Digital Commons Network^™

Appreciation Day For Clinical Staff At Vna Hospice, Melody Nguyen

Capstone Projects and Master's Theses

VNA Hospice of the Central Coast is a nonprofit that was created back in 1951. The staff at VNA are visiting about 75,000 homes per year. Throughout the years the staff have been seeing patients who reached the requirement of having 6 months or less to live. Working with Hospice patients can be hard for everyone but, the staff at VNA are seeing the patients from good days and bad days. Depression is known to negatively impact the clinical staff at VNA Hospice. Staff are working long hours which leads to sleep disturbance and chronic stress. Some staff are also …

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 …

Professional Caring In Affective Services; The Ambivalence Of Emotional Nurture In Practice, Niall Hanlon

Articles

Emotional nurturance is a fundamental feature of all forms of professional caring. As well as delivering expert social, health, education, practical or personal services, good caregivers possess an other-centred disposition, are emotionally intelligent and relationally skilled, and morally caring. Despite this, the value, role, and status of emotional nurturance in professional care is ambivalent. Drawing on feminist care theory, Hochchild’s emotional labour theory, and Bourdieusian social reproduction theory, as well as diverse empirical studies, this paper identifies how emotion is marginalised and misrecognised and calls for the reappraisal of emotion in professional care work in ways that appreciate tensions, contradictions, …

High Anxiety And Depression Scores And Mental Health Service Use Among South Asian Advanced Cancer Patients: A Multi-Country Study, Irene Teo, Semra Ozdemir, Chetna Malhotra, Grace Meijuan Yang, Remee Rose Quintana Ocampo, Sushma Bhatnagar, Thushari Hapuarachchi, Anjum Khan Joad, Lubna Mariam, Gayatri Palat, Rubayat Rahman, Eric A. Finkelstein

Research Collection School of Social Sciences

Context. Addressing symptoms of anxiety and depression is important in cancer palliative care. However, little information exists on the prevalence of anxiety and depression and mental health service use among advanced cancer patients in South Asia. Objectives. To examine among South Asian advanced cancer patients, the 1) prevalence of high anxiety and depression scores, 2) factors associated with high anxiety and depression scores, and 3) mental health service use. Methods. This cross-sectional, multi-site study recruited patients receiving oncology care across six major public hospitals in India, Bangladesh and Sri Lanka. Participants were adults, diagnosed with stage IV metastatic solid cancer …

Prognosis Does Not Change The Landscape: Palliative Home Care Clients Experience High Rates Of Pain And Nausea, Regardless Of Prognosis, Nicole Williams, Kirsten Hermans, Tara Stevens, John P. Hirdes, Anja Declercq, Joachim Cohen, Dawn M. Guthrie

Health Sciences Faculty Publications

Background: Most individuals who typically receive palliative care (PC) tend to have cancer and a relatively short prognosis (< 6 months). People with other life-limiting illnesses can also benefit from a palliative care approach. However, little is known about those who receive palliative home care in Ontario, Canada's largest province. To address this gap, the goal of this project was to understand the needs, symptoms and potential differences between those with a shorter (< 6 months) and longer prognosis (6+ months) for individuals receiving PC in the community.

Methods: A cross-sectional analysis was conducted using interRAI Palliative Care (interRAI PC) assessment data collected between 2011 and 2018. Individuals with a shorter prognosis (< 6 months; n = 48,019 or 64.1%) were compared to those with a longer prognosis (6+ months; n = 26,945) across several clinical symptoms. The standardized difference (stdiff), between proportions, was calculated to identify statistically meaningful differences between those with a shorter and longer prognosis. Values of the stdiff of 0.2 or higher (absolute value) indicated a statistically significant difference.

Results: Overall, cancer was the most prevalent diagnosis (83.2%). Those with a shorter prognosis were significantly more likely to experience fatigue (75.3% vs. 59.5%; stdiff = 0.34) and shortness of breath at rest (22.1% vs. 13.4%; stdiff = 0.23). However, the two groups were similar in terms of severe pain (73.5% vs. 66.5%; stdiff = - …

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 …

Ameliorating Stress And Burnout Among Professionals Who Work With Migrants And Refugees, Mark Lusk, Samuel Terrazas

Journal of Human Services: Training, Research, and Practice

Professionals and volunteers who work with refugees and forced migrants experience burnout and secondary stress as a result of exposure to the trauma and adversities confronted by their clients. A pilot project aimed at reducing these problems through the use of group discussion, sharing, guided movement, relaxation techniques, and mindfulness was found to reduce burnout and secondary traumatic stress among participants.

