Holistic Care and Treatments

An important area in nursing practice is in palliative and end-of-life care. Palliative care provides a more holistic approach to patient care and attempts to slow the progression of a disease. Palliative care can include an array of non-pharmaceutical therapies such as massage therapy or yoga. It can also include shorter or smaller treatments aimed at reducing negative side effects.

End-of-life care is about the process of dying. Helping patients and their families through this time can be difficult yet rewarding. Patients deserve respect and quality care through this time as well. Like nurses who practice in palliative care organizations, hospice nurses are moving toward alternative therapies to aid in comforting the terminally ill patient. As more care is being delivered in the home, the role of the nurse in providing palliative and end-of-life care will continue to evolve.

The use of complementary and alternative therapies in the treatment of cancer patients, terminal patients, and many other types of patients is steadily increasing. The Resources also contain much information about the various alternative therapies currently being used.

Consider alternative therapies and discuss the challenges associated with them.

To prepare

· Review the Resources pertaining to alternative therapies.

· Select one of the following areas where alternative therapies are being used:

o Cancer treatment

o Cancer symptom management

o End-of-life care

o Palliative care


· Find at least two scholarly journal articles discussing alternative therapies in your chosen subtopic.

Identify at least one challenge associated with the nurse’s role in providing alternative therapies for patient care.
Explain how the nurse might integrate the use of Complementary and Alternative Medicine (CAM) approaches in your chosen subtopic and discuss the ethical issues nurses may face.
What are the main elements you would include in a teaching plan for nurses on the use of CAM in your chosen subtopic?
What is the shared role of the nurse and patient in developing care plans?

Support your response with references from the professional nursing literature.

Note Initial Post: A 5-paragraph (at least 550 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).




International Journal of Palliative Nursing 2015, Vol 21, No 3� 109

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Abstract Introduction: Effectively discussing palliative care with patients and families requires knowledge and skill. The purpose of this study was to determine perceived needs of inpatient nurses for communicating with patients and families about palliative and end-of-life (EoL) care. Method: A non-experimental design was used. In total, 60 inpatient nurses from one hospital in Idaho completed the End of Life Professional Caregiver Survey (EPCS), which examines three domains: patient and family-centered communication, cultural and ethical values, and effective care delivery. Results: The number of years’ experience nurses had (F(9,131.57)=2.22, p=0.0246; Wilk’s ^=0.709) and the unit they worked on (F(6,110)=2.49, p=0.0269; Wilk’s ^=0.775) had a significant effect on their comfort discussing EoL and palliative care with patients and their families. For all three domains, years of nursing experience was positively associated with comfort in communicating about EoL care. Oncology nurses were most comfortable with regard to patient and family-centered communication. Discussion: The success and sustainability of this service is dependent on education for health-care providers. Studies are needed to determine the most effective ways to meet this educational challenge. Key words: Palliative care l End-of-life care l End-of-life Professional Caregiver Survey l Patient-centered nursing

This article has been subject to double-blind peer review.

Review of the literature and the authors’ experiences have revealed that inpatient staff nurses may not be prepared to pro- vide optimal end-of-life (EoL) and palliative care to patients and their families (Chan and Webster, 2013; Patel et al, 2012; Prem et al, 2012; Agustinus and Chan, 2013). Palliative care patients can continue to seek curative treat- ments while evaluating their goals and care needs. EoL care patients are usually no longer receiving aggressive curative treatment, instead they are receiving comfort care only. In the US, the word ‘hospice’ is interchangeable or synony- mous with EoL care. These patients usually die at home or in the intensive care unit, limiting the contact a regular staff nurse may have in providing care for them. Nurses who are skilled and comfortable in communicating with patients and families about EoL (hospice) and palliative care may improve the quality of life for these patients in the hospital setting.

