Impact of Pediatric Primary Palliative Care Education and Mentoring in Practice.
Journal
Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association
ISSN: 1539-0705
Titre abrégé: J Hosp Palliat Nurs
Pays: United States
ID NLM: 100887419
Informations de publication
Date de publication:
01 02 2022
01 02 2022
Historique:
pubmed:
23
9
2021
medline:
18
3
2022
entrez:
22
9
2021
Statut:
ppublish
Résumé
Primary palliative care education and mentoring strengthens frontline clinicians' confidence and competence in pediatric palliative care, and potentially mitigates their moral distress. The project aims were to improve the knowledge, attitudes, and skills of frontline intradisciplinary clinicians in caring for children with serious conditions and their families. We undertook an intensive educational initiative consisting of didactic and mentoring sessions, and mentored quality improvement projects. Outcomes included the following: 93.3% of participants reported comfort in discussing death, suffering, spirituality, and hope with families, and increased comfort in end-of-life care (89.5%), increased knowledge (94.7%) and skills (100%), improved communication (100%), and being better prepared to discuss and access palliative care resources (100%). Secondary outcomes included 33% increase in specialty pediatric palliative care consults and 98% increase in the integration of specialty palliative care for patients with high-risk cancers. Specialty pediatric palliative care referral became standard for patients with cystic fibrosis, high-risk solid and brain tumors, heart failure, and patients receiving a stem cell transplant. Clinician self-reported moral distress decreased by 30%. This project improved primary palliative care knowledge, attitudes, and confidence in skills, access to care, and family satisfaction, and decreased clinician self-reported moral distress. We report on the 4-year period of project implementation and sustainability.
Identifiants
pubmed: 34550914
doi: 10.1097/NJH.0000000000000802
pii: 00129191-202202000-00005
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
22-29Informations de copyright
Copyright © 2021 by The Hospice and Palliative Nurses Association. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Committee on Bioethics and Committee on Hospital Care, American Academy of Pediatrics. Palliative care for children. Pediatrics . 2000;106(2, pt 1):351–357.
Field MJ, Behrman RE; Institute of Medicine. Committee on Palliative and End-of-Life Care for Children and Their Families. When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families . Washington, DC: National Academies Press; 2003.
Capc.org. 2019. America's care of serious illness: a state-by-state report card on access to palliative care in our nation's hospitals. https://www.capc.org/shop/americas-care-of-serious-condition-a-state-by-state-report-card-on-access-to-palliative-care-in-our-nations-hospitals_7/ . Accessed October 7, 2020.
Kase SM, Waldman ED, Weintraub AS. A cross-sectional pilot study of compassion fatigue, burnout, and compassion satisfaction in pediatric palliative care providers in the United States. Palliat Support Care . 2019;17(3):269–275. doi:10.1017/S1478951517001237.
doi: 10.1017/S1478951517001237
Gribben JL, Kase SM, Waldman ED, Weintraub AS. A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in pediatric critical care physicians in the United States. Pediatr Crit Care Med . 2019;20(3):213–222. doi:10.1097/PCC.0000000000001803.
doi: 10.1097/PCC.0000000000001803
Weintraub AS, Geithner EM, Stroustrup A, Waldman ED. Compassion fatigue, burnout and compassion satisfaction in neonatologists in the US. J Perinatol . 2016;36(11):1021–1026. doi:10.1038/jp.2016.121.
doi: 10.1038/jp.2016.121
Walter JK, DeCamp LR, Warrier KS, Murphy TP, Keefer PM. Care of the complex chronically ill child by generalist pediatricians: lessons learned from pediatric palliative care. Hosp Pediatr . 2013;3(2):129–138. doi:10.1542/hpeds.2012-0047.
doi: 10.1542/hpeds.2012-0047
Liberman DB, Song E, Radbill LM, Pham PK, Derrington SF. Early introduction of palliative care and advanced care planning for children with complex chronic medical conditions: a pilot study. Child Care Health Dev . 2016;42(3):439–449. doi:10.1111/cch.12332.
doi: 10.1111/cch.12332
Weaver MS, Mooney-Doyle K, Kelly KP, et al. The benefits and burdens of pediatric palliative care and end-of-life research: a systematic review. J Palliat Med . 2019;22(8):915–926. doi:10.1089/jpm.2018.0483.
