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Zogby CB. Burnout among palliative care providers. J Am Assoc Nurse Pract 2023; 35:676-681. [PMID: 37395681 DOI: 10.1097/jxx.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Burnout among health care professionals contributes to high job turnover. Within the United States, burnout among specialty palliative care (PC) providers will accentuate provider shortage problems. OBJECTIVES This systematic review was conducted to answer the question "what is known about burnout among specialty PC providers practicing in the United States?" More specifically, it was designed to identify the rate of burnout and factors that influence or mitigate it among PC nurse practitioners (NPs), physician assistants (PA), and physicians and to inform future research. DATA SOURCES An electronic literature search of studies conducted in the United States between 2012 and September 2022 was completed in Embase, PubMed, CINAHL, and PsycINFO. CONCLUSIONS Analysis of 14 studies showed that there are five primary themes related to burnout among PC providers: (1) the rate of burnout, (2) the physical, psychological, and clinical manifestations of burnout, (3) predictors of burnout, (4) factors of resiliency, and (5) interventions piloted to decrease burnout. The majority of studies have delineated the physician role but have failed to determine the rate and factors of burnout among PC NPs and PAs. IMPLICATIONS FOR PRACTICE As NPs and PAs are integral to the PC provider workforce, future research should be designed to understand more clearly how burnout affects these two PC roles to inform efforts to sustain the PC workforce.
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Affiliation(s)
- Colleen Borden Zogby
- St. Joseph Hospital, Syracuse, New York
- University of Maryland, Baltimore, Maryland
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2
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Battista V, Sciacca K. Professional Standards and the Role of the Advanced Practice Registered Nurse in Hospice and Palliative Care. J Hosp Palliat Nurs 2023; 25:249-254. [PMID: 37550855 DOI: 10.1097/njh.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Palliative care aims to optimize quality of life and reduce physical, psychological, social, and spiritual suffering for people living with serious and life-threatening illness throughout the life span. There are different educational pathways to becoming an advanced practice registered nurse (APRN) and a range of areas in which APRNs may specialize, including hospice and palliative care. National guidelines and professional standards have been developed to guide the delivery of high-quality palliative care and to demonstrate the need for all nurses to be competent in providing primary palliative care. Advanced practice registered nurses are well poised to integrate palliative care standards into their practice in a variety of settings and in myriad ways including clinical care, program development, leadership, education, and advocacy. This article is the first in a series that will highlight the different roles of the hospice and palliative care APRN, including the doctor of nursing practice, clinical nurse specialist, pediatric APRN, adult/gerontology APRN, and community-based APRN in a variety of settings throughout the country.
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3
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Oh H, White EM, Muench U, Santostefano C, Thapa B, Kosar C, Gadbois EA, Osakwe ZT, Gozalo P, Rahman M. Advanced practice clinician care and end-of-life outcomes for community- and nursing home-dwelling Medicare beneficiaries with dementia. Alzheimers Dement 2023; 19:3946-3964. [PMID: 37070972 PMCID: PMC10523969 DOI: 10.1002/alz.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Older adults with Alzheimer's disease and related dementias (ADRD) often face burdensome end-of-life care transfers. Advanced practice clinicians (APCs)-which include nurse practitioners and physician assistants-increasingly provide primary care to this population. To fill current gaps in the literature, we measured the association between APC involvement in end-of-life care versus hospice utilization and hospitalization for older adults with ADRD. METHODS Using Medicare data, we identified nursing home- (N=517,490) and community-dwelling (N=322,461) beneficiaries with ADRD who died between 2016 and 2018. We employed propensity score-weighted regression methods to examine the association between different levels of APC care during their final 9 months of life versus hospice utilization and hospitalization during their final month. RESULTS For both nursing home- and community-dwelling beneficiaries, higher APC care involvement associated with lower hospitalization rates and higher hospice rates. DISCUSSION APCs are an important group of providers delivering end-of-life primary care to individuals with ADRD. HIGHLIGHTS For both nursing home- and community-dwelling Medicare beneficiaries with ADRD, adjusted hospitalization rates were lower and hospice rates were higher for individuals with higher proportions of APC care involvement during their final 9 months of life. Associations between APC care involvement and both adjusted hospitalization rates and adjusted hospice rates persisted when accounting for primary care visit volume.
