Preventing Abuse in Palliative Care: A Literature Review

This literature review aims to identify and clarify key risk factors for abuse in palliative care and provide recommendations for prevention. It explores the current understanding of abuse in care settings and examines potential ageist factors that contribute to its occurrence. The review also discusses the importance of reporting and the legal implications of failing to disclose suspected abuse. Overall, the goal is to raise awareness and promote effective measures to prevent abuse in palliative care.

RESEARCH PROJECT
Project front sheet
Unit number and title

Unit Title 6: Research
Project
Project title
Learning
Outcome
Learning
Outcome Assessment
Criteria
In this assessment you will have the
opportunity to present evidence that
shows you are able to:
Task
no.
Evidence
(Page no)
LO1 1.1 Formulate and record possible research project
outline specifications
1.2 Identify the factors that contribute to the process
of research project selection
1.3 Undertake a critical review of key references
1.4 Produce a research project specification
1.5 Provide an appropriate plan and procedures
for the agreed research specification
LO2 2.1 Match resources efficiently to the research
question or hypothesis
2.2 Undertake the proposed research investigation
in accordance with the agreed specification and
procedures
2.3 Record and collate relevant data where
appropriate
LO3 3.1 Use appropriate research evaluation techniques
3.2 Interpret and analyse the results in terms of the
original research specification
3.3 Make recommendations and justify areas for
further consideration
LO4 4.1 Use an agreed format and appropriate media to
present the outcomes of the research to an
audience
Learner
declaration
I certify that the
work submitted
for this project is
my own and
research sources

are fully
acknowledged.
Student
signature:
TITLE PAGE
This study is submitted in part fulfilment of a HND in health and
social care management in St Patricks College
INSERT MONTH AND YEAR

ABSTRACT
The topic is related with Patient and the Palliative Care which is among the
important topic as it discusses about the important healthcare and practitioners and
their support towards their patient. The main purpose of the study was to ensure and
understand about the concept related Palliative care. Also, it will be the main focus
that when any of the patient is required the help of palliative care and what are
essential criteria which will be focused by practitioners. The methodologies has the
important part within the file because it certainly provides the knowledge that how
any of data can be collected. Here, in the file literature review has been opted as
secondary research and for primary research questionnaire were prepared by the
researcher. The finding in the file were related with the health practitioners who plays
the major role because they simply guides that how any of the work needs to be
done in any of the palliative care. At the same time, it was concluded that the
requirement of palliative care for any of the patient is required only in the condition
where they are suffering from any of the serious nature of issue related to health
which might continue for life time.

ACKNOWLEDGEMENT
Firstly I would like to thank God for for supporting me at every
phase of life and providing me confidence to achieve my goals.
I am also highly thankful to my teachers for giving me this
opportunity to conduct a research based on my interest area which
helped me in utilising my skills effectively so that better results can be
achieved. I am thankful to my tutors, friends and colleagues who helped
me and supported throughout the process and also encouraged me so
that I could complete the project on time.
Additionally I would like to thank my family members, friends and
all the people who helped me through the project so that I was efficiently
able to complete my project on time.

Contents
ABSTRACT ..................................................................................................................5
ACKNOWLEDGEMENT ..............................................................................................6
1.0 INTRODUCTION AND BACKGROUND ............................................................8
1.1RESEARCH AIM .................................................................................................8
1.2 OBJECTIVES ....................................................................................................8
1.3 RESEARCH QUESTION.....................................................................................9
CHAPTER 2: LITERATURE REVIEW .......................................................................10
CHAPTER 3: METHODOLOGY ................................................................................11
3.1 THEORETICAL PERSPECTIVE.......................................................................12
3.2 DESIGN/METHOD............................................................................................12
3.3 DATA COLLECTION METHOD .......................................................................12
3.4 SAMPLING TECHNIQUE .................................................................................13
3.5 DATA PRESENTATION & ANALYSIS..............................................................13
3.9 ETHICAL CONSIDERATION............................................................................13
CHAPTER 4: FINDINGS & ANALYSIS......................................................................13
CHAPTER 5: DISCUSSION.......................................................................................15
CHAPTER 6: CONCLUSION & RECOMMENDATIONS...........................................16
6.0 Conclusion.........................................................................................................16
................................................................................................................................16
6.1 RECOMMENDATION(S)...................................................................................16
APPENDICES ............................................................................................................19
APPENDIX 1: SAMPLE OF QUESTIONNAIRE .....................................................19
APPENDIX 2: SAMPLE OF PARTICIPANTS INFORMED CONSENT FORM .....20
APPENDIX 3: APPROVAL LETTER FROM MANAGER ......................................21

