International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access.

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting: A Scoping Review.

Palliative care focuses on symptom management, discussion of treatment and care decisions, network organization, and support of the family. As part of the advance care planning (ACP) process, staff nurses in the acute care setting are often involved in all of the above areas. It is yet unclear what nurses' roles and responsibilities are and what skills are needed in the ACP process. The themes that staff nurses and advanced practice registered nurses (APRNs) discuss in relationship to ACP are manifold. This scoping review demonstrates that staff nurses' core role is advocating for the wishes and values of patients with any life-limiting disease. Staff nurses also serve as facilitators, educators, and advocates to help start ACP conversations and ease patients' transitions between settings based on well-discussed decisions. To be able to engage in ACP discussions, APRNs must have excellent communication skills. Continuous training to improve these skills is mandatory. In the future, clarifying the contribution of staff nurses and APRNs in the ACP process in relation to other members of the interprofessional team can lay the groundwork for improved interprofessional collaboration.

Nurse practitioner students' perceptions of fibromyalgia pain and quality of life.

Perceptions of NP students were explored regarding fibromyalgia syndrome (FMS) pain and quality of life (QOL), and their preparedness in treating these issues. Participants acknowledged the importance of FMS pain control and QOL issues. However, they lacked confidence in treating FMS pain.confidence in treating MS pain.

Symptom distress, spirituality, and quality of life in African American breast cancer survivors.

This study examined the relationships among the demographic characteristics, symptom distress, spirituality, and quality of life (QOL) of African American breast cancer survivors. A convenience sample of 30 survivors with a mean age of 56 years and a mean survival of 6 years was recruited from African American breast cancer support groups and churches in the Southeastern United States. Data were collected through face-to-face interviews using a demographic questionnaire, the Quality of Life Index-Cancer Version, the Symptom Distress Scale, and the Spiritual Perspective Scale. Statistically significant relationships were found between symptoms and QOL (r = -0.62, P < .05) and between spirituality and QOL (r = 0.70, P < .05). No statistically significant relationships were found between age at diagnosis, income, or education and QOL. This research suggests that symptoms and spirituality are associated with QOL. Culturally appropriate care should be provided to these women to reduce health disparities and to improve their QOL.

Advances in how clinical nurses can evaluate and improve quality of life for individuals with cancer.

PURPOSE/OBJECTIVES: To describe advances in the ways that clinical nurses understand, assess, and work to improve quality of life (QOL) for individuals with cancer since the 1995 Oncology Nursing Society's State-of-the-Knowledge Conference on QOL. DATA SOURCES: Published research and clinical articles. DATA SYNTHESIS: The number of QOL assessment tools and methods for understanding QOL results has increased. However, scant literature has focused on how clinical oncology nurses evaluate QOL and the methods they use to affect QOL for individuals with cancer. CONCLUSIONS: Based on the nurse-patient relationship, clinical nurses are able to assess QOL in individuals with cancer and intervene appropriately to improve QOL. IMPLICATIONS FOR NURSING: Clinical nurses can involve individuals with cancer in rating their QOL to assist in providing high-quality care that is directed at positively affecting QOL.

Excellence through evidence: securing collegial/collaborative nurse-physician relationships, part 2.

Multiple nurse-physician (RNMD) relationships coexist on hospital units; collegial and collaborative (C/C) relationships positively impact patient outcomes more than the others. The goal of this multisite evidence-based management practice initiative was to identify structures that enable C/C RNMD relationships. In part 1, the authors discussed the methodology of the study, presented the results of the literature analysis, and the description and characteristics of the clinical units, experts interviewed, and of the collegial and collaborative RNMD relationships found in the 5 participating hospitals. Part 2 analyzes the extent to which the 5 structures identified by the National Joint Practice Commission as necessary for RNMD collaboration are present in the 5 hospitals, the structures identified by the experts in this study, and suggestions and implications for management practice.

Excellence through evidence: securing collegial/collaborative nurse-physician relationships, part 1.

Multiple nurse-physician (RNMD) relationships coexist on hospital units; collegial and collaborative (C/C) relationships positively impact, more than others, patient outcomes. The goal of this multisite evidence-based management practice initiative was to identify structures that enable C/C RNMD relationships. In part 1, the authors discuss the methodology and selection of the sample of 141 physicians, managers, and staff nurses from 44 clinical units in 5 hospitals that had previously demonstrated extensive C/C RNMD relationships. These 141 experts were interviewed to identify structures enabling C/C RNMD relationships. Part 1 presents the structures that enable C/C RNMD relationships as described and tested in the literature, as well as a description of the characteristics of the clinical units, experts, and C/C RNMD relationships found in this study. In part 2, the structures identified by the experts as needed for securing C/C RNMD relationships will be presented, along with suggestions for attainment.

The nurse's relationship-based perceptions of patient quality of life.

PURPOSE/OBJECTIVES: To explore patients' quality of life (QOL) as defined by RNs in adult and pediatric oncology settings and to examine, from the perspectives of clinical nurses, the knowledge that is needed to apply QOL research outcomes in clinical practice. DESIGN: Qualitative research design using a focus group technique to explore the research questions. SETTING: Three sites (i.e., a pediatric research center in western Tennessee and oncology nurses from a chapter of the Oncology Nursing Society [ONS] in Central Florida and another in upstate New York). SAMPLE: 24 oncology nurses working with adult or pediatric patients or both. METHODS: Oncology nurses were approached at work or through their local ONS chapters for a focus group discussion. FINDINGS: 47 unique themes were reported by all five focus groups in response to three questions. The most frequently reported themes were (a) Using the Patient's Standard, (b) Nursing Strategies, (c) Differences Decrease QOL Care, (d) Maintaining Social Interests, (e) Insightful Relations With Patient, and (f) Nurse-Patient Communication. CONCLUSIONS: Nurses' assessments of QOL primarily are based on their established relationships with their patients. From these relationships, nurses derive perceptions of patients' QOL and clinical direction for interventions to positively influence QOL. Based on these findings, the investigators developed a conceptual model of the nurses' relationship-based perceptions of patients' QOL. IMPLICATIONS FOR NURSING: The current QOL measures have minimal importance to nurse clinicians. Because nurse clinicians rely on their relationships with patients to assess QOL, available tools should be made more clinically useful. Further research should be conducted using the new conceptual model, specifically to learn more about how nurses complete a QOL assessment within the context of the nurse-patient relationship.