Medicine and Health Sciences Commons^™

Using Evidence-Based Interventions To Improve The Completion Rates Of Advance Care Directives, Fariba Sohrabi

Doctor of Nursing Practice (DNP) Projects

Background: Advance care directives reduce unnecessary suffering, improve life quality, and further engage patients and families in the decision-making process to ensure that end-of-life care preferences are considered and applied. Despite the proven benefits of advance care directives, advance directives completion rates are approximately 33% in the United States. Purpose: The purpose of this quality improvement project was to increase advance directive completion rates among patients at one clinic through an educational intervention. Methods: The intervention was used to educate patients about the benefits of advance care directives, and present opportunities for patients to complete the directive. The intervention included …

Understanding Hospital-Based Nurse End-Of-Life Care, Knowledge, And Comfort: A Quality Improvement Project, Emma Doran

Honors Theses and Capstones

Providing physical, emotional, and spiritual care to patients at the end of life (EOL) can relieve their suffering and the pain experienced by loved ones in their presence. As death approaches, patients’ symptoms may require increased comfort measures, and it is imperative that all nurses be properly trained and prepared to provide this care. In this quality improvement (QI) project, the End-of-Life Professional Caregiver Survey (EPCS) and demographic and experiential questions were administered in the form of a Qualtrics survey to nurses working on an acute care inpatient unit at a healthcare organization in New England. 18 survey responses were …

A Mixed Methodological Approach To Study The Feasibility Of An End-Of-Life Care Pathway, Noureen Azizullah Mistry

Theses & Dissertations

Background: The growing significance of end-of-life care in response to the increasing prevalence of chronic illnesses and aging populations has prompted recognition of the need for patient-centred care. Care pathways are employed worldwide to offer comprehensive end-of-life care to patients in various healthcare settings. In Pakistan, there is a recognised need to evaluate the feasibility of introducing an end-of-life care pathway.
Objectives: This study aimed to (a) determine the feasibility of using an end-of-life care pathway for hospital-based and home-based palliative care patients, and (b) explore the experiences and opinions of registered nurses piloting the pathway.
Methods: An explanatory sequential …

Discordant Cardiopulmonary Resuscitation At An Academic Midwest Medical Center- Prevalence And Solutions, Jeremy Payne, Anne Skinner, David Gannon, Jenenne A. Geske

Graduate Medical Education Research Journal

Background: Code status orders are important features of patient-centered clinical decisions, patient autonomy, and end-of-life care. Despite proper documentation of “do not resuscitate” (DNR) code status, hospitalized patients may be subjected to cardiopulmonary resuscitation (CPR) efforts that go against their wishes.

Purpose: The objective of this study was to identify and describe the population of hospitalized patients receiving discordant resuscitation efforts at a Midwest academic medical center utilizing electronic health records (EHR).

Method: The study included EHR records between 01/01/2011 and 01/01/2021 for hospitalized patients 19 years and older who experienced cardiac arrest (ICD-10 I46) and were documented as DNR. …

Expanding The Volunteer Role To Include Advance Care Planning Knowledge, Andrea C. Leomo

Master's Projects and Capstones

Problem: Transition patients at the end-of-life are those patients who are not mentally ready or physically eligible for hospice thus not enrolled in a Palliative or Hospice Program. Only one-third of the Transition patient census had completed and filed advance care plans. Healthcare providers are obligated to perform life-saving measures unless documented otherwise. A lack of advance care planning can create complicated scenarios and cause discordant care incidents.

Context: End-of-life care is a delicate subject to navigate conversations with patients. With holistic care being a large component of hospice and palliative care, it is important to have updated and accurate …

Spirituality Education For End Of Life Clinicians: A Quality Improvement Project, Mark S. Valigorsky

DNP Projects

Significance and Background: The focus of this project was to strength the knowledge, comfort, and training of end of life(EOL) clinicians working with patients in the palliative care and hospice environments. While spirituality is considered one of the essential domains of hospice care, it is an area that is often brushed aside by staff and patients and their families. Spirituality is inadequately addressed due to knowledge deficits, time issues, and lack of self-efficacy. Addressing spiritual care is particularly important for patients with chronic and end stage illnesses. Patients and their families view spirituality as a way of coping with suffering. …

