Palliative Nursing Commons^™

Application Of Root Cause Analysis For Fall Prevention: A Quality Improvement Initiative For Older Adults In A Skilled Nursing And Long-Term Care Facility, Terrence Ranjo

Doctoral Projects

Falls in older adults are common and often have severe outcomes. They are the leading cause of fatal and non-fatal injuries among people aged 65 and older and continue to increase. Half of residents in nursing facilities fall annually, and one in every ten falls will lead to a severe injury. Federal regulations like the Centers for Medicare and Medicaid Services require long-term care (LTC) facilities to incorporate quality assurance performance improvement initiatives to address identified quality concerns in LTC facilities. Root cause analysis (RCA) can help clinicians identify several root causes of falls and guide clinicians in developing personalized …

Exploring The Reassessment Of Palliative Home Care Clients: A Mixed Methods Study, Maya Canham

Theses and Dissertations (Comprehensive)

Introduction: The timely reassessment of clients receiving palliative home care (HC) is critical for supporting clinicians with care planning and service delivery. However, there is little information on the frequency of reassessments and factors driving reassessment in palliative HC clients.

Objectives: The objectives of this study were to: (i) determine the proportion of palliative HC clients reassessed with the interRAI Palliative Care (interRAI PC) instrument, (ii) calculate the average interRAI PC reassessment interval, (iii) identify the key factors driving interRAI PC reassessment at various intervals, and (iv) explore the factors that influence palliative HC clinicians to reassess their clients in …

Improving Performance And Documentation Of The Bedside Mobility Assessment Tool, Joseph P. Chellew

Master's Projects and Capstones

Objectives: Decreased patient mobility is associated with negative health outcomes including decreased functional capacity, pressure injuries, deep vein thrombosis, and bloodstream infections (Yasmeen et al., 2020). Early and increased mobilization mitigates these complications and is associated with positive outcomes (Wang et al., 2020). The Bedside Mobility Assessment Tool 2.0 (BMAT) is a mobility assessment that guides the selection of equipment to safely mobilize patients (Boynton et al., 2020). Aim: This quality improvement project aims to increase BMAT documentation compliance by 10% in three medical-surgical units at Hospital A where only 31.3% of patients were assessed per day using the BMAT. …

Medical Aid In Dying Education For Hospice Nurses, Ian K. Woo

Nursing | Student Research Posters

Background: Medical aid in dying (MAID) is an option surrounding end-of-life care for hospice patients. This process gives patients the autonomy to end their life during the time and location of their choosing. MAID is growing in legalization and practice across the US. However, many nurses feel uncomfortable or unprepared when providing care for patients contemplating it. Hospice nurses should have confidence in their ability to care for patients through the process of MAID. Objective: To evaluate the effectiveness of education in strengthening new hospice nurses’ ability to care for patients through the process of MAID. Method: The research will …

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 …

Management Of Post-Operative Pain In Those With A Drug History, Emelyn Stockton, Maddie Griggs

Scholars Week

Addressing postoperative pain management in patients with a history of opioid abuse is essential for enhancing patient safety and quality care. Implementing evidence-based practices and standardized protocols can reduce the risk of relapse and improve the outcomes for this population. By focusing on staff education and training, healthcare providers can gain the necessary skills to effectively manage pain while minimizing the reliance on opioids. Ultimately, a comprehensive approach that includes alternative therapies and consistent monitoring will foster better recovery experiences for patients.

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Central Line-Associated Bloodstream Infection Reduction In Hemodialysis Patients Across 9 Hospitals And 3 States, Nicki Roderman, Kasadi Moore, Shandlie Wilcox, Jennifer Jellerson, Zoey Bridges

HCA Healthcare Journal of Medicine

Background

This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.

Methods

To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) …

A Nurse-Driven Screening Process To Increase Icu Palliative Care Utilization, Sara L. Stock

Doctor of Nursing Practice Final Project Abstract

Purpose

A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds.

Background

Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. …

How Do Older Adults Define A Good Death? A Scoping Review, Ellen L. Csikai, Quentin R. Maynard

Midwest Social Sciences Journal

A scoping literature review of the concepts of ‘good death’ and ‘dying well’ among older adults was conducted. The purpose was to identify aspects that older adults specifically considered important in defining a ‘good death’. The search revealed five articles published between 2005 and 2019 that met inclusionary criteria for the review. Primary among the views of the older adults in these studies of a ‘good death’ was the desire to avoid being a burden to families; done so by dying pain-free/peacefully (preferably in sleep) and preparing in advance by involving family in decisions and funeral/estate planning. Family support throughout …

Improving Palliative Care Knowledge In The Acute Care Setting, Laura C. Brumett

MSN Capstone Projects

Aim: The aim of this paper is to present an education intervention for bedside nursing staff to improve their palliative care knowledge and the end-of-life care provided for terminally ill patients.

Background: When dying in the hospital, patients experience higher discomfort, lower quality of life, and prolonged family grieving. Suffering worsens when patient needs are unmet and can contribute to a traumatic death. Providing end-of-life education will increase a nurse’s knowledge of palliative care, address knowledge gaps, and promote better patient outcomes through improved clinical practice.

Design: The proposed intervention has three prongs which include: (1) virtual training using the …

Enhancing Discharge Process For Home Iv Milrinone Patients With Advanced Heart Failure, Kaitlyn Bauer

Doctor of Nursing Practice Final Project Abstract

Purpose: Discharge processes for patients with heart failure on home intravenous inotrope support is fraught with barriers and complexities, and causes patients, caregivers, and bedside nurses’ high levels of stress leading to potentially unsafe, complicated discharges. This project aimed to decrease discharge times and improve nurses’ ability to safely and effectively discharge patients.

Background: The project was implemented in a 42-bed advanced heart failure IMU in the Texas Medical Center, where discharge times were longer than hospital standards at over 6 hours.

Methodology: Using elements of the Transition of Care Model, a discharge checklist was created to help staff prepare …

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 …

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 …

Preventive Strategies For Elder Abuse Within Hospice Care By Healthcare Professionals, Joshua Eason

Nursing | Student Research Posters

Background: Healthcare professionals providing hospice care need to have particular specialized abilities, empathy, and trust. Unfortunately, some of these medical professionals are unable to provide their patients the care they need, so they will instead abuse and ignore them. Elder abuse must be identified and addressed in hospice care settings if older patients are to have their rights and dignity upheld and a standardized, compassionate end-of-life care program is to be provided for each patient.

Purpose: The purpose of this study is to examine the effectiveness and preventative strategies for elder abuse, implemented by healthcare providers within the hospice care …

Cultural Education Interventions Impact On Cultural Competence, Kaylie V. Griffin Ms

ONU Student Research Colloquium

Problem: In the United States, there is a substantial increase in diversity. This increase in diversity poses multiple challenges for healthcare workers and healthcare systems. Because nurses care for patients with various cultural backgrounds, health beliefs and practices, and languages, cultural competency plays a pivotal role in providing patient-centered care. There is a need to enhance cultural education for healthcare workers to ensure that healthcare workers have the skills and knowledge to effectively engage with all patient populations. Implementing cultural education interventions seeks to increase healthcare workers' competency, communication, and patient outcomes. Purpose: The purpose of this research question is …

The Significance Of Palliative Care Education And Areas For Improvement, Lindsey Bunday

Honors Projects

Palliative care is vital in prioritizing quality of life for patients with serious illnesses. Such care is crucial to help patients understand their prognosis, address needs, and meet goals of care. However, physician shortages, improper utilization, and non-standardized medical curriculum amplify the gaps in care and demonstrate significant room for improvement. Innovative curriculum and opportunities for knowledge advancement can refine education and improve patient care.

Improving Utilization Of Nonpharmacological Interventions In Adult Oncology Patients, Alison Keck

Doctor of Nursing Practice Scholarly Projects

Background: Anxiety is one of the most prevalent symptoms oncology patients experience and clinical guidelines support the use of nonpharmacological interventions (NPI) as a primary method for managing anxiety.

Local Problem: At a suburban, community hospital, a nurse perception survey revealed staff were “always” offering medications 69% of the time but NPIs were “never” used anywhere between 38-81% of the time. In a sampling of patients, only 33% recalled they had used NPIs. A Patient Reported Outcomes Measurement Information System (PROMIS) tool revealed that 69% of patients had higher than average levels of anxiety on the unit.

Methods: This quality …

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 …

Information Impact On Home-Based Palliative Care Admissions, Donna Rugh

West Chester University Doctoral Projects

Patients appropriate for Home-Based Palliative Care services are fragile with increased risk for mortality and hospital readmissions. Utilization of Home-Based Palliative Care skilled nursing services have been proven to decrease these risks and improve quality of life. Information deficits negatively impact nurse clinical decision making during the admission process, potentially misguiding the nurse resulting in a non-admission to service. This project focused on the impact of both nurse education and clinical information sharing at admission. Pre and post data was compared to examine the impact of these interventions on non-admissions rates for the reasons of “no skilled need” or “not …

Dying Is The Easiest Part: Implications Of Palliative Care In America, Sophia Jordan

Undergraduate Honors Theses

The purpose of this paper is to uncover why Americans fear death. What are the foundational principles that cause most individuals of the American society to prolong the dying process? The topics discussed will include physician bias, disease mongering by pharmaceutical companies, consequences of aggressive treatment, the barriers to palliative care and the specific effects of pediatric palliative care. There is a small amount of research on this specific topic, therefore, this paper also seeks to bring awareness to the benefits of palliative care. It is the overall aim of this paper for society to shift their beliefs towards the …

Preparing For End Of Life In A New Country: A Grounded Theory Study On African Migrants Living In Australia, Gertrude Gondwe Phiri

Theses: Doctorates and Masters

African migration to Australia has grown in the past 20 to 25 years with many migrants staying permanently. This has led to migrants dying away from their birthplaces where family is responsible for end-of-life care planning for the individual. Although migrating to Australia is considered a great achievement, many migrants also experienced challenges. Previous studies have explored the barriers faced by migrants in relation to end-of-life care but have not addressed the cause of those challenges. This constructivist grounded theory study examines how migrants from three African countries, Malawi, Zambia, and Zimbabwe (MZZ) prepare for end-of-life in Australia. The study …

Impact Of An End-Of-Life Simulation On Nurses’ Attitudes, Self-Confidence, And Communication Skills, Amanda Scofield

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: New graduate nurses (NGNs) often lack exposure to end-of-life (EOL) care. Simulation experiences offer a safe place for learning and reflection. Implementation of an EOL simulation has the potential to increase NGNs attitudes, selfconfidence, and communication skills.
Methods: Forty-one NGNs in a nurse residency program participated in an EOL simulation. Attitudes toward EOL, self-confidence regarding EOL care, and EOL communication were evaluated using a pretest posttest format.
Results: Following the simulation, mean self-confidence scores increased, however the increase was not statistically significant (p = 0.53). Mean scores increased for 1 of 2 categories related to attitude toward EOL, however …

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 …

Unleashing Wellness: Exploring The Impact Of Pet Therapy On Anxiety Reduction, Quality Of Life, And Treatment Adherence In Pediatric Oncology Patients, Karina Brouwer

Nursing | Senior Theses

Pet therapy is a complementary intervention that involves the interaction between a person and animal, with the focus of improving psychological well-being within diverse populations. In particular, children with oncological disorders have increases in anxiety and stress levels, therefore it is imperative to study the impact of animal interventions within this population. This literature critique explores the impact of pet therapy interventions on anxiety, stress, and quality of life perceptions in pediatric oncology patients. This research proposal will investigate how animal therapy interactions within pediatric oncology patients influence their anxiety levels and perceptions of quality of life and how these …

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 …

Unleashing Wellness: Exploring The Impact Of Pet Therapy On Anxiety Reduction, Quality Of Life, And Treatment Adherence In Pediatric Oncology Patients, Karina Brouwer

Nursing | Student Research Posters

Pet therapy is a complementary type of therapeutics in which a person and animal have a guided interaction with the purpose of helping someone cope with physical and/or mental illness. Animal-assisted therapy is used in numerous settings and has been shown to reduce stress, lower blood pressure and heart rate, and decrease anxiety and depression (Husson University, 2022). In particular, pediatric oncology patients have enormous amounts of stress in their lives, which leads to increased anxiety and decreased quality of life (Children's Cancer Cause, 2023). While evidence shows that integrating pet therapy in pediatric oncology patients produces significant benefits on …

Preparing Nurses For Medical-Assistance In Dying: The Role Of Comprehensive Education And Training, Keira O'Reilly

Nursing | Student Research Posters

Medical-assistance in dying (MAID) is a process in which a physician prescribes lethal medications that the consenting patient will self-administer with the intention of ending their life. By April 2024, medical-assistance in dying was legal in 10 states as well as the District of Columbia (“Death with Dignity,” 2024). With an evolving legal landscape around MAID, healthcare professional training on this procedure is often overlooked and inadequate (Winters et al., 2022). This is especially true for ICU nurses who manage critical and often end of life cases. This lack of education leaves nurses underprepared for the legal, ethical, and emotional …

Nursing Students’ Attitudes And Preparedness For Maid, Kristal Candray

Nursing | Student Research Posters

As the aging population grows, terminal illness diagnoses are increasing, which has increased global interest in Medical Assistance in Dying (MAiD), Physician-Assisted Suicide (PAS), and euthanasia. However, there hasn’t been much research on how nursing students in California feel about MAiD or how well their education prepares them for these practices. Studies show that religious beliefs and prior knowledge or clinical experience with MAiD can influence students’ attitudes and sense of preparedness. Qualitative research has also identified common challenges, like role confusion, conflicts between ethics and religion, and the need for better education on the topic. Despite this, there’s no …

Using The 4ms Framework To Prevent Falls, Gina L. Edgeworth

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Hospital falls are rising in inpatient facilities, requiring analysis and a plan of action to address the ongoing falls. A strategy taken among facilities is implementing a 4Ms Framework that allows the nurse to address what matters to the patient and assess their mentation, medications, and mobility upon admission. With an increase in falls on a med-surg unit, it was found that there was no straightforward process for addressing the needs and concerns of patients and no assessment of medications, mobility, or mentation for those aged 65 years and older. This knowledge gap prevents nurses from providing a structured framework …