Perceived Needs Among Healthcare Providers Caring for Seriously Ill Adults Regarding Electronic Health Record Triggers for Palliative Care Referral.

Many healthcare facilities in the United States currently utilize electronic health record triggers to promote and facilitate palliative care referral. The purpose of this study was to explore perceived needs regarding electronic health record trigger criteria for palliative care referral among healthcare providers caring for seriously ill adult hospitalized patients in a teaching hospital in New York State. A qualitative descriptive approach was utilized with use of individual semistructured interviews. Braun and Clarke's Reflexive Thematic Analysis method was used to analyze data. Data analysis generated one overarching theme, I'm in Favor of an Electronic Health Record Automatic Trigger for Palliative Care , and three key themes, Build a Checklist Screening Tool Into Epic With Predefined Conditions and a Palliative Consult in the Admission Order Set , If Providers Call a Palliative Care Consult Sooner, We Give Patients a Better Quality of Life , and Providers Need to Be Aware of the Different Facets of What Palliative Care Actually Does. Findings revealed that all participants supported incorporating electronic health record palliative care triggers. Future research is needed exploring provider palliative care education approaches to promote understanding of palliative care services and to address personal and/or professional bias.

A Faith Community Nursing Intervention for Informal Caregiver-Older Adult Dyads.

The purpose of this study was to test the impact of embedding trained Faith Community Nurse (FCN) interventionists in a Catholic Health System affiliated primary care practice as liaisons of care in the homes of older adult clients (OACs) and their informal caregiver (IC). Specific aims were to examine if a FCN intervention improved IC and OAC health, well-being, knowledge and understanding of chronic disease management, self-advocacy, and self-care. A non-random quasi-experimental design was used. Most ICs were spouses or adult children (M age = 66) who lived with the older adult (M age = 79). The ICs' scores significantly increased after the intervention on the Preparedness for Caregiving Scale (p = .002), Spirituality as Life, Meaning, and purpose (p = .026), and Rosenberg Self Esteem Scale (p = .005). Future research is needed examining the FCN intervention with larger sample sizes in more diverse communities and acute care settings.

The Experience of Working With a Faith Community Nurse Liaison of Care in a Primary Care Practice Among Older Adult Clients and Their Informal Caregiver.

Informal caregivers of older adults aging in place are at risk for adverse health and financial consequences. This descriptive qualitative study explored the experience of working with a faith community nurse (FCN) liaison of care in a Catholic health care system affiliated primary care practice among older adult clients and their informal caregiver. Semistructured face-to-face interviews were conducted with nine older adult client-informal caregiver dyads, three clients, and one caregiver (n = 22). Interviews were audio recorded, transcribed, and analyzed using Braun and Clarke's reflexive thematic analysis method. The analysis generated one overarching theme, I'm Sorry the Study and FCN Visits Are Coming to an End, and two key themes, The FCN Was Always There to Help Us (older adult clients) and The FCN Took the Pressure Off of Caregiving for Awhile (informal caregivers). Participants viewed the FCN as an instrumental member of their health care team and considered prayer and spiritual support offered by the FCN an essential element of care.

The Experience of Participating in an 8-Week Mindfulness Based Stress Reduction plus Sleep Retraining Course among Women Living with Multiple Sclerosis.

Adult women with multiple sclerosis (MS) can benefit from innovative mindfulness-based interventions designed and structured with understanding and consideration of the multifaceted challenges these women face on a daily basis. The purpose of this qualitative descriptive study was to explore the experience of participating in an online or traditional onsite 8-week, once a week, Mind Body Stress Reduction combined with Sleep Retraining course among women living with MS to establish online course acceptability. Braun and Clarke's Reflexive Thematic Analysis method was used to analyze focus group interview data. Time and length for both courses was found acceptable, camaraderie and interconnectedness were essential, having choice regarding course delivery format was important, and being provided with organized learning materials at the course start in a binder or packet was considered imperative. Acceptability was established for both the online and onsite formats.

Faith Community Nursing Practice and Holistic Nursing Practice: A Comprehensive and Inclusive Comparison of Both Specialties.

Faith community nursing and holistic nursing are recognized by the American Nurses Association as nursing specialties. Both nursing specialties practice with the understanding that holistically caring for an individual as a unique whole in his or her totality including respecting and attending to a human being's spiritual and/or faith-based needs across the life span is integral in promoting health and healing. The purpose of this article is to present the evolution of faith community nursing and holistic nursing practice and to compare their similarities and differences based on each specialty's current Scope and Standards of Practice. Utilizing each specialty's Scope and Standards of Practice allowed the authors a fair, practical, and extensive means for presenting a comprehensive and inclusive comparison. Continued and partnered research should be conducted by both specialties to advance their scope and standards of practice, to support comprehensive evidence-based and outcome-based care that promotes health, healing, compassion and caring, and to educate others regarding each nursing specialty's role, value, and significant contributions to the art and science of nursing.