1.0 INTRODUCTION AND BACKGROUND
ALTHOUGH THE THOUGHT of a dying elderly patient being abused is almost unreasonable,
regarding of the older at the last stage of their lives happen every day in the United State
(www.centeronelderabuse.org). seniors are at much highly risk for being maltreat at the end
of life (EOL) because they obtained a lot of the risk context form mistreat as they reduced.
With the elderly being the quicker increased part of the U S population, the issue of elderly
maltreat can only be anticipated to increase. Information of abuse is an important issue,
the present image of elder maltreat at the EOL is probable the “tip of the iceberg.” If the
end of life care team is going to tackle this mounting issue properly, then its group members
must become competent of recognised and acknowledging abuse, announce it, and put
intervention into place that will lower or stop the risk for forthcoming abuse. The end of life
care team (including the hospice team) is in a perfect position to recognise and avoid abuse
in this helpless group of clients.(www.centeronelderabuse.org) access 25th / 10/2019
During the background referred above, this survey happened after a decade of rising worry
about elderly abuse that has encourage work on explain and make clear the character and
measure of the issue (see Dixon et al 2009). Many of this regarding relates to care home and
hospital settings (Castle 2010; Patients’ Association 2010a). The assessment of the National
Service Framework for elderly people, make a good Living Later Life (Healthcare
Commission, 2006), completed safeguard of helpless Adults methods were set up in most
communities in UK, although it has been discovered that observed, reporting and review of
occurrence of abuse and the result of study could be enhanced.
RESEARCH AIM
the aim of this research is to create awareness of abuse of patient in palliative care.
1.2 OBJECTIVES
To identify patient factors that are predictive of key aspects of palliative care need and
physical and psychological symptom load.
 To examine the circumstances under which transitions to a palliative care approach
occur within care home, with a focus on the influence of age and disease type on
decision-making.
 To explore how decisions to move to a palliative care approach are made and who is
involved in decision-making.
 To examine if and how information about a transition to a palliative care approach is
communicated to patients and their families and how they are involved in decision-
making.
 To explore the perspectives of patients, service providers and commissioners
regarding acute hospital admissions and discharges associated with a transition in
care.
1.3 RESEARCH QUESTION
How do we prevent older people in palliative care from abuse?

CHAPTER 2: LITERATURE REVIEW
The Healthcare Commission’s report Spotlight on Complaints highlighted that one of the largest
areas of concern for patients is poor communication between staff and patients or family,
particularly following a death. This was of particular concern in acute trusts. Many of the complaints
related to families receiving contradictory information from the staff who had been caring for their
deceased relative. In other cases, relatives felt they were unprepared for the death of their relative
and did not have sufficient time to enable other family members to be present. Inconsistent practice
in respect of record keeping was also raised as a concern by a number of patients who felt that the
lack of recorded clinical observations meant that their relative had not been cared for properly . (End
of Life Care Strategy Promoting high quality care for all adults at the end of life (Equality Impact
Assessment, 2008). There is possibility for inequality in the EOL care in esteem of a literature review
concentrated on end-of-life (EOL) case management recognise 7 research articles, with satisfied
analysis disclosure two themes: (a) seeking to determine or establish the value of EOL case
management and (b) identifying ways to improve EOL case management. The proof, although
restricted, implies that End of life case management is helpful to dying individuals and their families.
Research is needed to more obviously demonstrates its usefulness or result and the extent of need
for it and actual availability. Among other benefits, EOL case management may help reduce hospital
utilization, a major worry with the high cost of hospital-based care and the higher wish for home-
based EOL care. JAYAWARDENA and LIAO (2006). literature review was also carried out gathering
evidence to inform this Equality Impact Assessment. The results of the literature review are given
below counter each of the equality type. The equality impact assessment process requires the policy
to be assessed against seven equality categories: age, gender, religion and belief, sexual orientation,
gender identity, race and disability. However, as other factors of life care, the End of Life Care
Strategy has also been assessed against these categories. (G.M GUTMAN, Y.YON 2004) A number of
articles and reports studied in this Equality Impact Assessment (see bibliography) suggest that there
is potential for inequality in end of life care in respect of a person’s age. Some studies suggest that
older people are less likely to receive end of life care. 4Healthcare Commission. (2007) Spotlight on
complaints 5 WHO. (2004). A study of the literature was undertaken as the first stage in the process
of collecting evidence to support this Equality Impact Assessment. The findings of the analysis of
literature are presented below against any of the definitions of equality. A number of articles and
reports studied in this Equality Impact Assessment (see bibliography) suggest that there is potential
for inequality in end of life care in respect of a person’s age. The review of the literature described
patient perceptions about palliative care as a deterrent to service participation. The national audit
found that data on palliative care is not generally available to cancer patients and the information
given does not solve the misunderstandings identified in the literature (Taylor, S, Wyld, L, Ziegler, L
et al.2019). A Literature review of studies assessing effects of palliative care programmes in various
ways shows that there is a long way to go in defining high-quality, efficient and sufficient palliative
care facilities. Such a lack of definition assumes for granted a shared comprehension of these
concepts although there is no agreement among the population in palliative care. (Jocham HR,
2020). The literature on end of life care for homeless people shows similar barriers to those
described above, but also shows that such care is threatened by e.g. limited resources, little proxy
support, no adequate care site and coordination of such care. Potential consequences are improper
pain medication and symptom management, as well as postponed acknowledgement or anticipation
of breakdown of a patient or phase of palliative care (Ebenau et al., 2020). Literature also discusses
the existing literature on the topic of violence, starting with issues relevant to the concept of abuse
primarily in care homes, in order to arrive at a description of abuse for my research purposes.
Consideration of the incidence of violence in nursing homes and recent attempts to remedy this
follows. The examination then examines the minimal research on older adult harassment theoretical
models and continues with a description of probable ageist factors upon their occurrence (moore,

