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Dyspnea is the most common and activity-limiting symptom for those with chronic obstructive pulmonary disease (COPD). Treatment is complex, palliative care (PC) dyspnea relief interventions are poorly understood, and PC remains underutilized in COPD despite national guidelines and recommendations. The purpose of this rapid review was to explore the concept of dyspnea and role of PC through the lens of providers, caregivers, and patients with COPD. A systematic approach for synthesis was used to identify 13 articles published between January 2018 and October 2023. Team members compared data via visualization and theme clustering to identify key conclusions describing operationalization of dyspnea, management, and PC implications. Dyspnea operationalization was challenging, with inconsistent measurement and terminology. Dyspnea was a significant burden in COPD and contributed to complexity of treatment. Opioids were used most often to treat dyspnea, but provider perspectives and biases can influence treatment decisions and perceptions of opioid therapy by the patient and caregiver. Evidence-based clinical practice guidelines and policies are needed to clarify the use of opioid therapy for dyspnea management to reduce stigmatization and barriers to treatment. Provider education should emphasize a multipronged approach to treatment of dyspnea in COPD with integration of PC early in the care continuum. [ABSTRACT FROM AUTHOR]

Because of the growing population of patients with serious illness, the demand for specialty palliative care exceeds the resources available. Nurses must be prepared to provide primary palliative care to fill the gap in the availability of specialized palliative care providers. However, meeting the educational needs of a vast number of practicing nurses poses a significant challenge. Often, institutions are limited in the financial and staffing support that they can contribute for continuing nursing education, especially when the training requires staff to spend substantial time away from work. In order to address this issue, one large medical center conducted a study to examine the educational and clinical practice outcomes of offering an online version of the End-of-Life Nursing Education Consortium Core Curriculum to nearly 100 nurses. The participants were divided into 2 groups. Group 1 received online education only, whereas the other group received the online education plus a 3-hour face-to-face training session. Both groups reported statistically significant improvements in symptom management and communication skills, with no significant difference between the pedagogical approaches. Most importantly, the education resulted in a statistically significant impact on the nurses' clinical practice. The results of this study demonstrate that online education can be used as an effective and efficient strategy to provide primary palliative care education to a large number of nurses. [ABSTRACT FROM AUTHOR]

Moral distress affects workplace environment, burnout, employee retention, and patient safety. Palliative care is frequently involved in complex care for patients that may cause moral distress among staff. The goal of this study was to measure change in moral distress among nurses after implementation of a policy that allows nurses to consult palliative care. Before the policy change, data were gathered via email using the Moral Distress Scale-Revised. The scale was redistributed 6 months after implementation of the consult policy. Pre and post Moral Distress Scale-Revised results were analyzed. Qualitative thematic analyses of the nurses" comments were conducted. A significantly lower percentage of nurses reported providing care for a hopelessly ill patient frequently or very frequently (34.6% vs 23.1%, P = .0397) after the policy change. However, a significantly higher percentage of nurses postpolicy reported frequently or very frequently providing less-than-optimal care because of pressures from administrators/insurers (14.4%vs 21.1%, P = .0378), caring for patients they did not feel qualified to care for (5.3%vs 14.8%, P = .0055), and working with providers who were not competent to care for the patient (13.9% vs 26.9%, P = .0059). Themes from nurses" comments were inadequate staffing, communication, ethical concerns, and lack of education. [ABSTRACT FROM AUTHOR]

Pain is common in those with a life-threatening illness, yet barriers to adequate treatment persist. New challenges add to the well-known barriers of limited education, lack of time, and impaired access to expert treatment. The opioid abuse epidemic and the rising rate of deaths related to misuse of opioids present new obstacles to cancer pain relief. Although many of the efforts to reduce the impact of the opioid epidemic are important to the community, there are unintended consequences. When facing these challenges, ethical principles serve as a guide to the provision of safe and effective pain control in hospice and palliative care. The ethical principle most challenged during our current state is justice, the equal and fair distribution of resources. There are numerous examples of unfair distribution of cancer pain treatment, notably limited access to pharmacologic and nonpharmacologic therapies. Hospice and palliative nurses who are dedicated to the provision of excellent cancer pain care can ensure equitable distribution of resources, including opioids. Solutions to the challenge of fair access include individual professional development, interventions by health care organizations, and action by professional organizations. [ABSTRACT FROM AUTHOR]

