Digital Commons Network^™

The Effect Of Early Palliative Care Consultation For Patient With Traumatic Brain Injury On Procedure Utilization, Length Of Stay And Discharge Location, Abdulelah Almutairi, Donald Courtney, Heather Rhodes

South Atlantic Division GME Research Day 2023

No abstract provided.

Disrupting And Expanding The Discourse: Palliative Care Clinicians' Experiences With Patients' Non-Physical Suffering, Maxxine Rattner

Theses and Dissertations (Comprehensive)

While one of the primary aims of palliative care is to prevent and relieve suffering, both physical and non-physical, research to date has been very limited re: clinicians’ experiences with patients’ non-physical suffering (e.g., suffering that may be psychological, emotional, social, spiritual and/or existential in nature); both how clinicians work with/respond to this kind of suffering in their day-to-day work, and the effect of this aspect of their work on clinicians themselves. No research to date has considered the impact of palliative care’s dominant non-physical suffering discourse — which presents the relief of non-physical suffering as falling along a binary …

2022-2023 Pediatric Subspecialty Trainees, Children's Mercy Kansas City

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in adolescent medicine, allergy/immunology, child abuse pediatrics, child neurology, clinical neuro-psychology, coagulation, congenital cardiac surgery, clinical child psychology, developmental-behavioral pediatrics, epilepsy, hospice & palliative care, laboratory genetics & genomics, pediatric anesthesiology, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric bioethics, pediatric cardiology, pediatric EM/child abuse, pediatric critical care medicine, pediatric dentistry, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric infectious diseases, pediatric nephrology, pediatric ophthalmology; pediatric optometry, pediatric orthopedic surgery, pediatric otolaryngology, pediatric pathology; pediatric pulmonology, pediatric radiology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, sleep medicine, pharmacy, pediatric residency …

Improving Palliative Care Education In The Acute Hospital Setting, Maria Klug

Doctor of Nursing Practice Scholarly Project

As the geriatric population grows rapidly, the importance of utilizing and understanding palliative services continues to rise. Although palliative and hospice care are included in different healthcare courses, misconceptions and lack of knowledge continue to serve as barriers to the utilization of palliative care. The purpose was to assess knowledge, improve palliative care education, and increase understanding of the perspectives of the interdisciplinary team involved in acute patient care. The setting was the telemetry unit in a 300-bed acute care Kansas hospital. A mixed design was utilized with a goal of quality improvement in the use of palliative care. The …

Implementation Of A Nurse Driven Palliative Care Consult: A Quality Improvement Project, Socnite Sebourne-Francis

DNP Projects

Background: Palliative care consult (PCC) is an approach that can improve the quality of life and symptom management of patients facing life-threatening illnesses. At a 20-bed medical oncology unit in Connecticut, patients with poor prognosis and worsening symptoms have high re-admission rates within 30 days of post-hospital discharge; yet healthcare providers fail to initiate PCC.

Purpose: This project hypothesizes how implementing a nurse-driven PCC on admission or hospital stays compared to the timing of a physician to a physician PCC improves a plan of care for oncology patients? Will it result in a decrease in 30-day re-admission rates? The …

The Covid-19 Pandemic: Early Ripple Effects In Pediatric Palliative Care, Linda Marisol Bustamante, Regina Okhuysen-Cawley, Julia Downing, Stephen R Connor, Mary Ann Muckaden, Marianne Phillips, Andrea Icaza, Nicole Garzon, Yuriko Nakashima, Kelsi Morgan, David Mauser, Michelle Grunauer

Faculty, Staff and Students Publications

Palliative care, which aims to provide comprehensive, interdisciplinary, holistic care to children, adolescents and adults with life-threatening, and ultimately life-limiting conditions, is a discipline that has emerged as an integral component of healthcare systems throughout the world. Although the value of life-affirming palliative care (PC) has been shown across many domains, funding and acceptance of palliative care teams have been variable: some hospital systems have free-standing, dedicated interdisciplinary teams while, in many instances, palliative care services are provided "pro bono" by individuals with a special interest in the discipline, who provide PC in addition to other responsibilities. In this article, …

Seroprevalence Of Covid-19 Igg Antibody In Resident And Fellow Physicians In Milwaukee, Wisconsin: Analysis Of A Cross-Sectional Survey, Dennis J. Baumgardner, Alexander Schwank, Jessica J. F. Kram, Wilhelm Lehmann, Jacob Bidwell, Tricia La Fratta, Kenneth Copeland

Journal of Patient-Centered Research and Reviews

Purpose: Medical trainees are likely at differential risk of exposure to COVID-19 per respective clinical activity. We sought to determine the seroprevalence of COVID-19 antibody (Ab) among resident and fellow physicians with varying degrees of exposure to COVID-19.

