71 research outputs found
Natural disaster management a presentation to commemorate the International Decade for Natural Disaster Reduction (IDNDR) ; 1990 - 2000
No full textAutonomy and choice in palliative care: time for a new model?
No full textAims. This paper will examine understandings of autonomy and choice in relation to
palliative and end-of-life care and identify implications for nursing.
Background. Autonomy in relation to patient-centred care and advocacy has been
identified as a key component of palliative and end-of-life care provision
internationally. Understandings of autonomy have emerged in an individualised
framework, which may be inadequate in supporting palliative and end-of-life care.
Design. A critical discussion paper.
Data sources. Seminal texts provide a backdrop to how autonomy is understood
in the context of palliative care. An overview of literature from 2001 is examined
to explore how autonomy and choice are presented in clinical practice.
Implications for nursing. A model of autonomy based on a ‘decision ecology’
model may be more applicable to palliative and end-of-life care. Decision ecology
aims to situate the individual in a wider social context and acknowledges the
relational dimensions involved in supporting choice and autonomy. Such a model
recognizes autonomy around wider care decisions but may also highlight the
everyday personal aspects of care, which can mean so much to an individual in
terms of personal empowerment and dignity.
Conclusion. A ‘decision ecology’ model that acknowledges the wider social
context, individual narratives and emphasises trust between professionals and
patients may support decision-making at end of life. Such a model must support
autonomy not just at the level of wider decisions around care choice but also at
the level of everyday care.
Keywords: autonomy, choice, decision ecology, decision-making, end-of-life, ethics,
nursing, palliative care
Christine Ingleton, Merryn Gott & Clare Gardine
The geology of the Ingleton & Stainmore coalfields
No full textThe problem is dealt with under two main headings, a) the short- term and b) the long-term effects of burning. Short-term effects. 1. On the vegetation. Calluna and the dwarf shrubs may be completely destroyed by fire, but species that are caespitose or have protected underground parts commonly survive. Regeneration of the dwarf shrubs is facilitated by their high seed-production, but they can regenerate vegetatively if not killed. The interval between successive burnings ('cycle-length'), and not fire damage, appears to be a major factor in determining the floristic composition of the vegetation. 2. On the soil. The base-status of the upper soil horizons declines through each cycle. Leaching experiments show that an increased amount of base is lost in the run-off water and leachate soon after burning. It is concluded, in view of the restriction of the rooting systems to the upper soil, that there is in this way an appreciable loss of bases from the peaty horizons at each burning. Long-term effects. 1. On the vegetation. There is evidence that 150 years ago heather moors were considerably richer in species than they are today. It is also shown that long-continued systematic burning leads to a greater loss of species than irregular and less frequent burning.2. On the soil. In all cases examined, woodland soils show a higher base-status than closely comparable soils under moorland, and it seems clear that the fertility of the moors is lower than it would have been had their former woodland persisted. The phytometrical use of green heather leaves substantiates these findings, and shows the fertility of old moors to be less than that of moors of recent origin. In the final section the economic utilisation of heather moor is discussed
Patient and public involvement in scope development for a palliative care health technology assessment in europe.
