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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]

Objective: Donation after cardiac death (DCD) or donation of organs after removal of life support is an accepted means of organ retrieval that usually occurs in the setting of sudden illness but has not been described in people with progressive neurologic illness. We report DCD in two people with progressive amyotrophic lateral sclerosis (ALS). Methods: Case series at an academic medical center of two men with progressive ALS who underwent withdrawal of artificial life support, rapid cardiac death, and subsequent organ donation. The primary outcome was donation of organs in concordance with patient and family wishes. Results: Both patients underwent peaceful withdrawal of life support in the presence of family, and multiple organs were donated. Conclusions: Patients may legally and ethically refuse life-sustaining care. These patients considered their lives to be more burdensome than beneficial near the end of their lives, both carefully planned the time and circumstance of their deaths, and both fulfilled a long-standing desire to donate their organs. This study describes a potential opportunity for patients with progressive neurologic illness. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To assess end-of-life (EOL) care core competencies deemed most important with corresponding educational needs from oncology nurses and to describe the characteristics of the respondents that are associated with selection of the top-ranked core competencies.Design: Descriptive, cross-sectional study.Setting: Mailed and online surveys.Sample: 714 members of the Oncology Nursing Society from Georgia, Virginia, Washington, and Wisconsin.Methods: Responses to a mailed or e-mailed researcher-developed questionnaire during a six-month period were collated and analyzed.Main Research Variables: Ranking of EOL care core competencies and perceived gaps in EOL continuing education.Findings: Almost all of the respondents indicated that EOL care was a part of their practice and that continuing education was important, but more than half of the respondents had fewer than two hours of continuing education regarding EOL care in the past two years. Twenty-five percent of the respondents do not believe they are adequately prepared to effectively care for a dying patient. Symptom management was the top-rated core competency, consistent across age, education level, practice role, and practice setting. How to talk to patients and families about dying and what comprises palliative care also was selected frequently.Conclusions: Symptom management is the number one core competency, and the quantity and quality of EOL continuing education is inadequate. Educational gaps exist in EOL nursing care.Implications for Nursing: Assessing what nurses believe to be leading EOL core competencies is useful in improving educational curricula along with considering characteristics of nurses when planning EOL educational programs. [ABSTRACT FROM AUTHOR]

Introduction: We studied the impact of an 11-bed inpatient palliative care unit (PCU) on site of death and observed mortality in the health system, oncology, and palliative care units. Observers were concerned that an active PCU would attract dying patients and worsen comparative mortality rates for Medicare and U.S. News & World Report comparisons., Methods: We reviewed 10 years of experience with all patients who died in the hospital before and after we opened our PCU in 2000., Results: The PCU concentrated dying patients on the PCU but total deaths did not change over 10 years and remained approximately 3% of admissions. Within 2 years, one quarter of all health system decedents died on the PCU. The proportion who died on the oncology floor and general units declined, but the number of intensive care unit deaths did not change., Conclusions: An inpatient PCU did not increase the hospital-wide death rate. The PCU did change the site of death to a more appropriate venue for one quarter of patients.