Journal of Hospice & Palliative Nursing最新文献

This article explores current global research on voluntarily stopping eating and drinking (VSED) and presents a detailed, deidentified case study of a patient who elected VSED in a hospice setting in the Southeastern United States. It highlights the collaborative efforts of health care professionals in effectively supporting the patient and family, sharing multiple perspectives from various health care team members who cared for the patient and family. It offers evidence-based recommendations to guide health care teams through the ethical, medical, and emotional challenges of VSED, ensuring compassionate and competent care. The article emphasizes the importance of structured protocols and empathetic care in hospice settings, advocating for the education and preparation of health care teams and families to address the complex challenges associated with VSED. By promoting open communication, interdisciplinary collaboration, and comprehensive support, hospices can respect the autonomy of patients and families choosing VSED, ensuring a compassionate and dignified end-of-life experience.

Chronic heart failure (CHF) represents a substantial public health challenge, impacting patients' emotional well-being, quality of life, and overall prognosis. Palliative care and hospice services are increasingly recognized in managing advanced CHF, yet their evidence-based benefits remain underexplored. This study aimed to assess the influence of hospice care on CHF patient outcomes. A total of 120 inpatients with CHF were randomly assigned to receive either hospice care in addition to standard treatment (experimental group) or standard care alone (control group). Patient assessments included heart function classification, activities of daily living, Minnesota Living With Heart Failure Questionnaire, anxiety scale, and pain assessment. Results demonstrated significant improvements in cardiac function, activities of daily living, anxiety levels, pain scores, and heart failure-related quality of life in the experimental group compared with controls. Reduced anxiety, enhanced emotional well-being, and overall health status improvements were particularly notable postintervention. Hospice care was associated with enhanced functional abilities, emotional well-being, pain management, and overall quality of life for CHF patients. In conclusion, this study underscores hospice care's positive impact on prognosis, quality of life, and emotional well-being in CHF, emphasizing its potential as a critical component in comprehensive CHF management strategies.

Patients with end-stage renal disease face numerous physical, emotional, and financial burdens, necessitating palliative care (PC) interventions. This cross-sectional study assessed the problems and unmet needs of 129 patients under renal dialysis from 6 hospitals. Findings revealed that 64.7% of participants experienced significant challenges, primarily financial difficulties (78.5%), autonomy concerns (68.8%), and a need for information (68.0%). More than half (51.9%) reported needing PC, particularly for managing fatigue (78.3%), pain (79.8%), and depression (72.9%). Unmet needs were common (47.6%), with the most notable gaps in financial support (52.5%) and information provision (50%). Correlation analysis demonstrated strong positive associations between reported problems, care needs, and unmet needs (r > 0.90, P < .001). Significant differences were observed by dialysis access type (F = 5.71, P = .001), with arteriovenous fistula patients reporting higher problems and unmet needs. Increased dialysis frequency was linked to more problems and unmet needs (F = 7.24, P < .001). In addition, patients with comorbidities experienced significantly higher problems, care needs, and unmet needs (all Ps < .001). These findings underscored the urgent need for tailored PC interventions for end-stage renal disease patients, particularly in addressing symptom management, psychosocial and spiritual support, financial support, and information deficits, to enhance their quality of life.

Despite mandates requiring hospitals to offer advance directives to all patients, many adults do not have advance directives in place at the end of life. This quality improvement project aimed to implement an evidence-based, standardized protocol to increase advance directive completion rates for hospitalized patients with serious illnesses. A preimplementation and postimplementation design was used to evaluate the impact of an educational intervention and advance directive completion protocol. The project was conducted at a midsized urban community hospital in the Northeastern United States. Charts were reviewed for 250 patients with serious, chronic illnesses admitted under family medicine. Over the 11-month project period, advance directive completion rates increased from 21% (17/82) preintervention to 43% (73/168) postintervention, a statistically significant improvement of 22% (P = .001). Protocol compliance rates increased from 0% to 50% (8/16) for nurses and from 17% to 31% (9/52 to 21/68) for resident providers. The results support the use of a standardized advance directive completion protocol, combined with educational sessions, to improve advance directive completion rates for seriously ill patients and safeguard their autonomy at the end of life.

