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Nursing and Allied Health Topics:

Healthcare Reform and End of Life Care


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Research has become a valued part of many nursing school programs with nursing students needing to present a variety of presentations and research papers on a variety of topics. Another somewhat recent development is more demand on students to find a special type of credible information called evidence-based practice information/articles. There are different levels of evidence-based practice information. A variety of sources are listed on the "Nursing and Allied Health Topics" web page to help Nursing and Allied Health students find credible peer-reviewed journal articles, including articles based on evidence-based practice. It seems that a majority of Nursing and Allied Health classes ask the students to cite according the APA Manual SIXTH EDITION, so the articles listed on the various Nursing and Allied Health Topics web pages will be presented according to the the American Psychological Association Manual.

Healthcare Reform and End-of-Life Care


Healthcare is one of the most important topics that concerns Americans. There have been plenty of attempts to increase the affordability and quality of healthcare. Healthcare reform to some degree continues on various levels of government. The following scholarly journal articles cover the subject of healthcare reform relating to end-of-life care. The following articles are cited according to APA Manual 6th edition.


  Aslakson, R.A., Curtis, J.R., & Nelson, J.E. (2014). The changing role of palliative care in the ICU. Critical Care Medicine, 42(11): 2418-28.

This is an evidence-based practice article. The full-text can be found through PubMed at:

Here are some excerpts from the abstract:


"Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation.


We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-


Palliative care is increasingly accepted as an essential component of comprehensive care for critically ill patients, regardless of diagnosis or prognosis. A variety of strategies to improve ICU palliative care appear to be effective, and resources including technical assistance and tools are available to support improvement efforts. As the longer-term impact of intensive care on those surviving acute critical illness is increasingly documented, palliative care can help prepare and support patients and families for challenges after ICU discharge. Further research is needed to inform efforts to integrate palliative care with intensive care more effectively and efficiently in and after the ICU and to document improvement using valid and responsive outcome measures."


  Fletcher, D.S., & Panke, J.T. (2012). Improving value in healthcare: Opportunities and challenges for palliative care professionals in the age of

  health reform. Journal of Hospice & Palliative Nursing, 14(7), 452-461.


The entire article can be found at: 

There are different levels of credibilty for evidence-based practice information. Articles where the authors perform a MAJOR literature search on the topic is one of the highest form of evidence-based practice information. However, there are studies and scholarly journal articles where the authors do research and give their analysis based on only one study or just some information that is available. I want to believe that this very good journal article is a form of evidence-based practice information.

"Despite having the highest per capita spending on healthcare in the world, seriously ill patients in the United States often do not receive the highest quality care. Improving the value of healthcare by increasing quality while reducing escalating costs is at the heart of US health reform. With the passage of the Patient Protection and Affordable Care Act of 2010, new healthcare delivery and payment models are being implemented to achieve these goals. This article reviews areas of health reform that have specific relevance for hospice and palliative care, highlights palliative care's positive outcomes, and reflects on current challenges within the healthcare system as well as within the field itself. Considerations regarding the language we use are explored, and recommendations are provided to ensure hospice and palliative care is represented in the planning and implementation of health reform initiatives."

  Frost, D., Cook, D., Heyland, D., & Fowler, R. (2011). Patient and healthcare professional factors influencing end-of-life decision-making during

  critical illness: A systematic review. Critical Care Medicine, 39(5), 1174-1189.

Now, THIS is an EVIDENCE-BASED PRACTICE journal article at it highest level of credibility. The authors searched the literature and studies. They studied the evidence in multiple sources and then gave their own summary of the evidence.


