‘You Took me Back to the sea:' Using Narrative to Explore and Inform the Practice of Social Work with Dying People

This article centres on a qualitative interview extract, the ‘Story of the Pebble', in which a West African Hospital Social Worker Ado, working in a UK context, and identifying as a Shaman, describes successfully trusting his instincts to create a symbol for a dying patient. Despite criticisms from colleagues, Ado's capacity to understand his patients needs are justified both before and after her death.The article discusses significant themes from the interview extract, including the meaning of professionalism, practice wisdom and cultural influences in a UK social work context, as well as through Ado's heritage and identification as a Shaman. The article considers holistic patient care in a medical context and suggests this has some useful lessons for social workers, particularly those involved with dying people. Although the extract, and wider research study from which it is drawn, pre-date the Covid 19 pandemic, this is referenced throughout, linking the interview extract to ways of helping practitioners and educators to consider people holistically at end of life. AD -, Chichester, UK ;, Chichester, UK

Distance and grief: Optimising wellbeing for transnational migrants in Tasmania

End-of-life care, bereavement and grief involve significant challenges and impact our wellbeing in varied ways. For transnational migrants, geographical distance to a dying loved one, relatives, friends and meaningful locations can further complicate care, bereavement and grief. Our research aims to improve understandings of the role distance plays for transnational migrant wellbeing at these times. Using an instrumental, interpretative case study design we explored the experiences of five people with migration backgrounds with end-of-life care, bereavement and grief in Tasmania, Australia. Additional data sources included policies for end-of-life and bereavement care in Tasmania. In our study, participants tended to seek – and create – places and spaces of informal, rather than formal, support, both in their receiving society and country of origin. Online spaces played a key role: keeping people in touch with family members overseas, providing a means to care from a distance and ways to participate in grief rituals – albeit with mixed success. A lack of places to perform death and grief rituals, and inability to be physically present at a loved one's death (for some, due to COVID-19 travel restrictions) posed significant challenges to participants' wellbeing and impacted coping. We argue that if societies better understand the significances of places, spaces and distance during times of end-of-life, bereavement and grief, we can adjust policy and practice accordingly to collectively optimise wellbeing for transnational migrants. © 2023

Designing the post-pandemic hospice environment: "The last place"

Where and how people die is a significant concern of human life and society (Worpole, 2009). In these days, people die either in their home or in an end-of-life care facility, such as hospice. Hospice is a place to provide end-of-life care to individuals certified as "terminal." Hospice care or end-of-life care is a multidisciplinary care and support (non-curative) system designed to address the physical, emotional, psychosocial, and spiritual concerns of terminal patients and their families. Thus, the facility design is significantly different in various dimensions. For example, hospice patients are mostly bed-bound, and a patient's family accommodation plays a significant role in the patient's dying experience. Providing a supportive physical environment of hospice has an imperative impact on the patient "quality of life" and the possibility of a "good death." With the COVID-19 challenges, it has become significant to explore the best possible solutions of hospice facility design. This chapter discusses the 11 therapeutic goals of hospice care environment which was developed by Kader and Diaz Moore in 2015 considering dying experiences. The physical settings of hospice along with the carefully designed organizational environment can contribute to the realization of desired therapeutic goals and have a positive effect on the lives of dying patients. This chapter discusses each therapeutic goal and how hospice facility design can support these goals with a few examples and presents six major design-related challenges of post-pandemic (COVID-19) hospice care facilities. Lastly, several prospective design concepts have explored considering pandemic resiliency. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

(Re)designing the continuum of care for older adults: The future of long-term care settings

This book broadens the visioning on new care environments that are designed to be inclusive, progressive, and convergent with the needs of an aging population. The contents cover a range of long-term care (LTC) settings in a single collection to address the needs of a wide audience. Due to the recent COVID-19 pandemic, rethinking the spatial design of care facilities in order to prepare for future respiratory and contagious pathogens is one of the prime concerns across the globe, along with social connectedness and autonomy in care settings. This book contributes to the next generation of knowledge and understanding of the growing field of the design of technology, programs, and environments for LTC that are more effective in infection prevention and control as well as social connectedness. To address these issues, the chapters are organized in four sections: Part I: Home- and community-based care;Part II: Facility-based care;Part III: Memory care and end-of-life care;and Part IV: Evidence-based applied projects and next steps. (Re)designing the Continuum of Care for Older Adults is an essential resource for researchers, practitioners, educators, policymakers, and students associated with LTC home and healthcare settings. With diverse topics in theory, substantive issues, and methods, the contributions from notable researchers and scholars cover a range of innovative programming, environments, and technologies which can impact the changing needs and support for older adults and their families across the continuum of care. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

End-of-Life Experiences Within a Dementia Support Program During COVID-19: Context and Circumstances Surrounding Death During the Pandemic.

Background: Persons with dementia (PWD) and their caregivers are uniquely impacted by the COVID-19 pandemic, including higher risk of mortality for PWD. Objectives: To describe the context and circumstances of deaths of PWD within a dementia support program during the COVID-19 pandemic. Design: Retrospective data collection of PWD deaths between March 1, 2020 and February 28, 2021. Setting/Subjects: Decedents enrolled in Care Ecosystem, a multidisciplinary team model for dementia care at University of California San Francisco, Ochsner Health, and UCHealth. Measurements: Using mixed methods, we analyzed data using descriptive measures and team-based thematic analysis to understand the end-of-life (EOL) experience of PWD-caregiver dyads. Results: Twenty-nine PWD died across three sites. Almost half (45%) were between ages 70-79 and 12 (41%) were women. Eighteen (62%) died at a private residence; two died in the hospital. Hospice was involved for 22 (76%) patients. There were known causes of death for 15 (53%) patients. Only two deaths were directly related to COVID-19 infection. Social isolation was perceived to have a high or very high impact for 12 (41%) decedents. Four qualitative themes were identified: (1) isolation due to the pandemic, (2) changes in use of dementia supports and resources, (3) impact on goals of care decisions, and (4) communication challenges for EOL care coordination. Conclusion: Among PWD and caregivers enrolled in a dementia support program, the COVID-19 pandemic had direct and indirect influences on mortality and EOL experiences of PWD. Caregivers' experiences of caring, decision making, and bereavement were also affected.

The Effects of the Ward Environment and Language in Palliative Care: A Qualitative Exploratory Study of Victorian Nurses' Perspectives.

OBJECTIVES: The current study aimed to explore regional nurses' perspectives of how bad news is delivered and the physical, natural, social, and symbolic environments where these conversations occur. BACKGROUND: In regional hospitals within Victoria, Australia, palliative and end-of-life patients are cared for in acute wards that are often busy, noisy, and do not have a palliative psychosocial focus. On the other hand, Palliative Care Units (PCUs) have more home-like dedicated spaces, yet nearly all these facilities are in metropolitan areas. Diagnostic/prognostic (bad news) conversations about life-limiting illnesses often occur at the bedside in both environments. METHOD: Nurses providing palliative or end-of-life care in regional or metropolitan Victorian hospital inpatient wards were invited to interview and recruited through social media and snowballing. Six semi-structured, audio-recorded online interviews were conducted between March and May 2022, and themes were developed using reflexive thematic analysis. RESULTS: Semi-structured online interviews were conducted with six female, registered nurses, four of whom worked in regional Victorian hospitals and two in metropolitan PCUs as Nurse Unit Managers. Three central themes were developed: "conducting family meetings," "palliative care practice," and "the environment matters." CONCLUSIONS: A therapeutic environment for palliative patients and their families consists of home-like ambience and aesthetics and a psychosocial environment created by staff who can provide holistic palliative care. Holistic palliative care requires mentoring and mirroring of expert practice to increase the expertise and capacity of the palliative care workforce in acute general hospital wards.

Prioritizing Health Equity in Palliative and End-of-Life Care

The COVID-19 pandemic brought to light significant health disparities in illness and death due to a person's race, ethnicity, and socioeconomic status. Also, those factors cause significant inequities in access to palliative and end-of-life care that remain largely unaddressed. The quality of care people receive once they are given a life-threatening diagnosis or as they approach the end of their life depends upon race, ethnicity, socioeconomic status, and who they love. Such disparities in treatment are unconscionable and must be addressed. They warrant serious attention from policymakers and clinicians as well as focused efforts to find solutions. Copyright 2022 American Society on Aging;all rights reserved.

Training interprofessional teamwork in palliative care: A pilot study of online simulation activity for registered nurses and nursing associates

Palliative care promotes quality of life for seriously ill and dying patients and their loved ones. An ageing population with more complex chronic and life-limiting conditions will increase the demand for competence in the field. Interprofessional cooperation will be a critical factor in achieving this. Such cooperation within the field of nursing is critical because of registered nurses' (RNs) role and function in patient- and family-centred care. A project focusing on learning interdisciplinary teamwork using simulation as a learning approach was established. Two groups of students participated in the project: one group consisted of 17 nursing associates who were participating in a 2-year part-time study programme in cancer care and palliative care at a vocational college. The second group was made up of 28 RNs, a social worker and learning disability nurses, all postgraduate students taking part in a part-time interdisciplinary programme in palliative care at master's degree level.Simulation activity is usually conducted with participants physically present, but because of the COVID-19 pandemic situation, this was not possible. A pilot project was conducted where simulation activity was tried out as online learning. RNs and nursing associates (NA) participated, and their cooperation was focused on palliative/end-of-life care. They were all trained clinicians in two different study programmes.In this chapter, we present how simulation activity with participants physically present was transformed into an online learning situation. A brief presentation of students' and teachers' reflections on the pedagogical advantages and disadvantages of such a transition is also included. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Dying in isolation

