Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.

Multiple barriers and facilitators to achieving death at home were identified in this study. Of particular significance was the identification of the fear and stigma associated with death among doctors, patients and their families serving as a barrier to home death, not previously identified in the literature. Additionally, the importance of social networks and resource provision were highlighted as key in influencing patient death at home.

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IntroductionEvidence suggests that the majority of patients wish to die at home. However, this is only attainable for few.AimTo identify the barriers and facilitators to being able to die at home in the UK. Methods: A two-step study approach was adopted.1A systematic literature review (SLR) and2primary qualitative data collection. In the SLR 3241 papers were retrieved. 72 articles remained after screening and filtering processes. Qualitative articles were analysed using meta-ethnography and quantitative articles were analysed using a descriptive approach. In the primary study, 33 in-depth interviews were conducted with experts in end-of-life care. Thematic Analysis of interview transcripts was conducted. Approval from Imperial College Research Ethics Committee was obtained for the study. The results from the SLR and primary data collection were amalgamated to produce a set of overarching barriers and facilitators.ResultsSix barriers and four facilitators were identified. The specific barrier of ‘challenges in resource planning’ will be discussed in this paper. This overarching theme included logistical issues in getting both the patient and equipment home, lack of continuity of care and geographic variation in resource provision, including 24/7 care.ConclusionsAddressing this barrier could allow more patients to achieve death at home. However, it is important to acknowledge the qualitative nature of results. As a result, further research is required to identify the relative impact this barrier has on patients’ ability to achieve home death when compared to other barriers and facilitators identified.

Background and objectives. During this time the unit cost of clinical practice in hospitals that practice becomes a vehicle which has not been done calculation costing more Clinical practice based on estimates, propriety and comparison with the cost of clinical practices from other hospitals. The costing is sometimes caused problems. Currently the cost of student practice in teaching hospitals varies between Rp. 300,000 - Rp. 500,000 / person / month. The problem that exists is how the unit cost and how much it costs the right based on unit cost and other considerations that apply to students practice at the Hospital Clinic as a vehicle for clinical practice. The purpose of this study to determine the unit cost and set the cost of professional practice of nurses that will be proposed applicable professional nurses students at Hospital.Method. This research was a descriptive observational study by conducting a case study in the dr. Soewandhi hospital East Java. Calculation of unit cost carried by Activity Based Costing (ABC), costing more to do content analysis after conducting focus group discussions, as well as other considerations.Research result. The results using the ABC method showed that the unit cost to the cost of professional practice nurses in the hospital Dr. Soewandhi Surabaya is Rp. 460,000, - / month / person, while the cost of practice set by the RS Dr. Soewandhi is Rp. 1.200.000, - / month / person. There is a practice of the profession excess costs Rp. 740,000, -. RS Dr. Surabaya Soewandhi practice fees apply without using a standard based on the unit cost accordingly. Some educational institutions felt the cost was very heavy so the impact to the cancellation of the filing of the professional nurses student practice.Conclusions and recommendations. The hospital used a professional students practice nurses should use the standard fees in accordance with needs through precise calculations that the fees charged to students through educational institutions in accordance with the appropriate calculations.Keyword: ABC system - Profession nurses - Fee Practices