HNN108: Research Evidence, Symptom Management & Nursing Practice

This report provides an analysis of two research articles focusing on symptom management in palliative and end-of-life care. The first article examines the effectiveness of the CAREFuL program in improving comfort for elderly patients in acute geriatric wards, highlighting the importance of palliative care during the end-of-life phase. The second article explores experiences and questions related to symptom management, nutrition, and hydration at the end-of-life, revealing concerns about uncontrolled symptoms and the need for better medications and symptom management strategies. Both studies emphasize the need for improved palliative care to reduce suffering for patients and families, supported by a strong research evidence base. The report also discusses the limitations and implications of these studies, underscoring the importance of addressing deficiencies in end-of-life care through interdisciplinary approaches and educational initiatives.

HNN108 Assessment Task 1
Student Name
Student Number
Word Count

AnnotationArticle 1
Title & Abstract
Is the title appropriate? The tile of the article is appropriate as it gives the overall
idea of the paper along with the research design or method
used.
Is there a structured abstract? There is a structured abstract given for the paper including
the background, methods, findings and the interpretation of
the results.
The Study
Study Type The study involved a quantitative study design as it involved
access to the primary data
Study Design The study design involved a randomised controlled trial
conducted in the acute geriatric wards involving ten hospitals in
the Flemish Region of Belgium.
Was this Primary or Secondary
research?
This was a primary research as data was collected through
the randomised controlled trial.
Study Objective or Aims The aim or objective of this study was to evaluate the
efficacy of the Care Programme for the Last Days of Life
(CAREFuL) which was established in order to provide and improve
the quality and comfort of the care that is required at the dying
phase in the case of the aged adults.
Setting in which the study was
conducted
The study was carried out in a hospital setting, specifically in
the acute geriatric wards of the hospitals.
Inclusion / Exclusion Criteria Inclusion criteria- presence of at least one acute geriatric
ward, consent of collection of personal data of the patients
Exclusion criteria- absence of acute geriatric wards, non
agreement to provide patient’s personal data
How was data collected? Data was collected by randomly assigning patients to the
implementation of the CAREFuL or to the control group. The
hospitals were stratified in terms of the number of beds present
in the participating wards along with the proportion of patients
for whom the nurses could be able to obtain consent in the
baseline period. The groups were masked while data collection.
What data was collected? The data that was collected included the reasons involving
insufficient time, understaffing of the ward or wards, already
involved in other projects, or no stable structure at the ward or
wards because of new head nurse. The data included the
primary and the secondary outcomes.
How was the data analysed? The data was analysed by the measurement of the primary
and secondary outcomes by the nurse and the family carer.
The analysis was done through the intention to treat.
What ethical considerations are Ethics approval was obtained from the Central Ethics Committee
of the Vrije Universiteit Brussel and from the local ethics
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AnnotationArticle 1
associated with the research? committees of the participating hospitals in the Flemish Region.
Findings/Results
Sample size – How many
participants were included in the
research?
31 eligible hospitals were invited to participate initially
Was the sample size justified? The sample size was small, which could have increased the
biasness of the study.
Key Findings/ Results The key findings showed that the Implementation of CAREFuL
compared with control significantly improved nurse assessed
comfort which was CAD-EOLD baseline-adjusted mean difference
4·30, 95% CI 2·07–6·53; p<0·0001). However no significant
differences were noted for the CAD-EOLD assessed by family
carers ( Beernaert et al., 2017)
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AnnotationArticle 2
Title & Abstract
Is the title appropriate? The title is appropriate as it provides the overview of the
idea of the research study. However mention of further
questions is not that appropriate.
Is there a structured abstract? There isa structured abstract present including the
background, methods,the results, and conclusion.
The Study
Study Type This research includes a qualitative study
Study Design A supplementary analysis was carried out through the PeolcPSP
study design
Was this Primary or Secondary
research?
This is a primary research as primary data is collected
through the conduction of the survey.
Study Objective or Aims The aim of this article is to evaluate and report on a
supplementary analysis that explores the experiences and
questions of PeolcPSP survey respondents regarding symptoms,
hydration and nutrition.
Setting in which the study was
conducted
The study was carried out in among the people living in
United Kingdom.
