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Full-Text Articles in Nursing

Digital Phobia: An Inquiry For Mapping The Unseen Dimension Of New Digital Anxiety, The ‘Digiphobia’, Amarjit Kumar Singh ,Library Assistant, Md. Arshad Ali , Professional Assistant, Dr. Pankaj Mathur, Deputy Librarian, Jan 2024

Digital Phobia: An Inquiry For Mapping The Unseen Dimension Of New Digital Anxiety, The ‘Digiphobia’, Amarjit Kumar Singh ,Library Assistant, Md. Arshad Ali , Professional Assistant, Dr. Pankaj Mathur, Deputy Librarian,

Library Philosophy and Practice (e-journal)

Background: As technology continues to advance, individuals' interactions with digital platforms have become integral to daily life. Amidst this technological evolution, a novel concern emerges—Digital Phobia, hereafter referred to as “Digiphobia.” This phenomenon, although not previously explored in scholarly literature, necessitates an in-depth investigation due to its potential impact on individuals' well-being. Our research employs a two-step methodology to investigate its existence, implications, and manifestations.

Introduction: This research paper introduces and proposes the term "Digiphobia" as a comprehensive conceptualization of anxiety arising from interactions with digital spaces, applications, and environments. The proliferation of digital technologies has led to the emergence …


The Clinical Inquiry Process Diagram (V. 5), Roy E. Brown Jan 2024

The Clinical Inquiry Process Diagram (V. 5), Roy E. Brown

VCU Libraries Faculty and Staff Publications

This updated edition of The Clinical Inquiry Process Diagram improves on the 2023 version. It provides a depiction of the steps involved in the clinical inquiry process, covering research, performance improvement, and evidence-based practice. The revisions in this version emphasize the importance of alerting users to the iterative nature of clinical inquiry and the ongoing need to assess the situation or patient based on evolving evidence. It's crucial to recognize that the clinical inquiry process does not follow a linear, sequential progression. Instead, individuals may find themselves concurrently addressing different aspects of the process or revisiting prior steps as they …


The Clinical Inquiry Process Diagram Question Development Checklist, Roy E. Brown Jan 2024

The Clinical Inquiry Process Diagram Question Development Checklist, Roy E. Brown

VCU Libraries Faculty and Staff Publications

This updated handout, previously published in 2023, serves as a reference for those who are either in an EBP course or are practicing healthcare providers involved in questioning practices to improve patient care. The handout guides the user from identifying and developing a question to determining whether the clinical question, based on evidence, will be an evidence-based practice project/initiative, a performance improvement project, or a research project. It aligns with the fifth version of the Clinical Inquiry Process Diagram and now includes several different formats that can be used when trying to create a focused clinical question.


Evidence-Based Decision Making At The Bedside Process, Roy E. Brown Jan 2024

Evidence-Based Decision Making At The Bedside Process, Roy E. Brown

VCU Libraries Faculty and Staff Publications

Evidence-based practice (EBP) is crucial in healthcare for improving care and organizational outcomes. However, there is a lack of consensus among various health professions regarding the definition and implementation of evidence-based practice in the clinical environment. This lack of consensus centers on whether EBP is project-based or if it occurs primarily at the bedside. This diagram illustrates how evidence is utilized to inform bedside decision-making. It demonstrates that the process is iterative and the intervention or decision made is contingent upon the evidence, one’s clinical experience, and the patient/situation.

