Literature Review

Anti-DEI initiatives in medicine harm us all MedPage Today - Perspectives; by Aderonke Pederson, MD; 4/9/24I entered into medical school as a top student at the University of Chicago with a high GPA ... and a stellar CV exhibiting strong leadership qualities. I had beaten all odds, despite being a Black orphan migrant with no financial means. Medical school was a grueling process ... I would likely have felt even more socially isolated at my predominantly white institution if not for three essential factors. First, I was welcomed by Diversity, Equity, and Inclusion (DEI) administrators and participants ... Second, I had a dean of DEI who... said, "You can do this, Ronke." Finally, without my deep faith, ... I would not be where I am today. My experience is not unique from other underrepresented physicians of color. Despite this, DEI programs across the country are under attack.

Why difficult conversations matter: How delivering bad news with clarity and empathy impacts both provider and patient Cedars Sinai, by Cassie Tomlin; 4/8/24Good physicians rely on a battery of hard-won skills to treat serious illness—they observe, predict, test, prescribe and diagnose. But many physicians haven’t been taught how to have productive, mutually beneficial conversations—such as sharing a life-changing diagnosis or informing patients about disease trajectory and symptoms, prognosis and end-of-life care. High-impact communication tools can be learned at any point in a physician’s career, says Jessica Besbris, MD, director of Neuropalliative Care and the Neurology Supportive Care Medicine Program at Cedars-Sinai. Here, Besbris shares why such careful conversations matter for everyone involved, and ways physicians can improve how they discuss serious illness.

A day in the life: Hospice nurseDaily Nurse - The Pulse of Nursing; blog by Renee Hewitt; 4/8/24 Supporting someone with a life-limiting diagnosis or talking about death can be difficult for many people, but not for a hospice nurse. What’s it like to care for patients and their families in the end-of-life process? Maryette Williamson, RN, BSN, knows firsthand from working as a BAYADA Hospice Nurse in Fayetteville, North Carolina. We asked her about her work. What follows is our interview ... [From Maryette] ... "There was a learning curve from long-term care to hospice. The most significant difference in hospice is our focus on quality of life rather than a cure. That was the most important change for me."Editor's Note: Consider linking to this resource with your nurse recruitment tools. Hospice executives, this nurse's common transition when moving from long-term care to hospice. Ensure solid orientation/onboarding/precepting training, time, resources, support, and accountability for new hospice employees. Do not assume that they will automatically translate their years of practice into hospice principles and best practices. 

Improved onboarding process could boost worker retentionMcKnights Senior Living, by Kathleen Steel Gaivin; 4/8/24As long-term care providers navigate post-pandemic workforce challenges, they also need to improve the onboarding process, according to the results of a new survey by Viventium. ... The study detailed in the company’s 2024 Caregiver Onboarding Experience Report solicited responses from 175 administrators and caregivers in skilled nursing, assisted living, independent living, home health, home care and hospice care in November and December. The survey, Viventium said, found a “shockingly low bar for what passes as a ‘good’ onboarding experience, with strong indications that raising that bar could correlate to higher retention rates.”Editor's Note: See the article in today's newsletter, "A day in the life: Hospice nurse" for the importance of onboarding hospice nurses to to differences between long-term care and hospice care.

How’s Your Soul? JAMA Network, by Daivd Vermette, MD, MBA, MHS; 3/28/24 "Brother David, how’s your soul?” The question took me by surprise. It was time for my first advisement meeting with my residency program director. In medicine, the machine runs on competence and achievement of “milestones.” Yet, as I braced for a meeting to trudge through performance evaluations and in-training exam scores, I awoke to humanity. ... Medical education has numerous models for coaching, advising, and mentoring. While these models helped develop my professional life, they missed the fundamental core of who I am: a human being. Perhaps instead we could embrace a model in medical education built on the tenets of pastoral care. ...

20 states facing acute nursing shortages Becker's Hospital Review, by Kelly Gooch; 3/25/24 ... On March 1, Medical Solutions, a healthcare staffing company, released the 20 states where nurses are needed the most based on the most current nurse-to-state population ratios and projected need by 2030. Ratios in the report were from Census and Bureau of Labor Statistics data published in NurseJournal. Projected need by 2030 is from Projections Central, a site sponsored by the Labor Department. Here are the 20 states where nurses are needed the most, per the Medical Solutions article: ... 

Fall prevention for the elderly: 13 strategies to keep them safe U.S. News & World Report, by Claire Wolters, ed. by Christine Comizion, MPH; 3/26/24Falls are the leading cause of injury in adults 65 and older – with reports showing about 14 million adults fall each year, according to the Centers for Disease Control and Prevention. ... According to the CDC, falls are also the leading cause of injury-related death in the 65-and-older population – and the fall death rate is growing.Here's what to know about what increases risk for falls in older adults, and get familiar with fall prevention tips and safety measures that can help reduce the risk.Editor's Note: This U.S. News article primes the pump. Preventing falls matters especially for vulnerable hospice patients as their disease progresses, and as they and/or family want the person to be as mobile as possible. What do your Incident Reports tell you about falls? What falls-specific education do you provide for your interdisciplinary teams? On-call staff? Family caregivers? Volunteers? What QAPI programs have addressed falls? 

Meaningful conversations to have with your loved oneMediaFeed.org, by Merritt Whitley; 3/27/24“One of the most important concepts in the field of grief and loss is that people drift in and out of the awareness of dying,” says Kenneth Doka, a senior consultant to the Hospice Foundation of America, and professor emeritus of gerontology at the graduate school of The College of New Rochelle. “Sometimes they do talk about it, sometimes not. The dying one should control the agenda. Don’t force conversations on them.” When your loved one feels ready to talk, the following suggestions can be comforting ways to begin a conversation: ...

Harvard Thinking: Facing death with dignityThe Harvard Gazette, podcast and transcript; moderated by Samantha Laine Perfas; 3/27/24In podcast episode, a chaplain, a bioethicist, and a doctor talk about end-of-life care.

Hospice of Santa Barbara offers insights into family grievingSanta Barbara Independent, by Hospice of Santa Barbara; 3/26/24Grieving the loss of a family member is a deeply intricate emotional journey. Shared bonds and histories make family grief especially unique. Family grief extends beyond the individual and intertwines with the collective fabric of shared experiences, roles and responsibilities. ... It is common for death to change the family dynamic. This can be a result of several factors, including age, relationship, role, difference in coping mechanisms, heightened stress and emotions, and unresolved family issues which can lead to the resurfacing of past grievances.Editor's Note: CMS Hospice COPs §418.3 defines: "Bereavement counseling means emotional, psychosocial, and spiritual support and services provided before and after the death of the patient to assist with issues related to grief, loss, and adjustment." The interdisciplinary team needs to understand individual and family grief, within the scope of their roles and responsibilities with family members.

Researchers advocate for more home-based options for end-of-life care McKnights Home Care, by Adam Healy; 3/25/24 As older adults increasingly prefer to receive end-of-life care in their homes, new, community-based options will be critical to help patients achieve a home death, according to a new research review published in Palliative Care and Social Practice. ... The researchers analyzed 28 studies conducted between 2002 and 2023 related to factors that affect patients’ abilities to achieve a home death. One persistent issue, they found, was a lack of available home palliative care services. 

How home care providers build out successful training programs Home Health Care News, by Patrick Filbin; 3/19/24 Building a successful and sustainable caregiver training program in personal home care demands meticulous planning and execution. From defining leadership responsibilities to establishing a comprehensive training schedule, every aspect plays a pivotal role in shaping the program’s effectiveness. Strong training programs and ongoing education also go a long way in retaining caregivers in an industry where every provider is trying their best to hold onto the employees they onboard.