Palliative Nursing Commons^™

Improving Lymphedema Self-Management And Screening In Newly Diagnosed Breast Cancer Clients Through The Use Of A Self-Management Lymphedema Toolkit, Kescia Gray

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: With breast cancer effecting women at much younger ages and modern treatments prolonging the life span, survivors are at increased risk of developing breast cancer-related lymphedema (BCRL), a chronic, progressive condition that can cause disability.

Purpose: The purpose of the project was to determine the level of knowledge and awareness of BCRL in newly diagnosed breast cancer clients; and to provided education on self-care after treatment, using of a self-management lymphedema toolkit (SMLT), to decrease risks of treatment-related lymphedema, improve self-efficacy, and enhance quality of life (QOL).

Methods: Newly diagnosed breast cancer clients (N=10) from the Breast …

Specialty Palliative Care: A Quality Improvement Project, Leticia Ries

Master's Projects and Capstones

Abstract

Problem: Patients identified on the regional database as specialty palliative care (SPC) patients with congestive heart failure (CHF) have not been consulted annually, as expected by evidence-based practice.

Context: Twenty-three percent of patients with a life-limiting illness on the SPC registry were seen year to date. Patients with CHF are vulnerable populations who benefit from an SPC consult to address quality of life, frequent admissions, and suffering.

Interventions: A rapid experiment of two interventions was evaluated for a solution approach. An electronic report identifying hospitalized registry patients and a standardized triage process were the critically assessed interventions to mitigate …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Advance Care Planning Evidence Based Practice Benchmark, Natalie K. Waggoner

MSN Capstone Projects

America is aging, with the estimated number of patients over the age of 65 to reach 72 million by 2030, approximately 20% of the population (Sade, 2012). This demographic shift characterized by an increasing elderly population has elevated the subject of death and dying to a crucial component of health care delivery. A study done by Silveira et al. (2010) demonstrated that 70% of individuals aged 60 and older were unable to participate in treatment decisions during their final days. However, most individuals in the United States have no advance directive.

The goal of this evidence-based practice intervention is to …

A Performance Improvement Project To Improve Hand-Off Communication Documentation Within The Surgical Services Department, Bobbie J. Wich, Millie Escalona, Judy E. Bowling, Ana L. Santos

Nursing & Health Sciences Research Journal

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary …

Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale

MSN Capstone Projects

Patient care is forever changing to improve satisfaction, safety, and overall treatment. Over the past few years, patients and their families are more invested in their overall care in the hospital and expect to be informed every step of the way. A common complaint from patients or their families is that one nurse or staff did not know the individuals care or treatment plan, there were no shift goals to work toward discharge, and the nurse did not update the patient/family with changes in care. All of these complaints along with the patient satisfaction scores and communication between the treatment …

The Effects Of Social Determinants On Renal Care Among Eskd Patients In The Philippines: Rural Vs. Urban Areas, Melanie Rojas

Nursing | Senior Theses

From a Public Health Nursing (PHN) perspective, populations who are diagnosed with chronic disease or illness are the most vulnerable to end-stage kidney disease (ESKD) or end-stage renal disease (ESRD). The International Society of Nephrology (ISN) states that the mortality rate for ESKD amounts to roughly 7 million individuals worldwide. In examining causes of ESKD throughout both history and the lifespan, high mortality rates are attributed to the lack of access to life-sustaining therapies such as dialysis or transplantation. The lack of access to therapy or healthcare services has been an immense Public Health crisis in the last few decades. …

A Good Life: Palliative Care In The World Of Dementia, Nicola Farmer

Journal of Interdisciplinary Graduate Research

Objective: The World Health Organization (2019) reports that dementia is the seventh leading cause of death with an estimated 50 million people worldwide with this disease. In the United States out of one and a half million Medicare patients on hospice in 2016, only 18% had dementia (The National Hospice and Palliative Care Organization, 2017). McAteer and Wellbery (2013) identified that while referrals to services seem to be on the rise, many are not made until the patient is close to death in the last weeks of an illness. The purpose of this project was to review the literature to …

