Improving Support for Family Caregivers of People with a Serious Illness in the United States: Strategic Agenda and Call to Action.

Background: An estimated 30% of the adult American population are caregivers and many of the people they support live with serious illnesses. Caregivers provide an average of 20 hours of services per week and are heavily involved in assisting with activities of daily living. This input represents considerable economic value to the health care system and to the well-being of communities. However, the impact of the burden on caregivers is considerable with negative outcomes on their physical, psychological, social, and financial well-being. The current landscape of caregiver policy in the United States is not well coordinated and does not meet the needs of this population. Objective: To develop a strategy to enhance the future of family caregiver support of people with serious illness within the United States. Methods: (1) Creation of project steering and key stakeholder groups; (2) survey and in-depth interviews with key stakeholders; (3) review of key family caregiver reports, systematic reviews, policies, and financial initiatives. Results: A strategy to provide clear direction to enhance the future of family caregiver support of people with serious illness within the United States was developed focusing explicitly on policy, research, training, service delivery, and public engagement. Conclusions: The strategy is an initial step aimed at enhancing support for family caregivers of people living with serious illness. It outlines key recommendations and a "call to action." Subsequent work will be needed on prioritization of tasks, gaining buy-in at all levels of the policy-making apparatus, operationalization, and implementation.

Best practices and inclusion of team science principles in appointment promotion and tenure documents in research intensive schools of nursing.

BACKGROUND: Nurse scientists are highly sought after and find satisfaction in serving as members of interdisciplinary research teams. These teams also tend to be highly productive. However, nurse scientists in academia also have to reach certain productivity milestones to be promoted and receive tenure that may be incongruent with team science principles. PURPOSE: This study therefore sought to examine whether APT documents in research intensive nursing schools incorporate team science principles. METHODS: Qualitatively analyzed the appointment, promotion and tenure documents of 18 U.S. based research intensive schools of nursing with over $2 million in NIH funding in fiscal year 2014. FINDINGS: The study found that only 8 of 18 documents included any reference to team science principles and even these mentions were largely negligible. There were few best practices to recommend across documents. By not recognizing team science within these documents, nursing risks marginalization within the larger scientific community by limiting mentorship and learning opportunities for early career nurse scientists. DISCUSSION: Schools of nursing should revisit their promotion and tenure criteria and include a greater commitment to encouragement of team science.

Moving the needle: Providing evidence based care to older adults with behavioral issues through knowledge translation.

Implementing evidence based practices into practice settings is exceedingly difficult. Knowledge translation is a framework used for moving practices from the literature into the real world. This article discusses how six articles in this special issue of Gerontology and Geriatrics Education use various knowledge translation approaches to implement evidence based practices in older adults with behavioral health issues including dementia, delirium and serious mental illness across a variety of settings, as well as lessons learned for future knowledge translation and implementation science studies.

Evidence-based practice councils: potential path to staff nurse empowerment and leadership growth.

OBJECTIVE: This study aimed to examine the effects of participation in staff nurse-led practice councils on nurse job satisfaction and professional development. BACKGROUND: Although evidence-based practice (EBP) has become a key component of improving the quality of care, few studies have examined how implementation of staff nurse led councils model affect the involved nurses. METHODS: A 3-stage evaluation involving ethnography, semi-structured phenomenological private interviews and a 10-item survey were conducted with nurses, managers and executives participating in or involved with EBP councils tasked with improving patient outcomes at 6 community hospitals in a single non-profit hospital system. RESULTS: Five themes were identified as outcomes: empowerment, meaningfulness, leadership growth, exposure to quality improvement, and vision. CONCLUSIONS: Staff-led councils have the potential to improve quality of care, job satisfaction, vision and leadership provided that managers and executives are sufficiently prepared to work with and support the councils.

The effects of an inpatient palliative care team on discharge disposition.

OVERVIEW: Inpatient palliative care teams' (PCT) contribution to improved quality of life and patient satisfaction as well as decreased utilization and costs has been well established. Yet few studies have examined the specific effect of an inpatient PCT on discharge disposition, despite evidence of an association between hospice enrollment, decreased rehospitalization, and improved resource utilization. METHODS: Patients admitted to a large nonprofit multisite hospital between June 2004 and December 2007 and seen by the PCT were matched to usual care (UC) patients on age, mortality risk, prior year hospitalized days, and disease severity. Discharge disposition and demographic factors were abstracted from hospital administrative claims; mortality data was collected from the social security death index. Analyses were performed using Wilcoxon's test, chi(2) analysis, and multinomial logit regression. RESULTS: Three hundred sixty-one matched pairs were available for analysis. Compared to UC, patients who received a PCT consultation were 3.24 times more likely to be discharged to hospice (p < 0.0001), 1.52 times more likely to be discharged to a nursing facility, and 1.59 times more likely to be discharged home with services (p < 0.001), controlling for patient demographics and disease severity. PCT patients were also referred to hospice earlier in their disease trajectory, rather than in the last few weeks of life. CONCLUSION: Patients receiving an inpatient PCT consultation are more likely to receive follow-up services upon discharge from the hospital. These services likely contribute to better quality of care and financial benefits, and warrants further study, especially considering the current focus on health care efficiency and quality.

What impact do setting and transitions have on the quality of life at the end of life and the quality of the dying process?

PURPOSE: The aim of this article was to identify major research needs related to quality of life at the end of life and quality of the dying process for vulnerable older people at home, in assisted living facilities, in skilled nursing facilities, and in prisons. DESIGN AND METHODS: Review and analysis of the literature was used. RESULTS: The science is generally weak in relationship to what is known about quality of life at the end of life and quality of dying for vulnerable older adults in different settings. Few studies address actively dying patients and the reasons for transfers between home and other settings. Existing studies are primarily anecdotal, descriptive, have small samples, and involve a single setting. Participant decisional capacity is a barrier to conducting research in these settings. IMPLICATIONS: Research recommendations for each setting and across settings are provided. The National Institutes of Health should clarify criteria for enrollment of persons with diminished, fluctuating, and absent decisional capacity in research.