Browsing by Subject "End-of-life care"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Continuous Commitment: Registered nurses in long-term care experience communicating with residents and their families about end-of-life care preferences
    (2021-05) Bennett, Frank
    This dissertation begins with an introduction to the current state of the science in nursing research regarding long-term care (LTC) registered nurses’ communication with residents regarding their end-of-life (EOL) care preferences. In LTC registered nurses lead care planning and evidence suggests residents, their families and nurses all benefit from engaging in EOL care communication, but systemic and individual barriers and obstacles impede it. With a large and growing population of older adult residents in U.S. LTC facilities, most of whom have not articulated their EOL care preferences, there is a pressing need to understand LTC registered nurses’ EOL care communication strategies and facilitators. Three manuscripts are presented. The first reviews the literature regarding EOL care communication in LTC, finding there is a gap in nursing research about registered nurses’ experientially-derived knowledge. These findings led to the design of an interpretive phenomenological interview study of LTC registered nurses’ EOL care communication experience. The second manuscript presents insights from an innovative application of video conferencing technology to permit virtual, remote qualitative research data gathering during the novel coronavirus (COVID-19) pandemic. The third manuscript presents thematic and conceptual findings from a phenomenological interview study of 10 LTC registered nurses describing their EOL care communication process with residents and families. Finally, the body of aggregated work is synthesized, and implications for LTC organizational policy, nursing education, research and practice are noted.
  • Thumbnail Image
    Item
    Data-driven knowledge discovery of intervention patterns for older adults with and without end-of-life care interventions using visualization techniques
    (2022-08) Moore, Derek
    The majority of hospice care in the United States (also known as end-of-life care [EOLC]) is home-based, provided by public health and home care agencies. Worldwide, palliative and EOLC care are often combined and can be provided years before death. In the United States, however, as most reimbursement for EOLC is limited to six months before death, palliative care services are often separate from EOLC. A systematic review of home-based palliative care outcomes in the United States found strong evidence for lower hospitalization rates and lower costs and limited evidence for high patient satisfaction, increased dying at home, and quality of life improvement. To study home-based EOLC, data from 1167 clients with and EOLC intervention were matched 1:1 with older adult health care clients by gender and age using the Omaha System. Those with an EOLC intervention had 41.6% more total interventions, 59.0% more total visits, and 25.6% fewer problems than those without an EOLC intervention. Data visualization techniques from exploratory data analysis were then used to compare this data to standardized guidelines. Some overlap between guidelines and data was found, but granularity increased when terms were combined, showing the ability of the Omaha System terminology to adapt to the level of granularity needed, making it ideal for intervention dataset analysis. This study leveraged Omaha System data from practice settings to discover novel EOLC intervention patterns for older adults. These methods may be used to generate new practice-based evidence for other populations, settings, and practices.