Digital Commons Network^™

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

Master's Projects and Capstones

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

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

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

Master of Science in Nursing Final Projects

Abstract

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

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

Raps Sheet, December 2022, Retirement Association Of Portland State

RAPS Sheet: Monthly Newsletter

No abstract provided.

Epidemiology, Outcomes And Tolerability Of Protracted Treatment Of Nontuberculous Mycobacterial Infections At A Community Teaching Hospital In The Southeastern United States, Yuwei Vivian Tsai, Carolina Derrick, Ismaeel Yunusa Ph.D., Sharon Weissman, Majdi N. Al-Hasan, Julie Ann Justo Pharm.D., P. Brandon Bookstaver Pharm.D.

Faculty Publications

Nontuberculous mycobacterial (NTM) infections present a treatment challenge for clinicians and patients. There are limited data about current susceptibility patterns and treatment outcomes in U.S. adults. This was a 10-year, single-center, retrospective, observational cohort study of adults with a positive NTM culture and clinical suspicion of infection between 1 January 2010 and 30 June 2020. The primary objective was to identify predictors for favorable treatment outcomes. Key secondary objectives were characterization of NTM epidemiology, susceptibility profiles, and safety and tolerability of treatment, including the proportion of subjects with an antimicrobial change and the reasons for the change. Of 250 subjects …

Palliative Care In The Icu, Grace Cunningham

MSN Capstone Projects

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

Improving Patient Mobility-A Great Move!, Heather Hwang Granada, O Erin Reitz, Johanna Lemke

Nursing

Background: Hospital associated disability has been linked to prolonged and inappropriate mobility. Ambulating hospitalized patients can improve outcomes, but this practice is often overlooked by nurses who have competing priorities.

Local Problem: At Advocate Illinois Masonic Medical Center after conducting an interview with frontline staff there were revealed gaps in knowledge of progressive mobility protocols/assessment, completing priorities, and perception around a lack of assistance to mobilize complex patients. Additionally, a random sample audit of 100 charts only revealed 10% of patients with any mobility documented.

Methods: This is a quality improvement initiative that utilized a prospective design and took …

Raps Sheet, November 2022, Retirement Association Of Portland State

RAPS Sheet: Monthly Newsletter

No abstract provided.

Research Attitudes, Practice And Literacy Among Kenyan Palliative Care Healthcare Professionals: An Observational, Crosssectional Online Survey, Ra Powell, Z Ali, Nancy Gikaara, Qanungo S, Es Melikam, Kb Cartmell

Internal Medicine, East Africa

Background: While research is needed to advocate for implementation of global agendas to strengthen palliative care, healthcare professionals’ research literacy must improve to bridge the gap between evidence and practice. A resurgent focus on North-South power disparities, means attention should also focus on understanding low- and middle-income countries’ local agency to implement palliative care research agendas.

Methods: An observational, cross-sectional online survey among Kenyan palliative healthcare professionals currently working at any of the palliative and hospice care organizations operational during January – December 2019, using descriptive statistics.

Results: Among the 93 survey respondents, participants were mainly nurses (50.54%; n=47). Regarding …

Parents/Caregiver's Health, Stress, And Perceived Caregiver Burden In The Difficult First 3 Months After Their Infant/Child With Special Health Care Needs Is Discharged Home, Carmen Caicedo

Sigma Foundation for Nursing Research Grant Reports

The purpose of this exploratory study with three time points will examine the physical health, mental health, stress using biomarker levels (salivary cortisol), and perceived caregiver burden of Hispanic, Black, and White parents of an infant/child (birth to 5 years) newly diagnosed with special health care needs (SHCN) over the first three months after discharge home from a NICU or PICU.

