Introduction
Identifying Need
The vague language of the current Intermountain Healthcare (IH) description of primary care results in insufficient elaboration of specific nursing responsibilities such as quality of patient life, caregiver support, and non-discriminant patient treatment. A comprehensive primary care policy has not been adopted in the IH facilities, leaving care teams to devise an individual approach to each terminal patient, which may be inefficient and result in subpar service. Across the country, many HCPs lack knowledge and skills in pain and symptom management, communication, and care coordination. At the same time, the public has only a vague understanding of the benefits of primary care and how to access it (Meier et al., 2017). Given a wide range of responsibilities in providing palliative care (PC) and lack of specific instructions, IH healthcare providers (HCPs) filling only immediate orders such as medical prescriptions may coincidentally neglect some care aspects. Therefore, an instructive primary care policy is needed to facilitate successful administration and ensure equitable access to care services in the IH facilities.
Current Policy
Due to the lack of an established primary care policy, most details were obtained from annual reports and public website sections. Palliative care in IH facilities pursues several goals: quality of patient life, symptom relief, family and caregiver support, and a team approach to care and care aligned with patients’ aspirations (Intermountain Healthcare, 2018). However, the current key goal is for HCPs to focus on managing pain and other symptoms like nausea or sleep problems (Intermountain Healthcare, 2020b). None of the listed elements are thoroughly elaborated, including the critical goal. Intermountain Healthcare (2022) nursing services for end-of-life care include symptom assessment, “skilled services and treatments,” and situational management. In addition to nursing care, patients and their families can expect the care team to cover counseling, emotional and spiritual support, medication and supplies, domestic helper services, and home care in acute need (Intermountain Healthcare, 2022). The nuances are to be addressed in a plan of care (POC) jointly created by the care team and the patient based on the diagnosis, symptoms, and other needs (Intermountain Healthcare, 2022). However, it is unclear what ‘skilled services’ constitute or how detailed POCs are.
Literature Review
Scholars in medical and legal research encourage the development of detailed palliative care policies. Supporting this initiative, IH developed a hospital-based electronic palliative care algorithm to improve the identification of patients benefitting from PC services and calculate PC penetration rates (Gruhler et al., 2018). The algorithm then indicated that the need for receiving PC might be as high as 26.4% of the total IH inpatient population (Gruhler et al., 2018). It will be progressively more challenging for HCPs to devise individualized care plans for IH patients with as high and potentially increasing numbers. Therefore, an approach with great universal applicability is needed to meet this demand.
Furthermore, the policy focus should be on restructuring service delivery. For example, Palmryd et al. (2021) found that nurses caring for intensive care unit patients did not prioritize integrity, arguing that more explicit guidelines are required to ease the issue. This issue may be applicable to the IH facilities, given that extant IH guidance on PC does not identify the expectations and responsibilities of each party. Thus, the research mandates a policy change to guide productive communication between providers and patients.
Additionally, the lack of a universal, comprehensive PC opens a leeway for bias. For example, a striking finding was that patients’ quality of end-of-life care might depend on the patient’s disease (Martinsson et al., 2018). At the same time, Spraker-Perlman et al. (2019) found that IH patients without known critical conditions (CC) benefit significantly from PC support before their death, just as much as patients without CC. Therefore, the research necessitates ensuring that the non-discriminant approach to PC provision is specified in the policy.
Lastly, blaming IH nurses for negligence is impractical, given their inability to assist sometimes. The outbreak of the COVID-19 pandemic has demonstrated that the lack of resources and nursing burnout contribute to the increased scarcity of care in PC (Human Rights Watch, 2021). In its Annual Report (2020a), IH recognized that its caregivers focused on creating personal protective equipment (PPE) assembly lines. Their regular duties saw a significant decrease in hours because of the pandemic. This situation mandates ensuring that nurses can meet the care requirements. Hence, the policy to improve patient care should involve reconsidering the carer support system, as nurses’ workload can interfere with the quality and quantity of services provided.
