Date of Paper/Work

5-2022

Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Gwendolyn Short

Department/School

Doctor of Nursing Practice

Abstract

Palliative care is specialized care for those with serious disease and focuses on providing relief from symptoms (Radbruch et al., 2020). The goal of palliative care is to improve quality of life for both the patient and the family. As the COVID-19 pandemic continued to change healthcare delivery and visitor restrictions, alternative approaches to safely deliver care to both the patient and family have been uncovered. A Midwest veterans home was looking to bridge the gap in communication between staff, resident, and family during end-of-life care. Creation of an online accessible educational resource for nursing home staff is an alternative format for providing staff education. This project focused on online education supplied in a central location with the expected outcome to be increased communication between staff and family during residents’ end-of-life. Patient care staff participated in this quality improvement project by responding to two online surveys. Results demonstrate that staff were satisfied with the online resources as a tool to promote conversation with family. This can assist in future education and training surrounding end-of-life care and communication while achieving positive palliative care outcomes. Evolving to an online education platform provides flexibility in convenience, equity, service, and access. While the ongoing COVID-19 pandemic demands attention towards traditional end-of life care standards, it also provides the opportunity to create new methods to palliative care amongst a vulnerable population. Additional staff education on end-of-life care will not only meet the needs of palliative care in the Midwest veterans home but will also be a sustainable option for future practice. 5 In 2016, there were more than 19 million living United States (US) veterans, representing almost 10% of the total adult US population (Schaeffer, 2021). Years of US military service often come with a cost, resulting in unique physical, mental, emotional, and spiritual health issues that continue to manifest throughout veterans lives (Schaeffer, 2021). Veteran needs at end of life vary, as they may suffer from a spectrum of challenges related to their time in service (Schaeffer, 2021). Veterans challenges may relate to presumptive diseases from environmental exposures, or other debilitating emotional or spiritual issues (Shamas & Gillespie-Heyman, 2018). Quality healthcare for veterans is essential at all stages of life. It is important to recognize the difficulties veterans may face and to create a care team with the knowledge, skills, and confidence to properly care for veterans in all stages of life. The current end of life care for veterans is done exceptionally well at this veterans home in the Midwest. It has been reported that nursing staff and bereaved family members feel veterans are being well taken care of at the end of their lives (S. Hogan, personal communication, June 2, 2021). For example, there is a final salute for the veteran as they are leaving the home for the last time. This ceremony is significant to the family, staff, and other veterans involved. It is special to have the opportunity to honor America’s heroes until the very end. However, this care has changed within the past two years because of the COVID-19 pandemic and subsequent visitor restrictions in long term care (S. Hogan, personal communication, June 2, 2021). The COVID-19 pandemic has put a strain on communication in long term and residential care to protect the residents. At the veterans home, a strict zero visitor policy except for imminent death was put in place to protect the vulnerable veteran population from COVID-19 (S. Hogan, personal communication, June 2, 2021). The new visitor policy poses a challenge to 6 inclusion of the family in end-of-life care. Many family members have reported feeling ignored, and that opportunities for communications have been missed (S. Hogan, personal communication, June 2, 2021). Military service has affected the individual resident, and the family and care team need to remain mindful of any special needs this requires. The question persists in how to properly educate, include, and communicate with family in end-of-life care, especially given the recent COVID-19 pandemic and visitor restrictions.

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