2020). The aim of this literature review is to identify and clarify key risk factors for the offender and
the elder abuse victim's vulnerability. The purpose of the research is to offer realistic knowledge of
risk factors correlated with harassment of the elderly to practitioners working with older adults or in
the sense of elder violence and to establish the framework for an empirically developed risk
management tool for the exploitation of elderly persons Consequently, a literature review on
diverse risk factors for elder abuse was performed to identify: (1) perpetrator-related factors that
decreased their risk of continuing elder abuse; and (2) victim-related factors that put them at
enhanced risk of continued violence. The notification requirement is founded on a rational
assumption that a disabled person was or is likely to be misused, abused or manipulated. Reporting
alleged misconduct is not only essential for the wellbeing of the allegedly victimised older person
but also for the provider. Many laws guard from civil or criminal responsibility for disclosing false
suspected elder violence. In fact, failure to disclose alleged harassment in certain states can result in
the provider being charged with a felony and disclosing it to their licence or specialist. Both older
people and women may be at risk of violence, and this can happen anywhere they stay or travel.
That could include: someone's own house, a carer's house, a day centre, a church, a nursing home or
a hospital. The main concern is not whether anyone stays or travels, but whether or not there is an
incentive for someone to misuse and manipulate or damage the partnership of confidence. That's
why it's crucial to think ahead of time on whether someone might that the risk of violence,
preventing loneliness or dependence, and having an eye on issues for more than one person. Based
on others doesn't imply being reliant on them, learning of self-protection is more about common
sense than mistrust (Action on Elder Abuse. 2020).
CHAPTER 3: METHODOLOGY
3.0 INTRODUCTION Methodology is based on improvement a method (e.g focus group or
textual analysis) or compare and contrast the use of several different method.
The study involved 36 follow-up interviews with older people who had responded to the
survey and three interviews with older people accessed through specialist BME
organisations. Twenty-two of these involved incidents where the perpetrator was a family
member, paid carer or close friend. The remaining cases involved neighbours, acquaintances
and, exceptionally, strangers. Three interviews were also carried out with family members
who had supported the older person.
Key Findings Respondents reported a range of effects on their health, well-being and quality
of life, reflecting views expressed in the focus groups. These included
• They had lost their self-confidence and were depressed or anxious
• They were nervous about leaving their houses
• Their physical health had been affected
The research shows clearly that physical frailty or dependency does not, and must not, be
equated with loss of autonomy or a lack of robust views about a situation and how to deal
with it.
What clearly emerges from the interviews is that adversity does not mean collapse and
capitulation. Although there were certainly a range of negative impacts and experiences,
and some respondents found it less easy to cope, the resilience of other respondents was

