Journal of Hospice & Palliative Nursing最新文献

Early integration of palliative care benefits both people with advanced cancer and their family caregivers, yet research on holistic end-of-life care and advance care planning remains limited. The primary objective of this study was to examine the effect of a peaceful end-of-life care program on perceived good death outcomes in people with advanced cancer and their family caregivers. Secondary objectives included exploring the program's effect on the quality relationship and end-of-life care knowledge among family caregivers. In this quasi-experimental design with repeated measures, 122 participants were enrolled. On the basis of the Theory of the Peaceful End of Life, the experimental group received a 4-week program comprising health education, self-care for symptom management, advance care planning, psychosocial support, and family involvement plus standard care, whereas the control group received standard care alone. The Good Death Inventory was the primary measurement tool. The results showed a significant improvement in perceived good death, quality relationships, and end-of-life care knowledge in the experimental group, with no such improvements observed in the control group. The program improved good death outcomes, caregiver relationships, and end-of-life care knowledge. Therefore, early initiation of this program is recommended to optimize its benefits.

Psychedelic-assisted therapy (PAT) involves supported experiences with psychedelic medicines in carefully curated environments. Early evidence suggests possible utility of PAT for addressing psychosocial-spiritual-existential concerns, yet gaps remain in understanding findings related to PAT's role in palliative care. This rapid review aims to synthesize current literature on applications of PAT in the context of palliative care. Through a systematic process, we identified 34 articles published between January 2021 and July 2024. Protocols varied yet included common components of participant screening, preparation, dosing, and integration. Psilocybin was the most commonly studied compound. Results support safety and initial efficacy of PAT for psycho-spiritual-existential outcomes among carefully screened and highly homogonous samples of patients with serious illness (predominantly cancer). Current efforts and challenges around integrating PAT into systems of palliative care were highlighted. Additional work is needed to (1) explore PAT's safety and efficacy within more diverse samples and contexts, (2) train palliative care providers on PAT, (3) determine systems of care delivery best suited for translation of PAT into practice, and (4) begin developing policy solutions to support safe and equitable access to PAT. Because many patients lack access to basic psychosocial-spiritual-existential care, careful consideration is needed around integration of PAT. The psychedelic substances which are the topic of this article are not currently FDA approved for use in the United States.

Communities use rituals at end of life to foster a peaceful death, ensure passage to the afterlife, and grieve their lost loved ones. Studies report fear of misunderstanding or impeding rituals as a barrier to accepting hospice care. However, there has been little research on cultural and spiritual rituals in the setting of hospice care or how patient preference should be assessed, documented, and supported by hospice staff. This project sought to identify the current practice for assessment of cultural or spiritual end-of-life practice preferences, and the documentation of those preferences, within pediatric hospice programs in a Midwestern state. In surveys of 2 pediatric hospice programs, employee respondents reported routine assessment (97.3%) and routine documentation (70.3%) of cultural or spiritual end-of-life practice preferences. Most respondents reported documentation was written by various disciplines and in various locations in the medical record. Additionally, a retrospective chart review was performed including decedents of 1 pediatric hospice program over a 5-year period. Documentation affirming familial spiritual beliefs was identified in 75.9% of charts, of which, only 12.2% had documentation regarding end-of-life-specific spiritual needs. Standardized documentation practices may help foster equitable hospice care for all patients by ensuring care providers are aware of the patient and/or family's end-of-life spiritual needs.

This study aims to deepen the understanding of rapport formation between nurses and end-of-life patients by synthesizing existing qualitative research. Using meta-ethnography, this research integrates findings from various studies to explore the essence and process of rapport formation from nurses' perspectives. A comprehensive search across MEDLINE, EMBASE, CINAHL, and Web of Science databases in August 2024 identified 13 relevant studies. The quality of these studies was assessed using the Critical Appraisal Skills Programme checklist. The analysis identified 5 key themes in rapport building: "secure acceptance and safety," "genuine and transparent interaction," "insight into the patient's world," "bonding enhanced by professional support," and "advancing connections within boundaries." These themes underscore the role of rapport in enhancing the quality of palliative care, providing emotional stability, and improving the nurse-patient relationship. This study offers valuable insights for health care professionals to strengthen nurse-patient interactions, emphasizing the importance of rapport in end-of-life care.

Diverse teaching and learning strategies are needed to develop emotionally intelligent new-graduate nurses who can empathetically care for dying patients. Reflective pedagogy, a teaching strategy that infuses reflection into education, is an effective strategy to enhance nursing student learning, educational enrichment, and emotional intelligence. This project aimed to explore nursing students' thoughts and feelings about end-of-life care through participation in the Grace in Grief intervention. This study examined the implementation of the student-centered intervention with mindful reflection and artistic expression to discuss emotions surrounding death and grief. The intervention was completed in a safe learning environment where course faculty facilitated the navigation of emotions, attitudes, and fears about death and how to care for dying patients and families through classroom discussion, artistic expression, and private reflection. After the intervention, students were asked to complete an online survey to reflect on the experience. Thematic analysis was used to analyze the students' responses to the survey. Four themes emerged from the qualitative analysis of open-ended responses. Summative themes indicated that educators could utilize reflection-based, student-centered learning activities to assist nursing students' development of emotional intelligence.

