The Role of the Palliative Care Registered Nurse in the Nursing Facility Setting

Investigating the Multidomain Impact of Palliative Care on End-of-Life Patients: A Comprehensive Evaluation

Background: Palliative care is recognized for its holistic approach in improving the quality of life for patients and their families, focusing on pain relief, symptom management, and addressing emotional, social, and spiritual needs. However, the field is evolving due to increasing demand for these specialized services, emphasizing the need for the ongoing research into palliative care practices. Research Purpose: Is to investigate the multidomain impact of palliative care on end-of-life patients and evaluate their effectiveness on these domains. Method: A quantitative descriptive design was adopted for conducting the current study. Approval obtained from a designated hospital in Amman, Jordan, and official permission to carry out the study. The study's participants consisted primarily of physicians and nurses who were involved in providing care to terminally ill patients. The research tool employed in this study is a standardized palliative care assessment that was used in Australia, with modifications based on the literature review. The validity and reliability of the adapted tool have been ensured through rigorous testing procedures. Results: Findings indicated that the implementation of standardized practical palliative care exhibited an average level across all domains, specifically, the spiritual domain received the highest mean score (1.80), while the structural domain had the lowest (1.69). There were significant differences in palliative care provision across specialized work sites, with radiotherapy and blood disease sites scoring higher (M = 2.04 and M = 1.87, respectively). Educational levels significantly influenced care perceptions, favoring BSc holders. Age did not significantly affect palliative care provision, probably because of standardized care protocols and sample size. In addition, nurses rated palliative care higher than physicians, likely due to their more direct patient involvement. Conclusion: In light of the results, it is evident that there is a pressing need to consistently evaluate the healthcare services offered to meet the needs of the increasing population of terminally ill patients.

The Effectiveness of Palliative Care Interventions in Long-Term Care Facilities: A Systematic Review

The increasing elderly population is driving higher utilization rates of long-term care facilities, where residents often have multiple chronic diseases, making them potential candidates for palliative care. Timely palliative care interventions can improve their quality of life and medical autonomy. This study systematically reviews the effectiveness of palliative care programs in long-term care facilities. Databases such as PubMed, EMBASE, Cochrane Library, and Airiti Library were searched up to 31 December 2023, using PICO criteria and the following keywords: 'care home', 'nursing home', 'residential aged care facility', and 'long-term care facility' for patients; and 'Gold Standard Framework in Care Homes', 'integrated care pathway', 'care home project', and 'palliative care program' for interventions. Seven articles were included. The results indicate that the Program of All-Inclusive Care for the Elderly (PACE) intervention did not significantly influence overall quality of life but did improve the quality of death. There were no statistical differences in comfort or quality of death between the dementia and non-dementia groups. However, PACE significantly reduced healthcare costs. The implementation of the Liverpool Care Pathway (LCP) notably enhanced the control of terminal symptoms, while the Gold Standard Framework in Care Homes (GSFCH) effectively improved end-of-life care rates, do-not-resuscitate (DNR) signing rates, advance care planning (ACP) completion rates, and reduced inappropriate readmission rates. While palliative care interventions are shown to improve the quality of end-of-life care, their practical application should be adapted to fit the implementation conditions and capabilities of domestic long-term care facilities.

Improving Communication in Nursing Homes Using Plan-Do-Study-Act Cycles of an SBAR Training Program

BACKGROUND

Incomplete communication between staff and providers may cause adverse outcomes for nursing home residents. The Situation-Background-Assessment-Recommendation (SBAR) tool is designed to improve communication around changes in condition (CIC). An adapted SBAR was developed for the Centers for Medicare and Medicaid Services demonstration project, OPTIMISTIC, to increase its use during a resident CIC and to improve documentation.

METHODS

Four Plan-Do-Study-Act (PDSA) cycles to develop and refine successive protocol implementation of the OPTIMISTIC SBAR were deployed in four Indiana nursing homes. Use of SBAR, documentation quality, and participant surveys were assessed pre- and post-intervention implementation.

RESULTS

OPTIMISTIC SBAR use and documentation quality improved in three of the four buildings. Participants reported improved collaboration between nurses and providers after SBAR intervention.

CONCLUSION

Successive PDSA cycles implementing changes in an OPTIMISTIC SBAR protocol for resident CIC led to an increase in SBAR use, improved documentation, and better collaboration between nursing staff and providers.

Nursing Home Palliative Care during the Pandemic: Directions for the Future

Background and Objectives

Palliative care addresses physical, emotional, psychological, and spiritual suffering that accompanies serious illness. Emphasis on symptom management and goals of care is especially valuable for seriously ill nursing home residents. We investigated barriers to nursing home palliative care provision highlighted by the coronavirus disease 2019 (COVID-19) pandemic and the solutions nursing home staff used to provide care in the face of those barriers.

