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Lee JE, Haynes E, DeSanto-Madeya S, Kim YM. Social Determinants of Health and Multimorbidity Among Adults 50 Years and Older in the United States. Nurs Res 2024; 73:126-137. [PMID: 38411567 DOI: 10.1097/nnr.0000000000000708] [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: 02/28/2024]
Abstract
BACKGROUND Living with two or more chronic conditions simultaneously-known as multimorbidity-has become increasingly prevalent as the aging population continues to grow. However, the factors that influence the development of multimorbidity are still not fully understood. OBJECTIVES The purpose of this study was to investigate the prevalence of multimorbidity among U.S. adults 50 years and older and identify associated factors with multimorbidity. METHODS We used data from four cycles from the National Health and Nutrition Examination Survey (2011-2018) to examine the associations between social determinants of health and multimorbidity among American adults aged 50 years and older. A set of variables on socioeconomic status and health behaviors was chosen based on the social determinants of health conceptual framework developed by the World Health Organization. In our study, 4,552 participants were included. All analyses were accounted for a complex survey design and the use of survey weights. Multiple logistic regression analyses were performed to examine the associated factors with multimorbidity. RESULTS The average age was 63.1 years, and 52.9% were female. The average number of chronic conditions was 2.27. The prevalence of multimorbidity was 63.8%, with high cholesterol and hypertension being the most prevalent conditions. In the adjusted model, age, gender, household income, citizenship status, health insurance, healthcare access, body mass index, and smoking status were found to be associated with living with multimorbidity. DISCUSSION Our results indicate that continued efforts aimed at promoting smoking cessation and maintaining a healthy weight will be beneficial in preventing the onset of chronic conditions. Additional research is warranted to gain a deeper understanding of the interrelationships between gender, race/ethnicity, household income, citizenship status, health insurance, and healthcare access as social determinants of health in the context of multimorbidity. Further research will help us develop targeted interventions and policies to address disparities and improve health outcomes for individuals with multimorbidity.
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Basley SA, Ferszt GG, DeSanto-Madeya S. The Experiences of Nurses as Double-Duty Caregivers for a Family Member at the End of Life: Interpretive Description. J Hosp Palliat Nurs 2024:00129191-990000000-00115. [PMID: 38206386 DOI: 10.1097/njh.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Increasing numbers of individuals with complex, advanced illnesses are living longer and being cared for in the home by family members. As a result, family caregivers often experience physical, emotional, psychological, and social distress. A unique subset of this population are nurses who find themselves providing care in both their family lives and work lives, a phenomenon known as "double-duty caregiving." This study explored the experiences of nurses providing end-of-life care for family members while continuing to work as a nurse and the consequences of this experience. A qualitative design, using semistructured, in-depth interviews, was used to capture the double-duty caregivers' experiences. Four overarching themes were identified: It Takes a Village, Driving the Bus, Juggling Many Hats, and Moving Through and Looking Back. These themes captured the components of a support system that are essential for the double-duty caregiver to perform this work, the multifaceted expectations placed upon the double-duty caregiver, the double-duty caregiver's relentless need to balance multiple roles, and the immediate and long-term impact of double-duty caregiving. As nurses, we must acknowledge the need for self-care during this experience, and as a profession, we must provide support for the double-duty caregiver to preserve their personal and professional well-being.
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Ancuta C, DeSanto-Madeya S, Gaman D, Ferszt G, Mitrea N. Benefits of Early Palliative Care Integration in a Day Care Program: The Patients' Perspective. J Palliat Med 2023; 26:1535-1541. [PMID: 37672610 DOI: 10.1089/jpm.2023.0279] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Aim: The aim of this study is to present the experiences of cancer patients who participate in a social model palliative day care program (PDCP). This is the first research study that evaluates early integration of PDCP, from the patients' perspective, in Central and Eastern Europe. Methods: A descriptive qualitative study using five focus groups was conducted with patients cared by Hospice Casa Sperantei Foundation (HCS) in Brasov, Romania. Fifty participants were recruited from the PDCP. Discussions were transcribed and analyzed thematically. Results: Three major categories emerged from the focus groups: (1) significance of diagnosis before integration of palliative care (PC); (2) perceptions of diagnosis after integration of PC; and (3) benefits of attending the PDCP. The findings indicate that PDCPs facilitate continuity of care for patients and families with PC needs by addressing and responding to physical, psychosocial, and spiritual needs. Participation in the PDCP fosters a sense of connectedness with others, helps individuals reconnect with self, and provides an opportunity to engage in activities that bring meaning and value to daily living. Conclusions: This study is highly important in the context of a national- and regional-wide interest for increasing the coverage of PC needs of patients and families, by varying the types of services. It explores the benefits of integration of PC services early on the trajectory of the disease of cancer patients. The themes that emerged from this study are consistent with previous international studies referring to benefits of early integration of PC throughout PDCP. Future research is needed to examine further the benefits of early integration of PDCP services for patients living with serious illnesses. Clinical Trials Registration Number 1/03.02.2020.
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Affiliation(s)
- Camelia Ancuta
- Department of Fundamental, Prophylactic, and Clinical Disciplines, University of Transylvania, Brasov, Romania
- Department of National Development and Educational Programs, Hospice Casa Sperantei, Brasov, Romania
| | - Susan DeSanto-Madeya
- Interdisciplinary Palliative Care Program, College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA
| | - Doina Gaman
- Department of National Development and Educational Programs, Hospice Casa Sperantei, Brasov, Romania
| | - Ginette Ferszt
- Interdisciplinary Palliative Care Program, College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nicoleta Mitrea
- Department of Fundamental, Prophylactic, and Clinical Disciplines, University of Transylvania, Brasov, Romania
- Department of National Development and Educational Programs, Hospice Casa Sperantei, Brasov, Romania
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Puerto G, Chiriboga G, DeSanto-Madeya S, Duodu V, Cruz-Oliver DM, Tjia J. Advance Care Planning for Spanish-Language Speakers: Patient, Family, and Interpreter Perspectives. J Appl Gerontol 2023; 42:1840-1849. [PMID: 36794526 PMCID: PMC10440849 DOI: 10.1177/07334648231156864] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Language access barriers for individuals with limited-English proficiency are a challenge to advance care planning (ACP). Whether Spanish-language translations of ACP resources are broadly acceptable by US Spanish-language speakers from diverse countries is unclear. This ethnographic qualitative study ascertained challenges and facilitators to ACP with respect to Spanish-language translation of ACP resources. We conducted focus groups with a heterogeneous sample of 29 Spanish-speaking persons who had experience with ACP as a patient, family member, and/or medical interpreter. We conducted thematic analysis with axial coding. Themes include: (1). ACP translations are confusing; (2). ACP understanding is affected by country of origin; (3). ACP understanding is affected by local healthcare provider culture and practice; and (4). ACP needs to be normalized into local communities. ACP is both a cultural and clinical practice. Recommendations for increasing ACP uptake extend beyond language translation to acknowledging users' culture of origin and local healthcare culture.
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Dahlin C, DeSanto-Madeya S, Hurley SL, Chan SH, Wood O, Barron AM, Gazarian PK. Understanding primary palliative nursing education in undergraduate nursing programs. J Prof Nurs 2023; 46:205-212. [PMID: 37188412 DOI: 10.1016/j.profnurs.2023.02.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Nurses are the largest segment of health care professionals and often the first one to interact with individuals about their health and illness. Ensuring nurses have the education to care for individuals with serious illness is essential to quality health care. The new AACN Essentials: Competencies for Professional Nursing Education delineates hospice/palliative/supportive care as one of four spheres of nursing care. Surveying undergraduate schools/colleges of nursing in Massachusetts about content pertaining to care of individuals with serious illness provides the foundation for a state strategy to ensure quality primary palliative education for undergraduate nursing students. METHODS A Massachusetts statewide college/school of nursing survey approach to assessing primary palliative nursing education within undergraduate baccalaureate nursing curricula was performed from June 2020 to December 2020. Because the project was a collaboration with the Deans of the college/school of nursing, the survey identified the programs. RESULTS Survey results revealed that only a small number of Massachusetts nursing programs are preparing nurses with specific and formal primary palliative nursing education. However, programs are open to support and resources. CONCLUSION The survey provided information to inform a successful strategy to support primary palliative nursing education within Massachusetts undergraduate baccalaureate nursing curricula. A survey approach can serve as a model for other states.