one of the most striking features to emerge from the data. This resilience could exist in the
face of sometimes profound disabilities, serious health problems and adversity in personal
relationships. (National Dignity Council, 2020)
.
3.1 THEORETICAL PERSPECTIVE
A theoretical context is a collection of real-life observations that shape the questions
we pose and the kinds of responses that follow. The article used to direct this
analysis is positivism that is generally considered a valuable approach to perform
rational investigation. A theoretical context is a collection of real-life observations that
shape the questions we pose and the kinds of responses that follow. The article
used to direct this analysis is positivism that is generally considered a valuable
approach to perform rational investigation.
3.2 DESIGN/METHOD
Design Method is process is a theory and methodology that provides insight and
allows the work easier. This encourages you to understand the situation and the
question, and then . encounter are becoming more complex and companies face a
greater risk of failure, this structural challenging task and due to globalisation new
technologies and societal change the problem designers procedures enables you to
decide what the design solution needs to do with EOL patients, and also has the
Potential to enhance designers ' productivity by providing feedback on their actions,
so the creation of approaches is a highly appropriate strategy. The challenging task
and the proliferation of new technologies and societal changes are rendering the
issue designers face more complicated and businesses are experiencing a greater risk of
failure, problem. The ones with uncertainty should be accepted Operational processes
which help people deal with the
3.3 DATA COLLECTION METHOD
Data collection is the method of collecting and evaluating information on interest
factors, in a defined organised sector, and so on to address specified research
questions, test hypotheses, and analyse findings. Research's data collection aspect
is popular to all fields of study including the fashion of physical and social sciences
that enables classics. Although procedures differ by discipline, the focus on providing
accurate and truthful selection remains constant. The goal for all data collection is to
gather reliable information which then converts into rich data analysis and facilitates
the production of a compelling and accurate response to the questions posed.
Regardless of the field of study or the choice for data interpretation)) (quantitative,
qualitative), reliable collection of data is essential to maintain scientific credibility.
Either the use of appropriate data collection instruments (existing, updated or freshly
developed) and clearly delineated guidelines for their proper usage minimise the risk
of errors occurring. Data processing is one of the most critical steps of a testing
process .You may have the best research plan in the country, but if you cannot
gather the required data, you will not be able to finish your project. Data collection is
a very difficult job that requires careful management, hard work, persistence,
persistence and more to be able to successfully complete the task .The collection of
data and kind of data necessary followed begins with the selection of a sample from
a given population. Before that, the data from the identified sample must be
extracted utilising a certain instrument (Anon, 2020)
3.4 SAMPLING TECHNIQUE
Sampling is the process of selecting a presentative group from the population under study

3.5 DATA PRESENTATION & ANALYSIS
PRESENTATION OF DATA This applies to the arrangement of data into tables,
diagrams or maps, so that it is possible to draw reasonable and mathematical results
from the measurements obtained. (RuOcenar, Europe 2020). Data analysis is the
process by which statistical and/or logical approaches are systematically applied to
clarify and illustrate, condense, recapture and analyse the data. Numerous analytical
techniques, according to Shamoo and Resnik (2003), provide a way to draw
inductive conclusions from the data and separate the signal (the direction of interest)
from the noise (statistical fluctuations) present in the data.
3.7 LIMITATIONS
They are the shortcomings, conditions or influences that cannot be controlled by the
researcher that place restrictions on your methodology and conclusions. E.g.: the
time constraints, analysis, finance sample etc. To overcome limitations is to Embrace
better time -management techniques. Time and resources were managed in order to
reduces financial implication and the respondent were followed up appropriately to
avoid delay in their response to questionnaire.
3.9 ETHICAL CONSIDERATION
Ethical issue based on relevant to search in general. They are especially relevant in medical
and nursing research. Here we find the following definition of research ethics, which can be
applicable to other research areas too:
Research ethics addresses the question of which ethically relevant issues caused by the
intervention of researchers can be expected to impact on the people with or about whom
they research. It is concerned in addition with the steps taken to protect those who
participate in the research, if this is necessary (schnell and Heinritz2006, p.17)
CHAPTER 4: FINDINGS & ANALYSIS