This study aimed to investigate predictors of palliative care self-efficacy among Vietnamese health care professionals. An online descriptive cross-sectional survey was conducted at 1 hospital in Vietnam. Participants completed survey questionnaires including demographics, professional experience, Palliative Care Self-Efficacy, Palliative Care Quiz for Nursing, Frommelt Attitudes Toward Care of the Dying-Form B, Santa Clara Brief Compassion Scale, and Self-Compassion Scale-Short Form. After data collection, descriptive statistics and stepwise regression were applied for data analysis. A total of 128 nurses and 42 physicians completed the survey. The mean score for palliative care self-efficacy was 27.6 ± 10.6 out of 48. The results indicated that compassion for others, self-compassion, and palliative care knowledge explained 17.8% of health care professionals' self-efficacy levels. This study supports the positive relationship between self-efficacy, compassion for others, and self-compassion among health care professionals, underscoring the need for incorporating compassion training into the curriculum and the training program.

Since the inception of medical assistance in dying (MAiD) in Canada in 2016, the health care system continues to refine MAiD delivery models. The frameworks informing nursing practice related to MAiD are subject to variability across the country, leading to nursing role ambiguity and barriers in relational practice. Using critical incident technique, this qualitative research study explores the experiences of 7 Canadian nurses engaging with patients seeking MAiD. Semistructured interviews were conducted to understand the nurses' perceptions of the helping, hindering, and desired elements of current nursing practice supports within the context of MAiD. Eighteen significant incidents were included in the data analysis. Findings demonstrate that gaps in practice support exist related to nursing role clarity, educational support to enrich therapeutic communication skills, and staff-focused resources, such as debriefing and improved communication networks. Understanding nursing experiences within this context highlights the need for more consistent nursing practice frameworks and clinical practice supports to facilitate improved therapeutic relationships and patient care.

Despite initiatives to increase palliative care awareness, referrals in primary care settings are still primarily based on provider judgment, causing a lack of appropriate referrals and disparities in access to palliative care resources. The purpose of this quality improvement project was to develop and implement an evidence-based, standardized palliative care referral protocol to increase the palliative care referral rate for eligible patients at a primary care clinic. The project used a preimplementation and postimplementation design with the use of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to successfully implement and evaluate the standardized referral process. Over the 10-month project period, the palliative care referral rate increased from 2% (4/193) preimplementation to 11% (16/147) postimplementation of the standardized referral process, which is an increase of 9%. Taking into consideration the potential impact of multiple extraneous variables, there was an overall decrease of 69% in emergency room visits and 73% in hospitalizations for patients who received a palliative care referral. These outcomes support expansion of the standardized referral process throughout other primary care clinics to increase palliative care referrals and sustain a high level of quality patient care.

Neuropalliative care as a clinical speciality aims to address the unique end-of-life needs and concerns of patients with neurologic disease. Although literature has outlined clinical hurdles, a more nuanced understanding of how neuropalliative care was experienced, conceptualized, and enacted could provide context and depth to better outline practice and research priorities. This article presents findings from an ethnographic study of neuropalliative care conducted in a university-affiliated, tertiary care neurological hospital in Canada with a dedicated neuropalliative consultation service. Specifically, this article examines how clinical hurdles outlined in the neuropalliative literature were experienced and addressed by multiple stakeholders, including patients, families, and clinicians. These clinical hurdles include locating the scope of neuropalliative care, ascertaining the impact of prognostic uncertainty and poor recognition of the dying patient, and navigating the tensions between curative and palliative philosophies. In the discussion, the implications of these clinical hurdles are addressed, concluding with reflections on the role of ethnography, palliative care in the context of functional changes, and broadening approaches to uncertainty.

Transparent patient-centered communication is essential to providing quality hospice care for patients at the end of life. This study aimed to determine and describe the current state of aid-in-dying policies in California and their effect on hospice nursing in response to narratives about leave-the-room policies presenting professional and moral challenges. In total, 97 hospice program policies were analyzed with a focus on the role of nurses at the bedside and intent to discharge patients who pursue medical aid-in-dying. It is necessary to clarify the important role of hospice nurses who care for terminally ill patients pursuing their legal right to assisted dying. The results of this study underscore the need for improved policy transparency and organizational support to enhance hospice engagement, particularly by nurses, with their patients at the end of life.