Digital Commons Network^™

Palliative Care In The Neonatal Population, Raegan Miller

MSN Capstone Projects

In more than 90% of cases of neonate deaths, terminal comfort care was provided in a Neonatal Intensive Care Unit (NICU) (Soni et al., 2011). Palliative care teams are increasing, but not enough organizations have embraced the need for better palliative care guidelines. Nor do many organizations know when, how, or if palliative care should even be introduced. These events lead to comfort care measures being underutilized in the NICU for most newborn infants with life-limiting and life-threatening conditions. Neonatal palliative care is discussed more than in years past, but little research has been dedicated to how early palliative care …

Incarceration-Related Stigma And Caring Self-Efficacy Among Long-Term Care Nurses, Sandra D. Langston

Dissertations, Theses, and Capstone Projects

Background: A silver tsunami is occurring in U.S. prisons because of an unprecedented increase in the older population. Prisons are structurally ill-suited to care for this population and financially burdened with providing the necessary medical and nursing care. States have enacted legislation to afford justice-involved persons parole to manage chronic conditions in community-based long-term care (LTC) facilities. Changes in Medicaid regulations provide a seamless transition from prison to community long-term care for this population. However, it is not known if the stigma of justice involvement impacts the perception of long-term nurses concerning this population.

Aims/Purpose: This study examined the effects …

Analysis Of Palliative Care Knowledge And Symptom Burden Among Female Veterans With Serious Illness: A Cross-Sectional Study, Brandon M. Varilek, Patricia C. Da Rosa

College of Nursing Faculty Publications

Background: The female Veteran population is rapidly growing, as is their use of Veterans Affairs (VA) medical centers (VAMCs). Additionally, 90% of female Veterans are under 65 years old, meaning healthcare providers at VAMCs must be ready to manage the complex serious illnesses that affect female Veterans as they age. These serious illnesses require proper medical management, which can include palliative care. However, little palliative care research includes female Veterans.
Aims: The aims of this cross-sectional study were to examine palliative care knowledge and symptom burden among female Veterans’ and examine factors associated a symptom burden scale.
Methods: Consenting participants …

Facilitating Palliative Care In A Critical Access Hospital System: Implementation Of Screening And Educational Interventions, Michele Lovell

DNP Scholarly Projects

BACKGROUND: The United States health care system faces the dual challenge of an aging population with a concomitant increase in the presence of chronic and serious illness, the care of which accounts for the nation’s largest expenditure of burgeoning healthcare costs. Palliative care is specialized care for people with serious illness aimed at reducing suffering, optimizing quality of life, and enhancing medical decision making. An ample evidence base demonstrates that palliative care increases both quality of care and patient and family satisfaction while also reducing associated costs. The aim of this quality improvement project was to facilitate palliative care services …

Educating Nurses To Implement Serious Illness Conversations, Colleen Patricia Desai

Walden Dissertations and Doctoral Studies

AbstractAs part of investigating staff nurses’ reluctance to have serious illness conversations (SIC) at a local hospital, an educational deficit was noted. Nurses articulated they felt uneducated about how to have a SIC with a patient in need and questioned if the practice of conducting SICs was part of the nurses’ scope of practice in the New England State where they were employed. The purpose of this project was to create an educational tool and have it validated by a multidisciplinary group of experts. Once validated, the goal will be to educate nurses, raise awareness on the topic of SICs, …

บทบาทพยาบาลกับการตัดสินใจเชิงจริยธรรมในผู้ป่วยมะเร็งระยะท้าย: ประเด็นการยับยั้ง/การถอดถอนการรักษาพยุงชีพ, บุญสิตา ทิงาเครือ, พิรนันท์ ศิริ, นิชาภา พุมสอน, อิสระพันธ์ เรืองทอง, จันจิรา เพ็ญ, วาสินี วิเศษฤทธิ์

Journal of Nursing Research, Innovation, and Health

การตัดสินใจเชิงจริยธรรมเป็นกระบวนการที่ช่วยให้พยาบาลได้ตรวจสอบประเด็นขัดแย้งทางจริยธรรมในการปฏิบัติการพยาบาลอย่างเป็นระบบและเป็นองค์รวม โดยยึดหลักเหตุผลเชิงจริยธรรม พยาบาลผู้ตัดสินใจ  จะต้องรู้องค์ประกอบและปัจจัยที่เกี่ยวข้องกับการตัดสินใจและสามารถเลือกกระทำหรือไม่กระทำในสถานการณ์ที่เกิดขึ้นนั้นได้ เนื่องจากพยาบาลถือว่าเป็นบุคลากรทางด้านสุขภาพที่มีความใกล้ชิดกับผู้ป่วยมากที่สุด ในหลายสถานการณ์ที่พยาบาลต้องเผชิญกับประเด็นทางจริยธรรม โดยเฉพาะอย่างยิ่งในบทความนี้แสดงประเด็นที่เกี่ยวข้องกับการการยื้อหรือยุติการมีชีวิตอยู่ในผู้ป่วยมะเร็งระยะท้าย ถือได้ว่าเป็นมิติใหม่ที่ท้าทายบทบาทของพยาบาล พยาบาลจึงมีบทบาทสำคัญที่จำเป็นต้องมีทักษะ ความรู้ และประสบการณ์หลายด้านในการดูแลผู้ป่วยมะเร็งระยะท้าย รวมทั้งทีมบุคลากรด้านสุขภาพต้องให้ความสำคัญกับกระบวนการตัดสินใจเชิงจริยธรรมในการดูแลประคับประคองด้านข้อมูลและด้านจิตใจของผู้ป่วยและครอบครัว เพื่อเพิ่มความมั่นใจและศักยภาพในการดูแลผู้ป่วยมะเร็งระยะท้ายแบบองค์รวม ส่งผลให้ผู้ป่วยได้รับการดูแลอย่างสมศักดิ์ศรีความเป็นมนุษย์และเกิดประโยชน์สูงสุดต่อผู้ป่วยและครอบครัว

Giving Effective And Timely Hospice Education To Lessen Participant Stress (Get Helps), Caroline Rose Carter

Master's Theses and Capstones

In 2022, 1.72 million people chose to use hospice as their end-of life care. This is a 6.8% increase from 2019, and the number of patients who choose to use hospice is increasing (Summers, 2022). The aim of this quality improvement (QI) study was to decrease levels of stress reported by the patient and informal caretakers by combining the information from the hospice program’s admission packet and other approved handouts, while standardizing the verbiage through a Flesch-Kincaid readability scale to an eighth-grade reading level. Pre-survey perceived stress scores averaged 22.97 on a modified Perceived-Stress Scale, and the mean of the …

Educating Nurses To Implement Serious Illness Conversations, Colleen Patricia Desai

Walden Dissertations and Doctoral Studies

AbstractAs part of investigating staff nurses’ reluctance to have serious illness conversations (SIC) at a local hospital, an educational deficit was noted. Nurses articulated they felt uneducated about how to have a SIC with a patient in need and questioned if the practice of conducting SICs was part of the nurses’ scope of practice in the New England State where they were employed. The purpose of this project was to create an educational tool and have it validated by a multidisciplinary group of experts. Once validated, the goal will be to educate nurses, raise awareness on the topic of SICs, …

Utilizing Podcast Education To Improve Nurse Knowledge, Confidence, And Behaviors Related To Palliative Care Conversations In The Intensive Care Unit, Brittany Estridge

DNP Projects

Background: The personal connection that Registered Nurses (RNs) build with patients and their families puts them at the forefront of many conversations during the patient’s stay in the intensive care unit (ICU). Some of the most difficult conversations are related to palliative care (PC). It can be challenging to know how to respond to the complex questions posed in palliative care conversations (PCC) when patients and their caregivers are making decisions that will alter the course of the patient’s treatment, as well as affect the quality and length of their life.

Purpose: Nurses receive inadequate training in PCC. The purpose …

The Effectiveness Of Community-Based Palliative Care Program Components: A Systematic Review, M. Courtney Hughes, Erin Vernon, Allison Hainstock

Faculty Articles, Papers, and Other Scholarship

Background: there is evidence that community-based palliative care programs can improve patient outcomes and caregiver experiences cost-effectively. However, little is known about which specific components within these programs contribute to improving the outcomes.

Aim: to systematically review research that evaluates the effectiveness of community-based palliative care components.

Design: a systematic mixed studies review synthesizing quantitative, qualitative and mixed-methods study findings using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PROSPERO: ID # CRD42022302305.

Data sources: four databases were searched in August 2021 (CINAHL, Web of Science, ProQuest Federated, and PubMed including MEDLINE), and a close …

Factors Impacting Serious Illness Care In Alabama: An Assessment Of The Current State Of Hospital Palliative Care, Amy M. Beasley

All ETDs from UAB

BACKGROUND: Palliative care (PC) use has been shown to offer many benefits to patients and families. Hospital PC has expanded in the United States, though growth has been limited within hospital types and geographic locations. According to the Center to Advance Palliative Care (CAPC), Alabama was rated a “D,” indicating that significant improvements in PC are needed. The purpose of this study was to develop a thorough description of access to palliative care in Alabama hospitals. METHODS: A mixed methods multiple case study was employed with quantitative data embedded into a qualitative case study approach. Four hospitals were selected based …

Combating Compassion Fatigue In The Emergency Department, Pam Packard

Doctor of Nursing Practice Projects

Combating compassion fatigue in the emergency department is vital to nurses’ well-being. Compassion fatigue is the result of negative physical, emotional, and spiritual strains that often burden nurses. The weight of compassion fatigue is explored throughout this conceptualization of Combating Compassion Fatigue. Two questions were explored: Does compassion fatigue affect compassion satisfaction? If so, is compassion fatigue a precursor to suboptimal compassion satisfaction?

The Effect Of Standardized Patient Education On 30-Day Hospital Readmissions For Heart Failure Patients In The Outpatient Setting, Lurie Dimalanta

Master's Projects and Capstones

Problem: Heart failure (HF) is the second leading condition of hospital readmissions. Evidence shows that patient education on self-care and disease management can help reduce and prevent 30-day hospital readmissions. Registered nurse case managers (RN CMs) can help improve patients' ability to self-manage their condition and prevent 30-day hospital readmissions by applying a standard approach to patient education.

Context: The Integrated Care Management (ICM) is an outpatient department that provides post-discharge patient calls. The ICM RN CMs utilized various HF patient education tools for patient teaching. The organization’s HF task force developed health-literate patient resources to be used …

An Integrative Review: The Experiences Of Stress, Burnout, And Compassion Fatigue By Ambulatory Care Nurses, Rajean Adams

Master of Science in Nursing Final Projects

Abstract

Aim: One aim of this integrative review is to highlight workplace issues outpatient (ambulatory care) nurses experience, related to stress, burnout, and compassion fatigue. Another aim is to bring awareness to and discuss recently implemented tools and strategies to help alleviate these manifestations.

Background: Stressors in the outpatient setting date back to the 1970s when psychologist Herbert Freudenberger mentioned the burnout he experienced while in a Free Clinic. In modern-day, half of nurses experiencing workplace burnout, confess to feeling emotional exhaustion. Various studies discuss the challenges nurses endure in the inpatient setting, but only a few focus on ambulatory …

Palliative Care In The Icu, Grace Cunningham

MSN Capstone Projects

Death and dying is an evident part of being admitted to the intensive care unit. However, too many times, the end-of-life conversations and palliative care team introduction are done when it is too late. The PICOT question is “In ICU patients (P), how does early palliative care involvement in the death and dying process (I) compared to later palliative care involvement in the death and dying process (C) affect positive patient outcomes (O) within the ICU hospital stay (T)?” The objective of this change project is to instill a sense of urgency in providing palliative consults upon admission as this …

Palliative Care Early In The Care Continuum Among Patients With Serious Respiratory Illness An Official Ats/Aahpm/Hpna/Swhpn Policy Statement, Donald R. Sullivan, Anand S. Iyer, Susan Enguidanos, Christopher E. Cox, Morag Farquhar, Daisy J. A. Janssen, Kathleen O. Lindell, Richard A. Mularski, Natasha Smallwood, Alison E. Turnbull, Anne M. Wilkinson, Katherine R. Courtright, Matthew Maddocks, Mary Lynn Mcpherson, J. Daryl Thornton, Margaret L. Campbell, Tracy K. Fasolino, Patricia M. Fogelman, Larry Gershon, Thayer Gershon, Christiane Hartog, Judy Luther, Diane E. Meier, Judith E. Nelson, Elliot Rabinowitz, Cynda H. Rushton, Danetta H. Sloan, Erin K. Kross, Lynn F. Reinke

Research outputs 2022 to 2026

Background:

Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes.

Goals:

This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this.

Methods:

An international and interprofessional expert committee, …

Use Of The Prepare Tool To Increase Completion Rates Of Advance Care Planning Documentation, Janella Thompson

Student Scholarly Projects

Practice Problem: One in three adults aged 55 and older admitted to the hospital lack advance care planning. Patients without advance care planning may not receive treatment that reflects their personal values, wishes, and preferences

PICOT: The PICOT question that guided this project was in adults 65 years or older (P), how does the implementation of a patient-centered web-based advance planning tool kit (I) compared to the usual practice of addressing advance care planning (C), affect the completion rate of advance care planning documentation (O) within 10 weeks (T).

Evidence: The current evidence has demonstrated that advanced care …

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 …

Resiliency In Nursing: An Integrative Review, Valerie Yvonne Moke

Doctoral Dissertations and Projects

Nurses have been placed under tremendous pressure throughout their careers and the culmination of this pressure was the COVID-19 pandemic. Nurses had to remain stoic despite longer hours, heavier workloads, lack of PPE and the fear of becoming infected or infecting their families. A review of the current literature was accessed to see how nurses built their stamina to withstand those pressures and create interventions to improve patient outcomes. The research was used to evaluate ways to improve nurse retention, reduce nursing shortages, and improve job satisfaction for those nurses and future nurses. The evidence showed that nurses with support, …

Descriptive, Comparative, And Correlational Study Related To End-Of-Life Care Prior To The Covid-19 Pandemic Outbreak (Time 1) And 12 Months Following Lockdown (Time2), Elizabeth Infante

Theses & Dissertations

Background

Palliative care has grown in its acceptance nationally and formed the base of a growing number of programs to provide care in a way that recognizes the importance of supporting people with chronic, debilitating, and life-limiting illnesses by focusing on “care” rather than “cure.” This special care warrants an understanding by all nurses and requires education across specialties and disciplines. Despite the increase of palliative care services in hospitals and other settings, long-term care and home care agencies continue to struggle with the education of staff and delivery of care to clients that incorporate the central tenets of what …

Case Manager Discharge Planning For Safe Discharge Of Homeless Patients, Melody Jenkins

Master of Science in Nursing Theses and Projects

Acute care case managers are continually challenged with the task of identifying discharge barriers and preparing a discharge plan that facilitates successful recovery and healing. Planning a discharge for a patient that is homeless can be extremely challenging. This MSN Nursing project addresses the complex discharge barriers involved in planning a safe discharge for homeless patients. The project goal was to create a Case Management Resource Algorithm that will organize available community resources to meet the social determinants of health deficits to prevent the progression of disease processes, prevent repeat visits to the emergency room, decrease inpatient admissions, as well …

Perceptions Of Associate Degree Nursing Faculty Of A Primary End-Of-Life Care Course Within Prelicensure Nursing Curricula, Katherine Zaharchuk

Walden Dissertations and Doctoral Studies

AbstractThe responsibility for educating U.S. nursing students on end-of-life (EOL) care concepts lies with prelicensure nursing programs; however, the majority of all prelicensure nursing programs offer only a few lectures, and only a small percentage offer EOL and palliative care courses. The lack of education on EOL care results in greater stress for nurses, poor symptom management for patients, and reduced support for family caregivers. There is limited knowledge on why primary EOL education has not yet been adopted by many Associate Degree in Nursing (ADN) programs. The purpose of this qualitative study was to explore the perceptions of ADN …

End-Of-Life Care For African Americans: A Staff Education Project, Oneika Natasha Rigby-Britton

