scholarly journals Assessing Registered Nurses Knowledge of Comfort Measures Only: A Quality Improvement Project

2017 ◽  
Author(s):  
Priscilla Ventura-Medeiros
Keyword(s):  
Registered Nurses ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Delivery ◽  
Life Care ◽  
Improvement Project ◽  
Comfort Care ◽  
Education And Care ◽  
Provider Knowledge ◽  
Nurses Knowledge

End of life care is a growing specialty in healthcare and requires specialized knowledge and care by the nurse. Many patients end their life in an acute care setting which may be lacking in providers who are well versed in end of life care, specifically comfort measures. Therefore, assessing the registered nurses knowledge of comfort measures only, as a component of end of life care, is a critical first step in improving end of life patient and family experience. By identifying current provider knowledge of comfort care and the understanding of practice guidelines, a specific and relevant educational program can be developed. This project will evaluate the level of self-reported knowledge of registered nurses who are caring for patients designated with comfort measures only orders. With successful completion of this project, the educational needs for these registered nurses will be identified and utilized to improve education and care delivery for patients who are on comfort measures only.

scholarly journals Honoring Preferences—The Consistency Between End-of-Life Care and a Veteran’s Goal for Comfort Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 752-752
Author(s):  
Joan Carpenter ◽  
Winifred Scott ◽  
Mary Ersek ◽  
Cari Levy ◽  
Jennifer Cohen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Multivariate Logistic Regression ◽  
Comfort Care ◽  
Lower Odds ◽  
Medicare Data ◽  
Life Sustaining Treatment

Abstract This study examined the alignment between Veterans’ end-of-life care and a Life-Sustaining Treatment (LST) goal “to be comfortable.” It includes Veterans with VA inpatient or community living center stays overlapping July 2018--January 2019, with a LST template documented by January 31, 2019, and who died by April 30, 2019 (N = 18,163). Using VA and Medicare data, we found 80% of decedents with a comfort care goal received hospice and 57% a palliative care consult (compared to 57% and 46%, respectively, of decedents without a comfort care goal). Using multivariate logistic regression, a comfort care goal was associated with significantly lower odds of EOL hospital or ICU use. In the last 30 days of life, Veterans with a comfort care goal had 43% lower odds (AOR 0.57; 95% CI: 0.51, 0.64) of hospitalization and 46% lower odds of ICU use (AOR 0.54; 95% CI: 0.48, 0.61).

Managing End-of-Life Care

2012 ◽  
Author(s):  
John W. Albarran ◽  
Marika Hills
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Delivery ◽  
Symptom Relief ◽  
Death And Dying ◽  
Past Century ◽  
Life Care ◽  
Care Needs ◽  
Definition Of ◽  
The Uk

This chapter addresses the fundamental nursing role of managing end-of-life care. Death is as fundamental a part of life as living, and while caring for a dying patient and their family is demanding, complex, and emotionally exhausting, it can also be a gratifying and privileged experience for nurses. Specifically, nurses have a centre-stage role in leading and informing care delivery at the end of life. Care will typically embrace assessing the needs of the patient and family, providing symptom relief and comfort care, and providing cultural and spiritual support. Additionally, caring functions should also extend following death to caring for the deceased in a dignified manner and supporting the newly bereaved, demonstrating genuine concern, compassion, and effective communication skills (Hills and Albarran, 2010a; Maben et al., 2010). To examine the key themes and challenges of practice, it is important to understand the political, professional and societal influences, and contextual nature of death and dying in the UK. At present, there is neither a clear nor universally accepted definition of end-of-life care, but it is generally understood to be the care of a person who is identified as having failing health and who is in a progressive state of decline (Shipman et al., 2008). Establishing the last phase of a patient’s life can be a difficult and complex process, and this might occur:…● after the diagnosis of a life-limiting condition; ● during the transition or deterioration of a chronic disease illness; ● when there is an increasing frailty combined with greater dependence on care provision, particularly in the older adult; ● following a sudden infective episode, cardiac event, or a life-threatening accident….The last phase of end-of-life care is referred to as the dying phase. Consideration of the end-of-life care needs of people with chronic terminal conditions should begin at diagnosis, and must embrace after-death care and family support. Over the past century, progress and advancement in disease management, together with improvements in living standards, have resulted in changes to the national death profile, with currently two-thirds of the 0.5 million annual deaths in the UK occurring in people over 75 years of age.

