Hospice Care: Evidence Based Nursing Practice Report Analysis

This report provides an in-depth analysis of evidence-based nursing practices within the context of hospice care. It begins by defining the research problem of providing hospice home care to patients without family support and then utilizes the PICO framework to formulate a searchable question. The report identifies and evaluates two relevant databases, selecting Google Scholar and outlining effective search strategies. It then identifies two key pieces of evidence: patient-centered care and turnover in hospice organizations and the experience of family caregivers. The report also discusses two crucial steps in evidence-based practice relevant to hospice care: accessing patients and appraising the quality of evidence. It highlights the importance of patient-centered care and the challenges of family withdrawal, emphasizing the need for skilled nurses and emotional support for patients. The report concludes by summarizing the effectiveness of the patient-centered approach and the vital role of family involvement in improving the quality of life for patients in hospice care.

Evidence Based Nursing
Practice

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
Research Problem........................................................................................................................3
PICO components........................................................................................................................3
Identification of 2 databases........................................................................................................5
Selection of one database and discussing search strategies to find relevant literature................5
Identification of 2 evidence that are relevant to scenario............................................................6
2 steps of evidence based practice relevant to hospice care........................................................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Evidence based practice is basically problem solving and conscientious approach for the
clinical practices which helps in integrating best evidence from the well-designed studies. This
helps in making use of expertise in making various decisions about the patients’ care (Lindley
and Keim-Malpass, 2017). This report will focus on the hospice care given to the patients
without the support of the family members. PICO framework and appropriate databases will be
used for the same.
Research Problem
The major research problem in the given case is providing hospice home care to the
patients when their family caregivers have withdrawn.
PICO components
The major searchable question is How to provide hospice care to the patients without the
support of family members or caregivers.
PICO is basically a mnemonic which helps in describing the four major components of good
clinical foreground question.
Criteria Question Formed Relation with the scenario
Population How the problem or the
population of the patients can
be described?
The problem identified here is giving the
hospice care to the patients who are at the end
of the life without receiving the emotional
support from the family caregivers or the
members. The population described here is the
people who requires hospice care or who are
living the last days of their life (Baik and et.al.,
2020).
Intervention What major interventions can
be considered for solving
such problem?
Interventions related to their specific disease or
disorder must be given. For example, the
people with acute bronchitis must give
antibiotics. Other than the interventions
specific to the disease, the person also expects

physical and mental support. Emotional
support from the family members is necessary
but if they have withdrawn, the whole
responsibility lies in the hand of the
practitioners. In this case, when the patients do
not have family support then they can be
aggressive and can harm the hospices. So, they
must treat them accordingly and must build
emotional attachment with them by early
conversations and involving them in the
referral programs etc. Hospices must also
convey the health situation of the patient to
their family members so that they also become
aware and be fine. Counselling and narrative
therapies can help in improving the outcomes.
Control Is there any other alternative
which can be compared with
the intervention mentioned
above?
There is another alternative for the same are
the crisis intervention and patient education. In
this the hospices can provide psychological
support to the patients as well as their families.
This can be helpful in solving the different
types of crisis such as family conflicts,
physical violence etc. Hospices can also make
the patient understand about the treatment
plans and the benefits of end-of-life issues
(Jansky, Owusu-Boakye and Nauck, 2019).
They can also help them in accessing various
resources.
Outcomes What are the outcomes which
can be accomplished by
implementing the
interventions mentioned or
These interventions will help the patient in
coping with change and loss. The patients face
the painful and challenging moments of their
time so giving counsel and comfort can be

how can they be measured,
improved or affected?
deeply satisfying experience. This can make
the end days of the life of the patients happy
and satisfying. This can also increase the end
days by 5.3% as the person improves mentally
and emotionally through this type of care
(Milner and Cosme, 2017). This will help the
patient to live happily at the end days of life
and will also satisfy the family members who
are not with them.
Identification of 2 databases
In regard to databases it can be said that it refers an organized collection of structured
information, data that are mainly stored electronically. For this study and for knowing about
effectiveness along with ways of providing qualitative hospice care, CINAHL PLUS has been
used. It is one of the best and effective databases that covers literature related to both nursing and
allied health (Glanville and et.al., 2019). Through this database, relevant articles of hospice care
will be researched. Articles that will be found via this database can help out in knowing the
reason as why family members or caregivers of patients live them in hospice care. Other
database that has been selected for this study is: google scholar. It is an effective searchable
database of scholarly literature. So, it can help in researching appropriate literature and articles of
hospice care.
Selection of one database and discussing search strategies to find relevant literature
Database Search strategy
Google scholar  For searching relevant articles and literatures there is
requirement of using appropriate keywords. As this study is
related to hospice care so relevant keywords being used:
Strategies, Hospice care, family centred approach in hospice
care, caregivers of patients in hospice care etc.
 Year was added in order to select accurate and reliable literatures