Questionnaire
Q1. With whom the palliative care is discussed by the health care professional?
a) With the patients only
b) With the Family only
c) Both of them
Q2. What are the things that are discussed in context of the palliative care?
a) Social assistance and care environment for the patient
b) Regrading the conditions of the health and life support treatment
c) Overall medical treatment to be provided
d) All of the above
Q3. The palliative care team includes different personnel such as -
a) Same members
b) Different members
c) Combination of both
Q4. What are the situations in which palliative care is recommended to the patients by
the health care professionals?
a) Chronic life-limiting illnesses
b) For each and every illness
Q5. Which level of palliative care is mostly offered to the patients?
a) Level One - Palliative Care Approach
b) Level Two - Palliative Care Approach
c) Level Three - Specialist Palliative Care Approach
Q6. What are different areas for which palliative care can be offered to the patients?
a) Social
b) Mental
c) Physical
d) Emotional
Q7. How the awareness among the patients can be created for the palliative care so
that better treatment can be provided?
a) Workshops
b) Media coverage
c) Recommendations by General Practitioners
d) All of the above
Q8. What are the factors or principles that are taken into consideration while
providing palliative care to the the patients?
a) Caring attitude
b) Consent
c) Choice of site of care
d) Consideration of individuality
Q9. Do you think the perspective of patients is important for the acute admission and
discharge in relation to transition in care?
a) Yes
b) No
Q10. What are the perspectives of the service providers regarding acute
hospital admissions associated with a transition in care?
a) Providing better health care services
b) Improving quality of life
Q11. What are the perspectives of the service providers regarding acute
hospital discharges associated with a transition in care?
a) Completion of the treatment

b) Completion of the legal formalities
Q12. How the information regrading transition to a palliative care approach is
communicated to patients and their families?
a) Phones
b) Emails
c) Face to Face interaction
Frequency Table
Q1. With whom the palliative care is discussed by the health care
professional?
Frequency
a) With the patients only 15
b) With the Family only 15
c) Both of them 20
Q2. What are the things that are discussed in context of the palliative
care?
Frequency
a) Social assistance and care environment for the patient 10
b) Regrading the conditions of the health and life support treatment 11
c) Overall medical treatment to be provided 14
d) All of the above 15
Q3. The palliative care team includes different personnel such as - Frequency
a) Same members 18
b) Different members 16
c) Combination of both 16
Q4. What are the situations in which palliative care is recommended to
the patients by the health care professionals?
Frequency
a) Chronic life-limiting illnesses 42
b) For each and every illness 8
Q5. Which level of palliative care is mostly offered to the patients? Frequency
a) Level One - Palliative Care Approach 12
b) Level Two - General Palliative Care 14
c) Level Three - Specialist Palliative Care Approach 24
Q6. What are different areas for which palliative care can be offered to
the patients?
Frequency
a) Social 11
b) Mental 11
c) Physical 19
d) Emotional 9
Q7. How the awareness among the patients can be created for the
palliative care so that better treatment can be provided?
Frequency

a) Workshops 7
b) Media coverage 8
c) Recommendations by General Practitioners 15
d) All of the above 20
Q8. What are the factors or principles that are taken into consideration
while providing palliative care to the the patients?
Frequency
a) Caring attitude 15
b) Consent 14
c) Choice of site of care 11
d) Consideration of individuality 10
Q9. Do you think the perspective of patients is important for the acute
admission and discharge in relation to transition in care?
Frequency
a) Yes 29
b) No 21
Q10. What are the perspectives of the service providers
regarding acute hospital admissions associated with a transition
in care?
Frequency
a) Providing better health care services 26
b) Improving quality of life 24
Q11. What are the perspectives of the service providers
regarding acute hospital discharges associated with a transition
in care?
Frequency
a) Completion of the treatment 35
b) Completion of the legal formalities 15
Q12. How the information regrading transition to a palliative care
approach is communicated to patients and their families?
Frequency
a) Phones 8
b) Emails 16
c) Face to Face interaction 26

