Journal of Hospice & Palliative Nursing最新文献

The American Association of Colleges of Nursing identifies palliative and hospice care as one of 4 core spheres of nursing in its new Essentials outcomes. However, research shows inpatient medical-surgical nurses are not adequately trained to deliver end-of-life (EOL) care. This lack of foundational learning leads to gaps when communicating with patients and families and negatively impacts quality of care. When a large urban hospital opened a specialty unit for comfort-focused EOL care, nurses felt unprepared to communicate effectively with patients and families. A literature review and staff interviews identified barriers to communication, such as lack of formal education and experience; personal, cultural, and emotional challenges; and high workload. A multimodal intervention focusing on improving staff nurse communication skills was designed. It included environmental cues, engaging pocket cards, and an education module on communication techniques. Data were collected on nurses' confidence and competence in EOL communication, and qualitative feedback on the usefulness of the interventions was obtained. Nurses demonstrated increased confidence and competence immediately following the education session, enduring at 4 weeks. Nurses reported pocket cards and posters were helpful clinical reminders. Innovative, clinically relevant interventions can positively impact communication skills without requiring increased time commitments or high cost.

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.

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.

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.