and getting results.
 PICO search strategy has also been used for better study on
hospice care.
 Qualitative evidence synthesis was also being performed. only
full text, research articles were selected.
 Thematic analysis was being done for positive results.
Identification of 2 evidence that are relevant to scenario
Patient-centred care and turnover in hospice care organizations
In regard to hospice care, some best and appropriate strategies have been known by
searching relevant articles. In this article it is known that patient centre care approach can make
home health care nurse to provide qualitative hospice care even when family members of patient
leave them. When caregivers of patient show lack of engagement, then patient centre care
approach is known as the best strategy.
Patient centre care approach in hospice care: In this approach, patients’ desires are
being given priority because patients at end of life stage feel de-valued and require some respect,
engagement and valued. So, for making them feel valued and increasing desire of living a
healthy life with happiness as well as increasing patients’ engagement in treatment process, this
approach needs to be selected. In hospice care, nurses require prioritizing quality as well as
comfort of life by decreasing pain and suffering.
For example: If there is a person who is suffering from acute bronchitis and other severe
disease and if patient is at his end of life then it is important for nurses and hospices to make
patient feel valued. It is possible only with this model in which the main focus is on patient like
understanding their feelings, their needs and others. Nurses also need to make them aware about
treatments that they are going to take and educate them about that (Martí-García and et.al.,
2020). The reason behind it is increasing engagement level in treatment process and
accomplishing positive health outcomes.
Further, this article shows reasons as why families, care providers and sometimes nurses
leave hospice care organizations and patients as well. So, it found in this regard that due to poor
quality of care, risks of patients’ death, increase workload, higher overtime costs, staff leave

organizations and rather taking care of such patients they prefer to take care of patients that can
be treated in a timely manner. Due to poor quality of care and increasing risks of patients dying,
families and care providers of patients also leave their patients. So, it also becomes the reason of
nursing staff turnover in hospice care (Atiyeh, 2020).
Experience of family caregivers of patients with terminal disease and the quality of end
life care received: A mixed methods study
In other article, perception as well as experience of relatives of patients who are at life
ending stage and are dying from a terminal disease. High quality end of life care requires
emotional support, physical comfort and coordination of care and it can mainly be given by
family members of patients. But it found that at the last stage where patients require quality of
emotional care, their family members withdrawn. It affects patients mentally and emotionally.
The reason behind this perception and reason of leaving to patients is increasing dependency.
Patients become dependent on their family members completely. So, overall, it can be said that
providing care in hospices is too difficult. Nurses require having empathy, communication,
patience and other skills for better qualitative care.
2 steps of evidence based practice relevant to hospice care
In regard to provide better and qualitative care, there is requirement of following 2 steps such as:
Access patients: In hospice care, there is requirement of accessing patients the first. In
this step, nurses need to determine clinical problem and also considering questions that arise
from the care of patients. On the basis of above discussed articles in which importance of patient
centred care approach is being discussed, can be said that it can help in knowing areas that need
to be focused the most (Padmanabhan and et.al., 2019). In other articles, where reasons of family
withdrawn is known, can be said that by accessing patients, extent of fear and problems can be
known. It can also help in making family members of patients educate about importance of
providing emotional care to patients.
Appraise the quality of evidence: After accessing patients it is important to appraise that
evidence of all information for its applicability and validity. In this step, there is need to select
some appropriate articles and getting positive health outcomes. Main article that can help in
knowing reasons of withdrawn of families of patients and appropriate strategies in hospice care

(Eric, 2016). It is evidence based that can help in knowing requirement of both family
involvement as well as patient centred care approach.
Overall, it can be said that for providing qualitative hospice care, there is requirement of
skilled nurses that have empathy and other skills. Also, emotional care by family members also
play a vital role in improving health of patient of end of life stage (Burke and et.al., 2020).
CONCLUSION
It has been summarized from the above study that hospice care is a difficult care in which
patients suffer from severe painful life ending disease. It has shown effectiveness of patient
centred care approach for patients in this hospice care. Families and care providers of patients
also play a vital role in providing emotional care to patients in hospices as it makes patients feel
valued.

REFERENCES
Books and Journals
Atiyeh, B., 2020. End-Of-Life (EOL) comfort care and Withdrawal of Life Support (WLS) of
severely burned patients: a review of the literature. Annals of Burns and Fire
Disasters. 33(2). p.154.
Baik, D. and et.al., 2020. Building trust and facilitating goals of care conversations: A qualitative
study in people with heart failure receiving home hospice care. Palliative
medicine. 34(7). pp.925-933.
Burke, S. and et.al., 2020. Physical activity in hospice care: a social ecological perspective to
inform policy and practice. Research quarterly for exercise and sport. 91(3). pp.500-
513.
Glanville, J. and et.al., 2019. Development of a search filter to identify reports of controlled
clinical trials within CINAHL Plus. Health Information & Libraries Journal. 36(1).
pp.73-90.
Jansky, M., Owusu-Boakye, S. and Nauck, F., 2019. “An odyssey without receiving proper
care”–experts’ views on palliative care provision for patients with migration
background in Germany. BMC palliative care. 18(1). pp.1-10.
Lindley, L.C. and Keim-Malpass, J., 2017. Quality of paediatric hospice care for children with
and without multiple complex chronic conditions. International journal of palliative
nursing. 23(5). pp.230-237.
Martí-García, C. and et.al., 2020. Experiences of family caregivers of patients with terminal
disease and the quality of end-of-life care received: a mixed methods study. PeerJ. 8.
p.e10516.
Milner, K.A. and Cosme, S., 2017. The PICO Game: An Innovative Strategy for Teaching Step 1
in Evidence‐Based Practice. Worldviews on Evidence‐Based Nursing. 14(6). pp.514-
516.
Padmanabhan, A. and et.al., 2019. Guidelines on the use of therapeutic apheresis in clinical
practice–evidence‐based approach from the Writing Committee of the American Society
for Apheresis: the eighth special issue. Journal of clinical apheresis. 34(3). pp.171-354.
Online
Eric., G. 2016. Patient Cantered Care and Turnover in Hospice Care Organization. 2020.
[ONLINE]. Available through :< https://spaef.org/news/36/2%20Kirby.pdf >
Celia and et.at., 2020. Experience of family caregivers of patients with terminal disease
and the quality of end life care received: A mixed methods study. [ONLINE]. Available
through :< https://spaef.org/news/36/2%20Kirby.pdf >