Fearing Pain at the End of Life: A Review of Advance Directives.

BACKGROUND: Patients, caregivers, and healthcare professionals often describe a "good death" as a pain-free process. However, many patients experience pain during their last weeks of life. Advance directives (ADs) are legally binding documents that allow individuals to express their wishes for end-of-life care which should include management of their pain. METHODS: An interprofessional team conducted a comprehensive analysis of ADs from all 50 states and the District of Columbia to assess the inclusion of language that reflects patients' wishes for pain relief at the end of life. RESULTS: Thirty-seven (73%) of the 51 entities examined reflected the prototypical directive, containing explicit instructions for withholding or withdrawing interventions that may prolong suffering rather than options for treating pain. Of these, 12 (24%) did not include the word "pain". Only 14 states (27%) provided clear guidance for managing pain. Unexpectantly, researchers found that 13 (25%) addressed the common fears of patients, caregivers, and healthcare teams when using opioids to relieve suffering, such as addiction, sedation, appetite, or respiratory suppression, and hastening death. CONCLUSION: The majority of ADs reviewed lacked clear and comprehensive measures for addressing pain relief. This deficiency may contribute to the undertreatment of pain and amplify the anxiety felt by patients, families, and healthcare providers when making end-of-life decisions. The results highlight the need for improvements in ADs to help ensure that patients' wishes regarding pain management are adequately addressed, documented and respected.

Acute Care Nurses' Arrhythmia Knowledge: Defining Competency.

BACKGROUND: Most methods of evaluating arrhythmia knowledge acquisition are internally developed by nursing professional development practitioners and are institution specific. This approach has resulted in assessing nurses' minimal qualifications for rhythm recognition as defined by the facility but does not result in describing basic, intermediate, and advanced competency levels for practice. METHOD: This quantitative study with a convenience sample of 85 acute care nurses refined an instrument to assess varying levels of arrhythmia recognition competency for acute care nurses. RESULTS: The final instrument, called the Cardiac Arrhythmia Recognition Tool (CART), consisted of 33 items divided into basic, intermediate, and advanced subscales, with an overall Cronbach's alpha of .84. CONCLUSION: This study significantly contributes to defining arrhythmia competency in nurses caring for electrocardiographically monitored patients. [J Contin Educ Nurs. 2020;51(1):39-45.].

Exploring Quality of Life in End-of-Life Discussions.

Advance directives (ADs) allow individuals to legally determine their preferences for end-of-life (EOL) medical treatment and designate a health-care proxy to act on their behalf prior to losing the cognitive ability to make informed decisions for themselves. An interprofessional group of researchers (law, nursing, medicine, and social work) conducted an exploratory study to identify the differences in quality-of-life (QOL) language found within the AD state statutes from 50 US states and the District of Columbia. Data were coded using constant comparative analysis. Identified concepts were grouped into 2 focus areas for EOL discussions: communication/awareness of surroundings and activities of daily living. Language regarding communication/awareness of surroundings was present in the half of the statutes. Activities of daily living were addressed in only 18% of the statutes. Only 3 states (Arkansas, Nevada, and Tennessee) specifically addressed QOL. Patients are best served when professionals, regardless of discipline, can share and transform knowledge for patients in times of crisis and loss in ways that are empathetic and precise. Interprofessional collaborative practice (IPCP) comprises multiple health workers from different professional backgrounds working together with patients, families, and communities to deliver the highest quality of care. One of the major competencies of IPCP encompasses values and ethics. Interprofessional collaborative practice is offered as the means to deliver person-centered value-based care when facilitating these crucial dialogs and making recommendations for change.

Advance Directives in Hospice Healthcare Providers: A Clinical Challenge.

BACKGROUND: On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are no data concerning the prevalence of advance directives among hospice healthcare providers. We therefore explored the prevalence and factors influencing completion rates in a survey of hospice healthcare providers. METHODS: Surveys that included 32 items to explore completion rates, as well as barriers, knowledge, and demographics, were e-mailed to 2097 healthcare providers, including employees and volunteers, at a nonprofit hospice. RESULTS: Of 890 respondents, 44% reported having completed an advance directive. Ethnicity, age, relationship status, and perceived knowledge were all significant factors influencing the completion rates, whereas years of experience or working directly with patients had no effect. Procrastination, fear of the subject, and costs were common reasons reported as barriers. Upon completion of the survey, 43% said they will now complete an advance directive, and 45% will talk to patients and families about their wishes. CONCLUSION: The majority of hospice healthcare providers have not completed an advance directive. These results are very similar to those for other healthcare providers treating patients with terminal diseases, specifically oncologists. Because, at completion, 43% said that they would now complete an advance directive, such a survey of healthcare providers may help increase completion rates.

Structured Coaching Programs to Develop Staff.

Health care environments are complex and chaotic, therein challenging patients and professionals to attain satisfaction, well-being, and exceptional outcomes. These chaotic environments increase the stress and burnout of professionals and reduce the likelihood of optimizing success in many dimensions. Coaching is evolving as a professional skill that may influence the optimization of the health care environment. This article reflects on three coaching programs: Gallup Strengths-Based Coaching, Dartmouth Microsystem Coaching, and Health and Wellness Nurse Coaching. Each approach is presented, processes and outcomes are considered, and implications for educators are offered. Continuing education departments may recognize various coaching approaches as opportunities to support staff professionals achieve not only the triple aim, but also the quadruple aim. J Contin Educ Nurs. 2017;48(8):373-378.

Use of a Surgical Safety Checklist to Improve Team Communication.

To improve surgical team communication, a team at Broward Health Imperial Point Hospital, Ft Lauderdale, Florida, implemented a program for process improvement using a locally adapted World Health Organization Surgical Safety Checklist. This program included a standardized, comprehensive time out and a briefing/debriefing process. Postimplementation responses to the Safety Attitudes Questionnaire revealed a significant increase in the surgical team's perception of communication compared with that reported on the pretest (6% improvement resulting in t79 = -1.72, P < .05, d = 0.39). Perceptions of communication increased significantly for nurses (12% increase, P = .002), although the increase for surgeons and surgical technologists was lower (4% for surgeons, P = .15 and 2.3% for surgical technologists, P = .06). As a result of this program, we have observed improved surgical teamwork behaviors and an enhanced culture of safety in the OR.

Lessons Learned: Accessing the Voice of Nurses to Improve a Novice Nurse Program.

A novice nurse program was developed to address the need for educational and clinical support for entry-level nurses in a community hospital setting. A focus group was used to assess the novice nurses' perception of the program and to synthesize lessons learned. Nursing professional development specialists are advised to access the voice of novice nurse participants to meaningfully evaluate and further develop residency programs.

Discharge phone calls: using person-centred communication to improve outcomes.

AIM: This article describes the Clinical Nurse Leader role in implementing person-centred care bundles to improve patient outcomes through an innovative culture of caring. BACKGROUND: Demonstrating the financial value of introducing the Clinical Nurse Leader role into an organisation is essential for sustainability. Previous authors have established the Clinical Nurse Leaders' influence on patient satisfaction and have suggested that Clinical Nurse Leaders improve the continuity of care after discharge. EVALUATION: Descriptive data are shared to illustrate the effectiveness of implementing the patient care bundles and a Clinical Nurse Leader-driven discharge phone call process. KEY ISSUES: Clinical Nurse Leaders who practise from a caring lens are uniquely situated to lead initiatives that drive person-centred care with the goal of reducing readmission rates. Patients who receive person-centred care have an improved perception of the hospital experience and are more likely to return to the facility. CONCLUSIONS: Clinical Nurse Leaders establish relationships with patients that increase the likelihood of successful outcomes from the discharge phone call process. Further evaluation of the Clinical Nurse Leader's role and potential impact on patient outcomes is warranted. IMPLICATIONS FOR NURSING MANAGEMENT: Clinical Nurse Leaders are uniquely prepared to lead transformational change within an organisation. Clinical Nurse Leader interventions that are developed at the microsystem level in response to problems may have system-wide implications.

Exploring the charge nurse role: holding the frontline.

This study describes the experience of being a charge nurse in acute-care practice. The charge nurse role has become instrumental in achieving safe and effective outcomes. The role remains poorly defined with little focus on charge nurse development. This qualitative study used a descriptive exploratory method. Semistructured interviews were conducted with 20 charge nurses from 4 acute-care facilities. Eight themes emerged to describe the experience of being a charge nurse in acute-care practice. Findings can be used by nursing executives to emphasize the importance of this role to the organization and support leadership development at the charge nurse level.

A quantitative approach to evaluating caring in nursing simulation.

AIM: This study was designed to test a quantitative method of measuring caring in the simulated environment. BACKGROUND: Since competency in caring is central to nursing practice, ways of including caring concepts in designing scenarios and in evaluation of performance need to be developed. Coates' Caring Efficacy scales were adapted for simulation and named the Caring Efficacy Scale-Simulation Student Version (CES-SSV) and Caring Efficacy Scale-Simulation Faculty Version (CES-SFV). METHOD: A correlational study was designed to compare student self-ratings with faculty ratings on caring efficacy during an adult acute simulation experience with traditional and accelerated baccalaureate students in a nursing program grounded in caring theory. RESULTS: Student self-ratings were significantly correlated with objective ratings (r = 0.345, 0.356). CONCLUSIONS: Both the CES-SSV and the CES-SFV were found to have excellent internal consistency and significantly correlated interrater reliability. They were useful in measuring caring in the simulated learning environment.

Understanding homelessness using a simulated nursing experience.

Students have an opportunity to understand the full experience of being homeless using simulated community nursing situations with a high-fidelity simulator. The Community Nursing Practice Model provides a context for using this innovative teaching strategy to enable students to respond holistically to the needs of the homeless.

Transitioning internationally recruited nurses into clinical settings.

With a growing shortage of nurses, more health care organizations are turning to international nurse recruitment as part of their work force strategy. Although organizations that recruit internationally invest significant resources, there has been little research about the challenges of transitioning international nurses into practice environments outside their countries of origin. The purpose of the qualitative research presented in this article was to investigate the educational and support needs of international nurses from both their perspective and that of managers with experience in supervising internationally recruited nurses. The authors present educational recommendations and the implications for staff development.

Development of a leadership competency model.

BACKGROUND: Although research findings support that the nurse manager has a pivotal role in influencing all aspects of the nursing environment, recruiting talented staff into these nursing leadership positions has become increasingly more difficult. There is a need to better understand the competencies needed by contemporary nurse managers and the challenges in the role. OBJECTIVE: The purpose of this research was to explore the viewpoints of 120 nurse manager study participants on the contemporary nurse manager role and to gain perspective on the critical leadership skills and competencies to build a nursing leadership competency model. DESIGN: A grounded theory methodology was used in this study to capture the perspectives of the nurse managers interviewed about their role. RESULTS: Six competency categories emerged from the research findings to form a nursing leadership competency model. Two major themes identified from the data included the nurse manager role as a career choice and the stressors and challenges in the role. CONCLUSION: The results of this study led to the design of a nursing leadership competency model and confirmed that there is a need to formally develop and mentor our next generation of nurse leaders.