Education; continuing; Medical; professional issues
Description
BACKGROUND: The need for educational training of healthcare professionals in palliative care is an important issue. Training and practice of pediatric residents in the field of pediatric palliative care (PPC) has never been assessed, although the organization of the medical curriculum in France is currently being revised. MATERIALS AND METHODS: This study presents a national survey of pediatric residents, using a computerized anonymous questionnaire. Four different areas were studied: epidemiological data, theoretical and practical knowledge, education, and clinical experience in PPC. RESULTS: The response rate was 39% (n=365/927). Whatever their age or regional location, 25% of residents did not know any details of the French law concerning patients' rights and the end of life. Experience with PPC starts very early since 77% of the first-year pediatric residents experienced at least one child in a palliative care and/or end-of-life situation. During their entire residency, 87% of the residents had experience with PPC and nearly all (96%) end-of-life care. Furthermore, 76% had participated in announcing palliative care (cancer, ICU, etc.) or a serious illness, and 45% had met and discussed with bereaved parents. Furthermore, while 97% of the pediatric residents received training in adult palliative care, mainly before their residency, only 60% received specific PPC training. DISCUSSION AND CONCLUSION: Ninety-six percent of all French pediatric residents encountered a PPC situation during their residency. That 77% of them had experienced PPC during their first year of residency shows the importance of early training in PPC for pediatric residents. Furthermore, this study points out that there is a significant lack in PPC training since 40% of all residents in the study received no specific PPC training. Progress in education remains insufficient in the dissemination of knowledge on the legal framework and concepts of palliative medicine: while the medical curriculum is being revised, we suggest that training in medical ethics and PPC should be introduced very early and systematically.
2014-08
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Active List; Activity Indicators; Annual Report; Clinical Intervention Structuring; Neurosciences & Neurology; Pediatric Palliative Care; Regional Resources Teams
Description
Context. - The regional resource teams of pediatric palliative care, like any adult mobile palliative care team in France, have to realize an annual report including several indicators that are often imposed by the regional public health authorities. Our regional resource team of pediatric palliative care raised the question of the relevance and performance of the "active list'' (number of patients) as indicator of the clinical activity. Methodology. - All the situations met by our regional resource team of pediatric palliative between 2011 and 2012 were analyzed and then classified. Results. - Four levels of intervention were identified: The first level consists in answering the questions from the professionals: e.g. symptom management, ethical questions and issues, etc. At this level, the regional resource team of pediatric palliative does not meet the child nor his/her family. It often acts by specific interventions, such as telephone calls or meetings between teams. The second level corresponds to the intervention in collaboration with the specialized reference team. The regional resource team of pediatric palliative then meets the child and his family. The regional resource team of pediatric palliative provides support for professionals and the family on the questions of anticipation, clinical worsening, and/or ethical issues when realizing or omitting therapeutic acts. The hospital team remains the reference team. The third level involves the regional resource team of pediatric palliative in collaboration with the reference team but becomes progressively itself the reference team for the child, his family and other caregivers. This may occur in home-care based situations. This level includes that regional resource team of pediatric palliative often coordinates the home-care providers (nurses, general practitioner, etc.) and that its main activity is to support the families and the child. At this level, the regional resource team of pediatric palliative is called if needed as the first line team. Finally, the fourth level can be summed up as all situations for which the regional resource team of pediatric palliative is the only involved team, e.g. bereavement support. Conclusion. - The approach and the identification of the four levels describe more specifically the clinical activity of the regional resource teams of pediatric palliative in their various assumptions of responsibilities. Further on, it identifies more precisely the implication of all teams involved. Thinking in levels of implication is innovative and adjusted with clinical reality. The levels of intervention may change during the care pathway of each child. This tool for evaluation of the clinical activity finds an interest within our network of all regional resource teams of pediatric palliative. Perhaps its use could also be relevant for other palliative care networks or mobile teams. (C) 2017 Elsevier Masson SAS. All rights reserved.
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Pediatrics; Palliative care; Home-based care services; Primary nursing care
Description
PURPOSE: Our Home Care Unit (HCU) undertakes close to twenty pediatric palliative care engagements per year. We investigated the factors underlying such care by independent home health nurses. METHODS: This was a retrospective, observational, single-center study. Home nurses who had provided palliative pediatric care in the past 16 months were included. RESULTS: Fifty-six questionnaires were sent out (response rate of 44.6%). Eight home nurses had never provided pediatric palliative care. Three-quarters of the home nurses (76%) acknowledged having misgivings accepting these duties. The factors that facilitated providing this care were the availability of the HCU doctor and nurses, the proactiveness of the HCU team, and house calls. In 76% of cases, the involvement of the home nurses exceeded the strictly professional setting. Forty-six percent of the home nurses were amenable to undertaking another pediatric palliative care engagement, although 48% deemed the remuneration to be somewhat lacking. CONCLUSION: The analysis allowed us to identify several prerequisites for these care engagements: the availability and the proactiveness of the HCU team, communication, and planning. This study showed the pronounced personal involvement of home nurses in complex situations, with both the child and their entire family. Home nurses appear to be skilled at using the resources available to manage the exhaustion that can arise with such an engagement. Facilitating and respecting the choice to stay home of the child and their family was meaningful to them. The personal and professional enrichment were a source of motivation despite certain limitations (availability, remuneration).
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).