Inpatient Palliative Care Is Less Utilized In Rare, Fatal Extrahepatic Cholangiocarcinoma: A Ten-Year National Perspective, Zahra Mojtahedi, Ji Won Yoo, Karen Callahan, Neeraj Bhandari, Donghui Lou, Katayoon Ghodsi, Jay J. Shen

School of Medicine Faculty Research

Background—Extrahepatic cholangiocarcinoma (ECC) is a rare, morbid, fatal cancer with distressing symptoms. Maintaining a high quality of life while reducing hospital charges and length of stay (LOS) for the end-of-life period remains a major challenge for the healthcare system. Palliative care utilization has been shown to address these challenges; moreover, its use has increased in recent years among cancer patients. However, the utilization of palliative care in rare cancers, such as ECC, has not yet been explored. Objectives—To investigate palliative care utilization among ECC patients admitted to US hospitals between 2007 and 2016 and its association with patient demographics, clinical …

“The System Is Well Intentioned, But Complicated And Fallible” Interviews With Caregivers And Decision Makers About Palliative Care In Canada, Nicole Luymes, Nicole Williams, Liz Garrison, Donna Goodridge, Maria Silveira, Dawn M. Guthrie

Health Sciences Faculty Publications

Background: Canadian palliative care (PC) philosophy seeks to support individuals in a person-centered and sensitive manner. Unfortunately, philosophy does not necessarily translate into practice and this divide may leave patients without appropriate care at the end of life, causing distress for some families. The primary goal of the study was to identify key factors affecting perceptions of quality PC from the perspective of informal caregivers and decision makers (e.g., program managers) and to understand how their experiences within the health care system may have influenced their perceptions.

Methods: Nine caregivers and 11 decision makers from Yukon Territory, British Columbia, Alberta, …

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, …

4. Law Update 2021, Southwestern Oklahoma State University

SWOSU/OU 2021 Joint Preceptor Conference Handouts

This is a document from the SWOSU/OU 2021 Joint Preceptor Conference

Financial Hardship And Health Related Quality Of Life Among Older Latinos With Chronic Diseases, Frances R Nedjat-Haiem, Tamara Cadet, Humberto Parada, Tessa Jones, Elvira E Jimenez, Beti Thompson, Kristen J Wells, Shiraz I Mishra

Pediatrics Research and Scholarship

BACKGROUND: Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations.

OBJECTIVE: We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer.

METHODS: This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). …

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 …

2021-2022 Pediatric Subspecialty Trainees, Children's Mercy Hospital

Residents and Fellows Portraits

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

Utilizing Virtual Reality To Introduce Hospice And End-Of-Life Approaches, Sydney P. Springer, George P. Allen

Pharmacy Practice Faculty Posters

Research poster describing the following:

The objective of this study was to assess changes in students’ comfort with talking about and caring for patients at EOL. A gap in the degree of instruction regarding palliative care in pharmacy curricula has been identified. The use of a virtual reality experience (VRE) has been shown to increase students’ understanding of and empathy for older adults with age-related conditions. We created a two-part palliative care series embedded into the 3rd professional year curriculum. Part one discussed perceptions of death and deprescribing at end-of-life (EOL). Part two used the Embodied Labs® VRE to follow …

Essential Package Of Palliative Care For Women With Cervical Cancer: Responding To The Suffering Of A Highly Vulnerable Population, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of …

Augmented Package Of Palliative Care For Women With Cervical Cancer: Responding To Refractory Suffering, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all …

Optimizing Communication In Palliative And Hospice Care: A Toolkit For Audiologists, Sherry E. Queen

Dissertations, Theses, and Capstone Projects

The prevalence of hearing loss increases with age, with age-related hearing loss (ARHL) being one of the most prevalent forms of sensory decline in older adults. Hearing loss is often overlooked in medical settings including palliative and hospice care. Screening for hearing loss in these settings is rare as is formal staff training on assessing and managing hearing loss in palliative and hospice care. An evidence-based toolkit for integrating audiologists into end-of-life care protocols is presented. This toolkit was developed to optimize communication in palliative and hospice care for patients, caregivers, audiologists, physicians, and other palliative care staff. Effective communication …

Nursing And Midwifery Links [June 2021 Issue], Secretariat At Johns Hopkins University School Of Nursing Global Network Of Who Collaborating Centers For Nursing And Midwifery

Nursing and Midwifery Links (LINKS)

In this June edition, all regions of the Collaborating Centers are represented with insight into the global health experience as Nurses, Midwives, Students, and Educators over the past six months. Progressive programs for better supporting the dedicated Nurse are explored. Our international colleagues are celebrated and honored; as well as mourned. In honor of those who lost their lives during the Covid Pandemic, and those who continue to forge on in the face of loss, we offer a heartfelt representation of solidarity in the form of voices from Collaborating Centers across the globe, from our community to yours.

