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Reducing The Rate Of Falls In Hospice Patients: A Fall Prevention Pilot Program, Allison Floyd

Doctor of Nursing Practice Final Manuscripts

Background and Evidence Problem: As the population ages, there is an increase in the incidents of falls. Falls are the predominant cause of both nonfatal and fatal injuries among adults aged 65 years and older (Bergen et al., 2016). Extensive research has been conducted in fall prevention in hospitals, skilled nursing, and rehabilitation units. End-of-life care in a hospice setting presents a greater challenge in risk identification and prevention of falls. A local hospice had 457 falls between July 2018 to mid-March 2019 with a lack of consistent, detailed, fall education and documentation.

Evidence-Based Practice Intervention: Utilizing the American Geriatrics …

Adoption Of Macy Catheter By Aurora At Home Hospice Staff: A Quality Improvement Evaluation Study, Patrick Herson, Kavita Sharma, Kristi Barfield, Nora Clapsaddle

Aurora Hospice/Palliative Medicine Fellows

Background: The Macy Catheter (MC) is a tool to aid rectal delivery of oral medications in microenemas. In 2019, Aurora Health at Home hospice chose the MC as a preferred route for delivery of medications when patients no longer tolerate the oral route. Despite training, adoption of the MC has been slow.

Purpose: To determine what barriers exist to faster adoption and utilization of the MC by hospice nursing staff. It is anticipated that once the barriers are identified they will be addressed through a campaign of quality improvement projects with subsequent monitoring of adoption.

Methods: An anonymous survey was …

The Effect Of The Timing Of A Hospice Referral And The Perceived Quality Of Care By The Family, Caitlin Tran

Nursing | Senior Theses

Hospice care is a specialized type of palliative care for patients with a time-limiting illness. Despite its benefits, hospice remains underutilized. A key reason behind the underutilization are untimely referrals, often made during the last weeks or days of the patient’s life. The purpose of this paper is to investigate the existing barriers towards hospice that play into late referrals and its effect on patient/family satisfaction. This information will be examined to propose a pilot research study for further exploration.

Santa Cruz Hospice: Transitions And Palliative Care Services Pilot Volunteer Program, Renalyn Mae Serrano

Capstone Projects and Master's Theses

Hospice of Santa Cruz County is regarded as the most experienced hospice program in the region. Currently, terminally ill patients who are not enrolled in any type of hospice care program are not receiving resources for services soon enough. Also, the transitions and palliative care patients at Hospice aren’t receiving adequate social or emotional support. This project piloted a Transitions and Palliative Care Services Volunteer Program with volunteers providing direct services through biweekly or monthly visits to patients that included companionship, emotional support and cognitively stimulating activities. The direct service of volunteer visits was used in order to increase patient …

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 …

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 …

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 …

Elnec Core Module 1: Palliative Nursing Care, Betty Rolling Ferrell, Pamela Malloy, Polly M. Mazanec, Judith Ann Paice, Patrick Coyne

General Submissions: Presentations (Oral and Poster)

Describe the role of the nurse in providing quality palliative care for patients across the lifespan. Identify the need for collaborating with interdisciplinary team members while implementing the nursing role in palliative care. Recognize changes in population demographics, healthcare economics, and service delivery that necessitate improved professional preparation for palliative care. Describe the philosophy and principles of hospice and palliative care that can be integrated across settings to affect quality care at the end of life. Discuss aspects of assembling physiological, psychological, spiritual, and social domains of quality of life for patients and families facing a life‐threatening illness or event.

Elnec Pediatric 2018: Module 1, Betty Rolling Ferrell, Pamela Malloy, Polly M. Mazanec, Judith Ann Paice, Patrick Coyne, Amy Haskamp

General Submissions: Presentations (Oral and Poster)

Principles of Hospice & Palliative Care for Children

Child and family as unit of care with attention to caregiver support

Adolescents and young adults have distinctive needs

Attention to physical, psychological, social, and spiritual needs

We Are The Medicine, Madalynn Wendland, Toni Speed

Interprofessional Education

We are all healers— to ourselves, each other and the world around us. Whether you are on the path of becoming a health professional, or have been in practice for a long time, this half-day workshop will help you to view healing from a holistic perspective that draws from the ancient traditions while respecting contemporary science.

Improving Nurses' Proficiency And Confidence In The Use Of Aromatherapy For Patients In The Hospice Setting, Erika Bigwood-Keaton

Master's Projects and Capstones

The Institute of Medicine noted patient centered care as one of the six priority areas of improvement for the U.S. healthcare system. Recognizing that patients in hospice require specialized care to address the physical, emotional and spiritual needs that are associated with a terminal illness, the focus of this project is to improve the hospice nurses’ knowledge of and confidence in the use of aromatherapy for symptom management. There is recognition within the field of healthcare that patients are interested in having options for treatment. With little to no side effects, aromatherapy has been shown to be an effective alternative …

Gadgets And Grieving: A Chronological Analysis On The Ways In Which Advancements In Medical Technologies Have Altered The Grieving Process, Grace Mcnair

Dialogue & Nexus

Since the 1940s, both end-of-life care and advancements in medical technologies have expanded exponentially. This article explores the advancements in medical technologies and how these have altered the way that Western society grieves death. With the capabilities to prolong life, the family, the patient, and the medical team, all grieve the end of life in different ways. This article provides a chronological analysis of palliative care, hospice care, and various medical advancements. These changes in medicine are then paralleled with alterations in the bereavement process. This article explores historical narratives of Western society’s transformation of grief through the lens of …

Hospice And Palliative Care: Imperative To The Education Of Nursing, Crystal Lynn Jordan

Nursing Theses and Capstone Projects

Many advanced practice nursing programs do not have hospice and palliative care content included in their curricula. Reviewing the literature regarding the nature of hospice and palliative care content in advanced practice nursing curricula revealed few published studies. Rather than a small snapshot of what end-of-life care entails, it is vital to integrate end-of-life care into every aspect taught in advance practice nursing school. The purpose of this thesis was ascertain the nature of hospice and palliative care content contained in advanced practice nursing curricula. A survey was sent to advance practice nursing program directors asking for information related to …

Perceptions Of Hospice Among Social Work Students: The Influences Of Sociodemographic Factors, Delia Vanessa Valenzuela

Electronic Theses, Projects, and Dissertations

The older adult population is rapidly growing along with the use and continued need for hospice care services. Due to these circumstances there is on ongoing demand for experienced and knowledgeable social workers to meet the unique needs of this population. Research in this study indicates that social workers currently working in the hospice field do not feel adequately prepared to work with dying and bereaved patients. Furthermore, research shows a lack of education within social programs and social work textbooks regarding the subject of end of life care. The purpose of this study was to gain a better understanding …

Describing The End Of Life Knowledge, Beliefs, And Preferences Of Alaska Native And American Indian Peoples, Colleen Marie Kelley

Theses and Dissertations

This dissertation is comprised of three manuscripts that will be submitted for publication, describing the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The first manuscript is a literature review that examines what is known about the understanding about the end of life knowledge, beliefs, and preferences of Alaska Native and American Indian Peoples. The second manuscript offers results of an exploratory descriptive study designed to describe the end of life knowledge of hospice care services, beliefs about dying, and preferences for end of life care of Alaska Native and American Indian Peoples. Finally, …

Hospice Performance: Environmental And Organizational Correlates, Mengying He

All ETDs from UAB

The purpose of this dissertation is to explore hospice performance using a three paper format. Based on Structure-Conduct-Performance (SCP) and Structure-Process-Outcome (SPO) models, paper 1 conducts a systematic literature review to identify gaps in hospice performance research. Paper 2 explores the relationship between hospice market structure and inpatient services provision (Structure-Conduct). Market munificence is related to hospice inpatient services offering. Organizational factors such as hospice chain-affiliation, age, and ownership also play roles in predicting hospices’ probability in providing inpatient services. Paper 3 examines the impact of hospice inpatient service provision on service utilization and financial performance (Structure-Process-Outcome). Hospices that not …

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 …

Music Therapy Interventions For End-Of-Life Care: An Integrative Literature Review, Ranjani Sukumaran

Theses and Dissertations--Music

Music therapy plays an integral role in end-of-life care, positively impacting emotional, social, physical, cognitive and spiritual health. The purpose of this integrative review was to collect and compile studies (N= 55) between 2000 and 2016 on the topic of music therapy interventions in end-of-life care, in order to provide both music therapy students and therapists access to the most recent and commonly used music therapy interventions and goals. Results of the integrative literature review indicate that the most common intervention for all age groups in end-of-life care is songwriting and composition, with the most common therapeutic goal …

Hospice Social Work And The Patient Protection And Affordable Care Act, Christine A. Couture

Theses, Dissertations, and Projects

This study was undertaken to explore how hospice social workers based at United States hospice agencies perceive changes in their work responsibilities in relation to the Patient Protection and Affordable Care Act (PPACA). Secondly, this study sought to explore hospice social worker support of the Patient Protection and Affordable Care Act healthcare policy reform.

