Defining palliative wound care: A scoping review by European Association for Palliative Care wound care taskforce
Duygu SezginJemell GeraghtyTanya GrahamKarin BlombergKaren CharnleySharon DobbsAideen McElvaneySebastian ProbstDimitri BeeckmanPatricia GrocottGeorgina Gethin
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Abstract:
Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management. To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review. Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English. The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar. A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis. A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care. Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound. A review protocol was developed but not registered.Keywords:
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Dignity
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The dignity of human is a philosophy problem that concerns the human's consciousness and the realization of human value.When we give out the question of human dignity,we want to find a way that we announce the one of requests in unchanging and justice when we individually get to self-satisfy from dignity.Now our society needs us to learn the dignity for each other,and get to dignity from other,thus human dignity will truly have the meaning of universalism.
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In the traditional understanding, human dignity is often portrayed as a «final», «inherent», and «absolute» value. If human dignity as the core of the status of a human being did indeed have thos characteristics, this would yield a severe limitation for obligations that stem from the moral status of non-human animals, plants, eco systems and other entities discussed in environmental ethics; for obligations that arise from human dignity standardly take priority over the duties toward entities with non-human moral status. Yet, many theorists of human dignity nowadays have given up the traditional picture in favour of a more «contingent» understanding of human dignity that abandons one or more of its traditional characteristics.In this paper, I argue that to the contrary, we have good reasons to think that the three characteristics of human dignity just mentioned can indeed be attributed to a value that deserves the name «human dignity». In a first part, I argue for a specific understanding of the three value characteristics under consideration. After these preliminaries, I show in a second part that given such an understanding, we have ample evidence that we can indeed say that human dignity is an inherent, absolute and final value; and also that these three characteristics are properties of a single value.
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Abstract This chapter opens by critiquing the dominant philosophical approach to dignity, which has its origins in Kant, on the grounds that it excludes vulnerable individuals, and cannot account for the phenomenon of lost or damaged dignity. It then lays out the central theoretical framework that informs the remainder of the book. This framework involves three distinct strands of dignity: personal dignity; social dignity; and status dignity. The strands emerge from distinguishing between self-respect and the respect of others, on the one hand, and recognition respect and appraisal respect, on the other.
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Research suggests that palliative care is poorly understood and often associated with imminent death (Canny, 2002). This, in turn, can negatively impact upon the transition to palliative care services. The aims of this three phase, multi-method study were to: (1) examine and compare the attitudes of health professionals toward palliative care; (2) examine and compare the attitudes and personal constructs of four key participant groups including patients receiving palliative care services, people living with cancer and the carers of both of these groups; and (3) to examine potential strategies for changing attitudes through education. Phase One involved a detailed assessment of health professionals’ attitudes toward, and understanding of, palliative care by means of a postal survey (182/700) and a small number of one-to-one interviews (n=5). Attitudes toward palliative care, as measured by the Health Professional Attitude Questionnaire (HPAQ), were explained by a number of key factors including: (1) knowledge of palliative care services; (2) relationship with the patient and family; and (3) personal reflection on mortality. Thematic analysis of the qualitative data further illuminated and developed this factorial model. Phase Two utilised one-to-one semi-structured interviews (n=30) and a battery of quantitative measures (n=75) to identify and compare attitudes toward, and experiences of, palliative care amongst patients receiving palliative care services (n=15), people living with cancer (n=25) and the carers of both of these groups (n=35). Repertory grids (n=12) were also used to explore and compare participants’ constructs of palliative care. Thematic analysis of the interview data revealed four key themes and associated subthemes that described patients’ and carers’ attitudes toward palliative care. Within each theme, different perspectives were adopted by each of the participant groups and these were explored and quantified by means of the repertory grid analysis. The findings from Phases One and Two were then used to inform the development of two health professional and patient interventions for Phase
Three that aimed to: (1) provide information about palliative care services; (2) utilise the patient ‘voice’ and story; (3) focus on the health promoting benefits of palliative care; and (4) demystify hospice, palliative care and the dying process. The study adds to the relatively small pool of evidence in this area and the use of the repertory grid technique, in particular, offers an interesting psychological tool for investigating palliative care research and practice.
