Journal of Hospice & Palliative Nursing最新文献

While it is recommended that nurses be prepared to deliver primary palliative care, these services remain inaccessible for many. Nurses, as frontline providers, should have the knowledge and skills to provide this care. The aim of this study was to determine faculty experiences in palliative and end-of-life care and how those experiences affected their perceptions of student preparedness to deliver primary palliative care and their preparedness to teach primary palliative care. A descriptive, comparative study in the Midwestern United States was conducted with faculty from 4 universities integrating palliative care education into their nursing programs. Faculty with teaching experience in palliative care significantly rated student preparedness to deliver primary palliative care higher than faculty without this teaching experience, P < .01. Having education or training in palliative care had a significant effect on faculty's self-reported preparedness to teach primary palliative care after controlling for years of teaching experience, F(1, 30) = 6.935, P = .013. These findings can be used as nursing schools intentionally implement palliative care in accordance with the American Association of Colleges of Nursing Essentials.

Many acutely hospitalized patients wish to spend their final days at home, but primary care nurses often face barriers such as unclear discharge planning, limited medication access, and inadequate communication across care sectors, compromising continuity of care. To address these challenges, the Acute Basic Palliation Concept was developed to enable patients to return home safely and strengthen nurses' ability to provide quality terminal care in home settings. This study explored nurses' experiences with using the concept and its influence on home-based terminal care. Fifteen semi-structured interviews were conducted with nurses who had applied the concept, which included a discharge checklist, a medical supply package, nursing guidelines, a medication decision tool, and informational materials for patients and relatives. Data were analyzed inductively using thematic analysis. Three key themes were identified: Streamlining Workflows, enabling nurses to focus on patient-centered care; Effective and Timely Symptom Relief, supporting prompt symptom management; and Enhanced Communication and Information Flow, improving collaboration across care sectors and reducing stress for patients and relatives. Findings suggest the concept may support nurses in delivering more coordinated, person-centered terminal care at home by proactively addressing common barriers. However, further education in palliative symptom management may be needed to optimize its use.

Allogeneic bone marrow transplant patients face significant risks of morbidity and mortality. National guidelines recommend early and frequent advance care planning (ACP) discussions to prepare patients for these risks. At University of North Carolina Medical Center, allogeneic bone marrow transplant patients receive preadmission ACP discussions but lack follow-up during inpatient care, presenting an opportunity for nurse-driven ACP follow-up. This project aimed to improve nurse-driven ACP documentation and confidence, while reducing barriers, through an educational intervention and standardized ACP protocol. Over 3 months, a pre and post intervention quality improvement project used surveys and chart audits to assess the impact of ACP training and a standardized follow-up protocol. Pre and post surveys measured changes in nurse confidence, discussion frequency, and barriers. Chart audits tracked ACP documentation. Ten registered nurses completed 3 surveys, demonstrating significant improvements in nurse confidence (P = .002), frequency of ACP discussions (P = .022), and documentation (P < .001). Reported barriers decreased significantly. Chart audits confirmed improved ACP documentation, with 100% of eligible admissions receiving ACP follow-up. Educational interventions and standardized protocols may enhance nurse involvement in ACP discussions and help reduce barriers. These findings suggest that nurse-led ACP is a promising strategy, though further research is needed to optimize workflows and assess long-term sustainability.

Nurses can relieve spiritual suffering experienced by advanced cancer patients through meaningful spiritual conversations (eg, spiritual histories), but may be reticent to do so, citing lack of knowledge, skills, and time as primary barriers. The Lift the Spirit (LtS), a novel online educational communication intervention targeting these barriers, was tested using a pilot quasi-experimental concurrent mixed-methods design. The LtS pilot integrated online education, simulated spiritual history assessment using the Faith, Importance, Community, Action tool, and post-test debriefing with nurse participants (n = 17) to elicit their perceptions of the facilitators and barriers of the LtS and conducting spiritual histories in clinical practice. Debrief interview data were deductively then inductively coded, and content analyzed to describe patterns of response. Participants described barriers and facilitators at the levels of institution/profession (lack of education and training), self (vulnerability and perceived riskiness), and patient (cultural difference) that were similar to barriers noted in the literature. Facilitators included feeling equipped and supported, and having external cues as reminders. No new barriers were uncovered, but the degree of negative affect (eg, angst, fear, and vulnerability) in the responses was discovered. The LtS, primarily the Faith, Importance, Community, Action tool and role-play components, demonstrated clinical utility in equipping nurses to overcome barriers to spiritual care in clinical practice.

Accelerated nursing programs face unique challenges in incorporating palliative care. This report describes a high-fidelity home hospice simulation developed for first-semester students in a 12-month accelerated baccalaureate nursing program in the northeastern United States. The simulation integrated foundational nursing skills with palliative care competencies. Thematic analysis of student reflections revealed 5 emerging themes: pain management, empathy, family involvement, communication, and knowledge and preparation. Despite challenges in creating a realistic home environment, the simulation provided valuable hands-on experience in palliative care, demonstrating the potential for early curricular integration of these crucial skills.

