Journal of Hospice & Palliative Nursing最新文献

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.

The implementation of active methodologies in end-of-life education can play a crucial role in stimulating participatory learning and facilitating the acquisition of socioemotional competencies. An exploratory descriptive qualitative study was conducted to describe the students' perspective on the use of simulation, reflective dialogue, and the flipped classroom in an end-of-life education program. Undergraduate nursing students who had not yet begun their practicums were included. At the end of the training program, 4 focus groups were used. After the analysis, 3 themes and 32 categories emerged from the study. The themes included the contribution of the methodologies to learning, the characteristics that the methodology had to meet to be more effective, and motivational and emotional aspects triggered by the educational resources used. From the students' perspective, simulation, reflective dialogue, and flipped classroom enhance the conceptual learning process and facilitate students' socioemotional preparation to face this complex and challenging professional situation.

Spiritual care is an integral component of palliative care and addresses the physical, psychosocial, and spiritual needs of patients and their families. This study aimed to determine the spiritual needs of hospitalized palliative care patients in Turkey and to provide insights into culturally sensitive spiritual care practices. This descriptive, cross-sectional study was conducted with 108 palliative care patients hospitalized in a public hospital between July 2022 and December 2023. Data were collected using a sociodemographic questionnaire and the Turkish version of the Spiritual Needs Assessment Scale. The average age of the participants was 72.43 ± 15.53, and 50% were women. The most frequently reported spiritual needs in palliative care patients were "compassion and kindness" (59.3%), "feeling hopeful" (55.5%), "gratitude" (54.6%), "inner peace" (52.8%), and "companionship" (51.9%). Existential and relational dimensions, such as feeling connected to the world and receiving love, were identified in the data. The findings underscored the need for holistic approaches that integrate spiritual, cultural, and psychosocial dimensions into palliative care. Standardizing spiritual care practices and incorporating them into health care professionals' training could enhance the quality of care in Turkish palliative care settings.

The nurse practitioner plays an important and unique role in delivery of high-quality pediatric palliative care. The combination of their nursing roots, advanced education, and training makes the pediatric nurse practitioner well-suited to excel in the domains of palliative care clinical practice, education, and outreach. This will be highlighted through case examples that encompass the early lifespan and include pediatric subspecialties commonly served by palliative care.