Reflecting on one's own death: The existential questions that nurses face during end-of-life care

2016 ◽  
Vol 15 (2) ◽  
pp. 158-167 ◽  
Author(s):  
Margareta Karlsson ◽  
Anne Kasén ◽  
Carola Wärnå-Furu
Keyword(s):  
Focus Group ◽  
Registered Nurses ◽  
End Of Life ◽  
End Of Life Care ◽  
Community Care ◽  
Life Care ◽  
Human Beings ◽  
Focus Group Interviews ◽  
Care Experience ◽  
Group Interviews

AbstractObjective:When registered nurses care for patients at the end of life, they are often confronted with different issues related to suffering, dying, and death whether working in hospital or community care. Serious existential questions that challenge nurses’ identities as human beings can arise as a result of these situations. The aim of our study was to describe and gain a deeper understanding of nurses’ existential questions when caring for dying patients.Method:Focus-group interviews with registered nurses who shared similar experiences and backgrounds about experiences in end-of-life care were employed to gain a deeper understanding about this sensitive subject. Focus-group interviews were performed in hospice care, in community care, and in a palliative care unit in western Sweden. A qualitative hermeneutic approach was employed to interpret the data.Results:Nurses’ existential questions balanced between responsibility and guilt in relation to their patients, between fear and courage in relation to being professional caregivers and fellow human beings, and between hope and despair in relation to the other's and their own death.Significance of results:Nurses in end-of-life care experience various emotions from patients related to things physical, spatial, and temporal. When nurses encounter these emotions as expressing a patient's suffering, they lead to challenges of balancing between different feelings in relation to patients, as both professional caregivers and fellow human beings. Nurses can experience growth both professionally and as human beings when caring for patients at the end of life.

Long-term care nurses' knowledge of end-of-life care

2002 ◽  
Vol 23 (6) ◽  
pp. 296-301 ◽  
Author(s):  
Barbara M. Raudonis ◽  
Ferne C.N. Kyba ◽  
Terri A. Kinsey
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Long Term Care ◽  
Life Care ◽  
Term Care ◽  
Nurses Knowledge

scholarly journals Are registered nurses ready to take care at the end-of-life: crossectional survey

2020 ◽  
Author(s):  
Aurelija Blazeviciene ◽  
Lina Laurs ◽  
Jamesetta A Newland
Keyword(s):  
Registered Nurses ◽  
End Of Life ◽  
End Of Life Care ◽  
Spiritual Needs ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Healthcare Settings ◽  
Correlational Design ◽  
Inadequate Knowledge

Abstract Background: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason it is very important to assess all the obstacles to end-of-life care and to provide safe and quality services to patients. The main purpose of this study was to examine attitudes faced by registered nurses in providing end-of-life care and to explore obstacles and supportive behaviors for nurses. Methods: A descriptive, correlational design was applied in this study. Cross‐sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. Results: Registered nurses working in the three different profiles emphasized safe and effective care andthe importance of meeting the patient's spiritual needs at the end of life. The main obstacles assigned by nurses caring for patients at the end of life were angry family membersthe inadequate understanding of nursing care by the patient's relatives; family members' inadequate knowledge about the situation and lack of time to talk to patients about their wishes, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. Conclusions: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related obstacles remain one of the main obstacles to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

scholarly journals Chameleon project: a children’s end-of-life care quality improvement project

2021 ◽  
Vol 10 (4) ◽  
pp. e001520
Author(s):  
Toni Wolff ◽  
Caroline Dorsett ◽  
Alexander Connolly ◽  
Nicola Kelly ◽  
Jennifer Turnbull ◽  
...  
Keyword(s):  
Quality Improvement ◽  
End Of Life ◽  
End Of Life Care ◽  
Quality Improvement Project ◽  
Care Planning ◽  
Life Care ◽  
Marginal Rate ◽  
Improvement Project ◽  
Care Plans ◽  
Bed Days

In response to there being no specialist paediatric palliative care (PPC) team in a region of England, we undertook a 12-month quality improvement project (funded by National Health Service England’s Marginal Rate Emergency Threshold and Readmission fund) to improve children’s end-of-life care.Improvements were implemented during two plan–do–study–act (PDSA) cycles and included specialist experts, clinical champions, focused education and training, and tools and materials to support identification, care planning and communication. A lead paediatrician with expertise in PPC (10 hours/week) led the project, supported by a PPC nurse (3 days/week) and a network administrator (2 days/week).Children who died an expected death were identified from the child death review teams. Numbers of non-elective hospital admissions, bed days, and costs were identified.Twenty-nine children died an expected death during the 12 months of the project and coincidentally 29 children died an expected death during the previous 12 months. The median number of non-elective admissions in the last 12 months of life was reduced from two per child to one. There was a reduction in specialist hospital (14%) and district general hospital (38%) bed days. The percentage of children who died an expected death who had anticipatory care plans rose from 50% to 72%.The results indicate that a network of clinicians with expertise in PPC working together across a region can improve personalised care planning and reduce admissions and bed days for children in their last year-of-life with reduced bed utilisation costs.

scholarly journals Attitudes of registered nurses about the end – of – life care in multi-profile hospitals: a cross sectional survey

2020 ◽  
Author(s):  
Aurelija Blazeviciene ◽  
Lina Laurs ◽  
Jamesetta A Newland
Keyword(s):  
Registered Nurses ◽  
End Of Life ◽  
Family Involvement ◽  
Nursing Care ◽  
End Of Life Care ◽  
Spiritual Needs ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Healthcare Settings

Abstract Background: End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses' attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe.Methods: A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1,320 registered nurses within 7 hospitals in Lithuania. Results: Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient's spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient's relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient's family, lack of evaluation of nurses' opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement.Conclusions: Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

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