Search

Background: When an outpatient in a northeastern cancer institute requested a Medical Orders for Life-Sustaining Treatment (MOLST) form, the state's approved resuscitation form in all settings, none were available. A project was undertaken to institute MOLST forms into policy and routine practice. Research supports early discussions of end-of-life care in patients with cancer and the use of MOLST as an effective tool. Objectives: The purpose of this article is to discuss the initiation and facilitation of MOLST implementation into practice and policy at a cancer institute. Methods: Introducing, overcoming resistance to, piloting, and adopting MOLST in an oncology setting is reported and explained based on the three stages of Lewin's Theory of Planned Change: unfreezing, moving, and refreezing. Findings: A small pilot of MOLST with palliative care providers demonstrated the feasibility and suitability of using MOLST in the oncology setting. MOLST was adopted into policy and routine practice at the cancer institute. [ABSTRACT FROM AUTHOR]

Delirium is a state of confusion that occurs in up to 90% of patients facing end-of-life. Despite its prevalence, there is a paucity of data that describes the prodrome to delirium. Family and caregivers are key observers of the phenomenology of delirium and often recall subtle signs and symptoms that herald the delirious episode: The objective of this study was to describe caregiver observations regarding the onset, characteristics, and progression of the predelirium state in hospice patients diagnosed with delirium. A purposive sample of 10 caregivers of hospice patients took part in private, semistructured, audiotaped interviews. The interviews were transcribed verbatim and analyzed using the Straussian approach to grounded theory. Six categories of commonalities emerged: physically declining, cognitively/psychologically declining, withdrawing, end-of-life awareness, deteriorating sleep pattern, and suffering. A process model was created that illustrates the temporal progression of Sleep deterioration in the presence of overall decline, which leads to the diagnosis of delirium. In addition, the model illustrates the experience of suffering, which is woven throughout this temporal decline, becoming increasingly magnified as delirium progresses. These findings provide insight regarding early signs and symptoms of emerging delirium. [ABSTRACT FROM AUTHOR]

Faculty at the University at Buffalo designed and implemented a mock cardiac arrest that involved joint participation by both undergraduate and graduate students. Various instruments were developed to evaluate the effectiveness of this teaching modality, including scales that measured pre- and postsimulation knowledge and confidence. Students were also asked to evaluate the strengths and weaknesses of the experience especially regarding teamwork during an emergency situation. Management of the arrest by the graduate students was evaluated using a scale that included competency criteria related to assessment, diagnosis, treatment, and resource management. Undergraduate students' performance was also evaluated. Using paired t-test statistics, postsimulation knowledge scores were significantly higher than presimulation scores (p = .000), while postsimulation confidence scores were not statistically significant (p = .177). Students at both levels reported high satisfaction with the experience and with the opportunity to participate in a simulated cardiac arrest as a member of the health team. The use of a computer-assisted human patient simulator involving different levels of nursing students appears to be an effective teaching method; more investigation into specific outcomes is needed. [ABSTRACT FROM AUTHOR]