The purpose of the diagram is to help those involved in …


The Supervisors Are Carrying The Bag: The Nurses' Emergency Council, Settlement Houses, And The 1918 Influenza Pandemic In New York City, Eric C. Cimino Jan 2024

The Supervisors Are Carrying The Bag: The Nurses' Emergency Council, Settlement Houses, And The 1918 Influenza Pandemic In New York City, Eric C. Cimino

History and Political Science: Faculty Publications

This article examines the combined efforts of the Nurses’ Emergency Council (NEC), settlement houses, and the Department of Health during the 1918 Influenza Pandemic in New York City. To coordinate public health nursing, the NEC united the settlements and municipal agencies into an umbrella organization that was chaired by Lillian Wald of the Henry Street Settlement. Together, the NEC and the Health Department recruited a corps of nurses to treat influenza patients, primarily in their homes. Historical accounts of the 1918 Pandemic often emphasize the incompetence of American cities in dealing with influenza’s spread. New York’s Health Commissioner Royal Copeland, …


Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White Jan 2024

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …


Effectiveness Of Harm Reduction And Narcan Education For Young Adults, Jason Bolfango Jan 2024

Effectiveness Of Harm Reduction And Narcan Education For Young Adults, Jason Bolfango

Nursing | Student Research Posters

Education on the Harm Reduction Model is an upstream preventative approach to addressing the opioid crisis and a strategic method to promote safety among young adults.


Empowering Caregivers In The Prevention Of Clinical Delirium For At Risk Older Adults Boarding In The Emergency Department Setting, Danielle Brewer Jan 2024

Empowering Caregivers In The Prevention Of Clinical Delirium For At Risk Older Adults Boarding In The Emergency Department Setting, Danielle Brewer

DNP Projects

Background: Emergency Department (ED) overcrowding is a global healthcare crisis documented in the literature for more than a decade, impacting patient outcomes and resource availability. While awaiting delayed transfer to an inpatient room, older adults in the ED remain vulnerable to developing acute delirium. Boarding potentiates the risk for worsening health outcomes, which are further compounded by delirium. Scarcity of resources and time constraints delay delirium detection and increase risk for down-stream hospital-acquired complications, higher cost, and prolonged length of stay. Current ED models do not prioritize caregiver partnership or involvement in delirium-conscious care, which is a holistic approach to …


Physical Health Of People With Mental Illness: A Snapshot Of Consumer Engagement In The Provision Of Care In Primary Care., Irene Ngune, Dianne Wynaden, Karen Heslop Jan 2024

Physical Health Of People With Mental Illness: A Snapshot Of Consumer Engagement In The Provision Of Care In Primary Care., Irene Ngune, Dianne Wynaden, Karen Heslop

Research outputs 2022 to 2026

Primary care is crucial to the health of people with mental illness. However, there is limited information on their reported engagement in this setting. This study surveyed 100 people with mental illness who had a general practitioner or a general practitioner and a case manager from a tertiary mental health service to determine their engagement level with their GP and what interventions they received to manage their health. Forty-four per cent had their psychotropic medications primarily prescribed by their GP, and 58% reported visiting their GP for physical health problems. Ninety-four point nine percent of participants aged 50 years and …


Hidden And Unacknowledged: The Mental Health And Psychosocial Interventions Delivered By School Nurses In Western Australia, Anita Moyes, Shirley Mcgough, Dianne Wynaden Jan 2024

Hidden And Unacknowledged: The Mental Health And Psychosocial Interventions Delivered By School Nurses In Western Australia, Anita Moyes, Shirley Mcgough, Dianne Wynaden

Research outputs 2022 to 2026

Schools are an important setting for the early identification, assessment and intervention of mental health problems in children and young people. Internationally, many nurses work in schools, but the role of this group with young people experiencing mental health problems has had only limited investigation. This study explored the activities school nurses undertook with young people experiencing mental health problems in Australia. Reporting was guided by the COREQ checklist. Thirty-one nurses participated in a semi-structured interview. Data were analysed using the constant comparative method of analysis as developed by Glaser and Strauss (1967). The findings identified that nurses working in …


Environmental Sustainability, Healthcare Workers And Healthcare Students: A Literature Review Of Attitudes And Learning Approaches, Pamela R. Mccauley, Kavita Mathur, Reza Kamali Miab, Nina Cohen, Kedena Henriques-Thompson, Jyo Gopinath Jan 2024

Environmental Sustainability, Healthcare Workers And Healthcare Students: A Literature Review Of Attitudes And Learning Approaches, Pamela R. Mccauley, Kavita Mathur, Reza Kamali Miab, Nina Cohen, Kedena Henriques-Thompson, Jyo Gopinath

Health Professions Education

Purpose: Today, increased attention has been placed on the healthcare industry and its workers in the wake of the global COVID-19 pandemic. Increases in facemask production, personal protective equipment, and the number of patients admitted into hospitals have resulted in a sharp rise in medical waste and environmental concerns. This has led to a greater interest by the research community to study the type of training and education that healthcare workers and students receive which could facilitate the implementation of sustainability activities during their work.

