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The National Academies of Sciences, Engineering, and Medicine (NASEM) convened a committee in Fall 2020 to address the quality of nursing home care with three specific tasks: (1) examine how [...]

Of all the various healthcare professionals that provide care to children and their families facing life's end, no one spends more time at the bedside observing, critically thinking, consulting, and providing direct care than the pediatric nurse. Previous research, however, demonstrates that undergraduate education has not prepared nurses to provide optimum end-of-life (EOL) care (Ferrell, Grant, & Virani, 1999; Ferrell, Virani, & Grant, 1999). Although many reasons have been cited in the literature for this inadequacy, the fact remains that when nurses complete their basic education and enter practice, they often are grossly unprepared to care for children and families in need of end-of-life care (Field & Behrman, 2003)., The End-of-Life Nursing Education Consortium--Pediatric Palliative Care (ELNEC-PPC) Project, has, to date, reached over 400 pediatric nurses through three national training programs. These nurses have returned to their own institution [...]

Mr Rivera, right-handed and aged 91 years, had been living an active, independent life until he lifted a gallon of milk and noted severe pain in his right arm. He [...]

Brown's article on the use of placebos in clinical practice presented some inaccuracies about placebos and pain management. Pain relief from placebos is poorly understood, but about one-third of patients experience it. Placebos should not be used to assess pain, diagnose psychogenic symptoms, or identify malingerers. Placebos can produce side-effects as well as induce positive effects. Some nursing organizations regard the clinical use of placebos as unethical. Nurses violate professional ethics and the principle of informed consent when they administer placebos deceitfully.

Background:Mutually respectful and long-term global partnerships are critical to increasing hospice and palliative care access as a key component of universal health coverage. The importance of sustained, transnational palliative care collaboration has become more urgent since the COVID-19 pandemic.Aim:To provide an overview of characteristics for successful global palliative nursing partnerships.Method:The authors highlight the need to adapt approaches to meet the challenges and demands of COVID-19 in both clinical and academic spaces. Exemplars of thriving global partnerships are provided, alongside palliative nursing considerations and strategies to advance and sustain them.Conclusion:The role of nursing to drive and enhance palliative care partnerships, especially with equitable input from low- and middle-income country stakeholders, must be leveraged to advance shared goals and reduce serious health-related suffering around the world.

Continuous extrapleural intercostal block (EPIB) with bupivacaine has been reported to be an effective analgesic technique in patients after thoracotomy. We report a retrospective study of EPIB using a continuous [...]

Background. Pain is an important problem for patients with cancer and is particularly important for elderly patients with cancer and their family care givers. Increasingly, cancer is managed on an outpatient basis with pain management responsibility assumed by the family at home. This study evaluated a structured pain education program that included three components: basic pain management principles and assessment, pharmacologic interventions, and nondrug treatments. Methods. The pain education intervention was implemented across three home visits with two points of follow-up evaluation. Outcomes of the 66 elderly patients with cancer completing the educational program included measures of quality of life, patient knowledge and attitudes regarding pain, and use of a self-care log to document drug and nondrug interventions and their effectiveness. Results. Repeated measurement analysis was used to evaluate the outcomes of the three-part education intervention. Results indicate an improvement in knowledge and attitudes regarding pain as well as the use of drug and nondrug interventions. Outcomes of the quality of life instrument suggest significant effect of pain on all aspects of quality of life, including physical well being, psychological well being, social concerns, and spiritual well being. Conclusions. The investigators concluded that the pain education intervention provided important support to elderly patients with cancer and family members at home. Structured pain education based on an evolving science of pain relief should become a part of the standard health care for pain management. Improved pain management includes quality of life for the elderly patient with cancer as well as for family care givers. Cancer 1994; 74:2139-46.

Opioid addiction is the excessive dependence on psychotropic drugs to achieve psychic effect rather than for medical purposes. Because of the psychological implications of opioid use, many physicians refrain from using it as medication. Patients who use opioid for effects other than pain relief suffer from withdrawal symptoms if the opioid is discontinued, especially when the patients has been taking increasing doses of the drug. Included is a questionnaire relating the probability of opioid addiction among patients.

Cancer patients and their families should be provided with clear and practical information about pain management. A three-step pain education program involving pain assessment, drug therapy and pain relief is presented. Several rating scales for pain assessment such as word descriptor scales and color scales can be used for determining medication amount. Patients should also be educated about drug dependence and effective drug therapy. Nondrug methods which provide effective pain relief include cutaneous stimulation and cognitive interventions.

Background:COVID-19 has highlighted the need for universal palliative care access. Nurses require palliative care education throughout the trajectory of professional training to effectively achieve this vision.Method:Review of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and use of educational exemplars highlight opportunities for improving palliative nursing education in academic and clinical settings.Results:Consistently applying palliative care principles affects nursing outcomes across myriad domains of person-centered services. All nurses are responsible for delivering primary palliative care, but they cannot practice what they do not know. The End-of-Life Nursing Education Consortium Project offers evidence-based education for nursing students and practicing nurses nationally and globally.Conclusion:Equipping both nurses and nursing students with palliative care education is critical to improve the overall quality of health care throughout the continuum during COVID-19 and in the face of future health crises. Equipping both nurses and nursing students with palliative care education is critical to improve the overall quality of health care throughout the continuum during COVID-19 and in the face of future health crises. [[J Contin Educ Nurs. 2021;52(3):130–135.]