Advanced Care Planning In Primary Care, Kaylee Beals, Amanda Merriman

Doctor of Nursing Practice Projects

In Illinois, the do-not-resuscitate (DNR) form that is legally binding in all healthcare facilities is known as the Practitioner Orders for Life-Sustaining Treatment (POLST) form. The Patient Self-Determination Act (PSDA) of 1991 mandates only certain facilities to discuss advanced care planning (ACP). Primary care offices are not included in this mandate. Therefore, no structured process exists for primary care providers to identify patients who may benefit from ACP discussions. The purpose of this Doctor of Nursing Practice (DNP) project was to initiate conversations about ACP with patients 55 years and older in a primary care office and complete POLST forms …

Interventions To Alleviate Guilt In Family Caregivers Of Patients Receiving Hospice Or End-Of-Life Care: A Scoping Review, Kyla N. Huelle

Honors Undergraduate Theses

This scoping review contains a literature analysis regarding interventions used by health care workers to alleviate guilt in caregivers of patients during end-of-life care. During end-of-life care, many transitions and decisions are made that add to the burden of caregivers. Family caregivers experience many physical, financial, and emotional stressors during the journey of end-of-life care, and this can result in guilt. Feelings of guilt can lead to poorer health outcomes and coping in family caregivers and should be addressed by health providers. In this scoping review, a literature search was conducted using various key terms like "guilt," "hospice," "end-of-life care," …

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 …

Implementing Cards As A Tool To Expand End-Of-Life Conversations, Amanda Caldwell

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Starting an end-of-life conversation can be daunting for a healthcare provider. These conversations are often challenging and bring up complex emotions for the patient. The aging population is growing immensely, leading to an increased need for advanced care planning in the coming years. Advanced care planning and the discussions surrounding it are commonly limited to issues of cardiopulmonary resuscitation measures. In addition to this, the conversation needs to be focused on values and goals at the end-of-life. Current research shows that value-based end-of-life conversations allow patients to express issues that are important to them. This will allow each patient to …

Frequency And Magnitude Of Obstacles And Helpful Behavior Items In End-Of-Life Care As Perceived By Nurses Working In Critical Access Hospitals, Shalyn C. Larsen

Theses and Dissertations

Background: Twenty percent of Americans live in rural areas where most of their healthcare is provided in Critical Access Hospitals (CAHs). It is unknown how frequently obstacle and helpful behavior items occur in End-of-Life (EOL) care in CAHs. Objectives: To determine the frequency of occurrence scores of obstacle and helpful behavior items in providing EOL care in CAHs. To also determine which obstacles and helpful behaviors have the greatest or least impact on EOL care based on the magnitude scores. Methods: A questionnaire was sent to nurses working in 39 CAHs in the United States. Nurse participants were asked to …

Effectiveness Of Concurrent Care To Improve Pediatric And Family Outcomes At The End Of Life: An Analytic Codebook, Radion Svynarenko, Theresa L. Profant, Lisa C. Lindley

Faculty Publications and Other Works -- Nursing

Implementation of the section 2302 of the 2010 Patient Protection and Affordable Care Act (ACA) enabled children enrolled in Medicaid/Children's Health Insurance Program with a prognosis of 6 months to live to use hospice care while continuing treatment for their terminal illness. Although concurrent hospice care became available more than a decade ago, little is known about the socio-demographic and health characteristics of children who received concurrent care; health care services they received while enrolled in concurrent care, their continuity, management, intensity, fragmentation; and the costs of care. The purpose of this study was to answer these questions using national …

Enhancing Hospitalists' Knowledge In Relation To Palliative Care, Herline Raphael

DNP Research Projects

Abstract

Palliative care was not the specialty of many hospitalists; thus, communication was hindered regarding ELC and advanced directives. Despite healthcare utilization in the United States, inadequate treatment of serious illnesses continues due to the lack of provider education and understanding of ELC (palliative and hospice care). Hospitalists are not formally or informally trained to care for patients that need palliative or hospice care. A quantitative, quasi- experimental and qualitative approach was utilized to determine if hospitalists who received educational training on palliative care communication and collaboration improved knowledge, skills, and collaboration when caring for end-of-life or critically ill patients. …

