Journal of Hospice & Palliative Nursing最新文献

Despite research findings that rural Appalachians prefer to die at home, few people access palliative and hospice care services, and many report limited knowledge about palliative/end-of-life care resources. A community-academic partnership was formed to address this need. Train-the-trainer workshop and materials were co-developed. This study tested the feasibility and cultural acceptability of the training intervention to increase community members' knowledge about palliative/end-of-life care resources for East Tennessee Appalachian people. Community-based participatory research design and culture care theory guided the project, intervention, and research. After engaging in end-of-life training, participants completed a retrospective pretest-posttest survey. Paired samples t tests were used to compare knowledge before and after training. Means and standard deviations were used to report training material usefulness and cultural acceptability. Short-answer qualitative data were analyzed using content analysis. Sixty-six adults completed the survey. Ratings for training materials and cultural/theological acceptability were high. Participant knowledge rankings showed significant improvement after training at the P <.001 level. Qualitative feedback was positive. The training intervention was feasible, culturally acceptable, and effective for increasing East Tennessee Appalachian persons' palliative/end-of-life care knowledge. Community member expertise/collaboration integrated into every stage of the project is the bedrock of cultural acceptability and feasibility.

End-of-life (EOL) care in pediatrics is a unique subspecialty lacking adequate provider education and training. Patient and family outcomes may improve when clinicians are provided with training in this care. Recognizing the need for this specialized education, a small group of bereavement coordinators created an institution-wide pediatric EOL summit at a large urban pediatric teaching hospital. One hundred forty-five clinicians from 14 diverse disciplines attended the first annual pediatric EOL summit. A survey was sent to the participants for feedback. The survey results suggested an overwhelmingly positive response to the summit. Continuing to provide this educational conference is critical to improving care for patients and families, particularly at the end of life.

Organ donation after brain death is an alternative to living organ donation, which has various risks and is a means of addressing organ supply shortages. In South Korea, primarily, the organ donation decision is made by the brain-dead donor's family under the guidance of medical staff. Intensive care unit nurses, who are consistently present with patients, can significantly influence families' decision-making process. Hence, nurses' experiences of caring for brain-dead donors should be explored to obtain detailed explanations of the related complex social phenomena. This qualitative study aimed to understand the structure and nature of nurses' experiences using Colaizzi's phenomenological method. Data were collected from 10 intensive care unit nurses from a hospital-based organ procurement organization between June 27 and September 10, 2022. Twelve themes and 5 components were identified from participants' interviews, including "nursing with regret," "enduring agony from repeatedly caring for deceased organ donors," "lack of a support system," "deep emotional pain and scarring left after care," and "balancing emotions." It is necessary to clarify the required nursing interventions and role of nurses in intensive care units who care for brain-dead donors and develop specific guidelines to assist them in their work.

The purpose of this study was to test the reliability and validity of the Advance Care Planning Engagement Survey-9 Korean version in patients with cardiovascular diseases or metabolic syndrome. In this cross-sectional study, data on advance care planning engagement, registration of advance directives and the intention, and sociodemographic characteristics were collected from 105 patients (mean age, 66.3 years) at 4 medical institutions. Cronbach α was used to test the reliability. Confirmatory factor analysis and independent t tests were used to test the validity. Cronbach α s for the total scale and the self-efficacy and readiness dimensions were .93, .82, and .97, respectively. In confirmatory factor analysis with 2 factors, all indices of model fit were acceptable: comparative fit index, 0.995; Tucker-Lewis index, 0.989; standardized root-mean-square residual, 0.024; root-mean-square error of approximation, 0.059; and factor loadings > 0.65. Patients who registered advance directives ( P < .001) or had the intention ( P < .001) had higher scores of the Advance Care Planning Engagement Survey-9 Korean version than their counterparts. The findings demonstrate that the Advance Care Planning Engagement Survey-9 Korean version was a reliable and valid instrument. Health care providers, including nurses, can use this instrument to assess and manage advance care planning engagement in Korean patients with cardiovascular diseases or metabolic syndrome.