“The Hierarchy Is Your Constraint:” A Qualitative Investigation Of Social Workers’ Moral Distress Across A U.S. Health System, Sophia Fantus, Rebecca Cole, Lataya Hawkins

School of Social Work Faculty Publications

This paper reports findings from a qualitative study on the triggers of hospital social workers’ moral distress at a large southern U.S. health system. Moral distress occurs when ethical conflict cannot be resolved in a way that aligns with an individual’s personal and professional values and ethics. Participants indicated that moral distress derives from both individual interactions and the culture and climate of health systems. For example, participants expressed how sources of moral distress derived from client-centered decisions, such as end-of-life care and patient autonomy; interpersonal dynamics, including team or supervisory conflict; structural issues, such as insurance barriers or internal …

Hybrid Theory: Creation Of A Faculty Position That Allows Half-Time Hospice Employment Alongside Academic Palliative Care, Michael Cafarchio, Dierdre M. Salanger, W. Anthony Riley, Amanda Vanderzyl, Catherine Y. Hamel, Thomas J. Smith, Danielle J. Doberman

Administration Articles

BACKGROUND: The specialty of hospice and palliative medicine struggles to merge the fast-paced technological consultative work of acute hospital palliative care with slower paced and home-based hospice. Each has equal if different merits. Here, we describe creation of a position that allowed half-time hospice employment, alongside academic hospital-based palliative care.

METHODS: Johns Hopkins Medicine and Gilchrist, Inc., a large nonprofit hospice, partnered to form a joint position with time spent equally between the two locations.

RESULTS: Created as a university position with "leasing" to the hospice, specific attention has been paid to mentoring at both sites to allow professional advancement. …

A Pruritic Eyelid Lesion Followed By Conjunctival Swelling, Eun Young Choi, A D. Proia, Kyle Kirkland

Osteopathic Medicine, Jerry M. Wallace School of

No abstract provided.

Physician False Claims Act Liability—The Circuit “Split” That Illustrates The Need For Health Courts, Nicole Rickerd

Chapman Law Review

"A man was diagnosed with lung cancer. 1 His oncologists discovered the cancer metastasized, meaning it spread to his brain and bones. 2 The patient received chemotherapy treatments. 3 Chemotherapy has numerous side effects, one of which is febrile neutropenia, a fever resulting from a patient lacking in a type of white blood cells. 4 Unfortunately, the patient developed febrile neutropenia approximately six months after his diagnosis. 5 He was admitted to the hospital, where he was treated by the inpatient physicians. 6 The inpatient physicians prescribed and administered broad spectrum antibiotics, which resolved the patient’s fever. 7 Concerned the …

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

Research outputs 2022 to 2026

Background:

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

Goals:

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

Methods:

An international and interprofessional expert committee, …

No Leave To Grieve: How Misfit Frameworks And America's "Grief Tsunami" Require Better Bereavement Policy, Katherine S. Hanson

Marquette Benefits and Social Welfare Law Review

The COVID-19 pandemic fueled America’s recent death surge: 2021 has become the deadliest year on record in the United States. Scholars and commentators claim that the American workplace re-mains unprepared for the impending “grief tsunami” in the wake of such pervasive loss. Likewise, American law is ill-equipped for workplace grief. Bereavement, while medically “normal,” lacks a substantial foothold in workplace benefits and in the law. Currently, organizations bear the burden of developing their own policies—and where available, these policies remain insufficient to accommodate the myriad logistical and emotional complexities associated with the loss of a loved one. In the event …

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

Student Scholarly Projects

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

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

Evidence: The current evidence has demonstrated that advanced care …

What Is The State Of The Literature About Robotic Animal Use Among Older Adults Receiving Hospice Or Palliative Care?, Allyson Miles

Social Work Theses - Archive

Objective: This review aims to assess the extent of the literature on robotic pet use among older adults receivinghospice or palliative care. Introduction: In 2015, in the U.S, an estimated 1,426,00 individuals received hospice; among this population, 94.6% were aged 65 or older (National Center for Health Statistics,2019). According to the literature, a social robot is defined as something that interacts with individuals socio-emotionally during the intervention (Hudson et al., 2020). Social robots, including robotic pets, are promising technological interventions that can benefit the psychosocial health of older adults and people with dementia. Although there are previous reviews on robotic …