End-Of-Life Education For Long-Term Care Nurses, Naquita Altidor Jacques

Walden Dissertations and Doctoral Studies

Long-term care (LTC) nurses play a crucial role in preserving the quality of life of terminally ill patients. However, many identify deficits in skills, education, and training for end-of-life (EOL) care. The objective of this project was to educate LTC nurses caring for individuals reaching the end of their lives on EOL care. The practice-oriented question concerned whether an evidence-based educational program improved nurses’ knowledge related to EOL care and confidence in caring for EOL patients and families. The End-of-Life Nursing Education Consortium's evidence-based educational module was used to provide the content. Rosswurm and Larrabee’s model for change to evidence-based …

Improving Advance Care Planning Among Native Americans, Jasjit Kaur Pataria

Walden Dissertations and Doctoral Studies

A staff education project was created in a tribal health system of primary care clinics to improve advance care planning (ACP) conversations between care providers and Native American tribal patients. ACP conversations and advance directive documentation occurrences were found to be low or negligible in the project site despite primary care clinics being an ideal place to start these conversations. The purpose of the staff education project was to improve the knowledge and attitudes of providers toward initiating ACP conversations in a rural underserved community of Native Americans. The knowledge-to-action model was used to frame the project. Pretests and posttests …

End-Of-Life Care For African Americans: A Staff Education Project, Oneika Natasha Rigby-Britton

Walden Dissertations and Doctoral Studies

Increased knowledge is needed among long-term care facility staff members regarding end-of-life care services. There is a gap in staff knowledge regarding how to initiate education about these care services with patients and family members and how these services impact patient care and health outcomes, especially among the African American residents in long-term care facilities. The practice-focused question addressed in this project was whether staff education increased the staff members’ knowledge about end-of-life care and how to initiate conversations with African American patients and families on available services. The development of this staff education project used Roger’s diffusion of innovation …

Palliative Care Experiences And Educational Needs Of Healthcare Interprofessionals In Jamaica: A Mixed Methods Study, Rebecca L. Edwards

All ETDs from UAB

Universal access to palliative care (PC) is a human right that much of the world has not accomplished and educating a PC workforce is critical to PC advancement. Higher PC disparities exist in low-and-middle income countries, such as Jamaica. The World Health Organization Public Health Model and the International PC Initiative’s PC roadmap emphasize the importance of PC education. The purpose of this mixed methods dissertation study was to investigate the PC experiences and educational needs of healthcare interprofessionals who provide care for patients with late-stage serious illnesses in Jamaica. Three specific aims incorporated quantitative investigation of physicians’, nurses’, and …

Critical Access Hospital Nurses' Perceptions Of Obstacles And Helpful Behaviors In End-Of-Life Care, Trissa Michelle Lyman

Theses and Dissertations

Background: The Critical Access Hospitals (CAHs) system was developed to bring health care to rural populations. Although CAHs lack equipment and resources, CAH nurses still provide end-of-life (EOL) care to critically-ill and dying patients. Objectives: To determine the largest and smallest ranked obstacles and helpful behaviors to providing EOL care to rural patients as perceived by CAH nurses. Also, to determine how CAH nurses' perceptions of obstacles and helpful behaviors to providing EOL care compare to that of their urban counterparts. Methods: A cross-sectional, nationally representative sample of nurses working in 39 CAHs were sent a questionnaire. Nurse participants were …

Nursing Attitudes To Hospice Care In The Intensive Care Unit, Claudia Lacivita

Master of Science in Nursing Theses and Projects

Nurses deliver care to patients 24 hours per day and are experts in the care of critically ill patients in the intensive care unit (ICU). The critical care nurse is trained to assess, treat, and monitor severely ill patients to facilitate their recovery, but may often feel ill-prepared and lacking the support usually available to the hospice or palliative care nurse. It also can be difficult to refocus when the desired outcome changes from stabilizing and getting a critically ill patient better to hospice or end-of-life care (EOLC). The purpose of this project was to improve the delivery of care …

