...palliative care patients?” Regina Nelson Governors State University Abstract Palliative Care Nurses are at risk of experiencing stressful situations related to symptom management and death. The aim of this paper is to critically examine the current stress nurses face caring for Palliative Care patients. Four Nursing Journals and one Psycho-Oncology were reviewed. There was strong evidence to support that nurse’s experience stress caring for Palliative care patients. Common concerns in the first study were caring for a dying patient; personal level, comfort of the patient, and mediating between patient and family. The second study reported physical and emotional health consequences for nurses who provide hospice and palliative care over extended periods of time. The third study of nursesreported job satisfaction, stressors, coping strategies, and support. The fourth study nurses had 10 themes that conceptualize their work that may enable palliative care workers to remain resilient and effectively buffer or moderate stressful effects. The fifth study reported routinization of care, lack of nursing staff’s availability for emotional engagement, frequent interruptions, quiet afternoons, upbeat and positive culture, and a matter of fact attitude surrounding death and dying ,were all the behaviors that “being with” could not create. Although the report showed nurses able to cope by not “being with” the overall impact is stress related to caring for Palliative care patients. Although...
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...Hospice Care in the United States Catherine Harmer HCS.212 Feb.23, 2013 Prof. Mark Miller Hospice Care in the United States Hospice care is one of the best services the health care industry has to offer, and is available to all walks of life. When the patient has reached end of life, hospice provides support to the loved ones as well. “Hospice focuses on caring, not curing and, in most cases; care is provided in the patient’s home. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities. Hospice services are available to patients of any age, religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations” (NHPCO, 2011, par.2). Hospice care has evolved over many years and has a lot to offer: Patients are kept as comfortable as humanly possible. For loved ones, finding peace or comfort is likely more achievable when helping their loved ones let go, making the course of grieving and acceptance much less difficult. Caregivers, employees, and volunteers are faced day-to-day with the reality that life as we know it does expire; it is only fitting then, that greater patience and appreciation of self, family, and life in general become more characteristic of the providers than might be otherwise. This facet of health care, one might fear, would require tremendous resilience. On the other hand however, facilitating a...
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...Moore-Ramos 15 July 2013 Hospices Under Federal Scrutiny Investigations by federal agents have found that many hospices, especially in Florida, have systematically billed Medicare for patients not eligible for care or over-billed for “crisis care” that patients did not need. A huge false-billing lawsuit has been launched against Miami-based Vitas Healthcare, one of the nation’s largest hospice providers, accusing the organization of collecting tens of millions of dollars through unjustified and inflated bills (Lamendola). The suit came after four years of investigation in which the government found that eleven smaller hospices had been over-billing. Those hospices had to pay $88 million in settlements. And in January the government joined a lawsuit accusing Hospice of the Comforter near Orlando in phony billings at an estimated $11 million. The federal Inspector General’s office overseeing Medicare has placed hospice overcharges among one of its investigative projects for the year. They have also proposed tightening billing codes that hospices have used to increase Medicare payments six-fold since 1998 (Lamendola). Paul Ledford, executive director of the Florida Hospice & Palliative Care Association says that although hospice has escaped scrutiny over the years, they are getting more attention now. He does not think that hospices in Florida are committing fraud but that instead they are big targets for the government due to the fact that hospices are huge in Florida due...
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...The Effects of Palliative Care on Other Family Members Tonya Kerney McKendree University The Effects of Palliative Care on Other Family Members Family members of patients who are in palliative care experience emotions including hopelessness, guilt, and sadness. They are often physically exhausted and may become ill themselves. Many experience depression. Family Caregiver Alliance (as cited in McMillan et al., 2006) has estimated that over fifty million Americans assist a family member with a disability or illness on a regular basis. Of these ill patients, many require extensive care from family members. Caregivers of cancer patients especially experience very high stress levels. They are often burdened with physical exhaustion, emotional distress, and financial worries from loss of time at work to care for their loved one (Emanuel & Emanuel, as cited in McMillan et al., 2006). The purpose of the study I reviewed was “to determine whether hospice plus a coping skill training intervention improved family caregivers’ quality of life, burden, coping, and mastery, compared with hospice plus emotional support and usual hospice care (McMillan et al., 2006, p. 214)”. To participate in the study, caregivers had to be caring for adult cancer patients, both had to give consent, both had to be able to read and comprehend English, both had to have achieved at least a sixth grade education, and both had to achieve a minimun score of seven on the Short Portable Mental Status Questionnaire...
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... Serenity and the Importance to Nursing Practice THE CONCEPT OF SERENITY 6 References Beckstead, J.P., Conley, C.E., Kruse, B.G. (2005). Psychometric Properties of the Serenity Scale: Journal of Hospice and Palliative Nursing, November/December Volume 7, 337-344. Chinn, P.L., Kramer, M.K., (2004). Empiric Knowledge Development: Explaining and Structuring. Yvonne Alexopoulos. Melissa Boyle , Kristin Hebberd (6th Edition), Integrated Knowledge Development in Nursing (pp.54-90). St. Louis, Missouri. Dictionary.com, (2010). An Ask.com Service. Retrieved on January 25th, 2010 from http://dictionary.reference.com Get Palliative Care, (2010). What is Palliative Care. Retrieved on January 25th, 2010 from http://www.getpalliativecare.org/home/ . THE CONCEPT OF SERENITY 2 Incorporating the concept of serenity within nursing practice has been proven to be very beneficial when applied to patient care. The concept of serenity can have different meanings to different people. How one goes about obtaining serenity may vary greatly with each individual. The idea of serenity, of inner peace is desired by many. Nurses can assist patients with obtaining and maintaining this important concept. This paper will identify the concept of serenity...
