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Polypharmacy is commonly encountered by providers caring for patients with medically complex and palliative care needs in many settings. The purpose of this quality improvement project was to measure the impact of an evidence-based educational deprescribing intervention on polypharmacy rate and provider confidence and knowledge in the nursing home. We invited providers working in 52 nursing homes to attend a 1-hour-long educational deprescribing session. Twenty-one nurse practitioners and 1 physician assistant across 11 states participated in the intervention. Provider confidence level related to deprescribing improved in all categories, with statistical significance demonstrated with both paired t test and Wilcoxon signed rank test (P <.001). The polypharmacy rate 3 months after the intervention decreased more in centers where a provider had attended the training. Additional open-ended data about experiences with and barriers to deprescribing were collected and analyzed. The findings from this quality improvement project demonstrate that an educational intervention focused on providers practicing in the nursing home setting can improve deprescribing confidence and reduce polypharmacy rates. These findings may be used to implement similar deprescribing education programs for palliative care nurses and providers that prioritize goals of care for patients living with serious illness. [ABSTRACT FROM AUTHOR]

This pilot study explored the feasibility of a Forever Heart Program and the impact it has on oncology nurses' perception of the dying experience and their own compassion competence. Guided by Kubler-Ross's framework, the Forever Heart Program consists of a gemstone keepsake offered to patients and families during end-of-life care to support the grieving process. A mixed-methods approach utilized pretest/posttest design in a convenience sample of oncology nurses in an academic medical center over a 3-month period. The study collected demographics, Compassion Competence Scale scores, and qualitative responses via survey and an optional focus group. Twenty-five nurses participated in the presurvey, and 14 participated in the postsurvey. Seven nurses attended the focus groups. Overall, compassion competence scores were high, both pre and post. Qualitative themes included appreciation, connection, positive nursing, patient and family experience/relationships, grieving guidance, program benefits, and process opportunities. Although the study did not show statistically significant differences in compassion, it did show program feasibility and the potential positive impact that keepsakes like the Forever Heart Program can have on nurses and their role in the dying experience. [ABSTRACT FROM AUTHOR]

The demand for palliative and end-of-life nursing is increasing with the aging US population. The American Association of Colleges of Nursing published recommendations for incorporating palliative and end-of-life care across nursing curriculum to prepare the future workforce. However, recommendations regarding teaching end-of-life content are limited. This project aimed to integrate and evaluate the outcomes of end-of-life education introduced in a prelicensure nursing program. Using a documentary created by the American Nurses Foundation, students had the opportunity to discuss common themes in end-of-life care, practice morgue care in the simulation laboratory, and practice reflective journaling. The students' preevaluations and postevaluations indicated that the educational program significantly increased their confidence in providing end-of-life care and support to patients and families, demonstrating the importance of end-of-life curricula in nursing school. [ABSTRACT FROM AUTHOR]

The evolving legal landscape associated with medical assistance in dying (MAiD) may pose significant challenges for hospice and palliative care professionals. In the United States, 10 states and 1 jurisdiction have passed legislation allowing MAiD. National organizations, such as the Hospice and Palliative Nurses Association, have created position statements to serve as guides to care. Given the clinical and ethical challenges associated with MAiD, a rapid review was conducted to provide current evidence for policymakers, health care professionals, and researchers to use when considering care management and policy initiatives. Using a systematic approach, publications related to MAiD between 2019 and 2024 were extracted and synthesized. The review provides definitions of terms that differentiate between MAiD, euthanasia, physician-assisted suicide, medically assisted death of the nonterminal patient, and death with dignity. A total of 23 articles were included in the review and categorized into 4 themes: (1) legal, regulatory, and policy concerns; (2) health care professional experience ofMAiD; (3) patient and caregiver experience of and communication about MAiD; and (4) disparate access to MAiD. [ABSTRACT FROM AUTHOR]

Organ, tissue, and eye donations provide opportunities to leave a legacy by saving and/or enhancing the quality of life of others. There has been little published related to tissue or eye donation in hospice/palliative care and few initiatives to facilitate donation among hospice patients/ families. Donation myths, gaps in knowledge, and, most significantly, lack of donation referral processes result in missed opportunities for patient/families to consider donation. One donor has the potential to impact 75 lives or more through tissue donation and 2 lives through eye donation. Hospice/palliative care providers can play key roles related to education, advocacy, and collaboration. The support of hospice/palliative care organizations and the local Organ Procurement Organization/Tissue and Eye Recovery Agency are essential for facilitating donation opportunities. This article summarizes current literature, examines legislation and regulations related to donation, presents a case that illustrates an opportunity for hospice community based donation, and shares practices that support donation in hospice/palliative care organizations together with the local Organ Procurement Organization/ Tissue and Eye Recovery Agency. This article will hopefully provide the impetus for further study and the development of practices to optimize donation in hospice/ palliative care, thus providing more patients and families the opportunity to turn loss into legacy. [ABSTRACT FROM AUTHOR]

