Palliative Care Commons^™

Non-Pharmacological Solutions To Sleep And Circadian Rhythm Disruption: Voiced Bedside Experiences Of Hospice And End-Oflife Staff Caregivers, Rana Sagha Zadeh, Elizabeth Capezuti, Paul Eshelman, Nicole Woody, Jennifer Tiffany, Ana C. Krieger

Publications and Research

Background: Sleep disturbance is a significant issue, particularly for patients with advanced terminal illness. Currently, there are no practice-based recommended approaches for managing sleep and circadian disruptions in this population. To address this gap, a cross-sectional focus group study was performed engaging 32 staff members at four hospices/end-of-life programs in three demographically diverse counties in New York State.

Methods: Participants responded to structured open-ended questions. Responses were transcribed and subjected to qualitative content analysis. The themes and recommendations for improved practice that emerged were tabulated using Atlas TI qualitative software.

Results: This report details the experiences of hospice and end-of-life …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Needs Assessment For Palliative Care In Pediatric Oncology: An Integrative Literature Review, Tabitha Negrete

Grace Peterson Nursing Research Colloquium

Abstract

Background: Cancer is the leading cause of non-accidental death in childhood. Cancer is the primary disease for which pediatric palliative care services are utilized worldwide. Improvement in pediatric palliative care has been identified as an ongoing research priority. There are still significant gaps in current knowledge of pediatric palliative care because education has not been integrated into curriculum and clinical experiences.

Objectives: The purpose of this integrative literature review aims to provide a comprehensive review of current research about the need of nursing education on palliative care for long-term care in pediatric oncology.

Methods: This integrative literature review focused …

Euthanasia, Assisted-Suicide, And Palliative Sedation: A Brief Clarification And Reinforcement Of The Moral Logic, Peter A. Depergola Ii

Journal of Health Ethics

A persistent misunderstanding of the moral distinctions between the practices of euthanasia, assisted suicide, and palliative sedation suggests a critical need to revisit the relationship each shares with licit medical practice in the context of palliative care. To that end, this essay grounds its arguments in two, straightforward premises: (i) the licitness of medical practice is largely determined by the balance between (a) good ends, (b) proportionate means, (c) appropriate circumstances, and (d) benevolent intentions; and (ii) whereas palliative sedation employs criteria A-D (above), both euthanasia and assisted suicide fail to secure criteria A-C. Drawing from this syllogism, the aim …

Reconstruction Of Heel Soft Tissue Defects Using Sensate Medial Plantar Flap, Mihaela Pertea, Natalia Velenciuc, Oxana Grosu, Bogdan Veliceasa, Vladimir Poroch, Sorinel Lunca

Journal of Mind and Medical Sciences

Introduction. Reconstruction of heel soft tissue defects represents a true challenge for any surgeon due to the particularities of this anatomical region. The tissue used to reconstruct the heel area must be resistant, innervated, and adapted to take over the body weight. Innervated medial plantar fasciocutaneous flap is one of the best solutions to cover defects at the heel level.

Materials and Methods. We studied 5 patients, 4 males and one female, aged 42 to 67 years, who presented heel soft tissue defects of various etiologies. In all cases, the used reconstructive method was an insular innervated medial plantar fasciocutaneous …

Integrating Art And Narrative To Enhance Quality Of Life In Palliative Care, Jennifer Fortuna

The Open Journal of Occupational Therapy

Lacie Lee Wallace, a mixed-media artist from Wheeling, West Virginia, is featured on the cover of the Fall 2018 issue of The Open Journal of Occupational Therapy (OJOT). The photograph depicts Lacie holding a self-portrait painted by artist CeCey Rose. Lacie’s physical appearance in the photograph is strikingly different from the physical appearance of the woman featured in the painting. The portrait was created 4 years before Lacie was diagnosed with advanced stage colon cancer. In the year following the diagnosis, Lacie lost nearly 100 lbs. as a result of an aggressive treatment regimen. When the palliative care team at …