Improving Sleep among Adults with Multiple Sclerosis using Mindfulness plus Sleep Education.

We explored the feasibility of a mindfulness plus sleep education intervention, SleepWell!, delivered via videoconference compared to onsite among adults with MS. A non-randomized wait-list control design was used. Participants wore actigraphy watches and kept sleep diaries for seven days pre- and post intervention. Questionnaires were completed pre-intervention, post-intervention, and three months post-intervention. One group was conducted onsite. Three groups participated via videoconference. Attrition among videoconference groups was 23% compared to 57% in the onsite group. Within group analysis showed moderate-to-large effect sizes on sleep efficiency (d=0.78) and total sleep time (d=0.54) in the videoconference groups. One-way repeated measures ANOVA post-hoc analysis suggested small-to-medium effect over three months on sleep quality (ηp2 =0.28), physical health quality of life (ηp2 =0.42), mental health quality of life (ηp2 =0.13), and mindfulness (ηp2 =0.29). Results indicate feasibility of providing our intervention via videoconferencing. Preliminary analysis suggests that SleepWell! improves sleep and mindfulness among adults with MS.

Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters.

OBJECTIVE: Little attention has been given to factors contributing to firefighters' psychosomatic well-being. The purpose of this descriptive study was to examine such contributing factors in a sample of professional firefighters. METHODS: Measures assessing sleep, depression, substance use, social bonding, and quality of life were examined in 112 firefighters. RESULTS: Overall, many firefighters reported sleep deprivation (59%), binge drinking behavior (58%), poor mental well-being (21%), current nicotine use (20%), hazardous drinking behavior (14%), depression (11%), poor physical well-being (8%), caffeine overuse (5%), or poor social bonding (4%). CONCLUSIONS: Small-to-medium correlations were identified between sleep deprivation, depression, physical/mental well-being, and drinking behaviors. High-risk behaviors that impact psychosomatic well-being are prevalent in professional firefighters, which require environmental and individual-based health promotion interventions. The inter-correlation relationships between such behaviors, therefore, need to be explored in further details.

Measures assessing spirituality as more than religiosity: a methodological review of nursing and health-related literature.

AIMS: This paper is a report of a methodological review conducted to analyse, evaluate and synthesize the rigour of measures found in nursing and health-related literature used to assess and evaluate patient spirituality as more than religiosity. BACKGROUND: Holistic healthcare practitioners recognize important distinctions exist about what constitutes spiritual care needs and preferences and what constitutes religious care needs and preferences in patient care practice. DATA SOURCES: Databases searched, limited to the years 1982 and 2009, included AMED, Alt Health Watch, CINAHL Plus with Full Text, EBSCO Host, EBSCO Host Religion and Philosophy, ERIC, Google Scholar, HAPI, HUBNET, IngentaConnect, Mental Measurements Yearbook Online, Ovid MEDLINE, Social Work Abstracts and Hill and Hood's Measures of Religiosity text. REVIEW METHODS: A methodological review was carried out. Measures assessing spirituality as more than religiosity were critically reviewed including quality appraisal, relevant data extraction and a narrative synthesis of findings. RESULTS: Ten measures fitting inclusion criteria were included in the review. Despite agreement among nursing and health-related disciplines that spirituality and religiosity are distinct and diverse concepts, the concept of spirituality was often used interchangeably with the concept religion to assess and evaluate patient spirituality. The term spiritual or spirituality was used in a preponderance of items to assess or evaluate spirituality. CONCLUSIONS: Measures differentiating spirituality from religiosity are grossly lacking in nursing and health-related literature.

Applying the transtheoretical model to health care proxy completion.

BACKGROUND: For many, an important health decision is whether or not to document end-of-life wishes using an advance directive (e.g., health care proxy). To date, interventions targeting this health behavior have had little effect on increasing advance directive completion rates. Health behavior models, such as the transtheoretical model (TTM) could be useful for understanding the health decision-making processes used along a continuum, from no intention to complete an advance directive to completing one and discussing it with an appointed advocate. PURPOSE: To explore the applicability of the TTM for a previously understudied health behavior-completing a health care proxy (HCP). METHOD: Four established TTM measures for completing a HCP (stages of change, processes of change, decisional balance, and self-efficacy) were administered to 566 adults with coverage from 1 of 2 health insurance companies. Separate analyses of variance were used to test the relationships between the independent variable (stages of change) and dependent variables (processes of change, decisional balance, self-efficacy scores). RESULTS: Consistent with other TTM research both the experiential and the behavioral processes of change revealed the lowest scores in the precontemplation stage peaking in the preparation stage. The pattern of pros and cons was replicated from previous TTM studies, with the 2 scores crossing over just prior to the preparation stage. Self-efficacy scores incrementally increased across the stages of change with the largest effect evident from the precontemplation to preparation stage. CONCLUSION: The models developed from this study can be used to guide the development of stage-based interventions for promoting health care proxy completion.