Walden Dissertations and Doctoral Studies

Increased knowledge is needed among long-term care facility staff members regarding end-of-life care services. There is a gap in staff knowledge regarding how to initiate education about these care services with patients and family members and how these services impact patient care and health outcomes, especially among the African American residents in long-term care facilities. The practice-focused question addressed in this project was whether staff education increased the staff members’ knowledge about end-of-life care and how to initiate conversations with African American patients and families on available services. The development of this staff education project used Roger’s diffusion of innovation …

Knowledge Gaps: Addressing The Need For Palliative Care Education For University Nursing Students, Odin Todd Bickford

Honors Theses and Capstones

This study aimed to analyze undergraduate nursing students’ primary palliative care knowledge to determine if there is a need for further palliative care education in undergraduate, pre-licensure curriculums. To make this determination, this study utilized the Undergraduate Nursing Palliative Care Knowledge Survey (UNPCKS), created by Dr. Andra Davis and Dr. Megan Lippe, a 27-question survey that addresses the 6 domains of holistic palliative care; i) holistic, patient-centered care (Whole person care), ii) collaborative (Interprofessional), iii) understanding of primary palliative care as a resource and how to support patients/families (Advocacy and Knowledge of Primary Palliative Care), iv) the importance of understanding …

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 …

An Educational Program For Hospice Nurses About End-Of-Life Protocols, Rhonda Coleman

Walden Dissertations and Doctoral Studies

Abstract Palliative care is specialized care for people living with a serious illness. This type of care is centered on providing relief from the symptoms and stress of the illness with a primary goal to improve the quality of life for both the patient and the family. A gap in nursing practice was identified in a hospice facility in the South Central United States.; the nurses did not use palliative care or end-of-life (EoL) protocols. This project focused, therefore, on the development of a nursing staff education program for hospice nurses to increase knowledge about the use of EoL protocols. …

End-Of-Life Education For Long-Term Care Nurses, Naquita Altidor Jacques

Walden Dissertations and Doctoral Studies

Long-term care (LTC) nurses play a crucial role in preserving the quality of life of terminally ill patients. However, many identify deficits in skills, education, and training for end-of-life (EOL) care. The objective of this project was to educate LTC nurses caring for individuals reaching the end of their lives on EOL care. The practice-oriented question concerned whether an evidence-based educational program improved nurses’ knowledge related to EOL care and confidence in caring for EOL patients and families. The End-of-Life Nursing Education Consortium's evidence-based educational module was used to provide the content. Rosswurm and Larrabee’s model for change to evidence-based …

Nurses’ Perceptions Of Using Volunteer Support In Health Care Settings: A Systematic Scoping Review, Kate Crookes, Rosemary Saunders, Vivien Kemp, Olivia Gallagher, Manonita Ghosh, Caroline Bulsara, Karen Gullick, Bev O'Connell

IHR Papers and Journal Articles

Aims

To understand nurses’ perceptions of volunteer support in health care settings.

Background

Increasingly, volunteers provide specialised support to health care service users, requiring volunteers and nurses to work closely together. However, little is known about nurses’ perceptions of volunteer support.

Methods

A scoping review was conducted following the PRISMA-ScR checklist. A mixed-methods convergent integrative approach was taken guided by the JBI framework. Quantitative data were transformed into qualitative data for synthesis and descriptive thematic analysis. Six databases were searched (CINHAL+, EMBASE, PubMed, Scopus, PsycInfo, ProQuest Health and Medical Collection) on 24 January 2022 using terms related to nurses, perceptions, …

Patient Factors Associated With Different Hospice Programs In Korea: Analyzing Healthcare Big Data, Young-Taek Park, Daekyun Kim, Su-Jin Koh, Yeon Soon Kim, Sang Mi Kim

Nursing Faculty Publications

The Korean government has implemented a pilot project that introduces a new type of hospice care program called “Consultative Hospice Care” (COHC) since August 2017. The COHC is a new type of hospice program for terminally ill patients in acute care wards, which is different from the Independent Hospice Unit (IHU) care. This study aimed to compare the characteristics of two groups of hospice patients: COHC care only and both IHU care and COHC groups. Healthcare claim data from 1 April 2018 to 31 March 2020 were retrieved from the HIRA data warehouse system. The main outcome variable was patients …