Self-Assessment of Skills and Competencies among Residents Participating in a Pediatric Hospice and Palliative Medicine Elective Rotation
education; Academic Medical Centers; Education; Health Services Accessibility; Hospice Care; Hospices; Human; Internal Medicine; Palliative Care; Pediatric Care; Social Behavior; Terminally Ill Patients; Time Factors; Psychosocial Factors; human; Course Evaluation; Interns and Residents; Pediatricians; Professional Development; Rotation; Self Assessment; Social Skills; Surveys; Tertiary Health Care
OBJECTIVE: To describe our institutional experience with a four-week pediatric HPM elective rotation and its impact on residents' self-rated competencies. BACKGROUND: In the spirit of bolstering primary hospice and palliative medicine (HPM) skills of all pediatricians, it is unclear how best to teach pediatric HPM. An elective rotation during residency may serve this need. METHODS: An anonymous online survey was distributed to pediatric and internal medicine/pediatrics residents at a single, tertiary academic children's hospital. Respondents were asked to rate education, experience, and comfort with five aspects of communication with families of children with terminal illnesses and six domains of managing the symptoms of terminal illnesses. Self-ratings were recorded on a 1-5 scale: none, minimal, moderate, good, or excellent. Demographic data, including details of training and prior HPM training, were collected. Respondents completed a set of six questions gauging their attitude toward palliative care in general and at the study institution specifically. RESULTS: All respondents desire more HPM training. Those residents who self-selected to complete a pediatric HPM elective rotation had significantly higher self-ratings in 10 of 11 competency/skill domains. Free-text comments expressed concern about reliance on the specialty HPM team. DISCUSSION: A pediatric HPM elective can significantly increase residents' self-rated competency. Such rotations are an under-realized opportunity in developing the primary HPM skills of pediatricians, but wider adoption is restricted by the limited availability of pediatric HPM rotations and limited elective time during training.
Rossfeld ZM; Tumin D; Humphrey L
Journal of Palliative Medicine
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/jpm.2017.0201" target="_blank" rel="noreferrer noopener">10.1089/jpm.2017.0201</a>
The lived experiences of nurses caring for patients at the end of life in clinical settings.
Life Experiences; Nurses; Palliative Care; Terminally Ill Patients; Health Maintenance Organizations; Adulthood (18 Yrs & Older)
Abstract. Background: End-of-life care has become the focus of most health care organizations due to the increasing number of patients who are living longer with chronic and terminal diseases. Today, patients are more involved in the discussion towards end-of-life care, and nurses are the ones who provide this care. Most studies that explore the experiences of nurses providing end-of-life care focused mostly on nurses working in oncology and pediatrics. These studies suggested that nurses caring for patients at the end of life lack formal training in end-of-life care. This lack of knowledge and training was perceived to have a negative impact on patients' care. These studies, however, lack generalization, as nurses in varies clinical settings other than oncology and pediatric will likely care for a dying patient at some point in their nursing career. Purpose: The purpose of this study explored the lived experiences of nurses who provide care to patients at the end of life. Exploring the nurses' experiences in various clinical settings, such as an acute care and long-term care facilities will bring more knowledge and a deeper understanding about the essence of the experience of nurses who provide end-of-life care to dying patients. This study has the potential to provide information on nurses’ experiences in order to develop end-of-life care educational programs for nursing students based on nurses’ needs. Methods: This study was guided by Moustakas's (1994) Transcendental Phenomenological approach to phenomenology. The target population was registered nurses and licensed practical nurses who experienced caring for dying patients and have had no prior education or training in palliative or hospice care, post nursing school graduation. Results: From the experiences of 16 nurses who provides end of life care in clinical settings, one primary theme and three subthemes were identified. Conclusion: Experiences of nurses’ generosity as described in kind acts and empathetic behavior and their commitment to patients who are dying, illustrates the essence of dedication. Daily interactions support their commitment to patients and competence increase their confidence and improve the skills needed to create a balance between daily work challenges and patient's care. The results of this study supports the need for nurse educators and employers to provide more opportunities to end life care educational programs for professional nurses and nursing students. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
O'Connor D
Dissertation Abstracts International: Section B: The Sciences And Engineering
2017
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="https://search.proquest.com/openview/1d3f712e02d91cac886888bfed0acdc1/1?pq-origsite=gscholar&cbl=18750&diss=y" target="_blank" rel="noreferrer">10260393</a>
A Systematic Review of Race/Ethnicity and Parental Treatment Decision-Making.
