Hospice Family Caregiver Perceptions of Benefits and Challenges of a Telenovela Educational Intervention

Background: Telenovelas show significant promise as a mode of education that could potentially enhance hospice family caregivers' (HFCG) ability to manage distress or pain for themselves and the care recipient. Objectives: We sought to understand HFCGs' perceived benefits and challenges of NOVELA using the Levels of Kirkpatrick as a conceptual framework. Setting/Subjects: HFCGs from two hospices in the Mid-Atlantic region of the United States. Measurements: Semistructured interviews were conducted to understand perceptions of HFCGs on the benefits and challenges of the NOVELA intervention. Results: Participants (N = 20) in our study were mainly homebound, well educated, White female, and adult children of people with advanced cancer who reported mild anxiety and moderate self-efficacy at baseline. Three unique themes were identified: acceptability of NOVELA, usability and relevance of NOVELA, and the effect of NOVELA. According to our conceptual model, the intervention positively affects all three adult learning categories: reaction, learning, and behavior. Conclusion: Our findings suggest that HFCGs support the proposed NOVELA intervention and it appears to be an acceptable educational tool during hospice care (NCT04533594).

Defining Core Competencies for Generalist-Level Palliative Social Work

CONTEXT

Care provided to seriously ill patients by frontline social workers is a component of generalist-level palliative care. The core competencies for high-quality generalist-level palliative social work are necessary to promote training curricula and best practices but have not yet been defined in the U.S.

OBJECTIVE

The objective of this study was to develop consensus-derived core competencies for generalist-level palliative social work.

METHODS

Fifty-five proposed social work competencies were categorized by the eight domains of palliative care identified by the National Consensus Project for Quality Palliative Care. The competencies were rated by 41 regionally dispersed, Master's level social workers selected through purposive and snowball sampling using a Delphi method. Each was rated as essential for generalist-level palliative social work, acceptable with modifications, or rejected based on the judgment that it was not essential for generalist-level palliative social work or was outside the scope of practice. Consensus was defined as >70% agreement to accept or reject a competency. Three review rounds were needed to achieve consensus on all competencies.

RESULTS

Two competencies were added to the original list. Of the 57 proposed competencies, 41 were accepted (19 after modification) and 16 were rejected. Competencies in the social, spiritual, cultural, and ethical/legal aspects of care domains were relatively more likely to be accepted compared with those in structure and processes of care, physical care, psychological care, and care of patient at the end of life.

CONCLUSION

The 41 consensus-derived competencies for generalist-level palliative social work may inform the development of training curricula and standards for high-quality care.

Communicating Caregivers' Challenges With Cancer Pain Management: An Analysis of Home Hospice Visits

CONTEXT

Family caregivers (FCGs) of hospice cancer patients face significant challenges related to pain management. Addressing many of these challenges requires effective communication between FCGs and hospice nurses, yet little empirical evidence exists on the nature of communication about pain management between hospice nurses and FCGs.

OBJECTIVES

We identified ways in which FCGs of hospice cancer patients communicated their pain management challenges to nurses during home visits and explored nurses' responses when pain management concerns were raised.

METHODS

Using secondary data from audio recordings of hospice nurses' home visits, a deductive content analysis was conducted. We coded caregivers' pain management challenges and immediate nurses' responses to these challenges.

RESULTS

From 63 hospice nurse visits, 101 statements describing caregivers' pain management challenges were identified. Thirty percent of these statements pertained to communication and teamwork issues. Twenty-seven percent concerned caregivers' medication skills and knowledge. In 52% of the cases, nurses responded to caregivers' pain management challenges with a validating statement. They provided information in 42% of the cases. Nurses did not address 14% of the statements made by caregivers reflecting pain management challenges.

CONCLUSION

To optimize hospice patients' comfort and reduce caregivers' anxiety and burden related to pain management, hospice nurses need to assess and address caregivers' pain management challenges during home visits. Communication and educational tools designed to reduce caregivers' barriers to pain management would likely improve clinical practice and both patient- and caregiver-related outcomes.

The Social Construction of the “Dying Role” and the Hospice Drama

The social construction of a “dying role” is emerging in response to terminal illness for which the “sick role” is no longer functional. When people are in the process of dying, in the absence of a “dying role,” they take on the rights and responsibilities of the “sick role” to which they have been socialized. This is problematic for the individual who will not get well no matter how hard the effort. Hospice, a professional community with a central purpose of bringing the drama of dying to an appropriate close, marks the transition from a sick role to a dying role. This article looks at how the hospice community directs this transition and redefinition of self for the dying and significant others. Utilizing the symbolic interactionist and phenomenlogical perspective and the sick role theory of Talcott Parsons, this view of the drama is demonstrated through stories of hospice patients.

