Dorothy J. Wholihan

Faculty

Dorothy J Wholihan headshot

Dorothy J. Wholihan

ACHPN AGACNP-BC DNP GNP-BC

Clinical Professor
Program Director, Advanced Practice Palliative Care Specialty Sequence

1 212 992 9429

433 First Ave
New York, NY 10010
United States

Dorothy J. Wholihan's additional information

Dorothy J. Wholihan, ACHPN, AGACNP-BC, GNP-BC, DNP, is the director of the Advanced Practice Palliative Care Specialty Sequence Program and a clinical associate professor at NYU Rory Meyers College of Nursing. She is a palliative care nurse practitioner with over 30 years of nursing experience. She has practiced as an oncology and pain management clinical nurse specialist and is actively practicing as a nurse practitioner in palliative care. Her practice and research interests include spiritual aspects of care, teaching communication skills, and the care of veterans at end of life.

Wholihan received her DNP from George Washington University, MSN from Yale University, and BSN from the University of Pennsylvania. She also holds a Post-Master's Certificate from Christian Specialty, General Theological Seminary, and a Post-Master's Certificate ANP from Uniformed Services, University of the Health Sciences.

DNP - George Washington University (2011)
Post-Master's Certificate - Christian Specialty, General Theological Seminary (2008)
Post-Master's Certificate, ANP - Uniformed Services, University of the Health Sciences (1999)
MSN - Yale University (1989)
BSN - University of Pennsylvania (1983)

Palliative care

American Association of Nurse Practitioners
American Nurses Association
Hospice and Palliative Nursing Association
National Faculty Member, End of Life Nursing Education Consortium
Sigma Theta Tau

Faculty Honors Awards

Distinguished Teaching Award, NYU Meyers (2019)
Fellow, American Academy of Nursing
Fellow, Palliative Care Nursing

Publications

Curricular Quality Improvement in Midwifery: Simulating Unexpected Perinatal Loss

Altman, S. D., Tilley, C. P., Feldman, R., Brennan, M., & Wholihan, D. (2023). Journal of Midwifery and Women’s Health, 68(4), 523-530. 10.1111/jmwh.13498
Abstract
Abstract
Introduction: Caring for families experiencing perinatal loss is a fundamental component of midwifery practice, but little attention is paid to perinatal palliative care in midwifery curricula. Lack of educational preparation and self-care resources negatively impacts midwifery students and health care teams caring for families experiencing stillbirth. Process: A private, urban university conducted a curricular quality improvement project to integrate perinatal palliative care into the midwifery curriculum using a high-fidelity, branching simulation pedagogy. Simulation objectives were developed from curricular gap analyses and the Core Competencies for Basic Midwifery Practice. Development of the Unexpected Perinatal Loss Simulation was guided by the International Nursing Association for Clinical Simulation and Learning Outcomes and Objectives and Design Standards. The Unexpected Perinatal Loss Simulation was revised based on qualitative data from student focus groups and expert content validation. Outcomes: Qualitative data yielded 4 key domains: presimulation, simulation skills, prior experience/personal reflections, and recommendations. Simulation procedures and scenario content were revised, after which 8 expert clinicians in the fields of midwifery, palliative care, and psychiatry validated the scenario content using the Lynn method. Two items did not meet the content validity index (CVI) threshold of 0.78, necessitating review by stakeholders; however, the overall scenario CVI threshold was met (0.82). Discussion: Through this project, faculty integrated perinatal palliative care into the midwifery program using a novel approach of high-fidelity, branching simulation, structured debriefing, and an introductory self-care skills workshop. Potential clinical impact includes skillful perinatal palliative care with effective communication skills to mitigate how families experience and remember a traumatic loss and facilitate the grieving process. Students voiced insights into how they would process loss and seek support to mitigate their own grief as future midwives.

Impact of Co-occurring Cancer-Related and Wound-Specific Symptoms on Functional Performance Among Patients With Advanced Cancer and Malignant Fungating Wounds: An Exploratory, Observational Study

Tilley, C. P., Yu, G., Comfort, C., Li, Z., Axelrod, D., Colon-Cavallito, K., Wholihan, D., & Fu, M. R. (2023). Journal of Wound, Ostomy and Continence Nursing, 50(6), 451-457. 10.1097/WON.0000000000001017
Abstract
Abstract
PURPOSE: The purpose of this study was to examine the impact of co-occurring symptoms in patients with advanced cancer and malignant fungating wounds (MFWs) on palliative and functional performance, and the feasibility of collecting self-reported data in this population. DESIGN: This was an exploratory, observational study. Quantitative surveys and qualitative semistructured interviews using a phenomenological approach were employed. SUBJECTS AND SETTING: The sample comprised 5 adults with advanced breast, oral, and ovarian cancer and MFWs. Participants were recruited from an urban outpatient cancer center, hospice, and wound center located in the Northeastern United States. METHODS: Demographic and clinical characteristics were collected, and self-reported symptom and functional performance data measured. Descriptive statistics, T scores, confidence intervals, and standard deviation were calculated for quantitative data. One-to-one semistructured interviews were conducted by the first author to gain deeper understanding of participants' symptom experience. Qualitative data were analyzed using an iterative and inductive thematic data analysis method to identify major themes. RESULTS: The mean cancer-related and wound-specific symptom occurrence was 17 (SD = 5.56) and 4 (SD = 1.26), respectively. Distressing, extensive co-occurring symptom burdens were experienced by all participants; they also reported poor functional performance and diminished palliative performance. Qualitative findings supported quantitative results. CONCLUSIONS: Findings suggest that co-occurring cancer-related and wound-specific symptoms have incremental and negative impact on functional performance. The use of multiple data collection methods was feasible, including self-reported data in this advanced cancer population.

