PubMed Health⌕ Search

Biomedical subjects

S A Payne

Publications and source records attributed to S A Payne.

14 recordsLinked to original sources
PubMed2005

An exploration of family carers' experience of respite services in one specialist palliative care unit.

BACKGROUND: Changing patterns of care for terminally ill people mean that 90% of patients in the UK now spend the majority of their last year of life at home. It is now widely accepted that supporting individuals to die at home relies heavily on the availability of family carers to provide the majority of the care needed. However, one of the most common reasons for unplanned admissions near the end of life is carers' inability to provide continuing care. One strategy to overcome these challenges has been to offer planned respite care. Despite recent studies, in reality little is known about respite services for patients with life limiting illness, in particular how respite is experienced by the caregivers or to what extent respite services address their needs. METHODS: This prospective study, comprising mixed methods of data collection, explored the experiences of 25 family carers whose relative had been admitted to the local hospice for inpatient respite care. Semi-structured interviews were conducted at two time points: pre- and post-respite. The Relative Stress Scale Inventory was administered at both interviews. RESULTS: Just over half of the sample were caring for a relative with a diagnosis of cancer (n=13); the majority of the others had a number of neurological conditions (n = 12). The data demonstrate that managing care for relatives with a life limiting illness was perceived to be hard work, both physically and mentally. Inpatient respite care was considered important as it enabled family carers to have a break from the ongoing care-giving responsibilities, as well as being an opportunity to experience 'normal life' independently. The majority of family carers felt that their expectations of respite for themselves had been achieved. The respite service was well evaluated in relation to: standard of nursing care; alternative facilities on offer, atmosphere; and other care homes. DISCUSSION: Currently, inpatient respite services are provided to two patient groups--those in the last year of life and those with a chronic life limiting illness. However, on closer analysis, the current model of service delivery, a two-week inpatient stay, may not be best suited to those caring for a relative in the last year of life. Similarly, it might be questioned whether an inpatient hospice is the most suitable setting for those patients needing supportive care, rather than specialist palliative care. The study has raised many issues that need to be considered in the support of carers caring for relatives with a life limiting illness with uncertain trajectories.

Adult↗
PubMed2004

Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals.

OBJECTIVES: To determine the problems and issues of accessing specialist palliative care by patients, informal carers and health and social care professionals involved in their care in primary and secondary care settings. DATA SOURCES: Eleven electronic databases (medical, health-related and social science) were searched from the beginning of 1997 to October 2003. Palliative Medicine (January 1997-October 2003) was also hand-searched. STUDY SELECTION: Systematic search for studies, reports and policy papers written in English. DATA EXTRACTION: Included papers were data-extracted and the quality of each included study was assessed using 10 questions on a 40-point scale. RESULTS: The search resulted in 9921 hits. Two hundred and seven papers were directly concerned with symptoms or issues of access, referral or barriers and obstacles to receiving palliative care. Only 40 (19%) papers met the inclusion criteria. Several barriers to access and referral to palliative care were identified including lack of knowledge and education amongst health and social care professionals, and a lack of standardized referral criteria. Some groups of people failed to receive timely referrals e.g., those from minority ethnic communities, older people and patients with nonmalignant conditions as well as people that are socially excluded e.g., homeless people. CONCLUSIONS: There is a need to improve education and knowledge about specialist palliative care and hospice care amongst health and social care professionals, patients and carers. Standardized referral criteria need to be developed. Further work is also needed to assess the needs of those not currently accessing palliative care services.

Aged↗
PubMed2000

Creating and maintaining 'optimism' in cancer care communication.

This study investigates nurse-patient communication in the cancer care context. Interviews with nurses and patients about their communication experiences and audio-recorded nurse-patient conversations were collected and analysed. A theme of 'optimism' largely manifesting as 'constructive realism' was one of four features identified by the qualitative analysis. The health professional has traditionally been viewed as the party with the power and control over conversation progression and topics. In particular, the superficial, positive and chatty nature of nurse-patient interaction has often been attributed to a lack of nurses' communication skills training. This research indicates that both patient and nurse are active in its construction and argues that the optimistic cheerful nature of nurse-patient interaction may be better viewed as a jointly produced institutional feature of cancer care. This paper illustrates and examines some of the ways this outcome was created and maintained by participants and discusses the implications of this.

Attitude to Health↗
PubMed1999

Terminally ill patients' and lay-carers' perceptions and experiences of community-based services.

This paper reports on terminally ill patients' and their lay-carers' perceptions and experiences of community-based services. It forms part of a larger investigation which examined the extent of service provision and any perceived gaps and problems from the perspectives of both clients and providers of community-based assistance for the terminally ill. The participants were nine terminally ill patients and 12 lay-carers receiving community nursing care. Fifteen face-to-face, semi-structured interviews were conducted to elicit their experiences and perceptions of the care being provided. Qualitative, thematic analysis was carried out on the audio-taped interviews. On the whole, respondents reported a high level of satisfaction and appreciation for the help provided. Several areas appeared more problematic, however, and warrant further consideration. These include perceptions of health professionals, particularly their role domains, power and expertise, and some of the practical disadvantages and problems faced by some patients and their families. These are illustrated and the implications for dying patients, their lay-carers and community-based health professionals are discussed.

Adult↗
PubMed1998

A comparative study of death anxiety in hospice and emergency nurses.

