Palliative Nursing Commons^™

Provider Admission Visit To Implement Medication Deprescribing In Hospice, Shaunda A. Bueno

SACAD: Scholarly Activities

A large portion of healthcare spending is focused on patients with multiple chronic illnesses, and most of these patients are on numerous medications, commonly referred to as polypharmacy or hyper-polypharmacy. Furthermore, hospice-eligible patients have at least one disease process that is considered life-limiting with a life expectancy of less than six months, and often have multiple medical conditions with complicated treatment regimens known as multimorbidity. The high incidence of multiple comorbidities for hospice patients, combined with advanced age and the incidence of polypharmacy and hyperpolypharmacy, has also caused an increased treatment burden for patients and caregivers. To address this issue, …

Implementing An Evidence-Based Wound Care Protocol For Inpatient End-Of-Life Residents That Aligns With Hospice Comfort Care Goals, Oge C. Okeke

Doctor of Nursing Practice Final Project Abstract

Implementing an evidence-based wound care protocol for inpatient end-of-life residents that aligns with hospice comfort care goals.

Purpose

This quality improvement (QI) project aimed to adopt a patient-centered, comfort-focused approach to wound care at the DNP project site and improve patient outcomes by increasing nursing staff's knowledge of evidence-based wound treatment strategies by 20%.

Background

Curative treatments involving aggressive methods do not align with hospice principles. Residents at the project site experience increased suffering at the end of life because of limited nursing knowledge of evidence-based, atraumatic wound care practices for end-of-life patients.

Results

Pre-intervention nursing knowledge survey scores ranged …

Decreasing Burdensome Transitions In Hospice Care By Increasing Nursing Visits, Kristin S. Rivers

Doctor of Nursing Practice Projects

Background: Burdensome transitions occur when hospice patients discontinue hospice services to seek hospital treatment, often disrupting end-of-life goals and creating distress for patients and caregivers. These transitions continue to rise throughout the country, highlighting the need for strategies to support patients in remaining at home throughout the dying process.

Purpose: This quality improvement project aimed to decrease hospital transitions by increasing nursing visits for hospice patients at high-risk for burdensome transitions.

Project Design: This quality improvement project used a Plan-Do-Study-Act methodology to form and implement an intervention to reduce burdensome transitions. Patients were already identified as low or high-risk …

Implementation Of A Standardized Pain Assessment Tool To Drive Opioid Management In End-Of-Life Patients In A Medical Intensive Care Unit, Sonia Carrizales

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement project implemented a standardized pain assessment tool, the Multidimensional Observational Pain Assessment Tool (MOPAT), to drive opioid administration for end-of-life (EOL) patients. This project intended to increase opioid administration to EOL patients through increased confidence levels noted in bedside staff with the use of a standardized pain assessment tool.

Background

The project was implemented in a thirty-two-bed adult medical intensive care unit in Round Rock, Texas. The patients focused on in this project were those transitioned to EOL care.

Methodology

A pre-and post-survey was sent to bedside staff to gauge confidence levels. The MOPAT was then …

Improving End-Of-Life Care: A Nursing Education Initiative, Spring C. Kingsley

DNP Projects

Background: This study addresses the gap in education and training for medical intensive care unit (MICU) nurses regarding the care of hospice patients. The traditional medical model of healthcare prioritizes illness treatment, often leading to inadequate end-of-life support and increased hospitalization during patients' final days. The rise of in-hospital hospice programs, or scatter-bed hospice models, highlights the need for nurses to enhance their skills in providing end-of-life compassionate care. The MICU at the University of Kentucky’s Chandler Hospital serves as a focal point for this initiative, given its role in caring for critically ill patients who require hospice attention.

Purpose: …

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 …

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 …

Simplifying Qualitative Case Study Research Methodology: A Step-By-Step Guide Using A Palliative Care Example, Elizabeth M. Miller Mrs, Joanne E. Porter Professor, Michael S. Barbagallo Dr

The Qualitative Report

Qualitative case study research can be a helpful methodology when conducting health research. However, it can be overlooked or dismissed as a possible methodological choice due to different epistemological positionings by case study theorists and often confusing and contradictory definitions and terminology. Much has been written about case studies, but it takes time to wade through volumes of often philosophically and methodologically dense material to locate a theorist who presents case study research at a depth the novice researcher can understand. Case study research literature may offer a condensed summary of processes but often needs more theoretical detail. Therefore, discerning …

Improving Advance Directive Documentation In A Primary Care Clinic In The Midwest, Teresa Hagedorn

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Teresa Gayle Hagedorn

Advance care planning (ACP) is a continuous communication process linking patients, family members, caregivers, and healthcare providers. Personal values, life goals, and preferences regarding future medical care are significant to every person as we will inevitably reach the end of life. Advance directives (ADs) promote patient autonomy and provide legal documentation of a patient’s wishes for future care. According to the National Institute of Health (2018), only 1 in 3 adults in the United States have a documented AD in their electronic medical records (EMR). This quality improvement project aimed …

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

Nursing | Student Research Posters

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 …

Doing Death Better: Practical Ways For Healthcare Professionals To Care For The Dying Patient And Their Families, Andrea Wilson

Undergraduate Honors Theses

Healthcare professionals care for patients with unique personal, cultural, religious, and medical needs, but these needs are not always met in a way that ensures the patient and their families are being treated as unique individuals. This paper first provides an overview of the physiological aspects of dying and how to educate patients and their families regarding expectations in end-of-life. The impacts of the death of a child and a parent were explored, and areas in need of more resources for these individuals were identified. The beliefs and practices of Hindu, Native American, and Islamic cultures were discussed, and lessons …

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 …

Increasing Knowledge And Comfort Levels Of Icu Nurses In Goals Of Care Discussions Through Palliative Care Education, Stephanie Harrison

Doctor of Nursing Practice Projects

Critical care nurses are tasked with treating patients during the most complex times, typically beginning with aggressive treatment measures and in many cases, transitioning to end-of-life care. According to the literature review, critical care nurses report they frequently provide care that they feel is futile and palliative care resources are underutilized in the intensive care unit. They also report limited education/training and comfort in understanding their role in goals of care conversations and end-of-life care despite their vital role in providing direct patient care. The goal of this project was to implement an education program using the IMPACT-ICU toolkit to …

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 …