Literature Review

The role of PMHNPs in palliative psychiatry: An ethical framework for care when remission is unattainableJournal of Hospice and Palliative Nursing; by Trae Stewart; 8/23Patients with serious and persistent mental illness may experience intractable suffering despite exhaustive treatment, challenging the dominant curative paradigm in psychiatry. Palliative psychiatry offers an emerging alternative-prioritizing comfort, dignity, and quality of life when remission is no longer attainable. This article presents a comprehensive ethical and clinical framework for integrating palliative psychiatry into psychiatric-mental health nurse practitioner (PMHNP) practice. Drawing parallels with somatic palliative care, the author explores the theoretical foundations, diagnostic complexities, and ethical imperatives guiding palliative psychiatry. Legal challenges, such as hospice eligibility criteria and involuntary treatment statutes, are also examined, with recommendations for practice and policy reform. Assistant Editor's note: As I search for pertinent articles to add to this newsletter, I am delighted to find so many that address a variety of aspects of palliative care. I see articles on palliative care in the ED, palliative care for special populations, palliative care for transplant patients, and as highlighted in this article, palliative care in psychiatry. It makes me think that maybe, just maybe(!), the many benefits of palliative care are finally being recognized and embraced by mainstream health care.

From panic to purpose: Tulane student’s bell project brings hope to cancer patients nationwide CBS WWL-4, New Orleans, LA; by Meg Farris; 9/8/25 A little girl whose mother was diagnosed with a very serious illness could have never dreamed that several years later, she'd be helping patients across the country and beyond. ... Belle Spar vividly remembers, ... “I had a panic attack, hysterically crying. I thought I was going to lose my mom. I was 12. I was terrified ...” Belle Spar, 21. [The ritual of ringing the bell at the end of cancer treatment became a symbol of hope.] That 12-year-old ... is now a senior at Tulane University. During those nine years as an adolescent, she and her sister, Alexa, accomplished something remarkable. They have raised money to donate 130 bells, so far, to radiation and transplant centers around the U.S., and even in South America.

Would you go to a local Death Cafe? It's a chance to eat cake and talk end-of-life issues Times Telegram, Utica, NY; by Amy Neff Roth; 8/12/25 Key Points:

Sovereign Hospice highlights nutrition's role in hospice home care services News Channel Nebraska (NCN), reprinted from Aubrey, TX; Press Release; 8/8/25 Eating becomes more than a necessity during serious illness—it becomes a part of daily care that supports comfort, strength, and emotional connection. At Sovereign Hospice in Aubrey, Texas, nutrition is integrated into the services hospice offers, especially for patients receiving hospice at home services. The goal is to use food as a gentle tool to improve quality of life. Serious illnesses can change how patients eat. Appetite loss, difficulty swallowing, and taste changes are common, but they can be managed through small adjustments. 

Hearing loss, loneliness may contribute to cognitive decline in older adults McKnights Senior Living; by John Roszkowski; 7/28/25 Hearing loss and loneliness can contribute to dementia in older adults, and simple interventions to address hearing loss, such as hearing aids, may reduce cognitive decline in some cases, new research finds. ... Results of the study showed that higher levels and worsening self-reported hearing impairment were associated with steeper decline in episodic memory issues and executive functioning (verbal fluency). Further, the researchers found that individuals who were not socially isolated but still felt lonely saw their cognitive decline accelerate if they were deaf.

Ok, please help calm my anxiety. My mother has drastically improved in the last couple of days since goin on hospice. Aging Care; by Oedgar23; 7/17/25 So in the hospital, my mother was in kidney failure. The last couple days after stopping vancomycin for about five days, her GFR had come up to 19. That’s the most recent Number and then they stopped drawing labs because we placed her on Hospice. We consulted with palliative care team. They wanted to do a feeding tube and we said no. They said she had advanced dementia. [Describes improvements since hospice.] ... What if she gets taken off hospice? ... What if she no longer qualifies for hospice, passes as normal cognitively, starts demanding to go home, does not qualify for long-term care, Medicaid, etc. ... But I am super unnerved because she looks a whole lot better than she has been looking. ...Editor's Note: Yes, we all know that the person can get better with hospice care, because of holistic person-centered care, caregiver education and support, and many more factors. This can be confusing. The dying trajectory may have been interrupted or simply calmed with better symptom management and quality of life. This daughter is asking normal, crucial questions which the hospice team needs to be addressing with her. Examine your live discharge data, Policies and Procedures, communication practices with the patient and family about recertifications, Incident Reports from upset caregivers/families, and CAHPS Hospice scores.

How long was Adriana Smith on life support? Brain‑dead nurse's baby delivered by C‑section Enstarz; by David Unyime Nkanta; 6/18/25 The 31-year-old nurse was declared brain dead early in her pregnancy—her baby was born via C-section nearly four months later, sparking legal and ethical debate. Adriana Smith, a 31‑year‑old nurse in Atlanta, was declared brain dead in mid‑February after suffering serious blood clots in her brain. Despite devastating diagnosis, she remained on life support for nearly four months—a decision doctors said was legally necessary under Georgia's strict abortion laws. This rare case of maternal somatic support—keeping a brain-dead woman alive to deliver a baby—is highly unusual. On 13 June, doctors at Emory University Hospital performed an emergency c‑section, delivering a boy they named Chance, weighing just 1 lb 13 oz (around 830 g). ... Smith's mother, April Newkirk, described the ordeal as 'torture,' saying: 'I see my daughter breathing, but she's not there.' The family maintain that they were never allowed to make treatment decisions, a situation that has deeply distressed them and prompted calls for change. 