A Provider-Based Survey On Quality Of Care And Identification Of Quality Gaps In Inpatient Palliative Care, Adam Pennarola, Md, Mph, Matthew Murphy, Md, Elizabeth Collins, Md, Beth Wagner, Msn, Crnp, Achpn, John Liantonio, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Inpatient Palliative Care Teams (IPCTs) are often called upon to provide multidisciplinary care across hospital settings at Jefferson. However, there is currently no mechanism in place wherein providers consulting the IPCT can provide feedback to specialty palliative care clinicians. Such input from providers could be used to elucidate those services provided by the team which are most appreciated and those which require further development in order to be truly effective. Furthermore, such input may also serve to identify completely new areas for inpatient palliative care needs.

Implementation Of A Volunteer-Based Hospital Program For Older Adults, Elizabeth Collins, Md, Kristine Swartz, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• A multi-faceted, volunteer-led, hospital-based program1has been shown to: •Reduce the incidence of delirium •Decrease hospital length of stay •Reduce hospital costs.
• Implementation of such a program requires upfront investment.
• A smaller, volunteer-based visitation program for older adults may provide support for the allocation of more hospital resources in delirium prevention and establishment of a formal Hospital Elder Life Program1in this institution.
• This research aims to investigate: •If the implementation of a visitation program is feasible at this hospital •Volunteer experience with the program.

Musician As Physician: Interwoven Artistry For Complex, Cancer Pain Management, Douglas E. Brandoff

Crossroads of Music and Medicine

The author, who is both a classical musician and a physician, reflects on how to interweave the skills he has from experience in both realms to become a more "complete" palliative care physician when working with patients.

The Death Debate: Penumbra Conundrum, Robert F. Johnson

Peer Reviewed Articles

Determination and declaration of death by neurologic criteria, brain death, is an established and legally accepted clinical practice with profound implications. Concerns regarding the accuracy of this diagnosis raise important clinical, ethical, and legal issues. A recent magazine article highlights these concerns by describing a poignant example of a patient meeting accepted clinical and ancillary testing criteria for brain death in the setting of post cardiac arrest hypoxic ischemic encephalopathy (CA-HIE). With continuation of ventilatory and nutritional support, this patient not only survived but over time demonstrated findings that were no longer consistent with brain death. Offered here is a …

Laude, Jan (Fa 1140), Manuscripts & Folklife Archives

Folklife Archives Finding Aids

Finding aid only for Folklife Archives Project 1140. Cassette recordings of the "Attunement for Healing" and "Exploring Your Dreams and ESP" conferences sponsored by the Edgar Cayce Association for Research and Enlightenment held in Virginia Beach, Virginia from 12 July 1981 to 24 July 1981. The recordings, collected by WKU folk studies graduate student Jan Laude, were used as source material for Laude’s Master’s thesis titled “A Contemporary Female Psychic: A Folkloristic Study of a Traditional Occupation,” which was published in 1982. Because the Department does not have consent forms or own copyright to these tapes, they may be used …

Hospital-Based Physicians' Intubation Decisions And Associated Mental Models When Managing A Critically And Terminally Ill Older Patient., Shannon Haliko, Julie Downs, Deepika Mohan, Robert Arnold, Amber E Barnato

Articles, Abstracts, and Reports

BACKGROUND: Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences.

OBJECTIVE: We sought to describe physicians' mental models (i.e., thought processes) when encountering a simulated critically and terminally ill older patient, and to compare those models based on whether their treatment plan was patient preference-concordant or preference-discordant.

METHODS: Seventy-three hospital-based physicians from 3 academic medical centers engaged in a simulated patient encounter and completed a mental model interview while watching the video recording of their encounter. We used an "expert" model to code the …

Analyzing The Differentiation Among State Medical Marijuana Policies By Examining State Policies & Trends, Richard Furlong

Political Science Theses and Capstones

Support for marijuana has been growing nationwide. This increased support has gained a lot of momentum since the late 1990s when California became the first state to legalize marijuana for medical use by enacting Proposition 215, or the Compassionate Use Act. Since the enactment of Proposition 215, 28 more states and the District of Columbia have legalized marijuana for medicinal use. I look into why states have begun to adopt these laws, and what makes these states differ throughout the country in the timeliness of their actions. I assembled data to examine a variety of state policies to attempt to …

It’S Not About You—It’S About Me, Robert F. Johnson

Peer Reviewed Articles

Hold Me, a film written and directed by Teace Snyder (2016) was distributed by email to palliative care clinicians and educators. The viewpoint presented here is not a review of this movie as a drama for entertainment. Rather it reviews the film to address the suggestion by its producers that it could serve as an adjunct to palliative care professional education.

