What Will My Life Be Like at Age 70? Perspectives of Undergraduate Students in an Aging Course.

The affective domain of learning is an essential component in the professional development of nursing students. Teaching strategies stimulating an emotional response can impact students' attitudes, values, and beliefs. This qualitative study examined the use of a reflective journaling assignment in eliciting perspectives from 142 students about aging. Most students identified the assignment to be a real "eye opener" and perceived older adults in a different light. Students consulted with a grandparent or another older adult while writing the essay, which led to a mutually satisfying connection. Students were most fearful about loss of functional status, being too ill to enjoy activities, and the deaths of loved ones. Students often lack the ability to see patients beyond their current health status because educational programs largely focus on the cognitive domain. Using strategies targeting the affective domain can help students reconsider their values and beliefs toward the older population. [Journal of Gerontological Nursing, 46(4), 48-52.].

Palliative Care in the Management of Patients with Advanced Heart Failure.

Globally, there are 18-million individuals living with heart failure, a disease that is responsible for 12-15 million office visits and 6.5 million inpatient hospitalizations each year. As HF becomes advanced or end-stage, patients often live in a cycle of frequent transitions between care settings, and with unmet needs, including distress from inadequately managed symptoms. Prognostication in patients with heart failure can be challenging due to the unpredictable exacerbating-remitting illness trajectory that is associated with this progressive disease. Recurrent hospitalizations, worsening functional status and refractory symptoms, despite optimal therapies, are among the most salient predictors indicating that patients with advanced heart failure are nearing the end of life. Palliative care is a specialized form of medical care that has been shown to help improve severity of symptoms, facilitate discussions regarding medical decision making/advance care planning, and provide support for patients and their families. Palliative care can be used alongside curative treatments and has been shown to improve patient satisfaction and quality of life. Anorexia-cachexia syndrome, dyspnea, fatigue, pain and depression are among the most common symptoms experienced by patients suffering from advanced heart failure. Palliative care can help alleviate these symptoms and also facilitate conversations about decision making surrounding resuscitation status and use or deactivation of medical devices, such as an implantable-cardioverter-defibrillator (ICD). Clinical practice guidelines from the American College of Cardiology and American Heart Association report that aggressive life-sustaining treatments and therapies should not be utilized in patients with advanced heart failure who have refractory symptoms that are not responding to medical therapy. The focus of care should switch to controlling symptoms, reducing hospital admissions and improving health-related quality of life, which can be supported by the incorporation of palliative care into the treatment plan.

Living with advanced heart failure or COPD: experiences and goals of individuals nearing the end of life.

The last phase of life of patients with end-stage heart failure (HF) or chronic obstructive pulmonary disease (COPD) is marked by high symptom burden and uncertainty about the future. Few enroll in hospice, and their preferences for care remain unknown. The purpose of this qualitative study was to describe the experiences and goals for care of patients with end-stage HF and COPD who were recently discharged from the hospital. Forty semi-structured interviews were completed with 20 participants. Despite conditions considered life-threatening by clinicians, participants believed they still had time. They hoped that their illnesses would remain stable, although specific experiences made them think they might be worsening. All expected that their doctors would tell them when their illnesses became life-threatening.

Short of breath and dying: state of the science on opioid agents for the palliation of refractory dyspnea in older adults.

The purpose of this narrative literature review was to describe the state of the science on the effectiveness of opioid medications to palliate dyspnea in older adults with advanced disease. A three-stage critical appraisal process was used to evaluate articles published between 2000-2011 that were retrieved from the CINAHL, Ovid MEDLINE, and PsycINFO databases. Low-dose opioid medication use was associated with statistically significant reductions in dyspnea intensity scores in the majority of studies included in the analysis. Many recent articles on this topic shed light on the importance but underuse of opioid agents to palliate dyspnea, particularly in older adults with advanced chronic illnesses, such as heart failure and chronic obstructive pulmonary disease. ADRA (Assess, Document, Re-assess, Advocate) is a proposed framework that gerontological nurses can use to ensure patients receive adequate symptom management for refractory dyspnea.

Withholding Medical Interventions and Ageism During a Pandemic: A Model for Resource Allocation Decision Making.

Decisions surrounding withholding and withdrawing medical interventions are common within the palliative and hospice care community. The unexpected effects of the recent pandemic ignited conversations about scarcity of resources and withholding medical interventions, based on age, among providers with limited expertise in palliative care. Using a case study and literature review, the aim of this article was to examine the best ethical considerations for resource allocation decision making that minimizes the effects of ageism. Public health ethics differs from clinical ethics by giving priority to promoting the greatest good over the protection of individual autonomy. This divide in ethics sheds light on the dangers associated with ageism. Age is often a component within clinical instruments that guide clinicians with allocation decisions. Basing decisions solely on age without evaluating health and functional status is dangerous and further propagates the discriminatory practices that fuel ageism. Previous research identified using ethical principles to guide resource allocation decisions but that may not be enough to protect the rights of older adults. A new model to guide these decisions should include advance directives and goals of care, medical indicators instead of demographics, functionality, transparent medical team, and impact of social determinants of health.

Impact of a Simulation Workshop on Nursing Students' Attitudes Toward Poverty.

