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

Residents and Fellows Portraits

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

Legislating The Right-To-Die With Dignity In A Confucian Society—Taiwan’S Patient Right To Autonomy Act, Chih-Hsiung Chen

UC Law SF International Law Review

In Confucian societies, people tend to avoid the discussion on death matters, let alone making advance directives to reject life-sustaining treatments at the end of life. Taiwan might be a pioneer in legislating the right-to-die with dignity among Confucian countries. As early as 2000, the Hospice Palliative Care Act was declared in Taiwan, which give terminally-ill patients the options to forgo life-sustaining treatments. Furthermore, in 2016, Taiwan passed the Patient Right to Autonomy Act to enhance patients’ choice at the end of life and expanded the coverage to certain types of nonterminally ill patients. On the other hand, end-of-life issues …

Changes In Baccalaureate Nursing Students' Perceptions About Caring For Dying Patients, Helen M. Taggart, Pamela L. Mahan, Haresh Rochani

International Nursing Research Congress (INRC)

The purposes of this study were to determine the changes in attitudes of baccalaureate nursing students toward caring for the dying from the beginning to the end of a baccalaureate nursing program and identify factors that influence students' perceptions. A multi method study was utilized.

Challenges In Advanced Care Planning In Primary Care: A Systematic Review, Pamela Willson, Sue Ellen Gondran

International Nursing Research Congress (INRC)

The greatest obstacle to Advance Care Planning (ACP) is initiating the difficult conversation about death and planning for the end that is culturally sensitive and patient-centered. Poor end-of-life communication skills, lack of relationship building skills, and time constraints were the highest rated barriers to ACP. Improving outcomes will be discussed.

Closing The Gap In Hospice Utilization For The Minority Medicare Population, M. Courtney Hughes, Erin Vernon

Faculty Articles, Papers, and Other Scholarship

Background: Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people. With lower hospice utilization rates, racial/ethnic minorities receive fewer hospice-related benefits such as lesser symptoms, lower costs, and improved quality of life. For-profit hospices have higher dropout rates than nonprofit hospices, yet target racial/ethnic minority communities more through community outreach. This analysis examined the relationship between hospice utilization and for-profit hospice status and conducted an economic analysis of racial/ethnic minority utilization. Method: Cross-sectional analysis of 2014 Centers for Medicare & Medicaid Services (CMS), U.S. Census, and Hospice Analytics data. Measures …

Using Dance/Movement Therapy To Educate Hospice Providers On Preventing Burnout: A Method, Victoria G. Powell

Expressive Therapies Capstone Theses

Burnout is a clinical condition that an individual may experience whenever they are in a constant state of stress. It is categorized by three groups of symptoms: emotional exhaustion, depersonalization, and negative self-evaluation of personal achievement (Rizo-Baeza et al., 2017, p. 19). This inquiry investigated the impact of burnout on hospice professionals and volunteers through researching previous literature. The research led to the development of a psychoeducational, body-based method with a Dance/Movement Therapy (DMT) foundation. This preventative method was implemented in two separate workshops for hospice professionals and volunteers at a Massachusetts-based hospital system. Results indicate a need for training …

Joan Marston Oral History.

Pediatric Palliative Care Oral History Project

Ms. Marston introduces her career beginnings as a response to the HIV/AIDS crisis in South Africa and describes some of the memorable experiences with youth she cared for. She explains her role in the initial implementation of pediatric palliative day care and home care as well as some of the challenges around growing provider, political, and community education in South Africa. Ms. Marston then talks about her international experiences meeting other in pioneers in the pediatric palliative care field. She touches on her work in developing hospice programs as well as some of the global challenges she's experienced while establishing …

Stephen Connor Oral History.

