The Power of Collaborative Research
We identified 39 sources, grouped into three categories: education, certification, and workforce. Palliative nursing education was not formally integrated into U.S. nursing curricula until 2021 with the American Association of Colleges of Nursing publication of The Essentials, and only 12 healthcare organizations offer specialty nurse residency or fellowship programs. The National Board for Certification of Hospice Nurses was established in 1992 in the U.S. and awarded the first certification to registered nurses in 1994; in 2025 nearly 12,000 nurses are certified. Workforce data remain limited due to the diversity of nursing roles in hospice and palliative care. No comprehensive estimate exists for the broader palliative nursing workforce; however, a 2024 national survey estimated 56,619 registered nurses working in hospice.
In this article, we outlined empirically grounded and practical steps investigators can follow to inform the preimplementation phase of research and quality improvement projects in nursing homes and other complex care environments. Using a deliberate approach to identify an implementation science framework, investigate enablers and barriers, and integrate implementation strategies has the potential to support data-informed decision-making for research teams moving to the implementation phase.
We identified 6 overarching domains: (1) CNH staff interactions reflected comments related to staff demeanor, communication, and attentiveness; (2) VA's role in CNH-based hospice care encompassed themes related to available options for hospice care, CNH screening and oversight, VA involvement, and benefits; (3) hospice care delivery and coordination included comments related to hospice team communication and care delivery, as well as coordination of care with the CNH; (4) CNH resources focused on CNH staffing levels, environmental conditions, and available services; (5) attention to personal care needs by CNH staff included themes related to food and hydration, skin care, and toileting; and (6) symptom management focused on how pain and other symptoms were managed by staff.
Research is necessary to generate evidence to influence change in health care. However, research alone is insufficient to drive change. The Betty Irene Moore Fellowship for Nurse Leaders and Innovators prepares nurses to translate research into change-inducing equitable practices, policies, and sustainable products. This paper illustrates how several Moore fellows are applying their research and findings to develop actionable guidance, best practices, and innovative skills that nurses in all settings can adopt. The first exemplar highlights impactful policy work to promote health and safety of a marginalized population. The second example focuses on barriers and facilitators of research-to-practice translation among people living with serious illnesses. The third example recognizes nurses’ role in translating research innovations into commercialized products and/or sustainable businesses. The findings and exemplars presented in this paper inform a call to action that underscores the critical role of nurses in translating research into practice, policies, and sustainable products.
Clinical champions are often engaged to implement new evidence-based practices in health care settings. Previous research suggests that the mere presence of a champion does not guarantee successful implementation; therefore, we aimed to identify specific champion attributes and site-level factors that contribute to evidence-based practice adoption. During a Department of Veterans Affairs (VA) quality improvement program, we engaged site champions to implement an advance care planning evidence-based practice with seriously ill Veterans in VA home based primary care (HBPC) and community nursing homes (CNHs).
The core category that emerged was support for navigating uncertainty and complexity in serious illness within the context of NHs. NH staff engaged in a set of interrelated strategies to manage the core category by using PC consultation. They used PC consultation for (1) managing expectations, (2) sensemaking, (3) strategic reframing of end-of-life, and (4) addressing symptoms and preventing crises. These strategies enabled the residents, family, and NH staff to obtain comfort and ease in navigating uncertainty and complexity in serious illness.