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Affiliation(s)
- Constance Dahlin
- Salem Hospital, Salem, MA, United States of America; Center to Advance Palliative Care, New York, NY, United States of America.
| | - Susan DeSanto-Madeya
- College of Nursing, University of Rhode Island, Providence, RI, United States of America
| | | | - Stephanie H Chan
- Massachusetts Coalition for Serious Illness Care, Blue Cross Blue Shield of Massachusetts, Boston, MA, United States of America
| | - Olivia Wood
- Care Dimensions, Danvers, MA, United States of America; Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Anne-Marie Barron
- College of Natural, Behavioral and Health Sciences, Simmons University, United States of America; Massachusetts General Hospital, United States of America
| | - Priscilla K Gazarian
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States of America
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Forster-Holt N, DeSanto-Madeya S, Davis J. The Mortality of Family Business Leaders: Using a Palliative Care Model to Re-imagine Letting Go. Journal of Management Inquiry 2023. [DOI: 10.1177/10564926231159331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
The succession literature frames a leader's reluctance to let go as the single largest deterrent to succession planning, and early literature pointed to the stronghold that mortality can have on letting go. The notion has not captured our continued curiosity, preventing a full understanding of the tensions and antecedents of family business succession. Most scholarship on letting go describes a quest for immortality and in this sense, ‘mortality’ has been misapplied and one dimensional. In an interdisciplinary boost to family business, we turn to palliative care, where it is believed that the acknowledgment of one's mortality will facilitate letting go. We develop four typologies of letting go by combining elements of mortality awareness and planning that offers nuance and insights into long-held beliefs about this most vital and finite ‘soft issue’. We discuss emotion governance tools that help change the mortality awareness trajectory and support family business succession.
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Affiliation(s)
- Nancy Forster-Holt
- College of Business Administration, University of Rhode Island, Kingston, RI, USA
| | | | - James Davis
- Huntsman School of Business, Utah State University, Logan, UT, USA
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Rosa WE, Izumi S, Sullivan DR, Lakin J, Rosenberg AR, Creutzfeldt CJ, Lafond D, Tjia J, Cotter V, Wallace C, Sloan DE, Cruz-Oliver DM, DeSanto-Madeya S, Bernacki R, Leblanc TW, Epstein AS. Advance Care Planning in Serious Illness: A Narrative Review. J Pain Symptom Manage 2023; 65:e63-e78. [PMID: 36028176 PMCID: PMC9884468 DOI: 10.1016/j.jpainsymman.2022.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Advance care planning (ACP) intends to support person-centered medical decision-making by eliciting patient preferences. Research has not identified significant associations between ACP and goal-concordant end-of-life care, leading to justified scientific debate regarding ACP utility. OBJECTIVE To delineate ACP's potential benefits and missed opportunities and identify an evidence-informed, clinically relevant path ahead for ACP in serious illness. METHODS We conducted a narrative review merging the best available ACP empirical data, grey literature, and emergent scholarly discourse using a snowball search of PubMed, Medline, and Google Scholar (2000-2022). Findings were informed by our team's interprofessional clinical and research expertise in serious illness care. RESULTS Early ACP practices were largely tied to mandated document completion, potentially failing to capture the holistic preferences of patients and surrogates. ACP models focused on serious illness communication rather than documentation show promising patient and clinician results. Ideally, ACP would lead to goal-concordant care even amid the unpredictability of serious illness trajectories. But ACP might also provide a false sense of security that patients' wishes will be honored and revisited at end-of-life. An iterative, 'building block' framework to integrate ACP throughout serious illness is provided alongside clinical practice, research, and policy recommendations. CONCLUSIONS We advocate a balanced approach to ACP, recognizing empirical deficits while acknowledging potential benefits and ethical imperatives (e.g., fostering clinician-patient trust and shared decision-making). We support prioritizing patient/surrogate-centered outcomes with more robust measures to account for interpersonal clinician-patient variables that likely inform ACP efficacy and may better evaluate information gleaned during serious illness encounters.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Shigeko Izumi
- School of Nursing (S.I.), Oregon Health and Science University, Portland, Oregon
| | - Donald R Sullivan
- Division of Pulmonary and Critical Care Medicine (D.R.S.), School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Joshua Lakin
- Department of Psychosocial Oncology and Palliative Care (J.L., R.B.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Abby R Rosenberg
- Division of Hematology-Oncology, Department of Pediatrics (A.R.R.), University of Washington School of Medicine, Seattle, Washington; Palliative Care and Resilience Lab (A.R.R.), Seattle Children's Research Institute, Seattle, Washington
| | | | - Debbie Lafond
- Pediatric and Neonatal Needs Advanced (PANDA) Education Consultants (D.L.)
| | - Jennifer Tjia
- Chan Medical School, University of Massachusetts (J.T.), Worcester, Massachusetts
| | - Valerie Cotter
- School of Nursing, Johns Hopkins University (V.C.), Baltimore, Maryland; School of Medicine, Johns Hopkins University (V.C.), Baltimore, Maryland
| | - Cara Wallace
- College for Public Health and Social Justice (C.W.), Saint Louis University, St. Louis, Missouri
| | - Danetta E Sloan
- Department of Health (D.E.S.), Behavior and Society, Johns Hopkins University, Baltimore, Maryland
| | - Dulce Maria Cruz-Oliver
- Geriatric Medicine and Gerontology (D.M.C.O.), Beacham Center for Geriatric Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | | | - Rachelle Bernacki
- Department of Psychosocial Oncology and Palliative Care (J.L., R.B.), Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Thomas W Leblanc
- Department of Medicine (T.W.L.), Duke University School of Medicine, Durham, North Carolina
| | - Andrew S Epstein
- Department of Medicine (A.S.E.), Memorial Sloan Kettering Cancer Center, New York, New York
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Mitrea N, Gerzevitz D, Mathe T, Steller J, White P, Ferszt G, DeSanto-Madeya S. Palliative Care Masterclass for Nurses in Central-Eastern Europe: An International Collaboration. J Hosp Palliat Nurs 2022; 24:E83-E87. [PMID: 35334480 DOI: 10.1097/njh.0000000000000859] [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: 11/26/2022]
Abstract
Given the increased need for palliative care services globally, the education of nurses has become paramount. In response, a group of nurses from Romania and the United States developed diverse nursing educational programs to meet the palliative care educational needs of nurses in Central-Eastern European countries. The purpose of this article is to describe a palliative nursing masterclass that was offered virtually to 59 participants, primarily nurses but also other health care professionals, from 11 Central-Eastern European countries.
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Joseph B, Sulmonte K, DeSanto-Madeya S, Koeniger-Donohue R, Cocchi M. Improving Accuracy in Documenting Cardiopulmonary Arrest Events. Am J Nurs 2022; 122:40-45. [PMID: 35348517 DOI: 10.1097/01.naj.0000827332.60571.70] [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] [Indexed: 10/18/2022]
Abstract
PURPOSE Traditional paper documentation of cardiopulmonary arrest (CPA) events is often inaccurate and incomplete. Electronic documentation supports appropriate process improvements and optimal patient care and contributes to greater accuracy in national databases from which national benchmarks are derived. The aim of this quality improvement initiative was to compare the timeliness and accuracy of paper-based versus electronic documentation of live CPA events. METHODS Nurses on four medical-surgical pilot units received training on the use of a handheld electronic device with a documentation app (Full Code Pro) to document live CPA events. The data were downloaded into an Excel file and compared for completeness and accuracy with the data downloaded from the LIFEPAK 15 defibrillator using CODE-STAT 10.0 software. Electronic documentation and traditional paper documentation of events from units where the intervention wasn't implemented (control units) were also compared with the CODE-STAT data. RESULTS There were 26 CPA events: six on the pilot units were documented using the electronic app, 12 on the pilot units were documented using the paper-based method (the latter were excluded from analysis), and eight on the control units were documented using the existing paper forms. Data accuracy was significantly greater in the electronic group compared with the paper-based group for recorded rhythm (100% versus 13%, P = 0.01) and end-tidal carbon dioxide (67% versus 0%, P = 0.02). The electronic method significantly outperformed the paper-based method in legibility (100% versus 13%, P < 0.01). Staff reported increased satisfaction with the electronic documentation method. CONCLUSION Using electronic handheld devices to document live resuscitation events demonstrated the inaccuracies of paper-based documentation, supporting the findings of previous studies. Electronic documentation was superior to paper in overall documentation quality and allowed providers to identify and quickly document the initial rhythm of the event. A larger study using electronic documentation to capture more ventricular fibrillation and ventricular tachycardia arrests would show a greater accuracy of timing, which would have large positive effects on overall resuscitation quality.
