Palliative Care Commons^™

Exploring Caregiving Choice In The Adult Cancer Population, Jennifer L. Huggins

MUSC Theses and Dissertations

ABSTRACT Purpose Although extensive research examines family caregivers (FCs) across populations, less attention has been paid to how lack of choice in assuming the role affects quality of life (QOL) among FCs of adults with cancer. Understanding choice could guide interventions protecting this invaluable, often invisible workforce. Aims (1) Synthesize what is known about perceived choice among informal caregivers of adults with serious illness; (2) assess relationships between caregiving choice and caregiver QOL, burden, sleep, depression, stress, and social determinants of health; (3) describe experiences of FCs of adults with cancer providing care with no, little, or some choice. Design …

Implementation Of Symptom Management Standing Order Sets In An Ambulatory Palliative Care Clinic, Anna Manfreda

Doctor of Nursing Practice Final Manuscripts

Background: As outpatient palliative care expands, the need for timely, evidence-based symptom management has become increasingly critical. In many ambulatory settings, triage nurses are the first point of contact for patient symptom reporting; however, without standing orders, management may vary by provider availability and individual practice patterns, leading to potential treatment delays and inconsistencies in care from evidence-based recommendations.
Purpose: The purpose of this Doctor of Nursing Practice project was to improve the workflow and quality of gastrointestinal (GI) symptom management in an ambulatory palliative care clinic.
Framework: This project was guided by the Iowa Model Revised: Evidence-Based Practice to …

Investigating The Role Of Traditional Chinese Herbal Medicine For Cancer Symptom Management In Older Adults: A Rapid Review, Isabelle C. Karshner

Honors Undergraduate Theses

Background: Patients with cancer often experience symptoms related to disease, complications, and treatment. One potential method of alleviating these symptoms is traditional Chinese herbal medications (TCHM). This rapid review explores the role of traditional Chinese herbal medications in treating cancer-related symptoms in older adults.

Purpose: The purpose of this rapid review is to gain and provide a better understanding of the effects of TCHM on cancer-symptom management in the older adult population. This review explores the association between TCHM and effects on cancer symptoms in older adults, including interactions, toxicity, and signs/symptoms of TCHM use that may be useful information …

A Virtual Wellness Program To Enhance Well-Being For Pediatric Oncology Staff During The Covid-19 Pandemic, Karen Moody, Maria Swartz, Zachary Gresham, Martha Askins, Laura Cahalan, Pavilia Francis, Christine Geistkemper, Amy Heaton, Ruitao Lin, Melissa Melo, Alakh Rajan, Madeline Smith, Priti Tewari, Keyana R. Williams, Cheng-Han Yang, Rhonda Robert

Advances in Cancer Education and Quality Improvement

In response to the COVID-19 global health crisis and mandated social isolation, Pediatric leadership at MD Anderson Children’s Cancer Hospital was concerned for the psychological impact on its workforce and encouraged wellness programming. A grassroots wellness taskforce was assembled for the Division of Pediatrics. The task force’s primary mission was to promote the well-being of clinicians and non-clinical staff members through a broadly accessible, sustainable, and effective virtual wellness program. Guided by the Stanford Model for Professional Fulfillment, a virtual program entitled, “Weekly Wellness Webex” for Pediatrics staff was launched. Weekly Wellness Webex is a 1-hour live-streamed program with varied …

In-Person And Virtual Adaptation Of An Interprofessional Palliative Care Communications Skills Training Course For Pediatric Oncology Clinicians, Karen Moody, Clark R. Andersen, Robert M. Arnold, Julie Bradley, Allie Carter, Lauren Draper, Timothy Garrington, Jonathan B. Gill, Douglas J. Harrison, Masanori Hayashi, Amy Heaton, Cynthia Holladay, Alex Lion, Alakh Rajan, Beatriz N. Rozo, Daniel V. Runco, Shermini Saini, Laura K. Salvador, Kathryn Sutton, Verna Ferguson

Advances in Cancer Education and Quality Improvement

Introduction

Empathic communication is crucial for clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Training was provided using an in-person format and then adapted to a virtual platform to accommodate remote learners.