Discussion Outline
A detailed assessment of contributing factors, strategic goals, and budget plan will be required to successfully create and implement the policy. The policy should ensure even responsibility distribution and uphold an appropriate accountability standard for non-compliance. It should provide a proper level of detail in each aspect and implement enforcement mechanisms to avoid regular duties suffering due to negligence. Moreover, sufficient staffing in every establishment is mandatory to prevent situations where IH staff is overwhelmed with double duty. Overall, the proposed approach should create concrete and explicit guidelines regulating nursing staff responsibilities in end-of-life care, a comprehensive support network for HCPs and patients, and specific instances of accountability.
Assessment
Demographics
The COVID-19 pandemic highlighted that curative care is currently at the core of provider-patient interaction over any PC aspect. In addition, during an acute crisis, hundreds of IH staff members were sent to help in New York hospitals (Intermountain Healthcare, 2020a). The problem may have passed, but the question of which duties take priority remains, which may be overwhelming for the IH facilities staff. Therefore, the primary demographic that policy changes can affect will be the nursing staff needing explicit guidance on responsibilities and expectations. Further, the inpatient population of the IH facilities will be experiencing the consequences of the changed PC routine.
Morbidity and Mortality Rates
Not addressing the issue of inadequate PC may impact mortality rates significantly. For example, Gruhler et al. (2018) estimate that 90 million Americans currently live with severe, life-threatening illnesses and expect to double within 25 years. In addition, there is strong evidence that PC-reducing acute unplanned hospitalizations and specialized PC services are associated with improved short- and long-term care outcomes (Sleeman et al., 2021). Therefore, improving the policy approach to specialist palliative care would improve overall patient comfort, especially at the end of their lives.
Disparities Resulting from the Current Policy
The poorly recognized role of end-of-life care in current policy contributes to unequal access to care. Although PC is increasingly recognized as a human right, the lack of guidelines’ support and research prevents many from utilizing it (Sleeman et al., 2021). Specifically, there are two downsides resulting from IH policy reliance on individual POCs to facilitate end-of-life and palliative care. First, individualized POCs mean no universal standard of conduct is established; coupled with a potentially limited level of patient understanding of the services they may require, this could result in underperformance. Second, Intermountain Healthcare’s (2022) policy states that the hospice program and the patient’s physician must approve any proposed POC tests, procedures, and services, adding that “generally, treatments necessary for symptom or pain management” are supported. Therefore, services beyond the necessary symptom management may not be approved.
Cultural Issues
The proposed change in policy would provide an all-encompassing transformation of the extant system. If any of the PC aspects in IH are currently dependent on creating individualized POCs, these aspects will be thoroughly regulated in the future system. For the IH care teams that are used to working closely with each patient, such a system may initially seem overly prescriptive. Additionally, the cultural background may influence patients’ decision-making regarding pain and PC, making it vital to consider the patient’s beliefs regarding care and death before forming an all-encompassing instructive guidance of staff conduct.
Readiness for Change and Stakeholders
America has seen tremendous growth in palliative care in the 21st century, indicating the national readiness for policy change and implementation. The IH facilities are receptive to innovative missions and have supported designing other healthcare policies, such as Primary Promise’s plan to build a children’s national model health system (Intermountain Healthcare, 2020a). In addition, providers and policymakers have begun recognizing the potential benefits of PC for patients with severe illness at any stage (May et al., 2021). The primary stakeholders are HCPs and terminally ill patients in IH facilities, both groups being receptive to potential policy changes.
Costs
The costs of implementing a PC health policy have been scarcely investigated in recent years. Increasingly, though still limited, evidence supports the efficacy and cost-effectiveness of specialized PC (Sleeman et al., 2021; May et al., 2021). Patients who receive early technological PC show improved outcomes, including physical symptom control, survival, and quality of life, and caregivers report increased satisfaction and decreased depression (Sleeman et al., 2021). Moreover, appropriate and timely provision of PC likely lowers overall healthcare expenses (May et al., 2021). Therefore, the costs of keeping current HCPs and effectively helping patients in IH facilities may be reduced by implementing a new policy. Finally, the purpose of end-of-life care is for comfort, and not providing a PC to them can increase their discomfort when we should be keeping them as comfortable as possible in their last hours or days.