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Affiliation(s)
- Bridgid Joseph
- Bridgid Joseph is director of patient experience at Yale New Haven Health-Lawrence + Memorial Hospital, New London, CT, and chief executive officer of ThriveIn LLC, a health care consulting company. At the time of this writing, she was director of emergency cardiovascular care at Beth Israel Deaconess Medical Center in Boston, where Kimberlyann Sulmonte is associate chief nurse, quality and safety, and Michael Cocchi is chief medical officer. Susan DeSanto-Madeya is Beth Israel Hospital Nurses Alumnae Association endowed nurse scientist at Beth Israel Deaconess Medical Center and Weyker Chair for Palliative Care associate professor at the University of Rhode Island College of Nursing in Kingston. Rebecca Koeniger-Donohue is associate professor at Simmons University in Boston. Contact author: Bridgid Joseph, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Hurley SL, DeSanto-Madeya S, Fortney CA, Izumi S, Phongtankuel V, Carpenter JG. Building Strong Clinician-Researcher Collaborations for Successful Hospice and Palliative Care Research. J Hosp Palliat Nurs 2022; 24:64-69. [PMID: 34873127 PMCID: PMC8720061 DOI: 10.1097/njh.0000000000000818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hospice and palliative care research aim to build a knowledge base to guide high-quality care for people with serious illness and improve their quality of life. Considering its focus on patient and family caregiver's experiences, hospice and palliative care research activities primarily take place in real-world clinical settings where seriously ill patients and their family caregivers receive care (eg, nursing homes, clinics, inpatient units). Conducting research in these settings poses many challenges because researchers, clinicians, and administrators may have different priorities-and scientific control is difficult. Therefore, clinician-researcher-administrator collaboration in planning and conducting studies is critical for successful hospice and palliative care research. For an effective collaboration, clinicians, researchers, and site administrators must be considered equal partners. Each collaborator brings their unique expertise, knowledge, and skills that when combined can strengthen scientific rigor, feasibility, and success of the project, as well as have study outcomes that are more translatable to real-world practice. However, little guidance exists to give actionable steps to build collaborative partnerships for hospice and palliative care researchers. The purpose of this article is to describe the process of forming successful clinician-researcher-administrator collaborations through five phases of the research life cycle: idea generation, partnership, proposal writing, research process, and dissemination. Exemplars are drawn from the authors' experiences conducting collaborative research and highlight strategies and resources for successful hospice and palliative care collaborations.
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Tjia J, Clayton MF, Fromme EK, McPherson ML, DeSanto-Madeya S. Shared Medication PLanning In (SIMPLIfy) Home Hospice: An Educational Program to Enable Goal-Concordant Prescribing In Home Hospice. J Pain Symptom Manage 2021; 62:1092-1099. [PMID: 34098012 PMCID: PMC8556298 DOI: 10.1016/j.jpainsymman.2021.05.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/14/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Simplifying medication regimens by tapering and/or withdrawing unnecessary drugs is important to optimize quality of life and safety for patients with serious illness. Few resources are available to educate clinicians, patients and family caregivers about this process. OBJECTIVE To describe the development of an educational program called Shared Medication PLanning In (SIMPLIfy) Home Hospice. METHODS An environmental scan identified a state-of-the-art educational program for home hospice deprescribing that we adapted using a stakeholder panel engagement process. The stakeholder panel (two hospice administrators, three nurses, two physicians, two pharmacists, and two former family caregivers) drawn from two geographically diverse hospice agencies reviewed the educational program and recommended additional content. RESULTS Iterative rounds of review and feedback resulted in: 1) a three-part clinician educational program (total duration = 1.5 hour) that presents a standardized, goal-concordant, medication review approach to align medications and conversations about regimen simplification with patient and family caregiver goals of care; 2) a patient-family caregiver medication management educational notebook that presents common symptoms, hospice medications, and medication regimen simplification principles; and 3) a brief guide including helpful phrases to use as conversation starters for key steps in the program. A professional designer created thematic coherence for all materials that was well received by stakeholder panelists and hospice staff. CONCLUSION Educational materials can support hospice programs' and clinicians' efforts to implement goal-concordant medication simplification that optimizes end-of-life outcomes for patients and family caregivers. Evaluation of outcomes including medication appropriateness and family caregiver medication administration burden are not yet available.
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Affiliation(s)
- Jennifer Tjia
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.
| | | | - Erik K Fromme
- Ariadne Labs, Boston, Massachusetts, USA; Harvard Medical School, Cambridge, Massachusetts, USA
| | | | - Susan DeSanto-Madeya
- Ariadne Labs, Boston, Massachusetts, USA; University of Rhode Island College of Nursing, Kingston, Rhode Island, USA
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Joseph B, Mackinson LG, Sokol-Hessner L, Law AC, DeSanto-Madeya S. CE: A Prone Positioning Protocol for Awake, Nonintubated Patients with COVID-19. Am J Nurs 2021; 121:36-44. [PMID: 34510111 DOI: 10.1097/01.naj.0000794108.07908.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Prone positioning of critically ill patients with acute respiratory distress syndrome is an accepted therapy done to improve oxygenation and promote weaning from mechanical ventilation. But there is limited information regarding its use outside of the ICU. At one Boston hospital, the influx of patients with suspected or confirmed COVID-19 strained its resources, requiring sweeping systems changes and inspiring innovations in clinical care. This article describes how an interdisciplinary team of clinicians developed a prone positioning protocol for use with awake, nonintubated, oxygen-dependent patients with suspected or confirmed COVID-19 on medical-surgical units, with the hope of hastening their recovery and avoiding deterioration and ICU transfer. A protocol implementation plan and staff educational materials were disseminated via the hospital incident command system and supported through daily leadership huddles. Patient eligibility criteria, including indications and contraindications, and a clear nursing procedure for the implementation of prone positioning with a given patient, were key elements. Nurses' feedback of their experiences with the protocol was elicited through an e-mailed survey. Nearly all respondents reported improvements in patients' oxygen saturation levels, while few respondents reported barriers to protocol implementation. The prone positioning protocol was found to be both feasible for and well tolerated by awake, nonintubated patients on medical-surgical units, and can serve as an example for other hospitals during this pandemic.
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Affiliation(s)
- Bridgid Joseph
- Bridgid Joseph is program director of the Emergency Cardiovascular Care Center at Beth Israel Deaconess Medical Center in Boston, where Lynn G. Mackinson is a nurse specialist in the Department of Cardiovascular Medicine, Lauge Sokol-Hessner is an attending physician in the Department of Hospital Medicine and the medical director of patient safety, and Anica C. Law is an attending physician in the Department of Pulmonary, Critical Care, and Sleep Medicine. Susan DeSanto-Madeya is the Miriam Weyker Endowed Chair for Palliative Care and an associate professor at the University of Rhode Island College of Nursing, Providence. Contact author: Bridgid Joseph, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Clements C, Barsamian J, Burnham N, Cruz C, Darcy AMG, Duphiney L, FitzGerald J, Holland S, Joyce C, DeSanto-Madeya S. Supporting Frontline Staff During the COVID-19 Pandemic. Am J Nurs 2021; 121:46-55. [PMID: 34438429 DOI: 10.1097/01.naj.0000790632.18077.c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic that emerged in early 2020 put unprecedented physical, mental, and emotional strain on the staff of health care organizations, who have been caring for a critically ill patient population for more than a year and a half. Amid the ongoing pandemic, health care workers have struggled to keep up with new information about the disease, while also coping with the anxiety associated with caring for affected patients. It has also been a continual challenge for nurse leaders to provide adequate support for staff members and keep them informed about frequently changing practices and protocols. In this article, nursing leaders at an academic medical center in Boston reflect on the initial COVID-19 patient surge, which occurred from March to June 2020, and identify key actions taken to provide clinical and emotional support to frontline staff who cared for these patients. Lessons learned in this period provide insight into the management of redeployed staff, use of emotional support and debriefing, and relationship between access to information and staff morale. The knowledge gained through these initial experiences has been a vital resource as health care workers continue to face challenges associated with the ongoing pandemic.