Educating Oncology Nurse Practitioners To Provide Basic Palliative Care, Lynn Adams, Dnp, Ms, Anp-Bc, Aocn

Doctor of Nursing Practice Projects

Background: Approximately 1.66 million Americans are diagnosed with cancer each year and another 589,430 die from the disease. As treatment options have expanded, many cancer patients are living longer with worsening symptoms and disabilities and an increased illness burden. These patients are ideal candidates for palliative care. Palliative care involves care delivered by a team of clinicians with specialty training and a focus on improving the quality of life for patients with serious illnesses. A number of major organizations have made formal recommendations regarding the integration of palliative care into comprehensive cancer care including the American Society of Clinical Oncology …

Referral Patterns From Long-Term Care Services To Palliative Care: Perceptions Of Directors Of Nursing, Karen S. Sharrah, Dnp, Msn, Aprn, Fnp-C

Doctor of Nursing Practice Projects

Background: Palliative care referrals are important in long-term care facilities because they are the first step in generating the services that the patient may need. This study looked at the phenomena of how Directors of Nursing in long-term care facilities that had access to palliative care services determined if a referral was needed.

Objectives: The purpose of this study was to gain a deeper understanding of the decision- making process used by Directors of Nursing for referrals. The study’s aims were to determine what factors prompt a referral in long-term care settings. The primary research question was: How …

The Effect Of Palliative Care Nursing Education To Improve Knowledge In Palliative Care Of Hospital-Based Nurses Caring For Patients With Chronic, Serious Illness, Madelyn Rose Balicas, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Palliative care nursing provides care for the relief of pain and suffering throughout the course of a patient’s chronic, serious illness. Hospital-based nurses need to be equipped with palliative care nursing knowledge to provide optimal care for patients and their families to improve the quality of life. Lack of education in pain and symptom management and communication about goals of care can result in a suboptimal and high cost of care.

Objectives: To determine if a brief palliative care nursing education can improve the knowledge of hospital-based nurses about palliative care nursing.

Methods: A cross-sectional quantitative pre-posttest design used …

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.

Partnership Between Islam And Palliative Care At Swedish Health Services, Hodo Mohamud, Renee Rassilyer-Bomers, Samantha Bohn, Greg Malone, Hilaire Thompson (Faculty Capstone Project Committee Chair), Eeeseung Byun (Committee Member), Margaret Heitkemper (Committee Member)

Articles, Abstracts, and Reports

The spiritual practice of Islam is considered one of the three major monotheistic religions. Islam is the second largest religion in the world with 1.6 billion followers; about 3.5 million of those live in the U.S.1 The number of Muslims in the U.S. is projected to double by 2030.1 Additionally, the number of adults age 65 and older in the U.S. is projected to double from 46 million today to over 98 million by 2060.2 As the U.S. population ages, many healthcare workers are often too overwhelmed to handle the varying and intricate social, economic, familial, spiritual, and cultural needs …

Taking Care Of Palliative Care, Jolene Baker, Kristina Larsen, Amanda Schumacher

Master of Social Work Student Policy Advocacy Briefs

Minnesota has done well with the amount of palliative care services provided across the state. However, rural communities in Minnesota have far less access to palliative care programs than those living in urban settings. This is in part due to the lack of availability of health care professionals in rural communities, and the lower reimbursement rates provided for palliative care programs in rural settings. Although the majority of large hospitals in Minnesota offer palliative care programs, most hospitals with fifty beds or less do not. Palliative care has been shown to improve the quality of life of individuals living with …