Psychometric testing of four transtheoretical model questionnaires for the behavior, completing health care proxies.

The purpose of the study was to develop four questionnaires based on the transtheoretical model (TTM) to assess the behavior, completing a healthcare proxy (HCP). The aims were to (a) operationalize the four TTM constructs for completing a HCP and (b) evaluate the psychometric properties of the questionnaires. The questionnaires were constructed and content validity established using an expert panel. Internal consistency values for each questionnaire and subscales within each questionnaire were >.79. Confirmatory factor analysis provided evidence that decisional balance and the processes of change questionnaires each contained two factors. Our data support validity and reliability of the TTM questionnaires related to HCP completion.

The role of spirituality in advance directive decision making among independent community dwelling older adults.

The purpose of this grounded theory study, based on Strauss and Corbin's (1998) grounded theory methodology, was to investigate the meaning, definition, and needs regarding the role of spirituality in end of life care among independent community dwelling older adults in relation to advance directive decision making (ADDM). Findings revealed that through the use of story telling, independent community dwelling older adults were able to define spirituality and describe the important role spirituality plays in everyday life and in ADDM. A theoretical model was constructed consisting of a mirrored basic social process, Spirituality as Connecting.

Spirituality in nursing and health-related literature: a concept analysis.

Spirituality has become an increasingly popular concept among the nursing and health-related literature. The purpose for conducting this concept analysis, guided by Walker and Avant's methodology, was to (a) examine how spirituality has been used within the current body of nursing and health-related literature, (b) clarify the meaning of spirituality by discovering what this concept's current critical attributes/characteristics are, and (c) propose a definition of spirituality based on the concept analysis findings. A total of 90 references were reviewed, including 73 nursing and health-related references. Concept analysis findings revealed that spirituality was defined within four main themes in the nursing and health-related literature: (a) spirituality as religious systems of beliefs and values (spirituality = religion); (b) spirituality as life meaning, purpose, and connection with others; (c) spirituality as nonreligious systems of beliefs and values; and (d) spirituality as metaphysical or transcendental phenomena.

The effectiveness of interventions to increase advance directive completion rates.

OBJECTIVE: Despite federal and state laws governing advance directives (ADs), interventions to increase rates of legally completed ADs have not produced significant results. This study synthesizes the state of the science regarding effectiveness of interventions to increase AD completion rates. METHODS: Garrard's method for conducting a systematic literature review was followed. In all, 25 studies meeting inclusion criteria were reviewed. Interventions fell into two types: (a) didactic-information distributed through an educational program or clinical encounter or by a mailing and (b) interactive-person-to-person interaction where participants had the opportunity to ask questions and/or receive assistance completing the forms. RESULTS: Postintervention rates of AD completion were: didactic = no change to 34% increase; interactive = 23% to 71% increase. DISCUSSION: Education without the ability to ask questions does not significantly increase the AD completion rate. Didactic interventions did not usually increase completion rates higher than the predicted average rate for the general population.

Incorporating Florence Nightingale's theory of nursing into teaching a group of preadolescent children about negative peer pressure.

Clinically based nurses often question the value of nursing theory, ultimately resulting in the reluctance to implement nursing theory into practice. This clinical practicum project successfully used Nightingale's primary tenets, such as building trust, self-assessment, and group leadership, as a theoretical framework in a nursing practice group for the purpose of teaching a group of preadolescent children about negative peer pressure. Preadolescent children are particularly vulnerable to peer group culture. Proactive strategies, as demonstrated through this project, can be used to positively influence children's behavior toward each other during the formative middle years. Group sessions addressed such topics as moral beliefs and values, bullying, and saying "no" to peer pressure and were structured using a variety of contemporary resources to develop interactive exercises that engaged the children and enhanced group communication. The children and their parents reported positive outcomes from the nurse-led group sessions.

Teaching holistic child health promotion using Watson's theory of human science and human care.

"Preservation and advancement of human care is a critical issue for nursing today in our increasingly depersonalized society. The mandate for nursing within science as well as within society is a demand for cherishing of the wholeness of human personality" (Watson, 1999, p. 29). Children today are being faced with having to deal with this societal "depersonalization." How children grow up to perceive themselves and others is crucial in developing future adults who genuinely care about themselves and humankind in its totality. Watson's (1999) human science and human care theory was incorporated into teaching health promotion to a group of preadolescent children.