Hospice Nurses Research Articles

Mediating Effect of Resilience on the Relationship Between Job Stress and the Professional Quality of Life of Hospice and Palliative Care Nurses: A Multicenter Cross-sectional Study

Mediating Effect of Resilience on the Relationship Between Job Stress and the Professional Quality of Life of Hospice and Palliative Care Nurses: A Multicenter Cross-sectional Study

“Negative Energy Magnetic Field”: A Descriptive Qualitative Study on Occupational Stressors among Chinese Hospice Nurses

“Negative Energy Magnetic Field”: A Descriptive Qualitative Study on Occupational Stressors among Chinese Hospice Nurses

DIFFERENCES IN HOSPICE AND NONHOSPICE NURSES’ PERSONAL AND PROFESSIONAL CHARACTERISTICS

Abstract The overextension of nurses due to an aging population, increase in chronic conditions, and the COVID-19 pandemic, places them at risk of negative outcomes. However, less is known about how hospice nurses compare to nurses in other subfields in terms of professional quality of life or factors that may potentially protect against adverse consequences of caregiving. Therefore, this study investigated differences between hospice and non-hospice nurses across several factors, including the work environment, self-awareness (SA), psychological flexibility (PF), palliative care self-efficacy (SE), and three components of professional quality of life – compassion satisfaction (CS), burnout, and secondary traumatic stress (STS). Using a cross-sectional, exploratory, and quantitative design, participants were sampled through snowball and convenience techniques. Participants (N= 72) completed an online survey, 31 (43%) identifying as working in hospice and 41 (57%) as working in non-hospice settings. Independent samples t-tests were conducted. Hospice nurses reported significantly healthier work environments, higher levels of SA, SE, and CS, and lower levels of burnout than non-hospice nurses. However, there was no significant difference in PF or STS. These findings offer a novel comparison between hospice and non-hospice nurses that could inform workplace change to better support nurses as they face increased demands and increased risk for negative outcome.

THE PROMINENT ROLE OF HOME CARE AIDES IN END-OF-LIFE CARE DURING A PUBLIC HEALTH EMERGENCY AND BEYOND

Abstract Many patients and families rely on paid aides to provide personal care services at the end of life, but the COVID-19 pandemic caused widespread delays and disruption in this care. Our study examined COVID-related care disruptions among patients in a large, New York City health system who died between March 1, 2020 and March 1, 2021. We linked the electronic health records of 124 patients cared for by a geriatric outpatient practice and referred to hospice to the hospice’s electronic health records, and conducted an in-depth qualitative thematic analysis. We found many home health aides continued caring for existing patients after hospice enrollment, often in tandem with hospice aides. But, patients and families experienced disruption in both usual and hospice aide services due to patient or aide illness, COVID isolation policies, and the exacerbation of ongoing workforce shortages. Aides experienced emotional strain and escalation of care responsibilities including the provision of more clinically-focused end-of-life tasks (e.g., wound care, oxygen administration) usually performed by hospice nurses. When the hospice team was unable to provide home visits, the aide became the primary source of patient information. Hospice staff supported aides in care tasks and provided emotional and spiritual care, often virtually, to aides and patients’ families. Findings highlight the critical role of aides within the care team and its intensification in a crisis, suggesting opportunities to better integrate aides into hospice care teams while providing formal training and support to help aides manage end of life care tasks and emotional demands.

MAINTAINING PERSONHOOD AND AUTONOMY: A GROUNDED THEORY OF COMMUNITY-BASED HOSPICE CARE TRANSITIONS

Abstract Supporting care transitions as decline occurs for patients facing serious illness and their families necessitates ongoing identification of person-centered, family-oriented goals. However, little is known about the process patients and caregivers undergo when making decisions while transitioning to home hospice care. Using a Straussian grounded theory approach, we explored processes patients and caregivers use when transitioning from cure- to comfort-focused care. Data were collected through eight interviews of patients, patient and caregiver dyads, and hospice nurses (n=11). Participants were recruited from hospice and palliative care agencies serving three counties in Western New York. Interviews were recorded and transcribed verbatim. Data were analyzed using constant comparative method. Our results generated a theory grounded in the process of maintaining personhood and autonomy (e.g., changing roles, losing sense of self, wanting to be heard, wanting privacy) while making decisions to transition to hospice care. This process includes five contemporaneous steps: Shopping for the right services (e.g., recognizing existing care limitations, overcoming systemic barriers), Involving caregivers (e.g., acting as an advocate, filling other family members in, accepting the patient’s decisions), Navigating the business of dying while living (e.g., dealing with legalities, planning for the end), Processing and expressing emotions (e.g., fear, anger, trauma, loss), and Seeking input as health declines/recognizing futility (e.g., pursuing a diagnosis, validating what is happening with the nurse and physician, recognizing options). The process identified in the study reveals important mechanistic targets for the development of interventions that promote patient-centered hospice care transitions in the home setting.

Building bridges of excellence: a comprehensive competence framework for nurses in hospice and palliative care—a mixed method study

BackgroundHospice and Palliative Care (HPC) is in high demand in China; however, the country is facing the shortage of qualified HPC nurses. A well-suited competence framework is needed to promote HPC human resource development. Nevertheless, existing unstandardized single-structured frameworks may not be sufficient to meet this need. This study aimed at constructing a comprehensive multi-structured HPC competence framework for nurses.MethodsThis study employed a mixed-method approach, including a systematic review and qualitative interview for HPC competence profile extraction, a two-round Delphi survey to determine the competences for the framework, and a cross-sectional study for framework structure exploration. The competence profiles were extracted from publications from academic databases and interviews recruiting nurses working in the HPC field. The research team synthesized profiles and transferred them to competences utilizing existing competence dictionaries. These synthesized competences were then subjected to Delphi expert panels to determine the framework elements. The study analyzed theoretical structure of the framework through exploratory factor analysis (EFA) based on a cross-sectional study receiving 491 valid questionnaires.ResultsThe systematic review involved 30 publications from 10 countries between 1995 and 2021, while 13 nurses from three hospitals were interviewed. In total, 87 and 48 competence profiles were respectively extracted from systematic review and interview and later synthesized into 32 competences. After the Delphi survey, 25 competences were incorporated into the HPC competence framework for nurses. The EFA found a two-factor structure, with factor 1 comprising 18 competences namely Basic Competences; factor 2 concluding 7 competences namely Developmental Competences.ConclusionsThe two-factor HPC competence framework provided valuable insights into the need and directions of Chinese HPC nurses’ development.

Be an Advocate for the Hospice and Palliative Nurses Association

Be an Advocate for the Hospice and Palliative Nurses Association

Nursing Students' Intention to Work in Hospice Care in the Future: A Cross-sectional Study.

Studies reveal that nursing students rank hospice nursing among their least preferred career choices. The purpose of this study was to explore the association between nursing students' intention to work in hospice care in the future and their attitudes toward caring for dying patients, death anxiety, personal and/or professional experience of caring for dying patients, and type of nursing program studied. In this cross-sectional study, 200 nursing students completed an online survey based on the Frommelt Attitude Toward Care of the Dying Scale and the Turkish Death Anxiety Scale. Only 11% of the respondents were found to express interest in working in hospice care in the future. Studying in the accelerated program for nonnursing Bachelor of Arts graduates predicted a higher intention to work in hospice care in the future, than studying in the generic program (β = 0.27, P < .001). Completion of clinical experience in a medical ward predicted lower intention (β = -0.21, P < .01). These findings suggest that nursing students in the accelerated program for nonnursing Bachelor of Arts graduates should be provided with appropriate experience and support to maintain their interest in hospice nursing. Clinical experience in medical wards does not seem to be a good substitute for clinical experience in hospice care.

Nurses' Subjectivity in Patient-Centered Communication for End-of-Life Patients.