Palliative care is a nursing and medical specialty focused on providing comfort to those with chronic, life-limiting illness from diagnosis to the end of life through symptom management, aligning goals of care, and providing psychosocial/spiritual support. During the COVID-19 pandemic, millions experienced new, rapid symptoms and many faced untimely deaths. As experts in end-of-life care, palliative care clinicians played a vital role in pandemic care. Yet, the delivery of palliative care required significant adjustments due to visitor restrictions and isolation precautions. These changes included, but are not limited to, communication styles, involvement of family in symptom management, and adoption of telehealth. Throughout pandemic care, palliative care clinicians were also helping patients, families, and clinicians navigate a multitude of ethical decisions, including supporting frontline healthcare workers. This chapter focuses on palliative and end-of-life issues during the COVID-19 pandemic. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

"The communication I had with him back then is still stuck in my mind." Bereaved families of cancer patients' experiences for end-of-life communication.

PURPOSE: Communication with family members is important to end-of-life care for patients with cancer. It is an interactive engagement between terminally-ill cancer patients and their families through which they expand their mutual understanding to cope with losses and find meaning in death. This study aimed to describe the experiences of end-of-life communication between patients with cancer and their family members in South Korea. METHODS: This is a qualitative descriptive study using in-depth semi-structured interviews. Ten bereaved family members with end-of-life communication experience with terminal cancer patients were recruited through purposive sampling. Data were analyzed using qualitative content analysis. RESULTS: A total of 29 constructed meanings, 11 sub-categories, and the following 3 categories were derived: "Offering a space for patients to reminisce and reflect," "Building a bond," and "Reflections on what we need." End-of-life communication primarily centered on the patients, with families struggling to share their stories with them. Although the families coped well, they also regretted the lack of meaningful communication with the patients, indicating a need for support to facilitate effective end-of-life communication. CONCLUSION: The study highlighted concrete communication for finding meaning at the end-of-life for cancer patients and their families. We found that the families have the potential to communicate appropriately to cope with the patients' end-of-life. Nevertheless, end-of-life presents a unique challenge in which families require adequate support. Given the increasing number of patients and families dealing with end-of-life care in hospitals, healthcare providers should be mindful of their needs and help them cope effectively.

Managing the end of life in COVID patients. The role of palliative care in emergency departments during the pandemic.

Managing COVID-19 patients has been an extremely difficult and dramatic task, especially for emergency departments during the strongest waves of the pandemic in Italy. Medical staff and health professionals were redeployed from their work setting to COVID units; many were overwhelmed by the deaths of so many patients in a very short time. This work aimed to explore palliative care health professionals' and physicians' perceptions of end-of-life care management in COVID units during the first two waves of the pandemic in Italy. Qualitative data was collected through 24 semi-structured in-depth interviews. The participants were palliative care medical and health professionals redeployed, or in a supporting role, COVID units from the most affected areas of northern and central Italy. The interview questions were focused on four thematic areas concerning different aspects of the role and responsibilities of the palliative care specialist (physician and healthcare professional). A brief presentation of the main sociological literature on end-of-life management in hospital contexts will be firstly presented and discussed to offer a theoretical frame. Subsequently, some of the most significant results that emerged from our research will be illustrated concerning the role played by palliative care professionals during the pandemic and the relevance of the palliative care approach in emergency contexts.

Applying Jewish theology to issues in mental and physical health

Jewish theological convictions and values undergird the approaches of Judaism to all aspects of life. This article first describes five fundamental Jewish convictions about God, human beings, and the relations between them as well as the place of medicine in life. It then describes the positions taken by the three largest denominations of contemporary Judaism on end-of-life issues and the approach of Judaism to mental health issues, two aspects of medical ethics that have become especially prominent during the COVID-19 pandemic but have always been, and will always be, important aspects of human life to which religious traditions can and should give guidance.

