Utilizing Palliative Care Principles to Improve Mood and Quality of Life in a Nursing Home: An APRN Initiative

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Purpose: The purpose of this DNP project was to implement nurse practitioner (NP) led palliative care (PC) services and to evaluate the practice change by measuring nursing home (NH) residents’ mood and quality of life (QOL). Methods: 20 patients residing in one NH in a single Midwestern state in the United States that met PC criteria (any chronic, serious illness) were included in the project. Patients received visits from a palliative/hospice trained NP once a week in addition to other facility services. Self-report measures of depression and QOL were administered at baseline and one month later. Repeated measures ANOVAs were performed to examine the change in mood and QOL over time. Results: 20 participants aged 44-88 years (average = 74.7 years, SD = 9.8 years) were enrolled, and 19 successfully completed four weeks of PC visits and questionnaires at baseline and four weeks. The average overall QOL z-score at the initial visit was -0.59 (SE=0.21) and average QOL z-score at the final visit remained -0.59 (SE=0.17). Results of repeated measures ANOVA showed no significant change in QOL score, F(1,18)=0.00, p=0.997, η2 p=0.00. Average PHQ-9 score at the initial visit was 9.90 (SE=1.11). At the final visit, average PHQ-9 score was 8.21 (SE=1.39). Repeated measures ANOVA showed no significant change in PHQ-9 score over time when examining the entire sample, F(1,18)=2.03, p=0.171, and the effect size was small, η2 p=0.101. However, when selecting for clinically significant depression symptoms (PHQ-9 score ³10) at baseline, there was a trend towards a decline in depression symptoms, F(1,10)=3.38, p=0.096, with a large effect size, η2 p=0.253. Though not statistically significant, the decline in depressive symptoms in this subset may be clinically meaningful. Conclusion: This project implemented PC focused visits with a NP in a single NH, with the goal of improving symptom burden, and focused on mood (PHQ-9) and QOL (MQOLexpanded). Despite limitations, results provide preliminary support for improvement in depressive symptoms among a subset of patients receiving PC services. Additional studies with a larger population are needed to determine if mood and QOL can be improved using PC services in the NH setting.

Palliative care, palliative medicine, long term care, nursing home, quality of life, depression, geriatrics, chronic disease