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research proposal: Patients experience of home-based palliative care in Ireland

research proposal: Patients experience of home-based palliative care in Ireland

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An essay for the 2011 Undergraduate Awards (Ireland) Competition by rebecca ni mhurchu. Originally submitted for general nursing at University College Cork, with lecturer eileen savage in the category of Nursing
An essay for the 2011 Undergraduate Awards (Ireland) Competition by rebecca ni mhurchu. Originally submitted for general nursing at University College Cork, with lecturer eileen savage in the category of Nursing

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Published by: Undergraduate Awards on Aug 31, 2012
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Patients experience of home-based palliative care in Ireland.
Abstract:This research proposal examines the lived experience of caregivers and patients receivinghome-based palliative care in Ireland. A number of studies have revealed that home-basedpalliative care can have beneficial and positive outcomes for both the patient and caregiver,and is regarded as the best place of care for dying patients when adequate support structuresare present (Peters and Sellick, 2006). Review of the literature reveals that very little researchhas been carried out in Ireland in the area of home-based palliative care. In order to gaindeeper understanding of the experience of home-based palliative care, true data from the
 patients‟ perspective is essential. A qualit
ative phenomenological approach is proposed forthis study. A purposive sample of patients (n=10) will be selected for this study once ethicalapproval has been granted. Data will be collected using in-depth semi-structured interviews.IntroductionDying is part of living and it is a very natural, unique and special experience for eachindividual (Neuberger, 2005). The terminal phase of an illness is considered to be the last journey of a
 person‟s life on earth (Furst and Doyle, 2004). There are many chal
lengesassociated with the physical and psychological wellbeing of the dying patient includinghis/her family during this sensitive time, and various determining factors will influence their journey (Sivesind and Baile, 2001).According to the International Association for Hospice and Palliative Care (2009), WorldHealth Organisation (2009) and Travis and Mitchell (2007) palliative care is a human rightand is provided to those who have been diagnosed with a terminal illness. Palliative carefocuses on easing the transition from life to death. According to Clarke (2009) palliative careis a healthcare service that many people are unaware of, yet could be considered as one of themost important healthcare services one might ever receive. Palliative care promotes patientsdignity, respect and autonomy, providing the physical and emotional support to achieve a
2better quality of life and death for both the patient and the caregiver (Koffman and Higginson2004).It is evident from research that the majority of patients receiving palliative care would like todie in the comfort of their own home, in a conscious and pain-free state with their families(Condon, 2009). This is significant because 26,776 new cancer cases were registered in 2006(The National Cancer Registry Board, 2006) and Condon (2009) revealed that 30,000 peopledie each year of cancer. It is estimated that 3 out of 4 patients do not die in their own homesbut in health care institutions. Yet patients and family members have described the comfortof spending the last few weeks of life at home to be a positive experience (Tang, 2009).Although the concept of palliative care is not solely designed for cancer sufferers theliterature reviewed within this proposal will address cancer patients. Two studies focus on theperception and effectiveness of palliative care educational services, and three studies focuson the manageability of home-based care in terms of the patients and carers.
Chapter 1
Literature Review1.1 IntroductionThe purpose of this literature review is to explore and gain an insight into the outcomes andexperience of end-of-life palliative care in the home. Literature was retrieved using thefollowing database, Cinahl and PubMed. Key words used in the search inclu
ded „palliativecare‟,
kin‟, „caregivers‟, „
life care‟, „advanced cancer care‟, and „home
 palliative care‟.
Limits applied were to full text articles between the years 1999-2009 andpeer reviewed journals. A manual search was also carried out in the college and hospitallibraries. All of the literature used in this review had ethical approval and informed consent.The articles reviewed will be presented under two themes;1. Palliative care needs.2. Ability to manage home-based palliative care.
3A gap in the literature will be identified to explore the possibility of further research.1.2 Palliative care needs.McIlfatrick (2007) conducted a qualitative study to identify the perspectives of patients,carers and professionals with regards to palliative care needs and services for both cancer andnon-cancer population in Northern Ireland. A purposive sample of palliative care patients andcarers (n=24) was used and data were collected by semi-structured interviews in the homes of the participants. Also focus group discussions were conducted with a sample of multi-professionals (n=59) in hospital and community settings.Interviews and focus group discussions explored areas such as palliative care provisions,perception of needs, barriers and suggestions for improvements. Audio-taped interviewslasted 60 minutes and were subsequently
transcribed verbatim using Burnard‟s
(1991)framework. The transcripts were categorised into various themes, based on the aim of thestudy. To ensure rigour during the study, reflective diaries, observational techniques, memberchecking and reflexivity were adopted to interpret and analyse the data, thus enhancingvalidity of the study.In summary, areas of need identified were complexity with regards to choice,communication and information exchange between health-service providers and carers,physical and psychosocial support and financial concerns. Nurses need to be aware of theseissues
so they can reduce barriers to meet patients‟ needs.
In Melbourne a combined qualitative and quantitative study was carried out by Hudson,Thomas, Quinn Cockayne and Braithwaite (2009). The researchers endeavoured to evaluatethe effectiveness of group educational programs (G.E.P) for carers of patients receivingpalliative care at home. The main objective was to prepare and provide support for carers intheir role as a palliative caregiver and evaluate its effectiveness. The data were collected bythe use of three time point sessions which were organised on a weekly basis. Participants(n=156) took part however, only (n=96) completed all 3 sessions. To establish if there was a

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