Medicine and Health Sciences Commons^™

Implementation Of A Palliative Care Program In Rural Minnesota, Barbara Lenarz

Nursing DNP Projects

Background: Rural areas have higher percentages of older adults with multiple chronic illnesses yet disparities exist with access to palliative care (PC) in rural areas. Palliative care can improve quality measures that positively impact care and health outcomes.

Objective: The evidence-based project’s (EBP) objective was to implement a community-based PC program in a rural primary care clinic in rural Minnesota, US and evaluate quality metrics to further support program sustainability.

Design: The project developed and implemented a community-based PC program in rural Minnesota. A tool kit was created for use for the site’s care providers and leaders.

Setting/Subjects: …

Improving Nurse Knowledge And Comfort In Advance Care Planning, Hajrudina Brkic, Marisia Young

Nursing DNP Projects

Objectives: The purpose of this project was to increase nurses’ knowledge and comfort level regarding advance care planning (ACP) in patients with a diagnosis of heart failure (HF) in a clinical setting.

Methods: A quasi-experimental design was used with a pre-and-post test administered to nurses prior to the beginning of a four-hour interactive class and immediately following the class. The data was analyzed using a 5-point Likert scale and paired t-tests were used to determine statistical significance. Statistical significance was set at 0.05.

Results: Of the eight nurses who participated in the interactive course, seven were female, one …

Nurse Practitioner Intervention In Palliative Care Settings, Lacie N. Harris

MSN Capstone Projects

Palliative care is a specialty of healthcare that focuses on chronic and severe disease. As chronic disease continues to rise annually related to genetics, sedentary lifestyle, and environmental factors, the need for interventions will increase to meet demands of patients, families, and organizations. Therefore, implementation of a nurse practitioner in the palliative care setting is ideal for optimal patient outcomes.

Thoughts Of A Palliative Care Nurse In Times Of Pandemic, Angela L. Simões

Patient Experience Journal

This narrative presents a series of stories (interactions) lived by a palliative care nurse during the time of COVID-19, a time when we tirelessly prepare to help the services that need us, but we have little preparation of ourselves for the changes that we will have to face in the care of our patients and families. It shares the lived experiences, difficulties, emotions lived by me but shared by so many around the world. It also tries to show that despite the scarcity of physical presence, creativity and commitment to patients and families make us go beyond ourselves and continue …

Evaluating Family Satisfaction On An Advanced Certification Palliative Care Unit., Ruby Aebersold

Doctor of Nursing Practice Papers

Inpatient palliative care programs with The Joint Commission (TJC) Advanced Certification for Palliative Care are accountable for evaluating multiple health outcomes, including family satisfaction. A midwestern urban hospital’s palliative care unit received certification in January 2019. To comply with TJC standards, a clear data management and evaluation plan for family satisfaction data was needed. Investigation of the previous family satisfaction measure processes revealed areas in need of improvement in the satisfaction survey distribution, data collection, and evaluation processes. Satisfaction surveys were often unable to be distributed to families of deceased patients because the documented mailing address was a nursing facility. …

Effectiveness Of High-Fidelity Simulation In Nursing Education For End-Of-Life Care: A Quasi-Experimental Design, Salma Rattani, Zohra Kurji, Amina Aijaz Khowaja Ap, Jacqueline Maria Dias, Anila Naz Alisher

School of Nursing & Midwifery

Background: Providing end of life (EOL) care is a component of palliative care but dealing with dying patients and their family members is stressful for the healthcare providers. To prepare them for providing EOL care, the high-fidelity simulation could be used as a pedagogy in which real-life scenarios are used on the computerized manikins mimicking the real patients.
Aims: The aim of this study was to measure the effectiveness of high-fidelity simulation to teach EOL care in the palliative nursing course in the undergraduate nursing education program at the School of Nursing and Midwifery at Aga Khan University which is …

The Implementation Of An Evidence Based Decision Aid To Improve Self-Efficacy Of Critical Care Nurses In The Recognition Of Need For Palliative Care In Icu Patients., Abigail Southall

