Journal of Hospice & Palliative Nursing最新文献

Many seriously ill patients receive nursing care at home to manage their illness. There is a growing overlap between homecare and palliative or hospice care. In the homecare setting, nurses may be uncertain about their role and responsibility for engaging in "serious illness communication." The term "serious illness communication" is sometimes used ambiguously, overlapping with other terms such as goals of care discussions or end-of-life conversations. Proponents of serious illness communication emphasize the need for a shift from traditional advance care planning toward a real-time, patient-centered dialogue adaptive to the evolving nature of serious illness. These combined factors highlight the need for further clarification and standardization of the concept, particularly for homecare nurses. The purpose of this project was to analyze the concept of serious illness communication within the context of homecare nursing. A literature review and concept analysis using the method defined by Walker and Avant were performed. A review of the literature highlighted key attributes, including the importance of a relationship focus that is driven by patient values and understanding, is appropriately timed, and incorporates a multidisciplinary team process. This concept analysis discusses the concept and use of serious illness communication as a responsive strategy for meeting a patient's evolving goals and preferences.

Patients with serious and persistent mental illness may experience intractable suffering despite exhaustive treatment, challenging the dominant curative paradigm in psychiatry. Palliative psychiatry offers an emerging alternative-prioritizing comfort, dignity, and quality of life when remission is no longer attainable. This article presents a comprehensive ethical and clinical framework for integrating palliative psychiatry into psychiatric-mental health nurse practitioner (PMHNP) practice. Drawing parallels with somatic palliative care, the author explores the theoretical foundations, diagnostic complexities, and ethical imperatives guiding palliative psychiatry. The article delineates PMHNP competencies in prognostic assessment, symptom management, advance-care planning, and interprofessional collaboration. Legal challenges, such as hospice eligibility criteria and involuntary treatment statutes, are also examined, with recommendations for practice and policy reform. Through this synthesis, the author argues that PMHNPs are ideally positioned to lead a paradigm shift that upholds the humanity of patients at the limits of recovery.

Evidence-based practice is critical to providing high-quality hospice and palliative nursing care. Professional organizations, such as the Hospice and Palliative Nurses Association (HPNA), play a critical role in shaping the future of the hospice and palliative nursing field by identifying gaps in the science and fostering collaborative research efforts to inform evidence-based practices. One such driver is the tri-annual HPNA Research Agenda, which outlines key research priorities in hospice and palliative nursing, ultimately aiming to accelerate translation of research into practice and practice improvements. In this article, 6 emerging research scholars in the field and present and former co-chairs of the HPNA Emerging Research Scholar Special Interest Group reflect on the experiences that led them to pursue research careers in hospice and palliative nursing. Through a process of collective self-assessment, these scholars articulated their shared progress toward addressing the research priorities outlined in the 2023-2026 HPNA Research Agenda as a means of generating insights to direct future research efforts in the field.

Negative compassion-excessive empathy that leads to emotional overload-presents a significant ethical challenge in end-of-life care. This qualitative phenomenological study explored how negative compassion affects adherence to advance directives and ethical decision-making among health care professionals in 6 long-term care facilities in Spain and Italy. Through 8 focus groups and 9 in-depth interviews with nurses, auxiliary caregivers, and support staff (n = 105), 3 key themes emerged: decision paralysis and emotional overload, conflicts between personal beliefs and professional responsibilities, and institutional barriers to ethical practice. Findings reveal that excessive emotional involvement can hinder the implementation of patients' documented wishes, potentially compromising patient autonomy and increasing caregiver distress. The study highlights the need for institutional policies that support emotional resilience, structured debriefing, and ethics training. Mindfulness-based interventions may help caregivers regulate emotional responses while maintaining professional integrity. These insights are highly relevant for palliative nursing practice, offering guidance for supporting staff and upholding patient-centered care in end-of-life settings.

Terminal secretions, commonly referred to as the "death rattle," are oropharyngeal secretions that accumulate in patients nearing the end of life who cannot clear them. Although physiologically benign, these secretions can cause emotional distress to families, nurses, and care providers. They are presumed to impact the quality of death, relating to comfort and dignity. This document reviews interventions for managing terminal secretions, emphasizing evidence-based practices. It explores pharmacologic methods, like anticholinergic medications-though little evidence supports their benefit-suggesting their use be considered individually. Nonpharmacologic interventions are recommended as first-line treatments; these include repositioning, mouth care, hydration management, communication, and family education. These strategies align well with comfort care goals. Nurse-led communication can reduce family anxiety and improve understanding of the dying process. A standard nurse-led, evidence-based approach focuses on comfort, dignity, and presence at the end of life. Barriers to implementing nonpharmacologic measures and the emotional impact on families and clinicians are addressed. Reviewed resources include clinical trials, systematic reviews, palliative care guidelines, and nursing resource guides, advocating a collaborative, interdisciplinary approach to first-line, nonpharmacologic care for terminal secretions.

Hematologic cancer has serious physical and psychological impacts, increasing the supportive care needs of patients and their caregivers. This study aimed to investigate the supportive care needs of patients with hematologic cancer and their caregivers. It was conducted using a convergent parallel design to understand the supportive care needs of these patients and their caregivers. More in-depth explanations were provided through simultaneous qualitative and quantitative data collection processes. At the beginning of the study, qualitative and quantitative data were collected in parallel and analyzed separately, and then the results were integrated. In the quantitative phase of the study, patients had high levels of care needs, whereas their caregivers had moderate levels of care needs. The qualitative phase provided a more detailed examination of supportive care needs. Based on the thematic analysis results, the needs of the patients and their caregivers were grouped under 3 main themes: (1) symptom management needs, (2) psychological needs, and (3) socio-economic needs. This study revealed that the care needs of patients with cancer and their caregivers are substantial, particularly in the areas of symptom management, psychological support, and socio-economic assistance.

Spirituality is increasingly recognized as a core element of holistic nursing care, yet its personal meaning and application in clinical practice remain underexplored-especially among nurses pursuing advanced postgraduate training. This qualitative study aimed to investigate how nurses enrolled in a Postgraduate First-Level Master's Degree in palliative care and pain therapy perceive and interpret spirituality in relation to their professional roles. Semistructured interviews were conducted with 20 nurses working in diverse hospital and community care settings. Data were analyzed using reflexive thematic analysis, following Braun and Clarke's methodology. Five key themes emerged: (1) conceptualizations of spirituality, highlighting self-awareness, existential reflection, and openness to patients' needs; (2) the relationship between spirituality and religion, revealing both overlapping and distinct perspectives; (3) pathways to connect with personal spirituality, including self-exploration and life experiences; (4) the role of education and clinical practice in fostering spiritual development; and (5) the perceived role of spirituality in alleviating suffering and supporting patients at the end of life. Findings emphasize the importance of structured educational programs and reflective practice to foster spiritual competence in palliative nursing. These insights can inform educators and health care leaders to better integrate spirituality into advanced nursing education and clinical care.

Advance care planning is a critical process that allows individuals to articulate their values and preferences for end-of-life care before a medical crisis occurs. This study explored the challenges that religious leaders experience when engaging in advance care planning and death-related conversations with first- and second-generation Korean Americans, and the strategies employed to overcome these challenges. Using a descriptive qualitative study design, interviews were conducted with 12 religious leaders in the United States who provide spiritual/pastoral care to Korean Americans. Analysis revealed both cultural and structural obstacles to advance care planning. Cultural obstacles include emotional suppression, stigma around death, intergenerational conflict, and religious ambivalence. Structural obstacles included knowledge gaps and misconceptions about advance care planning. Despite these obstacles, religious leaders acted as cultural mediators by employing strategies, such as waiting for emotional readiness, building long-term trust, adapting communication to family needs, reframing death through spiritual narratives, utilizing teachable moments for end-of-life conversations, and offering practical guidance. These findings underscore religious leaders' unique role in bridging health care and cultural values, and highlight the need for community-based, community-specific approaches to improve end-of-life communication and planning for Korean Americans.

Continuity of care prioritizes patient-centered approaches. Effective continuity of care is essential for ensuring high-quality service delivery and benefits for patients in the end-of-life phase. Although continuity of care has been well-established, few studies have focused on promoting continuity of care in big cities. The purpose of this action research was to develop a model for continuity of care during the end-of-life phase in Bangkok. Key participants were 8 nurses involved in continuity of care services. The data collection consisted of in-depth interviews, focus group discussions, observation, and document reviews. The research process followed the action research cycle. Content analysis was employed. The 3 emerging domains of continuity of care during the end-of-life included (1) comprehensive patient information; (2) collaborative care management; and (3) technology-supported care. The participants indicated that the key factors to successful continuity of care during the end-of-life involved: (1) clear goals; (2) effective communication; (3) proactive coordination; and (4) good health care provider-client relationships. The model motivated nurses and other providers in the hospital to change practices associated with continuity of care for palliative care patients. This study's findings provide a foundation for future research to strengthen sustainable care continuity and develop palliative care networks in urban Thailand.

The percent of the American population that self-identifies as LGBTQ+ is currently doubling generation after generation. Advance Care Planning and Health Care Proxy completion have unique challenges in this growing, aging queer community due to nontraditional family structures, as well as risk factors from historical and current discrimination. LGBTQ+ older adults benefit from a systematized and provider-led approach to assistance with making difficult decisions and mitigating their vulnerability in health settings. This article highlights the implementation of a novel, community-emergent, and evidence-based LGBTQ+-specific Advance Care Planning toolkit as a free, online resource that can be accessed and used by any patient or provider in America to address this critical palliative care need. This quality improvement project empowers nurse-led, interdisciplinary health equity initiatives using this novel online Advance Care Planning toolkit resource to serve vulnerable populations.