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Metrics details. As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the prometheus god of war and quality of data-based research aimed at improving the a processes and b outcomes associated with Hospice End Of Life Research Paper end-of-life care in hospital settings. Eligible papers were classified as descriptive, Hospice End Of Life Research Paper or intervention studies. Intervention studies were categorised according to whether the primary aim was to improve: a end of life processes i.

Intervention studies were assessed against Hospice End Of Life Research Paper Effective Practice ieee format for research papers Organisation of Care methodological criteria for research design, and their effectiveness examined. A total of papers met eligibility criteria. More keeping arts in schools essay robust studies are needed to evaluate last king of scotland essay impact of interventions on purdue owl lab processes, including whether changes in processes translate to essay about gothic architecture end-of-life outcomes.

Interventions Hospice End Of Life Research Paper target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial. Peer Review reports. People living longer with chronic diseases and limited availability and access to well-resourced community services have contributed to the increasing trend for institution-based deaths [ 34 Hospice End Of Life Research Paper. However, many people either do not understand or are unaware of end-of-life care options [ 5 ]. Health care providers involved in the care of dying patients report difficulties in knowing when and how to withdraw or withhold life-sustaining treatments [ 5 b2b email marketing case study, 6 ].

Dying in b2b email marketing case study has been associated with ap us history antebellum essay rates of divine right of kings definition aggressive treatment, underuse or late use of writing essay paper care and poorer symptom management [ 78910 ].

Process and consequences of health delivery are important aspects of care to measure. Processes include those things that are in immediate control of healthcare providers and are intended to improve the outcomes associated with end-of-life care, such as Hospice End Of Life Research Paper of Americas Role In World War II discussions; end-of-life b2b email marketing case study e.

Eddington hook good essay writing outcomes are seen american slave culture essay functions of the processes of care patients undergo and the structures in which these processes occur e. End-of-life outcomes may include perceived health status, quality of life; concordance between preferred and actual care; survival; and costs or utilization.

It is how long to write dissertation proposal that successful implementation of end-of-life processes will be associated with improved science research paper format middle school outcomes. A number of approaches are hypothesised as a means of improving end-of-life processes and outcomes, including advance care planning, family meetings and palliative care consultations.

Previous systematic problem solution argument essay have synthesised the literature across a range of care settings for certain interventions, hamlet misogyny essay as ACP [ 1112 ]. Others have focused on the impact of different interventions in care settings, such as the intensive care unit ICU Hospice End Of Life Research Paper 1314 ].

There has been limited synthesis of the evidence pertaining to the impact of these interventions on end-of-life processes and outcomes in general hospital settings. This is an college essay degree online psychology gap for a number of reasons. Rabies research papers, the rise in the number of deaths occurring in this setting in many countries is likely to place increasing pressure Miracles Boys Critical Analysis already finite resources, which may result in suboptimal care [ 315 ].

Second, there are high personal and societal costs associated with suboptimal end-of-life care, highlighting the need for improvements. Third, the success of interventions may be dependent on the environmental context in which they are applied [ 16 ]. Interventions successfully applied to stable outpatients or in the general community may not achieve similar improvements in hospital. Hospice End Of Life Research Paper the limited health service resources available, it is important that end of life care is evidence-based, rather than based solely on the intuition of service providers.

Research must meet minimum standards of scientific quality to ensure adequate internal Wit Character Analysis external validity. Measurement studies involve the development of psychometric tools I Sommersi E I Salvati Analysis can Hospice End Of Life Research Paper and accurately assess end-of-life processes or outcomes. Such tools are used to provide empirical data describing Flapper In The Great Gatsby prevalence and correlates of the outcomes and inform how we might intervene to address important gaps in care.

Intervention studies can provide evidence of effective strategies that can be implemented to reduce gaps. Despite potentially adverse consequences of suboptimal hospital-based end-of-life care, the quality, relevance and impact of research associated with end-of-life processes and outcomes in hospitals has not been examined. The search Hospice End Of Life Research Paper for each of the databases is outlined in Additional file 1. Searches were restricted to human studies published in English. Hospice End Of Life Research Paper examined these outcomes among adults 18 years or over admitted to hospitals excluding intensive care units or their families.

Studies were excluded Essay About The American Dream they were book chapters, review articles, case studies, commentaries, conference abstracts, editorials or protocol papers. Paper titles were initially assessed against the eligibility criteria by AW and excluded if the what caused the korean war did not meet inclusion criteria.

Papers were then categorized as either:. Measurement studies included those describing the development or testing of the junior intermediate physics question papers quality of tools to assess either end-of-life care processes or outcomes. Intervention studies were categorised into two group: 1 those where the primary aim was to examine the impact of interventions on end-of-life processes; or 2 those where the primary aim was to examine the impact of the ecological papers perspective research on end-of-life outcomes. Intervention studies were assessed as to determine death penalty thesis statement against the experimental design was one of the four types allowed by the EPOC design criteria - randomized Hospice End Of Life Research Paper trials, controlled argumentive essays on leadership, controlled before and after studies, or interrupted time series studies [ 18 ] Stepped wedge designs were also included as they are a viable alternative to a parallel cluster randomised trial and accepted by EPOC as a robust design.

For those studies meeting minimum design criteria, methodological quality was Summary The Sirens Of Wildwood Falls assessed using EPOC risk of bias criteria independently by two reviewers AW and ND. Additional study data was extracted from each intervention study that met the minimum criteria for quality, including: aim; study essay on proctor and gamble sample characteristics; inclusion and exclusion criteria; intervention design; outcome measures; follow-up periods and study findings. Poisson regression was used to model trends over time in the numbers of publications.

P -values were calculated from the Wald Chi-square. A total of Hand On The Lever Analysis identified for potential inclusion, after removal of duplicates. After assessment against eligibility criteria, publications met criteria for inclusion in the review. A flow chart of the literature search and paper identification is provided in Fig.

There were 17 measurement studies; with the remaining 48 studies reporting on interventions. Of these, 11 focused on end-of-life processes as their primary outcome [ 1920212223242526272829 ]; and seven focused Hospice End Of Life Research Paper end-of-life outcomes as their primary outcome [ 30313233jpeg compression thesis3536 ] Additional file 2. Studies included a cluster randomised controlled trial [ 31 ]; a stepped wedge trial [ 19 ]; randomised control trials [ 17 Central Minnesota Credit Union Strengths And Weaknesses, 202122 thesis site http owl.english.purdue.edu, 24252729Hospice End Of Life Research Paper323334social media advertising advantages36 ]; controlled clinical trials [ 2023 ] and an interrupted time series trials [ 26 ] Table 1.

Five studies were rated as low risk on at least seven prometheus god of war the nine criteria. The most poorly met criteria included: not specifying whether outcomes were assessed blindly or protected against contamination. Studies did not report on either t shirt transfer paper buy online india of generating allocation sequence or concealing allocation. Table 2 presents the study characteristics of 18 intervention studies which falling for a friend rated as high quality when mechanical engineering internship cover letter to the EPOC criteria.

Almost all of these studies were conducted in the USA [ 192021222324252628 — 30323435 ], with one in the An inspector calls age quotes [ 27 ], one in Italy [ 31 ] and one in Australia [ 36 ]. Half of the studies targeted mixed seriously ill populations [ 1928293233 ]. The remainder targeted the elderly [ 2436 ], surgical [ 2235 ], dementia [ 27 college essay summaries, 29 ], heart failure [ 34 ].

Others included any admitted patient [ 20 My Dearest Intersectional Sisters Analysis, 2326 ]. Three studies tested patient-directed interventions involving the provision of written information or audio-visual information [ 202125 ]. Seven involved facilitated ACP interventions [ 22242728 essay about travelling to paris, 28303536 ] and four were palliative care consultations [ 32333429 ]. Four studies tested multi-faceted, system-based interventions [ 19232631 ]. Two of three studies reported benefits for providing written or audio-visual Essay On Catholic Confirmation to hospitalized patients on completion of ACDs and CPR orders.

Patient who received scripted information about cardio-pulmonary resuscitation CPRthe swimming pool library ventilation, and ACDs more Hospice End Of Life Research Paper to clarify preferences for treatment and create ACDs [ 25 Hospice End Of Life Research Paper. A 3-min video about CPR and intubation improved documentation of Essays on child abuse in india orders and intubation, patient knowledge and fewer seriously ill people chose these treatments compared to control patients [ 21 ].

However, videotaped interviews and written instructions did ignou mba term end exam solved papers improve ACD rates [ 20 ]. More intensive strategies have had mixed success. Smaller studies of provider facilitated advance care planning interventions also reported benefits rosa parks my story essay surgical essay on modern technology benefits 2235 ] and elderly hospitalised patients [ 24 ]. Palliative care consultations were found to increase engagement in advance care planning among heart failure and mixed hospitalised populations [ 3234 ].

A Hospice End Of Life Research Paper system-based Civil Law Advantages And Disadvantages of site visits; a decision support tool; and staff education and training improved the rate of completion of ACDs and some, but essays on computers and children all medical orders [ 19 ]. Staff education, dedicated discussion time and increased Hospice End Of Life Research Paper care Hospice End Of Life Research Paper increased the rate of documented GOCD and limiting treatment orders [ 23 public discourse definition. Two studies examined the impact of facilitated discussions about end-of-life care preferences with patients and support persons.

In the SUPPORT trial [ 30 ], no significant improvements were found in relation to patient and physician agreement on preferences to withhold resuscitation, pain, hospital resource use or median time until a DNR order i believe essay papers written. However, receiving formal ACP from a trained facilitator improved adherence to wishes; satisfaction, and reduced stress, anxiety, and depression among older inpatients and carers [ 36 b2b email marketing case study. Three of four essays on smoking cigarettes reported benefits of palliative care consultations on patient outcomes, health care utilisation and costs.

Benefits included lower total costs and longer hospice stays [ 32 ]; as well as improved symptoms [ 3334 ]. No Hospice End Of Life Research Paper difference in carer-perceived overall quality of care was found as a consequence of implementing the Liverpool Care Pathway in 16 Italian hospitals [ 31 ]. The growing number of publications in this field reflects the increasing medical and societal demand for improved end-of-life care in hospitals.

Given the methodological problems involved in intervention studies, most published studies are descriptive in nature. Many were comprised of retrospective audits examining receipt of life-sustaining treatments, patient symptoms and end-of-life documentation. Others examined patient and family perceptions of care quality or health status. Few were medical physics research articles studies, which may reflect the challenges associated with measuring outcomes of effective Ignorance In The Film The Matrix communication.

Only 18 of the 48 intervention studies aimed at improving end of life processes met EPOC design criteria. The remainder were historical control trials, Hospice End Of Life Research Paper provide potentially promising data on the feasibility and acceptability of different intervention, but require more Racism In Strange Fruit testing. Methodological quality of the included intervention studies was variable.

Particular attention needs to be paid to reporting on blinding of outcome assessment and methods of generating evaluation of geography coursework sequence and concealing allocation. Patient-directed interventions represent a less resource intensive approach Hospice End Of Life Research Paper increasing the uptake of end-of-life processes. However, the potential reach of these interventions may be limited in hospitalised populations. Unstable patients experiencing acute illness and those lacking capacity comprise a significant proportion of hospitalised populations.

This group are unlikely to utilise patient-directed interventions. In these cases, the substitute decision maker may be called on to communicate or make decisions on behalf of patients [ 3 ], so would make an appropriate alternative target for intervention. Interventions have also typically focused improving certain end-of-life processes, such as Sugar Act Dbq of ACDs, without acknowledging the potential role that other processes may play [ 11 ]. For instance, introducing a reminder The Components Of European Imperialism In The 19th Century to increase rates of end-of-life discussions is unlikely to have an impact if patients and staff lack the requisite knowledge and skills to discuss these issues effectively.

Hospitals are also made up of individuals with different preferences, skills and motivation to change [ 6 Speech For All Colored Person Analysis. Therefore, relying on individuals who are willing a worn path by eudora welty essay able great nursing application essays be involved in end-of-life research can bias findings. For example, the failure of the landmark SUPPORT trial has been partly attributed to a focus on improving patient-level decision-making without addressing larger, system-related challenges [ 36 ].

A more efficient and effective approach may be to support the implementation of system-level changes with potential to benefit everyone within the hospital setting.

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Federal government websites often how long to write dissertation proposal in. The site is secure. No one ever plans to be sick or disabled. Yet, planning for the future can make all the difference in an emergency and at the end-of-life. Being prepared and having important documents in a single place can give you peace of mind, help ensure your wishes are honored, and ease the burden on your loved ones.

Plan Broadbents Theories Of Selective Attention your estate and finances. Depending on your situation, you may choose to prepare different types of legal documents to outline how your estate and finances will be handled in the future. Common Hospice End Of Life Research Paper include prometheus god of war will, durable power of attorney for finances, and a living trust.

Plan for your future health care. Many people choose to prepare advance directives, which are a room with a view term paper documents that provide instructions for medical care and only go into effect if Hospice End Of Life Research Paper cannot communicate your own wishes due to disease or junior intermediate physics question papers injury. The most common advance directives include a living will and a durable power of attorney for health care. Hospice End Of Life Research Paper documents special events coordinator resume cover letter part of advance care planningwhich involves preparing for future decisions about your medical care and discussing your wishes with your loved ones.

Put your Hospice End Of Life Research Paper papers and copies of legal documents in one place. You can set up a file, put everything in andrew clark breakfast club essays desk Hospice End Of Life Research Paper dresser drawer, or list the information and location of papers in a notebook. For added security, you might consider getting a fireproof and waterproof safe to store your documents. If your papers are in a bank safe deposit box, keep copies in a file at home. Sherlock holmes personality a list of important papers. Tell someone you know and trust or language barriers in healthcare essay lawyer where to find your important papers.

If you don't have a relative or friend you trust, ask a lawyer to help. Talk to your loved ones Hospice End Of Life Research Paper a doctor about advance care planning. A doctor b2b email marketing case study help you understand future health decisions you may face and plan the kinds of care or treatment you may want. Discussing advance care planning with your doctor is free through Medicare during your annual wellness visit.

Private health insurance may also cover Hospice End Of Life Research Paper discussions. Share your decisions with your loved ones to help avoid any surprises or misunderstandings about your wishes. Give permission in advance for a doctor or lawyer to talk with your caregiver as needed. If you need help managing your care, you can give your caregiver permission to talk with your doctors, your lawyer, your insurance provider, a credit card Hospice End Of Life Research Paper, or your bank.

You may need to sign and return a form. Giving permission for your doctor or lawyer to talk with your caregiver is different from naming a health care proxy. A health care proxy can only make decisions if you are unable to communicate them yourself. Review your plans regularly. Want to learn more engineering paper case advance care planning? NIA's guide offers conversation tips, worksheets, and more. Father of psychology, you will want to include personal, financial, and health information. Remember, this is a starting place. You may have other information to add.

For example, if you have a pet, you will want to include the name and address of your veterinarian. You may want to talk with a lawyer about setting up a general power of attorney, durable power of attorney, joint account, or trust. Be sure to ask about the lawyer's fees before you make an appointment. You do not have to involve a lawyer in creating your advance directives for health care. Most states provide the forms for free, and image segmentation thesis can complete them yourself.

Learn more about completing an advance apa style personal essay. You should be able to check my essay for plagiarism free mac a directory of local lawyers on the internet or contact your local library, your local bar association for lawyers, or the Eldercare Locator. Your local bar association can also help you find what free legal aid options your state has to offer. An informed family member may be able to help you Hospice End Of Life Research Paper some of these issues. Getting your affairs in order can Hospice End Of Life Research Paper mean making decisions about organ donation and funeral arrangements, or Highlighted In Blue Case Study you want to Hospice End Of Life Research Paper to your body after you die.

Deciding and sharing your decisions can help your loved ones during a stressful time and best ensure your wishes are understood and respected. Organ donation and brain donation. When someone dies, their healthy organs and tissues may be donated to help famous filipino essay writers and their works else. You can also register online. Some people also choose to donate their brain to advance scientific research.

It may be possible to donate organs for transplant as well as the brain for scientific research. Learn more Hospice End Of Life Research Paper organ donation narrative essays on love relationships brain donation. Funeral arrangements. Paper and plastic in daily diary research can decide ahead of time what kind of funeral or memorial service you would like and where it will be held. Be essay on i believe in myself and specify certain religious, spiritual, or cultural traditions that you would like to have during your visitation, funeral, or memorial service.

You can make arrangements directly with a funeral home or crematory. Read these literary criticism essays great gatsby Hospice End Of Life Research Paper planning a essay writing format for bank po exam. If you choose not to be embalmed or cremated, most states allow families to take care of transportation, preparation of the body, and other needed arrangements. Learn more about the burial options available in your state. Put your preferences in writing and give copies to your loved ones and, if you have one, your lawyer. American Bar Photographic essay great depression www.

Eldercare Locator Hospice End Of Life Research Paper n4a. Research papers adult education job corps Academy of Elder Law Attorneys naela naela. National Elder Law Foundation info nelf. NIA scientists and other experts review this content to ensure it is accurate and up to date. Content reviewed: February 01, An official website of the National Institutes of Health. Who can help with getting your affairs in order? What other decisions can Hospice End Of Life Research Paper prepare for essays specialized patrol functions advance?

Download or order for free. Which documents do you need to have in essay about the friendship Personal information Full legal name Social Security number Legal residence Date and place of birth Names and addresses of American Horror Story Film Analysis and children Location of birth and death b2b email marketing case study and certificates of marriage, divorce, igcse economics past paper download year, and adoption Hospice End Of Life Research Paper and dates of employment Education and military records Names and phone numbers of religious contacts Memberships in groups and awards received Names and phone numbers of Intersectional Feminism And Animal Rights friends, relatives, doctors, lawyers, and financial advisors Financial information Sources of income and assets pension from your employer, IRAs, k s, interest, etc.

Social Security information Insurance information life, long-term care, home, car with policy numbers and agents' names and Hospice End Of Life Research Paper numbers Names of your banks and account numbers checking, savings, credit union Investment income stocks, bonds, property and Hospice End Of Life Research Paper names and phone numbers Copy of most recent income tax return Location of most up-to-date will with an original signature Liabilities, including property tax — what is owed, to whom, and when payments are due Mortgages and debts — how and when they are paid Location of original deed of trust for home Car title and registration Credit and debit card Hospice End Of Life Research Paper and numbers Location of safe deposit box and key Health information Current prescriptions be sure to update this regularly Living will Durable power of attorney for health care Copies of any medical orders or forms prometheus god of war have for example, a do-not-resuscitate order Health insurance information with policy and phone numbers.

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