Moral distress is a state of concern or anxiety that occurs when there is a correct action to take but an individual's ability to take that action is constrained in some way. Nurses, especially those who work in intensive care units (ICUs), may struggle with moral distress due to feelings of futility when caring for end-of-life patients. The purpose of this 1-group pretest-posttest quasi-experimental study, guided by Lazarus's theory of stress, coping, and adaptation, was to determine whether End-of-Life Nursing Education Consortium (ELNEC) education reduces moral distress in ICU nurses caring for end-of-life patients. A revised Moral Distress Survey (MDS-R 2017) by Hamric was given before and after ELNEC education to determine whether ELNEC reduced ICU nurses' moral distress level in relation to providing end-of-life care. Participants were 56 ICU nurses recruited from several healthcare institutions in the northeastern United States. Dependent t-test results showed that there was a significant difference (p = .002) in the intensity and frequency of moral distress in ICU nurses before versus after participating in an ELNEC education program. Recommendations for future study include investigating the potential long-term effects of ELNEC education on moral distress, using a larger sample size, and including nurses who work in areas other than ICU. This study may contribute to the development of interventions to reduce moral distress in nurses to make them less likely to leave their employers, subject to lower levels of moral distress, and able to achieve greater emotional and physical well-being. In showing that providing nurses with additional education can decrease their moral distress, this study may promote decreased job turnover and increased physical well-being for nurses, as well as improved nursing care at the end of life which may affect positive social change.

Most nurses receive limited formal education regarding end-of-life (EOL) care, which affects their ability to meet dying patients' needs. Guided by Bandura's social learning theory, this explanatory correlational study examined the relationships between critical care nurses' personal and professional characteristics and their perceived knowledge and self-efficacy when providing EOL care at an academic medical center. Convenience sampling was used to recruit participants from the eligible adult, pediatric, and neonatal critical care nurses for this study. The 67 participants completed the End-of-Life Professional Caregiver Survey (EPCS) to assess EOL care knowledge and self-confidence. Total EPCS scores revealed only moderate levels of EOL knowledge and self-confidence. The Fisher's exact test indicated that higher EPCS scores were significantly associated with nurses' age and completion of advance directive. A 3-day workshop was designed to address deficits related to EPCS scores and advance directive completion, while educating younger nurses to gain confidence in their EOL discussions. Additional research is recommended to distinguish between nurses' actual knowledge and perceived knowledge about EOL care, the long-term effects of EOL care education on the quality of patient care, nurses' levels of moral distress and burnout, and nurses' communication skills with patients and other health care providers. The result of this research promotes positive social change through EOL education to improve the confidence of nurses working with dying patients and their families, as well as to understand the challenges of communicating difficult decisions regarding EOL care.

Falls among the elderly is a health concern affecting multiple patients annually. Hospice patients and those with multiple comorbidities are at the greatest risk of falling and sustaining injuries from falls. Aromatherapy has been used for reducing multiple symptoms as well as for decreasing falls. The practice-focused question explored whether an education program on using aromatherapy for fall prevention would increase knowledge of this intervention for an interdisciplinary group of hospice staff. The design was developed using Knowles's theory of andragogy and Bloom's taxonomy. Thirteen staff members from the same facility participated in the education program. The program was targeted to educate staff who worked with hospice patients about implementing the intervention in their practice. The program was also offered facility-wide to allow all staff the opportunity to increase their knowledge in using the intervention in their fall- reduction programs. Assessment tools including pretest, posttest, and evaluations were completed by all program participants. Using a Likert scale to calculate participant responses, results revealed an increase in knowledge gained from 15% to 60%. The participants rated the program favorably with a mean score of 4.4 to 4.6 out of 5. This program would be beneficial to hospice caregivers and a broader range of staff members including nonhospice nurses, therapists, and providers who are interested in decreasing falls in their patient population. The program would also be of interest to accrediting bodies, hospice, palliative care, oncologic, and geriatric organizations for alternative fall-reduction interventions. Reducing falls will result in a positive social change by decreasing fall-related injuries costs and improving quality at end-of-life.

