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Defining Quality Of Life: The Lived Experience Of Adults With Pulmonary Hypertension And The Impact Of Activity-Induced Respiratory Distress, Bethany Jean Adams

Walden Dissertations and Doctoral Studies

Pulmonary hypertension (PH) is a progressive, life-limiting disease that significantly affects quality-of-life (QoL). Limited research has explored lived experiences of individuals with PH. Guided by Parse’s human becoming theory, this qualitative descriptive phenomenological study explored the lived experiences of individuals affected by PH and examined how activity-induced respiratory distress affected QoL. The research Question was: How do individuals with PH describe the impact of activity-induced respiratory distress on their QoL. I conducted interviews with nine participants, including eight adults diagnosed with PH and one caregiver of an individual with PH. Data were analyzed using Saldaña's comparative coding framework to identify …

Recognizing Appropriate General Inpatient Hospice Patients Time To Stop Normalizing Suffering, Oliver Charles Roth

Walden Dissertations and Doctoral Studies

Hospice patients experiencing uncontrolled pain, dyspnea, agitation, anxiety, delirium, or other severe symptoms may require General Inpatient (GIP) hospice care for intensive symptom management. However, inconsistent recognition of symptom crises can delay escalation to the appropriate level of care, contributing to unnecessary patient suffering, caregiver distress, and avoidable emergency department or hospital utilization. This Doctor of Nursing Practice executive leadership project evaluated the implementation of an educational framework designed to improve clinician recognition and timely escalation of patients who may be appropriate for GIP hospice care. Education emphasized early identification of uncontrolled symptoms, interdisciplinary communication, documentation, and escalation for clinical …

Staff Education To Improve End-Of- Life Pain Management Confidence Among Long-Term Care Nurses, Andrea Osuji

Walden Dissertations and Doctoral Studies

No abstract provided.

Advancing Palliative Care Competency Through An Evidence-Based Educational Intervention For Healthcare Providers, Lauren Elizabeth Griffin

Walden Dissertations and Doctoral Studies

A major gap in acute care is the delayed initiation of palliative consultations. Although over 58 million people worldwide could benefit, only 14% receive such care. Despite evidence that early involvement improves outcomes, providers often overlook their value, leading to late referrals, typically after repeated hospitalizations or near end-of-life, when hospice may be more appropriate. This Doctor of Nursing Practice (DNP) educational intervention addressed a critical practice-focused question to enhance healthcare providers’ understanding of palliative care improve hospital-based patient outcomes. The intervention aimed to demonstrate a ≥20% knowledge gain from pretest to posttest scores related to distinguishing palliative care from …

Addressing And Recognizing Secondary Traumatic Stress In Hospice And Palliative Care Clinicians, Laquisha La Chelle Jackson

Walden Dissertations and Doctoral Studies

In the emotionally demanding field of hospice and palliative care, the well-being of clinicians is critical. This Doctor of Nursing Practice (DNP) project focused on implementing a staffing education initiative to address secondary traumatic stress (STS). I designed this staffing education project to enhance clinician awareness, resilience, and coping strategies while informing organizational leadership on how improved staffing models and support systems can mitigate STS. Hospice and palliative care clinicians are uniquely vulnerable to STS due to constant exposure to trauma, death, and grieving families. The guiding question for this project was: In hospice and palliative care clinicians, how does …

African American Caregivers' Perceptions Of Ecological Factors Related To Hospice Utilization, Monica Prescott Lonon

Walden Dissertations and Doctoral Studies

African Americans remain an underrepresented demographic in hospice care because they underutilize the service at disproportionate rates compared to the total population. The research problem addressed African American perceptions of the microsystem, mesosystem, exosystem, macrosystem, and chronosystem factors that impacted their perceptions and utilization of hospice. The purpose of this generic qualitative study was to explore African American caregivers’ perceptions of environment-related factors that affected their utilization of hospice care. Data were collected from semistructured interviews with 10 African American family caregivers aged 18 and over, with at least 2 years of experience as hospice caregivers. Findings from coding and …

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, …

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, …

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 …

Human And Social Services Direct Service Professionals' Perception Of Late-Life Cumulative Grief And Loss, Deanna Robinson

Walden Dissertations and Doctoral Studies

Globally, the adult population 65 and older is anticipated to grow, signaling the necessity of awareness of late-life issues and concerns. Although research has shown that losses and changes in late life are anticipated, there is very little empirical evidence of how HSPs direct care professionals understand, assess, or perceive the complexities of cumulative grief and loss in their 65 and older clients. Charmaz’s constructivist grounded theory (CGT) (2014) was used as the conceptual framework a qualitative methodology to explore the understanding, assessment, and perception of the complexities of late-life cumulative grief and loss of HSPs working with adults 65 …