Loneliness, Social Isolation, And Their Connection To Overall Health Across The Lifespan, Paige Miller

Senior Honors Theses

Due to recent circumstances, the incidence of loneliness and social isolation has skyrocketed. Fortunately, there have already been countless studies examining the longer-term implications of these two factors on health. Loneliness and social isolation have been found to impact cardiovascular health, stress response, immune function, resilience, mental health, attachment, spiritual health, and many other determinants of health. A variety of research was examined outlining the psychological implications of loneliness and social isolation. These factors also influence physiological processes and can exacerbate a variety of diseases. After presentation of this evidence, a collection of possible interventions will be discussed, and their …

Health-Illness Transition Experiences Among Patients With Pancreatic Cancer, Jessica Goldberg

Dissertations, Theses, and Capstone Projects

Pancreatic cancer is one of the most commonly diagnosed cancers and is associated with a poor prognosis measured in terms of months and with significant palliative care needs, including psychological distress. Self-management describes a patient’s ability to manage the sequelae of serious illness, which can have an impact on quality of life and psychological health. One of the fundamental self-management skills is the management of transitions. A transition is a change in life situation or status that causes a shift in a patient’s identity, role, behavior, or interpersonal relationships. Patients with cancer experience multiple, often overlapping transitions that can influence …

Early Specialty Palliative Care For High Mortality Cancers, Dulce E. Alcantara

Master's Projects and Capstones

Problem: Patients with stage IV cancer have a high mortality rate. Evidence shows that patients have a better quality of life when they receive specialty palliative care (SPC) services. In the microsystem of focus for this project, referrals to SPC are not automatic, and there are no triggers to help the oncologist decide when to refer during a patient’s terminal illness trajectory. Siloes between oncology and SPC exist, which leads to a lack of communication and coordination of care, ultimately affecting patient access to support services from SPC.

Context: A multi-disciplinary SPC clinic and a referring oncologist within the …

Distress Evaluation During Chemotherapy: The Real-Time Assessment Strategies For Oncology Nurses Among Asian Population In Outpatient Clinics, Ying Huang

DNP Qualifying Manuscripts

Background: Routine oncology visits failed to identify 50-94% of patient’s distress, which creates a considerable burden, impairs emotional well-being and reduces patients’ quality of life. Limited in-person visits during the COVID-19 pandemic have reduced access to care for many patients, further adding to their emotional distress. Untreated distress also leads to elevated stress levels, systemic inflammation, non-compliance with treatment, and higher mortality rates. Early distress screening and multidisciplinary care are recommended to reduce the impacts of distress.

Objectives: To identify the best outpatient practices to address newly diagnosed cancer patients’ unique needs due to distress.

Methods: Databases searched including CINAHL® …

Assessment And Oral Care: An Essential Nursing Activity For Patients Receiving Cancer Treatment, Radhika R. Pai, Ravikiran Ongole, Sourjya Banerjee

Manipal Journal of Nursing and Health Sciences

Head and neck radiation therapy and chemoradiation are inherently associated with severe oral complications such as oral mucositis, infection, and functional issues of the oral cavity, significantly affecting the quality of oral cavity health in cancer patients. Oral care in cancer patients is a vital part of nursing care but can be seen as a most neglected job, along with other duties or a tedious task to undertake. Recognizing the effect of cancer treatment and delivery of oral care as per the specific guidelines to cancer patients is not well known, and it is not clear. Literature review reports that …

A Telehealth Palliative Care Objective Structured Clinical Examination, Lindsey Q. Mcintyre

Dissertations

Problem: Palliative care is a service focused on symptom management and improved quality of life for persons with serious or chronic illnesses and is widely underutilized. Although advanced practice registered nurses (APRNs) possess a unique skillset to contribute to palliative care, there is minimal reporting on palliative care training for this professional group. The purpose of this clinical scholarship project was to implement the End-of-Life Nursing Education Consortium (ELNEC) online training program for APRN students in the BSN-DNP program and evaluate its effect on student performance during a telehealth objective structured clinical examination (OSCE).