Intensive Care Unit Nurse: Could We Call A Palliative Care Consult? Intensive Care Unit Provider: It's Too Early. Palliative Care Integration In The Intensive Care Unit: The Struggle To Translate Evidence Into Practice, Natalie S. Mcandrew, Jill L. Guttormson, Sean Marks, Mary Rhodes, Jayshil Patel, Colleen Mccracken

College of Nursing Faculty Research and Publications

Despite evidence regarding the value of palliative care, there remains a translation-to-practice gap in the intensive care setting. The purpose of this article is to describe challenges and propose solutions to palliative care integration through the presentation and discussion of a critical care patient scenario. We also present recommendations for a collaborative palliative care practice framework that holds the potential to improve quality of life for patients and families. Collaborative palliative care is characterized by close working relationships with families, interprofessional intensive care unit healthcare teams, and palliative care specialists. The shortage of palliative care specialists has become a pressing …

Clinical Staff Perceptions On The Quality Of End-Of-Life Care In An Australian Acute Private Hospital: A Cross-Sectional Survey, Rosemary Saunders, Courtney Glass, Karla Seaman, Karen Gullick, Julie Andrew, Anne Wilkinson, Ashwini Davray

Research outputs 2014 to 2021

Objective: To explore the perceptions of clinical staff on the quality of end-of-life care in an acute private hospital. Methods: A descriptive cross-sectional study with a convenience sample of clinical staff in an acute private hospital were surveyed using a validated end-of-life survey. Data from the surveys were analysed using descriptive statistics for quantitative responses and inductive content analysis for the open-ended responses. Results: Overall, 133 staff completed the survey. Of these, 107 had cared for a dying patient in the hospital. In total, 87.6% of participants felt confident in their ability to recognise a dying patient and 66.7% felt …

Revealing Meaning From Story: The Application Of Narrative Inquiry To Explore The Factors That Influence Decision Making In Relation To The Withdrawal Of Life-Sustaining Treatment In The Intensive Care Unit, Fiona Foxall, Deborah Sundin, Amanda Towell-Barnard Phd, Mnursing, Beverly Ewens, Vivien Kemp, Davina Porock

Research outputs 2014 to 2021

This paper considers the effectiveness of narrative inquiry as a research method in collecting and analyzing stories from a purposive sample of intensive care nurses and doctors, regarding their perceptions of the factors that influence decision-making in relation to the withdrawal of life sustaining treatment. Delaying the withdrawal of treatment when it is clearly indicated, may result in unnecessary patient suffering at the end of life, distress for the family as well as moral distress for staff. In narrative inquiry participants’ first-hand accounts of their experiences are told through story; the focus of analysis is the story, with the story …

Understanding End-Of-Life Care Experiences Of Baccalaureate Mexican American Nursing Students: An Interpretive Phenomenology Study, Shalla M. Copeland

Nursing Theses and Dissertations

Although education is an important factor regarding competent end-of-life care, varying educational strategies occur within pre-licensure nursing curricula without evidence as to what strategy is most effective for the learner. The aim of this study was to generate a holistic understanding of Mexican American baccalaureate nursing student experiences of providing end-of-life care and to solicit experience-based approaches to adequately prepare those students to care for dying persons. An integrative review of the literature was completed to summarize the current evidence of pre-licensure nursing educational strategies that affect nursing students’ attitudes toward care of the dying. A concept analysis of a …

Family Behaviors As Unchanging Obstacles In End-Of-Life Care: 16-Year Comparative Data, Renea L. Beckstrand, Jasmine B. Jenkins, Karlen E. Luthy, Janelle L. B. Macintosh

Faculty Publications

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined.

Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time.

Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999.

Results Of the 2000 questionnaires …

The Impact Of Perinatal Palliative Care Simulation On Undergraduate Nursing Students, Erin Anderson

Nursing (graduate) Student Scholarship

Background: Nurses who have limited exposure to perinatal palliative care often avoid interactions with patients, limiting the quality of care provided. Undergraduate nursing students are often not afforded opportunities for experiencing perinatal palliative care during direct patient care clinicals. Simulation may provide an opportunity for students to have these experiences.

