Search results

1 – 10 of 740
Book part
Publication date: 1 January 2000

Jennifer Leich

This chapter explores the relationship between hospice home care and the recent trend toward dehospitalization. Hospice home care nurses are increasingly responsible for attending…

Abstract

This chapter explores the relationship between hospice home care and the recent trend toward dehospitalization. Hospice home care nurses are increasingly responsible for attending to their employing organization's bottom line, in addition to patient care. Their concern for helping patients achieve the good death thus intersects, and sometimes competes, with their employing organization's interest in controlling patients' access to costly hospital and other acute care. I describe several of the ways in which nurses in this study control home hospice caregivers' abilities to support terminally ill patients' death at home: (1) through their assessments of patient and caregiver appropriateness and competence; (2) by appealing to the caregiver's emotional connection to the patient in order to encourage commitment to the goal of death at home and; (3) by normalizing the idea of death at home. I argue that, through their work of training hospice caregivers to adapt and maintain the value of staying at home, hospice home care nurses provide a subtle, yet significant, new mechanism for dehospitalizing terminally ill patients. Moreover, the work of hospice home care nurses is shifting our understanding of what constitutes a “good death”.

Details

Health, Illness, and use of Care: The Impact of Social Factors
Type: Book
ISBN: 978-1-84950-084-5

Abstract

Details

Postmodern Malpractice: A Medical Case Study in The Culture War
Type: Book
ISBN: 978-1-84950-091-3

Book part
Publication date: 1 October 2013

Christine Vatovec, Laura Senier and Michael Mayerfeld Bell

Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of dying has…

Abstract

Purpose

Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of dying has received social and economic critiques for decades. This chapter offers a further analysis to these critiques by examining the ecological impacts of inpatient end-of-life care on the natural environment and occupational and public health.

Methodology

We compare the ecological health outcomes of medical care in three inpatient units (conventional cancer unit, palliative care ward, and hospice facility) using ethnographic observations, semi-structured interviews, and institutional records on medical supply use, waste generation, and pharmaceutical administration and disposal.

Findings

Care provided on all three medical units had significant socioecological impacts. Cumulative impacts were greatest on the conventional unit, followed by palliative care, and lowest on the hospice unit. Variations in impacts mirrored differences in dependence on material interventions, which arose from variations in patient needs, institutional policies, and nursing cultures between the three units.

Practical implications

Social and economic concerns have been major drivers in reforming end-of-life medical care, and our analysis shows that ecological concerns must also be considered. Transitioning terminal patients to less materially intensive modes of care when appropriate could mitigate ecological health impacts while honoring patient preferences.

Originality

This chapter describes how the medicalization of dying has converged with institutional policies, practices, and actors to increase the negative consequences of medical care, and recognizes that the far-reaching impacts of clinical decisions make the provision of medical care a socioecological act.

Details

Ecological Health: Society, Ecology and Health
Type: Book
ISBN: 978-1-78190-323-0

Keywords

Book part
Publication date: 24 August 2005

Toshiko Morita

We wish to die peacefully in a manner suited to our values and taste. We also wish to be attended at our deathbed by people whom we love and try to find meaning in death. Here, I…

Abstract

We wish to die peacefully in a manner suited to our values and taste. We also wish to be attended at our deathbed by people whom we love and try to find meaning in death. Here, I evaluate nursing of dying patients with regard to alienation of life and death from our daily living, problems concerning the judgment of death, how to die in a manner that fits the person's values and taste, and nursing for spiritual healing with traditional views of life and death, and cultural background of attending dying persons of the Japanese.

Details

Taking Life and Death Seriously - Bioethics from Japan
Type: Book
ISBN: 978-0-76231-206-1

Book part
Publication date: 24 September 2010

Maria DiTullio and Douglas MacDonald

A primary impetus of the modern hospice movement was the disparity, during the later 20th century, between the care provided to persons with illnesses considered “curable” and the…

Abstract

A primary impetus of the modern hospice movement was the disparity, during the later 20th century, between the care provided to persons with illnesses considered “curable” and the treatment – or lack of it – accorded the incurably or terminally ill. In its transformation from a reform-oriented, interdisciplinary response to the needs of the dying to an integrated component of the American healthcare system, hospice care's original mission, target population, and modality of service delivery were all significantly altered in ways that generated new disparities in access to “death with dignity.” This chapter attempts to trace the political, economic, and institutional dimensions of this transformation as reflected in the experiences of one Northeastern hospice during a 6-month period in 2001. Using an analytic approach known as institutional ethnography (IE), the authors focus on the work of the Hospice's Interdisciplinary Group (IDG) to uncover the linkages between local problems in the delivery of hospice care and extra-local sites of power and constraint at the mezzo- and macrolevels of the American healthcare system. The significance of these linkages for patients, frontline workers, and other stakeholders are interpreted from several perspectives. Implications for change are discussed.

