Dorothy Wholihan

Putting the Mouth Back in the Head: HEENT to HEENOT

Improving oral health is a leading population health goal; however, curricula preparing health professionals have a dearth of oral health content and clinical experiences. We detail an educational and clinical innovation transitioning the traditional head, ears, eyes, nose, and throat (HEENT) examination to the addition of the teeth, gums, mucosa, tongue, and palate examination (HEENOT) for assessment, diagnosis, and treatment of oral-systemic health. Many New York University nursing, dental, and medical faculty and students have been exposed to interprofessional oral health HEENOT classroom, simulation, and clinical experiences. This was associated with increased dental-primary care referrals. This innovation has potential to build interprofessional oral health workforce capacity that addresses a significant public health issue, increases oral health care access, and improves oral-systemic health across the lifespan.

The value of reminiscence in hospice care

Any professional or volunteer who has worked with dying patients can attest to the multitude of emotional problems these patients can face. The healthcare literature describes the devastating effects of such emotional difficulties as fear, loneliness, depression and anxiety.1-4 In terminally ill patients, factors such as pain, increasing dependency, social isolation, loss of role function and altered appearance can all interact to cause emotional distress. Patients with advanced disease appear to experience these problems to a greater degree as they face their deteriorating physical condition, increasing losses and impending death.

Seeing the Light: End-of-Life Experiences—Visions, Energy Surges, and Other Death Bed Phenomena

Spiritual care is an integral part of multidimensional palliative care and a major domain of care identified in definitions and guidelines. Death bed phenomena include visions, dreams, hallucinations, and premortem energy surges, which can be deeply spiritual experiences. Death bed occurrences are often a source of consolation. However, they have been underrecognized. The last hours of life are sacred; as holistic, multidimensional practitioners, nurses should remain open to experiences not easily explained within a traditional medical model. As the most consistent caregivers, nurses assess, recognize, and validate such experiences to assist patients in finding meaning, comfort, and a peaceful end-of-life.

Empowering nursing assistants to improve end-of-life care

Nursing assistants are integral to palliative care and are often the most deeply involved and consistent care providers to dying patients. Yet the contributions of nursing assistants are often unrecognized and underappreciated. They are frequently marginalized when it comes to professional education activities, particularly in the acute care setting. This article describes an educational initiative based on the Hospice and Palliative Nursing Association nursing assistant core curriculum. A daylong educational intervention was provided to a voluntary convenience sample of nursing assistants from a variety of inpatient units. Presurveys and postsurveys about knowledge, attitudes, and awareness of ethical issues were administered to those attending the class, as well as a control group of nursing assistants. The results of this pilot study showed that a daylong conference on end-of-life care was associated with improved measures of knowledge, attitudes about care of the dying, and awareness of ethical issues. Interesting points of discussion concerned the points of tension identified by nursing assistants in the care of dying patients, the need for ongoing support for these staff members, and the practical issues of how to best educate and integrate nursing assistants into the palliative care team.

Providing Palliative Care to LGBTQ Patients

Nurses should be familiar with and equipped to address the challenges that arise when caring for lesbian, gay, bisexual, transgender, or queer-identified (LGBTQ) patients. LGBTQ individuals have increased rates of certain physical diseases and are at greater risk of suffering from stress-sensitive mental health issues. Negative social attitudes, widespread discrimination and stigma, physical and psychological victimization, and less social support with aging contribute to the complexity of care for these individuals. Open communication, welcoming and accepting attitudes and environments, and sensitivity to unique multidimensional issues improve care to LGBTQ patients with serious advanced illness. Nursing can reach this vulnerable minority and positively impact the quality of care.

A Framework for Integrating Oncology Palliative Care in Doctor of Nursing Practice (DNP) Education

Doctor of Nursing Practice (DNP) faculty play a critical role in preparing students to meet the complex needs of the nation as the number of cancer rates and survivors rise (National Cancer Institute, 2018) and as an unprecedented number of older Americans enter into the healthcare system with complicated comorbidities (Whitehead, 2016). Palliative care has dramatically expanded over the past decade and has been increasingly accepted as a standard of care for people with cancer and other serious, chronic, or life-limiting illnesses. Advanced practice registered nurses (APRNs) are recognized as important providers of palliative care (Walling et al., 2017). A 2-day course was held with support from the National Cancer Institute to enhance integration of palliative oncology care into DNP curriculum. The course participants (N = 183), consisting of DNP faculty or deans, practicing DNP clinicians, and students, received detailed annotated slides, case studies, and suggested activities to increase student engagement with the learning process. Course content was developed and delivered by palliative care experts and DNP faculty skilled in curriculum design. Participants were required to develop goals on how to enhance their schools DNP curriculum with the course content. They provided updates regarding their progress at integrating the content into their schools curriculum at 6, 12, and 18 months post course. Results demonstrated an increase in incorporating oncology palliative care in DNP scholarly projects and clinical opportunities. Challenges to inclusion of this content in DNP curricula included lack of: perceived time in curriculum; faculty educated in palliative care; and available clinical sites.

The doctrine of double effect: A review for the bedside nurse providing end-of-life care

Nurses on the front lines of palliative care are frequently presented with ethically challenging situations involving the use of palliative sedation and increasing opioids at the end of life. The doctrine of double effect is an ethical principle dating back to the 13th century that explains how the bad consequences of an action can be considered ethically justified if the original intent was for good intention. This article examines the doctrine of double effect through case examples and presents supporting and opposing opinions about its relevance to clinical practice. Implications for nursing care are discussed.

The 'VANAC team': Establishing a cancer prevention team

Nurses recognize the increasing need to focus on primary and secondary prevention of cancer, yet the demands of current staffing prohibit many nurses from organizing and/or participating in cancer prevention and detection activities. This article describes an innovative program established at the Bronx Veterans Affairs Medical Center (VA). Funded by an American Cancer Society professional education grant, nurses at the Bronx VA formed the “VANAC” Team (VA Nurses Against Cancer). The camaraderie of a team approach invited generalist nurses to become involved with the program. The formation and activities of the team are described. After an intensive orientation, nurses participated in a wide range of educational activities, including patient education, staff seminars, and community presentations. The logistics of arranging such a program are discussed and recommendations for future direction are offered. It is hoped that nurses in other institutions can adapt the VANAC approach to their individual settings, thereby increasing the number of nurses involved in cancer prevention.

Home health in rural Kenya.

Despite the many environmental and cultural differences, many similarities exist between home health nursing in Kenya and the United States. Family-focused care is the goal, with emphasis on education and prevention.

Incorporating cancer prevention interventions into the home health visit.

Home healthcare nurses can use their unique position to influence the cancer prevention behavior of their clients