Enhancing end-of-life care practices on the medicine units: perspectives from nurses and families.

Background: Death is a part of life. While most often a sombre event, opportunities exist to optimise the experience both for the dying patient and their loved ones. This is especially true in institutionalised settings, such as acute care hospitals where cure and recovery tend to be paramount.

Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards.

Objectives: Caring for dying hospitalised patients is a healthcare priority. Our objective was to understand the learning needs of front-line nurses on the general internal medicine (GIM) hospital wards, and perceived barriers to, and facilitators of, optimal end-of-life care.

Methods: We developed an 85-item survey informed by the Theoretical Domains Framework and Capability-Opportunity-Motivation-Behaviour system.

Enhancing end of life care on general internal medical wards: the 3 Wishes Project.

Background: Initially developed in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton (SJHH) the 3 Wishes Project (3WP) provides personalized, compassionate care to dying patients and their families. The objective of this study was to develop and evaluate 3WP expansion strategies for patients cared for on General Internal Medicine (GIM) wards in our hospital.

Use of Video Technology in End-of-Life Care for Hospitalized Patients During the COVID-19 Pandemic.

Background: Infection control protocols, including visitor restrictions, implemented during the COVID-19 pandemic threatened the ability to provide compassionate, family-centered care to patients dying in the hospital. In response, clinicians used videoconferencing technology to facilitate conversations between patients and their families.

Objectives: To understand clinicians' perspectives on using videoconferencing technology to adapt to pandemic policies when caring for dying patients.

Sacrifice and solidarity: a qualitative study of family experiences of death and bereavement in critical care settings during the pandemic.

Background: Pandemic-related restrictions are expected to continue to shape end-of-life care and impact the experiences of dying hospitalised patients and their families.

Objective: To understand families' experiences of loss and bereavement during and after the death of their loved one amidst the SARS-CoV-2 (COVID-19) pandemic.

Design: Qualitative descriptive study.

Scale-up and sustainability of a personalized end-of-life care intervention: a longitudinal mixed-methods study.

Background: Scaling-up and sustaining healthcare interventions can be challenging. Our objective was to describe how the 3 Wishes Project (3WP), a personalized end-of-life intervention, was scaled-up and sustained in an intensive care unit (ICU).

Methods: In a longitudinal mixed-methods study from January 12,013 - December 31, 2018, dying patients and families were invited to participate if the probability of patient death was > 95% or after a decision to withdraw life support.

Experiences of Bereaved Family Members Receiving Commemorative Paintings: A Qualitative Study.

Importance: Although family members of patients who die in the intensive care unit commonly experience long-term psychological distress, end-of-life bereavement support programs for such relatives are uncommon. Whether art influences the grief experience of families is largely unexplored.

Objective: To explore the influence of personalized paintings created to honor deceased critically ill patients on family members' bereavement experience.

Clinician Perspectives on Caring for Dying Patients During the Pandemic : A Mixed-Methods Study.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected the hospital experience for patients, visitors, and staff.

Objective: To understand clinician perspectives on adaptations to end-of-life care for dying patients and their families during the pandemic.

Design: Mixed-methods embedded study.

End-of-Life Skills and Professionalism for Critical Care Residents in Training: The ESPRIT Survey.

End-of-life (EOL) care is a key aspect of critical care medicine (CCM) training. The goal of this study was to survey CCM residents and program directors (PDs) across Canada to describe current EOL care education. Using a literature review, we created a self-administered survey encompassing 10 CCM national objectives of training to address: (1) curricular content and evaluation methods, (2) residents' preparedness to meet these objectives, and (3) opportunities for educational improvement.

Building organizational compassion among teams delivering end-of-life care in the intensive care unit: The 3 Wishes Project.

Background: The 3 Wishes Project is a semistructured program that improves the quality of care for patients dying in the intensive care unit by eliciting and implementing wishes. This simple intervention honors the legacy of patients and eases family grief, forging human connections between family members and clinicians.

Aim: To examine how the 3 Wishes Project enables collective patterns of compassion between patients, families, clinicians, and managerial leaders in the intensive care unit.

Palliative care clinical rotations among undergraduate and postgraduate medical trainees in Canada: a descriptive study.

Background: The number of medical undergraduate and postgraduate students completing palliative care clinical rotations in Canadian medical schools is currently unknown. The aim of this study was to assess the proportion of Canadian medical trainees completing clinical rotations in palliative care and to determine whether changes took place between 2008 and 2018.

Methods: In this descriptive study, all Canadian medical schools ( = 17) were invited to provide data at the undergraduate and postgraduate levels (2007/08-2015/16 and 2007/08-2017/18, respectively).

Compassionate End-of-Life Care: Mixed-Methods Multisite Evaluation of the 3 Wishes Project.

Background: The 3 Wishes Project (3WP) is an end-of-life program that aims to honor the dignity of dying patients by creating meaningful patient- and family-centered memories while promoting humanistic interprofessional care.

Objective: To determine whether this palliative intervention could be successfully implemented-defined as demonstrating value, transferability, affordability, and sustainability-beyond the intensive care unit in which it was created.

Design: Mixed-methods formative program evaluation.

The Development and Validation of Updated Palliative and End-of-Life Care Competencies for Medical Undergraduates in Canada.

In 2008, a Canadian strategy called the "Educating Future Physicians in Palliative and End-of-Life Care" (EFPPEC) project published national medical undergraduate competencies for palliative and end-of-life care. Since that time, there have been several changes in the practice environment. To formally incorporate these changes and also update the competencies for EFPPEC, an EFPPEC update project team was established in 2017.

Staffing a Specialist Palliative Care Service, a Team-Based Approach: Expert Consensus White Paper.

Palliative care is an evolving field with extensive studies demonstrating its benefits to patients, families, and the health care system. Many health systems have developed or are developing palliative care programs. The Canadian Society of Palliative Care Physicians (CSPCP) is often asked to recommend how many palliative care specialists are needed to implement and support an integrated palliative care program.

Narrative medicine and death in the ICU: word clouds as a visual legacy.

Objective: The Word Cloud is a frequent wish in the 3 Wishes Project developed to nurture peace and ease the grieving process for dying critically ill patients. The objective was to examine whether Word Clouds can act as a heuristic approach to encourage a narrative orientation to medicine. Narrative medicine is an approach which can strengthen relationships, compassion and resilience.

Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit.

Rationale: The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality.

Objectives: To describe how family members and clinicians experience and express spirituality during the dying process in a 21-bed medical-surgical ICU.

Methods: Reflecting the care of 70 dying patients, we conducted 208 semistructured qualitative interviews with 76 family members and 150 clinicians participating in the Three Wishes Project.

Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study.

Background: Dying in the complex, efficiency-driven environment of the intensive care unit can be dehumanizing for the patient and have profound, long-lasting consequences for all persons attendant to that death.

Objective: To bring peace to the final days of a patient's life and to ease the grieving process.

Design: Mixed-methods study.

An evidence-based quality improvement perspective for a chronic obstructive pulmonary disease case-finding program.

Chronic obstructive pulmonary disease (COPD) is a persistent progressive respiratory disease that is increasing in prevalence and cost in the United States health care system. Delays in recognition, diagnosis, and treatment are associated with poorer clinical outcomes. These delays are seen more often in populations experiencing economic hardship, lack of access to care, and lack of insurance, such as those seen in an indigent care clinic.

A method to enhance student teams in palliative care: piloting the McMaster-Ottawa Team Observed Structured Clinical Encounter.

Background: The need for palliative and end-of-life care (PEOLC) education in prelicensure education has been identified. PEOLC requires effective collaborative teamwork. The competencies required for effective collaborative teamwork are only now emerging and methods to evaluate them must be developed.

Oral health measurement in nursing research: state of the science.

Oral health can impact general health and systemic disease. Changes in dental plaque, oral microbial flora, and local oral immunity may be important in the development or exacerbation of disease in critically ill patients, trauma patients, adults with chronic obstructive pulmonary disease, and frail elderly. Inasmuch as oral health potentially can be influenced by nursing interventions, nursing research in this area can contribute greatly to improved patient outcomes in these diverse populations.

Update on chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is one of the most significant chronic illnesses of adults. Comprehensive care of the affected patient requires the medical-surgical nurse to have knowledge of the disease process, collaborative management, and nursing care based on research and current practice guidelines.