Hospice nurses encounter profound challenges that make self-care both essential and deeply complex. This study explored the lived experience of self-care among hospice nurses using an existential-phenomenological approach. Hospice nursing, characterized by its focus on comfort care and end-of-life support, presents unique emotional, physical, and ethical challenges that often lead to burnout and compassion fatigue. Phenomenological analysis revealed 4 central themes: Threads of Trust: Weaving Meaningful Connections; A Full Heart, an Empty Cup; When Caring Hurts: The Emotional Cost of Hospice Nursing (with 2 subthemes-The Cost of Grief and The Stigma and Misunderstood Nature of Hospice Work); and The System Forgot the Caregiver. Participants highlighted the emotional strain of hospice work. The participants shared their lived experiences, emphasizing the emotional demands of their work, sparse self-care practices, and a lack of organizational support. The findings suggest that practicing self-care must be augmented by other actions such as systemic changes, caseload limits, leadership training, and structured emotional support systems. This study highlights the urgent need for health care systems to prioritize hospice nurses' well-being and help sustain compassionate nursing care.

Death is universal, and nurses are at the forefront of providing holistic care to dying patients. Understanding the factors that influence nurses' attitudes toward caring for the dying is essential, as these attitudes directly affect the quality of end-of-life care. The aim of this study was to examine the associations between death anxiety, spiritual care perceptions, and attitudes toward caring for the dying among palliative care nurses. This cross-sectional study was conducted in the palliative care clinics of 5 public hospitals in Turkey between May and November 2023. Data were collected using a participant information form, the Thorson-Powell Death Anxiety Scale, the Spirituality and Spiritual Care Rating Scale, and the Frommelt Attitude Toward Care of the Dying Scale. Participants demonstrated moderate levels of death anxiety, high levels of spiritual care perceptions, and positive attitudes toward caring for the dying. Spiritual care perceptions (β = 0.525), educational level (β = 0.245), end-of-life care training (β = 0.216), and experiences of patient death (β = -0.231) were significant predictors of attitudes toward caring for the dying (R² = 0.609, P < .001). This study highlights the critical role of spiritual care perceptions, both independently and in combination with educational level and end-of-life care training, in fostering positive attitudes toward caring for the dying.

The purpose of this study was to develop a spiritual self-care program for hospice team members and to evaluate its effects on stress management, spiritual self-care, and burnout. The research method was a quasi-experimental study with a nonequivalent control group pre-post design, and the participants were hospice team members working in a hospice care organization, with 20 participants in the experimental group and 19 participants in the control group. The experimental group completed a spiritual self-care program over 7 sessions, which included topics such as self-awareness, finding meaning in life, and mindfulness. Stress management, spiritual self-care, and burnout were assessed before the program and immediately after the program ended. The results showed that stress management and spiritual self-care scores significantly increased in the experimental group compared with the control group. Burnout scores also decreased significantly in the experimental group. The spiritual self-care program for hospice team was found to be effective in improving stress management and reducing burnout. This study emphasizes the necessity for developing self-care programs aimed at supporting the emotional and psychological health of hospice team and suggests providing educational programs on a regular basis with the establishment of an organizational-level support system.

Nurses and nursing students must be competent to provide quality care in a population with increasing serious illness needs. A significant gap exists in nursing education and professional development, in palliative care communication, and in its role in serious illness. Simulation-based education provides a dynamic, interactive platform to practice communication strategies in a safe setting. This paper describes how an established, standardized palliative communication simulation was adapted to fill curriculum gaps in prelicensure and nurse residency programs. The original simulation was adjusted to prelicensure students in an unfolding scenario in their third and fourth year of a 4-year prelicensure nursing program. Students practiced conversations about symptom management, advance directives, and advance care planning in their third year. In the students' fourth year, they use communication tools to discuss goals of care with the same patient they met the previous year. Key modifications from the original simulation included guided discussions based on a foundational article about palliative care concepts, as well as pre- and post-reflections on students' feelings about engaging in these conversations. The nurse residency program incorporated all phase 1 adaptations used in the prelicensure version. Data was gathered through a simple open-ended question, and results from students and nurse residents showed that they had less fear and anxiety about conversations and learned approaches to talking with patients. Implementing more palliative care training, including simulations, provides greater exposure to effective communication.

Nursing programs are compelled to integrate end-of-life care into curricula; however, consistency and quality between programs vary. The End-of-Life Nursing Education Consortium (ELNEC) created an online undergraduate curriculum to meet the need for consistent, high-quality palliative care education. The purpose of this study was to examine the impact of ELNEC's curriculum on undergraduate nursing students' confidence. The ELNEC curriculum was integrated across undergraduate nursing courses at a Midwestern Jesuit university. Upon completion of all 6 ELNEC modules, the Primary Palliative Nursing Care Competency Assessment Tool was used to assess students' self-perceived confidence before and after the program. Comparative and descriptive statistical analysis revealed significant positive changes in student confidence (P = .003), roughly equivalent to changing from "Somewhat Confident" to "Confident." Students rated themselves similarly across most domains with significant gains post ELNEC curriculum (P < .0000). In conclusion, the undergraduate ELNEC curriculum positively impacts nursing students' self-perceived skill and confidence in their delivery of palliative and end-of-life care. Further reinforcement of ELNEC content through interactive and experiential learning supports student knowledge and a holistic approach to care of the entire person. Educators and clinicians might consider how ELNEC's programming can be leveraged to promote primary palliative nursing care competency.