Older persons' perceptions and experiences of community palliative care: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this review was to critically appraise and synthesize qualitative evidence of older persons' perceptions and experiences of community palliative care. INTRODUCTION: Palliative care focuses on the relief of symptoms and suffering at the end of life and is needed by approximately 56.8 million people globally each year. An increase in aging populations coupled with the desire to die at home highlights the growing demand for community palliative care. This review provides an understanding of the unique experiences and perceptions of older adults receiving community palliative care. INCLUSION CRITERIA: This review appraised qualitative studies examining the perceptions and experiences of older adults (65 years or older) receiving community palliative care. Eligible research designs included, but were not limited to, ethnography, grounded theory, and phenomenology. METHODS: A search of the literature across CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid SP), Web of Science Core Collection, and Scopus databases was undertaken in July 2021 and updated November 1, 2022. Included studies were published in English between 2000 and 2022. The search for unpublished studies included ProQuest Dissertations and Theses. Study selection, quality appraisal, and data extraction were performed by 2 independent reviewers. Findings from the included studies were pooled using the JBI meta-aggregation method. RESULTS: Nine qualitative studies involving 98 participants were included in this review. A total of 100 findings were extracted and grouped into 14 categories. Four synthesized findings evolved from these categories: i) Older persons receiving palliative care in the community recognize that their life is changed and come to terms with their situation, redefining what is normal, appreciating life lived, and celebrating the life they still have by living one day at a time; ii) Older persons receiving palliative care in the community experience isolation and loneliness exacerbated by their detachment and withdrawal from and by others; iii) Older persons receiving palliative care in the community face major challenges managing prevailing symptoms, medication management difficulties, and costs of medical care and equipment; and iv) Older persons want to receive palliative care and to die at home; however, this requires both informal and formal supports, including continuity of care, good communication, and positive relationships with health care providers. CONCLUSIONS: Experiences and perceptions of community palliative care vary among older adults. These are influenced by the individual's expectations and needs, available services, and cost. Older adults' input into decision-making about their care is fundamental to their needs being met and is contingent on effective communication between the patient, family, and staff across services. Policy that advocates for trained palliative care staff to provide care is necessary to optimize care outcomes, while collaboration between staff and services is critical to enabling holistic care, managing symptoms, and providing compassionate care and support.

Loyalty in the Workplace: Some Considerations for Mental Health Nurses.

Nurses are expected to be loyal to their patients, employer and the nursing profession, while also remaining 'loyal' to their own values and aims as both a person and clinician. Loyalty therefore is of central importance to how we relate to people in personal and professional relationships and may affect our attitude to the organization we work for. This column explores the concept of loyalty, and its role in professional relationships, behaviour and practice. Ways that loyalty can be influential in achieving personal, patient and organizational outcomes are explored and the potential to enhance loyalty is considered.

Safety, risk, and aggression: Health professionals' experiences of caring for people affected by methamphetamine when presenting for emergency care.

The crystalline form of methamphetamine, commonly known as crystal meth (crystal methamphetamine) or ICE, is a highly-addictive and powerful stimulant. Users of crystal meth often require emergency care, and are associated with a substantial burden of care by emergency care providers. The aim of the present qualitative study was to explore health professionals' experiences of providing care for patients affected by ICE who presented to the emergency department (ED). Nine semistructured interviews were conducted. The major theme, 'staying safe', was revealed, in which participants described their experiences of being exposed to potentially unsafe situations, and their responses to challenging behaviours, including aggression. The findings highlight the need for ED staff to understand the nature of ICE use and its adverse impact on the mental and physical health of users. Furthermore, it is clear that establishing and maintaining safety in the emergency care setting is of utmost importance, and should be a priority for health-care managers.

Mental health nurse prescribing: A qualitative, systematic review.

The aim of the present qualitative, systematic review was to identify and summarize qualitative research that focussed on mental health nurse prescribing, synthesize findings, and outline key themes discerned. In November 2016, a systematic search was conducted for primary studies of the electronic databases PubMed, Excerpta Medica, (Embase), Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO. Of the 101 papers identified through the search strategy, 12 qualitative studies met the review inclusion criteria. These studies included perspectives from nurses, doctors, and patients/clients regarding their attitudes about, and experiences of, nurse prescribing. Three themes emerged from the review: (i) patient-centred care; (ii) professional role; and (iii) professional support. Nurse prescribers embrace a patient-centred approach, providing timely and effective medication management. Adequate education and continuing professional development inclusive of clinical supervision enable competency development in nurse prescribing, supportive professional relationships, and patient safety. Further research is necessary to establish safety and demonstrate enhanced clinical outcomes from mental health nurse prescribing.

Overview of Substance Use and Mental Health Among the "Baby Boomers" Generation.

As the population ages, risk factors commonly shared by chronic degenerative disease can be exacerbated by behaviours and lifestyle choices. There is increasing evidence that those affected by chronic disease (and associated symptoms such as pain), depression and adverse behavioural and lifestyle patterns are at risk of substance misuse. This paper overviews substance use in Baby Boomers, which are defined as people aged between 52-70 years old, and the implications this may have on their mental health and well-being. We provide an overview of the characteristics of the Baby Boomer generation, their health status and what is currently known about their substance use and misuse. A strengthening of older adult mental health outpatient services is recommended to prevent and address substance use among older adults. Further research examining factors that influence substance use among this group could better inform health promotion programs targeting Baby Boomers.

Experiences of Health Professionals Caring for People Presenting to the Emergency Department After Taking Crystal Methamphetamine ("ICE").

Globally, addiction to "ICE" (crystal methamphetamine) is increasing and presents emergency health care services personnel with a number of challenges. This paper reports the first of two major themes arising from a qualitative study investigating health professionals' experiences' managing people presenting to the Emergency Department (ED) after taking "ICE." The theme "Caring for people who use 'ICE' when presenting to EDs" comprises five subthemes. These are: (a) expecting the unexpected: "they're just off their heads"; (b) complexity of care: "underlying trauma and emotional dysregulation";

Service and infrastructure needs to support recovery programmes for Indigenous community mental health consumers.

Mental health is a major concern in Indigenous communities, as Indigenous people experience poorer health outcomes generally, and poorer social and emotional well-being throughout their lives, compared to non-Indigenous populations. Interviews were conducted with 20 mental health workers from a housing assistance programme for Indigenous clients with mental illness. Service and infrastructure needs identified to support clients were classified under the following overarching theme 'supports along the road to recovery'. Subthemes were: (i) It is OK to seek help; (ii) linking in to the local community; (iii) trusting the workers; and (iv) help with goal setting and having activities that support their achievement. This paper highlights the importance of targeted housing and accommodation support programmes for Indigenous people to prevent homelessness, and the essential services and infrastructure required to support Indigenous clients' mental health needs. These insights may inform service review, workforce development, and further research.

The Role of the Mental Health Worker in a Housing and Accommodation Support Initiative for Indigenous Australians.

PURPOSE: To explore the experiences of mental health workers and perceptions of their role and the scope of their work. DESIGN AND METHODS: Qualitative design. Twenty interviews were conducted with mental health workers. Interviews were analyzed using thematic analysis. FINDINGS: Three overarching themes were identified. In this paper the overarching theme of "dimensions of my role" is discussed. Subthemes were (a) information and education, (b) person-centered care, and (c) networking and partnerships. PRACTICE IMPLICATIONS: Professional development, networking, and partnerships underpin the provision of coordinated services and ultimately person-centered care. Enhancing staff capacity building may also enable sustainability of appropriate quality services.