Design/Methodology: We have conducted a literature review (2010 to 2024) on healthcare worker …


Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis Jan 2024

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis

Nursing | Senior Theses

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care-based training, with the …


Male Caregiver Strain: The Mental Effects Of Being An Informal Caregiver For A Family Member With Dementia And Alzheimer's Disease, Alessandra M. Barillas, Elijah Rammel B. Borja Jan 2024

Male Caregiver Strain: The Mental Effects Of Being An Informal Caregiver For A Family Member With Dementia And Alzheimer's Disease, Alessandra M. Barillas, Elijah Rammel B. Borja

Nursing | Senior Theses

Background: Caregivers are vital in fulfilling patients' primary care needs, and families prefer them over sending their loved ones to skilled nursing facilities (SNFs). Alzheimer's Disease and Dementia are prevalent conditions necessitating continuous assistance due to memory and cognition impairments. As a result, support is essential for tasks like mobility, feeding, bathing, and perineal care, as well as emotional and physical challenges inherent in caregiving. Purpose: Upon diving into the mental health impacts of serving as an informal caregiver for individuals with Alzheimer's Disease and Dementia, a notable research gap becomes evident, especially concerning male caregivers. This lack of information …


How The Lockdown Of Covid-19 Influenced The Neurocognitive And Psychosocial Development Of Preschoolers, Kay Picson Jan 2024

How The Lockdown Of Covid-19 Influenced The Neurocognitive And Psychosocial Development Of Preschoolers, Kay Picson

Nursing | Senior Theses

COVID-19 caused schools to turn to online learning through platforms such as Zoom or Google Meet. The influence and effects caused by the transition to online lessons and quarantine were seen across all patient populations and demographics, but none more so than preschool children, who are regarded as one of the more vulnerable populations due to their susceptibility to change. This research aims to fill gaps in the existing literature by evaluating the similarities and differences of the neurocognitive and psychosocial development of preschoolers exposed to the pandemic and those who were not. This study involves a comparative cohort approach …


Telehealth: A Rising Intervention For Latina Mothers Experiencing Prenatal And Postpartum Depression, Britney Gutierrez Jan 2024

Telehealth: A Rising Intervention For Latina Mothers Experiencing Prenatal And Postpartum Depression, Britney Gutierrez

Nursing | Senior Theses

Background: Postpartum depression (PPD) is high among Latina women but often goes unrecognized and untreated. Recognition and management of PPD in this population is crucial as PPD contributes to negative health effects on the mother and infant. Purpose: This research aims to look into telehealth to improve screening methods and treatment for Latina mothers through a Spanish mobile health application that will provide screening and education on PPD. Method: This mixed-method quality improvement study will include 300 participants from an OB-GYN and Pediatrics community clinic, > 18 years old, of Hispanic/Latino ethnicity, Spanish speaking, currently pregnant, or had a child within …


“Share The Fear”: Communication Concerns Of Parents With Cancer With Dependents And Coparents: A Qualitative Needs Assessment Study, Cinzia Caparso, Zoe Bowen, Sung Won Choi Jan 2024

“Share The Fear”: Communication Concerns Of Parents With Cancer With Dependents And Coparents: A Qualitative Needs Assessment Study, Cinzia Caparso, Zoe Bowen, Sung Won Choi

Nursing Faculty Research Publications

Background: The estimated 1.6 million adults in the United States with cancer who also have dependents face unique challenges given the profound impact of cancer on their families, such as increased psychological distress, decreased quality of life, and altered family functioning. Unfortunately, little is known about the mutual cancer-related communication concerns for the perspectives of the parents with cancer or the coparents. Coparents care for the patient and dependents until they reach adulthood (e.g., unmarried, divorced, stepparent, and/or same-sex partnerships).