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...HOSPICE NETTAH NDUNGU Texas Tech University Health Science Center School of Nursing Hospice Hospice is a comprehensive, medically directed, team oriented program of care that emphasizes pain control and symptom management rather than curative treatment. It directs acceptance of death as a natural part of life and addresses the psychological and spiritual needs of the patient and family. This paper will outline the history of hospice, the effect it has on healthcare today, why it is important to nursing, how nursing is impacted by the availability of hospice services, and finally, what nursing has done to affect change related to hospice. History of Hospice Hospice was first applied to specialized care for dying patients by Dr. Dame Cicely Saunders, who started working with the terminally ill in 1948 (NHCPO, 2015). Dr. Saunders later created the first modern hospice – St. Christopher’s Hospice in a residential suburb in London. Her approach was later introduced to healthcare professionals and chaplains in the U.S in 1963 during a lecture at Yale University. In 1969 Elizabeth Kubler-Ross contributed to the idea of hospice centered care in her book: On Death and Dying which highlighted the five stages of dying and a plea for home care as opposed to treatment in an institutional setting. In 1978, the United States’ Department of Health, Education and Welfare Task Force acknowledged the hospice concept as a means of providing more humane care for America’s terminally...
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...Season’s hospice. I used to work there part-time. Individuals become eligible for hospice upon reaching a 6 month or less terminal diagnosis. Individuals have the choice of dying comfortably in a hospital, nursing facility, or their home after electing hospice. Hospice care delivers palliative care to terminally ill patients. Patients with an identifiable short prognosis receive comprehensive interdisciplinary team-based palliative care through hospice in a place where they chose. There are various problems with the the design, delivery and maintenance of hospice care standards throughout the country. There are a lot of challenges facing hospice that destabilize the repute which hinders optimal care delivery. Education is the key to these issues. The potential issues in the care delivery is due to the lack of education and awareness. The Need for Change The change that is to be delivered is a broad change to improve the efficiency and thereby maximizing profits and to maintain the core values. Hospice care has a bad reputation of keeping patients too long even after their prognoses improve. There were a few cases of fraud and hospices filing bankruptcy and closing due to medicare audits investigating patient eligibility. This brought a negative light upon hospices including Seasons hospice. Even though change is difficult, there need to be steps taken to regain and reshape the trust of the public so that they will put their loved ones to the care of Seasons hospice. Additionally...
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...Greene, J. (2013, August). The Denver Hospice. H&HN: Hospital &Health Networks, 87(8), 37-38. This article is about how the Denver hospice has won a lucrative award 2013 Circle of Life Award. What allowed the Denver hospice win this award was there unique program that they come up with in dealing with palliative care. Palliative care is an up and coming method of health care that deals with easing of pain for any stage of someone’s disease. Hospice care only deals with patients in the final stages of their disease. The Denver hospice is leading the way by branching out and developing a palliative care program to service more people than just standard hospice alone. The Denver Hospice's fearless culture of innovation has produced partnerships that bring hospice and palliative services to a wide variety of people who might not otherwise have access to them (Greene). Palliative care is a difficult item to get funding for. No one wants to fund the final minutes of a person’s life. Although, Denver Hospice has a reputation of never turning anyone away, they will treat whoever is in need. Denver Hospice works with many different groups to try to cater to the clientele as well as get funding. The Veterans Administration has worked with the Denver Hospice to identify special needs of veterans, who make up 31 percent of the hospice's patients (Greene). Many of which may have seen combat or had to endure something that which has made care now that much more difficult. It is...
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...Hospice care is a subject most families avoid. Death is taboo for many cultures because of religious considerations or superstitions. Many households don't bring this up until it's too late and everyone is utterly stressed. If you are suffering from a terminal condition, it's time to prepare for it. Think of the service as an insurance variation. People will always need a particular insurance or another to prepare for life's occurrences. Hospice care is no different because death is bound to happen whether we are prepared or not. How important is it? It's very important because everyone needs peace of mind in this critical time. Without proper hospice care, patients may not have access to needed pain alleviation. Physical agony is not...
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...Despite high levels of satisfaction expressed by hospice employees when compared to employees in other sectors of health care, hospice social workers have the lowest job satisfaction compared to other professionals on the hospice interdisciplinary team (Casarret, Spencer, Haskins, & Teno, 2011; Monroe & DeLoach, 2004). Job satisfaction amongst health care employees contributes to the retention or tenure of qualified and experienced employees (Fritzsche & Parrish, 2005; Head, Washington & Myers, 2013; Kobayshi & McCallister, 2013; Miller, 2008). High turnover has been shown to be associated with decreased job satisfaction among direct care hospice workers and has also been shown to compromise quality of care for hospice patients (Dill & Kagle,...
