I A postal survey was used to collect data from family members of deceased residents of six long-term care (lTC) facilities in order to explore endof-life (EOl) care using the Family Perception of Care Scale. This article reports on the results of thematic analysis of family member comments provided while completing the survey. Family comments fell into two themes: 1) appreciation for Care and 2) concerns with care. The appreciation for care theme included the following subthemes: psychosocial support, family care, and spiritual care. The concerns with care theme included the subthemes: physical care, staffing levels, staff knowledge, physician availability, communication, and physical environment. This study identified the need for improvement in EOl care skills among LTC staff and attending physicians. As such, there is a need to implement continuing education to address these issues. Resume I Nous avons peste un questionnaire aux families dont un des membres decede etait heberge dans un des six hOpitaux de soins de longue duree, afin de connaitre leur opinion sur la quallte des soins de vie selon l'Echelle de Perception familiale des soins. Cet article rapporte les resultats de I'analyse thematlque des commentaires emis par les families dans Ie questionnaire. Ces commentaires tombaient sous deux categories: 1) evaluation des soins 2) la quaiite des soins. le premier theme comprenait les sous-cateqorles suivantes: aide psychosociale, besoins des families et pastorale et soins spirituels. le theme traitant de la qualite des soins avait pour soustheme: les soins physiques, Ie manque de personnel, les connaissances du personnel, la disponibilite des rnedeclns, les communications et I'environnement du malade. Cette etude a identifie la necesslte d'arnellorer les connaissances en soins de fin de vie chez Ie personnel et les rnedeclns dans une institution de soins de longue duree. En fait, iI ressort qu'il faudra instaurer des cours de formation continue pour repondre aces preoccupations.

The study examined the utility of the Family Perception of Care Scale (FPCS), which consists of four subscales: resident care, family support, communication, and rooming. This instrument was developed for the purposes of this study. Overall, family members were satisfied with end-of-life care. Satisfaction did not have a statistically significant relationship to family and resident characteristics. Survey questions with the highest number of low satisfaction ratings included staffing levels, updating families and involving them in care planning, and decision making. Family members considered pain control an important priority, followed by comfort care that included caring for a family member with dignity and sensitivity. Family members also valued it when staff were able to inform them that the death of their family member was near. Place of death was significantly associated with satisfaction, family members being more satisfied with end-of-life care when their family member died in the LTC facility as opposed to in hospital. Resume I Cette etude avait pour objectif d'evaluer I'utilite de l'Echelle de perception des soins de la famille laquelle comprend quatre sous-echetles portant sur les soins en institution de longue duree, Ie soutien de la famille, les communications et Ie lieu ou Ie patient etalt soigne. Cette echelle a ete developpee uniquement aux fins de cette etude. Dans I'ensemble les families etalent satisfaites des solns de fin de vie qui avaient ete procures aux leurs. Ce degre de satisfaction n'avait aucun lien statistiquement significatif avec les caracteristlques propres ala famille et au resident. Dans cette etude, les questions ayant obtenu Ie plus grand nombre de reponses peu satisfaisantes avaient trait aux differents membres du personnel, a I'information transmise aux families, a la participation de la famille aux soins et a la prise de decisions. Les membres des families conslderaient Ie controls de la douleur comme etant la plus importante prlorite, suivi par la suita du confort du malade, et enfin de la dignite et de la senslblllte a apporter dans les relations avec les membres de la famille. Egalement d'importance l:1tait Ie fait que Ie personnel soignant puisse etre capable de prevonlr la famille lorsque la mort etait proche. L'endroit ou la personne est decedee etait un autre facteur de satisfaction, puisque les families etaient plus satisfaites lorsque leurs proches etalent morts dans une institution de soins prolonqes que dans un h6pital.

No abstract

A qualitative study using a grounded theory approach investigated adolescents' perceptions about complementary/alternative medicine (CAM) use. Adolescents, attending a clinic at the Canadian College of Naturopathic Medicine, were interviewed after receiving ethics approval. Data were collected using semi-structured interviews. The decision of adolescents to use CAM was based within the context of their world and how it shaped influencing factors. Factors that influenced adolescents' decision to use CAM were identified as certain personality traits, culture, media, social contacts and the ability of CAM providers to develop therapeutic relationships. The barriers and benefits of CAM use influenced evaluation of choices. The importance of barriers in limiting freedom of choice in health care decisions should be investigated by practitioners as they provide care to adolescents. Health care planning for integrative models of care requires determining the "right" blend of expertise by knowing interprofessional boundaries, determining mixed skill sets to provide the essential services and ensuring appropriate regulation that allows practitioners to use their full scope of practice.