Methods: An observational, descriptive …

Emergency Department Visits And Hospital Admissions For Adult Cancer Patients Post Outpatient Chemotherapy: Does The Oncology Nurse Navigator Make A Difference?, Sunny L. Stirling

Dissertations

Background: Cancer is the second leading cause of death in the United States and worldwide. Oncology related hospital visits account for over $88 billion annually; 35% of this cost is attributable to inpatient hospital stays even though most cancer treatments are given outpatient. The Centers for Medicare and Medicaid Services introduced the Chemotherapy Measure which tracks Emergency Department visits and hospitalization within 30 days of any outpatient chemotherapy treatment. The Oncology Nurse Navigator (ONN) has offered some benefit in cancer care, but its role in ED visits and hospital admissions is unknown for adult patients with cancer post outpatient …

Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht

Doctor of Nursing Practice Final Manuscripts

Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.

Standardized Education On Physician Orders For Life Sustaining Treatment (Polst) Conversations, Venessa Oteniya

Doctor of Nursing Practice Final Manuscripts

According to research literature, 15% of Medicare beneficiaries spend more than 7 days in the intensive care unit before they die. These Medicare beneficiaries receive aggressive, life-prolonging medical treatments that might not be in agreement with their wishes. Approximately 13% of SNF residents have improperly completed POLST forms that can result in intensive treatments that patients did not want. One barrier to the lack of POLST completion in SNFs is staff difficulty with understanding and explaining the form, a result of inadequate education.

In August 2020, the San Diego Coalition for Compassionate Care formed an education program to provide virtual …

Achieving Advance Care Planning In Diverse Populations Via Teleconferencing With Skilled Nursing Facility Residents, Tania Huezo

Doctor of Nursing Practice Final Manuscripts

Background: Advance care planning (ACP) has always been a priority in healthcare, and even more crucial during the COVID-19 pandemic. It has been extremely challenging for ACP to occur in the skilled nursing facility (SNF) population once social distancing restrictions were put in place to protect residents and staff.

Purpose: The purpose of this evidence-based project was to assess the effectiveness of ACP via teleconferencing with skilled nursing facility (SNF) residents in the hope of increasing completion of high-quality Physician’s Orders for Life-Sustaining Treatment (POLST) forms.

Methods: The San Diego Coalition for Compassionate Care developed an ACP community outreach program …

The Essential Characteristics Of An Effective Hospice And Palliative Care Nurse, Alexis Doyle

The Eleanor Mann School of Nursing Undergraduate Honors Theses

No abstract provided.

Understanding The Role Of Hospice Care: Reflections From A Service-Learning Project, Avery Mccutcheon

The Eleanor Mann School of Nursing Undergraduate Honors Theses

There is little known about the part end-of-life care plays in patient care. This paper examines the role of end-of-life care in the care of a dying patient and consists of findings from a service-learning project with Circle of Life hospice. To be able to effectively care for those in the end stages of life, healthcare professionals must turn away from the curative aspects of medicine, to treating symptoms and improving quality of whatever life remains for the patient. In order to normalize EOL Care and consequently make it more accessible, we must educate our healthcare practitioners regarding the benefits …

The Changing Face In The Workplace: The Arrival Of The Millennial Generation, Sarah Clonch

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The entrance of the Millennial generation into the nursing workforce signifies a bright future for the nursing profession and the nursing workforce. This study began with a current review of available research that identified the Millennial generation and their views toward job satisfaction and work engagement, as compared with Baby Boomer and Generation X nurses.

PubMed, CINAHL Complete, and Google Scholar databases were employed to find 15 peer-reviewed articles for evaluation. The research findings suggest that Millennial nurses have lower rates of job satisfaction and work engagement, compared to nurses of older generations. Overall, the extracted data results were significant …

Improving Family Nurse Practitioners’ Knowledge Of Palliative Care Resources, Michelle L. Bond

