Many organizations such as the Institute of Medicine, the World Health Organization and the National Consensus Project for Quality Palliative Care have identified the need for equitable access to palliative and end-of-life care (Ferrell, Coyle, & Paice, 2015). However, in many rural areas of the world, including rural Wyoming, patients at end-of-life are cared for in acute care settings where nurses have not received specialized training and education on evidence based end-of-life care. The aim for this DNP project was to assess rural registered nurses' perceptions of competencies important in end-of-life nursing practice (Coyne & White, 2011). A 32-item survey developed by White and Coyne (2011) was adapted for use in a rural critical access hospital to determine content priorities and educational needs of generalist nurses in a rural setting, regarding providing palliative and end-of-life care. A purposive sample of 16 nurses in a rural critical access hospital in Wheatland, WY, who care for patients at end-of-life, completed the survey. Only one-third of the nurses surveyed reported receiving any type of end-of-life care education in the prior two years. Similar to findings from the study completed in 2011 in an urban area, symptom management, talking to patients and families about death and dying, and pain control were the highest ranking core competencies. Nurses who did report receiving education in end-of-life care still felt inadequately prepared to talk to patients and families about dying, and this needs assessment identified that educational gaps are evident regarding provision of end-of-life nursing care in rural settings. The information gleaned from this survey will be used to design an educational program to disseminate evidence based practice guidelines regarding providing quality end-of-life care using ELNEC (End-of-Life Nursing Education Consortium) modules based on the findings of the needs assessment survey

This study is a descriptive qualitative analysis of the values and traits of rehabilitation counselor life care planners. Using the theoretical foundation of the Person-Environment fit theory, it reviews the available literature on rehabilitation counselor life care planners and fills in a missing sub-category of research on Person-Group fit within the private rehabilitation field and life care planning. It contains a review of rehabilitation counselor identity in order to provide context to how rehabilitation counselor life care planners view themselves as practitioners, particularly the role of income in career fit given ethical concerns surrounding money in the practice of life care planning. The primary traits resulting from this study are emotional differentiation, counselor as educator/performer, desiring intellectual excellence, detail oriented, and financial awareness. The primary values resulting from this study are recognition of humanity, integrity, objectivity, freedom in work, and social and financial responsibility. These results are discussed within the social culture of rehabilitation counseling to better understand their development.

Title from PDF of title page (University of Missouri--Columbia, viewed on March 10, 2010). The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Thesis advisor: Dr. James Keller. Includes bibliographical references.

No description available.

The purpose of this study was, first, to further our understanding of the experience of dying in a long-term care (LTC) facility from the perspective of family members and second, to identify the relationships between the various factors which may influence satisfaction with end-of-life care. Using a sequential mixed methods design, a convenience sample of 87 family members completed a survey interview using a modified version of the Toolkit of Instruments to Measure End-of-life Care (TIME) Nursing Home Version in the first phase of the study. Findings from the parametric and non-parametric analyses indicated that family satisfaction with end-of-life care was best predicted by contact and communication with nursing staff, feeling that care provided at the end of life met expectations, staff providing consistent care, feeling that the health care aide listened to their concerns about care and that respondents felt they had received enough emotional support. Being transferred to hospital in the last month of life, dying in a place other than the LTC facility, and respondent age and employment status were all associated with significant mean differences in satisfaction scores. In the second phase, three focus groups were conducted to further explore areas of satisfaction and dissatisfaction with end-of-life care. Focus groups provided confirmation of the findings of the first phase of the study and were instrumental in developing a list of ten recommendations for improvements in end-of-life care delivery. Recommendations for future research are made based on the study results.

Emergency departments (EDs) are often thought of solely as places where life-saving interventions occur. However, EDs are also places where dying patients receive end of life care. Though research examining expert nurse behaviours in care of the dying has been conducted in a variety of care settings, little is known about this topic as it relates to care of the dying adult in the ED. A descriptive exploratory study was conducted with registered nurse experts (n = 6) in two urban EDs in Western Canada. Five expert nurse behaviours deemed essential in care of the dying adult patient in the ED were identified: 1) providing comfort; 2) honouring the personhood of the patient; 3) responding to the family; 4) responding after the death of the patient; and 5) responding to colleagues. These findings contribute to the empirical evidence concerning expert nursing care of the dying.