Palliative care aims to optimize quality of life and reduce physical, psychological, social, and spiritual suffering for people living with serious and life-threatening illness throughout the life span. There are different educational pathways to becoming an advanced practice registered nurse (APRN) and a range of areas in which APRNs may specialize, including hospice and palliative care. National guidelines and professional standards have been developed to guide the delivery of high-quality palliative care and to demonstrate the need for all nurses to be competent in providing primary palliative care. Advanced practice registered nurses are well poised to integrate palliative care standards into their practice in a variety of settings and in myriad ways including clinical care, program development, leadership, education, and advocacy. This article is the first in a series that will highlight the different roles of the hospice and palliative care APRN, including the doctor of nursing practice, clinical nurse specialist, pediatric APRN, adult/gerontology APRN, and community-based APRN in a variety of settings throughout the country. [ABSTRACT FROM AUTHOR]

Nurses play an essential role in managing mental health conditions, such as posttraumatic stress disorder (PTSD), especially in rural areas where access to mental health care is limited. Posttraumatic stress disorder may emerge at the end of life and complicate health care and is a particular concern for aging Vietnam veterans. We describe the development of 3 videos that illustrate how to recognize PTSD, respond to trauma disclosures, and manage PTSD in cognitive impairment during an in-home hospice nurse visit. Through problem identification and needs assessment, we identified 6 goals and 28 specific content objectives presented through cinematic action with flashbacks or voice-over narration with graphics. Videos were evaluated through a survey (N = 155) and analysis of "chat" responses (N = 186) to targeted questions during a webinar presentation to clinicians (N = 345). Approximately 75% rated videos as "very much" relevant to needs, having helped learn something new, and realistic. Analysis of chat responses showed videos conveyed most content objectives (92%). In addition, participants stated videos were helpful in demonstrating nursing skills of listening, responding, and displaying empathy, as well as showing case presentations involving cognitive impairment and the patient experience. Participants expressed a desire for longer videos/more information including a wider range of PTSD presentations and comorbidities. [ABSTRACT FROM AUTHOR]

The palliative care team identified a lack of knowledge and confidence for nurses providing end-of-life care in a hospital. The team completed a quality improvement project establishing significant improvement in knowledge and self-efficacy after a 2-hour educational intervention. The next step was to study the impact on practice. Clinical management of pain, dyspnea, secretions, and agitation was compared for a 3-month period before and after intervention. Thirty-six patients were identified in the preintervention group, and 46 patients were in the postintervention group. A 2-sample proportion Z test (α =.05, 2-tailed) showed no statistical significance in the number of doses of opioids administered between preintervention and postintervention groups; however, the number of patients in the postintervention group that received an opioid orally was significantly greater (z = −2.098, P =.0357). A significantly lower proportion of the postintervention group received benzodiazepines (z = −4.334, P <.00001). The postintervention group had a statistically significant lower proportion of anticholinergics administered (z = −4.189, P <.00001). Significantly more patients in the postintervention group had oxygen titrated (z = −3.196, P =.0014) and were on room air at the time of death (z = −3.891, P =.0001). A 2-hour training led to statistically significant changes in the use of evidence-based interventions. [ABSTRACT FROM AUTHOR]

Palliative care nurses are key members of the health care team and provide support to patients and their families navigating chronic and life-limiting illness. Financial burden is an issue inherent to chronic illness, yet has not been fully addressed in family caregivers. The purpose of this article is to (1) provide a case study of a family caregiver navigating chronic illness with her daughter and the associated financial and employment consequences and (2) review the nursing ethical, policy, and practice implications of financial burden for family caregivers. The ethical implications of financial burden in family caregivers relate to health equity and health outcomes for both the patient and family caregiver in treatment access and quality. The policy implications include state and federal policies related to caregiver compensation and support and family medical leave. Palliative care nurses play an integral role in addressing caregiver financial burden through assessment, education, referral, and policy support. Family caregivers are essential to the palliative care team, and palliative care nurses have the opportunity to lead initiatives to support the financial well-being of family caregivers in practice, research, and policy settings. [ABSTRACT FROM AUTHOR]