Objective: To understand the mutual cancer-related communication concerns from the perspectives of parents with cancer and the coparents and intervention …


Nursing Care During Natural Disasters, War Zones, And Mass Casualty Incidents: Implications For An Educational And Professional Overhaul, Erin N. White Jan 2024

Nursing Care During Natural Disasters, War Zones, And Mass Casualty Incidents: Implications For An Educational And Professional Overhaul, Erin N. White

Undergraduate Honors Theses

Emergency situations around the world are inevitable. Any nurse who practices for any period of time is sure to encounter situations like these. Their hospital may be flooded with traumatic and severely life-threatening patient cases where supplies can become scarce. In these situations, a nurse and all other healthcare personnel are expected to act effectively, efficiently and in a highly organized way. Despite this need, many hospitals fail to implement effective disaster preparedness programs and plans. This leaves healthcare workers at a loss for how to treat patients, communicate within and outside of the hospital, coordinate transport, and all the …


Pediatric Vaccination Adherence: Enhancing Compliance Among First-Generation Asian American Parents, Katelyn Leong Jan 2024

Pediatric Vaccination Adherence: Enhancing Compliance Among First-Generation Asian American Parents, Katelyn Leong

Nursing | Student Research Posters

Background: Vaccine adherence in the pediatric population refers to receiving vaccines as per the recommended schedule, which significantly reduces vaccine-preventable diseases and enhances community immunity. Vaccine hesitancy, driven by concerns such as safety, misinformation, or cultural beliefs can affect adherence. National coverage of state-mandated vaccines among kindergarteners declined from 95% to around 93% between 2019 and 2022, varying across different vaccines. Objective: This research proposal’s focus is to determine if an educational intervention targeting first-generation Asian Americans, who have adopted their immigrant parents' misinformation about vaccines, will effectively increase vaccination rates among their children. The study aims to assess the …


Male Caregiver Strain: The Mental Effects Of Being An Informal Caregiver For A Family Member With Dementia And Alzheimer's Disease, Alessandra M. Barillas, Elijah Rammel B. Borja Jan 2024

Male Caregiver Strain: The Mental Effects Of Being An Informal Caregiver For A Family Member With Dementia And Alzheimer's Disease, Alessandra M. Barillas, Elijah Rammel B. Borja

Nursing | Student Research Posters

Background: Caregivers are vital in fulfilling patients' primary care needs, and families prefer them over sending their loved ones to skilled nursing facilities (SNFs). Alzheimer's Disease and Dementia are prevalent conditions necessitating continuous assistance due to memory and cognition impairments. As a result, support is essential for tasks like mobility, feeding, bathing, and perineal care, as well as emotional and physical challenges inherent in caregiving. Purpose: Upon diving into the mental health impacts of serving as an informal caregiver for individuals with Alzheimer's Disease and Dementia, a notable research gap becomes evident, especially concerning male caregivers. This lack of information …


Postpartum Depression: The Effects On Infant Development During The First Year Of Life, Sophie John Jan 2024

Postpartum Depression: The Effects On Infant Development During The First Year Of Life, Sophie John

Nursing | Student Research Posters

Childbirth is considered one of the most pivotal events in a woman’s life, bringing along profound changes. While often seen as joyful, the experience can be extremely challenging or stressful. This might trigger a wide range of emotions that can hinder a mother’s ability to care for herself as well as her newborn. Unlike temporary “baby blues,” postpartum depression (PPD) is similar to major depressive disorder, with symptoms like guilt, anxiety, hopelessness, and even suicidal thoughts. Though typically diagnosed within 4-6 weeks after birth, it often goes untreated or underdiagnosed due to inadequate screening. Untreated PPD can pose a risk …


