Friday 27th June 2014
Ombudsman report calls for improved end-of-life care
Better communications with patients and family crucial in last days of life. A study says
Ombudsman Peter Tyndall: ‘Those moments at the end of a loved one’s life are extremely precious and will be relived again and again’.
End-of-life care could be improved through better communication with patients and their family and friends, a new report suggests.
The report by Ombudsman Peter Tyndall makes a series of recommendations for improving end-of-life care.
Irish people need to have a considered and thoughtful conversation about death and dying in order to ensure the best possible end of life is achieved for all, the chief executive of the Irish Hospice Foundation, (IHF), Sharon Foley, said, speaking today at the launch of the report.
“It is time we broke the silence about dying. A national palliative care and end-of-life and bereavement strategy needs to be put in place to put the needs of the dying higher up our healthcare agenda,” said Ms Foley.
The report picks up on some of the common themes in complaints made to the Ombudsman about end-of-life care. These include the management of complaints, the return of deceased people’s belongings, issues around post mortems, support for families and friends, and specialised palliative care.
“If there is one message to be learned from complaints brought to us, it is that small things make a big difference. Those moments at the end of a loved one’s life are extremely precious and will be relived again and again,” said Mr Tyndall.
Almost all of the complaints made to the Ombudsman about end-of-life care arise because of poor communication and a lack of clarity about the duties and rights of doctors, nurses, patients and families, according to the report.
Good communication depends on more than empathy between individuals, it says. “Patients and families need to know that they can rely on an institution to deliver the best care possible. Communication systems . . . need to be planned, well structured and effective so that patients and families will have proper and timely access to the supports they expect and require.”
The report says there is often a gap between the message professionals intend to give and what is understood by patients and families. “Sometimes the language used is overly technical or complicated. Sometimes the manner in which information is given distorts its true meaning. Sometimes the message is rushed and basic information is omitted.”
The report points out that families and friends may not be clear about the “unique relationship” of a patient to a doctor and the rights of the patient over those of the family. “This will have implications for the care of a patient and can leave family and friends in the dark as to what is happening to their loved one.”
“It is clear too that patients do not always want to communicate openly with their own families and this can lead to dilemmas if the patient’s condition deteriorates.”
Complaints regularly feature overburdened staff and a lack of physical facilities, the report notes. “Sometimes the defence offered by staff of being very busy and under pressure does not explain or justify the poor and insensitive service. Sometimes management has no choice but to accept the fact that services are unviable unless further investment is provided.”
In relation to physical facilities, patients and families want peace and privacy at the end of life, the report points out, and for most people this means access to a private room.
Patients and families are often confused about the meaning of “do not resuscitate” notices, according to the Ombudsman, who says complaints highlight the need for a more rigorous or formal procedure for making, recording and communicating DNR decisions. “Patients and their families or next of kin need to understand what such a decision entails and who holds responsibility.”
While the provision of palliative care is a question of clinical judgment, the Ombudsman says it is clear that patients want to be as comfortable and pain-free as possible. After discharge, the hospital has a responsibility to ensure that a patient is brought to the attention of the local services and had their pain needs met at home.
Every year, about 29,000 people die and up to 290,000 people are left bereaved. While most people want to die at home, only one-quarter actually do so, while 43 per cent die in an acute hospital.
The launch included a preview screening of an RTÉ/IHF documentary, Way to Go – Death and the Irish, by Norah Casey, to be broadcast next Tuesday. The businesswoman, whose husband Richard died in 2011, talks to people candidly about going through the last months of their lives.
Women are ‘more controlling and aggressive than men’ in relationships
A new study suggests
Men are often thought to be the more aggressive partner, but a new study suggests this is not the case
Dr Elizabeth Bates says women are more likely to try to control their partner than men.
Women are more likely than men to be aggressive and controlling towards their partner, according to a study.
