TY - JOUR
T1 - Investigation of Modifiable Variables to Increase Hospice Nurse Comfort With Care Provision to Children and Families in the Community
T2 - A Population-Level Study Across Tennessee, Mississippi, and Arkansas
AU - Kaye, Erica C.
AU - Gattas, Melanie
AU - Kiefer, Ashley
AU - Reynolds, Jason
AU - Zalud, Kristina
AU - Li, Chen
AU - Lu, Zhaohua
AU - Baker, Justin N.
N1 - Publisher Copyright:
© 2020 American Academy of Hospice and Palliative Medicine
PY - 2020/12
Y1 - 2020/12
N2 - Context: Most hospice nurses across Tennessee, Arkansas, and Mississippi report significant discomfort with provision of pediatric palliative and hospice care (PPHC). How best to target and modify variables to increase nurse comfort levels is not well understood. Objectives: To determine whether modifiable variables are associated with increased hospice nurse comfort with PPHC provision in the community. Methods: A cross-sectional survey was developed, pilot tested, and distributed to hospice nurses across a tristate region to assess nurse training experiences and comfort with PPHC provision. Targeted subanalyses were conducted to investigate associations between nurse comfort level and clinical, training, and patient frequency variables. Results: A total of 551 respondents representing 71 hospices across Tennessee, Arkansas, and Mississippi completed surveys. Hospice nurse comfort with provision of care to children was statistically significantly associated with exposure to prior PPHC clinical experiences (P < 0.001), receipt of formal pediatric PPHC training (P < 0.001), and higher hospice-level (P = 0.01) and individual-level frequency of PPHC provision (P < 0.001). PPHC clinical experience was the most impactful variable with respect to comfort with overall and end-of-life PPHC provision; formal training was the most impactful variable with respect to comfort with management of severe symptoms at the end of life. Conclusion: Modifiable variables exist that are readily targetable to improve hospice nurse comfort with PPHC provision. These findings should inform the development and investigation of clinical and educational interventions to empower both nurses and hospices to optimize the provision of quality care to children with serious illness and their families in the community.
AB - Context: Most hospice nurses across Tennessee, Arkansas, and Mississippi report significant discomfort with provision of pediatric palliative and hospice care (PPHC). How best to target and modify variables to increase nurse comfort levels is not well understood. Objectives: To determine whether modifiable variables are associated with increased hospice nurse comfort with PPHC provision in the community. Methods: A cross-sectional survey was developed, pilot tested, and distributed to hospice nurses across a tristate region to assess nurse training experiences and comfort with PPHC provision. Targeted subanalyses were conducted to investigate associations between nurse comfort level and clinical, training, and patient frequency variables. Results: A total of 551 respondents representing 71 hospices across Tennessee, Arkansas, and Mississippi completed surveys. Hospice nurse comfort with provision of care to children was statistically significantly associated with exposure to prior PPHC clinical experiences (P < 0.001), receipt of formal pediatric PPHC training (P < 0.001), and higher hospice-level (P = 0.01) and individual-level frequency of PPHC provision (P < 0.001). PPHC clinical experience was the most impactful variable with respect to comfort with overall and end-of-life PPHC provision; formal training was the most impactful variable with respect to comfort with management of severe symptoms at the end of life. Conclusion: Modifiable variables exist that are readily targetable to improve hospice nurse comfort with PPHC provision. These findings should inform the development and investigation of clinical and educational interventions to empower both nurses and hospices to optimize the provision of quality care to children with serious illness and their families in the community.
KW - Pediatric
KW - community
KW - education
KW - hospice
KW - palliative care
KW - training
UR - http://www.scopus.com/inward/record.url?scp=85088587155&partnerID=8YFLogxK
U2 - 10.1016/j.jpainsymman.2020.06.036
DO - 10.1016/j.jpainsymman.2020.06.036
M3 - Article
C2 - 32622898
AN - SCOPUS:85088587155
SN - 0885-3924
VL - 60
SP - 1144
EP - 1153
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 6
ER -