End-Of-Life Care Communication in Long-Term Care Among Nurses, Residents, and Families: A Critical Review of Qualitative Research.

RNs in long-term care (LTC) are a critical nexus for end-of-life (EOL) care communication with older adult residents and their families. A critical review of 17 qualitative research studies examined nurses' experience with EOL care in LTC. Findings indicate that time, preparation, advocacy, organizational resources, and a continuous, relational approach support EOL care communication. Regulatory burdens, understaffing, workflow demands, family and organizational dysfunction, anxiety, and depression impede EOL care communication. The current review revealed a gap in the literature describing LTC RNs' unique perspectives and knowledge regarding EOL care communication with residents and families. There is a current, pressing need to understand the facilitators LTC RNs use to overcome obstacles to effective EOL care communication. Future research could inform clinical practice guidelines and EOL care nursing education, enhancing LTC nurses' capacity to develop trust-based relationships and improving the efficacy of current EOL care communication interventions in LTC. [Journal of Gerontological Nursing, 47(7), 43-49.].

Evidence-Based Teaching Practice in Nursing Education: Faculty Perspectives and Practices.

PURPOSE: This national online study was conducted to describe nursing faculty perspectives and practices about evidence-based teaching practice (EBTP). BACKGROUND: Professional standards for nurse educator practice stress the importance of EBTP; however, the use of evidence by faculty in curriculum design, evaluation and educational measurement, and program development has not been reported. METHOD: Nurse administrators of accredited nursing programs in the United States (N = 1,586) were emailed information about the study, including the research consent form and anonymous survey link, and invited to forward information to nursing faculty. RESULTS: Respondents (551 faculty and nurse administrators) described the importance of EBTP in nursing education, used multiple sources of evidence in their faculty responsibilities, and identified factors that influence their ability to use EBTP. CONCLUSION: EBTP in nursing education requires sustained institutional, administrative, and collegial support to promote faculty effectiveness and student learning.

Educating leaders in nursing: faculty perspectives.

Recent changes in health care legislation have presented an unprecedented opportunity for nurses to engage as full partners in transforming health care (Institute of Medicine, 2010). According to diverse opinion leaders from insurance, corporate, health services, government, and higher education, nurses should have more influence than they do now on health policy, planning, and management (Robert Wood Johnson Foundation, 2010). More than ever before, nursing needs leaders, and nursing faculty are in a pivotal position to educate leaders in nursing. This article describes the findings of a descriptive study that surveyed nursing faculty teaching in all degree levels to ascertain how they prepare students to be leaders in nursing. Data were analyzed using qualitative methods. Findings demonstrate that faculty engage in self-development as leaders, promote student role development as leaders, and use multiple teaching-learning strategies to educate students to be leaders in nursing.

Factors that influence patient advocacy by pain management nurses: results of the American society for pain management nursing survey.

What is the meaning of advocacy, and how does it relate to the nurse who wants patients to experience optimum pain management? This question and the lack of empirical data provided the stimulus for the American Society for Pain Management Nursing (ASPMN) Research Committee to explore ASPMN members' beliefs, knowledge, and skills regarding pain management advocacy activities. The specific aim of the study was to determine the educational needs for and barriers of advocacy for nurses working with patients experiencing pain. An ASPMN Advocacy Survey Instrument was developed to gather data about advocacy activities and interventions. The sample consisted of 188 ASPMN nurses (20% of the membership) who responded via the internet. Study findings revealed that the majority of nurse respondents were active in personal advocacy, serving as guardians of the patient. They confronted physicians as necessary and assisted patients to evaluate their pain management. Regarding making the public aware of pain management-related issues (i.e., public awareness advocacy), the respondents were not as active. Respondents were knowledgeable about pain management and best practices/best evidence, with the exceptions of legislative issues and media training. These two areas need support and educational intervention. Additional areas in need of education and training, as identified by respondents, are social and political advocacy interventions. "Lack of time" was identified as the barrier to advocacy experienced by the greatest number of nurses.

Quality of life among children with velocardiofacial syndrome.

OBJECTIVE: To explore the health-related quality of life (QoL) among children with velocardiofacial syndrome (VCFS) and to compare QoL by gender and with samples of chronically ill and healthy children. DESIGN AND SETTING: Cross-sectional design, comparing data obtained from a survey of parents of children with VCFS to previously published data from comparison groups of children who are healthy or who have other chronic conditions. PARTICIPANTS: Parents of 45 children aged 2 to 18 years with VCFS participated in this study. Results were compared with published data on the same measures from samples of parents of healthy children (n = 10,343) and children with a variety of chronic conditions (n = 683). MAIN OUTCOME MEASURES: Quality of life, including fatigue, was measured using the PedsQL(TM) Measurement Model. Strengths were assessed by parent report from a list of character traits developed from the Values in Action Classification System. RESULTS: Quality of life was lower across all domains compared with healthy children. Boys with VCFS scored significantly lower than girls on school functioning (p < .05) and cognitive fatigue (p < .01). Compared with children with chronic conditions, children with VCFS scored lower on emotional (p < .01), social (p < .01), and school functioning (p < .001) but not on physical health. Parents described their children's strengths as humor, caring, kindness, persistence, and enthusiasm. CONCLUSIONS: Quality of life among children with VCFS is characterized by significant challenges in the cognitive, social, and emotional domains. These children have strengths that may be useful in coping with the daily challenges of this condition.

Financial and employment problems in families of children with special health care needs: implications for research and practice.

INTRODUCTION: The purpose of this study was to identify factors related to financial burden among families of children with special needs and to identify specific provider-level activities associated with decreased risk for such burden. METHOD: Data for secondary analysis are from the National Survey of Children with Special Health Care Needs (CSHCN). Logistic regression analysis of state-level data was conducted to identify significant predictors of financial and employment problems among families of children with SHCN in Minnesota. RESULTS: Children with more severe conditions and whose family members provided health care at home were more likely to have parents report financial and employment problems due to the child's condition. On the other hand, families whose health care providers communicated well with other service providers and who helped them feel like partners in their child's care were significantly less likely to report financial and employment problems. DISCUSSION: Pediatric nurses and nurse practitioners can use these findings as they work with families for optimal family outcomes. Advocacy and policy implications at state and federal levels also are discussed.

Preparing pediatric nurse leaders for practice.

The growing prevalence of chronic conditions in childhood underscores the urgent need to educate pediatric nurse leaders to address the complex issues these children and families face. This article describes a model of graduate education for preparing pediatric nurse leaders who are equipped to manage and advocate for these children and families. Fifty-one master's prepared graduates completed a Strategic Plan Needs Assessment Survey in 2007 and were asked to indicate specific clinical and leadership competencies that they perceived were essential for pediatric nurse leaders in their areas of practice. Results revealed the highest priority for continuing education and outreach regarding pediatric health to be clinical updates and management of children with special healthcare needs (CSHCN), followed by health promotion for CSHCN and care coordination/case management. The highest priority for continuing education and outreach regarding leadership in pediatrics was evidence-based practice, followed by team care/interdisciplinary practice. The challenge for current nurse leaders is to be cognizant of the urgent need to prepare and retain future pediatric nurse leaders who are experts in the care of CSHCN and their families.