Positive Ageing And Death Or Dying: A Scoping Review, Robin Otto

Social Work Theses - Archive

This scoping review aims to examine the extent and how research that utilizes successful, active, productive, and healthy ageing framework(s) include death or dying. An examination of peer-reviewed academic articles published between 1980 and 2021 were reviewed following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's five-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A thematic analysis was the qualitative method employed to identify how research utilizes the concepts of death and dying in the context of four …

Choices Related To Maximizing Quality Of Life At End Of Life, Theresa Lynn

Dissertations

Humans, including those residing in the United States, can live in denial of their own mortality. Because of this, futile care is sometimes provided, often at great monetary expense and for little or no return in terms of quality or length of life. At least two opportunities exist for making choices regarding care at the end of life in the U.S.: completing advance directives and choosing hospice care.

2022-2023 Pediatric Subspecialty Trainees, Children's Mercy Kansas City

Residents and Fellows Portraits

Photo composites of the graduate pediatric trainees in adolescent medicine, allergy/immunology, child abuse pediatrics, child neurology, clinical neuro-psychology, coagulation, congenital cardiac surgery, clinical child psychology, developmental-behavioral pediatrics, epilepsy, hospice & palliative care, laboratory genetics & genomics, pediatric anesthesiology, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric bioethics, pediatric cardiology, pediatric EM/child abuse, pediatric critical care medicine, pediatric dentistry, pediatric emergency medicine, 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 pathology; pediatric pulmonology, pediatric radiology, pediatric rehabilitation, pediatric sports medicine, pediatric surgery, sleep medicine, pharmacy, pediatric residency …

Music Therapy Program Development In A Hospital Setting: A Critical Review Of Literature, Alexandria Rodriguez

Expressive Therapies Capstone Theses

This capstone is a critical review of literature regarding development of music therapy programs in general hospital settings within the United States. This document will assist in defining important aspects of program success and serve to help better advocate for music therapy programs, creative arts therapies, and well-being programs functioning within a traditional general hospital setting. This capstone thesis presents key elements of successful music therapy program development, as proposed by in-field music therapist interview, studies utilizing music therapy in general hospital settings to serve both patients, hospital staff, and community outreach, suggestions for arts in health curricular development, and …

Improving Palliative Care Education In The Acute Hospital Setting, Maria Klug

Doctor of Nursing Practice Scholarly Project

As the geriatric population grows rapidly, the importance of utilizing and understanding palliative services continues to rise. Although palliative and hospice care are included in different healthcare courses, misconceptions and lack of knowledge continue to serve as barriers to the utilization of palliative care. The purpose was to assess knowledge, improve palliative care education, and increase understanding of the perspectives of the interdisciplinary team involved in acute patient care. The setting was the telemetry unit in a 300-bed acute care Kansas hospital. A mixed design was utilized with a goal of quality improvement in the use of palliative care. The …

Not Quite What The Doctor Ordered: The Third Circuit Pulls The Plug On Objective Falsity In United States Ex Rel. Druding V. Care Alternatives, Jenna L. Schaffer

Villanova Law Review (1956 - )

No abstract provided.

Implementation Of A Nurse Driven Palliative Care Consult: A Quality Improvement Project, Socnite Sebourne-Francis

DNP Projects

Background: Palliative care consult (PCC) is an approach that can improve the quality of life and symptom management of patients facing life-threatening illnesses. At a 20-bed medical oncology unit in Connecticut, patients with poor prognosis and worsening symptoms have high re-admission rates within 30 days of post-hospital discharge; yet healthcare providers fail to initiate PCC.

