Part 1 Based on the article, Prison Hospice Care and the video, Angola Prison Hospice: Opening the Door: video attached and article do not use anything else thank you Describe the fundamental challen

Part 1 Based on the article, Prison Hospice Care and the video, Angola Prison Hospice: Opening the Door: video attached and article do not use anything else thank you Describe the fundamental challen
Education, Care Coordination Essential to Expanding Pediatric Palliative Care By Holly Vossel March 4, 2022 Pediatric patients are among the most underserved seriously ill population in hospice and palliative care. Hospices have worked to expand their scope of pediatric services, with a focus on increasing access to palliative care and opening up referral streams. Compared to adults on hospice, children represent a smaller but crucial group of patients, according to Joe Rotella, M.D., chief medical officer of the American Academy of Hospice and Palliative Medicine (AAHPM). ?Children are a very important population that is underserved by palliative care,? Rotella told Hospice News. ?Any palliative care providers that are treating just adults ought to be looking at the unmet needs of pediatric palliative care in their community and thinking about a way to provide that. Pediatric palliative care looks different than in adults but every bit as important, if not more so.? The large bulk of hospice and palliative care patient populations are older adults. Nearly 63% of Medicare decedents who received hospice care in 2019 were 85 and older, according to a Medicare Payment Advisory Commission (MedPAC)?eport. This compared to less than a third (29.4%) under the age of 65. But the incidence of serious and chronic illness is not limited to seniors. Each year an estimated 500,000 children present with a serious illness in the United States, with many becoming hospice-eligible within a year, according to 2018?esearch?ublished in the Journal of Pain and Symptom Management. These patients account for roughly 45,000 deaths nationwide annually, a 2019?tudy found. Underutilization of pediatric hospice and palliative care occurs for myriad reasons, including the reality that the needs of terminally ill children are distinct from those of adults. Providers need specialist knowledge regarding medication dosing, specialized equipment and assistance with family dynamics and support. ?Pediatric palliative care is highly complicated and complex,? said Harold Siden, M.D., medical director at Canada-based Vancouver Canuck Place Children?s Hospice. ?One issue is the nature of the conditions. There is often a long period of chronic care involved with children.? As is often true for palliative care in general, families of seriously ill children are frequently unaware of the nature of those services. Many among the public ? and some clinicians ? conflate those services with hospice, and families often fear losing their other health care options. Few understand that laws and payers generally allow children to receive concurrent curative care. The availability of concurrent care presents both?hallenges and opportunities?or providers. On one hand, it enables them to bring more pediatric patients under their wings. On the other hand, it can complicate back office processes like billing.? Ensuring regulatory compliance when providing concurrent care can also become complex, requiring consistent and effective communication with state agencies and care coordination with the patient?s other health care providers. The large majority of those providers are primary care or or subspecialty clinicians, according to American Academy of Pediatrics (AAP)?esearch.? Seriously ill pediatric patients are a relatively small population, but tend to generate a somewhat disproportionate amount of health care costs. These patients represent less than 10% of the U.S. population but account for at least 50% of hospital resources for youth patients, according to AAP research. Palliative care?s track record on reducing hospitalizations is an important component of its value proposition when it comes to reducing the spend. But that care does not exist in a vacuum. Developing and expanding pediatric palliative care programs depends on the quality of referral relationships with these and other clinicians, Siden told Hospice News. ?Pediatric palliative care fills a small part of the overall referral pie,? said Siden. ?Working alongside this treatment orientation in partnership is a key element of pediatric palliative care, rather than seeing it as an either/or proposition.? Because this level of coordination is essential, palliative care teams are constantly focused on facilitating and maintaining relationships with referring clinicians, according to Raya Elfadel Kheirbek, M.D., professor of medicine and chief of gerontology, geriatrics and palliative medicine at the University of Maryland School of Medicine.? ?Consistently receiving appropriate referrals stimulates growth and keeps [these] programs thriving,? Kheirbek told Hospice News over an email. ?Though the dynamics may vary from institution to institution, palliative care specialists share common obstacles when it comes to building these essential relationships. Most often, it begins with effectively showing how palliative care can support the efforts of clinicians as all parties work together to give seriously ill patients the best care possible.?