The research found that women showed controlling behaviour along with serious levels of threats, intimidation and physical violence when in a relationship more often than men.
More than 1,000 young men and women were questioned about any “Intimate Partner Violence” (IPV) they had inflicted on a girlfriend or boyfriend, or been subjected to themselves.
The results are in contrast to earlier studies which suggested women are almost always the victims of such behaviour.
Dr Elizabeth Bates, who led the study at the University of Cumbria, said: “Previous studies have sought to explain male violence towards women as arising from patriarchal values, which motivate men to seek to control women’s behaviour, using violence if necessary.”
“This study found that women demonstrated a desire to control their partners and were more likely to use physical aggression than men.
“It wasn’t just pushing and shoving,” said Dr Bates, who presented the results at a meeting of the British Psychological Society in Glasgow. “Some people were circling the boxes for things like beating up, kicking, and threatening to use a weapon.
“In terms of high levels of control and aggression, there was no difference between men and women.”
A study in the 1990s led by the US sociologist Professor Michael P Johnson coined the term “intimate terrorism” to describe controlling behaviour in a relationship.
He found that such “terrorists” are almost always men, a claim which Dr Bates refutes, pointing to the fact that Professor Johnson’s study looked at men in prison and women in refuges, rather than more typical members of the public.
“The stereotypical popular view is still one of dominant control by men,” Dr Bates added. “That does occur but research over the last 10 or 15 years has highlighted the fact that women are controlling and aggressive in relationships too.
“A contributing factor could be that in the past women have talked about it more. Now there is more support for men and more of them are feeling comfortable coming forward.”
Mark Brooks, chair of the ManKind Initiative, which offers support for male victims of domestic abuse, said the research was “game changing”.
“No-one can ever now say that violence against a man from a female partner should be treated less seriously than domestic violence committed against a woman,” he said.
“At the charity we’re not surprised at the findings, because of the type of calls we get to our helpline every day. What concerns us still is the lack of awareness and services available to support those men suffering in this way.
“The Government, local authorities and the police must do more to ensure that domestic abuse against men is viewed and treated in exactly the same way as it rightly is for female victims.”
Financial software at HSE is in need of overhaul
Say’s James Reilly
Financial control systems in the HSE are clearly in need of overhaul, Health Minister James Reilly said yesterday.
“I was astonished to hear that last year we had 1,700 different software systems operating throughout the health service, many of which are not connected to each other,” he said.
He believed that the Department of Public Expenditure and Reform would give the HSE’s business case for funding to develop a new financial system serious consideration.
The minister also said he had full confidence in the leadership of the health service.
Two weeks ago, the chair of the Public Accounts Committee, John McGuinness, accused the HSE of being unfit for purpose because of the HSE’s mishandling of the discretionary medical card issue.
Mr McGuinness called on the secretary general of the Department of Health, Dr Ambrose McLoughlin, and the director general of the HSE, Tony O’Brien, to resign.
The minister, who was speaking following the inaugural meeting of the Healthy Ireland Council in Dublin Castle yesterday, said he felt that the way the two gentlemen were treated was utterly inappropriate.
“They are public servants and I would put on the record here that the leadership of the health service has my full confidence, including the secretary general.”
He also insisted that patient safety would not be compromised by a budget overrun in the health service.
“We made it very clear in the HSE Service Plan that patient safety was the overriding priority; it remains the overriding priority and, whatever happens, patient safety will not be compromised,” he said.
Dr Reilly’s comments came in the wake of publicity about aninternal consultants’ report that was highly critical of the HSE’s accounting system.
This said the manner in which the organisation had implemented its cost cutting programme lacked focus and risked patient safety.
The report, prepared for the Department of Health by PA Consulting, presented a dim view of the financial management arrangements in the HSE.
- – There was limited evidence of effective control of income or costs which could be used to predict its spending;
- – The oversight of HSE spending by the departments of health and public expenditure was not supported by financial management;
- – The budgetary process is flawed and fails to reflect realistic targets;
- – Governance lacks clarity;
- – Limited financial management exists among staff.