As care providers across the health continuumfor patients with serious illness, advanced practice registered nurses (APRNs) are essential to quality palliative care. Many APRNs, however, lack palliative care education and training. To promote palliative-specific education for practicing APRNs, the End-of-Life Nursing Education Consortium (ELNEC) created an APRN curriculum and developed a 2-day course on clinical issues and program development in palliative care pertinent to APRN practice. In the past 3 years, more than 940 APRNs representing the spectrum of disease specialties, populations, and health care settings have attended this national course. Completion of precourse and postcourse surveys demonstrated that the course has improved their knowledge and their practice. ELNEC-APRN is an essential educational forum for APRNs to provide high-quality palliative care for patients with serious illness. Advanced practice registered nurses can incorporate content into their practice, integrate content into other educational forums, and use principles to build palliative care services. [ABSTRACT FROM AUTHOR]

As the numbers of medically uninsured rise, more and more Americans are depending on public/safety net (P/SN hospitals--hospitals responsible for the care of the uninsured and underinsured, The Center to Advance Palliative Care has found that far fewer P/SN hospitals report palliative care services, compared with similarly sized not-for-profit hospitals, While the development of dedicate palliative care services is an important way to enhance palliative care in P/SN hospitals, P/SN providers may need to develop alternative strategies in these underresourced settings. The purpose of this article was to describe the implementation and evaluation of the End-of-Life Nursing Education Consortium for Public Hospitals (ELNEC-PH), a comprehensive, statewide initiative to enhance palliative car education and leadership in 16 (out of 17) California P/SN hospitals. Funded by a grant from the California HealthCare Foundation, the 2-year (2011-2013) ELNEC-PH nursing project was designed to provide education and mentoring the public hospital nurses and to promote collaboration between participants and their hospital-based palliative care programs. The ELNEC-PH project consisted of 5 main activities: ELNEC education, mentoring, online palliative car education, an annual grantee meeting, and a workshop. At 18 months after course, participants reported that the program significantly increased their effectiveness and ability to teach palliative care content to their colleagues (P = .028). There was a significant increase in the number of educational programs for all modules offered across all 16 hospitals (P < .05). Lessons learned included developing a team, aligning the palliative care program with the goals and mission of the organization, and identifying key stakeholders and their needs. The ELNEC-PH project has been an invaluable educational effort that has attempted to address the growing need for palliative care education in California P/SN hospitals, which can be a model for other P/SN hospitals nationally. [ABSTRACT FROM AUTHOR]

Palliative care nurses provide care for patients who live with declining functional capacity and symptoms associated with their illnesses and who, ultimately, face death, Despite a large body of research that provides evidence{or the efficacy of palliative care, less is known about those who provide it. This study explores how palliative care nurses understand their role, and what, if any, concerns or needs they have that relate to their ability to provide high-quality palliative care to their patients. We utilize an inductive thematic analysis of qualitative survey responses to gain understanding of palliative nursing practice and competencies to learn more about the particular issues, concerns, and needs of these nurses. Results demonstrated that palliative nurses view end-of-life and palliative nursing competencies as a toolkit they draw upon based on the customized needs of patients and families rather than a ranked Fist of important skills. Additionally, responses reflected the importance palliative nurses place on interpersonal skills to work with patients and families, physicians, and as a health care team. Finally, respondents overwhelmingly reported concerns about the level of palliative and end-of-life education of their health care professional colleagues. These findings suggest that palliative nurses may be an untapped resource that health care administrators could use to address the growing educational needs of other health care professionals who would benefit from an increased understanding of the benefits of palliative care options. Listening to voices from the bedside is a useful way to learn more about the practice and delivery of palliative care. [ABSTRACT FROM AUTHOR]

At the frontlines, members of Hospice and Palliative Nurses Association (HPNA) are advocating for better outcomes for patients and their families, improving education for caregivers, and developing new knowledge in caring for their patients with life-limiting conditions. The purpose of this research was to assess core competencies deemed most important by HPNA members by assessing the quantity and quality of continuing education, personal effectiveness, and the level of commitment to end-of-life or palliative care by the nurse's employer. A validated and replicated survey was mailed to 4022 HPNA members, with a nationally representative return rate of 31.2%. The main research variable was ranking of end-of-life care competencies and perceived gaps in palliative care continuing education. Nearly all of the respondents indicated that palliative care continuing education was important and nearly 80% of the respondents had 7 or more hours of specific continuing education in the preceding 2 years. Ninety-six percent of the respondents believe they are adequately prepared to effectively care for an individual with a life-limiting condition. Symptom management was the top-rated core competency, although pain management and how to talk to patients and families about dying were also frequently selected. HPNA nurse respondents are comfortable with the quantity and quality of orientation and continuing education within their scopes of practice in palliative care. [ABSTRACT FROM AUTHOR]

