Browsing by Author "Zalud, Kristina"

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    Community Hospice Nurses’ Perspectives on Needs, Preferences, and Challenges Related to Caring for Children With Serious Illness
    (American Medical Association, 2021-10-01) Porter, Amy S.; Zalud, Kristina; Applegarth, Jacob; Woods, Cameka; Gattas, Melanie; Rutt, Emily; Williams, Karen; Baker, Justin N.; Kaye, Erica C.; Medicine, School of Medicine
    Importance: Many of the 50 000 children who die annually are eligible for provision of community-based hospice care, yet few hospice organizations offer formal pediatric services. Population-level data demonstrate that hospice nurses lack training, experience, and comfort in caring for children, but their specific educational needs and preferences are poorly understood. Objective: To assess the pediatric-specific training and support needs of hospice nurses caring for children in the community. Design, setting, and participants: For this qualitative study, 41 nurses were purposively seletected from a population-level cohort of 551 hospice nurses who completed a previous mixed-methods survey; these 41 nurses participated in semistructured interviews between February and April 2019. Hospice nurses were recruited from all accredited hospice organizations in Tennessee, Mississippi, and Arkansas that offer care to pediatric patients. Content analysis of interview transcripts was conducted. Main outcomes and measures: The interview guide probed for topics related to prior pediatric hospice training experiences, desires and preferences for training, and perceived barriers to training. Results: Interviews were conducted with 41 nurses representing different geographic regions and levels of comfort with pediatric hospice provision (as self-reported in the prior survey). Thirty-eight of the nurses were women (92.7%), with a median age of 40-49 years (range, 20-29 to ≥60 years) and median tenure of 5-9 years (range, <1 to ≥20 years) as a hospice nurse. Respondents included 1 American Indian or Alaska Native nurse (2.4%), 1 Black nurse (2.4%), and 39 White nurses (95.1%). Across interviews, most hospice nurses reported feeling uncomfortable caring for children with serious illness, and all nurses used language to express the immediacy behind the need for pediatric-specific training and support. Nurses explained why further training and support are needed and clear preferences for who should provide the education, educational modalities, and specific training topics. Nurses also articulated barriers to training and support opportunities and proposed innovative suggestions for overcoming these challenges. Notably, nurses emphasized the need for connection with experts, a sense of community, and solidarity to support frontline clinicians providing end-of-life care to children in the community. Conclusions and relevance: In this qualitative study, community hospice nurses expressed an urgent need for improvements in pediatric-specific training opportunities and support, clear preferences for how education should be provided, and recommendations for circumventing barriers to training. These findings are a call to action for the palliative care community to collaborate in rapid implementation of educational programs and networks to systematically support hospice nurses caring for children in the community.
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    Impact of personal experiences on career path, clinical practice, and professional endurance among hospice nurses caring for dying children
    (Sciedu, 2022) Porter, Amy S.; Reeves, Tegan J.; Zalud, Kristina; Applegarth, Jacob; Woods, Cameka; Gattas, Melanie; Rutt, Emily; Williams, Karen; Baker, Justin N.; Kaye, Erica C.; Cameka; Medicine, School of Medicine
    Context and objective: The multifaceted demands of pediatric hospice work often discourage nurses from pursuing the career route and may overwhelm nurses who choose to do the work, risking burnout. The relationship between nurses’ personal experiences and their decisions to pursue this difficult work, as well as their ability to sustain it, has not been studied previously. The study objective was to explore the influences of pediatric hospice nurses’ personal experiences on their career trajectories, their clinical approaches to caring for dying children, and their endurance in doing so. Methods: From the 551 community hospice nurses in Tennessee, Mississppi, and Arkansas who completed a survey as part of a previous study, purposive sampling was used to select a cohort of 41 nurses. Semi-structured interviews were conducted, recorded, and transcribed. Content analysis of interview transcripts was performed. Results: Nurses described three types of personal experiences that shaped their professional practice: 1) personal illness, 2) personal loss, and 3) parenthood. We identified two major themes characterizing how personal experiences influence their work: 1) leading them into the hospice field (“career trajectory”) and 2) strengthening their clinical practice (“clinical approach”) through four mechanisms: a) identifying tools for patient care, b) connecting with pediatric patients, c) connecting with bereaved families, and d) finding balance between competing priorities. Conclusions: Personal experiences of illness, loss, and parenthood influence hospice nurses’ career trajectories and how they care for dying children. Normalizing these influences and integrating reflection on them into hospice training may empower nurses to pursue pediatric hospice nursing, find meaning in the work, and build professional endurance.
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    The Impact of Specialty Palliative Care in Pediatric Oncology: A Systematic Review
    (Elsevier, 2021) Kaye, Erica C.; Weaver, Meaghann S.; DeWitt, Leila Hamzi; Leila Hamzi, Elizabeth; Stevens, Sarah E.; Lukowski, Joe; Shih, Brandon; Zalud, Kristina; Applegarth, Jacob; Wong, Hong-Nei; Baker, Justin N.; Ullrich, Christina K.; AAHPM Research Commttee; Medicine, School of Medicine
    Context: Children with cancer and their families have complex needs related to symptoms, decision-making, care planning, and psychosocial impact extending across the illness trajectory, which for some includes end of life. Whether specialty pediatric palliative care (SPPC) is associated with improved outcomes for children with cancer and their families is unknown. Objective: We conducted a systematic review following PRISMA guidelines to investigate outcomes associated with SPPC in pediatric oncology with a focus on intervention delivery, collaboration, and alignment with National Quality Forum domains. Methods: We searched PubMed, Embase, Scopus, Web of Science, and CINAHL databases from inception until April 2020 and reviewed references manually. Eligible articles were published in English, involved pediatric patients aged 0-18 years with cancer, and contained original data regarding patient and family illness and end-of-life experiences, including symptom management, communication, decision-making, quality of life, satisfaction, and healthcare utilization. Results: We screened 6682 article abstracts and 82 full-text articles; 32 studies met inclusion criteria, representing 15,635 unique children with cancer and 342 parents. Generally, children with cancer who received SPPC had improved symptom burden, pain control, and quality of life with decreased intensive procedures, increased completion of advance care planning and resuscitation status documentation, and fewer end-of-life intensive care stays with higher likelihood of dying at home. Family impact included satisfaction with SPPC and perception of improved communication. Conclusion: SPPC may improve illness experiences for children with cancer and their families. Multisite studies utilizing comparative effectiveness approaches and validated metrics may support further advancement of the field.