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Biomedical subjects

Betty R Ferrell

Publications and source records attributed to Betty R Ferrell.

At least 19 recordsLinked to original sources
PubMed2006

Medical and nursing education and training opportunities to improve survivorship care.

Improving the quality of care for cancer survivors is contingent on having physicians, nurses, and other professionals with adequate training in survivorship care. Previous literature has documented the deficiencies in existing formal education programs regarding the complex needs of this growing population. Continuing education programs and basic curricula need to incorporate the expanding body of knowledge regarding the physiologic and psychosocial sequelae of survivorship. This article reviews the current status of survivorship education and provides direction for essential content in future education. Topics such as prevention of secondary cancers, long-term complications, rehabilitation services, quality-of-life issues, pain and symptom management, and treatment of recurrent cancer are critical competencies of education that should then become routine care for cancer survivors.

Aftercare↗
PubMed2006

Understanding the moral distress of nurses witnessing medically futile care.

PURPOSE/OBJECTIVES: To explore the topic of moral distress in nurses related to witnessing futile care. DATA SOURCES: Literature related to moral distress and futility; analysis of narratives written by 108 nurses attending one of two national continuing education courses on end-of-life care regarding their experiences in the area. DATA SYNTHESIS: Nurses were invited to share a clinical situation in which they experienced moral distress related to a patient receiving care that they considered futile. Nurses described clinical situations across care settings, with the most common conflict being that aggressive care denies palliative care. Conflicts regarding code status, life support, and nutrition also were common. Patients with cancer were involved quite often, second only to geriatric patients and patients with dementia. The instances created strong emotional responses from nurses, including feeling the need for patient advocacy and that futile care was violent and cruel. Important spiritual and religious factors were cited as influencing the clinical experiences. CONCLUSIONS: Instances of futile care evoke strong emotional responses from nurses, and nurses require support in dealing with their distress. IMPLICATIONS FOR NURSING: The ethical dilemma of futile care is complex. Additional research and support are needed for patients, families, and nurses.

Humans↗
PubMed2006

Appraisal of the Graduate End-of-Life Nursing Education Consortium Training Program.

BACKGROUND: Advanced practice nurses (APNs) are crucial in the provision of quality end-oflife care. However, little attention is devoted to palliative care in most graduate nursing curricula, leaving advanced practice nurses poorly prepared to meet the needs of those approaching the end of their lives. OBJECTIVE: The purpose of the graduate version of the End-of-Life Nursing Education Consortium (ELNEC-Graduate) Training Program is to provide nursing faculty with the knowledge and materials necessary to include palliative care throughout the graduate nursing curriculum. DESIGN AND SETTINGS: Sixty graduate nursing faculty members attended the first ELNECGraduate training course. Prior to attending the course, each participant completed surveys regarding the adequacy of end-of-life (EOL) content within their curriculum, as well as overall perceptions of EOL education in their university. Participants were asked to respond to these same questions immediately and at 12 months after completion of the course. RESULTS: Respondents reported significant improvements in the adequacy of eight areas of EOL content taught within their settings. Participants noted improved effectiveness in their ability to teach EOL care, of their curriculum in including EOL care, and of their graduate nursing students in providing care to the dying. The total hours of EOL content added to graduate nursing curricula as a result of attending ELNEC-Graduate was 18.4 +/- 17.4 standard deviation (SD) hours. Additional unintended consequences were noted. CONCLUSION: The ELNEC-Graduate Program is a national initiative that effectively improves faculty expertise in EOL care and expands palliative care content within graduate nursing curricula.

Education, Nursing, Graduate↗
PubMed2006

Evaluation of the end-of-life nursing education consortium project in the USA.

Care of patients at the end of life is contingent on adequate preparation of health care providers. Nursing, as the predominant caring profession in end-of-life (EOL) care, must achieve competence in physical and psychosocial care of patients and families facing terminal illness. Previous research has demonstrated that nursing education has not prepared nurses to provide optimum EOL care. To date, there has not been a unified or organized effort to broadly address the preparation of nurses in EOL care. This article describes one national project, the End-of-Life Nursing Education Consortium (ELNEC), which was developed as a comprehensive effort to improve EOL care by nurses in the United States. The ELNEC project consists of EOL education for various nursing audiences: the undergraduate faculty; continuing education providers; paediatrics; oncology; and the graduate faculty. This organized effort is a major step towards strengthening nursing knowledge in EOL care to improve care of the dying.

Clinical Competence↗
PubMed2005

Management of pain and nausea in outpatient surgery.