Methods: A cross-sectional study of Milwaukee-based resident and fellow physicians, encompassing December 2019–June 2020, was conducted. Relevant variables of interest were ascertained by survey and payroll data, and Abbott ARCHITECT Ab test (index cut-off of ≥ 1.4) was performed. Descriptive statistics were generated, with 95% CI calculated for the study’s primary outcome of seroprevalence.

Results: Among survey respondents (92 of 148, 62%), …

Incidence Of Adult (≥40y) Traumatic Intracranial Bleeding And Likelihood Of Routine Discharge: Do Co-Morbidities Matter?​, Stephanie Anderson, Heather Rhodes, Antonio Pepe, Donald Courtney

South Atlantic Division GME Research Day 2022

No abstract provided.

Impact Of Provider Cultural Competency On Latino/Hispanic Patients During End-Of-Life And Hospice Care, Nicholle Nacionales

Theses and Graduate Projects

Background: Cultural competency in healthcare means delivering high quality care to patients with diverse beliefs, attitudes, values, and behaviors. Latinos/Hispanics are one of the fastest growing ethnic group and with an aging population, there is an increased need for providers to deliver culturally sensitive end-of-life and hospice care. Latino/Hispanic patients face many disparities that affect their quality of care which cultural competency aims to address. Purpose: The purpose of this literature review is to identify factors that affect Latino/Hispanic patient’s end-of-life and hospice care and how cultural competency of providers can influence management of their pain and quality of …

Palliative Privacy, Lina Fernandez, Jarratt Burton Banks, Stephen Meyer

South Atlantic Division GME Research Day 2022

No abstract provided.

The Use Of A Pediatric Palliative And Hospice Education Module To Enhance The Knowledge And Practice Of Emergency Room Providers, Morgan Garrett

DNP Projects

Background: Palliative and hospice care resources are underutilized in pediatric patients with chronic and life-limiting illnesses. One contributing factor is the lack of formalized education for medical providers regarding the differences and scope of palliative and hospice care models. Without adequate education about these services, providers are not able to effectively utilize otherwise available resources to provide holistic care.

Purpose: The purpose of this study was to assess the current perception of knowledge among providers pertaining to pediatric palliative and hospice care. The study investigated improvements in educational outcomes in ten categories after participation in a web-based training. A secondary …

Spiritual Care Competency Of Critical Care Nurses: A Literature Review, Julia O. Rohm

Bachelors of Science in Nursing

While caring for their patients, nurses often encounter spiritual needs. In a study with 241 hospice, palliative care, and holistic nurses, “all respondents (100%) indicated they had encountered a patient with spiritual needs throughout their nursing clinical practice” (Lukovsky et al., 2021, p. 32). Despite the prevalence of spiritual needs, many nurses feel unable to confront spiritual issues among their patients. According to a survey conducted among 4054 nurses from the UK, “almost 93% of the nurses surveyed believed spiritual care should be addressed, yet only 5.3% felt always able to meet the spiritual need of patients on a regular …

Inpatient Palliative Care Is Less Utilized In Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective, Zahra Mojtahedi, Ji Won Yoo, Karen Callahan, Neeraj Bhandari, Donghui Lou, Katayoon Ghodsi, Jay J. Shen

School of Medicine Faculty Research

Background—Extrahepatic cholangiocarcinoma (ECC) is a rare, morbid, fatal cancer with distressing symptoms. Maintaining a high quality of life while reducing hospital charges and length of stay (LOS) for the end-of-life period remains a major challenge for the healthcare system. Palliative care utilization has been shown to address these challenges; moreover, its use has increased in recent years among cancer patients. However, the utilization of palliative care in rare cancers, such as ECC, has not yet been explored. Objectives—To investigate palliative care utilization among ECC patients admitted to US hospitals between 2007 and 2016 and its association with patient demographics, clinical …

A Telehealth Palliative Care Objective Structured Clinical Examination, Lindsey Q. Mcintyre

Dissertations

Problem: Palliative care is a service focused on symptom management and improved quality of life for persons with serious or chronic illnesses and is widely underutilized. Although advanced practice registered nurses (APRNs) possess a unique skillset to contribute to palliative care, there is minimal reporting on palliative care training for this professional group. The purpose of this clinical scholarship project was to implement the End-of-Life Nursing Education Consortium (ELNEC) online training program for APRN students in the BSN-DNP program and evaluate its effect on student performance during a telehealth objective structured clinical examination (OSCE).

