Are we getting it right? A review of end-of-life care in community nursing

2021 ◽  
Vol 26 (7) ◽  
pp. 348-352
Author(s):  
Nicky Thorpe ◽  
Rachel Singh ◽  
Helen Chapman ◽  
Lisa Farndon
Keyword(s):  
End Of Life ◽  
Response Rate ◽  
Patient Records ◽  
Community Nursing ◽  
Electronic Patient Records ◽  
Convenience Sample ◽  
Nursing Service ◽  
E Learning ◽  
Community Trust ◽  
Eol Care

End-of-life (EoL) care is an important role in community nursing. In order to assess a community nursing team's performance in the delivery of EoL care, an evaluation of the EoL care template was undertaken from electronic patient records. Records were assessed against a set of four care priorities across 23 nursing teams in a large acute/community trust. Some 103 electronic patient records were evaluated out of a convenience sample of 110 (94% response rate). The results demonstrated that patients' wishes are being discussed and documented and the priorities of care are being considered with patients needing EoL care. Thus, patients and their families are being supported by the community nursing service, which is communicating with them sensitively and involving patients in the decision-making process. In some cases, the EoL Care Template was not fully completed, which would result in poorer communication across teams and organisations of practice within the wider community. Future action will be focused on continuing to encourage and improve the use of the EoL care template as well as the local online e-learning package for EoL care.

Paramedic Knowledge, Attitudes, and Training in End-of-Life Care

2009 ◽  
Vol 24 (6) ◽  
pp. 529-534 ◽  
Author(s):  
Susan C. Stone ◽  
Jean Abbott ◽  
Christian D. McClung ◽  
Chris B. Colwell ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Los Angeles ◽  
End Of Life ◽  
Life Support ◽  
Clinical Skills ◽  
Chi Square ◽  
Convenience Sample ◽  
Terminal Disease ◽  
The Past ◽  
Almost All ◽  
Eol Care

AbstractIntroduction:Paramedics often are asked to care for patients at the end of life. To do this, they must communicate effectively with family and caregivers, understand their legal obligations, and know when to withhold unwanted interventions. The objectives of this study were to ascertain paramedics' attitudes toward end-of-life (EOL) situations and the frequency with which they encounter them; and to compare paramedics' preparation during training for a variety of EOL care skills.Methods:A written survey was administered to a convenience sample of paramedics in two cities: Denver, Colorado and Los Angeles, California. Questions addressed: (1) attitudes toward EOL decision-making in prehospital settings; (2) experience (number of EOL situations experienced in the past two years); (3) importance of various EOL tasks in clinical practice (pronouncing and communicating death, ending resuscitation, honoring advance directives (ADs)); and (4) self-assessed preparation for these EOL tasks. For each task, importance and preparation were measured using a four-point Likert scale. Proportions were compared using McNemar chi-square statistics to identify areas of under or over-preparation.Results:Two hundred thirty-six paramedics completed the survey. The mean age was 39 years (range 22–59 years), and 222 (94%) were male. Twenty percent had >20 years of experience. Almost all participants (95%; 95% CI = 91–97%) agreed that prehospital providers should honor field ADs, and more than half (59%; 95% CI = 52–65%) felt that providers should honor verbal wishes to limit resuscitation at the scene. Ninety-eight percent of the participants (95% CI = 96–100%) had questioned whether specific life support interventions were appropriate for patients who appeared to have a terminal disease. Twenty-six percent (95% CI = 20–32%) reported to have used their own judgment during the past two years to withhold or end resuscitation in a patient who appeared to have a terminal disease. Significant discrepancies between the importance in practice and the level of preparation during training for the four EOL situations included: (1) understanding ADs (75% very important vs. 40% well prepared; difference 35%: 95% CI = 26–43%); (2) knowing when to honor written ADs (90% very important vs. 59% well-prepared; difference 31%: 95% CI = 23–38%); and (3) verbal ADs (75% very important vs. 54% well-prepared, difference 21%: 95% CI = 12–29%); and (4) communicating death to family or friends (79% very important vs. 48% well prepared, difference 31%: 95% CI = 23–39%). Paramedics' preparation in EOL skills was significantly lower than that for clinical skills such as endotracheal intubation or defibrillation.Conclusions:There is a need to include more training in EOL care into prehospital training curricula, including how to verify and apply ADs, when to withhold treatments, and how to discuss death with victims' family or friends.

