Orchestrating Care: A Grounded Theory Study of Family Caregiving for Older Adults in Rural Areas.

Family caregivers provide the majority of long-term care and support of older adults as they age or approach the end of life. Studies often refer to family caregivers as invisible because the American healthcare system, public policy, and society do not support or recognize their work. Family caregivers who provide care to older adults who live in rural areas face unique challenges due to the rural environment.

The meaning of comfort measures only order sets for hospital-based palliative care providers.

Purpose: (CMO) is a label commonly used in the USA that guides the care of a hospitalized patient who is likely to die. The CMO label has unclear and inconsistent meaning, calling to question the experiences and practices of hospital-basedalliative care providers. The purpose of this study was to understand the meaning of CMO as experienced by hospital-based palliative care providers.

Navigating the caregiving abyss: A metasynthesis of how family caregivers manage end-of-life care for older adults at home.

Background: Demographic changes (global aging, decreased fertility, increased home deaths) will present a critical need for end-of-life family caregivers of older adults at home. In order to support these family caregivers, we need to better understand their experiences, struggles, and needs.

Aim: To describe and explain the process of end-of-life caregiving as experienced by family caregivers of older adults residing in the home setting.

Transition to comfort-focused care: Moral agency of acute care nurses.

Background: Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families.

Family Outcomes and Perceptions of End-of-Life Care in the Intensive Care Unit: A Mixed-Methods Review.

The purpose of this review was to evaluate end-of-life care (EOLC) in the intensive care unit (ICU) from the perspective of family members. Sandelowski's segregated approach from Joanna Briggs Institute (JBI) Mixed-Methods Systematic Reviews guided this review. A search was conducted in PubMed, CINAHL, PsycINFO, EMBASE, and ProQuest databases and identified 50 papers (33 quantitative, 15 qualitative, and 2 mixed-methodology studies).

Guiding the Process of Dying: The Personal Impact on Nurses.

Some of the most ethically challenging and emotionally demanding aspects of nursing occur in caring for patients and their family at the end of life. The aims of this study were to examine the views of acute care nurses caring for patients during transition to comfort care, to describe the personal impact on nurses, and to identify nurses' strategies for self-support and development of competence. Using a qualitative descriptive approach, we analyzed data from 26 semistructured interviews.

Metasynthesis: Dying adults' transition process from cure-focused to comfort-focused care.

Aim: To describe and explain the process of transition from cure-focused to comfort-focused health care as perceived and reported by patients, family members, and healthcare providers.

Background: Moving into the last phase of life due to advanced illness constitutes a developmental transition with increased vulnerability for patients and family.

Design: Qualitative metasynthesis.

Changing Focus: End-of-Life Care in a New York State Managed Long-Term Care Program.

In the United States, managed long-term care programs offer a noninstitutional approach to meeting the needs of increasing numbers of frail elders. Providing services that support both quality of life and quality of dying poses unique challenges. Using a qualitative descriptive design, we explored these challenges from the perspectives of care providers.

Is It the Difference a Day Makes? Bereaved Caregivers' Perceptions of Short Hospice Enrollment.

Context: Hospice enrollment for less than one month has been considered too late by some caregivers and at the right time for others. Perceptions of the appropriate time for hospice enrollment in cancer are not well understood.

Objectives: The objectives of the study were to identify contributing factors of hospice utilization in cancer for ≤7 days, to describe and compare caregivers' perceptions of this as "too late" or at the "right time.

The Developmental Transition From Living With to Dying From Cancer: Hospice Decision Making.

Despite increasing utilization of hospice care, older adults with cancer enroll in hospice for shorter periods of time than those with other life-limiting illnesses. How older adults with cancer and their family members consider hospice is unknown. The purpose of this study was to compare decision making in late-stage cancer in people who enrolled in hospice with those who declined.

Examining family meetings at end of life: The model of practice in a hospice inpatient unit.

Objective: Our purpose was to rigorously examine the nature of family meetings as conducted in an inpatient hospice care unit in order to generate an inductive theoretical model.

Method: In this two-phase project, we first interviewed eight members of the interdisciplinary care team who participated in multiple family meetings each week. Interview questions explored why and how they conducted family meetings.

Contending with advanced illness: patient and caregiver perspectives.

Context: Despite improvements in end-of-life care, some unrelieved suffering persists for patients with advanced illness and their family members. Hospice and palliative care services can reduce suffering, but these services remain under-used.