Methods: An observational, descriptive …

2021-2022 Pediatric Subspecialty Trainees, Children's Mercy Hospital

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in adolescent medicine, advance non-invasive imaging, allergy/immunology, child abuse pediatrics, child neurology, coagulation, congenital cardiac surgery, clinical child psychology, developmental-behavioral pediatrics, epilepsy, headache medicine, hospice & palliative care, laboratory genetics & genomics, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric bioethics, pediatric cardiology, pediatric clinical pharmacology, pediatric critical care medicine, pediatric dentistry, pediatric emergency medicine, pediatric EM/child abuse, pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric infectious diseases, pediatric nephrology, pediatric ophthalmology; pediatric optometry, pediatric orthopedic surgery, pediatric otolaryngology, pediatric pulmonology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, sleep medicine, pharmacy, pediatric residency …

Essential Package Of Palliative Care For Women With Cervical Cancer: Responding To The Suffering Of A Highly Vulnerable Population, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of …

Augmented Package Of Palliative Care For Women With Cervical Cancer: Responding To Refractory Suffering, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all …

Guided Imagery And Sentinel Lymph Node Biopsy Pain, Brandy Alicia Kirk

Evidence-Based Practice Project Reports

The standard of care in the treatment for women diagnosed with breast cancer includes identification and biopsy of the sentinel lymph nodes (SLN) of the breast (Chaterjee et al., 2017; Kneece, 2017). The process of identifying the SLNs involves radioisotope injections into or near the areola. Because this area is highly sensitive, women report this procedure to be considerably painful. The purpose of this evidence-based practice (EBP) project was to determine if the provision of a 5-minute session of guided imagery (GI), as a complementary alternative medicine, prior to SLN injections was effective in mitigating reports of procedural pain. A …

Critical Conversations: Improving Goals Of Care Conversations At Southeast Family Medicine, Elizabeth Deyo, Michael Dirks, Tyler Nelson, Katherine Cobb, Nicholas Wolfgang, Hannah Kadavy, Ben Pederson

Milwaukie Family Medicine 2021

Quality Improvement Project - Background

Introduction Goals of care (GOC) conversations are an essential element of high quality patient care across care contexts. At our residency clinic site, Southeast Family Medicine, there currently is not a standardized workflow that encourages and reminds providers to complete and document GOC discussions with their patients. Currently, end of life planning is tracked and monitored primarily through two tools: patient completion of advanced directives and POLST forms. Although these two documents are important, their use and application is at times to general or specific to truly reflect a patient’s perspective on their goals of …

Cervical Cancer-Associated Suffering: Estimating The Palliative Care Needs Of A Highly Vulnerable Population, Eric L. Krakauer, Xiaoxiao Kwete, Khadidjatou Kane, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa, C R Beena Devi C R Beena Devi

Department of Anaesthesia

Purpose: To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration.
Methods: We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified Delphi process with experts in cervical cancer care to supplement the literature. For each type of suffering, we distinguished between decedents (those who die from cervical cancer in a given year) and nondecedents (those who have cervical cancer in a given year but do not die). By applying …

Hospice Care For The Primary Physician, Katie Mechler, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Palliative vs Hospice Care
• History of Hospice Care
• Description of the Hospice Benefit
• Review of Hospice Eligibility
• Discussing Hospice with your Patients

Early Palliative Care Implementation In Metastatic Lung Cancer Patients: A Quality Improvement Project, Megan Joan Biegler, Erin Hamar, Stephanie Spinolo

All Electronic Theses and Dissertations

This was a quality improvement project that will allow improvements to be made in healthcare services offered and the overall health status of Stage IV metastatic lung cancer patients receiving palliative care referrals. Data was collected retrospectively from electronic medical records of Stage IV metastatic lung cancer patients with palliative care referrals between January 2019 and March 2020. The palliative care referrals between January 2019 and August 2019 were given per oncologist discretion in timing compared to August 2019-March 2020 when new patients received nurse navigator driven palliative care referrals immediately upon diagnosis. Data analysis looked at correlations for each …

Assessment Of Palliative Care Needs In A Kenyan Intensive Care Unit Based On A Trigger-Based Model., Linda Atero Barasa

Master of Medicine in Internal Medicine

Background: Palliative care triggers have been used in the Intensive Care Unit (ICU) setting, usually in high-income countries, to identify patients who may benefit from palliative care consults. The utility and benefits of palliative care triggers in the ICU have not been previously studied in sub-Saharan Africa. Objectives: The primary objective of this study was to estimate the prevalence of ICU admissions who meet the criteria for one or more palliative care triggers. The secondary objectives were to determine an association between palliative care consults and length of ICU stay, mortality, and time to formal change of goals of care …

Advance Care Planning And Palliative Care In Heart Failure: A Literature Review, Laura Dack