This study explores and examines the roles of caregivers within rest home facilities in New Zealand; and specifically, how they unpack and deal with managing the tensions associated with end of life (EOL) care. It adopted a qualitative perspective to enable an exploration of how the experiences of caregivers help guide their practice and understanding of their roles in relation to EOL care. A grounded theory framework was utilised in order to explore how caregivers make meaning and find value in the roles they perform within rest home facilities. This study offers insights into some of the tensions that caregivers face in a working environment where life and death occur simultaneously. It was apparent that caregivers are aware of the many social taboos they must negotiate in order to conduct their work. It was also apparent that they understood that others might perceive their work as dirty but that this did not prevent them from finding job satisfaction and create meaning in their work. Instead, they created meaning by using the conceptual tool the imagination of care. This involved utilising their imagination and past experiences to enable EOL care which represented the dying rites of individual residents but also fitted within their ethic of care.

The purpose of this study was, first, to further our understanding of the experience of dying in a long-term care (LTC) facility from the perspective of family members and second, to identify the relationships between the various factors which may influence satisfaction with end-of-life care. Using a sequential mixed methods design, a convenience sample of 87 family members completed a survey interview using a modified version of the Toolkit of Instruments to Measure End-of-life Care (TIME) Nursing Home Version in the first phase of the study. Findings from the parametric and non-parametric analyses indicated that family satisfaction with end-of-life care was best predicted by contact and communication with nursing staff, feeling that care provided at the end of life met expectations, staff providing consistent care, feeling that the health care aide listened to their concerns about care and that respondents felt they had received enough emotional support. Being transferred to hospital in the last month of life, dying in a place other than the LTC facility, and respondent age and employment status were all associated with significant mean differences in satisfaction scores. In the second phase, three focus groups were conducted to further explore areas of satisfaction and dissatisfaction with end-of-life care. Focus groups provided confirmation of the findings of the first phase of the study and were instrumental in developing a list of ten recommendations for improvements in end-of-life care delivery. Recommendations for future research are made based on the study results.

Emergency departments (EDs) are often thought of solely as places where life-saving interventions occur. However, EDs are also places where dying patients receive end of life care. Though research examining expert nurse behaviours in care of the dying has been conducted in a variety of care settings, little is known about this topic as it relates to care of the dying adult in the ED. A descriptive exploratory study was conducted with registered nurse experts (n = 6) in two urban EDs in Western Canada. Five expert nurse behaviours deemed essential in care of the dying adult patient in the ED were identified: 1) providing comfort; 2) honouring the personhood of the patient; 3) responding to the family; 4) responding after the death of the patient; and 5) responding to colleagues. These findings contribute to the empirical evidence concerning expert nursing care of the dying.

The purpose of this study was, first, to further our understanding of the experience of dying in a long-term care (LTC) facility from the perspective of family members and second, to identify the relationships between the various factors which may influence satisfaction with end-of-life care. Using a sequential mixed methods design, a convenience sample of 87 family members completed a survey interview using a modified version of the Toolkit of Instruments to Measure End-of-life Care (TIME) Nursing Home Version in the first phase of the study. Findings from the parametric and non-parametric analyses indicated that family satisfaction with end-of-life care was best predicted by contact and communication with nursing staff, feeling that care provided at the end of life met expectations, staff providing consistent care, feeling that the health care aide listened to their concerns about care and that respondents felt they had received enough emotional support. Being transferred to hospital in the last month of life, dying in a place other than the LTC facility, and respondent age and employment status were all associated with significant mean differences in satisfaction scores. In the second phase, three focus groups were conducted to further explore areas of satisfaction and dissatisfaction with end-of-life care. Focus groups provided confirmation of the findings of the first phase of the study and were instrumental in developing a list of ten recommendations for improvements in end-of-life care delivery. Recommendations for future research are made based on the study results. / October 2007