Background:More than 90 million Americans are struggling to live with serious illness and are in need of palliative and end-of-life care. Yet, many novice RNs have not been adequately prepared during their undergraduate programs to care for them.Method:A large southwestern Magnet comprehensive cancer center piloted integrating the End-of-Life Nursing Education Consortium (ELNEC)-Undergraduate Curriculum into their nurse residency program during 2018 with 55 new RNs.Results:A pre-and posteducation evaluation questionnaire measured comfort with caring for patients with serious illness, competence, and knowledge in six areas of palliative care. All eight evaluation questions demonstrated statistically significant improvement posteducational intervention. Many nurse residents reported a change in clinical practice 1 month posteducation.Conclusion:The nurse residency is an opportune training time to prepare novice nurses to provide primary palliative care for all patients with serious illness and their families. The nurse residency is an opportune training time to prepare novice nurses to provide primary palliative care for all patients with serious illness and their families. [[J Contin Educ Nurs. 2020;51(6):280–286.]

Family caregivers are centrally involved in cancer pain management, especially for patients with advanced disease. This issue is becoming ever more important as care shifts to the outpatient setting and home care and as the aging population creates more patients who have multiple illnesses and family caregivers who often live with serious illnesses. This narrative review evaluated current knowledge and literature regarding family caregivers’ involvement in cancer pain management and identified areas for future research and clinical practice. There is a need for additional research in this area and for clinical models of support for family caregivers as they provide pain management for patients with cancer.

The article by Khatcheressian and colleagues addresses the important topic of futility in chemotherapy use. While extensive previous literature has addressed the use of futile treatment by oncologists, Khatcheressian and [...]

To the Editor: We are writing to challenge nurses in the field of medical-surgical nursing to address the urgent need for improved end-of-life care. The care that nurses provide to [...]

Spiritual issues play a prominent role for patients with cancer. Studies have demonstrated a positive connection between a patient’s spirituality and health outcomes, including quality of life, depression and anxiety, hopefulness, and the ability to cope with illness. Spiritual or existential distress is prominent in patients with cancer. Models are described that identify ways for clinicians to identify or diagnose spiritual or existential distress, and to attend to that distress. It is critical that all clinicians assess for spiritual distress as part of a routine distress assessment, identify appropriate treatment strategies, and work closely with trained spiritual care professionals.

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is effective at reducing lung cancer mortality in high-risk current and former smokers. Despite the fact that screening is recommended by the U.S. Preventative Services Task Force (USPSTF), few eligible patients are screened. We set out to study the barriers to LCS by surveying primary care physicians (PCPs).

Although we know that families of seriously ill children experience spiritual distress, especially at the end of the child's life, there is little information on the specific spiritual needs of families. In order to develop further training for nurses in paediatrics and help nurses develop skills for communicating about spirituality, this research examined the spiritual needs of families based on nurses' experiences with families of seriously ill children. Nurses' experiences revealed that families' anger with God, blame/regret, forgiveness, and ritual and cultural traditions are salient spiritual needs requiring effective nurse communication skills to support families of ill children.

IMPORTANCE: For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy. OBJECTIVE: To evaluate the safety, clinical, and cost impact of discontinuing statin medications for patients in the palliative care setting. DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter, parallel-group, unblinded, pragmatic clinical trial. Eligibility included adults with an estimated life expectancy of between 1 month and 1 year, statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease, recent deterioration in functional status, and no recent active cardiovascular disease. Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year. The study was conducted from June 3, 2011, to May 2, 2013. All analyses were performed using an intent-to-treat approach. INTERVENTIONS: Statin therapy was withdrawn from eligible patients who were randomized to the discontinuation group. Patients in the continuation group continued to receive statins. MAIN OUTCOMES AND MEASURES: Outcomes included death within 60 days (primary outcome), survival, cardiovascular events, performance status, quality of life (QOL), symptoms, number of nonstatin medications, and cost savings. RESULTS: A total of 381 patients were enrolled; 189 of these were randomized to discontinue statins, and 192 were randomized to continue therapy. Mean (SD) age was 74.1 (11.6) years, 22.0% of the participants were cognitively impaired, and 48.8% had cancer. The proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, −3.5% to 10.5%; P = .36) and did not meet the noninferiority end point. Total QOL was better for the group discontinuing statin therapy (mean McGill QOL score, 7.07 vs 6.74; P = .03). Few participants experienced cardiovascular events (13 in the discontinuation group vs 11 in the continuation group). Mean cost savings were $3.37 per day and $716 per patient. CONCLUSIONS AND RELEVANCE: This pragmatic trial suggests that stopping statin medication therapy is safe and may be associated with benefits including improved QOL, use of fewer nonstatin medications, and a corresponding reduction in medication costs. Thoughtful patient-provider discussions regarding the uncertain benefit and potential decrement in QOL associated with statin continuation in this setting are warranted. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01415934