicians and practitioners are bound by ethical principles of autonomy, beneficence, and nonmaleficence. This means their actions are done for the benefit of others and they must do no harm. There are laws that govern the legal aspects and requirements of these practices in which physicians and other practitioners may not be familiar. The limitations of life sustaining treatments vary from each state and are based on statutory and case law. The Fourteenth Amendment to the Constitution protects a competent person’s right to proceed with treatment which includes nutrition and hydration. The legal aspect of...
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...Hospice care The term was from the medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey. The name was first applied to specialized care for dying patients by physician Dame Cicely Saunders, who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice—St. Christopher’s Hospice—in a residential suburb of London. Sanders idea of specialized care for the dying to the United States during a 1963 visit with Yale University brought on the thought of helping the ones that couldn’t help them self and more and day were limited. To help them go in peace. It been an ongoing thing since the 1963 and still used to day Hospice is a type of care and a philosophy of care that focuses on the palliation of a terminally ill or seriously ill patient's symptoms. These symptoms can be physical, emotional, or psychosocial in nature. Hospice care focuses on bringing comfort, self-respect, and tranquility to people in the final years of life. Patients’ symptoms and pain are controlled, goals of care are discussed and emotional needs are supported. Hospice believes that the end of life is not a medical experience, it is a human experience that benefits from expert medical and holistic support that hospice offers. The concept of hospice has been evolving since the 11th century. Then, and for centuries thereafter, hospices were places of hospitality for the sick, wounded, or dying, as well as those...
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...Physician-Assisted Suicide Must Be Legalized Sheryl Tello GEN 499 Prof. David Ward March 14, 2014 Physician-Assisted Suicide Must Be Legalized Imagine that you just received a phone call from your physician’s nurse and she told you that the doctor wants to see you right away. When you ask her what is the problem; she tells you that it would be best if you came into the office as soon as possible. You tell her that there is no way that you can come in until next week; she asks if you can hold for a minute while she relays the message to your doctor, and the next thing you know your physician is on the phone and tells you that he wants to see you today. You try to rationalize everything that your physician could possibly tell you. Then you tell yourself that it cannot be too bad because you have always taken good care of your body, you eat right, you get plenty of exercise, and you see your doctor once a year. At the doctor’s office, the doctor informs you that there is no easy way of telling you that a large amount of cancer cells have been found in your blood work. As you try to speak, he continues to inform you that the cancer cells have completely taken over your blood and have migrated to your vital organs. As you try to speak again, he interrupts you one more time, however, this time it is to deliver the final blow; you only have six weeks left to live, which you will surely spend in extreme pain and unremitting suffering as your body goes into complete organ...
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...Season’s hospice. I used to work there part-time. Individuals become eligible for hospice upon reaching a 6 month or less terminal diagnosis. Individuals have the choice of dying comfortably in a hospital, nursing facility, or their home after electing hospice. Hospice care delivers palliative care to terminally ill patients. Patients with an identifiable short prognosis receive comprehensive interdisciplinary team-based palliative care through hospice in a place where they chose. There are various problems with the the design, delivery and maintenance of hospice care standards throughout the country. There are a lot of challenges facing hospice that destabilize the repute which hinders optimal care delivery. Education is the key to these issues. The potential issues in the care delivery is due to the lack of education and awareness. The Need for Change The change that is to be delivered is a broad change to improve the efficiency and thereby maximizing profits and to maintain the core values. Hospice care has a bad reputation of keeping patients too long even after their prognoses improve. There were a few cases of fraud and hospices filing bankruptcy and closing due to medicare audits investigating patient eligibility. This brought a negative light upon hospices including Seasons hospice. Even though change is difficult, there need to be steps taken to regain and reshape the trust of the public so that they will put their loved ones to the care of Seasons hospice. Additionally...
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...nurses and hospice nurses collaborate on the administration of morphine. The rationale for this question is nurses are to medically provide comfort to the dying but not assist with a rapid increase of death. Appendix B on page 28 asked the following questions: 1. What is the problem and why is it important? The problem that exist is morphine being issued to hospice patients and the medication suppresses respirations. 2. What is the current practice? The current practice is hospice patients are being ordered morphine as a standard of practice by hospice nurses and staff nurses are the practitioners who have to implement the orders. 3. What is the focus of the problem? The focus of the problem are clinical, educational. and administrative 4. How was the problem identified? Safety/Risk Management Quality Concerns Unsatisfactory Patient, Staff, or Organizational Outcomes 5. What is the scope of the problem? The scope of the problem is institution. 6. What is PICO components? P - Patient, Population, Problem - Hospice patient receiving medication as standard. The medication is noted to reduce respirations. I - Intervention - Collaborate with hospice nurses to order morphine as a individualized medication and not automatically used for protocol C - Comparison with other interventions, if applicable Research to be done to do comparison, O - Outcomes that include metrics for evaluation - The outcome of hospice staff coordinating...
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...The aim of this essay is to explore an aspect of care that a client group receives whilst in the community setting. The chosen aspect of care will be palliative care delivered to those patients who have been told they have a non-curative illness but are not yet at the end of life. The stage of the illness of the client group chosen is one where the patient is managed at home because there as there is nothing anyone can do to make things better (Calman-Hine Report 1998). The essay will also briefly describe three different professional groups involved in providing palliative care. It will then go on to discuss how good communication and collaborative working between these professional can provide the best quality of care of the patient and how poor communication can compromise the patients quality of care. Palliative care can be defined as the overall care of patients whose disease does not respond to curative treatment. The aim of Palliative care is to improve as much as possible the quality of life of patients and their families facing a life-threatening illness. This can be achieved by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to bereavement (WHO 2002). Patients with life threatening illness may require care from a variety of different specialists and services at a number of points in their illness; this will include both statutory and non-statutory organisations (National Health Service Executive 1998). To ensure that all...
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