No full textThe contributions deals with the patient and public involvement in scope development for a palliative care health technology assessment in Europe during an UE FP7 Research Project
State of Disaster Risk Reduction at the Local Level: A report on the Patterns of Disaster Risk Reduction Actions at Local Level
No full textSedimentology of the Mid-Visean limestones of the southern part of the Askrigg Block, North Yorkshire
No full textThe earliest Carboniferous deposits, resting with profound unconformity on Lower Palaeozoic rocks, have been mapped across their entire outcrop area on the Askrigg Block. The sediments, comprising approximately half of the thickness of the Dinantian Great Scar Group, have been subdivided into four formations listed in ascending stratigraphlcal order:- the Thornton Force Formation and its lateral equivalent the Douk Gill Formation, the Raven Ray Formation and finally, the Horton Limestone.Each of these formations has been described in great detail, noting the variations in thickness and the various rock-types contained therein. This data has been used to identify sixteen rock-types which occur in at least one and usually in all of the studied formations.The depositional environment of each of these rock-types has been interpreted by means of palaeoenvironmental analysis of the fossil groups and sedimentary structures present and from the distribution of each of the rock-types. The diagenetic history of the carbonates has been studied by means of staining techniques.The earliest deposits of the Thornton Force Formation were formed in a marginal marine environment. Although beach-nearshore sediments accumulated in an active environment, inundation of the Askrigg Block appears to have been a gradual and gentle process, allowing local preservation of soils and debris flow deposits in more protected pockets and hollows. The ridges of Lower Palaeozoic rock supplied detritus throughout deposition of nearshore shallow subtidal calcarenltes of the formation.The Douk Gill Formation, restricted in outcrop to a local topographic hollow in Ribblesdale, is probably a lateral equivalent of the Thornton Force Formation. A ridge of Lower Palaeozoic rocks provided a protective barrier, allowing clastlc and later carbonate sediments to accumulate in the sheltered environment. Infilling of the lagoon resulted in the formation of tidal flats, and culminated in subaerial exposure and the development of a thin coal.During deposition of the Raven Ray Formation a shelf-edge shoal must have formed, separating the Pennine Basin from the normal marine shelf lagoon of lime mud deposition. Small shoals occasionally developed in the extensive lagoon environment. Shoreline deposits formed around those Lower Palaeozoic ridges which persisted as islands.The Horton Limestone represents an episode of deposition predominantly of cross-laminated calcarenites formed within surge depth. Eventually, shelf-edge shoals created a barrier which separated the Pennine Basin from a restricted marine, shallow lagoon of lime mud deposition. Gradual infilling of the lagoon led to the creation of a tidal flat environment. Tidal channels were common in this environment. Periodically the barrier shoals were breached and the lagoon-tidal flat environment overwhelmed by carbonate sand.The principal mechanisms controlling sedimentation have been discussed. During the initial stages of inundation, the topography of the pre-Carboniferous rocks exerted a significant but dwindling influence on the rock-types deposited and on their distribution. Burial of the land surface eliminated this effect and the rates of sedimentation and subsidence became the most significant mechanisms controlling the type and distribution of Dinantian sediments
Barriers to providing palliative care for older people in acute hospitals
No full textBackground: the need for access to high-quality palliative care at the end of life is becoming of increasing public health concern. The majority of deaths in the UK occur in acute hospitals, and older people are particularly likely to die in this setting. However, little is known about the barriers to palliative care provision for older people within acute hospitals.
Objective: to explore the perspectives of health professionals regarding barriers to optimal palliative care for older people in acute hospitals.
Methods: fifty-eight health professionals participated in eight focus groups and four semi-structured interviews.
Results: participants identified various barriers to palliative care provision for older people, including attitudinal differences to the care of older people, a focus on curative treatments within hospitals and a lack of resources. Participants also reported differing understandings of whose responsibility it was to provide palliative care for older people, and uncertainly over the roles of specialist and generalist palliative care providers in acute hospitals.
Conclusions: numerous barriers exist to the provision of high-quality palliative care for older people within acute hospital settings. Additional research is now required to further explore age-related issues contributing to poor access to palliative care
A qualitative study exploring the benefits of hospital admissions from the perspectives of patients with palliative care needs
No full textCan comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK
No full textThe Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led,
multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service
worked. Seventy-one per cent of patients died at home. This model may have application elsewhere
Specialist palliative care nursing and the philosophy of palliative care: a critical discussion
No full textNursing is the largest regulated health professional workforce providing palliative care across a range of clinical settings. Historically, palliative care nursing has been informed by a strong philosophy of care which is soundly articulated in palliative care policy, research and practice. Indeed, palliative care is now considered to be an integral component of nursing practice regardless of the specialty or clinical setting. However, there has been a change in the way palliative care is provided. Upstreaming and mainstreaming of palliative care and the dominance of a biomedical model with increasing medicalisation and specialisation are key factors in the evolution of contemporary palliative care and are likely to impact on nursing practice. Using a critical reflection of the authors own experiences and supported by literature and theory from seminal texts and contemporary academic, policy and clinical literature, this discussion paper will explore the influence of philosophy on nursing knowledge and theory in the context of an evolving model of palliative care
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