Avoidable hospitalizations of hospice patients cost Medicare $3 billion a year. When hospice nurses are able to identify early signs and symptoms of acute illness and provide appropriate interventions to prevent such admissions, 20-60% of the hospitalizations are preventable. The practice problem addressed in this quality improvement doctor of nursing project was the 30% hospital admission rate of hospice patients as evidenced by chart review, admission data, and revocation data. The first purpose of the project was to identify evidence-based nursing care paths in the literature for the top 5 medical diagnoses related to avoidable hospital admissions. The second purpose was to develop an educational curriculum to educate the staff on the care paths with a pretest/posttest to assess knowledge gained from the education. Rosswurm and Larrabee's conceptual model was used to frame the project. Three content experts evaluated the curriculum plan using a 4 item dichotomous rating of 1 (not met) and 2 (met). An average score of 2 revealed that the curriculum content met the course objectives. Content experts validated each of the 16 pretest/posttest items using a Likert scale ranging from 1 (not relevant) to 4 (highly relevant). The content validation index score was .94, indicating that the pretest/posttest reflected the course objectives and content. Recommendations were made for structuring the pretest/posttest. The project promotes social change by assessing, intervening, and treating patients in the outpatient hospice setting to prevent avoidable hospitalizations, thus promoting patient well-being and fiscal responsibility of healthcare dollars.

Background: Advance directives allow patients to put in writing the type of health care they want if they are unable to make decisions due to their medical condition. Purpose: The purpose of this study was to determine if there were differences in senior nursing students’ knowledge, attitudes, and confidence based on when the information is positioned in the curriculum. Theoretical: Social cognitive learning theory and Zimmerman’s self-regulation model provided the theoretical framework. Methods: This study reflected a non-experimental, exploratory design, with a convenience sample of senior nursing students from 2 different nursing programs in central Illinois. One program offers advance directive education in the first year and the other program offers the information in the second year. A total of 131 students participated in the study that used subscales of the Knowledge, Attitudinal, Experiential Survey on Advance Directives. Results: The group that received the information the second year rated themselves as having more confidence with advance directives. However, both groups scored low in the area of knowledge of advance directives, the Patient Self-Determination Act, and Illinois law. Students who reported higher knowledge levels had higher attitudes about end-of-life care. There was no difference in attitudes between the two groups. Conclusion: The results of this study highlight the need to review nursing curricula specifically relating to end-of-life care content and its placement in the curriculum.

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Helping patients and their families prepare for the end of life is a privilege for physicians. Often these discussions are very sensitive; one must be able to navigate the complexities of dying while maintaining the strong, intimate relationship with a person who has entrusted the doctor with his or her final care. Many of the same principles of medical ethics still apply such as informed consent, acknowledging different degrees of health literacy, and cultural humility. With end-of-life care, physicians are responsible for providing their patients dignity in death. In doing so, it is important to decide how aggressive or intense medical treatment should be. There is evidence to suggest that early involvement of palliative care, foregoing invasive procedures or surgeries, and honest communication with families can improve the dying experience. The COVID-19 pandemic has only added more challenges to an already difficult art that physicians spend entire careers working on perfecting. Nevertheless, this provides even more reason to be proactive in determining what is most important for every individual in their final days. / Urban Bioethics

Disgust is a part of medical education. Whether in the anatomy lab, the operating room, or the hospital wards, medical school is often the first time that future doctors see human suffering manifested in bodies that elicit embarrassment, disgust and fear. Over the course of training, seeing such bodies goes from exceptional to commonplace as doctors learn to witness and empathize with suffering without becoming overwhelmed by it. In this thesis, I examine students’ first encounters with abject bodies in the anatomy lab, their later encounters with such bodies in their clinical years, and the educational programming shapes students’ gaze towards these bodies as they develop from laypeople into professionals. I argue that while medical humanities curricula implemented into gross anatomy help students manage challenging personal feelings elicited by the corpse, taboos and silences during the clinical years prevent students from thinking deeply about how patients experience having bodies that elicit disgust. The dearth of reflection on feelings of disgust during clinical training leaves doctors in training ill-equipped to promote and maintain patient dignity during medical care, particularly at the end of life. / Urban Bioethics

The mature minor doctrine legally allows minors with the maturity of an adult to make decisions about their medical treatment, sometimes without the knowledge of their parent or guardian. However, the mature minor doctrine does not live up to its expectations; there are no guidelines for determining if a minor is mature or if the minor has the capacity to consent. The court system’s reluctance to allow minors to refuse treatment, the focus on stereotypical adolescent behavior, and the possibility of penalization of the family also serve as drawbacks to minors exercising their right to bodily autonomy through the mature minor doctrine. Standardization can solve these issues, revolutionizing the mature minor doctrine so that minors’ preferences about their care, particularly in the setting of life-threatening illness, can be honored. / Urban Bioethics