140 results on '"Patrick J. Coyne"'
Search Results
2. Management of Dyspnea in Advanced Cancer: ASCO Guideline
- Author
-
David C. Currow, Margaret L. Campbell, Stefano Nava, David Hui, Ting Bao, Carole Seigel, Kari Bohlke, Masanori Mori, Lynn F. Reinke, Aliza L. Leiser, Arjun Gupta, Declan Walsh, Patrick J. Coyne, Eric Roeland, Toby C. Campbell, Hui D., Bohlke K., Bao T., Campbell T.C., Coyne P.J., Currow D.C., Gupta A., Leiser A.L., Mori M., Nava S., Reinke L.F., Roeland E.J., Seigel C., Walsh D., and Campbell M.L.
- Subjects
Cancer Research ,medicine.medical_specialty ,Adult patients ,business.industry ,MEDLINE ,Guideline ,Advanced cancer ,1103 Clinical Sciences, 1112 Oncology and Carcinogenesis ,respiratory tract diseases ,03 medical and health sciences ,Dyspnea ,0302 clinical medicine ,Oncology ,Neoplasms ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,medicine ,Neoplasm ,Humans ,Oncology & Carcinogenesis ,030212 general & internal medicine ,Intensive care medicine ,business ,Human - Abstract
PURPOSE To provide guidance on the clinical management of dyspnea in adult patients with advanced cancer. METHODS ASCO convened an Expert Panel to review the evidence and formulate recommendations. An Agency for Healthcare Research and Quality (AHRQ) systematic review provided the evidence base for nonpharmacologic and pharmacologic interventions to alleviate dyspnea. The review included randomized controlled trials (RCTs) and observational studies with a concurrent comparison group published through early May 2020. The ASCO Expert Panel also wished to address dyspnea assessment, management of underlying conditions, and palliative care referrals, and for these questions, an additional systematic review identified RCTs, systematic reviews, and guidelines published through July 2020. RESULTS The AHRQ systematic review included 48 RCTs and two retrospective cohort studies. Lung cancer and mesothelioma were the most commonly addressed types of cancer. Nonpharmacologic interventions such as fans provided some relief from breathlessness. Support for pharmacologic interventions was limited. A meta-analysis of specialty breathlessness services reported improvements in distress because of dyspnea. RECOMMENDATIONS A hierarchical approach to dyspnea management is recommended, beginning with dyspnea assessment, ascertainment and management of potentially reversible causes, and referral to an interdisciplinary palliative care team. Nonpharmacologic interventions that may be offered to relieve dyspnea include airflow interventions (eg, a fan directed at the cheek), standard supplemental oxygen for patients with hypoxemia, and other psychoeducational, self-management, or complementary approaches. For patients who derive inadequate relief from nonpharmacologic interventions, systemic opioids should be offered. Other pharmacologic interventions, such as corticosteroids and benzodiazepines, are also discussed. Additional information is available at www.asco.org/supportive-care-guidelines .
- Published
- 2021
3. Iatrogenic Oral Ketamine Overdose in Palliative Care
- Author
-
Jennifer D Dulin, Patrick J. Coyne, and Jennifer Hardcopf
- Subjects
Adult ,Male ,Drug ,medicine.medical_specialty ,Palliative care ,media_common.quotation_subject ,Iatrogenic Disease ,Anesthetic Agent ,medicine ,Humans ,Pain Management ,Ketamine ,Dosing ,Intensive care medicine ,General Nursing ,media_common ,Analgesics ,business.industry ,Palliative Care ,General Medicine ,Anesthesiology and Pain Medicine ,Nociception ,Opioid ,Neuropathic pain ,business ,medicine.drug - Abstract
Background: Optimal pain management in the palliative care setting often requires multiple pharmacological interventions including novel and off-label therapies. Ketamine is an anesthetic agent with increasing evidence supporting its use for pain. Through N-methyl-d-aspartate antagonism and activity at opioid receptors, it is an adjuvant to traditional analgesics with the benefit of being opioid sparing. Ketamine has a wide safety profile with limited reports of overdose. Little is published on supratherpeutic dosing in the pain setting. Objective: We report a case of a 41-year-old male with refractory nociceptive and neuropathic cancer-related pain. Conventional therapies were ineffective. Ketamine was initiated to reduce opioid burden and attenuate pain with good response. The patient received an iatrogenic overdose (10 times ordered dose) of the drug. Several self-limited physiologic and psychologic reactions were observed during subsequent monitoring. Design: This is a study and analysis of a patient with refractory nociceptive and neuropathic pain syndrome treated with ketamine who sustained an iatrogenic overdose of ketamine. Conclusions: Ketamine's use to treat pain is increasing along with its evidence of efficacy. Despite ketamine's wide safety profile, the medication is not without risk, especially in palliative care wherein patients are on multiple drugs with potentially severe interactions. Careful examination of the risks of overdose, especially of the various formulations of the drug, is needed.
- Published
- 2021
4. Nebulized Fentanyl for Dyspnea: A Retrospective Chart Review
- Author
-
Jennifer D Dulin, Margaret M Miller, Aaron M Young, Elizabeth A. Higgins, Amanda N Overstreet, Patrick J. Coyne, Joan Cain, and Leigh M. Vaughan
- Subjects
Adult ,Aged, 80 and over ,Male ,medicine.medical_specialty ,Palliative care ,business.industry ,Nebulizers and Vaporizers ,Pain ,Middle Aged ,Fentanyl ,Analgesics, Opioid ,Dyspnea ,Anesthesiology and Pain Medicine ,Chart review ,Administration, Inhalation ,Emergency medicine ,medicine ,Humans ,Female ,Pharmacology (medical) ,business ,Aged ,Retrospective Studies ,medicine.drug - Abstract
Nebulized fentanyl is well established for analgesia but its use for dyspnea requires further investigation. The aim of our study was to determine the effectiveness of nebulized fentanyl in treating patients with dyspnea and to determine if there were harmful side effects described by patients or their providers. We used a convenience sample of patients from July 1 2014 to July 1 2018 and performed a retrospective chart review. We found that 360 doses of nebulized fentanyl were given to 73 patients during that time period. Of the 73 patients evaluated, 32 patients (43.8%) were female and forty-one were male (56.1%). The median age was 67 and the median length of stay was 9 days. There were no documented findings of bronchospasm, hypotension, or allergic reaction in any of the medical records reviewed. Patients treated with nebulized fentanyl for dyspnea showed a mean decreased respiratory rate of 4.3 breaths/min and a mean increased oxygen saturation of 2.3%. Also, 71% of patients with documented responses experienced an improvement in their dyspnea. Our preliminary data suggest that nebulized fentanyl has limited side effects and may have a role in the treatment of dyspnea. Further research is necessary to determine its efficacy.
- Published
- 2020
5. Nebulized Vasopressin for the Control of Hematemesis and Hemoptysis in a Child With Recurrent, Refractory Stage III Burkitt Lymphoma
- Author
-
Jennifer D Dulin and Patrick J. Coyne
- Subjects
Male ,Hemoptysis ,Vasopressin ,medicine.medical_specialty ,Weakness ,Vasopressins ,Gastroenterology ,03 medical and health sciences ,Fatal Outcome ,0302 clinical medicine ,Refractory ,Internal medicine ,Administration, Inhalation ,Humans ,Vasoconstrictor Agents ,Medicine ,030212 general & internal medicine ,Child ,business.industry ,Palliative Care ,Hematemesis ,General Medicine ,Burkitt Lymphoma ,Stage III Follicular Lymphoma ,030228 respiratory system ,Anxiety ,medicine.symptom ,business - Abstract
Background: Bleeding occurs with some regularity at the end of life. Patients often endure fatigue, weakness, pain, dyspnea and anxiety. These symptoms are magnified in visually apparent bleeds. Management can be particularly challenging as we attempt to balance therapies with goals of care. Children are at risk for such complications and symptoms; providers must ensure comfort for both the patient and family. Case Description: A 7-year-old male with recurrent, refractory Burkitt lymphoma was frequently hospitalized for palliative chemotherapy and disease complications. On his final admission, he experienced gross hemoptysis and hematemesis: he was short of breath, fatigued and anxious due to his blood loss. His and his family’s angst were heightened by “seeing” his bleed. Potential, especially invasive, treatments were limited by our goals to promote comfort, limit interventions, maintain alertness, poor intravenous access and a small bowel obstruction. Nebulized vasopressin, 10 units in 4ml of normal saline given over 10 minutes provided JC with needed relief. His bleeding remitted and he tolerated its administration. Conclusion: There are many treatments for hemorrhage; however, given the challenges of goals of care, administration, side-effects and tolerability, further investigation into nebulized vasopressin as a potential therapy for hemoptysis and hematemesis at the end-of-life is warranted.
