Journal of Hospice & Palliative Nursing最新文献

For learning to influence change in palliative clinical practice, education needs to be ongoing, incorporating specific interventions targeted to the learner, in a format that enhances knowledge and networking. This novel, online, interactive, case-based educational offering provided a method to allow ongoing integration of palliative care principles for health care professionals who attended the End-of-Life Nursing Education Consortium/Open Medical Institute courses in Salzburg during 2019-2022. Eight monthly teleconferences based on challenging clinical cases allowed discussion between palliative care professionals from 9 countries, serving as a mechanism for deepening theoretical information, allowing incorporation of best practice into the clinical setting, and, ultimately, improving care for all with serious illness. Many of the challenges encountered providing palliative care are universal. Through case vignettes, the group has been able to offer specific interventions, advances in practice, and discussions of approaches toward family and other health care professionals to provide optimal care. The participants report that the opportunity to learn from and support peers in other countries has been a rewarding and emotionally uplifting experience. These discussions were highly rated by participants who strongly voiced that the interactions would change their clinical practice to positively impact patient care.

Depression can worsen physical suffering and psychiatric distresses in individuals with life-limiting illnesses and is associated with increased rates of pain, fatigue, dyspnea, and worse survival outcomes. Evidence supports protocol development to address depression in the hospice setting using validated screening tools and a process for referral and treatment. After protocol development and integration of validated screening tools into the electronic medical record, newly admitted patients meeting inclusion criteria were screened during the social workers' initial psychosocial assessment. Patients were referred for pharmacological and nonpharmacological treatment strategies based on the severity of depression detailed in the protocol. Of all patients who met inclusion criteria, 100% were screened using the Patient Health Questionnaire-2 with 52% being identified as having some severity of depression, 26% being appropriately referred for treatment, and 50% receiving a pharmacological strategy, whereas 26% received nonpharmacological strategies. There was a statistically significant difference in severity of depression found between those identified as having a depressed mood preintervention and those with some severity of depression using a validated screening tool postintervention. Implementing a standardized practice protocol to address depression in a hospice setting allowed for consistent evaluation through the use of validated screening tool(s) and increased recognition of those with symptoms of depression.

A dignified death is described as a good death or dying with dignity. Nurses caring for veterans are aware of the honor veterans can receive at the time of death. The purpose of this study was to describe and compare perceptions of a dignified death in nurses who care for veterans in Veterans Affairs settings. This descriptive, exploratory design used an online survey including scales of dying with dignity and a good death. Subjects were nurses who worked at Veterans Affairs facilities. Dying with dignity scores were high and moderately high for a good death. Good death items of wishes, peace, spirituality, and pain free were considered essential by most nurses. There was no difference in scores based on age or end-of-life experiences. Veterans Affairs nurses had a good perception of a dignified death providing a foundation for veteran support before, during, and after death.

Virtual reality (VR) is an emerging technology that can provide a nonpharmacological approach to symptom management for those with serious illnesses. The VR platform offers a unique perspective to connect patients with places and experiences they might otherwise miss. This rapid review aims to present the current literature on the uses and benefits of VR for palliative care and hospice patients. Through a systematic process, we identified 14 articles published between 2018 and 2023 that used VR as an interventional strategy for symptom management. The VR equipment includes a head-mounted display, such as the Oculus Go, and sometimes requires hand controllers or joysticks. Virtual reality software was contained exclusively in the head-mounted displays or required a laptop. Nature scenes, memorable locations, and the solar system are examples of options patients could select for the VR experience. Assessments of the intervention were measured before, during, after, and several hours afterward to evaluate benefits and potential adverse effects. Pain was the predominant symptom assessed in the studies. Overall, most of the studies focused on establishing the safety, efficacy, and feasibility of VR using a single-arm interventional method. Future research should implement randomized controlled trials, increase sample size, and expand to pediatric populations.

Hospice cancer caregivers' (HCCs') burden and unmet needs are well documented in the literature through retrospective, standardized self-report surveys. Hospice cancer caregiver daily experiences of burden and unmet needs are rarely captured within a real-time context. The purpose of this secondary data analysis was to characterize HCCs' day-to-day burden and unmet needs with prospective HCC (N = 50) audio diary data between hospice enrollment and patient death. Uncertainty theory provided a framework for analysis. Diaries were transcribed, analyzed deductively and inductively, and organized thematically. Uncertainty in day-to-day experiences was an important driver of HCC burden and unmet needs. Unmet needs included unclear/unmet expectations regarding hospice care team support; not understanding the extent of HCC role and involvement; and communication challenges with hospice team members. Sources of HCCs' burden were dissonance between how they "should" feel and how they actually felt; feeling alone/having no outlet to express feelings; concerns about their own health and subsequent patient impact; and feeling helpless/occupying a liminal space. Uncertainty surrounding HCCs' experiences encompassed interactions with hospice care teams and the nature of end-of-life caregiving with symptom management, the dying process, and the HCC role. Hospice care teams can respond to uncertainty through assessment, understanding, and recognition of the daily context of HCCs.

