Journal of Hospice & Palliative Nursing最新文献

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.

The National Consensus Project Domain Structure and Process of Care focuses on a comprehensive assessment, patient and family engagement, communication, care coordination, and continuity of care across care settings. For people with Parkinson disease and their family care partners (n = 20), a qualitative descriptive study was conducted to examine elements of the Structures and Process of Care and the primary palliative care needs of people with Parkinson disease, their family care partners, clinicians, and community services and programs (n = 48). The data yielded 4 themes that highlight the needs of this population: (1) uncertainty about the progressive speed of the disease and its symptoms, (2) the need for advocacy to access needed care, (3) poorly coordinated care and limited access to palliative care, and (4) awareness that nurses are untapped resources within the health care system.

This study examines the professional identity formation of home hospice nurses through a single-center qualitative exploratory study in Assisi Hospice Singapore. Home hospice nurses with at least 6 months of working experience were recruited. An independent research assistant conducted individual semi-structured interviews to explore the interplay between the home hospice care setting and the nurses' personal values and beliefs, and interprofessional relationships. The interviews were audio-recorded, and the transcripts were anonymized and thematically analyzed. Fifteen nurses completed the interviews, and 4 key themes emerged: (1) relationship between personal identity and professional identity formation, (2) influence of the working environment on professional identity, (3) opportunities for transformational growth, and (4) challenges to professional identity formation. Defining characteristics of the professional identity of home hospice nurses are described, along with a novel framework illustrating their experiences with identity formation. Nurturing this development through a supportive environment and meaningful interpersonal relationships may enhance patient care outcomes and foster the well-being of palliative care professionals.

Palliative care (PC) consultation in high-risk patients with liver disease who are undergoing liver transplant (LT) evaluation is underused due to common beliefs that PC would negatively impact a patient's desire for transplant. This population is at risk due to high morbidity, mortality, and negative impact to overall quality of life. A 4-week pilot study was conducted in a transplant surgical intensive care unit at a single academic center to increase PC consultation during inpatient LT evaluation and improve transitions in care. Two Plan, Do, Study, Act quality improvement cycles were subsequently led by the PC nurse practitioner and social worker to increase the effectiveness of this intervention. The first cycle (November 29, 2018, to September 30, 2019) identified the need to increase PC education of intensive care unit nurses and promote interdisciplinary collaboration. The second cycle (October 1, 2019, to June 13, 2022) modified the study protocol to prioritize high-risk patients undergoing inpatient LT evaluation. Palliative care consultation increased by 262.5% from 2018 to 2019, with consults completed on 19% of all patients admitted for inpatient LT evaluations throughout the duration of the quality improvement study. Palliative care consultation on high-risk patients undergoing inpatient LT evaluation is a promising targeted strategy to increase utilization of PC in this population.

Patients with heart failure benefit from specialty palliative care but are often not evaluated for these services. The lack of standardized screening tools and limited nurse training for assessing palliative care needs are contributing factors. This quality improvement project aimed to improve the identification of unmet palliative care needs in patients with heart failure admitted to a progressive care unit by implementing a standardized nurse-administered palliative care screening tool. The nursing staff administered the Integrated Palliative Care Outcome Scale (IPOS) tool. The number of palliative consultations before project implementation was compared with those during the project. Spearman ρ was assessed for correlation between screening tool score and New York Heart Association (NYHA) heart failure class. Thirty-eight patients completed the screening tool. NYHA class was documented in 29% of patients. Among all patients, those categorized as NYHA III with heart failure with reduced ejection fraction demonstrated the highest need scores. Spearman ρ indicated a nonsignificant ( P > .05), very weak negative correlation between the IPOS scores and NYHA class ( rs = -0.18, P = .60). Implementing a nurse-administered screening tool effectively identified unmet palliative care needs among patients with heart failure with reduced ejection fraction and NYHA III. Despite low rates of palliative consults, standardization using IPOS could increase screening, contribute to institutional triggering palliative consultations, and improve awareness of unmet needs.

Underrepresented groups (URGs) in the United States, including African Americans, Latino/Hispanic Americans, Asian Pacific Islanders, and Native Americans, face significant barriers to accessing hospice and palliative care. Factors such as language barriers, cultural perceptions, and mistrust in healthcare systems contribute to the underutilization of these services. Recent advancements in artificial intelligence (AI) offer potential solutions to these challenges by enhancing cultural sensitivity, improving communication, and personalizing care. This article aims to synthesize the literature on AI in palliative/hospice care for URGs through the Technology Acceptance Model (TAM), highlighting current research and application in practice. The scoping review methodology, based on the framework developed by Arksey and O'Malley, was applied to rapidly map the field of AI in palliative and hospice care. A systematic search was conducted in 9 databases to identify studies examining AI applications in hospice and palliative care for URGs. Articles were independently assessed by 2 reviewers and then synthesized via narrative review through the lens of the TAM framework, which focuses on technology acceptance factors such as perceived ease of use and usefulness. Seventeen studies were identified. Findings suggest that AI has the potential to improve decision-making, enhance timely palliative care referrals, and bridge language and cultural gaps. Artificial intelligence tools were found to improve predictive accuracy, support serious illness communication, and assist in addressing language barriers, thus promoting equitable care for URGs. However, barriers such as limited generalizability, biases in data, and challenges in infrastructure were noted, hindering the full adoption of AI in hospice settings. Artificial intelligence has transformative potential to improve hospice care for URGs by enhancing cultural sensitivity, improving communication, and enabling more timely interventions. However, to fully realize its potential, AI solutions must address data biases, infrastructure limitations, and cultural nuances. Future research should prioritize developing culturally competent AI tools that are transparent, explainable, and scalable to ensure equitable access to hospice and palliative care services for all populations.

This rapid review provides an overview of active family engagement (defined as supporting the patient psychologically, physically, spiritually, or emotionally) in hospice and end-of-life care settings across the lifespan. A librarian-assisted search of the CINAHL (Cumulative Index to Nursing and Allied Health Literature) database over the past 5 years (English language only) yielded 1928 articles; 22 of these articles met the inclusion criteria for data extraction. The reviewed literature emphasized the importance of family engagement in hospice and end-of-life care, highlighting the need for effective communication, emotional support, and tailored interventions that nurses may use to support family caregivers. The literature highlighted opportunities to further educate and train palliative and hospice nurses on evidence-based and replicable approaches to supporting families as they deliver care at the end of life.