SWOT Analysis (Phase 1)
Palliative Care in ICU
SWOT analysis is one technique by which managers can assess the internal and external factors impacting their business. The goal of palliative care is to help patients with terminal conditions, revive their pain, and ensure that the quality of their lives does not diminish due to their illness. Palliative care is an essential field of the healthcare industry that allows terminally ill patients and their families to feel cared for. Therefore, the services at this unit should be of the highest quality. This paper will present a SWOT analysis of palliative care at the ICU in a table format and detail these environmental factors.
Table 1 summarizes all the SWOT factors for palliative care in the ICU. Firstly, the strengths of this unit are the patient-centered practices of care, which allow the development of a solid customer base. Mainly, people who require palliative care need special attention, and the medical personnel has to provide services considering the wishes and preferences of the patients. Moreover, this palliative care unit is a part of the hospital’s ICU, which means that patients who require intensive care can be easily transferred to the ICU unit with minimal effort. The facilities being in the same building makes transportation and provision of intensive care services more accessible.
On the other hand, the combination of ICU and palliative care services has some disadvantages. For example, the scope of services that this facility can provide is smaller than that of the facilities where palliative care is the main focus. Additionally, there may be a lack of personnel, especially nurses, to attend to the needs of the patients as these specialists may be more focused on providing services for the individuals under intensive care. The high turnover rates and the lack of qualified staff are general problems affecting the healthcare system in the United States, and COVID-19 has worsened the situation. This is especially true for nurses whose turnover rates are high, which can cause disruptions in the operations of this unit.
The threat to the palliative care unit in ICU is growing competition. Palliative care is a healthcare field that has been increasing, and over the last several years, several facilities that focus predominantly on palliative care were opened (Mojgan Ansari, 2018). Hence, patients in need of palliative care services may prefer a facility entirely dedicated to this type of healthcare service provider instead of a facility where palliative care is a part of the ICU unit. Moreover, patients expect a higher quality of services and more attention from healthcare professionals, which is an issue considering the weaknesses discussed above.
Despite several threats that may disrupt the operations of the palliative care unit, some opportunities can guarantee the growth and development of this unit. Firstly, the population is aging, which means that more people will require palliative care in the future. This means that this palliative unit can expand and prepare to provide services for a more significant number of patients, resulting in the growth of revenue. Additionally, the team can provide palliative care services linked to other care practices, for example, recreational therapy. This will allow the patients to receive better care; for example, they will participate in activities targeting their physical and mental health. For the palliative care unit, the provision of additional services will allow to hire of more specialists and attract patients that want more than regular daily care and medical checkups. Additionally, recreational therapy is in line with patient-centered care and self-care practices, which began the healthcare system’s focus in recent years. Hence, the palliative care unit in the ICU has a plethora of opportunities for growth and development and considering the strengths of this healthcare facility, it has the potential to facilitate these changes.
Table 1. SWOT analysis
Strategic Planning (Phase 2 and 3)
Goal: To evaluate the consistent delivery of end-of-care by nursing staff in the Intensive Care Unit by June 1.
Palliative care is a human right to a decent life to the end: without pain, without fear, without loneliness. Such assistance is provided not only to the patient but also to their family. Therefore, it is essential to preserve the patient’s highest possible quality of life until the end. Therefore, the main tasks of palliative care are the relief of pain and other painful symptoms, quality care, and social, psychological, and spiritual support for the patient and their relatives.
Short-term Goal
Specific. To measure and evaluate the effectiveness of care at the end of life to improve palliative care. This determines how successful health care and other social services support patients with incurable diseases at the end of their lives. Thus, it is necessary to establish indicators that ensure the accountability of the measurement within two months.
Measurable. Data can be measured following surveys conducted among patients. They calculate each individual’s preferences and the experience of the family member who has had to deal with palliative care. Thus, a quality satisfaction score will be established to estimate the necessary changes.
Achievable. Health officials have agreed on the required studies, and the necessary legal approvals have been obtained. Then, the templates needed for surveys and a system for considering the opinions of patients and family members will be compiled. This will allow you to calculate the data obtained due to the study quickly.
Relevant. The surveys will be derived from evaluating patients and their families who have experienced palliative care. All data will be entered into a common database, and a conclusion will be drawn based on this. A team will be appointed responsible for collecting the necessary information as part of the improvements.