Promoting Health Literacy To Aging Christians To Combat The Scourge Of Euthanasia Through The Church, Willie Mae Corley

Doctoral Dissertations and Projects

The many dilemmas that occur in the medical care of chronically ill seniors raise the question of whether senior populations have become the new black. The research seeks to provide an evidence-based review of limited health literacy among elderly African American Christians regarding diagnoses and medical treatments, which has resulted in unethical Christian practices becoming a norm. The researcher adapted the health literacy framework of Paasche Orlow and Wolf’s view of three distinct causes that influence health literacy: the access and utilization of health care, the patient-provider relationship, and self-care. The problem is that Victory Church members may not understand …

Beyond Bingo: Enhancing Quality Of Life In The Face Of Death For Hospice Patients With Dementia Through Integrated Expressive Arts Therapies, Development Of A Method, Jeanie Cooper Carson

Expressive Therapies Capstone Theses

This paper explores ways integrated expressive arts therapies (EAT) used with individuals with dementia in hospice can help facilitate living well in the face of dying. While research is limited regarding use of EAT with this population specifically, much significant research has been conducted to support the effectiveness of the employment of various creative arts modalities with individuals with dementia and also on hospice. Building on this research, the author developed and implemented an integrated EAT method with members of this population living in long-term care facilities in Greater Boston in the context of the pandemic of 2020-21. This paper …

Clinical Pharmacy Services And Medication Utilization In Hospice Care, Aishwarya Kulkarni

Electronic Theses and Dissertations

Background: As discussed within the guidelines from the American Society of Health-System Pharmacists (ASHP), pharmacists are an integral part of the hospice multidisciplinary team involved in optimizing the treatments. Methadone, a long-active opioid, is particularly useful in this population but may be clinically underutilized. Additionally, the cost share of medication utilization in hospice and palliative care is shifting towards hospice providers. The assessment of medication utilization and methadone use in this setting can help develop overall cost/clinical optimization strategies. Thus, there is a need to understand the use and expenditure of various medications and pharmacists' role in providing methadone …

Death And Dying: Incorporating A Hospice Approach, Dominique Gomez

Theoretical Foundation in Advanced Practice Nursing

No abstract provided.

Essential Competencies For Occupational Therapy In End-Of-Life Care, Karmella Bognot

UNLV Theses, Dissertations, Professional Papers, and Capstones

Occupational therapists carry an abundance of expertise in helping patients and caregivers navigate the end-of-life journey. The lack of knowledge of OT’s role impacts occupational therapy utilization and service provision in hospice. It reduces opportunities for this population to increase their understanding on how to maintain quality-of-life. The more a patient is able to do lessens the burdens shouldered by the caregiver. Education on pain management and promoting comfort are typical priorities addressed; however, not enough training is focused on maximizing independence or engagement in occupations. Competencies encompass a unique set of skills, knowledge, and abilities necessary for successful performance …

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 …

Improving Quality Of Life Among Individuals With Neurocognitive Disorders Using Occupational Therapy And A Sensory Integration Approach, Makenzie K. Johnson

Occupational Therapy Capstone Presentations

Abstract

Currently, 50 million people worldwide are affected by major neurocognitive disorder (MND). Those with MND often exhibit behavioral and psychological symptoms that have a significant impact on occupational participation and overall quality of life. Symptoms are frequently treated with anti-psychotics; however, a need for a non-pharmacological approach to alleviate these symptoms is indicated through current research. This 14-week Capstone experience was completed in the memory care neighborhoods at Sunrise Retirement Community in Sioux City, Iowa. Throughout this experience, knowledge related to effective caregiving strategies and sensory based interventions was enhanced, education was provided to memory care staff and occupational …

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 …

Critical Conversations: Improving Goals Of Care Conversations At Southeast Family Medicine, Elizabeth Deyo, Michael Dirks, Tyler Nelson, Katherine Cobb, Nicholas Wolfgang, Hannah Kadavy, Ben Pederson

Milwaukie Family Medicine 2021

Quality Improvement Project - Background

Introduction Goals of care (GOC) conversations are an essential element of high quality patient care across care contexts. At our residency clinic site, Southeast Family Medicine, there currently is not a standardized workflow that encourages and reminds providers to complete and document GOC discussions with their patients. Currently, end of life planning is tracked and monitored primarily through two tools: patient completion of advanced directives and POLST forms. Although these two documents are important, their use and application is at times to general or specific to truly reflect a patient’s perspective on their goals of …