Carla P. Hermann

Development and testing of the spiritual needs inventory for patients near the end of life

PURPOSE/OBJECTIVES To develop and test an instrument to measure the spiritual needs of patients near the end of life. DESIGN Instrumentation methodology. SETTING One inpatient and five outpatient hospices. SAMPLE 62 female and 38 male hospice patients with a mean age of 67 years; most were Caucasian, Protestant, and dying of cancer. METHODS Items for the Spiritual Needs Inventory (SNI) were developed from a qualitative study of spiritual needs of dying patients. Data were analyzed for internal consistency using Cronbachs alpha and item-to-total correlations and for content and construct validity using factor analysis. MAIN RESEARCH VARIABLES Spiritual needs and life satisfaction. FINDINGS The total scale alpha of the 27-item SNI was 0.81. Item-to-total correlations ranged from 0.07-0.65, resulting in seven items being eliminated. A principal component factor analysis with a promax oblique rotation was used to estimate content and construct validity. A total of 17 items comprised the five-factor solution. Cronbachs alpha for the revised SNI was 0.85. CONCLUSIONS The SNI is a valid and reliable measurement of spiritual needs of patients near the end of life. Further psychometric testing of this newly developed instrument is warranted. IMPLICATIONS FOR NURSING Nurses must recognize the spiritual needs of all patients, particularly those near the end of life. The SNI may be useful in the clinical setting as well as in future studies of spiritual needs of patients.

The Effectiveness of Symptom Management in Hospice Patients During the Last Seven Days of Life

PURPOSE. To identify the most common symptoms experienced by hospice patients in the last 7 days of life, to ascertain the interventions used to treat the symptoms, and to examine the effectiveness of the interventions. METHODS. A descriptive, correlational design was used. Data were collected via a retrospective chart review (N = 100). FINDINGS. Hospice patients in this study experienced a wide variety of symptoms. Most common were pain, dyspnea, lethargy, dysphagia, and terminal congestion. Interventions used for the symptoms were almost exclusively pharmacologic. Lack of documentation made the effectiveness of interventions difficult to determine. CONCLUSIONS AND IMPLICATIONS. Good symptom control is an essential component of quality end‐of‐life care. Only when pain and other symptoms are well controlled can patients focus on important issues such as emotional, spiritual, and social needs. Nurses are an essential link in the quest to provide high quality end‐of‐life care. Search terms: End of life, hospice, palliative care, symptom control, symptom management

Initiating and Sustaining a Standardized Pain Management Program in Long-Term Care Facilities

OBJECTIVES To identify current pain management practices in the long-term care setting; and, implement and evaluate a comprehensive pain management program in the long-term care setting. DESIGN An interventional pilot study. SETTING Community-based long-term care facilities. METHODS This study was conducted in two phases. Phase I consisted of interviewing long-term care facility administrators to ascertain current pain management policies and practices. This information was used to develop the Phase II intervention that involved collecting benchmark data, creating or modifying pain policies and procedures, implementing a pain management program and presenting educational programs. MEASUREMENTS Interviews with long term care administrators; facility and resident demographic data; chart audits for pain assessment and management data; pharmacy audits; telephone surveys. RESULTS Pain management policies and practices were inadequate prior to the study intervention. No facilities had policies or procedures that required ongoing (daily, weekly, etc.) pain assessment. Only one facility had mechanisms in place for measuring the presence or intensity of pain in their non-verbal, cognitively-impaired residents. Following the pain management program intervention, pain assessment significantly increased. and treatment for pain was provided for the vast majority of those indicating pain. All sites had a standardized pain assessment program in place one-year post-study completion. CONCLUSIONS Standardized pain management programs are critical to improving pain management in long-term care settings. Improvement in long-term care pain management can be obtained through a comprehensive pain management program that involves staff education, changes in pain policies and procedures, and identifying pain management as a quality indicator.

Lung Cancer Stigma Predicts Timing of Medical Help–Seeking Behavior

PURPOSE/OBJECTIVES To examine relationships among demographic variables, healthcare system distrust, lung cancer stigma, smoking status, and timing of medical help-seeking behavior in individuals with symptoms suggestive of lung cancer after controlling for ethnicity, socioeconomic status, and social desirability. DESIGN Descriptive, cross-sectional, correlational study. SETTING Outpatient oncology clinics in Louisville, KY. SAMPLE 94 patients diagnosed in the past three weeks to six years with all stages of lung cancer. METHODS Self-report, written survey packets were administered in person followed by a semistructured interview to assess symptoms and timing characteristics of practice-identified patients with lung cancer. MAIN RESEARCH VARIABLES Timing of medical help-seeking behavior, healthcare system distrust, lung cancer stigma, and smoking status. FINDINGS Lung cancer stigma was independently associated with timing of medical help-seeking behavior in patients with lung cancer. Healthcare system distrust and smoking status were not independently associated with timing of medical help-seeking behavior. CONCLUSIONS FINDINGS suggest that stigma influences medical help-seeking behavior for lung cancer symptoms, serving as a barrier to prompt medical help-seeking behavior. IMPLICATIONS FOR NURSING When designing interventions to promote early medical help-seeking behavior in individuals with symptoms suggestive of lung cancer, methods that consider lung cancer stigma as a barrier that can be addressed through public awareness and patient-targeted interventions should be included.

