COVID-19 Palliative Care Toolkit Development and Military Health System Deployment

Overview

Journal Nurs Outlook

Specialty Nursing

Date 2022 Dec 30

PMID 36585063

Authors

Laurie Migliore

Ceferina Brackett

Sarah Huffman

Rebecca Heyne

LeAnne Lovett-Floom

Lance McGinnis

Affiliations

Soon will be listed here.

Abstract

Background: During the initial phase of the pandemic, we identified a critical gap in the Military Health System's access to palliative care. Our team of nurse scientists and evidence-based practice (EBP) facilitators aimed to develop and implement an evidence-based point of care palliative care toolkit for frontline workers in inpatient settings lacking established palliative care specialists.

Methodology: We utilized Melnyk and Fineout-Overholt's (2018) seven-step EBP process. Six central themes were derived from 17 publications providing an evidence-base for toolkit resource selection and development. Our practice change implementation was piloted at a large West Coast military treatment facility. We included iPads in the toolkit for patient communication and palliative mobile application use.

Results: The most significant finding was the critical and continued need for basic palliative care education and training. Integrating the palliative care toolkit into daily practice was promising yet challenging due to the high volume of deployed medical staff.

References

Chidiac C, Feuer D, Naismith J, Flatley M, Preston N . Emergency Palliative Care Planning and Support in a COVID-19 Pandemic. J Palliat Med. 2020; 23(6):752-753. DOI: 10.1089/jpm.2020.0195. View

Rosa W, Davidson P . Coronavirus disease 2019 (COVID-19): strengthening our resolve to achieve universal palliative care. Int Nurs Rev. 2020; 67(2):160-163. PMC: 7300863. DOI: 10.1111/inr.12592. View

Hernandez S . A Case Report of Air Force Reserve Nurses Deployed to New York City for COVID-19 Support. Mil Med. 2021; 186(12 Suppl 2):56-60. PMC: 8499816. DOI: 10.1093/milmed/usab090. View

Hendin A, La Riviere C, Williscroft D, OConnor E, Hughes J, Fischer L . End-of-life care in the emergency department for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19). CJEM. 2020; 22(4):414-417. PMC: 7138612. DOI: 10.1017/cem.2020.352. View

Fadul N, Elsayem A, Bruera E . Integration of palliative care into COVID-19 pandemic planning. BMJ Support Palliat Care. 2020; 11(1):40-44. DOI: 10.1136/bmjspcare-2020-002364. View

Mitchell S, Maynard V, Lyons V, Jones N, Gardiner C . The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic. Palliat Med. 2020; 34(9):1182-1192. PMC: 7528540. DOI: 10.1177/0269216320947623. View

Lieneck C, Betancourt J, Daemen C, Eich R, Monty E, Petty M . Provision of Palliative Care during the COVID-19 Pandemic: A Systematic Review of Ambulatory Care Organizations in the United States. Medicina (Kaunas). 2021; 57(10). PMC: 8540351. DOI: 10.3390/medicina57101123. View

Aslakson R, Dy S, Wilson R, Waldfogel J, Zhang A, Isenberg S . Patient- and Caregiver-Reported Assessment Tools for Palliative Care: Summary of the 2017 Agency for Healthcare Research and Quality Technical Brief. J Pain Symptom Manage. 2017; 54(6):961-972.e16. DOI: 10.1016/j.jpainsymman.2017.04.022. View

Chen Q, Allot A, Lu Z . Keep up with the latest coronavirus research. Nature. 2020; 579(7798):193. DOI: 10.1038/d41586-020-00694-1. View

10.

Mottiar M, Hendin A, Fischer L, Roze des Ordons A, Hartwick M . End-of-life care in patients with a highly transmissible respiratory virus: implications for COVID-19. Can J Anaesth. 2020; 67(10):1417-1423. PMC: 7212843. DOI: 10.1007/s12630-020-01699-0. View

11.

Wade D, Halligan P . The biopsychosocial model of illness: a model whose time has come. Clin Rehabil. 2017; 31(8):995-1004. DOI: 10.1177/0269215517709890. View

12.

Curtis J, Kross E, Stapleton R . The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). JAMA. 2020; 323(18):1771-1772. DOI: 10.1001/jama.2020.4894. View

13.

Powell V, Silveira M . What Should Palliative Care's Response Be to the COVID-19 Pandemic?. J Pain Symptom Manage. 2020; 60(1):e1-e3. PMC: 7156808. DOI: 10.1016/j.jpainsymman.2020.03.013. View

14.

Galbadage T, Peterson B, Wang D, Wang J, Gunasekera R . Biopsychosocial and Spiritual Implications of Patients With COVID-19 Dying in Isolation. Front Psychol. 2020; 11:588623. PMC: 7706115. DOI: 10.3389/fpsyg.2020.588623. View

15.

Hick J, Hanfling D, Wynia M, Pavia A . Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2. NAM Perspect. 2021; 2020. PMC: 8406582. DOI: 10.31478/202003b. View

16.

Wang S, Teo W, Teo W, Chai Y . Virtual Reality as a Bridge in Palliative Care during COVID-19. J Palliat Med. 2020; 23(6):756. DOI: 10.1089/jpm.2020.0212. View

17.

Rosa W, Buck H, Squires A, Kozachik S, Abu-Saad Huijer H, Bakitas M . International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels. Nurs Outlook. 2021; 70(1):36-46. PMC: 8821131. DOI: 10.1016/j.outlook.2021.06.018. View

18.

Arya A, Buchman S, Gagnon B, Downar J . Pandemic palliative care: beyond ventilators and saving lives. CMAJ. 2020; 192(15):E400-E404. PMC: 7162443. DOI: 10.1503/cmaj.200465. View

19.

Pattison N . End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic. Intensive Crit Care Nurs. 2020; 58:102862. PMC: 7132475. DOI: 10.1016/j.iccn.2020.102862. View

20.

Kelly M, Mitchell I, Walker I, Mears J, Scholz B . End-of-life care in natural disasters including epidemics and pandemics: a systematic review. BMJ Support Palliat Care. 2021; 13(1):1-14. DOI: 10.1136/bmjspcare-2021-002973. View