Details

The Impact of Demographics on Health and Health Care: Race, Ethnicity and Other Social Factors
Type: Book
ISBN: 978-1-84950-715-8

Book part
Publication date: 24 August 2005

Tadashi Saga

Care for the elderly is the most pressing problem now facing Japan. For maintaining a long and healthy life, it is important to refine the self-care of people and to create a…

Abstract

Care for the elderly is the most pressing problem now facing Japan. For maintaining a long and healthy life, it is important to refine the self-care of people and to create a well-balanced system of support involving health care, welfare, nursing care, and medical treatment. Mutual support within each local community is also indispensable for restructuring care-minding areas. Due attention should also be paid to the ethical aspects concerning care of the elderly. This chapter attempts to reflect on the brief history of the care for the elderly in Japan.

Details

Taking Life and Death Seriously - Bioethics from Japan
Type: Book
ISBN: 978-0-76231-206-1

Book part
Publication date: 17 November 2010

Alexander J.J.A. Maas, Johannes H. Stravers and Frans P.M. Baar

Europe's population is aging. Compared to the number of people who live with an acute, life-threatening disease, more people now live with the effects of serious chronic…

Abstract

Europe's population is aging. Compared to the number of people who live with an acute, life-threatening disease, more people now live with the effects of serious chronic illnesses, and disability toward the end of life. Meeting both needs presents a public health challenge. Policy makers and health professionals recognize that these changes require a health program that encourages both inventive cure and care professionalization, particularly palliative care for those patients (and their families) who cannot be cured (Davies & Higginson, 2004).

Details

Relational Practices, Participative Organizing
Type: Book
ISBN: 978-0-85724-007-1

Book part
Publication date: 23 October 2003

Erica S Breslau

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from interactional…

Abstract

The sequence of stress, distress and somatization has occupied much of the late twentieth-century psychological research. The anatomy of stress can be viewed from interactional and hybrid theories that suggest that the individual relates with the surroundings by buffering the harmful effects of stressors. These acts or reactions are called coping strategies and are designed as protection from the stressors and adaptation to them. Failure to successfully adapt to stressors results in psychological distress. In some individuals, elevated levels of distress and failed coping are expressed in physical symptoms, rather than through feelings, words, or actions. Such “somatization” defends against the awareness of the psychological distress, as demonstrated in the psychosocial literature. The progression of behavior resulting from somatic distress moves from a private domain into the public arena, involving an elaborate medicalization process, is however less clear in sociological discourse. The invocation of a medical diagnosis to communicate physical discomfort by way of repeated use of health care services poses a major medical, social and economic problem. The goal of this paper is to clarify this connection by investigating the relevant literature in the area of women with breast cancer. This manuscript focuses on the relationship of psychological stress, the stress response of distress, and the preoccupation with one’s body, and proposes a new theoretical construct.

Details

Gender Perspectives on Health and Medicine
Type: Book
ISBN: 978-1-84950-239-9

Book part
Publication date: 24 August 2005

Takao Takahashi

Bioethics and environmental ethics have been largely separated, in principle. However, the two types of ethics do overlap when dealing with significant issues such as human…

Abstract

Bioethics and environmental ethics have been largely separated, in principle. However, the two types of ethics do overlap when dealing with significant issues such as human embryos, animal experimentation, and responsibility to future generations. In this paper, the possibility of synthesizing these two ethics through the concept of care is considered. Accordingly, the range of the object of the concept of care is similarly broadened. Moreover, after considering the serious defects of care-based theory, a care-based position, which regards human rights or their substitute as a complement to care, is advanced. This position can be said to be a Japanese approach to bioethics.

Details

Taking Life and Death Seriously - Bioethics from Japan
Type: Book
ISBN: 978-0-76231-206-1

Book part
Publication date: 9 April 2008

Urban Fransson, Daniel Hallberg and Mårten Lagergren

In Sweden, responsibility for the public care of the frail elderly rests with three authorities acting at different levels. At national level, the Riksdag and the Government…

Abstract

In Sweden, responsibility for the public care of the frail elderly rests with three authorities acting at different levels. At national level, the Riksdag and the Government realize policy goals through legislation and financial control measures. At regional level, 18 county councils and two regions are responsible for the provision of health and medical care. At local level, Sweden's 290 municipalities have a statutory duty to meet the social service and housing needs of the elderly. Sweden's municipalities and county council have a high level of autonomy by international standards. Activities in caring services are ultimately controlled by politicians appointed to policy-making assemblies in municipalities and county councils through general elections. The decentralization of responsibility for elderly care makes it possible for local and regional conditions to be taken into account when policies for the elderly are formulated. The national authorities – the National Board of Health and Welfare and the 20 county/region administrative boards – are responsible for supervision, follow-up, and evaluation of municipal and county council caring services.

Details

Simulating an Ageing Population: A Microsimulation Approach Applied to Sweden
Type: Book
ISBN: 978-0-444-53253-4

1 – 10 of 740