Methods: A review of the literature was conducted resulting in six articles addressing the evidence-based education question, do undergraduate nursing students report feeling more prepared to provided perinatal palliative care to patient and families after receiving didactic instruction along with simulation-based learning experiences, compared with nursing students who receive …

Examining Instructional Methods In End-Of-Life Nursing Education: Lecture Vs. Simulation, Jonathan M. Benson

Electronic Theses and Dissertations

Undergraduate nursing programs have historically glossed over end-of-life care, if their curricula addressed it at all. This lack of instruction can leave practicing nurses feeling poorly prepared to deliver this specialized care. Feeling incompetent and lacking confidence may lead to poorer attitudes regarding this nursing specialty. Thus, effective continuing education activities are paramount in equipping nurses to provide this care and improve attitudes towards caring for terminally ill patients and their families. The purpose of this study was to examine how registered nurse attitudes towards end-of-life care are impacted using a simulation-based learning experience compared to a traditional face-to-face lecture …

Neonatal Nurses' Perceptions Of Providing Palliative Care In The Neonatal Intensive Care Unit, Susan Di Nonno Chin

Theses & Dissertations

Although advances in neonatal medicine have greatly improved infant survival rates, there remains a significant number of infants admitted to the neonatal intensive care unit who will not survive. It is estimated that 50% of the 25,000 annual hospital pediatric deaths occur in the neonatal intensive care unit (NICU) (Conway-Oriel & Edlund, 2015). Despite widely supported guidelines endorsing neonatal palliative care (NPC), implementation has been sporadic and inconsistent (Kain & Wilkinson, 2013). Lack of palliative care protocols has been associated with negative impacts on infants, their families, and multidisciplinary team members. NICU nurses are uniquely positioned to influence end-of-life care …

Canadian Nursing Students’ Experiences With Medical Assistance In Dying / Les Expériences D’Étudiantes En Sciences Infirmières Au Regard De L’Aide Médicale À Mourir, Cedar Mcmechan, Anne Bruce, Rosanne Beuthin

Quality Advancement in Nursing Education - Avancées en formation infirmière

The recent introduction of medical assistance in dying (MAiD) has significant implications for healthcare workers, nurse educators, and society at large. Nursing students are being asked to participate directly or indirectly with a medically assisted death. Little is known about nursing students’ experiences with or attitudes toward MAiD in Canada.The purpose of this study was to explore the experiences of fourth-year nursing students in caring for patients who choose MAiD. The aim was to understand students’ perceptions of their educational preparation regarding MAiD and identify potential gaps in existing knowledge and skills. A qualitative design and thematic analysis were used. …

Exploring How Nurse Beliefs And Attitudes Influence End-Of-Life-Care Practice, Cara Chandler

Doctoral Dissertations

Nurses are the cornerstones to provide safe patient care. Studies about nurses experiencing challenges while providing end-of-life care (EOLC) are limited. It is imperative to understand how nurses’ beliefs and attitudes influence their actions while providing EOLC. The aims of this study were to (a) explore the relationship of personal factors and nurse beliefs and attitudes on providing EOLC and (b) examine the relationship of nurse beliefs and attitudes on intention and performance to provide EOLC. These aims were explored in a convenience sample of nurses working in multiple adult patient settings. The Theory of Planned Behavior guided a cross-sectional …

Nursing Faculty And Care Of The Dying, Jessi Balagtas

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: There is a demand for effective and efficient palliative and end of life nursing care that will meet the needs of the aging Baby Boomer generation. Though advancement has been made, palliative and end of life care for the seriously ill adult is still lacking. That deficiency can be traced to deficiency in nursing education. Further still, nursing faculty attitudes, knowledge and self-efficacy in palliative care may present a barrier for adequate palliative care nursing curriculum.

Objective: Explore the current knowledge, attitudes and self-efficacy of nursing faculty regarding care for seriously ill adults.

Methods and Design: A quantitative, descriptive …