Provision of End-of-Life Care in Nursing Homes

State Tested Nursing Aides’ Provision of End-of-Life Care in Nursing Homes Implications for Quality Improvement Emma Nochomovitz, MPH Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN Mary Dolansky, PhD, RN Mendel E. Singer, PhD Peter DeGolia, MD, CMD Scott H. Frank, MD, MS v An increasing prevalence in deaths occurring within nursing homes has led to a growing concern surrounding quality issues in end-of-life (EOL) nursing home care. In addition, prior research has failed to emphasize the importance of state tested nursing aides (STNAs) in providing this type of care. The purpose of this study was to examine quality issues in EOL nursing home care within the context of STNAs’ comfort in providing this care

. A convenience sample of 108 STNAs from four nursing homes in the Cleveland, Ohio area used PDAs to provide answers to an audio questionnaire. Questions included emergent themes from the literature pertaining to EOL care in nursing homes, as well as materials from a national education initiative to improve palliative care. Findings demonstrated lack of comfort in discussing death with nursing home residents and their families and insufficient knowledge surrounding EOL decisions and certain types of EOL care. Overall, the level of comfort providing EOL care was found to be associated with STNAs’ perceived importance of EOL care, understanding of hospice, and spiritual well-being. JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 4, July/August 2010 255 Author Affiliations: Emma Nochomovitz, MPH, is Research Analyst, National Quality Forum, Washington, DC and Case Western Reserve University, Cleveland, OH. Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN, is Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH. Mary Dolansky, PhD, RN, is Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH. Mendel E. Singer, PhD, is Associate Professor, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH. Peter DeGolia, MD, CMD, is Director, Center for Geriatric Medicine, University Hospitals Case Medical Center and Associate Professor, Family Medicine, Case Western Reserve University School of Medicine, Cleveland, OH. Scott H. Frank, MD, MS, is Director, Master of Public Health Program, Department of Epidemiology and Biostatistics, Department of Family Medicine, Case Western Reserve University, Cleveland, OH. Address correspondence to Emma Nochomovitz, MPH, National Quality Forum, 601 13th St NW, Suite 500 North Washington, DC 20005 (enochomo@yahoo.com). KEY WORDS end-of-life care hospice nursing aides nursing home I n recent years, the growth of the older segment of the population and the prevalence of chronic illness have led to increased institutionalization of the frail and elderly prior to their deaths. In particular, nursing homes have been identified as a place in which end-oflife (EOL) care is occurring with increasing prevalence, as 20{0e601fc7fe3603dc36f9ca2f49ef4cd268b5950ef1bbcf1f795cc00e94cdd119} to 25{0e601fc7fe3603dc36f9ca2f49ef4cd268b5950ef1bbcf1f795cc00e94cdd119} of deaths now occur in the nursing home setting.1 Given the increasing significance of EOL care within the nursing home setting, nursing homes are under increased scrutiny to provide quality care. This has led to the creation of nursing home specific measures of quality and outcomes. As a result, a growing body of literature highlights several concerns surrounding quality issues in EOL nursing home care. The purpose of this study was to examine quality issues in EOL care as they relate to the role of state tested nursing aides (STNAs), with a particular focus on the degree to which STNAs feel comfortable providing EOL care. v BACKGROUND Despite the significance of EOL care in nursing homes in the context of the growing elderly population likely to utilize EOL health services, there is evidence to suggest that it is not a topic that is widely understood or addressed by nursing home staff. According to Hanson et al,2 a focus group approach may have important implications for understanding the beliefs and practices among nursing home staff caring for dying residents. The study by Hanson and colleagues2 was conducted in two nursing home facilities.

An Ethical Dilemma in Nursing Homes

An Ethical Dilemma in Nursing Homes

This week’s readings identify a number of broad based ethical dilemmas found in nursing homes. Choose one from the following list and write a 2-3 page paper that explains the dilemma. Include in your writing how you would approach the decision making process to resolve issues within the dilemma you chose.

 

  • Nursing Home Placement
  • Autonomy and Informed Consent
  • Making a Determination of Incapacity
  • Compliance & Everyday Interventions
  • Rehabilitation
  • Unreasonable Demands
  • RestraintsSupport your statements with evidence from the Required Studies and your research. Cite and reference your sources in APA style.

 

This week’s readings identify a number of broad based ethical dilemmas found in nursing homes. Choose one from the following list and write a 2-3 page paper that explains the dilemma. Include in your writing how you would approach the decision making process to resolve issues within the dilemma you chose.

 

  • Nursing Home Placement
  • Autonomy and Informed Consent
  • Making a Determination of Incapacity
  • Compliance & Everyday Interventions
  • Rehabilitation
  • Unreasonable Demands
  • RestraintsSupport your statements with evidence from the Required Studies and your research. Cite and reference your sources in APA style.

Analyze theories from nursing and relevant fie

Viewpoints on Theory

What relationship(s) do you find between middle-range nursing theories and evidence-based practice? Provide one example that uses a specific middle-range theory to support your views.

In this thread we will cover the relationship between middle-range theory and evidence-based practice. Middle-range theories are less abstract or more focused in their scope than grand range theories. They provide the nurse with a limited view of nursing compared to the grand theories. Many middle-range theories can be applied directly to practice.

