Literature Review

Carolina Caring celebrates fourth graduating class of CNA Training and Job Placement Program Focus, Newton, NC; 11/13/24 On the evening of Thursday, October 24th, Carolina Caring recognized the seven graduates of its latest Certified Nurse Aide (CNA) Training and Job Placement Program. ... This state-approved CNA Training Program runs for eight weeks at Carolina Caring’s Newton campus on 3975 Robinson Road. Led by licensed nursing instructors, these courses provide expert hands-on education which prepares students to pass the intensive North Carolina Nurse Aide certification exam. Students receive financial aid throughout the program, and all graduates who successfully complete their certifications are offered positions with Carolina Caring. ... “Carolina Caring blessed me by selecting me for this program and providing me with an opportunity that I otherwise would not have been able to financially invest in at this current moment,” said Allison Ackley, class valedictorian. “They poured into me, and so I’m going to be pouring back into them.”Editor's note from Carolina Caring's website: "In 1979, Carolina Caring was established as one of North Carolina’s original three hospice providers. We were a small group of grassroots volunteers with a mission: to help our parents, grandparents and neighbors walk through their final moments with dignity and respect." We congratulate you on this innovative, mission-driven educational and staffing initiative.

High-risk medications in persons living with dementia-A randomized clinical trialJAMA Internal Medicine; Sonal Singh, MD, MPH; Xiaojuan Li, PhD, MSPH; Noelle M. Cocoros, DSc, MPH; Mary T. Antonelli, PhD, RN, MPH; Ramya Avula, MS; Sybil L. Crawford, PhD; Inna Dashevsky, MS; Hassan Fouayzi, PhD, MS; Thomas P. Harkins, MA, MPH; Kathleen M. Mazor, EdD; Ashley I. Michnick, PharmD, PhD; Lauren Parlett, PhD; Mark Paullin, MS; Richard Platt, MD, MSc; Paula A. Rochon, MD, MPH; Cassandra Saphirak, MA; Mia Si, MS; Yunping Zhou, MS; Jerry H. Gurwitz, MD; 10/24Question: Does a one-time mailed educational intervention to patients and their clinicians reduce prescribing of antipsychotics, sedative-hypnotics, and strong anticholinergic agents in community-dwelling persons living with Alzheimer disease (AD) or AD-related dementias (ADRD)? In this randomized clinical trial of 12,787 patients, there were no clinically meaningful or statistically significant differences from the mailed educational intervention compared with usual care in continued use of medications targeted for deprescribing. These findings suggest medication-specific educational mailings targeting patients with AD or ADRD and their clinicians are not effective in reducing the use of high-risk medications.

A moral code: Ethical dilemmas in medicine — three physicians face crossroads in patient care MedPage Today; podcast by Genevieve Friedman, Perspectives Editor; 10/25/24 We are back for another episode of our medical podcast, which we hope isn't really a podcast about medicine, but a podcast about life, death, dilemma, the challenges, and sometimes the joys of medicine. ... Now, medicine is complicated because a lot of times there aren't hard and fast rules ... One treatment isn't always right or wrong for someone. One surgery isn't always successful or unsuccessful, and one diagnosis isn't always correct. Decisions aren't black and white, they're varying shades of gray. So we come up with principles to help handle this -- codes if you will. But even those get a bit marred by complexity at times. As you'll hear in this episode of Anamnesis with the theme of "A Moral Code: Ethical Dilemmas in Medicine," one of our biggest codes is "do no harm." But what is harm? Who decides what harm is, what happens if we disagree?

‘Let patients lead the way’: Hospice veterans’ advice for new nurses Hospice News; by Jim Parker; 10/25/24 ... A key barrier to building [the hospice and palliative care] workforce is that, with some exceptions, most clinicians receive little to no exposure to those types of care during their training. Nurses who are new to the hospice space often face a learning curve, according to Briana Hilmer, an Iowa-based admissions nurse for St. Croix Hospice.

Patient, staff satisfaction biggest ROIs of trauma-informed hospice care Hospice News; by Holly Vossel; 10/23/24 Improved patient and staff satisfaction are among the most significant returns on investment for hospices that are pouring greater resources into trauma-informed training. The ability to build a trusting relationship with patients and their families is a key skill set for any hospice professional to possess, but one that takes on a profoundly different meaning when caring for survivors of abuse, violence and trauma. This is according to Amber Ash, pediatric hospice and palliative care social worker at Ohio-based Hospice of the Western Reserve. Trauma-informed education should be a normalized part of hospice’s interdisciplinary training to help staff recognize and respond to a range of experiences, Ash indicated. This type of training can help provide opportunities for improved goal-concordant care while also aligning with staff’s professional goals and personal values, she stated. 

Advance Directives: How to make sure your end-of-life decisions are followed Bottom Line Inc; by Mathew D. Pauley, JD; 10/24/24 Nearly 40% of older Americans have some form of advance directives, such as a living will to communicate wishes about life-saving treatment…or a medical power of attorney appointing a loved one as proxy if they’re incapacitated.  Problem: Your wishes may not always be followed in real-world situations. Examples: Emergency paramedics typically provide CPR to restart a patient’s heart even if that patient’s living will says otherwise. And complex medical circumstances at the end of life often arise that force your loved ones to make judgment calls about what you really want. Bottom Line Personal spoke to clinical ethicist Mathew Pauley about how to make sure hospitals, medical providers and family members follow your medical wishes.