The cost associated with surgical procedures has been dramatically decreased by the ability to perform these procedures on an outpatient basis. Pain and nausea, two common symptoms after anesthesia and surgical procedures, are among the greatest concerns for patients and their family members. As a result of the distress and sequelae associated with these symptoms, clinicians have attempted to determine the optimal intraoperative and postoperative symptom management for patients. The purpose of this quality improvement project was to describe the incidence of these symptoms and their management in patients who underwent planned outpatient surgical procedures in a cancer center. A sample of 39 patients were accrued at a comprehensive cancer center over a 3-month period. Data were collected at three specific time points (i.e., preoperatively, at 24 hours and at 7 days postoperatively). Postoperative pain and nausea were generally well managed, but improvement was needed in preoperative patient teaching, including the topics of drug and nondrug interventions. The methods used in this project have potential application for the measurement of other clinical outcomes after outpatient surgical procedures.

Adult↗
PubMed2005

Evaluation of the End-of-Life Nursing Education Consortium undergraduate faculty training program.

BACKGROUND: Previous research has demonstrated that nursing education has not prepared nurses to provide optimum end-of-life (EOL) care; and yet, care of patients at the EOL is contingent on adequate preparation of nurses. To date, there has not been a unified or organized effort to broadly address the preparation of nurses in EOL care. OBJECTIVE: The purpose of the End-of-Life Nursing Education Consortium (ELNEC), a Robert Wood Johnson Foundation funded project (2000-2004), was to develop and implement a comprehensive national effort to improve EOL care by nurses through a joint collaboration between the American Association of Colleges of Nursing (AACN) and the City of Hope Cancer Center. DESIGN AND SETTING: Based on the AACN Peaceful Death document, the ELNEC curriculum focuses on nine EOL core areas. This project is a synthesis of research and knowledge in EOL care and is intended to assist clinical nurses with implementing scientifically based care in practice. Eight national training courses followed the development of the core training curriculum to enhance EOL expertise in faculty in undergraduate nursing programs (five courses) as well as in continuing education programs (three courses). Development of the ELNEC program included detailed teaching materials to integrate EOL content into existing nursing curricula and clinical teaching and extensive follow up evaluation. RESULTS: The data revealed significant outcomes in the report of implementation in the nursing curriculum including an increase in the amount of content, perceived effectiveness of new graduates, and of faculty expertise in EOL care, and a broad dissemination of all modules geographically. CONCLUSION: This national organized effort is a major step toward preparing nurses in EOL care to improve care of the dying.

Curriculum↗
PubMed2005

Overview of the domains of variables relevant to end-of-life care.

Advancing the science of end-of-life care requires a foundation of clear domains and variables to guide research and clinical practice. Palliative care and hospice programs have grown rapidly in recent years in response to an increasing proportion of the population living with chronic, debilitating, and life-threatening illness. Numerous studies and key publications have proposed frameworks that identify key concepts or domains of end-of-life care. A major advance in defining the essential domains of palliative care has been the release in 2004 of national guidelines published by the National Consensus Project for Quality Palliative Care (NCP). This paper reviews and compares several models that have proposed domains of end-of-life care and then applies the domains of the NCP Clinical Practice Guidelines as a framework to identify potential outcome variables for research. Having definitions and concepts shared by scientists in end-of-life care can advance the science and provide an evidence base for practice to improve quality care.

Consensus↗
PubMed2005

Palliative care nursing education: opportunities for gerontological nurses.

Approximately 80% of Americans who die each year are 65 or older. Increasingly, gerontological nurses are asked to deliver high quality end-of-life care. Studies, however, have identified deficiencies in the delivery of care to older adults who are dying-particularly those who die in nursing homes. Enhancing nursing education and training in end-of-life care is one strategy proposed as a remedy for inadequate care for nursing home residents who are dying. This article reviews the current status of end-of-life nursing home care, describes the philosophy and components of quality palliative care, and provides information about opportunities and resources for educating gerontological nurses in end-of-life care.

Aged↗
PubMed2004

Palliative care: an essential aspect of quality cancer care.

The past 2 decades in the United States have witnessed major developments in palliative care. Despite major advances in the early detection and treatment of cancer, more than 550,000 people in the United States die each year from cancer. For most of these patients,treatment in the last months of life is focused on attempts to achieve comfort rather than on treatment aimed at cure of disease. This article discusses the goals of palliative care, the progress that has been made in meeting these goals, and the progress that still needs to be made.

Cancer Care Facilities↗
PubMed2003

The surgical treatment of cancer: a comparison of resource utilization following procedures performed with a curative and palliative intent.

