Browsing by Subject "End-of-life"
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Item Evaluating baccalaureate curriculum end-of-life care content based upon End of Life Nursing Education Consortium (ELNEC) guidelines(2016-05) Pfitzinger, Megan Elizabeth; Carter, Patricia A.; Volker, Deborah; Jones, Terry; Becker, Heather; Svinicki, MarillaEvidence shows that the demand for palliative and end-of-life care is increasing in healthcare, yet nurses lack the proper education to provide this care with confidence and competence. Before educational practices are modified, a method is needed to assess current palliative and end-of-life care education. This dissertation study described a process for assessing a baccalaureate curriculum for its palliative and end-of-life care content integration, using an adapted theoretical framework, the Palliative Care Curriculum Evaluation Model. The End of Life Nursing Education Consortium (ELNEC) Core Curriculum was decomposed to identify all its key elements. Faculty members teaching in a baccalaureate nursing program were surveyed to identify strategies used and courses within which the ELNEC Core Curriculum content was taught. Survey responses from students enrolled in required nursing-specific courses within the curriculum at two time points within the semester were analyzed to assess changes in their knowledge of palliative and end-of-life care, attitudes toward death and toward care of the dying, and perceived competence in providing palliative and end-of-life care. Findings revealed that clinical conference discussion/debriefing and lecture were the most frequently used strategies. The Pain Management and Symptom Management categories were most covered, and Final Hours and Introduction to Palliative Nursing were least covered. There was an overall 95.3% match between the ELNEC Core Curriculum and the baccalaureate curriculum studied when all faculty member survey responses were analyzed, but this incorporated courses with much variability in content covered. There was a 78.45% match when only courses for which the content was covered consistently were analyzed. Baseline student outcomes demonstrated significantly higher results on knowledge and attitudes toward care of the dying measures (p<.02) for students further along in the curriculum as opposed to students toward the beginning of the program. The improvement in perceived competence across the semester for students was not significant, but did have a near-moderate effect size. The findings suggest that the methods used in the study were successful in assessing palliative and end-of-life care education. Implications of the findings for nursing practice, education, policy, and research are discussed.Item Family conflict at the end-of-life : an examination of the experiences of hospice primary caregivers and hospice professionals(2010-05) Boelk, Amy Zlimen; Pomeroy, Elizabeth Cheney, 1955-; Choi, Namkee G.; Greene, Roberta R.; Jones, Barbara L.; Kramer, Betty J.Guided by an explanatory matrix of family conflict at the end-of-life, the goals of this mixed methods study were to further generate theory regarding family conflict and to provide insights into its correlates and predictors. Sources of data analyzed include quantitative survey responses from 161 hospice family caregivers, 15 in-depth interviews with hospice family caregivers, and 10 interdisciplinary focus groups with hospice professionals. An explanatory matrix is presented that portrays family conflict at the end-of-life as a complex phenomenon influenced by salient contextual variables, conditions, and factors that may contribute to a number of negative outcomes for patients, family members, and professionals. The matrix also provides a beginning understanding of approaches utilized by hospice professionals in their work with families experiencing conflict. Significant bivariate correlations were found between family conflict and family context variables (i.e. prior conflict, length of caregiving, caregiver gender, caregiver age, presence of children in the caregiver’s home, advance planning discussions within family), conditions (i.e. family coming out of the woodwork and patient care needs) and contributing factors (i.e. communication constraints and family asserting control). In the multivariate model, significant predictors of family conflict included prior conflict, caregiver gender, caregiver age, advance planning discussions within family, family coming out of the woodwork, communication constraints, and family asserting control; the model explained 60% of the variance in family conflict. Implications for routine assessment, further examination of interventions to prevent and address conflict, and future research are highlighted.Item For their patients : a grounded theory study of hospice nurses responding to their patients' suffering(2014-05) Sacks, Jodi Lee; Volker, Deborah L.The purpose of this study was to develop an inductive theory describing the process that hospice nurses use to identify and respond to their patients' suffering. Additionally, the study sought to describe the coping strategies that hospice nurses used when working with patients they considered to be suffering. By examining nurses' responses to suffering, this study is the first step in developing effective interventions to alleviate patient suffering and mitigate its consequences on the nurses caring for those patients. Additionally, by knowing the different strategies that nurses use to cope when working with suffering patients, nurse administrators could institute educational programs, build supportive environments, and develop policies to support nurses as they deal with these difficult clinical situations. This is especially important in a hospice environment where the registered nurse is the focal point for ensuring ongoing patient assessment and implementation of the interdisciplinary plan of care by the various team members. Charmaz (2006) description of grounded theory methodology guided the study design and analysis. Participants identified and responded to their patients' suffering within the context of the nurse-patient relationship. Phases of the relationship included: preparation, establishment, cultivation, maintenance, and letting go. The participants gained insight into the psychosocial and existential aspects of the patient's psyches by cultivating the nurse-patient relationship. Within this relational context, the participants used a four-phase process: observation, issue assessment, suffering, and intervention to respond to their patient's suffering. In addition to pain and other signs of physical suffering, the participants identified other aspects of suffering: role losses, the patient's fear of the impending death, the patient's aloneness, and the patient's feelings of guilt or regret. Interestingly, suffering also was considered a family affair and could involve the loss of self-identity. While the participants recognized the importance of self-care, often they had difficulty naming strategies used to respond and cope with their patients' suffering. Clinical supervision and emotional support through mentoring and practical guidance need to be further developed to help nurses cope with the complexity of feelings that arise when caring for dying people.Item Provision and utilization of Complementary and Alternative Medicine (CAM) in Texas hospices(2012-05) Olotu, Busuyi Sunday; Brown, Carolyn M., Ph. D.; Lawson, Kenneth A.; Barner, Jamie C.The purpose of this study was to describe the extent and nature of CAM services that are provided and used in Texas hospices. The study investigated the significance of hospice setting characteristics such as age, geographic location, agency type, profit orientation, Medicare certification, and number of patients served as they relate to the likelihood of offering CAM, using a robust methodological and analytical strategy. Data was collected via self-administered mail surveys to 369 hospice directors in the state of Texas. A total usable response rate of 35.7% was obtained after an initial and one follow-up mail-out. A majority (N = 62, 56.4%) of hospices provided at least one type of CAM to their clients; however, a sizeable proportion of patients did not utilize the provided CAMs. The most frequently offered CAMs included massage, music, relaxation, spiritual healing and pet therapies with females and non-Hispanic whites being the most frequent users of these CAM services. Among CAM providers, short length of stay and funding were the primary obstacles to CAM provision, with most hospices relying on a combination of general hospice funds and volunteers to sustain the delivery of CAM services. The odds of offering CAM in ‘not-for-profit’ hospices were approximately four times higher than in ‘for-profit’ hospices (OR = 3.77, p = 0.022), while the odds of offering CAM increased by 13% for every 100 patients served by hospices (OR = 1.131, p = 0.015). Other hospice setting characteristics were not significantly related to CAM provision. In conclusion, a majority of hospices offered CAM services to their clients, although many patients are not utilizing these services. This observation might be connected with the fact that most CAM services are currently not being reimbursed through the Medicare Hospice Benefit, a government program that a majority of hospices depend upon for the coverage of substantial portions of their end-of-life services. Nevertheless, our study showed that CAM provision is related to the number of patients served and profit orientation status, but is not related to other measured characteristics of hospices.