Some patients will make the transition from curative-based care to hospice care during a hos- pital stay. Whether the transition is made smoothly and gradually, depends on the kind of communication and education patients receive from doctors, nurses, and other caregivers while in the hospital (Adams, 2005; Beck et al, 2012; van Brummen and Griffiths, 2013). Palliative care options should be provided to patients in a way that helps them understand the goals and how it differs from EoL care. However, many people opt for palliative care only when they are very close to the end of their lives (Raijmakers et al, 2011; Wilson et al, 2011).

It seems reasonable to assume that a lack of education and accompanying uneasiness among clinical nurses in discussing palliative care with patients and their families may negatively impact the transition from curative-based care to hospice care. The current research focused on the role of the nurse during the transition in patients’ lives from curative to palliative care. The study aim was to determine the perceived

educational needs of inpatient staff nurses in the authors’ facility when communicating with patients and families about palliative and EoL care.

Methods A non-experimental survey design was used to examine differences based on the age of the nurse, years of nursing experience, and the unit on which he/she worked.

End-of-Life Professional Caregiver Survey (EPCS) To measure educational needs among nurses with regard to communicating about palliative and EoL care and their current degree of com- fort in caring for this patient population, the


Communicating with patients and their families about palliative and end-of-life care:

comfort and educational needs of nurses Cheryl Moir, Renee Roberts, Kim Martz, Judith Perry and Laura J Tivis

Cheryl Moir, Home Care/Hospice, Care Coordinator, St. Luke’s Health System, Boise, Idaho, US; Renee Roberts, Clinical Nurse, Bone Marrow Transplant, University of Colorado Hospital, Aurora, Colorado, US; Kim Martz, Assistant Professor, Boise State University, Idaho, US; Judith Perry, Home Care/Hospice, Nurse Practitioner, St. Luke’s Health System, Boise, Idaho, US; Laura Tivis, Nursing Research Director, St. Luke’s Health System, Boise, Idaho, US

Correspondence to: Cheryl Moir moirc@slhs.org

110� International Journal of Palliative Nursing 2015, Vol 21, No 3


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End-of-Life Professional Caregiver Survey (EPCS) was used in this study. The EPCS was distributed to a convenience sample of clinical nurses working exclusively in telemetry, oncol- ogy and critical care units (Lazenby et al, 2012). Permission to use the EPCS was granted by the survey designers. The EPCS is a 28-item, psy- chometrically valid scale developed to assess the palliative and EoL educational needs of profes- sionals, and was validated in a large study encompassing doctors, nurses and social work- ers (Lazenby et al, 2012). For each item, a 5-point Likert-style scale was presented (range: not at all to very much). Items represent care- provider comfort and skill with a variety of situ- ations related to palliative and EoL care (e.g. ‘I am comfortable helping families to accept a poor prognosis’). Higher scores indicate greater skill or comfort and skill. Three distinct factors were identified by Lazenby et al (2012): (1) patient and family-centered communication (PFCC), (2) cultural and ethical values (CEV), and (3) effective care delivery (ECD) (Lazenby et al (2012: 429).

Data collection Data were collected over a 1-month period in 2013. The survey was conducted at a 378-bed hospital in Idaho. Telemetry, oncology, and criti- cal care units were chosen because patients on these units were most often among those transi- tioning from curative-based care to EoL care. The three units employed a combined clinical nursing staff of approximately 215 (telemetry unit 90, oncology 35, and critical care 90).

Recruitment emails were sent to 175 clinical nurses (identified from the 215 as having active email addresses) employed on the designated units, requesting participation in the research project. In addition, recruitment flyers were posted on the selected units to inform nurses of the project and request participation.

Both online and handwritten survey options were available, and both options were anony- mous. Handwritten surveys were made available on each of the telemetry, oncology and critical care units in the hospital. An investigator- addressed envelope was attached to each paper survey for nurses to return the completed instru- ment through the hospital’s internal mail system to retain anonymity. The handwritten surveys were kept in a…

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