Show and Tell: Photography and Storytelling to Better Understand the End-of-Life Experience of Families in the Intensive Care Unit.

End-of-life in the Intensive Care Unit (ICU) is common, costly, and can contribute to negative health outcomes for bereaved family members. Insufficient understanding of the family experience results in poor quality, highly variable care riddled with deficiencies including effective identification and application of evidence-based clinical interventions. Successfully managing the multitude of transitions, for example changes in family role or personal identity requires creative practice guided by theory. This project supports the feasibility of using peri-mortem photographs captured by family members with story-telling and a standardized measurement of grief to explore the family experience of end-of-life in the ICU. Project findings reveal shared experiential themes and emphasize the value of photography and storytelling as meaning-making interventions for families. Further study to generalize findings and develop additional preventative and therapeutic interventions at and beyond end-of-life in the ICU is needed to better meet family needs and improve their health outcomes.

Development of a Standardized Simulation: Advance Care Planning Conversations for Nurses.

BACKGROUND: Advance care planning conversations focus on articulating and documenting patients' healthcare goals. These conversations should occur early and iteratively but are often not completed. Clinicians, specifically registered nurses, lack the needed training in advance care planning to have effective conversations; hands-on teaching modalities are necessary to enhance these communication skills. OBJECTIVES: The aim of this study was to increase knowledge and comfort in communication about advance care planning; therefore, a validated and standardized simulation was developed and tested among registered nurses. We examined the feasibility of an advance care planning simulation called Conversations Had at Trying Times to explore changes in knowledge, attitudes, and self-efficacy among registered nurses. METHODS: The National League of Nursing Jeffries simulation theory and Bandura's self-efficacy theory framed the study, which consisted of two stages: (a) simulation development and (b) simulation testing. Construct and content validity guided simulation development; standardization was achieved through International Nursing Association for Clinical Simulation and Learning standards. Testing consisted of a pilot one-group pretest/posttest. RESULTS: Conversations Had at Trying Times, a researcher-designed high-fidelity validated simulation, enhanced nurses' communication skills. Thirty-six registered nurses completed the simulation; knowledge, attitudes, and self-efficacy increased pre- to posttest. Postsimulation evaluations confirmed the feasibility of the simulation. The greatest variation in results was among registered nurses with less than a year of experience. DISCUSSION: The study findings support the feasibility and effectiveness of the Conversations Had at Trying Times simulation in its development and outcome measurements of knowledge, attitudes, and self-efficacy in advance care planning. Simulation is an educational modality underutilized, and Conversations Had at Trying Times is one of the few validated simulations for nurses. Further analysis showed that years of experience was a significant factor. Younger, inexperienced nurses had positive outcomes, but not to the extent of other practicing nurses, which suggests that simulation tailoring is necessary for newer nurses or alternative education modalities need to be explored. In addition, more training in advance care planning communication is needed for newer nurses through nurse residency programs, staff development, and mentorship. Finally, advance care planning communication needs to be addressed in undergraduate education to better prepare new graduate nurses.

Integrating Palliative Care into Nursing Care.

ABSTRACT: The need for palliative care in our health care system has exponentially increased in the past few years as a result of the COVID-19 pandemic, the aging population, and the increasing number of people living with serious illnesses. While nurses play a critical role in delivering palliative care, many lack confidence and knowledge, causing practice gaps in the clinical and psychological management of seriously ill patients. The collective burden of the pandemic has demonstrated the importance of palliative care education and training, specifically in communication, symptom management, and continuing education. All nurses, including nursing students, transitioning nurses, and practicing nurses, should be trained to offer generalist (or primary) palliative care, in accordance with the American Association of Colleges of Nursing Essentials: Core Competencies for Professional Nursing Education. Provision of holistic, relationship-based, and integrated palliative care for patients and their families is an ethical obligation for all nurses.

A Vax4HPV Mobile Application for Parents of Human Papillomavirus Vaccine-Eligible Children: Iterative Formative Assessments.

Although the human papillomavirus vaccine is efficacious, 40% of 13-year-old adolescents have been vaccinated for human papillomavirus. Implementing theory-based, user-centered applications can address this suboptimal coverage. This formative usability test aimed to develop a theory-based, user-centered interface to stimulate and inform parents' decision making on human papillomavirus vaccination and to help them act upon that decision. Iterative formative assessments were conducted through four focus groups of parents of children aged 9 to 14 years (N = 15). Participants discussed the desired content and features of a vaccine for human papillomavirus smartphone application while reviewing application prototypes. The discussions were recorded, transcribed verbatim, and then underwent qualitative content analysis. Four of the discovered themes were related to the content desired by parents: sources of information, facilitators of human papillomavirus vaccination, addressing the reasons for vaccine hesitancy, and gender-neutral content. The remaining three themes concerned the application's desirable designs and features: clear and descriptive interfaces, accessibility to broad groups of end users, and closing the intention-behavior gap. The need for adolescent human papillomavirus vaccination was generally well received by participants. This study found that theory-based, user-centered applications offering directions to appropriate clinics and human papillomavirus vaccine recommendations offered by nurses, can mitigate hesitancy by providing information via preferred routes and closing intention-behavior gaps.

Optimizing the Global Nursing Workforce to Ensure Universal Palliative Care Access and Alleviate Serious Health-Related Suffering Worldwide.

CONTEXT: Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal. OBJECTIVES: 1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services. METHODS: Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce. RESULTS: Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships. CONCLUSION: An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.

Ethical Implications of COVID-19: Palliative Care, Public Health, and Long-Term Care Facilities.

Outbreaks of COVID-19 among nursing homes, assisted living facilities, and other long-term care facilities in the United States have had devastating effects on residents. Restrictions such as banning visitors, sequestering residents, and testing health care staff have been implemented to mitigate the spread of the virus. However, consequences include a decline in mental and physical health, decompensation, and a sense of hopelessness among residents. We present and explore a case study at an assisted living facility addressing the ethical issues in balancing the management of the community versus the resident's right to autonomy and self-determination. A team of palliative care experts was brought into assisted living facilities to manage patients, care for well residents, and provide input in advance care planning and symptom management. The principles of self-determination and autonomy, stewardship, and distributive justice were explored. The use of nursing skills in triage and assessment, principles in public health, and the 8 domains of palliative care provided a comprehensive framework for structuring emergency operations. Palliative interventions and the role of palliative care nurses played an integral part in addressing ethical challenges in the containment of the virus and the deleterious effects of social isolation among the elderly.