Journal of Hospice & Palliative Nursing最新文献

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.

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.