The report said it had assessed the cost containment plans introduced by the HSE in 2012 and these resulted in “short-term measures which do not consider the whole health system, and may have unforeseen consequences as a result”.
It said because of these non-targeted reductions “there are inherent risks to patient safety, the quality of patient care, and operational administrative efficiency”.
The consultants said their report followed on from the Ogden report and was one of a series of documents that highlighted weaknesses in financial management in the HSE.
Minister Varadkar Calls for a ‘Sea Change’ in Maritime Safety Culture
Ireland’s Minister for Transport, Tourism & Sport Leo Varadkar has called for a sea change in attitudes to maritime safety, as he launched a new consultation process on maritime safety: Sea Change – Building a new Maritime Safety Culture.
Minister Varadkar highlighted the 134 maritime fatalities which have occurred since 2002, almost half of which were as a result of leisure activities on recreational craft. He was speaking at the launch of the consultation process in the Department of Transport, Tourism & Sport which included stakeholders from shipping, fishing, leisure, passenger operators, maritime safety and many other sectors.
Minister Varadkar said: “We all need to take a fresh look at how we use the waters in and around our island, and build a culture of maritime safety in our communities.
This requires a radical change of culture in our attitude to safety.”
The results of the consultation process will feed into the first ever Maritime Safety Strategy for Ireland.
A Sea Change looks at how to address the top ten factors contributing to loss of life at sea in Ireland:
- Lack of an adequate maritime safety culture;
- Unsuitable or inadequately maintained safety equipment on board, or lack thereof;
- Lack of crew training;
- Failure to plan journeys safely, including failure to take sea/weather conditions into account;
- Non-wearing of personal flotation device (PFD);
- Vessel unseaworthy, unstable and/or overloaded;
- Inadequate enforcement of regulations;
- Impairment due to fatigue or the influence of alcohol and/or drugs;
- Inadequate crewing levels/solo operation;
- Unsuitable clothing being worn on board.
The Ministry informs that the consultation period runs until 29th August 2014, and the new Strategy will be published later this year. It will be monitored closely during implementation and reviewed and updated within a five year period.
UN and Iran working together to Help save Asiatic Cheetah
There was a time when the Asiatic cheetah used to roam freely in Middle East and Asia. But now, just 50 of them are left and they too are confined to northeast regions of Iran.
This is the reason that the U.N. Development Program has started working with Iran’s Department of Environment to save the Asiatic cheetah. They are trying to raise awareness among citizens about the need to save the species.
Through their measures, officials want citizens to know the plight of the cheetahs, so, that they can do their part in protecting the endangered species. The initiative has been named as Conservation of Asiatic Cheetah Project (CACP).
There are times when the cheetahs come in contact with Iran’s farmers, who come to graze their sheep on habitats shared with the cheetahs. Now, members of CACP are ensuring that grazing as well as environmental protection laws are properly implied.
The officials are also training local villages as how to deal with encroaching cheetahs as revenge should not be the first option to deal with them. UNDP has paid to provide Iranian park rangers with night vision goggles, so they can keep a track on the cheetah population. There are many cheetahs that have been tagged with GPS collars.
Public support also matters, therefore, UNDP and CACP have come up with many public service announcements. “Our goal with the production of these PSAs is to capture the hearts of the people and make them realize that they too have a responsibility in the conservation of the Asiatic Cheetah”, affirmed Dr. Ahmad-Ali Keykhah, Iran’s Deputy of Natural Resources and Biodiversity.
Since the middle of the 20th century, the cheetahs are missing from India and many other neighbors of Iran. Poaching and shortage of food are main reasons behind the decline in their population.
Gary Lewis of the U.N. Development Program said the Asiatic Cheetahs found in Iran are quite unique. Therefore, it is essential to conserve them.