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Timely Transitioning To Hospice: A Needs Assessment With A Pace Program To Improve End Of Life Care, Kristina Kelley

Doctor of Nursing Practice (DNP) Projects

Background: Hospice care has been proven to improve patient outcomes at the end of life. However, patients frequently die without receiving hospice benefits. The challenge of transitioning patients from care with a life prolonging intent to a comfort focused approach can partly be attributed to poor prognostication or misconceptions about hospice. A Program for All Inclusive Care of Elders (PACE) in Massachusetts identified transitioning to hospice as an area for improvement. Purpose: To perform a needs assessment to gain understanding of the barriers to effective transitions to hospice and to provide education aimed at addressing those barriers. Methods: Subjects included …

Quality Improvement: Intimate Partner Violence Screen In Nurse Home Visit Program, Masayo Nishiyama

Doctor of Nursing Practice (DNP) Projects

Purpose: Women are disproportionately impacted from intimate partner violence (IPV). Their children also experience long-term adverse consequences. Effective IPV prevention and intervention efforts are vital. This quality improvement project addressed the lack of an evidence-based IPV training and protocol in a nurse home visit program.

Methods: Stakeholder engagement and an evidence-based practice intervention were implemented. Training effectiveness was examined by the pre-post-training assessments; completed by 17 nurses. To measure the IPV practice change, 196 pre- and 107 post-intervention charts were reviewed.

Results: The training significantly increased nurse knowledge and comfort (t=5.9, p< .001). Only 22% of those referred due to recent IPV history were screened before the intervention; 65% after the intervention. Multivariate analysis of screening rates was performed; predictors included county, mental health status, education, subprogram, and IPV referral reason. Due to low power, a one-tail test was employed. One county was 14 times less likely to screen than the other county (p= .023). 93% of those referred due to IPV history were enrolled in the crisis response subprogram, only offered by the other county. Those referred due to IPV history were three times more likely to be screened (p=.042) than those referred for other reasons. There was no significant change observed on IPV disclosure and intervention practice.

Conclusions: The adoption of an evidence-based IPV training …