Background Despite increasing use of telemedicine in the field of palliative care, studies about the best circumstances and processes where it could replace face-to-face interaction are lacking. This study aimed to: (1) identify situations that are most amenable to the use of telemedicine for the provision of palliative care to patients in nursing homes; and (2) understand how telemedicine could best be integrated into the routine practice of mobile palliative care teams. Methods A qualitative study based on semi-structured focus groups (n = 7) with professionals (n = 33) working in mobile palliative care teams in France. Results Between June and July 2019, 7 mobile palliative care teams participated in one focus group each. Using thematic analysis, we found that telemedicine use in palliative care is about navigating between usual and new practices. Several influencing factors also emerged, which influence the use of telemedicine for palliative care, depending on the situation. Finally, we built a use-case model of palliative care to help mobile palliative care teams identify circumstances where telemedicine could be useful, or not. Conclusions The potential utility of telemedicine for delivering palliative care in nursing homes largely depends on the motive for calling on the mobile palliative care team. Requests regarding symptoms may be particularly amenable to telemedicine, whereas psycho-social distress may not. Further studies are warranted to assess the impact of influencing factors on real-life palliative care practices. Telemedicine could nonetheless be a useful addition to the mobile palliative care teams' armamentarium.

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Building a telepalliative care strategy in nursing homes: a qualitative study with mobile palliative care teams.

The Chronic Disease Self‐Management Programme (CDSMP) has resulted in improved health outcomes for patients. However, research has focused mainly on those with chronic conditions and has not extensively explored prevention programmes targeting individuals with specific vulnerability profiles.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/hex.13430

The chronic disease Self‐Management Programme: A phenomenological study for empowering vulnerable patients with chronic diseases included in the EFFICHRONIC project

Pre-exposure prophylaxis (PrEP) for HIV is instrumental in the prevention of HIV for HIV-uninfected persons, by drastically reducing the risk of acquisition in the case of high-risk exposures. Despite its demonstrated efficacy, it remained under-prescribed in France until 2018. The principal aim of this study was to understand the motivations of Men who have Sex with Men (MSM) who started using PrEP in Montpellier, France. A phenomenological study was undertaken, using semi-structured interviews with twelve participants attending the University Hospital of Montpellier for PrEP. Interviews were analysed by means of triangulation up to the point of theoretical saturation, using a semio-pragmatic method. Fear of HIV infection, personalised regular follow-up, and the wish to take care of one’s health were the primary motivational factors. PrEP allows for a better sexual life restoring a sense of freedom despite the risks of STI, deemed manageable by PrEPers. PrEP does not modify long-term risk-taking behaviours but helps them better live their own sexuality and guides them towards a responsible approach to sexuality. Unclear information on PrEP, delivered by their family doctor, public campaigns or the media, leads to misrepresentations or negative social representation, including within the MSM community, which may delay its implementation. Fear of HIV infection and the benefits of regular medical follow-up to take care of one’s health were motivational factors of importance for the use of PrEP by MSM in this study. PrEP transforms all existential dimensions of their lived experience, improving sexual identity and happiness. There is a need to improve professional awareness of the effectiveness of PrEP and to develop a patient centered approach, to disseminate information more widely to the general public and among MSM to reduce stigmatisation.

/pdf/pre-exposure-prophylaxis-makes-it-possible-to-better-live-4hu26riv41.pdf

Pre-exposure prophylaxis makes it possible to better live one's sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP.

Recommendations for risk management and better living with epilepsy. Phenomenological study of the experience of patients, relatives, and bereaved families.

