Provider Orders for Life-Sustaining Treatment Implementation and Training in Nursing Facilities in Hawai'i.

A Provider Orders for Life-Sustaining Treatment (POLST) document transforms medical wishes for end-of-life care into actionable medical orders. This study was conducted to assess the extent of POLST implementation amongst nursing facilities in Hawai'i. We performed a telephone survey . The survey instrument included questions about advance care planning processes, POLST training procedures, and implementation of the POLST paradigm. Data were collected in July 2014, the month POLST signatory capacity expanded to include Advance Practice Registered Nurses (APRNs). Of the 39 nursing facilities contacted, 23 (59%) responded. All but one facility had a POLST program in place. Social workers and nursing staff usually held the POLST discussions. Of the 23 responding facilities, 13 (57%) had at least one APRN provider, and 8 had APRNs involved in POLST discussions. In all but one instance, APRNs were also already signing the document. The percentage of residents with completed POLST forms per facility was reported to be over 50% for 20 out of 23 (87%) of responding nursing facilities with 10 (43%) reporting achieving 100% implementation rates. Training seminars and online educational materials were the main methods for training staff, with social workers and nurses being the focus for training. The results of this study demonstrate significant penetration of the Hawai'i POLST program into the nursing home community. Most nursing facilities required staff to undergo POLST training. Some facilities reported APRNs were already involved in signing the POLST form, only weeks after their signatory capacity was enacted.

Developing emotional intelligence ability in oncology nurses: a clinical rounds approach.

PURPOSE/OBJECTIVES: To explore the feasibility and impact of an emotional intelligence ability development program on staff and patient care. DESIGN: A mixed method, pre/post-test design. SETTING: A tertiary care hospital in urban Honolulu, HI. Rounds took place on a 24-bed inpatient oncology unit. SAMPLE: 33 RNs in an oncology unit. METHODS: After collection of baseline data, the emotional intelligence rounds were conducted in an inpatient oncology nursing unit on all shifts during a 10-month period. MAIN RESEARCH VARIABLES: Demographic information, emotional intelligence scores, data from rounds, chart reviews of emotional care documentation, and unit-wide satisfaction and safety data. FINDINGS: The ability to identify emotions in self and others was demonstrated less frequently than expected in this population. The low test response rate prevented comparison of scores pre- and postintervention. CONCLUSIONS: The staff's 94% participation in rounds, the positive (100%) evaluation of rounds, and poststudy improvements in emotional care documentation and emotional care planning suggest a positive effect from the intervention. Additional research is recommended over a longer period of time to evaluate the impact emotional intelligence specifically has on the staff's identification of emotions. Because the intervention involved minimal time and resources, feasibility for continuation of the intervention poststudy was rated "high" by the research team. IMPLICATIONS FOR NURSING: Research in other disciplines suggests that improvement in emotional intelligence ability in clinical staff nurses may improve retention, performance, and teamwork in nursing, which would be of particular significance in high-risk clinical practice environments. KNOWLEDGE TRANSLATION: Few research studies have explored development of emotional intelligence abilities in clinical staff nurses. Evidence from this study suggests that interventions in the clinical environment may be used to develop emotional intelligence ability. Impact from such development may be used in the future to not only improve the quality of nursing care, but also potentially limit the negative effects of high-stress environments on nurses.