Decision making for nursing home (NH) residents with Alzheimer disease and related dementias often involves input from multiple family members and NH staff to address goals of care at the end of life. Using data from the Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life research study, a secondary analysis of qualitative data was conducted involving interviews of 144 NH staff and 44 proxies in 14 NHs to examine the perspectives of NH staff and proxies for NH residents with Alzheimer disease and related dementias on the involvement of multiple family members in decision making about end-of-life care decisions. Interviews took place between 2018 and 2021. Nursing home staff and proxies had differing perspectives of the involvement of multiple family members in decision making, with NH staff primarily viewing families as a source of conflict, whereas proxies viewed families as a source of support. Nursing home staff also had differing opinions of their role with families; some attempted to ameliorate conflict, and some did not get involved. Some NH staff felt that Black families had more conflict than White families, indicating unacceptable bias and stereotyping of Black families by NH staff. These findings suggest training and education is needed for NH staff to facilitate better communication with families and to support proxies in end-of-life decision making to address goals of care for NH residents with Alzheimer disease and related dementias.

Palliative care teams are increasingly called up to manage chronic pain in cancer survivors. Chronic pain is common in cancer survivors and is heavily influenced by biopsychosocial factors. This study aimed to determine the relative contribution of unique cancer-specific psychosocial factors, pain catastrophizing, and multisite pain to the pain experience in 41 cancer survivors who completed curative cancer treatment. To test the research hypotheses, a series of nested linear regression models were used with likelihood ratio testing to test the individual and collective contribution of cancer-specific psychosocial factors (fear of cancer recurrence, cancer distress, cancer-related trauma), pain catastrophizing, and the number of pain sites on the pain experience. The results indicate pain catastrophizing and multisite pain explained a significant degree of variance in pain interference scores ( P < .001) and pain severity ( P = .005). Cancer-specific psychosocial factors did not significantly predict variability in pain interference ( P = .313) or pain severity ( P = .668) over and above pain catastrophizing and the number of sites of pain. In summary, pain catastrophizing and multisite pain contribute to the chronic cancer-related pain experienced by cancer survivors. Palliative care nurses are well positioned to improve chronic pain among cancer survivors by assessing and treating pain catastrophizing and multisite pain.

The quality of care provided to patients with cancer at the end of their lives remains unsatisfactory, especially during their last days and hours of life. This study aimed to investigate knowledge and practice behaviors of oncology nurses in relation to the care of the dying and to analyze the influencing factors. A convenience sample of 222 oncology nurses was recruited from 14 hospitals in Beijing, China, in January 2022. These nurses completed an online survey that included a demographic and work characteristics questionnaire and knowledge and practice behavior questionnaires regarding the care needs of dying cancer patients. The self-perceived knowledge and practice behavior of oncology nurses toward the care of the dying were found to be moderate. However, their understanding of airway management, restlessness, and delirium management was insufficient. In addition, their ability to effectively communicate recommendations for discontinuing unnecessary procedures, medications, treatments, and monitoring was inadequate. Nurses' previous end-of-life care education and experience of caring for dying patients influenced their knowledge. Nurses' practice settings, experience of caring for dying patients, and their knowledge were key factors in shaping their behaviors. Providing targeted continuing education for nurses in hospital settings and exploring the nursing pathway may be important ways to bridge their knowledge gap and enhance their practice behaviors toward caring for dying patients.

Cancer hospice family caregivers provide intensive support for patients at the end of life, sometimes at the expense of self-care. This secondary analysis examined the role of caregiving burden, activities of daily living, and mental health on self-care behaviors among cancer hospice family caregivers. Logistic regression models were adjusted for sociodemographic and caregiver characteristics, and model fit was evaluated with Hosmer-Lemeshow tests. Participants (N = 86) were mostly women (n = 62, 72.09%), White (n = 76, 88.37%), and spousal caregivers (n = 44, 51.16%). Almost half reported not getting enough rest (47.67%), time to exercise (47.67%), or time to slow down and rest when feeling ill (46.51%). Caregivers with better mental health reported being more likely to have enough time to exercise (adjusted odds ratio [OR adj ], 1.15, [1.05, 1.26]; P = .004), rest (OR adj , 1.11, [1.01, 1.22]; P = .031), and slow down when ill (OR adj , 1.16, [1.04, 1.30]; P = .010). Controlling for sociodemographic and caregiver characteristics, men caregivers had 88% lower odds of being able to rest when ill (OR adj , 0.12, [0.03, 0.52]; P = .005) compared with women. Number of care tasks, not caregiving burden, was associated with self-care behaviors. Findings provide a preliminary understanding of factors related to caregiver self-care and have implications for increased assessment of caregiver mental health and self-care needs to better support family-oriented hospice care.