Getting The Most From M.O.S.T.: Promoting Most Education For Palliative Care Providers, Shelby Mood

Doctor of Nursing Practice Projects

Physician Orders for Life-Sustaining Treatment (POLST) forms are relatively new in medicine. These forms help patients and providers navigate some of the difficult decisions that can occur near the end of life and in palliative care. Each state has its own version of POLST forms. In the state this DNP project was implemented, this form is called Medical Orders for Scope of Treatment, or MOST form. Given the complexities of medical decisions, patients may not always understand the options covered in the MOST form or the implied tasks with each choice. To further patient understanding of the MOST form, this …

Impact Of An Aprn Directed Workflow Change On Outpatient Palliative Care Referral Acceptance Rates, Stefanie Rashti

West Chester University Doctoral Projects

Abstract

Patients diagnosed with an advanced disease or serious illness often experience a variety of distressing symptoms that can negatively impact their functional status and quality of life. Outpatient palliative care is a medical specialty that often requires a referral from a primary care or specialty care provider who has identified a need for specialized pain and symptom management, psychosocial or caregiver distress, end-of-life care management, or goals of care discussions. Despite notable effectiveness in the provision of palliative care for patients with advanced disease and serious illness, barriers exist that prevent patients from accepting palliative care referrals even after …

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 …

Facilitating Palliative Care In A Critical Access Hospital System: Implementation Of Screening And Educational Interventions, Michele Lovell

DNP Scholarly Projects

BACKGROUND: The United States health care system faces the dual challenge of an aging population with a concomitant increase in the presence of chronic and serious illness, the care of which accounts for the nation’s largest expenditure of burgeoning healthcare costs. Palliative care is specialized care for people with serious illness aimed at reducing suffering, optimizing quality of life, and enhancing medical decision making. An ample evidence base demonstrates that palliative care increases both quality of care and patient and family satisfaction while also reducing associated costs. The aim of this quality improvement project was to facilitate palliative care services …

Giving Effective And Timely Hospice Education To Lessen Participant Stress (Get Helps), Caroline Rose Carter

Master's Theses and Capstones

In 2022, 1.72 million people chose to use hospice as their end-of life care. This is a 6.8% increase from 2019, and the number of patients who choose to use hospice is increasing (Summers, 2022). The aim of this quality improvement (QI) study was to decrease levels of stress reported by the patient and informal caretakers by combining the information from the hospice program’s admission packet and other approved handouts, while standardizing the verbiage through a Flesch-Kincaid readability scale to an eighth-grade reading level. Pre-survey perceived stress scores averaged 22.97 on a modified Perceived-Stress Scale, and the mean of the …

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 …

Implementation Of A Death Anxiety Screening Protocol Specific To Patients With Advanced Cancer In An Outpatient Palliative Care Setting, Olivia M. Sasdi

DNP Projects

Abstract

Background: Recent studies have shown that upwards of 80% of patients with advanced cancer suffer from death anxiety resulting in increased physical and psychological suffering. Despite death anxiety’s ubiquitous nature and negative impact, the literature regarding this condition consistently indicates that it remains under-identified and undertreated in patients with advanced cancer. The “Death and Dying Distress Scale” (DADDS) is a clinically validated tool used to identify, measure, and guide effective treatment modalities for death anxiety specifically in patients with advanced cancer, but is scarcely used routinely in practice. Incorporating this screening tool to be used regularly could improve identification …

Utilizing Podcast Education To Improve Nurse Knowledge, Confidence, And Behaviors Related To Palliative Care Conversations In The Intensive Care Unit, Brittany Estridge

DNP Projects

Background: The personal connection that Registered Nurses (RNs) build with patients and their families puts them at the forefront of many conversations during the patient’s stay in the intensive care unit (ICU). Some of the most difficult conversations are related to palliative care (PC). It can be challenging to know how to respond to the complex questions posed in palliative care conversations (PCC) when patients and their caregivers are making decisions that will alter the course of the patient’s treatment, as well as affect the quality and length of their life.

Purpose: Nurses receive inadequate training in PCC. The purpose …

Interventions To Alleviate Guilt In Family Caregivers Of Patients Receiving Hospice Or End-Of-Life Care: A Scoping Review, Kyla N. Huelle

Honors Undergraduate Theses

This scoping review contains a literature analysis regarding interventions used by health care workers to alleviate guilt in caregivers of patients during end-of-life care. During end-of-life care, many transitions and decisions are made that add to the burden of caregivers. Family caregivers experience many physical, financial, and emotional stressors during the journey of end-of-life care, and this can result in guilt. Feelings of guilt can lead to poorer health outcomes and coping in family caregivers and should be addressed by health providers. In this scoping review, a literature search was conducted using various key terms like "guilt," "hospice," "end-of-life care," …

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

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, …

Increasing Equitable Access To Care: Implementation Of Universal Palliative Care Screening In The Intensive Care Unit, Sarah Weaver

Student Scholarly Projects

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations.

PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?"

Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance …

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

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 …

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

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

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

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 …