This paper describes a preliminary cross-sectional study which aimed to compare levels of death anxiety and coping responses in palliative care and accident and emergency (A & E) nurses. Forty-three nurses (23 from palliative care and 20 from A & E) were recruited from a district general hospital and nearby hospice. Both sites had the same mean annual death rate of 150 patients. Death anxiety was measured by the Death Attitude Profile-Revised Questionnaire and coping responses were elicited by a semi-structured interview. As hypothesized, hospice nurses had lower death anxiety and they were more likely to recall both good and difficult experiences related to patient care. Unlike the hospice nurses, a subgroup (20%) of A & E nurses reported that they were unable to discuss problems with colleagues. The study has implications for the development of institutional support for staff to enable nurses to provide good quality care for dying patients and bereaved people.

Adaptation, Psychological↗
PubMed1996

Dissonant Loss: the experiences of donor relatives.

Narrative type interviews were carried out with a purposive sample of 24 relatives of organ donors. Relatives were recruited through 3 Regional transplant co-ordinating centres in England. The study examined in-depth the relatives': emotional reactions to the death and donation, perceptions of the decision-making process, assessment of the problems donation caused for them, as well as the benefits it provided. An understanding of what the experience meant to them was elicited, as was the identification of their needs. The interviews were audiotaped and transcribed. The transcripts were analysed using a grounded theory approach, based on the constant comparative method. Themes emerging from the data were named to form categories. Categories were defined and integrated around the central theme of the research to form an analytical version of the story. Donor relatives' experiences were found to revolve around a process of conflict and resolution. Their experience is explained as a theory of "Dissonant Loss".

Adaptation, Psychological↗
PubMed1996

Perceptions of a 'good' death: a comparative study of the views of hospice staff and patients.

The literature suggests that health professionals working in palliative care have developed an idealised concept of dying which has been labelled the 'good' death. This paper reports the results of a preliminary qualitative study which compared the concepts of a 'good' death used by patients and staff in a palliative care unit. Semistructured interviews designed to elicit perceptions of 'good' and 'bad' deaths were conducted with 18 patients and 20 health professionals. The transcribed interviews were content analysed. There were major differences between the views of patients and staff. The patients' descriptions of a "good' death were diverse and included: dying in one's sleep, dying quietly, with dignity, being pain free and dying suddenly. In comparison, staff characterised a "good' death in terms of adequate symptom control, family involvement, peacefulness and lack of distress, while a "bad' death was described as involving uncontrolled symptoms, lack of acceptance and being young. The findings suggest that patients and staff differ in their conceptualisations of a "good' death.

Attitude of Health Personnel↗
PubMed1994

Gift Exchange Theory: a critique in relation to organ transplantation.

Organ transplantation is becoming more important as a viable method of treatment for certain severe medical conditions. It is a complex and demanding process for all involved. Nursing as a developing science must respond to cultural and economic changes. Therefore, a need exists to develop a body of empirically based knowledge to understand and support the process of organ transplantation. This paper will argue that as trading in organs is unacceptable to the moral standards of western society and outlawed in many countries, an alternative framework must be considered for understanding the mechanisms through which organs are donated and utilized. The donating and receiving of organs may be equated with gift-giving, as there is no barter of commodities involved. Therefore, a useful framework to explore this phenomenon will be one that underpins the process of giving and receiving of gifts. Gift Exchange Theory will be evaluated and critically examined in relation to organ transplantation and the role of nurses in this process.

Anthropology, Cultural↗
PubMed1992

A study of quality of life in cancer patients receiving palliative chemotherapy.

Although primary treatment for cancer has been associated with psychosocial distress, less research has focused on patients with advanced disease. Traditionally, the outcomes of treatment have been assessed using biomedical criteria, including tumour regression, progression and survival. It is argued that these data are inadequate to understand the impact of cancer upon the patient. Instead, quality of life considerations are crucial when treatments are aversive, especially when the aims are palliative rather than curative. Fifty-three patients with advanced breast cancer or ovarian cancer were studied prospectively for 6 months to assess whether the site and method of chemotherapy administration influenced their quality of life. Patients received palliative chemotherapy either at home or in hospital. Quality of life was operationalized as measurement of anxiety, depression, self-esteem, health locus of control, physical performance and symptoms. In addition, semi-structured interviews explored social roles, relationships, and perceptions of treatment. Hospital administered chemotherapy was perceived to be most distressing. Regression analysis indicated that anxiety and depression accounted for most of the variance in quality of life. Patients who died during the study 13 (24%) experienced considerable psychological and physical morbidity. Women over 60 years, experienced less psychological and physical distress. Quality of life broadens the criteria by which cancer treatments are evaluated, to include the experience of the patient.

Adult↗
PubMed1990

Coping with palliative chemotherapy.

Comparatively little is known about how patients with advanced cancer cope with palliative chemotherapy. This study uses grounded theory to analyse the coping responses of 24 women with advanced breast or ovarian cancer. Half the sample received chemotherapy at home, and the remainder were treated in hospital. The results suggest that four predominant coping styles are used; think positive/fighter (n = 8), acceptance (n = 8), fearfulness (n = 5) and hopelessness (n = 3). In addition, a range of coping strategies that reduced the threat of chemotherapy are identified. The findings have implications for the provision of quality patient care in palliative therapy, especially in relation to individualizing patient education.

Adaptation, Psychological↗