Differences Related To Patient-centered Care At The End Of Life In The ICU: An Exploratory Micro-system Evaluation And Framework Development

Teaching students and clinicians about end-of-life care is an important part of healthcare. Utilizing the framework of the Silver Hour is one method of illustrating the urgent, intense comfort needs required by patients and families throughout the imminently dying process, wherever the patient may be receiving services. When death is imminent, it is extremely important to provide patient- and family-centered care as the waning moments of life transition to the first moments of death. A variety of instructional methods can be used can be used to teach students to provide multidimensional, patient-centered care at the end of life. The author begins by describing the basic concept of patient-centered care and by discussing the importance of teaching students about this level of care. Next she describes the concept of the Silver Hour, along with a discussion of how the Silver Hour relates to nursing education. She also notes the importance of both role modeling in providing patient-centered care and of drawing upon the five ways of knowing to strengthen the teaching of students about care during the Silver Hour.

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Using modeling to inform patient-centered care choices at the end of life

Journal of Comparative Effectiveness Research ◽

10.2217/cer.13.53 ◽

2013 ◽

Vol 2 (5) ◽

pp. 497-508 ◽

Cited By ~ 2

Author(s):

Negin Hajizadeh ◽

Kristina Crothers ◽

R Scott Braithwaite

Keyword(s):

End Of Life ◽

Patient Centered Care ◽

Patient Centered ◽

Centered Care

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The spiritual strength story in end-of-life care: Two case studies

Palliative & Supportive Care ◽

10.1017/s1478951511000447 ◽

2011 ◽

Vol 9 (4) ◽

pp. 419-424 ◽

Cited By ~ 1

Author(s):

Robert G. Mundle

Keyword(s):

End Of Life ◽

Case Studies ◽

End Of Life Care ◽

Patient Centered Care ◽

Life Care ◽

Patient Centered ◽

Centered Care

AbstractIn this article I analyze two brief case studies to propose that a “spiritual strength story” has five defining characteristics: (1) it is brief; (2) it is ontological; (3) it uses symbols and metaphors; (4) it is a “big story” or meta-narrative with a positive spiritual and/or religious focus that informs other narrative data; and (5) most conspicuously of all, it repeats. Cultivating awareness of the “spiritual strength” narrative type can help to improve the quality of inter-professional patient-centered care teamwork and understanding, especially in regard to the reflexive, embodied, and relational aspects of palliative and end-of-life care.

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Oncology nurse perspectives on the nature and meaning of their positive relationships with seriously ill patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.42 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 42-42

Author(s):

Emily M. Wright ◽

Alaina Carr ◽

Barbara J. Cashavelly ◽

William F. Pirl ◽

Lara Traeger

Keyword(s):

End Of Life ◽

Academic Medical Center ◽

Well Being ◽

Patient Centered Care ◽

Positive Relationships ◽

Patient Centered ◽

Oncology Nurse ◽

Centered Care ◽

Patient Relationships ◽

Seriously Ill

42 Background: Inpatient oncology nurses regularly care for patients at or near the end of life. Given increasing attention to risk of compassion fatigue in this setting, we conducted a qualitative study to explore nurses’ perspectives on the nature and meaning of their positive relationships with patients who were seriously ill or dying. Methods: We conducted in-depth interviews with 24 registered nurses (RN)s working on an inpatient medical oncology unit at an academic medical center. We used a semi-structured interview guide to elicit RNs’ descriptions of ‘good’ relationships they had with patients/families with attention to aspects that made these relationships meaningful. Using a framework approach, including an iterative coding process, two team members independently coded all interview data (Kappa = .80) and worked with a multidisciplinary team to identify themes. Results: RNs (95.8% female; 95.8% non-Hispanic white, M age = 32.7 yrs [SD = 10.8 yrs], median yrs as RN = 4.0 [range: 1.5-35.0 yrs]) described specific cases in which they felt they had developed ‘good’ relationships with patients and families. RN descriptions centered on highly intimate and transformative moments in patient/family care. These unique moments occurred in the context of longitudinal nurse-patient relationships in which RNs felt able to 1) facilitate patient/family processing of emotions and disclosure of treatment preferences that they otherwise were not able to process or disclose to other loved ones or clinicians; 2) provide highly-skilled patient-centered care to reduce patient suffering; and/or 3) facilitate patient/family prognostic understanding and peace at the end of life. RNs felt privileged to serve these roles. Memorable transformative moments enriched RNs’ professional identities and inspired their continued work. Conclusions: Inpatient oncology nurse-patient relationships serve distinctive functions for both patient-centered care and RN well being. Results underscore the importance of assisting RNs in managing patient symptoms, forming longitudinal relationships with patients/families, and coping with factors that impede ‘good’ relationships.

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Evidence-Based End-of-Life Comfort Care Guidelines

10.46409/sr.rcrn7065 ◽

2021 ◽

Author(s):

◽

Myla Maranan

Keyword(s):

End Of Life ◽

Life Stage ◽

Patient Centered Care ◽

Evidence Based ◽

Patient Centered ◽

Comfort Care ◽

Dying Patients ◽

Centered Care ◽

Care Guidelines ◽

Dying Patient

Practice Problem: In the absence of end-of-life (EOL) comfort care guidelines, the nurses in a medical-surgical unit are apprehensive about caring for patients in their active stage of dying, which leads to abandoning the values of holistic and patient-centered care. PICOT: The PICOT question that guided this project was: "How do acute care bedside nurses (P) who utilize the evidence-based comfort care guidelines (I) compare to not using the evidence-based guidelines (C) perceive their confidence in their capability to provide holistic and patient-centered care (O) during the active onset of the patient's end-of-life stage (T)?" Evidence: The literature indicated that accessible, evidence-based EOL comfort care guidelines could help nurses to enhance their confidence and skills to deliver holistic and patient-centered care at the bedside for actively dying patients. Intervention: The nurses identified primary stressors for a dying patient within 24 hours of the patient deemed on EOL stage using a Patient Dignity Inventory Tool as an embedded part of EOL comfort care guidelines. The nurses initiated individualized plans of care based on the stressors identified, which upheld holistic and patient-centered EOL care concepts. Outcome: Pre-and post-EOL intervention survey data attested that having accessible EOL comfort care guidelines was valuable for nurses in attaining more confidence in providing patient-centered and holistic care at the bedside for the actively dying patient. Conclusion: Accessible, standardized, evidence-based EOL comfort care guidelines fostered the nurses' ability to provide care to patients who were actively dying, embracing the core concepts of holistic and patient-centered care.

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