Digital Commons Network^™

Deep And Continuous Palliative Sedation Without Artificial Nutrition And Hydration: An International Review, Richard Liu, Thaddeus Pope, April Xiaoyi Xu

Faculty Scholarship

Deep and continuous palliative sedation combined with withholding or withdrawal of artificial nutrition and hydration (collectively termed “PSs̄ANH”) is a medical process regularly used in end-of-life care as a means of alleviating suffering. But PSs̄ANH is often not governed by a clear legal framework. To shed light on different approaches to regulating PSs̄ANH, this Article conducts a comparative analysis of the PSs̄ANH legality across twelve jurisdictions.

To facilitate understanding of this broad issue, we subdivided PSs̄ANH into three categories:

(1) PSs̄ANH will not hasten death (“Type 1 PSs̄ANH”),
(2) PSs̄ANH might, but is not certain to, hasten death (“Type 2 …

The Integrated Support Plan For End-Of-Life Care (Isp-Eolc), Kaitlin R. Sugarman

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

The Integrated Support Plan for End-of-Life Care (ISP-EoLC) workbook was developed to address the growing need for structured, occupation-based resources for occupational therapy practitioners (OTPs) working in end-of-life care. Rooted in evidence-informed practice, this workbook guides OTPs in supporting patients and caregivers through one of life’s most complex transitions. Each chapter of the workbook focuses on a key topic, including early recognition of OT needs, meaningful role participation, iterative interventions, caregiver support, and interdisciplinary collaboration. Designed to be both educational and interactive, the workbook includes patient and caregiver-directed activities that promote communication, reflection, and emotional connection. It also offers practical …

Death And Dying Across The Lifespan, Paige Sala

Entry Level Occupational Therapy Doctoral Capstone Projects Class of 2025

Death and Dying Across The Lifespan centers on the creation of three interdisciplinary educational courses focused on end-of-life care for three distinct age groups: geriatrics, adults, and pediatrics. The courses aim to improve undergraduate students’ competence in addressing death and dying with patients, caregivers, and other healthcare professionals within the team. The courses were developed in response to growing evidence that supports the need for education on death, dying, and caring for individuals at the end of life. Many students are not adequately exposed to these topics in current curricula, despite the importance of interdisciplinary collaboration in this area of …

Implementation Of A Pediatric Skills And Simulation Workshop Among Rural Nurses, Cassandra Grabiel

Doctor of Nursing Practice (DNP) Practice Innovation Projects

No abstract provided.

Katie Beckett Program Update: A Joint Report To The Tennessee General Assembly [2025], Tenncare (Program), Tennessee. Department Of Disability And Aging

Katie Beckett Report to the General Assembly

This document contains the status of the Katie Beckett program, created in 2019 to assist Tennessee children with disabilities who are not eligible for Medicaid.

Has The Elimination Of Mandatory Buprenorphine X-Waiver Increased Presciptions Of This Medication Upon Discharge From The Hospital?, Kendall Moore, Robyn Meadows, Robyn Hoelle, Matthew Calestino

North Florida Division GME Research Day 2025

No abstract provided.

Comparing Chatgpt And Deepseek For Deprescription Support In Geriatric And Palliative Care: An Exploratory Study Using Clinical Vignettes, Gokhan Demir, Angel Sanchez, Sanaz Kashan

East Florida Division GME Research Day 2025

Background: Polypharmacy is common in older adults and increases risks of adverse drug events, falls, and hospitalizations. Deprescription can mitigate these harms but is often hindered by time constraints, fragmented guidelines, and complex comorbidities. Artificial intelligence (AI) large language models (LLMs) may provide decision-support for deprescription in geriatric and palliative care.

Objective: To compare ChatGPT and DeepSeek in their deprescription recommendations across standardized polypharmacy vignettes.