"OBJECTIVES: The need for better understanding of end-of-life care has never been greater. Debate about recent U.S. healthcare system reforms has highlighted that end-of-life decision-making is contentious. Providing compassionate end-of-life care that is appropriate and in accordance with patient wishes is an essential component of critical care. Because discord can undermine optimal end-of-life care, knowledge of factors that influence decision-making is important. We performed a systematic review to determine which factors are known to influence end-of-life decision-making among patients and healthcare providers. DATA SOURCES, SELECTION, AND ABSTRACTION: We conducted a structured search of Ovid Medline for interventional and observational research articles incorporating critical care and end-of-life decision-making terms. DATA SYNTHESIS: : Of 6259 publications, 102 were relevant to our review question. Patient factors predicting less intensive end-of-life care include increasing age, comorbidity, and limited functional status; these factors appear to be influential for both clinicians and patients. Patient and clinician race, ethnicity, and nationality also appear to influence the technological intensity of end-of-life care. In general, white patients and those in North America and Northern Europe may be less likely to desire intensive end-of-life care than others. Physicians of similar geo-ethnic origin to patients appear less likely to prescribe such therapy. Physicians with more clinical experience and those routinely working in the intensive care unit are less likely than other physicians to recommend technologically intense care for critically ill patients at the end-of-life. CONCLUSIONS: Patients and clinicians may approach end-of-life discussions with different expectations and preferences, influenced by religion, race, culture, and geography. Appreciation of those factors associated with more and less technologically intense care may raise awareness, aid communication, and guide clinicians in end-of-life discussions."



  Jennings, B., & Morrissey, M.B. (2011). Health care costs in end-of-life and palliative care: the quest for ethical reform.

  Journal of Social Work in End-of-Life & Palliative Care, 7(4): 300-17.


"Health reform in the United States must address both access to medical services and universal insurance coverage, as well as health care cost containment. Uncontrolled health care costs will undermine improvements in access and coverage in the long-run, and will also be detrimental to other important social programs and goals. Accordingly, the authors offer an ethical perspective on health care cost control in the context of end-of-life and palliative care, an area considered by many to be a principal candidate for cost containment. However, the policy and ethical challenges may be more difficult in end-of-life care than in other areas of medicine. Here we discuss barriers to developing high quality, cost effective, and beneficial end-of-life care, and barriers to maintaining a system of decision making that respects the wishes and values of dying patients, their families, and caregivers. The authors also consider improvements in present policy and practice-such as increased timely access and referral to hospice and palliative care; improved organizational incentives and cultural attitudes to reduce the use of ineffective treatments; and improved communication among health professionals, patients, and families in the end-of-life care planning and decision-making process."



  Lindley, L.C. (2011). Healthcare reform and concurrent curative care for terminally ill children: a policy analysis.

  Journal of Hospice & Palliative Nursing, 13(2), 81-88.

This journal article covers federal policy relating to healthcare reform and terminally ill children. The article can be found at:

  Morhaim, D.K., & Pollack, K.M. (2013). End-of-life care issues: A personal, economic, public policy, and public health crisis.

  American Journal of Public Health, 103(6): e8-e10. doi:  10.2105/AJPH.2013.301316

It is questionable if this is evidence-based pratice informatiion, but it is scholarly journal article. Some of the information provided may be helpful for your paper or presentation on this topic.

"IS END-OF-LIFE CARE A MATTER of personal values, economics, public policy, or a looming public health crisis? Actually, it is all of these. But when we consider the population’s demographic shift to older adults, which is associated with chronic illness and multiple comorbidities, the enormous health care costs consumed in end-of-life care, and complex ethical issues, it is time for the public health community to put this issue squarely on its agenda. Increasing the rate of completion of advance directives is a key step, and specific policy strategies can be identified to accomplish this objective."

The article is located at


  Wolf, S.M., Berlinger, N., & Jennings, B. (2015). Forty years of work on end-of-life care--from patients' rights to systemic reform.

  New England Journal of Medicine, 372 (7): 678-82.

This is NOT exactly evidence-based practice, BUT this informative article in this peer-reviewed journal might be helpful to give you ideas for your research paper or presentation..

This type of informative history article is located at:

"More than 2.5 million people die in the United States each year, most of them from progressive health conditions. Facing death is a profound challenge for patients, their relatives and friends, their caregivers, and health care institutions. Nearly 40 years of intensive work to improve care at the end of life has shown that aligning care with patients' needs and preferences in order to ease the dying process is surprisingly difficult — although there has been some incremental progress."


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