Effective patient-centered communication is essential in providing quality care for patients at the end of life. This study aimed to explore the subjectivity of nurses' communication approaches using Q methodology. In this study, 33 Q-samples were constructed based on in-depth interviews with 12 hospice nurses. The Q classification was performed by a total of 38 hospice nurses who had more than 3 years of experience in hospice settings. The collected data were analyzed through the principal component analysis method and the varimax rotation process using the PQ method program. As a result, a total of 4 distinct types emerged: "sincere listener," "family-centered caregiver," "resource utilization facilitator," and "sufficient time devoter." The factors accounted for 64% of the variance: 19%, 15%, 16%, and 14% respectively. By identifying distinct viewpoints, valuable insights into the diverse perspectives held by nurses in patient-centered communication were gained. Understanding these viewpoints will contribute to the development of tailored communication strategies and training programs. In addition, the study underscores the need for training, resources, and organizational support to enhance nurses' communication skills.

Caregiver Burden and Workplace Productivity Among Hospice Cancer Caregivers.

To examine the relationships among family caregiver burden and workplace productivity and activity impairment among home hospice family caregivers of individuals with cancer who worked while providing end-of-life caregiving. Baseline data from a longitudinal study of communication between hospice providers and hospice family caregivers were used for this secondary analysis. Working family caregivers with complete workplace productivity and activity impairment data were included in this analysis (N = 30). Demographic data, caregiver burden, and workplace productivity and activity impairment were examined with descriptive statistics, correlation analysis, and hierarchical linear regressions. Hospice family caregivers were primarily White, female, married, and employed full-time. Caregiver burden levels were significantly positively associated with activity impairment, presenteeism, and work productivity loss. These relationships remained statistically significant when controlling for age. Hospice and oncology nurses can support working hospice family caregivers by assessing for burden and associated workplace challenges, as well as by providing referrals for respite and community resources.

Being a Hospice Nurse in Times of the COVID-19 Pandemic: A Phenomenological Study of Providing End-of-Life Care.

End-of-life care changed during the COVID-19 pandemic, and the previous prevailing hospice philosophy and essential values of hospice care were suddenly under pressure. The aim was to explore hospice nurses' lived experience of providing end-of-life care to patients admitted in an out-hospital hospice setting during the COVID-19 pandemic. Data consist of 10 individual in-depth interviews of hospice nurses. A purposive sampling strategy was used, and the data collection and analysis was guided by a descriptive phenomenology. Providing end-of-life care was described through an existential dimension and a practical-related dimension. The pandemic and the ensuing constraints created an unfamiliar gap, triggering insecurity and unfamiliarity within nursing. Findings are elaborated in the following constituents: being a hospice nurse and providing end-of-life care. The latter constituent was further elucidated in additional perspectives: a new job position and bending the rules. Providing end-of-life care during the COVID-19 regime was a highly challenging and distressing experience due to the coercion of maintaining rules and restrictions as well as providing care. An experience of having to reinvent and work within a new agenda was present. Furthermore, the nurses experienced significant loss of job satisfaction and may be morally injured as well as highly exposed to secondary traumatization.

A study protocol for e-PainSupport: The use of a digital application for reporting pain and pain management in home hospice

High pain intensity is commonly experienced by patients with serious advanced illness. Impediments to improving pain intensity in home hospice include poor adherence to a pain management regimen due to caregivers' lack of knowledge and self-efficacy (confidence) in administering analgesics. e-PainSupport is a self-administered, digital application directly linked to patients' medical records. It has three elements: Education Module, Patient Pain Record, and the Pain Summary for Nurses. This study will test the effects of e-PainSupport on pain intensity when used by patients, caregivers, and nurses. The study's specific aims are as follows: Aim 1, compare the effects of e-PainSupport to a standard care condition, controlling for covariates (role [patient or caregiver], age, sex, ethnicity, education, and patient's diagnosis), on clinical improvement in pain intensity (primary outcome) and significant improvement on a pain intensity scale (secondary outcome); Aim 2, examine the mediating effects of patient and caregiver knowledge, self-efficacy, and adherence on change in pain intensity during 2 weeks, controlling for covariates and treatment condition; and Aim 3, identify nurses' perceptions of the use of e-PainSupport, including facilitators for and barriers to integration into agency workflow and benefits for patients. Participants (132 triads of patients, caregivers, and hospice nurses) will be recruited from Midwest hospice agencies. Patient and caregiver outcomes will be assessed at baseline and 2 weeks later. Data will be analyzed with multilevel modeling. Post-intervention, semi-structured interviews with nurses in the e-PainSupport condition will be analyzed using qualitative content analysis to identify perceived practice changes. e-PainSupport has the potential to facilitate nurse-patient communication and improve hospice patient pain management.

