{"title":"Improving Patient-Centered Care for End-Stage Renal Disease Patients at a Community Palliative Setting.","authors":"Behdokht Rouhi, Catherine Collins-Fulea","doi":"10.1097/NJH.0000000000001059","DOIUrl":"10.1097/NJH.0000000000001059","url":null,"abstract":"<p><p>End-stage renal disease (ESRD) is a complex medical condition growing fastest in Americans 65 years and older. Despite its chronic nature, fewer than 10% of these patients have had advanced care planning. A chart audit (n = 20) of the palliative patients at a community palliative program revealed that no patient had a conversation about prognostication, 10% (n = 2) about the burden of kidney disease, 30% (n = 6) had coordination of care with the nephrologist, and 35% (n = 7) had engaged in end-of-life planning. This project aimed to increase patient-centered care for ESRD patients to 80% in 90 days. The project utilized the Plan-Do-Study-Act quality improvement model in four 2-week rapid cycles with 2 focus improvement areas. The 2 core interventions were patient screening for preferences and values and providing the right care for palliative management utilizing a checklist. At the end of the project, patient-centered right care for ESRD increased from a baseline of 24% to 94%. Patient engagement scores increased from a baseline of 3.2 to 4.9 on a 5-point Likert scale, with 5 being the highest supporting a shared decision model of care in improving patient-centered right care.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"332-339"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth Byrd, Ashley McMath, Jennifer Ware, Rebecca Jacobs, Kendra Weaver
{"title":"End-of-Life Education in a Prelicensure Nursing Program.","authors":"Elizabeth Byrd, Ashley McMath, Jennifer Ware, Rebecca Jacobs, Kendra Weaver","doi":"10.1097/NJH.0000000000001057","DOIUrl":"10.1097/NJH.0000000000001057","url":null,"abstract":"<p><p>The demand for palliative and end-of-life nursing is increasing with the aging US population. The American Association of Colleges of Nursing published recommendations for incorporating palliative and end-of-life care across nursing curriculum to prepare the future workforce. However, recommendations regarding teaching end-of-life content are limited. This project aimed to integrate and evaluate the outcomes of end-of-life education introduced in a prelicensure nursing program. Using a documentary created by the American Nurses Foundation, students had the opportunity to discuss common themes in end-of-life care, practice morgue care in the simulation laboratory, and practice reflective journaling. The students' preevaluations and postevaluations indicated that the educational program significantly increased their confidence in providing end-of-life care and support to patients and families, demonstrating the importance of end-of-life curricula in nursing school.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"325-331"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katie E Nelson, Kassie Runsabove, Martha Abshire Saylor, Kathleen Adams, Patricia M Davidson, Nancy Perrin, Alicia Werk, Rebecca Wright, Teresa N Brockie
{"title":"Predictors of Supportive Care Needs During Serious Illness: Cross-sectional Analysis of Reservation-Based Informal Caregivers.","authors":"Katie E Nelson, Kassie Runsabove, Martha Abshire Saylor, Kathleen Adams, Patricia M Davidson, Nancy Perrin, Alicia Werk, Rebecca Wright, Teresa N Brockie","doi":"10.1097/NJH.0000000000001050","DOIUrl":"10.1097/NJH.0000000000001050","url":null,"abstract":"<p><p>Native Americans (Indigenous Americans) have high rates of serious illness in the United States. Informal caregivers are heavily relied on in caring for patients in low-resource settings. The needs of caregivers residing on reservations are sorely underreported. Therefore, our objective was to examine relationships between facilitators (communal mastery, cultural identity, and spirituality) and barriers (depression, anxiety, stress, and burden) with supportive care needs among adult informal caregivers in 1 reservation-based community. A cross-sectional survey was distributed in July and August 2022 as part of a larger multimethod, community-based participatory research study. We used descriptive statistics and linear regression models to examine relationships against the primary outcome, the Supportive Care Needs Assessment Tool for Indigenous People. Overall, 127 participants were included; most were female (n = 92, 72.4%), were between 30 and 49 years (n = 57, 44.9%), and had 6 months or less of caregiving experience (n = 41, 32.5%). Higher depression, anxiety, stress, and burden were significantly associated with higher Supportive Care Needs Assessment Tool for Indigenous People scores. Overall, mental health is a significant barrier that may indicate greater supportive care needs among informal caregivers, although further work is needed to differentiate symptoms and their impact on caregiving from a cultural perspective.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"273-281"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica Madiraca, Kathleen Lindell, Shannon Phillips, Patrick Coyne, Sarah Miller
{"title":"Palliative Care Needs of Women With Advanced Chronic Obstructive Pulmonary Disease: A Mixed Methods Study.","authors":"Jessica Madiraca, Kathleen Lindell, Shannon Phillips, Patrick Coyne, Sarah Miller","doi":"10.1097/NJH.0000000000001052","DOIUrl":"10.1097/NJH.0000000000001052","url":null,"abstract":"<p><p>Individuals with chronic obstructive pulmonary disease (COPD) experience high symptom burden, severe illness, and frequent deterioration in quality of life. Women with COPD represent a unique population with potential unmet care needs yet remain underrepresented in palliative care (PC) literature. The purpose of this study was to investigate specific needs of women with COPD, learn how COPD symptoms impact women, and explore factors related to PC knowledge, access, and barriers. A total of 30 individuals were enrolled in this prospective, single-arm multimethod study, using an adapted Maslow's hierarchy of needs framework. Fifteen participated in semistructured interviews. Women with advanced COPD identified care needs and barriers including access to medications/oxygen and resources (pulmonary rehabilitation/support groups), information about disease/treatment, and effect of weather conditions on symptoms. Some participants were not under the direct care of a pulmonologist but recognized the importance of their services. None of the participants had been referred to or received PC. This study provides evidence that women have unmet care needs, high symptom burden, and disease uncertainty. Women with COPD should have the opportunity to have the supportive care that PC offers. Palliative care and hospice nurses have opportunities to address unmet care needs, increased symptom burden, and disease uncertainty.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"E154-E162"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine M Mann, Hannah Maciejewski, Suzanne S Sullivan
{"title":"\"I Finally Feel Like I Have Help. Before, I Was Completely Alone\": A Grounded Theory of Community-Based Hospice Transitions.","authors":"Catherine M Mann, Hannah Maciejewski, Suzanne S Sullivan","doi":"10.1097/NJH.0000000000001049","DOIUrl":"10.1097/NJH.0000000000001049","url":null,"abstract":"<p><p>Little is known about community-based transitions to home hospice care. We used a Straussian grounded theory approach to understand the basic social process of care transitions that patients and their caregivers use when electing hospice care. Participants were recruited from hospice agencies serving 3 counties in New York State. Data were collected through 7 interviews of patients, patient-and-caregiver dyads, and a hospice nurse (n = 10). Data were analyzed using the constant comparative method. Our results generated an emerging grounded theory of the hospice care transition processes rooted in maintaining personhood and autonomy. There were 5 contemporaneous steps: (1) recognizing futility and pursuing comfort; (2) seeking help and input as health declines; (3) shopping for the right services, overcoming obstacles, and self-referring to hospice care; (4) attending to the business of dying while living; and (5) processing and expressing emotions. Although not central to the care transition process, an additional step was identified that occurred after the transition to hospice care: planning for an uncertain future. The hospice care transition process identified in the study reveals important mechanistic targets for the development of interventions that promote patient-centered hospice care transitions in the home setting.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"257-264"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan P Lippe, Gabrielle Wingett, Andra Davis, Theresa Jizba, Olga Ehrlich, Carrie L Cormack, Tracy Fasolino, Toni L Glover, Susan Meskis, Raeann G LeBlanc, Dan Weiss, Amanda J Kirkpatrick
{"title":"Instruments for Evaluating Student Learning Outcomes in Palliative Care: A Literature Review.","authors":"Megan P Lippe, Gabrielle Wingett, Andra Davis, Theresa Jizba, Olga Ehrlich, Carrie L Cormack, Tracy Fasolino, Toni L Glover, Susan Meskis, Raeann G LeBlanc, Dan Weiss, Amanda J Kirkpatrick","doi":"10.1097/NJH.0000000000001051","DOIUrl":"10.1097/NJH.0000000000001051","url":null,"abstract":"<p><p>Primary palliative care is a core component of nursing practice for which all students must receive formal education. Through competency-based education, nursing students develop the knowledge, attitudes, and skills to deliver quality primary palliative care before they transition to practice. Nurse educators in academic and practice settings should use reliable and valid means to evaluate student learning across cognitive, affective, and psychomotor domains. Expert faculty conducted a literature review to identify published instruments that evaluate primary palliative care student learning outcomes. Selected articles were required to include instrument reliability, validity, or both. The literature search yielded 20 articles that report on the development and testing of 21 instruments. Findings are organized into 3 learning domains that encompass 5 outcomes. Four instruments assess knowledge within the cognitive domain. In the affective domain, 3 instruments assess attitudes about caring for seriously ill or dying patients, 7 assess attitudes about death, and 5 assess self-efficacy. Competence and competency are evaluated in the psychomotor domain with 4 tools. Instrument implementation considerations within each domain are discussed. Faculty are encouraged to use robust evaluation measures such as those identified in the literature review to measure primary palliative care learning outcomes within a competency-based education framework.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"265-272"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Determining the Effects of Complex Education on Primary Care Nurse Practitioners' Self-efficacy in Advance Care Planning for Healthy Adults.","authors":"Yelena Geiler, Helene Bowen Brady","doi":"10.1097/NJH.0000000000001040","DOIUrl":"10.1097/NJH.0000000000001040","url":null,"abstract":"<p><p>Advance care planning is a process in which capable adults communicate their preferences for medical care in case of incapacitation. Regardless of health status, most adults are interested in advance care planning conversations and prefer providers to initiate these discussions. Primary care nurse practitioners are ideally positioned to lead these conversations but lack knowledge, confidence, and communication skills to do so. This project aimed to develop, implement, and evaluate an educational program for primary care nurse practitioners regarding leading advance care planning conversations with healthy adults. This evidence-based practice project used the Advance Care Planning Self-Efficacy Scale to measure primary care nurse practitioners' self-efficacy after completing a complex educational program. The educational program was developed based on a nationally recognized program incorporating didactic, observational, and role-play learning. The findings of this project indicated that providing complex education was an effective intervention immediately and after 3 months ( P = .018 and P = .023, respectively). The results indicate that educating nurse practitioners is an effective intervention for increasing their self-efficacy in leading advance care planning conversations with healthy adults over 3 months, recommending additional intervention at least earlier than 6 months.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"242-248"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heather Coats, Nadia Shive, Bonnie Adrian, Ardith Z Doorenbos, Sarah J Schmiege
{"title":"\"We Wanna Be Nurses Because We Want the Human Connection\": Acceptability and Usability of a Person-Centered Narrative Intervention in an Acute Care Setting.","authors":"Heather Coats, Nadia Shive, Bonnie Adrian, Ardith Z Doorenbos, Sarah J Schmiege","doi":"10.1097/NJH.0000000000001043","DOIUrl":"10.1097/NJH.0000000000001043","url":null,"abstract":"<p><p>The use of narrative interventions in health care is an effective way to communicate connection between patients and clinicians. The electronic health record (EHR) is a primary mode of communicating patient information across clinical teams. Thus, incorporating a person-centered cocreated narrative with patients into the EHR is an opportunity to share a person's cultural values, beliefs, and preferences; provide connection; and foster positive patient-clinician interactions. This study of a person-centered narrative intervention was a randomized controlled trial to test intervention effects on the person's (patient) perceptions of the quality of communication with their nurses and their psychosocial and existential well-being. This article describes the clinical team's experiences and reach of the cocreated person-centered narrative integration into the patient's EHR. The data collected included (1) exit interviews (n = 14), (2) a usability survey (n = 8), and (3) data collected from the EHR for clinicians (n = 600) who accessed the uploaded narratives. Overall, the System Usability Scale and nurse participant's experiences provided confirmation that the person-centered narrative intervention was usable. There were also interprofessional groups of clinicians in the health care system who accessed the narratives. Future research should continue to identify core components and implementation strategies of EHR-integrated person-centered narratives in complex health care settings.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"E143-E153"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mapping Competencies and Recommendations for Educating Nursing Students (CARES): Reviewing Palliative Care in a Baccalaureate Nursing Program.","authors":"Lisa A Cross, Bertha Lee, Katherine Adams","doi":"10.1097/NJH.0000000000001055","DOIUrl":"10.1097/NJH.0000000000001055","url":null,"abstract":"<p><p>The Competencies and Recommendations for Educating undergraduate Nursing Students (CARES) was originally designed for nursing students' palliative and end-of-life care education. The competencies were later revised to align with the 2021 American Association of Colleges of Nursing Essentials core competencies for baccalaureate nursing education. This project aimed to (1) review the courses in an accelerated baccalaureate nursing program for alignment with CARES, (2) determine any gaps, and (3) make program recommendations. The CARES competencies and Essentials were mapped according to the nursing program's 12 core curriculum courses and evaluated. Three CARES competencies were not met, and 12 were partially met. Areas of improvement were identified across the curriculum. Results of the mapping included palliative concepts needing earlier program introduction, reflective journaling was recommended for clinical practice courses, and incorporation of palliative care simulations was proposed to bridge the gaps.</p>","PeriodicalId":54807,"journal":{"name":"Journal of Hospice & Palliative Nursing","volume":" ","pages":"282-288"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}