Direct care staff and parents'/legal guardians' perspectives on end-of-life care in a long-term care facility for medically fragile and intellectually disabled pediatric and young adult residents

2012 ◽  
Vol 11 (4) ◽  
pp. 307-314 ◽  
Author(s):  
Richard I. Grossberg ◽  
Martha Blackford ◽  
Sarah Friebert ◽  
Ethan Benore ◽  
Michael D. Reed
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Response Rate ◽  
Care Facility ◽  
Life Care ◽  
Term Care ◽  
Long Term Care Facility ◽  
Legal Guardians ◽  
Eol Care

AbstractObjective:Children and young adults with severe disabilities and their families are faced with enormous challenges throughout the lifespan, including admitting the child to a long-term care facility (LTCF) and making end-of-life (EOL) care decisions. While children are residents of these specialized LTCF, the majority of their daily care, even up until death, is provided by nursing aides or habilitation aides (HAs) with limited training and educational backgrounds compared with other licensed healthcare providers. The purpose of this study was to determine the impact of a resident's EOL experience on the primary HAs and parents/guardians.Method:Thirty-five resident deaths occurred at Hattie Larlham Center for Children with Disabilities (HLCCD) between January 1, 2006 and February 28, 2009. The HAs and parents/legal guardians were identified for each death and invited to complete three surveys per resident (FAMCARE, Impact of Events Scale (IES)-revised, and Perspective on End-of-Life Care) to assess their experience. There were 112 surveys mailed to 62 HAs and 47 surveys mailed to 47 parents.Results:Forty-two surveys were returned from 18/62 HAs (response rate 29%) and 11/47 parents/legal guardians completed the surveys (response rate 23%). The FAMCARE survey found that parents were more satisfied with the EOL care than were the HAs. The IES-revised found no difference in traumatic responses from either group. Comments from the Perspective on End-of-Life Care survey were analyzed qualitatively for common themes including pain control, respect, decision making, environmental needs, resources, and support.Significance of results:Because of a low response rate, it was difficult to draw significant conclusions; however, several interesting trends were noted regarding the number of deaths HAs experienced, satisfaction with care, and distress. The special needs of this population and their caregivers can provide crucial insights into interventions (e.g. chaplaincy support, debriefings, anticipatory counseling, environmental changes) that might be of benefit for any caregiver or parent of a child with a long-term, chronic condition, particularly involving developmental disability.

scholarly journals Type 1 medication review based on a pharmacy’s electronic medication records: first steps towards an algorithm to stratify patients for tailored pharmacy services

2021 ◽  
Vol 18 (1) ◽  
pp. 1-15
Author(s):  
Ligia Reis ◽  
Miguel Monteiro ◽  
Luis Lourenço ◽  
João Gregório
Keyword(s):  
Medication Review ◽  
Median Number ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Convenience Sample ◽  
Knowledge Based ◽  
Inappropriate Drugs ◽  
Medication Reviews ◽  
Definition Of

Algorithms, queries, and knowledge-based systems are among approaches to screen electronic patient records stored in databases and support pharmacist medication reviews. The aim of this study was to perform a type 1 medication review and identify clusters that enable the definition of an algorithm to tailor pharmacy professional interv A retrospective observational study was conducted on a convenience sample of pharmacy records. Records were included if patients had a medication dispensing history between June 2017 - July 2018 and used two or more chronic medications. Statistical analysis used a two-step cluster to identify common characteristics among fifty-five sets of patient records which underwent Type 1 medication review. The median number of drugs used per patient was five [IQR: 3.0 – 7.0]. 18.2% of patients had inappropriate drugs, and 30.9% had moderate or major interaction potential. Four clusters were identified based on the variables of interactions, number of drugs used, contraindications, Beers criteria and measurable biomarkers, allowing to envision possible pharmaceutical interventions, as well as the priority in providing that intervention. The identification of patient clusters via medication review of electronic records of pharmacy patients supports the design of criteria-based algorithms, likely to be automated.