- Published
- 2019
6. Palliative APRN Practice and Leadership
- Author
-
Constance Dahlin and Patrick J. Coyne
- Abstract
Chapter 1 delves into the evolution of the palliative advanced practice registered nurse (APRN). Important historical milestones in palliative care and palliative nursing are highlighted. Palliative APRNs promote access to palliative care, facilitate evidence-based palliative practices, and deliver safe, quality palliative care across settings and populations. Overall, the emphasis is on the roles of the palliative APRN as a leader in clinical practice, program administration, palliative care–related advocacy and policy, palliative care education, and research in palliative care. The chapter offers a wealth of resources for professional development and addresses specialization, roles, mentorship, and leadership. The authors discuss how APRNs can influence the future of the specialty.
- Published
- 2021
7. Survey of Physician Perspective towards Management of Pain for Chronic Conditions in the Emergency Department
- Author
-
Azhar Rafiq, Thokozeni Lipato, Ding-Yu Fei, Shirley Johnson, Wally R. Smith, A. Alsalman, Jennifer Li Wong, Donna K. McClish, Daniel Sop, and Patrick J. Coyne
- Subjects
medicine.medical_specialty ,business.industry ,Perspective (graphical) ,Chronic pain ,Survey research ,Emergency department ,Disease ,Pain management ,medicine.disease ,Triage ,Article ,Emergency medicine ,Medicine ,Pancreatitis ,business - Abstract
Sickle cell disease (SCD) pain is often acute-on-chronic, likening it to other chronic acute-on-chronic pain conditions. Pain treatment of SCD was already reported as inadequate prior to the current opioid epidemic, but attitudes underlying treatment were understudied. Understanding these attitudes prior to the current epidemic would be revealing. Therefore in 1997, before the current opioid epidemic, we surveyed physicians' attitudes toward pain management and treatment preferences for acute pain exacerbations in the Emergency Department in SCD versus those of chronic pancreatitis and chronic low back pain, two other acute-on-chronic pain diseases. Thirty-nine residency trainees were surveyed in a level one triage hospital. Resident estimates of the rate of opioid addiction in SCD were higher than estimates in both chronic pancreatitis and chronic low back pain. Most residents relied on their personal clinical experience rather than external sources of data or knowledge as the most important driver when they managed chronic pain. This survey research shows that, predating the current opioid epidemic, there was both a backdrop of opioid-phobia and a bias against treating SCD pain compared to other chronic pain conditions among our sample. Repeating this survey research among current training physicians, along with surveys of other attitudes, would provide useful comparisons.
- Published
- 2021
8. The CASH assessment tool: A window into existential suffering
- Author
-
Nicholas Velez, Elizabeth Higgins, James Infanzon, Patrick J. Coyne, Hannah L Coyne, and Catherine K Mahrer Rogers
- Subjects
Health (social science) ,Existentialism ,media_common.quotation_subject ,Safety net ,050109 social psychology ,03 medical and health sciences ,Nursing ,030502 gerontology ,Health care ,Humans ,0501 psychology and cognitive sciences ,Spirituality ,media_common ,Health professionals ,business.industry ,05 social sciences ,Palliative Care ,Religious studies ,Clinical Psychology ,Palliative care.team ,Phobic Disorders ,Cash ,0305 other medical science ,business ,Psychology ,Clergy ,Fear of death - Abstract
Spiritual beliefs and practices have long served as a critical component of treating or managing serious illness. There is evidence to suggest that patients would like healthcare professionals to address their existential and spiritual needs. The CASH Assessment Tool focuses on four key areas of spiritual concern: Care, Assistance/Help, Stress, and Hopes/Fears. In this QI Project, a palliative care team within an urban, safety net, tertiary-care, and academic healthcare setting sought to elicit themes from the CASH assessment used by chaplains caring for patients with serious illnesses. Thirty patients were included in the pilot. Themes identified included knowing the patient as a person, concern about loved ones, concern about pain, and fear of death. We found that the CASH Assessment Tool was able to demonstrate the existential concerns of patients and serve as a framework for discussion about concerns and hopes of patients with serious illness.
- Published
- 2021
9. Online End-of-Life Nursing Education Consortium Core Curriculum for Staff Nurses
- Author
-
Jessica Pritchett, Jessica Bullington, Melissa Dunkerley, Heather Craven, Polly Mazanec, Caitlin Tabler Bishop, and Patrick J. Coyne
- Subjects
Adult ,Male ,Palliative care ,Population ,Specialty ,MEDLINE ,Staffing ,Statistics, Nonparametric ,Session (web analytics) ,Education, Distance ,03 medical and health sciences ,Education, Nursing, Continuing ,0302 clinical medicine ,Nursing ,030502 gerontology ,Humans ,Nurse education ,education ,Quality of Health Care ,Advanced and Specialized Nursing ,Community and Home Care ,education.field_of_study ,Work (electrical) ,030220 oncology & carcinogenesis ,Hospice and Palliative Care Nursing ,Female ,Curriculum ,0305 other medical science ,Psychology - Abstract
Because of the growing population of patients with serious illness, the demand for specialty palliative care exceeds the resources available. Nurses must be prepared to provide primary palliative care to fill the gap in the availability of specialized palliative care providers. However, meeting the educational needs of a vast number of practicing nurses poses a significant challenge. Often, institutions are limited in the financial and staffing support that they can contribute for continuing nursing education, especially when the training requires staff to spend substantial time away from work. In order to address this issue, one large medical center conducted a study to examine the educational and clinical practice outcomes of offering an online version of the End-of-Life Nursing Education Consortium Core Curriculum to nearly 100 nurses. The participants were divided into 2 groups. Group 1 received online education only, whereas the other group received the online education plus a 3-hour face-to-face training session. Both groups reported statistically significant improvements in symptom management and communication skills, with no significant difference between the pedagogical approaches. Most importantly, the education resulted in a statistically significant impact on the nurses' clinical practice. The results of this study demonstrate that online education can be used as an effective and efficient strategy to provide primary palliative care education to a large number of nurses.
- Published
- 2019
10. Palliative Care Consultation Policy Change and Its Effect on Nurses' Moral Distress in an Academic Medical Center
- Author
-
Zemin Su, Cathy L. Melvin, Justin Marsden, Patrick J. Coyne, and Maribeth H Bosshardt
- Subjects
Palliative care ,Employee retention ,Personnel Staffing and Scheduling ,Staffing ,MEDLINE ,Nurses ,Burnout ,Job Satisfaction ,Stress Disorders, Post-Traumatic ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Nursing ,Surveys and Questionnaires ,Ethics, Nursing ,Humans ,Medicine ,030212 general & internal medicine ,Referral and Consultation ,Qualitative Research ,Advanced and Specialized Nursing ,Community and Home Care ,Academic Medical Centers ,030504 nursing ,business.industry ,Communication ,Palliative Care ,humanities ,Job satisfaction ,0305 other medical science ,business ,Qualitative research - Abstract
Moral distress affects workplace environment, burnout, employee retention, and patient safety. Palliative care is frequently involved in complex care for patients that may cause moral distress among staff. The goal of this study was to measure change in moral distress among nurses after implementation of a policy that allows nurses to consult palliative care. Before the policy change, data were gathered via email using the Moral Distress Scale-Revised. The scale was redistributed 6 months after implementation of the consult policy. Pre and post Moral Distress Scale-Revised results were analyzed. Qualitative thematic analyses of the nurses' comments were conducted.A significantly lower percentage of nurses reported providing care for a hopelessly ill patient frequently or very frequently (34.6% vs 23.1%, P = .0397) after the policy change. However, a significantly higher percentage of nurses postpolicy reported frequently or very frequently providing less-than-optimal care because of pressures from administrators/insurers (14.4% vs 21.1%, P = .0378), caring for patients they did not feel qualified to care for (5.3% vs 14.8%, P = .0055), and working with providers who were not competent to care for the patient (13.9% vs 26.9%, P = .0059). Themes from nurses' comments were inadequate staffing, communication, ethical concerns, and lack of education.
- Published
- 2018
11. American Society for Pain Management Nursing and Hospice and Palliative Nurses Association Position Statement: Pain Management at the End of Life
- Author
-
Patrick J. Coyne, Judith A. Paice, and Carol Mulvenon
- Subjects
Advanced and Specialized Nursing ,Position statement ,Terminal Care ,business.industry ,MEDLINE ,Pain ,Pain management ,United States ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Ethical obligation ,Societies, Nursing ,030220 oncology & carcinogenesis ,Terminal care ,Humans ,Pain Management ,Vulnerable population ,Medicine ,030212 general & internal medicine ,business - Abstract
Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. Although nurses have an ethical obligation to reduce suffering, barriers remain regarding appropriate and adequate pain management at the end of life. This joint position statement from the American Society for Pain Management Nursing and Hospice and Palliative Nurses Association contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population.
- Published
- 2018
12. End of Life: Reflecting on Things That Matter
- Author
-
Constance Dahlin and Patrick J. Coyne
- Subjects
media_common.quotation_subject ,Decision Making ,Quality care ,InformationSystems_GENERAL ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Nursing ,Health care ,Humans ,Terminally Ill ,Medicine ,Quality (business) ,Nurse education ,Primary nursing ,media_common ,030504 nursing ,Oncology (nursing) ,business.industry ,Communication ,Oncology Nursing ,Life domain ,Oncology nursing ,030220 oncology & carcinogenesis ,Nurse-Patient Relations ,0305 other medical science ,business - Abstract
Objectives To promote oncology nurse communication that is grounded on principles of ethics, individual care, and shared decision-making. Data Sources Articles and references in the communication, nursing and oncology nursing literature Conclusion Communication is essential to effectively advocate to meet the needs of cancer patients and their families, and other health care providers, particularly in the quality–of life domains. Implications for Nursing Practice Oncology nurses are in a prime position to facilitate quality communication. Nurses need education in communication to promote quality care and navigate critical junctures in the cancer continuum.
- Published
- 2017
13. Justice in America
- Author
-
Judith A. Paice and Patrick J. Coyne
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,medicine.medical_specialty ,Ethical issues ,business.industry ,Control (management) ,Opioid abuse ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030212 general & internal medicine ,Justice (ethics) ,Psychiatry ,business ,Cancer pain - Abstract
Pain is common in those with a life-threatening illness, yet barriers to adequate treatment persist. New challenges add to the well-known barriers of limited education, lack of time, and impaired access to expert treatment. The opioid abuse epidemic and the rising rate of deaths related to misuse of
- Published
- 2017
14. ELNEC-APRN: Meeting the Needs of Advanced Practice Nurses Through Education
- Author
-
Pam Malloy, Judith A. Paice, Amy Haskamp, Constance Dahlin, Patrick J. Coyne, and Cheryl Thaxton
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,Palliative care ,030504 nursing ,business.industry ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Medicine ,Advanced Practice Nurses ,Program development ,030212 general & internal medicine ,0305 other medical science ,business - Abstract
As care providers across the health continuum for patients with serious illness, advanced practice registered nurses (APRNs) are essential to quality palliative care. Many APRNs, however, lack palliative care education and training. To promote palliative-specific education for practicing APRNs, the
- Published
- 2017
15. ASPMN 2019 Position Statement: Pain Assessment in the Patient Unable to Self-Report
- Author
-
Elizabeth Ely, Céline Gélinas, Patrick J. Coyne, Keela Herr, and Renee C.B. Manworren
- Subjects
Advanced and Specialized Nursing ,Position statement ,medicine.medical_specialty ,Pain experience ,030504 nursing ,Health professionals ,Response to intervention ,business.industry ,MEDLINE ,Professional-Patient Relations ,03 medical and health sciences ,0302 clinical medicine ,Pain assessment ,Managing pain ,Societies, Nursing ,Physical therapy ,Medicine ,Humans ,Pain Management ,030212 general & internal medicine ,Self Report ,0305 other medical science ,business ,Self report ,Pain Measurement - Abstract
Managing pain in those vulnerable populations who are unable to self-report or communicate is challenging due to difficulty recognizing pain presence and severity. As no valid and reliable objective measure of pain exists, the ASPMN supports assessment practice recommendations that gather relevant information to infer presence of pain and evaluate response to intervention. Nurses and other healthcare professionals must be advocates for those who are unable to speak for themselves regarding their pain experience.
- Published
- 2019
16. Pain Assessment in the Patient Unable to Self-Report: Clinical Practice Recommendations in Support of the ASPMN 2019 Position Statement
- Author
-
Patrick J. Coyne, Keela Herr, Céline Gélinas, Elizabeth Ely, and Renee C.B. Manworren
- Subjects
Advanced and Specialized Nursing ,Position statement ,medicine.medical_specialty ,030504 nursing ,Difficulty communicating ,Critically ill ,business.industry ,Critical Illness ,Psychological intervention ,MEDLINE ,Professional-Patient Relations ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Pain assessment ,Societies, Nursing ,Physical therapy ,medicine ,Consciousness Disorders ,Humans ,030212 general & internal medicine ,0305 other medical science ,Self report ,business ,Pain Measurement - Abstract
Pain is a subjective experience, unfortunately, some patients cannot provide a self-report of pain verbally, in writing, or by other means. In patients who are unable to self-report pain, other strategies must be used to infer pain and evaluate interventions. In support of the ASPMN position statement "Pain Assessment in the Patient Unable to Self-Report", this paper provides clinical practice recommendations for five populations in which difficulty communicating pain often exists: neonates, toddlers and young children, persons with intellectual disabilities, critically ill/unconscious patients, older adults with advanced dementia, and patients at the end of life. Nurses are integral to ensuring assessment and treatment of these vulnerable populations.
- Published
- 2019
17. Interdisciplinary Palliative Care Teams
- Author
-
Catherine K Mahrer Rogers, Jennifer Aron, Mary Catherine Dubois, Polly Mazanec, Jessica Bullington, Patrick J. Coyne, Rebekah Reimer, and Herman Harris
- Subjects
Palliative care ,Nursing ,business.industry ,education ,Medicine ,business - Abstract
This chapter defines the composition and roles of interdisciplinary team members on a palliative care team. The team has the responsibility to deliver patient-centered, family-focused care based on the recommendations from the National Consensus Project Guidelines for Quality Palliative Care. Within this chapter, interdisciplinary team members from an academic medical center discuss their respective roles on the team and describe how these roles supported a patient and family case study. The chapter provides an overview of the four most common models of palliative care delivery: inpatient consult teams, with or without a palliative care unit; ambulatory palliative care teams; community-based palliative care teams; and hospice teams. An introduction to essential considerations in the development of a palliative care team and the important components for maintaining a healthy, functional team are described.
- Published
- 2019
18. A Treatment for Refractory High Ileostomy Output
- Author
-
Elizabeth Higgins, Patrick J. Coyne, and Shana Semmens
- Subjects
0301 basic medicine ,Short Bowel Syndrome ,medicine.medical_specialty ,Parenteral Nutrition ,Palliative care ,medicine.medical_treatment ,Teduglutide ,03 medical and health sciences ,chemistry.chemical_compound ,Ileostomy ,0302 clinical medicine ,Quality of life (healthcare) ,Gastrointestinal Agents ,Health care ,medicine ,Humans ,Pharmacology (medical) ,Intensive care medicine ,030109 nutrition & dietetics ,business.industry ,digestive, oral, and skin physiology ,Middle Aged ,Short bowel syndrome ,medicine.disease ,Diarrhea ,Anesthesiology and Pain Medicine ,Parenteral nutrition ,chemistry ,Quality of Life ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,business ,Peptides - Abstract
We present a case where the glucagon-like peptide 2 (GLP-2) analog teduglutide was used successfully to decrease high ostomy output due to short bowel syndrome in a patient not entirely dependent on parenteral nutrition. Short bowel syndrome is known to decrease quality of life and is associated with high health care costs. Although use has been limited by cost, teduglutide appears to be a treatment option for palliative care practice if patients suffer from short bowel syndrome.
