Journal of Hospice & Palliative Nursing最新文献

Head and neck cancer chemotherapy and radiotherapy given over a 6-week treatment regimen produces significant symptoms. These symptoms escalate during weeks 2 and 3, continuing for weeks or months after treatment. This impacts quality of life and can result in delays or cessation of treatment. Involvement of palliative care earlier in treatment can result in improved cancer-related symptoms, quality of life, and patient outcomes. The primary aim of this project was to improve the timing of palliative care referrals for patients with head and neck cancer, ideally before week 2 of treatment. The secondary aim of the project was to assess whether patient-reported pain and distress scores improved from the initial visit to visit 2 with palliative care. A retrospective chart audit was completed for baseline data. The project intervention included a multiteam collaborative huddle to educate referral sources about the benefit of earlier palliative care referrals. Results showed improved referral timing from 28% to 7% referred greater than 14 days after initiation of cancer treatment. For the 58 charts with completed pain and distress scores, 46.5% of patients had improved pain scores, and 53.4% had improvement in distress scores from the first to the second palliative care visits.

Patients with terminal tongue cancer often experience severe physical pain, oral mucosal breakdown, and psychological distress that significantly diminishes quality of life. This case report describes the care of a 47-year-old man with recurrent terminal tongue cancer, demonstrating how Swanson's Caring Theory guided holistic and empathetic end-of-life nursing practice. Over a 16-day hospice admission in September 2020, assessment was based on Gordon's functional health patterns and interventions aligned with Swanson's 5 caring processes. Key issues included excruciating tumor pain (rated 10/10), a malodorous, bleeding oral wound, and anticipatory grief. Integrative strategies, including morphine titration, lidocaine mouthwash, aromatherapy, and life-review therapy, reduced the pain to 2/10, improved the wound odor, and helped the patient find emotional acceptance. Guided by Swanson's framework, the nursing team established trust, involved the caregiver, and supported the patient's spiritual needs. In conclusion, applying Swanson's Caring Theory enabled individualized, compassionate, multidimensional care, demonstrating the value of theory-based integrative approaches in improving the quality of dying for patients with terminal oral cancer.

Children with life-limiting illnesses living in nonurban areas have minimal access to community-based pediatric hospice and palliative care. Barriers such as geography, limited continuing education opportunities, and clinician discomfort compound this issue. Pediatric hospice and palliative patients require specially-trained clinicians to provide holistic support in areas such as disease progression, illness trajectory, and goals of care. An asynchronous online educational module, including a pre- and postmodule survey, was developed to provide education on timely pediatric quality-of-life conversations and skills for nurses who work with the adult population. This evidence-based project compared findings on knowledge, comfort, confidence, and willingness for adult hospice and palliative nurses in caring for pediatric patients. Registered nurses from 3 community hospice and palliative agencies were invited to participate. Following the education module, participants reported an increase in comfort from 25% to 93.3% and willingness from 59% to 93.3%. Additionally, postmodule confidence level increased to 94%. These findings suggest an asynchronous educational module approach benefits the needs of community-based adult hospice and palliative nurses and gains learned from this module may enhance nurse skill and improve access to care.

Patients undergoing hematopoietic stem cell transplant are at risk for significant morbidity and mortality throughout their treatment course. The aim of this evidence-based practice project was to determine if the use of a palliative care trigger tool impacted the number of palliative care consults and/or the early integration of palliative care services within the pediatric hematopoietic stem cell transplant patient population. A trigger tool was developed to identify patients at highest risk for stem cell transplant-associated morbidity and mortality. It was implemented on a 24-bed pediatric stem cell transplant unit over a 6-month period. Based on a retrospective chart review, 35% of patients met criteria for early integration of palliative care services, while 29% of those who qualified received services. After the implementation of the trigger tool, 27 patients underwent stem cell transplant, and 52% qualified for palliative care integration while it was received by 80%. The tool was determined to be effective in identifying patients for early integration of palliative care services and providing these services to identified patients. Providing early palliative care during stem cell transplant with a focus on symptom management, quality of life, and decision-making is a priority of care for patients undergoing stem cell transplant.

The health care built environment directly impacts health outcomes and the care experience of the patient and family members. Elements of the built environment include the architectural design, spatial organization, and physical features of clinical spaces that shape workflow, communication, and safety. The physical care setting becomes especially significant in hospice, where the primary wishes of the patient shift from curative care to comfort and support. This rapid review explores the role of the health care built environment in shaping hospice care delivery and supporting patients, families, and interdisciplinary teams in adapting approaches that promote comfort and quality of care. The objectives were to examine the elements of the built environment that support care delivery and assess the adaptations to the environment that can enhance hospice care delivery. Through a systematic process, the authors identified salient themes specific to hospice services. A database search of Cumulative Index to Nursing and Allied Health Literature and PsycINFO yielded 116 articles meeting the inclusion criteria. After a detailed review, 13 articles underwent a full review. Evidence of the impact of the built environment and adaptations for hospice delivery is lacking. Building and design guidelines, such as those set forth by the Facility Guideline Institute, can guide decision-making discussions. Given their unique perspective on day-to-day encounters, hospice and palliative care nurses can significantly shape the built environment.

The literature highlights that nursing curricula often lack sufficient focus on postmortem care, typically managed with on-the-job support from colleagues. This study employs a parallel-group randomized controlled quasi-experimental methodology that involves administering a pretest, posttest, and retention test. The research involved 95 senior nursing students from a public university. The data were assessed through the "Demographic Features Form", "Knowledge Test", "Student Nurses' End-of-Life and Postmortem Self-Efficacy Scale", and "Instructional Materials Motivation Survey". Within the scope of the study, the intervention group showed considerably higher postmortem care knowledge scores both immediately after the lecture and 4 weeks later, opposed to the control group ( P < .01). Additionally, self-efficacy related to postmortem care and motivation scores for instructional materials were notably higher among the intervention group than those in the control group ( P < .01). The escape room simulation enhanced students' knowledge, self-efficacy, and motivation toward instructional materials related to postmortem care.

Patients with terminal illnesses often endure profound physical, emotional, and spiritual distress. Nursing students play a vital role in alleviating this suffering through compassionate and holistic care. This study developed and evaluated a participatory model of palliative care education designed to enhance nursing students' spirituality in clinical practice. A mixed-method design was employed. Ten fourth-year nursing students engaged in focus group discussions to co-develop the model, which was subsequently implemented with third-year nursing students. Quantitative data were analyzed using means and standard deviations. The model comprises 4 sequential components: (1) simulated scenarios and case studies; (2) reflective conversations to explore patients' end-of-life needs; (3) relationship building with patients and their families; and (4) planning care transitions to home and community settings. The findings indicated a statistically significant improvement in nursing students' spirituality scores, increasing from a pre-intervention mean of 53.56 (SD = 3.87) to 56.87 (SD = 2.81) immediately after the intervention. This participatory model provides a structured and evidence-informed framework for nurse educators to cultivate spiritual awareness and compassionate care competencies among future palliative care nurses.

Advanced Practice Registered Nurses are increasingly recognized for their role and impact in hospice and palliative care. The Clinical Nurse Specialist (CNS) role is emerging as uniquely suitable for practice and leadership in this setting. The integration of a CNS into the practice of a large, multistate Hospice and Palliative Care program is discussed in this article. A timeline is provided with 4 phases of integration with priorities identified and specific strategies that were implemented to overcome challenges during the process. The value of CNS practice to the organization is highlighted in 3 practice exemplars, showing return on investment in terms of increased patient safety and implementation of evidence-based practice for home infusions, developing nurse confidence through complex case reviews, and reducing staff injuries through developing a Safe Patient Handling program.