Outcomes of a National Training Curriculum to Advance Generalist Level Palliative Care

Ferrell, B. R., Paice, J. A., Coyne, P. J., Economou, D., Thaxton, C. A., Wholihan, D., Battista, V., & Haskamp, A. (2023). Journal of Palliative Medicine, 26(2), 228-234. 10.1089/jpm.2022.0262
Abstract
Abstract
Background: The adoption of palliative care as an integral component of health care has led to the need for generalist level providers, especially important in serious illnesses such as cancer. Objectives: The goals of this National Cancer Institute-funded training program were to (1) identify the eight domains of quality palliative care applied to oncology practice, (2) demonstrate skills for oncology advanced practice registered nurses (APRNs) in the domains of palliative care, and (3) develop goals for implementing the skills training in practice through process improvement, staff education, and clinical care. Design: The training program led by the End of Life Nursing Education Consortium (ELNEC) project included oncology APRNs in a three-day training course with one-year follow-up for ongoing support and to assess impact. Settings: Five training courses included 430 APRNs from 46 U.S states including both pediatric and adult oncology settings. The project included 25% minority participants. Measurement: Measures included participant goal implementation, course evaluations, and surveys to assess implementation and palliative care practices (precourse, 6 and 12 months postcourse). Results: The ELNEC oncology APRN training course resulted in changes in practice across domains, improved perceived effectiveness in clinical practice, and valuable insight regarding the challenges in generalist level palliative care implementation. Conclusion: The ELNEC oncology APRN course serves as a model for the palliative care field to advance generalist level practice. Future training efforts can build on this project to reach more oncology professionals and those in other areas of serious illness care.

Decision making in frail patients at risk of postoperative delirium: A case study and literature review

English-Cremeans, M. K., Wholihan, D. J., Olson, E., Zhu, C., & Ko, F. C. (2022). Geriatric Nursing, 48, 356-359. 10.1016/j.gerinurse.2022.05.009
Abstract
Abstract
Preoperative frailty is strongly associated with risks of postoperative delirium. However, gaps exist in targeted recommendations for clinical decision making related to surgical interventions in frail older patients. A case study is presented involving a frail 74-year-old referred to the palliative care team for assistance with clinical decision making and in weighing risks and benefits of a surgical intervention. A literature review on the quantification of postoperative delirium risk and how this information might inform medical decision making in frail surgical patients did not identify clear clinical guidelines. In the absence of practice guidelines, the Patient Priorities Care model is proposed as a framework to help providers working with patients and caregivers facing complex medical decisions to better align interventions with patient values.

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels

Rosa, W. E., Buck, H. G., Squires, A. P., Kozachik, S. L., Huijer, H. A. S., Bakitas, M., Boit, J. M. G., Bradley, P. K., Cacchione, P. Z., Chan, G. K., Crisp, N., Dahlin, C., Daoust, P., Davidson, P. M., Davis, S., Doumit, M. A., Fink, R. M., Herr, K. A., Hinds, P. S., … Ferrell, B. R. (2022). Nursing Outlook, 70(1), 36-46. 10.1016/j.outlook.2021.06.018
Abstract
Abstract
The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access

Rosa, W. E., Buck, H. G., Squires, A. P., Kozachik, S. L., Huijer, H. A. S., Bakitas, M., Boit, J. M. G., Bradley, P. K., Cacchione, P. Z., Chan, G. K., Crisp, N., Dahlin, C., Daoust, P., Davidson, P. M., Davis, S., Doumit, M. A., Fink, R. M., Herr, K. A., Hinds, P. S., … Ferrell, B. R. (2021). Nursing Outlook, 69(6), 961-968. 10.1016/j.outlook.2021.06.011
Abstract
Abstract
The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.

Palliative Nursing: The Core of COVID-19 Care

Paice, J. A., Wholihan, D., Dahlin, C., Rosa, W. E., Mazanec, P., Long, C. O., Thaxton, C., & Greer, K. (2021). Journal of Hospice and Palliative Nursing, 23(1), 6-8. 10.1097/NJH.0000000000000709

 Palliative care for people with COVID-19 related symptoms.

Paice, J. A., Wholihan, D., Mazanec, P., Long, C., Thaxton, C., & Greer, K. (2020). Journal of Hospice and Palliative Nursing, 22(6), 421-427. 10.1097/NJH.0000000000000692

 Palliative nursing: the core of COVID-19 care

Paice, J. A., Wholihan, D., Dahlin, C., Rosa, W. E., Mazanec, P., Long, C., Thaxton, C., & Greer, K. (2020). Journal of Hospice and Palliative Nursing.

Psychological Issues of Patient Transition from Intensive Care to Palliative Care

Wholihan, D. (2019). Critical Care Nursing Clinics of North America, 31(4), 547-556. 10.1016/j.cnc.2019.07.010
Abstract
Abstract
End-of-life care in the intensive care unit is fraught with complicated psychological responses by patients, families, and staff. Empathic and mindful communication, inclusion of all integral staff in decision-making meetings, and multidimensional support of patients and families can ease the transition away from aggressive life-prolonging to comfort-oriented end of life care. Primary palliative care communication strategies can help clarify goals of care and facilitate transitions. Early integration of specialist palliative care is recommended.