Objectives: To investigate how patients with advanced illness and their primary caregivers experienced and responded to health care needs and decision making and how some dyads moved toward comfort-focused care.

Final decisions: how hospice enrollment prompts meaningful choices about life closure.

Objective: The purpose of this study was to explore and describe decisions that faced newly enrolled hospice patients and their caregivers after hospice enrollment.

Method: An exploratory, descriptive, cross-sectional design was employed using qualitative methods. In-depth in-person interviews were conducted with current hospice patients (n = 35) and caregivers (n = 45) from 53 families.

Communication and advanced care planning in palliative and end-of-life care.

Communication about and planning for the end of life has evolved with medical and technological changes. This article presents a focused literature review of Advance Directives (ADs), Advanced Care Planning (ACP), and communication in palliative and end-of-life care. Two focused Medline searches were conducted to locate articles that addressed ACP in the U.

What influences African American end-of-life preferences?

Background: The U.S. population is aging and increasingly culturally diverse.

Hospice decision making: diagnosis makes a difference.

Purpose: This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision.

Methods: This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care.

The nature and timing of family-provider communication in late-stage cancer: a qualitative study of caregivers' experiences.

Context: Family members of people with advanced cancer can experience intensified distress and uncertainty during the final stages of their loved one's illness. Enhanced comprehension about disease progression, symptom management, and options for care can help families adapt, cope, and plan for the future.

Objectives: Guided by concepts from the Sense of Coherence Theory, which illuminates factors that contribute to adaptation in stressful situations, the objective of this study was to explore and describe family caregivers' accounts of the nature and timing of communication they had with a loved one's health care provider(s) during the advanced stages of cancer and before hospice enrollment.

Responsive care management: family decision makers in advanced cancer.

The purpose of this prospective study was to develop a grounded theory explaining the process that family decision makers use to make care decisions with or for a family member with advanced cancer. Adult surrogate decision makers were recruited for multiple interviews over the patient's care trajectory: 40 surrogates provided 80 semi-structured interviews. Analysis of these narratives revealed a process of responsive care management that is inclusive of, but not limited to, decision-making roles.

Crisis in caregiving: when home-based end-of-life care is no longer possible.

Understanding the factors that precipitate caregiving crises that cannot be resolved at home is central to improving options for care at life's end. The purpose of this study was to explore caregivers' perceptions of the crises that preceded and were resolved by relocation during end-of-life care. In-depth interviews were conducted with 36 caregivers of people who died in a hospice house.

Applying the transtheoretical model to health care proxy completion.

Background: For many, an important health decision is whether or not to document end-of-life wishes using an advance directive (e.g., health care proxy).

Psychometric testing of four transtheoretical model questionnaires for the behavior, completing health care proxies.

The purpose of the study was to develop four questionnaires based on the transtheoretical model (TTM) to assess the behavior, completing a healthcare proxy (HCP). The aims were to (a) operationalize the four TTM constructs for completing a HCP and (b) evaluate the psychometric properties of the questionnaires. The questionnaires were constructed and content validity established using an expert panel.

Metasynthesis: withdrawing life-sustaining treatments: the experience of family decision-makers.

Aim: The present study was undertaken to synthesise findings from qualitative investigations of family participation in decisions to withdraw and/or withhold life-sustaining treatment from a seriously ill family member.

Background: As a consequence of increasing effectiveness and sophistication of available medical interventions, death is commonly preceded by a decision to withdraw or withhold potentially life-sustaining treatments. These decisions take place in a bioethical context characterised by the pre-eminence of self-determination, but patients are typically too ill to make their own decisions.

Teaching undergraduate nursing research from an evidence-based practice perspective.

We revised the undergraduate nursing research course using levels of evidence as the template with which to organize the course content and learning activities. A primary purpose in restructuring the course using an evidence-based practice framework was to increase student interest and engagement, and to promote the development of practitioners who will continue to learn about and use research. Learning to systematically locate, evaluate, and use the best available research is the hallmark of evidence-based practice and quality improvement initiatives.

The effectiveness of interventions to increase advance directive completion rates.

Objective: Despite federal and state laws governing advance directives (ADs), interventions to increase rates of legally completed ADs have not produced significant results. This study synthesizes the state of the science regarding effectiveness of interventions to increase AD completion rates.

Methods: Garrard's method for conducting a systematic literature review was followed.