Time-Bound. In terms of time, the goal takes two months, the first two weeks of which are developing templates and creating a responsible group. Next, a month is spent collecting the opinions of patients and family members; the last two weeks evaluate the results and summarize the results.
Medium-range Goal
Specific. To allocate money to develop personnel for a more excellent distribution of palliative care. This can provide access to high-quality delivery medical programs to support people in the terminal stages of illness (Arya et al., 2020). To achieve the goal, six months of budget distribution and investment use are appropriated.
Measurable. The success of achieving the goal is calculated by how much more efficient the work of the staff becomes. Moreover, this is determined by the increasing number of new personnel when hiring. Efficiency includes patient satisfaction and quality of service with better workers’ training.
Achievable. Each organization will be allocated an appropriate budget for staff training and development. The money raised from investors and the Ministry of Health will be used to create courses and teaching methods and purchase the necessary materials. Coordination of all financial activities is carried out by the administrative body of the organization.
Relevant. The allocation of budget and funding for courses for staff is aimed at achieving better delivery of palliative care. Monetary investments will increase the quality of services provided for the comfort of patients and their families. When developing education courses and staff instruction, the responsibility lies with a specially created team that organizes training events for medical workers.
Time-Bound. Improvements in funding for medical staff training will be achieved in six months. The first month will be spent developing a training program for medical professionals. In the next four months, training and certification will be performed. After that, a month of monitoring the progress of the personnel.
Long-term Goal
Specific. To fund research into palliative care to increase the evidence base. This assistance is limited due to the scarcity of research in this area. Thus, the goal is to improve understanding of the problem. Two years of study are allocated to complete the task.
Measurable. Success can be measured by increasing the amount of care provided to a diverse population of patients with ESRD. Moreover, coordination with other highly specialized areas will reflect the triumph of the goal. In addition, funding will provide a standardized methodology that will simplify the research process.
Achievable. It is necessary to attract funding from the healthcare sector and third-party investors to accomplish the task. The research funding program will be a successful model for scaling up palliative care in the country. The actors on whom the policy change depends will encourage suppliers to make long-term investments in research activities.
Relevant. Funding is one of the top priorities and efforts in the palliative care policy environment. High-quality programs aimed at providing improved patient services increase trust in medicine. Attracting financial assistance allows medical professionals to quickly put the results of research in a given area into practice.
Time-Bound. The challenge requires two years of research in palliative care. During this time, a critical review is carried out, taking ethical and moral considerations into account. After a year of study, targeted funding for promising scientists in a given field increases.
Policy Development
The public health policy for palliative care was created by the World Health Organization, which has a critical role in the United Nations system as the governing and coordinating body for international health. Its broad mandate includes providing leadership on increasingly complex global health issues (Gruhler et al., 2018). Moreover, the organization is responsible for creating health guidance, norms, and standards, monitoring and evaluating health trends, and formulating research programs in the health sector.
There are significant risks in organizing palliative care; therefore, it is imperative to conduct a thorough review before implementing a policy in an institution. The process should commence with an assessment of service needs in the area’s population served by the IH (Gruhler et al., 2018). Subsequently, a person in charge should be identified and have necessary conversations with all staff members. Moreover, IH should acquire a universal, comprehensive PC to stop bias. In this regard, training is of great matter in the development of palliative care, especially the movement of all healthcare workers on issues relating to anesthetic maintenance. It is also necessary to review the support system for caregivers because nurses’ workload may interfere with the quality and quantity of services provided.
It is crucial to organize educational events and public relations to promote and publicize the policy. Periodic advertising, including media and newsletters simultaneously, will help promote the quality of services, which can influence consciousness and education (Gruhler et al., 2018). Moreover, community outreach, weekly information sessions, videos, and surveys of families of former patients are essential. Ultimately, the Internet should be the primary source for promoting services and educating consumers about the benefits of hospice care.
