This paper reports an evaluation of a 3-year pilot community care project to extend 'hospice standards' of palliative care to nursing home residents in Nottingham. The evaluation involved two questionnaire surveys of all matrons of nursing homes with registered palliative care beds (39 and 43 matrons, respectively) and 35 interviews with a sample of local stakeholders selected to give a range of views regarding the project's impact. The interview sample included nursing home matrons (10) and care staff (7); nursing home residents and their relatives (4); community nurses (3); members of the Health Authority and Social Services (6); and local palliative care experts (5). Other sources of data included referral forms, evaluation of training sessions and a reflective account given by the project coordinator. The analysis used descriptive statistics to summarize the quantitative data and an iterative procedure to generate themes from the qualitative data. The overall perception of the project's impact was that it had helped to overcome the barriers that exist between NHS services and the independent sector. By providing assistance with individual care and access to specialist advice, equipment and training, the project was thought to have decreased the isolation experienced by staff and residents and improved equity of access to specialist palliative care for nursing home residents. Although it was widely agreed that the nursing home is an appropriate setting for palliative care, concern was expressed about the quality of care that can be given with mostly unqualified care staff. Ongoing needs for training and liaison between nursing homes and specialist palliative care services were identified.
Most cancer patients and their families experience the full impact of their diagnosis and the disruptions cancer brings to their lives in their own homes and communities. Access to supportive care programs within the community is critical if we are to assist these individuals in coping and adjusting to the realities of cancer. Interlink Community Cancer Nurses, a nonprofit nursing agency, provides supportive care across the continuum of cancer care from early diagnosis and treatment through to remission and/or palliative care through its independent model of supportive care delivered by expert oncology nurses. The program utilizes a unique, client-centred model of care delivery to ensure that needs are met, and to link patients to community services which promote their ability to meet the demands of cancer. Interlink's program of supportive care demonstrates that oncology nurses can make a significant impact on the outcomes of cancer for individuals and their families which may impact on cost, influence survival and enhance quality of life.
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