Journal of Hospice & Palliative Nursing最新文献

Nurses are important in delivering comfortable care and serve as central figures in patient-centered care in hospice and palliative care units. Nurse burnout negatively affects organizational outcomes by threatening patient safety and reducing the quality of nursing care. This study aimed to identify the factors influencing burnout among nurses in hospice and palliative care units. This descriptive correlational study investigated the effects of nursing practice environment, resilience, and nurses' character on burnout among hospice and palliative care ward nurses. The participants were 217 nurses working in hospice wards of 20 institutions selected from the 88 inpatient hospice and palliative care institutions designated by the Ministry of Health and Welfare in South Korea, as of 2021. The results showed that a better nursing practice environment and higher resilience were positively associated with lower burnout. Among hospice and palliative care nurses, being in their 30s and having fewer than 5 years of total clinical experience were associated with higher burnout. The explanatory power of the model is 43.6%. These findings suggest that multidimensional interventions are required to prevent burnout among nurses in hospice and palliative care settings.

Palliative care is underutilized in sickle cell disease despite it being a serious, inherited condition plagued by severe pain, other symptoms, and frequent death in young adulthood. We sought feedback from individuals with sickle cell disease (Sickle Cell Warriors) to inform the design of a palliative care intervention. In a qualitative descriptive approach, 12 adults participated in a 90-minute virtual focus group. The session was audio-recorded, transcribed verbatim, and thematically analyzed using a structured coding process. Participants provided insights on the preferred format, delivery, and content of an intervention aimed at improving symptom management and quality of life. Three themes were identified: (1) intervention design, delivery, and check-ins, reflecting preferences for hybrid delivery, consistency, and engagement; (2) successful aging with sickle cell disease, highlighting the importance of self-care, emotional well-being, and social connection; and (3) "palliative care" is foreign, illustrating the stigma and misunderstanding surrounding the term "palliative care." Participants expressed a strong need for mental health support, education, and flexible programming tailored to their lived experiences. Future palliative care interventions need to be culturally aligned with terminology and delivery strategies. This study offers guidance for developing patient-centered, nurse-led interventions to improve symptom management and supportive care among adults with sickle cell disease.

Grief and bereavement support are essential for patients and family members facing serious illness and the end of life. In total, 126 participants attended a 2-day palliative care training for oncology, the End-of-Life Nursing Education Consortium Oncology advanced practice registered nurse course, supported by a grant from the National Cancer Institute. Participants were asked to complete 3 open-ended questions and an 11-item survey assessing their confidence in providing bereavement support for patients and family members facing serious illness and end of life in postcourse evaluations. Results indicated that the lowest confidence scores were related to basic assessment of grief in adults and pediatrics and the highest confidence scores were providing emotional support for patients/families in their grief and supporting colleagues in their grief. Six themes emerged from the open-ended question that asked participants to share case studies describing a patient or family member that they had cared for who was experiencing grief and nurse interventions: (1) treatment failure/out of options, (2) unexpected death or recent loss, (3) impending death, (4) multiple or overlapping losses, (5) coping, and (6) anticipatory grief. Hospice and Palliative Care nurses can provide bereavement support for oncology patients, their families, and the oncology nurses who care for them.

Throughout history, end-of-life has posed profound ethical and emotional challenges. Today, the growing desire for control has led to two interconnected phenomena: death tourism and palliative care. Hopelessness and loss of control drive some patients to seek euthanasia or physician-assisted suicide abroad, especially where these practices are illegal in their home countries. For them, this difficult decision represents reclaiming agency in the face of unbearable suffering. In contrast, palliative care provides an alternative focused on improving quality of life for patients with life-threatening illnesses and their families. Its holistic approach-addressing physical, psychological, social, and spiritual needs-ensures dignity, comfort, and support. Expanding access to comprehensive palliative services can significantly reduce feelings of despair and diminish the demand for death tourism. By fostering a sense of being valued and supported, palliative care helps individuals face their final stages with meaning rather than fear. This underscores the critical role of nurses, whose professional preparedness is essential in addressing global ethical dilemmas and disseminating palliative practices effectively. Ultimately, the solution to protecting human dignity lies not in hastening death, but in alleviating suffering so that life, even in its final chapter, remains meaningful..