In this thread you will respond to and discuss: What relationship(s) do you find between middle-range nursing theories and evidence-based practice? Provide one example that uses a specific middle-range theory to support your views.

The course outcomes that will be used to guide the learning process are:

• Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic if the propositions, comprehensiveness, and utility to advanced nursing. (PO #1)

• Examine instances where theory is used to guide the development of new knowledge and implementation of evidence-based practice. (PO #6)

Apply leadership concepts, skills, and decision making in the provision of high quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings

Purpose

The purpose of this assignment is to develop a SMART-formatted goal related to your professional leadership applicable to your current practice setting or future leadership aspirations. This goal is about YOUR leadership development, not those of the organization or the department where you work.  Many organizations have developed the SMART-goal framework as they strive for performance improvement.  Your goal may tie to one of the departmental or organizational SMART goals but the components of the goal are about YOUR leadership development The Institute of Medicine’s quality initiative has identified five core healthcare profession competencies. This assignment focuses on only two of those initiatives. Either Patient-Centered Care or Working in Interdisciplinary and/or Interprofessional Teams will serve as a framework for identification of YOUR leadership SMART goal.

Course Outcomes

Completion of this assignment enables the student to meet the following course outcomes.

CO 1: Apply leadership concepts, skills, and decision making in the provision of high quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO #2)

CO 4: Apply concepts of leadership and team coordination to promote the achievement of safe and quality outcomes of care for diverse populations. (PO #4)

CO 5: Apply improvement methods, based on data from the outcomes of care processes, to design and test changes to continuously improve the quality and safety of healthcare. (PO #8)

CO 8: Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO #8)

 

This assignment consists of the completion of the My Leadership SMART Goal paper.  Submit assignment to the Dropbox by Sunday, 11:59 p.m. MT, by the end of Week 4.

Points

This assignment is worth 200 points.

Directions

Review the Institute of Medicine’s (IOM) core healthcare competencies. Select ONE of the competencies that you will work on for developing a Leadership SMART Goal.  You are to select one of the following competencies for YOUR SMART goal.

Managing Patient-Centered Care            or

Working in interdisciplinary and/or interprofessional teams;

 

  1. Create ONE leadership goal that is in the SMART goal format. You practiced this in the Week 3 Discussion, and received valuable feedback from your instructor and peers. Please refer to this as you work on the assignment.

S – Specific (Who besides YOU is involved in the goal, what is YOUR goal, where will it take place?)

M – Measurable (How are YOU going to achieve the goal?) Be specific with measureable outcomes.

A – Attainable (What resources and/or experts are available to assist YOU with attaining YOUR goal?)

R – Realistic (Is YOUR goal something that is realistically obtainable in YOUR professional practice?) Be specific.

T – Time bound (What specific dates or weeks will YOU accomplish each task related to your leadership goal?)

 

  • Example NOT in SMART format: I will learn how to be a manager. This goal is lofty, not measurable, and unattainable in the time allotted, probably not realistic, and not time bound.
  • Example in SMART Format: I will learn the disciplinary process of an employee who has excessive absences, by locating the organization’s attendance policy and meeting with the unit manager, reviewing peer-reviewed articles and credible websites to obtain information on the disciplinary process by Week 4 (or specified date).

Note: This particular example relates to Core Competency: Managing Patient-Centered Care.

This example is a SMART goal that is Specific, Measurable, Attainable, Realistic, and Time-bound.

 

S-Specific

  • Who– Your name, or “I” Indicate others who may be involved.
  • What– Learn the disciplinary process of employees who have excessive absences
  • Where– Your organization

 

M-Measurable

  • How: Through locating the organization’s attendance policy and passing a quiz on the content of the policy.

 

A-Attainable

  • Resources and/or Expert: Meeting with the unit manager, reviewing peer-reviewed articles, and credible websites

 

 

 

R-Realistic

  • Realistically obtainable: Access to the organization, policies, and unit manager. Various resources are available.

T-Time bound

  • Specific dates: By Week 4 (or specific date)
  1. Go to the Chamberlain library (http://library.chamberlain.edu) and search the databases (under Menu tab) to locate scholarly articles related to your SMART goal. Also, search for credible websites to gain insight into how to accomplish your goal.
  2. Construct a plan of action to reach My Leadership SMART goal. Be specific by creating a timeline of when you plan on doing each action; explain how, when, and where you plan to communicate with an expert; and identify specific resources you will use to help you achieve your goal.
    1. Example Plan of Action for above mentioned example:
  • Seek approval to review the organization’s policies and schedule a meeting/interview with the unit manager by _____ (fill in date).
  • Review the policies on disciplinary action by _____ (fill in date).
  • Review the American Nurses Association website and peer-reviewed articles in the American Journal of Nursing and Journal of Advanced Nursing by _____ (fill in date).
  • Evaluate the findings from the above resources by _____ (fill in date). Pass the quiz.

 

  1. Write a scholarly paper that follows APA formatting guidelines. Organize your content logically and express your thoughts clearly. Use appropriate headers to separate sections of your paper. Check for any grammar or spelling errors before submission.
  2. Submit your completed NR 447 My Leadership SMART Goal paper, which should be approximately six pages (excluding title page and references) to the Week 4 My Leadership SMART Goal Paper Dropbox by Sunday, 11:59 p.m. MT at the end of Week 4. Note: This assignment is automatically submitted to Turn It In.