Caregivers; Clinical; Databases; Decision Making; Ethnic Groups; Health Resource Utilization; Human; Parental Attitudes; Patient Compliance; Pediatrics; Physician Attitudes; Race Factors; Systematic Review; Terminally Ill Patients
Patient race/ethnicity affects health care utilization, provider trust, and treatment choice. It is uncertain how these influences affect pediatric care. We performed a systematic review (PubMed, Scopus, Web of Science, PsycINFO, Cochrane, and Embase) for articles examining race/ethnicity and parental treatment decision-making, adhering to PRISMA methodology. A total of 9200 studies were identified, and 17 met inclusion criteria. Studies focused on treatment decisions concerning end-of-life care, human papillomavirus vaccination, urological surgery, medication regimens, and dental care. Findings were not uniform between studies; however, pooled results showed (1) racial/ethnic minorities tended to prefer more aggressive end-of-life care; (2) familial tradition of neonatal circumcision influenced the decision to circumcise; and (3) non-Hispanic Whites were less likely to pursue human papillomavirus vaccination but more likely to complete the vaccine series if initiated. The paucity of studies precluded overarching findings regarding the influence of race/ethnicity on parental treatment decisions. Further investigation may improve family-centered communication, parent engagement, and shared decision-making.
Harris VC; Links AR; Walsh J; Schoo DP; Lee AH; Tunkel DE; Boss EF
Clinical Pediatrics
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here.
<a href="http://doi.org/10.1177/0009922818788307" target="_blank" rel="noreferrer noopener">10.1177/0009922818788307</a>
Siblings of children with life‐limiting conditions: Psychological adjustment and sibling relationships
Behavior Problems; behaviour problems; Childhood Development; Emotional Adjustment; impact on siblings; life‐limiting; quality of life; Quality of Life; Sibling Relations; Terminally Ill Patients
Background: This study explored psychological adjustment and sibling relationships of siblings of children with life‐limiting conditions (LLCs), expanding on previous research by defining LLCs using a systematic classification of these conditions. Methods: Thirty‐nine siblings participated, aged 3–16 years. Parents completed measures of siblings' emotional and behavioural difficulties, quality of life, sibling relationships and impact on families and siblings. Sibling and family adjustment and relationships were compared with population norms, where available, and to a matched comparison group of siblings of children with autistic spectrum disorder (ASD), as a comparable ‘high risk’ group. Results: LLC siblings presented significantly higher levels of emotional and behavioural difficulties, and lower quality of life than population norms. Their difficulties were at levels comparable to siblings of children with ASD. A wider impact on the family was confirmed. Family socio‐economic position, time since diagnosis, employment and accessing hospice care were factors associated with better psychological adjustment. Conclusions: Using a systematic classification of LLCs, the study supported earlier findings of increased levels of psychological difficulties in siblings of children with a LLC. The evidence is (i) highlighting the need to provide support to these siblings and their families, and (ii) that intervention approaches could be drawn from the ASD field. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Fullerton JM; Totsika V; Hain R; Hastings RP
Child: Care, Health and Development
2017
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/cch.12421" target="_blank" rel="noreferrer noopener">10.1111/cch.12421</a>
Pharmacological Management of Symptoms in Children with Life-Limiting
Asia; Death; Drug Therapy; Dyspnea; Geographic Locations; Health Personnel; Health Services Accessibility Evaluation; Hospice Care; Hospitals; Human; Nausea and Vomiting; Pacific Islands; Pain Diagnosis; Palliative Care; Pediatrics; Secretions; Terminally Ill Patients; Treatment Refusal
Background: The provision of pediatric palliative care in Asia Pacific varies between countries and availability of essential medications for symptoms at the end of life in this region is unclear. Objective: To determine medications available and used in the management of six symptoms at the end of life among pediatric palliative care practitioners in Asia Pacific. To identify alternative pharmacological strategies for these six symptoms if the oral route was no longer possible and injections are refused. Design and Setting: An online survey of all Asia Pacific Hospice Palliative Care Network (APHN) members was carried out to identify medications used for six symptoms (pain, dyspnea, excessive respiratory secretions, nausea/vomiting, restlessness, seizures) in dying children. Two scenarios were of interest: (1) hours to days before death and (2) when injectables were declined or refused. Results: There were 54 responses from 18 countries. Majority (63.0%) of respondents were hospital based. About half of all respondents were from specialist palliative care services and 55.6% were from high-income countries. All respondents had access to essential analgesics. Several perceived that there were no available drugs locally to treat the five other commonly encountered symptoms. There was a wide variation in preferred drugs for treating each symptom that went beyond differences in drug availability or formulations. Conclusion: Future studies are needed to explore barriers to medication access and possible knowledge gaps among service providers in the region, so that advocacy and education endeavors by the APHN may be optimized.
Chong LA; Chong PH; Chee J
Journal of Palliative Medicine
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here.
<a href="http://doi.org/10.1089/jpm.2017.0626" target="_blank" rel="noreferrer noopener">10.1089/jpm.2017.0626</a>