Palliative Nursing Commons^™

Advance Care Planning In Metastatic Lung Cancer Patients: A Quality Improvement Initiative, Khanh H. Thai

Student Theses

Background: Advance care planning (ACP) is essential in achieving goal-concordant care for patients with metastatic lung cancer (MLC), yet it remains underutilized.

Local problem: Despite its benefits, ACP has been inconsistently integrated into outpatient oncology settings, and a baseline evaluation at the project site revealed that only 11% of patients with MLC had ACP documented in the outpatient care clinic.

Methods: This Quality Improvement initiative implemented a formal, Nurse Practitioner (NP)-led intervention into routine oncology care. Using a quasi-experimental nonrandomized design, 13 eligible patients diagnosed with MLC without prior ACP documentation were enrolled in a four-week study. These participants were …

Advance Care Planning In Rehabilitation: Training Nurses And Social Workers To Facilitate Discussions, Celeste Christiansen

Student Scholarly Projects

Practice Problem: Patients and healthcare workers fail to hold advance care planning (ACP) discussions. Social workers perceive a lack of time and feel unprepared to hold ACP conversations.

PICOT: The PICOT question that guided this project was: Do patients in acute inpatient rehabilitation (P) who receive education and resources about ACP from trained nurses and social workers (I) accept and participate in ACP (O) compared to prior standards of care (C) while on the rehabilitation unit (T)?

Evidence: The public and healthcare workers have limited knowledge of ACPs and their role in these discussions. People are more likely to hold …

Education For Primary Care Providers On Advance Care Planning, Lindsey Ward

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown …

Advance Care Planning: Best Practice Toolkit For Improving Access To Advance Care Planning Using Telehealth Visits, Jae Jackson

Student Scholarly Projects

Advance care planning (ACP) predominately occurs during a life-threatening crisis or during an inpatient admission. The primary care provider (PCP) is generally not the healthcare provider addressing ACP at the time of a crisis or during an inpatient admission. Being proactive in limiting ACP decisions with unfamiliar providers, uncomfortable environments, and increasing access to ACP discussions with PCPs are supportive reasons to utilize an ACP telehealth toolkit in primary care. Patients risk having ACP discussions with random providers, environments that don’t provide comfort when having such personal discussions, or not having the peaceful death they deserve without having an ACP …

Cultural Perspectives In Pain And Palliative Care, Loan Lagué

Master's Projects

Culturally and linguistically diverse (CALD) patients are constantly challenged by the different levels on which lack of cultural competency or bias occurs in healthcare. This literature review focuses on the healthcare providers’ experiences when providing pain and palliative care to CALD populations and explores the challenges that may result in health inequalities. A review of current literature was conducted using PubMed, CINHAL, Sage Journals, Ovid, and Science Direct electronic databases. Sixteen published articles between 2015-2023 were reviewed. Findings from this review identified factors that induce poor quality palliative, pain, and end-of-life (EOL) care among culturally diverse groups. Improving quality of …

Nurses Addressing The Knowledge Gap In Advance Care Planning, Stephanie Winkel, Elaine B. Harwood

International Journal of Faith Community Nursing

Background: Advance care planning allows people autonomy about values and preferences related to care at the EOL. Engaging in advance care planning enables one to consider decisions about medical treatment at the EOL and informing significant others, including health care providers, about preferences (National Institute on Aging [NIA], 2018).

Methods: In this QI project, the intervention will be a one-time ZOOM^® meeting between nurse leaders and participating church members. The nurse leader will present the 5 Wishes curriculum and lead a question-and-answer portion at the end of the ZOOM^® meeting. Participants will be asked to complete a short …

Advance Care Planning In Faith Communities: A Quality Improvement Project, Lorie Hacker, Jan Gaddis, Jessica Grimm, Catherine Chung

International Journal of Faith Community Nursing

This quality improvement project examined the impact of providing an advance care planning training tool to faith community nurses in the community setting on advance care planning knowledge, self-efficacy, and implementation of advance care planning outreach and advance directive completion. The pre- and post-intervention frequencies measure and paired-t test survey design resulted in clinically significant improvements in knowledge, and self-efficacy of advance care planning among faith community nurses. A fifty-fold increase was seen in advance care planning outreach activities among the group from pre- to post-intervention. The limitations of the project included small sample size and short implementation timing. However, …

African Americans In Home Health: Advance Care Planning And Acute Care Services Use, Sharon Bigger, Lee Glenn

Epsilon Sigma at-Large Research Conference

Background: Home health is the fastest-growing healthcare setting in the country. Through Home Health Value-Based Purchasing (HHVBP), the Center for Medicare and Medicaid Services (CMS) provides incentives or penalties to HHAs based on outcomes. Hospitalization and emergency department use are weighted heaviest as poor outcomes. HHVBP requires HHAs to report on whether they are engaging in advance care planning (ACP) conversations. For this study, ACP was defined as a conversation held in advance of a medical crisis with a loved one and/or a health care provider about goals; values; preferences for future medical treatments; and choice of a surrogate decision-maker. …

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 …

Holistic Understanding, Bridget Burness

Theses and Graduate Projects

In 2007, the Association of American Retired People (AARP) published its Funeral and Burial Planners survey key findings that revealed 12 percent were interested in green burial and that practitioners should provide education on environmentally friendly options to this audience. Nurses are currently knowledgeable about Advance Care Directives (ACD) for cessation of care. To gain a better understanding of nurses' attitudes toward green burial, a plan to create a holistic nurse-learning circle was developed to discuss the Funeral Rule, pre-burial planning for green funerals and flameless cremation, and the importance of collaborating with funeral directors. To facilitate this group, a …