Suchergebnisse

Cover -- Half Title -- Title -- Copyright -- Contents -- Foreword -- Preface -- Individual Rights and the Human Good in Hospice -- Issues of Access in a Diverse Society -- Will Assisted Suicide Kill Hospice? -- Ethical Issues in Pain Management -- Focus on the Nurse: Ethical Dilemmas with Highly Symptomatic Patients Dying at Home -- Legal Requirements for Confidentiality in Hospice Care -- The Role of the Physician in Hospice -- The Role of Ethics Committees in Hospice Programs -- Growth in Caring and Professional Ethics in Hospice -- Hospice Organizations' Role in Health Care Improvement -- Hospice and Managed Care -- The Future of Hospice in a Reformed American Health Care System: What Are the Real Questions? -- Index

The differences in hospice care needs between United States veterans and non-veterans was explored using a systematic review research methodology that consisted of 18 articles. After a review of previous research studies, it was found that veterans tended to want their healthcare providers to be more open and to the point about their diagnosis than non-veterans did. Both non-veterans and veterans wanted to be in control of their end of life cares. Non-veterans were more likely to want their family and friends around compared to veterans who were less likely to want people around. Veterans who had post-traumatic stress disorder (PTSD) received a lower quality of care compared to hospice patients who did not have PTSD. Patients who received a palliative care consult reported having less discomfort compared to those who did not receive a palliative care consult. Patients who received extra services such as Reiki or music therapy or caregiver support had an increase in peacefulness and a decrease in pain. With the additional caregiver support, patients were able to stay at home longer or until their death. This study shows that there is not a lot of research done around hospice care with veterans, but it is a unique group that needs to be focused on more in order to increase the quality of care they receive.

The aim of this paper is to review the situation in communist and post-revolutionary Czechoslovakia in the area of palliative care. It will familiarize readers with the enormous efforts of two big personalities in the history of Czech health care: Marie Opatrná and Marie Svatošová, who tried to change the old and inconvenient Soviet health care system and make the care of terminal and dying people more human. At the end, it will present some challenges which the current Czech hospice care is confronted with.

This ethnography reflects on a non-profit hospice care organization in the Midwestern US where caregivers "slow down" medical care by acknowledging the plurality of forces that constitute the illness experience, philosophically departing from their biomedical, non-hospice counterparts. It demonstrates the ontological effect of "slowing down" and attending to a set of patient problems that extends beyond the biological, or any distinct, domain. The result is a medical world that privileges the embodied, lived expression of disease—rather than the statistical, clinical expression—resulting in medical care that is enmeshed in the variables of everyday life. I therefore situate hospice care in a historical moment witnessing the emergence of a sophisticated and "non-modern" (Latour 1991) form of medical care.

The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing homes may be excessive, has perhaps slowed the adoption of hospice services into the nursing home setting. Currently, access to hospice care in nursing homes is inequitable across facilities, and across geographic areas. In nursing homes where hospice is available and present, however, recent research documents superior outcomes for residents enrolled in hospice, and perhaps for nonhospice residents. Still, more research is needed, particularly research focusing on the government costs associated with the provision of hospice care in nursing homes. If subsequent research continues to support the "added value" of hospice care in nursing homes and at the same or less total costs, the issue of foremost concern becomes how equitable access to Medicare hospice care in nursing homes can be achieved. Access may be increased to some extent by changing government policies, and conflicting regulations and interpretive guidelines, so they support and encourage the nursing home/hospice collaboration.