To maintain trusting relationships and be effective in providing quality palliative care, it is necessary to understand the specifics and characteristics of the target group. When working with relatives and families in general, the multidisciplinary nature of respect and the specialist’s personal willingness to be in contact must be considered (Gruhler et al., 2018). Frequently, specialists consider one of the aspects – either psychological or physiological. However, quality palliative care regards a comprehensive team approach to meeting the needs of terminally ill children and their families. To communicate the new workplace policy to employees, it is vital to hold a meeting and share the updates. The procedure is extensive, and additional training with confidential feedback from employees should be provided.
Strategic Plan (Phase 4)
Implementation
The first step in the implementation process is to create a sense of urgency for changes. To achieve a sustainable transformation, everyone involved must feel the transition speed and believe that the new policy is required. If workers do not support the initiative, it will be challenging to maintain momentum, and therefore any modifications may not last for an extended period (Gruhler et al., 2018). Thus, the goal of the first step is to prepare employees for future changes and encourage their participation. To accomplish this aim, it is crucial to identify the existing challenges and opportunities of the IH using a SWOT analysis. Therefore, a thorough dialogue with the staff will be provided to explain the necessity for changes.
Furthermore, building a team with the crucial mastery, credentials, reputation, relationships, and credibility is vital to lead change initiatives and impacting stakeholders. Third, the team will have leaders liable for the transformation initiative. Their commitment will be to supply executive-level assistance and sufficient aid to implement the policy. The fourth step is to utilize all available communication channels to ensure that the medical staff comprehends the need for the approach and its benefits to both the institution and the patients. Finally, there will frequently be obstacles to implementing organizational shifts, and it is essential to focus on removing them.
The implementation process is endurable; therefore, the early phase will focus on short-term goals. It will be accomplished primarily to measure and evaluate the effectiveness of care to improve the strategies. The next step is to maintain policy by ensuring that teams work hard to achieve the vision of change by tracking their progress (Gruhler et al., 2018). People must be advised to refrain from honoring remarkable victories after a few terminated goals. Finally, to preserve the momentum of policy proceedings, a determination will be completed. There is a need to maximize the benefits of swift plans, and then the work on large-scale changes can start.
The goal of transformation leaders is to create a new culture in which policy can be sustained. It includes adjusting organizational standards and values, processes, reward systems, and other infrastructure segments. Everything must be aligned with the new strategy in this step. Therefore, a discussion of the importance of the latest changes, emphasizing the benefits they provide, will be conducted. Identifying and adopting norms and values that promote modifications are necessary. Leaders should assume unique models and consequences when identifying and engaging new talents or promoting employees. It is also vital to create further training and development programs to help employees acquire the skills and competencies needed to adapt to recent changes (Gruhler et al., 2018). Finally, one should improve or eradicate organizational processes that do not accommodate the new culture.
Policy Evaluation Considerations
Setbacks
Disproportion is one of the setbacks in the availability of a full range of medical interventions in favor of predominantly medical and social care. Furthermore, the tendency for hospices to be located far from urban hospitals causes complexities, which guides to a lack of awareness. In addition, students and residents have infrequent opportunities to practice palliative care. Finally, the lack of teaching and residency programs causes hardships in comprehending the need for policy implementation.
Plan for Sustainability
The sustainability of palliative care policies can be performed through planning and funding. Efforts should ensure the continuity of resources and be reliable guarantors of the implementation and reality of the strategy. Moreover, the policy can be implemented in other institutions. Its features allow the methodology to be applied at homes, outpatient clinics, nursing departments, and general hospitals. Standardized clinical methods should be utilized to measure patients’ suffering symptoms and functional capacity routinely.
The implementation of the policy should lead to the gradual expansion and integration of palliative care into the healthcare system. Access to medications must be improved, and human resources must be strengthened. It is also expected that every patient will be able to receive four-pronged urgent care. Palliative care is an essential component of service delivery, and its significant implication is to improve outcomes for patients and their relatives and reduce healthcare costs.
Senior management must agree that palliative care is part of the role of all healthcare workers. There is a need to review the approach and consider it a routine rather than a specialized medical activity. It is also essential to re-evaluate capacity, drug control, and training approaches. Policies allow services to be provided at the proper time in a suitable place, supported by individuals with the relevant skills and appropriate resources to provide care. The focus should be shifted from tools and high-tech equipment to coherence.
