Heather Tan

Ricoeur's Theory of Interpretation: An Instrument for Data Interpretation in Hermeneutic Phenomenology

Heideggers hermeneutic phenomenology, although providing an appropriate philosophical foundation for research in the social sciences that seeks to investigate the meaning of lived experience, does not provide clarity of process, making it difficult to assign the degree of rigor to the work demanded in an era dominated by the positivist paradigm. Ricoeur (1981) further developed both Heideggers and Gadamers ideas, in the areas of method and interpretation of hermeneutic phenomenological research, in a direction that has addressed this difficulty. In this article the authors outline Ricoeurs theory, including three levels of data analysis, describe its application to the interpretation of data, and discuss two apparent contradictions in his theory. Ricoeurs theory of interpretation, as a tool for the interpretation of data in studies whose philosophical underpinning is hermeneutic phenomenology, deserves consideration by human sciences researchers who seek to provide a rigorous foundation for their work.

GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study

BackgroundPrimary health care providers play a dominant role in the provision of palliative care (PC) in Australia but many gaps in after hours service remain. In some rural areas only 19% of people receiving palliative care achieve their goal of dying at home. This study, which builds on an earlier qualitative phase of the project, investigates the gaps in care from the perspective of general practitioners (GPs) and PC nurses.MethodsQuestionnaires, developed from the outcomes of the earlier phase, and containing both structured and open ended questions, were distributed through Divisions of General Practice (1 urban, 1 rural, 1 mixed) to GPs (n = 524) and through a special interest group to palliative care nurses (n = 122) in both rural and urban areas.ResultsQuestionnaires were returned by 114 GPs (22%) and 52 nurses (43%). The majority of GPs were associated with a practice which provided some after hours services but PC was not a strong focus for most. This was reflected in low levels of PC training, limited awareness of the existence of after hours triage services in their area, and of the availability of Enhanced Primary Care (EPC) Medicare items for care planning for palliative patients. However, more than half of both nurses and GPs were aware of accessible PC resources.Factors such as poor communication and limited availability of after hours services were identified the as most likely to impact negatively on service provision. Strategies considered most likely to improve after hours services were individual patient protocols, palliative care trained respite carers and regular multidisciplinary meetings that included the GP.ConclusionWhile some of the identified gaps can only be met by long term funding and policy change, educational tools for use in training programs in PC for health professionals, which focus on the utilisation of EPC Medicare items in palliative care planning, the development of advance care plans and good communication between members of multidisciplinary teams, which include the GP, may enhance after hours service provision for patients receiving palliative care at home. The role of locums in after PC is an area for further research

Responding to the death of a resident in aged care facilities: Perspectives of staff and residents

A qualitative study using individual semistructured interviews was undertaken to explore the perceptions and experiences of 23 aged care residents with mild dementia concerning the deaths of coresidents. The views of 25 facility staff members were also explored. The study was based in 3 aged residential facilities in Victoria, Australia. Interview data indicated that residents and staff had differing views. Residents reported that the impact of the death of a coresident was much less than staff members thought. Residents generally wanted to be told about the death of someone they knew and considered attempts to hide the death and the removal of the body both unnecessary and disrespectful. Both groups agreed that the celebration of the life of a resident was important, although they differed in their preferences for the way this is done. These findings have implications for staff education and practice.

International Study of Chaplains’ Attitudes About Research

An online survey was conducted by twelve professional chaplain organizations to assess chaplains’ attitudes about and involvement in research. A total of 2,092 chaplains from 23 countries responded to the survey. Over 80% thought research was definitely important and nearly 70% thought chaplains should definitely be research literate. Just over 40% said they regularly read research articles and almost 60% said they occasionally did. The respondents rated their own research literacy as 6.5 on a 0–10 scale. Significant positive inter-correlations were found among all four measures: importance of (a) research and (b) research literacy; (c) frequency of reading articles; and (d) research literacy rating. Approximately 35% were never involved, 37% had been involved, 17% were currently involved, and 11% expected to be involved in research. The last three groups were significantly more likely to think research and research literacy were important and to read research articles than chaplains who were never involved in research. Given chaplains’ interest in research, actions should be undertaken to facilitate further research engagement.

Transitioning from caregiver to visitor in a long-term care facility: the experience of caregivers of people with dementia.

Objectives: Transitioning from the primary caregiver to the visitor in a long-term care facility may be challenging for the caregiver; they are required to surrender their caring duties to the medical and nursing staff. The aim of this study was to explore the experiences of caregivers during their transition from day-to-day caregiver of a person with dementia to a visitor in a long-term care facility. Methods: This study utilised a qualitative descriptive design. Twenty caregivers of people with dementia were recruited from the one Aged Rehabilitation and Geriatric Evaluation and Management facility, located in Victoria, Australia. Semi-structured interviews were used to explore the caregivers experiences. Interviews were analysed using thematic analysis. Results: The interview data revealed that the participants were undergoing similar experiences. The findings revealed that it was difficult for the caregiver to transition to their new role of visitor; negative reactions of grief, loss of motivation and loneliness were also coupled with positive feelings of relief and the reassurance that their relative or friend would be well cared for and safe within the long-term care facility. Conclusion: The findings offer insight into the experiences felt by caregivers when their relative or friend with dementia is admitted to hospital. Implications of this study include the need to improve the transition process for the caregiver by allowing them to be involved in the decision-making process, keeping them informed of care decisions, and importantly, providing emotional support to help the caregiver positively adapt to this transition.

A case study approach to investigating end-of-life decision making in an acute health service

AIM To identify end-of-life (EOL) decision making processes for patients with non-cancer illnesses in a major metropolitan hospital. METHODS A retrospective review using a case study framework of 47 randomly selected patient records over a 6-month period explored issues in EOL care planning. RESULTS Reviewed charts represented 53% of total deaths in the study period. All patients (aged 66-99) had co-morbid conditions. In 64%, the first record of EOL discussions occurred in the last 24h of life. Four case groups were identified, ranging from a clear plan developed with patient/family involvement and fully implemented, to no plan with minimal patient/family involvement in decision making. Factors related to clearer EOL care planning according to expressed patient wishes included multiple previous admissions, shorter hospitalisations at EOL, living with a relative and involvement of family in decisions about care. CONCLUSION This study has shown that the development and effective implementation of EOL plans is associated with the active involvement of both family members and health professionals. It also draws attention to the risks of delaying EOL discussions until late in the illness trajectory or later in life as well as pointing to challenges in acting on EOL developed outside the hospital environment.

End-of-life care in a rehabilitation centre for older people in Australia

To investigate processes at the end of life for patients who died in a subacute evaluation and management facility for older people.

End-of-Life Care in an Australian Rehabilitation Facility for Older People: Staff Focus Groups

A qualitative study of staff experiences of end-of-life care for older people in a subacute rehabilitation facility was undertaken using three focus groups with senior multidisciplinary staff (5), junior nurses (8), and junior allied health staff (7). Content analysis revealed four major themes: being a key contact person; the quality of end–of-life care; referring to off-site service providers; and differing perspectives. These data have implications for multidisciplinary practice including staff education and capacity to change focus of care in facilities for older people dedicated to rehabilitation rather than palliation or end-of-life care.

The family meeting addressing spiritual and psychosocial needs in a palliative care setting: usefulness and challenges to implementation

Abstract Introduction This study evaluated the use of a family meeting model to address the spiritual needs of palliative patients and their family members in the context of two metropolitan palliative care (PC) services offering hospital, hospice, and home care. Murphys family meeting model that incorporates a broad understanding of spirituality was utilized. Here we report the acceptability of this model to staff and patients in these settings. Methods Qualitative methods, informed by an interpretive approach and underpinned by Hermeneutic phenomenology, were used to evaluate a trial of the family meeting model. Participants included 12 palliative patients and 35 family members. Twelve family meetings were facilitated, by the lead author (H.T.). Following each meeting individual in-depth interviews were conducted with consenting participants. Interviews were also held with 14 PC staff from a variety of disciplines, who had referred patients to the study. Transcribed interviews were analysed utilizing Ricoeurs theory of interpretation. Findings Patients, family members, and staff indicated that participation in a family meeting of this type would be a valuable addition to regular PC services. However, practical barriers to its application were identified and included the need for specific meeting facilitation skills, funding priorities, staff time, and possible language and cultural issues. Conclusion This model of family meeting is potentially a very useful intervention in a setting which promotes holistic care of patients and their family members, including attention to psychosocial and spiritual care. Strategies to overcome barriers to implementation such as time and cost issues need further investigation.

Outcomes from applying a Palliative Care Satisfaction Survey Instrument in Victoria, Australia

Background: Attempts to develop tools to measure client satisfaction in the palliative care sector have identified a number of challenges, including the lack of common definition of ‘satisfaction’. This paper reports on the utilization of the Victorian Palliative Care Satisfaction Instrument (VPCSI) in three Victoria-wide surveys over three years, of patient and carer satisfaction with palliative care provision. Aim: The VPCSI aimed to both meet the Australian Government performance indicator reporting and facilitate quality improvement for palliative care services. Setting/participants: All palliative services receiving funding from the Victorian Department of Health were invited to participate. Feedback via survey was captured from adult patients, carers, and bereaved carers in both inpatient and community palliative care settings. Results: Overall state-wide response rates averaged 26% over the three-year trial period. Satisfaction state-wide rated very high, ranging from 66% for patients to 74% for bereaved carers. Top five items given priority to improve varied across respondent type but overall included opportunities to talk to other carers; activities to pass the time; minimizing financial burden and training for carers to perform specific care tasks. The top five rated items overall were level of respect shown as an individual; nurse responses; expertise of staff; overall palliative care team performance; and support for physical care. Conclusion: These data demonstrate that the VPCSI is an important tool for the collection of consumer satisfaction data in the palliative care sector across a wide range of service providers.