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Date of Award

9-22-2021

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

Thesis Committee Chairperson

Janice Hobba-Glose DNS, MSN-CNS, RN

Additional Advisor

Mary Brogcinski MSN-CNS, RN

Keywords

liaison, palliative care

Abstract

Clinical Problem: It is universally known that there are many barriers hindering a smooth transition to palliative care services. One main barrier of transitioning from acute care to palliative care is lack of continuity of care. Factors that are lacking to sustain continuity include time pressure, limited resources, and increased demands for economic rationality. Factors that aided in the continuity of care are the hiring of extra personnel, advanced care planning, and increasing the competence of permanent employees (Midtbust et al., 2018).

Significance: This clinical problem poses significance because healthcare professionals experience many structural barriers which complicate the advancement of palliative care. This leads to uncontrolled symptom management, increased financial hospital expenses due to frequent admissions, poor goal attainment, patient and family dissatisfaction with the health care system and team, and patients feeling a lack of support from the healthcare team.

PICOT Question: This evidence-based proposal looks to answer the question of, “Among patients with incurable diseases of cancer, chronic obstructive pulmonary disease or congestive heart failure who are transitioning to palliative care, does implementation of a nurse practitioner liaison program 1) improve patient satisfaction with the transition of palliative care, 2) reduce hospital readmissions and 3) improve symptom management for pain control, respiratory distress and intractable nausea over six months?”.

Clinical Change: The clinical change proposed is to implement a nurse practitioner led liaison program to maintain continuity of care from the primary care setting into the palliative care setting.

Desired Outcome: The desired outcomes are an increase in patient satisfaction survey scores with the nurse practitioner liaison program and a noted decrease in hospital admissions post program implementation for symptom management such as pain control, respiratory distress, and intractable nausea.

Summary: After reviewing the literature it is concluded that lack of continuity of care was a large contributing barrier for patients when transitioning to palliative care. This evidence-based proposal demonstrates a plan for implementation of a nurse practitioner liaison program which can be adapted in multiple acute care settings. It is important to try to minimize complications associated with lack of continuity of care by implementing a nurse practitioner liaison program. The nurse practitioner liaison program aims to increase communication, meet the individual complex needs of the patients, increase satisfaction within the palliative care program, educate family members, reduce hospital admissions, and manage symptoms associated with chronic illnesses.

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