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Affiliation(s)
- Charlotte Clements
- Charlotte Clements is a nurse educator at Beth Israel Deaconess Medical Center in Boston, where Jennifer Barsamian and Ann Marie Grillo Darcy are nurse specialists, Nicolette Burnham , Claire Cruz , and Jacqueline FitzGerald are nursing directors, Lindsay Duphiney is a nurse educator, Susan Holland is a patient safety coordinator and risk manager, Christine Joyce is a resource nurse, and Susan DeSanto-Madeya is a nurse scientist. Contact author: Charlotte Clements, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Clark LTS, Sanchez S, Phelan C, Sokol-Hessner L, Bruce K, DeSanto-Madeya S. COVID-19 inpatient cohorting team: Successes and lessons learned. Nurs Manag (Harrow) 2021; 52:38-45. [PMID: 33908921 DOI: 10.1097/01.numa.0000737624.29748.4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lauren T S Clark
- At Beth Israel Deaconess Medical Center in Boston, Mass., Lauren T.S. Clark is a cardiac surgery clinical nurse and lead quality improvement management system fellow, Sandra Sanchez is the office of bed management and transfer center nursing director, Cynthia Phelan is an associate chief nurse, Lauge Sokol-Hessner is the patient safety medical director, Kendra Bruce is a cardiac medicine unit-based educator, and Susan DeSanto-Madeya is a nurse scientist and an associate professor at the University of Rhode Island College of Nursing in Kingston, R.I
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15
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Tjia J, Clayton M, Chiriboga G, Staples B, Puerto G, Rappaport L, DeSanto-Madeya S. Stakeholder-engaged process for refining the design of a clinical trial in home hospice. BMC Med Res Methodol 2021; 21:92. [PMID: 33941089 PMCID: PMC8091786 DOI: 10.1186/s12874-021-01275-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Clinical trials in home hospice settings are important to build the evidence base for practice, but balancing the burden and benefit of clinical trial conduct for clinicians, patients, and family caregivers is challenging. A stakeholder-engaged process can help inform and refine key aspects of home hospice clinical trials. The aim of this study was to describe a stakeholder-engaged process to refine, design, and implement aspects of an educational intervention trial in home hospice, including recommendations for refining intervention content and delivery, recruitment and enrollment strategies, and content and frequency of outcome measurement. Methods A panel of interprofessional (1 hospice administrator, 3 nurses, 2 physicians, 2 pharmacists) and 2 former family caregiver stakeholders was systematically selected and invited to participate based on expertise, representing 2 geographically distinct hospices who were participating in the clinical trial. Teleconferences followed a predetermined procedural sequence: 1. pre-meeting materials distribution and review; 2. pre-meeting email solicitation of concerns in response to materials; 3. teleconference with structured and guided discussion; and 4. documentation and distribution of minutes for accuracy review and future meeting guidance. Discussion topics were distinct for each panel meeting. Written reflections on the stakeholder engagement process were collected from panel members to further refine our process. Results Five initial biweekly teleconferences resulted in recommendations for recruitment strategy, enrollment process, measurement frequency, patient inclusion, and primary care physician notification of the patient’s trial involvement. The panel continues to participate in quarterly teleconferences to review progress and unexpected questions and concerns. Panelist reflections reveal personal and professional benefit from participation. Conclusions An interprofessional stakeholder process is feasible and invaluable for developing home hospice intervention studies, contributing to better science, successful trial implementation, and relevant, valid outcomes. Trial registration Clinicaltrials.gov, NCT03972163, Registered June 3, 2019.
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Affiliation(s)
- Jennifer Tjia
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA.
| | | | - Germán Chiriboga
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA
| | - Brooke Staples
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA
| | - Geraldine Puerto
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA
| | - Lynley Rappaport
- University of Massachusetts Medical School, 368 Plantation Street, AS6-2065, Worcester, MA, 01605, USA
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16
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Abstract
Lessons learned from one hospital's COVID-19 experience.
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Affiliation(s)
- Kimberly Cross
- At Beth Israel Deaconess Medical Center in Boston, Mass., Kimberly Cross is a nurse director of cardiac medicine, Alice Bradbury is a nurse director of general medicine, Nikki Burnham is a nurse director of inpatient surgery, Denise Corbett-Carbonneau is a nurse director of general medicine, Kym Peterson is a nurse specialist in neuroscience and general medicine, Cynthia Phelan is an associate chief nurse of patient care services, and Susan DeSanto-Madeya is a nurse scientist and the Weyker chair for palliative care and associate professor at the University of Rhode Island College of Nursing in Kingston, R.I
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17
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DeSanto-Madeya S, Tjia J, Fitch C, Wachholtz A. Feasibility and Acceptability of Digital Legacy-Making: An Innovative Story-Telling Intervention for Adults With Cancer. Am J Hosp Palliat Care 2020; 38:772-777. [PMID: 33167669 DOI: 10.1177/1049909120971569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study examined the feasibility, burden and acceptability of a legacy-making intervention in adults with cancer and preliminary effects on patient quality-of-life (QOL) measures. METHOD We conducted a Stage IB pilot, intervention study. The intervention was a digital video legacy-making interview of adults with advanced cancer to create a digital video of their memories and experiences. Baseline and post-video QOL assessments included: Functional Assessment of Cancer Therapy-General (FACT-G), Patient Dignity Inventory (PDI), Hospital Anxiety and Depression Scale (HADS), and Emotional Thermometers for distress, anxiety, anger, help and depression. Participants received a final copy of the digital video for distribution to their families. RESULTS Adults (n = 16) ages 38-83 years old with an advanced or life-limiting cancer diagnosis completed an intervention. Feasibility and acceptability was strong with 0% attrition. While the pilot study was not powered for quantitative significance, there were changes from baseline to post-intervention in the participants' total or subscale FACT-G scores, PDI, HADS anxiety or depression scores, and Emotional Thermometer scores. CONCLUSIONS A digital video legacy-making intervention is feasible for adults with cancer without significant negative outcomes for individuals completing the study. It remains unclear whether this intervention contributes to positive quality of life outcomes.
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Affiliation(s)
| | - Jennifer Tjia
- 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Christina Fitch
- 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Amy Wachholtz
- 12262University of Massachusetts Medical School, Worcester, MA, USA.,1878University of Colorado Denver, Denver, CO, USA
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18
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Dahlin C, Sanders J, Calton B, DeSanto-Madeya S, Donesky D, Lakin JR, Roeland E, Scherer JS, Walling A, Williams B. The Cambia Sojourns Scholars Leadership Program: Projects and Reflections on Leadership in Palliative Care. J Palliat Med 2019; 22:823-829. [PMID: 30810459 DOI: 10.1089/jpm.2018.0523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Effective leadership is necessary to meet the complex care needs of patients with serious, life-limiting illness. The Cambia Health Foundation Sojourns Scholars Program is advancing leadership in palliative care through supporting emerging leaders. The 2016 Cohort has implemented a range of projects to promote their leadership development. Objective: To describe the leadership themes emerging from individual project implementation of the 2016 Sojourns Leadership. Methods: We summarize the synthesized leadership themes derived from both remote and in-person meetings and written reflections of the 2016 Cambia Sojourn Leadership Cohort. Results: The 2016 Cambia Sojourn Leadership Scholar Cohort projects are described. We identified three leadership themes related to palliative care initiatives: openness and flexibility, partnership and team building, and leveraging expertise and risk. Discussion: Unprecedented challenges in a rapidly changing health environment demand palliative care leadership to influence care quality, delivery, policy, and clinical care. Flexibility and openness; partnership and team building; and expertise to implement change emerged as critical themes to advancing the care of patients with serious, life-limiting illness. These leadership themes are consistent with both previous Cambia Sojourns Scholar cohorts and the literature, are essential for the next generation of leaders to implement new models of quality palliative care, payment for palliative care, and education for patients, caregivers, and health care providers. Conclusion: In order to design and implement quality palliative care, leadership development is essential. Use of flexibility and openness; partnership and team building; and expertise to implement change are important themes for success. Whether through the Cambia Health Foundation Sojourns Leadership Program or opportunities within professional organizations, cultivation of the next generation of leaders is critical.