We examined the perception of palliative care nurses regarding challenges, coping strategies, resources, and needs when working in a university hospital in Austria. A qualitative descriptive design was applied, using semistructured interviews with 8 female and 2 male nurses. All interviews were recorded as digital audio and transcribed verbatim. We used thematic analysis and MAXQDA. In our analysis, 6 themes emerged: Four themes related to challenges: (a) lack of a supporting structural framework, (b) conflict in interdisciplinary work, (c) conflict with caregivers, and (d) dealing with death in a highly specialized university environment. One theme related to (e) individual solutions and coping strategies, and 1 theme comprised (f) needs and suggestions for improvements. Taking care of the family of a dying person, handling threatening situation, and working with inexperienced physicians were among the most important challenges reported by nurses. A supportive team, professional counseling, and training related to communication skills and to culturally specific needs of families are perceived to be necessary to provide high-quality palliative care. Addressing the needs of nurses can substantially improve their working condition and has an impact not only on the nurses themselves but also on the quality of patient care. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease remains a challenging epidemic across the United States. This serious illness impacts nearly twice as many individuals in the rural area compared with urban counterparts. As the disease progresses, the symptom burden and needs of the patient and caregivers escalate. Access gaps to services, such as hospice and palliative care, and the social determinants of health found in Appalachia may lead to marginalization and social injustice. Defined as the condition of being peripheralized based upon one's social margins of identity, associations, and/or environment, marginalization impacts health outcomes and quality of life. This article explores the triple threat of marginalization for patients with chronic obstructive pulmonary disease living in rural Appalachia. By recognizing marginalization and designing initiatives to reduce the impact, hospice and palliative care nurses serve as advocates and leaders to influence systemic change through partnerships with key policymakers and legislators. [ABSTRACT FROM AUTHOR]

This qualitative study explores the viewpoints of hospice nurses about end-of-life issues and proposed legislation that would allow assisted dying/euthanasia to be performed in New Zealand. The study uses data that were obtained from in-depth interviews with 15 experienced Palliative Care Nurses who were all working at various hospices around New Zealand. A thematic analysis process was used to develop a thematic framework, and the results indicated that there were at least 3 main themes supported by a number of related subthemes. These main themes were as follows: (a) personal values converge with professional ones when hospice nurses are asked to offer their viewpoints, (b) common end-of-life practices are not regarded by hospice nurses as acts of euthanasia, and (c) hospice nurses are greatly concerned about the effects of a euthanasia law on their profession and its relationships with the public. Our findings reveal that the hospice nurses in New Zealand largely hold negative viewpoints about the introduction of legalized assisted dying practices, arguing that such changes will present major challenges to their perceived role within their profession and within society. These findings suggest that this research should have a considerable primary impact among hospice and palliative care nurses in other nations. [ABSTRACT FROM AUTHOR]

Health care providers have an ethical obligation to reduce suffering during a patient's end of life (EOL), but few receive formal education on EOL care principles. The objective of this project was to determine the feasibility and potential benefits of an education initiative in which the principles of EOL care were taught to senior-level nursing students and practicing nurses. To assess feasibility, data regarding recruitment rates, retention rates, and implementation issues were collected. Workshop effectiveness was evaluated through use of the End-of-Life Nursing Education Consortium–Knowledge Assessment Test survey, which evaluates knowledge levels regarding EOL care principles. A mixed-effects linear model was used to test for changes from the preworkshop to postworkshop scores. Demographic information and satisfaction data were also collected. Nineteen students and 24 nurses participated (total N = 43). There was a statistically significant time difference (P =.0001), with the postworkshop scores being higher (43.5 ± 0.93) versus the preworkshop scores (41.2 ± 0.93). However, no statistically significant workshop date difference (P =.3146) emerged. Satisfaction data were positive. Retention for the second workshop was negatively affected by COVID-19. The unique needs of patients nearing their EOL are significant. This project describes the implementation and outcomes of an education initiative, focused on EOL care principles, that was both feasible and beneficial. [ABSTRACT FROM AUTHOR]

