Digital Commons Network^™

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 …

Benefits Of Montessori Method Use In Activity Involvement On Individuals With Dementia, Megan Canzoneri

MOT Student Capstones

Background: The Montessori Method was a teaching approach developed by Dr. Maria Montessori for children who did not have access to proper education and materials. She used this method by teaching them through familiar tasks, puzzles, and self-driven interest. This taught them independence, problem-solving, and decision make. This project discusses the use of the method within the geriatric and memory care population to help them remain independent through choosing activities that interest them. These activities consist of familiar tasks such as setting a table, washing dishes, and folding clothes. Method: This project used a needs survey, pre- and post-survey, and …

Improving Advanced Care Planning Through Proper Implementation Of The Polst Paradigm: An Integrative Review, Charles Hunter Shomo Ii

Doctoral Dissertations and Projects

End of life planning is critical to ensure enactment of patient wishes, ethical patient treatment, and improved family acceptance of death. As such, this project addressed integration of reviewed literature of advanced planning directives to influence end-of-life care. Implementation guidelines and incorporation of the Physician Orders for Life Sustaining Treatment (POLST) paradigm was the central focus of this project. Addressing best implementation practices of the POLST paradigm should increase advanced care planning and ultimately positively impact patient and surrogate decisions regarding end of life management and care. Completion of this integrative review has provided substantial implicative evidence regarding best practice …

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

Does The Management Of Compassion Fatigue In The Healthcare Setting Decrease Nurse Turnover: An Integrative Review, Barbara Fulcher Williams

Doctoral Dissertations and Projects

Healthcare systems are rapidly changing and with the increased age of the baby boomers, and shortage of nurses, and COVID-19, there is a rapid growth in compassion fatigue within the nursing community. More than 22% of nurses in direct patient care roles report experiencing emotional exhaustion. This results in negative consequences, reduced productivity, workplace violence, and poor patient care. Does the management of compassion fatigue in the healthcare setting decrease nurse turnover? This was an integrative review of the literature, utilizing 15-20 articles using Melnyk framework for evaluation. The variables addressed included the emotional state with negative psychological and physical …

Use Of Ecomaps In Qualitative Health Research, Veena Manja, Ananya Nrusimha, Harriet Macmillan, Lisa Schwartz Dr, Susan Jack

The Qualitative Report

Qualitative health research plays a central role in exploring individuals’ experiences and perceptions of wellness, illness, and healthcare services. Visual tools are increasingly used for data elicitation. An ecomap is a visual tool that applies ecosystems theory to human communities and relationships to provide an illustration of the quality of relationships. We describe the use of ecomaps in qualitative health research. Searches across eight databases identified 407 citations. We screened them in duplicate to identify 129 publications that underwent full text review and included 73 in the final synthesis. We classified and summarized data based on iterative comparisons across sources. …

Cross-Sectional Nutrition Profile Of Palliative Home Care Clients In Ontario And Performance Of The Interrai Palliative Care Nutrition Clinical Assessment Protocol, Tara Stevens, Heather Keller, Nicole Williams, James Downar, Dawn M. Guthrie

Health Sciences Faculty Publications

Background: The nutrition profile of palliative home care clients is unknown. This study describes this group and their nutrition issues and evaluates the performance of the interRAI nutrition Clinical Assessment Protocol (CAP).

Methods: This was a cross-sectional secondary analysis using Ontario interRAI Palliative Care (interRAI PC) Assessment data. The sample represents 74,963 unique Ontario home care clients assessed between 2011 and 2018. Frequencies and standardized differences (stdiffs) of nutrition characteristics were presented for cancer (n = 62,394) and noncancer (n = 12,569) diagnostic subgroups. Rates of triggering the nutrition CAP were presented by nutrition issue to evaluate its performance.

Results: …

A Propensity-Matched, Mortality-Adjusted Study Of Palliative Care Consult To Reduce 90-Day Hospital Readmission In A Heart Failure Cohort, Janice Shirley

Health Sciences Program Student Theses, Dissertations and Capstones

Centers for Medicare and Medicaid Services (CMS) instituted the Hospital Readmission Reduction Program (HRRP) to reduce the frequency of heart failure (HF) 30-day hospital readmissions. To meet the needs of patients with end-stage HF, palliative care (PC) is promoted to provide additional support to patients and reduceunnecessary hospital readmission. While PC is a plausible and logical intervention, effectiveness in achieving reductions in readmissions has not been assessed ina HF population with adequate controls to assess confounding.

The goal of this research was to assess the effectiveness of Palliative care for HF (HFPC) consult to effect change in 90-day hospital readmissions …

Nursing Attitudes To Hospice Care In The Intensive Care Unit, Claudia Lacivita

Master of Science in Nursing Theses and Projects

Nurses deliver care to patients 24 hours per day and are experts in the care of critically ill patients in the intensive care unit (ICU). The critical care nurse is trained to assess, treat, and monitor severely ill patients to facilitate their recovery, but may often feel ill-prepared and lacking the support usually available to the hospice or palliative care nurse. It also can be difficult to refocus when the desired outcome changes from stabilizing and getting a critically ill patient better to hospice or end-of-life care (EOLC). The purpose of this project was to improve the delivery of care …

Closing The Health Disparity Gap In U.S. Immigrant Communities In The Era Of Covid-19: A Narrative Review, Dina Refki, Rukhsana Ahmed, Jeanette Altarriba

Understanding and eliminating minority health disparities in a 21st-century pandemic: A White Paper Collection

The COVID-19 pandemic continues to have significant impacts on social determinants of health. Immigrant communities often bear a disproportionate burden of the crisis because of the immigration experience, which serves as an additional social determinant of health. Evidence suggests that these communities are hard hit by economic instability, food insecurities, isolation, lack of safe housing and safe neighborhoods, environmental dynamics that cut them off from systems of support, lack of sufficient access to educational tools that have become critical in remote and digital learning, limited access to health and healthcare resources, low health literacy, and restricted access to culturally and …

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 …

Effectiveness Of Online Communication Skills Training For Cancer And Palliative Care Health Professionals: A Systematic Review, Melissa N. Berg, Irene Ngune, Penelope Schofield, Lisa Grech, Ilona Juraskova, Michelle Strasser, Zoe Butt, Georgia K.B Halkett

Nursing Papers and Journal Articles

Objective: To determine the reported effect of online communication skills training (CST) on health professional (HP) communication skills and patient care outcomes in cancer and palliative care.

Methods: Primary research published in English between January 2003 and April 2019 was identified in bibliographic databases including Medline, Embase and Proquest (Prospero: CRD42018088681). An integrated mixed-method approach included studies describing a CST intervention and its effect, for cancer or palliative care HPs, delivered online or blended with an online component. Included studies' outcomes were categorised then findings were stratified by an evaluation framework and synthesised in an effect direction plot. Risk of …

Evidence-Based Hospice Care Education For Healthcare Clinicians, Nonie E. Weir

Walden Dissertations and Doctoral Studies

Vulnerable populations with a terminal illness, who reside in a nursing home setting, continue to experience psychological, physical, and emotional effects that lead to end-of- life (EOL) suffering and discomfort. Globally, millions of individuals receive care from a hospice provider. By 2030, this figure will triple due to the increased lifespan of the geriatric population. The literature review has revealed that the practical problem is the lack of hospice care education received by healthcare clinicians. It is, therefore, important to prepare and educate healthcare clinicians about a peaceful death through an individualized plan-of-care (POC) from a holistic approach. The purpose …

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 …

The Influence Of Military Service Experiences On Current And Daily Drinking, Andrew S. London, Janet M. Wilmoth, William J. Oliver, Jessica A. Hausauer

Population Health Research Brief Series

Traumatic military service experience can lead to increased alcohol consumption among veterans, who may use alcohol as a form of self-medication. Veterans with a psychiatric disorder or traumatic brain injury are more likely than nonveterans to be daily drinkers. Non-combat and combat veterans without a PD or TBI are less likely than nonveterans to be daily drinkers.

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 …

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 …

The Effect Of The Timing Of A Hospice Referral And The Perceived Quality Of Care By The Family, Caitlin Tran

Nursing | Senior Theses

Hospice care is a specialized type of palliative care for patients with a time-limiting illness. Despite its benefits, hospice remains underutilized. A key reason behind the underutilization are untimely referrals, often made during the last weeks or days of the patient’s life. The purpose of this paper is to investigate the existing barriers towards hospice that play into late referrals and its effect on patient/family satisfaction. This information will be examined to propose a pilot research study for further exploration.

