Back to Top Skip to main content Skip to sub-navigation

Palliative care provides comfort to COVID-19 patients, families

Image of Military health personnel taking care of a patient. Air Force 2nd Lt. Aundrea Temple, assigned to the 60th Medical Group, 60th Air Mobility Wing, Travis Air Force Base, Calif., cares for a patient at Dameron Hospital, California (Photo by: Army National Guard photo illustration by Staff Sgt. Eddie Siguenza).

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus

When COVID-19 was spreading across Italy in February 2020, all eyes at David Grant U.S. Air Force Medical Center at Travis Air Force Base, California were fixated on the unfolding pandemic, realizing their hospital may potentially be one of the first to be impacted.

Air Force Lt. Col. Laurie Migliore, acting director, Clinical Investigation Facility and director of Biobehavioral Research, along with essential medical personnel were charged with reviewing Grant's Crisis Standards of Care, particularly the availability of palliative care for potential COVID-19 patients.

Migliore said it became evident from seeing the death rates in Italy that DGMC may be impacted with unprecedented numbers of critically ill and potentially dying patients. They had to be ready to provide both medical and palliative care.

"Our goal was to develop a point of care tool that was targeted, practical and easy to use by frontline medical providers," said Migliore, who is also a registered nurse. "As the pandemic began to spread throughout the country, the volume of information evolved from scarce to the point of overwhelming."

Migliore developed a toolkit to provide guidance and information to medical personnel in four areas:

  • Basic understanding of palliative care and palliative care principles
  • Communication strategies and resources (getting on the same page, scripts)
  • Symptom management (alleviating pain, breathlessness, anxiety, etc.)
  • Support for caregivers (dealing with blame, guilt, anger, grief, death/dying)

Palliative care is specialty medical care for individuals with serious illnesses and is often provided by specially-trained teams of doctors, nurses, social workers, chaplains, and therapists.

Air Force Reserve Col. Stephen Hernandez, who was activated and deployed to New York City in April 2020, supported FEMA-led operations in New York. During his deployment, he served as the deputy team lead at Lincoln Medical Center in the Bronx, New York. He became a wealth of knowledge for Migliore with direct exposure to COVID-19 patients and their palliative needs.

During Hernandez's six weeks at the medical center, palliative care for COVID-19 patients was almost non-existent. He stated if the frontline medical staff had access to something similar to the toolkit the Grant team is developing, they could have focused more on providing palliative care rather than only life-prolonging care.

"Palliative care is important during a pandemic to optimize patient and family quality of life and to mitigate suffering among people with a serious illness," said Hernandez, who served as the chief nurse for more than 60 other reservists providing care at Lincoln. "It also has the potential to maximize and conserve limited resources to focus on seriously ill patients who have a higher likelihood of recovery."

Based on the evolving pandemic and feedback from Hernandez, Migliore and the staff supporting the project began a PICO (Population, Intervention, Comparison, Outcome and Time) analysis, literature review and toolkit development.

Military health personnel providing curbside COVID-19 testing
Air Force Maj. Alisha Florence and Senior Airman Rachael Tuczynski, nurses assigned to the 60th Medical Group, 60th Air Mobility Wing, Travis Air Force Base, California, gather information and perform preliminary patient checks outside of Adventist Health Lodi Memorial hospital in Lodi, California, July 29, 2020. The medical team, in support of Task Force 46, Joint Force Land Component Command, U.S. Army North, helped initiate curbside checks as a way to expedite care for growing COVID-19 cases in this San Joaquin County facility (Photo by: Army National Guard Staff Sgt. Eddie Siguenza).

They also submitted a grant proposal to purchase tablets and other technology required to provide communication between patients and their families.

Migliore said that the PICO analysis and literature review identified three primary needs by staff and patients during the pandemic.

  • Critical need for frontline/primary care staff to receive rapid palliative care training
  • Access to existing palliative care specialists as consultants and subject matter experts
  • Need for regular palliative education and training

About a year after the project began, the toolkit is now available, empowering frontline medical staff and bridging the gap in palliative care.

"The toolkit focuses on palliative care, communication, symptom management, and support of caregivers," said Migliore, who was personally affected during the pandemic and benefited from information the toolkit provided to the staff, taking care of her husband and using the means of communication the tablets provided. Her husband was admitted to Grant's ICU with cardiac issues during the pandemic.

"When I brought him to the emergency room I wasn't prepared for him to be admitted, I thought that he would get some medications, stabilize, and return home," she said.

Instead, he was admitted from the emergency room to the intensive care unit and the only means for them to communicate was through the tablets provided by the pilot program.

"The nurse taking care of my husband learned that I was one of the team leads for the project," Migliore added. "She told me how grateful the staff was for the tablets and how helpful they were for patients and staff during the visitor restrictions."

The toolkit is now available to all DHA medical professionals on the organization's internal website.

According to Migliore, the pilot is concluding soon and the results and lessons learned will be published and made available to military hospitals and clinics, incorporating the COVID-19 Palliative Care Toolkit into inpatient practices.

"We worked out some significant challenges despite constantly deploying staff and issues with inpatient internet capability," she said. "We incorporated feedback from the field to refine the contents for a simple yet relevant and practical resource."

The short-term goal of the pilot was to provide immediate palliative care resources to medical staff based on evidence and vetted by palliative care subject-matter experts for immediate use during the pandemic. The long-range objective is to develop centralized, standardized resources for palliative care use throughout the Military Health System.

"The enterprise would benefit from standard order sets, protocols, and simulation training for staff/patient communication for goals of care during high-stress crisis situations," Migliore said. "Ultimately, the impact (of palliative care) is improved quality of life, decreased suffering, and satisfied patients and families."

You also may be interested in...

Future of Nursing: Telehealth, More Innovation and Maybe Some Robots

Article
5/13/2022
Second Lt. Nina Hoskins, 81st Surgical Operations Squadron operating room nurse, briefs Col. Debra Lovette, 81st Training Wing commander, and other base leadership on robotics surgery capabilities inside the robotics surgery clinic at the Keesler Medical Center June 16, 2017. (Photo: Kemberly Groue, U.S. Air Force)

The future of nursing is here due in part to changes brought by the COVID-19 pandemic.

Recommended Content:

Nursing in the Military Health System | Coronavirus

‘I Love the Intensity’ – One Nurse Recalls Three COVID-19 Deployments

Article
5/5/2022
In 2020, Air Force 1st Lt. Tiffany Parra, an ICU nurse at the 633rd Medical Group, on Joint Base Langley-Eustis, Virginia, was deployed to a North Dakota hospital to support a FEMA COVID-19 mission. In the photo, she trains on equipment used for critical patients in a North Dakota ICU. (Photo: Courtesy of Air Force 1st Lt. Tiffany Parra)

Nurses are unique, they follow a calling to care for others. Military nurses do that as well as serve their nation. For Nurses Week, the MHS highlights some of their own.

Recommended Content:

Nurses Week Toolkit: United In Service, Rooted in Strength | Nursing in the Military Health System | Coronavirus

How One Military Nurse Persevered Through the COVID-19 Response

Article
5/5/2022
Air Force Capt. Courtney Ebeling, a medical-surgical nurse at Joint Base San Antonio-Randolph Family Health Clinic, Texas, was deployed to support the COVID-19 response in Afghanistan in 2021. They administered vaccinations to U.S. citizens, service members, and foreign military members as well as supported the preparation to withdraw from the country. (Photo: Courtesy of Air Force Capt. Courtney Ebeling)

Nurses across the Military Health System have played a vital role in providing routine patient care and meeting the needs of the COVID-19 pandemic.

Recommended Content:

Nurses Week Toolkit: United In Service, Rooted in Strength | Coronavirus | Nursing in the Military Health System

Pandemic Spotlights the Vital Role of Military Lab Workers

Article
5/2/2022
U.S. Air Force Staff Sgt. Ashley Solomon, 18th Medical Support Squadron NCO in charge of microbiology, unloads blood samples from a centrifuge at Kadena Air Base, Japan, Jan. 31, 2019. (Photo: Tech. Sgt. Matthew B. Fredericks, U.S. Air Force)

MHS clinical labs produce results.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus

Helping Your Child to Cope with Grief and Losses Related to COVID-19

Article
4/28/2022
Shirley Lanham Elementary School students perform Taiko drumming during a Month of the Military Child celebration aboard the Naval Air Facility Atsugi, Japan, April 6, 2022. (Photo: Petty Officer 2nd Class Ange-Olivier Clement, Naval Air Facility Atsugi)

Many military children have lost loved ones to COVID-19. How parents can help with the grief.

Recommended Content:

Month of the Military Child - Celebrating Military Kids | Children's Health | Psychological Fitness | Coronavirus and the COVID-19 Vaccine | Coronavirus

How to Help Military Children Reconnect After Two Years of the Pandemic

Article
4/25/2022
Airman 1st Class Rocio Romo, Space Launch Delta 30 public affairs specialist, and her son pose for a photo at Cocheo Park on Vandenberg Space Force Base, California, March 25, 2022. During the month of April, we celebrate Month of the Military Child to highlight the sacrifices military children make on the home front while their parents serve the United States. (Photo: Airman Kadielle Shaw, Space Launch Delta 30 Public Affairs)

How parents can help children stressed by more than two years of COVID-19.

Recommended Content:

Month of the Military Child - Celebrating Military Kids | Children's Health | Psychological Fitness | Coronavirus and the COVID-19 Vaccine | Coronavirus

COVID-19 Booster Effectiveness Remained High During Omicron Surge

Article
4/18/2022
Hospital Corpsman 1st Class Mary Ashcraft, assigned to the combat ship USS Tulsa, administers a COVID-19 vaccine booster to Aviation Machinist Mate 1st Class Anthony Johnson Jan. 10, 2022, at Apra Harbor, Guam. (Photo: Mass Communication Specialist Petty Officer 1st Class Devin M. Langer, Command Destroyer Squadron 7)

Two new studies of active-duty service members show COVID-19 booster vaccines are effective, but uptake rates in the military community lagged behind the civilian population.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus | COVID-19 Vaccine Efforts

8 Tips to Help Kids Adjust to Change during the New Pandemic Phase

Article
4/15/2022
A parent comforts his child while she receives a pediatric dose of the COVID-19 vaccine at Kadena Air Base, Japan, Jan. 28, 2022. (Photo: Airman 1st Class Anna Nolte, 18th Wing Public Affairs)

Parents should prepare their kids for the new normal of the ongoing pandemic, recognizing that the status of the disease can change quickly as new variants of COVID-19 emerge.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus | Children's Health

Military Medical Officials Back FY 23 Budget Before Senate Appropriations Committee

Article
4/6/2022
Marines with Marine Wing Headquarters Squadron, 3rd Marine Aircraft Wing take precautionary measures by cleaning and disinfecting their hands during field day on Marine Corps Air Station Miramar, Calif., March 20, 2020, to mitigate the spread of COVID-19 while continuing to perform mission-essential tasks. (Photo: Marine Corps Lance Cpl. Jaime Reyes)

Military Medical officials, including Army Lt. Gen. (Dr.) Ronald J. Place, Defense Health Agency director, back FY 23 Budget before the Senate Appropriations Committee, March 29, 2022.

Recommended Content:

Public Health | Coronavirus

How COVID-19 Made the Military Medical Community Stronger

Article
3/21/2022
Image of a service member being treated

Lessons learned from the COVID-19 pandemic has made the military medical community stronger and will help when confronting the next crisis, whether that’s another pandemic, a new conflict or natural disaster

Recommended Content:

Combat Support | Coronavirus and the COVID-19 Vaccine | Coronavirus

COVID-19 Responses Underscore Importance of Patient Safety

Article
3/14/2022
Every day, patient safety is one of the top priorities for the Defense Health Agency. Patient safety means providing ready, reliable care to service members, veterans, and dependents no matter the circumstances. (Photo: Defense Health Agency)

Patient safety is a topmost concern of MHS, and Patient Safety Awareness Week 2022 focuses on Ready, Reliable Care.

Recommended Content:

Patient Safety | Patient Safety Awareness Week | Coronavirus and the COVID-19 Vaccine | Coronavirus | Patient Safety Awareness Week

Defense Department Announces Distribution of COVID-19 Tests for Military Beneficiaries

Article
2/25/2022
A Soldier assigned to the Connecticut National Guard helps load a shipment of at-home COVID-19 testing kits into a truck at a regional distribution point in North Haven, Connecticut, Jan. 3, 2022. These kits were picked up by representatives from local towns and municipalities to be handed out to their communities.

The Department of Defense will offer at-home COVID-19 tests for military beneficiaries at military hospitals or clinics, on a supply available basis, in the coming weeks.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | At-Home COVID-19 Tests | Coronavirus

Answering Your Questions About COVID-19 Testing

Article
2/25/2022
Military personnel performing a COVID-19 Test

COVID-19 continues to spread, now as the Omicron variant. Getting vaccinated is the most effective way to protect you and your family from getting seriously ill, getting hospitalized, or dying. You should also make sure you’re up to date with your vaccines. Testing is another important step you can take to protect yourself and others.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus | At-Home COVID-19 Tests

Military Medical Units Support Civilian Hospitals Strained By COVID-19 Surge

Article
2/14/2022
Air Force Staff Sgt. Bradley Gorman, a medical technician assigned to a military medical team deployed to Yuma, Arizona performs a nasal swab at the Yuma Regional Medical Center’s COVID testing drive-thru in Yuma, Jan. 17, 2022.

Thousands of service members have been supporting civilian hospitals with testing, vaccinations and treatment of seriously ill patients.

Recommended Content:

Coronavirus

Do You Have COVID-19? Influenza? Or is it RSV? Here’s What to Look For

Article
1/24/2022
Military personnel preparing a COVID-19 test sample for processing

Knowing the symptoms of COVID-19/RSV/Flu will help your medical treatment

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Seasonal Influenza Vaccine Toolkit | Coronavirus
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 21
Refine your search
Last Updated: May 17, 2021

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.