Effective communication is crucial in pediatric palliative care and is essential to facilitate shared decision making between families and the health care team. This study explored the communication preferences of caregivers and health care specialists in Central-Eastern Europe, a region with unique cultural and health care dynamics. Through qualitative interviews, key communication style preferences and barriers were identified. The results affirm that caregivers need thorough information about their child's illness, symptoms, therapeutic options, and care plans. Pediatric palliative care specialists must deliver this information competently and compassionately. Both caregivers and specialists showed common preferences for clear, timely, and empathetic communication. However, specialists faced challenges in finding time within institutional frameworks to meet these communication needs effectively. These findings highlight the need for pediatric palliative care policies and practices that enable specialists to engage in meaningful, culturally sensitive communication, aligning with caregiver preferences while navigating health care system constraints to enhance caregiver satisfaction and improve patient outcomes.

Portable Medical Orders (PMO) such as the Physician's Order for Life-Sustaining Treatment and the Medical Order for Life-Sustaining Treatment have proven to be valuable documents that allow patients who are medically frail or have life-limiting illnesses to communicate their health care wishes. Because these documents are in the form of a Physician's Order that can travel across multiple health care settings, they offer a form of certainty and reassurance for the patient that their wishes will be respected. The PMO depends on a conversation between the trained health care provider and the patient or their designee. The PMO functions as a legal document, communicating medical orders that must be followed and providing clinicians who do so with legal protection. The choices within (including resuscitation, treatment choices, and artificial feeding) must be understood by the patient in association with their own prognosis and health care status; the signatures within the form attest that a discussion of those choices has taken place and the patient understands not only their choices, but also the implications of them. A PMO with incomplete signatures is not a valid legal document. In the scenario presented here, the author discusses a scenario in which the discussions did not take place and the signatures are questionable, leading the patient to receive aggressive medical treatment that might not be in their best interests. The reasons behind the above ethical issues are related to a misconception and misuse of the PMO within a long-term care facility. Unfortunately, as noted in the literature cited and in the author's own experience, these ethical issues are not uncommon.

Palliative care, a beacon of relief and comfort, ensures the best quality of life for patients nearing death, a patient population that often presents to emergency departments, by providing interventions to promote comfort and support final wishes. The purpose of this literature review was to examine the outcomes of palliative care interventions for adult patients with chronic illnesses who have died in emergency departments. The literature review was conducted in CINAHL, PubMed, SCOPUS, OVID, and APA Psych using the keywords "palliative," "emergency department," "adult," and "chronic disease." The search was limited to English language publications with no date limits and performed according to Preferred Reporting Items for Systematic reviews and Meta-Analysis statement standards. The search yielded 531 articles, with 226 duplicates excluded. After a review, only 16 articles met the inclusion criteria. Common interventions included implementing screening tools, enhancing communication skills, providing end-of-life care education, and health record alerts for palliative care criteria. This review highlights how critical palliative care interventions are needed in emergency departments. The inevitability of seriously ill patients presenting to emergency departments underscores the urgency and importance of palliative care interventions, leading to increased comfort and decreasing distressing symptoms experienced by dying patients.

Admissions for patients with injection drug use-associated infective endocarditis are increasing. Injection drug use-associated infective endocarditis is a serious and often fatal cardiac infection. Nurses are often frustrated when caring for these patients because these care assignments are physically and emotionally demanding. Nurses feel helpless, as they disposition young patients to a funeral homes, morgue, or hospice, or send them home to die, and yet a dearth of information regarding end-of-life care for injection drug use-associated infective endocarditis patients remains. This study explored the lived experiential impact these experiences have on nurses. The method was interpretive and participatory, a modified photo-elicitation phenomenological design. Twenty-nine nurses recruited by purposive sampling took photographs and wrote reflections, with 5 participating in an optional unstructured interview conducted by the author. Three themes emerged from the data that elucidated these experiences as (1) a "heartbreaking" experience to witness, (2) an "exhausting" experience to endure, and (3) a practice-altering experience that transforms. Data analysis reveals that nurses experience intense pain, exhaustion, and, yet, transformation, both negative and positive. Implications for nurses include the need for end-of-life education, formal debriefing process to mitigate turnover, and future research into nature-based therapies to help nurses process trauma, as a form of self-care.

Palliative care has expanded beyond its traditional focus on the oncology population to meet the growing needs of patients with diverse diagnoses. A model of specialty-aligned palliative care has emerged as a means of integrating palliative care into various clinical specialties. Equipped with expert clinical skills, a holistic approach to patient care, and an emphasis on interprofessional collaboration, nurse practitioners are uniquely positioned to lead these teams. This article examines the role nurse practitioners play as leaders of 4 specialty-aligned palliative care teams at a major metropolitan academic medical center. It highlights key contributions to the successful integration of palliative care into oncology, cardiac, renal, and medical-surgical specialties. Although there are clear benefits of nurse practitioner-led specialty-aligned teams, further research and advocacy is needed to strengthen this model and increase access to quality palliative care.