Introduction: Education and skill enhancement in palliative and end of life care is rarely part of the foundational medical education curriculum. The progress of student physicians tends to be measured by their abilit...Introduction: Education and skill enhancement in palliative and end of life care is rarely part of the foundational medical education curriculum. The progress of student physicians tends to be measured by their ability to synthesize and demonstrate basic medical knowledge and clinical skills but offers little assessment of the maturation of attitudes or their values. The University of New England College of Osteopathic Medicine (UNECOM), immerses second year medical students in a hospice home for 48 hours to enhance students’ perspectives in interprofessional palliative and end of life care. Methods: This project utilized qualitative ethnographic and autobiographic research designs. Two female second year medical students (27 y/o & 26 y/o) were immersed for 48 hours into a local hospice home, sleeping in a bed where others had died, to answer the question: “What is it like for ME to live in the Hospice Home for 48 hours and how does this contribute to my future as a practitioner?” Data were collected in the form of journal notes for pre-fieldwork, fieldwork, and post-fieldwork and included subjective and objective reporting of observations, experiences, and patient/family encounters. Analyses included journal review and thematic categorization and coding through content analysis. Results: Themes common to both students that factored in the research question and their prior stated interest areas of medical humanities and person-centered care at end of life were identified. Three themes were selected for this article: 1) Person-Centered Experiences, 2) Spectrum of Communication, and 3) Introspection: Attitudes and Values. The process of living in the hospice home for 48 hours revealed students’ attitudes about various disease processes, their personal experiences with death and dying, and their assumptions about how patients approach death. Conclusion: This Hospice Home Immersion project provided both an educational approach and learning environment that was effective in advancing medical students’ attitudes, skills, and knowledge as evidenced by their self-reported life altering learning about end of life and palliative care.展开更多
<strong>Background:</strong> Hospice care is to provide necessary medical care and support for patients and the families at the end of life (EOL). Hospice care patients typically withdraw from aggressive t...<strong>Background:</strong> Hospice care is to provide necessary medical care and support for patients and the families at the end of life (EOL). Hospice care patients typically withdraw from aggressive treatment. Even though home hospice has been shown to improve the quality of care, home hospice patients still revoke the services for various reasons. A little is known about where home hospice patients are being transferred. This study aims to address this gap and explore common reasons for home hospice discharge and placements, where patients being transferred other than home. <strong>Methods:</strong> Data were retrieved from the 2007 National Home and Hospice Care Survey (NHHCS). NHHCS is one in a series of nationally representative sample surveys of U.S. home health and hospice agencies. <strong>Results:</strong> Within identified home hospice patients, approximately 82.1% were deceased at discharge, and 846 (18.2%) were discharged for other reasons, including patients being stabilized or improved (30.2%), aggressive treatment (31.8%), moved (e.g., geographically, 13.5%) and others. Patients lived with a spouse were less likely to utilize external resources, like volunteers, thereby more likely to discharge patients to long-term facilities. <strong>Discussion:</strong> The current study suggest that it is difficult for the family to give all remaining care for their loved ones despite the support and resources for those home hospice patients. The characteristics of those who transferred to nursing facilities from home hospice will be discussed throughout.展开更多
文摘Introduction: Education and skill enhancement in palliative and end of life care is rarely part of the foundational medical education curriculum. The progress of student physicians tends to be measured by their ability to synthesize and demonstrate basic medical knowledge and clinical skills but offers little assessment of the maturation of attitudes or their values. The University of New England College of Osteopathic Medicine (UNECOM), immerses second year medical students in a hospice home for 48 hours to enhance students’ perspectives in interprofessional palliative and end of life care. Methods: This project utilized qualitative ethnographic and autobiographic research designs. Two female second year medical students (27 y/o & 26 y/o) were immersed for 48 hours into a local hospice home, sleeping in a bed where others had died, to answer the question: “What is it like for ME to live in the Hospice Home for 48 hours and how does this contribute to my future as a practitioner?” Data were collected in the form of journal notes for pre-fieldwork, fieldwork, and post-fieldwork and included subjective and objective reporting of observations, experiences, and patient/family encounters. Analyses included journal review and thematic categorization and coding through content analysis. Results: Themes common to both students that factored in the research question and their prior stated interest areas of medical humanities and person-centered care at end of life were identified. Three themes were selected for this article: 1) Person-Centered Experiences, 2) Spectrum of Communication, and 3) Introspection: Attitudes and Values. The process of living in the hospice home for 48 hours revealed students’ attitudes about various disease processes, their personal experiences with death and dying, and their assumptions about how patients approach death. Conclusion: This Hospice Home Immersion project provided both an educational approach and learning environment that was effective in advancing medical students’ attitudes, skills, and knowledge as evidenced by their self-reported life altering learning about end of life and palliative care.
文摘<strong>Background:</strong> Hospice care is to provide necessary medical care and support for patients and the families at the end of life (EOL). Hospice care patients typically withdraw from aggressive treatment. Even though home hospice has been shown to improve the quality of care, home hospice patients still revoke the services for various reasons. A little is known about where home hospice patients are being transferred. This study aims to address this gap and explore common reasons for home hospice discharge and placements, where patients being transferred other than home. <strong>Methods:</strong> Data were retrieved from the 2007 National Home and Hospice Care Survey (NHHCS). NHHCS is one in a series of nationally representative sample surveys of U.S. home health and hospice agencies. <strong>Results:</strong> Within identified home hospice patients, approximately 82.1% were deceased at discharge, and 846 (18.2%) were discharged for other reasons, including patients being stabilized or improved (30.2%), aggressive treatment (31.8%), moved (e.g., geographically, 13.5%) and others. Patients lived with a spouse were less likely to utilize external resources, like volunteers, thereby more likely to discharge patients to long-term facilities. <strong>Discussion:</strong> The current study suggest that it is difficult for the family to give all remaining care for their loved ones despite the support and resources for those home hospice patients. The characteristics of those who transferred to nursing facilities from home hospice will be discussed throughout.