The Interdisciplinary Curriculum for Oncology Palliative Care Education (iCOPE): Meeting the Challenge of Interprofessional Education

UNLABELLED Background: Interprofessional education is necessary to prepare students of the health professions for successful practice in todays health care environment. Because of its expertise in interdisciplinary practice and team-based care, palliative care should be leading the way in creating educational opportunities for students to learn the skills for team practice and provision of quality patient-centered care. Multiple barriers exist that can discourage those desiring to create and implement truly interdisciplinary curriculum. DESIGN An interdisciplinary faculty team planned and piloted a mandatory interdisciplinary palliative oncology curriculum and responded to formative feedback. SETTING/SUBJECTS The project took place at a large public metropolitan university. Medical, nursing, and social work students and chaplains completing a clinical pastoral education internship participated in the curriculum. MEASUREMENTS Formative feedback was received via the consultation of an interdisciplinary group of palliative education experts, focus groups from students, and student evaluations of each learning modality. RESULTS Multiple barriers were experienced and successfully addressed by the faculty team. Curricular components were redesigned based on formative feedback. Openness to this feedback coupled with flexibility and compromise enabled the faculty team to create an efficient, sustainable, and feasible interdisciplinary palliative oncology curriculum. CONCLUSION Interdisciplinary palliative education can be successful if faculty teams are willing to confront challenges, accept feedback on multiple levels, and compromise while maintaining focus on desired learner outcomes.

Evaluation of an Interdisciplinary Curriculum Teaching Team-Based Palliative Care Integration in Oncology

For students of the health care professions to succeed in today’s health care environment, they must be prepared to collaborate with other professionals and practice on interdisciplinary teams. As most will care for patients with cancer, they must also understand the principles of palliative care and its integration into oncology. This article reports the success of one university’s effort to design and implement an interdisciplinary curriculum teaching team-based palliative care in oncology which was mandatory for medical, nursing, social work, and chaplaincy students. Quantitative evaluation indicated that students made significant improvements related to palliative care knowledge and skills and readiness for interprofessional education. Qualitative feedback revealed that students appreciated the experiential aspects of the curriculum most, especially the opportunity to observe palliative teams at work and practice team-based skills with other learners. While there exist many obstacles to interprofessional education and hands-on learning, the value of such experiences to the learners justifies efforts to initiate and continue similar programs in the health sciences.

Preparing Nursing Students for Interprofessional Practice: The Interdisciplinary Curriculum for Oncology Palliative Care Education.

Interprofessional educational experiences for baccalaureate nursing students are essential to prepare them for interprofessional communication, collaboration, and team work. Nurse educators are ideally positioned to develop and lead such initiatives. The purpose of this article is to describe the development and implementation of an interprofessional education (IPE) project involving students in nursing, medicine, social work, and chaplaincy. The Interdisciplinary Curriculum for Oncology Palliative Care Education project uses team-based palliative oncology education as the framework for teaching students interprofessional practice skills. The need for IPE is apparent, but there are very few comprehensive, successful projects for nurse educators to use as models. This article describes the development of the curriculum by the interprofessional faculty team. Issues encountered by nursing faculty members as they implemented the IPE experience are discussed. Solutions developed to address the issues and ongoing challenges are presented. This project can serve as a model of a successful IPE initiative involving nursing students.

Enhancing Cancer Nursing Education Through School of Nursing Partnerships: The Cancer Nursing Faculty Fellows Program

This article describes the Cancer Nursing Faculty Fellows Program, an innovative program designed to provide nurse educators with state-of-the-art cancer knowledge to enhance their ability to teach cancer content. The Faculty Fellows Program was developed at the University of Louisville School of Nursing and was part of a multifaceted educational intervention to improve cancer nursing education. This intervention included comprehensive curriculum reviews, conferences with national consultants, cancer-specific faculty seminars, and funded instructional projects. The Faculty Fellows Program consisted of a mentored experience attending the Oncology Nursing Society Congress and a month-long intensive program to provide faculty with exposure to cancer experts, researchers, and clinical and community resources. By providing a forum for nurse educators to obtain this knowledge and provide the resources they need to change the way they educate nursing students, the program can significantly affect cancer-related nursing education and, ultimately, the care of patients with cancer and survivors.

Drawing to learn and win.

Many games developed for use in nursing education have been very specific in nature and useful for only certain content and purposes. In contrast, Draw-Learn-Win can be reproduced easily with different groups, settings, content, and supplies. Any number of students may play the game. Clinical sites, as well as classrooms, provide environments conducive to playing the game. In addition to use with students, Draw-Learn-Win can be easily adapted for use in teaching clients of all ages. Using the game with different groups in a variety of settings challenges the creativity of all involved.

Erratum to: Evaluation of an Interdisciplinary Curriculum Teaching Team-Based Care Integration in Oncology

1 Division of General Internal Medicine, Medical Education and Palliative Medicine, University of Louisville School of Medicine, Louisville, KY 40292, USA 2 University of Louisville Kent School of Social Work, Louisville, KY 40292, USA 3 University of the Free State, Bloemfontain, South Africa 4 University of Louisville School of Nursing, Louisville, KY 40292, USA 5 University Hospital, Louisville, KY 40202, USA 6 Office of UndergraduateMedical Education, University of Louisville School of Medicine, Louisville, KY 40292, USA 7 MedCenter One, Suite 330B 501 East Broadway, Louisville, KY 40202, USA J Canc Educ (2016) 31:181 DOI 10.1007/s13187-015-0971-4