Methods: Three validated clinical vignettes, varied by activities of daily living (ADL) status and cardiovascular disease (CVD) history, were presented to ChatGPT (GPT-4/5) and DeepSeek (2024 version). Each vignette was tested in three replicates per …

Death, End-Of-Life Doulas, And Art:
Exploring Connections Between Death Competency And Art Making, Jill K. Hoefgen

Art Therapy | Master's Theses

Death in the United States is often viewed as a medical event rather than the natural course of life, which results in avoidance of planning for the inevitable. The emergence of Hospice in the 1970s, Medical Aid in Dying (MAID) laws in several states, and the positive death movement have demonstrated a shift in attitudes and priorities about death and dying. Since the early 2000s, end of life doulas (EOLDs) have emerged as practitioners who help people plan for and transition to death. Emotional and existential coping skills are components that emerge from death work, and these elements can be …

A Nurse-Driven Protocol To Increase Music Therapy Referrals To Manage Patient Pain And Anxiety In The Medicine Intensive Care Unit, Ashley Fox

DNP Projects

Background: Critically ill patients often suffer from pain and anxiety. Music therapy is a safe and effective treatment option. However, most nurses never receive education or training on it, resulting in a lack of awareness of its value and its actual usage in care.

Purpose: The purpose of this project was to increase the number of music therapy referrals to manage pain and anxiety in eligible medicine intensive care unit (MICU) patients via a music therapy protocol that increased nurses’ knowledge, attitudes, and skills related to the use of music as an alternative treatment option for pain and anxiety in …

The Perspectives Of Provisionally Registered Psychologists On Voluntary Assisted Dying In Australia: An In-Depth Qualitative Investigation, Ker-Ni Vivienne Heng, Eyal Gringart

Research outputs 2022 to 2026

In Australia, voluntary assisted dying (VAD) is now widely legalised, and VAD uptake is on the rise. Thus, the demand for psychological support in the context of VAD is expected to grow. Despite their relevant expertise, psychologists remain underrepresented in end-of-life (EOL) literature and practice. The current in-depth qualitative study examined the perspectives of 20 provisionally registered psychologists in Australia on VAD, using reflexive thematic analysis grounded in social constructionism. Four main themes (‘Values’, ‘Fit-for-Role’, ‘Exposure’, and ‘Contributions’) and 14 sub-themes were generated from the data. Participants supported availing VAD for terminally ill patients and expressed the potential for its …

Exploring The Reassessment Of Palliative Home Care Clients: A Mixed Methods Study, Maya Canham

Theses and Dissertations (Comprehensive)

Introduction: The timely reassessment of clients receiving palliative home care (HC) is critical for supporting clinicians with care planning and service delivery. However, there is little information on the frequency of reassessments and factors driving reassessment in palliative HC clients.

Objectives: The objectives of this study were to: (i) determine the proportion of palliative HC clients reassessed with the interRAI Palliative Care (interRAI PC) instrument, (ii) calculate the average interRAI PC reassessment interval, (iii) identify the key factors driving interRAI PC reassessment at various intervals, and (iv) explore the factors that influence palliative HC clinicians to reassess their clients in …

Grief On The Margins: The Death Of A Family Member To Substance Use, Adair Shaw

Theses and Dissertations (Comprehensive)

Despite Canada's high death rates from substance use, there is limited research on the sociopsychological impact on families, who often face stigma and disenfranchised grief. This study explores how family members make meaning of a substance-related death. Through qualitative inquiry, eleven family members were interviewed on their experience of grief from substance death. The imprint of losing a family member to mental illness and substance use is fraught with intergenerational grief, ambiguity, prolonged mental-emotional distress, and relationship challenges. Substance death was also associated with stigma, social withdrawal, and shame for many participants. However, grievers reconstructed the socially prescribed negative perceptions …

"You Sure Feel Like You're Alone, Kind Of Flailing Away Out There": Family Caregiver Perspectives Of Caring For An Individual With Glioblastoma Multiforme, Christy Muasher-Kerwin, Abby Baumbach, Yujun Liu, M. Courtney Hughes

Faculty Articles, Papers, and Other Scholarship

Objectives

Glioblastoma multiforme (GBM) is the most common and aggressive form of brain cancer. Family caregivers of individuals with GBM must navigate a wide range of their care recipients’ physical, cognitive, and psychosocial deficits to provide effective care, which is both mentally and physically demanding. This study aimed to investigate the perspectives of family caregivers of GBM patients about the barriers and challenges they encounter when providing care to their care recipients. Methods

Nineteen current and former family caregivers for individuals with GBM participated in semi-structured interviews from October 2023 through January 2024. We conducted interviews virtually and used applied …

Transdisciplinary Collaboration Of Healthcare Professionals And The Emotional Connectedness With Working With Patients Coping With Death And Dying, Princess Nguyen, Lindsay Gietzen

Pacific Journal of Health

Abstract

Purpose: This study explores how an integrated approach to care for patients and families by transdisciplinary healthcare teams provides opportunities for a patient-centered care approach to support quality of life throughout one's chronic illness and at the end-of-life. Discussions and conversations about impending death or dying are often challenging and a complex task for healthcare professionals in whatever settings. While there is an understanding of aspects of collaborative care and transitions and processes to support patients and families about how to cope and communicate about death and dying, it is essential to recognize how best to support end-of-life care …

The Use Of Art Therapy On Children With Life-Limiting Conditions, Karissa K. Schillinger

Counselor Education Capstones

Art therapy is a growing therapeutic technique that is noninvasive. The present literature review sets out to determine what effect art therapy has on children with life-limiting conditions. This author completed a literature review that involved analyzing ten research studies on a variety of youth populations. Studies were found about children with cancer, a child with cerebral palsy and a child with a severe neurological disorder. Zero incidences of harm were found when using art therapy. However, the literature was complicated by the type of art therapy provided, small sample sizes, varying duration of treatment, lack of control groups, lack …

Exploring Disparities In Palliative Care Utilization For Patients With End-Stage Liver Failure: A Nationwide Cohort Analysis (2016-2020), Sheza Malik, Hajra Khan, Amatul Mueed Taqiyyah Fatima Syeda, Mohammed Faisaluddin, Babu Mohan Md, Asim Mushtaq, Karin Dunnigan

Advances in Clinical Medical Research and Healthcare Delivery

Background: Despite the very high symptom burden, palliative care (PC) services are underutilized in patients with End-stage liver disease (ESLD). Herein, we investigated the disparities in the utilization of PC services among patients with ESLD hospitalized in the United States.

Method: We conducted a retrospective cohort analysis by utilizing the Nationwide Inpatient Sample from 2016 to 2020. All patients greater than 18 years old admitted with ESLD were included in the analysis. A multivariate logistic regression model predicting referral to PC was created.

Results: In our analysis, significant racial disparities were observed in the utilization of palliative care services among …

Measures Of Success: Making The Case For Advanced Practice-Sensitive Quality Indicators, Ruth Kleinpell, April Kapu, Cynthia Borum

HCA Healthcare Journal of Medicine

Advanced practice registered nurses (APRNs) are key health care providers in a variety of settings. Often APRNs are grouped in a collective category, along with physician assistants, and referred to collectively as advanced practice providers. As APRNs assume an increasing role in patient care management in hospital, outpatient, and community settings, such as clinics and rural practices, measuring the impact of their care on patient outcomes and quality of care becomes a necessary component of performance evaluation. APRN-sensitive outcome indicators are an important way to identify the impact of the role. While a number of studies have been conducted that …

Integration Of Infection Management In Physician Orders For Life-Sustaining Treatment (Polst), Aluem Tark

Leadership Connection

Physician Orders for Life-Sustaining Treatment (POLST) is an advanced care planning tool which aims to facilitate End-of-Life communication between a dying patient and medical providers. Our research team examined the status of POLST program implementation across U.S. and identified state-level variations in how infection management is captured in POLST forms.

