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4-3 Milestone Three: Annotated BibliographyMilestone Three: Annotated BibliographySouthern New Hampshire UniversityNUR-440March 31, 2019PICO(T) Question: Comfort based care including pain management and symptom management is key to improving and maintaining quality of life of hospice patients, whether they are actively 1
4-3 Milestone Three: Annotated Bibliographydying or in early stages of the end of life. In patients with terminal illness on hospice/palliative care service, does education of comfort medications, compared to education at the time of transition to actively dying improve pain, symptom management, quality of life and apprehension during the end of life. Annotated BibliographyOliver, D. P., Wittenberg-Lyles, E., Washington, K., Kruse, R. L., Albright, D. L., Baldwin, P. K.,. . . Demiris, G. (2013). Hospice caregivers' experiences with pain management: "I'm not a doctor, and I don't know if I helped her go faster or slower". Journal of Pain and Symptom Management,46(6), 846-858. doi: 10.1016/j.jpainsymman.2013.02.011 In this study researchers aimed to understand the hospice patients’ caregivers experience with pain management at the end of life. This was a randomized clinic trial including qualitative and descriptive data obtained from interviews with 146 hospice caregivers. These caregivers were asked to answer 7 questions related to their experience of caring for a loved one during the end of life. These interviews resulted in 5 themes related to pain medication: administration, side effect concerns, ability to assess pain, communication and ongoing suffering. The study determined that education and communication related to administration of pain medication at the end of life should begin at the time of admission to hospice. It was also found that values and beliefs of patients and caregivers need to be taken into consideration. This research article has been peer reviewed and is reliable in the outcome of the research. However, there were limitations mentioned in the article related to participants 2
4-3 Milestone Three: Annotated Bibliographynot being available for follow-up interviews after their loved one’s death. Other limitations included not all the survey questions being answered by participants. This study found that >37% of caregivers were concerned about side effects of pain medications (Oliver et al., 2013). This article is consistent with the purposed PICO(T) question in that it reflects on the importance of early education and communication regarding caregiver and patient feelings on administration early on in hospice care leading to an improved end of life experience for the patient and caregivers. Howes, J. (2015). Nurses’ Perceptions of Medication Use at the End of Life in an Acute Care Setting. Journal of Hospice & Palliative Nursing, 17(6), 508-516. doi: 10.1097/NJH.000000000000192.