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...Although all people die, everyone's dying process is unique. Many people think of dying as merely a physical process, but dying is an experience of the whole person and is influenced by a combination of physical, psychological, social, cultural, and spiritual factors. There are as many ways to die as there are to live, so in order to better understand how people who are dying experience the process, researchers and clinicians have developed different models or theories that attempt to account for how people cope with dying. THEORIES/MODELS OF DYING Elisabeth Kubler-Ross's Stage Theory of Dying The general public is most likely to be familiar with Kubler-Ross's theory of dying. In 1969, she published a book titled On Death and Dying, which was based on interviews collected from 200 dying patients. In the book, Kubler-Ross discerned five stages that dying people experience. The five stages, which reflect different reactions to dying, are denial, anger, bargaining, depression, and acceptance. Denial is the "No, not me!" stage where the person is in shock or denial and cannot believe that they are going to die. Denial is self-protective and gives the person time to adjust psychologically to the news that he or she is going to die. Anger is the "Why me?" stage and may involve, in addition to anger, resentment, rage, and envy at God, doctors, nurses, family members, or anyone who is not dying. Bargaining is the "Yes me, but. . ." stage and often involves bargaining with God...
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...Case Study Care Plan Strategies: Shanti Care Plan Strategies: Shanti Shanti’s story describes the death and dying process of a 63 year old Indian woman with breast cancer and metastasis. She had lived in the United States for 32 years and both her and her family still strictly followed their Hindu beliefs and traditions. Shanti knew she was ill but not her diagnosis or prognosis. She was in constant pain and suffered from anorexia, weight loss, and digestive problems. Her religious and cultural beliefs were that all that happened in this life was the result of her past life and that her next life would be determined by her actions in this life. To Shanti the pain she was suffering was given to her by the gods and relief from her pain would produce bad karma and result in negative consequences in her next life (Gefland, Raspa, & Briller, 2005, pp 177-178). Because of her beliefs Shanti and her family had chosen not to know her diagnosis or prognosis which created multiple dilemmas in planning hospice care for the patient. After consulting their legal team and ethics committee hospice was able to honor the patient’s wishes and provide services. For the purpose of this paper the author with describe a care plan developed for the care of Shanti that respects the patient’s cultural and religious beliefs but still provides quality care. The care plan includes communication between staff, the patient, and family, treatments that align with the patient’s cultural and...
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...End of Life Population Health Framework University of Massachusetts Medical School Fall, 2011 Articles 1. http://www.cancer.gov/cancertopics/factsheet/Support/end-of-life-care 2. http://www.loisgreenlearningcommunity.org/ < Compare and Contrast: The National Cancer Institute’s End of Life Care Questions and Answers on their website are written more the for caregiver or patient and describe what end of life care refers to. It’s formally written and describes each step or phase of care from initial diagnoses of end of life approaching or withdrawal of life saving measures such as chemotherapy to knowing when the patient has passed. It describes ways to take care of a patient at the end of life and when to call for professional help. It’s mainly geared toward the caregiver and really addresses all issues in providing care no matter how minor. The priority here is the well being and education of the non-professional care taker and the patient. The Lois Green Learning Community is an online resource for health professionals and a community to share experiences and also take care of yourself by doing so. It’s a place to blog or unwind about an experience, there are many resources listed for certification for palliative care and how to treat patients. It’s written with a very open and warm way and it’s a safe place to share your experiences, not formal and official like the NCI website. Communities like this are very important for health professionals to have a place...
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...the company if anything were to happen to them in the future, legally. WR Grace like most large corporations, have their faults, except WR Grace has done more than just created a fault. They upset their whole strategic placement in the US. Their corporate culture which includes all their values which they seem to hold dear back years ago before the whole aspect of situation have the spotlight shined on it. They have five key values they say they represent in today's society; teamwork, performance, integrity, speed, and innovation. It is my understanding that they try to place their values on people yet they have absolutely tarnished every inch of the company’s soul to a point where not even today people will trust them, or should trust them. Their value of integrity states, “maintain and expect the highest level of ethical behavior”. This goes hand in hand with humanizing the work setting which is supposed to organize a workplace in such a way that it develops rather than impede the human potential. The immorality of WR Grace not telling the workers that asbestos is in all of the air they breathe, is the finest form of impeding human potential at people's lives are being cut short. The goal of a strong corporate culture, is to maximize the human potential in the workplace. And it actually been proven to increase the corporation's profits because if the workers are happy, then the customers are happy and so the employer, or the corporation, is happy. Sociologist Rosabeth Moss...
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...round bruises observed over several areas of Mr. L.’s back. In Asian culture, mind and body are one and are considered inseparable, the use of medicine that incorporates energy meridians and yin and yang are important (Hays & Erford, 2014). Lee, Jerng, Liu, Kang, Nam, and Lee (2014) report that moxibustion is often used to treat fatigue. Matzo & Sherman (2015) write, “existing religious and spiritual beliefs should be supported and encouraged” (p. 114). It would be judgmental to...
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