Part 1 Based on the article, Prison Hospice Care and the video, Angola Prison Hospice: Opening the Door: video attached and article do not use anything else thank you Describe the fundamental challen
EDITORIAL British Journal of Community Nursing Month 2021 Vol 26, No 5 213 Social justice in end-of-life care C ompared with the general population, people experiencing homelessness are twice as likely to have a long-term health condition; yet, they are frequently excluded and overlooked when it comes to healthcare provision (Care Quality Commission (CQC), 2020). People experiencing homelessness also tend to die young, often in their 40s, without access to palliative care support (CQC, 2017). I still find this statistic shocking every time I read it, and it prompted my masters (Webb, 2015) and PhD research (Webb et al, 2020) in this niche?ubject. The findings of my doctoral research revealed that homeless people fear needing care more than they fear death itself and so would rather ?drop dead suddenly? than receive a palliative diagnosis and need personal care (Webb et al, 2020). However, without a palliative diagnosis, it is difficult for people experiencing homelessness to access traditional palliative care services and support. They tend to fall through the cracks in the system, which means that they often die in hostels or in emergency departments. Worse still, some die in shop doorways and on park benches, alone and with very little dignity. Further, finding it difficult to trust people, those experiencing homelessness need to feel comfortable with caregivers or helpers at the end of life (Webb et al, 2020). They want to be somewhere that they can truly be themselves, where they do not feel judged or misunderstood. Simply put, when approaching the end of life, people experiencing homelessness are more likely to want to be cared for in the familiar hostel setting (Webb et al, 2020). However, hostel workers report feeling ill equipped to support residents whose health is clearly deteriorating (Webb, 2015). Hostel residents who have advancing ill health, and may even be approaching the end of life, are often between 30 and 50 years of age, have no formal palliative diagnosis and are not considered to be housebound. As such, they usually fail to meet the criteria for district nursing services, and hostel workers are left struggling to access additional care and services for their residents, particularly around personal care, continence issues, skin care, symptom control and psychological support (Webb, 2015). Meeting the end-of-life care needs of this marginalised population is uniquely challenging and may require collaborative teamwork between community nurses, hostel staff, mental health teams, substance misuse teams and hospice staff (Webb et al, 2018). It will require a creative, courageous, multidisciplinary approach in order to prevent these people from slipping through the gaps in care provision. This approach should have the hostel as the hub of the compassionate community; it should be a multidisciplinary, ?can-do? approach that permits some imaginative and necessary rule bending, one that encourages and supports the development of peer support workers (with lived experience of homelessness) who are trained in the basic principles of palliative care support. Community nurses, with their adaptable and resourceful attitude, are in a pivotal position to drive change and innovation in this area of end-of-life care, and to educate and support hostel staff and peer support workers, thereby making a positive contribution to the care provided to homeless people in their locality who may be approaching the end of life. I invite community nurses to be bold and step up to the challenge. I hope that they are stirred to proactively work towards closing this inequality gap and bring their skills, knowledge, compassion and expertise to bear on this important health and social justice issue. BJCN Wendy Ann Webb, Queen?s Nurse; Advanced Clinical Practitioner in Physical Health, Hatherton Centre, Forensic Mental Health and Learning Disabilities Unit, Midlands Partnership Foundation Trust, Stafford Care Quality Commission. A second class ending: exploring the barriers and championing outstanding end of life care for people who are homeless. 