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Affiliation(s)
- Hyesung Oh
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Elizabeth M White
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ulrike Muench
- Department of Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Christopher Santostefano
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Bishnu Thapa
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Cyrus Kosar
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Emily A Gadbois
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Zainab Toteh Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
| | - Pedro Gozalo
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Momotazur Rahman
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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4
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Ferrell BR, Paice JA, Coyne PJ, Economou D, Thaxton CA, Wholihan D, Battista V, Haskamp A. Outcomes of a National Training Curriculum to Advance Generalist Level Palliative Care. J Palliat Med 2023; 26:228-234. [PMID: 35976082 PMCID: PMC9894595 DOI: 10.1089/jpm.2022.0262] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The adoption of palliative care as an integral component of health care has led to the need for generalist level providers, especially important in serious illnesses such as cancer. Objectives: The goals of this National Cancer Institute-funded training program were to (1) identify the eight domains of quality palliative care applied to oncology practice, (2) demonstrate skills for oncology advanced practice registered nurses (APRNs) in the domains of palliative care, and (3) develop goals for implementing the skills training in practice through process improvement, staff education, and clinical care. Design: The training program led by the End of Life Nursing Education Consortium (ELNEC) project included oncology APRNs in a three-day training course with one-year follow-up for ongoing support and to assess impact. Settings: Five training courses included 430 APRNs from 46 U.S states including both pediatric and adult oncology settings. The project included 25% minority participants. Measurement: Measures included participant goal implementation, course evaluations, and surveys to assess implementation and palliative care practices (precourse, 6 and 12 months postcourse). Results: The ELNEC oncology APRN training course resulted in changes in practice across domains, improved perceived effectiveness in clinical practice, and valuable insight regarding the challenges in generalist level palliative care implementation. Conclusion: The ELNEC oncology APRN course serves as a model for the palliative care field to advance generalist level practice. Future training efforts can build on this project to reach more oncology professionals and those in other areas of serious illness care.
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Affiliation(s)
- Betty R. Ferrell
- Division of Nursing Research, City of Hope, Duarte, California, USA
| | - Judith A. Paice
- Northwestern University; Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patrick J. Coyne
- Palliative Care, Medical University of South Carolina in Charleston, South Carolina, USA
| | | | | | - Dorothy Wholihan
- NYU Meyers College of Nursing, Palliative Care Specialty Program, New York, New York, USA
| | - Vanessa Battista
- Dana Farber Cancer Institute, Psychosocial Oncology and Palliative Care, Boston, Massachusetts, USA
| | - Amy Haskamp
- Indiana University School of Medicine Pediatrics, Indianapolis, Indiana, USA
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5
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Chan S, Wilson DM, Santos Salas A. Examining the value and roles of palliative care nurse practitioners: A scoping review. Progress in Palliative Care 2022. [DOI: 10.1080/09699260.2022.2120725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- S. Chan
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - D. M. Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Canada
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6
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Hewitt J, Grealish L, Bonner A. Voluntary assisted dying in Australia and New Zealand: Exploring the potential for nurse practitioners to assess eligibility. Collegian 2022. [DOI: 10.1016/j.colegn.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fitzpatrick S, Somers S, Stryckman B, Gingold DB. Improving Hospice and Palliative Care Through Nurse Practitioner Engagement in a Community Paramedicine Program. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Peeler A, Gleason KT, Ferrell B, Battista V, Klinedinst R, Cho SM, Davidson PM. Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles. AACN Adv Crit Care 2021; 32:341-345. [PMID: 34490441 DOI: 10.4037/aacnacc2021862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Anna Peeler
- Anna Peeler is a PhD student, Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD 21205
| | - Kelly T Gleason
- Kelly T. Gleason is Assistant Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Betty Ferrell
- Betty Ferrell is Professor, City of Hope National Medical Center, Duarte, California
| | - Vanessa Battista
- Vanessa Battista is Nurse Practitioner, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel Klinedinst
- Rachel Klinedinst is Nurse Practitioner, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sung-Min Cho
- Sung-Min Cho is Neuro Intensivist and Assistant Professor, Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patricia M Davidson
- Patricia M. Davidson is Vice-Chancellor, University of Wollongong, Wollongong NSW, Australia
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Cheng Q, Zhang Q, Liu X, Chen Y. Initial exploration of training for palliative care specialist nurses in mainland China. Nurse Educ Today 2021; 101:104869. [PMID: 33798990 DOI: 10.1016/j.nedt.2021.104869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/20/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
This paper describes the initial exploration of training program for palliative care specialist nurses in mainland China. The training program included one month of theoretical learning and one month of clinical practice. The theoretical training contents were mainly set up around four modules such as clinical practice, teaching, scientific research and management. After the theoretical training, the trainees needed to practice in specific clinical practice hospitals. In total, 192 trainees from 27 provinces (municipalities) in mainland China participated in the training program. All trainees passed theoretical and clinical practice examinations. Their knowledge, attitude and behavior concerning palliative care were significantly improved after training (p < 0.001). The overall satisfaction rate of the trainees towards the theoretical courses was 95.6%, and the overall satisfaction rate of the trainees towards the clinical teaching base was 94.2%. The training program for palliative care specialist nurses can ensure the trainees to acquire basic professional knowledge and skills and improve their knowledge, attitudes and behaviors concerning palliative care. However, it is needed to explore training programs that are in part-time model, delivered online or suitable for different levels of nursing staff to improve the accessibility.