BACKGROUND: Costs associated with the provision of medical care continue to escalate. Therefore, providers must evaluate the cost-effectiveness and benefit to individual healthcare practices. The authors evaluated the immediate and short-term resource utilization needs of patients undergoing surgical intervention with curative or palliative intent. METHODS: Three hundred two patients undergoing surgery with therapeutic intent were observed from the time of admission for intervention until the time of death or until 6 months from the time of the surgical procedure. Surgeons preoperatively identified each case as either curative or palliative in intent. Demographic information, as well as the nature of all interactions with the cancer center, was recorded. RESULTS: Surgeons identified 58 (19%) procedures as palliative and 244 (81%) as curative in intent. Demographic characteristics between the two groups were similar, although recurrent or metastatic disease was more often present in palliative rather than curative patients (P = 0.0078) and palliative intent patients were more likely to have received previous therapy. During the 6-month period, 4690 encounters occurred with the cancer center. The mean number of encounters per patient in each group was similar, although curative intent patients were more likely to have visits with therapeutic intent including chemotherapy administration (P = 0.01), radiation (P = 0.003), or repeat surgical procedures (P = 0.006). In contrast, palliative patients were more likely to be admitted for management of symptoms (P = 0.0001) and had fewer hospital-free days than did curative patients (P = 0.0069). CONCLUSIONS: The average number of encounters for patients undergoing treatment of disease was not significantly different, suggesting that patients undergoing surgery with palliative intent do not require a greater amount of resources than curative intent patients. The nature of the interactions, however, was different, suggesting that resource needs are different and may need to be anticipated in the assessment of how better quality outcomes can be achieved in the palliative surgery setting.

Adolescent↗
PubMed2003

A prospective evaluation of palliative outcomes for surgery of advanced malignancies.

BACKGROUND: We prospectively evaluated the effectiveness of major surgery in treating symptoms of advanced malignancies. METHODS: Fifty-nine patients were evaluated for major symptoms of intent to treat and were followed up until death or last clinical evaluation. Surgeons identified planned operations before surgery as either curative or palliative and estimated patient survival time. An independent observer assessed symptom relief. A palliative surgery outcome score was determined for each symptomatic patient. RESULTS: Surgeons identified 22 operations (37%) as palliative intent and 37 (63%) as curative intent. The median overall survival time was 14.9 months and did not differ between curative and palliative operations. Surgical morbidity was high but did not differ between palliative (41%) and curative (44%) operations. Thirty-three patients (56%) were symptomatic before surgery, and major symptom resolution was achieved after surgery in 26 (79%) of 33. Good to excellent palliation, defined as a palliative surgery outcome score >70, was achieved in 64% of symptomatic patients. CONCLUSIONS: Most symptomatic patients with advanced malignancies undergoing major operations attained good to excellent symptom relief. Outcome measurements other than survival are feasible and can better define the role of surgery in multimodality palliative care. A new outcome measure to evaluate major palliative operations is proposed.

Adult↗
PubMed2002

Cancer pain education for patients and the public.

Pain education for patients and the public is an essential element of improved pain management. This article reports on the implementation of a national training project, Cancer Pain Education for Patients and the Public (CPEPP). The CPEPP curriculum was designed to address the multiple opportunities for pain education and to provide resources and support for successful implementation.

Health Education↗
PubMed2002

Decision making in palliative surgery.

BACKGROUND: Palliative surgery for advanced cancer patients involves complex decision making. Surgeons with a cancer-focused practice were surveyed to determine the extent to which palliative surgery was currently practiced, to identify ethical dilemmas and barriers they faced in performing palliative surgery, and to evaluate their treatment choices in four different clinical scenarios. STUDY DESIGN: A 110-item survey was devised after extensive review of the palliative care and palliative surgery literature to evaluate current practices and attitudes regarding palliative surgery. Case vignettes were devised to evaluate dinical factors influencing surgeons' selection of treatment for symptomatic patients with advanced malignancy. RESULTS: Survey response rate was 24% (419 of 1,740). Respondents reported 74% of their surgery caseload as cancer related, and 21% of these as palliative. On a scale of 1 (uncommon problem) to 7 (common problem), surgeons reported that the most common ethical dilemmas in palliative surgery were providing patients with honest information without destroying hope (5.6 +/- 1.4) (mean +/- standard deviation), and preserving patient choice (5.0 +/- 1.7). Bound on error of the average frequency estimate for ethical dilemmas, based on response rate, was 0.08. On a scale of 1 (not a barrier) to 7 (a severe barrier), surgeons rated the most severe barriers to optimum use of palliative surgery as limitations of managed care (4.1 +/- 2.0) and referral to surgery by other specialists (3.9 +/- 1.8). Bound on error of the estimate for average severity of barriers, based on response rate, was 0.09. They rated the least severe barriers to palliative surgery as surgeon avoidance of dying patients (3.0 +/- 1.8) and surgery department reluctance to perform palliative surgery (2.6 +/- 1.6). Analysis of surgeons' treatment selection in case vignettes indicated that patient age, aggressiveness of tumor biology, local extent of disease, and severity of patient symptoms were all variables of influence for treatment selection in patients with advanced malignancies. CONCLUSIONS: Palliative surgery involves numerous ethical dilemmas, the most prominent being providing honest information to patients without destroying hope, and complex treatment decision making. We have identified variables of major influence to surgeons in the palliative treatment selection for patients with advanced, solid malignancies. Validation of these variables as meaningful will require future studies focusing on patient outcomes.

Adult↗