The physician's role in patients' nursing home care: "She's a very courageous and lovely woman. I enjoy caring for her"

More than 1.5 million adults live in US nursing homes, and approximately 30% of individuals in the United States will die with a nursing home as their last place of residence. Physicians play a pivotal role in the rehabilitation, complex medical care, and end-of-life care of this frail and vulnerable population. The reasons for admission are multifactorial and a comprehensive care plan based on the Minimum Data Set guides the multidisciplinary nursing home team in the care of the patient and provides assessments of the quality of care provided. Using the cases of 2 patients with different experiences, we describe the physician's role in planning for admission, participating as a team member in the ongoing assessment and care in the nursing home, and guiding care at the end of life. The increasing population of older adults has also promoted community-based and residential alternatives to traditional nursing homes. The future of long-term care will include additional challenges and rich innovations in services and options for older adults.

The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents

BACKGROUND

Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS Mortality Rating Index (MMRI) for use in clinical practice to predict the probability of death in six months for care home residents.

METHODS

The design was a secondary analysis of a US Minimum Data Set (MDS) for long term care residents using regression analysis to identify predictors of mortality within six months.

RESULTS

Using twelve easy to collect items, the probability of mortality within six months was accurately predicted within the MDS database. The items are: admission to the care home within three months; lost weight unintentionally in past three months; renal failure; chronic heart failure; poor appetite; male; dehydrated; short of breath; active cancer diagnosis; age; deteriorated cognitive skills in past three months; activities of daily living score.

CONCLUSION

A lack of recognition of the proximity of death is often blamed for inappropriate admission to hospital at the end of an older person's life. An accurate prognosis for older adults living in a residential or nursing home can facilitate end of life decision making and planning for preferred place of care at the end of life. The original MMRI was derived and validated from a large database of long term care residents in the USA. However, this simplification of the revised index (MMRI-R) may provide a means for facilitating prognostication and end of life discussions for application outside the USA where the MDS is not in use. Prospective testing is needed to further test the accuracy of the MMRI-R and its application in the UK and other non-MDS settings.

Videophone Communication Between Residents and Family: A Case Study

OBJECTIVES

This case study examines the uses, perceived advantages and disadvantages, and expectations of videophone communication by a nursing home resident and a geographically distant family member.

METHODS

Interviews were conducted with these participants, one in person and one by phone.

RESULTS

Themes identified suggest that, with the added visual component, there are additional uses and psychosocial benefits of videophone communication when compared to the telephone for both nursing home residents and family members.

CONCLUSION

The study suggests that the use of the technology is not only feasible in an institutional setting but also beneficial. Further research with larger groups is supported.

Social work informatics: a new specialty

The use of technology in social work practice has risen dramatically over the past 10 years. Clinical interventions such as psychotherapy using telephones, interactive video, and the Internet are gaining in popularity. For a discipline traditionally tied to face-to-face interaction, many concerns about moving to technology-based practices have been raised. The National Association of SocialWorkers recently embraced a new initiative to address the challenges associated with technology in practice.The authors propose social work informatics as a new specialty for the profession to assist in meeting those challenges.

Examining variables related to successful collaboration on the hospice team

Although social work participation on interdisciplinary teams is long-standing, little research has been done to examine its effectiveness. This study used the Index of Interdisciplinary Collaboration to explore relationships between selected variables and teamwork in the hospice setting. The findings indicate that hospice social workers report a high level of interdisciplinary collaboration with colleagues. Whereas education, hospice census, the presence of other social workers, and quality of care were found to be unrelated to overall levels of collaboration, individual items measuring collaboration proved to be linked with hospice census, the presence of other social workers on the team, and quality of care. Further research is required to investigate other possible related variables and their impact on successful interdisciplinary collaboration and service delivery.

Hospice and nonhospice nursing home residents

OBJECTIVE

To compare hospice residents in nursing homes with residents who are noted as end-stage, but not in hospice programs.

DESIGN

Descriptive comparison of the outcomes reported on Minimum Data Set (MDS) for all residents admitted to Missouri nursing homes in 1999.

SETTING

Nursing homes.

PARTICIPANTS

Residents of nursing homes designated as either hospice or end-stage on admission MDS.

MEASUREMENTS

Percentage of hospice residents having various conditions as compared with other end-stage residents.

RESULTS/CONCLUSIONS

Overall the clinical conditions of both hospice and nonhospice end-stage residents were similar. A greater percentage of hospice residents were found to have living wills, DNR orders, and cancer, and to be in moderate or severe pain. Hospice and nonhospice residents experienced similar time from admission to death or discharge (20 and 36 days, respectively). Based on the clinical condition of the two groups, it would appear that there are limited clinical reasons for the low utilization of the hospice benefit in nursing homes. The increased prevalence of advance care planning may lead toward use of hospice or may result from hospice enrollment. Hospice services seem to be thought of more frequently for residents with cancer and residents experiencing pain. Nursing homes must recognize their role as caregivers to the dying before palliative care is seen as a need for nursing home residents. Nursing homes need education in determining when a patient is appropriate for palliative care as only 4% are designated as end of life, and only 2% are shown to be receiving hospice care in hospice-contracted facilities.

Hospice experience and perceptions in nursing homes

The purpose of this study was to describe the experiences and perceptions of hospice nurses caring for residents in long-term care facilities. The study used a fax-back survey to gather data from 69 hospice nursing and nurse managers in 24 hospices across one Midwestern state. Respondents reported negative experiences with pain management and care coordination in the nursing home setting. Although hospice is thought to be a benefit to residents, hospice staff report frustration in caring for nursing home patients, especially in trying to control pain. The study identifies opportunities for improvement in hospice and nursing home staff relationships.

Redefining hope for the terminally ill

This paper discusses how hospice social workers assist patients and families in finding new hope and meaning in their lives as care goals turn from cure to comfort. Assessment factors important to the redefinition process and intervention strategies are explored. Hope is defined as the positive expectation for meaning attached to life events with the emphasis on meaning instead of life events. The author seeks to demonstrate the importance of meaning to the feeling of hope and the possibility of socially constructing meaning to alleviate the traditional medical perspective that hope revolves around the outcome of disease.

Nursing home experience with hospice

OBJECTIVE

Much has been written regarding the problems of terminally ill people residing in nursing homes. Hospice care is one option these facilities have to assist in managing dying patients. The purpose of the study was to explore the knowledge base, experience, and attitudes of nursing home management with and toward hospice care.

DESIGN

A descriptive study that involved phone interviews of a systematic random sample of management personnel in nursing homes to explore their experiences with hospice care.

SETTING

Nursing homes.

PARTICIPANTS

60 administrators and directors of nursing (DON) from 42 nursing homes in Missouri.

MEASUREMENTS

Measurements included overall experience with hospice, the benefit of hospice to residents, specific experiences with hospice service, knowledge of hospice regulation and reimbursement, and perception of pain assessment skills.

RESULTS

Results show that management personnel believe that hospice was positive and valuable for residents. Concerns included the frequency and availability of hospice services for nursing home residents, especially in rural areas. Nursing home management claimed that hospice was knowledgeable in pain management, yet when measured, pain management skills ranked 2.1 on a scale of 1 to 5 (1 being the best). Community and physician understanding of hospice was identified as a major barrier for residents.

CONCLUSIONS

While the results indicate a positive overall experience, a number of shortcomings are identified. The study points to opportunities for improvement in hospice/nursing home relationships. It also identifies opportunities for hospices and nursing homes to educate their medical directors in an effort to obtain active participation in the identification of patients for palliative care. In addition, the need for medical directors to assist in the education of nursing home staff regarding hospice services and benefits is indicated. Specifically, medical directors can educate nursing home staff on care plan responsibilities with hospice patients and other regulatory issues.

Practice patterns of hospice medical directors in a Midwestern state

This study of hospice medical directors was conducted in a Midwestern state with the help of the state hospice organization in the summer of 1998. The hospice programs in this state were young and relatively small. While having practiced medicine for many years, the majority of hospice medical directors had been affiliated with a hospice program for less than five years. The programs reported little orientation or continuing education for their physician leaders. Pain management practices were analyzed and compared with practice standards in the hospice pain management literature. Attitudes on the scheduled dosing of opioids, use of adjuvant medications for bone pain, the assessment of pain by the patient, and physician comfort with high doses of morphine are consistent with suggested standards and attitudes in the literature. Practice patterns that differed with the literature included choice of drugs, routes of administration, and dosing issues. Opportunities exist to improve care and lower cost.