Use of the Palliative Performance Scale version 2 in obtaining palliative care consults.

AIMS AND OBJECTIVES: To examine whether an educational intervention and implementation of a validated prognostication tool can improve inpatient acute care nurses' knowledge of palliative care and their comfort in determining the need for palliative care and requesting a palliative care consult from the attending physician. BACKGROUND: Patients with chronic illness report low levels of quality of life. Relief from suffering may be found in services provided by palliative care; however, their services are often underused, in part, due to difficulties in prognostication. The Palliative Performance Scale version 2 is a prognostication tool that can help overcome this barrier. DESIGN: A pretest/post-test design with nursing education intervention was used on an acute care medical unit within a Midwest tertiary hospital. METHOD: Survey questions for both pre- and postintervention assessed nurses' knowledge related to palliative care and examined nurses' comfort in identifying patients appropriate for palliative care and requesting consults. Following the presurvey, education on palliative care and the use of the Palliative Performance Scale version 2 was provided during a regularly scheduled staff meeting. Posteducation mentoring occurred for one month prior to the postsurvey. RESULTS: Pre- and post-test comparisons showed an overall increase in both comfort and knowledge related to palliative care. There was also a significant improvement in the nurses' comfort in identifying patients appropriate for palliative care. CONCLUSIONS: Findings suggest that nursing education on palliative care and Palliative Performance Scale version 2 can improve their knowledge level and comfort in requesting palliative care consults. RELEVANCE TO CLINICAL PRACTICE: Nurses are in the best position to advocate for the patient and the management of their chronic illness. Educating nurses on the philosophy of palliative care and improving their comfort level in assessing the need for palliative care will overcome barriers to consultation.

Best Fit Orientation: An Innovative Strategy to Onboard Newly Licensed Nurses.

The premature turnover of newly licensed registered nurses is a costly problem prompting leaders to consider new orientation approaches. This article describes the "Best Fit Orientation"-an innovative approach for onboarding newly licensed registered nurses. It features centralized hiring, individualized orientation on diverse units, and realistic job preview tenets promoting self-evaluation, change management, relationship building, and "best fit" unit selection. Positive evaluations, high retention, and minimal added costs make this program very attractive.

Fatigue representations in women with heart failure.

Self-care management of symptoms for persons with heart failure (HF) may only be successful when their representations regarding their symptoms are accurate and linked to appropriate behavioral strategies. The purpose of this secondary data analysis (N = 169 women with HF) was to describe representations of one HF-related symptom, fatigue, and examine whether representations were related to physical health status, health care utilization, and psychological well-being and whether they differed by age. Overall, women agreed that fatigue was chronic, caused by HF, and had serious consequences. Midlife women reported more emotional distress and severe consequences from fatigue than older women. Higher levels of emotional distress due to fatigue from HF were associated with higher levels of health care utilization.

Partnering with patients and families in designing visual cues to prevent falls in hospitalized elders.

Prevention of falls in hospitalized elderly is critical to avoid injury and maintain independence. As part of a comprehensive program, nursing staff in a medical telemetry unit partnered with patients and their families to design and implement an educational poster to prevent falls. Ongoing patient/family feedback was used to modify the poster until it was appealing and effective for patients. The effort resulted in a marked decrease in falls on the unit over the pilot period.