Incorporation Of Nutrition Education With Medication Inject To Sustain Weight Loss, Julia Calvelo Jan 2024

Incorporation Of Nutrition Education With Medication Inject To Sustain Weight Loss, Julia Calvelo

Nursing | Student Research Posters

Nationwide prevalence of obesity is related to comorbidities including heart disease, type 2 diabetes, and stroke. The United States spends nearly $173 billion annually for the medical cost of obesity, and obese adults have a difference of $1,861 of medical costs than those with healthy weight (CDC, 2022). Overweight individuals experience chronic health issues, resuling in a significant financial burden due to increased costs associated with medical treatment. Ozempic is a newly approved drug accepted by the FDA in 2017 to treat diabetes but is now gradually being implemented as a weight loss medication. It is used in conjunction with …


Icu Nurse Mental Health: Telehealth Vs In-Person Therapy, Ariel Mach Jan 2024

Icu Nurse Mental Health: Telehealth Vs In-Person Therapy, Ariel Mach

Nursing | Student Research Posters

Background Nurses working within high-stress specialties, such as Intensive Care Units (ICUs), often face a lack of resources aimed at supporting their mental health. The expectation for the nurses is to independently manage their psychological well-being based on their knowledge and educational background. However, many times it is difficult to manage persistent stress, anxiety, or depression and this could adversely affect the quality of patient care and eventually lead to burnout. Telehealth therapy has become more readily available and used since the COVID-19 pandemic, leading to two forms of treatment delivery. Currently, there is limited research on the effectiveness of …


Effectiveness Of Early Intervention Programs For Children With Autism Spectrum Disorder, Milan Grace Mendoza Baccay Jan 2024

Effectiveness Of Early Intervention Programs For Children With Autism Spectrum Disorder, Milan Grace Mendoza Baccay

Nursing | Student Research Posters

Background: Autism spectrum disorder is one of the most common developmental disorders, which affects the way a child learns and gains certain skills. Intervention programs aid in the development of these skills and allow children with autism to reach their full potential. Purpose: The following paper examines the effectiveness of early intervention programs on the social, behavior, and cognitive skills for children with autism spectrum disorder. Methods: Participants will be recruited from local schools and community based organizations and their parents will be highly encouraged to participate. They will be separated into two groups: experimental and control. …


Delayed And Misdiagnosed Endometriosis, Teresa Doyle Jan 2024

Delayed And Misdiagnosed Endometriosis, Teresa Doyle

Nursing | Student Research Posters

Endometriosis is a chronic, painful disorder affecting approximately 10% of women of reproductive age globally.This condition arises when tissue similar to the endometrium, the lining of the uterus, grows outside the uterus, typically on the ovaries, Fallopian tubes, and other areas within the pelvis. Common symptoms of endometriosis include severe pelvic pain, fatigue, irregular menstruation, and infertility. These symptoms have a significant impact on women’s physical and mental health, affecting their interactions with their family, friends, and clinicians, often leading to significant impairment in their quality of life (Sims et al., 2021). The diagnostic journey for many women with endometriosis …


Caring For Native American Elders: Developing Cultural Knowledge And Comfort Levels Of Senior Nursing Students In Northern California, Ireland Odonnell Jan 2024

Caring For Native American Elders: Developing Cultural Knowledge And Comfort Levels Of Senior Nursing Students In Northern California, Ireland Odonnell

Nursing | Student Research Posters

It is important for healthcare staff to be knowledgeable of their patients’ culture in order to provide the best care possible and meet the needs of the individual patient (Yava et al., 2023). It has been proven that a lack of cultural understanding can lead to decreased patient adherence and negative health outcomes (Brottman et al., 2020).

