Digital Commons Network^™

Ethical Considerations For Hospice Patients In Inpatient Settings: A Systematic Review And Thematic Analysis, Matthew D. Harry

Honors Theses and Capstones

Hospice care is intended to prioritize comfort, dignity, symptom management, and quality of life for individuals with life-limiting illness. However, when hospice-eligible patients are managed within inpatient hospital settings, significant ethical challenges frequently emerge due to the tension between comfort-focused care and the curative, intervention-driven structure of acute care medicine. This paper presents a systematic literature review and thematic analysis examining the ethical considerations surrounding hospice patients in inpatient settings, with particular attention to clinical decision-making, communication, prognostic uncertainty, moral distress among nurses, and conflicts involving patient autonomy and family wishes. A structured review of peer-reviewed literature was conducted using …

Implementing Pain Reassessment Workflow To Improve Timely Pain Management In Hospice Patients: A Quality Improvement Project, Oluremi Omodara

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Timely pain reassessment is a vital component of hospice care, directly influencing the quality of life for patients. Despite the high prevalence of pain, which affects 55% of hospice patients due to disease progression or adverse drug reactions, only 51% of those reporting moderate to severe pain at admission receive a documented reassessment. The gap highlights an organizational issue in pain management stemming from the absence of a clearly defined period and workflow for reassessment.

Aim of the Project: The aim of the quality improvement (QI) project was to improve compliance with pain reassessment documentation within 48 hours …

Barriers Primary Care Physician Assistants Face In Referring Patients To Palliative Care Services Early In The Disease Process, Claire Petersen

Theses and Graduate Projects

Background: Medical specialties such as hospice and palliative care have been proven to improve quality of life for patients facing end-of-life and chronic illness. Though increasing awareness of these specialties has resulted in greater availability, it is essential to investigate the barriers clinicians, such as Physician Assistants, face in making these referrals in order to provide quality healthcare to those who need it. Physician Assistants specifically are an essential clinician group to evaluate, as they continue to become more prevalent in the healthcare system.

Purpose: To determine barriers primary care Physician Assistants face when identifying candidates for and referring to …

“We’Re Dealing With An Inhumane Lack Of Resources”: Provider Perspectives On Palliative And End-Of-Life Care For Adults Experiencing Homelessness, M. Pilar Ingle

Electronic Theses and Dissertations

Although palliative and end-of-life (PEOL) care offer many benefits to individuals with life-limiting illness, unhoused individuals face barriers in accessing these forms of care. Despite calls over the last several decades to improve PEOL services for unhoused individuals, this population remains underprioritized in efforts to improve access to healthcare. A richer understanding of these inequities as they relate to the specific social and political contexts within a state, such as Colorado, may offer more direct guidance on opportunities to improve policy and care provision.

The purpose of this study was to explore healthcare and social service provider-identified approaches and challenges …

The Effect Of Early Palliative Care Consultation For Patient With Traumatic Brain Injury On Procedure Utilization, Length Of Stay And Discharge Location, Abdulelah Almutairi, Donald Courtney, Heather Rhodes

South Atlantic Division GME Research Day 2023

No abstract provided.

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’ …

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 …

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 …

Removing Obstacles To A Peaceful Death, Kathy L. Cerminara, Barbara A. Noah

Faculty Scholarship

We all will die, but the American health care system often impedes a peaceful death. Instead of a quiet death at home surrounded by loved ones, many of us suffer through overutilization of sometimes-toxic therapeutic interventions long past the time when those interventions do more good than harm. This article proposes revisions to health professional training and payment policy to eliminate as much as possible physical and existential suffering while progressing through the terminal phase of illness. The solution lies in seamless progression from treatment with integrated palliative care to hospice before death, but provider attitudes and payor practices must …

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 …

Ketamine For The Treatment Of Depression In Patients Receiving Hospice Care: A Retrospective Medical Record Review Of Thirty-One Cases., Alana Iglewicz, Katherine Morrison, Richard A. Nelesen, Tingting Zhan, Boris Iglewicz, Nathan Fairman, Jeremy M. Hirst, Scott A. Irwin

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Depression is prevalent in patients receiving hospice care. Standard antidepressant medications do not work rapidly enough in this setting. Evidence suggests that ketamine rapidly treats treatment refractory depression in the general population. Ketamine׳s role for treating depression in the hospice population warrants further study.

METHODS: A retrospective medical record review of 31 inpatients receiving hospice care who received ketamine for depression on a clinical basis was conducted. The primary outcome measure was the Clinical Global Impression Scale, which was used retrospectively to rate subjects׳ therapeutic improvement, global improvement, and side effects from ketamine over 21 days. Additionally, time to …

Palliative Care And Hospice Community Education, Mary Castang

Regis University Student Publications (comprehensive collection)

Executive Summary Palliative Care and Hospice Community Education Problem In the researcher's home hospice practice, a need for community education regarding Palliative Care and Hospice is recognized. Patients and family members need information about End of Life (EOL) care options prior to the urgency of a crisis. According to Szirony, Oopko, Masiulaniec and Binder (2011) many patients and family members learn of hospice and palliative care services only after admission into a program. The decision to sign in to a program reflects their perception of there being no other choice rather than understanding the options and benefits (Szirony, et al, …

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 …

The Role Of Race In End-Of-Life Care, Barbara A. Noah

Journal of Health Care Law and Policy

No abstract provided.

Holistic Comfort And Bereavement Of Families Receiving Prenatal Hospice Support During The Loss Of An Unborn Child With Lethal Anomalies, Sally S. Smith

Nursing Theses and Capstone Projects

The purpose of this descriptive study was to explore the grieving process and coping mechanism of families that was faced with the impeding loss of their unborn child. Grief is a very lonely process.

The aim of this research is to examine how parents cope with the lost of an unborn child with the aid of perinatal hospices. Giving families a broader range of options in regards to continuing their pregnancy. Each family has a right to choice what option is right for them. Choices should be in the hands of the family in regards to continuing with their pregnancy …

Beyond Pain Management: A Primer For Providing Quality End-Of-Life Care, Linda P. Tomko, Terri L. Maxwell

Department of Family & Community Medicine Faculty Papers

Providing excellent care for a dying patient is something all patients deserve. Hospices and palliative care centers exist in many areas to aid primary care physicians and patients through this difficult time. It is important to remember that most patients want to prepare for death, if at all possible. Everyone does this in his or her own way, but oftentimes concern about pain and symptom management interfere with this very involved and valuable process. Being prepared to treat these symptoms as well as addressing your patient's emotional needs is imperative. Referral to a hospice, if possible, will only strengthen the …

Needs Of Terminally Ill Cancer Patients In An In-Patient Hospice Unit, Marylynn C. Oldham

Theses : Honours

In Western Australia, in-patient hospice/palliative care units are caring for increasing numbers of terminally ill cancer patients. Hospice philosophy is based on the belief that the terminally ill patient in individual needs are of paramount importance. The needs of advanced cancer patients have been researched in the home, for patients continuing or having completed curative treatment, and for patients receiving palliative care. However, there is a lack of literature about the needs of terminally ill cancer patients in in-patient hospices. Using a descriptive approach, this study investigated the needs of six terminally ill cancer patients in a 26 bed in-patient …