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Affiliation(s)
- Constance Dahlin
- 1 Hospice and Palliative Nurses Association, Pittsburgh Pennsylvania
| | - Justin Sanders
- 2 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and Ariadne Labs, Boston, Massachusetts
| | - Brook Calton
- 3 Division of Palliative Medicine, Department of Medicine, University of California-San Francisco, San Francisco, California
| | | | - DorAnne Donesky
- 5 School of Nursing, Touro University of California, Vallejo, California
| | - Joshua R Lakin
- 2 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and Ariadne Labs, Boston, Massachusetts
| | - Eric Roeland
- 6 Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jennifer S Scherer
- 7 Division of Palliative Care and Division of Nephrology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Anne Walling
- 8 Division of General Internal Medicine and Health Services Research, Department of Medicine, Division of Palliative Medicine, Department of Medicine, University of California-Los Angeles, Los Angeles, California.,9 VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Brie Williams
- 10 Division of Geriatrics, Department of Medicine, University of California-San Francisco, San Francisco, California
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19
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DeSanto-Madeya S, Willis D, McLaughlin J, Boslet A. Healing experience for family caregivers after an intensive care unit death. BMJ Support Palliat Care 2019; 12:e578-e584. [PMID: 30723073 DOI: 10.1136/bmjspcare-2018-001561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 01/02/2019] [Accepted: 01/16/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Family caregivers suffer a high burden of emotional and psychological distress following the death of a loved one in the intensive care unit and often struggle to heal in the weeks following their loss. The purpose of this hermeneutic phenomenological study was to describe and interpret the experience of healing for family caregivers six weeks following the death of a loved one in the ICU. METHODS Semi-structured telephone interviews were conducted with a purposive sample of twenty-four family caregivers six weeks following the death of their loved ones in the ICU. Qualitative analysis techniques were used to identify common themes central to the experience of healing across all interviews. RESULTS Seven themes were interpreted from the data: searching for clarity from a time of uncertainty; riding an emotional rollercoaster; seeking peace in one's decisions; moving forward with each new day; taking comfort in the memories; valuing layers of support; and discovering life on one's own. CONCLUSION By identifying and gaining an understanding of healing following the death of a loved one in the ICU, nursing and other healthcare providers have an opportunity to promote healing and positively impact family caregiver's bereavement.
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Affiliation(s)
- Susan DeSanto-Madeya
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA .,Patient Care Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Dan Willis
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Julie McLaughlin
- Medical Associates of Greater Boston, Natick, Massachusetts, USA
| | - Aristotle Boslet
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
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20
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DeSanto-Madeya S, Abrahamson C, DiGuglelmo K. ENGAGING KEY STAKEHOLDERS TO IMPROVE THE MOLST (MEDICAL ORDERS FOR LIFE-SUSTAINING TREATMENTS) PROCESS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3255] [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: 11/14/2022] Open
Affiliation(s)
| | - C Abrahamson
- Boston College, Connell School of Nursing, Chestnut Hill, MA, USA
| | - K DiGuglelmo
- Boston College, Connell School of Nursing, Chestnut Hill, MA, USA
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21
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Milliken A, Ludlow L, DeSanto-Madeya S, Grace P. The development and psychometric validation of the Ethical Awareness Scale. J Adv Nurs 2018; 74:2005-2016. [PMID: 29672907 DOI: 10.1111/jan.13688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 11/26/2022]
Abstract
AIM To develop and psychometrically assess the Ethical Awareness Scale using Rasch measurement principles and a Rasch item response theory model. BACKGROUND Critical care nurses must be equipped to provide good (ethical) patient care. This requires ethical awareness, which involves recognizing the ethical implications of all nursing actions. Ethical awareness is imperative in successfully addressing patient needs. Evidence suggests that the ethical import of everyday issues may often go unnoticed by nurses in practice. Assessing nurses' ethical awareness is a necessary first step in preparing nurses to identify and manage ethical issues in the highly dynamic critical care environment. DESIGN A cross-sectional design was used in two phases of instrument development. METHOD Using Rasch principles, an item bank representing nursing actions was developed (33 items). Content validity testing was performed. Eighteen items were selected for face validity testing. Two rounds of operational testing were performed with critical care nurses in Boston between February-April 2017. RESULTS A Rasch analysis suggests sufficient item invariance across samples and sufficient construct validity. The analysis further demonstrates a progression of items uniformly along a hierarchical continuum; items that match respondent ability levels; response categories that are sufficiently used; and adequate internal consistency. Mean ethical awareness scores were in the low/moderate range. CONCLUSION The results suggest the Ethical Awareness Scale is a psychometrically sound, reliable and valid measure of ethical awareness in critical care nurses.
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Affiliation(s)
- Aimee Milliken
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Larry Ludlow
- Lynch School of Education, Boston College, Chestnut Hill, Massachusetts, USA
| | | | - Pamela Grace
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
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22
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Einstein DJ, DeSanto-Madeya S, Gregas M, Lynch J, McDermott DF, Buss MK. Improving End-of-Life Care: Palliative Care Embedded in an Oncology Clinic Specializing in Targeted and Immune-Based Therapies. J Oncol Pract 2017; 13:e729-e737. [DOI: 10.1200/jop.2016.020396] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. Materials and Methods: We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care). We abstracted data from the medical records of 114 patients who died during the 3 years after this model’s implementation. Results: Compared with usual care (n = 88), patients with access to the embedded model (n = 26) encountered palliative care as outpatients more often ( P = .003) and earlier (mean, 231 v 109 days before death; P < .001). Hospice enrollment rates were similar ( P = .303), but duration was doubled (mean, 57 v 25 days; P = .006), and enrollment > 7 days before death—a core Quality Oncology Practice Initiative metric—was higher in the embedded model (odds ratio, 5.60; P = .034). Place of death ( P = .505) and end-of-life chemotherapy (odds ratio, 0.361; P = .204) did not differ between the two arms. Conclusion: A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.
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Affiliation(s)
- David J. Einstein
- Beth Israel Deaconess Medical Center; Boston College; and Massachusetts General Hospital, Boston, MA
| | - Susan DeSanto-Madeya
- Beth Israel Deaconess Medical Center; Boston College; and Massachusetts General Hospital, Boston, MA
| | - Matthew Gregas
- Beth Israel Deaconess Medical Center; Boston College; and Massachusetts General Hospital, Boston, MA
| | - Jessica Lynch
- Beth Israel Deaconess Medical Center; Boston College; and Massachusetts General Hospital, Boston, MA
| | - David F. McDermott
- Beth Israel Deaconess Medical Center; Boston College; and Massachusetts General Hospital, Boston, MA
| | - Mary K. Buss
- Beth Israel Deaconess Medical Center; Boston College; and Massachusetts General Hospital, Boston, MA
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23
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Einstein DJ, DeSanto-Madeya S, Gregas M, Lynch JA, McDermott DF, Buss MK. Improving end-of-life care: Palliative care embedded in an outpatient oncology clinic. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
77 Background: Patients with advanced cancer benefit from early involvement of palliative care. Nonetheless, the ideal method of palliative care integration remains to be determined. Prior studies proposed automatic referral criteria and embedding palliative care teams within specialty clinics. Methods: We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic based on automatic referral criteria. Patients seen in this clinic on a specific day had access to the “embedded” model, whereas patients seen on two other days could access a separate palliative care clinic upon oncologist referral (usual care). We abstracted data from the medical records of 118 patients who were cared for in this oncology clinic and died during the 3 years following implementation of the embedded model. Results: Compared with those with access to usual care (n = 88), patients with access to the embedded model (n = 30) encountered palliative care as outpatients more often (p < 0.001) and twice as long before death (mean 223 versus 106 days, p = 0.001). Hospice enrollment rates were similar (p = 0.717) but duration was twice as long (mean 53.5 versus 25.3 days, p = 0.03), and enrollment greater than 7 days before death—a core Quality Oncology Practice Initiative metric—was significantly higher in the embedded model (OR 5.60, p = 0.034). Place of death (p = 0.505) and end-of-life chemotherapy (OR 0.361, p = 0.204) did not differ significantly. Conclusions: A model of embedded palliative care with automatic referral criteria, compared with usual practice, was associated with significant improvements in utilization and timing of palliative care and hospice.
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Affiliation(s)
| | | | - Matt Gregas
- Boston College Research Services, Chestnut Hill, MA
| | | | | | - Mary K. Buss
- Beth Israel Deaconess Medical Center, Boston, MA
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24
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DeSanto-Madeya S, McDermott D, Zerillo JA, Weinstein N, Buss MK. Developing a model for embedded palliative care in a cancer clinic. BMJ Support Palliat Care 2017; 7:247-250. [PMID: 28258162 DOI: 10.1136/bmjspcare-2016-001304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/10/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Describe the development and key features of a model for embedded palliative care (PC) for patients with advanced kidney cancer or melanoma seen in a cancer clinic. METHODS Retrospective chart review of patients following an initial phase and then a prospective review following the implementation of a model for embedded PC. RESULTS In the initial phase, 18 patients were seen for a total of 53 visits; 78% were seen more than once, with a mean of three visits per patient. In the model phase, 46 patients were seen for a total of 163 visits; 74% were seen more than once, with a mean of 3.5 visits. Demographics were similar between the two groups. Content of the first PC visit in the initial and model phases was symptom management (61% and 57%), psychosocial support/relationship building (28% and 35%) and advance care planning/decision-making support (11% and 8%), respectively. CONCLUSIONS The initial phase demonstrated acceptability and feasibility of a model for embedded PC for patients and the oncology team. Establishment of specific eligibility criteria and screening to identify eligible patients in the model phase led to an increased uptake of PC for patients with advanced kidney cancer and melanoma in a cancer clinic.
