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Effectiveness Of End-Of-Life Strategies To Improve Health Outcomes And Reduce Disparities In Rural Appalachia: An Analytic Codebook, Radion Svynarenko, Guoping Huang, Theresa L. Profant, Lisa C. Lindley 2023 University of Tennessee, Knoxville

Effectiveness Of End-Of-Life Strategies To Improve Health Outcomes And Reduce Disparities In Rural Appalachia: An Analytic Codebook, Radion Svynarenko, Guoping Huang, Theresa L. Profant, Lisa C. Lindley

Faculty Publications and Other Works -- Nursing

Appalachia is one of the most medically underserved areas in the nation. The region has provider shortages and limited healthcare infrastructure. Children and adolescents in this area are in poor health and do not receive the needed quality care. Implementation of section 2302 of the 2010 Patient Protection and Affordable Care Act (ACA) enabled children enrolled in Medicaid/Children's Health Insurance Program with a terminal illness to use hospice care while continuing treatment for their terminal illness. In addition to being more comprehensive than standard hospice care, this relatively new type of care is more culturally congruent with the end-of-life values …


Delirium And Staff Injury, John Olague Jr 2022 University of San Francisco

Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …


Nurses Addressing The Knowledge Gap In Advance Care Planning, Stephanie Winkel, Elaine B. Harwood 2022 Four Seasons Palliative Care

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 2022 Marian University

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, …


Coping With Congenital Heart Disease: Implementation Of An Evidence-Based Intervention In A Pediatric Cardiac Intensive Care Unit, Victoria M. Raphael, Tracy L. Brewer, Sherry Pye 2022 University of Tennessee, Knoxville

Coping With Congenital Heart Disease: Implementation Of An Evidence-Based Intervention In A Pediatric Cardiac Intensive Care Unit, Victoria M. Raphael, Tracy L. Brewer, Sherry Pye

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Caregivers are exposed to many stressors in the pediatric cardiac intensive care unit (CICU) setting. In caregivers of children diagnosed with congenital heart defects admitted to the CICU, symptoms of psychological distress are prevalent (Doherty et al., 2009). These symptoms include, but are not limited to, feelings of acute and chronic stress, worry, anxiety, and depression. Without intervention, these symptoms can negatively influence the health and behavioral outcomes of the admitted child (Commodari, 2010). Providing support for these caregivers during their child’s admission can reduce the significance of these adverse psychological symptoms and promote both patient and caregiver well-being (Melnyk …


Nursing Students' Knowledge Of And Attitudes Towards Near-Death Experiences, Laura Lee Varela 2022 University of the Incarnate Word

Nursing Students' Knowledge Of And Attitudes Towards Near-Death Experiences, Laura Lee Varela

Theses & Dissertations

Incidence of reported near-death experiences (NDEs) has increased over decades; however, they continue to be inappropriately pathologized or dismissed. These types of responses to disclosures of NDEs by patients can potentially lead to them having problems integrating the experience into their lives. The purpose of this study was to assess undergraduate nursing students’ levels of accurate knowledge of and attitudes towards NDEs and to determine the predictors of nursing students’ knowledge of and attitudes toward NDEs. Additionally, I explored the sources in which nursing students acquire NDE knowledge. I accomplished this by using a cross-sectional, correlational research study design. I …


Palliative Care Services On An Adult Inpatient Oncology Unit, Heather E. Barger 2022 University of Missouri-St. Louis

Palliative Care Services On An Adult Inpatient Oncology Unit, Heather E. Barger

Dissertations

Abstract

Problem: Palliative care (PC) services are widely underutilized for patients with cancer, partly due to the shortage of PC specialists. Additionally, many Americans have not filled out advance directive (AD) paperwork which is commonly addressed in PC. In the absence of an AD, cancer patients are at risk of receiving undesired aggressive treatments in the event they are unable to make decisions independently.

Methods: This quality improvement pilot initiative utilized a descriptive observational design to evaluate the number of ADs documented in the electronic health record (EHR) on an inpatient oncology unit. A retrospective EHR review was used to …


Interprofessional Collaboration Competencies Of Nursing Students, Nurse Practitioner Students, And Paramedics In A Simulated Palliative Home Care Setting: A Pilot Study, Caroline Gibbons, Véronique Landry, Stéphanie Boudreau 2022 Université de Moncton, Moncton, N.B., Canada

Interprofessional Collaboration Competencies Of Nursing Students, Nurse Practitioner Students, And Paramedics In A Simulated Palliative Home Care Setting: A Pilot Study, Caroline Gibbons, Véronique Landry, Stéphanie Boudreau

Quality Advancement in Nursing Education - Avancées en formation infirmière

Background: Post-secondary institutions do not adequately prepare future professionals to provide quality palliative care. Furthermore, the competencies necessary for interprofessional collaborative practice in home-based palliative care are poorly described in the scientific literature. A palliative care simulation involving standardized patients and paramedics would be a strategy to educate nursing students and nurse practitioner students who have little opportunity to experience interprofessional collaborative palliative care in the home.

Objective: Describe the interprofessional competencies of nursing students, nurse practitioner students, and paramedics during a home-based palliative care simulation according to a National Competency Framework.

Method: This pilot study is qualitative descriptive. Six …


Implementing A Courtesy Call System To Increase Patient Satisfaction, Tessa Garcia 2022 The University of San Francisco

Implementing A Courtesy Call System To Increase Patient Satisfaction, Tessa Garcia

Master's Projects and Capstones

Abstract

Problem: An assessment of a home health microsystem found a decrease of patient satisfaction using Home Health Consumer of Healthcare Providers and Systems (HHCAHPS) survey scoring. Low HHCAHPS scores equivalate to poor quality care, which has a negative impact on patients and the organization itself.

Context: The setting for this project was a home health department microsystem in Northern, California serving a 400-patient population. The project was implemented within the quality department of the home health organization.

Interventions: Evidence shows that implementation of a courtesy call check-in improves satisfaction and patient outcomes. A courtesy call check-in was implemented to …


Caring For The Caregiver During Covid-19 Suspended Visitation, Melissa D. Rouse, Lorie K. Shoemaker, Priscilla Kyle, Chris Tenold, Whitney Anthony, Jordan White 2022 Northeast Georgia Health System

Caring For The Caregiver During Covid-19 Suspended Visitation, Melissa D. Rouse, Lorie K. Shoemaker, Priscilla Kyle, Chris Tenold, Whitney Anthony, Jordan White

Patient Experience Journal

During the 4th surge of COVID-19, August to November 2021, visitation was suspended in a hospital system in North Georgia. The Compassionate Connections Call Center (CCCC) was created to alleviate staff stress and to manage calls and communication. The goal of the initiative was to reduce interruptions to patient care caused by the increased number of calls to the clinical units by patients, families, loved ones and personal caregivers. The CCCC managed all incoming calls and communicated with the patient’s primary nurse through a coordinated process which limited interruptions. By caring for the caregiver, the aim was to improve the …


Can Variables From The Electronic Health Record Identify Delirium At Bedside?, Ariba Khan, Kayla Heslin, Michelle Simpson, Michael L. Malone 2022 Advocate Aurora Health; University of Wisconsin School of Medicine and Public Health

Can Variables From The Electronic Health Record Identify Delirium At Bedside?, Ariba Khan, Kayla Heslin, Michelle Simpson, Michael L. Malone

Journal of Patient-Centered Research and Reviews

Delirium, a common and serious disorder in older hospitalized patients, remains underrecognized. While several delirium predictive models have been developed, only a handful have focused on electronic health record (EHR) data. This prospective cohort study of older inpatients (≥ 65 years old) aimed to determine if variables within our health system’s EHR could be used to identify delirium among hospitalized patients at the bedside. Trained researchers screened daily for delirium using the 3-minute diagnostic Confusion Assessment Method (3D-CAM). Patient demographic and clinical variables were extracted from the EHR. Among 408 participants, mean age was 75 years, 60.8% were female, and …


Palliative Care Screening For Persons Living With Dementia In A Nursing Home, Shanika S. Pruitt 2022 University of Missouri-St. Louis

Palliative Care Screening For Persons Living With Dementia In A Nursing Home, Shanika S. Pruitt

Dissertations

Problem: Dementia is rapidly increasing as the people of the world mature and life expectancy increases. As the world ages and the prevalence of dementia increases, nursing home placement will and is the most sought place for care of this population. Dementia is under recognized as a terminal illness and palliative care is underutilized for nursing home residents with advanced symptoms of dementia.

Methods: This quality improvement (QI) initiative utilized a prospective, descriptive design. The Palliative Care Screening for the Elderly tool was administered to a purposive sample of persons living with dementia residing in the nursing home. Qualitative data …


Education Regarding Advance Directives Improves The End-Of-Life Choices Documentation In Heart Failure Patients, Phebe Hagins Wright 2022 Jacksonville State University

Education Regarding Advance Directives Improves The End-Of-Life Choices Documentation In Heart Failure Patients, Phebe Hagins Wright

Doctor of Nursing Practice Projects

Background: Heart failure affects the lives of more than 6 million people in the United States and outpatient heart failure clinics offer an opportunity to educate patients while providing evidence-based care. A needs analysis revealed that many heart failure patients do not have an advance directive (AD) on file.

Purpose: The DNP project aims to implement an educational program that provides the tools and knowledge to heart failure patients to assist patients in determining their end-of-life care goals and allow them to document these goals in the Five Wishes document.

Methods: This quality improvement project consisted of a didactic educational …


Canadian Nursing Students’ Understanding, And Comfort Levels Related To Medical Assistance In Dying, Shelley E. Canning Dr., Christine Drew 2022 University of the Fraser Valley

Canadian Nursing Students’ Understanding, And Comfort Levels Related To Medical Assistance In Dying, Shelley E. Canning Dr., Christine Drew

Quality Advancement in Nursing Education - Avancées en formation infirmière

Background: Recent legislation regarding medical assistance in dying (MAiD) has important implications for nursing practice and education. It follows that Canadian nursing programmes must integrate theoretical and clinical practice related to MAiD in current curricula. Understanding student knowledge and comfort regarding MAiD provides important direction for developing curricula.

Purpose: To explore the understanding and comfort levels of BSN students regarding MAiD.

Methods: An applied health research methodology drawing on Interpretive Description was employed. Forty BSN students were surveyed before receiving MAiD education delivered through coursework and clinical experiences; 32 students participated in post intervention surveys; six students participated in individual …


Pediatric Palliative Care Training To Advance Nurses’ Knowledge And Increase Patient Referrals, Whitney Lynn Stone, Lisa Merritt, Tammy Childers 2022 Fontbonne University

Pediatric Palliative Care Training To Advance Nurses’ Knowledge And Increase Patient Referrals, Whitney Lynn Stone, Lisa Merritt, Tammy Childers

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Objective: The purpose of this evidence-based practice quality improvement project was to implement an educational intervention to improve pediatric palliative care services in a Pediatric Intensive Care Unit (PICU). The goal was to improve nurses’ knowledge of palliative care and increase the number of palliative care consults.

Methods: Educational sessions were created using the End-of-Life Nursing Education Consortium (ELNEC) Pediatric Curriculum. Participants included 46 PICU nurses. Knowledge of palliative care was measured at three timepoints; pre-, immediately post- and four weeks post-intervention. The number of palliative care referrals were measured at two timepoints; three months pre- and three months post-intervention. …


Early Integration Of Palliative Care With Curative Oncology Treatment For Patients With Advanced Cancer: Implications For Clinical Nursing Practice, Rhea Rughani 2022 Seattle Pacific University

Early Integration Of Palliative Care With Curative Oncology Treatment For Patients With Advanced Cancer: Implications For Clinical Nursing Practice, Rhea Rughani

Honors Projects

Palliative care, though clinically established to improve health-related quality of life measures for patients with advanced illness, remains underutilized and largely limited to end of life care. This project aims to inform oncology nursing practice through the analysis of literature supporting the early integration of palliative care with standard curative oncology treatment for patients with clinically advanced cancer. Informed by relevant research, clinical practice guidelines, and improved specialty palliative care training, oncology nurses and nurse practitioners are ideally situated to advocate for and initiate early palliative care integration, to holistically improve the standard approach to complex cancer care.


Improving Palliative Care Education In The Acute Hospital Setting, Maria Klug 2022 Pittsburg State University

Improving Palliative Care Education In The Acute Hospital Setting, Maria Klug

Doctor of Nursing Practice

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 …


Factors Contributing To Nurse Burnout In Oncology, Caroline Withers 2022 University of Arkansas, Fayetteville

Factors Contributing To Nurse Burnout In Oncology, Caroline Withers

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Nurse burnout is a pressing concern for healthcare with significant implications for all areas of nursing and patient outcomes. However, the specialty of oncology experiences burnout differently than other specialties for a multitude of reasons. This literature review aims to determine factors that contribute to nurse burnout within oncology, and identify evidence-based prevention strategies. The twenty studies included in the review underscore the crucial role of management and leadership in the prevention of nurse burnout. Further education and research are needed to better understand causes of burnout, as well as proper interventions. Interventions need to be established on a hospital …


Advantages Of Early Utilization Of Palliative Care In The Pediatric Icu: A Scoping Review, Shelby Noel Cain BSN, RN, CPN, Dana Pabalate Zimmerman MSN, RN, Charis Elizabeth Oji MSN, APRN, CPNP-PC/AC, Michelle Rickard DNP, CPNP-AC 2022 University of Tennessee Health Science Center

Advantages Of Early Utilization Of Palliative Care In The Pediatric Icu: A Scoping Review, Shelby Noel Cain Bsn, Rn, Cpn, Dana Pabalate Zimmerman Msn, Rn, Charis Elizabeth Oji Msn, Aprn, Cpnp-Pc/Ac, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Abstract Purpose/Background Despite the increased use of palliative care in adults, only a tiny percentage of children with life-limiting illnesses or life-threatening conditions receive palliative care before dying. Palliative care has low utilization, and consults are often made late in a child’s hospitalization or diagnosis. Palliative care remains underutilized among hospitalized pediatric patients resulting in unnecessary treatments, costly and lengthy hospitalizations, and deaths occurring in the intensive care unit (ICU) rather than at home. The purpose of this scoping review is to evaluate current literature to determine the use and effect of pediatric palliative care, specifically, whether consultation of palliative …


Dnp Final Report: Psychosocial Screening For Oncology Patients, Robyn V. Beard 2022 University of Texas at Tyler

Dnp Final Report: Psychosocial Screening For Oncology Patients, Robyn V. Beard

DNP Final Reports

Background: Patients with cancer often face severe distress related to fear of death, body disfigurement, financial stress, and lack of support system. This distress may lead to physical and emotional symptoms that bring patients to seek care at emergency departments, delay care or make poor health choices, and increase utilization of prescription drugs. With the already over burdened healthcare system, addressing these psychosocial needs is vital to improving patients outcomes as well as improving healthcare expenditure. Purpose: The purpose of this evidence based practice project was to improve perceived quality of life for oncology patients through detailed screening and behavioural …


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