Silent Illumination: A Case Study Exploring the Spiritual Needs of a Transgender-Identified Elder Receiving Hospice Care With a growing population of transgender-identified elders in the United States, their unique spiritual end-of-life needs are coming to light. This article presents a case study of a hospice volunteer who used skillful means as an artist to help a transgender-identified woman express her spirituality in the last 6 months of her life. After data analysis, 4 themes emerged related to the expression of spirituality by lesbian, gay, bisexual, transgender, and queer (LGBTQ) elders at end of life. The themes that emerged included (1) the human element in advocacy for spiritual care, (2) the importance of safe spaces for reflection and meditation, (3) the importance of skillful means to work with LGBTQ people, and (4) acknowledgement of gender identity as a spiritual need. This case study serves as a springboard to advance research into the end-of-life needs of LGBTQ elders and the ways in which members of the hospice team can support spiritual care and alleviate suffering for this population.

Pilot Implementation of a Low-Literacy Zone Tool for Heart Failure Self-management Heart failure affects 6.5 million Americans, with 1 million hospitalizations annually, a 22% readmission rate, and $31 billion in health care costs. Palliative care decreases symptom burden, readmissions, and costs. Many elderly patients have difficulty recognizing and reporting heart failure symptoms to their providers in a timely manner. Self-management tools with color-coded zones (green = “all clear,” yellow = “caution,” red = “take action”) help patients recognize and respond to heart failure symptoms and reduce readmissions. The purpose of this quality improvement project was to develop, implement, and evaluate a low-literacy zone tool for heart failure self-management with home-based palliative care patients. An interdisciplinary palliative care team developed this zone tool. Health literacy was prescreened with the Newest Vital Sign instrument. Nurses provided the zone tool to patients and caregivers and instructed them in use of this tool for daily self-monitoring. In postimplementation surveys, participants rated the zone tool as easy to understand and helpful in recognizing and reporting symptoms. This project demonstrated feasibility of a new zone tool for heart failure self-management, resulting in a practice change for this home-based palliative care program. The interdisciplinary team eventually developed similar zone tools for cancer, cirrhosis, chronic obstructive pulmonary disease, dementia, and frailty self-management.

Live Discharge From Hospice: A Systematic Review Live discharges from hospice may occur because of patient choice or provider choice. However, when discharges occur before death, patients and families may feel abandoned and left to manage care needs previously provided by hospice. The purpose of this systematic review was to better understand the nature of live discharges, including frequency, patient characteristics, and hospice characteristics. Of 44 studies identified for review, 13 met inclusion criteria and were published between 2008 and 2018. Live discharge rates varied from 5% to 23%. Patients’ prehospice characteristics varied widely based on diagnosis, comorbidities, gender, race, and ethnicity. Hospice characteristics indicated that the likelihood of a live discharge was increased for patients enrolled in for-profit hospices and in rural areas. Only 2 studies captured the patient/family perspective of the live discharge experience, finding that the loss of hospice support was fraught with difficulties. A need for further study of the live discharge experience and the practices of hospices with high live discharge rates was identified.

Short-Stay Palliative Pain Management for Southwestern VA: Process Improvement Plan The increased demand for palliative care services has led to concerns surrounding workforce knowledge and resiliency, specifically with regard to palliative pain management for patients with life-limiting illnesses. Educational preparedness of nurses along with best processes and practices is necessary to promote optimal care for patients requiring palliative pain management. Through analyzing Veterans Administration Strategic Analytics for Improvement and Learning data, a deficiency in short-stay self-reported palliative patient pain management at the Southwestern Veterans Administration Medical Center, a level 1B, tertiary care referral center was defined. Best practices in the palliative care industry were then identified, and a quality improvement plan in the form of a nurse-driven palliative care pain education hands-on simulation was generated to promote excellence in care. Quality improvement for short-stay palliative pain management at the Southwestern Veterans Administration Medical Center was the end goal.

Transforming Nursing Students’ Attitudes Toward End-of-Life Care End-of-life care is an important nursing competency and must be incorporated into the baccalaureate nursing curriculum. The purpose of this research was to examine the outcomes of an actual hospice compared with a simulated hospice clinical experience. This pretest and posttest nonequivalent 2-group design consisted of a sample of 65 undergraduate nursing students enrolled in a community health course. All students enrolled in the community health course have 1 day for hospice experience and a 2-hour orientation from the nurse educator at a local hospice agency. Students enrolled in the first 7 weeks were paired with a hospice nurse and conducted home visits. Students enrolled in the second 7-week session participated in 2 simulated hospice clinical experiences on campus. Thirty-two students were in the simulated hospice group and 33 were in the home hospice group. Attitudes toward end-of-life care were measured before and after the intervention with the Frommelt Attitudes Toward Care of the Dying. The findings indicated positive attitude changes toward end-of-life care. After the hospice clinical experience, both groups seemed to show increases in their mean Frommelt Attitudes Toward Care of the Dying scores, possibly indicating a greater comfort with caring for dying patients.

TakingAIM: A Precision Health Framework for Promoting Person-Centered Advance Care Planning Advance care plans (ACP) align care with individual values and goals for the end of life, yet their rates are low. Communication barriers are a primary reason for these low rates. Precision health approaches that target individuals based on personal needs, behaviors, or choices may improve communication and positively influence rates of advance care plans. A framework to guide these efforts is needed. The purpose of this study is to develop a framework that guides clinicians in identifying individuals who will benefit from targeted advance care planning conversations. Walker and Avant’s theory derivation strategy integrates concepts of social marketing theory, population segmentation, the marketing mix, and the transtheoretical model of behavior change into a novel framework. The Aligning Individuals with Meaningful End-of-Life Discussions to Promote ACP (TakingAIM) model promotes population segmentation by integrating social marketing theory and the marketing mix into conceptual definitions within the context of ACP: plan (product), perception (price), preference (promotion), and pathway (place). The transtheoretical model of behavior change further guides ACP conversations at the individual level. Identifying at-risk groups and targeting their specific needs may improve the rates of advance care plans. This framework is appropriate for use in any clinical setting and is ready for empirical testing.

Developing, Promoting, and Sustaining Palliative Care Across Central Eastern Europe: Educating Nurses to Be Leaders Is a Critical First Step Worldwide, health care is becoming more complex and multifaceted. Nurses, who spend more time at the bedside or out in the community with patients and their families than any other health care professional, need leadership-building skills in order to navigate these challenging times. New guidelines focus on interprofessional and holistic care, emphasizing the importance of building leadership skills and abilities. The World Health Organization and the European Association for Palliative Care have shown interest in influencing the development and implementation of palliative care services globally, given the increasingly aging population, the growing incidence of cancer, and the human immunodeficiency virus/AIDS epidemic. Despite challenges in developing leadership skills in nurses throughout Central and Eastern Europe (CEE), visionary nursing leaders throughout these countries have taken the opportunity to develop the Transformational Palliative Nursing Leadership Program, which has been designed to improve the leadership abilities of palliative care nurses throughout CEE countries. The purpose of the Transformational Palliative Nursing Leadership Program education is to equip palliative care nurses with the ability to promote, develop, and sustain this specialized care in CEE countries or any other part of the world.

Advance Care Planning in Home Health: A Review of the Literature The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team’s role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.