Inclusion / Exclusion Criteria Inclusion criteria- residents of UK, individuals related tom
symptoms of nutrition or hydration.
How was data collected? Data was collected through a survey conducted through the
survey monkey link.
What data was collected? Data was collected regarding the symptoms of nutrition or
hydration
How was the data analysed? Data was analysed by converting the responses into word
documents and uploading those onto NVivo 10 software.
What ethical considerations are
associated with the research?
Respondents were asked to consent to their participation in the
PeolcPSP survey, following a written explanation of the study.
Findings/Results
Sample size – How many
participants were included in the
research?
The response included 190 individual responses
Was the sample size justified? The sample size was large enough which was justified.
Key Findings/ Results The key findings showed that five themes were identified which
included pain, breathlessness, agitation, nutrition and hydration.
The result showed that the majority of responses were related to
symptoms that were sub-optimally managed, in particular pain.
Nutrition and hydration were of significant concern, particularly
for carers ( Baillie et al., 2018)
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AnnotationArticle 2
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Summary of the Evidence.
Various initiatives have already been taken in order to provide care to the older adults
during their end of life phase. Similarly this study aimed to promote CAREFul program in order to
provide care to these individuals. From the conducted study it was found that the program was
successful in improving the quality of the care of the dying specifically in the acute geriatric hospital
wards. The study showed that there was significant improvement in the primary outcomes of the
trial that was carried out. A significant positive effect on symptoms and care needs was found along
with an adverse effect on satisfaction with care of the family carer. The limitations of the study
involved there was some lack of caution while the implementation of the positive effects of
CAREFuL. This included that that the nurses were not masked to the allocation hence this could
have affected the rigidity of the study. Additionally the study showed that there was low amount of
response rate obtained from the CAREFuL group in comparison to the control group. This difference
between the responses could result in biasness of the findings of the study. The study showed that
only 34–36% of patients present in the control and CAREFuL groups admitted to the wards gave
consent to use their personal data (Beernaert et al., 2017).
The implications of the study included that there is a requirement of optimal palliative care
for the patients who are dying in order to reduce the sufferings of both the patient and their family
members. A study by Vandervoort et al. (2014), showed that deficiencies present in the care of
dying inpatients in the hospital setting could be best addressed through the implementation of the
systems-oriented approach. This PCAD is a type of n interdisciplinary care path including a daily
documentation flow sheet, and a physician order sheet. van der Steen et al., (2014) in a study
argues that Inpatient Comfort Care Program (ICCP) could improve the quality of end-of-life care
provided in a Veterans Affairs (VA) medical center. The study also mentioned that this program
comprised of three major components namely staff education, case identification, and
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Summary of the Evidence.
implementation of a Comfort Care Order Set. In comparison to the implementation of CAREFuL
program, this program showed that availability of opioid pain medication at the time of death, as
documented in the patients’ records, increased significantly from 57.1% to 83.2% (P.001). it also
showed that the percentage of deaths that occurred in intensive care settings declined from 42.6%
to 32.6% through the implementation of the program but was not statistically significant (P=.17)
(Teno et al., 2013). Another goal of the intervention was to transfer patients from intensive care
settings to medical units, to reduce the use of uncomfortable or painful interventions and optimize
the family’s ability to spend time with the patient. In another study it was seen that the hospice
movement, which had challenged the existing death-defying attitude of the healthcare system. It
was also able to champion a positive attitude to caring for vulnerable and dying patients that
resonates with society. In order to implement this model of care a greater emphasis needs to be
given to the educational issues related to diagnosing dying. There is a need to disseminate widely
the expertise in the care of dying cancer patients along with to including the non-cancer population.
A clear structure for care is needed to empower generic workers if we are to achieve the
requirement of the NHS cancer plan that “the care of all dying patients must improve to the level of
the best.
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Summary of the Evidence.
According to the reports by WHO, there is a need for palliative care for around 20 million
people in a worldwide basis. There is a requirement for the management of symptoms that includes
pain (Gomes et al., 2013). This is an important aspect of palliative care, along with psychological,
spiritual and social support. The implications for the study involve concerns about uncontrolled
symptoms and quality of care has been identified from across the respondent groups. Vigorous,
research exploring the best mediations and drugs to oversee manifestations will decrease trouble
for the two patients and families, and lessen conceivable damage of ebb and flow medications.