- Published
- 2018
19. Scrambler Therapy for the management of chronic pain
- Author
-
Charles L. Loprinzi, Jeffrey R. Basford, Deirdre R. Pachman, Frank R. Sparadeo, Patrick J. Coyne, Randy A. Shelerud, Andrea L. Cheville, Daniel H. Lachance, David R. Farley, Kathryn J. Ruddy, Andreas S. Beutler, Carrie O’Neill, Neil Majithia, Salahadin Abdi, and Thomas J. Smith
- Subjects
medicine.medical_specialty ,business.industry ,Pain medicine ,Chronic pain ,Electric Stimulation Therapy ,medicine.disease ,Article ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Oncology ,Chemotherapy-induced peripheral neuropathy ,Scrambler therapy ,Treatment modality ,030220 oncology & carcinogenesis ,Humans ,Medicine ,Chronic Pain ,business ,030217 neurology & neurosurgery - Abstract
Chronic pain is a widespread and debilitating condition, encountered by physicians in a variety of practice settings. Although many pharmacologic and behavioral strategies exist for the management of this condition, treatment is often unsatisfactory. Scrambler Therapy is a novel, non-invasive pain modifying technique that utilizes trans-cutaneous electrical stimulation of pain fibers with the intent of re-organizing maladaptive signaling pathways. This review was conducted to further evaluate what is known regarding the mechanisms and mechanics of Scrambler Therapy and to investigate the preliminary data pertaining to the efficacy of this treatment modality.The PubMed/Medline, SCOPUS, EMBASE, and Google Scholar databases were searched for all articles published on Scrambler Therapy prior to November 2015. All case studies and clinical trials were evaluated and reported in a descriptive manner.To date, 20 reports, of varying scientific quality, have been published regarding this device; all but one small study, published only as an abstract, provided results that appear positive.The positive findings from preliminary studies with Scrambler Therapy support that this device provides benefit for patients with refractory pain syndromes. Larger, randomized studies are required to further evaluate the efficacy of this approach.
- Published
- 2016
20. Palliative Care Leadership
- Author
-
Jaime Goldberg, Patrick J. Coyne, Leigh M. Vaughan, and Constance Dahlin
- Subjects
Medical education ,Palliative care ,media_common.quotation_subject ,education ,General Medicine ,Leadership ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,030502 gerontology ,030220 oncology & carcinogenesis ,0305 other medical science ,Psychology ,Administration (government) ,health care economics and organizations ,Clinical skills ,media_common - Abstract
Palliative care is one of the newer health specialties and continues to mature. While there has been remarkable progression of clinical skills and education, there has been a lack of focus on palliative care interdisciplinary leadership or development of leadership skills. This article highlights the importance of interdisciplinary palliative leadership within the 5 realms of clinical practice, research, education, policy/advocacy, and administration. A definition of leadership is offered and discussion of successful leadership skills is described. A current review of leadership opportunities is provided.
- Published
- 2018
21. Palliative Nursing Leadership Essentials (P10)
- Author
-
Constance Dahlin and Patrick J. Coyne
- Subjects
Palliative Nursing ,Anesthesiology and Pain Medicine ,Nursing ,business.industry ,Medicine ,Neurology (clinical) ,business ,General Nursing - Published
- 2019
22. The palliative APRN leader
- Author
-
Patrick J. Coyne and Constance Dahlin
- Subjects
Palliative care ,Economic shortage ,Nurse's Role ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Medicine ,Policy advocacy ,Humans ,030212 general & internal medicine ,Clinical care ,Education, Nursing ,Palliative Medicine ,Nursing Process ,Advanced and Specialized Nursing ,Nursing practice ,Advanced Practice Nursing ,030504 nursing ,business.industry ,Health Policy ,Palliative Care ,Administrative Personnel ,Professional Practice ,Clinical Practice ,Leadership ,Nursing Research ,Anesthesiology and Pain Medicine ,Hospice and Palliative Care Nursing ,0305 other medical science ,business ,Administration (government) - Abstract
Advanced practice registered nurses (APRNs) are leaders in clinical practice, systems-level care delivery, nursing practice, and policy. The challenge is that in the current environment, their leadership is not highlighted. With the national shortage of palliative care clinicians, APRN leaders will be necessary to care for all the patients and their families with serious illness. While many programs describe their APRNs as leader in clinical care, there is not much written about their leadership in other areas. This paper provides a description of APRN palliative care leadership and opportunities across all domains of clinical care, education, advocacy/policy, research, and administration/management.
- Published
- 2017
23. Intravenous Lidocaine as an Adjuvant for Pain Associated with Sickle Cell Disease
- Author
-
Anne M Kome, Natalie L Nguyen, Denise K Lowe, Patrick J. Coyne, and Kelly G Hawks
- Subjects
Analgesics ,Lidocaine ,business.industry ,medicine.medical_treatment ,Pain ,Anemia, Sickle Cell ,Disease ,Anesthesiology and Pain Medicine ,Tolerability ,Anesthesia ,Humans ,Pain Management ,Medicine ,Drug Therapy, Combination ,Pharmacology (medical) ,Dosing ,Infusions, Intravenous ,Intravenous lidocaine ,business ,Adverse effect ,Prospective cohort study ,Adjuvant ,Retrospective Studies ,medicine.drug - Abstract
The objectives of this study were to evaluate the efficacy and safety of adjuvant intravenous (IV) lidocaine in adults with sickle cell disease (SCD). This was a retrospective review. Adults with SCD receiving at least one IV lidocaine infusion from 2004 to 2014 were included. Patient demographics, lidocaine treatment parameters, pain scores, pain medications, and adverse effects were recorded. Eleven patients were identified, yielding 15 IV lidocaine trials. Clinical improvement in pain scores from pre-lidocaine challenge to 24 hours post-lidocaine challenge, defined by ≥ 20% reduction in pain scores, was achieved in 53.3% (8 of 15) of IV lidocaine challenges. Of the 8 clinically successful trials, the mean reduction in morphine dose equivalents (MDE) from 24 hours pre-lidocaine challenge to 24 hours post-lidocaine challenge was 32.2%. Additionally, clinically successful trials had a mean initial and a maximum dose of 1 mg/kg/h (range: 0.5-2.7 mg/kg/h) and 1.3 mg/kg/h (range: 0.5-1.9 mg/kg/h), respectively. On average, these patients underwent 3 dose titrations (range: 1-8) and received lidocaine infusions for 4.4 days (range: 2-8 days). Two patients experienced disorientation and dizziness. The authors conclude that adjuvant IV lidocaine provided pain relief and a mean reduction in MDE during sickle cell pain crisis. These results provide preliminary insight into the use of IV lidocaine for treating pain in patients with SCD, although prospective studies are needed to determine efficacy, dosing, and tolerability of IV lidocaine in this patient population.
- Published
- 2015
24. Implementing Palliative Care Interdisciplinary Teams
- Author
-
Danielle Noreika and Patrick J. Coyne
- Subjects
Palliative care ,Health professionals ,business.industry ,media_common.quotation_subject ,education ,Critical Care Nursing ,Intensive care unit ,Patient care ,Variety (cybernetics) ,law.invention ,Care setting ,Nursing ,law ,Medicine ,business ,Function (engineering) ,media_common - Abstract
Interdisciplinary teams are at the core of intensive care unit palliative care consultation. They allow health professionals of different disciplines to collaborate in a synergistic fashion to achieve the goals of patients and their families. Interdisciplinary teams can have a variety of members depending on available resources and the goals for its function. There are multiple benefits to highly functioning teams, as well as challenges that may be faced when trying to provide patient care in a team-based setting. Interdisciplinary teams of different structures may provide the ideal support for complex cases in critical care settings.
- Published
- 2015
25. Decreased Low Back Pain Intensity and Differential Gene Expression Following Calmare®: Results From a Double-Blinded Randomized Sham-Controlled Study
- Author
-
Ronald K. Elswick, Debra E. Lyon, Angela Starkweather, Jamie Sturgill, Patrick J. Coyne, and Kyungeh An
- Subjects
business.industry ,Analgesic ,Chronic pain ,medicine.disease ,Low back pain ,law.invention ,Randomized controlled trial ,law ,Scrambler therapy ,Anesthesia ,Severity of illness ,Threshold of pain ,Back pain ,Medicine ,medicine.symptom ,business ,General Nursing - Abstract
In this double-blinded, randomized controlled trial we evaluated the effects of Calmare®, a non-invasive neurocutaneous electrical pain intervention, on lower back pain intensity as measured by the "worst" pain score and on pain interference using the Brief Pain Inventory-Short Form, on measures of pain sensitivity assessed by quantitative sensory testing, and on mRNA expression of pain sensitivity genes. Thirty participants were randomized to receive up to 10 sessions of Calmare® treatment (n = 15) or a sham treatment (n = 15) using the same device at a non-therapeutic threshold. At 3 weeks after conclusion of treatment, compared with the sham group, the Calmare® group reported a significant decrease in the "worst" pain and interference scores. There were also significant differences in pain sensitivity and differential mRNA expression of 17 pain genes, suggesting that Calmare® can be effective in reducing pain intensity and interference in individuals with persistent low back pain by altering the mechanisms of enhanced pain sensitivity. Further study of long-term pain outcomes, particularly functional status, analgesic use and health care utilization, is warranted.
