Context: Providing nonbeneficial care at the end of life and delays in initiating comfort care have been associated with provider and nurse moral distress. Objective: Evaluate provider and nurse moral distress when using a comfort care order set and attitudes about timing of initiating comfort care for hospitalized patients. Methods: Cross-sectional survey of providers (physicians, nurse practitioners, and physician assistants) and nurses at 2 large academic hospitals in 2015. Providers and nurses were surveyed about their experiences providing comfort care in an inpatient setting. Results: Two hundred five nurse and 124 provider surveys were analyzed. A greater proportion of nurses compared to providers reported experiencing moral distress “some, most, or all of the time” when using the comfort care order set (40.5% and 19.4%, respectively, P = .002). Over 60% of nurses and providers reported comfort care was generally started too late in a patient’s course, with physician trainees (81.4%), as well as providers (80.9%) and nurses (84.0%) < 5 years from graduating professional school most likely to report that comfort care is generally started too late. Conclusions: The majority of providers and nurses reported that comfort care was started too late in a patient’s course. Nurses experienced higher levels of moral distress than providers when caring for patients using a comfort care order set. Further research is needed to determine what is driving this moral distress in order to tailor interventions for nurses and providers.
We successfully developed a new comfort care order set at our institutions that can serve as a resource for others. Further evaluation of this order set is needed.
Introduction In-hospital cardiac arrest in patients with COVID-19 presents significant challenges to health care teams. Airborne precautions can delay patient care, place providers at high risk of virus exposure, and exacerbate an already stressful environment. Within the constraints of an ongoing pandemic, an efficient educational program is required to prepare health care teams for airborne isolation code blue. Methods This simulation was conducted in a room on the target unit using a CPR manikin to represent the patient. A “talk-through walk-through” scripted simulation directed learners (internal medicine residents, unit nurses, and other code blue responders) through a resuscitation using an airborne isolation code blue protocol. Key scripted events prompted role identification, communication, and item transfer. Learners self-assessed their airborne isolation code blue knowledge and skills and their confidence in providing quality care while maintaining safety using a pre-/posttraining 5-point Likert-scale survey. Results We trained 100 participants over a 5-month period, with 65 participants surveyed (43 respondents; 16 residents, 22 nurses). Following training, participants had a statistically significant ( p < .001) increase in percentage selecting agree/strongly agree for all statements related to knowledge and skills specific to airborne isolation code blue protocol, as well as confidence in providing care while keeping themselves and their colleagues safe. Discussion Our simulation program allowed a small number of educators to feasibly train a large number of learners, let learners practice required skills, and improved learners’ self-assessed knowledge, skills, and confidence regarding quality and safety of care.
Changes in legislation on assisted dying, euthanasia, and physician-assisted suicide are increasingly being debated around the world. Terminology and differences in legislation are considerable and may contribute to how palliative care professionals deal with requests, communicate with patients about their wishes and interactions with patients and families during the assisted-suicide process through to bereavement. The use of varied terminology, including assisted dying, physician-assisted suicide, and aid in dying may depend on cultural, ethical, or political perspective and local legislation. The impact of euthanasia in the Netherlands, physician-assisted suicide in Switzerland, and the Death With Dignity Act in the United States will be highlighted to discuss how legislative differences add to the debate's complexity and may alter how professionals deal with requests and in which support is needed. The ethical and practical dilemmas that affect palliative care professionals will be presented, deriving from the results of field research conducted in the three different countries by the presenters of the workshop. This workshop has a multidisciplinary dimension developed from the experiences of a nurse, social worker, and physician who have all worked as palliative care professionals and are each completing or have completed qualitative research on the impact of assisted dying legislation on palliative care in the United States and Europe. Their presentation will address different ways professionals deal with the requests and how they cope both personally and professionally. They will integrate their research findings to present strategies for hospice and palliative care professionals to utilize as they cope with current or changing legislation and the emotional and professional challenges in various locations.
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