Urgency for Policy Change
The vague language of the current Intermountain Healthcare (IH) description of primary care results in insufficient elaboration of specific nursing responsibilities such as quality of patient life, caregiver support, and non-discriminant patient treatment. A comprehensive primary care policy has not been adopted in the IH facilities, leaving care teams to devise an individual approach to each terminal patient, which may be inefficient and result in subpar service. Across the country, many HCPs lack knowledge and skills in pain and symptom management, communication, and care coordination. At the same time, the public has only a vague understanding of the benefits of primary care and how to access it (Meier et al., 2017). Given a wide range of responsibilities in providing palliative care (PC) and lack of specific instructions, IH healthcare providers (HCPs) filling only immediate orders such as medical prescriptions may coincidentally neglect some care aspects. Therefore, an instructive primary care policy is needed to facilitate successful administration and ensure equitable access to care services in the IH facilities.
Policy Change Advocacies
Several issues affect the development of detailed palliative care policies. The rise in negligence cases and lack of supporting infrastructure has primarily been attributed to a lack of change advocates. In response to these challenges, IH developed a hospital-based electronic palliative care algorithm to improve the identification of patients benefitting from PC services and calculate PC penetration rates (Gruhler et al., 2018). The algorithm indicated that the need for receiving PC might be as high as 26.4% of the total IH inpatient population (Gruhler et al., 2018). It will be progressively more challenging for HCPs to devise individualized care plans for IH patients with as high and potentially increasing numbers. Therefore, an approach with great universal applicability is needed to meet this demand.
Palliative care also lacks focus on all the essential service requirements. Facilities must adopt policies that address all issues regarding restructuring services. Palmryd et al. (2021) revealed that nurses caring for intensive care unit patients did not prioritize integrity, arguing that more explicit guidelines are required to facilitate the issue. This issue may be applicable to the IH facilities, given that extant IH guidance on PC does not identify the expectations and responsibilities of each party. Consequently, developing productive communication resulting in comprehensive care is crucial to meeting the facility’s needs.
Moreover, having a universal, comprehensive PC is critical as it opens a leeway for bias. For example, a striking finding by Martinsson et al. (2018) revealed that patients’ quality of end-of-life care might depend on the disease the patient suffers. Similarly, Spraker-Perlman et al. (2019) found that IH patients without known critical conditions (CC) benefit significantly from PC support before their death just as much as patients without CC. Therefore, a non-discriminant approach in palliative care is a significant attribute that nursing and caregivers must implement through policy change.
Lastly, the protection of every nurse is crucial to caregiving, hence requiring supportive staff and protective gear, and infrastructure. The COVID-19 pandemic demonstrated that the lack of resources and nursing burnout contribute to PC’s increased scarcity of care (Human Rights Watch, 2021). In its Annual Report (2020a), IH recognized that its caregivers focused on creating personal protective equipment (PPE) assembly lines. Their regular duties saw a significant decrease in hours because of the pandemic. This situation mandates ensuring that nurses can meet the care requirements. Hence, the policy to improve patient care should involve reconsidering the carer support system, as nurses’ workload can interfere with the quality and quantity of services provided.
The Vision for Policy Change
A successful policy change requires detailed attention to palliative success contributing factors, strategic goals, and budget plans. Focusing on these PC needs helps nurses ensure effective responsibility distribution and accountability standards non-compliance. The change must provide an appropriate level of detail in each aspect and implement enforcement mechanisms to avoid regular duties suffering due to negligence. Moreover, the change should result in a well-balanced staff to ensure no nurse experiences burnout because of working long hours.
Barriers to Effective Policy Change
Identifying barriers to change early is crucial to understanding ways to implement the proposed policies. The most common change distractors include nurses’ diverse demographics, morbidity and mortality rates, conflicting policies, and cultural differences. The COVID-19 pandemic highlighted that curative care is currently at the core of provider-patient interaction over any PC aspect. According to Intermountain Healthcare (2020a), hundreds of IH staff members volunteered to help in New York hospitals during acute results of the virus. The pandemic may have subsided, but IH facilities staff must have understood their core duties and where they must focus. Therefore, policy changes can mainly affect nursing staff needing explicit guidance on responsibilities and expectations. Further, the inpatient population of the IH facilities will be experiencing the consequences of the changed PC routine, which may initially affect caregiving services.