- Published
- 2015
26. Palliative Care Delivery Models
- Author
-
Clareen Wiencek and Patrick J. Coyne
- Subjects
Male ,medicine.medical_specialty ,Palliative care ,Home Care Services, Hospital-Based ,Disease ,Cancer Care Facilities ,Nursing ,Ambulatory care ,Neoplasms ,Outcome Assessment, Health Care ,Ambulatory Care ,Humans ,Medicine ,Models, Nursing ,Program Development ,Referral and Consultation ,Curative care ,Specialist palliative care ,Nursing practice ,Inpatients ,Oncology (nursing) ,business.industry ,Oncology Nursing ,Palliative Care ,Focus Groups ,Survival Analysis ,United States ,Ambulatory care nursing ,Family medicine ,Ambulatory ,Female ,business ,Program Evaluation - Abstract
Objectives To provide an overview of the four major palliative care delivery models: ambulatory clinics, home-based programs, inpatient palliative care units, and inpatient consultation services. The advantages and disadvantages of each model and the generalist and specialist roles in palliative care will be discussed. Data Sources Literature review. Conclusion The discipline of palliative care continues to experience growth in the number of programs and in types of delivery models. Ambulatory- and home-based models are the newest on the scene. Implications for Nursing Practice Nurses caring for oncology patients with life-limiting disease should be informed about these models for optimal impact on patient care outcomes. Oncology nurses should demonstrate generalist skills in the care of the seriously ill and access specialist palliative care providers as warranted by the patient's condition.
- Published
- 2014
27. Management of Refractory Status Epilepticus in an Actively Dying Patient
- Author
-
Jennifer D Dulin, Danielle Noreika, and Patrick J. Coyne
- Subjects
Male ,medicine.medical_specialty ,Palliative care ,Population ,Status epilepticus ,Out of hospital cardiac arrest ,Route of administration ,Status Epilepticus ,Refractory ,medicine ,Humans ,Pharmacology (medical) ,Hypoxia, Brain ,Intensive care medicine ,education ,Propofol ,Aged ,education.field_of_study ,business.industry ,Palliative Care ,Middle Aged ,nervous system diseases ,Anesthesiology and Pain Medicine ,Female ,medicine.symptom ,business ,Myoclonus ,Anesthetics, Intravenous ,Out-of-Hospital Cardiac Arrest ,medicine.drug - Abstract
No consensus guidelines exist for the treatment of refractory myoclonic status epilepticus or refractory myoclonus in the palliative care setting. Evidence-based guidelines for the general medical population are often neither practical nor applicable at the end of life. Many challenges, including medication availability, route of administration, monitoring, and work-up are all unique to the palliative care setting. Two patients with refractory myoclonus versus refractory myoclonic status epilepticus are described here, illustrating the challenges involved in treatment as well the need for further research for therapy in the palliative care setting.
- Published
- 2014
28. Creating a Fabric for Palliative Care in Safety Net Hospitals
- Author
-
Pam Malloy, Rose Virani, Patrick J. Coyne, and Connie Dahlin
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,medicine.medical_specialty ,Palliative care ,Nursing ,business.industry ,Family medicine ,Safety net ,medicine ,Nurse education ,business ,Underinsured - Abstract
As the numbers of medically uninsured rise, more and more Americans are depending on public/safety net (P/SN) hospitals—hospitals responsible for the care of the uninsured and underinsured. The Center to Advance Palliative Care has found that far fewer P/SN hospitals report palliative care services
- Published
- 2014
29. Promoting Palliative Care Worldwide Through International Nursing Education
- Author
-
Thomas J. Smith, Judith A. Paice, Betty Ferrell, Patrick J. Coyne, Nessa Coyle, and Pam Malloy
- Subjects
Palliative care ,business.industry ,International Cooperation ,Palliative Care ,Ethnic group ,Health Promotion ,International education ,Team nursing ,Nursing ,Health care ,Humans ,Medicine ,Curriculum ,Nurse education ,Program Development ,Education, Nursing ,business ,End-of-life care ,General Nursing ,Primary nursing - Abstract
Many challenges exist when providing international education to those who care for people at the end of life. Though issues related to culture and language may vary, the one commonality that crosses all nations is that its people die. In general, societies seek to provide the best care they are trained to give. Many have few resources to provide this care well. Traditions of the past influence norms and dictate policies and procedures of the present. Since its inception in 2000, the End-of-Life Nursing Education Consortium Project has provided palliative care education to nurses and other members of the interdisciplinary team in six of the seven continents. This article describes the efforts of this project to improve education around the globe, with the goal of providing excellent, compassionate palliative care, irrespective of location, financial status, political views, religion, race, and/or ethnicity.
- Published
- 2014
30. Letters
- Author
-
Patrick J. Coyne, Elena Ochakovski, and Jennifer Ballard Carpenter
- Subjects
Adult ,Advanced and Specialized Nursing ,Huntington Disease ,Humans ,Assessment and Diagnosis ,Emergency Nursing ,LPN and LVN ,Critical Care Nursing - Published
- 2019
31. Managing Pain with Algorithms: An Opportunity for Improvement? Or: The Development and Utilization of Algorithms to Manage Acute Pain
- Author
-
Donna Blaney-Brouse, Laurie J. Lyckholm, Patrick J. Coyne, Leanne M. Yanni, Barton Bobb, and Sarah E. Harrington
- Subjects
Adult ,Advanced and Specialized Nursing ,Analgesics ,Quality management ,business.industry ,Analgesic ,MEDLINE ,Pharmacy ,Acute Pain ,Quality Improvement ,Organizational Policy ,Analgesics, Opioid ,Outcome and Process Assessment, Health Care ,Managing pain ,Intervention (counseling) ,Health care ,Humans ,Pain Management ,Medicine ,Patient Safety ,Hospitals, Teaching ,business ,Algorithm ,Algorithms ,Acute pain - Abstract
Pain management in a hospital setting remains a challenge today. Many health care providers remain anxious and uninformed regarding analgesic titration within a hospital setting. Overcoming the potential risks to obtain the benefits of opiate titration is a challenge within any health care setting. Virginia Commonwealth University, a tertiary medical center which houses schools of medicine, nursing, and pharmacy, evaluated the use of algorithms for managing acute pain. This article describes the Pain Committee's efforts and offers one potential intervention for safe analgesic opioid titration, an algorithm for acute pain management.
- Published
- 2013
32. Preparing oncology advanced practice nurses (OAPRNs) to provide primary palliative care (PC)
- Author
-
Pam Malloy, Patrick J. Coyne, Cheryl Ann Thaxton, Polly Mazanec, Betty Ferrell, Rose Virani, and Judith A. Paice
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Palliative care ,business.industry ,Public health ,Specialty ,Palliative care.team ,Internal medicine ,medicine ,Oncology patients ,Advanced Practice Nurses ,business ,Curriculum - Abstract
84 Background: A major public health concern is the recognition of the growing demand for PC in oncology practice. Despite proven benefits, there is often no system in place to provide concurrent palliative and oncology care. Oncology patients and families often report psychological and social stress from cancer care impacted by unmet information and care coordination needs. OAPRNs within cancer centers can provide models of leadership which facilitate systems and organizational changes to provide the best quality PC for oncology patients. Methods: This unique skills-based innovative program/curriculum, supported by R25 funding from NCI, is designed to educate OAPRNs to provide primary PC in oncology practice. Five national workshops will be conducted 2018 - 2021. The participants are competitively selected from NCI designated and community cancer centers depending on goals and the commitment to partner with a specialty palliative care team. All participants will be followed at 6 and 12 months regarding challenges and opportunities in developing/instituting primary palliative care in their oncology practice/institution. Results: The first national workshop was held April 2018, N = 69 representing 23 states, with post course evaluations rating [on a scale of 1 = low to 5 = high] that the materials and resources were applicable to their practice as 4.94, and information stimulating and thought provoking regarding palliative care issues as 4.95. This presentation will report on the OAPRNs’ 6 month post-course outcomes, which will reflect on the challenges and opportunities in implementing skills as primary PC providers within their institutions. This presentation will also report on monthly webinars that reinforce content and enable the OAPRNs to share experiences in implementing primary PC, in order to foster professional networking. Conclusions: This unique educational offering will provide practicing OAPRNs with the knowledge and skills to provide primary palliative care to facilitate systems and organizational changes for quality PC within oncology settings.