Palliative and hospice care in the prehospital setting

University of Maryland bolstering palliative care workforce via master’s degree, certification program Hospice News; by Molly Bookner; 10/7/24 The University of Maryland, Baltimore (UMB) School of Pharmacy is seeking to address the dearth of palliative care-trained clinicians and improve care among seriously ill patients. By 2060, the demand for palliative care is expected to nearly double, according to the World Health Organization. Yet, despite this need, significant gaps in training remain, with many professionals lacking exposure to hospice or palliative care during their schooling. UMB seeks to bolster the palliative care workforce through its online Graduate Studies in Palliative Care program, launched in 2017. While most palliative care clinical education programs see small cohorts of five or fewer students, UMB is seeing a larger crowd of professionals enter the workforce. Of the Class of 2024, 36 students received their Master of Science degree and seven received a graduate certificate. “We have an amazing diversity of students,” Mary Lynn McPherson, professor in the Department of Practice, Sciences, and Health Outcomes Research at the School of Pharmacy and executive program director of Graduate Studies in Palliative Care, told Palliative Care News. 

Well-being outcomes of health care workers after a 5-hour continuing education intervention-The WELL-B randomized clinical trialJAMA Network Open; J. Bryan Sexton, PhD; Kathryn C. Adair, PhD; 9/24To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program [was developed] to deliver ... interventions to improve 4 dimensions of HCW [health care workers] well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration). [The] ... sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention. 

Global collaboration launches culturally inclusive palliative care education tool Hospice News; by Holly Vossel; 9/16/24 An international collaboration has led to the development of a new palliative care training tool aimed at improving quality and equitable access. Health systems across the globe are recognizing a growing need to boost the supply of providers able to care for a swelling, aging population of serious and terminally ill patients. Rising demand was among the driving forces behind the newly unveiled COllaboratively DEveloped culturalY Appropriate and inclusive Assessment tool for Palliative Care Education (CODE-YAA@PC-EDU). The palliative care education tool was developed in concert by the Council of Europe, the World Health Organization (WHO) and the United Nations. The organizations joined forces to design a sustainable training model that could build up the palliative workforce. The project is supported in part by the research network European Cooperation in Science and Technology (COST).

The patient care experience on full display Modern Healthcare; by Mary Ellen Podmolik; 9/13/24 Art exhibits can promote a visceral reaction. The one that just opened along a hallway of windows on Thomas Jefferson University’s health sciences campus certainly does just that. The installation includes five hospital beds, life-sized mannequins inside large pill bottles, personal possessions and deeply personal quotes from five unnamed people who’ve gone through life-threatening trauma — a miscarriage, a pulmonary embolism, a wait for a kidney transplant, a case of undiagnosed paralysis and cancer. The Philadelphia artist behind the exhibit, Pepón Osorio, is the cancer patient. “Convalescence” is a complex and compelling exhibit of patient pain, reliance on drugs and inequitable care — part of the patient experience that can get lost in the daily tussle between providers and payers. “It is a critique of the healthcare system,” Megan Voeller, director of health humanities at the university, told me.

The persistent stigma attached to dementia encourages denial InForum; by Carol Bradley Bursack; 9/14/24 Dear Carol: ... At age 70, I was diagnosed with mild cognitive impairment (MCI). Theoretically, that diagnosis means that I have a few more memory glitches than normal for my age. A percentage of people with MCI will develop Alzheimer’s disease, but not all. Yet, some family members treat me like I shouldn’t make decisions beyond what I want for dinner. ...Dear Al: The stigma attached to mental illness, cognitive decline, and even aging, illustrates widespread ignorance of facts. The more people like you speak up the better the future will be for others. ... For now, work on educating your family about MCI.  ... Here's a start: 

Innovative program reduces nurse turnover and fosters development Oncology Nursing News; by Heather Wood, RN, OCN and Marie Garcia, RN, OCN; 9/12/24 Cancer incidence is on the rise in the US, especially among the growing older population. ... Unfortunately, the current shortage of oncology nurses is expected to worsen, as fewer people enter the profession while aging nurses retire. By 2025, a shortage of 200,000 to 450,000 oncology nurses is predicted in the US. ... In response, The US Oncology Network (The Network) has developed one of the most comprehensive programs in the nation to support the professional development and retention of new oncology nurses. ... Designed to enhance their knowledge of fundamental oncology, OCEAN is a collaborative effort bringing together a multidisciplinary team of experts and speakers from across The Network. The program provides fundamental oncology knowledge around 12 core areas delivered over 22.5 hours of live virtual learning. Content ranges from ... various treatment modalities ... to palliative care and advanced care planning. OCEAN’s impact extends beyond skill development, fostering a sense of belonging and purpose among participating nurses. ... Early results from the program are promising, such as increased retention rates [12% better than the national average] and cost savings.