Hospice of the Valley

<h3></h3> The care of the dying patient document (CDP) is a document used in hospitals and hospices to ensure patients who are approaching the end of their life receive appropriate care. The CDP focuses on recognition of dying, holistic care planning, symptom management, support for family and care of the patient after death. This audit examined the documentation within the CDP at a local hospice from medical and nursing staff. Data was collected from 10 patients who had the Care of the dying patient document (CDP) initiated during their stay at a local Hospice. The CDPs were reviewed using a yes/no questionnaire, assessing each section of the document. Sections that were incomplete were recorded as ‘no,’ while completed sections were recorded as ‘yes.’ Comments could also be made to highlight areas for discussion. Overall documentation quality was high across domains. Recognition of death, likely cause of death, nutrition and hydration status, symptom management, initial discussions with carers/relatives and medical reassessment achieved 100% compliance. Initial holistic nursing assessment received 85% compliance. Documentation of tissue/eye donation was 50%, spiritual/religious needs were documented in 60% of cases and daily nursing assessment of carers/relatives was documented in 20% of cases. The audit demonstrated good overall documentation by medical and nursing teams but identified areas for improvement - recording eye/tissue donation discussions, documentation of relative/carer communication, and capturing spiritual needs. Gaps likely reflect documentation issues, not care omissions. Training and standardization, including input from an organ donation nurse specialist, are planned, with the aim of improving confidence to have conversations regarding tissue and organ donation with patients and their relatives. The hospice plans to re-audit following further training.

The prevalence of dementia is rising worldwide, with global projections exceeding 152.7 million individuals within the next 25 years. Nursing assistants (NAs) play a crucial role in providing direct care for individuals with dementia across all healthcare settings. However, dementia‐specific education is not required in most states’ NA program curricula. To address this gap, a one‐day dementia‐specific training was provided to NA program instructors. The training included dementia basics, person‐centered care, simulations, teaching techniques, and two one‐hour lessons for classroom implementation. This project aimed to evaluate the impact of incorporating this Train‐the‐Trainer dementia education program into the NA curriculum on students’ confidence in dementia care, attitudes toward dementia, and clinical practice.Pre‐evaluation data was collected from 89 NA students in four cohorts across three Arizona community college programs. Participants were primarily female (83.15%) and ranged in age from 18 to 54 (mean = 27.99). Of these, 32.58% identified as White, 29.21% as Hispanic or Latino, and 13.48% as African American/Black, with 58.43% reporting some college education. Additionally, 44.94% of participants knew someone with dementia, and 19.10% had prior experience caring for individuals with dementia.The Confidence in Dementia Scale (CODE) and Dementia Attitudes Scale (DAS) measured students’ confidence and attitudes before and after the education. Confidence scores significantly improved from 25.88±8.30 to 35.96±5.76 (t=‐11.90, p < .001), while attitudes increased from 102.77±14.50 to 112.96±15.05 (t=‐6.65, p < .001). Open‐ended responses revealed themes of increased confidence, patience, empathy, and understanding. NA instructors reported using the training in lectures and labs but identified time constraints and limited resources as barriers to providing dementia‐specific education.The findings demonstrate that dementia‐specific education enhances NA students’ confidence and attitudes, fostering greater empathy and understanding in dementia care. Integrating this training into NA programs addresses critical gaps in dementia education, equipping future NAs to deliver high‐quality, person‐centered care.

In this research brief, we describe how the HOPe Lab (UC Merced), Faith in the Valley (Fresno), and Cultiva Central Valley (Merced) are collaborating to address housing-related disparities within California’s culturally diverse Central Valley. Focused on the transformative role of Local Organizing Committees (LOCs), our research employs an anti-racist research praxis to actively engage residents, enhance leadership capacity, and foster communication between residents and elected officials. Drawing on several theory-of-change statements and the practical insights gained from “field experts” carrying out ongoing initiatives, this report explores the positive impact of LOCs on meaningful community involvement, empowerment, engagement, accountability, and policy changes.

