scholarly journals P020: Paramedic comfort with providing palliative support: pre-implementation survey

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S84-S85
Author(s):  
A. Carter ◽  
M. Arab ◽  
M. Harrison ◽  
J. Goldstein ◽  
J. Jensen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Crisis Management ◽  
Online Survey ◽  
Training Session ◽  
Likert Scale ◽  
Point Scale ◽  
Goals Of Care ◽  
And Training ◽  
Healthcare Need ◽  
Do So

Introduction: Paramedics are sometimes called for crisis management and relief of symptoms or for patients receiving palliative care. To address the mismatch between the system protocols and resources, and patient’s goals of care, a new protocol, new medications, and an 8-hour training program Learning Essentials Approach to Palliative Care (LEAP) were implemented in our provincial EMS system. Methods: Prior to attending their training session paramedics received an invitation to complete an online survey regarding their comfort, confidence, and attitudes toward delivering palliative care. Comfort and confidence questions were scored on a 4-point Likert scale, while attitudes toward specific aspects of care were scored on a 7-point Likert scale. Descriptive statistics were calculated. Identifiers will permit linkage of these responses to a repeat survey post-implementation. Results: 188 (58%) paramedics completed the survey of the 325 who opened the link. 134 (68%) were male with a mean age of 38.5 years. 95 (50%) were primary care paramedics. The average experience as a paramedic was 12.7 years, with an estimated mean number of palliative calls per year of 9.6 each. On a 4 point scale, most (156, 83%) were comfortable with providing care to someone with palliative goals, and 130 (69.1%) were comfortable providing care without transport. Only 82 (43.6%) were confident they had the tools to deliver this care, and 76 (40.4%) were confident they could do so without transport to hospital. On a 7 point scale, paramedics disagreed with the statement “caring for dying persons is not a worthwhile experience for me”, median 7 (IQR 5-7). Paramedics also disagreed with the statement “Dying persons make me feel uneasy”, median 5 (IQR 4-6). Conclusion: Prior to the implementation of the new protocol, medications, and training, most paramedics were comfortable with the concept of providing care with palliative goals and felt that caring for dying persons is a worthwhile experience, but they were not confident that they have the tools and resources to do so. This suggests paramedics would be open to system improvements to meet an unmet healthcare need for crisis management of patients with palliative goals of care.

scholarly journals Physical activity counselling in Ireland: a survey of doctors’ knowledge, attitudes and self-reported practice

2019 ◽  
Vol 5 (1) ◽  
pp. e000572 ◽  
Author(s):  
Sarah O'Brien ◽  
Lucia Prihodova ◽  
Mairéad Heffron ◽  
Peter Wright
Keyword(s):  
Physical Activity ◽  
General Practitioners ◽  
Royal College ◽  
Patient Preference ◽  
Online Survey ◽  
Response Rate ◽  
Further Education ◽  
Pharmaceutical Intervention ◽  
And Training ◽  
Do So

ObjectivePhysical activity (PA) counselling has been shown to raise awareness of the importance of PA and to increase the rate of PA engagement among patients. While much attention has been paid to examining the knowledge, attitudes and practice of general practitioners in relation to PA counselling, there is less literature examining such issues in hospital-based doctors in Ireland and further afield. This study aimed to explore doctors’ PA counselling practices and to analyse how this related to their level of PA knowledge, training and attitudes.MethodsAn invitation to participate in an online survey was sent to 4692 members of the Royal College of Physicians of Ireland who were listed as having an address in Ireland. Descriptive and explorative analyses of the data were performed using IBM SPSS V.22.0.ResultsA total of 595 valid responses were included (response rate 12.7%; 42.7% male, 42.6±12.1 years). The majority reported enquiring about PA levels (88.0%) and providing PA counselling (86.4%) in at least some of their patients. Doctors who saw it as their role and those who felt more effective/confident in providing PA counselling were significantly more likely to do so. A perceived lack of patient interest in PA and patient preference for pharmaceutical intervention were significant barriers to undertaking PA counselling.ConclusionThis study demonstrates the need for further education and training in PA counselling in Ireland with a particular focus on improving the attitudes and self-efficacy of doctors in this area at both undergraduate and postgraduate levels.

Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients

2019 ◽  
Vol 36 (8) ◽  
pp. 669-674 ◽  
Author(s):  
Holly B. Cunningham ◽  
Shannon A. Scielzo ◽  
Paul A. Nakonezny ◽  
Brandon R. Bruns ◽  
Karen J. Brasel ◽  
...  
Keyword(s):  
Palliative Care ◽  
Geriatric Patients ◽  
Care Physician ◽  
Physician Attitudes ◽  
The Other ◽  
Goals Of Care ◽  
Care Community ◽  
Trauma Surgeons ◽  
Better Than ◽  
Do So

Background: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties’ attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty’s ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so. Methods: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine. Results: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions. Conclusions: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.

scholarly journals P024: Physician reporting of medically unfit drivers: knowledge, attitudes, and practice

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S85-S86
Author(s):  
J.R. Brubacher ◽  
C. Renschler ◽  
B. Huang ◽  
W.C. Lee ◽  
A.M. Gomez ◽  
...  
Keyword(s):  
Public Health ◽  
Motor Skills ◽  
Online Survey ◽  
Public Health Problem ◽  
Fitness To Drive ◽  
Physician Knowledge ◽  
Unfit Patients ◽  
And Training ◽  
Potential Public Health ◽  
Do So

Introduction: Medical conditions that impair perception, cognition or motor skills may make people unfit to drive. Reporting unfit drivers to licensing authorities is seen by many as a public health obligation. This study investigates physician knowledge, attitudes and practice around the management of medically unfit drivers. Methods: We used an online survey to explore physician knowledge of fitness to drive issues and their attitudes and practice with regard to counselling and reporting unfit drivers. Email invitations to participate in the survey were sent to all physicians in BC through DoctorsofBC and to all emergency physicians (EPs) in the UBC Department of Emergency Medicine. Results: We received responses from 242 physicians (47% EPs, 40% GPs, 13% others). The majority (78%) reported little/no knowledge on determining driver fitness and 94% had little/no training around guidelines, reporting, and laws involving fitness to drive. Most (88%) agreed that physicians should be obligated to advise medically unfit patients not to drive, and 74% reported that they often warn patients not to drive. The majority of physicians also chart their opinion of patients’ fitness to drive (67% do so more than twice per year). Most respondents (70%) indicated that it is “always appropriate” to report definitely unfit drivers whereas only 25% indicated that it is “always appropriate” to report potentially unfit drivers. However, in practice physicians see far more unfit drivers than they report to licensing authority: 67% of physicians encounter definitely unfit drivers more than twice per year but only 19% report definitely unfit drivers more than twice per year and 34% never report definitely unfit drivers. Compared to other physicians, EPs reported less knowledge and training about criteria for determining fitness to drive, were more likely to feel that reporting unfit drivers was not their responsibility, and were less likely to report unfit drivers to licensing authorities. Conclusion: Our findings indicate a need for more education and information resources to help physicians, particularly EPs, identify and manage medically unfit drivers. Although most physicians warn unfit drivers not to drive and document this in medical records, many medically unfit drivers are not reported to licensing authorities, a potential public health problem that should be further investigated.

scholarly journals Reporting the Asian tsunami: Ethical issues

2005 ◽  
Vol 11 (2) ◽  
pp. 151-167 ◽  
Author(s):  
James Hollings
Keyword(s):  
New Zealand ◽  
Online Survey ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Codes Of Ethics ◽  
Likert Scale ◽  
Ethical Approach ◽  
2004 Tsunami ◽  
And Training

This article explores the ethical issues faced by New Zealand journalists reporting a disaster. Journalists who travelled to Asia to report on the 2004 tsunami were asked to complete an online survey containing a mixture of Likert scale and open-ended questions. Of the 20 journalists known to have travelled to Asia to cover the tsunami, 13, or 65 percent, took part in the survey. Many were confronted with ethical dilemmas. These problems were compared to the literature on reporting disasters, and triangulated through a one-on-one interview with a psychologist working with survivors of the tsunami. This comparison raised further issues not mentioned by the respondents. A second survey was sent out to elicit responses to these further issues. Four out of 20 replied, and their responses were compared to the literature and to the relevant codes of ethics. The results suggest New Zealand journalists have a strongly ethical approach but that there is a lack of awareness of some significant ethical issues. This indicates the level of support and training given to those covering such events needs revision. Further research on the issues raised would be fruitful.

scholarly journals P011: Discerning perceived barriers and facilitators to goals of care discussion in the emergency department: A survey of emergency physicians and residents

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S81
Author(s):  
N. Argintaru ◽  
S. Vaillancourt ◽  
L.B. Chartier ◽  
J.S. Lee ◽  
E. O’Connor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Online Survey ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Emergency Physicians ◽  
Urban Centre ◽  
Advanced Directives ◽  
Goals Of Care ◽  
Competing Priorities

Introduction: Patients presenting to the Emergency Department (ED) may require clarification of their goals of care (GOC) to ensure they receive treatments aligned with their values. However, these discussions can be difficult to conduct for multiple reasons, including lack of time in a busy ED, competing priorities and a limited relationship with the patient. Few studies have examined the perceived challenges faced by Emergency Physicians in conducting GOC discussions. This study sought to contextualize and discern the barriers and facilitators to having these conversations as reported by Emergency physicians. Methods: An interdisciplinary team of Emergency Medicine, Palliative Care and Internal Medicine providers developed an online survey comprised of multiple choice, Likert-scale and open-ended questions to explore four domains of GOC discussions: training; communication; environment; and personal beliefs. Invitations and scheduled reminders were sent to 275 ED physicians at six academic sites in a Canadian urban centre, including 49 EM residents. Results: 105 (46%) staff physicians and 23 (47%) residents responded with similar representation from all sites. Differences were reported in the frequency of GOC discussions: 59% of staff physicians conduct several per month whereas 65% of residents conduct less than one per month. Most agreed that GOC discussions are within their scope of practice (92%), they feel comfortable (96%), and are adequately trained (73%) to have them; however, 66% reported difficulty initiating GOC discussions. 73% believed that admitting services should conduct GOC discussions, yet acuity was noted in the comments as a major determinant with initiating GOC discussions by ED physicians. Main barriers identified were lack of time, chaotic environment, lack of advanced directives and the inability to reach substitute decision makers. 54% of respondents indicated that the availability of 24-hour Palliative Care consults would facilitate GOC discussions in the ED. Conclusion: Emergency physicians are prepared to conduct goals of care discussions, but often believe they should instead be conducted by the patient’s admitting service. Multiple perceived barriers to goals of care discussion in the ED were identified, and a majority of respondents felt that the availability of Palliative Care in the ED may facilitate these discussions.

Much Ado About Fried Chicken: Abetting Aspiration or Respecting Autonomy?

2019 ◽  
Vol 28 (3) ◽  
pp. 1356-1362
Author(s):  
Laurence Tan Lean Chin ◽  
Yu Jun Lim ◽  
Wan Ling Choo
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Multidisciplinary Team ◽  
Biopsychosocial Model ◽  
Family Members ◽  
Clinical Decisions ◽  
Goals Of Care ◽  
Complex Needs ◽  
Aspiration Risk ◽  
Patient Centric

Purpose Palliative care is a philosophy of care that encompasses holistic, patient-centric care involving patients and their family members and loved ones. Palliative care patients often have complex needs. A common challenge in managing patients near their end of life is the complexity of navigating clinical decisions and finding achievable and realistic goals of care that are in line with the values and wishes of patients. This often results in differing opinions and conflicts within the multidisciplinary team. Conclusion This article describes a tool derived from the biopsychosocial model and the 4-quadrant ethical model. The authors describe the use of this tool in managing a patient who wishes to have fried chicken despite aspiration risk and how this tool was used to encourage discussions and reduce conflict and distress within the multidisciplinary team.