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Affiliation(s)
- Susan DeSanto-Madeya
- Boston College, Wm. F.Connell School of Nursing, Chestnut Hill, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - David McDermott
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nancy Weinstein
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mary K Buss
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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25
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Baker KM, DeSanto-Madeya S, Banzett RB. Routine dyspnea assessment and documentation: Nurses' experience yields wide acceptance. BMC Nurs 2017; 16:3. [PMID: 28100958 PMCID: PMC5237543 DOI: 10.1186/s12912-016-0196-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/12/2016] [Indexed: 01/27/2023] Open
Abstract
Background Dyspnea (breathing discomfort) is a common and distressing symptom. Routine assessment and documentation can improve management and relieve suffering. A major barrier to routine dyspnea documentation is the concern that it will have a deleterious effect on nursing workflow and that it will not be readily accepted by nurses. Nurses at our institution recently began to assess and document dyspnea on all medical-surgical patients upon admission and once per shift throughout their hospitalization. A year after dyspnea measurement was implemented we explored nurses’ approach to dyspnea assessment, their perception of patient response, and their perception of the utility and burden of dyspnea measurement. Methods We obtained feedback from nurses using a three-part assessment of practice: 1) a series of recorded focus group interviews with nurses, 2) a time-motion observation of nurses performing routine dyspnea and pain assessment, and 3) a randomized, anonymous on-line survey based, in part, on issues raised in focus groups. Results Ninety-four percent of the nurses surveyed reported administering the dyspnea assessment is “easy” or “very easy”. None of the nurses reported that assessing dyspnea negatively impacted workflow and many reported that it positively improved their practice by increasing their awareness. Our time-motion data showed dyspnea assessment and documentation takes well less than a minute. Nurses endorsed the importance of routine measurement and agreed that most patients were able to provide a meaningful rating of their dyspnea. Nurses found the patient report very useful, and used it in conjunction with observed signs to respond to changes in a patient’s condition. Conclusions In this study, we have demonstrated that routine dyspnea assessment and documentation was widely accepted by the nurses at our institution. Our nurses fully incorporated routine dyspnea assessment and documentation into their practice and felt that it improved patient-centered care. Electronic supplementary material The online version of this article (doi:10.1186/s12912-016-0196-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathy M Baker
- Lois E. Silverman Department of Nursing, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Reisman 1113, Boston, MA 02215 USA
| | - Susan DeSanto-Madeya
- Lois E. Silverman Department of Nursing, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Reisman 1113, Boston, MA 02215 USA ; Connell School of Nursing, Boston College, Chestnut Hill, MA USA
| | - Robert B Banzett
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA ; Harvard Medical School, Boston, MA USA
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Abstract
Nurse educators are continually challenged to develop teaching strategies that enhance students' critical thinking, problem-solving, and decision-making skills. Case studies are a creative learning strategy that fosters these skills through the use of in-depth descriptions of realistic clinical situations. Conceptual models of nursing provide a unique body of knowledge that can be used to guide construction of case studies and enhance application of didactic course content to nursing practice. In this column, the author discusses the use of case studies constructed within the context of the Roy adaptation model for a senior level medical-surgical nursing course.
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Affiliation(s)
- Susan DeSanto-Madeya
- College of Nursing and Health Sciences, University of Massachusetts-Boston, Boston, MA, USA
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27
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Abstract
Healing and transcendence are concepts of considerable interest to nurses who engage in holistic nursing practice. The two concepts are often used within the context of adaptation to describe the processes experienced by individuals who experience suffering and distress from various life events. Despite their intuitive significance to the human experience, the similarities and differences between the two concepts remains unclear. The purpose of this paper is to present the results of a Roy adaptation model-guided comparison of the two concepts that addresses their shared and distinct characteristics.
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28
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Lynch JA, DeSanto-Madeya S, Zerillo JA, Gregas M, McDermott DF, Mukamal KJ, Buss MK. Impact of integrated palliative care model on end-of-life (EOL) quality metrics for patients with kidney cancer (RCC) and melanoma (M). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.29_suppl.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
137 Background: Early palliative care (PC) improves quality of life (QOL) and enhances end-of-life (EOL) care, but the optimal timing and most effective model for integrating PC into oncologic care is uncertain. To understand the impact of an integrated model with PC providers embedded with oncologists vs. usual care (UC) with referral at the discretion of the same oncologists, we examined the timing and delivery of PC and Quality Oncology Practice Initiative (QPOI) EOL metrics among patients with RCC and M in a single clinic. We hypothesized that integrated PC would result in more referrals, earlier contact with PC and better QOPI EOL metrics compared with UC. Methods: In a retrospective cohort study of patients with RCC and M in the Beth Israel Deaconess Biologics Clinic who expired between 10/1/12 and 12/31/14, we compared patients seen 2 days/week, when referral to PC was discretionary, with a third day when PC providers shared the clinic for real-time consultations. Patients were identified as meeting PC eligibility if they had recurrent, metastatic disease and were on active treatment or had a symptom severity of 7+ on Edmonton Symptom Assessment Scale (ESAS). Two oncologists saw all patients, regardless of day. Results: Seventy-six patients expired, 19 in the Integrated PC model and 57 with UC. Patients were similar with respect to diagnosis and demographics except for smoking. The integrated model substantially improved timing and location of PC. In the integrated PC model, 85% were seen by PC compared with 45% in UC (P = 0.002). All patients in the integrated model began PC as an outpatient compared with 36% in UC (P < 0.001). The mean number of days from first PC contact to death was 28 (SD = 54) for UC and 118 (SD = 120) with integrated PC (P < 0.001). The location of death did not differ significantly between models, occurring outside the hospital with hospice among 71% of patients in the integrated model and 53% in UC (P = 0.25). Results were similar in relative risk models adjusted for smoking. Conclusions: A practice model that integrated PC with oncologic care was associated with more PC referrals, earlier contact, and a nonsignificant trend toward fewer deaths in hospital and ICU.
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Affiliation(s)
| | | | | | - Matt Gregas
- Boston College Research Services, Chestnut Hill, MA
| | | | | | - Mary K. Buss
- Beth Israel Deaconess Medical Center, Newton, MA
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29
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O'Donoghue SC, DeSanto-Madeya S, Fealy N, Saba CR, Smith S, McHugh AT. Nurses' Perceptions of Role, Team Performance, and Education Regarding Resuscitation in the Adult Medical-Surgical Patient. Medsurg Nurs 2015; 24:309-317. [PMID: 26665866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to explore nurses' perception of their roles, team performance, and educational needs during resuscitation using an electronic survey. Findings provide direction for clinical practice, nursing education, and future research to improve resuscitation care.
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DiLibero J, Lavieri M, O’Donoghue S, DeSanto-Madeya S. Withholding or continuing enteral feedings during repositioning and the incidence of aspiration. Am J Crit Care 2015; 24:258-61. [PMID: 25934723 DOI: 10.4037/ajcc2015482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Withholding enteral feedings during repositioning is based on tradition, but available evidence does not support this practice. Although research indicates that withholding of enteral feedings during repositioning contributes to undernourishment, the relationship between continuing enteral feedings during repositioning and the incidence of aspiration has not been determined. OBJECTIVE To determine the feasibility of a study designed to explore differences in the incidence of aspiration when enteral feedings are withheld or continued during repositioning. METHODS A crossover design with a convenience sample from 3 medical and 3 surgical intensive care units was used. Two sample sets of subglottal secretions were collected from each patient, once when enteral feedings were withheld during repositioning and once when enteral feedings were continued during the change in position. The incidence of aspiration was assessed by testing specimens for the presence of pepsin. RESULTS Sublgottal secretions were collected from 23 patients (n = 46 with crossover design). Aspiration during repositioning occurred in 2 patients when enteral feedings were withheld and in 2 patients when feedings were continued during repositioning. According to the McNemar test, the incidence of aspiration when enteral feedings were withheld did not differ significantly from the incidence when the feedings were continued during repositioning (P = .88). CONCLUSIONS A research protocol to directly explore the relationship between the incidence of aspiration and withholding or continuing enteral feedings during repositioning is feasible.