Factors Associated With End-Of-Life Planning In Huntington Disease., Nancy R Downing, Siera Goodnight, Sena Chae, Joel S Perlmutter, Michael Mccormack, Elizabeth Hahn, Stacey K Barton, Noelle Carlozzi

Rowan-Virtua School of Osteopathic Medicine Departmental Research

OBJECTIVE: Knowledge of one's gene status for adult onset conditions provides opportunity to make advance end-of-life (EOL) plans. The purposes of these analyses were to (1) determine the prevalence of EOL plans, including advance directives (ADs) among persons across 3 stages of Huntington disease (HD) and (2) examine factors associated with having ADs in this sample.

METHODS: Data are from 503 participants in the HD Quality of Life study. Participants completed an online health-related quality-of-life survey that included questions regarding EOL planning and self-reported HD symptoms. Frequencies were calculated for EOL planning by the HD stage. Bivariate analysis and logistic …

Pain Management: Time To Minimize Variations In Practice., Parag Bharadwaj, Brynn E Sheehan, Sunita Dodani, Charles F Von Gunten

Ambulatory and Primary Care Articles

There continue to be great variations in the management of pain in palliative care. Efforts need to be made within the field develop strategies to address this to avoid undue distress in patients.

Pre-Licensure Nursing Student Attitudes Toward Physician-Assisted Suicide, Stephanie K. Cox

Honors Undergraduate Theses

Physician assisted suicide (PAS) has been a legalized presence in the United States since Oregon first passed the Death with Dignity Act in 1994. Now PAS is legalized in six states and it is realistic that nurses may encounter PAS during their career. This project explores pre-licensure nursing student attitudes toward PAS.

A mixed method design incorporating descriptive correlation and thematic analysis of an open-ended question was used. Surveys were sent to 550 nursing students enrolled in the UCF nursing program asking participants to complete the 34-question survey. This survey included a 12 item “Domino scale” on student nursing opinions …

Effects Of Energy-Based Therapies On Postoperative Recovery: An Integrative Review Of The Literature, Emily M. Wooten

Honors Undergraduate Theses

Associated with health care reform, there has been a growing interest among healthcare professionals regarding use of energy-based therapies as a complementary therapeutic intervention. The purpose of this integrative literature review was to examine the impact of energy-based therapies (i.e. healing touch, reiki, therapeutic touch) on patients’ postoperative recovery. The methodology included identifying appropriate peer-reviewed, English-language research articles on the topic area that were published between 2006 to 2018. Following a search in select data bases, articles focusing on the topic were critiqued, analyzed and synthesized by the researcher. Consistent and inconsistent findings along with gaps in the literature are …

The Effect Of A Single-Session Group Songwriting Intervention On Grief Processing In Hospice Clinicians, Melissa Deaton

Theses and Dissertations--Music

The purpose of this study was to determine the effect of a single-session group music therapy songwriting session on grief processing in hospice clinicians. The study design was quasi-experimental. Participants were cluster randomized into a control group and a treatment group. The researcher led a 50-minute songwriting session focused on sharing and processing experiences of grief-related stress and burnout in hospice work. Grief processing was measured using a self-report survey for n=25. Overall differences between control and treatment groups were not found to be statistically significant. Significant differences were also not found in treatment score differences for type of …

Redirecting Care, Directing Support: End Of Life Huddles In The Intensive Care Nursery, Tiffany Willis, Sandra Ganey

Posters

No abstract provided.

An Assessment To Determine The Need For A Palliative Care Team To Improve Patient Satisfaction And Decrease Healthcare Costs, Nathalie Weis

DNP Projects

Abstract

Objective: The purpose of this project was to determine if there is a need for a palliative care team (PCT) to which primary care medical professionals can refer patients. The specific objectives of this project were: 1. To assess the knowledge of primary care providers regarding palliative care. 2. To assess the value and need for palliative care from the PCPs’ perspective. 3. To evaluate the current ED utilization data for adults with serious chronic illness.

Methods: This was a descriptive study that involved an analysis of ED visit data for chronic illness, and a survey all …