Effect Of A Pharmacist-Led Antimicrobial Stewardship (Ams) Program On Outpatient Fluoroquinolone Prescribing In The Elderly, Katie Larue, Chelsea Mannebach, Bonnie Jiron

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Title: Effect of a pharmacist-led antimicrobial stewardship (AMS) program on outpatient fluoroquinolone prescribing in the elderly

Authors: LaRue, Katie PharmD; Mannebach, Chelsea PharmD, BCPS, BCACP; Jiron, Bonnie, PharmD, BCACP

Introduction: The Center for Disease Control and Prevention, the Society of Infectious Diseases Pharmacists, and American Pharmacists Association recognize the need for outpatient AMS programs and the important role pharmacists play in appropriate prescribing. Fluoroquinolones (FQ) pose many risks, highlighted by U.S Food and Drug Administration safety warnings, including aortic dissection, hypoglycemia, mental health side effects, and tendonitis, along with the risk of Clostridium difficile infections, particularly in …

Prevalence And Acceptance Of Methadone Recommendations In Hospice And Palliative Care, Aishwarya Kulkarni

Graduate Student Research Symposium

Background:Clinical pharmacists play an important role in the care of patients in hospice/palliative care, particularly for the treatment of pain. Methadone, a long-active opioid, is particularly useful in this population, but may be underutilized. The objective of the study was to evaluate the prevalence ofpharmacist recommendations and subsequent physician acceptance for the use of methadonefor painin newly admitted hospice/palliative care patients. Methods: The study was conductedfrom October-December 2019in coordination with a locally-based pharmacy services organization which works with hospice/palliative care providers. A selectedgroup of pharmacists at the organization identified patients reviewed as new admissions as part of their usual clinical …

2020-04-10 Daily Unm Global Health Covid-19 Briefing, Christophe G. Lambert, Samuel Anyona, Shawn Stoicu, Anastasiya Nestsiarovich, Praveen Kumar, Nicolas Lauve, Evans Raballah, Perez Olewe, Carolyne Ndege, Hannah Groves, Danielle Rivera, Estefania Montanez, Tudor I. Oprea, Orrin Myers, Rachel D. King, Andrew S. Rowland, Kristine Tollestrup, Douglas J. Perkins

HSC Covid 19 Briefings

Executive Summary:

Extra NM HSD SNAP benefits. NM cases >1000. Meds supply chain threatened. Mass graves in NY. Surgeon General screening app. Presidential briefing. Italian healthcare worker deaths. Taiwan tiered care model. Communicating risks to public. French public demand hydroxychloroquine. Vaccination pause dangers. Retesting needed after discharge. CDC report geography and incidence. UW clinical informatics response. UW preparedness guidelines. Wuhan outbreak control. CDC asymptomatic exposed worker guidelines. Mask innovation. Unemployment spikes. Workforce gaps. Workspace modifications reduce transmission. Guidelines and recommendations: ER physician, surgery, cardiopulmonary resuscitation, chest imaging, geriatrics, critically ill children, postpyloric tube placement, genitourinary malignancies, obstetrics, and home work …

Impact Of The Covid-19 Outbreak On Long-Term Care In The United States, Courtney H. Van Houtven, Nathan A. Boucher, Walter D. Dawson

Institute on Aging Publications

The United States (US) currently has the most confirmed cases of COVID-19 of any country. Yet, adequate testing for the virus remains a major issue. Approximately 51.6 million Americans are over the age of 65 and 56 percent of adults over 65 are living with two or more chronic conditions (23 percent have 3 or more). Given the higher risk of death and complications associated with advanced age and underlying health conditions, COVID-19 has had an immense impact upon LTC in the United States. Yet, the level and intensity of impact has been sporadic in application. This is due in …

Physician Behaviors, Nursing, And Other Obstacles In End-Of-Life Care: Additional Critical Care Nurse Perceptions, Elizabeth Elouise Willmore

Theses and Dissertations

Background: Critical Care Nurses (CCNs) frequently provide end of life (EOL) care in intensive care units (ICUs). Barriers to EOL care in ICUs exist and have been previously published, but qualitative reports from CCNs themselves remain scarce. Qualitative data exploring barriers faced during ICU EOL care may increase awareness of obstacles and help remove them. Objective: Excluding family experiences, what are the major themes recounted by CCNs when asked to share common obstacles experienced in providing ICU EOL care? Methods: Members of the American Association of Critical-Care Nurses were randomly surveyed and responses to a single qualitative question were used. …

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.

Evidence-Based End-Of-Life Care Education For Intensive Care Nurses, Kimberly Ann Hare

Walden Dissertations and Doctoral Studies

Most nurses have limited education on end-of-life care (EoLC), which can affect their ability to provide care to meet the needs of the dying patient. Nurses in a critical care unit in a hospital in the Southeastern United States lacked education on EoLC for their patients. The purpose of this study was to develop a project guided by Kolcaba’s theory on caring. The staff education project addressed the attitudes and knowledge of 36 nurses before and after an educational presentation on EoLC. Data were analyzed descriptively. Results indicated that 56% of the staff nurses had never received prior education on …

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 …