Dyspnea is a subjective experience of breathing discomfort that consists of qualitatively distinct sensations, varies in intensity, and can only be known through the patient's report. Dyspnea is akin to suffocation and is one of the most distressing symptoms experienced by patients with advanced illness and at the end of life. Common approaches to dyspnea management, such as pulmonary rehabilitation, breathing strategies, or supplemental oxygen, have become accepted through pragmatic use or because studies do not include dyspnea as a measured outcome. Patients and clinicians urgently need evidence-based treatments to alleviate this frightening symptom. To fill this gap, a group of dyspnea researchers with expertise to conduct a literature review of evidence-based interventions for dyspnea in patients with serious illness produced these guidelines. We present the evidence from the strongest recommendations for practice to the weakest recommendations and include practical considerations for clinical nurses. [ABSTRACT FROM AUTHOR]

Poor quality of sleep is common among those with advanced serious illness. Several interventions have been demonstrated to improve sleep; however, the extent to which these are used is unknown. This study describes nurses' perceptions of 36 nonpharmacological sleep-promoting interventions as well as facilitators and barriers to implementing nonpharmacological interventions. A descriptive survey design was used to collect data via an online, anonymous survey from nurses throughout the United States that included demographic items and open-ended questions (barriers and facilitators). The 108 respondents were nurses working in either a hospital (33.3%) or home care/outpatient (54.6%) setting. Among 36 interventions presented, a mean (SD) total score of feasible interventions per respondent was 27.1 (6.5). There were no significant differences in the mean total feasibility score due to practice site, nurse type, or years of experience. Most thought individual belief in the efficacy of the nonpharmacological intervention was an important facilitator whereas perceived lack of value and institutional support were the major barriers. There was an overall appreciation and positive perception of nonpharmacological, sleep-promoting interventions by palliative care nurses. Increasing use will depend on overcoming barriers by identification of specific patient/caregiver and institutional factors in each setting or patient population. [ABSTRACT FROM AUTHOR]

The provision of spiritual care is referred to in professional practice guidelines and mandated in nurses' ethical codes. Still, a gap exists regarding essential training in spiritual conversation and assessment, leaving some health care providers feeling uncomfortable when assessing spiritual support needs. The purpose of this study was to assess hospice and palliative nurses' and holistic nurses' perceptions of spirituality and spiritual care. It was assumed that the standards of care for hospice and palliative nurses and holistic nurses stipulate that spiritualty is addressed within the framework of their specialties and provide education for spiritual care, thus making these nurses proficient in providing spiritual care. This exploratory, descriptive study utilized a web-based survey to measure perception of spirituality and spiritual care giving using a modified Spirituality and Spiritual Care Rating Scale. A convenience sample was recruited from members of the Hospice and Palliative Nurses Association and the American Holistic Nurses Association (n = 250). Descriptive statistics summarized data as well as qualitative analysis of written narratives. Content analysis of open-ended survey questions was used to identify themes until saturation. This study found that given adequate resources and education, nurses can be positioned to address the spiritual needs of patients and provide appropriate care. This study adds to an emerging body of evidence suggesting that training in spiritual care should be an important component of the foundational nursing curriculum. [ABSTRACT FROM AUTHOR]

This study aimed to compare perceptions of spiritual care among patients with life-threatening cancer, their primary family caregivers, and hospice/palliative care nurses. Data were collected using both structured and unstructured approaches. Structured questionnaire data were examined using statistical analysis methods, and unstructured data were examined using content analysis to compare the 3 participant groups. The questionnaire revealed that among all 3 groups, spiritual care was commonly perceived to relate to "having the opportunity for internal reflection," "finding meaning," "encouraging hope," and "listening to and being with patients." Content analysis of the unstructured data revealed 5 themes: "Caring with sincerity," "Strengthening spiritual resources," "Alleviating physical pain and discomfort" (among patients and primary family caregivers only), "Improving spiritual care service," and "Multifaceted cooperation" (among hospice/palliative care nurses only). Our findings suggest that for patients with life-threatening illnesses such as terminal cancer, spiritual care should not be limited to religious practice but should also satisfy inner existential needs, for example, by encouraging hope, providing empathy, and helping patients find meaning in their circumstances. [ABSTRACT FROM AUTHOR]

