Journal of Hospice & Palliative Nursing最新文献

End-of-life care requires nurses to integrate ethical sensitivity, emotional presence, and effective communication. Reflective writing, a key component of Narrative Medicine, offers nursing students a structured method to process complex emotional experiences and deepen their ethical understanding. This study investigated how third-year nursing students reflected on ethical issues and emotional responses related to end-of-life care through a structured reflective writing activity conducted after a film-based educational session. A qualitative phenomenological approach was applied to analyze 55 written reflections produced by Italian nursing students. The reflections were collected following a classroom screening of a film portraying terminal illness and decision-making at the end of life. Data were examined thematically using Braun and Clarke method. Four key themes emerged: emotional responses to death; relational and ethical dynamics; communication and connection; and temporal-spiritual meaning-making. Students' reflections revealed an emerging awareness of ethical dimensions such as patient autonomy, vulnerability, and the value of nonverbal communication. Through reflective writing, participants articulated emotions including fear, anger, and guilt and engaged in personal meaning-making related to self-determination and compassionate care. Overall, reflective writing facilitated the development of ethical awareness and emotional resilience among students preparing for palliative care practice. The integration of structured reflection into hospice and palliative nursing education may enhance students' readiness to deliver empathetic, person-centered care.

Effective symptom assessment and management are the cornerstone of quality palliative care, yet unique barriers exist for people with intellectual and developmental disabilities (IDD). More recently, there has been growing interest in pain assessment for people with IDD, but other symptoms, such as dyspnea, have not been as readily explored. People with IDD experience death due to respiratory conditions at rates higher than the general population, yet not much is known about dyspnea assessment in this population. Individuals with IDD are often left out of research, including studies that validate clinical assessment tools. Communication differences or cognitive abilities can impact the reliability of self-reports for some people with IDD, making the understanding of clinical assessment tools for this population more important for palliative care clinicians in managing symptoms. Currently, no clinical assessment scales have been validated for use in people with IDD. This article examines 4 commonly used and validated clinical assessment tools for dyspnea and offers recommendations for future research and comprehensive dyspnea assessment in people with IDD.

The global shift toward an aging population, evident in Thailand, highlights the critical need for end-of-life care (EOLC) competencies among care providers in long-term care facilities (LTCFs). As the number of older people requiring complex and compassionate care at the end of life continues to rise, the competencies required for care providers in Thai LTCFs remain underexplored. This study aimed to identify the key competencies required to deliver effective EOLC in Thai LTCFs. A Delphi method was used, engaging a panel of 12 experts, including nurses, academics, and LTCF managers. The study achieved consensus on 7 core competencies, encompassing 32 subcompetencies essential for high-quality EOLC. These competencies include knowledge of EOLC, caregiving skills, communication, leadership, innovation, ethical decision-making, and professional development. This study provides a culturally relevant framework for EOLC competencies in Thai LTCFs, emphasizing the importance of integrating technical and interpersonal skills to enhance the quality of care for older people in their final stages of life. These findings can inform educational programs and policy development, ensuring that care providers are adequately prepared to meet the complex needs of this vulnerable population.

Palliative Extended and Care at Home (PEACH) program, implemented in 2013, aimed to support palliative care clients in their last days of life at their own home. Understanding the factors that influence the sustainability of a program was vital to improving the longevity, adaptability, and quality of service delivery models. This study aimed to assess the sustainability of PEACH model of care through analysis of data at different time points where services were delivered by different service providers. Deidentified data were collected retrospectively for all consecutive patients receiving a PEACH package until separation from the package to explore the clinical and sociodemographic determinants of the sustainable PEACH model of care. Additionally, feedback on the services via survey was obtained from the clients' primary carers. The majority of the PEACH package recipients who had a clear preference to die at home when the service was initiated were able to achieve their goal to die at home (77%-84%). Eighty-six percent of the carers were "satisfied" or "very satisfied" with the overall care provided by PEACH. The result shows that PEACH model of care managed to sustain and optimize the patients' outcome despite transitioning to different service providers for partnerships and collaboration.

Approximately 50,000 children die annually in the United States from complex medical conditions, yet only a fraction receive end-of-life services. This study aimed to evaluate the implementation of a novel telehealth transition of care program for pediatric palliative and end-of-life patients (imPACT). After retrospective review, a total of 27 patients were enrolled in the first year of the program, with 20% experiencing a readmission and 18% utilizing emergency/urgent care services. imPACT was successfully implemented in a geographically and racially/ethnically diverse population.

Patients with terminal illnesses presenting to the emergency department (ED) may be admitted to the hospital receiving aggressive treatment that will not reverse the dying process and is not aligned with their wishes. Misdirected, incongruous care negatively impacts the comfort of the patient and increases health care costs. This project aimed to determine if embedding a palliative care nurse practitioner in the ED at a community-based hospital is a meaningful method for addressing goals of care early in the preadmission period, with the potential secondary benefit of improved fiscal health of the system. A preintervention and postintervention EPIC (electronic medical record) review was done to evaluate change in readmission rates, hospice and palliative care referrals, and advance care planning sessions. The target population was adults presenting to the ED with an expected mortality within 6 months. An EPIC-generated report compared how many similar patients, during the same month, 1 year prior (November 2022), explored goals of care in the ED (as evidenced by above measures). Exploring goals of care in the ED for patients with terminal illnesses may lead to a more comfortable death and result in better utilization of resources, reduced unnecessary admissions, and cost savings to the hospital system.

Patients undergoing hematopoietic stem cell transplant and chimeric antigen receptor-T cell therapy face significant uncertainty, distress, risk of serious treatment-related complications, and disease relapse. Although palliative care and advance care planning offer clear benefits, both remain underutilized or delayed in this patient population. To address this gap, a nurse practitioner (NP)-led primary palliative care intervention was implemented in the outpatient Bone Marrow Transplant and Cellular Therapy Services at a comprehensive cancer center. This paper provides an overview of the program model, involving NP-led health-related values and care preferences discussions with patients and their families. This highlights the pivotal role of NPs in delivering primary palliative care by integrating values-based discussions into routine oncology practice. Future goals include evaluating the intervention's impact on patient and caregiver outcomes, clinician understanding, care alignment with patient's goals, advance directive completion, and high-intensity care at the end of life.

Pressure injuries are a major problem in all health care settings. The incidence of pressure injuries at the end of life is as high as 58% in some facilities, and there is little consensus on how pressure injuries are managed at the end of life. A scoping review was conducted, to investigate what is known of the factors associated with the management of pressure injuries at the end of life. Literature was sourced from several databases. A total of 1760 potential sources were identified; after applying the Population Concept Context inclusion and exclusion criteria, 16 empirical research articles were sourced: 10 were quantitative, 5 were qualitative, and 1 was mixed methods. Studies were published between 2003 and 2021 and originated from Italy, the United States, Australia, Sweden, Brazil, Taiwan, Turkey, and Canada. Key interventions included regular second hourly turning, wound debridement, wound assessment, and application of various wound coverings. The most widely discussed management strategy, regular second hourly turning, proved controversial and inconsistent in practice. There were also inconsistencies with wound assessment, with practice not always following best evidence-based assessment guidelines. Research findings also highlighted issues with prognostication and identification of the end-of-life phase with no consistent tool applied to assist end-of-life pressure injury management decision-making.

Assisted living (AL) and residential care (RC) settings are experiencing substantial growth as older adults with lower care needs seek alternatives to nursing homes. Despite this trend, there is a lack of skilled nursing care to support palliative care (PC) in these environments. Primary PC delivered by AL staff has emerged as a potential model to bridge this gap, focusing on symptom management and holistic support for individuals with serious illness. A metasynthesis of 88 qualitative studies was conducted to explore the provision of primary PC in AL/RC settings. The National Consensus Project Clinical Practice Guidelines for Quality Palliative Care was used to provide a holistic framework to identify unmet PC need and gaps in PC delivery. Studies published between 2012 and 2024 were analyzed to identify themes and categories related to PC domains, including physical, psychological, social, spiritual, cultural, end-of-life care, and ethical and legal considerations. Thematic synthesis revealed key findings across the identified PC domains within AL/RC settings. Studies highlighted challenges and opportunities for delivering primary PC in these environments, emphasizing the importance of addressing physical symptoms, psychological distress, social isolation, and spiritual needs among residents with serious illnesses. The metasynthesis underscores the critical role of primary PC in enhancing quality of life and care continuity for older adults residing in AL/RC settings. It also identifies gaps in current practices and emphasizes the need for tailored interventions and training to support care providers in delivering comprehensive PC to this population. By integrating qualitative research findings with the National Consensus Project guidelines, this metasynthesis provides a comprehensive overview of primary PC in AL/RC settings. The study underscores the necessity of enhancing PC delivery in these environments to meet the evolving needs of older adults with serious illnesses, thereby improving overall quality of care for residents with unmet palliative needs.