Analysis
Q1. With whom the palliative care is discussed by the health care
professional?
Frequency
a) With the patients only 15
b) With the Family only 15
c) Both of them 20
15
15
20
a) With the patients only
b) With the Family only
c) Both of them
Interpretation: On the basis of above graph it can be analysed that with whom the
problem faced by the patient must be discussed by the health care professional so
that they can ensure that better well being and care is offered to the patient. As per
the responses of the health care workers it can be identified that 15 out of 50
respondents are in favour of discussion with the patient as they have been facing
various issues due to which they can take better decisions for them. While other 15
respondents believe that only family must be informed so that they can ensure that
better decisions are taken for the patient by taking into consideration various related
aspects. But 20 respondents were in favour of the discussion with both so that
mutual decision can be taken.
Q2. What are the things that are discussed in context of the palliative
care?
Frequency
a) Social assistance and care environment for the patient 10
b) Regrading the conditions of the health and life support treatment 11
c) Overall medical treatment to be provided 14

d) All of the above 15
10
11
14
15 a) Social assistance and
care environment for the
patient
b) Regrading the conditions
of the health and life support
treatment
c) Overall medical treatment
to be provided
d) All of the above
Interpretation: On the basis of this graph it can be analysed that what all aspects
must be discussed by the professional with the patient and their family for palliative
care. 10 of the professional people believed that social assistance and care
environment is must for the patient while 11 have a belief that condition of the health
of the patient and life support system that will be used during the care must be used.
This will ensure that the abuse to the palliative care is not faced. Most of the
respondents i.e., 15 are in favour of the discussion of overall medical treatment with
which they have better awareness. But for better health all the aspects must be
taken into consideration.
Q3. The palliative care team includes different personnel such as - Frequency
a) Same members 18
b) Different members 16
c) Combination of both 16

18
16
16
a) Same members
b) Different members
c) Combination of both
Interpretation: With the help of this graph it can be analysed that the most of the
respondents are in favour of the fact that the team of the professionals must include
same members as they have better understanding due to which better services can
be offered to the customers. While 16 respondents each are in favour of both
different members and combination of the two. Because with this better abilities can
be ensured within the team with which all the needs of the patients can be ensured.
Q4. What are the situations in which palliative care is recommended to
the patients by the health care professionals?
Frequency
a) Chronic life-limiting illnesses 42
b) For each and every illness 8
42
8
a) Chronic life-limiting
illnesses
b) For each and every illness
Interpretation: With the help of this graph it can be identified that most of the
respondents i.e., 42 respondents out of 50 within the health care organisation

believed that palliative care must be offered in case of the chronic life limiting illness
as during such disease better and severe care is to be provided to the patients. In
this the patient is kept under observation due to which they can ensure each and
every requirement of the patient along with their progress.
Q5. Which level of palliative care is mostly offered to the patients? Frequency
a) Level One - Palliative Care Approach 12
b) Level Two - General Palliative Care 14
c) Level Three - Specialist Palliative Care Approach 24
12
14
24
a) Level One - Palliative
Care Approach
b) Level Two - General
Palliative Care
c) Level Three - Specialist
Palliative Care Approach
Interpretation: On the basis of this graph and the responses of the health care
workers it can be identified that most of the patients are provided with specialist
palliative care as they have been provided such care in case of chronic illness. But
other believed that other two level services are also offered but in case the impact of
the disease on the patient is not much as the required level of care is not significant.
Q6. What are different areas for which palliative care can be offered to the
patients?
Frequency
a) Social 11
b) Mental 11
c) Physical 19
d) Emotional 9

11
11
19
9
a) Social
b) Mental
c) Physical
d) Emotional
Interpretation: With the help of this graph it can be identified that most of the
palliative care is offered for the physical areas as 19 out of 50 respondents were in
favour of this. This is because in the palliative care the pain in the body part, injury,
fatigue physically can easily be taken care off. But in context of the other areas also
the care is provided as the care by the team with special treatment make the patient
comfortable with the issues that they have been facing as they get social support,
moral support etc.
Q7. How the awareness among the patients can be created for the
palliative care so that better treatment can be provided?
Frequency
a) Workshops 7
b) Media coverage 8
c) Recommendations by General Practitioners 15
d) All of the above 20

7
8
15
20 a) Workshops
b) Media coverage
c) Recommendations by
General Practitioners
d) All of the above
Interpretation: On the basis of above graph it can be analysed that the
communication is crucial so that awareness can be created among different people.
Most of the respondents are in favour of the recommendations made by the general
practitioner to the patients as with this they can easily convince. Further the
awareness can be created through various sources but the issues with other sources
is that of the ability of the people to understand the concept and its effectiveness.
Q8. What are the factors or principles that are taken into consideration
while providing palliative care to the the patients?
Frequency
a) Caring attitude 15
b) Consent 14
c) Choice of site of care 11
d) Consideration of individuality 10