Theses and Graduate Projects

The shift in healthcare indicates Americans are living longer with progressive chronic illnesses subsequently reducing quality-of-life. Primary care providers have opportunities to assess the need for and implement palliative care to offer holistic symptom management to improve patient’s quality-of-life. The purpose of this scholarly project, guided by Jean Watson’s Theory of Human Caring, is to assess primary care providers knowledge and comfort regarding initiating palliative care while determining if additional education improves their familiarity. The objectives were to review current palliative care literature identifying barriers and inadequacies, determine evidence-based practice to develop an educational presentation and resources to improve communication, …

Advance Care Planning Education For Older Adults, Jamie E. Seaquist

Theses and Graduate Projects

Advanced care planning guides health care professionals and surrogate decision-makers choices on end of life (EOL) care when individuals are no longer able to speak for themselves. Advanced care plans can benefit patients in their last six months of life by improving their quality of life and by reducing family members anxiety, depression, and stress when dealing with EOL treatment options. Aside from these benefits, poor communication and knowledge deficits often create barriers when medical staff, families or patients try to broach the subject of EOL care. Barriers can be overcome when health care professionals facilitate advanced care planning conversations …

Effects Of Palliative Care On Nurses’ Knowledge And Attitudes, Daniel Kerr

MSN Capstone Projects

Heart failure (HF) is a chronic, progressive disease that affects 6 million Americans (Ng & Wong, 2017). During the course of the disease, patients have worsening symptoms and need increasing levels of care from both medical staff and home caregivers. Often, these caregivers are family members or friends who spend a significant amount of their free time assisting the patient, leading to significant stress and burden on the caregivers. Recent changes in recommendations from the American Heart Association (AHA) include Palliative Care (PC) consultation for patients diagnosed with advanced stage heart failure, but many physicians have not included a PC …

Exploring The Lived Experience Of Adolescent Caregivers, Abbigale Laurentius

Honors Theses

In today’s society, the population is aging, and any member of the family could find themselves in the role as an informal caregiver. Adolescents between the ages of 12 and 18 years old may have these caregiving responsibilities, and it is imperative that healthcare professionals recognize and support this change of roles. A literature review revealed a general lack of research from within the last five years regarding adolescent caregivers. Those studies that were analyzed in the review presented themes of depression, anxiety, lack of education, and insufficient social supports for the adolescent. An unfolding case study was then designed …

Evidence-Based End-Of-Life Comfort Care Guidelines, Myla Maranan

Student Scholarly Projects

Practice Problem: In the absence of end-of-life (EOL) comfort care guidelines, the nurses in a medical-surgical unit are apprehensive about caring for patients in their active stage of dying, which leads to abandoning the values of holistic and patient-centered care.

PICOT: The PICOT question that guided this project was: "How do acute care bedside nurses (P) who utilize the evidence-based comfort care guidelines (I) compare to not using the evidence-based guidelines (C) perceive their confidence in their capability to provide holistic and patient-centered care (O) during the active onset of the patient's end-of-life stage (T)?"

Evidence: The literature indicated …

Assisting Nursing Students In Their Development Of Empathy: A Guide To Fostering Requisite Skills For The Art Of Empathetic Communication, Susan Mee

Open Educational Resources

This 7-week lesson plan is designed for use in clinical nursing courses. It is designed specifically for use by Nursing faculty teaching in the absence of state required patient facing clinical opportunity due to COVID restrictions. The lesson plan describes pedagogical techniques and provides video and education OER resources designed to help support the development of empathetic communication skills over 7 weeks. Refection and video debriefing techniques will be employed. Role play will culminate in the group presentation project of a brief video modeling effective therapeutic empathetic communication.

Hospice Families Shared Experiences With Time-Of-Death Visits, Katherine S. Katzenberger

Electronic Theses and Dissertations

The death of someone we love is a life-altering experience and may happen in a variety of settings. Hospice patients may die in their homes with their loved ones caring for them in their last moments of life. Families may receive a visit at the time of death from their hospice nurse. Few studies have been conducted looking at the lived experiences of home hospice families that have received a visit at the time of death from hospice. To better meet these families’ needs, the researcher conducted a study to explore and better understand their lived experiences. A qualitative phenomenological …

Palliative Nursing: The Core Of Covid-19 Care, Polly Mazanec

Faculty Scholarship

No abstract provided.

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 …