Burnout, a condition characterized by emotional exhaustion, depersonalization, and decreased personal accomplishment, has been studied in many disciplines in health care, including nursing, medicine, and social work. The purpose of this study was to examine the relationship between perceived organizational support, coworker social support, the nursing practice environment, and nurse demographics (age, years of nursing experience, education level, marital status, and sex) on burnout in a national sample of palliative care nurses. The study aims were (1) to examine the relationship between perceived organizational support, coworker social support, and nursing practice environment on burnout in palliative care nurses; (2) to examine the relationship between age, years of nursing experience, education level, marital status, and sex on burnout in palliative care nurses; and (3) to examine potential moderators (perceived organizational support and coworker social support) on the relationship between demographic characteristics and palliative care nurse burnout. A convenience sample of 73 Hospice and Palliative Nurses Association registered nurses who were bedside caregivers was recruited from Hospice and Palliative Nurses Association's membership. Data were analyzed using Pearson correlation and regression modeling. Findings indicated palliative care nurses had moderate to high levels of burnout. There was a negative correlation between burnout and perceived organizational support, and between burnout and coworker social support. The nursing practice environment of palliative care nurses was favorable; perceived organizational support and coworker social support were not moderators for demographics of age and years of experience and their relationship to burnout. [ABSTRACT FROM AUTHOR]

Job satisfaction among hospice and palliative nurses is important as turnover and a dissatisfied workforce impact the work environment and the care provided to seriously ill patients and their families. This article reports the results of a nationwide survey of 633 hospice and palliative nurses evaluating job satisfaction, intent to leave, job stressors, suggested work improvements, and self-care strategies. Statistically significant correlations were found between the Home Healthcare Job Satisfaction Scale and subscales and the individual's self-rating of overall job satisfaction, likelihood of leaving the job, and thoughts of quitting. Multiple regression revealed a significant positive association between salary and overall job satisfaction, relationship with the organization, professional pride, autonomy, and control. A grounded theory approach was utilized to analyze qualitative data. Top job stressors identified were workload and problems with administration. Physical activities were cited as the most popular for self-care. Results indicate that most participants were highly satisfied with their work, but almost half think of quitting some or all of the time, indicating dissatisfaction with the work environment. Respondents suggested that employers increase recognition and salary, create a more positive work environment, decrease workload, and focus on patient needs rather than profits. [ABSTRACT FROM AUTHOR]

Despite the frequency, complexity, and intensity of communication that occurs between nurses, patients, and families, palliative care nurses often struggle with end-of-life communication. The primary goal of this quality improvement project was to increase nurse confidence and satisfaction engaging in end-of-life communication following the implementation of the COMFORT model; the secondary goal was to improve patient-family satisfaction with care provided in the palliative care unit. Fourteen palliative care nurses attended a 4-hour course to learn the tenets of the COMFORT model and practice through role-play exercises. A repeated-measures design was used to measure nurse confidence and satisfaction precourse, postcourse, and 3 months postcourse. A between- subjects pre-post design was used to compare family satisfaction survey scores in the 3-month period before versus the 3 months after implementation. Analysis revealed a statistically significant increase in all measures of nurse confidence and satisfaction from precourse to postcourse and from precourse to 3 months postcourse. There was no statistical difference between the family satisfaction survey scores before versus after training, although survey results were generally high at baseline and most respondents rated palliative services with the best possible response. This project demonstrates that COMFORT model training increased confidence and satisfaction of palliative care nurses engaged in end-of-life communication and demonstrates potential for use in other clinical areas that do not specialize in end-of-life nursing (eg, critical care) but find themselves in need of the communications skills to address end-of-life care. [ABSTRACT FROM AUTHOR]

The objective of this study was to understand Australian palliative care nurses' experience with existential/spiritual interventions and their critical appraisal of Outlook. Existential/spiritual interventions are showing positive results with palliative care patients. The majority of interventions are conducted by nonnurses, yet nurses are the most populous health care workers and are willing to provide holistic care, and patients are open to their help. A qualitative study through semistructured interviews was conducted. Participants were recruited using purposive sampling of a cross section of 20 palliative care nurses. Questions focused on their experience and review of existential/spiritual interventions in general and a published intervention Outlook. Their responses were transcribed and subjected to thematic analysis. The nurses' responses yielded both a range of experiences with existential/spiritual interventions and a review of Outlook: The review of Outlook identified a further 6 subthemes, including (1) Outlook can provide a framework, (2) session II difficult but valuable, (3) benefit for the bereaved, (4) benefit for the nurse/health care team, (5) potential difficulties in delivering Outlook, and (6) possible modifications. Australian palliative care nurses have limited experience with published existential/spiritual interventions, but many are already including elements of these in their practice, and most welcomed the validated tool. Identified needs included training, experience, dedicated space, and time. [ABSTRACT FROM AUTHOR]