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Affiliation(s)
- Justin DiLibero
- Justin DiLibero, Sharon O’Donoghue, and Mary Lavieri are clinical nurse specialists at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Susan DeSanto-Madeya is an associate professor at Boston College, Boston, Massachusetts, and is the Beth Israel Hospital Nurses’ Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center
| | - Mary Lavieri
- Justin DiLibero, Sharon O’Donoghue, and Mary Lavieri are clinical nurse specialists at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Susan DeSanto-Madeya is an associate professor at Boston College, Boston, Massachusetts, and is the Beth Israel Hospital Nurses’ Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center
| | - Sharon O’Donoghue
- Justin DiLibero, Sharon O’Donoghue, and Mary Lavieri are clinical nurse specialists at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Susan DeSanto-Madeya is an associate professor at Boston College, Boston, Massachusetts, and is the Beth Israel Hospital Nurses’ Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center
| | - Susan DeSanto-Madeya
- Justin DiLibero, Sharon O’Donoghue, and Mary Lavieri are clinical nurse specialists at Beth Israel Deaconess Medical Center, Boston, Massachusetts. Susan DeSanto-Madeya is an associate professor at Boston College, Boston, Massachusetts, and is the Beth Israel Hospital Nurses’ Alumnae Association Endowed Nurse Scientist at Beth Israel Deaconess Medical Center
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Abstract
The authors present an explanation of the development of a situation-specific theory of men’s healing from maltreatment during childhood. Development of the theory was guided by Rogers’ science of unitary human beings (SUHB). The four multidimensional concepts of the theory are interpreted within the context of the SUHB from themes discovered from the findings of a hermeneutic phenomenological study of men who had been exposed to childhood maltreatment, including neglect and abuse. The concepts are: moving beyond suffering, desiring release from suffering, dwelling in suffering, and experiencing wellbeing. Moving beyond suffering is the process of healing from childhood maltreatment. Desiring release from suffering is the facilitator of men’s life experiences that speeds up the rate of evolution from moving beyond suffering to experiencing healing. Dwelling in suffering is the barrier in men’s life experiences that slows down the rate of evolution from moving beyond suffering to experiencing wellbeing.
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Abstract
56 Background: Early palliative care (PC) has been shown to improve quality of life (QOL), enhance quality end-of-life (EOL) care, and reduce costs, yet many cancer centers lack resources to provide outpatient palliative care services. Data is needed to identify the optimal timing and most effective and efficient model for integrating PC into the care of cancer patients. In order to understand what components of PC have the greatest impact on patients, we examined the acceptability of early PC among patients with kidney cancer (RCC) and melanoma (M) and describe the content of PC visits. Methods: In July 2013, the outpatient PC team at Beth Israel Deaconess Medical Center, including physician (MD), social worker (SW) and chaplain (chap) were invited to see patients within a clinic that specializes in seeing patients with advanced RCC and M. All patients completed data on symptom burden using the Edmonton Symptom Assessment Scale, measures of QOL and degree of psycho-social and spiritual support. Referral to PC was based on these metrics and physician discretion. Results: Of the 21 patients seen by PC, 57% had RCC; 76% male; 86% White; 57% married. Mean age was 62 (range: 36-87). At the 1st PC visit: All had locally adv/metastatic disease; 48% were being treated with curative intent; 29% had not yet started treatment; 57% rated pain 0 on 0-10 scale (range: 0-9). First PC visit content: 76% psychosocial support (including building rapport); 67% symptom management; 33% included advance care planning (ACP) and decision-making support. Ninety-one percent were seen >1 by PC; 19% seen by SW or chap; median PC visits: 3. Eighty-one percent completed health care proxy. Additional data on patient outcomes will be presented. Conclusions: Nearly half of patients seen by PC were being treated with curative intent, suggesting acceptability of early PC integration in patients with RCC and M. Symptom management and psychosocial support dominated the early PC visits.
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Affiliation(s)
- Mary K. Buss
- Beth Israel Deaconess Medical Center, Boston, MA
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Willis DG, Zucchero TL, DeSanto-Madeya S, Ross R, Leone D, Kaubris S, Moll K, Kuhlow E, Easton SD. Dwelling in suffering: barriers to men's healing from childhood maltreatment. Issues Ment Health Nurs 2014; 35:569-79. [PMID: 25072209 DOI: 10.3109/01612840.2013.856972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Based on findings from a hermeneutic phenomenological study, this article provides a description and interpretation of barriers to healing that men encountered in the aftermath of childhood maltreatment. An analysis of interview data collected from 52 adult male survivors healing from childhood maltreatment identified a theme, Dwelling in Suffering, as representing the full range of barriers that impeded their healing. Subthemes of Dwelling in Suffering Personally, Relationally, and Social-Environmentally are discussed. This research highlights a complex understanding of the challenges men experience in healing from childhood maltreatment and the need for practice interventions and future research to ameliorate men's suffering.
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Affiliation(s)
- Danny G Willis
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA
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Smith AR, DeSanto-Madeya S, Pérez JE, Tracey EF, DeCristofaro S, Norris RL, Mukkamala SL. How women with advanced cancer pray: a report from two focus groups. Oncol Nurs Forum 2012; 39:E310-6. [PMID: 22543402 DOI: 10.1188/12.onf.e310-e316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore the meaning, function, and focus of prayer for patients with advanced cancer, and to identify the effects of prayer on their coping. RESEARCH APPROACH Qualitative, descriptive design using focus groups. SETTING Three cancer centers that are part of a university-affiliated comprehensive cancer network in the northeastern United States. PARTICIPANTS 13 adult, female outpatients receiving active treatment for ovarian or lung cancer. METHODOLOGIC APPROACH Two semistructured, focus group interviews were conducted. Audiotapes were transcribed verbatim. Data were coded and analyzed using standard content analysis procedures. MAIN RESEARCH VARIABLES Prayer and coping. FINDINGS Four themes emerged: finding one's own way, renewed appreciation for life, provision of strength and courage, and gaining a stronger spiritual connection. In addition, praying for others, conversational prayer, petitionary prayer, ritual prayer, and thanksgiving prayer were used most often by participants to cope. CONCLUSIONS The findings support prayer as a positive coping mechanism for women with advanced ovarian or lung cancer. INTERPRETATION The study provides knowledge about prayer as a source of spiritual and psychological support. Oncology nurses should consider the use of prayer for patients coping with advanced cancer.
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Affiliation(s)
- Amy Rex Smith
- College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA.
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Cannon S, Connelly T, DeSanto-Madeya S, Fawcett J, Hayman LL, Hickson K, Lee H. Project report: analysis of the contents of the journal of family nursing (1995-2007). J Fam Nurs 2011; 17:270-271. [PMID: 21531860 DOI: 10.1177/1074840711404160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Sheila Cannon
- University of Massachusetts Boston, Boston, MA 02125-3393, USA
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DeSanto-Madeya S, Nilsson M, Loggers ET, Paulk E, Stieglitz H, Kupersztoch YM, Prigerson HG. Associations between United States acculturation and the end-of-life experience of caregivers of patients with advanced cancer. J Palliat Med 2010; 12:1143-9. [PMID: 19995291 DOI: 10.1089/jpm.2009.0063] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cultural beliefs and values influence treatment preferences for and experiences with end-of-life (EOL) care among racial and ethnic groups. Within-group variations, however, may exist based on level of acculturation. OBJECTIVES To examine the extent to which EOL treatment factors (EOL treatment preferences and physician-caregiver communication) and select psychosocial factors (mental health, complementary therapies, and internal and external social support) differ based on the level of acculturation of caregivers of patients with advanced cancer. METHODS One hundred sixty-seven primary caregivers of patients with advanced cancer were interviewed as part of the multisite, prospective Coping with Cancer Study. RESULTS Caregivers who were less acculturated were more positively predisposed to use of a feeding tube at EOL (odds ratio [OR] 0.99 [p = 0.05]), were more likely to perceive that they received too much information from their doctors (OR 0.95 [p = 0.05]), were less likely to use mental health services (OR 1.03 [p = 0.003] and OR 1.02 [p = 0.02]), and desire additional services (OR 1.03 [p = 0.10] to 1.05 [p = 0.009]) than their more acculturated counterparts. Additionally, caregivers who were less acculturated cared for patients who were less likely to report having a living will (OR 1.03 [p = 0.0003]) or durable power of attorney for health care (OR 1.02 [p = 0.007]) than more acculturated caregivers. Caregivers who were less acculturated felt their religious and spiritual needs were supported by both the community (beta -0.28 [p = 0.0003]) and medical system (beta -0.38 [p < 0.0001]), had higher degrees of self-efficacy (beta -0.22 [p = 0.005]), and had stronger family relationships and support (beta -0.27 [p = 0.0004]). CONCLUSIONS The level of acculturation of caregivers of patients with advanced cancer does contribute to differences in EOL preferences and EOL medical decision-making.