Methods

Clinicians were trained in dyads (one physician and one nurse [RN] or advanced practice provider [APP]) over 3 days (in-person or virtually). Four pediatric oncology cases were …

Use Of Interdisciplinary Rounds For The Identification Of Hospitalized Adults In Need Of Palliative Care, Brenda A. Blunt

Evidence-Based Practice Project Reports

Palliative care (PC) is specialized care that aims to provide relief from the stress and symptoms of living with a serious illness (Center to Advance Palliative Care, 2022). PC services are often underutilized in the hospital, leaving a significant number of patients with unmet needs (Haranis et al, 2023; Kawashima & Evans, 2023; Smith et al, 2019). The purpose of this evidence-based practice project was to improve processes for identifying hospitalized patients for referral to specialty inpatient PC. The intervention involved interdisciplinary rounds (IDR) for adult inpatients on two medical-surgical (MESG) units in an 84-bed community hospital in suburban Milwaukee, …

Early Palliative Care In Heart Failure, Meadow Stempek, Beverly Balfe, Jennifer Tantarelli

Articles, Abstracts, and Reports

No abstract provided.

Nursing Students’ Attitudes And Preparedness For Maid, Kristal Candray

Nursing | Senior Theses

Medical assistance in dying (MAiD) also known as physician-assisted suicide in addition to euthanasia is on the rise with an increase in decriminalization of the practice(s) and enactment of practice-protected policies in many countries. Ethics and morals on the subject continue to be controversial in healthcare. As student nurses enter the field as clinicians, they may encounter a patient requesting MAiD. Studies from students in other countries where MAiD and/or euthanasia is practiced found that student nurses do not feel adequately prepared to navigate such situations. However, although MAiD has been legalized in a handful of states within the United …

Improving Timely Palliative Care Consultation In The Micu: A Nurse-Driven Quality Improvement Initiative, Sandy Louise Gray

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Improving Timely Palliative Care Consultation in the MICU: A Nurse-Driven Quality Improvement Initiative

Sandy L Gray

Background: Early palliative care in intensive care units improves outcomes and reduces costs, yet referrals are often delayed. At J.W. Ruby Memorial Hospital’s medical intensive care unit (MICU), baseline median time to consultation was 112 hours (mean=246), exceeding recommended benchmarks and highlighting the need for a standardized process.

Purpose: This quality improvement project evaluated a nurse-driven screening tool to improve timeliness and consistency of palliative care consultations in the MICU.

Intervention: The tool was embedded in the electronic health record (EHR) …

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 …

A Nurse-Driven Screening Process To Increase Icu Palliative Care Utilization, Sara L. Stock

Doctor of Nursing Practice Final Project Abstract

Purpose

A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds.

Background

Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. …

The Implementation Of Comfort Medication Kits In Hospice Patients’ Homes To Reduce Hospice Revocations, Brandi J. Parker

Doctor of Nursing Practice Projects

Background: When hospice patients experience a symptomatic crisis at the end of life, unmanaged symptoms can lead to unwanted hospitalizations and the revocation of their hospice benefits. Strategies to reduce the incidents of hospice revocation are needed to improve patient care and quality of life.

Purpose: The quality improvement project aimed to reduce hospice revocation rates by implementing comfort medication kits in eligible hospice patients’ homes.

Methods: The project’s intervention included identifying patients at high risk for revocation, patients with a cancer diagnosis, and patients with a prognosis of two weeks or less. Comfort medication kits were placed in the …

Using A Virtual, Case-Based Approach To Developing Clinical Competency In Hospice, Melissa Robinson, Sasha Holden, Tara Poulsen

Providence Nursing Research Conference 2023 – Present

Background:

There has been a shift in nursing education away from a teacher-centered approach that is focused on requiring learners to memorize large amounts of content to a concept-based approach that is learner-centered and focuses on the development of critical thinking, clinical judgment, and problem-solving skills (Giddens et al., 2020). Conceptual learning requires learners to connect facts and exemplars to concepts through active learning experiences such as completing case studies or problem-solving activities (Baron, 2017). This allows learners to ‘practice’ thinking and apply new knowledge to clinical practice.

The clinical education team is applying this knowledge to the current competency-based …

Memory Cart: Memory-Making Interventions For Nurses To Enhance The Meaningfulness Of End-Of-Life Care In The Icu, Grace Zimmerman

Articles, Abstracts, and Reports

No abstract provided.

Nursing Students’ Attitudes And Preparedness For Maid, Kristal Candray

Nursing | Student Research Posters

As the aging population grows, terminal illness diagnoses are increasing, which has increased global interest in Medical Assistance in Dying (MAiD), Physician-Assisted Suicide (PAS), and euthanasia. However, there hasn’t been much research on how nursing students in California feel about MAiD or how well their education prepares them for these practices. Studies show that religious beliefs and prior knowledge or clinical experience with MAiD can influence students’ attitudes and sense of preparedness. Qualitative research has also identified common challenges, like role confusion, conflicts between ethics and religion, and the need for better education on the topic. Despite this, there’s no …

Palliative Care Referral Protocol: Best Practice Toolkit For Improving Early Referral Rate For Adult Cancer Patients, Linda Dinh Nguyen

Student Scholarly Projects

Despite the benefits of palliative care being well-documented in studies and early palliative care services being strongly recommended by reputable organizations, such as the American Society of Clinical Oncology, many patients did not receive or received late referrals (Pigni et al., 2022). This mainly occurs because oncologists commonly base their referrals on perceived needs and clinical judgment (Smith et al., 2017). Thus, this program development project aimed to create a toolkit to improve early identification and referral to palliative care for adult patients who would benefit from palliative care services. The PICO question that guides this program is: In ambulatory …

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. …

Competency-Based Nursing Education And The Future Of Nursing: Where The Faith Community Nurse Fits In, Mary Lynne Knighten Dnp, Rn, Nea-Bc

International Journal of Faith Community Nursing

Abstract

Two significant nursing landmark reports published in 2021 are enhancing standards and providing guidance for nursing education and practice. The American Association of Colleges of Nursing (AACN) Essentials: Core Competencies of Professional Nursing Education (2021) provides a blueprint for educationally and experientially preparing nurses for practice. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report defines issues such as health disparities and inequities, with recommendations for the role nurses should play in making change to improve the health of the nation.

This paper seeks to explore the intersections of these two reports with the specialty …

Improving Timeliness Of Palliative Care Referrals Within The Intensive Care Unit: A Quality Improvement Project, Stephanie Fiore

DNP Projects

Significance and Background: Palliative care (PC) services are often underutilized in the ICU. There is a lack of understanding of PC by providers, staff, patients, and families which then leads to difficulty obtaining appropriate and adequate referrals to the PC team. In the ICU practice setting, the current process for palliative care referrals (PCRs) has the attending physician as the only individual to initiate a PCR referral. Another element missing from the current process is a criteria trigger tool that other disciplines, including nursing, can use to assess the patient’s need for PCR in the first 48 hours of admission. …

Integrating Palliative Care In A Family Nurse Practitioner Curricula - Post Survey Data, Betty Lang, Susan Montgomery, Ellen P. Moore, Amanda Townsend

MSN Project Data

There is a growing need to integrate Palliative Care in Family Nurse Practitioner (FNP) curricula. Due to increasing costs in an already overstretched healthcare system, a large portion of primary care is delivered by FNPs, often to older or sicker patients. Therefore, it is imperative that FNPs receive formal educational and professional preparation regarding palliative care resources. One of the Core concepts presented by The American Association of Colleges of Nursing's Essentials: Core Concepts for Professional Nursing Education (2021) is palliative care, as are hospice and supportive care. Graduate Competencies and Recommendations for Educating nursing Students (G-CARES) further describe advanced-level …

A Dnp Quality Improvement Project To Assess The Traumatic Brain Injury Survivor And Their Family Caregivers' Coping And Resiliency, Marcelle Angall-Leonce

DNP Research Projects

Abstract

Background: Traumatic brain injury (TBI) support groups are vital to TBI survivors in the community and provide resources to family caregivers (FCs) to mitigate caregiver burden. Resiliency is a necessary characteristic to cope with chronic diseases and the demands of caregiving. However, a gap exists in how TBI support groups mitigate family stress and empower coping and resiliency for the TBI survivor and FCs. Method: The quality improvement project assessed TBI survivors' and FCs' coping and resiliency before and after an educational module on coping, resiliency, and self-care strategies. Intervention: A quality improvement project in a support group of …

Estimulación Cognitiva Y De La Actividad Fisica En La Persona Mayor - Una Experiencia Desde La Práctica, Maria Victoria Rojas Martinez, Adriana Hernandez Bustos, Blanca Gregoria Melo Melo

Ciencias de la Salud

El trabajar con la persona mayor que presenta limitación física o mental, lleva a la aparición de grandes retos para el estudiante y futuro profesional de enfermería, más aún cuando el campo de acción es el hogar, porque el cuidado será compartido entre la persona, el cuidador o grupo familiar, dentro de su propio espacio, por lo tanto, se convierte en una intervención individual con el uso de recursos propios y generalmente con la participación directa del cuidador o acompañante. Para el cuidado en el hogar el autocuidado es base fundamental para el cumplimiento de metas en la salud de …

Asking The Question ‘What Matters To You?’ In A London Intensive Care Unit, Harriet Pittaway, Laura White, Karen Turner, Angelique Mcgillivary

Journal of Patient-Centered Research and Reviews

Purpose: At the heart of the paradigm shift in approach to patient care from paternalism toward shared decision-making lies the international “What Matters To You?” (WMTY) movement. However, WMTY principles are not frequently applied to the critical care setting. The aim of this quality improvement project work was to design and integrate a tool for all patients admitted to the intensive care unit (ICU) that helped answer WMTY.