Research Design and Methods

For this descriptive qualitative study, seven Massachusetts nursing home directors of nursing were interviewed remotely about palliative care provision before and during the COVID-19 pandemic. Interview data were analyzed using thematic analysis.

Results

Before the pandemic, palliative care was delivered primarily by nursing home staff depending on formal and informal consultations from palliative care specialists affiliated with hospice providers. When COVID-19 lockdowns precluded these consultations, nursing staff did their best to provide palliative care, but were often overwhelmed by shortfalls in resources, resident decline brought on by isolation and COVID-19 itself, and a sense that their expertise was lacking. Advance care planning conversations focused on hospitalization decisions and options for care given resource constraints. Nevertheless, nursing staff discovered previously untapped capacity to provide palliative care on-site as part of standard care, building trust of residents and families.

Discussion and Implications

Nursing staff rose to the palliative care challenge during the COVID-19 pandemic, albeit with great effort. Consistent with prepandemic analysis, we conclude that nursing home payment and quality standards should support development of in-house staff capacity to deliver palliative care while expanding access to the formal consultations and family involvement that were restricted by the pandemic. Future research should be directed to evaluating initiatives that pursue these aims.

Palliative Care: A Concept Analysis Review

Introduction

Palliative care is critically important for the world's aging population and can change illness trajectories and promote advances in health care technologies. As health care team members, nurses have the most contact with palliative care patients. However, misconceptions about which patients need to receive palliative care may be an obstacle to meeting patients' needs for palliative care.

Objectives

This study aimed to describe preceding events, characteristics and outcomes of patients in palliative care according to current concept analysis studies.

Methods

A literature review was conducted. Inclusion criteria were: (1) concept analysis studies, (2) use of the term palliative care or palliative nursing care, (3) palliative care explanation including antecedents, attributes, and consequences, and (4) articles written in English published between 2004 and 2021.

Results

Four concept analysis studies on palliative care were included in this review. Palliative care was described as an approach to alleviating physical and psychological suffering and improving patients' and families' quality of life in the early stages of diagnosed illness. Terminal illnesses, acute or chronic diseases, and actual or potentially life-threatening illnesses were confirmed as the events preceding palliative care. Characteristics of palliative care include holistic care, interdisciplinary teamwork, and compassionate, patient- and family-centered care. Improved patient and family quality of life, enhanced human dignity, improved self-care, and strengthened coping abilities are outcomes of palliative care.

Conclusions/Implications for Practice

Palliative care is a concept that is related to the early stage of an illness, the timing of illness diagnosis, and the onset of symptoms. Including palliative care terms in nursing education and training and developing palliative care models in clinical practice are recommended to ensure nurses understand the services of the palliative care needs of patients and their families. Future reviews, including grounded qualitative studies on the concept of palliative care, are recommended.

The palliative care difficulty levels of the nursing students during clinical practices

PURPOSE

This study aimed to determine the palliative care difficulties experienced by nursing students during their clinical practice.

DESIGN AND METHODS

This descriptive and cross-sectional study was conducted with 305 nursing students at a university in Turkey. Data were collected using a student identification form and the palliative care difficulties scale.

FINDINGS

Nursing students experience a moderate level of difficulty in providing care for palliative care patients and receiving expert support facilitates their care initiatives.

PRACTICE IMPLICATIONS

It is important to support nursing students during their nursing education courses and clinical training, along with psychiatric nursing skills.

Registered nurses in expanded roles improve care in nursing homes: Swiss perspective based on the modified Delphi method

AIM

To define both competencies and envisaged outcomes for registered nurses in expanded roles in Swiss nursing homes to be implemented and evaluated within a new model of care.

BACKGROUND

In regions where Advanced Practice Nurses are rare or absent, registered nurses take up clinical leadership and expanded roles. To allow effective implementation, monitoring and evaluation of these nurses, stakeholders need a shared understanding of the competencies they require and what outcomes they should achieve.

DESIGN

RAND/UCLA Appropriateness Method - a modified Delphi method.

METHODS

A critical literature review and case studies were conducted to identify possible competencies and outcomes for registered nurses in expanded roles. In 2017, a two-round rating process and an in-person panel discussion was completed by a group of multi-professional stakeholders.

FINDINGS

Two rounds generated 190 competencies and 72 outcomes relevant to registered nurses in expanded roles.

CONCLUSION

The relevant competencies and outcomes of registered nurses in expanded roles indicate their support for care teams and development of nursing care in nursing homes. Their geriatric expertise allows them to function as role models and innovators, reinforcing overall perceptions of nursing as a profession. These nurses are especially important in countries and settings where Advanced Practice Nurses are scarce or unavailable.

IMPACT

The identified competencies clarify the duties of expanded-role registered nurses, thereby differentiating them from other care providers. Although conducted in the Swiss healthcare system, our methods and findings can be adapted to other healthcare settings. The results of this study will guide the development of an educational programme in a multi-centre study to reduce avoidable hospitalizations, while the defined outcomes guide the evaluation of their impact.