Impact Of Hemoglobin A1c Screening Program Among Medicare Patients, Mary Jo Quinn, Susan Schaffer

Leadership Connection

In 2016, HouseCalls began conducting point-of-care hemoglobin A1c screening as part of an annual preventative home visit program for patients covered under one Medicare Advantage health plan. This retrospective study (n = 34,348) evaluated the impact of this intervention on the following year's body mass index and hemoglobin A1c.

Examining Dnar Status In Pediatric Palliative Surgical Patients: An Application Of A Decision Analysis Tool, Margaret H. Hartig

Leadership Connection

Pediatric palliative care (PPC) involves a multidisciplinary approach for the improved quality of life of children with life-limiting conditions. Many PPC patients present for palliative surgery, which involves procedures that manage symptoms but include risks that could result in catastrophic perioperative events. Determining a patient's and family's wishes regarding do-not-attempt-resuscitation (DNAR) order status can be a difficult topic to broach for providers who encounter these patients for the first time during the preoperative evaluation. A decision analysis tool may help in determining the need for preoperative DNAR communication.

End Of Life In African American Older Adults: An Integrative Literature Review, Karen O. Moss, Karen M. Rose

Leadership Connection

Session presented on Friday, September 26, 2014:

End-of-life care in the United States is described as deficient and fragmented. Minority populations engage in end-of-life planning less frequently than Caucasians. African Americans represent the second largest minority group in the United States with its older adult population projected to increase by 114% by 2030. The Patient-Self Determination Act of 1990 requires Medicare and Medicaid funded healthcare organizations to empower patients to refuse or accept medical care and execute advance directives. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) confirmed substantial shortcomings of healthcare for seriously …

Effect Of A Multimodal Intervention On Advance Directive Completion Rates, Maria B. Douthett

Group: Nebraska Methodist College

Advance care planning (ACP) could be working better both in the primary and hospital settings. When a patient is admitted in the hospital, there are several questions asked during admission regarding ACP but little screening on ACP is done in the primary care setting. Existing research supports ACP as a benefit to quality of death and health care costs, however, there is limited research on how to apply it in the primary care setting. Most of the research regarding ACP and end-of-life (EOL) care focuses on the process in the hospital or in nursing homes.

The goal of this project …

Advance Directive Protocol In The Primary Care Setting, Alexei Boettcher

Group: Nebraska Methodist College

Background and Review of Literature: Advance directives (AD) are documents that offer patients a way to avoid unwanted care in the event of a serious illness or incapacity. Studies demonstrate the care patients receive at the end-of-life is not often consistent with their preferences, as a result of suboptimal communication between the patient and provider as well as documentation of health care proxies and treatment preferences (Isaac & Curtis, 2016). The lack of a current formal protocol used by primary care providers regarding ADs, particularly towards the young adult patient population, resulting in insufficient discussions of patients’ wishes regarding end-of-life …

Culturally Competent Care At The End Of Life- A Hindu Perspective, Sujatha Shanmugasundaram, Margaret O'Connor, Ken Sellick

General Submissions: Clinical Settings Materials

Knowledge of particular cultural requirements is especially important in times of transition such as at the end of life, where issues of death and dying require great sensitivity to cultural and religious differences. Healthcare professionals need to understand different cultures and deliver care accordingly. This article explores the cultural aspects of end of life care among Hindus who live in places other than India and is based on a study of Hindus in Australia. The purpose of this study was to investigate the experience of families of terminally ill Indian patients. This article will explore aspects of the Hindu faith …

Examining The Relationship Between Ethnocentrism, Perspective-Taking And Cultural Competence In Medical-Surgical Nurses, Lori Ann Palmieri

Seton Hall University Dissertations and Theses (ETDs)

