RESUMO
Background: Hospitalized advanced cancer patients and their families are inadequately informed about their cancer diagnosis and prognosis, which limits educated and reasonable decision-making for their care and end-of-life planning. Objectives: The primary objective of this evidence-based project was to enhance serious illness conversations (SICs) with advanced cancer patients by providing advanced practice providers (APP) training and to increase the frequency of SIC documentation in the electronic medical record (EMR). Methods: SIC training included a 45-minute Zoom video recording and 30-minute discussion groups. Advanced practice providers' beliefs and self-efficacy were measured pre- and post-training via a survey. Prior training was queried in the pre-survey. Data from APP discussion groups were summarized and themes identified. Serious illness conversation documentation frequency was measured. Pre- and post-survey differences were assessed using Wilcoxon rank sum tests. Findings: 19 inpatient medical oncology nurse practitioners and 6 physician assistants participated. Many reported little formal training yet are engaging in SICs regularly. Scores on both the belief and self-efficacy survey sections were high prior to training and did not significantly change following training. Despite the high pre-survey scores, many of the APPs verbalized the need for more training to improve their confidence and to learn SIC communication skills. Training significantly improved the APP's ability to manage their own emotions and be present. This indicates a trend toward improved APP comfort with SICs. Accessible documentation in the EMR increased with training.
RESUMO
OBJECTIVES: To discuss the evolution and effectiveness of the comprehensive geriatric assessment (CGA), the need for interprofessional collaboration, and the role of oncology nurses in the assessment and care coordination of the older patient with cancer. DATA SOURCES: Historical and recent publications. CONCLUSION: Oncology nurses collect and synthesize geriatric data and can be a central resource to the multidisciplinary team. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can incorporate CGA and results into their practice to enhance the care of the older person.
Assuntos
Avaliação Geriátrica/métodos , Enfermagem Geriátrica/normas , Neoplasias/enfermagem , Papel do Profissional de Enfermagem , Enfermagem Oncológica/normas , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Feminino , Humanos , Relações Interprofissionais , Masculino , Relações Enfermeiro-PacienteRESUMO
Orthostatic hypotension (OH) in older adults with dementia is associated with increased confusion, dizziness, syncope, and falls. These problems may result in a negative, downward spiral accompanied by high morbidity and mortality. The literature supports that nonpharmacological interventions are effective in the reduction of symptoms and prevention of orthostasis. The purpose of this quality improvement project was to increase staff knowledge and skill in the assessment, documentation, and care of residents with OH in dementia care units within a continuing care retirement community. An in-service program using a protocol based on clinical practice guidelines was presented to RNs, licensed practical nurses, therapists, and unlicensed caregivers. Assessments, documentation of assessments, and interventions for residents with OH increased following the in-service program. As staff continue to apply their knowledge in care routines, it is expected that this evidence-based practice will reduce symptoms of OH and increase safety and quality of life within this specific population.