The Missing Farewell: End-of-Life Care and Good br Death during the COVID-19 Pandemic

End-of-life care aims to provide supportive physical, social, mental, and spiritual care for terminally ill patients and their family members. Not only does it help patients approach the end of their lives with dignity and peace, but it also helps family members overcome the grief of losing a loved one. In the context of the COVID-19 pandemic, ethical dilemmas have emerged within the field of end-of-life care, and it has been challenging to help people experience a good death. This article takes the example of the pandemic-related restrictions in Hong Kong that affected visiting and funeral arrangements. It analyzes the impact of anti-pandemic measures on end-of-life care and the provision of a good death. It examines the ethical justifications of these measures through the Confucian themes of human-orientedness, familism, and death rituals, and it outlines practical implications for end-of-life care under similar circumstances.

Risk Modeling Framework for Strategic and Operational Intervention to Enhance the Effectiveness of a Closed-Loop Supply Chain

In a closed-loop supply chain (CLSC), acquiring end-of-life vehicles (ELVs) and their components from both primary and secondary markets has posed a huge uncertainty and risk. Moreover, the constant supply of ELV components with minimization of cost and exploitation of natural resources is another pressing challenge. To address the issues, the present study has developed a risk simulation framework to study market uncertainty/risk in a CLSC. In the first phase of the framework, a total of 12 important variables are identified from the existing studies. The total interpretive structural model (TISM) is used to develop a causal relationship network among the variables. Then, Matriced Impacts Cruoses Multiplication Applique a un Classement is used for determining the nature of relationships (i.e., driving or dependence power). In the second phase, the relationship of TISM is used to derive a Bayesian belief network model for determining the level of risks (i.e., high, medium, and low) associated with the CLSC through the generation of conditional probabilities across 1) multi-, 2) single-, and 3) without-parent nodes. The study findings will help decision-makers in adopting strategic and operational interventions to increase the effectiveness and resiliency of the network. Furthermore, it will help practitioners to make decisions on change management implementation for stakeholders'performance audits on the attributes of the ELV recovery program and developing resilience in the CLSC network. Overall, the present study holistically contributes to a broader investigation of the implications of strategic decisions in automobile manufacturers and resellers. IEEE

Recovery of Platinum and Palladium from Spent Automotive Catalysts: Study of a New Leaching System Using a Complete Factorial Design

The recovery of materials and energy from end-of-life products is increasingly a fundamental factor in the sustainable development of various countries. Recovering metals from different types of waste is not only a practice in support of the environment, but is also a profitable economic activity. For this reason, exhausted automotive catalysts can become renewable sources of critical raw materials such as Pt, Pd, and Rh. However, recovering Pt and Pd from spent catalysts through an efficient, economical, and green method remains a challenge. This article presents a new leaching process for the hydrometallurgical recovery of Pt and Pd from exhausted automotive catalysts. The leaching solution consists of an aqueous mixture of hydrochloric acid, two organic acids (citric acid and acetic acid) and hydrogen peroxide. A complete factorial plan on two levels (2k) was performed in order to evaluate the main effects of the analyzed factors and their interactions. The factors that were presumed to be the most influential on the leaching of Pt and Pd were the concentrations of the different reagents and the reaction time. The optimal circumstances for achieving the largest recovery (over 80% Pt and 100% Pd) were achieved using the following conditions: a concentration of HCl of 5 M, a concentration of H2O2 of 10% wt./vol., a concentration of C2H4O2 of 10%vol./vol., and a reaction time of 3 h.

Quality of End-of-Life Care for Older Adults with Dementia during the COVID-19 Pandemic.

OBJECTIVES: End-of-life (EOL) care during the coronavirus disease 2019 (COVID-19) pandemic has been a concern under the overwhelming pressure of health care service systems. People with dementia often receive suboptimal EOL care; thus, they may be at particular risk of poor care quality during the COVID-19 pandemic. This study investigated the interaction between dementia and pandemic on the proxies' overall ratings and ratings for 13 indicators. DESIGN: A longitudinal study. SETTING AND PARTICIPANTS: Data were collected from 1050 proxies for deceased participants in the National Health and Aging Trends Study, a nationally representative sample of community-dwelling Medicare beneficiaries aged ≥65 years. Participants were included if they had died between 2018 and 2021. METHODS: Participants were categorized into 4 groups depending on the period of death (before vs during the COVID-19 pandemic) and having no vs probable dementia, as defined by a previously validated algorithm. The quality of EOL care was assessed through postmortem interviews with bereaved caregivers. Multivariable binomial logistic regression analyses were performed to examine the main effects of dementia and pandemic period, and the interaction between dementia and pandemic on ratings of quality indicators. RESULTS: A total of 423 participants had probable dementia at the baseline. People with dementia who died were less likely to talk about religion in the last month of life than those without dementia. Decedents during the pandemic were more likely to have an overall rating of care as being not excellent than those before the onset of the pandemic. However, the interaction between dementia and pandemic was not significant in the 13 indicators and the overall rating of EOL care quality. CONCLUSION AND IMPLICATIONS: Most EOL care indicators preserved the level of quality, regardless of dementia and the COVID-19 pandemic. Disparities in spiritual care may exist across people with and without dementia.