Administration of manifestations might be impartial over various care settings, to empower patients
to remain in their favoured place of care. At long last, and potentially out of the blue, an extent of
medicinal services experts both distinguished themselves and reacted as clinicians, and patients or
carers. Palliative care is everyone's business and the after effects of this supplementary
investigation feature the requirement for pressing endeavors to enhance understanding
consideration, maintained by a strong research prove base.
The limitations of the research study incorporates that researchers were not able define
respondents' reports, or unlawful further inside and out data as would be standard in a subjective
meeting, the respondents concentrated on regions important to them, without impact from the
specialists. In spite of the fact that the scientists were not able affirm the character of respondents,
because of the mysterious idea of the information and the reactions were harmonious with people
who had involvement of the results they portrayed (Baillie et al., 2018).
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Summary of the Evidence.
The dying patients confront the unpredictable difficulties that debilitate the passionate,
physical and the profound uprightness. An investigation uncovers that there is a solid assertion
between the finish of life mind members meanings of what is included a decent passing. Most more
established Americans presently confront constant disease and handicap in the last long periods of
life. These last years can demonstrate excruciating and troublesome for wiped out and debilitated
elderly individuals, who may experience issues discovering consideration to address their issues.
This period is frequently unpleasant and costly for families (Chan & Webster, 2013). As right now
designed, social insurance and network benefits just are not sorted out to address the issues of the
substantial and developing number of individuals confronting a significant lot of dynamic ailment
and inability before death. This blends a developing assortment of research on the issue of
ceaseless ailment in the last period of life. Albeit family providing care has been seriously examined
in the previous decade, little consideration has been paid to the effect of end-of-life mind on
parental figures who are relatives of people with dementia or to the guardians' reactions to the
demise of the patient (Vandervoort et al., 2014).
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Summary of the Evidence.
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Reference List.
Beernaert, K., Smets, T., Cohen, J., Verhofstede, R., Costantini, M., Eecloo, K., ... & Deliens, L.
(2017). Improving comfort around dying in elderly people: a cluster randomised controlled
trial. The Lancet, 390(10090), 125-134. Retrieved from: https://doi.org/10.1016/S0140-
6736(17)31265-5
Chan, R. J., & Webster, J. (2013). End‐of‐life care pathways for improving outcomes in caring for the
dying. Cochrane database of systematic reviews, (11). Retrieved from:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008006.pub3/abstract
Goddard, C., Stewart, F., Thompson, G., & Hall, S. (2013). Providing end-of-life care in care homes
for older people: A qualitative study of the views of care home staff and community
nurses. Journal of Applied Gerontology, 32(1), 76-95. Retrieved from:
https://doi.org/10.1177/0733464811405047
Gomes, B., Calanzani, N., Gysels, M., Hall, S., & Higginson, I. J. (2013). Heterogeneity and changes
in preferences for dying at home: a systematic review. BMC palliative care, 12(1), 7.
Retrieved from: https://doi.org/10.1186/1472-684X-12-7
Baillie, J., Anagnostou, D., Sivell, S., Van Godwin, J., Byrne, A., & Nelson, A. (2018).
Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of
patients’, carers’ and health professionals’ experiences and further research questions. BMC
palliative care, 17(1), 60. Retrieved from: https://doi.org/10.1186/s12904-018-0314-4
Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., ... & Mor, V.
(2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of care,
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van der Steen, J. T., Radbruch, L., Hertogh, C. M., de Boer, M. E., Hughes, J. C., Larkin, P., ... &
Koopmans, R. T. (2014). White paper defining optimal palliative care in older people with
dementia: a Delphi study and recommendations from the European Association for Palliative
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Reference List.
Care. Palliative medicine, 28(3), 197-209. Retrieved from:
https://doi.org/10.1177/0269216313493685
Vandervoort, A., Houttekier, D., Vander Stichele, R., Van der Steen, J. T., & Van den Block, L.
(2014). Quality of dying in nursing home residents dying with dementia: does advanced care
planning matter? A nationwide postmortem study. PloS one, 9(3), e91130. Retrieved from:
https://doi.org/10.1371/journal.pone.0091130
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