This article reports on the item construction of a new screening scale to measure coping and communication among adolescents with a parent enrolled in hospice. The aim of this study was to use cognitive interviewing methodology to determine the validity and reliability of the Adolescent Coping and Communication Scale (ACCS). The young adults in this study identified the need for a consistent point person on the hospice care team to discuss their concerns and provide information and support. The ACCS is a concise 15-question tool using a 5-point Likert scale to monitor the adolescent's coping and communication needs in real time. It can easily be formatted electronically or in paper format and completed in less than 10 minutes. It can be used as a clinical screening tool by health professionals who seek to help adolescents navigate this critical time when their parent is near the end of life. These results can also be used to inform the development of interventions that assist families with strategies tailored to an adolescent's specific needs. Additional research is needed to assess the psychometric properties of scale items. Future research should investigate the use of this tool in other age groups and populations.

Although patient falls in the acute care setting have been thoroughly studied, published studies exploring falls for patients receiving hospice care remain limited. Patients receiving hospice care present with considerable risk factors for falls, including physical and cognitive changes associated with a terminal diagnosis. An increasing pattern of patient fall rates was identified at the organization and a quality initiative was developed to address this aspect of patient care. The SMART aim of this project was to establish a sustainable process to decrease the percentage of patient falls from 5% to 3% in an organization's hospice regional branch within a 3-month period. This project adopted the Plan-Do-Study-Act process as its change model. A bundled intervention was introduced including early referrals to the therapy team for newly admitted patients, staff education, and providing supplemental patient education. The measurable outcome was to achieve a decrease in fall rates. Although the goal was not achieved within the 3-month timeframe, data did indicate a positive trend toward the intended goal. Results indicated ongoing opportunities for nurses to enhance reliability in making therapy referrals. However, nurses demonstrated consistency in providing supplemental education.

Hospice and palliative care nurses initiate goals of care conversations with patients and family members while advocating for the completion of advance directives. As leaders in these conversations, nurses must have a working knowledge of the various forms, such as portable medical orders. The National Physician Orders for Life-Sustaining Treatment (POLST) Paradigm calls for the standardization of portable medical orders to ensure goal-concordant care that can cross all healthcare settings. This rapid review provides an overview of state-level portable medical order forms, compares and contrasts them with the National POLST form, and proposes policy recommendations for hospice and palliative care nurses to advocate within their state, territory, or tribal nation. Portable medical order forms were obtained from governmental websites, and data were extracted systematically, with the National POLST form serving as the template. Only 5 states use the National POLST form, and the other 46 demonstrate wide variations in form structure, sequence of orders, and level of specificity for treatment options. No portable medical orders were identified for US territories and tribal nations. Hospice and palliative care nurses can utilize the results of this rapid review to advocate for legislative changes, such as reordering treatment options, integrating rather than always starting with high-intensity care.

Research participation of hospice and palliative care patients and family caregivers is essential to develop and test best practices. Yet, healthcare professionals are often hesitant to ask patients and caregivers to participate in research, fearing it is too intrusive or unethical during a sensitive time. This review focused on the motivating factors, benefits, and burdens of research participation for patients with serious illness and their family caregivers. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist, searches were conducted in 4 online databases for articles between January 1, 2015 and January 31, 2024. The team reviewed 3169 articles; 28 met inclusion criteria and findings were extracted and synthesized using the Joanna Briggs Institute's mixed-method systematic reviews methodology following evaluation of each study. Results suggest greater benefits than burdens, reporting value in participation even when a burden is experienced. Burdens point to important social determinants of health concerns in research participation. For clinicians and researchers, connecting patients and caregivers to palliative and end-of-life research may be both beneficial as a contribution to scientific literature and as an additional source of ongoing support.

Spousal caregivers of persons living with serious illnesses experience significant emotional and social challenges related to their caregiving role. The purpose of this study was to gain a deeper understanding of how spousal caregivers perceive current and anticipated losses associated with caring for a partner living with advanced cancer. Spousal caregiver participants engaged in semistructured interviews about their caregiving experiences and subsequent changes that occurred in their lives. Caregivers experienced social changes, emotional energy investment, and relationship changes as sources of grief. Social changes involved a loss of freedom and increased isolation, while emotional energy investment manifested as suppressed emotions and fears about the future. Relationship changes encompassed both positive and negative shifts in communication and roles. Targeted interventions, such as support groups and counseling, are essential to mitigate the negative impacts of caregiving and improve the well-being of older adult spousal caregivers.