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Dignity is a complex concept necessary for the adequate treatment of patients in the healthcare setting. Autonomy, self-sufficiency, respect, and equality are concepts used to define dignity. Dignity has not been studied in people who inject drugs (PWID).This study aimed to determine how PWID maintain or have their dignity threatened during hospitalization in an acute care unit.The qualitative descriptive study was a deductive thematic analysis of secondary data on PWID experiences with received nursing care. In-depth, semistructured interviews were conducted and transcribed verbatim with a constant comparison method for thematic analysis using NVivo. A priori codes of dignity concepts from the literature and dignity scales were used as a guide to examine the nine qualitative transcripts.The three most common threats to dignity during hospitalization were lack of equality compared with other patients, not feeling valued as an individual, and not feeling respected by the healthcare workers providing care. The three most common protectors of dignity were feeling respected by healthcare workers, having autonomy in treatment choices, and feeling valued as an individual.Protecting dignity significantly affects whether PWID are willing to seek healthcare in the hospital setting. Preserving dignity in PWID during their hospitalizations can encourage this population to seek care earlier. Nurses must be experienced in caring for PWID and provide nonjudgmental care for this population.
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Background: The cognitive and communication challenges experienced by people with intellectual disability present difficulties for health professionals, particularly in the face of illness and dying. Aim: To explore the experiences of specialist palliative care staff in talking with people with intellectual disability about their dying and death, and factors that influence these conversations. Design: An inductive thematic analysis was conducted on data from a larger qualitative semi-structured interview study. Setting/participants: Twenty palliative care staff from health services across Australia were interviewed. Participants were employed in multidisciplinary specialist palliative care teams and had provided palliative care to dying persons with intellectual disability. Results: Specialist palliative care staff did not consistently talk with people with intellectual disability about their dying and death. Conversations were influenced by (a) the perceived capacity of the person with intellectual disability, (b) experience and expertise of palliative care staff, (c) the relationship between palliative care staff and dying person and (d) values of palliative care staff and other caregivers (namely family members and paid carers). Conclusions: Specialist palliative care staff experience difficulties in talking with people with intellectual disability about their dying. Development of communication guidelines, resources and training for palliative care teams are urgently required to improve palliative care for this patient group. A more comprehensive research agenda on the needs of people with intellectual disability and their caregivers in palliative care is needed, with a particular focus on strategies to effectively communicate about dying and death.
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Chapter Two focuses on the concept of dignity. It characterizes the two main competing conceptions subsequently analysed in the book, sovereign and human dignity. It begins by exploring the intellectual origins of the concept of dignity – with its religious and philosophical strands. Within human dignity, particular emphasis is laid on the Christian and Kantian (secularised) conceptions of human dignity due to their distinctive historical influence on the shaping of international law. On this basis, the first component of the analytical framework is built, namely the conceptual categories of dignity that will, subsequently, be used to explore how dignity has found expression in international law.
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Human dignity means that all people have equal worth and deserve to live in dignity. This chapter posits that human dignity and a healthy environment are indivisible rights essential to the three dimensions of sustainability – environmental, social, and economic. A healthy environment is a necessary component of living in dignity: all have an equal claim to healthy air, water, and surroundings. Dignity is elemental to social sustainability, that is, building strong and resilient communities under the rule of law. Dignity is also essential to economic sustainability.
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Abstract Objectives This study aimed to describe insights from interviews about the experience of physiotherapists providing palliative care in Ontario and their perceptions of the role and value of physiotherapists' involvement in palliative care. Methods We conducted interviews with physiotherapists in Ontario, Canada ( n = 14), and received emailed submissions from two others (one physiotherapist and one physiotherapy student) with current or recent practice experience in palliative care. We conducted inductive thematic analysis of the interview data and emailed submissions. Results Participants' reflections were categorized into three major themes: perceived value of the contribution of physiotherapists in palliative care; the experience of providing physiotherapy in palliative care; and reflections on the palliative care system. Participants described their role in palliative care as diverse, driven by patient goals and focused on the experience of patients and families. Participants perceived a high value in collaborative networks for supporting them to fulfill their role in palliative care settings. Participants also recommended efforts to increase awareness of the potential for physiotherapists to contribute to palliative care. Conclusions The findings confirm those of research in other jurisdictions and extend our understanding of the value and meaningfulness of physiotherapy in palliative care, to patients, families, and physiotherapists themselves.
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