Journal of Hospice & Palliative Nursing最新文献

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.

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.