bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Palliative APRN in Telehealth
Authors: Kyle Katherine , Dahlin Constance 
Published: May 2023

Abstract
This chapter examines the current role of the advanced practice registered nurse (APRN) in providing care across the country using telehealth. Telehealth palliative care extends the boundaries of palliative care by promoting access to individuals previously limited by geography and providers while simultaneously complementing in-person provider visits. The chapter provides an overview of telehealth technology, with a synopsis of telehealth integration into healthcare and palliative care. It reviews the types of telehealth platforms available and discusses implementation as well as opportunities and barriers. It offers steps on how to provide a telehealth visit and the necessary documentation. It concludes with billing and coding.
Health Disparities in Palliative Care and Social Determinants of Health
Authors: Dixon Alma Y. , Motschenbacher Cecilia R. 
Published: May 2023

Abstract
Patients are more than a diagnosis; they are complex beings who live in various social situations. It has been long understood that social determinants of health play a role in palliative care. This has been highlighted by the ongoing COVID-19 pandemic. Palliative advanced practice registered nurses (APRNs) must integrate social determinants of health into care delivery, through their role as a patient and family advocate who assesses all patients for structural vulnerability. In delivering unbiased palliative care, the interdisciplinary team plays a key role in securing needed resources for the structurally vulnerable patient and for self-monitoring to determine if implicit biases exist. To be effective, they must reflect on any implicit biases and then practice through a lens of structural vulnerability.
Recurrent Disease and Long-Term Survivorship
Authors: Economou Denice , Bradford Brittany 
Published: May 2023

Abstract
The coordination of services between the survivorship clinic and palliative care is an essential part of the role of the palliative advanced practice registered nurse (APRN) role. Cancer survivors experience different trajectories from diagnosis to survivorship and potential recurrence. Managing long-term survivors who are experiencing recurrent disease and who also may be experiencing comorbidities related to aging and the long-term side effects of cancer treatment requires comprehensive and coordinated care. Integrating the principles of palliative care to improve the quality of care in long-term cancer survivors provides more effective and efficient management of recurrent cancer survivors, reducing suffering, conserving costs, and sharing resources.
The Pediatric Palliative APRN
Authors: Thaxton Cheryl Ann , Sartor Nicole 
Published: May 2023

Abstract
The role of the pediatric palliative advanced practice registered nurse (APRN) is dynamic; it extends into the realms of clinical expert, educator, business marketing champion, and transformational leader. This chapter focuses on several vital aspects of the role, including specifics on how to excel in the role of the pediatric palliative APRN and build key partnerships. Furthermore, the case study clearly articulates the impact of the pediatric palliative APRN role on child- and family-centered care in addition to indicating the need to continue a holistic approach to the management of children with complex and chronic conditions. A review of the history of the pediatric palliative APRN role supports the recognition of key advances in the field of pediatric palliative care (PPC) over several decades. Role qualifications and a sample job description have been integrated into the chapter.
The Pediatric Palliative APRN in the Clinic
Authors: Bass Alice , Battista Vanessa 
Published: May 2023

Abstract
This chapter explores the unique role of the pediatric palliative care (PPC) advanced practice registered nurse (APRN) in delivering high-quality PPC in the ambulatory setting. Common barriers to ambulatory PPC include misperceptions about PPC only being appropriate at end of life, fears of “giving up” or abandonment, and discomfort around pediatric advance care planning or goals of care discussions. In the outpatient clinic, the PPC APRN provides comprehensive pain and symptom management, decision-making support, advance care planning, and support for the child or adolescent and his or her family. The role of the PCC APRN is discussed, along with the considerations of caring for special populations. A description of the different PPC clinic models is offered. The opportunities and challenges of the PPC APRN in the pediatric clinic are explored.
Family Meetings
Authors: Gentry Jennifer , McDowell Kerrith , McKinzie Paula 
Published: May 2023

Abstract
Excellent communication is the foundation for effective family meetings, and leading family meetings is a key role for the advanced practice registered nurse (APRN). Facilitated family meetings can go far to improve communication and goal-concordant care in the course of serious illness. APRNs frequently lead formal and informal family meetings, discuss prognosis, clarify goals of care, assist with advance care planning, deliver bad news, and provide care when death is imminent. APRNs must be skilled in the principles of good communication, including attending to emotion and negotiating conflict, to provide effective care through family meetings.
Challenging Symptoms
Authors: Bobb Barton T. , Wojcikewych Devon S. 
Published: May 2023

Abstract
Dry mouth, hiccups, fevers, pruritus, and sleep disorders are symptoms often found in palliative care patients. They can be challenging to treat and require the palliative advanced practice registered nurse (APRN) to have a working knowledge to effectively manage them. Pruritus can be challenging, and determining the cause when possible can help tailor treatment. Hiccups and dry mouth are common; although seemingly benign, they can affect quality of life. Fever may require scheduled antipyretic treatment at end of life if it is distressing. Sleep disorders can also cause distress, but there are a variety of potential treatment options that may require titration/rotation. Appropriate assessment tools for these common symptoms are reviewed in this chapter. Nonpharmacological, pharmacological, and interventional treatments are discussed, always while emphasizing the importance of all interventions being individualized to the patient’s needs and goals of care.
Navigating Ethical Dilemmas
Authors: Coyle Nessa , Kirk Timothy W. 
Published: May 2023

Abstract
This chapter provides the advanced practice registered nurse (APRN) with the structure and language that complement the classic patient-centered care model of autonomy, beneficence, nonmaleficence, and justice. The chapter builds on the ethical foundation already inherent in the practice of palliative nursing, explaining ethical principles and skills to facilitate and guide navigation of ethical discussions. Throughout, the palliative APRN is recognized as being uniquely well-trained and situated within palliative care teams to be an advocate to ensure that the values, goals, perspectives, and concerns of patients, families, and fellow clinicians are appropriately heard in patient care conversations. Progressive illness with a long trajectory provides both the opportunity and the obligation for the palliative APRN to have these ongoing conversations. The importance of these conversations and clearly documenting them becomes even more urgent when the patient presents with advanced disease. An appendix is provided with common definitions and distinctions in palliative care ethics.
Developmental Disabilities
Authors: Kuehl Justin 
Published: May 2023

Abstract
Individuals with developmental disabilities may present with psychiatric emergencies. Given that developmental disabilities can be broadly defined, this chapter narrows the focus of discussion to intellectual and developmental disabilities (IDD) with an emphasis on intellectual disabilities and autism spectrum disorder. The estimated prevalence of co-occurring mental illness and IDD is taken into consideration, which includes a discussion regarding the challenges in accurately quantifying these data. The remainder of the chapter discusses best practices and offers recommendations for conducting a thorough and accurate psychiatric assessment. A good evaluation begins with clearly identifying the presenting problem that precipitated the emergency situation. It is also important to gather collateral information from reliable sources, which should include efforts to verify the presence of an IDD diagnosis. The assessment should be modified to account for communication and comprehension deficits in this population. It is important to recognize the impact of co-occurring medical conditions, and some of the most common are reviewed in this chapter. The risks and benefits of psychopharmacological treatment are discussed, including further consideration of commonly occurring side effects. There is also an emphasis on recognizing and addressing any history of trauma. The chapter concludes by acknowledging the role of primary caregivers and the responsibility to support their needs.
Institutional Responses and the Role of the Chief Wellness Officer
Authors: Ripp Jonathan A. , Kiely Sharon , Frieman Amy 
Published: May 2023

Abstract
Health care organizations and academic health centers are beginning to address the well-being of the workforce, medical students, and graduate medical education (GME) trainees through large-scale institutional commitments. Some are doing so through the naming of a Chief Wellness Officer (CWO). The CWO role is relatively new and still evolving, with a host of responsibilities being defined. The position varies considerably in terms of scope of constituencies served and programs under its purview. When effective, the CWO can help guide an institution in its strategic decision-making with a result that optimizes well-being. This commitment has clear implications and ultimately benefit for the well-being of medical students and GME trainees who learn in these environments. The growing understanding of how CWOs can influence well-being in partnership with other institutional undergraduate and graduate medical education well-being leaders is also positively influencing the overall landscape of well-being programs.
Mixed-status informal couples in a cascading crisis. Immobilisation, mobilisation, and normalisation?
Authors: Odasso Laura 
Published: May 2023

Abstract
In France, the COVID-19 pandemic was experienced as a cascading crisis, with its effects rippling out beyond its initial health domain. Due to the lockdown and ban on travel, the closure of borders, and the slowdown of administrative services, the pandemic had an unanticipated effect on transnational French/foreign couples lacking formal legal relationship status, causing separation and uncertainty. Overlapping health and migration concerns generated a new specific border regime, which reinforced the already existing ‘deservingness’ criteria for seeking to move to and integrate into the nation. The imposed geographical and administrative immobilisation led to some couples creating online self-help communities, which offered emotional support and shared coping strategies for couples caught in the deadlock. These communities have given the challenges faced by mixed-status couples fresh visibility. Drawing on an ethnography conducted in four online communities, in-depth interviews with transnational couples, and an analysis of politico-juridical materials and grey literature, this article focuses on marriage becoming the option for French/foreign couples seeking the right to reunite in France during an uncertain period. More precisely, by using crisis studies to frame the impact of the pandemic and articulating the scholarship on socio-legal and intimate citizenship, the experiences of such couples can be understood as specific processes in legal consciousness, producing acts of intimate citizenship. This perspective helps demonstrate how the pandemic emphasised the policing of migrant couples, and how institutional and legal opportunities narrowed the choices available to such couples, reducing the potential of change that is generally inherent in crises.
Students’ Leadership Development During a High-fidelity Military Medical Field Practicum
Authors: Van Shufflin Matthew W , Barry Erin S , Vojta Leslie , Yarnell Angela , Cole Rebekah 
Published: May 2023

ABSTRACT

Introduction
Leadership development is a cornerstone aspect of military medical education. Operation Bushmaster, a medical field practicum (MFP) conducted by the USU, tests fourth-year medical students’ clinical skills and leadership acumen in an operational environment. No studies have examined students’ perceptions of their own leadership development during this MFP. Therefore, this study explored leadership development from the students’ perspectives.

Materials and Methods
Using a qualitative phenomenological design, we analyzed the reflection papers of 166 military medical students who participated in Operation Bushmaster during the fall of 2021. Our research team coded and categorized the data. Once defined, these categories served as the themes in this study.

Results
Three central themes were expressed: (1) the importance of direct and decisive communication, (2) unit cohesion and interpersonal relationships enhance the team’s ability to adapt, and (3) followership quality determines leadership outcomes. The students’ leadership ability was maximized by established relationships within their unit and well-practiced communication, and a decreased propensity for followership negatively affected leadership. Overall, Operation Bushmaster increased students’ appreciation of the importance of leadership development and overall enhanced their leadership outlook as a future military medical officer.

Conclusions
This study provided an introspective vantage from military medical students pertaining to their own leadership development, as participants described how the challenging environment of a military MFP challenged them to hone and develop their leadership skills. As a result, the participants gained a greater appreciation of continued leadership development and realization of their future roles and responsibilities within the military health care system.
Medical Students’ Integration of Formative Feedback During Simulation: A Grounded Theory Study
Authors: Cole Rebekah , Garrigan Audra G , Peters Sidney A , Tilley Laura , Conley Sean P , Schwartz James , Vojta Leslie , Rudinsky Sherri L 
Published: May 2023

ABSTRACT

Introduction
Formative feedback is critical for trainees’ growth and development. However, there is a gap in the professional literature regarding the ways in which formative feedback affects student performance during simulation. This grounded theory study addresses this gap by exploring the ways in which medical students received and integrated ongoing formative feedback throughout a multiday, high-fidelity military medical simulation, Operation Bushmaster.

Materials and Methods
Our research team interviewed 18 fourth-year medical students in order to investigate how they processed formative feedback during the simulation. Guided by the grounded theory tradition of qualitative research, our research team used open coding and axial coding to categorize the data. We then used selective coding to determine the casual relationships between each of the categories that emerged from the data. These relationships determined our grounded theory framework.

Results
Four phases emerged from the data and provided a framework to delineate the process in which students received and integrated formative feedback throughout the simulation: (1) ability to self-assess, (2) self-efficacy, (3) leadership and teamwork, and (4) appreciation of feedback for personal and professional growth. The participants first focused on feedback related to their individual performance but then shifted to a teamwork and leadership mindset. Once they adapted this new mindset, they began to intentionally provide feedback to their peers, increasing their team’s performance. At the end of the simulation, the participants recognized the benefits of formative feedback and peer feedback for ongoing professional development throughout their careers, signifying a growth mindset.

Conclusions
This grounded theory study provided a framework for determining how medical students integrated formative feedback during a high-fidelity, multiday medical simulation. Medical educators can use this framework to intentionally guide their formative feedback in order to maximize student learning during simulation.
The Impact of High-fidelity Simulations on Medical Student Readiness
Authors: Cole Rebekah , Egan Sean J , Schwartz James , Rudinsky Sherri L 
Published: May 2023

ABSTRACT

Introduction
Simulation is a key aspect of the military unique curriculum at the Uniformed Services University (USU). The Department of Military and Emergency Medicine conducts rigorous high-fidelity simulations for military medical students during each year of their medical school training: Patient Experience (first year), Advanced Combat Medical Experience (second year), Operation Gunpowder (third year), and Operation Bushmaster (fourth year). There is currently a gap in the professional literature regarding students’ progression through each of these simulations. This study, therefore, explores the experiences of military medical students at USU in order to understand how they learn and develop as they progress through these high-fidelity simulations.

Materials and Methods
Using a grounded theory approach to qualitative research design, we analyzed qualitative data from 400 military medical students across all four years of military school who participated in the four high-fidelity simulations during 2021–2022. Our research team used open and axial coding to categorize the data and to make connections between each of these categories, which we articulated in a theoretical framework and illustrated in a consequential matrix. This research was approved by the Institutional Review Board at USU.

Results
During Patient Experience, the first-year medical students described the stress, chaos, and lack of resources that military physicians face as they experienced the realism of the operational environment. Later at Advanced Combat Medical Experience, the second-year medical students practiced their medical skills hands-on for the first time in the simulated stressful operational environment. As a result, they gained confidence and began to formulate their professional identity. Next, at Operation Gunpowder, the third-year medical students advanced to more complex tactical field care as they performed prolonged casualty care, forward resuscitative care, forward resuscitative surgical care, and en route care as a team, often revealing gaps in their knowledge that needed to be filled. During the capstone simulation, Operation Bushmaster, the fourth-year medical students closed these gaps and solidified their professional identity as leaders and physicians, culminating in a strong confidence regarding their readiness for their first deployment.

Conclusions
Each of the four high-fidelity simulations impacted the students in unique ways as they were incrementally challenged to practice and build upon their knowledge, skills, and abilities related to combat casualty care, teamwork, and leadership in the operational environment. As they completed each of the simulations, their skills improved, confidence grew, and professional identity solidified. Therefore, completing these rigorous simulations progressively over the course of 4 years of medical school appears to be a vital process and foundation for the deployment readiness of early-career military physicians.
“Not for the Faint of Heart”: First-year Military Medical Students’ Professional Identity Formation During the Innovative Patient Experience at Operation Bushmaster
Authors: Rudinsky Sherri L , Weissbrod Elizabeth , Cole Rebekah 
Published: May 2023

ABSTRACT

Introduction
The role of a military medical officer (MMO) is complex. Therefore, it is essential that military medical students formulate their professional identity early on in medical school in order to prepare them for their first deployment. At the Uniformed Services University, students are challenged to progressively develop their professional identity through yearly high-fidelity military medical field practicums (MFPs). One of these MFPs, Operation Bushmaster, consists of an innovative “Patient Experience” in which first-year medical students portray patients cared for by fourth-year medical students in a simulated operational environment. The purpose of this qualitative study was to examine how participating in the Patient Experience impacted first-year medical students’ professional identity formation.

Materials and Methods
Our research team used a phenomenological, qualitative research design to analyze the end-of-course reflection papers of 175 first-year military medical students who participated in the Patient Experience during Operation Bushmaster. Our research team members individually coded each student’s reflection paper and then came to consensus on how to organize these codes into themes and subthemes.

Results
Two themes and seven subthemes emerged from the data regarding the first-year medical students’ understanding of the MMO: (1) multiple roles of the MMO (educator, leader, diplomat, and advisor) and (2) role of the MMO in the operational environment (navigates hazardous environment, adaptability, and position within health care team). As they participated in the Patient Experience, the first-year medical students not only recognized the complexity of the MMO’s multiple roles within the operational environment but also envisioned themselves in these roles.

Conclusions
The Patient Experience provided first-year medical students with a unique opportunity to formulate their professional identity as they portrayed patients during Operation Bushmaster. This study’s results hold implications for both military and civilian medical schools regarding the benefits of innovative military MFPs for professional identity formation in junior medical students, preparing them early on in medical school for their first deployment.