BACKGROUND: Poverty is a global issue that negatively affects health outcomes and quality of life. Incorporating simulation in nursing education programs can help students develop a better understanding about poverty. METHOD: A cross-sectional mixed-methods pre- and posttest survey design was used with two cohorts of undergraduate nursing students who participated in a poverty simulation. RESULTS: A convenience sample of 132 students participated in this study. Most of the students reported they had learned something new that would impact the way they will interact with patients affected by poverty. CONCLUSION: To ensure a competent nursing workforce in an ever-changing global health care environment, all nursing students must have a basic understanding about the implications of poverty on health. Nursing education can enhance a 1-day poverty simulation by partnering with local community groups and agencies so that students can actively participate in improving the lives of disadvantaged individuals who are affected by poverty. [J Nurs Educ. 2021;60(8):462-465.].

An Examination and Comparison of Stethoscope Hygiene in Nursing Education Programs.

BACKGROUND: Improper stethoscope hygiene has been found to contribute to the development of health care associated infections, which affects approximately one in every 30 hospitalized patients. Various pathogens have been found on the stethoscopes of health care workers. METHOD: A correlational descriptive design was used to compare stethoscopes from 117 nursing students. Sterile swab samples were obtained from four separate areas of each stethoscope. Samples were plated and incubated for 24 to 48 hours. RESULTS: Bacteria were found on all parts of the stethoscopes from both undergraduate and graduate nursing students, with the earpiece having the highest percentage of contamination. Staphylococcus was the most prevalent microbe found on all four swab sites. CONCLUSION: Educating students about stethoscope hygiene and consistently reinforcing it in practice are essential to reduce the transmission of pathogens in the health care environment. Nurses can model best practice with students and other disciplines to increase the likelihood of adherence. [J Nurs Educ. 2021;60(5):277-280.].

Management of Severe Pain in Terminally Ill Patients at Home: An Evidence-Based Strategy.

The purpose of this article is to describe current evidence-based strategies to manage severe pain in patients living with terminal illnesses. A comprehensive pain assessment is a critical step in the initial development of a pain management plan and for ongoing evaluation of patients' pain. Although we have many effective clinical tools available for pain assessment, they are not always used consistently, which can negatively affect the pain management plan. Home care and hospice nurses need to be consistent in using the tools and documenting the patient's pain level and response to the pain management plan. Patients and caregivers have concerns and fears surrounding medication use, particularly with narcotic analgesics. It is vital that nurses provide thorough patient-centered teaching about medications to help address these concerns. Research has found that nurses who also provided validation to patients and families regarding their concerns, followed by education, were the most effective.

Letting go before a death: a concept analysis.

AIM: This paper is a report of a concept analysis of letting go within the context of family caregivers and end-of-life care. BACKGROUND: The term 'letting go' has been used in an informal manner by nurses and other clinicians working with patients and families with terminal illnesses to depict a lack of acceptance of a loved one's impending death. DATA SOURCES: The CINAHL, Ovid Medline and PsychInfo databases were searched for the period of 1995-2007 for literature published in English in peer-reviewed journals from a variety of disciplines, using the specific keywords letting go or to let go. METHODS: The Walker and Avant method of concept analysis was used, and the study was guided by Zerwekh's family caregiving model of core competencies for hospice nurses. RESULTS: Letting go before the death of a loved one involves a shift in thinking in which there is acknowledgement of impending loss without impeding its natural progression. An emotional attachment and recognition that everything has been carried out usually precede the concept, followed by a peaceful death and acknowledgement of change. CONCLUSION: The concept of letting go has been explored in many contexts but the core essence of the awareness and work towards the acceptance of an impending loss appears to be a universal domain. Research is needed to further explore and identify patterns of this phenomenon in family caregivers in the context of death of a loved one.

Students' Knowledge of and Interest in Older Adults: Impact of a Geriatrics Course.

BACKGROUND: The number of older adults living with chronic conditions is steadily increasing, so nurses must be prepared to care for the needs of this population. However, only one third of nursing education programs include a stand-alone geriatrics course. METHOD: A cross-sectional mixed-methods design was used to compare two cohorts of 46 nursing students. Knowledge, attitude, and interest in older adults were examined using an online survey. The control cohort did not complete the geriatric course. RESULTS: No demographic differences were found between groups. Completing the geriatric course was not correlated with having greater aging-related knowledge. Decreased interest in working with the older adult population was found. CONCLUSION: Findings from this cross-sectional pilot study suggest that previous experience with an aging relative was associated with better aging-related knowledge. Further research exploring students' perceptions is needed to understand the relationship between the geriatric course and attitudes toward aging. [J Nurs Educ. 2018;57(2):106-109.].

Spinal cord compression: an oncologic emergency associated with metastatic cancer: evaluation and management for the home health clinician.

Spinal cord compression is an oncologic emergency that needs to be identified, evaluated, and treated promptly for favorable patient outcomes. Although there are nonmalignant types of spinal cord compression, this article focuses on patients presenting with metastatic cancer. Home care clinicians should be knowledgeable with current assessment strategies aimed at recognizing this potentially debilitating condition. Using an assessment tool could assist clinicians with early detection of spinal cord compression, which could improve the overall quality of life.