A nonprobability sample of availability was used to find research participants. The researcher recruited participants through online social and professional networking groups and forums and by snowball sampling methods. Self-selected participants electronically confirmed their eligibility for participation in the study, prior to completing the 20-question online …

Comparing The Quality Of End Of Life Cancer Care In The Medicare Population Prior To And After The Enactment Of The Medicare Prescription Drug, Improvement And Modernization Act Of 2003, Rene Jooste

All ETDs from UAB

Reimbursement for chemotherapy could account for two thirds of the income for oncologists in private practice. The Medicare prescription drug improvement and modernization act of 2003 (MMA) brought about a dramatic change in the way physicians were reimbursed for delivering chemotherapy in an attempt to slow the skyrocketing costs of drugs and Medicare costs for covering these drugs . The MMA reduced Medicare reimbursements for covered outpatient prescription drugs from 95% to 85% of the average wholesale price. In 2005, a new payment system was instituted that reimbursed fee-for-service providers for drugs at the national average sales price plus 6%. …

Impact Of Hospice Nurse Education On After-Hours Calls And Visits, Cheryl Slack

Evidence-Based Practice Project Reports

Medicare-certified hospice home care agencies must provide a 24/7 on call system for after business hours patient concerns. An agency identified a problem with a high volume of after-hours hospice calls for symptom management. How these calls are handled impact patient and family outcomes and satisfaction. A literature review provided evidence that hospice nurse education and appropriate telephone support improves symptom management, enhances family support, provides a sense of security, reduces anxiety, and promotes comfort. Providing hospice nurse education on symptom management supported the goal of this evidence based practice (EBP) project to reduce the family/caregiver need for frequent on-call …

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. This dissertation consists of three studies related to this topic. The first is a quantitative study about advance directives and attitude toward death. The advance directive completion rate among adults in the …

The Effect Of Art Therapy On Hospice And Palliative Caregivers, Carol E. Gress

Nursing Theses and Capstone Projects

A quazi-experimental, one-group, pretest/posttest study was conducted with a group of 25 hospice workers employed by a medium sized county hospice organization in the southeastern United States that was experiencing rapid personnel turn-over. Participants in the study included a doctor, a physician’s assistant, a nurse practitioner, a massage therapist, a grief counselor, a licensed practical nurse, a certified nursing assistant, two clergy, three administrative staff, three social workers, seven volunteers, eight registered nurses and one other. The purpose was to investigate whether attending four 1-hour art therapy sessions could help reduce stress and thereby Burnout. Stamm’s (2010) Professional Quality of …

Intricate Conversations: Caring For Clients With Severe Mental Illness, John D. Chovan

Nursing Faculty Scholarship

This presentation describes the characteristics of persons living with severe mental illness who intersect with hospice, and palliative care, and their communication challenges.

Behavioral Adjustment In Children With Life Threatening Illness A Qualitative Study, E. Joseph Becher Jr.

Antioch University Dissertations & Theses

This study investigated factors that affect adjustment in children with life-threatening illness from the viewpoint of the parents/caregivers. The data were collected from parents/caregivers whose children have a life threatening diagnosis. Parents/caregivers were interviewed and asked to complete the Parent Request Questionnaire (PRQ) which was given to them after the in-person interview. This newly developed PRQ was utilized into prior research to predict the levels of adjustment in children. It includes age, whether the child has been informed of the diagnosis, whether the child engages in age-appropriate activities, the child's prior experience with death, the child's family's involvement in treatment, …

Into The Abyss: A Review Of The Literature Related To The Spiritual Care Of Family Caregivers In Community Hospice And Palliative Care, Donna Mann

Consensus

No abstract provided.

Reaching The End : An Exploration Of Attachment And Existential Theory As A Path To Assist In The Dying Process, Jillian Debenedetto

Theses, Dissertations, and Projects

In this exploration I will utilize the theory of Attachment as well as Existential Theory to assist in expounding upon available paths to assist elderly individuals in their journey at the end of life. I will present an overview of the two selected theories of Attachment as well as Existential Theory and argue that such approaches honor the venerable end stage of life. A discussion pertaining to these two theories will shed light on the question of how a clinician can seek to improve the quality of life for an individual during the end of life process and therefore assist …

Business Ethics: The Impact On Healthcare Professionals, Paul D. Longenecker

Health and Sport Sciences Faculty Scholarship

No abstract provided.