What is already known about the topic? To date, research regarding the economic dimension of palliative and end of life care provision has been relatively limited.  The importance of family care givers has long been recognised within palliative care.  T ly What this paper adds? Evidence relating to the costs and implications of caregiving is relatively limited.  The review identified 21 studies relating to the costs and implications of caregiving in a palliative care context  The financial costs of caring for someone at the end of life are substantial.  Financial costs can result in significant and multidimensional caregiver burden; various factors mediate the extent of financial burden. Implications for practice, theory or policy? This review identified a significant gap in the evidence base regarding the economic implications of providing care to a family member within a palliative care context.  Further research is required to explore these economic costs  Policy initiatives across much of the developed world to move the provision of palliative care from hospital to community settings should be mindful of the significant costs incurred by family caregivers.

Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non-Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access-to-care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self-identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non-users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care services for patients and families and provide consultative services to primary healthcare providers in the community.

No abstract

On the basis of our findings, we recommend a shift to the term 'potentially avoidable' admission rather than 'inappropriate admission'. We also identify an urgent need for debate regarding the role of the acute hospital within a palliative care context. Interventions to reduce hospital admissions within this population must target societal understandings of death and dying within the context of medicalisation, as well as take into account cultural and ethnic diversity in attitudes, if they are to be successful.

Aim: This study determines whether the culture within an acute care hospital empowers 'all' nurses to be leaders by exploring intersectionality and nursing leadership in the context of the social environment.Background: Nurses practice leadership in their day-to-day activities as clinical leaders alongside traditional roles of management and leadership. However, some nurses do not acknowledge nursing work as leadership activity, nor is it seen so by others where hierarchical leadership approaches remain prevalent. Social constructs of gender and race are barriers to accessing formal leadership positions for some, while dominant power structures such as class diminish the value of bedside nursing work.Unexplored is the impact of the intersection of these and other social identities on nurses being leaders.Design: An embedded case study design.Methods: Thirty-one participants participated in semi-structured interviews. Four levels of analysis including inductive and deductive approaches were applied to the data. The research complied with COREQ guidelines for reporting qualitative research. Results:This study shows nurses do not identify themselves as leaders without an associated title and the pathway to leadership varies depending on intersecting social constructions. Conclusion:The impact of the organisational structures and the experience of navigating intersecting social constructions on nurses being leaders goes unseen, privileging some while disadvantaging others.