Effective patient-centered communication is essential in providing quality care for patients at the end of life. This study aimed to explore the subjectivity of nurses' communication approaches using Q methodology. In this study, 33 Q-samples were constructed based on in-depth interviews with 12 hospice nurses. The Q classification was performed by a total of 38 hospice nurses who had more than 3 years of experience in hospice settings. The collected data were analyzed through the principal component analysis method and the varimax rotation process using the PQ method program. As a result, a total of 4 distinct types emerged: "sincere listener," "family-centered caregiver," "resource utilization facilitator," and "sufficient time devoter." The factors accounted for 64% of the variance: 19%, 15%, 16%, and 14% respectively. By identifying distinct viewpoints, valuable insights into the diverse perspectives held by nurses in patient-centered communication were gained. Understanding these viewpoints will contribute to the development of tailored communication strategies and training programs. In addition, the study underscores the need for training, resources, and organizational support to enhance nurses' communication skills.

Doctor of nursing practice-prepared nurses are well suited to provide high-quality palliative care to patients with serious illness and their caregivers. Their rigorous education and expertise prepare them for the complexity often associated with chronic disease and end of life. There are clear and strong recommendations from multiple national organizations supporting palliative care education for nurses and tools available for nurses to implement palliative care into practice. This article is from the perspective of the doctor of nursing practice nurse. It reviews the limited evidence on palliative care integration into the doctor of nursing practice role, the barriers to palliative care education and implementing palliative care into practice, and the potential roles that a doctor of nursing practice palliative care nurse may fill in health care.

Upon admission to an acute care hospital, patients and families are faced with determining their cardiopulmonary resuscitation status during conversation with providers. Medical providers are tasked with providing education and options in the context of the patient's acute and chronic conditions. Misconceptions are common in the general public, and providers may struggle with providing guidance in high-stress situations. Literature review revealed a lack of national consensus on code status definitions. Electronic health records may include multiple options for code status orders, which may lead to confusion for patients and medical staff, resulting in provision of potentially ineffective or undesired medical care. The following discussion will examine multiple cases in a large health care system and a novel way of standardizing resuscitation options using Havelock's change theory. This quality improvement project was approved by the institutional review board.

The purpose of this study was to describe the experiences of nurses caring for patients with intravenous drug use-associated infective endocarditis at the end of life in Appalachia. This study was a secondary analysis of 9 phenomenological unstructured interviews conducted by the author with nurses as part of a study exploring their lived experiences caring for this population. Data were analyzed using van Manen's 6-step approach. The analysis revealed 5 themes: (1) care at the end of life as a resolve to care for lost causes, (2) care at the end of life as an act of courageous communication, (3) care at the end of life as a resolve to endure chaos, (4) care at the end of life as a resolve to protect self and others, and (5) care at the end of life as a resolve to carry on and let go. Nurses perceived patients who use injection drugs as being at the end of life with eventual death. Patients with recurrent infective endocarditis from drug use are viewed as lost causes. To empower nurses, they need to be at the table of surgical decision making. Communication being one of a nurse's greatest tools, end-of-life communication education is needed. Administrative support should be a standard to safeguard nurses when dealing with emotionally challenging situations.

Evidence suggests that nursing students in a prelicensure nursing program lack the required preparation to care for patients at the end of life (EOL), causing feelings of inadequacy and stress. New graduate nurses (years 0-5) struggle to address the needs of this patient population, leading to considering career changes. Nursing simulation has been shown to enhance competency and is gaining increasing favor in prelicensure nursing education. Little research has been conducted on the application of simulation using standardized patients in EOL patient scenarios. This study used live standardized patients who simulated a home health patient encounter with the nursing student acting as a home health hospice nurse. Watson's theory of caring and interpretive phenomenological analysis guided the qualitative research method and analysis. Five students chose to participate in this simulation and completed 6 reflective questions. After simulation, they felt more comfortable having difficult discussions about EOL care, treatment options, and patient fears. Participants noted the importance of communication in a team setting, which included the caregiver as an integral member. The use of standardized patient-simulated experiences increases realism and provides students the opportunity to bridge the gap between didactic education and clinical practice. This will enhance their readiness and confidence in providing EOL care.