Purpose: This project hypothesizes how implementing a nurse-driven PCC on admission or hospital stays compared to the timing of a physician to a physician PCC improves a plan of care for oncology patients? Will it result in a decrease in 30-day re-admission rates? The …

What Can We Learn From The Caregivers Of Adults With Dementia? A Qualitative Study, Lauren Michalakes Md

Muskie School Capstones and Dissertations

Introduction: In the US today, there are approximately 6.5 million people age 65 or older living with Alzheimer’s Disease or other dementias. This number is expected to increase to 12.7 million by 2050. Dementia imposes debility and frailty upon those effected, which is progressive and often follows an unpredictable trajectory. This places significant burdens on their informal caregivers, negatively impacting financial security, emotional and physical health, and overall quality of life. Informal caregivers are a heterogeneous group of partners, spouses, adult children, family members and others. Purpose: This qualitative study explores the experiences, worries and concerns of informal caregivers of …

Resiliency In Nursing: An Integrative Review, Valerie Yvonne Moke

Doctoral Dissertations and Projects

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

Improving End Of Life Care: Symptom Assessment And Education For Informal Hospice Caregivers (A Quality Improvement Project), Erika Buchholz

DNP and Student Works

In the setting of COVID-19, more individuals experience the dying process in their home rather than at hospice facilities. Currently, there are limited resources to help informal caregivers identify signs and symptoms of death and dying. The Edmonton Symptom Assessment System (ESAS) is a standardized assessment tool that can be offered in the hospice setting. This quality improvement (QI) project aims to increase utilization of the ESAS tool among caregivers with loved ones enrolled in hospice.

The Covid-19 Pandemic: Early Ripple Effects In Pediatric Palliative Care, Linda Marisol Bustamante, Regina Okhuysen-Cawley, Julia Downing, Stephen R Connor, Mary Ann Muckaden, Marianne Phillips, Andrea Icaza, Nicole Garzon, Yuriko Nakashima, Kelsi Morgan, David Mauser, Michelle Grunauer

Faculty, Staff and Students Publications

Palliative care, which aims to provide comprehensive, interdisciplinary, holistic care to children, adolescents and adults with life-threatening, and ultimately life-limiting conditions, is a discipline that has emerged as an integral component of healthcare systems throughout the world. Although the value of life-affirming palliative care (PC) has been shown across many domains, funding and acceptance of palliative care teams have been variable: some hospital systems have free-standing, dedicated interdisciplinary teams while, in many instances, palliative care services are provided "pro bono" by individuals with a special interest in the discipline, who provide PC in addition to other responsibilities. In this article, …

The Caregiver's Conflict: The Toll Of Death And Dying On Nurses' Mental Health And Wellbeing, Madison Brown

Student Works

A major responsibility for nurses is caring for patients during the end-of-life process, as well as helping families and patients cope with the death and dying process. It is well known that death and dying greatly impacts families, but little holistic research has been done on how death and dying impacts nurses’ mental and emotional wellbeing. Using databases Google Scholar, Web of Science, and EBSCO, 14 articles were analyzed regarding the impact of death on nurses’ mental health. Results show that the age of a patient plays a bigger role on death impact than nursing specialty does, as younger patients’ …

A Multi-Stage Process To Develop Quality Indicators For Community-Based Palliative Care Using Interrai Data, Dawn M. Guthrie, Nicole Williams, Cheryl Beach, Emma Buzath, Joachim Cohen, Anna Declercq, Kathryn Fisher, Brant E. Fries, Donna Goodridge, Kirsten Hermans, John P. Hirdes, Hsien Seow, Maria Silveira, Aynharan Sinnarajah, Susan Stevens, Peter Tanuseputro, Deanne Taylor, Christina Vadeboncoeur, Tracy Lyn Wityk Martin

Health Sciences Faculty Publications

Background: Individuals receiving palliative care (PC) are generally thought to prefer to receive care and die in their homes, yet little research has assessed the quality of home- and community-based PC. This project developed a set of valid and reliable quality indicators (QIs) that can be generated using data that are already gathered with interRAI assessments-an internationally validated set of tools commonly used in North America for home care clients. The QIs can serve as decision-support measures to assist providers and decision makers in delivering optimal care to individuals and their families.

Methods: The development efforts took part in multiple …