- Published
- 2018
33. Advanced Practice Palliative Nursing
- Author
-
Constance Dahlin, Patrick J. Coyne, Betty R. Ferrell, Constance Dahlin, Patrick J. Coyne, and Betty R. Ferrell
- Subjects
- Palliative treatment, Nursing, Hospice care, Terminal care
- Abstract
Advanced Practice Palliative Nursing is the first text devoted to advanced practice nursing care of the seriously ill and dying. This comprehensive work addresses all aspects of palliative care including physical, psychological, social, and spiritual needs. Chapters include: symptoms common in serious illness, pediatric palliative care, spiritual and existential issues, issues around the role and function of the advanced practice nurse (APN), reimbursement, and nursing leadership on palliative care teams. Each chapter contains case examples and a strong evidence base to support the highest quality of care. The text is written by leaders in the field and includes authors who have pioneered the role of the advanced practice nurse in palliative care. This volume offers advanced practice content and practical resources for clinical practice across all settings of care and encompassing all ages, from pediatrics to geriatrics.
- Published
- 2016
34. Voices From the Bedside
- Author
-
Patrick J. Coyne, Kenneth R. White, Laura E. McClelland, and Lynn M. VanderWielen
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,Palliative care ,Nursing ,Nurses perceptions ,business.industry ,Medicine ,business - Abstract
Palliative care nurses provide care for patients who live with declining functional capacity and symptoms associated with their illnesses and who, ultimately, face death. Despite a large body of research that provides evidence for the efficacy of palliative care, less is known about those who provid
- Published
- 2013
35. Oral Ketamine for Sickle Cell Crisis Pain Refractory to Opioids
- Author
-
Barton Bobb, Danielle Noreika, Cara Jennings, and Patrick J. Coyne
- Subjects
Adult ,Palliative care ,Analgesic ,Administration, Oral ,Anemia, Sickle Cell ,Pharmacotherapy ,Activities of Daily Living ,medicine ,Humans ,Pharmacology (medical) ,Ketamine ,Analgesics ,Dose-Response Relationship, Drug ,business.industry ,Palliative Care ,Chronic pain ,medicine.disease ,Acute Pain ,Black or African American ,Analgesics, Opioid ,Regimen ,Anesthesiology and Pain Medicine ,Anesthesia ,Thalassemia ,Drug Therapy, Combination ,Female ,Chronic Pain ,Opiate ,business ,Sickle Cell-Thalassemia ,medicine.drug - Abstract
There is literature demonstrating that the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine has analgesic properties that can be used as an adjuvant to opiates for pain relief in multiple various conditions and pain states. However, there is a lack of published information on ketamine used in persons with sickle cell disease in acute pain crises. The Virginia Commonwealth University Palliative Care team was consulted on a 38-year-old African American female with sickle cell thalassemia in severe acute pain crisis overlying chronic pain related to her disease. Pain control was unable to be achieved with escalating doses of opiates and other adjuvant medications. The patient responded well to an intravenous test dose of ketamine and was subsequently placed on an oral regimen of ketamine in addition to opiates. In the 24-hour period following ketamine initiation, the patient's pain was able to be controlled on decreased amounts of opiates. She was eventually transitioned to an oral opiate and ketamine regimen, which allowed her to be discharged home with pain levels close to her baseline and the ability to function and perform all activities of daily living.
- Published
- 2013
36. History of the Advanced Practice Role in Palliative Nursing
- Author
-
Constance Dahlin and Patrick J. Coyne
- Subjects
Palliative Nursing ,medicine.medical_specialty ,Nursing ,business.industry ,Family medicine ,medicine ,business - Published
- 2016
37. A Case of Inaccurate Prognostication After the ARCTIC Protocol
- Author
-
Thomas J. Smith, Laurel J. Lyckholm, Patrick J. Coyne, and Christina J. Chen
- Subjects
Male ,Resuscitation ,Palliative care ,Sedation ,Physical examination ,Return of spontaneous circulation ,law.invention ,Hypothermia, Induced ,law ,Intensive care ,medicine ,Humans ,Diagnostic Errors ,General Nursing ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Hypothermia ,Intensive care unit ,Heart Arrest ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Anesthesia ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Therapeutic hypothermia (ARCTIC, or Advanced Resuscitation Cooling Therapeutics and Intensive Care protocol) is a widely recommended intervention to improve mortality and neurologic outcomes after cardiac arrest. However, neurologic outcomes are difficult to predict soon after cardiac arrest in the setting of hypothermia, as illustrated by this case report. A 60-year-old man had witnessed cardiac arrest at home. He was defibrillated twice, with return of spontaneous circulation, and cooled to 33°C for 24 hours. Neurologic exam on Day 6 revealed limited brainstem reflexes, and the intensive care unit team discussed with the patient's family that his prognosis for neurologic recovery was poor. Palliative care was consulted to participate in a goals-of-care meeting. Just prior to the meeting on Day 7, the patient awoke. He fully recovered and walked out of the hospital on Day 18. Prior to induced hypothermia, indicators of poor outcome included lack of one or more brainstem reflexes (pupillary or corneal reflex), absence of motor response at 72 hours, myoclonus, status epilepticus, electroencephalogram with generalized suppression, and absent bilateral cortical N20 response to somatosensory-evoked potentials. However, several studies have found these indicators to be unreliable after hypothermia. This may be the result of sedatives, which can affect physical examination and electroencephalogram results, and delayed clearance. Because of the unreliability of prognostication tests within the first 72 hours of hypothermic protocols in the setting of sedation, it appears prudent in some cases to delay final prognosis discussions until at least six days postcardiac arrest and after neurologic evaluation is done with patients sedative-free.
- Published
- 2012
38. Are Hospice and Palliative Nurses Adequately Prepared for End-of-Life Care?
- Author
-
Kenneth R. White, Susan G. White, and Patrick J. Coyne
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,medicine.medical_specialty ,Nursing ,business.industry ,Family medicine ,medicine ,business ,End-of-life care - Published
- 2012
39. Nurses' Perceptions of Educational Gaps in Delivering End-of-Life Care
- Author
-
Kenneth R. White and Patrick J. Coyne
- Subjects
Adult ,Male ,Palliative care ,Attitude of Health Personnel ,MEDLINE ,Nursing Staff, Hospital ,Young Adult ,Nursing care ,Nursing ,Humans ,Medicine ,Curriculum ,Aged ,Terminal Care ,business.industry ,Oncology Nursing ,Core competency ,Middle Aged ,humanities ,Oncology nursing ,Cross-Sectional Studies ,Nursing Education Research ,Needs assessment ,Female ,Clinical Competence ,business ,End-of-life care ,Needs Assessment - Abstract
Purpose/objectives To assess end-of-life (EOL) care core competencies deemed most important with corresponding educational needs from oncology nurses and to describe the characteristics of the respondents that are associated with selection of the top-ranked core competencies. Design Descriptive, cross-sectional study. Setting Mailed and online surveys. Sample 714 members of the Oncology Nursing Society from Georgia, Virginia, Washington, and Wisconsin. Methods Responses to a mailed or e-mailed researcher-developed questionnaire during a six-month period were collated and analyzed. Main research variables Ranking of EOL care core competencies and perceived gaps in EOL continuing education. Findings Almost all of the respondents indicated that EOL care was a part of their practice and that continuing education was important, but more than half of the respondents had fewer than two hours of continuing education regarding EOL care in the past two years. Twenty-five percent of the respondents do not believe they are adequately prepared to effectively care for a dying patient. Symptom management was the top-rated core competency, consistent across age, education level, practice role, and practice setting. How to talk to patients and families about dying and what comprises palliative care also was selected frequently. Conclusions Symptom management is the number one core competency, and the quantity and quality of EOL continuing education is inadequate. Educational gaps exist in EOL nursing care. Implications for nursing Assessing what nurses believe to be leading EOL core competencies is useful in improving educational curricula along with considering characteristics of nurses when planning EOL educational programs.