<h3></h3> Паллиативная медицинская помощь, по определению Всемирной организации здравоохранения, заключается в подходе, позволяющем улучшить качество жизни больных и их семей, которые сталкиваются с бременем неизлечимых заболеваний. Однако в современную эпоху развитых медицинских технологий вопросу оказания паллиативной помощи уделяется мало внимания вплоть до полного его игнорирования. Медицинская сестра в системе оказания паллиативной помощи играет важную роль. Именно ей приходится проводить больше всего времени рядом с больным, оказывать медицинскую помощь и психологическую поддержку, определять его нужды и потребности. <h3>ЦЕЛЬ ОБЗОРА</h3> Изучить актуальные проблемы подготовленности сестринского персонала к оказанию паллиативной помощи. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Авторами проведен поиск научных статей на английском и русском языках, опубликованных не позднее 2015 г., в базах данных PubMed, Scopus, EBSCOhost, Wiley. Исследование проводилось с февраля по декабрь 2022 г. В качестве аналитического материала для обзора литературы отобрано 62 публикации. <h3>РЕЗУЛЬТАТЫ</h3> Исследования, проведенные в последние годы в нескольких странах среди медсестер, работающих в различных медицинских учреждениях, показали, что медсестры испытывают дефицит знаний при ведении такого рода пациентов. А именно, отмечен низкий уровень знаний у медсестер по уходу за людьми с деменцией, в вопросах распознавания и облегчения боли, в оценке ее характера и интенсивности, степени влияния на качество повседневной жизни больного, в использовании специальных инструментов оценки боли, также ощущается недостаток знаний о социальных и культурных традициях, верованиях пациентов. Основными барьерами являются отсутствие специального образования, понимания и разграничения обязанностей между специалистами, большая нагрузка на рабочем месте, ограниченная легитимность. Работа мобильных бригад, волонтерство, услуги на дому — основные принципы паллиативной помощи, которые необходимо внедрять повсеместно. <h3>ВЫВОДЫ</h3> На данном этапе развития паллиативной помощи во многих странах существует острая необходимость разработки образовательных программ по паллиативной помощи для всех медицинских университетов и колледжей, при этом особое внимание следует уделять культурным особенностям пациентов, навыкам общения и навыкам поэтапной анестезии. В состав мобильных бригад должны входить медсестры, прошедшие обучение по дополнительным профессиональным программам, включающим вопросы паллиативного ухода. Четкое разделение функциональных обязанностей, делегирование полномочий и снижение нагрузки на медсестер повысят качество паллиативной сестринской помощи. 

Actual issues and prospects of training nurses for the palliative care system

Despite a broad consensus and recommendations, numerous international reports or studies have shown the difficulties of implementing palliative care within healthcare services. The objective of this study was to understand the palliative approach of registered nurses in hospital medical and surgical care units and their use of mobile palliative care teams. Qualitative study using individual in depth semi-structured interviews and focus group of registered nurses. Data were analyzed using a semiopragmatic phenomenological analysis. Expert nurses of mobile palliative care team carried out this study. 20 registered nurses from three different hospitals in France agreed to participate. Nurses recognize their role as being witnesses to the patient’s experience through their constant presence. This is in line with their professional values and gives them an “alert role” that can anticipate a patient-centered palliative approach. The physician’s positioning on palliative care plays a key role in its implementation. The lack of recognition of the individual role of the nurse leads to a questioning of her/his professional values, causing inappropriate behavior and distress. According to nurses, “rethinking care within a team environment” allows for the anticipation of a patient-centered palliative approach. Mobile Palliative Care Team highlights the major role of physicians-nurses “balance” while providing personal and professional support. The Physician’s positioning and attitude toward palliative approach sets the tone for its early implementation and determines the behavior of different staff members within healthcare service. “Recognition at work”, specifically “recognition of the individual role of nurse” is an essential concept for understanding what causes the delay in the implementation of a palliative approach. Interprofessional training (physicians and nurses) could optimize sharing expertise. Registered nurses consider MPCT as a “facilitating intermediary” within the healthcare service improving communication. Restoring a balance in sharing care and decision between physicians and other caregivers lead care teams to an anticipated and patient-centered palliative approach according to guidelines.

/pdf/a-phenomenological-study-of-nurses-experience-about-their-3v6eq832rr.pdf

A phenomenological study of nurses experience about their palliative approach and their use of mobile palliative care teams in medical and surgical care units in France.

Remy Crosnier

Papers

A phenomenological study of nurses experience about their palliative approach and their use of mobile palliative care teams in medical and surgical care units in France.