Literature Review

Cooling down the clinic: How to de-escalate angry patients and family members Oncology Nurse Advisor; by Kathleen Wolf, MBA, BSN, RN, NEA-BC; 5/17/24Handling challenging interactions with patients and families can be a source of stress for oncology nurses. Patients and caregivers could be feeling angry for any number of reasons. The key is to not take their anger personally. It’s more productive to instead understand the cause of their anger. [Read more for common causes and basic de-escalation strategies.]

When families fight over a relative with dementia, it’s time to call in the mediator The New York Times; by Paula Span; 5/13/24 Trained negotiators can help families struggling with vexing elder-care issues.  The four adult children were in agreement. Their father, William Curry, a retired electrical engineer and business executive, was sinking deeper into dementia. ... [But their mother] remained determined to continue caring for her 81-year-old husband at home, despite the increasing toll on her own health. ... As the weeks passed, “we were really at an impasse,” [a daughter] said. “Do you override your mother?” ...  [Increasingly,] families seek elder mediation privately, before disputes land in court and imperil or destroy family relationships. [Continue reading for descriptions of how mediation differs from arbitration, from family therapy, and for cautions about this being "a fairly new field with no nationwide certification or licensing requirements."]Editor's Notes: Executive leaders, what community education and resources are you providing for Advance Directives? What family systems education and and problem-solving are you providing for your interdisciplinary team members and grief counselors? Family conflicts are inherent--in some form or fashion--with almost anyone needing dementia care, especially when paired with palliative or hospice care. (If in doubt, ask your seasoned, front-line professionals.)

The Check-Up: How seniors can better take care of their mental health The Keene Sentinel; by Olivia Belanger Sentinel Staff; 5/8/24 My generation talks about mental health a lot. In our late 20s, my friends and I routinely check in to see how we’re feeling, reschedule plans because we’re in a mental funk or talk about how we can help support each other when we’re not feeling mentally healthy. ... But I know that for older generations, this can be hard to come by. ... [Older] adults are more likely to experience life changes — like coping with a serious illness or losing a loved one — which can lead to feelings of grief, social isolation or loneliness, according to the National Institute of Mental Health (NIMH). Loneliness in particular is one of the biggest threats to seniors, especially those who live in rural areas like the Monadnock Region where reliable transportation is limited. Research shows loneliness is as bad for people’s health as smoking 15 cigarettes per day, according to the U.S. Surgeon General. Signs that you may need to help your mental health, NIMH says, include: ... 

Improving inclusive palliative care for transgender patients Hospice News; by Holly Vossel; 5/7/24... Nearly a quarter (21.3%) of 865 interdisciplinary palliative professionals indicated that they had observed some form of discriminatory care delivered to a transgender patient in a recent study published in Cambridge University Press’ journal Palliative Support Care. Furthermore, 85.3% of study participants said they witnessed disrespectful care, while inadequate and abusive care was observed by 35.9% and 10.3% of palliative teams, respectively. ... [Read more for descriptions and interventions, as discussed with Zachary Fried, licensed clinical social worker and training supervisor of Optum at Home, a subsidiary of UnitedHealth Group.] 

Curricular reform in serious illness communication and palliative care: Using medical students' voices to guide change  Academic Medicine: Journal of the Association of American Medical Colleges; by Jennifer A Reidy, Kate Brizzi, Stephanie H Chan, Hollis Day, Scott K Epstein, Melissa Fischer, Priya S Garg, Anna Gosline, Carolina Jaramillo, Emma Livne, Suzanne Mitchell, Sarah Morgan, Molly W Olmsted, Patricia Stebbins, Isabella Stumpf, Tamara Vesel, Irene M Yeh, Megan E Young, Roberta E Goldman; 5/1/24 Purpose: To gather and leverage the voices of students to drive creation of required, integrated palliative care curricula within undergraduate medical education in Massachusetts, which is lacking in a majority of U.S. medical schools. Conclusions: This study confirms long-standing themes on students' experiences with SIC and palliative care topics, including feeling inadequately prepared to care for seriously ill patients as future physicians. Our study collected students' perspectives as actionable data to develop recommendations for curricular change.

Exploring unmet concerns in home hospice cancer care: Perspectives of patients, informal caregivers, palliative care providers, and family physicians Cambridge University Press; by Eran Ben-Arye, Noah Samuels, Yael Keshet, Miri Golan, Erez Baruch, and Jama Dagash; 4/8/24 Objectives: The study examines perspectives of patients in home hospice care; their informal caregivers; palliative health-care providers (HCPs); and family physicians, all regarding patients’ unmet needs and quality of life (QoL)-related concerns.Conclusions: While the 4 groups were similar in their scoring of patient QoL-related concerns, there were discrepancies for some concerns (e.g., patient fatigue) and expectations regarding the need to discuss emotional and spiritual concerns, including on death and dying. Educational initiatives with programs providing training to all 4 groups may help bridge this gap, creating a more open and collaborative hospice care environment.

Shocked at end-of-life: An educational video for hospice workers about Implantable Cardioverter-Defibrillators Journal of Pain and Symptom Management; by Sarah Godfrey, MD, MPH; Christine L. Chen, MD; Melanie S. Sulistio, MD; Sharika Kumar, MD; and Kelley Newcomer, MD; 2/24 Introduction: Hundreds of thousands of patients with implantable cardioverter-defibrillators (ICDs) die yearly. Though ICD shocks can be lifesaving, they can also be severely painful. One third of ICD patients are shocked in the last day of life irrespective of DNR status. Over 97% of hospice programs admit patients with ICDs, yet only 10% have deactivation policies and less than 50% of hospice patients have their ICD deactivated. ...  Conclusion: Hospice personnel have limited knowledge about ICDs, prohibiting best care of patients with these devices at EOL. A short educational video increased knowledge and may serve as a helpful tool. Improving ICD knowledge amongst hospice personnel is essential to ensuring the unique needs of hospice patients with ICDs are met.

Hospital CEOs chart paths into healthcare's futureBecker's Hospital Review; by Kelly Gooch; 4/24/24Hospital and health system CEOs understand the need to meet demand for healthcare services while also focusing on the well-being of employees and strengthening the talent pipeline. They are also focusing on healthcare education and workforce development. Additionally, they are zeroing in on technology or partnerships that can expand capacity, help improve care and drive innovation. The innovation piece particularly resonates with Bert O'Malley, MD, president and CEO of Baltimore-based University of Maryland Medical Center.

Mercy Hospital surgeon teaches high school student future of surgical medicine CBS News TV 13 Sacramento, CA; 4/21/24 A unique experience for high school students, taking a step into the world of robotic surgery. Mercy Hospital hosted students to learn the ins and outs of the future of surgical medicine.

Health care system eats away at the doctor-patient relationship The Boston Globe; updated 4/17/24... The system economically rewards throughput (the number of patients seen per unit time) and procedures rather than the time needed to develop an open and communicative doctor-patient relationship. While a good physician might understand the tests and evaluations that are indicated by a presenting medical problem, the excellent clinician knows which tests and evaluations should not be done. This is primarily ascertained by delving into details of the patient’s physical, psychological, social, family, and economic history. This process, as James highlights, can lead to collaborative and more effective care. ...Editor's Note: This article highlights "Dr. Thea James’s remarkable work at Boston Medical Center in addressing structural inequity in medical care as a means of enhancing outcomes brings up an underlying structural problem across the entire medical care system (“Her health equity message being heard,” April 13, 2024.)

Potential CMS measure shows divide over quality training standards Modern Healthcare, by Mari Devereaux; 4/12/24 Hospitals may soon be required to provide set quality training to staff as part of a Medicare reporting program, but health systems and advocacy organizations are split on whether the standardization of quality-related skill sets is necessary to improve patient care.

How to become a nurse later in life Board Vitals; 4/11/24 Embarking on a career in the nursing field later in life is an inspiring journey that many individuals choose to undertake. Whether it’s a personal passion or a long-held dream, it’s never too late to pursue a fulfilling career in healthcare. In this guide, we will answer the most common questions asked by those starting a nursing career later in life. Editor's Note: Does your hospice or palliative care organization partner with a nursing school? Or with any other type of university, community college, etc. that educates professionals for roles used in your organization? Explore opportunities to instill information and interest in end-of-life care.

Why so many nurses are fleeing healthcare — and how hospitals can address the problem MedCity News, by Katie Adams; 4/10/24Nearly one-fifth of nurses are projected to leave the healthcare workforce by 2027. The American Organization for Nursing Leadership published a report revealing one of the biggest reasons nurses are exiting the industry: their managers are too busy to train and support them.