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Affiliation(s)
| | - Qinghui Zhang
- Hunan University of Chinese Medicine, Changsha, PR China
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10
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Harrison M, Gardiner C, Taylor B, Ejegi-Memeh S, Darlison L. Understanding the palliative care needs and experiences of people with mesothelioma and their family carers: An integrative systematic review. Palliat Med 2021; 35:1039-1051. [PMID: 33829930 PMCID: PMC8188997 DOI: 10.1177/02692163211007379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with mesothelioma and their families have palliative care needs throughout the relatively short trajectory of their illness. AIM To describe the palliative care needs and experiences of people with mesothelioma and their family carers. DESIGN Integrative systematic review with narrative synthesis (PROSPERO: CRD42020190115). DATA SOURCES MEDLINE, CINAHL, PsycINFO and the Cochrane Library were searched for articles published between 01 January 2000 and 10 May 2020. Articles were included if they presented empirical studies or comprehensive reviews including information about the palliative care needs and experiences of people with mesothelioma and their family carers. RESULTS The search yielded 508 articles, 14 were included in the analysis. A cross cutting theme of 'uncertainty' was identified encompassing five themes: (1) organisation and co-ordination of services, (2) communication and information needs, (3) management of care needs and high symptom burden, (4) consideration of the impact of seeking compensation and (5) family carer needs. Our findings demonstrate that people with mesothelioma want a co-ordinated, team-based approach to palliative care with a named point of contact. Whilst carers value and benefit from early referral to specialist palliative care, this does not necessarily reflect the outcomes and views of patients. CONCLUSION The evidence base around the palliative care needs and experiences of people with mesothelioma and their carers needs to be strengthened. The results of this review support the need to develop a greater understanding about the role non-specialist palliative care clinicians' play in providing generalist palliative care for people with mesothelioma and their carers.
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Affiliation(s)
- Madeleine Harrison
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Bethany Taylor
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Stephanie Ejegi-Memeh
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Liz Darlison
- The Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Mesothelioma UK, Leicester, UK
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11
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Vellani S, Boscart V, Escrig-Pinol A, Cumal A, Krassikova A, Sidani S, Zheng N, Yeung L, McGilton KS. Complexity of Nurse Practitioners' Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic. J Pers Med 2021; 11:433. [PMID: 34069545 PMCID: PMC8161387 DOI: 10.3390/jpm11050433] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022] Open
Abstract
Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey.
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Affiliation(s)
- Shirin Vellani
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Veronique Boscart
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Canadian Institute for Seniors Care, Conestoga College, Kitchener, ON N2G 4M4, Canada
| | - Astrid Escrig-Pinol
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Mar Nursing School, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Alexia Cumal
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Alexandra Krassikova
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON M5B 1Z5, Canada;
| | - Nancy Zheng
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
| | - Lydia Yeung
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
| | - Katherine S. McGilton
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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Abstract
Numerous organizations have cited the increasing demand for palliative care in oncology and the challenge of a limited workforce to deliver specialty palliative care. Advanced practitioners in oncology can provide generalist or primary palliative care to complement the care provided by specialists and enhance the overall provision of care. This article reports on a National Cancer Institute-funded training program to prepare advanced practice nurses to incorporate palliative care within their practice. One-year follow-up of the first three national cohorts (N = 276) included evaluation of goal achievement as these nurses integrated palliative care within their oncology practice. Goal analysis reported here demonstrates the success of the training program in impacting practice as well as the barriers to implementation efforts. The advanced practice registered nurses' implemented goals included extensive training of clinicians across disciplines and numerous systems changes to improve delivery of palliative care. Advanced practice nurses will continue to be a valuable source of extending palliative care into oncology care to support patients and families across the disease trajectory.
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Affiliation(s)
| | - Rose Virani
- From City of Hope National Medical Center, Duarte, California
| | - Elinor Han
- From City of Hope National Medical Center, Duarte, California
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Kwon SH, Park MH, Kim HS. Education, Role, and Prospects of Advanced Practice Nurses in Hospice and Palliative Care in South Korea. J Hosp Palliat Care 2021; 24:1-12. [PMID: 37675054 PMCID: PMC10179999 DOI: 10.14475/jhpc.2021.24.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 09/08/2023]
Abstract
Hospice palliative care refers to holistic care provided by an interdisciplinary team aimed at improving the quality of life of patients suffering from life-threatening diseases and their families. Among interdisciplinary team members, hospice advanced practice nurses (APNs) trained as master's-level advanced nursing professionals are leaders who play an important role in providing patient-centered care and improving the quality of services. The Medical Service Act revised in 2018 requires the scope of practice of APNs in each field to be specified in the Ordinance of the Ministry of Health and Welfare. Accordingly, discussions on the role and scope of practice of hospice APNs are actively underway. In this review, the curriculum of hospice APNs, their work responsibilities and roles, and their current status are reviewed, and the future direction of the hospice APN system is also discussed.
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Affiliation(s)
- So-Hi Kwon
- Hospice & Palliative Center, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Myung-Hee Park
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea
| | - Hyun Sook Kim
- Department of Nursing, Korea National University of Transportation, Jeungpyeong, Korea
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14
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Stadolnik V. Letter to the Editor. Can Oncol Nurs J 2019; 29:155. [PMID: 31966002 PMCID: PMC6970469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Victoria Stadolnik
- Bachelor of Science Nursing Candidate 2019, Curry College School of Nursing, Milton, MA USA
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