Compounded medications offer great opportunities for enabling healthcare professionals to control pain or other symptoms through unique delivery routes and nonstandard formulations or dosages. These formulations can include gels, trouches, suspensions, capsules, and suppositories, as well as many other delivery routes. The use of compounded agents has continued to increase over the last 2 decades. These unique interventions are not without their own set of issues and have not been widely examined within the literature. This article seeks to explore the role of compounding medications while discussing the benefits and potential risks of using the medications. Compounding allows for the ability to deliver a medication that is not currently commercially manufactured, unavailable, or being used for off-label purposes. Compounded medications can be produced by pharmacists or physicians, but currently, no training in this procedure is required. There is limited federal oversight of compounding medications; most oversight of this procedure is through various state boards of pharmacy. In evaluating this special intervention, nurses must consider bioavailability, sterility, safety, efficacy, and stability, as well as costs associated with these medications. Recognizing certain changes in the physical formulation may help the nurse assess the formulation to determine whether the medication is stable. This is critical, as the stability of compounded medication is not known as each drug is individually formulated. When compounded medications are considered, many questions must be explored to determine if this avenue serves patients well. [ABSTRACT FROM AUTHOR]

Provides information on the compounding of drugs or the process of customizing pharmaceuticals for a patient. Reasons why drugs are compounded; Conditions when the U.S. Food and Drug Administration does not regulate compounded drugs for efficacy and safety; Evaluation of compounded drugs.

Focuses on cancer pain in patients. Factors contributing to cancer pain; Difference between nociceptive and neuropathic pain; Pain assessment of cancer patients.

Discusses the palliative treatment to the AIDS disease in the United States. Symptom assessment; Management of symptoms; Pathophysiology of symptoms. INSET: ABCD Assessment of People with HIV or AIDS..

The author comments on the article on challenges encountered by patients with Huntington disease which he claims did not merit any mention of palliative care as component option in the care of this patient population.

The author reflects on the role of physicians in providing palliative care to terminally ill patients. He described the case of an 87 year old man who was diagnosed with cancer, along with his medical condition. He discussed how an oncologist was able to provide true and honest information to the patient's son, which in turn helped the son in making clear decision for his terminally ill father. The author argues that physicians should not give false hopes and unrealistic treatment.

The author discusses a change in healthcare practice which he chooses to define as the shift mentality. He says the development may be promoting the handoff mindset among medical professionals, which equates to that they have already done that they can do during their predetermined hours. He believes that survival may be the reason for such a work ethic. He stresses the need for such professionals to find a balance in their lives.

Relates the experience of the author as a nurse on caring patient with hypercalcemia and dehydration. Accounts on the struggles of the patient; Discussion of the author concerning the health status of the patient; Alternatives of the patient to move to an assisted-living center or nursing home.

Background: Life-threatening illnesses such as HIV/AIDS, malaria, tuberculosis, and other disorders are prevalent in the developing world, including Kenya., Objective: The aim of this project was to assist in the development of palliative care throughout Kenya by enhancing the knowledge and skill of faculty members in palliative care so they could integrate this content into existing nursing curricula., Methods: In an effort to develop palliative care throughout the country, experts from the Kenya Hospices and Palliative Care Association and the Kenyatta National Hospital invited faculty from the End-of-Life Nursing Education Consortium with the United States to adopt the content of its training program to address the needs of nurses and other health care professionals in Kenya. This curriculum was delivered to nursing faculty from throughout Kenya during a 5-day training course that incorporated presentations, case studies, exercises, and other teaching methods., Results: The course participants completed daily course evaluations in which they rated each session on a scale of 0 = not helpful to 5 = very helpful. All of the sessions were rated very favorably, with scores for all sessions across the 5 days ranging from 4.57 to 4.91., Conclusion: End-of-Life Nursing Education Consortium provided educational and other support to faculty teaching in nursing schools in Kenya so they could advance palliative care efforts in this country., Implications for Practice: Nurses working in the United States can share their expertise and learn immense lessons from colleagues in developing worlds.

Relief of symptoms for patients and families throughout the illness trajectory requires that palliative care practitioners have knowledge and skill, both in assessment and use of pharmacologic and complementary therapies. This article presents the didactic content of symptom assessment and management, and the experiential experiences used in a nondrug laboratory within the End-of-Life Nursing Education Consortium (ELNEC) curriculum.