- Published
- 2011
40. Providing Pain and Palliative Care Education Internationally
- Author
-
Polly Mazanec, Betty Ferrell, Carma Erickson-Hurt, Carol O. Long, Pam Malloy, Thomas J. Smith, Nessa Coyle, Judith A. Paice, and Patrick J. Coyne
- Subjects
medicine.medical_specialty ,Palliative care ,business.industry ,Health Personnel ,International Cooperation ,Palliative Care ,Pain management ,Medical Oncology ,Health personnel ,Oncology ,Nursing ,Neoplasms ,Family medicine ,medicine ,Humans ,Pain Management ,Pharmacology (medical) ,business ,Curative care - Published
- 2011
41. Advancing Palliative Care in Kenya
- Author
-
Judith A. Paice, Patrick J. Coyne, Zipporah Ali, Betty Ferrell, Esther Munyoro, Pam Malloy, and Thomas J. Smith
- Subjects
Adult ,Male ,Palliative care ,Quality Assurance, Health Care ,International Cooperation ,Teaching method ,education ,Developing country ,Nurse's Role ,Young Adult ,Education, Nursing, Continuing ,Nursing ,Acquired immunodeficiency syndrome (AIDS) ,Neoplasms ,Health care ,Humans ,Medicine ,Models, Nursing ,Nurse education ,Curriculum ,Oncology (nursing) ,business.industry ,Oncology Nursing ,Palliative Care ,Middle Aged ,medicine.disease ,Kenya ,United States ,Oncology ,Scale (social sciences) ,Female ,Interdisciplinary Communication ,Clinical Competence ,business ,Program Evaluation - Abstract
BACKGROUND Life-threatening illnesses such as HIV/AIDS, malaria, tuberculosis, and other disorders are prevalent in the developing world, including Kenya. OBJECTIVE The aim of this project was to assist in the development of palliative care throughout Kenya by enhancing the knowledge and skill of faculty members in palliative care so they could integrate this content into existing nursing curricula. METHODS In an effort to develop palliative care throughout the country, experts from the Kenya Hospices and Palliative Care Association and the Kenyatta National Hospital invited faculty from the End-of-Life Nursing Education Consortium with the United States to adopt the content of its training program to address the needs of nurses and other health care professionals in Kenya. This curriculum was delivered to nursing faculty from throughout Kenya during a 5-day training course that incorporated presentations, case studies, exercises, and other teaching methods. RESULTS The course participants completed daily course evaluations in which they rated each session on a scale of 0 = not helpful to 5 = very helpful. All of the sessions were rated very favorably, with scores for all sessions across the 5 days ranging from 4.57 to 4.91. CONCLUSION End-of-Life Nursing Education Consortium provided educational and other support to faculty teaching in nursing schools in Kenya so they could advance palliative care efforts in this country. IMPLICATIONS FOR PRACTICE Nurses working in the United States can share their expertise and learn immense lessons from colleagues in developing worlds.
- Published
- 2011
42. Pilot Trial of a Patient-Specific Cutaneous Electrostimulation Device (MC5-A Calmare®) for Chemotherapy-Induced Peripheral Neuropathy
- Author
-
G. L. Parker, Viswanathan Ramakrishnan, Thomas J. Smith, Patrick J. Coyne, and Patricia Dodson
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Antineoplastic Agents ,Pilot Projects ,Context (language use) ,Article ,Bortezomib ,Scrambler therapy ,Internal medicine ,medicine ,Humans ,General Nursing ,Aged ,Pain Measurement ,Chemotherapy ,business.industry ,Pilot trial ,Peripheral Nervous System Diseases ,Patient specific ,Middle Aged ,medicine.disease ,Boronic Acids ,Surgery ,Clinical trial ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Peripheral neuropathy ,Oncology ,Chemotherapy-induced peripheral neuropathy ,Pyrazines ,Anesthesia ,Transcutaneous Electric Nerve Stimulation ,Female ,Taxoids ,Neurology (clinical) ,Cancer pain ,business ,medicine.drug - Abstract
Context. Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting and persistent consequence of numerous classes of antineoplastic agents, affecting up to 30%e40% of patients. To date, there is no effective prevention or therapy. An evolving hypothesis for reducing CIPN pain involves direct nerve stimulation to reduce the pain impulse. Objectives. To evaluate the impact on CIPN associated with the MC5-A Calmare therapy device (Competitive Technologies, Inc. Fairfield, CT). Methods. The MC5-A Calmare therapy device is designed to generate a patient-specific cutaneous electrostimulation to reduce the abnormal pain intensity. Sixteen patients from one center received one-hour interventions daily over 10 working days. Results. Of 18 patients, 16 were evaluable. The mean age of the patients was 58.6 yearsdfour men and 14 womendand the duration of CIPN was three months to eight years. The most common drugs were taxanes, platinums, and bortezomib (Velcade, Millenium Pharmaceuticals, Cambridge MA). At the end of the study (Day 10), a 20% reduction in numeric pain scores was achieved in 15 of 16 patients. The pain score fell 59% from 5.81 � 1.11 before treatment to 2.38 � 1.82 at the end of 10 days (P < 0.0001 by paired t-test). A daily treatment benefit was seen with a strong statistically significant difference between the preand post-daily pain scores (P < 0.001). Four patients had their CIPN reduced to zero. A repeated-measures analysis using the scores from all 10 days confirmed these results. No toxicity was seen. Some responses have been durable without maintenance. Conclusions. Patient-specific cutaneous electrostimulation with the MC5-A Calmare device appears to dramatically reduce pain in refractory CIPN patients with no toxicity. Further studies are underway to define the benefit, mechanisms of action, and optimal schedule. J Pain Symptom Manage 2010;-:-e-. 2010 Published by Elsevier Inc on behalf of U.S. Cancer Pain Relief Committee.
- Published
- 2010
43. Artificial Nutrition for Cognitively Impaired Individuals
- Author
-
Laurie J. Lyckholm and Patrick J. Coyne
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,Geriatrics ,Gerontology ,medicine.medical_specialty ,Standard of care ,Physical medicine and rehabilitation ,business.industry ,medicine ,Artificial nutrition ,Cognitively impaired ,business - Abstract
Artificial nutrition has become a standard of care in some institutions. It is considered a way to provide nutrition to cognitively impaired individuals, regardless of prognosis. More than 216,000 feeding tubes were placed in 2000, and in 30% of such cases, the patient was demented [Geriatrics. 2006
- Published
- 2010
44. Preparation, Confidence, and Attitudes About Chronic Noncancer Pain in Graduate Medical Education
- Author
-
Robin Matsuyama, Mark Fagan, Jessica L. McKinney-Ketchum, Betty Anne Johnson, Christine N. Huynh, BS Saad Amin, Sarah B. Harrington, Leanne M. Yanni, Patrick J. Coyne, and Linda Garufi-Clark
- Subjects
medicine.medical_specialty ,business.industry ,Family medicine ,Alternative medicine ,medicine ,Medical school ,Graduate medical education ,Specialty ,General Medicine ,business ,Teaching, Learning and Assessment - Abstract
Background Physicians report they feel ill-prepared to manage chronic noncancer pain (CNCP), in part because of inadequate training. Published studies and clinical observation demonstrate that trainees lack confidence and reflect negative attitudes about CNCP. Overall, there is minimal published guidance on specific specialty roles and responsibilities in CNCP management. Objective The purpose of this study was to assess resident preparation, confidence, and attitudes about CNCP across graduate medical education programs and to assess resident perception of roles and responsibilities in CNCP management. Methods In 2006 we surveyed residents from 13 graduate medical education programs in 3 institutions about CNCP and report quantitative and qualitative analyses of survey responses from 246 respondents. Results A total of 59% of respondents rated their medical school preparation and 36% rated their residency preparation as “fair” or “poor”; only 17% reported being “confident” or “very confident” in assessing patients with CNCP; and 30% used negative or derogatory terms (eg, manipulative, irritable, needy) to describe patients with CNCP. Respondents from postgraduate years 3–6 were more than twice as likely as postgraduate year 1 or postgraduate year 2 respondents (44% versus 21% and 20%, respectively) to use negative or derogatory terms (P = .0007). Respondents were significantly more likely to report that pain specialists are “good” or “excellent” in managing CNCP compared with generalists (73% versus 6%; P < .0001). Conclusion Education in pain management should begin in medical school and continue through graduate medical education, regardless of specialty. Early and sustained training interventions are needed to foster empathy in caring for patients with pain. Residency and fellowhip training should impart a clear understanding of each specialty's role and responsibilities in pain management to better foster patient-centered pain care.