The 2023-2026 Hospice and Palliative Nurses Association Research Agenda.

The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.

Resourcefulness and stress among hospice and palliative nurses: the role of positive thinking

Background: Among healthcare professionals, hospice and palliative nurses have a high risk of experiencing work stress. However, little attention has been paid to protective factors that could mitigate the impact of daily stressors on hospice and palliative nurses. Aim: This study aimed to determine whether resourcefulness and positive thinking have a negative association with perceived stress among hospice and palliative nurses, and whether positive thinking moderates or mediates the link between resourcefulness and stress among hospice and palliative nurses. Method: A cross-sectional, correlational design was used to address these two aims. Results: A convenience sample of 86 hospice and palliative nurses (95% female) in the US completed an online survey. The results demonstrated that positive thinking and resourcefulness are useful predictors of stress reduction and help mitigate the effects of stress. Positive thinking did not mediate the relationship between resourcefulness and stress. Conclusion: Moderation analysis suggests that social resourcefulness may be especially helpful in reducing stress among hospice and palliative nurses with a low level of positive thinking.

Patient Goals in Hospice Cancer Pain Management: A Total Pain Case Scenario.

Evidence-based clinical practice guidelines and hospice agency policies and procedures direct nursing assessment and interventions for the care of persons with cancer-related pain. Guidelines assert that pain should be assessed from a holistic perspective that considers physical, psychological, social, and spiritual aspects. In addition, guidelines maintain that hospice nurses should ascertain patient goals for pain management. Assessment and documentation of goals other than pain intensity goals is an area of nursing practice that has not been developed. Without inclusion of personally meaningful goals in pain assessment instruments, such goals cannot be routinely or consistently included in the hospice care plan. To address the assessment of pain and patient goals for pain management, this scenario-based article merges theoretical knowledge about pain from concept analyses with clinical guideline recommendations. Although research is needed to develop pain goal assessment tools, nurses can use this empirically based approach for asking about goals and integrating them into the plan of care.

Prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses: A cross-sectional study

AimTo explore the prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses. BackgroundBecause of prolonged and continual contact with suffering, deaths, and grief, hospice nurses may be vulnerable to emotional burdens and have difficulty maintaining their professional quality of life. MethodsA cross-sectional study was conducted. A total of 478 hospice nurses were selected from 24 medical institutions in Sichuan province. Demographic, work-related information and work-related trauma questionnaire, the Chinese version of the Interpersonal Reactivity Index, the Chinese version of the Emotion Regulation Questionnaire, and the Chinese version of the Professional Quality of Life Scale for Nurses were used for collecting data. ResultsThe mean scores of compassion satisfaction, secondary traumatic stress, and burnout were 34.89 ± 6.21, 26.35 ± 5.24, and 24.49 ± 5.01, respectively. Job satisfaction, perspective-taking, empathic concern, working in tertiary hospitals, and adopting cognitive reappraisal strategy were positively associated with compassion satisfaction, while personal distress was a negative factor, all variables explaining 50.7 % of the variance. Higher burnout was found among nurse who had higher personal distress, worked in secondary or primary hospitals, worked >8 h per day and caring for >10 dying patients last month. In addition, job satisfaction, social support, perspective-taking, empathic concern, and cognitive reappraisal were identified as significant protectors, explaining 50.1 % of the variance. We also found that lower job satisfaction, higher personal distress, higher expressive suppression, lack of social support, senior nurses, and cared for >10 dying patients last month, were positively related to secondary traumatic stress. However, cognitive reappraisal had negative associations. These seven factors explained 32.0 % of the variance. ConclusionsHospice care has specific characteristics and hospice nurses may suffer from more work-related stressors compared with other nurses. Our study may provide clues to help nursing administrators identify hospice nurses who are at higher risk of compassion fatigue and design targeted interventions focused on potential risk factors and protectors to improve hospice nurses' compassion satisfaction, while reducing compassion fatigue.