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Affiliation(s)
- Susan DeSanto-Madeya
- College of Nursing & Health Sciences, University of Massachusetts-Boston, Boston, Massachusetts 02125, USA.
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Abstract
The Roy adaptation model concepts of stimuli, coping mechanisms, and modes of adaptation have been translated into several middle-range concepts and measured using existing and new instruments. The concept of adaptation level, however, has rarely been used in Roy adaptation model-based research. This paper presents a description of how the Roy adaptation model concept of adaptation level was translated into the logically congruent middle-range theory concept of adjustment. A single-item instrument, the Adjustment Scale, is identified as one way to measure adjustment.
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Loggers ET, Maciejewski PK, Paulk E, DeSanto-Madeya S, Nilsson M, Viswanath K, Wright AA, Balboni TA, Temel J, Stieglitz H, Block S, Prigerson HG. Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. J Clin Oncol 2009; 27:5559-64. [PMID: 19805675 DOI: 10.1200/jco.2009.22.4733] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Black patients are more likely than white patients to receive life-prolonging care near death. This study examined predictors of intensive end-of-life (EOL) care for black and white advanced cancer patients. PATIENTS AND METHODS Three hundred two self-reported black (n = 68) and white (n = 234) patients with stage IV cancer and caregivers participated in a US multisite, prospective, interview-based cohort study from September 2002 to August 2008. Participants were observed until death, a median of 116 days from baseline. Patient-reported baseline predictors included EOL care preference, physician trust, EOL discussion, completion of a Do Not Resuscitate (DNR) order, and religious coping. Caregiver postmortem interviews provided information regarding EOL care received. Intensive EOL care was defined as resuscitation and/or ventilation followed by death in an intensive care unit. RESULTS Although black patients were three times more likely than white patients to receive intensive EOL care (adjusted odds ratio [aOR] = 3.04, P = .037), white patients with a preference for this care were approximately three times more likely to receive it (aOR = 13.20, P = .008) than black patients with the same preference (aOR = 4.46, P = .058). White patients who reported an EOL discussion or DNR order did not receive intensive EOL care; similar reports were not protective for black patients (aOR = 0.53, P = .460; and aOR = 0.65, P = .618, respectively). CONCLUSION White patients with advanced cancer are more likely than black patients with advanced cancer to receive the EOL care they initially prefer. EOL discussions and DNR orders are not associated with care for black patients, highlighting a need to improve communication between black patients and their clinicians.
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Affiliation(s)
- Elizabeth Trice Loggers
- Department of MedicalOncology, Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute Boston, MA 02114, USA
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Trice ED, Nilsson ME, Paulk E, DeSanto-Madeya S, Wright AA, Balboni TA, Steiglitz H, Maciejewski PK, Block SD, Prigerson HG. Predictors of aggressive end-of-life care among Hispanic and white advanced cancer patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9538 Background: Some ethnic/racial minority cancer patients (e.g. African Americans) have been shown to receive more life-prolonging care at the end-of-life (EOL) than white patients. Nevertheless, few studies have investigated whether Hispanic cancer patients receive more aggressive care than white patients and limited information exists on the predictors of aggressive care among Hispanic patients. The present study examined rates and predictors of aggressive EOL care among Hispanic and white cancer patients. Methods: Subjects participated in a US multi-site, prospective study between September 2002 - August 2008. Data were derived from interviews, conducted in English or Spanish, of 292 self-reported Hispanic (N=58) or white (N=234) stage IV cancer patients and their caregivers. Patients were followed until death, a median of 118.5 days later. Caregiver post-mortem interviews documented patient care in the last week of life. “Aggressive EOL care” was operationalized as cardiopulmonary resuscitation and/or ventilation and death in an intensive care unit. Aggressive EOL care was regressed on the following baseline, patient-reported, independent variables: a preference for life-prolonging care, EOL treatment discussion, do-not-resuscitate (DNR) order, terminal illness acknowledgement, and religious coping. Logistic regression models were stratified by ethnic status and controlled for significant confounds (e.g. socioeconomic status). Results: Hispanic and white advanced cancer patients were equally likely to receive aggressive EOL care (5.2% and 3.4%, respectively; p=0.878). Although religious coping and treatment preferences predicted aggressive EOL care for white patients (adjusted odds ratio 7.76 [p=0.025] and 13.20 [p=0.008]), they were not predictive among Hispanic patients. Hispanic patients were less likely than white patients to have DNR orders (22.4% vs 50.4%; p=0.007). For both white and Hispanic cancer patients, no patient who reported an EOL discussion or DNR order at baseline received aggressive EOL care. Conclusions: Given that EOL discussions and DNR orders may prevent aggressive EOL care among Hispanic cancer patients, further efforts to engage Hispanic patients and their caregivers in these activities may reduce aggressive EOL care. No significant financial relationships to disclose.
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Affiliation(s)
- E. D. Trice
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - M. E. Nilsson
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - E. Paulk
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - S. DeSanto-Madeya
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - A. A. Wright
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - T. A. Balboni
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - H. Steiglitz
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - P. K. Maciejewski
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - S. D. Block
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - H. G. Prigerson
- Dana-Farber Cancer Institute, Boston, MA; University of Texas, Southwestern, Dallas, TX; University of Massachusetts-Boston, Boston, MA; Brigham and Women's Hospital, Boston, MA
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Abstract
Based on the Roy adaptation model, this cross-sectional study was conducted with 15 spinal cord injured individuals and their family members to examine the physical, emotional, functional, and social components of adaptation to spinal cord injury at 1 year (n=7 dyads) and 3 years (n=8 dyads) post-injury. Findings indicate that spinal cord injured individuals and their family members, regardless of time since the initial injury, have a moderate level of adaptation and adjustment to spinal cord injury. The data suggested that adaptation to spinal cord injury during the first 3 years can be enhanced by providing ongoing social and educational support for not only the injured individuals, but also their family members.
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Trice ED, Paulk E, Nilsson ME, Wright AA, Balboni T, Viswanath K, Emmons KM, Stieglitz H, DeSanto-Madeya S, Prigerson HG. Understanding the role of ethnic status in Intensive Care Unit (ICU) deaths among advanced cancer patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
PURPOSE/OBJECTIVES To detail the daily activities of women with advanced breast cancer. DESIGN Descriptive, qualitative. SETTING Six clinical sites in New England. Of the six sites, three were urban, one was suburban, and two were rural, with three sites being comprehensive cancer centers. SAMPLE 84 women with a confirmed diagnosis of stage IV breast cancer with a life expectancy of four months or more. METHODS A secondary analysis of an expressive writing intervention study control group. As part of the control writing group, participants kept handwritten activity logs for four consecutive days. Standard content analysis procedures were used to analyze the transcribed activity logs. MAIN RESEARCH VARIABLES Activities of daily living in women with advanced breast cancer. FINDINGS 22 codes were identified that depicted the daily activities of participants. Subsequent analysis merged the 22 codes into six themes. CONCLUSIONS Findings demonstrated that patients with advanced breast cancer are living very full, active lives despite numerous symptoms and cancer treatments. IMPLICATIONS FOR NURSING The study serves as a foundation for the development of interventions to enhance daily functioning. Oncology nurses should counsel women with advanced cancer regarding pacing and self-care activities.
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Abstract
A phenomenological study was conducted with 20 spinal cord injured persons and their family members to examine the meaning of living with spinal cord injury 5 to 10 years after the initial injury. Seven themes emerged from the data. The themes are looking for understanding to a life that is unknown, stumbling along an unlit path, viewing self through a stained glass window, challenging the bonds of love, being chained to the injury, moving forward in a new way of life, and reaching normalcy. The uncovered meanings enhance our understanding and appreciation that living with spinal cord injury is a continuous learning experience. The study findings may be useful in the development of self-care strategies and ongoing interventions that focus on maintaining physical and psychological health for both spinal cord injured persons and their family members throughout the course of living with the disability.
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Affiliation(s)
- Susan DeSanto-Madeya
- College of Nursing and Health Sciences, University of Massachusetts-Boston, MA 02125, USA.
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