Levinas as a Reader of Jewish Texts

2018 ◽  
pp. 442-458
Author(s):  
Ethan Kleinberg
Keyword(s):  
Reading Strategies ◽  
Related Issue ◽  
Written Texts ◽  
The Holocaust ◽  
Historical Moment ◽  
And Training ◽  
Do So

This article attempts to understand Levinas as a reader of Jewish texts, with particular attention paid to his Talmudic commentaries. To do so, the entangled relation between oral and written texts is explored; one must be able to properly “read” but also “write,” and there is the related issue of the methodology and training to be able to do so properly. Levinas offers commentary on each issue. Several interpretations of Talmudic texts and an important discussion of reading Scripture are analyzed in order to elucidate Levinas’s reading strategies, what this tells us about his relation to the larger tradition of Talmudic commentary, and Levinas’s particular historical moment, especially the role of the Holocaust for his approach to reading the Talmud and traditional texts.

scholarly journals Burnout Determinants among Nurses Working in Palliative Care during the Coronavirus Disease 2019 Pandemic

2021 ◽  
Vol 18 (7) ◽  
pp. 3358
Author(s):  
José Vítor Gonçalves ◽  
Luísa Castro ◽  
Guilhermina Rêgo ◽  
Rui Nunes
Keyword(s):  
Palliative Care ◽  
Health Care Professionals ◽  
Online Survey ◽  
Three Dimensions ◽  
Linear Regression Models ◽  
Perceived Health Status ◽  
Cross Sectional ◽  
National Network ◽  
Work Related ◽  
High Level

Nurses working in palliative care are at risk of burnout. The Copenhagen Burnout Inventory was used to determine burnout levels of nurses working in the Portuguese national network of palliative care. We evaluated the contribution of personal, work, and COVID-19 variables in three burnout subclasses: personal, work, and patient-related. A cross-sectional, exploratory, and quantitative design was employed and participants were sampled using convenience and snowball technique. An online survey was conducted and 153 nurses participated in our study. Socio-demographic characterization was conducted, levels of burnout and determinants were explored through multiple linear regression models for its three dimensions. High levels of personal, working, and patient burnout were present in 71 (46%), 68 (44%), and 33 nurses (22%), respectively. Most of them agreed that COVID-19 had an impact on their activities. Significant personal and work related burnout factors found were specialization in palliative care, self-perceived health status, unit type, weekly hours of work, and allocation to COVID-19 units. Gender was found to be a significant factor in patient-related burnout. There is a high level of burnout among nurses working in the Portuguese national network of palliative care. Measures for identification and mitigation of burnout are necessary to protect health care professionals.

scholarly journals Crisis Communication Preparedness Practices Among U.S. Charitable Organizations: Results From a National Survey

SAGE Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 215824402110145
Author(s):  
Ryan P. Fuller ◽  
Antonio La Sala
Keyword(s):  
Nonprofit Organizations ◽  
Crisis Management ◽  
Crisis Communication ◽  
Online Survey ◽  
Word Of Mouth ◽  
Negative Word ◽  
Organizational Crisis ◽  
Crisis Planning ◽  
Charitable Organizations ◽  
Major Stakeholder

Organizations should prepare for crises, through identifying crisis concerns, having written crisis communication plans, and designating teams for crisis planning and response, for example. Nonprofit organizations, which represent an important sector of U.S. society, are no different in needing to prepare, but to date, a review of their crisis communication preparedness is lacking. Therefore, a national online survey of 2,005 U.S. charitable organizations was administered to determine nonprofit organizations’ adoption of an anticipatory perspective of crisis management. The anticipatory perspective shifts the organization’s focus from reaction to crises to anticipation of them. According to the survey, 75% of organizations reported at least one organizational crisis in the 24 months prior to taking the survey (circa 2017–2019). Loss of a major stakeholder was the most common organizational crisis that had occurred and the greatest future concern. Most nonprofits (97.5%) reported implementing some crisis communication preparedness tactics. Importantly, charitable organizations can enact communication preparedness tactics without significantly detracting from program delivery. Moreover, given the general concerns within the sector, nonprofit organizations should prepare specifically for loss of a major stakeholder and technologically created crises such as data breaches and negative word of mouth on social media.

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