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Patynowska KA, McConnell T, McAtamney C, Hasson F. 'That just doesn't feel right at times' - lone working practices, support and educational needs of newly employed Healthcare Assistants providing 24/7 palliative care in the community: A qualitative interview study. Palliat Med 2023; 37:1183-1192. [PMID: 37334445 PMCID: PMC10503246 DOI: 10.1177/02692163231175990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Healthcare assistants working in hospice at home settings have a pivotal role in supporting people dying at home and their family caregivers. Some healthcare assistants are working alone in patients' homes, which magnifies some of the issues reported for those working closely with other team members. There is a dearth of evidence in terms of education, training and support needs for healthcare assistants when working alone. AIM To explore the role of newly employed lone working healthcare assistants delivering palliative care in the community, and their support and educational needs. DESIGN Qualitative exploratory study using semi-structured interviews. SETTING/PARTICIPANTS Healthcare assistants (n = 16) employed less than 12 months by a national non-profit hospice and palliative care provider located across the UK. RESULTS Analysis of interviews identified three main themes: (1) Healthcare assistants have a unique and complex role catering for holistic needs of patients and their family caregivers in the home environment; (2) preparation for the complex role requires focus on experiential learning and specific training to support holistic care provision; (3) lone workers experience loneliness and isolation and identify peer support as a key intervention to support their wellbeing. CONCLUSIONS Given the complexities of their role within community palliative care teams, there are key learning points in relation to healthcare assistant preparation. Education and support networks should be prioritised to reduce isolation and support ongoing learning and development of newly employed healthcare assistants; all of which is vital to ensure safety and quality of care for the growing number of people they support in the community.
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Affiliation(s)
| | - Tracey McConnell
- Marie Curie Hospice Belfast, Belfast, UK
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, Belfast, UK
| | | | - Felicity Hasson
- Institute of Nursing and Health Sciences, School of Nursing and Paramedic Sciences Ulster University, Belfast Campus, UK
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Hanna JR, McConnell T, Harrison C, Patynowska KA, Finucane AM, Hudson B, Paradine S, McCullagh A, Reid J. 'There's something about admitting that you are lonely' - prevalence, impact and solutions to loneliness in terminal illness: An explanatory sequential multi-methods study. Palliat Med 2022; 36:1483-1492. [PMID: 36081273 PMCID: PMC9749015 DOI: 10.1177/02692163221122269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Loneliness is a prevalent societal issue and can impact on a person's physical and mental health. It is unclear how loneliness impacts on end of life experiences or how such feelings can be alleviated. AIM To explore the perceived prevalence, impact and possible solutions to loneliness among people who are terminally ill and their carers in Northern Ireland through the lens of health and social care professionals. DESIGN An explanatory multi-method study. SETTING/PARTICIPANTS An online survey (n = 68, response rate 30%) followed by three online focus groups with palliative and end of life care health and social care professionals (n = 14). Data were analysed using descriptive statistics and thematic analysis. RESULTS Loneliness was perceived by professionals as highly prevalent for people with a terminal illness (92.6%) and their carers (86.8%). Loneliness was considered a taboo subject and impacts on symptoms including pain and breathlessness and overall wellbeing at end of life. Social support was viewed as central towards alleviating feelings of loneliness and promoting connectedness at end of life. Four themes were identified: (1) the stigma of loneliness, (2) COVID-19: The loneliness pandemic (3) impact of loneliness across physical and mental health domains and (4) the power of social networks. CONCLUSION There is a need for greater investment for social support initiatives to tackle experiences of loneliness at end of life. These services must be co-produced with people impacted by terminal illness to ensure they meet the needs of this population.
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Weetman K, Dale J, Mitchell SJ, Ferguson C, Finucane AM, Buckle P, Arnold E, Clarke G, Karakitsiou DE, McConnell T, Sanyal N, Schuberth A, Tindle G, Perry R, Grewal B, Patynowska KA, MacArtney JI. Communication of palliative care needs in discharge letters from hospice providers to primary care: a multisite sequential explanatory mixed methods study. Palliat Care 2022; 21:155. [PMID: 36064662 PMCID: PMC9444706 DOI: 10.1186/s12904-022-01038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background The provision of palliative care is increasing, with many people dying in community-based settings. It is essential that communication is effective if and when patients transition from hospice to community palliative care. Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges. Methods An explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. Discharge letters were extracted for key content information using a standardised form. Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Thematic analysis was used to analyse the focus group transcripts. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care. Results We sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Twenty-five staff took part in focus groups. The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. The extent to which patients received a copy of their discharge letter varied. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”. Conclusions The content and structure of discharge letters varied between hospices, although generally focused on physical needs. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. A patient-centred set of hospice-specific discharge letter principles could help improve future practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01038-8.
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Affiliation(s)
- Katharine Weetman
- Interactive Studies Unit, Institute of Clinical Sciences, Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK. .,Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Claire Ferguson
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | - Anne M Finucane
- Marie Curie Hospice Edinburgh, Edinburgh, UK.,The University of Edinburgh School of Health in Social Science, Clinical Psychology, Edinburgh, UK
| | - Peter Buckle
- Marie Curie Research Voices Group, Marie Curie, England, London, UK
| | | | - Gemma Clarke
- Marie Curie Hospice Bradford, Bradford, UK.,University of Leeds, Academic Unit of Palliative Care, Leeds, West Yorkshire, UK
| | | | - Tracey McConnell
- Marie Curie Hospice Belfast, Belfast, UK.,Queen's University Belfast School of Nursing and Midwifery, Belfast, UK
| | - Nikhil Sanyal
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | | | - Georgia Tindle
- Marie Curie Hospice Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Rachel Perry
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | | | | | - John I MacArtney
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.,Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
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