End-of-Life Heart Failure Education With Staff Nurses; A Quality Improvement Project

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCEHeart failure (HF) is a serious diagnosis and a major public health concern. The symptoms can be exhausting and can vary from person to person with periods of acute exacerbations requiring hospital admission. It is important for hospital staff nurses to be able to speak with knowledge and comfort about end‐of‐life planning. The purpose of this quality improvement project was to increase nurses’ awareness of the functional classification systems of HF, options and timing for palliative care, and describe nurses’ intent to use the information in practice. Nurses reported planning on using the information to “Be more Sensitive and Listen.” The prevailing theme to barriers to implementing this into practice was “Not enough time and discomfort.” Nurses who were comfortable having end‐of‐life discussions did not feel they had enough time, and those who were not comfortable did not engage because of discomfort toward the topic. Furthermore, recommendations from this study were the addition of a supportive palliative care team to manage patients with HF.End-of-Life Heart Failure Education with Staff Nurses; A Quality Improvement Project / Abstract / Table of Contents / Project / Background and Significant / Project Purpose / Literature Review / Methods / Analysis and Findings / Dissemination / Discussion / Conclusion / Impact on Practice / References / Appendix A New York Heart Failure Classification System / Appendix B Plan-Do-Check-Act Cycle / Appendix C Consent Form / Appendix D IRB Approval Letter / Appendix E Permission Letter / Appendix F Pre-Education Survey / Appendix G Post-Education Survey / Appendix H Case Study #1 / Appendix I Case Study #2 / Appendix J 'Do' Phase Education Intervention Lesson Plan / Appendix K Themes from QI Projec

Comparing Engagement in Advance Care Planning Between Stages of Heart Failure

Indiana University-Purdue University Indianapolis (IUPUI)Heart failure is a terminal disease with an unpredictable trajectory. Family members of patients with heart failure are often called upon to make decisions about treatment and end of life care, sometimes with little guidance as to the patients’ wishes. Advance care planning (ACP) is an ongoing process by which patients make decisions about their future healthcare. Only about one-third of patients with heart failure have participated in ACP, which is a similar percentage to the overall population. Despite increased focus on ACP and interventions to improve it, the rates of ACP in the population remain relatively unchanged. There is a need to develop interventions that are targeted based on patient engagement in the process rather than the existing broad-based interventions. The purpose of this dissertation study is to examine the relationship between the American Heart Association stage of heart failure and readiness to engage in advance care planning. The study consisted of mailed surveys that consisted of demographic questionnaires and the Advance Care Planning Engagement Survey. Engagement was analyzed in relation to heart failure stage, heart failure class, comorbidities, perception of health status, recent hospitalizations, making healthcare decisions for others, and demographic variables. The results demonstrated that although there was no significant association between heart failure stage or class and engagement in advance care planning, there were significant associations between medical comorbidities and advance care planning engagement. Other significantly associated participant characteristics included age, gender, education, ethnicity, and income. Findings suggest that people with multiple comorbid conditions will be more likely to be ready to engage in ACP than those with fewer health conditions. The results from this study will contribute to the development of strategies to improve advance care planning that are targeted based on engagement level

After Autonomy

Bioethicists today are like Bolsheviks on the death of Lenin. They have, rather to their surprise, won the day. Their principle of autonomy is dogma. Their era of charismatic leadership is over. Their work of Weberian rationalization, of institutionalizing principle and party, has begun. The liturgy is reverently recited, but the vitality of Lenin\u27s What Is To Be Done? has yielded to the vacuity of Stalin\u27s The Foundations of Leninism. Effort once lavished on expounding ideology is now devoted to establishing associations, organizing degree programs, installing bioethicist commissars in every hospital, and staffing IRB soviets. Not-so-secret police prowl the libraries hunting counter-revolutionaries and other wreckers; anxious academics denounce deviationist colleagues. A field once comprising diverse people from diverse backgrounds with diverse perspectives is increasingly populated by standard academics with standard academic opinions. Nevertheless, the samizdat literature persistently asserts that the policy of autonomy is betraying its promise. Explication of the autonomy principle is becoming repetitive and arid. Programs always need one more revision, one more Five Year Plan, before they can actually begin to work. Life in the vanguard of the (patient) proletariat grows irksome when the proletariat is so balky and ungrateful. Surely somewhere the next great bioethical idea is slouching toward Moscow to be born

Life, Life Support, and Death Principles, Guidelines, Policies and Procedures for Making Decisions That Respect Life

The following is the third edition of a booklet by the American Life League, Inc. The section on Ordinary/Extraordinary Means has been revised. The sections on Quality of Life, Pain, Paired Organ and Non-vital Organ and Tissue Transplant, and Determination of Death have been added. There are other changes throughout the booklet

Enough: The Failure of the Living Will

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90575/1/3527683.pd

Perceived Social Support among Chinese American Hemodialysis Patients

Social support is linked to improved health outcomes both in Western and Asian societies and is a vital factor in a patient\u27s adjustment to end-stage renal disease and its treatment regimen. This study explored perceived social support among 46 Chinese American hemodialysis patients in San Francisco\u27s Chinatown using the Norbeck Social Support Questionnaire plus open-ended questions. Findings unexpectedly revealed low levels of perceived social support and lack of tangible support especially in elder patients. We can no longer assume that traditional family cultural values are providing adequate social support for this population

Ariel - Volume 5 Number 5

Editors Mark Dembert J. D. Kanofsky Entertainment Robert Breckenridge Joe Conti Gary Kaskey Photographer Scot Kastner Overseas Editor Mike Sinason Circulation Jay Amsterdam Humorist Jim McCann Staff Ken Jaffe Bob Sklaroff Janet Welsh Dave Jacoby Phil Nimoityn Frank Chervane

Overcoming the Legacy of Mistrust: African Americans’ Mistrust of Medical Profession

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans feel reluctant to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust