To describe the palliative care provided by physicians in the Quebec city region and to identify factors that affect its delivery.
Quebec city region.
General practitioners in active clinical practice.
Physicians' personal and professional characteristics and their palliative care practice (volume of work, source of requests for follow-up care, place of delivery of care, resources used, difficulties, encountered).
Of the 476 physicians (67%) who responded to our survey, 295 (62%) provided palliative care. Of these, 70% saw no more than two patients requiring palliative care per month, and 55% devoted no more than 2 hours per week to this aspect of patient care. Most (76%) provided palliative care in a variety of settings (private office, home, institution). Home care teams working out of local community health centres are the resource physicians drew upon most frequently (69%). The main difficulties encountered were a lack of clinical expertise, scheduling home care, and providing patients and families with emotional support.
Most physicians in the Quebec city region provided palliative care occasionally. This care could be improved by removing various logistical and professional barriers.
Cites: Br Med J (Clin Res Ed). 1986 Apr 19;292(6527):1051-32421820
Cites: J R Coll Gen Pract. 1988 Sep;38(314):411-33256657
Cites: Aust Fam Physician. 1990 Dec;19(12):1835-412275665
Although community health nurses have to face the increasing needs in curative and palliative care, they still engage in health promotion activities for the elderly, mainly cognitive and behavioural ones. The Quebec community health nurses who choose the McGill model of nursing, are able to integrate health promotion interventions in their daily practice with old aged people. In fact, this model helps these nurses consider the elderly, health, sickness and nursing care in a way that makes them promote self-esteem, empowerment, development and coping through most of their interventions. Moreover, the elderly population would benefit from an increased implication of nurses in ecological, environmental and community health promotion projects.
For over 25 years, the Maison Michel-Sarrazin, a private palliative care institution in the Quebec City region, has had an original agreement with other establishments in the healthcare network (hospitals, long-term residential centres and CLSCs), in the form of the loan of nursing services. Based on the findings of a study as part of a research program, this article describes the loan of nursing services and qualitatively assesses its effects on the development of nurses' palliative care skills. An evaluative descriptive approach based on two conceptual frameworks (Giddens; Patton) was used to compile the views of 79 players. The findings demonstrate the innovative nature of the loan of nursing services and its considerable influence on the development of nursing skills, thanks to training based on the apprenticeship model (learning through observation and imitation), and on nursing practice at the Maison Michel-Sarrazin. Nevertheless, the controversy surrounding training using the apprenticeship model and the lack of recognition of this training on the part of the lending institutions raise questions despite the general satisfaction with the loan of nursing services.