Skip to main content

Military Health System

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 & the MHS Response

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...

Teamwork, adaptability, service – MTFs shine during COVID-19 pandemic

Article
5/14/2021
People at screening area

MHS readiness was put to the test at the onset of the COVID-19 pandemic, in early 2020.

Recommended Content:

Mental Health: Seeking Care with TRICARE | May | Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

Join Us!! Sixth Live COVID-19 Town Hall

Article
5/12/2021
Image describing today's Town Hall with Dr. Paul Scott and COL Clinton K. Murray, MD.  They are with the Walter Reed Army Institute of Research, and will discuss COVID-19 Vaccine Advancement and Trials.

Join us for today's Town Hall with Dr. Paul Scott and COL Clinton K. Murray, MD. They are with the Walter Reed Army Institute of Research, and will discuss COVID-19 Vaccine Advancement and Trials.

Recommended Content:

Coronavirus & the MHS Response | COVID-19 Vaccine Efforts | Coronavirus and the COVID-19 Vaccine

Navy nurse steps into Jacksonville community for COVID-19 vaccinations

Article
5/7/2021
Military health personnel wearing face mask discussing the COVID-19 vaccine program

Navy Cmdr. Glenn “Pete” Bradford is aiding the underserved Jacksonville community in COVID-19 vaccination mission

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts

DHA, HA leaders discuss MHS Transformation at AHA panel

Article
5/6/2021
Military personnel talking at a podium

Army Lt. Gen. (Dr.) Ronald Place and Dr. Terry Adirim discussed MHS Transformation, MHS GENESIS, and highlighted the DHA’s response to COVID-19 in a virtual roundtable hosted April 12 by the American Hospital Association.

Recommended Content:

MHS GENESIS: The Electronic Health Record | Military Health System Transformation | Coronavirus & the MHS Response | Coronavirus and the COVID-19 Vaccine | Readiness Capabilities

Nurse and Tech Week: Air Force airmen are battle-tested and ready

Article
5/6/2021
12 COVID-19 patients aboard a C-17 Globemaster III aircraft

For the past year, Air Force nurses and medical technicians have found themselves on the front lines in the battle against the COVID-19 disease.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Health Care Technology | Nursing in the Military Health System | Mental Health: Seeking Care with TRICARE | Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response

EACH celebrates National Nurses Week with a reflection on the pandemic

Article
5/6/2021
Military health personnel inputting information into a computer

Evans Army Community Hospital celebrates National Nurses Week 2021.

Recommended Content:

Nursing in the Military Health System | Coronavirus & the MHS Response | Coronavirus and the COVID-19 Vaccine | Coronavirus and the COVID-19 Vaccine

Janssen COVID-19 vaccine returns to Military Health System

Article
5/4/2021
Military personnel wearing a face mask and a face shield administering the COVID-19 vaccine

Doses of the Janssen COVID-19 vaccine became available April 29 to those in the Military Health System eligible and authorized to receive COVID-19 vaccinations.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts

U.S. continues sending medical supplies to India for COVID-19 fight

Article
5/3/2021
A picture of a C-5M Super Galaxy

DOD provides medical aid to India in the fight against the COVID-19 global pandemic.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts

U.S. Army Medical Team Administers COVID-19 Vaccines in Guam

Article
4/29/2021
Military health personnel wearing a face mask administering the COVID-19 vaccine

Army medical professionals assist in administering COVID-19 vaccine doses to local Guamanians.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts | Readiness Capabilities

Military kids are resilient, but far from immune to pandemic effects

Article
4/28/2021
Military personnel wearing face mask holding up posters for Month of the Military Child

Military children are known for being resilient to constant change, but COVID-19 has affected their mental health, too.

Recommended Content:

Month of the Military Child - Celebrating Military Kids | Children's Health | Coronavirus and the COVID-19 Vaccine | Staying Resilient | Coronavirus & the MHS Response

Join Us!! Fourth COVID-19 Townhall Update with Lt. Col. Matthew T. Swingholm!

Article
4/27/2021
Fourth MHS Town Hall announcement with image of Lt. Col. Matthew T. Swingholm, discussing the Critical Need for Blood Donations, Wednesday, April 28 at 2 p.m. ET

Join us for the MHS' Fourth COVID-19 Townhall Update with Lt. Col. Matthew T. Swingholm

Recommended Content:

Armed Services Blood Program | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts | Coronavirus and the COVID-19 Vaccine

COVID-19 remote patient monitoring pilot marks initial successes

Article
4/27/2021
Photo of Army Maj. Daniel Yourk

Virtual health and other digital health technologies are an essential part of care delivery going forward for all patients, and especially the most vulnerable.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus and the COVID-19 Vaccine | Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts

DHA’s immunization health care specialists support vaccine rollout

Article
4/26/2021
Image of military personnel getting COVID-19 vaccines ready. Click to open a larger version of the image.

The Defense Health Agency’s Immunization Health Care Division specialists were instrumental in rolling out the COVID-19 vaccines to Department of Defense military medical treatment facilities around the world.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts | Coronavirus and the COVID-19 Vaccine

From coast to coast, Navy personnel helping stop COVID-19 spread

Article
4/26/2021
Military personnel wearing face mask getting people ready for the COVID-19 vaccine

From coast to coast, Navy Medicine personnel are helping to stop the spread of COVID-19.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts | Coronavirus and the COVID-19 Vaccine

DHA Appointing Portal simplifies signing up for COVID-19 vaccination

Article
4/23/2021
Image of military health personnel wearing a face mask scheduling COVID-19 vaccine shots. Click to open a larger version of the image.

A new online and easy-to-use COVID-19 vaccine appointment portal is rolling out around the world at Military Treatment Facilities. It needs some tweaking on the admin end, users say.

Recommended Content:

Coronavirus and the COVID-19 Vaccine | Coronavirus and the COVID-19 Vaccine | Coronavirus & the MHS Response | COVID-19 Vaccine Efforts
<< < ... 6 7 8 9 10  ... > >> 
Showing results 76 - 90 Page 6 of 14
Refine your search
Last Updated: January 17, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery