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nurse specialist creating potential for bias. Another being that the research was limited to one clinical site. The research article does reflect on the importance of education and communication regarding nurses as end of life caregiver and their feelings on administration of pain medication at the end of life. Study FourThe research study from the Journal of Palliative Medicine was to identify how hospice nurses prepare caregivers/families of terminally ill patients for the end of life. This included whatinformation should be provided and whether or not the information was tailored to the needs of 6
HOSPICE AND COMFORT MEDICATIONSthe caregiver and patient. This was a qualitative study that included 19 hospice clinicians, these clinicians were interviewed regarding information on symptoms, symptom management, implications of symptoms, and what to expect next. This study is peer reviewed and reliable. Theresearch in this study proved that timing in family/caregiver preparation at the end of life is key to positive outcomes. The majority of nurses timed preparation to symptom, condition changes and use of medications. Nurses also expressed that preparation for the end of life should not onlybegin on admission but prior to admission to hospice care. Preparing caregivers for the of life care enables ongoing education, support and ease in decision making as death nears. One noted limitation in this study was the discussion of advanced care planning and patient wishes were notincluded as part of the research. Kehl states that this should be done prior to or during admissionto hospice care (2014). This study supports the idea that early education regarding end of life care for caregivers and patients is useful. A major limitation to this study was that participants were greater than 90% white, lacking other cultural and religious backgrounds. Study FiveThe purpose of this study was for researchers to understand the relationship between caregiver barriers regarding pain management and the effects of those barriers. This study was a longitudinal correlation study. There was a total of 59 patient caregiver dyads that participated inthis study. Surveys were distributed to established caregiver barriers and patient outcomes. The survey included questions pertaining to demographics, caregiver barriers to pain management, adherence to medication administration regimens and patient outcomes. Patient levels of pain, depression and quality of life were measured. The result of the study found that the highest concern regarding pain management was concern for addiction. There was a link between fatalism, pain severity, and depression. The researchers also relate a correlation with caregiver 7
HOSPICE AND COMFORT MEDICATIONSadherence to pain management regimens a marked decreased in pain reported by patients, depression levels, and better quality of life. This study was found to be reliable; it is a peer reviewed study. Limitations to this study included a small sample size and only one hospice care setting.