Using Family Narrative Reports to Identify Practices for Improving End-of-Life Care Quality.

Context: Patient experiences should be considered by healthcare systems when implementing care practices to improve quality of end-of-life care. Families and caregivers of recent in-patient decedents may be best positioned to recommend practices for quality improvement.

Objectives: To identify actionable practices that bereaved families highlight as contributing to high quality end-of-life care.

Using a Quality Improvement Model to Implement Distress Screening in a Community Cancer Setting.

Background: Quality cancer care includes routine screening for psychosocial distress. This quality improvement project focused on the implementation of distress screening at a licensed affiliate of Cancer Support Community, a community-based non-profit organization that provides professionally led cancer support.

Methods: An advanced practice oncology nurse assisted the staff in implementing and evaluating the process of distress screening.

Empowering the Latino Community Related to Palliative Care and Chronic Disease Management through (Community Health Workers).

Latinos are the largest minority group in the United States and when compared with non-Latino whites suffer from higher rates of certain chronic diseases. Latino community health workers () are successful in improving the health of their communities. However, evidence of their effectiveness in increasing awareness of palliative care (PC) is limited.

Developing Unique Insights From Narrative Responses to Bereaved Family Surveys.

Context: Although bereaved family surveys (BFS) are routinely used quantitatively for quality assessment, open-ended and narrative responses are rarely systematically analyzed. Analysis of narrative responses may identify opportunities for improving end-of-life (EOL) care delivery.

Objectives: To highlight the value of routine and systematic analysis of narrative responses and to thematically summarize narrative responses to the BFS of Veterans Affairs.

Pilot Implementation of a Low-Literacy Zone Tool for Heart Failure Self-management.

Heart failure affects 6.5 million Americans, with 1 million hospitalizations annually, a 22% readmission rate, and $31 billion in health care costs. Palliative care decreases symptom burden, readmissions, and costs.

Pain Screening in the Older Adult With Delirium.

Background: In patients with cognitive impairments who are unable to self-report pain, nurses must rely on behavioral observation tools to assess and manage pain. Although frequently employed in medical-surgical units, evidence supporting the psychometric efficacy of the Pain in Advanced Dementia (PAINAD) for pain screening in older adults with delirium is lacking.

Aim: To examine the psychometrics of the PAINAD for older adults with delirium in medical-surgical settings.

The Patient-Centered Medical Home Model and Diabetes Outcomes: An Integrative Literature Review.

The purpose of this integrative review was to synthesize the existing evidence on diabetes care within a Patient-Centered Medical Home (PCMH) model to evaluate its effectiveness on quality outcomes. Literature published in English between 2005 and 2015 was searched using thefollowing keywords: PCMH and diabetes, comprehensive care, care coordination, patient-centered care, quality and safety, and accessible care. The following databases were searched: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Cochrane Review, Academic Premier (EBSCO), and Psych INFO.

Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review.

Importance: Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes.

Early malnutrition screening and low cost protein supplementation in elderly patients admitted to a skilled nursing facility.

Background: Malnutrition among skilled nursing facility (SNF) patients can lead to hospital readmissions and multiple complications.

Purpose: To evaluate the effect of an existing malnutrition screening and management program on prealbumin levels of patients in skilled nursing facilities.

Methods: A retrospective design was used to evaluate baseline admission data including a prealbumin level.

Palliative care in neonatal intensive care, effects on parent stress and satisfaction: a feasibility study.

Context: Approximately 1 in 10 infants require neonatal intensive care unit (NICU) hospitalization, which causes parental stress. Palliative care (PC) provides an opportunity to alleviate suffering and stress.

Objectives: This study examines the effects of PC on NICU parent stress and satisfaction.

Developing an informatics tool to advance supportive care: the Veterans Health Care Administration Palliative Care National Clinical Template.

Background: Increasing emphasis in performance-based payment, public reporting, and quality improvement (QI) has led to widespread interest in measuring and improving the quality of care. By 2014, hospice programs will be required to report quality data to the federal government or incur financial penalties. With this increased interest in quality reporting comes an opportunity to develop informatics tools to capture data that reflect the complex practices involved in palliative care (PC).

Provider approaches to palliative dyspnea assessment: implications for informatics-based clinical tools.