2017. https://tinyurl.com/2jn42cnr (accessed 31 March 2021)Care Quality Commission. Nigel?s surgery 29: looking after homeless patients in general practice. 2020. https://tinyurl.com/ys6aejrt (accessed 31 March 2021)Department of Health and Social Care. Healthcare for single homeless people. 2010. https://tinyurl.com/2ye295rs (accessed 31 March 2021)Webb WA. When dying at home is not an option: exploration of hostel staff views on palliative care for homeless people. Int J Palliat Nurs. 2015; 21(5):236?244. https://doi.org/10.12968/ijpn.2015.21.5.236Webb WA, Mitchell T, Nyatanga B, Snelling P. Nursing management of people experiencing homelessness at the end of life. Nurs Stand. 2018; 32(27):53?62. https://doi.org/10.7748/ns.2018.e11070Webb WA, Mitchell T, Nyatanga B, Snelling P. Life?s hard and then you die: the end-of-life priorities of people experiencing homeless – ness in the UK. Int J Palliat Nurs. 2020; 26(3):120?132. https://doi.org/10.12968/ijpn.2020.26.3.120 EDITORIAL BOARD Consultant Editor Alison While Emeritus Professor of Community Nursing, Kin s College LondonEditor Rucha Kurtkoti [email?rotected] Manager Edward Croome [email?rotected] Classied Sales Manager Daniel Doherty [email?rotected] Director Sally Boettcher Production Manager Kyri Apostolou Production Assistant Larry Oakes Managing Director Anthony Kerr Associate Publisher Sophie Gardner Publishing Director Andrew Iafrati Publishing Director Chloe Benson Chief Executive Ocer Ben Allen Ben BowersNIHR School for Primary Care Research PhD Student, Quee s Nurse, University of CambridgeJulie BlissHead of Practice Learning, Florence Nightingale Faculty of Nursing and Midwifery, Kin s College London; Chair of the Association of District Nurse Educators; and Quee s NurseAnn BryanExecutive Director of International Partnerships, Health and Social Care, University of ChesterJulie ClennellAssociate Director of Risk & Clinical Governance, North Tees and Hartpool NHS Foundation Trust Jane Griffiths Senior Lecturer, Division of Nursing, Midwifery and Social Work, University of Manchester Maria Horne Associate Professor in Community and Public Health, School of Healthcare, Faculty of Medicine and Health, University of LeedsJulie Hughes Quee s Nurse, Independent Healthcare ConsultantCatriona Kennedy QNIS Professor of Community Nursing, School of Nursing and Midwifery, Robert Gordon UniversityBrian Nyatanga Senior Lecturer, Three Counties School of Nursing and Midwifery,University of WorcesterPatricia RobinsonSenior Lecturer, Community Health Team, University of BrightonVera Todorovic Manager, Dietetics & Nutrition Service, BassetlawHospitalCate WoodSenior Lecturer Healthcare Leadership and Management, Birmingham City University UK PERSONAL SUBSCRIPTION RATES Quarterly Direct Debit 36Annual Direct Debit 141Annual Credit Card 1482yr Annual Credit Card 2523yr Annual Credit Card 355 Subscribe online: www.magsubscriptions.com Subscribe by phone: (0) 1722 716997Contact [email?rotected] for institutional pricing The British Journal of Community Nursing is published by MA Healthcare Ltd, St Jud s Church, Dulwich Road, London SE24 0PB. Tel: (0)20 7738 5454.Website: www.bjcn.co.uk MA Healthcare Ltd is part of the Mark Allen Group The views expressed do not necessarily represent those of the editor or the British Journal of Community Nursing . Advertisements in the journal do not imply endorsement of the products or services advertised MA Healthcare Ltd, 2021. All rights reserved. No part of the British Journal of Community Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without prior written permission of the Publishing Director.ISSN 1462-4753 Printed by Pensord Press Ltd, Blackwood, NP12 2YACover image: AdobeStock/nadianb The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint. www.markallengroup.com Part of Copyright ofBritish Journal ofCommunity Nursingisthe property ofMark Allen Publishing Ltd and itscontent maynotbecopied oremailed tomultiple sitesorposted toalistserv without thecopyright holder’sexpresswrittenpermission. However,usersmayprint, download, oremail articles forindividual use.

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