scholarly journals Why Is Spiritual Care Infrequent at the End of Life? Spiritual Care Perceptions Among Patients, Nurses, and Physicians and the Role of Training

2013 ◽  
Vol 31 (4) ◽  
pp. 461-467 ◽  
Author(s):  
Michael J. Balboni ◽  
Adam Sullivan ◽  
Adaugo Amobi ◽  
Andrea C. Phelps ◽  
Daniel P. Gorman ◽  
...  
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Spiritual Care ◽  
Response Rate ◽  
Five Factors ◽  
Palliative Radiation Therapy ◽  
P 16 ◽  
Care Guidelines ◽  
Nurses And Physicians ◽  
Eol Care

Purpose To determine factors contributing to the infrequent provision of spiritual care (SC) by nurses and physicians caring for patients at the end of life (EOL). Patients and Methods This is a survey-based, multisite study conducted from March 2006 through January 2009. All eligible patients with advanced cancer receiving palliative radiation therapy and oncology physician and nurses at four Boston academic centers were approached for study participation; 75 patients (response rate = 73%) and 339 nurses and physicians (response rate = 63%) participated. The survey assessed practical and operational dimensions of SC, including eight SC examples. Outcomes assessed five factors hypothesized to contribute to SC infrequency. Results Most patients with advanced cancer had never received any form of spiritual care from their oncology nurses or physicians (87% and 94%, respectively; P for difference = .043). Majorities of patients indicated that SC is an important component of cancer care from nurses and physicians (86% and 87%, respectively; P = .1). Most nurses and physicians thought that SC should at least occasionally be provided (87% and 80%, respectively; P = .16). Majorities of patients, nurses, and physicians endorsed the appropriateness of eight examples of SC (averages, 78%, 93%, and 87%, respectively; P = .01). In adjusted analyses, the strongest predictor of SC provision by nurses and physicians was reception of SC training (odds ratio [OR] = 11.20, 95% CI, 1.24 to 101; and OR = 7.22, 95% CI, 1.91 to 27.30, respectively). Most nurses and physicians had not received SC training (88% and 86%, respectively; P = .83). Conclusion Patients, nurses, and physicians view SC as an important, appropriate, and beneficial component of EOL care. SC infrequency may be primarily due to lack of training, suggesting that SC training is critical to meeting national EOL care guidelines.

Graduating nurses' knowledge of palliative and end-of-life care

2020 ◽  
Vol 26 (1) ◽  
pp. 5-12
Author(s):  
Ann Selena Cleary
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Baccalaureate Nursing ◽  
Survey Design ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Eol Care ◽  
Care Course ◽  
Nurses Knowledge

Background: Generalist nurses frequently care for people who have advanced chronic diseases in decline, or who are dying. Few studies have measured graduating nurses' knowledge about end-of-life (EoL) care. Aims: To measure and compare knowledge about EoL care using the palliative care quiz for nurses among two cohorts of graduating nurses in a baccalaureate nursing programme. Methods: A quantitative cross-sectional survey design using a convenience sample of two cohorts of students. Findings: Total mean scores were low at 44.5% and 46.5% for the cohorts, respectively; this was not statistically significant. Misconceptions related to presentation and symptom management of the dying patient and integration of palliative with acute care. Palliative care knowledge was higher among the cohort who completed the dedicated EoL care course. Conclusion: Significant misconceptions about EoL care exist among these graduating nurses; this information provides direction for curriculum revision.

scholarly journals Greater preferences for death in hospital and mechanical ventilation at the end of life among non-whites recently diagnosed with cancer

2021 ◽  
Author(s):  
David Boyce ◽  
Kaiping Liao ◽  
Christopher Miller ◽  
Susan K. Peterson ◽  
Linda Elting ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Cancer Patients ◽  
Population Based ◽  
Convenience Sample ◽  
Location Of Death ◽  
Aggressive Care ◽  
Dying At Home ◽  
Eol Care ◽  
At Home

