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A Good Life: Palliative Care In The World Of Dementia, Nicola Farmer

Journal of Interdisciplinary Graduate Research

Objective: The World Health Organization (2019) reports that dementia is the seventh leading cause of death with an estimated 50 million people worldwide with this disease. In the United States out of one and a half million Medicare patients on hospice in 2016, only 18% had dementia (The National Hospice and Palliative Care Organization, 2017). McAteer and Wellbery (2013) identified that while referrals to services seem to be on the rise, many are not made until the patient is close to death in the last weeks of an illness. The purpose of this project was to review the literature to …

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 …

Social Determinants Of Health Assessment For Skilled Nursing Patients, Heather Welch

Master's Projects and Capstones

Section I: Abstract

Problem: Skilled nursing facility (SNF) patients are vulnerable, aging, and have complex medical histories. Readmissions from an SNF impact healthcare costs and hospital resources and indicate poorly coordinated transitions home. Patients discharging from SNFs are at risk for higher social determinants of health (SDOH) disparities, such as limited caregiver support, transportation, housing insecurity, and food access. These SDOH risks can significantly increase an SNF patient's risk for hospital readmissions. Assessing and addressing SNF patients' social needs to reduce 30-day post-SNF readmissions can improve health outcomes and positively impact healthcare costs and a patient's financial liabilities.

Context: Frailty, …

Reducing The Incidence Of Compassion Fatigue In Obstetrical Nurses, Naveen Samuel

Student Scholarly Projects

Practice Problem: Compassion fatigue is a growing problem that can affect 21% to 39% of nurses who work in hospital settings (Berger et al., 2015). Compassion fatigue has been further exacerbated due to the COVID-19 pandemic. Compassion fatigue negatively impacts the nurses in profound physical and emotional ways.

PICOT: The PICOT question that guided this project was: For obstetrical nurses working in a nonprofit organization, what is the effect of a compassion fatigue program, compared with no program, on nurses in reducing compassion fatigue after two months?

Evidence: Current evidence shows that mindfulness decreases compassion fatigue and increases compassion …

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 …

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 …

The Essential Characteristics Of An Effective Hospice And Palliative Care Nurse, Alexis Doyle

The Eleanor Mann School of Nursing Undergraduate Honors Theses

No abstract provided.

Enhancing Outpatient Participation In Advance Care Planning Via Nurse-Led Intervention: An Integrative Review, Daniel Patrick Arthur

Doctoral Dissertations and Projects

Advance care planning allows for medical care at the end-of-life that is congruent with a patient’s wishes, values, and beliefs. Even with well-known organizations such as the Institute of Medicine recommending advance care planning completion and legislative encouragement such as the Patient Self-Determination Act of 1990, only approximately one-third of American adults have completed any form of advance directive. Barriers to participation include lack of time, lack of knowledge, and misconceptions on the part of healthcare providers and patients. As an integral part of the care team having significant patient contact in most healthcare settings, nurses are in an ideal …

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 …

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. …

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 …

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 …

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.

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. …

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 …

Hospital-Based Palliative Care Programs: Perspectives Regarding Conceptualization And Accreditation, Karen L. Walker

Nursing Theses and Dissertations

Palliative care has been shown to improve symptoms and increase quality of life in people with a life-limiting illness. Despite growth in hospital-based palliative care programs throughout the United States, only 91 hospitals have obtained The Joint Commission’s Advanced Palliative Certification. The purpose of this descriptive study was to identify how programs that do not have The Joint Commission’s Advanced Palliative Care Certification defined and conceptualized palliative care. An additional focus was to identify the barriers these programs perceived or experienced that prevented them from obtaining the advanced palliative care certification. This research program began with an evolutionary concept analysis …

Factors Related To 30-Day Readmission Among Hispanics With Type 2 Diabetes, Athena Mohebbi

Dissertations

Background: Medicare spends $17 billion yearly on 30-day readmissions. Hispanic adults have a higher prevalence of diabetes (12.6%) compared to non-Hispanic whites (9.4%). Those with a diagnosis of diabetes have the 17% higher rate (14-23%) for 30-day readmission. Little research has been conducted on Hispanics with diabetes relative to 30-day readmissions. Aims: Among Hispanics with type 2 diabetes: 1) measure the incidence of 30-day readmission by sociodemographic, behavioral and clinical factors;2) identify independent factors associated with 30-day readmission among Hispanic adults with type 2 diabetes accounting for potential covariates; 3) compare the ability of the Hispanic Diabetic Study Model plus …

The Effectiveness Of A Robotic Seal On Compassion Satisfaction In Acute Care Nurses: A Mixed Methods Approach, Jo S. Henson

Nursing Theses and Dissertations

Problem: Nurses face a variety of stressors that can result in decreased levels of compassion satisfaction. The purpose of this study was to investigate the efficacy of a computerized interactive social assist robot (PARO) to decrease stressors and increase compassion levels of acute care nurses in an inpatient setting.

Theory: The Professional Quality of Life Model posits that low Compassion Satisfaction, Burnout, and Secondary Traumatic Stress leads to Compassion Fatigue.

Hypotheses: It was hypothesized that interaction with a social assist robot with artificial intelligence will result in decreasing levels of stress therefore increasing levels of compassion satisfaction in nurses working …

Cultural Aspects Of End Of Life Advance Care Planning For African Americans: An Ethnonursing Study, John Collins

Electronic Theses and Dissertations

Introduction: Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are impacted by demographic variables, cultural distinctives related to patient autonomy, mistrust of the healthcare system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. End of Life (EOL) advance care planning (ACP) promotes patient and family centered care. The purpose of this study was to identify culturally based meanings, expressions, and traditions of EOL ACP and decision making among African Americans, to better understand and provide culturally congruent nursing …

Assessing Palliative Care Needs In Residents With Alzheimer's, Emily Yarnell

Doctor of Nursing Practice Projects

Current evidence indicates a lack of assessment protocols focusing on palliative care needs for patients with Alzheimer’s disease. This gap in practice supported the need to implement an evidence-based assessment protocol for early identification of palliative care needs in patients with Alzheimer’s disease residing in a long-term care facility. The protocol included using the patient’s Global Deterioration Scale (GDS) score to determine the patient’s palliative care needs according to the Dementia Progression Prioritization of Goals model. If the score indicated moderate to severe Alzheimer’s disease, then their goal was maximization of comfort, indicating a need to begin palliative care plans. …

Raising Awareness Of Compassion Fatigue Among Healthcare Providers In The Coronary Care Unit, Keri Tifft

Doctoral Dissertations and Projects

Compassion fatigue is a pressing issue in critical care units across the healthcare field. There is a sincere desire by nurses to give the best care possible to each of their patients; however, many obligations split the nurse’s attention so they do not feel as if they are providing the best care to their patients. When nurses stop viewing their patients as humans and start viewing them as tasks, the compassion that the nursing profession prides itself on, is no longer there to the degree that is needed for quality care. Increasing awareness of compassion fatigue and teaching nurses and …

Stress And Coping In Hospice Care, Elyse L. Collier

DNP Projects

Accommodating current hospice care needs and anticipated industry expansion requires protection and optimization of human resources serving as frontline care providers. Coping responses employed by individuals serve as important determinants of their overall personal and occupational well-being. There is limited research focusing on the coping responses of hospice professionals, specifically, how they perceive and manage their own work stress and work-related quality of life. The purpose of this study was to examine how coping responses are related to work-related quality of life among individual professionals working together on outpatient interdisciplinary hospice care teams. A cross-sectional survey-based design was utilized to …

Interventions For Promoting Earlier Enrollment Into Hospice And Palliative Care Among Patients With A Terminal Illness, Jody K. Kampa

All Electronic Theses and Dissertations

Background: Although research supports palliative care (PC) to improve symptoms and quality of life for patients with terminal illnesses, these services are underutilized. While 80% of people prefer to die at home, the majority still die in an acute care facility, sometimes receiving aggressive interventions that may increase suffering up until the very end of life. Earlier referral to PC or hospice care can improve symptom management and facilitate end-of-life (EOL) wishes. Purpose: The purpose of this critical review of literature was to identify barriers as well as evidenced-based interventions to promote earlier enrollment into hospice and PC among patients …

Ethical Patient Care Overview For Doctoral Nursing Students, Courtney Reinisch

School of Nursing Faculty Scholarship and Creative Works

Clinical care is guided by knowledge, competency, and the maintenance of ethical standards. Maintenance of ethical standards is necessary by all care providers across disciplines. Attention should be paid to the following ethical tenets: autonomy, beneficence, non-malfeasance, justice, veracity, and confidentiality. Avoiding paternalism is a goal for providers to optimize outcomes for individuals and families. Providers who demonstrate a thorough understanding of ethical principles best serve individuals, communities, and populations by strengthening trust with adherence to ethical standards.

Evaluating Interventions To Mitigate Compassion Fatigue Among At-Risk Nursing Populations, Emily R. Derayunan

Honors Undergraduate Theses

This thesis examined the experience of compassion fatigue in nurses through analysis of research studies conducted within the past ten years. A literature review was completed using CINAHL Plus with Full Text, MEDLINE, and PsycINFO databases. Efficacy of current management strategies and interventions was evaluated. Findings indicate that educating nurses working in high-risk units improves self-recognition and lowers compassion fatigue levels. Institutional factors such as a lack of managerial support and organizational commitment contribute to the experience of compassion fatigue. An organization's involvement in maximizing compassion satisfaction through meaningful recognition of nurses' contributions to care and implementation of organizational prevention …

Spirituality, Religiosity, And Perceived Ability To Provide Spiritual Care In Nursing Students, Shannon O'Connell-Persaud

Electronic Theses and Dissertations

Objective. The objective of this study was to explore nursing students’ spirituality, religiosity, and perceived ability to provide spiritual care. Background. Nursing students must be prepared to respond to a patient’s spiritual needs. A gap in knowledge exists as to the educational preparedness necessary to provide a nursing student with the ability to respond to a patient’s spiritual need. To address the gap, this study explored the relationships between nursing students’ spirituality, religiosity, and perceived ability to provide spiritual care. Study Setting and Sample. This multi-site study used two accredited nursing programs located in the Western Region of the United …