This descriptive correlational study explored the relationships between cultural competence, ethnocentrism, and perspective-taking in practicing medical-surgical nurses living in the United States (US). Participants (N=111) were recruited from the New Jersey Board of Nursing (NJBON) and from the Academy of Medical-Surgical Nurses (AMSN). The survey consisted of three validated instruments a) the cultural competence assessment instrument (CCA-I); b) the generalized ethnocentrism scale (GENE); c) the perspective-taking (PT) subscale of the interpersonal reactivity index (IRI), and d) demographic profile questions. Data were collected via Qualtrics and analyzed with IBM SPSS Statistics (Version 28/29). Ethnocentrism and perspective-taking explained 30.2% of the variance …

Undergraduate Nursing Students’ Simulation Experiences With End-Of-Life Care In A Rural Setting: A Scoping Review, Christopher Norman Msn, Aprn, Gnp-Bc, Jodi Sutherland Phd, Rn, Acrn, Cne, Lori Marie Sprague Phd, Rn, Chse, Deborah Palmer Ms, Rn, Alma Rood Msn, Rn, Laura Lipke Ms, Mlis, Ahip

Nursing Faculty Scholarship

Objective: The purpose of this scoping review is to provide nurse educators and nurse leaders in practice with the findings on the state of the science surrounding undergraduate nursing education simulation-based experiences focused on end-of-life (EOL) care in rural settings. This scoping review aims to identify undergraduate nursing student experiences with EOL care in the rural setting and identify key simulation-based educational strategies utilized in undergraduate nursing programs to inform educational programs about simulation practices. The outcome of this review is intended to advance nursing education to better prepare future nurses for practice and to develop competence in providing EOL …

School Of Nursing Newsletter Fall 2024, Southern Adventist University

Southern Nursing - School of Nursing Newsletter

The Fall 2024 issue of the newsletter features information on the Fall 2023 NCLEX pass rate, Giving Day success, and alumni recognitions.

How Do Older Adults Define A Good Death? A Scoping Review, Ellen L. Csikai, Quentin R. Maynard

Midwest Social Sciences Journal

A scoping literature review of the concepts of ‘good death’ and ‘dying well’ among older adults was conducted. The purpose was to identify aspects that older adults specifically considered important in defining a ‘good death’. The search revealed five articles published between 2005 and 2019 that met inclusionary criteria for the review. Primary among the views of the older adults in these studies of a ‘good death’ was the desire to avoid being a burden to families; done so by dying pain-free/peacefully (preferably in sleep) and preparing in advance by involving family in decisions and funeral/estate planning. Family support throughout …

Cyber Victimization In The Healthcare Industry: Analyzing Offender Motivations And Target Characteristics Through Routine Activities Theory (Rat) And Cyber-Routine Activities Theory (Cyber-Rat), Yashna Praveen, Mijin Kim, Kyung-Shick Choi

International Journal of Cybersecurity Intelligence & Cybercrime

The integration of computer technology in healthcare has revolutionized patient care but has also introduced significant cyber risks. Despite the healthcare sector being a primary target for cyber-attacks, research on the dynamics of these threats and practical solutions remains limited. Understanding the complexities of cyberattacks in this sector is critical, as the impact extends beyond financial losses to directly affect patient care and the protection of sensitive information. This paper applies Routine Activities Theory (RAT) and Cyber Routine Activities Theory (C-RAT) to analyze high-tech cyber victimization case studies in healthcare. The analysis explores the motivations behind these attacks and identifies …

Bridging Education And Service Learning Through Palliative Care, Jamie Borchardt

Journal of Community Engagement and Higher Education

Service learning can bridge the gap between traditional and transformational learning, as students are able to relate the course terminology directly to field experience. This project was set up to determine if volunteering for a semester at Hospice had any effect on emotional intelligence and positivity. A paired samples t-test compared differences in pre- and post-test scores on the Positivity Scale (PS) and the Schutte Self-Report Emotional Intelligence Test (SSEIT). The PS revealed a significant difference in pre- and post-test surveys: t(5)=-2.4, p=.03.