Japanese Local Governments' Dissemination Activities for Advance Care Planning: A Descriptive Analysis of a Nationwide Survey during the COVID-19 Pandemic.

This study aims to compare the awareness-raising activities between municipalities with and without focused anti-infection measures during the 2019 coronavirus disease (COVID-19) pandemic. Descriptive analysis was conducted using a nationwide self-administered questionnaire survey on municipalities' activities for residents and for healthcare providers and care workers (HCPs) in October 2022 in Japan. This study included 433 municipalities that had conducted awareness-raising activities before 2019 Fiscal Year. Workshops for residents were conducted in 85.2% of the municipalities, and they were more likely to be conducted in areas with focused anti-infection measures than those without measures (86.8% vs. 75.4%). Additionally, 85.9% of the municipalities were impacted by the pandemic; 50.1% canceled workshops, while 26.0% switched to a web-based style. Activities for HCPs were conducted in 55.2-63.7% of the municipalities, and they were more likely to be conducted in areas with focused anti-infection measures. A total of 50.6-62.1% of the municipalities changed their workshops for HCPs to a web-based style. Comparisons between areas with and without focused anti-infection measures indicated that the percentages of those impacted for all activities were not significantly different. In conclusion, awareness-raising activities in municipalities were conducted with new methods during the COVID-19 pandemic. Using information technology is essential to further promote such activities for residents.

Barriers and facilitators to goals of care conversations with Veteran residents of community nursing homes.

BACKGROUND: Despite evidence that structured goals of care conversations (GoCCs) and documentation of life-sustaining treatment (LST) preferences improve the delivery of goal-concordant care for seriously ill patients, rates of completion remain low among nursing home residents. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) program aims to improve the consistent documentation of LST preferences among Veterans receiving care in veterans affairs (VA)-paid community nursing homes (CNH); however, the barriers and facilitators of completing and documenting GoCCs in this unique context of care have not been described. METHODS: We conducted semi-structured, qualitative interviews with key stakeholders of the VA CNH programs located at six VA Medical Centers between July 2021 and July 2022. With a rapid approach to analysis, interview transcripts were reduced into memo templates using the Tailored Implementation for Chronic Disease Checklist and coded and analyzed using qualitative data analysis software. RESULTS: The 40 participants consisted of nurses (n = 13), social workers (n = 25), and VA physicians (n = 2). Most participants felt confident about conducting GoCC; however, several barriers were identified. At the staff level, our results indicated inconsistent completion of GoCC and documentation due to a lack of training, confusion about roles and responsibilities, and challenging communication within the VA as well as with CNH. At the organizational level, there was a lack of standardization across sites for how LST preferences were documented. At the patient level, we found key barriers related to patient and family readiness and issues finding surrogate decision makers. While COVID-19 brought end-of-life issues to the forefront, lockdowns hindered communication about the goals of care. CONCLUSION: Findings from this pre-implementation evaluation revealed multi-level barriers in conducting and documenting GoCCs with Veterans receiving VA-paid CNH care, as well as several facilitators that can be used to inform strategies for improvement.

Differences in Palliative Care Provision by Primary and Specialist Providers Supporting Patients with COVID-19: A Qualitative Study.

Objectives: To describe the delivery of palliative care by primary providers (PP) and specialist providers (SP) to hospitalized patients with COVID-19. Methods: PP and SP completed interviews about their experiences providing palliative care. Results were analyzed using thematic analysis. Results: Twenty-one physicians (11 SP, 10 PP) were interviewed. Six thematic categories emerged. Care provision: PP and SP described their support of care discussions, symptom management, managing end of life, and care withdrawal. Patients provided care: PP described patients at end of life, with comfort-focused goals; SP included patients seeking life-prolonging treatments. Approach to symptom management: SP described comfort, and PP discomfort in providing opioids with survival-focused goals. Goals of care: SP felt these conversations were code status-focused. Supporting family: both groups indicated difficulties engaging families due to visitor restrictions; SP also outlined challenges in managing family grief and need to advocate for family at the bedside. Care coordination: internist PP and SP described difficulties supporting those leaving the hospital. Conclusion: PP and SP may have a different approach to care, which may affect consistency and quality of care.