Pulmonary clinicians and patients anecdotally report barriers to home supplemental oxygen services including inadequate supply, unacceptable portable options, and equipment malfunction. Limited evidence exists to describe or quantify these problems. To describe the frequency and type of problems experienced by supplemental oxygen users in the United States. The Patient Supplemental Oxygen Survey, a self-report questionnaire, was posted on the American Thoracic Society Public Advisory Roundtable and patient and health care-affiliated websites. Respondents were invited to complete the questionnaire, using targeted e-mail notifications. Data were analyzed using descriptive statistics, paired t tests, and χ2 analysis. In total, 1,926 responses were analyzed. Most respondents reported using oxygen 24 h/d, for 1-5 years, and 31% used high flow with exertion. Oxygen use varied, with only 29% adjusting flow rates based on oximeter readings. The majority (65%) reported not having their oxygen saturation checked when equipment was delivered. Sources of instruction included the delivery person (64%), clinician (8%), and no instruction (10%). Approximately one-third reported feeling "very" or "somewhat" unprepared to operate their equipment. Fifty-one percent of the patients reported oxygen problems, with the most frequent being equipment malfunction, lack of physically manageable portable systems, and lack of portable systems with high flow rates. Most respondents identified multiple problems (average, 3.6 ± 2.3; range, 1-12) in addition to limitations in activities outside the home because of inadequate portable oxygen systems (44%). Patients living in Competitive Bidding Program areas reported oxygen problems more often than those who did not (55% [389] vs. 45% [318]; P = 0.025). Differences in sample characteristics and oxygen problems were noted across diagnostic categories, with younger, dyspneic, high-flow users, and respondents who did not receive oxygen education, relating more oxygen problems. Respondents reporting oxygen problems also experienced increased health care resource utilization. Supplemental oxygen users experience frequent and varied problems, particularly a lack of access to effective instruction and adequate portable systems. Initiatives by professional and patient organizations are needed to improve patient education, and to promote access to equipment and services tailored to each patient's needs.

Subcutaneous methylnaltrexone is efficacious and well tolerated in inducing bowel movements in patients with advanced illness and opioid-induced constipation (OIC); factors determining optimal responsiveness to OIC treatment, however, have not been elucidated. This post hoc responder analysis examined the influence of demographic and baseline characteristics on methylnaltrexone efficacy and tolerability in this population. Data were pooled from 2 randomized, double-blind, placebo-controlled, phase 3 studies of subcutaneous methylnaltrexone (0.15 and 0.30 mg/kg) [ClinicalTrials.gov identifiers: Study 301 - NCT00401362; Study 302 - NCT00402038]. Subgroup analyses of the primary outcome, percentage of patients with rescue medication-free bowel movements (RFBM) within 4 hours of first dose, were conducted for age, sex, primary diagnosis, baseline constipation-related distress score, and baseline oral morphine equivalent dose. More than 50% of 165 patients treated with either methylnaltrexone dose experienced a RFBM within 4 hours vs. 14.6% of 123 placebo-treated patients (P < 0.0001 for both methylnaltrexone doses vs. placebo). Methylnaltrexone response was significantly greater than placebo response in all subgroups (P < 0.01). The largest differences vs. placebo were observed for patients taking methylnaltrexone 0.30 mg/kg with a noncancer primary diagnosis (70.0% [methylnaltrexone] vs. 12.8% [placebo]; P < 0.001) and for patients taking methylnaltrexone 0.30 mg/kg maintained on ≥ 150 mg/day baseline morphine equivalent doses (73.3% vs. 16.7%; P < 0.0001). Common adverse events were abdominal pain (pooled methylnaltrexone: 27.9%, placebo: 9.8%), flatulence (13.3%, 5.7%), and nausea (10.9%, 4.9%). Tolerability was comparable across subgroups. Subcutaneous methylnaltrexone provides a rapid, robust, and consistent RFBM response in patients with advanced illness and OIC. Methylnaltrexone 0.30 mg/kg may elicit particularly favorable responses in select patient populations.

Communication skills are critical in hospice care but challenging to teach. Therefore, a hospice agency developed a communication skills laboratory for nurses and social workers. Learners role-played 3 common hospice scenarios. The role-play modalities were in-person, Second Life, and telephone. Learners were scored on 4 communication aspects. Learners in all modalities rated the laboratory as very effective. However, learners in the Second Life and phone modality showed greater improvements from scene 1 to 3 than those in the in-person modality. There were no significant differences in improvement between the Second Life and phone modalities. Results support the effectiveness of this communication skills laboratory while using different teaching modalities and show phone and Second Life role-plays were more effective than an in-person role-play.

Although the role of volunteers is at the heart of hospice care, little is known about hospice volunteer training and volunteer activity. A survey was used to assess current training programs for hospice volunteers. Hospices were invited to participate in the study from a link on the website for the Hospice Volunteer Association and Hospice Educators Affirming Life Project. Survey results revealed that the majority of volunteer work is in patient care, with most hospice agencies requiring a minimum 12-month volunteer commitment and an average 4-hour volunteer shift per week. Volunteer training is separate from staff training, is provided by paid agency staff, and costs approximately $14,303 per year. Communication and family support are considered important curriculum topics. Revisions to current volunteer training curriculum and format are suggested.

Paula Schneider, RN, MPH, CHPN, has been a healthcare professional for 29 years, and a hospice professional for 5 years, serving as nurse case manager at Barton Hospice of the Valley. You may e-mail the author at [email protected].

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