In addition, mortality rates in IH can affect the morale of caregivers, hence the need to address PC issues. Gruhler et al. (2018) estimate that 90 million Americans live with severe, life-threatening illnesses, and the figure will double within 25 years. There is strong evidence of PC reducing acute unplanned hospitalizations and specialized PC services associated with improved short- and long-term care outcomes (Sleeman et al., 2021). Therefore, improving the policy approach to specialist palliative care would improve overall patient comfort, especially at the end of their lives.
The poorly recognized role of end-of-life care in current policy contributes to unequal access to care. Although PC is increasingly recognized as a human right, the lack of guidelines’ support and research prevents many from utilizing it (Sleeman et al., 2021). Specifically, there are two downsides resulting from IH policy reliance on individual POCs to facilitate end-of-life and palliative care. First, individualized POCs mean no universal standard of conduct is established; coupled with a potentially limited level of patient understanding of the services they may require, this could result in underperformance. Second, Intermountain Healthcare’s (2022) policy states that the hospice program and the patient’s physician must approve any proposed POC tests, procedures, and services, adding that “generally, treatments necessary for symptom or pain management” are supported. Therefore, services beyond the necessary symptom management may not be approved.
The proposed change in policy would provide an all-encompassing transformation of the extant system. If any of the PC aspects in IH are currently dependent on creating individualized POCs, these aspects will be thoroughly regulated in the future system. For the IH care teams that are used to working closely with each patient, such a system may initially seem overly prescriptive. Additionally, the cultural background may influence patients’ decision-making regarding pain and PC, making it vital to consider the patient’s beliefs regarding care and death before forming an all-encompassing instructive guidance of staff conduct.
Appreciating Short-term Wins from the Policy Change
The success of any policy starts with the stakeholders of a given facility, and the influence spreads to all the parties involved in the nursing fraternity, including patients. America has seen tremendous growth in palliative care in the 21st century, indicating the national readiness for policy change and implementation. The IH facilities are receptive to innovative missions and have supported designing other healthcare policies, such as Primary Promise’s plan to build a children’s national model health system (Intermountain Healthcare, 2020a). In addition, providers and policymakers have begun recognizing the potential benefits of PC for patients with severe illness at any stage (May et al., 2021). The primary stakeholders are HCPs and terminally ill patients in IH facilities, both groups being receptive to potential policy changes.
Improving the Policy
The success of policy change relies heavily on the time and money invested in ensuring every proposition of the guidelines is achieved. Policy implementation outcomes are visibly reduced costs and quality care. According to Sleeman et al. (2021) and May et al. (2021), evidence supports the efficacy and cost-effectiveness of specialized PC. Sleeman et al. (2021) further reiterate that patients who receive early technical PC show improvements in various outcomes, including physical symptom control, survival, and quality of life, and caregivers report increased satisfaction and decreased depression. Moreover, appropriate and timely provision of PC likely lowers overall healthcare expenses (May et al., 2021). Therefore, the costs of keeping current HCPs and effectively helping patients in IH facilities may be reduced by implementing a new policy. The purpose of end-of-life care is for comfort, and not providing a PC to them can increase their discomfort when we should be keeping them as comfortable as possible in their last hours or days.
Full Policy Change Adoption
Adopting new approaches to care practices may first prove challenging due to the barriers to policy change. On the contrary, the success of any policy change starts with the internal leaders and employees, and then the clients adopt these changes. According to May et al. (2021), various stakeholders have begun recognizing the potential benefits of PC for patients with severe illness at any stage. This reveals the need for continued efforts to ensure nurses understand and adopt these policies as part of the organizational culture and teach them to the patients. This top-down approach to policy change adoption can help IH develop its culture aligning with the facility’s principles and commitment to caregiving.