- Published
- 2010
45. Oncology End-of-Life Nursing Education Consortium Training Program: Improving Palliative Care in Cancer
- Author
-
Patrick J. Coyne, Pam Malloy, Rose Virani, Laura Fennimore, Judith A. Paice, and Betty Ferrell
- Subjects
Male ,Oncology ,Educational measurement ,medicine.medical_specialty ,Palliative care ,Attitude of Health Personnel ,education ,MEDLINE ,Education, Nursing, Continuing ,Nursing ,Neoplasms ,Internal medicine ,medicine ,Humans ,Nurse education ,Primary nursing ,Terminal Care ,business.industry ,Oncology Nursing ,Palliative Care ,United States ,humanities ,Ambulatory care nursing ,Oncology nursing ,Team nursing ,Nursing Evaluation Research ,Female ,Clinical Competence ,Educational Measurement ,business - Abstract
Purpose/objectives To describe an evaluation of the oncology version of the End-of-Life Nursing Education Consortium (ELNEC-Oncology) training program, which is designed to provide oncology nurses with the knowledge and materials necessary to disseminate palliative care information to their colleagues in local chapters of the Oncology Nursing Society (ONS). Data sources Participant reports. Data synthesis 124 nurses representing 74 ONS chapters attended the first two courses. Dyads of ONS members from local chapters applied to attend ELNEC and completed surveys regarding their goals and expectations for implementing end-of-life (EOL) education and training after completion of the program. Participants educated more than 26,000 nurses after attending the program, including 7,593 nurses within their ONS chapters and 18,517 colleagues within their workplaces. Barriers to implementation included a lack of funding and time constraints. Participants sought additional palliative care learning opportunities, including attending other workshops, subscribing to palliative care journals, and becoming involved in committees focused on palliative care. Conclusion The ELNEC-Oncology program is a national collaboration with ONS that provides oncology nurses with the tools and expertise to effectively disseminate palliative care content to colleagues within their local chapters and work settings. Implications for nursing EOL care information remains critical to the science of oncology nursing, and ELNEC-Oncology provides an effective strategy for disseminating the information.
- Published
- 2007
46. Palliative Care Consultation in the Process of Organ Donation after Cardiac Death
- Author
-
Thomas J. Smith, Catherine Mc Vearry Kelso, Laurie J. Lyckholm, and Patrick J. Coyne
- Subjects
medicine.medical_specialty ,Time Factors ,Tissue and Organ Procurement ,Palliative care ,Process (engineering) ,Family support ,MEDLINE ,Professional Role ,Clinical Protocols ,Professional-Family Relations ,Humans ,Medicine ,Organ donation ,Intensive care medicine ,Referral and Consultation ,General Nursing ,Patient Care Team ,Terminal Care ,business.industry ,Symptom management ,Communication ,Palliative Care ,General Medicine ,medicine.disease ,Euthanasia, Passive ,Death ,Life Support Care ,Organ procurement ,Anesthesiology and Pain Medicine ,Donation ,Medical emergency ,Clergy ,business - Abstract
Palliative care consultation has been demonstrated to be useful in many situations in which expert symptom management, communication around sensitive issues, and family support may serve to enhance or improve care. The process of organ donation is an example of this concept, specifically the process of donation after cardiac death (DCD). DCD allows patients with severe, irreversible brain injuries that do not meet standard criteria for brain death to donate organs when death is declared by cardiopulmonary criteria. The DCD method of donation has been deemed an ethically appropriate means of organ donation and is supported by the organ procurement and medical communities, as well as the public. The palliative care (PC) team can make a significant contribution to the care of the patient and family in the organ donation process. In this paper we describe the controlled DCD process at one institution that utilizes the PC team to provide expert end-of-life care, including comprehensive medical management and family support. PC skills and principles applicable to the DCD process include communication, coordination of care, and skillful ventilator withdrawal. If death occurs within 90 minutes of withdrawal of life support, organs may be successfully recovered for transplantation. If the patient survives longer than 90 minutes, his or her care continues to be provided by the PC team. Palliative care can contribute to standardizing quality end-of-life care practices in the DCD process and provide education for involved personnel. Further experience, research and national discussions will be helpful in refining these practices, to make this difficult and challenging experience as gentle and supportive as possible for the courageous families who participate in this process.
- Published
- 2007
47. Physical Pain and Symptoms
- Author
-
Danielle Noreika, Barton Bobb, and Patrick J. Coyne
- Subjects
medicine.medical_specialty ,business.industry ,Physical therapy ,Medicine ,Pain catastrophizing ,business - Published
- 2015
48. Discontinuance of life sustaining treatment utilizing ketamine for symptom management
- Author
-
Patrick J. Coyne and Danielle Noreika
- Subjects
Palliative care ,medicine.drug_class ,Fentanyl ,Young Adult ,Extracorporeal Membrane Oxygenation ,Medicine ,Humans ,Pharmacology (medical) ,Dexmedetomidine ,Analgesics ,business.industry ,Palliative Care ,Hydromorphone ,Life Support Care ,Anesthesiology and Pain Medicine ,Withholding Treatment ,Sedative ,Anesthesia ,Midazolam ,Female ,Ketamine ,business ,Propofol ,Respiratory Insufficiency ,medicine.drug ,Methadone - Abstract
We present the case of an otherwise healthy 21-year-old female who developed severe respiratory failure following a minor procedure requiring ECMO and bi-level ventilation. During her protracted ICU course, she had significant difficulties with agitation and was titrated to the following regimen: hydromorphone 30 mg/hour, fentanyl 200 mcg/hour, dexmedetomidine 1.5 mcg/kg/hour, propofol at 70 mcg/kg/min, and midazolam at 20 mg/hour. We were consulted to assist in withdrawal of life prolonging measures at the family's request and given high doses of commonly used opioid and sedative medications successfully utilized methadone and ketamine for symptom control. This case study would indicate that in selected patients on high dose opioid and sedative medications prior to withdrawal of life prolonging measures ketamine may be considered for symptom management.
- Published
- 2015
49. Clinical interventions, economic impact, and palliative care
- Author
-
Thomas J. Smith, Laurie J. Lyckholm, and Patrick J. Coyne
- Subjects
medicine.medical_specialty ,Palliative care ,Nursing ,business.industry ,Family medicine ,medicine ,Psychological intervention ,Economic impact analysis ,business ,Curative care - Abstract
Economic outcomes are increasingly important for all types of healthcare, including palliative care. There are substantial opportunities for improvement by using disease management strategies and care pathways. Directed, ethically motivated interventions about futile care appear to produce significant cost savings. The use of advance directives or hospice care may be good medical care, but have not been shown to produce major economic benefit. Integrated palliative care teams have been shown to reduce hospital and end-of-life care costs for seriously ill patients. For treatment to be justified, there must be some demonstrable improvement in disease-free or overall survival, toxicity, quality of life, or cost effectiveness.
- Published
- 2015
50. Pain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations
- Author
-
Keela Herr, Sandra Merkel, Margo McCaffery, Jane Pelosi-Kelly, Patrick J. Coyne, Tonya Key, Lori Wild, and Renee C.B. Manworren
- Subjects
Position statement ,education ,MEDLINE ,Patient Advocacy ,Unconsciousness ,Nurse's Role ,Principle-Based Ethics ,Nonverbal communication ,Nursing ,Pain assessment ,Codes of Ethics ,Intubation, Intratracheal ,Humans ,Medicine ,Nonverbal Communication ,Nursing Assessment ,health care economics and organizations ,Aged ,Pain Measurement ,Ethical code ,Advanced and Specialized Nursing ,Critically ill ,business.industry ,Task force ,Communication Barriers ,Age Factors ,Infant, Newborn ,Infant ,Clinical Practice ,Communication Disorders ,Dementia ,business ,psychological phenomena and processes - Abstract
The article presents the position statement and clinical practice recommendations for pain assessment in the nonverbal patient developed by an appointed Task Force and approved by the ASPMN Board of Directors.
- Published
- 2006
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.