Doctor of Nursing Practice Papers

BACKGROUND: Internal and external evidence demonstrates a poor understanding of the definition and scope of palliative care for ICU patients by nurses. Palliative care and hospice care are often viewed as mutually exclusive rather than complimentary. This knowledge gap causes delayed palliative care consultation for ICU patients which has been shown to increase length of stay and cost of care while decreasing patient/family satisfaction. SETTING: The project took in a 36-bed Intensive Care-Open Heart Unit (ICU-OHU) in an urban hospital in the Midwest United States. PURPOSE: The purpose of the quality improvement project was to address misconceptions regarding palliative care …

Reducing The Rate Of Falls In Hospice Patients: A Fall Prevention Pilot Program, Allison Floyd

Doctor of Nursing Practice Final Manuscripts

Background and Evidence Problem: As the population ages, there is an increase in the incidents of falls. Falls are the predominant cause of both nonfatal and fatal injuries among adults aged 65 years and older (Bergen et al., 2016). Extensive research has been conducted in fall prevention in hospitals, skilled nursing, and rehabilitation units. End-of-life care in a hospice setting presents a greater challenge in risk identification and prevention of falls. A local hospice had 457 falls between July 2018 to mid-March 2019 with a lack of consistent, detailed, fall education and documentation.

Evidence-Based Practice Intervention: Utilizing the American Geriatrics …

Utilization Of Peer-Led Education To Enhance Advance Care Planning And Advance Directive Completion, Jenna Juenger

Doctor of Nursing Practice Final Manuscripts

Background: The integration of advance care planning (ACP) and palliative care (PC) into oncology plays a critical role in symptom management and quality of life. Studies reveal a large subset of oncology patients with unmet needs regarding ACP and advance directive (AD) completion. Successful ACP helps to promote congruent medical treatment with patients’ values and preferences and motivates patients to complete ADs.

Objective: An evidence-based practice project was conducted to assess the effectiveness of peer-led education to nursing staff to improve ACP and AD completion among inpatient oncology and PC patients

Design: A standardized survey created from the …

Early Initiation Of Palliative Care, Ann R. Phillips

MSN Capstone Projects

The overall aim of this project, based upon the best available evidence, clinical experience of oncology nurses, and patient preferences for information about palliative care, is to propose the creation and initiation of a protocol which empowers oncology/palliative care nurses to be able to initiate early discussions about palliative care for patients with advanced stage cancer (III-IV) diagnoses.

By having frank conversations surrounding palliative care early on in the treatment process, patients are better able to make informed decisions about treatment, depending on the trajectory their disease takes. Such conversations provide patients with a clearer picture of what is likely …

Exploring Nurses' Attitudes Toward Assisted Suicide: A Study Of Nurses Working With Terminally Ill Patients, Marjie L. Schoolfield

Scholar Week 2016 - present

Physician-assisted suicide, legalized in many states is becoming an option for patients diagnosed with a terminal illness. Nurse participation in physician-assisted suicide is not supported through state nurse practice acts or national nursing organizations, causing potential contradictions in practice rights for advanced practice nurses. The purpose of this study was to examine the attitudes of registered and advanced practice nurses who work with the terminally ill regarding the patient option of physician-assisted suicide. This quantitative research was conducted with hospice registered nurses employed by a hospice organization in the Midwest and included participants from states where physician-assisted suicide is legal, …

A Quality Improvement Project To Improve Financial Sustainability Of Home-Based Palliative Care Program, Andrea L. Giffel

Doctoral Projects

Background and Objectives: Home palliative care services are challenging to bill due to the complexity of services and competing time demands. Objectives and protocol were developed to guide coding and billing to increase Relative Value Unit generation and improve financial sustainability.

Design: A quality improvement project.

Setting: A home-based palliative care program in one health system in the Midwest.

Participants: Participants included 7 nurse practitioners.

Intervention: Coding protocol were developed, providers were educated, electronic health record audits were conducted to collect data on improvement, and feedback provided to prompt improvement.