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 …

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 …

Integration Of Morphine And Virtual Reality: Pain Management For Adult Hospice Cancer Patients, Arlisa Hurd

Walden Dissertations and Doctoral Studies

There is currently a problem in that cancer patients engaging in hospice may experience an excessive amount of perceived pain and a decreased quality of life. The purpose of this study was to explore an intervention that could lessen the perceived pain experienced by, and increase the quality of life of, cancer patients engaging in hospice. Immersion music virtual reality (IMVR) allows a user to interact with a realistic, computer-generated environment. 3D music (IMVR) is likely suited for pain management with patients in hospice and was used for this study. The theory for the study is the gate control theory. …

Secondary Traumatic Stress Among Catholic Priests, Richard Ehusani

Walden Dissertations and Doctoral Studies

Research suggests that the clergy could be at the risk of developing secondary traumatic stress (STS) because of their secondary exposure to trauma within pastoral work; however, there has been no explicit discussion of STS related to Catholic priests who may be more at the risk of developing STS than their counterparts in other churches. The requirement of priestly celibacy often leaves Catholic priests with little to no immediate social and emotional support network of family. Because of their sacred vow to keep the confessional seal unbroken in whatever circumstance, Catholic priests also may not share confessional information, even when …

The Lived Experience Of Work Stress And Coping In Eldercare Hospice Nurses, Yvette Abraham

Walden Dissertations and Doctoral Studies

The number of elderly people living with terminal diagnoses has increased, along with the need for hospice nurses with specialized training to provide high-quality personal care that addresses their unique, critical needs. Research on nurses and other professionals who function in a demanding environment has demonstrated the experience of work stress, and negative physical and psychological consequences. However, little is known about the unique work stress and challenges of hospice nurses who care for the dying elderly. This study explored the meaning of hospice nurses’ experience of work stress and coping. Giorgi’s empirical phenomenological approach guided the development of the …

Urban And Rural Alaskan Physicians’ Knowledge, Attitudes, And Behaviors Regarding Palliative Care, Mary Bernadette Cavalier

Walden Dissertations and Doctoral Studies

Palliative care provides multidisciplinary treatment of the physical, psychological, social, and spiritual needs of patients and families with serious illnesses. Alaska has the highest per capita rates of serious illnesses in the United States, but many Alaskans lack access to palliative care. Using Engel’s biopsychosocial model of care, Saunders’ total pain theory, and Bandura’s theory of self-efficacy, the purpose of this study was to assess the role of physicians regarding palliative care access in Alaska. This quantitative multivariable regression analysis examined the relationship between 133 Alaskan physicians’ knowledge and attitudes (independent variables) and their behaviors (dependent variable) regarding palliative care; …

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 …

Implementing Aromatherapy For Falls Reduction In The Inpatient Hospice Population, Kimberly Kay Pistek

Walden Dissertations and Doctoral Studies

Falls among the elderly is a health concern affecting multiple patients annually. Hospice patients and those with multiple comorbidities are at the greatest risk of falling and sustaining injuries from falls. Aromatherapy has been used for reducing multiple symptoms as well as for decreasing falls. The practice-focused question explored whether an education program on using aromatherapy for fall prevention would increase knowledge of this intervention for an interdisciplinary group of hospice staff. The design was developed using Knowles's theory of andragogy and Bloom's taxonomy. Thirteen staff members from the same facility participated in the education program. The program was targeted …

Nurses' Lived Experiences Of Comfort Care Among Residents At The End Of Life, Ezekiel Olufemi Osundina

Walden Dissertations and Doctoral Studies

Nurses provide comfort care for individuals who are at the end of life and reside in the long-€term care environment. However, how nurses provide comfort care to those who are dying and nurses' perceptions about providing comfort care are not known. The purpose of this phenomenological study, guided by Kolcaba's theory of comfort, was to examine nurses' lived experiences of comfort care among residents at the end of life in long-term care facilities. The research questions were designed to elicit rich data about the lived experiences of nurses in providing comfort care to dying residents to find out factors that …

Chaplaincy Inclusion In Hospital Interdisciplinary Teams And Its Impact On Chaplains' Well-Being, Chike Nzegwu

Walden Dissertations and Doctoral Studies

Healthcare providers may impede the delivery of spiritual and emotional support to

patients and their families by healthcare professional chaplains if they misunderstand how to effectively use chaplains, who often prefer to be engaged sooner than they are. This issue prevents highly trained, board-certified professional chaplains from providing services, thereby impacting the quality of patient care. The purpose of this phenomenological study was to examine, through the lived experiences of professional chaplains, the extent to which chaplains feel that others perceive them as valued members of an interdisciplinary team (IDT), as well as to determine how team inclusion may impact …

Inclusion Of Social Workers In End-Of-Life Discussions In Intensive Care Units, Olivett D. Underwood-Mobley

Walden Dissertations and Doctoral Studies

Clinical social workers have roles in providing end-of-life care in the United States. Although clinical social workers are present in the intensive care unit (ICU) setting and have expertise to address end-of-life care dynamics, social workers are not consistently included in end-of-life discussions in the ICU setting. The purpose of this action research study was to explore the barriers that prevent clinical social workers from being included in end-of-life discussions in the ICU and how clinical social workers perceive their roles in end-of-life discussions in the adult ICU setting. Open-ended questions were used to gather data by facilitating 4 focus …

Knowledge And Attitudes Of Emergency Room Nurses Regarding Palliative Care Patients, Pearl Alethea Harrison

Walden Dissertations and Doctoral Studies

Palliative care (PC) is the comprehensive management of patients diagnosed with terminal illness. Care for PC patients focuses on relieving symptoms. The purpose of this study was to determine the difference between pretest and posttest scores on the Frommelt Attitude towards the Care of the Dying (FATCOD) and the Palliative Care Quiz for Nurses (PCQN) after an educational intervention to emergency department (ED) nurses. The framework for this project was Bandura's social cognitive theory. The FATCOD was used to assess ED nurses' attitudes toward PC, and the PCQN was used to assess ED nurses' knowledge about PC prior to the …

Examining Nurse Practitioners' Perceptions And Beliefs Regarding Hospice Referrals For African Americans, Karen Jackson Mcclary

Walden Dissertations and Doctoral Studies

Terminally ill patients often have difficult choices at the end-of-life, and electing to receive hospice services is one of them. Hospice has been linked to improved quality of life and death and is accessible to terminally ill patients. Despite the accessibility, African American patients often make the decision to forgo hospice services. The purpose of this descriptive study was to explore perceptions and beliefs of nurse practitioners (NPs) regarding the lack of utilization of hospice for African American patients and the feasibility of NPs for initial referral for terminally ill African American patients. The research questions addressed whether an NP's …

An Educational Initiative To Prevent Unnecessary Hospitalization For Hospice Patients, Alkeisha Hill Mims

Walden Dissertations and Doctoral Studies

Avoidable hospitalizations of hospice patients cost Medicare $3 billion a year. When hospice nurses are able to identify early signs and symptoms of acute illness and provide appropriate interventions to prevent such admissions, 20-60% of the hospitalizations are preventable. The practice problem addressed in this quality improvement doctor of nursing project was the 30% hospital admission rate of hospice patients as evidenced by chart review, admission data, and revocation data. The first purpose of the project was to identify evidence-based nursing care paths in the literature for the top 5 medical diagnoses related to avoidable hospital admissions. The second purpose …

Motivation For Volunteering With Older Adults In A Rural Community, Tonia Maria Truesdell

Walden Dissertations and Doctoral Studies

The Baby Boomer generation in the United States is growing older, and the number of adults age 65 years or older is expected to double by 2050. The increase in older adults combined with the reduction in services to older adults has created a gap in available social services and volunteers are needed to fill those gaps. This quantitative, nonexperimental study was designed to identify the motivations of volunteers who served the socialization needs of isolated older adults in a rural U.S. community. The functional approach theory was utilized to explain how volunteers engage in the same volunteer activity for …

Development Of A Program Proposal For A Nitrous Oxide Program In Pediatrics, Sarah Oleson

Walden Dissertations and Doctoral Studies

When pediatric patients are admitted to the inpatient or outpatient hospital setting they potentially have to endure procedures that cause pain, fear, and anxiety which can have a lifelong impact on the child's response to future healthcare needs. The purpose of this project was to create a comprehensive program proposal for a nitrous oxide sedation program to minimize those perceptions towards medical procedures. The project utilized a systematic review of literature and secondary data to address the most important indicators for developing a comprehensive program proposal to present to the pediatric leadership team. Multiple studies have shown nitrous oxide having …