You might live to be 100. Are you ready? The Guardian; by Andrew J. Scott; 5/15/25 Ethel Caterham, at the age of 115 years, is said to be the oldest person alive. She offers the sage life advice to “say yes to every opportunity because you never know what it will lead to. Have a positive mental attitude and have everything in moderation.” When she was born in 1909, the average life expectancy of a British female was 52 years – becoming a centenarian was a remote prospect. ... Today, according to the United Nations, centenarians are the fastest growing age group. By 1950, there were an estimated 14,000 whilst today there are nearly 750,000, projected to reach nearly 4 million by 2054. ...  Today, there is too large a gap between average lifespan and healthspan. The number of years we are likely to live has increased more than the number of years we are likely to remain healthy. Reducing this gap is critical for seizing the advantages of longer lives.

‘Don’t be sad. I’ve had a great life’: John Shakespeare on the art of livingOur Community Now; by Peter FitzSimons; 5/18/25 JS [John Shakespeare]: I’m a realist at heart, Pete, and once I know that something is irreversible I have no choice but to accept it. There is a certain sense of peace that comes from acceptance. It eliminates the need to ask “why me?” and “if only”. Fitz: I have been told, wonderfully, that since that outpouring of love for you last Friday, there has been a small uptick in your prognosis?JS: Haha, I think I just had a big adrenaline rush from that one! Hard not to feel better with 209 people you love, in turn, lining up to hug you! ... [ More dialogue]Fitz: What you are going through will soon enough confront all of us, as we come face to face with our mortality. What advice do you have for us? JS: My motto is “accept, adjust, adapt”. The key is to be able to accept something that can’t be changed. Only then will you find some peace. Otherwise, it will be a battle with the unmovable. Sort out your financials so that your family will be as secure as possible, and that will give yourself a sense of relief to carry into your final days. Have as much fun as your energy levels allow!

Palliative and end-of-life care during critical cardiovascular illness: A scientific statement from the American Heart Association American Heart Association; by Erin A. Bohula, MD, DPhil, Michael J. Landzberg, MD, Venu Menon, MD, FAHA, Carlos L. Alviar, MD, Gregory W. Barsness, MD, FAHA, Daniela R. Crousillat, MD, Nelia Jain, MD, MA, Robert Page II, PharmD, MSPH, FAHA, Rachel Wells, PhD, MSN, and Abdulla A. Damluji, MD, PhD, MBA, FAHA on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; and Council on Cardiovascular and Stroke Nursing; 5/15/25 Abstract: Cardiac intensive care units are witnessing a demographic shift, characterized by patients with increasingly complex or end-stage cardiovascular disease with a greater burden of concomitant comorbid noncardiovascular disease. Despite technical advances in care that may be offered, many critically ill cardiovascular patients will nevertheless experience significant morbidity and mortality during the acute decompensation, including physical and psychological suffering. Palliative care, with its specialized focus on alleviating suffering, aligns treatments with patient and caregiver values and improves overall care planning. Integrating palliative care into cardiovascular disease management extends the therapeutic approach beyond life-sustaining measures to encompass life-enhancing goals, addressing the physical, emotional, psychosocial, and spiritual needs of critically ill patients. This American Heart Association scientific statement aims to explore the definitions and conceptual framework of palliative care and to suggest strategies to integrate palliative care principles into the management of patients with critical cardiovascular illness.

To the brink and back: How near-death experiences can change how people work The Conversation; by Adauri.AI; 5/5/25 What happens when someone comes close to death and then returns to everyday life, including work? For some, the experience can be transformative. ... Although near-death experiences (NDEs) have been studied since the 1970s, we know relatively little about how they affect people after the event. Research suggests people who have near-death experiences may feel increased empathy, spiritual growth, a sense of purpose and even change how they approach their jobs. Our recent study explored how near-death experiences impact people’s return to work. We interviewed 14 working adults who had a near-death experience as a result of medical crises such as a heart attack or accidents such as a car crash. What we found challenges conventional ideas about success, motivation and workplace culture.

Breaking with the status quo in end-of-life care through de-implementation Journal of Internal Medicine; by Chetna Malhotra and Ellie Bostwick Andres; 4/17/25... In the realm of serious illness, many patients undergo interventions that may marginally prolong life but often sacrifice quality of life and entail significant costs. These interventions, categorized as ‘low-value care’, often involve complex procedures, frequent hospitalizations and intense medical management, leading to considerable discomfort, reduced functional ability and overall decreased well-being and calling into question the efficiency and effectiveness of current end-of-life (EOL) care practices. ... How to conduct de-implementation in EOL contexts: