Journal of Hospice & Palliative Nursing最新文献

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.

In rural communities, primary care providers and other nonspecialists provide palliative care services when specialty care is not available. Recognizing the need to improve palliative care knowledge of providers across the care spectrum, groups across South Dakota have initiated programs to expand palliative care education. South Dakota also has a growing community health worker (CHW) infrastructure, and integrating CHWs into palliative care teams may be a way to further expand the reach of palliative care services. This mixed-methods study examines challenges, barriers, and facilitators of integrating CHWs into palliative care teams from the perspective of palliative care providers and advocates. Organizational culture and implementation climate are included as potential barriers and facilitators, and the results of the mixed-methods inquiry are used to select implementation strategies for integrating CHWs into palliative care teams in the South Dakota context from the Expert Recommendations for Implementation Change project.

Optimizing medication benefit and minimizing harm through effective and appropriate medication management is emerging as an important strategy in hospice and palliative care. This approach, however, often fails to align patient and family goals for remaining life with clinician priorities. Ascertaining patient and caregiver values and goals and aligning these goals with clinicians' priorities for care is a complex and iterative process. This process requires effective communication between all participants as a patient's illness trajectory moves toward death. The purpose of this article was to present a beginning conceptual framework for clinical consideration and use, as well as an example of a potential measurement framework envisioned from the conceptual framework for future research application. Both frameworks focus on goal-concordant prescribing among seriously ill older adults in home hospice. An environmental scan of existing deprescribing frameworks and approaches to goal ascertainment that inform hospice deprescribing was conducted. Feedback from practicing hospice clinicians engaged in a pilot project implementing a novel goal-concordant prescribing approach, as well as interprofessional clinicians and family caregivers from previous projects, were also used to identify theoretical and clinically relevant gaps in care as well as future research opportunities. The environmental scan and multiproject feedback served as the foundation for the development of the conceptual framework. The suggested communication frameworks for goal-concordant prescribing seek to bridge the gap between the preferences and priorities of the patient and family caregiver, and the risk-benefit considerations brought forth by clinicians.

Patients with end-stage renal disease face numerous physical, emotional, and financial burdens, necessitating palliative care (PC) interventions. This cross-sectional study assessed the problems and unmet needs of 129 patients under renal dialysis from 6 hospitals. Findings revealed that 64.7% of participants experienced significant challenges, primarily financial difficulties (78.5%), autonomy concerns (68.8%), and a need for information (68.0%). More than half (51.9%) reported needing PC, particularly for managing fatigue (78.3%), pain (79.8%), and depression (72.9%). Unmet needs were common (47.6%), with the most notable gaps in financial support (52.5%) and information provision (50%). Correlation analysis demonstrated strong positive associations between reported problems, care needs, and unmet needs ( r > 0.90, P < .001). Significant differences were observed by dialysis access type ( F = 5.71, P = .001), with arteriovenous fistula patients reporting higher problems and unmet needs. Increased dialysis frequency was linked to more problems and unmet needs ( F = 7.24, P < .001). In addition, patients with comorbidities experienced significantly higher problems, care needs, and unmet needs (all P s < .001). These findings underscored the urgent need for tailored PC interventions for end-stage renal disease patients, particularly in addressing symptom management, psychosocial and spiritual support, financial support, and information deficits, to enhance their quality of life.

The field of palliative care faces an impending clinician shortage, and nurse practitioners (NPs) are well-positioned to fill this critical need. However, there are currently not enough advanced practice educational opportunities for NPs in the form of fellowships/residencies to prepare them to fill this gap, despite the demonstrated benefit of such programs on self-reported preparedness for entry to practice and corresponding patient outcomes. Palliative care fellowship opportunities are limited by a lack of funding and developmental opportunities, with many experienced NPs in the field foregoing such an experience before entering practice. The purpose of this article is to overview the yearlong palliative care fellowship at Columbia University School of Nursing, wherein the part-time structure offers fellows the opportunity to build an exceptional foundation in palliative care while balancing other professional responsibilities. Palliative care will require NP leaders who are prepared to advance the field in practice, advocacy, education, and research; NP fellowships offer a remarkable foundation to prepare NPs to lead in this regard.

This study aimed to investigate predictors of palliative care self-efficacy among Vietnamese health care professionals. An online descriptive cross-sectional survey was conducted at 1 hospital in Vietnam. Participants completed survey questionnaires including demographics, professional experience, Palliative Care Self-Efficacy, Palliative Care Quiz for Nursing, Frommelt Attitudes Toward Care of the Dying-Form B, Santa Clara Brief Compassion Scale, and Self-Compassion Scale-Short Form. After data collection, descriptive statistics and stepwise regression were applied for data analysis. A total of 128 nurses and 42 physicians completed the survey. The mean score for palliative care self-efficacy was 27.6 ± 10.6 out of 48. The results indicated that compassion for others, self-compassion, and palliative care knowledge explained 17.8% of health care professionals' self-efficacy levels. This study supports the positive relationship between self-efficacy, compassion for others, and self-compassion among health care professionals, underscoring the need for incorporating compassion training into the curriculum and the training program.

Providing ethical, timely, and goal-concordant care for critical patients who are incapacitated with no evident advance directives or surrogates (INEADS) can pose challenges to nursing staff and other care team members and may delay or alter care trajectories. In a nested case-control study, we aimed to determine whether critical care patients who are INEADS have different hospitalization timelines, consultative services, and discharge dispositions relative to matched control subjects. Data were obtained from the publicly accessible Medical Information Mart for Intensive Care III database of 23 904 adult critical care hospitalizations in a Boston, Massachusetts, hospital from 2001 to 2012. Using natural language processing and verifying by manual chart review, we identified 40 patients in this cohort who were INEADS and matched them 1:1 with control subjects based on age, sex, and comorbidity index. Average length of hospitalization was 11 days for patients and 9 days for control subjects; average time until code status documentation was 8 days for patients and 6 days for control subjects, and average time until documentation of social work involvement was 9 days for patients and 2 days for control subjects. Although these differences were not statistically significant, procedures to support timely ethical decision-making for patients who are INEADS require attention.