Search

Provision of high-quality end-of-life care in a cost-effective work environment is the aim of all hospice organizations. This opportunity can be negatively affected when there is a limited supply of parenteral narcotics or administration routes are either not functional or fail to control symptoms. To combat these challenges, including a shortage of available parenteral narcotics, staff at a hospice organization adopted the use of a rectal catheter to deliver oral medications that were readily available. The implementation of a rectal catheter resulted in better control of symptoms, fewer titrations, and improvement in pain control and/or symptom management needs during end-of-life care management.

Abstract: The provision of care through telehealth is emerging as a strategy to meet the challenges of a changing health care system; however, educational experiences associated with telehealth are limited in nursing curricula. In 2018, the National Organization of Nurse Practitioner Faculties (NONPF) recommended incorporating telehealth modalities in nurse practitioner education, including clinical skills assessment. Objective structured clinical examinations (OSCEs) have been used as formative and summative evaluations of health science students since the 1970s to assess application of didactic learning in clinical practice. Although few studies have investigated integrating OSCEs, virtual simulation, or telehealth in distance education, those that exist demonstrate significant improvement in clinical decision making. This article describes the development and implementation of an OSCE at a large Midwestern university delivered via web conferencing to evaluate online family nurse practitioner (FNP) students' abilities to deliver care using telecommunication technology. An e-visit notification listing the types of symptoms available for treatment by telehealth served as a content list. Students completed a 15-minute e-visit assessing and managing the care of a standardized patient presenting with a recent onset of dysuria. The video conference included the FNP student, standardized patient, and faculty evaluating in real time using a rubric incorporating NONPF competencies for telehealth. Structured group debrief, an integral part of the learning process in clinical simulations, followed the e-visit OSCE using free conference calling. Faculty and student feedback and evaluations of this summative OSCE implemented for three cohort groups (103 students) positively reflect the importance of preparing students for practice in a transformed health care system., Competing Interests: Competing interests: The authors report no conflicts of interest., (Copyright © 2020 American Association of Nurse Practitioners.)

Nurse practitioners play an integral part of the face-to-face visit. The face-to-face visit requirement came into effect on January 11, 2011, for hospice patients entering their third or later benefit period. The face-to-face requirement was created because of concerns regarding high numbers of hospice patients with lengths of stay greater than 180 days, in addition to concerns the physician was not as active in the care of the hospice patient as required. Face-to-face visits can be completed by the hospice physician or nurse practitioner employed by the hospice agency. The face-to-face narrative includes a clear title, date, clinical findings demonstrating continued hospice eligibility and a signature of the individual completing the face-to-face visit. In addition, an attestation statement stating that the encounter was completed with the patient and the clinical findings were provided to the certifying physician is also a requirement of the narrative. Documenting clinical findings that demonstrate hospice eligibility can be challenging. Using the FACE-2-FACE method can help clarify the clinical findings necessary to demonstrate the patient's continued hospice eligibility.