Conclusion
The current Intermountain Healthcare (IH) plays a vital role in elaborating the responsibilities of nurses, like non-discriminant patient treatment. It also facilitates evidence-based medicine and treatment that has proven effective in providing the proper care. Rather than filling immediate orders like medical prescriptions, IH has been missing some key aspects, thus calling for primary care policy to facilitate successful administration and ensure equitable access to care services in the IH facilities. Palliative care in IH facilities is evident to pursue several goals such as quality of patient life, symptom relief, family and caregiving support, and a team approach to care and alignment with patient’s aspirations. IH has supported the initiative of detailed palliative care policies by developing a hospital-based palliative care logarithm to improve the identification of patients benefiting from PC services and calculate PC penetration rates. The frequent increase in patients has led to difficulties for HCPs in dealing with individualized care plans for IH patients.
Integrity is also not prioritized by nurses because explicit guidelines are required to ease this issue. The lack of universal comprehensive also forms an excellent room for biasness. This is because IH patients with critical conditions benefit significantly from PC support before their death just as much as those that are not in critical condition. Scarcity of care results from insufficient funds and nurses’ burnout. IH has recognized its caregivers to focus on Personal Protective Equipment (PPE), enabling nurses to meet the care requirements, resulting in improved patient care.
Poorly recognized the end of life care is currently contributing to unequal access to care. The lack of guidelines’ support prevents many from utilizing it even though PC recognizes human rights increasingly. Two downsides are individualized POCs and approval of POC tests, procedures, and services have resulted in IH policy reliance on the individual POCs to facilitate the end of life and palliative care. The proposed policy provides an all-encompassing transformation of the extant system. America has also gone the extra mile and boosted tremendous growth in palliative care in the 21st century, thus indicating the nation’s readiness for policy change and implementation.
Palliative care is part of the ICU, thus improving the quality of life for patients with life-threatening conditions and their families. It relieves suffering by identifying, assessing, and treating pain and other physical, psychological, and spiritual problems. This results from the provision of better symptom management by IH. On the other hand, palliative care is also linked with some weaknesses such as lack of quailed personnel, shifting the focus to intensive care, and other patients also receive less attention from the staff since most of the attention is focused on intensive care patients, this brings about inequality among patients. This calls for the implementation of strategic plans geared toward achieving sustainable transformation, making everyone feel the transition speed and believe in the need for the new policy. Adopting these new practices may at first feel wearied due to specific barriers. All of these reveal the need for efforts to ensure that nurses understand and adapt to these policies as part of the organizational culture and teach them to their patients.
References
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Eligibility and coverage: End-of-life care. (2022). Intermountain Healthcare. Web.
Gruhler, H., Krutka, A., Luetke-Stahlman, H., & Gardner, E. (2018). Determining palliative care penetration rates in the acute care setting. Journal of Pain and Symptom Management, 55(2), 226–235. Web.
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Appendix
The public health policy for palliative care is one of the most comprehensive and multidisciplinary approaches developed to improve patients’ lives. This policy aims to deter and alleviate suffering through early detection, proper examination, and curing of pain and other concerns. The approach promotes dignity, quality of life, and adjustment to progressive disease by employing the most satisfactory possible evidence. It represents comprehensive physical, psychological, and spiritual care for the patient and support for the family. The policy includes a few significant steps to guarantee the result. It starts from the point the disease is diagnosed and continues regardless of whether or not the patient receives treatment for the disease itself.
The basis for palliative care strategy is the speed and necessity of getting rid of pain and other suffering symptoms. Furthermore, it is not limited by these aims and includes measures to improve the quality of life and even thoroughly influence the course of the disease. A vital policy condition is that all individuals, regardless of earnings, illness, or age, should access a nationally established set of essential health assistance, including palliative care. In addition, medications must be available to all who need them. Such lists include opioid and non-opioid pain medications and medicines used to manage the most common symptoms in palliative care.
The leading methods of the policy are divided into several categories: physical care, psychological, emotional, and spiritual maintenance, care planning, coordination, and communication. It operates brief screening methods tested in rich and developing countries. Moreover, the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Indicators (POS) are essential policy elements. Treatment should focus on symptoms that reduce patients’ quality of life. Otherwise, the side effects of the intervention may cause harm rather than the pathological condition itself. A multidisciplinary team qualified in palliative care, including physicians, nurses, community health workers, and volunteers, must be involved to implement the policy.