Methods: Using Plan-Do-Study-Act (PDSA) methodology across 8 cycles, a multidisciplinary team designed and integrated a bedside poster into the ICU. Quantitative and qualitative data were collected via a bedside audit process on …

Podium Persentation: Trauma-Informed Care In Palliative Care, Amber Piranio

2022 Providence Nurse Research Conference

No abstract provided.

Does Comfort Care Make You Uncomfortable? Use Of The Cares Tool For End-Of-Life Symptom Assessment And Management, Christina Covington

Doctor of Nursing Practice Final Manuscripts

Acute care nurses caring for end-of-life (EOL) patients often feel unprepared for and undereducated about this high-need population. According to current literature, many nurses lack adequate training in providing EOL care. This project aimed to improve symptom management of dying patients by providing acute care nurses education about EOL symptom assessment and medication use for symptom management. The revised Iowa model, which emphasizes clinician involvement, guided this evidence-based practice project. Sixteen acute care nurses received 30-minute in-person education, consisting of instruction in EOL symptom assessment and management via use of the CARES (comfort, airway, restlessness, emotional, self-care) tool and basic …

Early Integration Of Palliative Care With Curative Oncology Treatment For Patients With Advanced Cancer: Implications For Clinical Nursing Practice, Rhea Rughani

Honors Projects

Palliative care, though clinically established to improve health-related quality of life measures for patients with advanced illness, remains underutilized and largely limited to end of life care. This project aims to inform oncology nursing practice through the analysis of literature supporting the early integration of palliative care with standard curative oncology treatment for patients with clinically advanced cancer. Informed by relevant research, clinical practice guidelines, and improved specialty palliative care training, oncology nurses and nurse practitioners are ideally situated to advocate for and initiate early palliative care integration, to holistically improve the standard approach to complex cancer care.

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 …

Effective Therapies And Nursing Approaches: Improving Cognition In Older Adult Stroke Patients, Selyna Baltazar

Nursing | Senior Theses

Background

Ischemic stroke occurs in thousands of older adults throughout the year. Due to the lack of oxygen entering the brain, many patients experience a decline in cognitive function due to ischemic stroke. Cognition is the ability to understand, learn, and remember information which is needed for completing daily tasks. Modern technology has allowed for patients to survive ischemic strokes but has yet to provide proper screening tools and methods for stroke-related cognitive impairment.

Objective

To investigate the best practices for identifying, treating, and caring for patients with a cognitive injury related to a stroke. A review of the research …

Advantages Of Early Utilization Of Palliative Care In The Pediatric Icu: A Scoping Review, Shelby Noel Cain Bsn, Rn, Cpn, Dana Pabalate Zimmerman Msn, Rn, Charis Elizabeth Oji Msn, Aprn, Cpnp-Pc/Ac, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Abstract Purpose/Background Despite the increased use of palliative care in adults, only a tiny percentage of children with life-limiting illnesses or life-threatening conditions receive palliative care before dying. Palliative care has low utilization, and consults are often made late in a child’s hospitalization or diagnosis. Palliative care remains underutilized among hospitalized pediatric patients resulting in unnecessary treatments, costly and lengthy hospitalizations, and deaths occurring in the intensive care unit (ICU) rather than at home. The purpose of this scoping review is to evaluate current literature to determine the use and effect of pediatric palliative care, specifically, whether consultation of palliative …

Alzheimer's And Patient Caregiver Burnout: A Review Of The Literature, Madeline Hekeler

James Madison Undergraduate Research Journal (JMURJ)

The term “silent epidemic” is fitting for Alzheimer’s disease (AD), as its negative impact is widely felt but rarely discussed. Burnout among AD caregivers has become an epidemic of its own as caregivers experience an increase in health risks, stress, and financial burden. This literature review focuses on caregiver burnout and how imperative it is that caregivers are better supported in their role. Researchers have developed instruments to assess and intervene in caregiver burnout that have shown effectiveness among caregivers and their families.Nevertheless, further longitudinal research is warranted regarding more effective interventions, including stress management and social support mechanisms.