Outcomes Associated With a Nurse-Driven Palliative Care Screening Tool in the Intensive Care Unit.

BACKGROUND: Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools. OBJECTIVE: To identify outcomes associated with specialty palliative care referral among patients with critical illness. METHODS: Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care. RESULTS: Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation (χ2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult (χ2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult (χ2 = 19.39, P < .001). CONCLUSIONS: Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.

The use of a game-based learning platform to engage nursing students: A descriptive, qualitative study.

Baccalaureate nursing programs require students to complete a research course, and faculty find it challenging to engage students. Educational gaming has recently gained attention as a technique to motivate students and enhance learning. The purpose of this pilot study was to describe undergraduate nursing students' reflections of their experiences with 3D Gamelab©, a game-based learning platform. A descriptive qualitative research design was used to elicit students' reflections of their experiences. Educational content such as handouts, videos, activities, and recommended resources for a required junior level nursing research course was organized into quests for use in 3D GameLab©. At the end of the semester, students were invited to give their feedback through a survey with open-ended questions. Thematic analysis resulted in the following components of the game-based learning experience: navigation, motivation, gaming concept, knowledge, technology, and target population. Although the overall response to 3D GameLab© in this course was negative, game-based learning does have the potential to engage students and enhance learning. To better understand how educational gaming could be used in nursing, further research should be conducted to determine the most motivating elements and the types of course content best delivered in this manner.

The Changing Nature of Guilt in Family Caregivers: Living Through Care Transitions of Parents at the End of Life.

Older adults cared for at home by family members at the end of life are at risk for care transitions to residential and institutional care settings. These transitions are emotionally distressing and fraught with suffering for both families and the older adult. A theoretical model titled "The Changing Nature of Guilt in Family Caregivers: Living Through Care Transitions of Parents at the End of Life" was developed using the method of grounded theory. When a dying parent cannot remain at home to die, family members experience guilt throughout the transition process. Findings indicated that guilt surrounding transfers escalated during the initial stages of the transfer but was mitigated by achieving what family members deemed as a "good" death when relatives were receiving hospice care. The findings of this interpretative approach provide new insights into family-focused perspectives in care transfers of the dying.

Characteristics of Prison Hospice Patients: Medical History, Hospice Care, and End-of-Life Symptom Prevalence.

Increasing numbers of prisoners in the United States are dying from age-related and chronic illnesses while incarcerated. This study is among the first to document characteristics of a population of prison hospice patients. Retrospective review of medical records for all patients admitted to the Louisiana State Penitentiary prison hospice program between January 1, 2004, and May 31, 2012 (N = 79) examined demographics, medical history, hospice diagnosis, length of stay, and end-of-life symptom prevalence on admission and during final 72 hours before death. Resulting data were contrasted with community-based end-of-life care study data, demonstrating a unique clinical profile of this group. As prisons consider adopting programs to meet the growing need for inmate end-of-life care, more research concerning the particular characteristics and unique needs of prison hospice patients will inform these efforts.

Communicating with patients and their families about palliative and end-of-life care: comfort and educational needs of nurses.

INTRODUCTION: Effectively discussing palliative care with patients and families requires knowledge and skill. The purpose of this study was to determine perceived needs of inpatient nurses for communicating with patients and families about palliative and end-of-life (EoL) care. METHOD: A non-experimental design was used. In total, 60 inpatient nurses from one hospital in Idaho completed the End of Life Professional Caregiver Survey (EPCS), which examines three domains: patient and family-centered communication, cultural and ethical values, and effective care delivery. RESULTS: The number of years' experience nurses had (F(9,131.57)=2.22, p=0.0246; Wilk's ^=0.709) and the unit they worked on (F(6,110)=2.49, p=0.0269; Wilk's ^=0.775) had a significant effect on their comfort discussing EoL and palliative care with patients and their families. For all three domains, years of nursing experience was positively associated with comfort in communicating about EoL care. Oncology nurses were most comfortable with regard to patient and family-centered communication. DISCUSSION: The success and sustainability of this service is dependent on education for health-care providers. Studies are needed to determine the most effective ways to meet this educational challenge.

Awaiting diagnosis of breast cancer: strategies of enduring for preserving self.

PURPOSE/OBJECTIVES: To explicate the emotional experiences of women undergoing breast cancer diagnosis who are waiting for the results of breast biopsy. RESEARCH APPROACH: Glaserian Grounded Theory. SETTING: Urban area in western Canada. PARTICIPANTS: 37 women aged 32-76 years. The breast cancer diagnosis was positive for 11 women, negative for 24 women, and two results were unclear. METHODOLOGIC APPROACH: Unstructured, recorded telephone interviews. FINDINGS: Undergoing breast cancer diagnosis is a profoundly distressing experience dictated by diagnostic processes and procedures. Women rapidly transitioned from wellness to frightening phases of facing cancer to continuing terror during the testing phase. While waiting to hear results, women controlled their emotions, which enabled them to get through the experience and highlighted the protective function of enduring and its necessity for survival. The basic social psychological process, preserving self, is the outcome of enduring. CONCLUSIONS: A mid-range theory, Awaiting Diagnosis: Enduring for Preserving Self, was developed. This theory explicates the emotional responses of women who were undergoing diagnosis for breast cancer and provides a theoretical behavioral basis for responding to cues and signals of suffering. INTERPRETATION: The Praxis Theory of Suffering enables nurses to recognize and respond according to the behaviors of suffering, and to endure with healthy, adaptive, and normalizing behaviors that enable preserving self.

Somali Bantu refugees in southwest Idaho: assessment using participatory research.

The Somali Bantu represent a subset of African refugees, many of whom are preliterate with no native written language. This population presents significant challenges for nurses and other healthcare providers. A community-based participatory research project using qualitative techniques to combine community and cultural assessment was conducted over 18 months. A thorough description of methodology and results are provided. The results of the assessment are discussed as well as implications for healthcare providers. The findings indicate that this is a vulnerable population, with limited resources placing them at high risk for health disparities. Further research should focus on obtaining actual health data.