Aim: To understand provider practices around dyspnea assessment to inform the development of an electronic medical record (EMR)-based dyspnea assessment module in an inpatient palliative care consultation template.

Design: Qualitative analysis of palliative care provider interviews.

Results: Three themes emerged: (1) integration of patient self-report of breathlessness with a clinical observation of dyspnea; (2) identification of patients for dyspnea assessment based on perceived patient need; and (3) variability in preferences for and use of existing severity scales for dyspnea.

Prescription sharing, alcohol use, and street drug use to manage pain among veterans.

Context: Efforts to promote awareness and management of chronic pain have been accompanied by a troubling increase in prescription medication abuse. At the same time, some patients may misuse substances in an effort to manage chronic pain.

Objectives: This study examines self-reported substance misuse for pain management among veterans and identifies the contributing factors.

Factors associated with clinician intention to address diverse aspects of pain in seriously ill outpatients.

Background: Pain is a common, often undertreated problem among patients with palliative needs.

Objectives: To evaluate clinician factors associated with intention to address diverse aspects of pain.

Design: Clinicians reviewed a clinical vignette describing a frail elderly patient with advanced hormone-refractory metastatic prostate cancer, depression, and pain not on analgesic therapy.

Nursing staff, patient, and environmental factors associated with accurate pain assessment.

Context: Although pain ranks highly among reasons for seeking care, routine pain assessment is often inaccurate.

Objectives: This study evaluated factors associated with nurses (e.g.

Addressing patients' concerns about pain management and addiction risks.

Fear of engendering addiction is frequently reported as both a provider and a patient barrier to effective pain management. In this study, a clinical scenario ascertained nursing staff members' usual practice in addressing addiction fears for patients with concerns about the addictive potential of pain medication. One hundred forty-five Veterans Health Administration nursing staff members from eight ambulatory care sites were queried to identify variables associated with proclivity to address patient fears about addiction risks in a population where pain is prevalent and the risk for substance abuse is high.

Does screening for pain correspond to high quality care for veterans?

Background: Routine numeric screening for pain is widely recommended, but its association with overall quality of pain care is unclear.

Objective: To assess adherence to measures of pain management quality and identify associated patient and provider factors.

Design: A cross-sectional visit-based study.

Exploring alternative approaches to routine outpatient pain screening.

Objective: To evaluate potential alternatives to the numeric rating scale (NRS) for routine pain screening.

Design: Cross-sectional.

Setting: Nineteen Veterans Affairs outpatient clinics in Southern California at two hospitals and six community sites.

Heart failure: the hidden problem of pain.

Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67+/-11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2).

Caring for special populations: total pain theory in advanced heart failure: applications to research and practice.

Topic: Total pain theory.

Purpose: Describe total pain theory and apply it to research and practice in advanced heart failure (HF).

Source Of Information: Total pain theory provides a holistic perspective for improving care, especially at the end of life.

How reliable is pain as the fifth vital sign?

Background: Although many health care organizations require routine pain screening (eg, "5th vital sign") with the 0 to 10 numeric rating scale (NRS), its accuracy has been questioned; here we evaluated its accuracy and potential causes for error.

Methods: We randomly surveyed veterans and reviewed their charts after outpatient encounters at 2 hospitals and 6 affiliated community sites. Using correlation and receiver operating characteristic analysis, we compared the routinely measured "5th vital sign" (nurse-recorded NRS) with a research-administered NRS (research-recorded NRS) and the Brief Pain Inventory (BPI).

Early identification of co-occurring pain, depression and anxiety.

Background: Depression and anxiety frequently co-occur with pain and may affect treatment outcomes. Early identification of these co-occurring psychiatric conditions during routine pain screening may be critical for optimal treatment.

Objective: To determine aspects of pain related to psychological distress, and, among distressed patients, to determine whether pain factors are related to provider identification of distress.

A comparative study of pain in heart failure and non-heart failure veterans.

Background: Progress has been made in addressing pain in specific diseases such as cancer, but less attention has focused on understanding pain in nonmalignant states, including heart failure (HF).

Methods And Results: From March 2006 to June 2007, 672 veterans were surveyed and scores for the Brief Pain Inventory, pain distress, clinically significant pain levels (moderate to severe pain), and pain locations were compared using univariate and multivariate models. Fifteen percent of the final sample had HF (95/634).