doi: 10.1089/jpm.2018.0483
Yu JA, Schenker Y, Maurer SH, Cook SC, Kavlieratos D, Houtrow A. Pediatric palliative care in the medical neighborhood for children with medical complexity. Fam Syst Health . 2019;37(2):107–119. doi:10.1037/fsh0000414.
doi: 10.1037/fsh0000414
Zernikow B, Szybalski K, Hübner-Möhler B, et al. Specialized pediatric palliative care services for children dying from cancer: a repeated cohort study on the developments of symptom management and quality of care over a 10-year period. Palliat Med . 2019;33(3):381–391. doi:10.1177/0269216318818022.
doi: 10.1177/0269216318818022
Lafond DA, Bowling S, Fortkiewicz JM, Reggio C, Hinds PS. Integrating the Comfort Theory™ into pediatric primary palliative care to improve access to care. J Hosp Palliat Nurs . 2019;21(5):382–389. doi:10.1097/NJH.0000000000000538.
doi: 10.1097/NJH.0000000000000538
Evans AM, Jonas M, Lantos J. Pediatric palliative care in a pandemic: role obligations, moral distress, and the care you can give. Pediatrics . 2020;146(1):e20201163. doi:10.1542/peds.2020-1163.
doi: 10.1542/peds.2020-1163
Brock KE, Cohen HJ, Sourkes BM, Good JJ, Halamek LP. Training pediatric fellows in palliative care: a pilot comparison of simulation training and didactic education. J Palliat Med . 2017;20(10):1074–1084. doi:10.1089/jpm.2016.0556.
doi: 10.1089/jpm.2016.0556
Committee on Approaching Death: Addressing Key End of Life Issues, Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life . Washington, DC: National Academies Press (US); 2015.
Lin J, Supiano KP, Madden C, McLeskey N. The impact of the End-of-Life Nurse Education Consortium on attitudes of undergraduate nursing students toward care of dying patients. J Hosp Palliat Nurs . 2018;20(4):340–348. doi:10.1097/NJH.0000000000000445.
doi: 10.1097/NJH.0000000000000445
Friedrichsdorf SJ, Remke S, Hauser J, et al. Development of a pediatric palliative care curriculum and dissemination model: education in palliative and End-of-Life Care (EPEC) Pediatrics. J Pain Symptom Manage . 2019;58(4):707–720.e3. doi:10.1016/j.jpainsymman.2019.06.008.
doi: 10.1016/j.jpainsymman.2019.06.008
Chong PH, De Castro Molina JA, Teo K, Tan WS. Paediatric palliative care improves patient outcomes and reduces healthcare costs: evaluation of a home-based program. BMC Palliat Care . 2018;17(1):11. doi:10.1186/s12904-017-0267-z.
doi: 10.1186/s12904-017-0267-z
Ribbers S, Wager J, Hartenstein-Pinter A, Zernikow B, Reuther M. Core outcome domains of pediatric palliative care for children with severe neurological impairment and their families: a qualitative interview study. Palliat Med . 2020;34(3):309–318. doi:10.1177/0269216319885818.
doi: 10.1177/0269216319885818
Cross LA. Compassion fatigue in PC nursing: a concept analysis. J Hosp Palliat Nurs . 2019;21(1):21–28. doi:10.1097/NJH.0000000000000477.
doi: 10.1097/NJH.0000000000000477
Grauerholz KR, Fredenburg M, Jones PT, Jenkins KN. Fostering vicarious resilience for perinatal PC professionals. Front Pediatr . 2020;8:572933. doi:10.3389/fped.2020.572933.
doi: 10.3389/fped.2020.572933
Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research . 2012;3(2):1–9.
Drach LL, Cook M, Shields S, Burger KJ. Changing the culture of pediatric palliative care at the bedside. J Hosp Palliat Nurs . 2021;23(1):20–27. doi:10.1097/NJH.0000000000000707.
doi: 10.1097/NJH.0000000000000707
Moynihan KM, Snaman JM, Kaye EC, et al. Integration of pediatric palliative care into cardiac intensive care: a champion-based model. Pediatrics . 2019;144(2):e20190160. doi:10.1542/peds.2019-0160.
doi: 10.1542/peds.2019-0160