Development and Formative Evaluation of the Family-Based Dignity Therapy Protocol for Palliative Cancer Patients and Their Families: A Mixed-Methods Study.

Palliative cancer patients and family members in China may experience difficulties in expressing their feelings, concerns, and needs to each other because of the death-taboo culture and the strong desire to protect each other from being exposed to emotional distress. The aims of this study were to develop a nurse-led psychotherapeutic intervention aiming to facilitate meaningful conversations between palliative cancer patients and their family members, named family-based dignity therapy (FBDT), and preliminarily explore the anticipated benefits and challenges of the implementation of FBDT. A convergent parallel mixed-methods design was used. The FBDT was designed based on the dignity therapy protocol and additionally inspired by the Chinese tradition of "4 important things in life." Ten palliative cancer patients, 10 family members, and 13 oncology and hospice nurses were surveyed to evaluate the FBDT protocol both quantitatively and qualitatively. The FBDT interview guide was endorsed by most palliative cancer patients and family members (>75.0%), as well as oncology and hospice nurses (>90.0%). Potential perceived benefits and challenges of FBDT were proposed by participants. The FBDT protocol was modified according to feedback from participants to make it more suitable to use in clinical practice in China. The FBDT was perceived to be a potentially promising intervention to facilitate meaningful end-of-life conversations among palliative cancer patients and family members in China. The FBDT might provide a means for nurses to promote potentially enhanced end-of-life communications for palliative cancer patients and their families. Further studies are needed to examine the feasibility, acceptability, and efficacy of FBDT to confirm this in China.

Influence of Spirituality and Job Satisfaction on the Compassion Competence of Hospice Nurses.

The aim of this study was to examine the influence of spirituality and job satisfaction on the compassion competence of hospice nurses. This was a cross-sectional study of 118 hospice nurses from 16 hospitals in Daejeon, Chungcheong Province, and Jeolla Province. A self-administered survey was conducted using a structured questionnaire including the Spirituality Scale, Index of Work Satisfaction, the Compassion Competence Scale for Nurses, and general socio-demographic information. The data were analyzed using descriptive statistics, the t-test, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows version 26.0. Compassion competence was correlated with spirituality (r=0.66, P<0.001) and job satisfaction (r=0.52, P<0.001), and spirituality was correlated with job satisfaction (r=0.44, P<0.001). Spirituality (β=0.513, P<0.001) and job satisfaction (β=0.273, P<0.001) were significant factors affecting the compassion competence of hospice nurses, after adjusting for the sociodemographic and work-related covariates. The step-by-step results from hierarchical linear regression analysis also indicated that spirituality had a stronger impact than job satisfaction on compassion competence. Our findings demonstrate the importance of spirituality, which plays a role in guiding the compassion competence of hospice nurses. It is necessary to support the spirituality and job satisfaction of hospice nurses, which could facilitate their compassion competence and thereby contribute to improving the quality of hospice and palliative care.

The Call to Write

Journal of Hospice & Palliative Nursing 24(6):p 289, December 2022. | DOI: 10.1097/NJH.0000000000000915

An Innovative Academic-Practice Partnership Using Simulation to Provide End-of-Life Education for Undergraduate Nursing Students in Rural Settings.

Innovations that foster academic-practice partnerships can fill direct clinical care gaps and supplement faculty expertise, particularly in rural settings. An end-of-life simulation was cocreated by nursing faculty and regional certified hospice and palliative care nurses (CHPNs) as a course improvement project for traditional baccalaureate students who lacked direct care experience. Groups of students experienced skills-based pain management and end-of-life conversation-based scenarios using CHPNs as standardized patients. The simulation conformed to current standards in health care simulation, including prebriefing and debriefing components. Feedback from students and CHPNs supports the partnership as an effective teaching/learning strategy.