Measurement and Analysis: Documentation of advanced care planning and billing, …

Knowledge And Attitude Of Nurses About Palliative Care, Asia Parveen, Khawar Sultana, Ali Waqas, Sidra Tasneem, Robina Jabeen, Ayesha Faiz Dr., Abu Ul Hassan Faiz Dr

Journal of Bioresource Management

Palliative care enhances the quality of life. To improve the quality of life, it is necessary for nurses to have good knowledge and attitude towards palliative care. It is imperative that nurses provide quality care to terminally ill and chronically sick patients. The present study was designed to assess the knowledge and attitude of medical staff nurses about palliative care in cancer. This cross-sectional, descriptive study was conducted in Mayo Hospital, Lahore and Jinnah Hospital, Lahore with sample size of 300 registered nurses by using the simple random sampling technique. Inclusion and exclusion criteria was used. Data was collected from …

Attitudes Towards End-Of-Life Care: An Educational Intervention In Long-Term Care, Nicole Mullen, Jeannie Giese, David Phillippi, Lucyellen Dahlgren

DNP Scholarly Projects

Background: Nursing assistants provide the most consistent care to dying patients in long-term care facilities; however, they receive little training to do so. Nursing assistants are significant, yet under recognized members of the health care team. Purpose: To provide a brief educational intervention to nursing assistants in long-term care facilities with a goal of increasing comfort and improving attitudes towards caring for palliative care patients. Review of Evidence: Symptom management, stress related to the role as a provider, goals of care, time limitations, and fear, are the most significant challenges nursing assistants experience. Few studies have examined …

Screening For Palliative Care Services In An Assisted Living Facility, Maria Delia Crosby

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Palliative care services remain under-utilized, even as evidence suggests that early palliative care leads to positive health outcomes, reduced ED visits, and substantial cost savings. Barriers include a lack of knowledge of palliative care services in the community, and under-utilization of validated assessment tools, including a symptom checklist. Aims of this project: 1. To determine whether the integration of validated community-based palliative care screening tool in an assisted living setting will identify older adults with unmet palliative care needs. 2. To determine if tool implementation could lead to a referral for palliative care consultation.

Methods: A screening tool developed …

Case Study Describing Access To Palliative Care In Pakistan, Salma Amin Rattani

Theses & Dissertations

Around the world, cancer is a leading cause of death and the burden of cancer is expected to increase in low-and middle-income countries (LMICs), where 82% of the world’s population resides. In these countries, which include Pakistan, aspects of the culture and traditions, inaccessibility to diagnostic and treatment facilities impede access to palliative care. In many cases, people do not reach treatment facilities until they are at the stage when the person is at the end-of-life and is dying. This paints the picture of cancer as a deadly disease and as soon as it is diagnosed nothing can be done …

Perceptions, Impact And Scope Of Medication Errors With Opioids In Australian Specialist Palliative Care Inpatient Services: A Mixed Methods Study (The Periscope Project), Nicole Heneka

Theses

Background: Opioids are a high-risk medicine, and one of the most frequently reported drug classes causing patient harm. In specialist palliative care inpatient services opioids are widely used to manage cancer pain and other symptoms. Palliative care inpatients are vulnerable to both exposure to, and harm from, opioid errors due to a combination of their: advanced age, comorbidities which affect drug metabolism, polypharmacy, and the seriousness of their illness. Despite this potential for harm, and the frequency of opioid administration in this specialist setting, little is known about opioid errors in palliative care. Better understanding the prevalence, patient impact and …

Clinically Significant Depressive Symptoms Are Prevalent In People With Extremely Short Prognoses - A Systematic Review, Wei Lee, Marley Pulbrook, Caitlin Sheehan, Slavica Kochovska, Sungwon Chang, Annmarie Hosie, Elizabeth Lobb, Deborah Parker, Brian Draper, Meera R. Agar, David Currow

Nursing Papers and Journal Articles

Context: Currently, systematic evidence of prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management.

Objectives: To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks).

Methods: A systematic review and meta-analysis (random effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994-2019). Data were screened for prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced …