One impact of the baby boom generation and improved medical care is that nursing homes will be the place of care and site of death for growing numbers of frail, older persons dying of chronic progressive illnesses. The nursing home settings may appear to be an appropriate environment wherein residents could receive palliative care, but the literature suggests that provision of such care is replete with challenge. Some of these challenges are external to the nursing home environment and are beyond the setting's control, others have internal origins and to some extent may be under the home's control. In part I of this two-part article, we review and critically analyse the primary external factors identified in the literature -- characteristics of the residents -- as they impact on the ability of care homes to deliver palliative care.

Palliative medication kits are a simple and effective way of anticipating and addressing comfort and symptom control for dying patients being cared for in the community. These kits can avert institutional crisis admissions, extend the period of time patients can be cared for in their homes and may increase the likelihood of a home death.

The findings from this pilot study provide preliminary empirical evidence that could inform educational programs for and performance evaluation of, health care aides providing end-of-life care in personal care home environments.

Nursing homes are increasingly becoming the place of care and site of death for growing numbers of frail older people dying of chronic progressive illnesses. Despite this increase, empirical evidence suggests that providing palliative care in nursing homes is replete with challenges. In a previous publication, the authors examined challenges external to the nursing home that influence the provision of palliative care, and which may be beyond the nursing home's control (Wowchuk et al, 2006). This paper reviews the primary internal factors identified in the literature that affect the provision of palliative care and are, to some extent, under the nursing home's control. The internal factors include: i) lack of care provider knowledge about the principles and practices of palliative care; ii) care provider attitudes and beliefs about death and dying; iii) staffing levels and lack of available time for dying residents; iv) lack of physician support; v) lack of privacy for residents and families; vi) families' expectations regarding residents' care; vii) hospitalisation of dying residents. Suggestions for practice, education and research are provided.

The purpose of the study was to evaluate the role of an online resource for dying children, their family members, and health care providers from the perspective of pediatric palliative care experts. Semistructured interviews with 12 leaders in pediatric palliative care in North America were conducted, exploring their perceptions and attitudes towards various aspects of Web-based resources for dying children and their care providers. Informants felt that an online resource may allow for a different form of expression, a connection between people undergoing a rare event, and an increase in education and support. Major challenges, such as accessibility, monitoring, and remaining current, would be ongoing. Other key themes included access, information, and anonymity. The data suggest that developing Web-based resources for dying young patients and their families may have merit. Should this take place, a feasibility study will be necessary to further determine the value of such a Web site for these vulnerable populations. Resume I l.'etude a pour objet d'evaluer Ie role d'une ressource en ligne destlnee aux enfants mourants, aux membres de leur famille, ainsi qu'aux professionnels de la sante, et ce du point de vue des specialistes en soins palliatifs pedlatrlques, On a effectue des entrevues ssml-structurees aupres de 12 leaders du domaine des soins palliatifs pediatriques a l'echelle nord-arnericaine, afin de decouvrir leurs perceptions et attitudes envers differents aspects des ressources Internet elaborees a I'intention des enfants mourants et de leurs soignants. Les personnes lnterroqees etaient d'avis qu'une ressource en ligne pourrait favoriser une forme d'expression nouvelle, la creation de liens entre des personnes vivant une experience unique, de marne qu'une hausse du niveau de sensibilisation et de soutien. On devra relever cependant de grands defls, tels que l'accessibllite, la surveillance et Ie necessaire de mise ajour du site. Au nombre des themes cles, mentionnons l'acces, I'information et I'anonymat. Les donnees recueillies laissent supposer que la mise au point de ressources sur Internet pour les enfants mourants et les membres de leur famille pourrait avoir du merits. Si Ie projet devait se realiser, il serait necessaire de conduire au prealable une etude de faisabilite qui permettrait de mieux determiner Ie bien-fonda d'un tel site Internet pour ces populations vulnerables.