There is very little research conducted about student nurses’ knowledge and comfort level when caring for Native American Elders. However, research shows that nurses and nurse educators are not confident when caring for culturally diverse patients, despite their responsibility of teaching the next …


Evidence Synthesis Methodology: Promoting Reproducible Methodology Through Modified Assignments, Laura Lipke, Neyda Gilman Jan 2024

Evidence Synthesis Methodology: Promoting Reproducible Methodology Through Modified Assignments, Laura Lipke, Neyda Gilman

Library Created Resources

Initially, systematic reviews in healthcare served to synthesize findings from clinical studies, aiding comprehensive access to the most effective treatments within evidence-based practice. Over time, their scope has broadened beyond treatment effectiveness, leading to a surge in publication. Consequently, many health science faculty now assign systematic reviews in classrooms without a full grasp of the standardized process, leaving students ill-equipped due to insufficient guidance and resources.

While mastering systematic review techniques is crucial for evidence-based practice, faculty can opt for modified assignments to foster a deeper understanding of the review process. These modified tasks, can be completed within a semester, …


Clinical Practice Guideline For The Management Of Depression In Primary Care, Estrella Catherine Villarreal Jan 2024

Clinical Practice Guideline For The Management Of Depression In Primary Care, Estrella Catherine Villarreal

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: The prevalence of depression poses a significant challenge in primary care, emphasizing the urgent need to address this issue during patient visits. Primary care providers are at the forefront of managing depression, yet they encounter difficulties in screening, diagnosing, assessing, and treating this complex condition. Clinical guidelines serve as valuable tools for primary care providers and practices, offering support in identifying and addressing depression effectively. An evidence-based approach to treating depression in primary care, with a focus on collaborative interventions with behavioral health to enhance depression management for American Indian/Alaskan Native (AI/AN) communities.

Methods: The descriptive analysis was conducted …


Intravenous Contrast Extravasations Of Ct Contrast Media Prevention Bundle, Shakerra T. Brown Jan 2024

Intravenous Contrast Extravasations Of Ct Contrast Media Prevention Bundle, Shakerra T. Brown

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Contrast extravasations pose significant risks during intravenous contrast media imaging procedures, with potential adverse outcomes ranging from minor skin irritation to severe tissue necrosis. Despite technological advancements and procedural safeguards, contrast extravasations remain a concern in healthcare settings. A comprehensive needs assessment at our institution revealed a notable incidence of contrast extravasations, highlighting the need for targeted interventions to mitigate risk and enhance patient safety. This project aims to explore the complexities of contrast extravasations, examining contributing factors, associated complications, and current prevention and management strategies to inform evidence-based practices and improve patient outcomes. This Doctor of Nursing Practice (DNP) …


Guideline For Creating A Support Group For Adults With Down Syndrome Who Suffer With Prolonged Grief, Brandon Chace Warman Jan 2024

Guideline For Creating A Support Group For Adults With Down Syndrome Who Suffer With Prolonged Grief, Brandon Chace Warman

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Adults with Down syndrome process and express their grief differently from the general population. There are a multitude of support groups and organizations for individuals grieving a loss and experiencing prolonged grief but there are none that exist for people with Down syndrome. This project develops a guideline for creating support groups aimed at adults with Down syndrome who experience prolonged grief. Fifty-one pieces of literature from all over the world were reviewed to formulate recommendations that were graded by seven stakeholders. These recommendations were then used to develop a guideline for creating support groups for this population. Analysis of …


Implementation Of Prognosticator Algorithm For Initiation Of Serious Illness Discussions And Improving The Rate Of Palliative And Hospice Referrals, Joy Isebor Jan 2024

Implementation Of Prognosticator Algorithm For Initiation Of Serious Illness Discussions And Improving The Rate Of Palliative And Hospice Referrals, Joy Isebor

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Context: Early serious illness conversations related to end-of-life and goals of care with seriously ill patients have been associated with improving patients' outcomes and quality of care (Bernacki et al., 2015). However, initiating these serious illness discussions has been challenging in the home-based primary care setting.

Objectives: To train and support home-based primary care clinicians in integrating best practices in serious illness discussions and decision-making engagement among patients sixty-five and older with serious illnesses, optimize the alignment between patient goals and the medical care they receive, improving their quality of life and the rate of palliative care and hospice referrals. …