Teaching end-of-life care to baccalaureate nursing students: lessons learned.

End-of-life (EoL) care is increasingly provided by nurses outside of traditional hospice environments, yet many general nurses have limited education in EoL care. This article describes the development and evolution of an EOL care course in a baccalaureate nursing program, and the resources and strategies the faculty used to facilitate student engagement and learning. The original EoL course was then eliminated and replaced by the inclusion of EOL care education within existing courses. Faculty drew on the experience gained and lessons learned over several years to identify essential content from the course and include it in the new curriculum, to be integrated into existing courses and levels.

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

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.

Parkinson's Disease: Exploring Motives for Long-Term Adherence to a Group Exercise Program.

PURPOSE: The aim of this study was to explore why people with Parkinson's disease maintained attendance at a community group exercise program. DESIGN: Qualitative design was used for this study. METHODS: A purposive sample was used to recruit participants. Interviews with individual and focus groups collected narrative data that were interpreted using content analysis. FINDINGS: Eighteen participants enrolled in the study. Four themes emerged: (1) changing and challenging workout; (2) gaining strength, inspiration, and knowledge and doing it among friends; (3) professionals, not amateurs; and (4) holistic lasting benefit. CONCLUSIONS: For the participants in this study, exercising in a group among peers in an enjoyable, varied, and challenging program that was structured, socially supportive, and supervised provided incentive for maintaining attendance. CLINICAL RELEVANCE: Exercise is a life-long recommendation for everyone, including people with Parkinson's disease, for whom maintaining attendance is more challenging. The words of these participants encourage healthcare providers to consider the relevance of socialization, supervision, and structure when developing exercise programs for this population.

Integrating palliative care into primary care for patients with chronic, life-limiting conditions.

As longevity increases, individuals with chronic, life-limiting conditions will live longer with disease burden and functional decline. Nurse practitioners can integrate symptom management, early decision-making, and supportive care into the primary care setting to improve quality of life and decrease economic and emotional impact at the end of life.

Iontophoresis successfully delivers dexamethasone sodium phosphate to dermis as measured by microdialysis.

Despite its widespread and long term use, the effectiveness of iontophoresis to increase the delivery of dexamethasone sodium phosphate (DSP) remains controversial. The goal of this study was to quantitatively compare the DSP concentrations in dermis' dialysates in two delivery scenarios: with and without iontophoresis. Interstitial fluid concentrations were measured by cutaneous microdialysis. Passive and active iontophoresis were applied simultaneously on the skin of the forearm in eight healthy adult participants using each participant as his/her own control. The iontophoresis apparatus and procedures were identical to those used in common clinical practice. Iontophoresis electrodes were loaded with 2 mL of 4.4 mg/mL of preservative-free DSP solution. Electric current (4 mA) was applied for 20 min. Dialysate samples were collected for 2 h and analyzed for DSP and its active metabolite dexamethasone (DXM). Seven out of eight iontophoresis sites contained quantifiable levels of DSP and DXM, whereas none of the samples collected at the passive site contained either form of the drug. In conclusion, this study demonstrates that iontophoresis significantly (p < 0.0001) increases delivery of DSP to the dermis compared with passive delivery of the same, and that microdialysis can be used to monitor DSP delivery and DXM formation in skin.