Abstract Purpose: Minority cancer patients receive more aggressive care near death. This may indicate low quality end-of-life (EOL) care if discordant with patient preferences. We investigated preferred potential place of death and preferences regarding use of mechanical ventilation in a cohort of Texas cancer patients.Methods: A population-based convenience sample of recently diagnosed cancer patients from the Texas Cancer Registry was surveyed using a multi-scale inventory between March 2018 and June 2020. Item responses to questions about preferences regarding location of death and mechanical ventilation were the outcome measures of this investigation. Inverse probability weighting analysis was used to construct multivariable logistic regression examining the associations of covariates. Results: Of 1460 respondents, a majority (82%) preferred to die at home compared to 8% who preferred dying at the hospital. In total 25% of respondents expressed a preference for undergoing mechanical ventilation at the EOL. Adjusted analysis showed increased preference among Black (OR=1.81; 95% CI: 1.19-2.73) and other non-white, non-Hispanic race individuals (OR=3.53; 95% CI: 1.99-6.27) for dying at a hospital. Males, married individuals, those of higher education and poor self-reported health showed significantly higher preference for dying at home. Minority respondents of all non-white races were more likely to prefer mechanical ventilation at the EOL as were individuals who lived with another person at home. Conclusion: Minority cancer patients were more likely to express preferences coinciding with aggressive EOL care including dying at the hospital and utilizing mechanical ventilation. These findings were independent of other sociodemographic characteristics, including decisional self-efficacy.

Electronic Patient Records in Medical Practice: A Multidisciplinary Endeavor

1999 ◽  
Vol 38 (04/05) ◽  
pp. 287-288 ◽  
Author(s):  
J. van der Lei ◽  
P. W. Moorman ◽  
M. A. Musen
Keyword(s):  
Medical Practice ◽  
Patient Records ◽  
Electronic Patient Records

Postmarketing Surveillance Based on Electronic Patient Records: The IPCI Project

1999 ◽  
Vol 38 (04/05) ◽  
pp. 339-344 ◽  
Author(s):  
J. van der Lei ◽  
B. M. Th. Mosseveld ◽  
M. A. M. van Wijk ◽  
P. D. van der Linden ◽  
M. C. J. M. Sturkenboom ◽  
...  
Keyword(s):  
General Practitioner ◽  
General Practitioners ◽  
Validation Studies ◽  
Resource Planning ◽  
Routine Practice ◽  
Patient Records ◽  
Postmarketing Surveillance ◽  
Electronic Patient Records ◽  
Use Of Data ◽  
Data Requirements

AbstractResearchers claim that data in electronic patient records can be used for a variety of purposes including individual patient care, management, and resource planning for scientific research. Our objective in the project Integrated Primary Care Information (IPCI) was to assess whether the electronic patient records of Dutch general practitioners contain sufficient data to perform studies in the area of postmarketing surveillance studies. We determined the data requirements for postmarketing surveil-lance studies, implemented additional software in the electronic patient records of the general practitioner, developed an organization to monitor the use of data, and performed validation studies to test the quality of the data. Analysis of the data requirements showed that additional software had to be installed to collect data that is not recorded in routine practice. To avoid having to obtain informed consent from each enrolled patient, we developed IPCI as a semianonymous system: both patients and participating general practitioners are anonymous for the researchers. Under specific circumstances, the researcher can contact indirectly (through a trusted third party) the physician that made the data available. Only the treating general practitioner is able to decode the identity of his patients. A Board of Supervisors predominantly consisting of participating general practitioners monitors the use of data. Validation studies show the data can be used for postmarketing surveillance. With additional software to collect data not normally recorded in routine practice, data from electronic patient record of general practitioners can be used for postmarketing surveillance.

scholarly journals A descriptive analysis of end-of-life discussions for high-grade glioma patients

2021 ◽  
Author(s):  
Ai Chikada ◽  
Sayaka Takenouchi ◽  
Yoshiki Arakawa ◽  
Kazuko Nin
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Patient Participation ◽  
High Grade Glioma ◽  
Team Approach ◽  
High Grade ◽  
Care Providers ◽  
Patient Goals ◽  
Significant Difference ◽  
Eol Care

Abstract Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher’s exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient’s wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.

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