15
14
11
10
a) Caring attitude
b) Consent
c) Choice of site of care
d) Consideration of
individuality
Interpretation: On the basis of above graph various factors that are to be taken into
consideration are analysed such as most of the health care professionals are in
favour of the caring attitude as with this they have caring behaviour of the employees
towards the patients. But other 14 believes that consent of the patient is must as
they must know the treatment that has been provided to them.
Q9. Do you think the perspective of patients is important for the acute
admission and discharge in relation to transition in care?
Frequency
a) Yes 29
b) No 21
29
21
a) Yes
b) No
Interpretation: On the basis of the above graph it can be identified that the
perspectives of both the patient as well as the practitioner is crucial for acute

admission and discharge in relation to transition in care as 29 respondents are in support of
this. With this the better services and better satisfaction can be ensured because consent and
perspective of both is taken into consideration.
Q10. What are the perspectives of the service providers
regarding acute hospital admissions associated with a
transition in care?
Frequency
a) Providing better health care services 26
b) Improving quality of life 24
Interpretation: Looking at the above table, it needs to understand that out of total 50
respondent there are 26 respondent who thinks that providing better health care
services are important for the acute hospitals. But at the same time there were other
24 respondent as well who had the assumptions that acute hospital must focus upon
improving the quality of life which is much important.
Q11. What are the perspectives of the service providers
regarding acute hospital discharges associated with a
transition in care?
Frequency
a) Completion of the treatment 35
b) Completion of the legal formalities 15
35
15
a) Completion of the
treatment
b) Completion of the legal
formalities

Interpretation: From the above prepared table, it is clearly understandable that
different people might have different perspective towards acute hospitals. Among 50
respondents, there were 35 total respondents who thinks that patient under palliative
care must be discharged only after the completion of their treatment. Still, there were
15 respondent who disagree with completion of the treatment as they things that
patient should be discharged only after the completion of legal formalities of the
health care centre.
Q12. How the information regrading transition to a palliative
care approach is communicated to patients and their families?
Frequency
a) Phones 8
b) Emails 16
c) Face to Face interaction 26
8
16
26
a) Phones
b) Emails
c) Face to Face interaction
Interpretation: As per the above mentioned table, it seem that proper communication
channels must be used at the time of communicating with any of the patient or with
their family members. It was found that out of total 50 respondent, there were only 8
person who thinks that the must effective process of communication is phone. There
are other 16 who thinks that email is the best way of communication in any of the
healthcare field. But, there are 26 other people who thinks that without having face to
face communication, it will not be possible to communicate the information.

CHAPTER 5: DISCUSSION
In order to make any of the discussion on detail, it is essential to work on the
objective of the research where it was found that who should be the one where
palliative care should be provided. For the purpose of collecting data in detail, there
was a requirement of primary and secondary data for which literature reviews were
collected from different journals and books. At the same time, questionnaire were
prepared for expertise with whom different question were asked which were related
with palliative care. This can certainly allow to understand that whether goals of
research can be accomplished.
To examine the circumstances under which transitions to a palliative care
approach occur within care home, with a focus on the influence of age and
disease type on decision-making.
After analysing primary and secondary research, it is needed to understand
that palliative approach must be given to only those particular person who are not
capable of performing their part of work. The care and health for individual must be
given in only that respective circumstances where person suffers from any of the life
long illness such as cancer, kidney failure and many more. It also depends upon the
nature of disease and age. Both of this factor has huge importance. The presented
Literature review and questionnaire simply focuses that there are number of people
to whom Palliative care approach is needed but it completely depends upon the
healthcare because they are the one who needs to decided that up to how law
treatment. Still, most of the cases of palliative care occurs in the situation where age
do not support the patient to take their care of own and secondly in the condition
where nature of illness do not allows them to recover for life time period. This are the
main things which needs to understand but additionally, it is required to understand
that nursing department plays crucial within any of the palliative care approach. It is
because they are the one who needs to work for the fulfilment of every single thing
for patient.
To explore how decisions to move to a palliative care approach are made and
who is involved in decision-making.
In current scenario, making any of the decision is never an easy in the
premisses of health care. Looking at this, it is essential to understand that role of
healthcare practitioners increases in it. It is because they are the one who needs to
take decision regarding the selection that who are those patient to whom palliative
care is required. This is among the most important factor but it is equally necessary
to ensure that family member are playing their role to decided whether there is the
requirement of palliative care or not. Even patient and different members needs to
show their equal importance because this is one of the decision which will help to
decide whether any of the chances are available or not for performing any of the
work. The research on the topic shows that the person who will hold the
responsibility of palliative care must be able to complete their part of work without
any sort of mistakes.
To examine if and how information about a transition to a palliative care
approach is communicated to patients and their families and how they are
involved in decision-making.
The analysis of primary and secondary research shows that any of the work
within the research is not easy because data must be collected and must be
compared. Here, primary and secondary source simply discusses that what are
those approaches which must be used within palliative care approach. There are
different types of communication process can be used such as written