All Graduate Theses, Dissertations, and Other Capstone Projects

Despite advancing therapies, heart failure remains a progressive disease with high symptom burden. Advance care planning and palliative care assist in maximizing the quality of life for affected individuals. These interventions are supported by current heart failure guidelines yet application into practice is poor. The purpose of this literature review is to investigate the relationship between advance care planning and palliative care interventions on the quality of life of adults with heart failure. A search of the literature was completed between October 20^th, 2020 to November 10^th, 2020. Databases searched include Academic Search Premier, CINAHL Plus, …

A Qualitative Analysis Of End-Of-Life Healthcare In Tennessee: Politics, Principles, And Perceptions, Erin Mauck

Electronic Theses and Dissertations

The unprecedented growth of the aging population in Tennessee is a significant demographic trend that highlights the necessity for healthcare policy that tackles end-of-life issues. This study examined the perceived quality of end-of-life healthcare in Tennessee, areas that are in need of improvement, policies that have the potential to influence improvements, and the role of politics in end-of-life healthcare policy. It also assessed the support for end-of-life healthcare policy that would advance quality of care and expand end-of-life choices for Tennesseans, while evaluating the policy-making process that legislators employ.

For this study, data were collected using semi-structured, in-depth interviews with …

2020-2021 Pediatric Subspecialty Trainees, Children's Mercy Hospital

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in adolescent medicine, allergy/immunology, child abuse pediatrics, child neurology, coagulation, congenital cardiac surgery; clinical child psychology, developmental-behavioral pediatrics, epilepsy, headache medicine, hospice & palliative care, laboratory genetics & genomics, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric bioethics, pediatric cardiology, pediatric clinical pharmacology, pediatric critical care medicine, pediatric dentistry, pediatric emergency medicine, pediatric EM/child abuse, pediatric dermatology, pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric infectious diseases, pediatric nephrology, pediatric optometry, pediatric otolaryngology, pediatric pathology, pediatric pulmonology, pediatric readiology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, pharmacy, pediatric residency and med/peds residency

Benefits Of Palliative Care In The Intensive Care Unit, Stephen Swenson, Stephen M. Swenson

Nursing Masters Papers

Abstract

The use of palliative care is often overlooked until the terminal phase of serious illness when life-prolonging interventions are deemed futile and death is considered imminent.

Alongside the well regarded Clinical Practice Guidelines for Quality Palliative Care (National Coalition for Hospice and Palliative Care, 2018), numerous critical care societies including the American Association of Critical-Care Nurses (Medina & Puntillo, 2006), American College of Critical Care Medicine (Davidson et al., 2008), American College of Chest Physicians (Selecky et al., 2005), American College of Surgeons (2017), and the American Thoracic Society (Lanken et al., 2007) have each published individual policies highlighting …

Meaning-Centered Supervision: A Structured Self-Reflection Model To Reconnect With Personal And Professional Meaning In Palliative Care Work, Rebecca Cammy, Msw, Lcsw

Department of Medical Oncology Posters

Meaning-centered supervision explores participant’s sense of meaning of past, present, and future personal and professional experiences. The series aims to reintegrate selfreflection into clinical practice through experiential exercises, homework journaling, and group discussion. Social workers develop a narrative around themes of professional attitude, living and creating work life, and connections with the social work profession. The goal is to help palliative care social workers create a sense meaning and purpose in their work as they develop their personal and professional identities. Additionally, the hope is to support supervisees through any concerns of burnout and compassion fatigue.

2019-2020 Pediatric Subspecialty Trainees, Children's Mercy Hospital

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in allergy/immunology, child abuse pediatrics, child neurology, clinical child psychology, developmental-behavioral pediatrics, epilepsy; headache medicine; hospice & palliative care, laboratory genetics & genomics, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric anesthesiology, pediatric bioethics, pediatric cardiology, pediatric clinical pharmacology, pediatric critical care medicine, pediatric cardiac congenital surgery; pediatric dentistry, pediatric emergency medicine, pediatric EM/child abuse; pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric infectious diseases, pediatric nephrology, pediatric ophthalmology, pediatric optometry, pediatric otolaryngology, pediatric pulmonology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, pharmacy, sleep medicine, pediatric residency and med/peds residency.

An Evidence-Based Toolkit For Early Identification Of Frail Inmates, Morgan A. Kochajda

Doctoral Projects

There are significant numbers of people aging and nearing end of life while being incarcerated (Richter & Hostettler, 2017). Currently the Department of Corrections (DOC) does not have a standardized process for early identification of inmates who may need increased end of life care services. A potential solution to this problem would be the use of a frailty screening tool for early identification of those inmates who may need increased resources. At this time, there is not a formalized relationship between a Midwest hospice and palliative care department and the DOC. There is a desire from leadership of the hospice …