Pediatric Palliative Care Oral History Project

Dr. Stephen Connor begins by describing some of his early professional experiences and mentors who supported him as he developed his interest in death and dying. Dr. Connor explains that after several "epiphany moments" and observing some of the death and dying practices abroad, he and several other like-minded professionals said: "You know, really, we should just start a hospice." Dr. Connor then describes his early professional experiences of co-founding some of the earliest hospice programs in the United States, which drove his career from local hospice programming to national programming and finally into the international programming, research, publications, and …

A Step Toward Normalizing End-Of-Life Care: Implications Of The Palliative Care And Hospice Education And Training Act (Pcheta), Robert Bulanda

Northern Illinois University Law Review

Despite their rapid development in recent decades, hospice and palliative care continue to face challenges to universal acceptance and access throughout American society, as the American population and medical professions are reluctant to move away from traditional preventative care throughout the death and dying process. The Palliative Care and Hospice Education and Training Act (PCHETA) is a federal bill seeking to increase access to palliative and hospice care. This Note analyzes the history of the palliative and hospice care movement and the implications of the PCHETA, arguing that the bill acts as an important step toward normalizing hospice and palliative …

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. …

Developing Stem Identity Of Nez Perce Students: Identifying Entry-Level Competencies For Forestry And Fire Management, Raymond A. Dixon, Karla Eitel, Yudi Zhu

Journal of Research in Technical Careers

The purpose of this study was to identify the competencies that are required for entry-level forestry and fire management technicians. The strategy is a part of a larger goal to develop the STEM identity of Nez Perce students through the integration of relevant competencies in middle and high school curriculums. The DACUM process was used. Through this groupware process, nine experts from the Nez Perce Natural Resources produced a competency profile consisting of 12 duties and 79 tasks, along with general knowledge and skills, attitudes, tools, and future trends. Findings indicate that the experts view relevant cultural competencies as central …

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 …

Kajian Narrative Terhadap Profil Farmakokinetik Antibiotik Pada Pasien Kritis: Implikasi Terhadap Ketercapaian Target Farmakokinetik-Farmakodinamik, Eko Setiawan, Widyati, Ferdy Royland Marpaung, Edy Sukandar, Susaniwati, Dwi Lily Lukas, Heru Wijono, Taufin Warindra, Roni Kurniawan, Tjipto Wibowo, Wahyu Hendradi, Menino Osbert Costa, Mohd-Hafiz Abdu Aziz, Jason Roberts

Pharmaceutical Sciences and Research

The severity of diseases, the complexity of treatment, and the use of medical devices in the intensive care unit (ICU) may change the pharmacokinetics (PK) profile of antibiotics among critically ill patients.This narrative review aims to explain the PK profile of critically ill patients compared to other group of patients and to describe the pharmacokinetic-pharmacidynamic (PK-PD) target attainment among this group of patients. Only articles published less than 10 years ago were included in this narrative review. Evidences have indicated that critically ill patients have relatively larger volume distribution (Vd) of hydrophilic antibiotics compared to patients with stable conditions. The …

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 …

Loss Of A Sibling: A Phenomenological Exploration Of The Experiences Of School-Aged Children, Barbara Dixon

Dissertations

More than 50,000 child mortalities are recorded in the U.S. each year. As a result, almost 8% of the population experience the loss of a brother or sister before age 25 (Jacobs & Bovasso, 2000). This study was an open conversational exchange with ten Grief Counselors who worked with school-aged children, who had experienced the loss of a sibling, to identify the behaviors and expressions of this group of Disenfranchised Grievers. Three patterns were identified: 1) Grief in children takes different forms, 2) Sibling loss in childhood is a life-changing event and 3) Childhood grief has its own time. Each …

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

Doctoral Projects

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

Short-Stay Palliative Pain Management For Southwestern Va: Process Improvement Plan, Christopher M. Rumsey

DNP and Student Works

The increased demand for palliative care services has led to concerns regarding workforce knowledge specific to palliative pain management for patients with life-limiting illnesses. Educational preparedness of nurses along with best processes and practices are necessary to promote optimal care for patients requiring palliative pain management. Through analyzing Veterans Administration (VA) Strategic Analytics for Improvement and Learning (SAIL) data, a deficiency in short-stay self-reported palliative Veteran (patient) pain management at the Southwestern (SWVAMC) a level 1B, tertiary care referral center was identified. Best practices in the palliative care industry were identified, and a quality improvement plan in the form of …

Fostering A Spirit Of Well-Being: One Faculty's Journey In Shaping A Culture Of Civility, Elizabeth White-Macdonald, Colette R. Foisy-Doll, Vincent Salyers, Emily M. Khalema, Safina Mcintyre, Melanie Gates, Gail Couch, Rosie Gakhal, Sara Bevan, Binthi Samuel, Keri-Ann Berga, Mona Haimour, Jessica Wyllie

Creating Healthy Work Environments (CHWE)

Civility matters and is challenging to foster and sustain in organizations. Current evidence supports strategic and ongoing efforts to create and sustain healthy work environments. This presentation outlines the strategic pathway used by one Faculty of Nursing in Canada to foster a Spirit of Well-Being for faculty, students, and staff.

Understanding Care When Cure Is Not Likely For Young Adults Who Face Cancer: A Realist Analysis Of Data From Patients, Families And Healthcare Professionals, Susie Pearce

School of Nursing and Midwifery

No abstract provided.

Multidisciplinary Care In Motor Neuron Disease, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Motor neuron disease (MND) is a progressive degenerative disorder of the motor neurons, resulting in progressive limb, bulbar and respiratory muscle weakness. No definitive disease modifying treatment is available at this time. The mainstay of management remains multidisciplinary care, which has shown to improve quality of life, prevents complications and may also increase life span. In this review, different medical specialties necessary to offer complete multidisciplinary care are discussed. Symptomatic management of individual symptoms commonly experienced by patients with MND is elaborated on.

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 …

Elderly Abuse, Jessica Morris

Integrated Studies

The aim of this paper is to inform individuals about the rising issues of Elder abuse. The different types abuse includes mental, physical, emotional and exploitation. Each state has their own regulation surrounding abuse. 1993 All states enacted laws addressing elder abuse. The laws are very diverse with many sections. (Domestic Elder Abuse and the Law

Gerald J. Jogerst, Jeanette M. Daly, Margaret F. Brinig, Jeffrey D. Dawson, Gretchen A. Schmuch, Jerry G. Ingram).

Elder abuse effects many lives across the United States. The lives that it affects are forever changed. Elder abuse …

Potential Quality Indicators For Seriously Ill Home Care Clients: A Cross-Sectional Analysis Using Resident Assessment Instrument For Home Care (Rai-Hc) Data For Ontario, Lisa E. Harman, Dawn M. Guthrie, Joachim Cohen, Anja Declercq, Kathryn Fisher, Donna Goodridge, John P. Hirdes, Hsien Seow

Health Sciences Faculty Publications

Background

Currently, there are no formalized measures for the quality of home based palliative care in Ontario. This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment.

Methods

Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of …

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 …

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 …

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 …

Implementing Serious Illness Conversations In A Gastrointestinal Oncology Clinic: A Mixed Method Evaluation Of A Quality Improvement Initiative In A Boston Hospital, Rhaea N. Photopoulos

DNP Scholarly Projects

INTRODUCTION: Many times, advanced care planning happens too late in patients with metastatic gastrointestinal cancer, patients and families are not educated on prognostic awareness and are often not well and poorly equipped to make informed end of life decisions.

AVAILABLE KNOWLEDGE: A Serious Illness Conversation guide was developed and implemented in a Boston hospital to aid practitioners (oncology nurse practitioners and oncologists) in facilitating advanced care planning. The aim of this study was to describe provider experience with the conversation guide and understand facilitators and barriers to implementation of advanced care planning.

METHODS: The Plan Do Study Act Method of …

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 …

Advance Directives For Older Adults In Primary Care: An Intervention To Promote Screening And Documentation, Kathryn Bower

DNP Projects

Background: Advance care planning is the process of making decisions about the healthcare one wishes to receive should they become unable to make decisions for themselves, including the development of advance directives and designation of health care surrogates. Advance care planning is universally supported by governing bodies and professional organizations; however, less than one-third of Americans have an advance directive or designated health care surrogate.

Purpose: The purpose of this project was to assess primary care provider attitudes and knowledge of advance care planning and to increase screening for and documentation of advance directives and/or health care surrogates …