communication where present condition of patient can be shared with its positive and
negative impact. Even similar form of process can be used to provide information to
patient themselves.
This particular process is necessary because it can certainly allow to
understand and take effective decision that whether patient requires any of the
palliative care service or not. Family members and patient themselves plays crucial
because according to the situation of the patient they are needed to take decision
which is quite necessary in to ensure that proper health facilities are being received
by patient.
To explore the perspectives of patients, service providers and commissioners
regarding acute hospital admissions and discharges associated with a
transition in care.
As per the research, the literature review and questionnaire are directly
related where both of them discusses that how any of the work needs to be
conducted within palliative care. As per the acute hospital admission, their major
focus was upon finding the ways that how quality of life can be improved so that
goals and target can be accomplished. The improvement of in the quality of life of
patient can certainly allow the practitioners to ensure that recover can be seen.
Although, in the discussion it was found that palliative care is mainly required
for the life time but it is equally important to understand that it is not possible to give
care to each of the patient for life time period of the available number of staff. So,
major focus of acute hospital is to take care of any patient till the time period of
completion of treatment because it can certainly become helpful for the patient. All of
this factor must be considered in any of the acute hospital.

CHAPTER 6: CONCLUSION & RECOMMENDATIONS
6.0 Conclusion
Outcome research in palliative care represent a new dimension of clinical research
that should be investigated in the near future. the limit in but it should be properly
linked to outcome research are not well defined in nursing research or in palliative
care dimension, but it should be properly linked to evidence based practice. The
palliative care needs of society are likely to increase in the future, although the
magnitude of changes is difficult to be gauged accurately palliative care service
should be in line with WHO recommendations and further attempts made to assess
unsatisfied requirements and intervene where necessary. These unsatisfied
requirements and the increase of patients with dementia and other diagnoses in
need for palliative care are probably the driving force behind these services in the
future. this literature review of studies measuring outcomes of palliative care services
in different ways suggest that identifying high- quality effective and appropriate
palliative care services a long way away. Such a lack of definition takes a universal
understanding of these terms for granted, despite the fact that there is no consensus
among the palliative care community (Jocham, 2019).
.
6.1 RECOMMENDATION(S)
On the basis of the above research it can be identified that most of the
health care organisation has to take into consideration that the better
services and quality of the services for the patient is ensured. With the
help of this it can be identified the communication for the palliative care
must be shared among people within nation by health care organisations
and regulatory bodies so that they can ensure that improved services
and quality of the life of the patients is improved. For this they must take
into consideration various sources of communication as well as various
health care programs need to be launched by them so that they can
ensure that most of the services are as per the need and the disease of
the patient. It is important that an awareness related with the abuse
which is faced by patients who are under palliative care is created so
that the health care providers can know about the appropriate actions
they need to take so that patients can be treated properly and their
health can be improved. Following are the recommendations which can
help in improving the conditions of patients and decreasing abuse
against patients:
 The government and regulatory bodies can form policies which
can help in improving the conditions of health care centres along
with providing them with better budgets so that effective health
care can be given to patients.
 Media coverage can also help in creating awareness about the
abuse of patient so that patients can be treated effectively with
care and respect.

 It is essential that organisational culture is developed which can
help in creating an environment where patients are treated with
care so that their dignity is maintained and equal treatment
opportunities are provided to them in order to improve their
conditions.

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APPENDICES
APPENDIX 1: SAMPLE OF QUESTIONNAIRE

APPENDIX 2: SAMPLE OF PARTICIPANTS INFORMED CONSENT FORM

APPENDIX 3: APPROVAL LETTER FROM MANAGER
(IF THE RESEARCH WAS CARRIED OUT AMONG COLLEAGUES AT
WORKPLACE OR ANOTHER RELEVANT EVIDENCE i.e EMAIL WITH A
COMPANY DETAILS